Journal of Laboratory Physicians
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   Table of Contents - Current issue
July-September 2018
Volume 10 | Issue 3
Page Nos. 255-361

Online since Friday, July 6, 2018

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Spectrum of candidal species isolated from neonates admitted in an Intensive Care Unit of teaching hospital of Kashmir, North India p. 255
Asifa Nazir, Talat Masoodi
BACKGROUND: Candidal infections are an important cause of morbidity and mortality in Neonatal Intensive Care Unit. Neonatal candidiasis is increasing in frequency, mainly because of increase in the survival of babies with low-birth weight, preterm births, advancement in medical field, life support systems, relative immunodeficiency, and extensive use of broad-spectrum antibiotics. Over the past few decades, there has been a progressive shift from the predominance of Candida albicans to nonalbicans Candida species. AIMS AND OBJECTIVES: The objective of the current study was to know the prevalence of non albicans candidemia in neonates and their antifungal susceptibility pattern. MATERIALS AND METHODS: In this study, a total of 424 samples from clinically diagnosed septicemic neonates were included. Identification of Candida isolates from these samples as well as their antifungal sensitivity testing was performed with Vitek 2 Compact (Biomerieux France) using Vitek 2 cards for identification of yeast and yeast-like organisms (ID-YST cards). RESULTS: A total of 246/424 (58.01%) cases were blood culture positive. Out of these, 80/246 samples tested positive for candidemia (32.5%). Candida tropicalis (13.8%) was the predominant species isolated among the non-albicans Candida followed by Candida krusei (4.8%), Candida parapsilosis (3.2%), Candida guilliermondii (2.8%), and Candida dubliniensis (2.0%). We found an increase in the antifungal drug resistance, especially for the azole group of drugs, both in C. albicans and non-albicans Candida species. All the isolates were uniformly sensitive to micafungin, voriconazole, and caspofungin. CONCLUSION: Candidemia in neonates is an ominous prognostic sign and is an important entity in our region. The present study highlights the mycological shift of Candida species in neonatal candidemia with a preponderance of nonalbicans Candida species.
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Direct testing by VITEK® 2: A dependable method to reduce turnaround time in Gram-negative bloodstream infections p. 260
Purabi Barman, Shimpi Chopra, Tarun Thukral
CONTEXT: Bloodstream infections pose a major health-care burden worldwide. Routine microbiological methods are time-consuming, thereby delaying appropriate treatment. AIMS: The aim of this study is to evaluate the method of direct testing of identification (ID) and antimicrobial susceptibility testing (AST) of positive blood culture bottles by VITEK®2. SETTINGS AND DESIGN: This was a prospective study at a tertiary level hospital. SUBJECTS AND METHODS: One hundred positive BACTEC blood culture bottles with monomicrobial Gram-negative organisms on microscopy were tested in parallel by direct ID/AST as well as conventional method. Results obtained by two methods were compared in terms of ID/AST and turnaround time (TAT). RESULTS: Of the 100 isolates tested, only one was misidentified by the direct method and there was no unidentified isolate. The AST results demonstrated 99.74% categorical and 99.65% essential agreement. Of 1144 organism-antibiotic combinations, there were 0.44% major error, no very major error, or minor error observed. CONCLUSIONS: While conventional method is the gold standard, the direct ID/AST methods have demonstrated that it can be successfully utilized to decrease TAT to the final results by 18–24 h, without sacrificing test accuracy. This technique will help to tailor antimicrobial therapy, thereby reducing patient morbidity, mortality, and antibiotic resistance, as well.
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Evaluation of antibacterial properties of hydroxyapatite/bioactive glass and fluorapatite/bioactive glass nanocomposite foams as a cellular scaffold of bone tissue p. 265
Seyedali Seyedmajidi, Ramazan Rajabnia, Maryam Seyedmajidi
AIMS AND OBJECTIVES: Infection is a serious problem for patients after implantation surgery, which is difficult to treat with antibiotic therapy. The present study was developed to evaluate and compare the antibacterial properties of hydroxyapatite/bioactive glass (HA/BG) and fluorapatite/bioactive glass (FA/BG) nanocomposite foams as a cellular scaffold for use in bone defects by two macrodilution and disk diffusion methods. MATERIALS AND METHODS: Staphylococcus aureus, Enterococcus faecalis, and Streptococcus mutans were cultured in brain heart infusion broth medium with nanocomposite powder for 5 days, and their bioactivity levels were evaluated by daily culturing on solid agar medium plates. To carry out the disk diffusion test, a disc form of nanocomposite foams was used on agar medium with 48 h incubation. RESULTS: None of two nanocomposites even at their highest concentration (200 mg/mL) did not prevent the growth of two Staphylococcus aureus and Enterococcus faecalis microorganisms. However, HA/BG nanocomposite on the 3rd day at a concentration of 200 mg/mL and on 4th and 5th day at a concentration of 100 mg/mL and FA/BG nanocomposite on the 4th day at a concentration of 100 mg/mL and on the 5th day at a concentration of 50 mg/mL could be able to kill Streptococcus mutans microorganism. In the disc diffusion test, none of the nanocomposites could create a nongrowth zone. Both tested biomaterials showed increased antibacterial properties over time and concentration increase. CONCLUSION: HA/BG and FA/BG nanocomposites, due to their biocompatibility and antimicrobial properties, are good choices for implantation instead of damaged bone tissue in tissue engineering.
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Rosuvastatin as forthcoming antibiotic or as adjuvant additive agent: In vitro novel antibacterial study Highly accessed article p. 271
Hayder M Al-Kuraishy, Ali I Al-Gareeb, Ali K Al-Buhadily
INTRODUCTION: Rosuvastatin is a lipid-lowering agent that inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase leading to a reduction of cholesterol biosynthesis. Many studies have shown an association between statins use and the reduction of sepsis. The aim of the present study was to evaluate the in vitro combined antibacterial activity of rosuvastatin and cefixime. MATERIALS AND METHODS: Five pathogenic bacteria isolates (Gram positive and Gram negative) were used for testing the antibacterial activity of rosuvastatin alone and in combination with cefixime. RESULTS: Rosuvastatin mainly inhibited Klebsiella pneumoniae and Escherichia coli where it caused zones of inhibition of (17.9 ± 0.6 mm) and (16.9 ± 0.3 mm), respectively; however, it moderately inhibited the growth of Staphylococcus epidermidis (12.9 ± 0.2 mm) and Staphylococcus aureus (12.76 ± 0.2) and produced less inhibition for Pseudomonas aeruginosa growth where it led to a zone of inhibition equal to (9.1 ± 0.5 mm). Minimal inhibitory concentration ( μ g/mL) of rosuvastatin was high compared to cefixime. Fractional inhibitory concentration (FIC) of rosuvastatin was low for E. coli and K. pneumoniae compared to the other types of bacterial strains. Rosuvastatin exhibited additive effects with cefixime against E. coli and K. pneumoniae. Σ FIC index was 0.536 and 0.734 for E. coli and K. pneumoniae, respectively. CONCLUSION: Rosuvastatin has a significant antibacterial activity against both Gram-negative and Gram-positive bacteria with a potential additive effect when used in combination with cefixime.
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Concept and connotation of oxidative stress in preeclampsia p. 276
Hayder M Al-Kuraishy, Ali I Al-Gareeb, Thabat J Al-Maiahy
BACKGROUND: Preeclampsia (PE) is a systemic pregnancy-related disorder characterized by hypertension, proteinuria, and edema. Free radicals seem to play an important role in the induction of endothelial dysfunction in PE. AIM: The aim of the present study was to investigate serum levels of nitric oxide (NO), peroxynitrite (ONOO), paraoxonase (PON-1), malondialdehyde (MDA), and lipid profile in preeclamptic patients compared to the women with normal pregnancy. MATERIALS AND METHODS: A total of 68 pregnant women were recruited. They were divided into two groups - Group A, 40 women were a newly diagnosed with PE and Group B, 28 women with normal pregnancy. Anthropometric measurements including body mass index and blood pressure in accordance with biochemical measurements including NO, ONOO, PON-1, MDA, and lipid profile were done for preeclamptic pregnant women compared to the controls. RESULTS: Pregnant women with pre-eclampsia illustrated insignificant differences in the age (31.22±2.87) compared to the age of control P > 0.05. There were significant changes in the body mass index (BMI) , type of delivery and smoking status of pregnant women with pre-eclampsia compared to the control P < 0.05. Both systolic and diastolic blood pressures were high in pregnant women with pre-eclampsia compared to the control P < 0.01. PON-1 and NO serum levels were significantly decreased (P < 0.01) while ONOO and MDA serum levels were significantly increased in PE compared to the women with normal pregnancy. CONCLUSIONS: This study concluded that PE is associated with the augmentation of oxidative stress and reduction of endogenous antioxidant capacity regarding PON-1.
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Occurrence and characterization of hyperviscous K1 and K2 serotype in Klebsiella pneumoniae p. 283
Poothakuzhiyil Remya, Mariappan Shanthi, Uma Sekar
BACKGROUND: Klebsiella pneumoniae causes both nosocomial and community-associated infections. Hypervirulent K. pneumoniae (hvKP), new variant of K. pneumoniae, can cause invasive infections in young healthy individuals as well as in the immunocompromised population. Hypervirulent strains frequently belong to capsular serotypes K1 or K2. Emergence of antimicrobial resistance in hvKP is a cause for concern. AIM AND OBJECTIVE: The present study was done to detect the K1 and K2 serotypes among clinical isolates of K. pneumoniae, spectrum of infections caused by them and presence of common beta-lactamases encoding genes in them. MATERIALS AND METHODS: A total of 370 isolates of K. pneumoniae, isolated from various clinical samples over a period of 1 year was included in this study. Antibiotic susceptibility testing to various classes of antimicrobials was done as per Clinical and Laboratory Standard Institute guidelines. The presence of K2A (specific to serotype K2), magA (specific to serotype K1), and rmpA genes was detected by multiplex polymerase chain reaction (PCR). Extended-spectrum beta-lactamases (TEM, SHV, and CTX-M), plasmid-mediated AmpCs (MOX, CIT, DHA, ACC, EBC, and FOX), and carbapenemase genes (IMP, VIM, NDM, KPC, and OXA-48) were also determined by PCR. RESULTS: Among the 370 isolates, 8 harbored K2A gene and one harbored magA. rmpA gene was detected in three isolates along with K1 or K2 serotypes. Seven K2A- positive isolates were resistant to one or more classes of antimicrobials. The studied ESBL genes were present in four isolates. Two isolates harbored carbapenemase genes (NDM-1, OXA-48) along with ESBLs. CONCLUSION: K2 serotype is more prevalent among hvKP isolates. They can harbor ESBLs and Carbapenemase genes. K1 serotype is rather uncommon in K. pneumoniae. Acquisition of multidrug-resistant genes by these strains adds to their virulence and limits the treatment options.
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Clinical and laboratory standards institute versus European committee for antimicrobial susceptibility testing guidelines for interpretation of carbapenem antimicrobial susceptibility results for Escherichia coli in urinary tract infection (UTI) p. 289
Chinmoy Sahu, Vidhi Jain, Prabhakar Mishra, Kashi Nath Prasad
BACKGROUND: Carbapenems show excellent activity against resistant uropathogens, and they are the antibiotics of choice for urinary tract infections (UTIs). The choice of carbapenem prescription is strongly influenced by antimicrobial susceptibility testing (AST) report. With the publication of recent AST guidelines by the European Committee on AST (EUCAST), we were curious to evaluate the difference in results between Clinical and Laboratory Standards Institute (CLSI) and the EUCAST guidelines for the interpretation of carbapenems. METHODS: During a period of 1 year, midstream urine specimens received in the laboratory were cultured by conventional techniques and 2932 of them grew significant colony counts of Escherichia coli. Out of them, 501 E. coli isolates which were resistant to at least six first-line antibiotics were further subjected to second-line antimicrobials imipenem and meropenem, reported by E-tests (bioMerieux, France). The E-test results were interpreted by both CLSI 2016 and EUCAST 6.0 (2016) guidelines. Weighted kappa was used to determine absolute agreement, and McNemar's Chi-square test was used to test the difference in proportions of susceptibility between two methods, respectively. RESULTS: Taking CLSI guidelines as a gold standard, there was 100% sensitivity in a susceptible category by the EUCAST guidelines for both the carbapenems. Weighted kappa showed good and moderate agreement between them for imipenem and meropenem, respectively. However, McNemar Chi-square test in the nonsusceptible category between the two tests was 9.38% and 33.03% for imipenem and meropenem, respectively, and they were highly significant (P < 0.001). CONCLUSIONS: A laboratory can follow EUCAST guidelines as well and the guidelines are more useful in urinary concentrated antibiotics such as carbapenems. Further other antibiotics need to be evaluated by both these guidelines.
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Importance of combined approach of investigations for detection of asymptomatic Hashimoto Thyroiditis in early stage p. 294
Sonali Rajesh Saraf, Nitin M Gadgil, Sheetal Yadav, Alka D Kalgutkar
INTRODUCTION: Hashimoto's thyroiditis (HT) is the most common cause of goitrous hypothyroidism in iodine sufficient areas. The diagnosis of HT is important because it progresses to hypothyroidism, and also, it is associated with thyroid lymphoma and papillary thyroid carcinoma. Apart from thyroid antibodies, assessment of thyroid function test (TFT) levels, ultrasonography (USG), and cytological analysis can help in early diagnosis and management of HT. AIMS AND OBJECTIVES OF THIS STUDY: To know the age incidence and clinical presentation of HT, its association with thyroid hormone levels and with thyroid antibodies and its correlation with the cytologic grade of HT. MATERIALS AND METHODS: Consecutive convenient method of sampling was adopted at the cytology clinic. Fine-needle aspiration cytology of patients presenting with thyroid enlargement was done using standard technique and aseptic precautions. RESULTS: Out of 875 cases of thyroid cytology, 134 cases were diagnosed as HT over a 4-year period. A strong female preponderance was observed. A significant proportion of them (103/134) presented in the first four decades of life. Majority of cases (60.63%) were hypothyroid, while 15.74% were hyperthyroid and 23.62% were euthyroid. Apart from thyroid enlargement, although a majority of patients presented with symptoms related to the thyroid, a significant number of patients (38.80%) were asymptomatic. CONCLUSIONS: A combined approach of cytological grading of HT along with USG, TFT levels, and thyroid antibodies can detect hypothyroid and subclinical hypothyroid or euthyroid state of HT and provide an appropriate guide to therapy.
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Direct identification and susceptibility testing of Gram-negative bacilli from turbid urine samples using VITEK2 p. 299
Neelima Angaali, Laxmi Vemu, Chavali Padmasri, Neeraja Mamidi, Vijay Dharma Teja
INTRODUCTION: Urinary tract infections (UTIs) are the most common infectious diseases occurring in either the community or healthcare setting. Turnaround time for urine culture is about 24 h, and antimicrobial susceptibility testing (AST) requires another 24 h. Consequently, initial antibiotic therapy is mostly empirical. MATERIALS AND METHODS: This study was conducted at Nizam's Institute of Medical Sciences, Hyderabad. Turbid urine samples which showed pus cells and Gram-negative (GN) bacilli of single morphotype were included. The turbidity of the urine was adjusted to 0.5 McFarland and uploaded directly in the VITEK 2 identification (ID) GN and N-280 panel for AST. The specimen was also inoculated on CHROMagar, and the ID and AST of the isolates from the agar plate were repeated on VITEK 2, and the results were compared. RESULTS: Out of 844 turbid urines screened, 62 met the inclusion criteria. Escherichia coli was the most common isolate (71.9%). Complete agreement for ID was 80.7%, misidentified were 12.2%, and unidentified were 7%. Complete agreement with AST was 94.3%, very major errors 0.5%, major errors 2.2%, and minor errors 3%. CONCLUSION: With a 94.3% agreement for AST and a reduced turnaround time by 24 h, the direct inoculation had a potential clinical benefit for initiating timely and appropriate antibiotic therapy for UTI.
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Evaluation of impact of occult hepatitis B infection in chronic HCV-infected patients: A retrospective cohort study p. 304
Mohit Bhatia, Ekta Gupta, Manish C Choudhary, Ankur Jindal, Shiv Kumar Sarin
CONTEXT: Occult hepatitis B infection (OBI) may contribute to liver damage and variable therapeutic response in patients with chronic hepatitis C (CHC) infection. AIMS: To study the prevalence of OBI and to evaluate its impact and/or that of anti-HBc total seropositivity on clinical outcomes and response to directly acting antiviral (DAA) therapy in CHC-infected patients. SETTINGS AND DESIGN: A retrospective cohort study was conducted in a tertiary care liver hospital from January to May 2017. SUBJECTS AND METHODS: Eighty HBsAg-negative CHC patients who were initiated on DAA therapy were retrospectively included. Archived pretreatment baseline plasma samples were retrieved and tested for quantitative HBV DNA, anti-HBs, and anti-HBc total antibodies. HCV RNA, genotype, clinical, biochemical and histopathological parameters & treatment response data were obtained from the hospital information system. STATISTICAL ANALYSIS USED: Comparison of continuous variables was done by Mann–Whitney and Kruskal–Wallis tests and categorical variables by Fisher's exact test or Pearson's Chi-square test. RESULTS: Prevalence of OBI was 1.25%. Anti-HBc total positivity was seen in 25% patients. Based on anti-HBc total status, patients were categorized into two groups namely Group 1 (anti-HBc positive) and Group 2 (anti-HBc negative). Group 1 patients were further categorized into three subgroups based on signal/cutoff (S/Co) of HBc total antibody semi-quantitative values. HBc total antibody levels did not influence the severity of CHC disease. Comparative evaluation of parameters such as median log10baseline RNA (P = 0.929 and 0.464), median alanine aminotransferase (ALT 0) (P = 0.519 and 0.449), ALT at 12 weeks (P = 0.875 and 0.594), sustained virological response (SVR) at 12 weeks (P = 0.405 and 0.263) and SVR at 24 weeks (P = 0.265 and 0.625) between Groups 1 and 2 and among three categories within Group 1, respectively, were not found to be statistically significant. CONCLUSIONS: Very low prevalence of OBI was seen in CHC patients. HBc total antibody levels did not influence clinical outcome and response to DAA therapy in this cohort.
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Association of intercellular adhesion gene A with biofilm formation in staphylococci isolates from patients with conjunctivitis p. 309
Taghreed H T. Elkhashab, Lamiaa A Adel, Mona Saad Nour, Magda Mahran, Mai Elkaffas
BACKGROUND: There is a great negative impact of biofilm-mediated infection on patient health which necessitates the use of reliable methods for detecting biofilm producers. AIMS: This study was done to determine biofilm-producing ability and the presence of intercellular adhesion gene A in clinical staphylococcal isolates and to assess the reliability of two phenotypic methods used for biofilm detection. MATERIALS AND METHODS: Fifty staphylococcal strains were isolated from 100 conjunctival swabs from patients attended the Ophthalmology Outpatient Department of the Research Institute of Ophthalmology. Two phenotypic methods were used for detection of biofilm production; qualitative congo red agar (CRA); and quantitative microtiter plate. Polymerase chain reaction was used to determine the presence of icaA gene. RESULTS: In Staph aureus, 60% were positive biofilm forming and 40% were negative biofilm forming by both phenotypic methods. All positive biofilm-forming isolates were positive for icaA gene production. In coagulase negative staph, 50% were positive biofilm forming and 50% were negative biofilm forming by both phenotypic methods. All positive biofilm-forming strains were positive for icaA gene. All negative cases by CRA and microtiter plate methods were negative for icaA gene except two isolates. All staphylococcal isolates were subjected to antibiotic susceptibility test to correlate biofilm formation with multidrug resistance in staph. CONCLUSION: There is high significant correlation between icaA gene presence and biofilm forming ability; however, the biofilm-forming ability of some isolates in the absence of icaA gene highlights the importance of further genetic investigations of ica-independent biofilm formation mechanisms.
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Systemic inflammatory response markers in preeclampsia p. 316
Ersin Cintesun, Feyza Nur Incesu Cintesun, Huriye Ezveci, Fikret Akyurek, Cetin Celik
PURPOSE: Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), and plateletcrit (PCT) are known as systemic inflammatory response markers. In this study, we aimed to evaluate changes in NLR, PLR, PDW, RDW, MPV, and PCT in preeclampsia (PE) and their use in predicting its severity. MATERIALS AND METHODS: This is a retrospective case–control study. The study comprised 64 control group (healthy pregnant females), 51 females with mild PE, and 13 with severe PE. These three groups were compared with demographic data and inflammation markers. RESULTS: There were no statistically significant differences between healthy pregnant females and preeclaptic females in terms of median age, hemoglobin, lymphocyte, neutrophil, platelet, NLR, PLR, PDV, RDW, MPV, PCT (P > 0.05). The control group has a higher number of gravity and parity than the PE group (P < 0.001). MPV value is a lower PE group than the control group (P < 0.001). Both gravity and parity were significantly higher in the patients with mild PE than in the control group (P < 0.001). MPV value was statistically higher in the control group compared both mild and severe PE (P < 0.001), however, no statistical difference between mild and severe PE (P = 0.305). CONCLUSIONS: MPV may be clinically useful markers in the prediction of PE. Further, prospective multicenter studies are needed to reveal the association between these markers and PE.
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Determination of antibacterial activity and metabolite profile of Ruta graveolens against Streptococcus mutans and Streptococcus sobrinus p. 320
Hamzah Abdulrahman Salman, Sankarasetty Venkatesh, Ramasamy Senthilkumar, BS Gnanesh Kumar, Aamer Mousa Ali
BACKGROUND: Ruta graveolens is one of the most used phytomedicines. To date, there is no report of determining the bioactivity of R. graveolens against cariogenic causing bacteria (Streptococcus mutans and Streptococcus sobrinus). OBJECTIVE: The objective of the present study was to determine the antibacterial activity and metabolite profile of R. graveolens against S. mutans and S. sobrinus. MATERIALS AND METHODS: R. graveolens plant material was collected and processed in the month of February. The plant material was extracted by Soxhlet apparatus using methanol solvent. Two strains of S. mutans and two strains of S. sobrinus were isolated from dental caries-active participants and cultured on mitis salivarius-bacitracin agar. The antibacterial susceptibility testing of methanolic extract of R. graveolens was performed by disc diffusion method. The metabolite profile of the plant extract was determined using electrospray ionization-tandem mass spectrometry. RESULTS: The methanolic extract of R. graveolens showed a promising antibacterial activity against S. mutans and S. sobrinus. Two compounds named γ-fagarine and kokusaginine were identified from the methanolic extract of R. graveolens. CONCLUSION: The study concluded that R. graveolens contains significant antibacterial activity. However, further investigations are suggested to understand the anticaries properties of these pure compounds.
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Seroprevalence of HSV-1 and 2 in HIV-infected males with and without GUD: Study from a tertiary care setting of India p. 326
Arshi Munawwar, Somesh Gupta, Surendra Kumar Sharma, Sarman Singh
BACKGROUND: Herpes simplex virus (HSV) infection is associated with an increased risk of both human immune deficiency virus (HIV) transmission and acquisition. However, in India, literature on HSV infections in in HIV-infected males has been scarce. The present study was carried out to assess the seroprevalence of these viruses in HIV-infected males, so as to provide a baseline data from India and report on HSV associated GUD prevalence in HIV infected males. OBJECTIVE: The aim of the study was to estimate the seroprevalence of herpes simplex type 1 and 2 viruses in HIV-infected males with and without genital ulcers disease (GUD). MATERIAL AND METHODS: It was a prospective study. We included a total of 351 male participants in this study. Among these 233 were HIV-infected and 118 HIV-uninfected males who served as controls. The seroprevalence was estimated, using HSV-1 and 2 type specific IgG and IgM antibodies by ELISA. RESULTS: HIV-infected patients had a median age of 32 ± 6.97 years (interquartile range: 28–36). Of the 351 males, 25.92% (91/351) were infected with HSV-1 and HSV-2 both. The overall seroprevalence of HSV-1 singly infected, HSV-2 singly infected, and dual infection in HIV-infected males was 39.92%, 25.58%, and 37.33% whereas in HIV-uninfected group the corresponding figures were 71.18%, 5.08%, and 3.38%, respectively. Seven of 233 (3%) HIV-infected males were having incident HSV infection. GUD was reported in both HSV-1 and HSV-2 seropositive individuals. CONCLUSIONS: Both HSV-1 and HSV-2 infections were found to be associated with GUD in HIV-infected patients. The prevalence of HIV-HSV co-infection among GUD patients is high.
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Bloodstream infections and trends of antimicrobial sensitivity patterns at Port Blair p. 332
Amit Banik, Sanjeev H Bhat, Abhay Kumar, Agnijeet Palit, Kandregula Snehaa
PURPOSE: Bloodstream infection can range from inapparent bacteremia until fulminant septic shock with high mortality. Microorganisms present in circulating blood whether continuously, intermittently, or transiently are a threat to every organ in the body. Culture of blood is a vital tool to diagnose such infections. Drug susceptibility patterns help in rationalizing therapy. OBJECTIVE: The objective of this study was to perform bacteriological analysis and assess drug sensitivity patterns of isolates from blood stream infections. DESIGN: Retrospective observational study was conducted from May 2015 to February 2017 at a tertiary care hospital, Port Blair, India. Blood samples were collected with aseptic guidelines and cultured for 7 days. Growths were identified using standard biochemical tests and subjected to sensitivity testing according to Modified Kirby–Bauer's disk diffusion method. Data for the source of blood collection and duration of incubation were noted and compared. RESULTS: A total of 270 (14.24%) pathogens were isolated from 1895 bacteremia suspect patient blood specimens. Contamination was observed at a rate of 1.63%. Gram-positive cocci (60.37%) were predominant organisms recovered followed by Gram-negative Bacilli (36.29%) and Yeasts (3.33%). Staphylococcus aureus, CoNS, and Acinetobacter spp. were the primary pathogens isolated. Aminoglycosides, carbapenems, and glycopeptides were the most effective drugs for treating bacteremia. CONCLUSIONS: Successful treatment of sepsis depends on early diagnosis and proper antimicrobial therapy. Local knowledge of bacteriological profile and antimicrobial sensitivity patterns helps rationalize empiric treatment strategies.
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Second-trimester fetal autopsy: A morphological study with prenatal USG correlations and clinical implications p. 338
Chaitra Venkataswamy, Umamaheswari Gurusamy, S Vidhya Lakshmi
OBJECTIVES: The objective of this study is to analyze the second-trimester fetal autopsies and to reemphasize the role of autopsy by comparing autopsy findings with prenatal ultrasound observations. MATERIALS AND METHODS: Retrospective analysis of second-trimester fetal autopsies over a period of 7.5 years (January 2009–June 2016). A standard protocol of autopsy procedure was followed, which included external examination with photography, X-ray, internal examination, and histopathological examination. In fetuses with congenital malformations (CMs), the findings of prenatal ultrasonogram and autopsy examination were compared. RESULTS: We analyzed a total of 66 fetuses, which includes 17 intrauterine fetal death, 49 terminations for CM, and increased risk for chromosomal abnormality. In fetuses with CM, multiple anomalies were more common than a single anomaly. The most common anomalies were seen involving central nervous system (neural tube defect) followed by the genitourinary system. Autopsy confirmed prenatal ultrasound findings in all cases except three. Complete agreement between USG findings and autopsy were seen in 17 cases (39.7%). Additional findings on autopsy were noted in 25 cases (62.2%). Among these, 15 cases had a significant change of recurrence risk due to altered initial ultrasound diagnosis. CONCLUSION: Fetal autopsy plays an important role in arriving at the final diagnosis and detecting the cause of death. This information is very essential for the clinicians, in genetic counseling of the parents, and management of future pregnancies.
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Comparisons of metabolite profile from paired serum and ethylenediaminetetraacetic acid–plasma samples using dry chemistry technology: An emergency department perspective p. 346
Lokesh Kumar Sharma, Deep Dutta, Neera Sharma, Bhaskar Thakur
BACKGROUND: No data is available evaluating the difference in serum versus plasma sample assay of commonly tested parameters in the emergency department, where the sample processing time can be significantly reduced if plasma is used for analysis instead of conventionally used serum. Hence, this study aimed to evaluate the differences in serum versus plasma sample estimation of commonly evaluated biochemical parameters using dry chemistry technology. MATERIALS AND METHODS: Paired blood samples were collected from a single venipuncture of 405 patients admitted to the emergency department. Dry chemistry autoanalyzer (Vitros-350, Ortho Clinical Diagnostics) was used to process all the samples. RESULTS: Data from 401 patients were analyzed. Percentage differences between serum versus plasma samples for all analytes ranged from 0.0% to 57.44% and were <±4% for a majority of parameters, except uric acid (−6.25%), albumin (+11.90%), chloride (–5.05%), phosphorus (−6.06%), creatine phosphokinase (CPK) total (−57.44%), amylase (−37.53%), lipase (−42.74%), lactate dehydrogenase (LDH) (−8.53%), and C-reactive protein (−7.44%). For albumin, CPK total, amylase, and lipase, the difference between serum and plasma samples was more than the accepted upper range recommended by College of American Pathologists. CONCLUSION: Glucose, urea, creatinine, bilirubin, total protein, serum glutamate-pyruvate transaminase, total cholesterol, high-density lipoprotein cholesterol, triglycerides, sodium, and CPK-mb can be reliably assayed from either serum or plasma samples in emergency/routine practice. CPK total, amylase, and lipase should always be assayed from serum and not plasma due to significant variations. Uric acid, chloride, phosphorous, and LDH only in emergency situations should be assayed from plasma. For routine assays, serum should be preferred.
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Primitive neuroectodermal tumor of the kidney: A rare case report p. 351
Amrita Talwar, Manjari Kishore, Minakshi Bhardwaj, Devender Singh Chauhan
Renal primitive neuroectodermal tumor (PNET) is a rare primary renal neoplasm. Morphologically, it may mimic small blue round-cell tumor. Hence, histopathology in conjunction with immunohistochemistry plays a significant role in correctly diagnosing this malignancy. We report a case of PNET of kidney in a 30-year-old female with an extension to inferior vena cava, who succumbed following an aggressive course of illness.
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Cytologic diagnosis of unusual, large multiple cutaneous myxomas in a case of Carney complex p. 354
Manjusha Karegar, Mrinal Sarwate, Kanchan Kothari, Amey Rojekar, Leena Naik
Cutaneous myxomas are rare benign neoplasms which are frequently associated with Carney complex (CNC). Although more than 500 cases of CNC are reported, there is no literature on cytologic diagnosis of Cutaneous myxomas. An 18-year-old male, with no significant family history, presented with multiple cutaneous swellings, largest measuring 15 cm on the right cheek. He also had spotty skin pigmentations, raised adrenocorticotropic hormone levels and recurrent cardiac myxomas. Fine-needle aspiration cytology from the right cheek and suprapubic swellings revealed paucicellular smears with abundant myxoid material in the background, admixed with fragments of spindle and stellate cells with bland nuclear morphology, and vascular proliferation in few fragments. There was no mitosis, necrosis, or any epithelial element. Hence, diagnosis of cutaneous myxomas in CNC was made which was confirmed on histopathology. This is the first report of cytologic diagnosis of multiple cutaneous myxomas in CNC and the largest cutaneous myxoma reported in literature.
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Incubation and its effect on Leishman stain p. 357
Rateesh Sareen, Menka Kapil, GN Gupta
BACKGROUND: Leishman stain is the universal stain used in staining of peripheral blood smears all over the world. AIM: To study the effect of incubation of buffer solution, slide alone and slide & buffer both on standard Leishman staining. The staining at times causes difficulty particularly in rainy season when there is increased moisture. METHOD: The study comprised of twenty peripheral blood smears selected consecutively in batches of ten each for two successive days . Minor modification in standard Leishman stain was done by either incubating slide or buffer solution or both. The staining characteristics were scored using system by NG et al and the statistical analysis was done. RESULTS: The highest mean score for background (1.5), nuclear (1.55), cytoplasmic features (1.5) and granules visualization (1.8) were seen in technique involving incubation of both slide and buffer. The results were statistically significant. CONCLUSION: We found that incubating glass slides or buffer solution or both yield better stained slide. Our study showed that there was better staining features seen in incubated slide verses routine method.
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