Nargis K. Bali

Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India

Please cite this paper as: Bali NK et al. (2012) Knowledge, attitude, and practices about the seasonal influenza vaccination among healthcare workers in Srinagar, India. Influenza and Other Respiratory Viruses 7(4), 540–545.

Poor uptake of influenza vaccination in pregnancy in northern India

To study the uptake of influenza vaccination among pregnant women in northern India and physicians’ beliefs and practices regarding vaccination.

Pandemic and seasonal influenza viruses among patients with acute respiratory illness in Kashmir (India).

Please cite this paper as: Koul PA., et al. (2011) Pandemic and seasonal influenza viruses among patients with acute respiratory illness in Kashmir (India). Influenza and Other Respiratory Viruses 5(6), e521–e527.

Emergence of carbapenem-resistant Acinetobacter in a temperate north Indian State.

Abstract This study aims to determine drug sensitivity, metallo-β-lactamase (MBL) production and elaboration of blaOXA-type carbapenemases in Acinetobacter spp. in a temperate climate area in north India with a heavy influx of tourists. Antimicrobial sensitivity of 165 isolates was performed. Imipenem-resistant isolates were subjected to combined disk (CDT) and double-disk diffusion tests (DDT) for MBL detection. Minimum inhibitory concentration (MIC) and MBL production were tested by Etest. A multiplex polymerase chain reaction (PCR) was performed for the detection of genes encoding blaOXA-23 like, blaOXA-24 like, blaOXA-51 like and blaOXA-58 like genes. Ninety-nine (60%) isolates were imipenem-resistant (MICs 2–96 μg/mL). Fifty (50.5%) of the 99 carbapenem-resistant isolates were MBL producers by CDT and 26 (26.3%) by DDT. The majority (77%) of the isolates elaborated blaOXA-23 and blaOXA-51 like genes. Forty seven of the 50 MBL-positive isolates harboured blaOXA-23 like and blaOXA-51 like genes. MBL-producing Acinetobacter has emerged as a major pathogen in Kashmir with elaboration of blaOXA-23 and blaOXA-51 related carbapenemases. This poses a significant challenge for healthcare professionals and policy planners, and needs to be addressed immediately. Primary care physicians treating visitors to Kashmir need to be aware of the situation.

Influenza vaccination in India: Challenges for universal adoption

India is currently battling the most severe epidemic of /H1N1pdm09 influenza virus since the first appearance of the irus in the country in 2009. The outbreak has engulfed large areas f the country affecting the states of Gujarat, Rajasthan, Telanana, Madhya Pradesh Maharashtra and Jammu & Kashmir, with he western state of Gujarat being the most affected. With more han 30,000 recorded patients and more than 2000 deaths, the curent epidemic has outnumbered the Ministry of Health’s recorded oll in WHO-declared pandemic times in 2009 (27,236 affected/981 eaths) and 2010 (20,604 affected/1763 deaths) [1]. The epidemic ith its heavy death toll caused intense panic among the public and aked a media outcry. Many state governments were criticized for heir lackadaisical approach to the epidemic, inability to pre-empt pread or stock pile enough antiviral drugs and vaccines. In utter isregard to the ministry’s regular pacifying bulletins, media fury esulted in panic buying of drugs, vaccines and personal protection quipment like masks leading to quick disappearance of the stocks rom the shelves, perpetuating the panic. World Health Organizaion issued an advisory to the media to exercise restraint during eporting but to little avail, with people dreading visiting health are facilities resulting in a severe drop in patient attendance; only he very sick reporting to the hospitals. Religious and social gathrings too witnessed a steep drop in attendance regardless of the HO assessment of the influenza activity as a low-level one.

Influenza Illness in Pregnant Indian Women: A Cross-Sectional Study

Data about burden of influenza in pregnancy in India are scant. In order to assess the contribution of influenza to acute respiratory illness (ARI) in pregnancy, 266 north Indian pregnant females with febrile ARI were studied from December 2014 to May 2015. Twin nasopharyngeal/oropharyngeal swabs were obtained and tested for influenza viruses by RT-PCR. Fifty (18.8%) patients tested positive for influenza (A/H1N1pdm09 in 41, A/H3N2 in 8, and influenza B Yamagata in 1). Rigors, headache, and a family history of ARI were significantly more frequent in influenza positive patients. Oseltamivir and supportive therapy were administered to all confirmed cases. Nine influenza positive cases needed hospitalization for their respiratory illness, and 5 developed respiratory failure. Of these, 4 (3 in third trimester) succumbed to their illness. We conclude that influenza viruses are a cause of significant morbidity and mortality among pregnant females with ARI in north India. As such, appropriate preventive strategies of influenza vaccination and early initiation of antiviral therapy during illness are stressed.

Serological Evidence of Scrub Typhus among Cases of PUO in the Kashmir Valley- A Hospital Based Study

INTRODUCTION Rickettsial infections are being increasingly recognized as a cause of acute febrile illnesses and should be considered a distinct possibility in patients presenting with suggestive clinical features. Their diagnosis remains a challenge in a country like ours where tests like immunofluorescence assay cannot be routinely done. Results of serological tests, when correlated with patients clinical profile can aid in the timely diagnosis of scrub typhus. AIM To find out the extent to which scrub typhus contributes to Pyrexia of Unknown Origin (PUO) in patients admitted to or attending the OPD of our hospital using simple tests like Weil-Felix Agglutination Test (WFT) and Enzyme Linked Immunosorbent Assay (ELISA). MATERIALS AND METHODS A cross-sectional study was carried out in the Department of Microbiology, Government Medical College and Hospital, Srinagar, over a period of eight months (1(st) March to 31(st) October 2015). Serum samples from patients suffering from Pyrexia of Unknown Origin (PUO) were processed for the detection of Scrub typhus. A total of 162 samples were included in the study. These were subjected to WFT using OX-K strain. The serum samples were diluted 1/20 to 1/640 and a titre of ≥ 1:160 was considered as positive. The samples were also tested for IgM and IgG antibodies for scrub typhus by ELISA and tube agglutination test was done to detect typhoid fever and brucellosis. RESULTS Of the 162 serum samples tested 22.8% tested positive scrub typhus by WFT. IgM ELISA and IgG was positive in 8 (4.9%) and 15 (9.3%) samples respectively. Sensitivity, specificity, positive and negative predictive values of WFT; taking IgM ELISA as a reference standard were 75%, 79.9%, 16.2% and 98.4% respectively. CONCLUSION Scrub typhus is prevalent in our state and the results of WFT supplemented by those of ELISA can aid in its diagnosis. However the results of these tests should always be regarded in light of the clinical condition of the patient.

Detection of vanA and vanB Genetic Determinants in Vancomycin Resistant Enterococci in Kashmir Region of North India-A Hospital Based Study

Introduction: Enterococci have emerged as one of the most important multidrug resistant microorganisms over the past few decades and have been reported to be the third most important hospital-acquired pathogens. Indiscriminate use of vancomycin and extended spectrum cephalosporins in hospitals has significantly contributed to the emergence of vancomycin resistance in Enterococci. Transferable vancomycin resistance in Enterococci is predominantly encoded for by vanA and vanB gene clusters. Polymerase Chain Reaction (PCR) allows rapid detection of these genes which is very important for infection control and prevention of nosocomial spread. Aims: To estimate prevalence of VRE infections in our hospital and identify genetic determinants of vancomycin resistance in these isolates. Original Research Article Manzoor et al.; BMRJ, 17(2): 1-8, 2016; Article no.BMRJ.29246 2 Methodology: This prospective study was carried out in the department of Microbiology, Sher-iKashmir Institute of Medical Sciences, Srinagar J&K over a period of one year from 1 August 2013 to 30 July 2014. VRE isolated from clinical samples taken from patients admitted in the hospital or attending OPD were subject to DNA extraction and genotyping by PCR using vanA and vanB specific primers. PCR amplicons were then analyzed on 2% agarose gel by electrophoresis using ethidium bromide stain. Results: Out of total 498 isolated Enterococcus spp., 35 (7.0%) were found to be vancomycin resistant after MIC testing. All the VRE were isolated from inpatients particularly from ICU (34.3%; p<0.001). Majority of VRE were isolated from blood samples (34.3%; p<0.001). Prior use of vancomycin was noted in 54.3% patients from whom VRE were isolated (p=0.003). All the 35 VRE isolates were positive for presence of vanA gene, whereas none of the VRE in our study harbored vanB gene which was in accordance with phenotypic resistance pattern of the isolates. Conclusion: VRE have emerged as important pathogens in our hospital with a prevalence of 7.0% and vanA is the predominant genotype of the resistant strains.