Tata Memorial Hospital

About: Tata Memorial Hospital is a healthcare organization based out in Mumbai, India. It is known for research contribution in the topics: Cancer & Breast cancer. The organization has 3187 authors who have published 4636 publications receiving 109143 citations.

Epidemiology of blood stream infections in pediatric patients at a Tertiary Care Cancer Centre.

Abstract: Background: Blood stream infections (BSI) are among the most common causes of preventable deaths in children with cancer in a developing country. Knowledge of its etiology as well as antibiotic sensitivity is essential not only for planning antimicrobial policy, but also the larger infection prevention and control measures. Aims: To describe the etiology and sensitivity of BSI in the pediatric oncology unit at a tertiary cancer center. Materials and Methods: All the samples representative of BSI sent from pediatric oncology unit during the period of January to December, 2013 were included in the study, and analyzed for microbiological spectrum with their antibiotic sensitivity. Results: A total of 4198 samples were representative of BSI. The overall cultures positivity rate was 6.97% with higher positivity rate (10.28%) from central lines. Of the positive cultures, 208 (70.9%) were Gram-negative bacilli (GNB), 71 (24.2%) were Gram-positive organisms, and 14 (4.7%) were Candida species. Lactose fermenting Enterobacteriaceae i.e., Escherichia coli (28.4%), Klebsiella pneumoniae (22.1%), and Enterobacter (4.8%) accounted for 55.3% of all GNB. Pseudomonas accounted for 53 (25.5%) and Acinetobacter 19 (9.1%) of GNB. Among Gram-positive isolates, staphylococci were the most frequent (47.8%), followed by Streptococcus pneumoniae 17 (23.9%), beta-hemolytic streptococci 11 (15.5%), and enterococci 9 (12.68%). Of GNB, 45.7% were pan-sensitive, 24% extended spectrum beta–lactamase (ESBL) producers, 27% were resistant to carbapenems, and 3.4% resistant to colistin. Pseudomonas was most sensitive, and Klebsiella was least sensitive of GNB. Of the staphylococcal isolates, 41.67% were methicillin-resistant Staphylococcus aureus (MRSA) and 10% of Coagulase Negative Stapylococci (CONS) were methicillin. Conclusion: A high degree of ESBL producers and carbapenem-resistant Enterobacteriaceae is concerning; with emerging resistance to colistin, raising the fear of a return to the preantibiotic era. An urgent intervention including creating awareness and establishment of robust infection control and antibiotic stewardship program is the most important need of the hour.

Mucocutaneous exposure to body fluids during digestive endoscopy: the need for universal precautions.

Abstract: Background Endoscopy personnel are at high risk of exposure to infectious body fluids during endoscopy. There are no studies documenting the frequency of such exposure. Aim To determine the frequency of exposure to body fluids, and factors that may modify the risk of exposure during digestive endoscopy. Methods During a 10-month period, 948 endoscopy procedures done by two endoscopists were assessed for the occurrence of splashes to uncovered parts of the body. Odds ratio was used to determine any change in the exposure risk with different risk factors. Results The overall frequency of splash to any part of the body was 13.2% (95% CI 10.8-15.9). Common sites of exposure were the eyes, face, forearms and feet. Splash to the skin of the face, forearms and feet occurred in 9.5% (95% CI 7.5-11.8). The risk remained unchanged during therapeutic endoscopy, assisted endoscopy, or endoscopy with biopsy or cytology. Using video endoscopy led to significant reduction in splashes on the skin. Overall splash rate to the eyes was 4.1% (95% CI 2.9-5.6). This remained unchanged during therapeutic endoscopy, assisted endoscopy, and endoscopic biopsy or cytology sampling. The risk was not reduced during video endoscopy. Conclusions Endoscopy results in muco-cutaneous exposure to potentially infectious body fluids in 13% or more procedures. The risk of exposure is not reduced by video endoscopy, or by avoiding instrumentation of the biopsy channel. We recommend that all endoscopists and endoscopy assistants must follow universal precautions.

A study of histopathological features of medullary carcinoma of the thyroid: Cases from a single institute in India

Abstract: BACKGROUND: The microscopic features of medullary carcinoma have been described in world literature, together with its behavior and molecular biology. However, no large study has been reported from India. AIMS: This study aims to analyse the clinical, and especially the pathological features of medullary carcinoma of the thyroid, and the surrounding thyroid. MATERIALS AND METHODS: In this study a total of 234 cases of medullary thyroid carcinoma (MTC) were gathered over a period of 3 decades. The clinical presentation, the microscopic features and the clinical outcome were analyzed. RESULTS: MTC was found to be twice as common in men as in women and for some reason it occurred 10 years earlier in women. The histology revealed certain interesting features like the presence of apoptosis in over half of the tumors, in addition to the other common and not so common histological findings (encapsulated variant, small cell variants, follicular pattern, rosettes, oncocytic change, osteosarcoma-like pattern, and cribriform pattern). The adjacent thyroid in about 19% of the cases showed optically clear nuclei in the follicles that were close to the tumor cells. These features were similar to those seen in papillary thyroid carcinoma. CONCLUSIONS: The thyroid adjacent to MTC showed nuclear changes, which are also found in papillary carcinoma of the thyroid. The occasional concurrent occurrence of these two tumors and the involvement of the RET gene in both medullary and papillary carcinomas, makes this observation worth discussing and studying further.