Tuberculosis is the most important OI before initiation of HAART. Both EFV and NVP-based regimens are equally efficacious in controlling OIs.

Neonatal septicemia is one of the leading causes of neonatal mortality and morbidity worldwide. Hence, the present study was undertaken to isolate the bacteria causing neonatal sepsis and determine their antibiotic susceptibility pattern. Fifty neonates suspected to have septicemia were screened for 2 months (July and August 2014). Out of 50 specimen, 15 (30%) were blood culture positive. Coagulase-negative staphylococci was the most common isolate (10, 66.6%), with 60% (6 isolates) methicillin resistance. In view of the increasing antibiotic resistance, periodic surveillance should be conducted to control the emergence and spread of antimicrobial resistance.

Background and Objective: Diabetic foot ulceration is a multifactorial process involving various intrinsic complications of diabetes mellitus which cause injury to the foot at risk. The diabetic foot ulcer infections are polymicrobial in nature. Failure to recognize and control of the infectious process may have devastating consequences of limb amputation, sepsis, and mortality. Hence, the study was undertaken to determine the bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques and the antimicrobial sensitivity pattern of the isolates. Materials and Methods: A total of 100 patients with diabetic foot ulcer of Wagner's grade I and above were included in the study. Pus and tissue biopsy were collected for bacteriological study. The specimen was processed in the microbiology laboratory for Gram stain, aerobic culture, and anaerobic culture. The organisms isolated were identified by standard procedures and antimicrobial susceptibility was done by Kirby-Bauer disc diffusion method. Results: A total of 187 organisms were isolated, with an average of 1.87 organisms per specimen. Pseudomonas sp, 36 (21.9%), was the most common aerobic organisms isolated followed by Klebsiella sp, 32 (19.4%). Anaerobic organisms isolated were 22 (11.77%). The predominant anaerobic organisms isolated were Peptostreptococcus sp, 10 (45.5%). All the aerobic Gram-negative organisms were sensitive to imipenem (100%). Gram-positive organism was 100% sensitive to vancomycin. Methicillin resistant staphylococcus aureus (MRSA) was seen in 66.7%. All the anaerobes were sensitive to metronidazole, clindamycin, cefoxitin, and penicillin G. Conclusion: Pseudomonas was the most common organism isolated in our study. MRSA was seen in 66.7% of the isolate.

Background:The high cost of CD4 count estimation in resource-limited settings is a major obstacle in initiating patients on highly active antiretroviral therapy (HAART). Thus, there is a need to evaluate other less expensive surrogate markers like total lymphocyte count (TLC) and absolute lymphocyte count (ALC).ObjectivesTo evaluate the correlation of TLC and ALC to CD4 count. To determine a range of TLC and ALC cut-offs for initiating HAART in HIV-infected patients in resource-limited settings.Materials and Methods:In a prospective observational cohort study of 108 ART-naive HIV-positive patients, Spearman correlation between ALC and CD4 cell count, and TLC and CD4 cell count were assessed. Sensitivity, specificity, positive and negative predictive values of various ALC and TLC cut-offs were computed for CD4 count <200 cells/cu.mm.Results:Good correlation was noted between ALC and CD4 (r=0.5604) and TLC and CD4 (r=0.3497). ALC of 1400 cells/cu.mm had a sensitivity of 71.08% and specificity of 78.26% for predicting CD4 cell counts less than 200 cells/cu.mm. Similarly, TLC of 1200 cells/cu.mm had a sensitivity of 63.41% and specificity of 69.57%.Conclusion:Either ALC or TLC may be helpful in deciding when to initiate antiretroviral therapy in resource-poor settings, though ALC is better than TLC as a surrogate for CD4 counts.

Introduction: There are few studies from India documenting the adverse effects of generic HAART (Highly Active Anti-retroviral Therapy). Methodology: A prospective study was conducted at Mysore, India, to study the adverse effects after HAART initiation in a cohort of 100 antiretroviral therapy (ART)-naive patients, who were evaluated prospectively every three months by clinical and laboratory monitoring for adverse effects after HAART initiation for one year. Results: The most common first-line regimens were zidovudine (AZT) plus lamivudine (3TC) plus nevirapine (NVP) (42%); followed by Stavudine (d4T) plus 3TC plus NVP (33%); AZT plus 3TC plus efavirenz (EFV) (13%); and d4T plus 3TC plus EFV (12%). The first-line regimen was modified in14% of patients. The most common reasons for modifying therapy were development of an adverse effect (eight cases; 57.14%) and completion of antituberculous therapy (six cases; 42.86%). The commonest cause for modifying therapy was skin rashes due to NVP (four cases) followed by anaemia two cases) and peripheral neuropathy (two cases). Grade 1 or 2 severity adverse effects by laboratory monitoring were seen in 54 patients after ART initiation and grade 3 or 4 severity adverse effects were seen in eight patients. Conclusions: A significant proportion of patients had adverse effects of a lower grade severity after HAART. A significant proportion of those started on ART substitute therapy due to adverse effects and those on NVP-based regimens are more likely to do so when compared with those on non-NVP-based regimens.

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