Introduction:Uncomplicated but symptomatic urinary tract infections (UTIs) are a common problem seen in practice. The study was undertaken to assess the most common pathogens responsible for uncomplicated symptomatic UTIs and the antimicrobial resistance pattern in a hospital in Bangalore. The study also explores the issue of antibiotic usage for these patients.Materials and Methods:The study was conducted in the Medicine department of a tertiary hospital in Bangalore. In all, 196 patients presented with symptoms of UTI. Bacterial growth was determined by standard microbiology techniques on freshly voided mid-steam urine samples collected from recruited patients. Patients’ demographic data, urine culture results, resistance rates to antimicrobial agents and prescribed empiric antimicrobial therapy were analyzed.Results:The prevalence of UTI was 32.1%; majority (67.9%) of the symptomatic did not have UTI based on culture report. Gram-negative bacteria constituted the largest group with a prevalence of 84.1% (53/63), with Escherichia coli being the most common (70%) uropathogen. Gram-negative isolates showed high level of sensitivity to amikacin (90.6%) and nitrofurantoin (77.4%). Most of the gram-positive organisms were susceptible to nitrofurantoin (70%) and gentamicin (50%). Uropathogens isolated demonstrated high resistance to cotrimoxazole, fluoroquinolones, and beta-lactam antibiotics. It was found out that 30.1% of the patients were wrongly managed of which 14.7% were over treated.Conclusion:UTI can be over diagnosed and over treated on the basis of clinical signs, symptoms and urine microscopy. In the era of emerging anti-microbial resistance, effective counseling and delay in antibiotic initiation or empirical therapy with a short course of nitrofurantoin is highly recommended. Empirical therapy guidelines should be updated periodically to reflect changes in antimicrobial resistance of uropathogens.
Background: Cardiovascular diseases (CVD) account for almost half of all non-communicable disease related deaths and are now the leading cause of death in low-and middle-income countries including India. There is no published data on multivariable risk prediction for cardiovascular disease from rural India. Aims & Objective: Determine the cardiovascular risk profile and the 10 year risk of fatal and non-fatal cardiovascular event in a rural population. Materials and Methods: A community based cross sectional study was done in 47 villages of Karnataka over a period of 3 years. A total of 3780 adults were screened for CVD risk factors. Various risk stratification criteria including the WHO 10 year risk of fatal/ non-fatal CVD event were used to study the magnitude of individual and aggregated risk factors for CVD. Results: The study reveals a high prevalence of CVD risk factors despite using three different risk stratification methods. The prevalence of at least one modifiable CVD risk factor in the population was 98.5%. An alarming 15.2% of the population had a high risk (>30%) of getting fatal or non-fatal MI or stroke in 10 years. Older age, lack of education, physical inactivity and family history of MI/ stroke were associated with high risk for CVD. Conclusion: The prevalence of CVD risk factors as well as the probability of a fatal or non-fatal cardiovascular event is very high in this rural population. This warrants strategies that would improve awareness and promote healthy lifestyles to reduce the risk of cardiovascular disease in this population.
This study highlights the challenges faced by physicians in dealing with the increasing number of patients presenting with CVD risk factors in rural areas. It also suggests options that could minimize these barriers, enabling them to manage their patients with CVD risk in the best way possible. It is critical to institute guidelines and algorithms to manage these risk factors in the rural Indian context.
Purpose: Children with developmental disabilities, if given skilled early intervention, have the potential to lead productive lives and can contribute to the social and economic development of their communities. This study explores the barriers to early diagnosis and intervention for children with developmental disabilities who live in rural and urban areas of Bangalore city, India. Methods: The study was conducted in selected villages of Devanahalli Taluk in Bangalore Rural District, and in Devara Jeevanahalli (DJ Halli), a shanty town in Bangalore city. The qualitative study design consisted of in-depth interviews and focus group discussions (FGDs).Parents of children with developmental disabilities, doctors practising in the area and school teachers were interviewed using a purposive sampling framework. An inductive, data-driven thematic analysis was carried out. Results: The physician-related barriers were identified as lack of skills and understanding of children with developmental disabilities, lack of knowledge and resources, lack of specialist backup services, and communication difficulties with regard to conveying bad news to clients. Parent-related barriers were financial constraints, delay in accepting the diagnosis, and prevalent myths, beliefs and stigma pertaining to disability. The teachers viewed children with special needs as an additional responsibility, and were also apprehensive about the attitudes and interaction of other children at school with children with disabilities.
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