Journal of Laboratory Physicians
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October-December 2018
Volume 10 | Issue 4
Page Nos. 363-472

Online since Wednesday, October 24, 2018

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ORIGINAL ARTICLES  

Is the platelet-to-lymphocyte ratio a new prognostic marker in multiple myeloma? Highly accessed article p. 363
Serife Solmaz, Ozcan Uzun, Celal Acar, Omur Gokmen Sevindik, Ozden Piskin, Hayri Guner Ozsan, Fatih Demirkan, Bulent Undar, Ahmet Alacacioglu, Mehmet Ali Ozcan, Inci Alacacioglu
DOI:10.4103/JLP.JLP_36_18  
BACKGROUND: Recent reports showed neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as a predictor of progression-free survival (PFS) and overall survival (OS) in various malignancies. MATERIALS AND METHODS: We retrospectively examined the PLR, NLR, and MLR in a cohort of 186 newly diagnosed multiple myeloma (MM) patients. This study investigated the prognostic relevance of NLR, PLR, and MLR in MM patients. NLR, PLR, and MLR were calculated from whole blood counts before therapy. The Kaplan–Meier curves and multivariate Cox models were used for the evaluation of survival. RESULTS: Applying cutoff of 1.9 (NLR), 120.00 (PLR), and 0.27 (MLR), decreased PLR showed a negative impact on the outcome. Decreased PLR is an independent predictor for PFS and OS. There were no significant differences in median survival between the high and low NLR (P = 0.80) and MLR (P = 0.87) groups. CONCLUSIONS: In this study, thrombocytopenia and low PLR are associated with poor survival in MM patients does this P value apply to thrombocytopenia or low PLR and may serve as the cost-effective prognostic biomarker.
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HBG2 -158 (C>T) polymorphism and its contribution to fetal hemoglobin variability in Iraqi Kurds with beta-thalassemia minor p. 370
Dilan J Albarawi, Amer A Balatay, Nasir Al-Allawi
DOI:10.4103/JLP.JLP_22_18  
PURPOSE: Hemoglobin (Hb) F% is increased in up to half of beta-thalassemia (β-thal) carriers. Several polymorphisms have been linked to such variability in different populations, including HBG2 - 158(C>T) (Xmn I polymorphism) on chromosome 11. To determine the role of this polymorphism in such variability among Iraqi Kurds, the current study was initiated. MATERIALS AND METHODS: A total of 102 consecutive patients diagnosed as β-thal minor were enrolled. The enrollees had their diagnosis based on peripheral blood counts and high-performance liquid chromatography to determine HbA2 and HbF. All enrollees had their DNA extracted by phenol-chloroform method and Xmn I polymorphism detected by restriction fragment length polymorphism-polymerase chain reaction. RESULTS: The mean age (standard deviation [SD]) of the 102 enrollees was 25.4 (14.0) years, and the enrollees included 48 males and 54 females. Xmn I polymorphism was identified in heterozygous state in 46 (45.1%) patients and in homozygous state in one patient (0.98%). Thus, the minor allele frequency of this polymorphism was 0.235 in the studied group. There were no significant differences in red cell indices and HbA2% in carriers of the minor allele compared to noncarriers, while HbF% and absolute HbF concentrations were significantly higher in the former subgroup (P = 0.032 and 0.014, respectively). This polymorphism's contribution to HbF variability was found to be 5.8% in the studied sample. Furthermore, those with HbF ≥2% were 3.2 folds more likely to carry the minor allele. CONCLUSIONS: Xmn I polymorphism is frequently encountered in Iraqi Kurds with β-thal minor, and it is significantly associated with higher fetal hemoglobin in these patients.
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Assessment of knowledge, attitude, and practices toward prevention of hepatitis B infection among medical students in a high-risk setting of a newly established medical institution p. 374
Akanksha Rathi, Vikas Kumar, Jitendra Majhi, Shalini Jain, Panna Lal, Satyavir Singh
DOI:10.4103/JLP.JLP_93_18  
BACKGROUND: India is in the intermediate hepatitis B virus endemicity zone with hepatitis B surface antigen prevalence among the general population ranges from 2% to 8%. Among health-care workers, seroprevalence is two to four times higher than that of the general population. AIM: The aim of the study was done to assess the knowledge, attitude, and practices (KAPs) of medical students regarding hepatitis B. MATERIALS AND METHODS: This is a cross-sectional study that was conducted from March to April 2018. Students were invited to the department on specified dates for awareness and immunization against hepatitis B. Their KAP was assessed with the help of a self-administered questionnaire. RESULTS: With a response rate of 81.3%, a total of 161 students participated in the study out of 198. Out of the 161 study participants, only 13 (8%) students had received a completed course of hepatitis B vaccination in the past, 30 (18.7%) students had a history of inability to complete the three doses of hepatitis B vaccination, and the rest 118 (73.3%) students were never immunized against hepatitis B. The knowledge about the risk of acquiring the disease at the hospital or high-risk setting was present in less than half of the students. The average knowledge score was 10.63 out of 16 and average healthy practice score was 2.94 out of 4. On applying Pearson correlation test, it was found that there was a positive correlation of knowledge and practices of the students (P = 0.012), implying that better knowledge of the disease has a positive effect on the practices exercised by an individual. CONCLUSION: Newly enrolled students and other individuals attached to a high-risk setting such as a medical institution should be screened for immunization status during initial medical examination as the number of unimmunized persons, especially against hepatitis B is high.
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Evaluation of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide method for assessing biofilm formation in vitro by Trichosporon spp. p. 380
Thayanidhi Premamalini, Subramanian Anitha, Kanniappan Mohanapriya, Anupma Jyoti Kindo
DOI:10.4103/JLP.JLP_37_18  
BACKGROUND: Invasive infections due to Trichosporon spp. have increased recently and are frequently associated with indwelling medical devices. Such infections which are associated with biofilm formation do not respond to the routinely used antifungal agents and are often persistent, associated with high mortality rate. Various methods have been described by researchers to evaluate and quantify the biofilm formation. AIM: This study was conducted to compare two methods of biofilm production by Trichosporon sp, i.e., test tube method with crystal violet (CV) staining and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. MATERIALS AND METHODS: Seventy-two clinical isolates of Trichosporon spp. collected from various sources were considered for the study. The identity of all the isolates was genotypically confirmed by Trichosporon-specific polymerase chain reaction (PCR). The isolates were further speciated phenotypically using biochemical profile and growth characteristics which identified the isolates as Trichosporon asahii (64/72), Trichosporon asteroides (5/72), Trichosporon cutaneum (2/72), and Trichosporon mucoides (1/72). Biofilm production was then evaluated and compared by test tube-CV method and MTT assay. RESULTS: All the Trichosporon isolates produced biofilm by MTT assay, whereas only 42 (53.6%) of the isolates were detected to be biofilm producers by CV method. Furthermore, MTT assay could differentiate better between weak and moderate biofilm producers as compared to CV method. CONCLUSION: Hence, MTT assay is a reliable method for quantification of biofilm produced by Trichosporon spp. using 96-well microtiter plate.
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Prevalence of blaKPC and its occurrence with other beta-lactamases in Klebsiella pneumoniae p. 387
Poothakuzhiyil Remya, Mariappan Shanthi, Uma Sekar
DOI:10.4103/JLP.JLP_29_18  
BACKGROUND: Klebsiella pneumoniae (K. pneumoniae) is an important nosocomial pathogen, and the emergence of multidrug resistance in these organisms limits the treatment options for serious infections caused by them. K. pneumoniae carbapenemase (KPC) is one of the clinically significant Class A beta-lactamases. AIM AND OBJECTIVE: This study was aimed to detect the KPC and its coexistence with other beta-lactamases in K. pneumoniae. MATERIALS AND METHODS: A total of 370 isolates, collected over a period of 1 year, were included in this study. The source of these isolates were urine (n = 170), exudative specimens (n = 132), respiratory secretions such as bronchial wash, endotracheal aspirate, and pleural fluid (n = 38), and blood (n = 30). For all the isolates, antibiotic susceptibility tests by disc diffusion, modified Hodge test, and KPC screening test were done. Polymerase chain reaction (PCR) was performed for the detection of KPC and the copresence of other beta-lactamases genes. RESULTS: Among the 370 isolates, 41 were resistant to the carbapenem by disc diffusion and minimum inhibitory concentration tests. Screen test using ertapenem and the boronic acid disk was positive in 14 isolates. Only one isolate harbored KPC gene by PCR, and it was co-produced with SHV-12 and CTX-M-15. CONCLUSION: PCR remains the gold standard for detection of KPC compared with any other phenotypic methods. Early detection of these genes helps in initiating proper antibiotic treatment.
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Extracellular hydrolytic enzyme activities of the different Candida spp. isolated from the blood of the Intensive Care Unit-admitted patients p. 392
Nidhi Pandey, Munesh Kumar Gupta, Ragini Tilak
DOI:10.4103/JLP.JLP_81_18  
BACKGROUND: Candida spp. secretes various extracellular hydrolytic enzymes. These enzymes are the important virulence factor for the pathogenesis of Candida. We assessed four different enzymatic activities of Candida isolates obtained from bloodstream infections. MATERIALS AND METHODS: We isolated 79 strains of different Candida species from the blood of the Intensive Care Unit-admitted patients. Species were identified by conventional methods including culture characteristic, germ tube, sugar assimilation, and Dalmau's culture technique. Phospholipase, proteinase, hemolysin, and esterase enzymatic activities were determined by the Plate method. RESULTS: Non albicans candida were the most common isolates from the blood of the ICU admitted patient with a predominance of Candida tropicalis. Hemolytic activity was the most prominent enzyme activity followed by the proteinase activity. Candida albicans (89.86%) was the major proteinase producer, while 95.8% of C. tropicalis produced hemolysin. No esterase activity was shown by the Candida glabrata and Candida krusei. CONCLUSION: No significant difference was observed between the two most common causative agents of candidemia: C. albicans and C. tropicalis.
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Evaluation of mean monocyte volume in septicemia caused by Salmonella species p. 397
Dilip Kumar, Madhusoodanan Sudha, Bansidhar Tarai, Poonam Das
DOI:10.4103/JLP.JLP_45_18  
OBJECTIVE: The objective was to study the significance of volume, conductivity, and scatter (VCS) parameters of monocytes in Salmonella infection. MATERIALS AND METHODS: We selected peripheral blood samples of 52 patients whose blood culture was positive for Salmonella species (Salmonella typhi and Salmonella paratyphi A) and analyzed VCS parameters by subjecting them to differential count in hematology analyzer LH750 (Beckman Coulter). Out of these, we studied VCS parameters of monocytes in Salmonella infection and compared with two control groups (control 1: other infections and control 2: normal subjects). RESULTS: Mean monocyte volume (MMV), standard deviation (SD) of MMV, and SD of mean channel monocyte conductivity were found to be significantly increased in Salmonella infection (P < 0.05) when compared with both controls. We propose a cutoff value of 185 for MMV with sensitivity and specificity of 80% and 73%, respectively, to predict Salmonella infection. CONCLUSIONS: MMV can be a useful tool for predicting Salmonella infection under appropriate clinical settings.
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Extraintestinal infections caused by nontyphoidal Salmonella from a tertiary care center in India p. 401
Sukanya Sudhaharan, Padmaja Kanne, Lakshmi Vemu, Aparna Bhaskara
DOI:10.4103/JLP.JLP_79_18  
BACKGROUND: Infection with Salmonella has become an increasing problem worldwide. Recently, nontyphoid Salmonella (NTS) has become a global concern causing threat to the health of human. It causes gastrointestinal infection which may be self-limiting, but invasive infections may be fatal, requiring appropriate therapy. This study was done to analyze the spectrum of NTS infections causing extraintestinal infections and its susceptibility pattern from a tertiary care center in India. MATERIALS AND METHODS: The medical records of 27 patients whose cultures were positive for NTS between the years 2013–2016 were included in this retrospective study. The relevant demographic, clinical, and laboratory data were analyzed. RESULTS: Among the 27 patients, predominant patients were in the age group of 20–30 years. The male to female ratio is 1.7:1. Salmonella typhimurium was the predominant NTS isolated among 15/27 (55.5%), followed by Salmonella enteritidis 4/27 (14.8%). 18/27 (66.6%) of NTS were isolated from blood. Nalidixic acid was sensitive in 2/15 of S. typhimurium, 2/4 of S. enteritidis and 1/3 of Salmonella weltevreden, while others are nalidixic acid-resistant implying resistance to quinolones. They were sensitive to other antibiotics reported. CONCLUSION: This study highlights the spectrum of NTS causing extraintestinal infections which is an emerging infection occurring mostly in immunosuppressed individuals. There should be a high degree of clinical suspicion which would help in the early diagnosis and management of patients.
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Clinico-microbiological profile of healthcare associated pneumonia in critically ill patients at level-I trauma centre of India p. 406
Minu Kumari, Neha Rastogi, Rajesh Malhotra, Purva Mathur
DOI:10.4103/JLP.JLP_85_18  
INTRODUCTION: Device-associated infections constitute the majority of health-care infections in Intensive Care Units (ICUs). Trauma patients are more prone to acquire such infections; ventilator-associated pneumonia (VAP) being the most common Health care associated infections (HAI) in ICU has serious implications such as increased morbidity, prolonged hospital stay, and mortality. This study aims to compare the clinicomicrobiological profile of VAP and non-VAP trauma patients at Level I trauma center. MATERIALS AND METHODS: A 4-year retrospective study of prospectively maintained database was conducted at Level 1 trauma center from January 2013 to December 2016. The patients were classified into two groups named VAP and non-VAP patients. VAP patients were defined according to the criteria of the Centers for Disease Control and Prevention. The data were compiled and analyzed. Statistical data were analyzed using SPSS version 21 software. RESULTS: During the study period, 134 (13%) cases of VAP and 909 (87%) non-VAP cases were observed in our study. The total number of ventilator days for VAP patients was 5128 days, which ranged from 2 to 82 days (median 42 days). The length of hospital stay in non-VAP category ranged from 1 to 390 days (median 195.5 days). Inhospital mortality was observed in 62 (46%) patients with VAP. Three hundred and eighteen (35%) non-VAP patients had also had a fatal outcome. Gram-negative organisms, most commonly Acinetobacter spp. (13, 21%), were reported in the fatal VAP patients. CONCLUSION AND DISCUSSION: Higher rate of mortality was observed in patients with VAP in comparison to non-VAP patients, both being on mechanical ventilation. Early recognition of VAP, implementation of proper VAP preventive bundle strategies, and stringent infection control practices are essential mandates to prevent VAP.
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Correlation of expression of aberrant immunophenotypic markers in T-ALL with its morphology: A pilot study p. 410
Neha Garg, Mrinalini Kotru, Dilip Kumar, Rajesh Pathak, Meera Sikka
DOI:10.4103/JLP.JLP_35_18  
INTRODUCTION: Aberrant expression of immunophenotypic markers is commonly found in patients of acute leukemia. T-ALL also shows aberrant markers such as CD13, CD33, CD117, CD10, and CD79a. Morphologically, T-ALL has been categorized into L1, L2, and L3 subtypes. Till now, no study has been done to correlate these markers with morphological features of T-ALL. This study aimed to correlate the expression of aberrant immunophenotypic markers with morphology in T-ALL. MATERIALS AND METHODS: All the cases of T-ALL diagnosed by flow cytometry over a period of 2½ year were taken out from the records of Hematology Section of Department of Pathology of University College of Medical Science and Guru Teg Bahadur Hospital and Max Hospital, Saket. Their peripheral blood smear was screened to correlate the morphology of blasts with the expression of aberrant markers. RESULTS: A total of 40 cases of T-ALL were identified during 2½ year period of our study. Morphological correlation was available for 23 cases. Aberrant expression of CD10 was present in 6 (35.3%) cases, CD79a in 9 (47.36%) cases, CD117 in 5 (42.28%) cases and myeloid antigen CD33 in 5 (38.46%) cases. CD117 and CD33-positive cases showed L2 morphology with the presence of convolutions, while cases with expression of CD79a had L1 morphology with absent-slight convolutions. CD10-positive cases had L1/L2 morphology with absent occasionally present convolutions. CONCLUSIONS: There seems to be an association of aberrant markers with L1 and L2 morphology. However, this needs to be tested for statistical significance on a larger sample size.
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Characterization and antimicrobial susceptibility of coagulase-negative staphylococci isolated from clinical samples p. 414
Prapti Bora, Priya Datta, Varsha Gupta, Lipika Singhal, Jagdish Chander
DOI:10.4103/JLP.JLP_55_18  
PURPOSE: This study has been done to speciate coagulase-negative staphylococci (CoNS) and also study their antibiotic susceptibility pattern isolated from clinical samples. MATERIALS AND METHODS: A total of 120 consecutive CoNS were isolated from various clinical samples such as blood, pus, wound swab, drain fluid, tracheal aspirate, peritoneal fluid, and pleural fluid over a period of 6 months. CoNS were identified by characteristic growth on media such as Blood agar and MacConkey agar. Speciation and identification were done by a range of biochemical testing such as PYR broth hydrolysis, novobiocin resistance, polymyxin B sensitivity, and then by matrix-assisted laser desorption ionization-time of flight. Antibiotic susceptibility of the isolates was done by Kirby-Bauer disk diffusion method as per CLSI 2017 guidelines. RESULTS: Among the 120 isolates, the most common species was Staphylococcus epidermidis (56.67%) followed by Staphylococcus haemolyticus (21.67%), Staphylococcus lugdunensis (11.67%), Staphylococcus caprae (5%), Staphylococcus cohnii (3.33%), and finally Staphylococcus vitulinus (1.67%). Good in vitro susceptibility was noted toward linezolid (100%), vancomycin (100%), teicoplanin (100%), and doxycycline (80.2%). The antibiotics to which resistance was seen were penicillin (96.5%), ciprofloxacin (57.1%), and oxacillin (45.5%). MR CoNS in our study ranged from 50% to 68.67%. CONCLUSION: Antibiotic resistance in CoNS is increasing toward penicillin, ciprofloxacin, and oxacillin as found in our study. The antibiotics such as vancomycin, teicoplanin, linezolid, and doxycycline which showed good in vitro susceptibility, therefore, should be kept as reserve drugs and used judiciously.
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Y-Box binding protein 1 expression in breast cancer and its correlation with hormone receptors and other prognostic markers p. 420
Taruna Bansal, Nadeem Tanveer, Usha Rani Singh, Sonal Sharma, Navneet Kaur
DOI:10.4103/JLP.JLP_58_18  
INTRODUCTION: The present histologic and immunohistochemical prognostic markers of breast carcinoma do not effectively identify the subset of patients with poor prognosis. Y-Box binding protein 1 (YB1) is a novel biomarker which may identify and aid in targeted personalized therapy for such patients. MATERIALS AND METHODS: The study was conducted on histopathology specimens of 74 patients of breast carcinoma who had undergone modified radical mastectomy. YB1 immunohistochemistry (IHC) was performed on manual tissue microarray blocks (each having 15 cores). The YB1 expression was quantified in terms of “immunoreactive score” which was correlated with clinical parameters, hormone receptor status, and Her2neu overexpression by IHC. The Her2neu status of the equivocal cases was further evaluated by fluorescent in situ hybridization (FISH). RESULTS: YB1 was positive in 36/74 (48.6%) cases. On IHC and analysis by FISH, 25/74 (34%) cases had Her2neu overexpression. Estrogen receptor (ER) and progesterone receptor (PR) positivity was found in 42% and 36.5% cases, respectively. YB1 immunopositivity was negatively correlated with ER and PR expression, but showed a significant positive correlation with Her2neu expression. No correlation was found with other clinical parameters, tumor stage, and grade, except lymph node involvement, which showed a positive association with YB1 expression. Triple-negative breast carcinoma constituted 25.6% of the total cases, out of which 73.6% were YB1 positive. CONCLUSION: This study found that YB1 has an association with Her2neu expression. It may in future provide a therapeutic target in Her2neu overexpressing tumors.
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Prevalence, etiology, and antibiotic resistance profiles of bacterial bloodstream infections in a tertiary care hospital in Northern India: A 4-year study p. 426
Surbhi Khurana, Nidhi Bhardwaj, Minu Kumari, Rajesh Malhotra, Purva Mathur
DOI:10.4103/JLP.JLP_78_18  
INTRODUCTION: Bloodstream infections (BSIs) can lead to life-threatening sepsis and are globally associated with high morbidity and mortality. Although BSIs require immediate antimicrobial treatment, their prevalence, etiology, and antimicrobial susceptibilities differ from one country to other. There is a dearth of such data from India. Here, we report the 4-year etiologic data on BSI in trauma patients admitted to a tertiary care referral hospital in New Delhi, India. MATERIALS AND METHODS: A retrospective study was conducted at the trauma center between January 2013 and December 2016. The routine microbiological data on bacterial BSI were recorded and determined retrospectively from the laboratory records. Antimicrobial susceptibility profiles were statistically analyzed. RESULTS: A total of 2017 bacterial strains isolated from blood culture samples were included for microbiological analysis. During the study, the median age of the patients varied from 30 to 35 years, with the percentage of females in the study population varying from 17% to 19%. The predominant pathogens were Gram-negative bacteria, with Acinetobacter species, followed by Klebsiella species being the most commonly isolated organisms throughout the 4 years of study. Among Gram-positive isolates, Staphylococcus species were the leading pathogens (11%–15%). CONCLUSIONS: A detailed analysis of prevalence, etiology of BSIs in India and its resistance profile is crucial for appropriate antibiotic use, clinical management, and formulation of antibiotic policies and preventive measures.
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Pattern of antimicrobial resistance of Gram-negative bacilli in surgical site infections in in-patients and out-patients at an apex trauma center: 2013–2016 p. 432
Nidhi Bhardwaj, Surbhi Khurana, Minu Kumari, Rajesh Malhotra, Purva Mathur
DOI:10.4103/JLP.JLP_80_18  
INTRODUCTION: Antimicrobial resistance is an increasing problem worldwide especially among the surgical site infections (SSIs). SSI is becoming more serious due to hospital-acquired infections/nosocomial infections, which further leads to the overuse of broad-spectrum antibiotics. To investigate the antimicrobial resistance patterns among Gram-negative bacteria in SSI in in- and out-patients the present study was designed. METHODOLOGY: During the 4 years (January 2013–December 2016), the antimicrobial resistant pattern was studied in the admitted patients and in the patients who were followed up to the outpatients department (OPD) after discharge. Antimicrobial resistance pattern testing was done by the disk diffusion method on Mueller-Hinton agar and by E-test for ten antibiotics according to The Clinical and Laboratory Standards Institute guidelines for Gram-negative bacilli. RESULTS: A total of 2,447 strains were isolated from the studied population on over the period of 4 years. Of 2447, 1996 (81%) were isolated from patients who had SSI during the hospital stay, and 451 (18%) were from patients who attended the OPD after discharge. In the outpatients, who followed up in the OPD for the SSI, Escherichia coli ( 148), and Pseudomonas aeruginosa (93), whereas in the patients who develop SSI during their hospital stay, Acinetobacter baumannii (622), E. coli (424), and Klebsiella pneumoniae (315) were found to be common. A very high resistance pattern was observed in both the studied groups; however, a higher resistance pattern was seen in in-patients as compared to outpatients. CONCLUSION: In our study, we have reported resistance pattern in Gram-negative bacteria isolated from the patients who were came for the follow as well as in the inpatients. For the outpatients, it can be concluded that it could be a community-acquired infection which is also an alarming condition for our society.
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Evaluation of diagnostic utility of imprint cytology in paediatric renal tumours with special references to Ki 67 proliferative marker p. 437
Namrata Maity, Chhanda Das, Madhumita Mukhopadhyay, Tamanna Parvin, Ashis Kumar Saha, Biswanath Mukhopadhyay
DOI:10.4103/JLP.JLP_157_17  
BACKGROUND: Pediatric renal neoplasms comprise about 7%–8% of all neoplasms in children. Wilms tumour (WT) is the most common among pediatric renal tumours. AIMS AND OBJECTIVES: The study was undertaken to study the epidemiological occurrence of pediatric renal tumours in a tertiary care hospital and to ascertain the validity and reliability of touch smear imprint cytology in intraoperative diagnosis of renal tumours and correlate with subsequent histopathological diagnosis and to assess the expression of proliferation marker Ki-67 in different components and stages of WT. MATERIALS AND METHODS: It was a single-institution-based prospective and observational study, conducted for 2 years (from October 2013 to September 2015) in the department of pathology at our hospital. A total of fifty cases were enrolled in this study, all were below 15 years of age. RESULTS: Imprint cytology showed sensitivity, specificity, and diagnostic accuracy of 83%, 98%, and 95.74%, respectively, in diagnosing benign and malignant renal tumours. There was statistically significant correlation of imprint cytology with confirmatory histopathological examination of excision specimen (P < 0.001). Immunohistochemical analysis of Ki-67 was done in all WT cases. Epithelial component had higher proliferative index than blastemal component with P = 0.0082, which was highly statistically significant. CONCLUSION: Imprint cytology is found to be a less expensive, simple, and rapid method, which can be used as an adjunct to histopathology. Correlation between proliferation index as measured with Ki-67 antibody and tumour stage was found. Ki-67 is thus a relevant marker for assessing the proliferative activity.
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Coinfection of chikungunya and dengue viruses: A serological study from North Western region of Punjab, India p. 443
Maninder Kaur, Kanwardeep Singh, Shailpreet K Sidhu, Pushpa Devi, Manpreet Kaur, Sapna Soneja, Nacchartarjit Singh
DOI:10.4103/JLP.JLP_13_18  
INTRODUCTION: Dengue and chikungunya (CHIK) infections appear to be increasing in all parts of India. Aedes aegypti mosquitoes are common vectors for dengue virus (DENV) and CHIK virus (CHIKV). In areas where both viruses cocirculate, they can be transmitted together. There are very few studies discussing the dengue-chik coinfection from Punjab region of India. The present study was undertaken to study the clinical features of dengue–CHIK coinfection and compare with monoinfection. MATERIALS AND METHODS: IgM antibody capture (MAC) ELISA for dengue IgM and CHIK IgM and ELISA for nonstructural protein 1 antigen was performed on serum samples obtained from suspected patients. RESULTS: Out of total 3160 samples from suspected patients for dengue infection, 2178 (68.92%) samples were positive for DENV while CHIK IgM antibodies were positive in 127 patients out of the total suspected 373 cases (34.04%). In addition to this, 283 samples were tested for both viruses, out of which 27 sera were positive (9.54%) for coinfection of dengue and CHIK. The comparison of signs and symptoms showed that the coinfected patients had fever in all cases while rash was seen in only 30% cases. Arthralgia (79%) and thrombocytopenia (77%) was seen in significant number of coinfected cases thus revealing overlapping nature of dengue–CHIK coinfection. CONCLUSION: Increase in the number of Dengue and Chikungunya infections and their cocirculation is an important public health concern which warrants the implementation of strict control measures.
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Gallstone disease and quantitative analysis of independent biochemical parameters: Study in a tertiary care hospital of India p. 448
Deepak Dhamnetiya, Manish Kumar Goel, BalRaj Dhiman, Om Prakash Pathania
DOI:10.4103/JLP.JLP_75_18  
INTRODUCTION: Gallstone disease (GSD) represents a significant burden for health-care systems worldwide and is one of the most common disorders among patients presenting to emergency rooms with abdominal discomfort. This study was aimed to know the association of biochemical parameters and development of GSD. MATERIALS AND METHODS: We conducted a case–control study from January 2013 to December 2013 among patients attending outpatient department of general surgery at a tertiary care hospital of Delhi, North India; we recruited 120 cases and the same number of controls in the study. Data collection for both cases and controls was done on a self-designed pretested interview schedule and all the patients were investigated for relevant biochemical parameters. Logistic regression was used for univariate and multivariate analyses to find out different correlates and analyze the independent effects of these correlates on GSD. RESULTS: We have included 120 cases and the same number of age- and sex-matched controls in the study and final analysis. Almost 70% of the cases were females and 30% were males. In multivariate logistic regression, we have found maximum significant association with serum total cholesterol (odds ratio [OR]: 1.013, confidence interval [CI]: 1.003–1.024, P = 0.041) followed by low-density lipoprotein (LDL) cholesterol (OR: 1.017, CI: 1.001–1.034, P = 0.04) and triglycerides (OR: 1.009, CI: 1.001–1.018, P = 0.049). Fasting blood sugar (P = 0.18), high-density lipoprotein cholesterol (P = 0.07), aspartate transaminase (P = 0.21), alanine transaminase (P = 0.29), and total bilirubin (P = 0.13) were not found to be independently associated with GSD. CONCLUSION: Biochemical parameters such as plasma total cholesterol, triglycerides, and LDL cholesterol level were independently associated with GSD.
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CASE REPORTS Top

Malignant melanoma of conjunctiva: Diagnosis on fine-needle aspiration cytology p. 453
Manjari Kishore, Vijay Kumar, Manju Kaushal
DOI:10.4103/JLP.JLP_43_18  
Malignant melanoma of conjunctiva is an uncommon malignancy. The diagnosis is suspected clinically and confirmed on pathological examination. We present a case of a 63-year-old female with previous history of pigmented lesion in the right eye and subsequently diagnosed as malignant melanoma of right conjunctiva and cornea on fine-needle aspiration cytology and histopathology.
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Tuberculosis cutis orificialis with underlying pulmonary tuberculosis in an immunocompetent man p. 457
Biswajit Dey, Archana Hemant Deshpande, Sanjeev Hosdurg Bhat, Ashok Singh
DOI:10.4103/JLP.JLP_4_18  
Tuberculosis cutis orificialis (TCO) is a rare form of tuberculosis more often secondary to pulmonary tuberculosis. TCO has varied differential diagnoses and thus results in delayed diagnosis and treatment leading to serious consequences. The diagnosis of TCO is confirmed by biopsy and nucleic acid amplification tests in majority of cases. We report a case of TCO with underlying pulmonary tuberculosis in a 50-year-old male, who presented with a painful nonhealing ulcer of the right buccal mucosa. Biopsy and real-time polymerase chain reaction helped in confirming the diagnosis. The patient was treated with antitubercular therapy.
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Cytodiagnosis of Rosai–Dorfman disease masquerading as lymphoma: A case report with brief review of literature p. 460
Manjari Kishore, Prajwala Gupta, Arvind Ahuja, Minakshi Bhardwaj
DOI:10.4103/JLP.JLP_69_18  
Rosai–Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy (SHML) is a self-limiting, benign histiocytic disorder. We report a case of RDD mimicking lymphoma clinically and cytologically in a 3-year-old male child. The present case highlights the importance of cytology in the diagnosis of RDD along with cytological features of other differential diagnoses.
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Catheter associated urinary tract infections due to Trichosporon asahii p. 464
Tejashree Anantharaj Urs, Visakha Kadiyala, Saundarya Deepak, M Krishna Karthik
DOI:10.4103/JLP.JLP_71_18  
Urinary tract infections (UTIs) caused by fungi, frequently associated with medical devices, have increased and caused great morbidity and mortality among hospitalized patients. Difficulties on different species identification as well as the lack of standardized sensitivity tests in vitro, contribute to the limited information available on epidemiology, diagnosis, and therapeutics of Trichosporon infections. There are only sporadic reports of UTI caused by Trichosporon asahii reported from India. We report six cases of UTI caused by T. asahii in severely ill patients in a tertiary care setup. Among six positive T. asahii UTI, four were found in female patients with a mean age of 60 years. We observed that all patients were on indwelling urinary catheter, broad-spectrum antibiotics, and with other comorbid conditions. With regard to the antifungal susceptibility testing, all the isolates were resistant to amphotericin B and sensitive to voriconazole. Majority of them were sensitive to Itraconazole, half of them were sensitive to fluconazole. The ubiquity and biofilm formation poses difficulty in establishing pathogenicity and delineating environmental or nosocomial infections. Risk factors such as use of antibiotics, indwelling catheter, and comorbidities such as hypertension, diabetes, anemia, and chronic kidney disease predispose for the development of UTI by T. asahii. Isolation of the same yeast in three consecutive urine samples with significant counts, along with significant number of pus cells establishes T. asahii as an etiological agent of UTI. Furthermore, the clearance of the fungus from the urinary tract with the recovery of the patient following catheter removal and antifungal therapy further confirms T. asahii as the cause of UTI.
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LETTER TO THE EDITOR Top

Microbiological profile and antibiotic resistance pattern of skin and soft-tissue infections: A study from Northern India p. 471
Sonu Kumari Agrawal, Aashirwad Panigrahy, Sowjanya Perumalla, Arti Kapil, Benu Dhawan
DOI:10.4103/JLP.JLP_89_18  
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