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   2017| July-September  | Volume 7 | Issue 3  
    Online since August 14, 2017

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Prevalence of metabolic syndrome in psoriasis and levels of Interleukin-6 and tumor necrosis factor-α in psoriasis patients with metabolic syndrome: Indian Tertiary Care Hospital study
Surjit Singh, Sunil Dogra, Nusrat Shafiq, Anil Bhansali, Samir Malhotra
July-September 2017, 7(3):169-175
DOI:10.4103/ijabmr.IJABMR_330_16  PMID:28904916
Background: Psoriasis is a chronic inflammatory multisystem disease, found to be associated with metabolic syndrome (MS) and increased levels of cytokines. To evaluate the prevalence of MS in psoriasis and to determine the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in psoriasis patients with MS. Methods: Observational study on 334 psoriasis patients and 230 controls. MS was diagnosed by the presence of three or more criteria of original, revised, and modified National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATP III). Results: MS was significantly more common in psoriasis patients than in controls (multivariate odds ratio [95% confidence interval] of original NCEP ATP III = 5.73 [2.99–10.99], revised NCEP ATP III = 4.44 [2.43–8.10], and modified NCEP ATP III = 6.00 [3.43–10.52]). Higher prevalence of abdominal obesity (66.2% vs. 47%, P < 0.001), hypertriglyceridemia (40.4% vs. 29.6%, P = 0.009), systolic blood pressure (BP) ≥130 mmHg (25.1% vs. 7.4%, P < 0.001), diastolic BP ≥85 mmHg (30.2% vs. 12.2%, P < 0.001), and fasting plasma glucose ≥100 mg/dl (17.4% vs. 9.1%, P = 0.005) among psoriasis patients as compared to controls. Mean (standard deviation) values of IL-6 and TNF-α were 76.7 (73.9) pg/ml and 234.3 (273.9) in subgroup of psoriasis patients with MS (n = 42), significantly higher than the normal population (P < 0.0001). Conclusion: MS is more common in psoriasis. IL-6 and TNF-α is significantly higher in psoriasis patients with MS, signifying their role in pathogenesis of psoriasis and MS.
  6 2,030 232
Antimicrobial susceptibility pattern of extended-spectrum beta-lactamases producing organisms isolated in a Tertiary Care Hospital, Bangladesh
Mohammad Jobayer, Zeenat Afroz, Sultana Shazeda Nahar, Ayesha Begum, Shahin Ara Begum, SM Shamsuzzaman
July-September 2017, 7(3):189-192
DOI:10.4103/ijabmr.IJABMR_28_16  PMID:28904920
Context: Infection caused by extended-spectrum beta-lactamases (ESBL) producing organism is a major problem regarding antibiotic resistance. Aims: The aim of this study was to find out the antibiogram of ESBL producing organisms isolated from various samples. Settings and Design: This cross-sectional study was carried out in the Department of Microbiology of a Tertiary Care Hospital, Dhaka, Bangladesh from January to June 2014. Subjects and Methods: One Hundred and seventy-nine ESBL producing Gram-negative organisms detected phenotypically by double-disc synergy test were enrolled in this study. Required data were collected from the records of the Microbiology laboratory. Results: ESBL production was detected in 16.07% (179/1114) of isolated organism. Of Escherichia coli, 15.75% were ESBL producers; 14.01% Pseudomonas spp., 36.84% Proteus spp., 18.57% Klebsiella spp., and 21.05% of Acinetobacter spp., were ESBL producers. Maximum (43.58%) ESBL producers were isolated from surgery departments, and wound swabs yielded majority (53%) of them. About 13% ESBL producers were isolated in outdoor patients mostly from community-acquired infections. Most ESBL producers were resistant to commonly used antibiotics. Carbapenems especially imipenem was the most effective drug showing excellent sensitivity; colistin and piperacillin/tazobactam also had better sensitivity result. Most of the ESBL producers showed a good sensitivity to amikacin, but all of them were highly resistant to ciprofloxacin. Conclusions: ESBL production should be detected routinely in all Microbiology laboratories. Infection control, rational use of antibiotics must be done promptly to prevent the development and spread of ESBL producing organisms.
  5 1,929 284
Assessment of anxiety level of emergency health-care workers by generalized anxiety disorder-7 tool
Nesrin Alharthy, Osama Abdulrahman Alrajeh, Mohammed Almutairi, Ahmed Alhajri
July-September 2017, 7(3):150-154
DOI:10.4103/2229-516X.212963  PMID:28904912
Background: Dealing with emergency patients is considered to be a stressful situation to all health-care workers in the emergency department (ED). Prolonged stress predispose to physical and inconsequential psychiatric disturbances. Anxiety and depressive mode were found to be the most commonly experienced psychiatric manifestation among emergency health-care workers. The aim of this study is to screen and assess the severity of anxiety among health professionals working in ED. Methods: Cross-sectional study design was used. Generalized anxiety disorder (GAD)-7 screening tool was used to assess for anxiety symptoms. GAD-7 is a validated self-report tool that comprises seven questions where each question is rated on a 3-point scale. Demographic data were collected from the study sample. The study sample consists of emergency physician, nurses, and other emergency medical services workers. Data analysis was performed using SAS version 9.2 software. Descriptive statistics, nonparametric comparison, and correlation were performed as part of data analysis. Results: A total of 135 participants completed the questionnaire, of which, 66% of the participants were males. Occupational status of the respondents indicated that majority (35.6%) were physicians followed by 27.4% of emergency medical, and 27% of nurses. The results of this study indicated that 48% of the subjects were observed without an anxiety disorder. However, moderate to mild degrees of anxiety disorder was identified among 20.7% and 23.7% of the subjects, respectively. Severe anxiety disorder was found among 7.6% of the respondents. Emergency medical services workers were reported to have the highest GAD-7 score followed by physicians and nurses P = 0.039. Gender and older age group among health professionals were statistically significant correlated with higher GAD-7 score P = 0.028 and 0.048, respectively. There is no significant difference in GAD-7 score among health professional dealing with adult versus pediatrics patient. Conclusion: From this study, it was concluded that more than 52% of the health-care team members manifested with moderate to severe anxiety disorder that requires counseling and referral for support and treatment. Prolonged and unrecognized anxiety may predispose to major psychiatric morbidity, exhaustion, and resignations from the duties. Hospital administration needs to be aware of the level of anxiety and the most likely affected population to build preventive strategies.
  4 2,511 457
Evaluation of leptin as a marker of insulin resistance in type 2 diabetes mellitus
Thiyagarajan Manjuladevi Moonishaa, Sunil Kumar Nanda, Muthukrishnan Shamraj, Rajendran Sivaa, Periyasamy Sivakumar, Kandasamy Ravichandran
July-September 2017, 7(3):176-180
DOI:10.4103/ijabmr.IJABMR_278_16  PMID:28904917
Background: Type 2 diabetes mellitus (T2DM) is a leading cause of mortality and morbidity worldwide, whose incidence is rapidly increasing in India. T2DM is caused by varying degrees of insulin resistance (IR) and relative insulin deficiency. Leptin, an adipokine with the primary function of regulating energy balance, is found to mediate insulin secretion and sensitivity in peripheral tissues. Hence, we aimed to determine the role of leptin in the development of IR in newly diagnosed T2DM patients. Aim: This study aims to compare the leptin levels and homeostatic model assessment-IR (HOMA-IR) levels in the study population. Material and Methods: The study included a total of sixty patients newly diagnosed with T2DM. Their fasting blood samples were collected to estimate the glucose, insulin, and leptin levels. IR was calculated using HOMA-IR formula. Statistical analysis was done by Pearson's correlation, Spearman's correlation, and One-sample Wilcoxon Signed Rank test. Results: Leptin and HOMA-IR levels were significantly high in T2DM patients (P < 0.001) when compared with reference values. Body mass index showed a significant positive correlations with insulin (r = 0.40, P < 0.01), HOMA-IR (r = 0.37, P < 0.01), and leptin levels (r = 0.90, P < 0.01). Leptin levels showed significant positive correlations with plasma insulin (r = 0.35, P < 0.01) and HOMA-IR levels (r = 0.31, P < 0.05). The correlation between leptin and HOMA-IR levels was more pronounced and significant among the obese T2DM subjects (r = 0.82, P = 0.01). Conclusion: Hyperleptinemia reflecting leptin resistance plays an important role in the development of IR in obeseT2DM patients, making leptin a possible biomarker for the same.
  3 2,434 352
Report of a case and review of literature of internal hernia through peritoneal defect in pouch of douglas: A rare occurrence
Vamseedharan Muthukumar, Sarveswaran Venugopal, Surees Kumar Subramaniam
July-September 2017, 7(3):196-198
DOI:10.4103/ijabmr.IJABMR_297_16  PMID:28904922
Intestinal obstruction attributable to internal hernia as a cause is a rare phenomenon with a reported incidence of 0.6%–5.8%. Internal hernias ensuing as a result of defect in the pouch of Douglas is extremely rare with only six such cases reported so far in the literature. We present a case of 74-year-old posthysterectomy status female who presented with features of intestinal obstruction. Intraoperatively, the site of obstruction was found to be a rent in the peritoneum of the pouch of Douglas through which a loop of ileum was found herniating. The viability of the bowel was confirmed, and the defect was closed. The postoperative course was uneventful. This report presents an extremely rare type of internal hernia caused by defect in the pouch of Douglas and review of the literature so far available.
  2 1,893 135
A rare case of transvesical cesarean section
Sunil Kumar Juneja, Pooja Tandon, Bakul Kochhar, Harman Deep Singh, Bhanupriya Sharma
July-September 2017, 7(3):205-206
DOI:10.4103/ijabmr.IJABMR_120_16  PMID:28904925
Cesarean section, also commonly known as C-section, is a surgical procedure in which incision is made through a mother's abdomen and uterus to deliver one or more babies. According to urgency, they are classified either as elective or emergency. According to technique, they have been classified as classical, lower uterine segment and cesarean hysterectomy. Intentional transvesical cesarean though not a routinely practiced technique is used for delivery in women born with imperforate anus, ectopic intravaginal urethra, vaginal and urethral strictures, and bladder adherent completely over the uterus. Since such cases are very rare, we are reporting one such case of transvesical cesarean section.
  2 1,529 123
Toxic brain injury with nitrobenzene poisoning
Akshay Kumar, Chintan Bhavsar, Praveen Aggarwal, Nayer Jamshed
July-September 2017, 7(3):207-209
DOI:10.4103/ijabmr.IJABMR_271_16  PMID:28904926
Acute methemoglobinemia secondary to nitrobenzene ingestion is a rare but well-known clinical entity. It is extremely important to identify such patients as rapid and effective management with methylene blue and other supportive measures will often save these lives. We present a rare and unfortunate case of a girl who developed acute toxic brain injury following nitrobenzene ingestion and succumbed.
  1 1,654 126
Rare opportunistic bread mold fungal infection of maxillary sinus in a diabetic patient
Nandini Bhaskar, Vipin Chhabra, Nitin Kaushal, Salil Aggarwal
July-September 2017, 7(3):202-204
DOI:10.4103/ijabmr.IJABMR_368_16  PMID:28904924
Mucormycosis is a rare potentially fatal opportunistic fungal infection that affects human beings. Normally, a healthy is immune to such infections but there are some risk factors which predispose a person to mucormycosis, of which malnutrition and diabetes mellitus are the most common risk factors. India is the most commonly affected country by mucormycosis because of high proportion people with low socioeconomic status and diabetes mellitus. In diabetes mellitus, mucormycosis is more aggressive and fatal due to an impaired host defense mechanism. In spite of being a rare and fatal fungal infection, early diagnosis and prompt multidisciplinary treatment comprising control of underlying predisposing factor, surgical management, and medical management can be helpful in such cases.
  1 1,565 145
Evaluation of genetic polymorphisms in glutathione S-Transferase theta1, glutathione S-Transferase mu1, and glutathione S-Transferase mu3 in oral leukoplakia and oral squamous cell carcinoma with deleterious habits using polymerase chain reaction
Ayyagari Kameswara Rao, Peela Parameswar, Sumit Majumdar, Divya Uppala, Sreekanth Kotina, Naga Himabindu Vennamaneni
July-September 2017, 7(3):181-185
DOI:10.4103/ijabmr.IJABMR_58_16  PMID:28904918
Context: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer in the world. As per previous studies, most patients who develop oral cancer are elderly males who are heavy users of tobacco and alcohol; however, the incidence is increasing in younger individuals and in those who neither smoke nor drink. Many of the genes that code for the detoxification enzymes are polymorphic with abnormal activity profiles. Aims and Objectives: The aim of this study was to evaluate the risk of development of oral leukoplakia (OLP) and OSCC in glutathione S-transferase polymorphisms genes in the east coast of Andhra Pradesh population with tobacco consumption habit and habit-free controls using polymerase chain reaction (PCR-restriction fragment length polymorphism). Materials and Methods: This study included 15 patients each with histologically proven epithelial dysplasia and OSCC and compared with age- and gender-related controls with no tobacco habits in any form. A volume of 2 ml of blood sample was collected into presterilized vials containing ethylenediaminetetracetic acid from each individual under aseptic conditions. DNA extraction was done from whole blood, and PCR was performed. Statistical analysis was performed using Chi-square test and odds ratio (OR) and 95% confidence intervals (CIs). Results: The results are suggestive that glutathione S-transferase mu1 (GSTM1) null was associated with increased risk of OLP (OR = 5.5, 95% CI = 1.14–26.41, P = 0.021) and OSCC (OR = 11, 95% CI = 1.99–60.5, P = 0.021). Glutathione S-transferase theta1 (GSTT1) null genotype was associated with increased risk of OLP (OR = 2.154, 95% CI = 0.74–26.672, P > 0.99) and OSCC (OR = 2.154, 95% CI = 0.74–26.672, P > 0.99). The glutathione S-transferase mu3 (GSTM3) AB + BB genotypes appear to be risk factors for OSCC (OR = 1.31, 95% CI = 0.31–5.58, P = 0.7) although statistically insignificant. Conclusion: Hence to conclude, because of small sample size in the present study, statistically insignificant results were found and this study failed to observe the relationship between GSTM3 and GSTT1 polymorphism and risk of developing OSCC and positive relationship was observed with GSTM1 polymorphism and risk of developing OSCC.
  1 1,710 224
Pre- and Post-operative comparative analysis of serum lipid profile in patients with cholelithiasis
Gurpreet Singh Gill, Kapil Gupta
July-September 2017, 7(3):186-188
DOI:10.4103/2229-516X.212968  PMID:28904919
Background: Gallstones have become a major health problem because of their silent manifestation and unclear pathogenesis. Although the association between the disturbed lipid metabolism and formation of gallstones has been elucidated in many studies, the effect of cholecystectomy on lipid profile has not been studied in detail. Aim: The aim of the present study was to study the effect of cholecystectomy on lipid levels in patients with gallstones. Materials and Methods: The study was conducted on 50 patients with gallstones and 30 healthy volunteers for comparison of lipid levels. Subsequently, cholecystectomy was conducted on patients with gallstones and pre- and post-operative lipid levels were compared. Results: There was a significant decrease in total cholesterol, and triglycerides levels and increase in high-density lipoprotein levels after 1 month of surgery, while low-density lipoprotein levels and very low-density lipoprotein were not statistically changed. Conclusion: Cholecystectomy can significantly improve lipid levels in patients with gallstones.
  1 2,039 252
Cervical lymph nodes: Harbinger of benign inclusions as well as metastatic deposits of thyroid malignancy
Samarth Shukla, Sourya Acharya
July-September 2017, 7(3):210-212
DOI:10.4103/ijabmr.IJABMR_36_16  PMID:28904927
Lymph nodes can be harbinger to benign epithelial inclusions as well as metastatic deposits. Cervical lymph nodes are home to benign epithelial inclusions from thyroid better known as lateral aberrant thyroid as well as inclusions from salivary gland due to the unique embryologic origins of nodes with these organs. We present a case of a young female suspected of thyroid malignancy who was intraoperative diagnosed by frozen sections with papillary carcinoma of the thyroid along with bilateral cervical nodes (Level I–V) positive for reactive lymphadenopathy with Level II node being positive to benign salivary gland inclusions and Level VI node being positive to metastatic deposits of papillary carcinoma of the thyroid.
  - 1,947 144
Prenatal sonographic diagnosis of hypoplastic left heart syndrome
Raghu Teja Sadineni, B Santh Kumar, NB Chander, Durga Mahita Boppana
July-September 2017, 7(3):213-215
DOI:10.4103/ijabmr.IJABMR_389_16  PMID:28904928
Hypoplastic left heart syndrome (HLHS) represents a variety of cardiac malformations that may result from errors in the early stages of cardiac development. HLHS includes a wide spectrum of cardiac malformations including hypoplasia of the left ventricle, ascending aorta, hypoplasia, or atresia of the aortic and mitral valves. Over the recent years, the improved resolution of advanced equipment with awareness and increased performance of second-trimester ultrasound examinations for the assessment of fetal anomalies have helped in understanding the spectrum and have expanded our knowledge of HLHS. They are one of the causes which constitute for neonatal morbidity and mortality and hence the rapid need for prenatal evaluation with ultrasound to detect cardiac anomalies. Prenatal recognition of disease also allows families to prepare for a child with a life-threatening defect by consultation with the multidisciplinary team that will care for their newborn and discussing the short- and long-term prognosis.
  - 1,969 179
Congenital cyst adenoid malformation masquerading as bronchial asthma
Jagdish Prasad Goyal, Shishir Jindal, Mayank Mishra, Bhanu Kiran Bhakhri
July-September 2017, 7(3):199-201
DOI:10.4103/ijabmr.IJABMR_216_16  PMID:28904923
Congenital cyst adenoid malformation (CCAM) is a rare congenital malformation occurring in approximately 1–4 in 100,000 births. It is classified into five subtypes with type 1 CCAM is most common subtype. The diagnosis of CCAM is usually made in infancy, and it is rare in adolescents and adults. We report a 15-year-old female, who presented in pediatric outpatient department with a history of recurrent cough since infancy. On the basis of clinical examination, provisional diagnosis of asthma was considered and patient was started on inhaled corticosteroid and long-term β2 agonist. Lung function of the patient revealed low forced expiratory volume-1 s but without bronchodilator reversibility. Therefore, alternative diagnosis was suspected, and the patient was further evaluated with X-ray chest and high resolution computed tomography thorax. Based on radiological findings, a final diagnosis of CCAM was established. The case was highly unusual due to its atypical and late age of presentation. Acquaintance about this condition benefit clinician in making differential diagnosis of recurrent cough.
  - 1,935 121
Hashimoto's encephalitis: Rare manifestation of hypothyroidism
Manish Gutch, Annesh Bhattacharjee, Sukriti Kumar, Durgesh Pushkar
July-September 2017, 7(3):193-195
DOI:10.4103/ijabmr.IJABMR_256_16  PMID:28904921
Hashimoto's encephalitis is a rare, heterogeneous and completely treatable form of neuroendocrine disorder manifesting with seizures, stroke-like episodes, encephalopathy, dementia and variable neuropsychiatric manifestations. It is generally associated with a background of Hashimoto's Thyroiditis, and the patient has high titers of antithyroid antibodies, especially antithyroid peroxidase antibodies. This entity responds dramatically to corticosteroids, hence should be always considered and excluded while treating a patient with encephalopathy in the background of a thyroid disease.
  - 2,206 306
Insulin resistance: Quest for surrogate markers
Rajiv Mahajan
July-September 2017, 7(3):149-149
DOI:10.4103/ijabmr.IJABMR_198_17  PMID:28904911
  - 1,734 250
Inhibition by benidipine of contractility of isolated proximal and distal caprine ureter
Sumith K Mathew, Girish S Naik, Jacob Peedicayil
July-September 2017, 7(3):155-159
DOI:10.4103/ijabmr.IJABMR_87_16  PMID:28904913
Context: Benidipine is a calcium channel blocker that blocks all the major types (L, N, and T) of calcium channels. It has been shown to inhibit the contractility of many isolated smooth muscles but not isolated ureter. Aims: This study evaluated the ability of benidipine to inhibit the spontaneous contractility of isolated proximal and distal caprine (goat) ureter. Settings and Design: Spontaneous contractility of isolated goat ureter was recorded using a physiograph. Materials and Methods: Benidipine at concentrations in the range of 1 nM to 10 μM was analyzed for its inhibitory effects on the spontaneous contractility of the isolated proximal and distal caprine ureter. Statistical Analysis Used: Both parametric and nonparametric statistical tests were used. Results: The EC50of benidipine for inhibiting contractility in the distal ureter was found to be 54.68 nM. Benidipine was found to have a greater inhibitory effect on the distal ureter than on the proximal ureter. It was also found to inhibit amplitude of spontaneous ureteric contractility more readily than the frequency of spontaneous ureteric contractility. Conclusions: These results suggest that benidipine has differential inhibitory effects on the spontaneous contractility of the isolated ureter. Benidipine could be useful in the management of clinical conditions like ureteric colic due to its inhibitory effects on the contractility of the ureter.
  - 2,405 215
Novel cardiovascular risk markers in Nigerian cigarette smokers
Godwin O Adunmo, AbdulFatah Ayoade Adesokan, Olufemi Olumuyiwa Desalu, Sikiru Abayomi Biliaminu, Eyitayo O Adunmo
July-September 2017, 7(3):160-164
DOI:10.4103/ijabmr.IJABMR_140_16  PMID:28904914
Background: Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. While the effect of cigarette smoking on conventional markers that account for <50% of CVD s has been well studied, there are only a few studies on the effect of cigarette smoking on novel cardiovascular (CV) risk markers. Objective: To evaluate the effect of cigarette smoking on the novel CV markers such as homocysteine (HCY), lipoprotein (a) (Lp(a)), and C-reactive protein (CRP). Materials and Methods: One hundred and forty smokers, 12 ex-smokers, and 84 controls were recruited for the study. A structured questionnaire was used to obtain information on their clinical history, daily cigarette consumption, and duration of smoking. The smokers were further grouped according to the amount of cigarette consumption: light (<5 sticks/day), moderate (6–10 sticks/day), and heavy (>10 sticks/day) and duration of smoking: short (5–10 years), medium (11–20 years), and long (>20 years). HCY was determined by enzyme-linked immunosorbent assay method, and Lp(a) and CRP were determined spectrophotometrically. Results: HCY, Lp(a), and CRP were significantly elevated in smokers when compared with control (P < 0.05) and they correlated with daily cigarette consumption and duration of smoking. Ex-smokers also exhibited a significant increase in HCY, Lp(a), and CRP level (P < 0.05) when compared with the control, but were significantly lower than the current smokers. Conclusion: There is a linear relationship between the intensity and duration of cigarette smoking and serum levels of all three novel risk CV markers. These findings suggest that these markers may be an important mechanism by which smoking promotes atherosclerosis.
  - 2,106 251
Microbiological surveillance of operation theatres: Five year retrospective analysis from a Tertiary Care Hospital in North India
Dipender Kaur Najotra, Aneeta Singh Malhotra, Poonam Slathia, Shivani Raina, Ashok Dhar
July-September 2017, 7(3):165-168
DOI:10.4103/ijabmr.IJABMR_281_16  PMID:28904915
Introduction: Microbiological contamination of air and environment in the operation theaters (OTs) are major risk factor for surgical site and other hospital-associated infections. Objectives: The aim was to identify bacterial colonization of surfaces and equipment and to determine the microbial contamination of air in the OTs of a tertiary care hospital. Materials and Methods: Five years (January 2010–December 2014) retrospective analysis of the data obtained from routine microbiological surveillance of the five OTs of the hospital was done. Surface samples were taken with wet swabs from different sites and equipment. Bacterial species were isolated and identified by conventional methods. Air quality surveillance of OTs was done by settle plate method. Results: A total of 4387 samples were collected from surfaces and articles of various OTs. Out of these only 195 (4.4%), samples showed bacterial growth and yielded 210 isolates. The predominant species isolated was Bacillus with 184 (87.6%) isolates followed by coagulase-negative Staphylococcus 17 (8.1%), Staphylococcus aureus 6 (2.9%), and Enteroccoccus spp. 3 (1.4%). Analysis of the OT air samples showed least colony forming unit (cfu) rate of air (27 cfu/m3) in ophthalmology OT and highest rate of 133 cfu/m3 in general surgery OT. Conclusion: The study shows that OTs of our hospital showed a very low bacterial contamination rate on surface swabbing and a cfu count per m3 of air well within permissible limits.
  - 2,476 334