Evaluation of Rosners index vs Brandt correction and Chang’s %, in the interpretation of mixing studies at varying dilutions

Background: For evaluation of unexplained prolongation of PT and PTT, mixing tests forms a great diagnostic tool. On mixing equal volume of patient plasma with normal pooled plasma, if there is correction it indicates factor deficiency and non-correction indicates inhibitors.Methods: Sysmex CS-5100 Coagulometer with Pathrombin SL APTT reagent, LA1 and LA2 reagents supplied by siemens were used. All data were expressed as Mean±SD. Statistical analysis was done using unpaired students t test. A p value of <0.05 was used to indicate statistical significance in all analyse.Results: APTT with (1:1) and (4:1) mixing study for detection of factor deficiency showed a sensitivity of 91% and 92% for RI, 88% and 90% for Changs %, and 75% for Brandt correction PNP aPTT + 5 secs respectively. For Inhibitors, RI shows a sensitivity of 79% and 89%, Changs 71 and 80% and Brandt test 50% for APTT (1:1) and (4:1) mix, respectively.Conclusions: Mixing tests forms an important diagnostic tool in differentiating factor deficiency from inhibitors especially in LAC patients. This study recommends mandatory use of mixing tests in LAC cases as also advocated by BSH, ISTH and CLSI. Rosners Index is more sensitive than changes % and Brandt correction in the interpretation of mixing studies. It can be safely concluded that RI can be used as a reference method for evaluation of mixing studies and its sensitivity is greatly increased by using PP4:1 PNP. It’s a matter of debate that whether these indices can be effective with other Analysers and reagents?

Increasing secondary bacterial infections with Enterobacteriaceae harboring bla(CTX-M-15) and bla(CMY-6) in patients with bronchogenic carcinoma: an emerging point of concern

OBJECTIVE@#To look for secondary bacterial infections in bronchogenic carcinoma (BC(A)) with resistant organisms harboring bla genes considering the paucity of relevant studies.@*METHODS@#A total of 137 confirmed cases of BC(A) and 34 healthy volunteers were studied for the occurrence and prevalence of bla(CTX-M) and and bla(AmpC) harboring-enterobacteriaceae. A subset of these patients (n=69) was previously reported for the secondary infection with the Aspergillus species. Bronchoalveolar lavages (BAL) were subjected for bacterial and fungal cultures and the bacterial isolates were screened by multiplex PCRs for the presence of bla(CTX-M) and bla(AmpC). The isolates were also screened for the association of insertion sequence (IS26) by PCR and characterized by RAPD for any clonal relatedness.@*RESULTS@#A total of 143 bacterial isolates were obtained from 137 BAL specimens of BC(A) patients. The Enterobacteriaceae-isolates were multidrug-resistant showing concomitant resistance to fluoroquinolones and aminoglycosides. Both bla(CTX-M) and bla(AmpC) of CIT family were detected in 77.4% and 27.4% isolates, respectively. Sequencing revealed the presence of bla(CTX-M-15) and bla(CMY-6). Twenty one percent of the isolates were simultaneously harboring bla(ampC) and bla(CTX-M-15). IS26 PCR and RAPD typing revealed the presence of diverse bacterial population but no predominant clone was identified. The present study also suggests strong association of aspergillosis with lung cancer and further strengthens the potential use of non-validated serological tests suggested earlier.@*CONCLUSIONS@#We emphasize that all patients of bronchogenic carcinoma should also be screened for secondary bacterial infections, along with secondary fungal infections, so as to introduce early and specific antimicrobial therapy and to prevent unwanted deaths.

bla(CTX-M), bla(TEM), and bla(SHV) in Enterobacteriaceae from North-Indian tertiary hospital: high occurrence of combination genes

OBJECTIVE@#To delineate the frequency of occurrence of bla(CTX-M), bla(TEM), and bla(SHV) in Enterobacteriaceae from North-Indian tertiary hospital.@*METHODS@#A random collection of a subset of 45 Escherichia coli (E. coli) and 28 Klebsiella pneumoniae (K. pneumoniae) that was resistant to a third generation cephalosporin and obtained during 2007-2008 was selected for detailed screening for bla(CTX-M), bla(TEM), and bla(SHV) by monoplex PCRs. The isolates demonstrating the presence of bla(CTX-M) alleles were characterized for the specific CTX-M-genogroup by using a multiplex PCR.@*RESULTS@#Resistance to cefoperazone, ceftazidime, ceftriaxone, cefotaxime, cefoxitin and piperacillin was 100% each in K. pneumoniae isolates, whereas these resistance-rates for E. coli isolates were 93.1%, 83.8%, 91.9%, 93.6%, 97.3% and 97.1%, respectively. Concomitant resistance to aminoglycosides, quinolones and aztreonam was also noticed. Presence of any of the bla genes (bla(CTX-M), bla(TEM), and bla(SHV)) was noticed in a total of 28 (38.4%) isolates of the 73 isolates studied. Many isolates demonstrated occurrence of these genes in various combinations. bla(CTX-M), bla(TEM), and bla(SHV) were noticed in 28.8%, 10.9% and 13.7% isolates, respectively. Multiplex PCR in bla(CTX-M) harboring isolates demonstrated the presence of CTX-M-Genogroup-1 and sequencing for the specific CTX-M-type revealed presence of CTX-M-15 type. RAPD typing showed wide diversity in isolates.@*CONCLUSIONS@#This is amongst the premier report describing the simultaneous occurrence of bla(TEM), bla(SHV), and bla(ampC) in Indian Enterobacteriaceae and that wider dissemination of these genes, as demonstrated by diversity of isolates, raises concern and emphasizes a need for extensive search for the presence of these gene pools in Indian subcontinent.

effect of magnet rod position to crystal on response function of scintillation detector NAI[T1]

The effect of the magnet rod position of [0.5mT] intensity to the Scintillation detector Nal[T1] of 3" x 3" size [consist of the crystal and the photomultiplier tube] [P.M.] has been studied in this work. Six positions have been used which they are: at the crystal face [P1], at the middle of the crystal [P2], at the end of the crystal - the photocathode [P3], at the begin of the [P.M. [P4], at the middle of [P.M.] [P5] and of its end [P6]. The Co-60 radioactive Source was used in this study via the response function of Nal[T1] detector at each position, and to do the comparison, the energy spectrum was taken without the magnet rod [W.O.]. The result shows that the total area of the spectrum decrease when the magnet rod is exist with a percentage ratio 93.1 percent at P2 position and the scattering area decrease also with 88.2 percent ratio at [P2] position too. The net area of the photopeaks [1.173 and 1.333] MeV was decrease with the existane of the magnet rod with 87.9 percent for the first peak at [P3] position and with 84.5 percent and 85.5 percent for the second peak at the position [P2] and [P4] respectively. The energy resolutions will be worse [increase in magnitude] with the existence of the magnet rod especially at [P3] and [P5] positions