Radiological features of dengue fever in cases and control

Background:Dengue (pronounced Dengee) fever is a painful, debilitating mosquito-borne disease caused by any one of four closely related dengue viruses. Aim of the study was to study radiological features of dengue fever in cases and control.Methods:Randomized, double blind, placebo controlled, parallel group study conducted among 100 seropositive dengue patients,18-60 years of age (fulfilling inclusion and exclusion criteria) at Lala Lajpat Rai hospital, Kanpur for December2019 October 2021. Selected patients were subjected to history, examination, necessary investigations and then were managed according to national vector borne disease control programme (NVBDCP) guidelines. A total of 100 serology proven dengue patients were included and followed up. Two groups (fifty in each) were allocated by simple first and then systematic random sampling. Case group was given doxycycline and control group was given placebo. Results:USG findings commonly seen in both the cases and control group were hepatomegaly, splenomegaly, ascites right pleural effusion, thickened GB wall and edema. In both the groups, pleural effusion was the most common complication.Conclusions: Ultrasound examinations detected plasma leakage in multiple body compartments around time of defervescence. Presence of plasma leakage in form of ascites and pleural effusion was more in control group as compared to case group seems doxycycline decrease the plasma leakage. Pleural effusion is most common finding ofplasma leakage.

Study Of Association Between Vaginal Infection And Preterm Labour

Background:Preterm birth is the most common of neonatal morbidity and mortality. 85% of neonatal morbidity and mortality is due to premature birth. A large number of studies demonstrate an association between specific organisms and preterm delivery. Material And Methods:A retrospective cohort study of pregnant women who received antenatal care between august 2017 and November 2018 at our tertiary care hospital. 70 Cases with high risk for preterm labor were included in the study and 70 cases with term labor in the control group. High vaginal swabs were collected from the posterior fornix of the vagina. Result:This study shows that there is no association of preterm labor with age, parity and numbers of previous abortions. There are high chances of preterm birth in patients with history of previous preterm birth. 48(68%) patients with preterm labor had vaginal infection in which bacterial vaginosis is more common. Other contributing factors for preterm delivery: Anaemia and lower socio-economic status. Conclusion:In this study, a significant difference in the presence of vaginal infection in patients of preterm labor and term labor was found (P<0.05).Women at risk for preterm birth or preterm premature rupture of membranes because of vaginal infections should be screened, diagnosed, treated , reevaluated, and re-treated if necessary.

Comparison of efficacy of two topical drug therapy of acne vulgaris – 1% clindamycin versus 5% dapsone: A split face comparative study

Background: Acne vulgaris is common skin problem for adolescents and young adults. Topical clindamycin is an established treatment modality effective in mild-to-moderate acne. Dapsone has been used orally for the treatment of acne but used less due to its systemic side effects. Topical dapsone may offer new treatment option for acne vulgaris due to its dual anti-inflammatory and anti-microbial effect. Aim and Objective: The aim of the study was to compare the efficacy of 1% clindamycin gel with 5% dapsone gel in the patient of Grade II acne vulgaris. Materials and Methods: It was a prospective interventional study with split face comparative study design. Each patient was received a pair of labeled tubes of medication – Right (Rt) side containing clindamycin 1% and left (Lt) side containing dapsone gel 5%. The assessment was done by calculating the change from baseline, after 4, 8, and 12 weeks of the total lesion count and both inflammatory and non-inflammatory lesions using repeated measures analysis of variance. Results: A total of 40 patients were included in the study. Both inflammatory and non-inflammatory lesion count reduce significantly at the end of 4, 8, and 12 weeks on both side (P < 0.05). Mean reduction in total count of lesions after 12 weeks of therapy by dapsone 5% was 5.4 ± 5.05 (50.0%), while by clindamycin 1% gel was 5.0 ± 2.76 (50.5%). Conclusion: Dapsone 5% gel monotherapy and clindamycin 1% gel monotherapy have almost equal efficacy when compared after 12 weeks of therapy, but dapsone 5% gel therapy is slightly better effect on inflammatory lesions than clindamycin 1% gel.

Evaluation of phytoaccumulation potential of toxic metals from sewage sludge by high- value aromatic plant geranium

Aim: The present study aimed to assess the phytoextraction potential of plant geranium (CIM BIO-171) to remove metals from sewage sludge and to investigate the growth, yield and quality of essential oil of this aromatic plant grown in contaminated sludge.Methodology: The experiment was conducted at research farm of CSIR-CIMAP, Lucknow during 2017-18 in vertical cemented column pots dug into soil. Six treatment groups of sewage sludge and soil were taken with four replication, i.e., T1-100% sewage sludge, T2-80% sewage sludge + 20% soil, T3-60% sewage sludge + 40% soil, T4-40% sewage sludge + 60% soil, T5-20% sewage sludge + 80% soil and T6-soil (only soil). Experimental soil was analysed at pre-harvest and post-harvest stage for soil characters. All plant attributes were recorded at the time of harvesting. Results: Result of the present study showed reduction in the heavy metals in the soil at harvest in comparison to the contents observed in soil at initial stage. All the parameters of growth, yield, biomass and essential oil were found to increase with the application rate of sewage sludge in geranium (CIM BIO-171). Interpretation: The results of the present study clearly indicate the phytoextraction capability of geranium plant (CIM BIO-171). Furthermore, the plants grown in contaminated sludge has all the beneficial impact on growth, yield and quality of essential oil.

Comparison of Treatment Outcome of Transforaminal and Caudal Epidural Steroid Injections for Radiating Low Back Pain

Introduction: Back pain is one of the most common reasonsfor the patients to seek emergency care. Caudal-ESI is both thesafest and the easiest epidural injection, and it does not alwaysrequire fluoroscopic guidance. Transforaminal ESI seems tobe more effective at reducing pain, improving functionality,and preventing spinal surgery, based on the data reported inprevious studies and systematic reviews. Hence; under the lightof above mentioned data the present study was undertaken forassessing and comparing the efficacy of Transforaminal andCaudal Epidural Steroid Injections Outcome for the treatmentin patients with chronic low back pain.Material and methods: A total of 20 patients with chroniclow back pain who underwent treatment with Transforaminalor caudal epidural steroid injection were enrolled in thepresent study. Patients belonged to the age group of 20-75years of age. All the patients were divided into two groupswith 10 patients in each group as follows: Group 1 includedpatients who were given injections through Transforaminalroute, while group 2 included patients who were giveninjections through caudal route. Pain relief after the epiduralsteroid injection using Visual analogue scale (VAS). Clinicalprofile of the subjects was obtained and details were filled in aproforma. All the results were summarized in Microsoft excelsheet and were analyzed by SPSS software.Results: Mean VAS at Pre-injection, Immediate Postinjection, Post-injection 1 month and Post-injection 3 monthfor subjects of group 1 was found to be 7.5, 4.3, 3.5 and 3.4respectively. Mean VAS at Pre-injection, Immediate Postinjection, Post-injection 1 month and Post-injection 3 monthfor subjects of group 1 was found to be 7.2, 5.1, 4.1 and 4.2respectively. While comparing the mean VAS among thepatients of both the study groups, at different post-treatmenttime intervals, significant results were obtained.Conclusion: Transforaminal approach demonstrated superioreffectiveness and should be performed with increasingfrequency.

Comparative study of dexmedetomidine and clonidine as an adjunct to levobupivacaine in transversus abdominis plane block in patients undergoing total abdominal hysterectomy: a randomized control study

Background: Ultrasound guided TAP block is safe, simple and effective method of providing postoperative analgesia in surgeries involving abdominal wall incision by blocking anterior branches of thoracolumbar nerves originating from T6-L1. Our aim to study the efficacy of dexmedetomidine and clonidine as an adjunct to levobupivacaine in ultrasound guided TAP block for postoperative analgesia in patients undergoing TAH.Methods: Prospective, double blind randomized control study. Ninety ASA I and II patients scheduled for TAH were randomly assigned in a double blinded study and divided into three groups. Group L received 18ml of 0.25% levobupivacaine+2ml of NS to make total volume of 20ml on each side. Group LC and Group LD received 18ml of 0.25% levobupivacaine + 1 mcg/kg of clonidine or dexmedetomidine diluted in NS to make total volume of 20ml on each side. USG guided TAP block was given when subarachnoid block level regressed to T10 level. Postoperatively patients were assessed for pain scores, HR, SBP, DBP, nausea vomiting, sedation and satisfaction scores at 0, 2, 4, 6 and 12 and 24 hours. Statistical analysis was performed using SPSS software 17. p value<0.05 was considered significant.Results: Pain scores were significantly lower in LD and LC groups as compared to L group and demand for first rescue analgesic was delayed in LD group (491.50±73.29min) and group LC (268.00±35.47min) as compared to group L (129.17±10.67min). The total number of demand doses in 24 hours were significantly less in group LD (1.00±0.00) followed by group LC (2.03±0.18) and group L (2.77±0.57) respectively. Incidence of hypotension, bradycardia and sedation was more in LD group as compared to LC and L groups.Conclusions: TAP block with dexmetomidine as an adjunct to levobupivacaine provides prolonged postoperative analgesia as compared to clonidine as an adjunct and plain levobupivacaine.

Is There Any Correlation Between Obstructive Sleepapnoeaand Body Mass Index In Hypertensive Subject

To know the any correlation in obstructive sleep apnea and body mass index in hypertensive Subjects. Obstructive sleep apnoea (OSA) is increasingly being recognized as a major health burden with a strong focus on the associated cardiovascular risk. OSA is a considered as secondary hypertension. Its episodes produce surges in systolic and diastolic pressure that keep mean blood pressure levels elevated at night. In many patients, blood pressure remains elevated during the daytime, when breathing is normal. This was a cross-sectional study conducted on 100 hypertensive subjects both male and female to evaluate the correlation between obstructive sleep apnoea and body mass index in hypertensive subjects in Department of Physiology, Department of Pulmonary Medicine and department of Medicine, at Era's Lucknow Medical College & Hospital, Era University, Lucknow. In these 100 subjects there are underweight (n=5) high risk 1 and low risk 4, Normal (n=52) high risk 18 and low risk 34 Overweight (n=33) high risk 19 and low risk 14 and Obese (n=10) high risk 4 and low risk 6. Average BMI in high risk subjects (n=42) is 25.49±3.88 and in low risk subjects (24.14±5.02) with pvalve0.150 (p>0.05). Early identification of BMI and OSA in hypertensive's subject management may reduce the development of cardiovascular risk in hypertensive subjects

Correlation Between Tsh And Body Mass Index In Male And Female Patients With Subclinical Hypothyroidism

Hypothyroidism is a syndrome resulting from thyroid hormone deficiency or rarely inefficacy. It is a common endocrinological problem affecting especially women and the elderly. Thyroid hormones play an important role in synthesis, metabolism and mobilization of lipids. One of the most important symptoms of hypothyroidism is weight gain or inability to lose weight. The rapid increase in the prevalence of obesity in the past 20 to 30 years emphasizes the important role of lifestyle and environmental factors, because genetic changes could not have occurred so rapidly. Obesity is a complicated process that depends on signals of satiety and hunger, genetics, endocrine abnormalities, and other factors. Our study purposes to investigate the relationship between BMI and thyroid function in patients of subclinical hypothyroidism. Objective of this study is to correlate thyroid stimulating hormones (TSH) and body mass index (BMI) in male and female patients with subclinical hypothyroidism. This cross sectional study included 42 Subclinical hypothyroid patients, both males and females between 20-45 years of age and without a history of alcohol or tobacco consumption, history of any cardiovascular disorders or diabetes mellitus and any drug history like corticosteroids, beta blockers. and TSH test estimated by VITROS 5600 integrated analyzer and correlated with body mass index. The results showed a positive Correlation analysis in subclinical Hypothyroid males between BMI and TSH, (r= 0.47), which was found to be statistically significant (p=0.02*) in case of subclinical Hypothyroid females the results indicated positive correlation between BMI and TSH (r= 0.58) which was found to be statistically significant (p=0.005*). A strong positive correlation between Body Mass Index (BMI) and Thyroid stimulating hormones (TSH).

A Prospective Study of Comparing Functional Outcome in Case of Meniscal Injury Treated with Arthroscopic Meniscectomy Vs Meniscal Repair

Background: A meniscal tear is the most common injury to theknee, occuring from both athletic events and activities of dailyliving. Generally, the results of repair have been good, withhigh long-term success rates. This study aims to compare thefunctional result of arthroscopic meniscal repair andarthroscopic meniscectomy.Materials & Methods: This study was carried out in theDepartment of Orthopaedics, Mahatma Gandhi MedicalCollege and Hospital, Jaipur for comparing the functionaloutcome of arthroscopic meniscectomy and meniscal repair. 47of Meniscectomy and 35 of Meniscal Repair was done in ourstudy. Statistical analysis was done using SPSS (Statisticalpackage for Social science) 16.0 software. Categoricalvariables are expressed as frequencies and percentages.Results: Our study showed that the mean age for MeniscalRepair was 32.86 vs 29.89 for Meniscectomy. There was nosignificant gender specific difference while comparing bothgroups with a p-value of 1.0. The mean follow-up for both thegroups were same of 1.2 years with a non-significant p-value of0.78. The duration of surgery was 84.5 minute in meniscalrepair as compared to 45.6 minute. There is significantdifference in surgical time required with p-value of 0.0001. Nosignificant differences for Lysholm Score and Tegner activitylevel reduction, hkss, womac and vas scores in such a shortterm follow up.Conclusion: We concluded that more randomized studies withlarger sample sizes and longer follow-up are needed to furthershow the benefits of meniscal repair in terms of patientsperceptions of the outcome and prevention of posttraumaticosteoarthritis.

Anti-albuminuric effects of spironolactone and its effect along with ramipril in type-2 diabetic nephropathy

Background: The study was conducted to evaluate and compare the protective effects of spironolactone (alone) and its effects along with ACE inhibitor (ramipril) on diabetics (30-70year) in relation to proteinuria and state of diabetic nephropathy.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70year) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Patients were divided in two groups, group A (n=28, spironolactone 25mg and ramipril 5mg) and group B (n=27, spironolactone 25mg). Subjects were followed over 12weeks and baseline and 12-week urine ACR being compared.Results: Both the group after receiving respective drug were followed for 3month duration and response were assessed by measuring urine ACR value at end of 3months. Mean values of baseline and follow up urine ACR for group A and group B were 471.5±465.62, 244.66±237.54 and 474.88±438.94, 268.42±268.16 respectively, P value found to be >0.05 at 95%C.I. It was observed that percentage reduction of urine ACR were 48% and 43.47% in group A and group B respectively.Conclusions: In the study, it was concluded that spironolactone had significant effect over proteinuria reduction over follow up period in patient with diabetic nephropathy though there was no additional statistically significant advantage of addition of spironolactone and ACE inhibitor over proteinuria reduction. Significant reduction of proteinuria occurred in both group A and group B over 12weeks follow up period, 48 % reduction in group A and 43.47% in group B. This difference proved statistically not significant after applying independent t-test.

Correlation of Maternal Age with Prevalence of Chromosomal Anomalies in Patients of Anorectal Malformation

Introduction: Aims: To identify the Anorectal malformations patients in North Indian region and then study the karyotype of these patients to evaluate cytogenetic aberrations and then correlate it with the maternal age. Subjects and Methods: Forty eight patients of anorectal malformation were selected from Department of Paediatric Surgery, KGMU, UP, Lucknow. Blood samples were collected and their cytogenetic study was done in the Department of Anatomy, KGMU-U.P, Lucknow. Karyotypes obtained were further analysed. Results: Out of 48 children enrolled in the study, karyogram could be obtained for 45 cases (93.75%). Maternal age at the time of birth of the child was <30 years in 91.1% cases. There were only 8.9% women who were >30 years of age at the time of birth of the child. However, proportion of those with anomalies was significantly higher in >30 years age group (75%) as compared to that in <30 years age group (2.4%). Conclusion: Although low maternal age was found most commonly, but number of cases with chromosomal anomalies was reported more in >30 years of age, which could be due to increased risk of congenital anomalies and malformations with advanced age.

C-cell hyperplasia in sporadic and familial medullary thyroid carcinoma

Context: C-cell hyperplasia (CCH) is characterized by increased mass of C-cells and has been identified as a precursor condition for medullary thyroid carcinoma (MTC). Varying proportion of MTCs is associated with CCH in different studies. This could be due to the lack of uniformity of the definitions and techniques used to identify CCH in these studies. Aims: This study aims to study the occurrence, clinicopathological, and immunohistochemical features of CCH in MTC diagnosed during a 22-year period at a tertiary care center in North India and to review the available literature on CCH. Materials and Methods: Eighty-seven consecutive cases of MTC were included in the study. Histological evaluation for the presence of CCH and neoplastic CCH was performed. Confirmation of CCH was done by immunohistochemistry for calcitonin and chromogranin. The presence of neoplastic CCH was correlated with clinical factors and prognostic factors. Results: Of 87 cases of MTC included in the study, 71 (82%) patients were sporadic and 16 (18%) had familial MTC. Neoplastic CCH was seen in 12 (75%) familial and in 9 (13%) sporadic MTC. Patients with familial MTC were more frequently associated with neoplastic CCH than sporadic MTC (P < 0.001), were younger (P < 0.001), and had more often bilateral and multifocal tumors (P < 0.001). However, there was no significant difference in mean survival time and progression-free survival in patients with and without CCH. Conclusion: CCH, though more common in familial MTC, can also be seen in sporadic tumors. CCH is not associated with patient survival and disease progression.

S100 proteins: An emerging cynosure in pregnancy & adverse reproductive outcome

S100 proteins are calcium (Ca2+)-binding proteins and these have an important function in progression, manifestation and therapeutic aspects of various inflammatory, metabolic and neurodegenerative disorders. Based on their involvement in intracellular or extracellular regulatory effects, S100 proteins are classified into three subgroups: one subgroup is specialized in exerting only intracellular effects, other performs both intracellular and extracellular functions and the third subgroup members only display extracellular regulatory effects. S100 proteins are expressed particularly in vertebrates and have cell-specific expression. Functionally, S100 proteins act through their surface receptors and regulate cell functions in autocrine or paracrine mode. Receptor for advanced glycation end products (RAGEs) and toll-like receptor 4 are the main surface receptors. S100 proteins participate in the regulation of cellular differentiation, proliferation, apoptosis and inflammation along with Ca2+ homeostasis, energy metabolism and cellular migration, and perform the respective functions through their interaction with transcription factors, nucleic acids, enzymes, receptors, cytoskeleton system, etc. Currently, their role in adverse pregnancy outcomes and compromised reproductive health is being explored. These proteins are present in amniotic fluid, endometrium tissue and foetal brain; therefore, it is quite likely that alterations in the expression levels of S100 family members will be affecting the particular function they are involved in and ultimately affecting the pregnancy in adverse manner. The current review discusses about an association of S100 proteins in pregnancy disorders such as endometriosis, intrauterine growth retardation and miscarriage.

Violence against resident doctors, its psychological impact and associated factors in accident & emergency department in a tertiary care institute of Haryana

Background: Violence in the healthcare setting is very common with the emergency department (ED) having the highest rate of violence in the hospital. While on one hand, the physical violence at the workplace has always been well recognized, the existence of psychological violence has been long underestimated. Materials and Methods: The study was a descriptive type of cross-sectional study conducted in 6 months in a tertiary care center of Haryana among doctors in Emergency and casualty Department. Study subjects were junior residents and senior residents posted in the emergency department. The questionnaire is a predesigned survey questionnaire formulated by ILO/ ICN/ WHO/ PSI Joint. Results: Most of the physical violence was seen in Surgery & Orthopaedics department with respective frequency of 44% & 39% respectively; while most of the verbal abuse reported in Medicine department with frequency of 33%. Most of the physical violence and verbal abuse occurred in age group of 25-29; males were more predisposed to both physical and psychological violence. Only 63% of the subjects knew about the procedures of reporting existing in the health facility. Conclusion: The study concludes that physical violence and verbal abuse are high in our institute, but majority of doctors did not know about the procedures of reporting.

Gonorrhoea diagnostics: An update.

Diagnosis of gonorrhoea is an ongoing challenge. The organism is fastidious requiring meticulous collection and transport for successful cultivation. Asymptomatic infections are common which go undetected by conventional methods thereby leading to continued transmission and the risk of complications. The nucleic acid amplification tests, now increasingly used in developed countries, offer improved sensitivity compared to bacterial culture. However, these continue to suffer sequence related problems leading to false positive and false negative results. Further, these cannot be used for generation of data on antibiotic susceptibility because genetic markers of antibiotic resistance to recommended therapies have not been fully characterised. They are unaffordable in a setting like ours where reliance is placed on syndromic approach for sexually transmitted infection (STI) management. The use of syndromic approach has resulted in a considerable decline in the number of Neisseria gonorrhoeae isolates that have been cultured for diagnostic purposes. Many laboratories formerly doing so are no longer performing culture for gonococci, and the basic skills have been lost. There is a need to not only revive this skill but also adopt newer technologies that can aid in accurate diagnosis in a cost-effective manner. There is room for innovation that can facilitate the development of a point-of-care test for this bacterial STI.

Cloning and molecular characterisation of resuscitation promoting factor-like gene from Mycobacterium avium subspecies avium.

Purpose: Resuscitation promoting factor (Rpf)-like gene of Mycobacterium avium subspecies paratuberculosis has been known to stimulate the growth of mycobacteria and enhances the recovery of replicating cells from non-replicating phases. The objective of the study was to produce recombinant rpf-like protein of M. avium subspecies avium protein for purification and physico-chemical characterisation. Materials and Methods: The identified rpf gene of M. avium subspecies avium was cloned, subcloned, sequenced and expressed in Escherichia coli expression system for the production of the recombinant protein. The expressed recombinant Rpf protein was confirmed by Western blot and the extract was purified to yield a pure recombinant protein. Results: An rpf-like gene of 675 bp size in the M. avium subspecies avium was identified. This gene was expressed and the recombinant Rpf weighed 65 kDa as confirmed by Western blot. The M. avium recombinant Rpf protein was extracted under denatured conditions and purified yielding a recombinant protein with >90% purity. Conclusions: Identification, cloning, sequencing and expression of a rpf-like gene from M. avium suggest that RpfA is present in this species also, which might be involved in reactivation phenomenon in this high-risk pathogen.

Salivary Biomarkers for Periodontal Diseases-A Review.

Second most common oral disease next to dental caries is periodontal disease. It is considered to be inflammatory disorder that damages tissue through the complex interaction between periopathogens and the host defense systems. Researchers involved in periodontal disease diagnostics are currently investigating the possible use of oral fluids, such as saliva, for disease assessment. Secretions from the major salivary glands, which have a large number of proteins and peptides, are responsible for maintaining the integrity of the oral cavity. Also, because of its importance in oral biofilm formation and host defense, secreted saliva with its biomarkers may have a significant role in the establishment and progression of periodontal disease.

Over-expression of gene encoding heat shock protein 70 from Mycobacterium tuberculosis and its evaluation as vaccine adjuvant.

Background: Heat shock proteins (Hsps) are evolutionary ancient and highly conserved molecular chaperons found in prokaryotes as well as eukaryotes. Hsp70 is a predominant member of Hsp family. Microbial Hsp70s (mHsp70s) have acquired special significance in immunity since they have been shown to be potent activators of the innate immune system and generate specific immune responses against tumours and infectious agents. Objectives: The present study was aimed to clone express and purify recombinant Hsp70 from the Mycobacterium tuberculosis and characterise it immunologically. The study also aimed at determining the potential of recombinant M. tuberculosis heat shock protein (rMTB-Hsp70) as adjuvant or antigen carrier. Materials and Methods: Cloning of M. tuberculosis heat shock protein (MTB-Hsp70) amplicon was carried out using the pGEMT-Easy vector although for expression, pProExHTb prokaryotic expression vector was used. Purification of recombinant Hsp70 was carried out by nickel-nitrilotriacetic acid (Ni-NTA) affinity chromatography. For immunological characterization and determining the adjuvant effect of MTB-Hsp70, BALB/c mice were used. The data obtained was statistically analysed. Results: Hsp70 gene was cloned, sequenced and the sequence data were submitted to National Center for Biotechnology Information (NCBI). Recombinant MTB-Hsp70 was successfully over-expressed using the prokaryotic expression system and purified to homogeneity. The protein was found to be immunodominant. Significant adjuvant effect was produced by the rMTB-Hsp70 when inoculated with recombinant outer membrane protein 31; however, effect was less than the conventionally used the Freund's adjuvant. Conclusion: Protocol standardised can be followed for bulk production of rHsp70 in a cost-effective manner. Significant adjuvant effect was produced by rMTB-Hsp70; however, the effect was than Freund's adjuvant. Further, studies need to be carried out to explore its applicability as carrier of antigen.

Emergence of decreased susceptibility to extended-spectrum cephalosporins in Neisseria gonorrhoeae in India.

Background. In the past, Neisseria gonorrhoeae has developed resistance to antimicrobial agents used for its treatment. Consequently, extended-spectrum cephalosporins form the mainstay of treatment for gonorrhoea. Methods. Samples from 88 patients attending the sexually transmitted diseases clinics from December 2009 to January 2011 in two referral hospitals in New Delhi were studied. Antimicrobial susceptibility testing was done using the disc diffusion method as per the calibrated dichotomous sensitivity technique against the following antibiotics: penicillin (0.5 i.u.), tetracycline (10 μg), nalidixic acid (30 μg), ciprofloxacin (1 μg), spectinomycin (100 μg), ceftriaxone (0.5 μg) and cefpodoxime (10 μg) (Oxoid UK). Azithromycin (15 μg) (Oxoid, UK) was tested as per the guidelines of the Clinical and Laboratory Standards Institute. Minimum inhibitory concentrations were determined using the Etest for penicillin, tetracycline, ciprofloxacin, ceftriaxone, spectinomycin and azithromycin as per the manufacturer’s instruction (Biomerieux, France). Results. Eighteen isolates of Neisseria gonorrhoeae were obtained. Three of these had decreased susceptibility to ceftriaxone and cefpodoxime by the disc diffusion method. The minimum inhibitory concentrations of ceftriaxone for two isolates were 0.064 μg/ml and for one isolate it was 0.125 μg/ml. Conclusion. Higher minimum inhibitory concentrations to extended-spectrum cephalosporins is of concern as it has been shown to precede treatment failure. This may warrant its use in increased/multiple dosages alone or possibly in combination (dual therapy), thereby complicating effective disease control. Our report is in accordance with earlier reports from different parts of the world. Therefore, a continuous surveillance of antimicrobial resistance is crucial to tailor treatment schedules for Neisseria gonorrhoeae in a particular geographical region.