Acridine orange stained blood wet mounts for fluorescent detection of malaria.

The age old Romanowsky stained thick blood smear examination for malarial parasites may fail to reveal the low parasitaemia. The commercial 'QBC' like acridine orange stained capillary tube preparation has a limitation of precise species identification and the detection of extra-erythrocytic parasites. Hence, the present study was aimed to improve malarial parasite detection by using acridine orange to stain large blood drops in the form of wet coverglass mounts. The acridine orange stained blood wet mounts over 2420 suspected malaria cases from Indore city were examined under fluorescent microscope and the results compared with the Leishman's stained thick blood smears in a blind study. The positivity of malarial parasites reported by the modified acridine orange staining was 248 against 109 by Leishman's stained thick blood smears. The modified acridine orange stained method is simple, instant and more efficient, requires less scanning time and skill, allows scanning of larger blood volume (75 ul) at lower magnification and the morphological details at higher magnification helps to make the precise species identification.

Emerging bacterial drug resistance in hospital practice.

The growing multiple drug resistance among bacteria in hospital practice is posing a serious threat to the successful antimicrobial therapy. Our data on the bacterial drug resistance at a tertiary care centre during 1995-1996 has been alarming with an incidence of 73 to 99% resistance to the common antibiotics like ampicillin, chloramphenicol, cotrimoxazole and first generation cephalosporins among the gram negative isolates. The resistance to gentamicin and ciprofloxacin ranged from 53 to 79%. Resistance to amikacin, netilmicin and the third generation cephalosporins ranged from 30 to 73%. The frightening observation was the emergence of resistant isolates which were sensitive only to two drugs, sensitive only to one drug and resistant to all the available antibiotics (2.64, 17.6 and 11.5% respectively) during 1994 to 1996. Resistance among the gram positive bacteria was much less but the increase in methicillin resistant Staphylococci (52-65%) was a serious matter. The data were an eye opener and the infection control measures could bring marginal improvement in the situation in 1996. It is vehemently appealed that the national antibiotic policies be formed and be stringently implemented before we are thrown back to the pre-antibiotic era.

Aetiology and prognostic factors in hepatic failure in central India.

The present study was undertaken to establish the aetiology and prognostic factors of liver failure in central India. Of the 122 cases of hepatic failure 95 (78%), 19 (15.5%) and 8 (6.5%) were labelled as fulminant hepatic failure (FHF), chronic hepatic failure (CHF) and subacute hepatic failure (SAHF) respectively. Hepatitis E virus (HEV) and hepatitis B virus (HBV) were aetiological agents amongst 41% (n = 39) and 37% (n = 35) patients with FHF respectively. Mixed infection among such cases even though observed was infrequent and 15% (n = 14) of FHF did not have any serological markers. They were presumed to be due to non A-E viral infection. Thirty-one (33%) of the FHF patients were pregnant and 29 (94%) of them were due to HEV. Amongst patients with SAHF and CHF, HBV and HCV were important aetiological agents. The static prognostic risk factors noted in the present study are age above 40 years, presence of identifiable viral aetiology (A to E), alcoholic status in males and pregnancy particularly in the third trimester or postpartum state. Among the dynamic factors, bilirubin level above 20 mg/dl and prothrombin time over 20 seconds appeared to be the risk factors.

Immunogenicity of low dose hepatitis B vaccine by the intradermal route & persistence of anti-HBs after three years.

Plasma derived hepatitis B vaccine given intradermally (0.2 ml; 4 micrograms HBsAg) at 0, 1, 6 months to 200 health care workers, produced seroconversion in 97.5 per cent. Antibody levels to hepatitis B surface antigen (anti-HBs) crossed 1000 mIU/ml in 62 per cent while 26.5 per cent had levels of 100 to 1000 mIU/ml. Anti-HBs levels persisted in the same range in 41.7 per cent but dropped by a log in 58.3 per cent subjects at the end of 3 yr. Protective antibodies above 10 mIU/ml were documented in 93.3 per cent vaccinees after 3 yr. The 0.2 ml vaccine by intradermal (id) route was also found to give a good booster effect in another group of 27 persons who had received full dose vaccine 5 yr earlier. Thus, 0.2 ml vaccine by id route was safe, gave high seroconversion and persistent antibody levels over 3 yr and could offer effective protection at an economic cost.