Carriage and within-host diversity of mcr-1.1-harboring Escherichia coli from pregnant mothers: inter- and intra-mother transmission dynamics of mcr-1.1

Exchange of antimicrobial resistance genes via mobile genetic elements occur in the gut which can be transferred from mother to neonate during birth. This study is the first to analyze transmissible colistin resistance gene, mcr, in pregnant mothers and neonates. Samples were collected from pregnant mothers (rectal) and septicaemic neonates (rectal & blood) and analyzed for presence of mcr, its transmissibility, genome diversity, and exchange of mcr between isolates within an individualand across different individuals (not necessarily mother-baby pairs). mcr-1.1 was detected in rectal samples of pregnant mothers (n=10, 0.9%), but not in neonates. All mcr-positive mothers gave birth to healthy neonates from whom rectal specimen were not collected. Hence, transmission of mcr between these mother-neonate pairs could not be studied. mcr-1.1 was noted only in Escherichia coli (phylogroup A & B1), and carried few resistance and virulence genes. Isolates belonged to diverse sequence types (n=11) with two novel STs (ST12452, ST12455). mcr-1.1 was borne on conjugative IncHI2 bracketed between ISApl1 on Tn6630, and the plasmids exhibited similarities in sequences across the study isolates. Phylogenetic comparison showed that study isolates were related to mcr-positive isolates of animal origin from Southeast Asian countries. Spread of mcr-1.1 within this study occurred either via similar mcr-positive clones or similar mcr-bearing plasmids in mothers. Though this study could not build evidence for mother-baby transmission, but presence of such genes in the maternal specimen may enhance the chances of transmission to neonates

A study of surgical management of chronic suppurative otitis media with cholesteatoma and its outcome

OBJECTIVE: Aim of this study is evaluation of course of improvement of surgically treated cases of chronic suppurative otitis media (CSOM) with cholesteatoma; it includes hearing status, condition of mastoid cavity, study of different, natural and surgical condition and recurrence of disease within the study period. DESIGN: It is a prospective study. SETTINGS: This study was conducted in a premiere government hospital in Kolkata between May 2007 to April 2008. PATIENTS: Total 40 patients between age group of 6–70 years were included in the present study which includes 19 males and 21 females. INTERVENTION: Surgical interventions were done in all the cases. Different types of mastoidectomy with or without tympanoplasty was done according to extent of disease process. OUTCOME: Audiometrically documentable hearing improvement occurred in 35% cases (p = 14), in rest of the ears hearing status remained unaltered. At the end of 6 months follow up 92.5% (p = 14) in rest (p = 37) operated ears become completely dry. Five percent cases (p = 2) presented with facial paralysis; among them one patient improved completely and another patient improved from grade V to grade III facial paralysis. No patient developed any post operative intracranial complications and recurrence of cholesteatema not found in 6 months follow up. Meatal stenosis developed in 5% cases (p = 2) at the end of 6 months. CONCLUSION: Surgery is mainstay of treatment in CSOM with cholesteatoma. Eradication of disease, prevention of complication, maintenance and restoration of hearing, and giving the patient a non-discharging ear are main aim of treatment

Auricular Perichondritis in a Tertiary Rural Hospital

Objective:  Auricular perichondritis refers to inflammation involving the perichondrium of the external ear. It is a very serious disease which may lead to permanent deformity of the pinna. We describe the predisposing factors, pathogenic organisms, interventions and residual deformities in a prospective consecutive sample of patients.&#x0D; Methods:&#x0D; Design:           Prospective Cohort Study&#x0D; Setting:           Tertiary Rural Government Teaching Hospital&#x0D; Participants: All patients presenting with auricular perichondritis for a period of one year, between March 2011 and February 2012 were consecutively enrolled, and a clinical history and demographic details were obtained. Routine hematologic, blood biochemical examinations and culture / sensitivity of discharge from the pinna were conducted, and empiric intravenous ciprofloxacin was administered and continued if confirmed by culture and sensitivity. Those sensitive to co-amoxiclav, ceftazidime or amikacin were shifted to those medications. Medications were shifted to oral forms when available and indicated by resolution of acute inflammation, wound healing and no growth on cultures. Parenteral medications were maintained until the same parameters were achieved. Surgical incision and drainage was also performed when indicated, followed by a standardized wound care regimen. Follow up was for six months ending with assessment of pinna deformity.&#x0D; Results: Of the total study population of 50, 76% were male and 24% were female; 15-75 years of age (range 60 years) displaying male predominance and clustering in the fourth decade of life. The most common predisposing factors were trauma from motor vehicle accidents (30%) followed by high ear piercing (22%). Pseudomonas aeruginosa (48%) followed by Staphylococcus aureus (20%) were the most common organisms isolated. All were managed with intravenous antibiotics, but 76% also required surgical intervention.  Sixty-eight percent developed residual deformities of the pinna, with 50% being total and 18% being partial.&#x0D;  &#x0D; Conclusion: Auricular perichondritis is a frightening disease which requires early management.  As  Pseudomonas aeruginosa  is  the  commonest  organism,  antipseudomonal  antibiotics  should  be started  as  early  as  possible. Despite medical and surgical intervention, residual deformities may ensue.&#x0D;  &#x0D; Keywords:  auricular perichondritis, pinna, trauma, Pseudomonas aeruginosa</jats:p

Endoscopic Dacryocystorhinostomy: Advantage over External Approach

Introduction &#x0D; Although external DCR was considered to be the Gold Standard treatment for NLD obstruction, endoscopic DCR appears to give comparable results,  with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search.&#x0D; Materials and Methods &#x0D; In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing.&#x0D; Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ &amp; 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature.  &#x0D; Results &#x0D; The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR.&#x0D; Conclusion &#x0D; Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction.</jats:p

Endoscopic Dacryocystorhinostomy: Advantage over External Approach

Introduction Although external DCR was considered to be the Gold Standard treatment for NLD obstruction, endoscopic DCR appears to give comparable results,  with the advantage of the absence of external facial scar and no disruption of the medial palpebral ligament or the angular facial vessels. This study aims to evaluate the outcome of endoscopic dacryocystorhinostomy (DCR) and compare with the outcome of external DCR, based on data available on literature search. Materials and Methods In this prospective, longitudinal, interventional study, 67 cases of chronic dacryocystitis were operated endoscopically from January 2017 to December 2018. All patients were documented about detailed medical and operative history, thorough medical check up including ocular and ENT examination. Level of obstruction of nasolacrimal duct (NLD) was diagnosed by lacrimal syringing and probing. Surgery was performed under local anaesthesia except in uncooperative patients where general anaesthesia was used. 0˚ & 30˚ endoscopes were used in surgery. The surgical outcomes and complications were recorded, analyzed and compared to those of external DCR from available literature.   Results The overall success rate of endoscopic DCR was 94.7%, which is closely comparable to external DCR. Conclusion Endoscopic DCR is an effective and safe alternative to external DCR, with comparable results and better patient satisfaction