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GUEST EDITORIAL |
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Specimen collection methods in the diagnosis of childhood tuberculosis |
p. 249 |
BJ Marais, M Pai DOI:10.4103/0255-0857.29381 PMID:17185841 |
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REVIEW ARTICLES |
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Rotavirus vaccines |
p. 252 |
G Kang DOI:10.4103/0255-0857.29382 PMID:17185842 Rotavirus, the most common cause of severe diarrhea and a leading cause of mortality in children, has been a priority target for vaccine development for the past several years. The first rotavirus vaccine licensed in the United States was withdrawn because of an association of the vaccine with intussusception. However, the need for a vaccine is greatest in the developing world, because the benefits of preventing deaths due to rotavirus disease are substantially greater than the risk of intussusception. Early vaccines were based on animal strains. More recently developed and licenced vaccines are either animal-human reassortants or are based on human strains. In India, two candidate vaccines are in the development process, but have not yet reached efficacy trials. Many challenges regarding vaccine efficacy and safety remain. In addition to completing clinical evaluations of vaccines in development in settings with the highest disease burden and virus diversity, there is also a need to consider alternative vaccine development strategies. |
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SPECIAL ARTICLE |
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Total quality management in clinical virology laboratories |
p. 258 |
MW Tibbets, R Gomez, R Kannangai, G Sridharan DOI:10.4103/0255-0857.29383 PMID:17185843 The diagnostic laboratories in India are progressively promoting higher standards and are moving towards accreditation and international acceptance. Hence, the concept of "Quality" will need to be understood and implemented. Total quality management (TQM) in a laboratory is an integrated program involving all laboratory staff and management. TQM is a framework to operate and it is aiming for integration, consistency, increase in efficiency and a continuous drive for improvement. A well structured clinical virology service will include serology setup, cell culture facility and capacity for molecular diagnosis. The quality of results from the laboratory is significantly influenced by many pre-analytical and post-analytical factors which needed attention. The end goal of the TQM should be to provide the best care possible for the patient. |
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ORIGINAL ARTICLE |
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Candida colonization in preterm babies admitted to neonatal intensive care unit in the rural setting |
p. 263 |
DK Mendiratta, V Rawat, D Thamke, P Chaturvedi, S Chhabra, P Narang DOI:10.4103/0255-0857.29384 PMID:17185844 Purpose: Candida colonization in neonates results in significant morbidity and mortality. The purpose of this study was to determine colonization of Candida spp. in preterm babies and identify the risk factors. Methods: Swabs from oral, rectum, groin and umblicus of 103 preterm and 100 term neonates were obtained within 24 hours of birth, day three, day five, day seven and thereafter every week till the neonate was admitted in the neonatal intensive care unit (NICU). Swabs were also collected from the mother's vagina prior to delivery. Twice every month, air of the NICU was sampled by settle plate and swabs were collected from the hands of health care workers and inanimate objects of NICU. Identification and speciation was done by standard methods. Antibiotic sensitivity was studied against amphotericin B, ketoconazole and fluconazole by disk diffusion method. Results: Colonization with Candida was significantly higher in preterms. Earliest colonization was of oral mucosa and 77.1% of the preterms had colonised at various sites by the first week of life. Significant risk factors in colonized versus non-colonized preterms were male sex, longer duration of rupture of membranes (DROM), administration of steroids and antibiotics and vaginal colonization of mothers, whereas those in preterms versus terms were low birth weight and gestational age. C. albicans was the commonest species, both in the colonized preterms (45.9%) and vagina of mothers. Resistance was seen to fluconazole and ketoconazole only. No Candida spp. was isolated from health care personnel or environment. Conclusions: Colonization of preterms by Candida is a significant problem in NICU and the significant risk factors observed in colonized preterms were male sex, longer DROM, administration of steroids and antibiotics and vaginal colonization of mothers. |
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Rapid antibiotic susceptibility testing of Mycobacterium tuberculosis : Its utility in resource poor settings |
p. 268 |
A Poojary, G Nataraj, S Kanade, P Mehta, S Baveja DOI:10.4103/0255-0857.29385 PMID:17185845 Purpose: To compare the rapid colorimetric nitrate reductase based antibiotic susceptibility (CONRAS) test performed on Mycobacterium tuberculosis isolates with the conventional method i.e., the proportion method. Methods: One hundred clinical isolates of M. tuberculosis were tested for susceptibility to isoniazid (INH) and rifampicin (RIF) by the conventional proportion method and CONRAS in Middlebrook 7H9 liquid medium enriched with growth supplements (MB7H9S). Results: The performance of the CONRAS test was evaluated using proportion method as the gold standard. The sensitivity (ability to detect true drug resistance) and specificity (ability to detect true drug susceptibility) of the CONRAS test to INH was 93.75 and 98.52% and for RIF it was 96.10 and 100% respectively. The mean time for reporting was 6.3 days and the test showed excellent reproducibility. The kappa (k) value for INH was 0.92 and for RIF was 0.99, indicating excellent agreement between the two methods. Conclusions: CONRAS test is a rapid and reliable method of drug susceptibility for M. tuberculosis. |
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In-vitro susceptibility testing by agar dilution method to determine the minimum inhibitory concentrations of amphotericin B, fluconazole and ketoconazole against ocular fungal isolates
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p. 273 |
KL Therese, R Bagyalakshmi, HN Madhavan, P Deepa DOI:10.4103/0255-0857.29386 PMID:17185846 Purpose : To standardize in-vitro antifungal susceptibility testing by agar dilution method to find out the minimum inhibitory concentration (MIC) of amphotericin B, fluconazole and ketoconazole on ocular fungal isolates. Methods: A total of 180 ocular fungal isolates (130 filamentous fungi and 50 yeasts) were included. The antifungal drugs such as amphotericin B (0.0625-8 mg/mL), fluconazole (0.2-819.6 mg/mL) and ketoconazole (0.025-6.4 mg/mL) were incorporated in doubling dilutions in the yeast nitrogen base medium. The MIC was determined as the lowest concentration of the antifungal drug preventing growth of macroscopically visible colonies on drug containing plates when there was visible growth on the drug - free control plates. Results: All 50 ocular isolates of yeast were susceptible to amphotericin B, while two (4%) and five (10%) strains were resistant to fluconazole and ketoconazole respectively. Of the 130 filamentous fungi tested, six (4.6%) were resistant to amphotericin B, 49 (37.7%) and 10 (7.6%) were resistant to fluconazole and ketoconazole respectively. Percentile 50 (MIC 50) and Percentile 90 (MIC 90) for all the three antifungal agents were calculated. Aspergillus niger , Aspergillus terreus and Candida krusei were found to be resistant to fluconazole and ketoconazole. Conclusion: This technique was found to be reliable, cost effective and easy to perform with consistent results. |
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BRIEF COMMUNICATIONS |
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Serodiagnosis of dengue virus infection in patients presenting to a tertiary care hospital |
p. 280 |
M Neeraja, V Lakshmi, VD Teja, P Umabala, MV Subbalakshmi DOI:10.4103/0255-0857.29387 PMID:17185847 Dengue is an acute infectious disease of viral etiology. It is probably one of the most important arthropod borne viral disease in terms of human morbidity and mortality. The spectrum of disease ranges from self-limited dengue fever to more severe forms of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Laboratory diagnosis of dengue virus infection mainly depends on detection of virus specific antibodies. The aim of the study was to correlate the serological results with clinical presentation in patients with a diagnosis of dengue. Eleven out of 15 (73.3%) patients with DHF and DSS had secondary antibody response and mortality was 100% in these patients. |
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The clinical and microbiological correlates of premature rupture of membranes |
p. 283 |
C Karat, P Madhivanan, K Krupp, S Poornima, NV Jayanthi, JS Suguna, E Mathai DOI:10.4103/0255-0857.29388 PMID:17185848 Prematurity is the cause of 85% of neonatal morbidity and mortality. Premature rupture of the membranes (PROM) is associated with 30-40% of preterm deliveries. A case-control study conducted between July 2002 and 2003 examined the correlates and risk factors for PROM in Mysore, India. WBCs in vaginal fluid, leucocytes in urine, UTI and infection with E . coli , S . aureus , C. albicans and BV were significantly associated with PROM. BV, E. coli and WBCs in vaginal fluid were independent risk factors. Screening and treatment of BV and E. coli infection in pregnancy may reduce the risk of PROM. |
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CASE REPORTS |
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Infective endocarditis due to brucella |
p. 286 |
S Purwar, SC Metgud, A Darshan, MB Mutnal, MB Nagmoti DOI:10.4103/0255-0857.29389 PMID:17185849 One of the complications of brucellosis is infective endocarditis, which carries a high mortality rate if undiagnosed or misdiagnosed. We report a case of Brucella infective endocarditis, which was diagnosed serologically and by polymerase chain reaction. After Brucella specific treatment, patient showed dramatic improvement clinically, as evident by echocardiogram findings and other investigations. |
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Necrotizing (malignant) otitis externa: An unusual localization of mucormycosis |
p. 289 |
A Tuzcu, M Bahceci, MK Celen, N Kilinc, S Ozmen DOI:10.4103/0255-0857.29390 PMID:17185850 Malignant otitis externa (MOE) is a severe infection of external auditory canal and skull base. A 17-year-old diabetic girl was admitted with diabetic ketoacidosis. Cellulitis of her right ear occurred on the second day of hospitalization and a black necrotic scar in the same region appeared on the next day. The lesion rapidly invaded to right side of neck and surrounding tissue of the patient. Therefore, antimycotic therapy was started. Unfortunately the patient died on seventh day of hospitalization because of probably extensive fungal invasion. Physicians should suspect MOE connected to mucormycosis especially in patients with cutaneous lesions of ear unresponsive to antibiotic therapy. |
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Trichophyton violaceum : A rare isolate in 18-day-old neonate |
p. 292 |
RB Surpam, SD Deshpande, K Saraswathi, S Amladi, S Savant DOI:10.4103/0255-0857.29391 PMID:17185851 Trichophyton violaceum , a less common and geographically restricted infection is reported in a 18-day-old neonate. The diagnosis was made by potassium hydroxide of skin scraping examination and confirmed by culture. The patient was treated successfully with miconazole nitrate application. A large family with crowded living was considered the main predisposing factor. |
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Urinary tract infection by Trichosporon asahii |
p. 294 |
S Sood, D Pathak, R Sharma, S Rishi DOI:10.4103/0255-0857.29392 PMID:17185852 Trichosporon asahii is a basidiomycetous yeast which causes white piedra and onychomycosis in immunocompetent hosts as well as various localized and disseminated invasive infections in immunodeficient hosts. Urinary tract infection caused by Trichosporon asahii is rare. One month after posterior urethral valve surgery a seven-month-old male child presented with fever, severe vomiting and crying on micturition for five - to six days. Yeast-like fungus was isolated in pure cultures from three consecutive urine samples. It was identified as Trichosporon asahii using standard techniques. The response to antifungal therapy was dramatic. To the best of our knowledge this is the first report of a urinary tract infection caused by Trichosporon asahii from Western India. |
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Disseminated histoplamosis |
p. 297 |
SA Joshi, AS Kagal, RS Bharadwaj, SS Kulkarni, MV Jadhav DOI:10.4103/0255-0857.29393 PMID:17185853 A case of disseminated histoplasmosis in a 45-year-old male patient with acquired immunodeficiency syndrome (AIDS) from Pune is reported. The patient presented with high-grade fever and pain in hypochondrium. Clinical signs were pallor and hepatosplenomegaly. Bone marrow and splenic aspirate revealed numerous intracellular oval shaped yeast forms. Histoplasma capsulatum was isolated from the bone marrow and splenic aspirate.
H. capsulatum infection is an opportunistic infection usually reported from patient with AIDS in areas endemic for H. capsulatum . The present case highlights the fact that histoplasmosis could be an emerging opportunistic infection in India. |
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CORRESPONDENCE |
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Meningococcaemia: Experience at a tertiary care hospital in East Delhi |
p. 299 |
R Saha, D Gadre, M Mathur DOI:10.4103/0255-0857.29394 PMID:17185854 |
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Urinary tract infection due to Arcanobacterium haemolyticum |
p. 300 |
AM Ciraj, K Rajani, G Sreejith, KL Shobha, PS Rao DOI:10.4103/0255-0857.29395 PMID:17185855 |
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A simple modification of minimum inhibitory concentration determination by E-test in the clinical laboratory |
p. 301 |
MR Capoor, D Nair, M Deb, A Hasan, P Aggarwal DOI:10.4103/0255-0857.29396 PMID:17185856 |
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A preliminary study on the prevalence of leptospira serovars among suspected cases of leptospirosis at Tirupati, Andhra Pradesh |
p. 302 |
KK Sharma, A Gururajkumar, A Mohan, V Sivakumar, U Kalawat DOI:10.4103/0255-0857.29397 PMID:17185857 |
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Detection of biofilm |
p. 303 |
PK Maiti DOI:10.4103/0255-0857.29398 PMID:17185858 |
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Author's reply |
p. 303 |
Tarun Mathur |
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β-lactam antibiotic susceptibility testing of MRSA? |
p. 304 |
G Agrawal, SV Jalgaonkar DOI:10.4103/0255-0857.29400 PMID:17185859 |
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Authors' reply |
p. 305 |
K Rajaduraipandi |
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Can donor cornea transmit microsporidial infection? |
p. 305 |
J Joseph, PK Vaddavalli, U Gopinathan, S Sharma DOI:10.4103/0255-0857.29402 PMID:17185860 |
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Five-year follow-up of hepatitis B surface antigen positive healthy voluntary blood donors: A preliminary observation |
p. 306 |
AK Singal DOI:10.4103/0255-0857.29403 PMID:17185861 |
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SUPPLEMENT |
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Leptospirosis: Current status and future trends |
p. 309 |
RA Hartskeerl DOI:10.4103/0255-0857.29404 PMID:17185862 |
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Epidemiological patterns of leptospirosis |
p. 310 |
SC Sehgal DOI:10.4103/0255-0857.29405 PMID:17185863 |
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Understanding iron acquisition by pathogenic leptospires: A review |
p. 311 |
M Sritharan, S Asuthkar, V Sridhar DOI:10.4103/0255-0857.29406 PMID:17185864 |
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Historical perspectives in leptospirosis |
p. 316 |
WJ Terpstra DOI:10.4103/0255-0857.29407 PMID:17185865 |
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Recent advances in the laboratory diagnosis of leptospirosis and characterisation of leptospires |
p. 320 |
P Vijayachari, SC Sehgal DOI:10.4103/0255-0857.29408 PMID:17185866 |
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Clinico-epidemiological aspect of leptospirosis in South Gujarat |
p. 322 |
BK Patel, SJ Gandhi, DC Desai DOI:10.4103/0255-0857.29409 PMID:17185867 |
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Preventive measures for leptospirosis: Rodent control |
p. 325 |
AMK Mohan Rao DOI:10.4103/0255-0857.29410 PMID:17185868 |
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Seroprevalence of leptospirosis in man and animals in Tamilnadu |
p. 329 |
A Koteeswaran DOI:10.4103/0255-0857.29411 PMID:17185869 |
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Prospects of developing leptospiral vaccines for animals |
p. 331 |
SK Srivastava DOI:10.4103/0255-0857.29412 PMID:17185870 |
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Leptospirosis in Mumbai: Post-deluge outbreak 2005 |
p. 337 |
M Maskey, JS Shastri, K Saraswathi, R Surpam, N Vaidya DOI:10.4103/0255-0857.29413 PMID:17185871 |
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Iron limitation and expression of immunoreactive outer membrane proteins in Leptospira interrogans serovar icterohaemorrhagiae strain lai |
p. 339 |
S Velineni, S Asuthkar, M Sritharan DOI:10.4103/0255-0857.29414 PMID:17185872 |
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Early diagnosis of human leptospirosis by antigen detection in blood |
p. 342 |
M Nizamuddin, U Tuteja, J Shukla, L Nair, J Sudarsana DOI:10.4103/0255-0857.29415 PMID:17185873 |
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A two-year study of the efficacy of azithromycin in the treatment of leptospirosis in humans |
p. 345 |
Mohamed Ghouse, AB Maulana, M G] Mohamed Ali, VD Sarasa DOI:10.4103/0255-0857.29416 PMID:17185874 |
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Evaluation of recombinant Leptospira interrogans serovar canicola outer membrane proteins as diagnostic antigen |
p. 346 |
SK Srivastava, P Chaudhuri, E Thangapandian, R Mariya, R Amutha DOI:10.4103/0255-0857.29417 PMID:17185875 |
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Seroprevalence of leptospirosis in high risk groups in Calicut, North Kerala, India |
p. 349 |
RN Swapna, U Tuteja, L Nair, J Sudarsana DOI:10.4103/0255-0857.29418 PMID:17185876 |
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