ABSTRACT
Aims and objectives: To diagnose and treat the MDR Tuberculosis by XPERT MTB/RIF assay as early as possible so that transmission of infection can be minimized and To find out prevalence of MDR TB in our rural district of Maharashtra. Methods: This is a observational ,prospective study conducted over a period of 14 months ( Jan 15 to April 16 ) in the Dept. of Pulmonary Medicine, Shri Vasantrao Naik Gov.t Medical College, Yavatmal, Maharashtra. We have subjected 613 patients who fulfill the clinical criteria for RNTCP - MDRTB suspect 1.Treatment failure. 2. Retreatment case sputum positive at the end of 4 months, 3.Contact of known MDRTB case, 4.Sputum positive at diagnosis, retreatment case, 5. Any follow up sputum positive, 6.Other category (sputum negative retreatment cases), and 7. HIV-TB Cases. We have excluded all new cases (sputum positive, sputum negative and extrapulmonary cases ). With all precautions two sputum samples collected in the designated microscopy centre. One sample was subjected for routine ZN staining and other one for GENE X-PERT MTB/RIF assay. Result. Out of 613 MDR suspect subjects, 314 (51.23%) were found in the age group 30 to 50 which is economically productive age group. There were 428 (69.82%) male and 185 (30.18%) female. Out of total study patient 44 (7.18 %) were detected Rifampicin resistance by X-PERT MTB/RIF assay. Amongst MDR suspect criteria highest no (4.07 %) of Rifampicin resistant were found in Retreatment cases ( group 4 ) followed by 1.47 % in any follow up sputum positive ( group 5 ) , 0.65 % in sputum negative retreatment cases ( group 6), 0.32 % in treatment failure ( group 1 ) , 0.49 % in HIV TB cases (group7 and0.16 % in contacts of known MDR ( group 3) .There were 144 ( 23 .5 ) were co infected with HIV.TB. Conclusion: We conclude that GENE XPERT MTB /RIF assay has significant role in detecting Rifampicin resistance, patient can be started on treatment at the earliest thereby reducing morbidity, progression to XDR, mortality and transmission of MDR/XDR TB in the community can be minimized. However it has some shortcomings that it cannot detect resistance of other anti- tubercular drugs and atypical mycobacteria.[B.B.Bhadke NJIRM 2016; 7(5):33-39]
ABSTRACT
Background & Objectives: Awareness of Methicillin-resistant Staphylococcus aureus (MRSA) is still lacking in various regions of developing countries. The present study was carried out to assess the prevalence and to establish significant risk factors for colonization with MRSA in health care workers. Methods: A cross sectional study was carried out. Ninety one health care workers and were screened for MRSA by nasal swabbing. MRSA strains were detected by disc diffusion and chromogenic agar. The D test was also carried out to detect inducible clindamycin resistance. Hand hygiene practices were surveyed. Results:Twenty MRSA carriers were identified among the 91 health care workers (21.98%; CI95:13.97-31.88 %). A high prevalence was found in emergency ward (62.5 %; CI95: 24.49 -91.48 %) (p <0.05) .The surgical and orthopedic departments also showed high prevalence (54.55% and 75% respectively) (p< 0.001). Inducible clindamycin resistance was found in 20.45% samples. Chromogenic agar was found to have high sensitivity and results were similar to those of disc diffusion (p<0.001). Interpretation & Conclusion: The presence of significant risk factors aids in identification of high risk groups among hospital staff. Selective surveillance and effective lab techniques implemented in these groups will reduce the burden of MRSA in hospitals.
ABSTRACT
Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.