Background Accurate interpretation of antibiotic susceptibility testing (AST) is one of the most ... more Background Accurate interpretation of antibiotic susceptibility testing (AST) is one of the most crucial functions of the microbiology laboratory. However, its performance depends on a number of critical factors. We conducted a status survey to understand the existing practices in Indian laboratories that have a potential to influence performance of AST. Method We developed a 22-point online survey questionnaire on information about respondent's specifications, use of AST consumables, existing quality control protocols, and matters of contention in AST practices, and sent it by Google forms to 362 clinical microbiologists (holding MD or DNB certification). Participation was voluntary. Results were analyzed using descriptive statistics. Results Among 362, a total of 103 returned the questionnaire. The first 100 responses that were complete (all 22 questions answered) were analyzed. Respondents were from medical colleges (61%), private hospitals (26%), and stand-alone laboratories (13%). Analysis revealed that the Clinical & Laboratory Standards Institute (CLSI) guidelines were followed by all. Overall, 54% used disc diffusion as the primary method for performing AST. For the internal quality control testing of media and AST, 24% and 16% had adequate testing components and frequency, respectively. For performing AST of colistin, broth microdilution was used by 19%. Also, 86% participated in external quality control programs, and 54% respondents were dissatisfied or unsure about the development of competencies in AST methodology during their postgraduate training. Conclusion This survey reveals that potential gaps exist in the performance parameters and internal quality control of AST. There is an urgent need for harmonization in AST performance and postgraduate training in clinical microbiology in India.
BackgroundCefiderocol (FDC), a novel siderophore drug, is active against gram negative bacteria p... more BackgroundCefiderocol (FDC), a novel siderophore drug, is active against gram negative bacteria producing carbapenemases, including metallo-beta-lactamases.ObjectiveTo compare the in-vitro activity of FDC with ceftazidime-avibactam (CZA), CZA/ aztreonam (AT) combination and colistin (CST), in clinical isolates of meropenem-resistant (MER-R) Klebsiella pneumoniae.MethodsFrom 2052 clinical specimens submitted for culture testing, 245 K. pneumoniae isolates were recovered within a six month period in 2021. 103 non-duplicate, non-outbreak, MER-R (MIC >4 μg/ml) strains were included in the study. Identification and susceptibility was performed using VITEK-2 (bioMérieux). 10 meropenem-susceptible isolates served as controls. For FDC, BMD was performed after in-house standardisation. Disc diffusion (Liofilchem, Italy) and broth microdilution (BMD; ComASP, STC, Liofilchem, Italy) were used for susceptibility testing of CZA and CST respectively. Synergy testing for CZA and aztreonam (AT) ...
Methicillin-resistant Staphylococcus aureus (MRSA) is difcult to treat with methicillin, amoxici... more Methicillin-resistant Staphylococcus aureus (MRSA) is difcult to treat with methicillin, amoxicillin, penicillin, oxacillin, and other commonly used antibiotics because of its resistance. Staphylococcus organisms rapidly develop drug resistance as many as 50% of the domiciliary and 80% of the hospital strains are now penicillin resistant. Staphylococcus aureus also show multiple drug resistance. Therefore, Staphylococcal isolates should always be tested for antimicrobial sensitivity and chronic infection should be treated by more than one drug. Before 1960,when methicillin, is the rst penicillin's-resistant penicillin's, was brought into use, about 1%of the strains of the Staphylococcus aureus were "methicillin resistant" and by 1970 in Britain their proportion has risen to about 5%.These strains are tolerant of, low therapeutic concentrations of methicillin, cloxacillin, benzyl penicillin and ampicillin.They do not destroy methicillin and cloxacillin, but most o...
Journal of The Academy of Clinical Microbiologists, 2020
With the development of carbapenemase inhibitors such as avibactam, relebactam and vaborbactam, i... more With the development of carbapenemase inhibitors such as avibactam, relebactam and vaborbactam, it has become important to detect the type of carbapenemase produced for guiding antibiotic therapy. Among the several methods available for the same, we chose lateral flow assay (Resist-3 O. K. N., Coris BioConcepts, Gembloux, Belgium) and compared it against a commercially available molecular test (Xpert Carba R assay, version 2, Cepheid, Sunnyvale, CA, USA). Sixteen clinical isolates, which were resistant to carbapenems on phenotypic testing, were selected. Fourteen of these were Klebsiella pneumoniae and two were Escherichia coli a total of 22 carbapenemases. (OXA-48-14, New Delhi metallo-beta-lactamase [NDM]-7 and K. pneumoniae carbapenemase [KPC]-1) were detected by the Carba-R assay. Six isolates (K. pneumoniae-5 and E. coli-1) had co-production of OXA-48 and NDM. Resist-3 assay detected all twenty two enzymes. The distribution of enzymes in these 16 isolates was identical to that shown by the Carba-R (100% agreement). Hence, we conclude that lateral flow immunochromatography assay is a simple, rapid and cost-effective method for the detection of carbapenemases. This would help the clinician select the appropriate antibiotic and support antibiotic stewardship in the Indian settings.
International Education and Research Journal, 2019
The origin of the word dengue is not clear. It is believed “Cramp like seizure caused by an evil ... more The origin of the word dengue is not clear. It is believed “Cramp like seizure caused by an evil spirit”. In Spanish, dengue was said to have the posture and gait of a dandy, and the disease was known as ”Dandy Fever”. Benjamin Rush, Coined the term "Break bone fever" because of the symptoms of myalgia and arthralgia. 260 peer-reviewed articles referred to dengue as "Poor man's disease. It is a severe life-threatening disease. “Dengue is a mosquito-borne infection caused by a flavivirus. Dengue fever is continuous or "saddleback" with a break on 4th or 5th day and then recrudescence; usually lasts 7-8 days Classical dengue fever is characterized by the onset of fever, malaise, headache, facial flushing, retrobulbar pain that worsens on eye movements, conjunctive suffusion and severe back ace, which is a prominent symptom. Lymphadenopathy, petechial on the soft palate and transient morbilliform skin rashes may also appear on the limbs with subsequent spr...
Little is known about the precise mechanism involved in immunity to fungal infections. Researcher... more Little is known about the precise mechanism involved in immunity to fungal infections. Researchers discovered that fungal prostaglandins, deactivate immune cells, preventing them from destroying the infection. Fungi are known to make molecules similar to those of our own immune system. Scientists found that the fungus molecules weaken the immune system, which is essential in stopping infections. Opportunistic infections like Cryptococcus which normally pose no threat, but are potentially life-threatening in those with weakened immune systems. Scientists are now working to find the other ways these fungal molecules are affecting immune cells and how the immune cells are deactivated. Antibodies against fungi and yeasts may be
Hantaviruses are known to cause haemorrhagic fever with renal syndrome in Eurasia and hantavirus ... more Hantaviruses are known to cause haemorrhagic fever with renal syndrome in Eurasia and hantavirus cardiopulmonary syndrome in the Americas. They are globally emerging pathogens as newer serotypes are routinely being reported. This review discusses hantavirus biology, clinical features and pathogenesis of hantavirus disease, its diagnostics, distribution and mammalian hosts. Hantavirus research in India is also summarised.
The Journal of the Association of Physicians of India, 2012
Antiretroviral treatment (ART) programs from low-income countries utilizing standardized ART regi... more Antiretroviral treatment (ART) programs from low-income countries utilizing standardized ART regimens, simplified approaches to clinical decision making and basic lab monitoring have reported high mortality rates. We determined the risk factors for mortality among HIV-infected adults following the initiation of ART from a single center in south India. ART-naive HIV-infected south Indian adults attending the Infectious Diseases clinic in a 2000-bed academic medical center in south India who were initiated on ART (generic, fixed-dose combinations) as per the national guidelines were followed up. Cases (32 patients who died) were compared with age and sex matched controls. Eight-hundred and twenty-two patients were started on ART from January 1, 2000 to December 31, 2008. The cumulative mortality was 6.8% (56/822). Among the cases mean age was 44 years, 18% were women and mean CD4 counts was 107 cells/microl. Among the controls mean age was 41 years, 18% were women and mean CD4 counts ...
Human papillomavirus (HPV) causes cervical, head, and neck cancers. We studied 483 patients at a ... more Human papillomavirus (HPV) causes cervical, head, and neck cancers. We studied 483 patients at a youth clinic in Stockholm, Sweden, and found oral HPV prevalence was 9.3% and signifi cantly higher for female youth with than without cervical HPV infection (p = 0.043). Most oral HPV types matched the co-occurring cervical types.
1Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research Institute, ... more 1Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research Institute, Jubilee Hills, Hyderabad, Telangana, India 2Dean of Basic Sciences, American University School of Medicine Aruba, USA Office: 1172 Satellite Blvd, Suwanee, Georgia 30024, Aruba Campus: Wilhelminastraat 59, Oranjestad, Aruba 3Dean, Professor, Department of Medicine, Apollo Institute of Medical Sciences and Research, Jubilee Hills, Hyderabad, Telangana, India 4Asst. Vice President operations in Emirates Healthcare group.Dubai,UAE, 5Department of Pharmacology, , American University School of Medicine Aruba, USA Office: 1172 Satellite Blvd, Suwanee, Georgia 30024,Aruba Campus: Wilhelminastraat 59, Oranjestad, Aruba 6Professor of Microbiology, Clinical & Diagnostic Microbiologist, Department of Microbiology, Deccan college of Medical Science, Hyderabad, TS, India 7Assistant Professor,Department of Epidemiology and Biostatistics, American University School of Medicine Aruba, 8Department of Res...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2010
The microscopic observation drug susceptibility (MODS) assay is a rapid, sensitive, low-cost liqu... more The microscopic observation drug susceptibility (MODS) assay is a rapid, sensitive, low-cost liquid culture technique. To establish the accuracy of MODS for the detection of active pulmonary tuberculosis (TB), and to document the costs and challenges of setting up this assay in a low-income setting. Prospective blinded pilot study of 200 adult TB suspects at a tertiary referral hospital in India. Reference standard included culture (Löwenstein-Jensen and automated liquid culture) and clinical diagnosis. Patients were mostly male (n = 122, 61.1%) and out-patients (n = 184, 92.0%), with a mean age of 40.4 years (standard deviation 16.2). Seventeen (8.5%) were human immunodeficiency virus infected and 47 (23.5%) were reference culture-positive. Compared to reference culture, MODS was 78.9% sensitive (95%CI 62.2-90.0) and 96.7% specific (95%CI 92.0-98.8). Clinical assessment suggested that MODS was false-negative in 3/8 reference culture-positive MODS-negatives and true-positive in 4/6 ...
Context Stroke tops the list of causes for acquired disability among adults and is the second le... more Context Stroke tops the list of causes for acquired disability among adults and is the second leading cause of death worldwide. Evidence from developed countries indicate significant decline in stroke incidence and mortality, attributable to prevention of risk factors in general population. There is limited evidence on risk factors for stroke in rural India. Aims This study aims to ascertain the risk factors for stroke in rural Telangana and provide a guide to health care providers in adopting treatment and prevention strategies. Settings and Design The study was conducted in the Moinabad mandal of Ranga Reddy District, Telangana state of India. This is a population based unmatched case–control study. Methods and Materials All the houses of Moinabad were approached by a door-to-door survey to identify cases. A total of 288 persons were enrolled in the study which included 144 cases and 144 controls. Statistical Analysis To derive age and gender adjusted odds ratios of various r...
Introduction: Tuberculosis (TB) is a potentially life threatening disease with the majority of th... more Introduction: Tuberculosis (TB) is a potentially life threatening disease with the majority of the cases occurring in developing countries including India. Treatment is widely available through the WHO recommended Directly Observed Short Course treatment Strategy (DOTS). In countries like India, TB treatment monitoring is an uphill task because of the large number of cases and due to the shortage of healthcare workforce in the country. With the meteoric rise in the usage of mobile phones in India, even amongst the rural population, outreach to patients and access to information has never been easier. Mobile phones can be of great value for remote monitoring of patients, especially in areas with shortage of healthcare workers. We performed a mobile health study to monitor TB drug treatment via short text messages (SMS) and we report the reasons for refusal to participate in a m-Health service in our setting. Methods: Consecutive TB patients seeking care and support from DOTS centres were approached to participate in the mobile health (m-Health) study to improve drug adherence. After an informed consent a semi structured questionnaire was administered. Details on demographics, information on mobile phone usage, ability to read and write text messages, the reasons for refusal were collected. Proportions (including percentage) were calculated. Results: We screened 157 individuals and 34% (n=53) refused to participate in the study. Among those who refused, 81% (n=43) were males, 61% (n=32) were in the age group of 18-45 years, 45% (n=25) had no formal education, 96% (n=51) of individuals had a monthly income of 5000 rupees and 77% (n=41) patients resided in an urban area. The main reason for refusal to participate in the m-Health study included not owning a mobile phone (62%, n=33) with a significant proportion among illiterates (84%, n=21, p=0.002). Out of 38% (n=20) subjects who owned a mobile phone, 80% (n=16) were unable to use the SMS facility in their mobile phones. Conclusion: Mobile phones have not reached the neediest in the society, especially among those who cannot read and write. Evaluation (field testing) of m-Health system is a pre requisite before large scale deployment of such services.
International Journal of Antimicrobial Agents, 2002
The evolution in India of multi-drug resistant pathogens possessing extended-spectrum b-lactamase... more The evolution in India of multi-drug resistant pathogens possessing extended-spectrum b-lactamases (ESBLs) threatens to compromise the clinical utility of third-generation cephalosporins and monobactams. Using selected resistant strains from a recent Indian 10 centre surveillance study that measured the prevailing incidence of resistance to b-lactam antibiotics, the potential clinical utility of meropenem was assessed against nine other antimicrobial agents. A total of 212 Gram-negative bacilli were tested, of which 125 were confirmed by reference methods to be ESBL-producers. Meropenem was the most active of the test antimicrobials against these strains and the rank order of susceptibility was meropenem (99.1% susceptible) /piperacillin/tazobactam (76.9%) / ciprofloxacin (42.5%)/aminoglycosides (34.4 Á/39.6%) 0/other b-lactams (30.0 Á/39.6%). Of the tested strains only two (Acinetobacter spp. and Pseudomonas putida) showed an intermediate susceptibility (8 mg/l) to meropenem. Of the 57 tested strains of Salmonella spp., three had an ESBL phenotype, confirmed two of the strains. This study confirms the high levels of resistance to blactams agents in India reported elsewhere and also demonstrates, for Escherichia coli and Klebsiella spp. , high levels of coresistance between the tested b-lactam agents and ciprofloxacin and the aminoglycosides, gentamicin and tobramycin. However, carbapenems such as meropenem, remain a therapeutic option.
From times immemorial, peptone, a semi digested protein is being used as a basic ingredient in mi... more From times immemorial, peptone, a semi digested protein is being used as a basic ingredient in microbiological culture media throughout the globe. Peptone hold up and broadening the growth of bacteria from small inoculate, free from ferment -able carbohydrates, has a very low content of contaminating bacteria and a very low content of copper. Keeping in view the above criteria, every effort was made to find a suitable and cost effective substitute for peptone. The use of solid media, dates back 1884,on the advice of Frau Hesse to Robert Koch who used agar as coagulate and consolidate liaison in culture media. This made him the pioneer in isolation of pure cultures. Since a long time peptones are the basic ingredients of culture media. They are the breakdown products of proteins of animal origin. The cost of 500 gm of Peptone is Rs 1999/-Because their high nutritive value they proved to be to be good as cattle feeds. At the same time they are very cheap. The vegetable proteins obtain...
Background Accurate interpretation of antibiotic susceptibility testing (AST) is one of the most ... more Background Accurate interpretation of antibiotic susceptibility testing (AST) is one of the most crucial functions of the microbiology laboratory. However, its performance depends on a number of critical factors. We conducted a status survey to understand the existing practices in Indian laboratories that have a potential to influence performance of AST. Method We developed a 22-point online survey questionnaire on information about respondent's specifications, use of AST consumables, existing quality control protocols, and matters of contention in AST practices, and sent it by Google forms to 362 clinical microbiologists (holding MD or DNB certification). Participation was voluntary. Results were analyzed using descriptive statistics. Results Among 362, a total of 103 returned the questionnaire. The first 100 responses that were complete (all 22 questions answered) were analyzed. Respondents were from medical colleges (61%), private hospitals (26%), and stand-alone laboratories (13%). Analysis revealed that the Clinical & Laboratory Standards Institute (CLSI) guidelines were followed by all. Overall, 54% used disc diffusion as the primary method for performing AST. For the internal quality control testing of media and AST, 24% and 16% had adequate testing components and frequency, respectively. For performing AST of colistin, broth microdilution was used by 19%. Also, 86% participated in external quality control programs, and 54% respondents were dissatisfied or unsure about the development of competencies in AST methodology during their postgraduate training. Conclusion This survey reveals that potential gaps exist in the performance parameters and internal quality control of AST. There is an urgent need for harmonization in AST performance and postgraduate training in clinical microbiology in India.
BackgroundCefiderocol (FDC), a novel siderophore drug, is active against gram negative bacteria p... more BackgroundCefiderocol (FDC), a novel siderophore drug, is active against gram negative bacteria producing carbapenemases, including metallo-beta-lactamases.ObjectiveTo compare the in-vitro activity of FDC with ceftazidime-avibactam (CZA), CZA/ aztreonam (AT) combination and colistin (CST), in clinical isolates of meropenem-resistant (MER-R) Klebsiella pneumoniae.MethodsFrom 2052 clinical specimens submitted for culture testing, 245 K. pneumoniae isolates were recovered within a six month period in 2021. 103 non-duplicate, non-outbreak, MER-R (MIC >4 μg/ml) strains were included in the study. Identification and susceptibility was performed using VITEK-2 (bioMérieux). 10 meropenem-susceptible isolates served as controls. For FDC, BMD was performed after in-house standardisation. Disc diffusion (Liofilchem, Italy) and broth microdilution (BMD; ComASP, STC, Liofilchem, Italy) were used for susceptibility testing of CZA and CST respectively. Synergy testing for CZA and aztreonam (AT) ...
Methicillin-resistant Staphylococcus aureus (MRSA) is difcult to treat with methicillin, amoxici... more Methicillin-resistant Staphylococcus aureus (MRSA) is difcult to treat with methicillin, amoxicillin, penicillin, oxacillin, and other commonly used antibiotics because of its resistance. Staphylococcus organisms rapidly develop drug resistance as many as 50% of the domiciliary and 80% of the hospital strains are now penicillin resistant. Staphylococcus aureus also show multiple drug resistance. Therefore, Staphylococcal isolates should always be tested for antimicrobial sensitivity and chronic infection should be treated by more than one drug. Before 1960,when methicillin, is the rst penicillin's-resistant penicillin's, was brought into use, about 1%of the strains of the Staphylococcus aureus were "methicillin resistant" and by 1970 in Britain their proportion has risen to about 5%.These strains are tolerant of, low therapeutic concentrations of methicillin, cloxacillin, benzyl penicillin and ampicillin.They do not destroy methicillin and cloxacillin, but most o...
Journal of The Academy of Clinical Microbiologists, 2020
With the development of carbapenemase inhibitors such as avibactam, relebactam and vaborbactam, i... more With the development of carbapenemase inhibitors such as avibactam, relebactam and vaborbactam, it has become important to detect the type of carbapenemase produced for guiding antibiotic therapy. Among the several methods available for the same, we chose lateral flow assay (Resist-3 O. K. N., Coris BioConcepts, Gembloux, Belgium) and compared it against a commercially available molecular test (Xpert Carba R assay, version 2, Cepheid, Sunnyvale, CA, USA). Sixteen clinical isolates, which were resistant to carbapenems on phenotypic testing, were selected. Fourteen of these were Klebsiella pneumoniae and two were Escherichia coli a total of 22 carbapenemases. (OXA-48-14, New Delhi metallo-beta-lactamase [NDM]-7 and K. pneumoniae carbapenemase [KPC]-1) were detected by the Carba-R assay. Six isolates (K. pneumoniae-5 and E. coli-1) had co-production of OXA-48 and NDM. Resist-3 assay detected all twenty two enzymes. The distribution of enzymes in these 16 isolates was identical to that shown by the Carba-R (100% agreement). Hence, we conclude that lateral flow immunochromatography assay is a simple, rapid and cost-effective method for the detection of carbapenemases. This would help the clinician select the appropriate antibiotic and support antibiotic stewardship in the Indian settings.
International Education and Research Journal, 2019
The origin of the word dengue is not clear. It is believed “Cramp like seizure caused by an evil ... more The origin of the word dengue is not clear. It is believed “Cramp like seizure caused by an evil spirit”. In Spanish, dengue was said to have the posture and gait of a dandy, and the disease was known as ”Dandy Fever”. Benjamin Rush, Coined the term "Break bone fever" because of the symptoms of myalgia and arthralgia. 260 peer-reviewed articles referred to dengue as "Poor man's disease. It is a severe life-threatening disease. “Dengue is a mosquito-borne infection caused by a flavivirus. Dengue fever is continuous or "saddleback" with a break on 4th or 5th day and then recrudescence; usually lasts 7-8 days Classical dengue fever is characterized by the onset of fever, malaise, headache, facial flushing, retrobulbar pain that worsens on eye movements, conjunctive suffusion and severe back ace, which is a prominent symptom. Lymphadenopathy, petechial on the soft palate and transient morbilliform skin rashes may also appear on the limbs with subsequent spr...
Little is known about the precise mechanism involved in immunity to fungal infections. Researcher... more Little is known about the precise mechanism involved in immunity to fungal infections. Researchers discovered that fungal prostaglandins, deactivate immune cells, preventing them from destroying the infection. Fungi are known to make molecules similar to those of our own immune system. Scientists found that the fungus molecules weaken the immune system, which is essential in stopping infections. Opportunistic infections like Cryptococcus which normally pose no threat, but are potentially life-threatening in those with weakened immune systems. Scientists are now working to find the other ways these fungal molecules are affecting immune cells and how the immune cells are deactivated. Antibodies against fungi and yeasts may be
Hantaviruses are known to cause haemorrhagic fever with renal syndrome in Eurasia and hantavirus ... more Hantaviruses are known to cause haemorrhagic fever with renal syndrome in Eurasia and hantavirus cardiopulmonary syndrome in the Americas. They are globally emerging pathogens as newer serotypes are routinely being reported. This review discusses hantavirus biology, clinical features and pathogenesis of hantavirus disease, its diagnostics, distribution and mammalian hosts. Hantavirus research in India is also summarised.
The Journal of the Association of Physicians of India, 2012
Antiretroviral treatment (ART) programs from low-income countries utilizing standardized ART regi... more Antiretroviral treatment (ART) programs from low-income countries utilizing standardized ART regimens, simplified approaches to clinical decision making and basic lab monitoring have reported high mortality rates. We determined the risk factors for mortality among HIV-infected adults following the initiation of ART from a single center in south India. ART-naive HIV-infected south Indian adults attending the Infectious Diseases clinic in a 2000-bed academic medical center in south India who were initiated on ART (generic, fixed-dose combinations) as per the national guidelines were followed up. Cases (32 patients who died) were compared with age and sex matched controls. Eight-hundred and twenty-two patients were started on ART from January 1, 2000 to December 31, 2008. The cumulative mortality was 6.8% (56/822). Among the cases mean age was 44 years, 18% were women and mean CD4 counts was 107 cells/microl. Among the controls mean age was 41 years, 18% were women and mean CD4 counts ...
Human papillomavirus (HPV) causes cervical, head, and neck cancers. We studied 483 patients at a ... more Human papillomavirus (HPV) causes cervical, head, and neck cancers. We studied 483 patients at a youth clinic in Stockholm, Sweden, and found oral HPV prevalence was 9.3% and signifi cantly higher for female youth with than without cervical HPV infection (p = 0.043). Most oral HPV types matched the co-occurring cervical types.
1Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research Institute, ... more 1Department of Laboratory Medicine, Apollo Institute of Medical Sciences and Research Institute, Jubilee Hills, Hyderabad, Telangana, India 2Dean of Basic Sciences, American University School of Medicine Aruba, USA Office: 1172 Satellite Blvd, Suwanee, Georgia 30024, Aruba Campus: Wilhelminastraat 59, Oranjestad, Aruba 3Dean, Professor, Department of Medicine, Apollo Institute of Medical Sciences and Research, Jubilee Hills, Hyderabad, Telangana, India 4Asst. Vice President operations in Emirates Healthcare group.Dubai,UAE, 5Department of Pharmacology, , American University School of Medicine Aruba, USA Office: 1172 Satellite Blvd, Suwanee, Georgia 30024,Aruba Campus: Wilhelminastraat 59, Oranjestad, Aruba 6Professor of Microbiology, Clinical & Diagnostic Microbiologist, Department of Microbiology, Deccan college of Medical Science, Hyderabad, TS, India 7Assistant Professor,Department of Epidemiology and Biostatistics, American University School of Medicine Aruba, 8Department of Res...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2010
The microscopic observation drug susceptibility (MODS) assay is a rapid, sensitive, low-cost liqu... more The microscopic observation drug susceptibility (MODS) assay is a rapid, sensitive, low-cost liquid culture technique. To establish the accuracy of MODS for the detection of active pulmonary tuberculosis (TB), and to document the costs and challenges of setting up this assay in a low-income setting. Prospective blinded pilot study of 200 adult TB suspects at a tertiary referral hospital in India. Reference standard included culture (Löwenstein-Jensen and automated liquid culture) and clinical diagnosis. Patients were mostly male (n = 122, 61.1%) and out-patients (n = 184, 92.0%), with a mean age of 40.4 years (standard deviation 16.2). Seventeen (8.5%) were human immunodeficiency virus infected and 47 (23.5%) were reference culture-positive. Compared to reference culture, MODS was 78.9% sensitive (95%CI 62.2-90.0) and 96.7% specific (95%CI 92.0-98.8). Clinical assessment suggested that MODS was false-negative in 3/8 reference culture-positive MODS-negatives and true-positive in 4/6 ...
Context Stroke tops the list of causes for acquired disability among adults and is the second le... more Context Stroke tops the list of causes for acquired disability among adults and is the second leading cause of death worldwide. Evidence from developed countries indicate significant decline in stroke incidence and mortality, attributable to prevention of risk factors in general population. There is limited evidence on risk factors for stroke in rural India. Aims This study aims to ascertain the risk factors for stroke in rural Telangana and provide a guide to health care providers in adopting treatment and prevention strategies. Settings and Design The study was conducted in the Moinabad mandal of Ranga Reddy District, Telangana state of India. This is a population based unmatched case–control study. Methods and Materials All the houses of Moinabad were approached by a door-to-door survey to identify cases. A total of 288 persons were enrolled in the study which included 144 cases and 144 controls. Statistical Analysis To derive age and gender adjusted odds ratios of various r...
Introduction: Tuberculosis (TB) is a potentially life threatening disease with the majority of th... more Introduction: Tuberculosis (TB) is a potentially life threatening disease with the majority of the cases occurring in developing countries including India. Treatment is widely available through the WHO recommended Directly Observed Short Course treatment Strategy (DOTS). In countries like India, TB treatment monitoring is an uphill task because of the large number of cases and due to the shortage of healthcare workforce in the country. With the meteoric rise in the usage of mobile phones in India, even amongst the rural population, outreach to patients and access to information has never been easier. Mobile phones can be of great value for remote monitoring of patients, especially in areas with shortage of healthcare workers. We performed a mobile health study to monitor TB drug treatment via short text messages (SMS) and we report the reasons for refusal to participate in a m-Health service in our setting. Methods: Consecutive TB patients seeking care and support from DOTS centres were approached to participate in the mobile health (m-Health) study to improve drug adherence. After an informed consent a semi structured questionnaire was administered. Details on demographics, information on mobile phone usage, ability to read and write text messages, the reasons for refusal were collected. Proportions (including percentage) were calculated. Results: We screened 157 individuals and 34% (n=53) refused to participate in the study. Among those who refused, 81% (n=43) were males, 61% (n=32) were in the age group of 18-45 years, 45% (n=25) had no formal education, 96% (n=51) of individuals had a monthly income of 5000 rupees and 77% (n=41) patients resided in an urban area. The main reason for refusal to participate in the m-Health study included not owning a mobile phone (62%, n=33) with a significant proportion among illiterates (84%, n=21, p=0.002). Out of 38% (n=20) subjects who owned a mobile phone, 80% (n=16) were unable to use the SMS facility in their mobile phones. Conclusion: Mobile phones have not reached the neediest in the society, especially among those who cannot read and write. Evaluation (field testing) of m-Health system is a pre requisite before large scale deployment of such services.
International Journal of Antimicrobial Agents, 2002
The evolution in India of multi-drug resistant pathogens possessing extended-spectrum b-lactamase... more The evolution in India of multi-drug resistant pathogens possessing extended-spectrum b-lactamases (ESBLs) threatens to compromise the clinical utility of third-generation cephalosporins and monobactams. Using selected resistant strains from a recent Indian 10 centre surveillance study that measured the prevailing incidence of resistance to b-lactam antibiotics, the potential clinical utility of meropenem was assessed against nine other antimicrobial agents. A total of 212 Gram-negative bacilli were tested, of which 125 were confirmed by reference methods to be ESBL-producers. Meropenem was the most active of the test antimicrobials against these strains and the rank order of susceptibility was meropenem (99.1% susceptible) /piperacillin/tazobactam (76.9%) / ciprofloxacin (42.5%)/aminoglycosides (34.4 Á/39.6%) 0/other b-lactams (30.0 Á/39.6%). Of the tested strains only two (Acinetobacter spp. and Pseudomonas putida) showed an intermediate susceptibility (8 mg/l) to meropenem. Of the 57 tested strains of Salmonella spp., three had an ESBL phenotype, confirmed two of the strains. This study confirms the high levels of resistance to blactams agents in India reported elsewhere and also demonstrates, for Escherichia coli and Klebsiella spp. , high levels of coresistance between the tested b-lactam agents and ciprofloxacin and the aminoglycosides, gentamicin and tobramycin. However, carbapenems such as meropenem, remain a therapeutic option.
From times immemorial, peptone, a semi digested protein is being used as a basic ingredient in mi... more From times immemorial, peptone, a semi digested protein is being used as a basic ingredient in microbiological culture media throughout the globe. Peptone hold up and broadening the growth of bacteria from small inoculate, free from ferment -able carbohydrates, has a very low content of contaminating bacteria and a very low content of copper. Keeping in view the above criteria, every effort was made to find a suitable and cost effective substitute for peptone. The use of solid media, dates back 1884,on the advice of Frau Hesse to Robert Koch who used agar as coagulate and consolidate liaison in culture media. This made him the pioneer in isolation of pure cultures. Since a long time peptones are the basic ingredients of culture media. They are the breakdown products of proteins of animal origin. The cost of 500 gm of Peptone is Rs 1999/-Because their high nutritive value they proved to be to be good as cattle feeds. At the same time they are very cheap. The vegetable proteins obtain...
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