The increasing antimicrobial resistance worldwide, combined with dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health and safety of patients. To combat this hazard, antimicrobial stewardship programs (ASPs) have emerged. Antimicrobial stewardship programs prevent or slow the emergence of antimicrobial resistance by coordinated interventions designed to optimize antimicrobial use to achieve the best clinical outcomes and limiting selective pressures that drive the emergence of resistance. This also reduces excessive costs attributable to suboptimal antimicrobial use. Even though an ideal effective ASP should incorporate more than one element simultaneously, it also requires a multidisciplinary team, which should include an infectious diseases physician, a clinical pharmacist with infectious diseases training, infection control professionals, hospital epidemiologist, a clinical microbiologist and an information specialist. However, for antimicrobial stewardship (AMS) programs to be successful, they must address the specific needs of individual institutions, must be built on available resources, the limitations and advantages of each institution, and the available staffing and technological infrastructure.

Tuberculosis (TB) is still among the most life-threatening infectious diseases, resulting in high mortality in adults. A significant proportion of patients (15-25%) exist in whom the active TB infection is manifested in an extrapulmonary site. Healthcare workers, including dentists, are at the frontline and can make an important contribution to the control of this infectious epidemic. Oral TB has been considered to account for 0.1-5% of all TB infections. Nowadays, oral manifestations of TB are re-appearing alongside many forgotten extrapulmonary infections as a consequence of the outbreak and emergence of drug-resistant TB and of the emergence of acquired immune-deficiency syndrome.

Context: Micronucleus (MN) has been proved to be an important biomarker of genomic damage. MN scoring in oral exfoliated epithelial cells has been used in the past as a biomarker to identify different preneoplastic conditions much earlier than the manifestations of clinical features. However, no attention has been, until now, given to determine the overall accuracy of MN assay in diagnosing potentially malignant disorders (PMDs). Aim: The present study was being conducted to evaluate the diagnostic accuracy of MN assay in PMDs of oral cavity. Materials and Methods: Cytosmears from 30 controls with healthy mucosa and 45 cases as patients with suspicious lesions, clinically diagnosed as PMDs of the oral cavity were taken and separately stained with Papanicolaou (Pap) stain and haematoxylin and eosin (H and E) stain. MN frequency was evaluated and based on the 50 ^th percentile of all the MN (%) frequency values obtained for both the groups combined; a cut off value was calculated independently for each stain. Results: The sensitivity and specificity with Pap stain was found to be 84% and 93%, respectively, with diagnostic accuracy of 88%, whereas with H and E stain, sensitivity of 89% and specificity of 100% with diagnostic accuracy of 93% was observed. Conclusion: MN assay in oral exfoliated epithelial cells can be conveniently used as a biomarker for the screening of PMDs of oral cavity.

Background: Neurocysticercosis (NCC) is a common cause of epilepsy in the low- and middle-income countries. The risk factors for NCC vary from region to region. Aims: To study the risk factors NCC among patients with NCC and compare with age-and gender-matched controls without NCC. Setting and Design: Hospital-based case-control study. Materials and Methods: A total of 214 subjects were studied (109 NCC patients and 105 age- and gender-matched controls without NCC). The participants were selected from neurology and medical wards of a tertiary referral hospital in Northwest India. They were interviewed by trained medical interns using a questionnaire. Results: Patients with NCC were more likely to dispose garbage close to water source (P = 0.01), eat nonvegetarian food (P < 0.001), and often eat in restaurants (P < 0.001). Pigs were seen more in and around the NCC patient's houses than the control subjects residential areas (P = 0.001). A total of 15% of the NCC subjects lived close to slaughter houses, while only 2.7% of the control group stayed near a slaughter house (P = 0.002). Conclusions: Unhygienic practices, nonvegetarian food, and eating in restaurants were the risk factors for NCC in this study. There is an opportunity for prevention of NCC using public education.

Context: India is experiencing an epidemiological health transition characterized by rapid decline in nutritional and parasitic diseases (pre-transitional diseases) with an alarming rise in cardiovascular diseases, mainly coronary heart disease and stroke (post-transitional diseases). Many of these risk factors manifesting themselves as diseases in adults can be found during adolescence. Aims: To determine the prevalence of risk factors of heart disease among urban high-school students aged 13-15 yrs in Ludhiana city. Materials and Methods: This cross-sectional study included 330 high school-going early teens aged 13-15 years using a pretested questionnaire. Details regarding food habits, physical activity, and family history were collected along with anthropometric measures and blood pressure recordings. Statistical Analysis Used: Data was analysed using frequencies and proportion. Chi-square was the test of significance. Results: The prevalence of at least one risk factor in the population was 48.5%. Family history with prevalence of at least one coronary artery disease risk factor was of 27.4%, diabetic parents 12.2%, hypertension 17.6%, and heart disease was 1.8%. Physical inactivity as a risk factor showed an overall prevalence of 73%. Nearly 50% of the students consumed some junk food every day. Only 18.2% consume 3-5 servings of fruits per day, 11.2% do not take any fruits at all. Prevalence of overweight was 11.2% and 4.6% of them were obese. Hypertension was seen in 20.1% of subjects. Conclusions: The present generation of early teens are at high risk of future cardiovascular disease and schools and society need to address these issues urgently.

Background: Khaini is a widely used form of smokeless tobacco in India. Cigarette smoking has extensive effects on cardiovascular functions. Khaini is tobacco with slaked lime. Aims: This study aimed to determine the effect of Khaini on cardiovascular system adaptability to exercise. Materials and Methods: Cardiovascular functions were assessed after maximal exercise testing by recording parameters like maximum heart rate, delta heart rate, recovery heart rate and maximum oxygen pulse in two groups' viz., Khaini users and non-users. Results: On studying the differences in cardiovascular functions in users and controls, there was significant difference in maximum heart rate. The other parameters like delta heart rate and maximum oxygen pulse were on the higher side in controls while the recovery heart rate was significantly lower in the control group which was consistently maintained after exercise testing. Conclusion: Based on these findings there is a higher adaptability of the cardiovascular system to the exercise stimulus in the form of better VO ₂ max, faster recovery of the exercise heart rate, and a higher delta heart rate in non-Khaini users.

Background: Shigella is an important cause of invasive dysentery in children and others. The present study was done to study the prevalence, any seasonal variation, distribution among children and adults, and antimicrobial susceptibility pattern of Shigella isolates in stool. Materials and Methods: A retrospective study was conducted over a period of 1 year from June 2011 to June 2012 in the department of microbiology, in a tertiary care hospital in Punjab. Stool specimens from diarrhea/dysentery cases in different age-groups were processed. The specimens were processed by standard microbiological techniques. The suspected colonies of Shigella were identified by standard biochemical tests and serotyping was done by group specific antisera. The susceptibility of all the isolated Shigella species to different antibiotics were done by Kirby-Bauer's disk diffusion technique as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Shigella species were isolated from 30 (2.1%) of the total 1,402 stool samples received during the study period. Among these, Shigella flexneri was the predominant species accounting for 57% of isolates, followed by S. sonnei (36%) and S. boydii (7%). Over 70% of Shigella isolates were resistant to two or more drugs including ampicillin, trimethoprim-sulfamethoxazole, and norfloxacin; and 10% Shigella isolates were resistant to chloramphenicol and ceftriaxone during the study period. No resistance was observed to cefoperazone/sulbactam, piperacillin/tazobactam, and imipenem. Conclusions: The results of the study revealed the high prevalence of shigellosis with S. flexneri as the predominant species. The result also suggests that ampicillin, trimethoprim-sulfamethoxazole and norfloxacin should not be used empirically as the first line drugs in the treatment of shigellosis. Periodic analysis and reporting of antibiotic susceptibility is an important measure to check for antibiotic resistance and form appropriate treatment protocols.

Aims : To assess the chronic cardiac effects of anthracycline-based chemotherapy regimens on atrial and ventricular diameter, ejection fraction, and valvular abnormalities in relation to cumulative dose in breast cancer patients. Materials and Methods: Breast cancer patients who had received anthracycline-based chemotherapy and radiation therapy were enrolled. All patients had undergone a baseline and follow-up electrocardiogrphy, echocardiography, and clinical cardiac evaluation. Any changes in cardiac parameters were noted. Statistical Analysis Used: Statistical measures used were Chi-square test and independent t-test. Results: A total of 75 breast cancer patients were assessed. Out of these, 56 patients who received cumulative dose of doxorubicin ≥300 mg/m ² showed increased cardiac dysfunction. Patients with left side breast cancer had greater cardiac abnormalities compared with right side. Conclusion: Cardiac dysfunction was significant with cumulative dose of doxorubicin ≥300 mg/m ² and also was observed more in left side breast cancer patients.

The healthcare infratsructure is disproportionately developed in India. Apart from few States the rural health in our country is largely underdeveloped. This article highlights an important model to follow in developing health infrastructure in remote areas in this nation.

Global Tuberculosis Report - 2012, released by the World Health Organization (WHO) has revealed that in the year 2011 alone, 11.7 million new cases of tuberculosis (TB) have been reported worldwide, of which India contributed to almost one-quarter of the cases. Considering the global distribution, magnitude of the problem, serious impact on the quality of life, and high mortality rates; TB in today's world is the biggest public health disease of an infectious nature. Revised National Tuberculosis Control Program (RNTCP) has been geographically scaled-up and updated on multiple fronts based on the epidemiology of disease, infield practical experience, WHO's recommendations, and the successful implementation of different strategies in high burden countries. Refinement in the program has been observed in different fields such as diagnostics, treatment, involvement of medical college and private sector, along with some innovative measures. To conclude, strengthening of the RNTCP program has been planned in a comprehensive manner and due attention has been given to encourage and actively involve all the stakeholders so that global vision to achieve universal access to TB care can be accomplished.

Injuries to neural and vascular structures of the posterior fossa are the most dreaded complications of occipitocervical fi xation. We report an unusual complication of occipitocervical fi xation in a 38-year-old man, presenting with type III odontoid fracture, atlantoaxial instability, and quadriparesis; following a road traffic accident. Inadvertent dural tear occurred while drilling holes in the occipital bone for anchoring the implant. Postoperative imaging showed contusion and fat deposition in the cerebellum. Patient was managed with extraventricular drainage for the hydrocephalus and conservatively for the cerebellar lesion. Thorough search of literature showed no previous reports of such iatrogenic fat deposition within the cerebellum.

Dermatitis herpetiformis (DH) is an uncommon condition. We describe a young boy who presented with pruritic, recurrent grouped fluid filled and papular lesions over the body. DH was confirmed by histopathological examination of the vesicle.

A 60-year-old woman presented with progressive loss of vision and deafness with recurrent simple partial seizures. This patient was treated for carcinoma breast 13 years before this presentation. Magnetic resonance imaging brain and magnetic resonance angiography was normal. Cerebrospinal fluid analysis was inconclusive. Meningeal biopsy revealed metastatic deposits and malignant cells were positive for estrogen, progesterone, and HER2nu receptor. This case has some unique features in the form of involvement of optic and vestibulocochlear nerves together, primary site of malignancy was hidden, and diagnosis was made with meningeal biopsy.

AIDS-related malignancies have been a major cause of death among HIV-infected patients, and possibly other NON-AIDS defining malignancies may become an increasingly frequent problem. The development of any cancer in the setting of HIV-induced immunodeficiency can create significant difficulties in the care of such patients, who frequently develop intercurrent illnesses and tolerate anti-neoplastic therapies poorly. Is transitional cell carcinoma of the urinary bladder one of them?

A middle-aged woman presented with a history of asymptomatic lesions over the palms, which were progressively increasing in number. Examination revealed 2-mm sized yellowish papules over the palmar surface of fingers. A clinical diagnosis of palmar xanthomas was made. Fasting lipids indicated elevations consistent with dysbetalipidemia, confirming the diagnosis. We recommend that the thyroid stimulating hormone level and serum electrophoresis should be done as part of the work-up for this rare condition.