Background:Chemoport is an essential part of the management of children with cancer and provides long-term venous access. There are few studies from resource poor countries reporting complications of chemoport.Aims:This study was aimed at describing the complications of chemoport in patients with cancer.Materials and Methods:This retrospective observational study analyzed 200 patients <15 years of age who underwent chemoport insertion. The medical records of these patients were reviewed for the patient characteristics, diagnosis, nature of port use, port-related complications and their management.Results:A total of 209 ports were implanted in 200 patients and 24 ports were removed due to port-related complications. There were 122 boys and 78 girls whose ages ranged from 4 months to 13 years (median age 2.5 years). About72% of patients were <2 years old. The cumulative duration of catheterization was 54,100 days. Of 209 ports, there were 36 complications that led to the removal of 21 ports. Port-related infection was the most common infection observed in our study (0.66/1000 catheter days and 11.9%). Mechanical complications were seen in 9 patients. Venous thrombosis and skin necrosis occurred in one patient each.Conclusions:Use of chemoport is safe and is a boon for children with cancer in developing countries with incidence of complications similar to Western countries. Although use of chemoport is associated with complications, they are easily managed. With stringent catheter care by trained personnel, some complications can be prevented.

We examined 974 samples (304 coriander, 212 mint, 258 carrot, and 200 radish) collected from vegetable vendors in two cities, Bareilly (n = 832) and Kanpur (n = 142), in northern India during the early summer season in 2004. Salmonella was isolated from 35 samples (9 coriander, 5 mint, 10 radish, and 11 carrot) while Escherichia coli was detected in 181 samples (67 coriander, 44 mint, 36 carrot, and 34 radish). None of the E. coli belonged to the O:157 serogroup. Five Salmonella isolates from samples collected at Kanpur (3 coriander and 2 mint) belonged to 4 different serovars of S. enterica ssp. enterica-S. Mons, S. Rottenest, S. Saintpaul, and S. Weltevreden. Thirty Salmonella isolates from samples collected at Bareilly (11 carrot, 10 radish, 6 coriander, and 3 mint) belonged to 7 serovars-S. Anatum, S. Bsilla, S. Newport, S. Saintpaul, S. Teko, S. Virchow, and S. Weltevreden. The majority (82.9%) of Salmonella isolates were multidrug resistant. One quarter of the isolates were resistant to >or=10 antibiotics. Based on antibiotic resistance patterns, 35 isolates could be classified into 23 resistotypes. None of the 35 isolates was resistant to streptomycin and ceftriaxone, while >80% were resistant to sulfamethoxazole, nalidixic acid, and kanamycin. Resistance to imipenem (>20%) and amikacin (>30%) was also common. The correlation between presence of Salmonella and E. coli on raw vegetables was not significant (p = 0.13).

Children with malignancy require venous access that is reliable, safe and compliant on a long-term basis. There is little data available on utilization of totally implantable venous access devices (TIVAD) for long term chemotherapy in children in an Indian setting [1]. We report our long-term follow-up results of utilization of totally implantable venous access devices for long-term chemotherapy in children. This was a retrospective analysis of 122 children requiring longterm chemotherapy done between January 2008 and December 2013. Data collected included primary disease process, type of port, site of insertion, intraoperative events, early and late postoperative complications, and issues with utilization, maintenance and removal. 127 ports were placed in 122 children. The follow up ranged from 16 to 50 months. Internal jugular vein was accessed in 96.8 % of cases (123/127). Majority of children (61 %) had hematological malignancy. Early complications occurred in 5 children. Late complications occurred in 18 children which included port pocket infection in 3, port site skin issues in 5, catheter related issues in 3, venous thrombosis in 2 and catheter related bacteremia in 5 children respectively. Only 10 children have been lost to follow-up either due to death or discontinuation of treatment and rest are on follow up. Totally implantable venous access devices usage is safe and reliable for access needs in children for longterm chemotherapy. Their low complication and low cost maintenance should increase their utilization in children requiring long-term chemotherapy. Chemoport placement in children with hematological malignancy can be carried out safely without much impact on complication rates. Though management and compliance of children with malignancy has improved; critical analysis and standardization of port system care through prospective trials are necessary to reduce the morbidity and for cost analysis in these children.

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The purpose of this study was to determine the prevalence of Salmonella in the water used by Paan vendors in 11 North Indian cities. The analysis of 776 water samples and 120 samples each of preprocessed Paan (from vendor stock) and ready-to-eat Paan collected from Bareilly revealed that four of the ready-to-eat Paan and 34 of the water samples contained multidrug-resistant Salmonella strains. The isolates belonged to five different serovars, i.e., Salmonella Newport (1), Salmonella Paratyphi B (1), Salmonella Teko (1), Salmonella Virchow (3), and Salmonella Saintpaul (32), and could also be classified into 18 different resistotypes. All of the isolates were sensitive to cotrimoxazole, and 97.27% of the isolates were sensitive to chloramphenicol, imipenem, ciprofloxacin, ceftriaxone, and neomycin. Multidrug resistance (against 5 to 18 antibiotics) was common, particularly for nalidixic acid (65.79%), cephalothin (68.42%), cefoperazone (57.89%), sulfamethizole (52.63%), furazolidone (65.79%), kanamycin (68.42%), doxycycline (50.00%), and cefotaxime (44.74%). Bacteriological analysis of 16 Salmonella-positive and 23 Salmonella-negative samples revealed that the presence of Salmonella in water samples had a negative correlation (r = -0.35) with coliform counts and a positive correlation (r = 0.55) with nonlactose fermenter counts. We determined that centrifugation was a rapid and cheap method for concentrating large samples of Salmonella. The presence of multidrug-resistant strains of zoonotic Salmonella on ready-to-eat Paan is a public health concern and may be one of the factors responsible for the hyperendemic status of salmonellosis in India.