A BSTRACT Introduction: Although diarrheal diseases are highly preventable, they remain one of the leading causes of mortality and morbidity in the pediatric population in developing countries. Knowledge of etiological agents is essential to implement public health programs. Viral infections are the most common cause of acute infectious diarrhea among children. There is a paucity of information regarding viral enteropathogens responsible for diarrhea in India, as many hospitals do not routinely carry out diagnostic tests for viral detection. Aim and Objectives: To estimate the prevalence of viral enteropathogens in children under five years of age presenting with acute diarrhea using real-time multiplex polymerase chain reaction (PCR) and its correlation with clinico-demographic features. Methodology: A cross-sectional study was carried out in a tertiary care center in Maharashtra from January 2016 to June 2019. Our study included 300 children who were under five years old with acute diarrhea. Standard protocols were advocated for the collection and transportation of stool samples. All samples were subjected to real-time multiplex PCR (Light cycler 480 Roche) using Fast Track Diagnostic kits for viral gastroenteritis. Data analysis was done using descriptive and analytical methods. Results: In our study, 57% of samples were positive for viral enteropathogens. Rotavirus (32%) was the most common isolate, followed by Norovirus Genogroup II (GII) (17%). The majority of pathogens were isolated from children less than 2 years of age. Conclusion: There is a need to test stool specimens of clinically confirmed diarrheal patients for enteric virus. This will avoid blind antibiotic treatment.

A pulmonary nodule is a common radiological finding encountered in routine medical practice. It needs to be extensively evaluated as the differential diagnosis can range from sinister malignancies to fully treatable infectious causes. Here, we present a rare case of pulmonary paragonimiasis presenting as pulmonary nodule. This case report aims to sensitise the medical practitioner regarding pulmonary paragonimiasis which is completely treatable but carries a high risk of being under diagnosed.

A BSTRACT Introduction: Theory papers have been the most commonly employed method to assess learning outcomes in medical education. In these papers, both recall abilities and higher-order cognitive functions need to be assessed giving proper weightage as per relevance. Hence it becomes necessary that valid assessment methods are employed to evaluate the required objectives/competencies. The objective of the study was to develop a method for analyzing postgraduate question papers of various specialties. Methodology: A rubric matrix was created with three broad objective criteria to assess framing and layout of the questions in each paper, analysis of different sets for same examination, and finally an overall assessment of all the papers for each subject. Results: A total of 28 specialty papers were available. A total number of papers analysed = 340. The overall mean score out of total 60 marks was 38.64 ± 4.5. It was seen that the majority (60%) of the departments have been graded as fair on analysis of the theory papers. None of the departments were graded as very good, while 7% of them were graded as good. Although a very minuscule percentage of the papers had grammatical errors and duplication of questions in the sets, only 57% of the departments had done a proper moderation and 21% had used higher domains of learning for assessment. Conclusion: Analysis of postgraduate question papers showed that the questions asked for postgraduates are more recall-based instead of higher taxonomy of cognitive domain.

Background:Machine learning (ML) prepares and trains a model through supervised or unsupervised learning methods. Sputum, a respiratory tract secretion, is a common laboratory specimen that aids in diagnosing respiratory diseases, including pulmonary tuberculosis (TB). Gram stain is an easy, cost-effective stain, which may be applied to sputum smears to screen out an unsatisfactory sample. ML model may help in screening sputum smears.Methods:This collaborative project was carried out from June 2020-July 2021. In this study, a color-based segmentation ML algorithm using K-Means clustering was developed. A library of stained sputum smears was built. The Bartletts criteria (based on neutrophil and squamous cell count) for screening and selecting satisfactory sputum smears were used. A smartphone camera was used to take several photographs of satisfactory, as well as unsatisfactory, smears. The image segmentation algorithm was applied to medical image analysis, color-segmentation of sputum images was done. The hue saturation value (HSV) color ranges were defined on a prototype image. Then, all connected pixels were identified as a single object, and morphological operations were applied.Results:Usage of AI-driven model on the slide-image revealed the slide adequacy as the cell count was acceptable based on Bartlett's criteria. Both the manual cell counts (Range: 126-203 neutrophils, 14-47 squamous cells) and the model counts (Range: 117-242 neutrophils, 14-37 squamous cells) are within acceptable limits.Conclusion:The use of a model to screen a large number of sputum slides may be a boon in resource-limited settings where trained microscopists may not be easily available.

Background:Hepatitis B (HepB) is an important vaccine preventable infection among healthcare workers (HCWs). Vaccination against Hep B virus, remains the foremost preventive approach. This study aims to measure the antibody titres to Hep B surface antigen (anti-HBs) in a mixed cohort of HCWs. It also aims to study the association between time since vaccination and the anti-HBs titres thus evaluating the duration of seroprotection. Methods:A total of 200 HCWs, including nursing students (n = 112), nursing staff (n = 49), laboratory technicians (n = 30) and doctors (n = 9) who had received all three doses of the Hep B vaccine and met the inclusion criteria of having taken all three doses of vaccine were included in this study. Anti-HBs titres were estimated by bioMérieux mini VIDAS® automated immunoassay based on the principle of enzyme-linked fluorescence assay. Results:Two hundred subjects aged 19 to 52 years were included in the study; mean age was 27.29 ± 0.568 years. Duration since vaccination in the study cohort was ≤ 5 years in 149 (74.5.0%), 6-10 years in 20 (10.0%) and >10 years in 31 (15.5%) subjects. Postvaccination antibody titres were > 100 mIU/ml in 85.0%, 10-100 mIU/ml in 11.0% and ≤ 10 mIU/ml in 3.5%. There was a decline noted in antibody titres as duration after vaccination increased. Increasing age was associated with falling protective titres. Conclusion:The study revealed that majority of the HCWs had adequate anti-HBs titres and were protected after vaccination.

Background:A structured Attitude Ethics and Communication (AETCOM) module for undergraduates exists. For ensuring that the module achieves what it is intended to achieve, there was a felt need to develop a learning portfolio with an emphasis on reflections and with a scope for assessment. Methods:The AETCOM module by NMC has laid out objectives, lesson plans, and case-based scenarios. Hybrid portfolio development was necessary to align the sessions to the objectives and lesson plans and to help students capture their learning process with self-reflection, and at the same time, ensure the scope of assessment of these activities. Hence, writing reflections was considered the most important step. Measures were taken to train students in writing reflections, and faculty development workshops were also conducted. An evaluation was done using Kirkpatrick model level I-III using student's feedback form, scores of rubric matrix for assessment of reflections and one-on-one interaction with students by trained faculty. Faculty perspectives on portfolio development were collected. Results:A significant improvement in students' self-assessment scores on AETCOM module was seen (p <0.05). An assessment of reflections using a rubric matrix showed that all the students reached at least grade B by the end of three months. More than 90% of faculty members felt that the faculty is vital for assessing AETCOM. Conclusion:The development of a hybrid portfolio for AETCOM requires faculty development and special sessions for students on writing reflections. The hybrid portfolio provides the learner to self reflect, and a rubric matrix can be used to assess reflections.

Native valve endocarditis owing to Mycobacterium abscessus (M. abscessus) is extremely rare and only a few cases have been reported in the literature. We present a case of a 44-year old male patient, a coronary artery disease (CAD) case with a stent in situ with pyrexia of unknown origin (PUO). He started becoming febrile following placement of stent and continued to remain febrile for duration of five months before coming to our centre. Echocardiogram showed vegetations on the aortic valve and paired blood cultures grew M. abscessus. Antibiotics including Clarithromycin were added to his treatment and a valve replacement was planned. The patient underwent valve replacement, however succumbed to the illness despite best efforts.

BACKGROUND:Antibody response to SARS-CoV may be estimated to give trends and patterns emerging in a population during an evolving epidemic. The novel coronavirus has opened a new chapter in the history of pandemics and understanding the disease epidemiology.METHODS:The study was a cross-sectional descriptive study. Institutional Ethical clearance and informed consent were taken for participation in the study. The study population included all personnel reporting to the institute for training courses, permanent posting or joining back from leave during the study period of 2 months (16 June to 16 August 2020). The sample size was calculated assuming the prevalence of COVID-19 to be 1% with the absolute precision of 0.5% and 5% level of significance, and finite correction for population size of 500, and the calculated sample size was 377. Inclusion criteria were all personnel reporting to the institute from different states and districts. Exclusion criteria-Any personnel reported for a short visit of lesser than 14 days. Demographic details and details of any likely exposure to a confirmed COVID-19 case were noted. A blood sample was collected, and serological tests were done using ErbaLisa COVID-19 IgG kit by Calbiotech, as per the manufacturer's instructions.RESULTS:Overall seropositivity of IgG COVID-19 antibodies was 7.5% (31/413) (95% CI: 5.3-10.4%). Study population (n = 413) comprised of an adult population in the age range of 21 years-53 years, and the mean age was 31.4 years (SD = 6.2 years).CONCLUSION:As the personnel joining the institute have come from various parts of the country the study provides an estimation of antibodies against COVID-19.

BACKGROUND:Traditional teaching of medical microbiology has revolved around an organism centric, didactic lecture approach, lacking clinical relevance and appeal. Studies have shown that case-based learning in comparison to didactic lectures leads to a greater comprehension and understanding of the subject. To conduct a pilot study in our medical. College for the current MBBS batch (2019) (following the old pattern of syllabus), on student perceptions on case based learning (CBL) before the new Competency based undergraduate curriculum is rolled out for 2021 batch coming to second year of MBBS. METHODS:This pilot study was conducted at a medical college. The study was designed as an observational study on educational research and was approved by the institutional ethical committee (IEC). Study participants were second MBBS students willing to participate in the study (n = 60). Four topics were chosen to be taught as casebased scenarios as per the new CBME syllabus. Six weeks after the first CBL session was conducted, a survey questionnaire was given to the students to share their perceptions anonymously. The questionnaire had questions framed to assess the students' perception about CBL. The evaluation was done on a 5-point Likert. The responses collected were compiled in Microsoft excel sheet and the data was analysed statistically. Faculty perspective was also gathered. RESULTS:Majority of the students perceived CBL positively. There was a shift in the student's perspective towards the subject of microbiology, from being perceived earlier as theoretical and non-clinical to being perceived as appealing and clinically relevant.

This review article tries to bring together the important active and passive immunotherapeutic modalities currently under consideration for COVID-19 disease. The basis of immunotherapy is based on use of naturally occurring agents or drugs to modify the body's immune response to certain antigens, the host immune system competent to successfully target and eliminate the infectious agent, without altering the normal physiology. Pubmed was screened for studies using key words; COVID-19, Convalescent plasma therapy, Immunotherapy, Clinical trials. We identified 537 studies through database searches. After reviewing the title and abstracts, we excluded 452 studies that were not relevant, leaving 85 studies for full-text evaluation. Of these, 53 studies fulfilling predefined inclusion/exclusion criteria were finally included. This study found that the common immunotherapies which were used in COVID-19 pandemic times were plasma therapy, T-reg based therapy, tocilizumab, hydroxychloroquine, dexamethasone, and baricitinib.

Background: Antimicrobial resistance (AMR) is a real threat having the potential of impacting public health immensely. Biocides may contribute to AMR as they are routinely used in household formulations, often in suboptimal concentrations. Gram-negative bacteria like Pseudomonas aeruginosa (P. aeruginosa) can adapt to biocides such as chlorhexidine and cetrimide (CHX + CET) on repeated exposure and develop cross-resistance to antibiotics. Aim and Objective: The aim was to test CHX + CET laboratory-adapted clinical isolates of P. aeruginosa for the development of cross-resistance to antipseudomonal antibiotics. Materials and Methods: Ten clinical isolates of P. aeruginosa were included in the study. The initial antibiotic susceptibility pattern was noted before they were exposed to increasing concentrations of CHX + CET over several days. Briefly, 10 μl of bacterial suspension was inoculated into 10 ml of nutrient broth with the biocide and incubated at 37°C for 48 h. New series of tubes with increasing concentration of biocide were inoculated with growth from the previous tube every 48 h. Till, no further growth was obtained. Antibiotic susceptibility testing for antipseudomonal antibiotics by the disc diffusion as well as the minimum inhibitory concentration (MIC) by VITEK 2 bacterial identification system was performed and repeated before and after exposure to the biocide. The difference in the zone diameter and MIC was noted. Results: Significant difference (P < 0.05) in the mean of the zone size before and after exposure to CHX + CET was noted. Furthermore, there was an increase in MIC postexposure to the biocide. Conclusions: P. aeruginosa on exposure to biocides developed antibiotic resistance.

Introduction and Background: Both human papillomavirus (HPV) and the human immunodeficiency virus (HIV) are sexually transmitted. High-risk (HR) HPV types are a causal factor in cervical cancer. Persistent HPV infection in this subset of immunocompromised women results in faster disease progression. The study determined the prevalence of HPV genotypes in cervicovaginal secretions of HIV seropositive women and the correlation with CD4 counts and cytology.Method: One hundred, non-pregnant, HIV-positive women of 18 years of age and above were enrolled in this cross-sectional study following approval by the institutional ethical committee. A written consent, questionnaire, followed by sample collection including a Papanicolaou (Pap) smear for cytology was undertaken. Cervicovaginal secretion samples were collected in the Digene® specimen transport medium (STM) (Qiagen Gaithersburg Inc., MD, USA). HPV genotyping was carried out with PCR amplification of a 65-base pair (bp) fragment in the L1 region of the HPV genome using the short PCR fragment (SPF10) primers followed by reverse hybridization by line probe assay (LPA) using the INNOLiPA HPV Genotyping Extra kit (Fujirebio, Belgium). Quantitation of HPV-16 and−18 viral loads (VLs) was done by real-time PCR. Results of Pap smear cytology were correlated with CD4 counts and HPV-16 and−18 VLs.Results: Mean age of the subjects was 34.9 years ± 7.2 years (median 33.0 years, range 24–60 years). HPV was detected in 62 of 93 (66.6%) samples. Twenty (32.25%) of these 62 samples harbored a single HPV genotype. Multiple genotypes (more than two) were detected in 38 (61.3%) samples. HPV-16 was the commonest genotype detected in 26 (27.9%) of all samples and 41.9% of HPV positive samples. Pap smear cytology was reported for 93 women included in the study. Women who had normal cytology were reported as negative for intraepithelial malignancy or lesion (NILM; n = 62; 71.36%), two women had a high-grade squamous intraepithelial lesion (HSIL), low-grade squamous intraepithelial lesion (LSIL; n = 11), atypical squamous cells of undetermined significance (ASCUS; n = 12). Those smears with inadequate material were reported as scant (n = 6). The median CD4 count was 363/cu.mm (range 39–787) in HPV-positive women compared to 423/cu.mm (range 141–996) in those HPV-negative women. Quantitation of HPV-16 and−18 VL was done in duplicate for samples positive by PCR reverse hybridization (INNOLiPA). Of these 20 samples (65%), 12 samples were positive by real-time PCR. The normalized HPV-16 VL ranged between 18 and 240,000 copies/cell. The normalized HPV-18 VL in cervical samples ranged between ~24 and 60,000 copies/cell.Conclusion: HIV-positive women may be infected with multiple genotypes other than HPV-16 and−18. This may have implications on the vaccines available currently which target few specific genotypes only. Studies are required to determine the predictive role of HR HPV genotypes, in significant copy numbers especially in HIV seropositive women. It would be clinically relevant if the HPV VLs, cervical cytology, and CD4 counts are considered into cervical cancer screening programs for triage and follow-up of these women.

BACKGROUND:Military medicine is a unique and specific field for the armed forces doctors providing skill-based training on military specific injuries and diseases arising due to the unique occupational conditions. The current study retrospectively studied the planning and implementation of the military medicine module which was carried out with the aim of imparting the requisite skills to military doctors. METHODS:The study was a qualitative research, carried over two years, 2017-2019. The study population included two batches of recently graduated medical doctors about to be commissioned . The methodology included needs assessment and gap analysis which was carried out by consulting experts from the tri services. Feedback was taken by medical education experts from both the batches using surveys, and modifications were done after brainstorming with experts keeping feedback in mind. RESULTS:There was an improvement in the rating scores and an improved performance by participants was seen in the competencies. CONCLUSION:In conclusion the module was developed and implemented keeping in mind the important skills that military physicians need to learn through training as these are not been taught in any educational syllabus. To achieve such skills and capabilities, gap analysis is essential and programs should be implemented keeping scope for modification depending on the feedback after brainstorming. Feedback remains important in development of such modules and hence should be collected anonymously.

Background: As the world battles the coronavirus disease 2019 (COVID-19) pandemic, rapid detection is the key to contain the spread of the disease. Although real-time polymerase chain reaction (RT-PCR) remains the gold standard for the diagnosis of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection, it demands specialized equipment and technical expertise. SARS-CoV-2 rapid antigen detection test (RAT) is the user-friendly alternative, which needs evaluation in the hospital setting. Materials and Methods: This cross-sectional study was carried out at the Indian Council of Medical Research approved COVID-19 diagnostic molecular laboratory between November and December 2020. Nasopharyngeal swabs in viral transport medium (VTM) were received from suspected SARS-CoV-2 infected individuals were processed for SARS-CoV-2 RT-PCR and a rapid antigen detection test, COVID-19 Ag Respi-Strip. Results: A total of 342 samples were assessed for this study by RT-PCR and Rapid Antigen Test. The sensitivity of RAT was found to be 41% at an RT-PCR cycle threshold of 35 or below. Sensitivity of RAT improved to 81.2% when a RT-PCR cycle threshold of 25 or below was considered as positive. Specificity of RAT was 99% to 100%. Conclusion: Rapid antigen test is a cost-effective alternative for screening of symptomatic individuals in the hospital setting. However, due to low sensitivity, the negative results need to be interpreted with caution.

BACKGROUND In an infection caused by multidrug-resistant Enterobacteriaceae, carbapenems is one the last antibiotics used, but the carbapenemase producing Enterobacteriaceae pose a clinical challenge. A relatively new test which was described few years back known as modified carbapenem inactivation method (mCIM) is used to detect the presence of carbapenemase activity in Gramnegative bacilli. Various studies show this test be to be very sensitive and specific. We aim to study mCIM positivity on samples which are positive by Kirby-Bauer disk diffusion antibiotic sensitivity test method used for detection of carbapenem resistant Enterobacteriaceae (CRE) from clinical specimens. METHODS The study is a cross sectional descriptive study conducted in a tertiary care hospital. Samples received from February 2019 to September 2019 were included in the study. During this period 150 samples were collected which were resistant to meropenem by Kirby-Bauer disk diffusion method. These CREs isolates were further subjected to mCIM and the result was analysed. RESULTS Out of the total 150 CRE isolates which were 100 % resistant to meropenem by the conventional disc diffusion method it is found that mCIM was positive for 148 (98.66 %) isolates and negative for only 02 (1.33 %). Two most common CRE were Klebsiella pneumonia (58 %) and Escherichia coli (32 %). In statistical analysis chi square test revealed statistically significant difference (P < 0.05) in percentage of positivity between the two methods (98.66 % vs 100 %). CONCLUSIONS mCIM is highly sensitive and specific method; however, in practice it showed no added advantage over Kirby-Bauer disk diffusion method in detecting CRE. KEYWORDS Modified Carbapenem Inactivation Method (mCIM), Kirby-Bauer Disk Diffusion Method, Carbapenem Resistant Enterobacteriaceae