Journal of Laboratory Physicians
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July-September 2019
Volume 11 | Issue 3
Page Nos. 177-286

Online since Tuesday, September 17, 2019

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EDITORIAL  

Establishing national centre for point-of-care technology for 'Swasth Bharat, Samridh Bharat' p. 177
Vivek Chauhan, Sarman Singh, Sagar Galwankar, Praveen Aggarwal, Sanjeev Bhoi, Salvatore Di Somma, W Frank Peacock, Lorenzo Paladino
DOI:10.4103/JLP.JLP_139_19  PMID:31579259
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ORIGINAL ARTICLES Top

Abnormalities of the intestinal pacemaker cells, enteric neurons, and smooth muscle in intestinal atresia p. 180
OH Radhika Krishna, Mohammed Abdul Aleem, Geetha Kayla
DOI:10.4103/JLP.JLP_94_18  PMID:31579250
BACKGROUND: Small bowel atresia is a congenital disorder that carves a substantial morbidity. Numerous postoperative gastrointestinal motility problems occur. The underlying cause of this motility disorder is still unclear. Interstitial cells of Cajal (ICC) play a major role in gastrointestinal motility. AIMS AND OBJECTIVES: To investigate the morphological changes of enteric nervous system and ICC in small bowel atresia. MATERIAL AND METHODS: Resected small bowel specimen from affected patients (n=15) were divided into three parts (proximal, distal, atretic). Standard histology and immunohistochemistry with anti C-KIT receptor antibody (CD117), calretinin and α-SMA was carried out. The density of myenteric ICCs in the proximal, atretic and distal parts was demonstrated by CD 117 while Calretinin was used for ganglion cells and nerve bundles, α-SMA highlighted muscle hypertrophy. RESULT AND CONCLUSION: The proximal and distal bowel revealed clear changes in the morphology and density of enteric nervous system and interstitial cells of Cajal..
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Significance of platelet indices as severity marker in nonthrombocytopenic preeclampsia cases p. 186
Shilpa Gopal Reddy, Chinaiah Subramanyam Babu Rajendra Prasad
DOI:10.4103/JLP.JLP_161_18  PMID:31579247
CONTEXT: Preeclampsia is often asymptomatic, and hence, its detection depends on signs or investigations. The platelet (PLT) parameters, in cases of preeclampsia with normal PLT count, are seldom analyzed. Hence, this study was undertaken to study the PLT parameters in nonthrombocytopenic preeclampsia cases. AIM: The aim was to evaluate the use of PLT indices as severity markers in nonthrombocytopenic preeclampsia cases. SUBJECTS AND METHODS: This prospective study was done on 120 cases of severe preeclampsia, 115 cases of preeclampsia without severe features, and 203 normal pregnant women admitted in the obstetrics wards during the study period of 1 year. The PLT indices obtained by analyzing anticoagulated blood were recorded. STATISTICAL ANALYSIS USED: Analysis of variance test was used to see the significance of association. Receiver operating characteristic (ROC) curve and binary regression analysis was used to estimate the cutoff value and examine the predictive value of the PLT parameters in the disease progression of preeclampsia. RESULTS: Even in the absence of thrombocytopenia, mean platelet volume (MPV) and PLT distribution width were significantly higher in severe preeclampsia group (P < 0.001) and were also positively correlating with mean arterial pressure (r = 0.38 and 0.20, respectively). ROC curve analysis showed that MPV had the highest area under the curve of 0.78 (95% confidence interval [0.719–0.842]). Cutoff value of >10.95 fl for MPV was found to have significant predictive value for disease progression in preeclampsia. CONCLUSIONS: Even in the absence of thrombocytopenia, PLT indices, especially MPV, have a good diagnostic significance in detecting severe preeclampsia. Further studies are required to evaluate their role as biomarkers in preeclampsia.
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Study of vancomycin and high-level aminoglycoside-resistant Enterococcus species and evaluation of a rapid spot test for enterococci from Central Referral Hospital, Sikkim, India p. 192
Tsering Yangzom, T Shanti Kumar Singh
DOI:10.4103/JLP.JLP_5_19  PMID:31579233
BACKGROUND: Enterococcus is an important pathogen, and with its emergence of resistance to multiple antimicrobials, the management of infection is becoming increasingly difficult. AIM: The aim of the study is to determine the prevalence, antibiotic resistance, and risk factors associated with enterococcal infection or colonization. MATERIALS AND METHODS: In this prospective study, samples from inpatients were screened for resistant enterococci. Antibiotic susceptibility testing was performed using the disc diffusion method and minimum inhibitory concentration by the agar dilution method. A modification of a test tube method of sodium chloride-esculin hydrolysis to a spot test was evaluated for its rapidity and reliability in the presumptive diagnosis of enterococci. STATISTICAL ANALYSIS USED: Fisher's exact test was used for continuous (Student's t-test) and categorical variables. Multivariate analysis was performed with logistic regression using IBM SPSS 20.0 software (Armonk, NY, USA). RESULTS: Enterococcus species were isolated from 182 samples: Enterococcus faecalis (68.7%), Enterococcus faecium (20.9%), Enterococcus gallinarum (6%), and Enterococcus durans (4.4%). Maximum resistance was to ciprofloxacin (59.3%) and least to linezolid (0.5%). The isolation rate of vancomycin-resistant enterococci (VRE) was 13.7%; 30.2% and 20.9% were of high-level gentamicin and streptomycin, respectively. All 182 Enterococcus species gave positive results within 30–60 min by the rapid spot test. CONCLUSIONS: Overall, high-level aminoglycoside resistance (HLAR) was observed more than glycopeptide resistance. Surveillance strategies need to be upgraded and implemented in order to prevent the emergence and further spread of not only VRE but also HLAR enterococci in the hospital. The spot test gave reliable and rapid results in presumptive identification of enterococci.
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Renoprotective effect of irbesartan in a rat model of gentamicin-induced nephrotoxicity: Role of oxidative stress p. 200
Hayder M Al-Kuraishy, Ali I Al-Gareeb, Marwa S Al-Naimi
DOI:10.4103/JLP.JLP_136_18  PMID:31579224
BACKGROUND: The renin–angiotensin system (RAS) is essential in renal physiology; however, disturbance of the RAS is one of the chief pathways involved in renal injury. Dysregulation of RAS may result in both glomerular and tubulointerstitial injuries through direct effects of angiotensin II (Ang II) type 1 receptor. Irbesartan and other Ang II blockers have renoprotective effect through reduction of on renal inflammations. Therefore, the aim of the present study was to demonstrate the renoprotective effect of irbesartan on gentamicin-induced nephrotoxicity in rats concerning the oxidative stress. MATERIALS AND METHODS: Thirty Sprague-Dawley Male rats divided into three groups, Group I (10 rats) treated with distilled water, Group II (10 rats) treated with gentamicin, and Group III (10 rats) treated with gentamicin plus irbesartan for 12 days. Blood urea, serum creatinine, serum malondialdehyde (MDA), superoxide dismutase (SOD), glutathione reductase (GSH), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecules (KIM-1), and cystatin-c were measured in each group. RESULTS: Irbesartan significantly reduced blood urea, serum creatinine, serum MDA, NGAL, KIM-1, and cystatin-c P < 0.05. Irbesartan significantly increases SOD P < 0.05 without significant effect in elevation of GSH serum levels. CONCLUSION: Irbesartan has renoprotective effect in attenuation of acute nephrotoxicity through modulation of oxidative stress and antioxidant capacity in rats.
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Phenotypic and genotypic characterization of multidrug-resistant isolates from patients with catheter-associated urinary tract infection in a tertiary care hospital p. 206
Jaison Jayakaran, Nirupa Soundararajan, Priyadarshini Shanmugam
DOI:10.4103/JLP.JLP_22_19  PMID:31579254
INTRODUCTION: Urinary tract infections (UTIs) remain as the most common infection. Catheter-associated (CA) UTI can lead to bacteremia and thereby is the leading cause of morbidity and mortality in hospitalized patients in our country. AIMS AND OBJECTIVES: This study aims to check the prevalence of CAUTI and study the phenotypic and genotypic characters of the multidrug-resistant organisms in a tertiary care hospital, with special reference to NDM-1 and OXA-23. MATERIALS AND METHODS: A total of 231 urine samples from patients with CA-UTI in different wards in a tertiary care hospital over a period of 3 months between June and August 2018 were collected and processed following the standard protocol. Antibiotic susceptibility tests were performed by disk-diffusion method. Modified Hodge test (MHT) was done to isolate carbapenem-resistant isolates, and polymerase chain reaction was done to detect NDM-1 and OXA-23. RESULTS: Out of 231 samples, 101 samples yielded significant growth. These 38 samples were Gram-negative bacilli which were resistant to carbapenems. Out of the 38 which showed carbapenem resistance, 23 were MHT positive. Out of the 23 MHT-positive isolates, 8 (21.05%) were positive for NDM-1 gene and only 1 (2.6%) was positive for the OXA-23 gene. CONCLUSION: This study has shown that carbapenem-resistant isolates from all the CA urinary tract-infected patients were 52.77% and most of them were Klebsiella. About 21% of them harbored the NDM-1 gene whereas only 2% had the OXA-23 gene. There has been an alarming increase in the spread of carbapenem resistance.
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Resveratrol attenuates malathion-induced liver damage by reducing oxidative stress p. 212
Cyrus Jalili, Mohammad Hosein Farzaei, Shiva Roshankhah, Mohammad Reza Salahshoor
DOI:10.4103/JLP.JLP_43_19  PMID:31579256
BACKGROUND: Malathion is an organophosphate insecticide which disrupts the antioxidant system of the body. Resveratrol is a phytoestrogen and antioxidant of the red grape. AIM AND OBJECTIVE: This study was designed to evaluate the effects of resveratrol against toxic effects of malathion to the liver of rats. MATERIALS AND METHODS: In this study, 48 male rats were randomly assigned to 8 groups: control normal (saline) and malathion control-treated groups (50 mg/kg), resveratrol groups (2, 8, and 20 mg/kg), and malathion + resveratrol-treated groups (2, 8, and 20 mg/kg). Treatments were administered intraperitoneally daily for 14 days. Griess technique was assessed for determined serum nitrite oxide level. Aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase concentrations were determined for liver functional disturbances. In addition, thiobarbituric acid reactive species, antioxidant capacity, the diameter of hepatocytes, and the central hepatic vein (CHV) were investigated. RESULTS: Malathion administration significantly improved liver malondialdehyde (MDA) and nitrite oxide level, the mean diameter of CHV and hepatocyte, and liver enzymes and decreased tissue ferric-reducing ability of plasma (FRAP) level compared to the normal control group (P < 0.01). The resveratrol and resveratrol + malathion treatments at all doses significantly reduced the mean diameter of hepatocyte and CHV, liver enzymes, kidney MDA, and nitrite oxide levels and increased tissue FRAP level compared to the malathion control group (P < 0.01). CONCLUSION: It seems that resveratrol administration improved liver injury induced by malathion in rats.
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Development, optimization, standardization, and validation of a simple in-house agar gradient method to determine minimum inhibitory concentration of vancomycin for Staphylococcus aureus p. 220
Sumit Rai, Mukta Tandon, Narendra Pal Singh, Vikas Manchanda, Iqbal Rajinder Kaur
DOI:10.4103/JLP.JLP_11_19  PMID:31579244
BACKGROUND: The Clinical and Laboratory Standards Institute recommends reporting minimum inhibitory concentration (MIC) values of vancomycin for Staphylococcus aureus. Commercial MIC strips are expensive, and the traditional broth microdilution method is cumbersome. With this background, we attempted to develop and standardize an in-house agar gradient method to determine MIC values of vancomycin for S. aureus. OBJECTIVES: To develop and validate an in-house vancomycin MIC strip, based on simple agar gradient method for S. aureus as per bioassay development guidelines. MATERIALS AND METHODS: Filter paper gradient strips were made in house and impregnated with varying concentrations of vancomycin to create an antibiotic gradient. During standardization, MICs of ninety clinical strains of S. aureus and ATCC 29213 were tested by the broth microdilution and commercial strip followed by the in-house strip. During the validation stage, MICs of ninety different clinical strains of S. aureus and ATCC 29213 were determined by the in-house strip followed by MIC detection by broth microdilution and commercial strips. A reading of more than ± 1log2 dilution compared with broth microdilution was considered as an outlier. RESULTS: During the initial stage, there were 7/90 outliers in the clinical strains, and no outliers were seen with the ATCC 29213 control strain. Corrective action included increasing precaution during the antibiotic impregnation on the strip. During validation stage, only 4/90 outliers were observed in the clinical strains. The commercial strips had 29/90 among clinical and 15/30 outliers in the control strain during the prevalidation phase. Despite maintaining cold chain during the validation phase, the outliers for commercial strip were 18/90 and 4/30 for clinical and control strains, respectively. CONCLUSION: Reporting vancomycin MIC for S. aureus may be attempted using the in-house method after validating it with a gold standard broth microdilution method and quality control as per protocol.
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Reduction in sample rejections at the preanalytical phase – Impact of training in a tertiary care oncology center p. 229
Preeti D Chavan, Vivek G Bhat, Pratik P Poladia, Manikchandra R Tiwari, Chital Naresh
DOI:10.4103/JLP.JLP_4_19  PMID:31579248
CONTEXT: Major clinical decisions are based on the laboratory test results where preanalytical errors are an important cause of repeat collections in patients. Identification of problem areas and continuous training of phlebotomy staff are important tools in reducing these errors. AIMS: In this study, we looked at the most common causes of sample rejection in our setting and the efficacy of the corrective measures and training processes for staff in reducing preanalytical errors. SETTINGS AND DESIGNS: This prospective study was conducted at the laboratory diagnostic services of a tertiary care oncology center, with a hematopoietic stem cell transplant unit during the period of 2012–2017 in two phases. Sample rejections from various wards were analyzed for types of rejections. MATERIALS AND METHODS: In the first phase, we analyzed the problem areas (year 2012). Following a root cause analysis, current practices of training were altered. In the second phase (2013–2017), we studied the effects of these measures. STATISTICAL ANALYSIS USED: The percent variation and P value for significance in sample rejections were calculated. RESULTS: During the year 2012, 0.36% samples were rejected by laboratory. Following interventions in the period from 2013 to 2017, samples rejected dropped to 0.19% (P < 0.0001), 0.09% (P < 0.0001), 0.09% (P = 0.8387), 0.05% (P = 0.0004), and 0.05% (P = 0.329), respectively. The reduction was significant from surgical oncology ward (P = 0.0107) and intensive care unit (P = 0.0007). From 2013 to 2017, errors significantly reduced to 0.015% for hemolyzed samples (P = 0.0001), 0.005% for contaminated samples, 0.036% for clotted samples, and 0.019% for labeling errors. CONCLUSION: Intervention in the form of targeted training helps reduce errors and improves the quality of results generated and contributes to better clinical outcomes.
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Estimating the burden of enteric fever in Chhattisgarh: A single-center study on culture-positive cases from a newly built tertiary care hospital p. 234
Debabrata Dash, Padma Das, Anudita Bhargava, Ujjwala Nitin Gaikwad, Sanjay Singh Negi, Archana Wankhede
DOI:10.4103/JLP.JLP_154_18  PMID:31579242
BACKGROUND: Enteric fever is the most common cause of community acquired blood stream infections in under developed and developing countries. The enteric fever is exclusive to humans and transmitted through the faeco-oral route. Though India is an endemic zone for enteric fever, the data is very scarce from Central India. The present study was undertaken to determine the prevalence of enteric fever in this region and to know the antimicrobial susceptibility pattern of the isolated typhoidal Salmonellae. MATERIAL AND METHOD: We conducted a retrospective analysis of blood culture positive cases of enteric fever over a period of two years (December 2015 to December 2017). All blood cultures submitted for suspected enteric fever and associated symptoms were included in the study. Relevant demographic, clinical and laboratory data were analyzed. RESULT: A total of 51 cases (3.56%) were of typhoidal Salmonella from a total of 1430 blood culture submission. Salmonella Typhi were 70.5% while Salmonella Paratyphi A were 29.5% of the total isolated Salmonellae. The most vulnerable age group was 10-19years (41.2%). The mean minimum inhibitory concentration of ciprofloxacin for Salmonella Typhi and Salmonella Paratyphi A are 1.20 and 1.97 μg/ml respectively. All the isolates were susceptible to ceftriaxone. Highest isolation was in the July – September quarter (35.3%). CONCLUSION: There is a high prevalence of the disease which needs urgent focus on safe water, sanitation services and also to establish guidelines for empiric therapy for enteric fever.
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Molecular epidemiology of hepatitis B virus genotypes in blood donors in Islamabad, Pakistan p. 240
Iram Masood, Usman Waheed, Muhammad Arshad, Muhammad Saeed, Ahmad Farooq, Sadaf Moneeba, Nosheen Basharat, Hasan Abbas Zaheer
DOI:10.4103/JLP.JLP_150_18  PMID:31579261
BACKGROUND: Hepatitis B virus (HBV) is a major causative agent of early, severe and prolonged liver infection that subsequently leads to cirrhosis of liver and hepatocellular carcinoma. The aim of this study was to evaluate the molecular epidemiology of hepatitis B virus (HBV) genotypes and comparison of serological assay performance versus polymerase chain reaction (PCR) in HBV screening. METHODS: Blood samples of 8517 healthy blood donors were collected during the period of January to June 2017 from Blood Bank of Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad. Samples were screened for HBsAg assay using technique of chemiluminescence immunoassay. PCR of positive samples was carried out using already reported genotype-specific primers by Naito et al. (2001). The results were confirmed by visualizing genotype bands. RESULTS: The study confirmed the presence of HBV in 2.5% of blood donors, and PCR confirmed the presence of HBV-DNA in 92 samples. The genotyping was done by PCR using type-specific primer sequences. PCR was dogged to check six genotypes, i.e., A, B, C, D, E, and F. The results of this study show high levels of Genotype D is this region, i.e., 52.17% with less dominating Genotype C, which is 16.30% with decreasing ratio of Genotype E (14.13%), Genotype A and B (9.78%), and mixed D + E (2.17%). The presence of coinfection is found at lowest rate. Due to the high percentage of HBV/D, it is concluded that D genotype is common in our population. CONCLUSION: The most prevalent HBV genotype in ICT region was genotype D, which is responsible for liver cirrhosis and hepatocellular carcinoma. Efficacy of drugs varies with variation in genotypes of hepatitis B virus and also with geographical distribution.
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Single point insulin sensitivity estimator as an index for insulin sensitivity for metabolic syndrome: A study in North Indian population p. 244
Parmila Dudi, Bela Goyal, Vartika Saxena, Kamlesh Rabari, Anissa Atif Mirza, Manisha Naithani, Tarun Kumar, Rajeev Goyal
DOI:10.4103/JLP.JLP_163_18  PMID:31579190
BACKGROUND: Various indices for estimating insulin sensitivity, based on glucose tolerance test and fasting insulin levels, have been devised. However, they are laborious, time-consuming, and costly. Recently, a new index, single point insulin sensitivity estimator (SPISE) based on TG, high-density lipoproteins (HDL), and body mass index (BMI) was proposed in the European population and was found comparable to gold standard test. Decreased insulin sensitivity is a hallmark of metabolic syndrome (MetS). Hence, the current study was planned to determine the optimal cutoff of SPISE with high sensitivity and specificity in MetS patients of the North Indian population. MATERIALS AND METHODS: A community-based cross-sectional study including 229 MetS cases and 248 controls was conducted. MetS was defined according to the South Asian Modified National Cholesterol Education Program criteria. SPISE index was calculated for cases and controls using the formula devised by Paulmichl et al.: SPISE = 600 × HDL-C0.185/(TG0.2 × BMI1.338). Receiver operating characteristic (ROC) curve was plotted for determining optimal cutoff for SPISE in MetS. RESULTS: SPISE was significantly lower in MetS patients (5.35 ± 1.35) than that for controls (7.45 ± 2) with P < 0.05 (confidence interval [CI]: 1.79–2.41). ROC curve showed area under the curve = 0.83 for SPISE (P < 0.05, CI: 0.79–0.86), showing SPISE to have good predictive ability to discriminate MetS cases from controls. The cutoff value of SPISE index for predicting insulin sensitivity in MetS was found out to be 5.82 with sensitivity and specificity of 73% and 80%, respectively. This cutoff is lower than the European population (6.61), indicating higher insulin resistance (IR) in the study population. CONCLUSION: SPISE could be a useful potential low-cost indicator with high sensitivity and specificity for predicting IR in MetS.
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Evaluation of in vitro susceptibility of fosfomycin among Enterobacteriaceae isolates from urine cultures: A study from Puducherry p. 249
Srirangaraj Sreenivasan, Arunava Kali, MV Pravin Charles, Seetha Kunigal
DOI:10.4103/JLP.JLP_27_19  PMID:31579232
INTRODUCTION: The increasing drug resistance among Gram-negative uropathogens and a lack of effective oral antibiotics have limited the therapeutic options available for urinary tract infections (UTIs). This shortage of newer antibiotics has paved the way for considering the use of older antibiotics such as fosfomycin. This study aims to evaluate the in vitro susceptibility of Enterobacteriaceae isolates to fosfomycin. MATERIALS AND METHODS: In this descriptive study conducted over a period of 6 months, we processed 1500 urine samples. The Enterobacteriaceae isolates were subjected to in vitro susceptibility testing to fosfomycin, in addition to the regularly used urinary antibiotics, by Kirby–Bauer disc-diffusion method. RESULTS: Of 1500 urine samples processed, 582 samples yielded the growth of pathogens. Enterobacteriaceae accounted for 392 (67.3%) of the isolates. Among these isolates, lower rates of resistance were observed for imipenem (4.1%) and fosfomycin (13.3%). Relatively higher rates of resistance were observed for nitrofurantoin (35.5%) and amikacin (30.9%). Nalidixic acid, norfloxacin, gentamicin, cefotaxime, and cotrimoxazole showed a high resistance rate of 82.7%, 69.6%, 52.3%, 69.1%, and 71.4%, respectively. All antibiotics, except fosfomycin, were in routine clinical use in our hospital. The low resistance (13.3%) to fosfomycin is indicative of its utility as an excellent urinary antibiotic. CONCLUSIONS: Uropathogenic Enterobacteriaceae isolates displayed excellent in vitro susceptibility to fosfomycin. These in vitro findings suggest the unexplored potential of fosfomycin as a superior therapeutic option for treating uncomplicated UTI.
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Detection and genetic characterization of extended-spectrum beta-lactamases producers in a tertiary care hospital p. 253
Suryarashmi Sahoo, Sarita Otta, Bichitrananda Swain, Subrat Kumar Kar
DOI:10.4103/JLP.JLP_31_19  PMID:31579237
BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing organisms inactivate extended beta-lactam antibiotics and monobactams and also exhibit coresistance to many other classes of antibiotics. The present study was carried out to assess the prevalence of the ESBLs and to determine the most prevalent genotype in our hospital. MATERIALS AND METHODS: All clinically significant Gram-negative isolates were identified, and their antimicrobial susceptibility testing was done by Kirby–Bauers' disc diffusion method. ESBL detection was confirmed by minimal inhibitory concentration method using agar dilution technique for those who screened positive by ceftazidime (30 μg) disc. Further, the established ESBL-positive isolates were subjected to genotyping for bla TEM, bla CTX-M, and bla SHV genes by using conventional polymerase chain reaction. RESULTS: Escherichia coli was the most common (28.84%) Gram-negative bacillus followed by Klebsiella pneumoniae (18.07%), while Pseudomonas spp. (9.61%) was the most commonly identified nonfermenter. ESBL production was detected in 160 (30.8%) isolates. Klebsiella oxytoca (46.7%) followed by E. coli (44%) were the common ESBL producers. Most predominant ESBL gene was bla TEM, found in 122 (76.25%) isolates. Combinations of two genes were seen in 109 (68.1%) isolates, the most common (43.12%) combination being blaTEM and blaCTX-M. In this study, 16 (10%) strains had all the three types of genes. Most of the isolated Gram-negative bacilli (GNB) were sensitive to amikacin, imipenem, and colistin. CONCLUSION: In our study, the 30.8% of GNB were ESBL producers. This is the only study that shows that TEM is the most prevalent ESBL genotypes in our area. Of concern is a good number of isolates showing all three patterns of genes (TEM, SHV, and CTX-M). Amikacin, imipenem, and colistin were the most useful antibiotics in our setup.
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Predictive values of neutrophil-lymphocyte ratio as an early indicator for severe acute pancreatitis in the emergency department patients p. 259
Hyun Sok Park, Sang Guk In, Hai-Jeon Yoon, Woon Jeong Lee, Seon Hee Woo, Daehee Kim
DOI:10.4103/JLP.JLP_82_19  PMID:31579249
CONTEXT: Acute pancreatitis is an acute inflammatory disease presenting with a wide range of severity. AIMS: We investigated the predictive values of the neutrophil-lymphocyte ratio (NLR) as an indicator for severe acute pancreatitis in the emergency department patients. SETTINGS AND DESIGN: This retrospective study was conducted on patients with acute pancreatitis who were diagnosed in the emergency department, from January 2008 to December 2017. SUBJECTS AND METHODS: Patients were classified into either mild-to-moderate severe group or severe group according to the Revised Atlanta Classification for Acute Pancreatitis. Clinical features and laboratory blood test parameters were considered as independent variables. STATISTICAL ANALYSIS USED: Independent variables were analyzed using the Chi-square test and Mann–Whitney U-test to determine statistically significant differences between the two groups. Logistic regression analysis and receiver operating characteristic analysis were performed to evaluate the predictive values of significantly different variables. RESULTS: Of the 672 patients, 52 (7.7%) were classified into the severe group. Tachycardia, fever, prevalence of liver cirrhosis and chronic alcoholism, white blood cell count, NLR, C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine, aspartate transaminase, and total bilirubin were significantly higher in the severe group. Among them, NLR (adjusted odds ratio [aOR]: 1.13; 95% confidence interval [CI]: 1.081–1.181), CRP (aOR: 1.011; 95% CI: 1.004–1.017), BUN (aOR: 1.036; 95% CI: 1.004–1.069), and creatinine (aOR: 1.703; 95% CI: 1.008–2.877) were significant in the logistic regression analysis. NLR showed relatively high sensitivity (82.7%) and specificity (70%) and showed the highest area under the curve (0.821). CONCLUSIONS: The increase in NLR was associated with severe acute pancreatitis. NLR is expected to be useful as a prognostic factor in patients with acute pancreatitis who are visiting the emergency department.
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Association of ABO blood groups with dengue fever and its complications in a tertiary care hospital p. 265
Shivani Ravichandran, SR Ramya, Reba Kanungo
DOI:10.4103/JLP.JLP_95_19  PMID:31579269
CONTEXT: Dengue fever (DF) has been steadily increasing in India with outbreaks in certain areas taking the proportion of epidemics. Along with secondary dengue, several risk factors predispose to dengue hemorrhagic fever and dengue shock syndrome. Very few studies associating the relationship between dengue and its severity with ABO blood group have been documented. AIMS: The aim of this study was to determine the association between distribution of ABO Rh blood groups and DF and DF with thrombocytopenia. SETTINGS AND DESIGN: This was a retrospective descriptive study conducted at the clinical laboratory of the department of microbiology. MATERIALS AND METHODS: Dengue patients whose case record contained information on blood group were screened for details of blood group and confirmed dengue diagnosis. Randomly 384 case records were selected. These were divided into two groups; Group 1 included DF cases (platelet count >20,000) and Group 2 included DF cases with thrombocytopenia (platelet count <20,000). Control group consisted of patients other than dengue, whose blood grouping had been done; randomly 390 were selected and analyzed. STATISTICAL ANALYSIS USED: P value was calculated using the Chi-square test. Odds ratio were calculated using the Fisher's exact test. RESULTS: DF was higher in 23% of individuals with AB blood group as compared to 8.5% of controls (P = 0.0004), whereas patients with blood group O were significantly less affected with DF (P = 0.0048). Disease severity was not associated with any of the blood groups. CONCLUSIONS: Individuals with AB blood group are more prone to DF, whereas individuals with blood group O are less prone.
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Expression of p57 immunomarker in the classification and differential diagnosis of partial and complete hydatidiform moles p. 270
Santosh Kumar Mondal, Saikat Mandal, Saptarshi Bhattacharya, Utpal Kumar Panda, Arpan Ray, Sk Moyaraf Ali
DOI:10.4103/JLP.JLP_130_19  PMID:31579240
BACKGROUND: Hydatidiform mole (HM) is characterized histologically by cystic swelling of the chorionic villi, accompanied by variable trophoblastic proliferation. The most important reason for the correct recognition of moles is that they are associated with an increased risk of persistent trophoblastic disease (invasive mole) or choriocarcinoma. AIMS AND OBJECTIVES: The aim of the study was to determine whether there is any role of p57 in differentiating partial and complete moles by immunohistochemical staining. MATERIALS AND METHODS: A prospective observational study was undertaken in which 40 cases of molar pregnancy included over a period of 2 years. Detailed clinical and family histories were obtained from each patient. Histopathological examination followed by immunohistochemical study with p57 done in each case. Ultrasonography findings and serial titers of serum beta-human chorionic gonadotropin were noted whenever necessary. RESULTS: Among the forty cases included, 25 (62%) had complete molar (CM) pregnancy, whereas the rest 15 (38%) had partial mole (PM). Both CM and PM were more pronounced in the age group of 20–25 years (44% and 60%, respectively), and among nulliparous women (68% and 70% respectively), 17 (42.5%) mothers had a prior history of abortion. In the histologically unequivocal cases of complete mole, 96% (24 of 25) did not express p57 and a single case was focal positive. In contrast, it was strongly and continuously expressed in both villous cytotrophoblast and stromal cells in all cases of PM (15 of 15). CONCLUSION: p57 immunomarker is very helpful to diagnose and differentiate complete and partial HM.
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Multiplex PCR assay for simultaneous detection and differentiation of Entamoeba histolytica, Giardia lamblia, and Salmonella spp. in the municipality-supplied drinking water p. 275
Prem Shankar, Jyotsna Mishra, Vijaya Bharti, Deepak Parashar, Sarman Singh
DOI:10.4103/JLP.JLP_66_18  PMID:31579243
BACKGROUND: The contamination with Entamoeba histolytica, Giardia lamblia, and Salmonella spp. in drinking water is the most prevalent in Indian subcontinent, but often difficult to detect all these pathogens from the drinking water. MATERIALS AND METHODS: A multiplex polymerase chain reaction (mPCR) method was developed to detect contamination of municipality-supplied drinking water with E. histolytica, G. lamblia, and Salmonella spp. The primers were designed to target small subunit of 16S rRNA type gene of E. histolytica and G. lamblia, and invasive A gene of Salmonella typhimurium. The optimized mPCR assay was applied on 158 municipality-supplied drinking water samples collected from Delhi. RESULTS: Out of total 158 water samples, 89 (56.32%) were found positive for the targeted pathogens by mPCR while conventional methods could be detected only in 11 (6.96%) samples. The mPCR assay showed 100% sensitivity and specificity for these pathogens in comparison with culture and microscopic detection. Of the 89 mPCR-positive samples, G. lamblia, E. histolytica, and Salmonella spp. were present in 35 (22.15%), 26 (16.45%), and 28 (17.72%), respectively. Nine (5.69%) samples were positive for both E. histolytica and G. lamblia, 10 (6.32%) were positive for G. lamblia and Salmonella spp., and 8 (5.06%) had Salmonella spp. and E. histolytica. Nonetheless, 3 (1.89%) samples were positive for all three pathogens. CONCLUSIONS: The present assay is an alternative to conventional methods to serve as highly sensitive, specific, and economical means for water quality surveillance to detect the outbreak caused by E. histolytica, G. lamblia, and Salmonella spp. pathogens.
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CASE REPORTS Top

Plasma cell neoplasm with varied morphology: A report of two cases p. 281
Gautam Kumar Vasnik, S Venkatesan, Sanjeevan Sharma, Ajay Malik
DOI:10.4103/JLP.JLP_172_18  PMID:31579230
Plasma cell (PC) neoplasm (PCN) with varied morphology has been described in the literature. The majority of clonal proliferation of PCs is composed of easily recognizable morphology in the bone marrow (BM). However, few cases may cause diagnostic complexity, as they exhibit varied cytological and architectural heterogeneity which may pose problem in morphological diagnosis and require the use of ancillary techniques like immunohistochemistry (IHC). We illustrate here two such cases of PCN with varied morphology in BM aspirate, in the form of clustering/rosetting and multiple clear cytoplasmic vacuoles, respectively, leading to varied differential diagnosis. However, later, the histopathological features on BM biopsy findings were relatively characteristic and IHC confirmed the final diagnosis. The morphological variants documented in both these cases are exceptional and representative of the various forms of atypical PCs.
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Pleural effusion due to Chryseobacterium indologenes: Case report and review of literature p. 284
Nazneen Arif, Swati Khullar, Ratnesh Kumar, Shiv Kumar Choudhary, Arti Kapil, Benu Dhawan
DOI:10.4103/JLP.JLP_57_19  PMID:31579226
Chryseobacterium indologenes is found ubiquitously in the environment; it rarely causes human disease. Hence, we report a case of C. indologenes-associated pleural effusion in a patient with aortic dissection. Postoperatively, the patient developed massive right-sided pleural effusion with underlying consolidated lung. Culture of the pleural fluid yielded pure growth of C. indologenes which was susceptible to cotrimoxazole, minocycline, and tigecycline. Therapy was modified; tigecycline and cotrimoxazole were started following which the patient showed improvement, and subsequent cultures of the pleural fluid were sterile. This report promotes awareness of this organism as an emerging pathogen in lung infections and emphasizes the importance of targeted therapy.
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