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Introduction: Leprosy is a chronic granulomatous disease presents variedly depending on the patient's immune status at the time of infection. In this study, we are planning to perform a retrospective analysis to characterise the trend of Lepromatous spectrum of Hansen's disease cases registered in Tertiary care centre. To analyse the incidence,Aim: clinical patterns and variants of Lepromatous spectrum of Hansen's disease cases registered in Tertiary care centre. Objectives: To describe the epidemiological trend of Lepromatous Spectrum of Hansen's Disease and its clinical variants. A Retrospective observational study involving Lepromatous spectrum of Hansen's diseaseMethodology cases registered in leprosy clinic in last 5 years (2017-2021). Patient demographic details, duration of disease, clinical presentations , investigation details like slit skin smear, biopsy reports, treatment data was extracted from the Leprosy case register and data analysis was done in this study. 129 leprosy patients (BL-69, LL-43, Histoid-15, PureResults neuritic-2) reported during the period of 2017 to 2021[ 5 years]. 2018and 2019 had maximum number of cases approximately 30 new cases of leoromatous leprosy . Hypopigmented patches and glove & stocking anaesthesia seen in 59.8% cases, skin nodules seen in 45.7%, earlobe infiltration seen in 21.7%, epistaxis &saddle nose deformity seen in 4.3%, gynaecomastia seen in 2.2%, trophic ulcer seen in 26.1% at the time of presentation mainly involving the foot followed by hands, only nerve involvement without skin lesion present in 1.1% of cases. Claw hand was the most common deformity witnessed . The presence of Wartenberg sign was observed in 10 patients. Apart from ulnar and common peroneal nerve involvement present in 100 %of the patients, other peripheral nerves were involved in significant number of patients.All these patients showed positive acid fast bacilli in slit skin smear . Active surveillanceConclusion and early detection of the disease are imperative to prevent the spread of M. leprae. It is essential for timely implementation of treatment which will prevent deformities and disabilities. Active case detection plays the major role in early diagnosis of leprosy.
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Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial spine that can manifest with various clinical signs and symptoms. Chronic back pain and progressive spinal stiffness are the most common features of this disease. It is an autoimmune disease which also leads to the involvement of skeletal, cardiac, nervous tissues, and other systemic organs. Aim and Objectives: This study was conducted to assess the correlation between the Bath AS Disease Activity Index (BASDAI) score/visual analog scale (VAS) and various age groups in the patients suffering with AS using standard questionnaire. Materials and Methods: Forty-eight AS patients having BASDAI scores of ?4 were included in this study. The height and weight were taken and responses to the standard questionnaire were recorded. BASDAI Score, body mass index (BMI), and VAS were computed. The patients with history of chronic diseases such as hyper/hypothyroidism, diabetes mellitus, and hypertension or the use of any medication such as ?/? blockers, calcium channel blockers, and antiepileptics were excluded from the study. Results: The patients were divided into six different age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years. The mean ± SEM values of the BASDAI score in various age groups were 6.8 ± 0.34, 6.3 ± 0.33, 6.2 ± 0.26, 7.1 ± 0.41, 6.5 ± 0.30, and 5.8 ± 0.48, respectively. The mean ± SEM values of VAS are shown in relation to the various age groups, i.e., 15–20 years, 21–25 years, 26–30 years, 31–35 years, 36–40 years, and 41–45 years and the values were 6.88 ± 0.312, 6.58 ± 0.22, 6.55 ± 0.66, 6.00 ± 0.23, 6.72 ± 0.25, and 6.0 ± 0.50, respectively. Conclusion: This study indicates that in the young age group, patients BASDAI score is higher and BMI is lower, and in the older age group, patients BASDAI score is lower and BMI is higher than each other indicating higher disease activity in the younger patients than older patients. An inverse correlation between VAS and age further substantiates our previous finding.
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Aim: Irrational use of medicines is a global problem. In India, one contributing factor is the availability of a large number of fixed-dose combinations (FDCs). To improve rational use and to strengthen policies, it is important to assess the usage patterns and rationality of FDCs. Methods: This study was conducted as part of a 1-year prospective cross-sectional analysis of prescriptions in the outpatient clinics of broad specialities from 13 tertiary care hospitals across India. Five most commonly prescribed FDCs in each center were analyzed. In addition, all the prescribed FDCs were classified as per the Kokate Committee classification and it was noted whether any of the FDCs were irrational or banned as per the reference lists released by regulatory authorities. Results: A total of 4,838 prescriptions were analyzed. Of these, 2,093 (43.3%) prescriptions had at least one FDC. These 2,093 prescriptions had 366 different FDCs. Of the 366 FDCs, 241 were rational; 10 were irrational; 14 required further data generation; and the remaining 96 FDCs could not be categorized into any of the above. Vitamins and minerals/supplements, antibacterial for systemic use, and drugs for gastroesophageal reflux disease (GERD) and peptic ulcer were the most used FDCs. Conclusion: Based on the finding that some prescriptions contained irrational FDCs, it is recommended that a rigorous, regular, and uniform method of evaluation be implemented to approve/ban FDCs and that prescribers be periodically notified about the status of the bans.
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Introduction: Epidemiological data related to maternal mortality is valuable in each setup to design interventional programs to reduce the ratio favorably. This study was done to evaluate the maternal mortality rate in our hospital GGH GUNTUR from January 2020 to December 2021, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. Objectives: 1. To estimate the maternal mortality rate in GGH Guntur 2. To identify the causes associated with maternal mortality 3. To identify epidemiological risk factors for maternal mortality 4. To recommend ideas for reducing MMR to prevent maternal deaths. Methods: This is a 2-year retrospective study conducted in our hospital, GGH Guntur, Andhra Pradesh. All data presented were collected from hospital records and the causes were assessed, some of the epidemiological risk factors were identified, and maternal mortality rates were calculated. A total of 165 maternal deaths occurred. Most maternal deathsResults: occurred in the age group of 20–24 years, primi women (53.33%), women from rural areas (75.15%), and unbooked patients (95.15%). Direct causes accounted for 52.27% of maternal deaths, 28.48% of maternal deaths were due to indirect causes and 17.57% of maternal deaths were due to non-obstetric causes ( 89.65 % were due to covid-19) Conclusion: Better reporting of maternal deaths and implementation of evidence-based, focused strategies, along with effective monitoring of maternal health, emphasizes the need for regulation of the private sector and encourages further public-private partnerships and policies, as well as a robust political will and enhanced management capacity for improving maternal health, particularly in an unprecedented health crisis such as Covid-19. As a considerable number of the recorded deaths are preventable, there is substantial room for advancement.
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Introduction: Tobacco consumption is a preventable public health problem. GATS -2 survey in Tamil Nadu shows that 20% of adults use tobacco, 40% had plans to quit and 48% had made quit attempts. The purpose of the study was to assess factors associated with tobacco use; quitting plan, attempts and identify obstacles for tobacco cessation. Methods: A Cross-sectional study was done among 300 tobacco users in a suburban neighbourhood of Chen-nai and data was analysed using SPSS software. Results: Ninety five percent were smokers and 86% smoked cigarettes. 70% knew that it causes cancer and respiratory diseases. 60% planned to quit, 69% made quit attempts. Those with quit plans and health prob-lems had an increased odds (AOR of 1.02 and 1.004 respectively) of making quit attempts. Advice from health professionals (48%) and family (52%) triggered quit attempts. Stress and work pressure were obstacles for quitting (70%). Availability of therapy and professional help for tobacco cessation was known only to 49% and 14.7% respectively and none availed it. Conclusion: Awareness of health hazards of tobacco use was high. Quit attempts have increased but with high failure rates due to lack of information and access to tobacco cessation services. Provision of community and facility-based tobacco cessation services and integration with existing health programmes is the present need.
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ABSTRACT Hypoplastic coronary artery disease (HCAD) is a rare coronary artery anomaly that may be the cause of sudden death. It can involve a single or all coronary arteries. This anomaly may cause circulatory insufficiency leading to myocardial infarction. HCAD has no symptoms or may exhibit cardiovascular signs like syncope, dyspnea, chest discomfort, or dizziness. It is often diagnosed at autopsy, and early diagnosis is made with a coronary angiogram. We report HCAD as the cause of the sudden death of a 25-year-old female with a history of loss of consciousness following exertion. On autopsy, all the coronary arteries' lumen was narrowed with thin vessel walls. Histopathological examination shows an underdeveloped and missing muscular layer of the left anterior descending and circumflex coronary arteries' vascular wall. Many cases of HCAD diagnosed by radiographic imaging in living patients have been reported in the literature, but a structural anomaly of coronaries leading to HCAD has not been reported. We report a case of HCAD describing the histopathological examination findings of the vascular wall of coronary vessels illustrating the structural difference.
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Background: The five-year survival rate of oral cancer remains 50% or less despite the treatment advances. An effective screen- ing test is necessary for early detection of oral cancer. Aim: To assess the efficacy and diagnostic accuracy of centrifuged liquid-based cytology in comparison to conventional exfolia- tive cytology in normal oral mucosa and oral squamous cell carcinoma. Materials & Methods: The study population comprised of 40 individuals, equally divided into two groups: healthy individuals and previous histopathologically proven oral squamous cell carcinoma cases. Exfoliative cytology was done and the samples were processed by conventional cytology as well as by centrifuged liquid-based cytology and stained with Papanicolaou stain. Seven cytological parameters were analysed to assess the quality of slides prepared. A cytological diagnosis of the case group was also made and was compared with histopathological diagnosis to evaluate the diagnostic accuracy. Results: The present study revealed statistically significant superior results in all the cytological parameters evaluated by centri- fuged liquid-based cytology compared to conventional exfoliative cytology (P ?0.05). There was an ‘almost perfect agreement’ found between centrifuged liquid-based cytology diagnosis and histopathology (k=0.89) while only a ‘substantial agreement’ was found between conventional exfoliative cytology with histopathology (k=0.79). Conclusion: The present study summarizes that centrifuged liquid based cytology is more effective than conventional oral exfoliative cytology in screening oral cancer. Further studies with larger sample size in different oral lesions are necessary to validate the use of this cytology technique.
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Introduction: SARS-CoV-2 viral infection and the consequent COVID-19 disease rolled over the globe sweeping human lives and national health systems. Early diagnosis plays an important role in stopping its further escalation. Saliva as a Diagnostic Tool: Reverse transcription polymerase chain reaction (RT-PCR) remains the gold standard in the diag- nosis of COVID-19 disease. Nasopharyngeal/oropharyngeal swabs are the recommended specimen types for identification of viral RNA. However, false negative results may occur due to inadequate or improper oropharyngeal sampling. Saliva, as a prom- ising alternative, circumvents the limitations associated with the use of nasopharyngeal/oropharyngeal swabs and lessens the exposure risk of health care professionals. Salivaomics or salivary diagnostics includes the study of salivary proteins, salivary RNAs, salivary metabolites, salivary microR- NAs and salivary microbiota. Saliva sample collection is easy, non-invasive and more acceptable for repeat testing and can be performed by non-healthcare professionals or even be self-sampled. Recent studies suggest that the sensitivity of saliva-based SARS-CoV-2 RNA detection methods seem to be comparable to or better than that of nasopharyngeal swabs. Conclusion: This paper reviews the role of saliva in the diagnosis of covid-19 infection, with special emphasis on its advantages, limitations and clinical implications.
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Background: Oral lichen planus (OLP) is a chronic inflammatory disease for which the pathogenesis is complex and not fully understood; autoimmunity has been suggested as a causative factor. World health organization (WHO) has classified OLP as a potentially malignant lesion. Cyclooxygenase-2 (COX-2) is an inducible key enzyme that generates prostanoids which play a critical role in inflammation, immunopathology; also considered as a malignant potential marker. Aims: The present study was conducted to analyze and compare epithelial COX-2 expression in OLP clinical subtypes and normal oral mucosa to evaluate its role in the pathophysiology of the disease process. Methods: This retrospective immunohistochemistry (IHC) study was performed on tissue sections of 30 OLP and 10 normal oral mucosae for COX-2 expression. Statistical Analysis Used: Descriptive and comparative statistical methods were done using 'one-way Analysis of Variance (ANOVA), 't' and Chi-square tests. Results: All the OLP showed epithelial COX-2 expression; strong expression was noted in 80% of the OLP while normal oral mucosa sections showed no expression. Cox-2 expression was significantly higher in erosive lichen planus compared to reticular lichen planus. Conclusions: Strong expression of COX-2 in OLP suggested its important role in pathogenesis. Although COX-2 has been connected to malignant development and autoimmunity, as the malignant development in OLP is quite rare, this study suggests that increased levels of COX-2 seen here may support an autoimmune cause of the disease process.
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Background: 5-fluorouracil (5-FU) was the standard treatment care for colorectal cancer (CRC), however, its efficacy was limited due to safety concerns. Capecitabine and oxaliplatin (CAPOX) treatment was found equivalent to 5-FU in efficacy and preferred now due to easy management and convenience in administration. Hence, the present study aims to determine the efficacy and safety associated with CAPOX treatment in a real world non clinical setting. Methods: 145 treatment-naive and newly diagnosed CRC patients were recruited in the study. Each patient received oxaliplatin 130 mg/m2 infusion over 2 hours on day 1 and oral capecitabine 1000 mg/m2 in divided doses twice daily for the next 14 days of a 21-day cycle. Results: In the adjuvant setting, the observed disease-free survival rate was 62% (n=34) in the colon and 67% (n=15) in the rectum cancer patients at 2 years. The observed overall survival rate in the colon and rectal cancer was 80% (n=44) and 83% (n=18) respectively at 2 years. In the palliative setting the observed progression-free survival rate was 28% (n=13) in the colon and 33% (n=7) in rectal cancer patients at 2 years. The observed OSR at 2 years was 64% (n=30) in the colon and 67% (n=14) in the rectal cancer patients. Thrombocytopenia (17, 11.7%) and diarrhea (8, 5.5%) were the most commonly observed grade 3/4 hematological and gastrointestinal toxicities. Hand-foot syndrome and peripheral neuropathy were the major contributors for dose reduction (14, 9.6%), treatment delay (8, 5.4%), and drug discontinuation (9, 6.1%) in the study cohort. Conclusion: CAPOX treatment was found to be effective but associated with several dose-limiting toxicities.
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BACKGROUND Individuals working in the information technology (IT) industry are likely to develop lifestyle disorders. We aimed to determine the presence of defaecation-related disorders in IT personnel in Chennai. METHODS This cross-sectional, questionnaire-based study was done from June to December 2018. We included employees between 18 and 60 years of age and excluded those with <1 year stay in Chennai, pregnancy and those who sent incomplete responses. The cohort was classified as normal, irritable bowel syndrome (IBS), faecal evacuation disorder (FED) and a combination of the latter two. RESULTS The overall response rate was 95.6%. The study included 54.7% of men, and the median age was 31 years. The majority of respondents used an Indian toilet (554; 58%). Almost all (96.2%) passed stools daily, and stool consistency was soft in 59%. Based on the study criteria, 180 (18.8%) had FED, 56 (5.9%) had IBS and a small group had a combination of symptoms of IBS and FED (20; 2.1%). Respondents with symptoms of IBS had a higher proportion of comorbid states (p<0.0001), lesser stool frequency (p<0.0001) and required more toilet time (p<0.00001). CONCLUSION Over one-fourth (26.7%) of the respondents had defaecation-related issues, 18.8% had symptoms suggestive of FED and 5.6% that of IBS, often above 30 years of age.
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@#Endogenous endophthalmitis accounts for approximately 5 – 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a “string of pearls” present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally.
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Background: The pattern of burns in victims varies with the manner of infliction of burns. Age plays an important role in deciding the mortality and morbidity of burn victims. Other factors that decide the prognosis of burn victims are the total body surface area (TBSA), Depth of burns, and inhalational injury as evidenced by facial burns. Assessment of these epidemiological factors and inhalational injury can be done as a part of the initial evaluation. Such an assessment aid in resuscitation including emergent airway and decision making regarding the need for skin grafts or escharotomy. Serial measurement of total leucocyte count also helps in identifying the onset of infection and progress to septicaemia and increased mortality rates.Methods: As a part of the initial evaluation, we attempt to study the relation between TBSA, Depth of burns, facial burns, and total WBC count with mortality. A background of septicaemia was also noticed in the majority of patients.Results: For analysis, patients were divided into two groups- Survivors and Non-survivors. A fall in total WBC count coincided with the onset of sepsis and mortality. The other three factors also had a direct correlation with mortality rates.Conclusions: A scoring system constituting all the factors is essential as an initial diagnostic step and it will help in deciding early intubation, escharotomy, and aggressive fluid resuscitation.
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Obstructive Sleep Apnoea (OSA) is the most common sleep-related breathing disorder and is associated with significant morbidity. A simple but accurate tool to screen patients for OSA is needed. We wanted to compare STOP-BANG Questionnaire & Epworth Sleepiness Scale to predict the probability of OSA. MethodsA prospective observational study of 46 eligible patients was undertaken. They were assessed using SBQ & ESS & stratified as per the risk of OSA. The Apnoea Hypopnea Index (AHI) was calculated & patients were stratified into mild, moderate & severe OSA. The SBQ scores, ESS scores & AHI was then studied along with the predictive probabilities of both questionnaires in diagnosing OSA. ResultsOf the 46 patients, 89.13 % & 45.65 % were classified as high risk on the SBQ & ESS respectively. 78.26 % were diagnosed OSA on the sleep study according to AHI. SBQ had a high sensitivity to predict OSA (97.22 %) & low specificity (40 %). ESS had low sensitivity & high specificity to predict OSA being 52.78 % & 80 % respectively. ConclusionsBoth Stop-Bang questionnaire & ESS help in determining the risk of OSA. STOP-BANG is a better screening parameter due to its high sensitivity & negative predictive value.
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Interstitial Lung Diseases (ILDs) also known as diffuse parenchymal lung disease, include a group of diffuse parenchymal infiltrative lung diseases. A restrictive defect is the most frequent pulmonary abnormality in patients with pulmonary fibrosis which is the usual consequence of many ILDs. Connective tissue disorders are usually rare, but are potentially life threatening conditions. The spectrum of ILD varies from mucocutaneous symptoms, arthralgia / arthritis to impairment of pulmonary and renal function. Systemic Lupus Erythematosus (SLE), Systemic Sclerosis (SSc), Sjogren’s Syndrome (SS), inflammatory muscle diseases and overlap-syndromes are grouped together as connective-tissue disorders. Involvement of lung and its function is the most common form of interstitial lung disease, leading to high morbidity and mortality among the group of connective tissue disorders. We wanted to correlate the 6-Min Walk Distance (6MWTD) with the Pulmonary Function Test values such as % FEV1, % FVC and FEV1 / FVC, among patients with connective tissue disorder associated Interstitial Lung Disease in SRM Medical College Hospital, a tertiary care hospital in Tamilnadu, South India. MethodsThis study was done as a cross sectional analytical study among 31 patients in the Department of Respiratory Medicine, Rheumatology and General Medicine in SRM medical college and hospital. Each patient was explained the purpose of the study and the need for complete co-operation. Those who satisfied the inclusion and exclusion criteria were included. Data was collected using a structured proforma. 6-minute walk test and pulmonary function tests were performed and correlated. ResultsThere appears to be a significant correlation between 6-minute walk test, % desaturation, 6 Minute Walk Test Distance, 6 Minute Walk Test Pre BDI and 6 Minute Walk Test Post BDI with spirometry values especially with the Spirometry FEV 1 %, Spirometry FVC % and % predicted DLCO. Conclusions6MWT can be used as a useful surrogate for pulmonary function tests especially among the population where spirometry is not possible. 6MWT has good reproducibility, is simple to perform and can be used as a screening tool for Interstitial Lung Disease in connective tissue disorder patients.
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Background: Thyrotoxicosis is a clinical syndrome characterized by an excess of free thyroxine and triiodothyronine or both. One of the major and usual causes of thyrotoxicosis is Graves’ disease. Morbidity associated with the situation is very high and it demands early diagnosis and treatment. This can reduce the burden of the disease it imparts on the society. The aim of the study is to analyse the etiology, prevalence, clinical presentation, age, and sex-wise distribution of thyrotoxicosis among thyroid disorders presenting to Government Medical College, Thiruvananthapuram.Methods: It is a prospective study undertaken in tertiary care and teaching hospital over a period of one year. 2401 patients admitted in the general ward with thyroid disorders were included in the study. Definite inclusion and exclusion criteria were followed. Relevant blood tests were done in all cases.Results: On analysis of the data which were entered in excel format the prevalence of thyrotoxicosis was 2.5%. The majority of the study population was in the twenties and forties. Incidences in females were more mainly due to increased prevalence.Conclusions: By studying the etiology, prevalence, clinical presentation, age, and sex-wise distribution of Thyrotoxicosis, the disease burden in the population can be understood and early diagnosis and proper treatment can be instituted. Our study prevalence was comparable with similar studies done in other institutions.
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Aim: To isolate and identify Alcaligenes aquatilis PJS_1 from slaughter house soil samples for production of enzymatic fibrinolytic agent productionMethodology: Fibrinolytic enzyme producing bacterium was isolated from slaughter house soil samples and identified by biochemical tests and 16S rRNA sequencing. The fibrinolytic enzyme production media was optimized by various factors like energy sources, pH and temperature. Bioreactor used in the experiment was designed with suitable parameters for effective production and purification is by gel filtration chromatography. Blood clotting assay was performed to determine its anticoagulant property. Results: The isolated enzyme producing bacterium was identified as Alcaligenes aquatilis PJS_1. The medium with fructose and urea at pH 7.0 was found to have optimum production when incubated for 24 hr at 37ºC. The crude enzyme was purified by acetone precipitation followed by gel filtration chromatography. The enzyme showed a final specific activity of 629.32 Umg-1 with of 88.24% yield Interpretation: The present study provides information that the enzyme produced by Alcaligenes aquatilis PJS_1 acts as an effective fibrinolytic agent
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Background: Acetaminophen commonly called as paracetamol is the most used ‘over-the-counter’ analgesic for headache, musculoskeletal pain, dysmenorrhoea etc. It is the best drug to be used as antipyretic for fever due to any cause and safest to be prescribed in all age groups. Antipyretic dose of acetaminophen is 325 to 650 mg; 3 to 4 times a day and is available in the strength of 650 mg and 500 mg tablets. This study was conducted to analyse the antipyretic efficacy and safety profile of two different doses of acetaminophen in patients with low grade fever.Methods: 300 hospitalised patients aged more than 18 years, in department of General Medicine, having low grade fever (38º to 39º C) were randomly allocated into two groups of 150 each, group A received 500 mg and group B received 650 mg of single oral dose of acetaminophen tablets. Oral temperature was measured before dosing, 30 minutes after dosing, one hour, two hourlies thereafter for 6 hours after the dose. Safety was assessed by monitoring for adverse effects during the study and 24 hours after administration of the assigned drug.Results: There was a statistically significant decrease in temperature in group B patients from baseline 39.06±0.87º C to 37.02±0.89º C at the end of 6th hour as compared with 39.18±0.80º C to 38.03±0.77º C in Group A patients (p=0.031).Conclusions: Our study concluded that acetaminophen in a dose of 650 mg is highly efficacious antipyretic drug compared to acetaminophen 500 mg with no adverse effects.
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BACKGROUND Candida species is one of the most common causes of bloodstream infections among neonates and accounts for 9-13% of such infections. Non-albicans Candida have emerged as important opportunistic pathogens, notably C. tropicalis, C. glabrata, C. parapsilosis and C. krusei. With the introduction of antifungal agents, the causes of Candida infections shifted from an almost complete dominance of Candida albicans to the common involvement of Candida glabrata and other non-albicans Candida species.METHODSThis prospective, microbiological observational study was conducted in a tertiary care hospital for one and a half years from July 2016 to December 2017. Blood samples of neonates collected into Bactec Peds Plus/F Culture vials of an automated blood culture system (Bactec 9120, Becton Dikinson, USA) from clinically suspected cases of neonatal septicaemia were subjected to culture. Detailed clinical history such as presence of respiratory distress, abdominal distension, lethargy, feed intolerance, failure to thrive, poor perfusion, history of convulsions, duration of NICU stay and antibiotic use was taken from the medical records. The Candida species isolated were identified using standard mycological techniques. RESULTSOut of the total 250 clinically suspected cases of neonatal septicaemia, fungal growth was positive in 30 (12%) cases. Candida albicans accounted for 10% and non albicans Candida accounted for 90% of the fungal isolates. Candida glabrata (73.33%) was the commonest species followed by Candida tropicalis (16.67%) and Candida albicans (10%). Failure to thrive (60%), lethargy (50%) and respiratory distress (30%) were the most common clinical presentations seen, followed by feed intolerance (26.67%), abdominal distension (13.33%) and fever (10%). Among the risk factors observed for neonatal candidemia, low birth weight (76.67%) and prematurity (73.33%) were commonest followed by broad spectrum antibiotic use (66.67%), total parenteral nutrition (53.3%), ventilator support (36.67%) and indwelling catheters (26.67%).CONCLUSIONSNon-albicans Candida has emerged as an important pathogen causing neonatal septicaemia. Fungal sepsis is more common among preterm, low birth weight infants, those with prolonged antibiotic use and those on total parenteral nutrition. Candida glabrata caused the highest number of cases of fungal septicaemia
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Epidemiological studies based on molecular methods for identification of Plasmodium vivax and Plasmodium falciparum is gaining importance, because the conventional methods like microscopy, cannot detect low-level parasitaemia and mixed infections. Even though different types of laboratory investigations for diagnosing malaria-like rapid antigen detection and QBC were developed, still there are some negative interpretations among convalescent cases identified in endemic areas. These issues can be overcome by using molecular techniques like multiplex PCR, nested PCR, real-time PCR and reverse transcriptase PCR. Among these methods real-time PCR has been shown to be more sensitive in studying the epidemiology of malaria. We wanted to standardize Multiplex PCR for the identification of Plasmodium species in a single reaction mix.METHODSA total of 52 blood samples were collected from suspected cases of clinical malaria which were tested for microscopy by using Leishman's stain and confirmed by conventional and multiplex PCR. Standardization of multiplex PCR for the identification of Plasmodium species in a single reaction mix was done for the diagnosis of malaria.RESULTSOut of 52 blood samples collected, about 38 (73.08 %) samples were confirmed with a multiplex PCR technique and only 34 (65.38 %) by microscopy. The four samples negative by microscopy were found to be Plasmodium falciparum. A significant correlation was found with the positive samples by conventional and standardized multiplex PCR.CONCLUSIONSMultiplex PCR is more useful for accurate diagnosis and epidemiological study for the detection of various species of the genus Plasmodium in a single-step reaction.