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Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has become a global public health problem. The real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard test for the detection of SARS-CoV-2. However, the assay requires hours to get the final results. Therefore, antigen-based rapid assays are being used extensively to reduce the time. We have evaluated the performance of the antigen-based rapid test for the detection of SARS-CoV-2 virus in comparison with RT-PCR. Materials and methods: Nasopharyngeal and throat swabs were collected from 366 suspected patients of COVID-19 visiting our institute and subjected to qualitative RT-PCR and antigen-based rapid assays to detect the presence of SARS-CoV-2 virus. The sensitivity and specificity of the antigen-based assay were calculated in comparison with RT-PCR. Results: Compared with RT-PCR, sensitivity and specificity of the antigen-based rapid assay were observed to be 70.5% and 98.6%, respectively, in comparison with RT-PCR. However, the sensitivity of antigen-based rapid assay varied significantly with decreasing viral load. The sensitivity of the rapid antigen assay was equivalent to RT-PCR (23/23, 100%) at a higher viral load (Ct value 15�). In contrast, the antigen assay could only detect 3/21 (14.28%) samples with Ct value >30. Conclusion: The antigen-based assay could assist in the rapid screening of a large population. However, the rapid antigen assay might not detect early stages of infection represented by low viral load. Therefore, the antigen-based assay could not replace RT-PCR testing. The study reiterates that all antigen-based negative tests should be confirmed by RT-PCR.
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The aim of this study was to find out how Biomedical Waste (BMW) is disposed of in the Leh district and whether the healthcare facilities are following BMWM Rules 2016. A total of 19 health care facilities from Leh district were selected for this study. The data were collected through a semi-structured questionnaire from June 2021-August 2021. After analysis, it was found that all the health care facilities are involved in the disposal of BMW inside their premises. There is no involvement of the municipality or CBMWTF in handling BMW in Leh district. All the healthcare facilities have adopted the BMWM Rules 2016 but only partially.
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Background: Chronic obstructive pulmonary disease (COPD) and asthma are the two most commonly seen obstructive airway disorders, affecting millions of people across the world. Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) includes the patients having features of both COPD and asthma. Objectives: The objectives of the study were to evaluate spectrum of fungal infection in sputum/induced sputum/bronchoalveolar lavage (BAL) samples of ACOS patients. Materials and Methods: Our prospective study conducted on 80 patients diagnosed ACOS, in exacerbation, of either sex attending the Department of Respiratory Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, after taking permission from the ethical committee. Sputum or induced sputum or BAL sample was collected in sterile vials and sent to the microbiology department for the examination for fungal species. In microbiology, sputum/BAL samples were subjected to direct microscopic examination using KOH and cultured on Sabouraud Dextrose Agar. The culture was observed daily until 21 days for any fungal growth. Results: Out of 80 patients of ACOS, 43 were males and 37 were females. Culture results were positive for fungal species in 33 patients out of 80 patients (41.2%). Different species of fungi were cultured such as Candida (22.6%), Aspergillus flavus (5%), Aspergillus fumigatus (2.5%), Aspergillus niger (2.5%), Penicillium non-marneffei (3.8%), Trichosporon spp. (3.8%), and Geotrichum spp. (1.3%). Conclusion: Our observations show that a wide spectrum of fungal species is prevalent in respiratory tract in ACOS patients. Determination of pulmonary mycosis in ACOS is required to detect, and treat the coinfection with fungus well in time and decrease morbidity and mortality due to ACOS.
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@#Introduction: An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendontrochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI. Materials and Methods:This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater. Results: The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG. Conclusions:The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.
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Introduction: EQAS program at New Delhi under IAMM was started in January 2014 across North and North east regions of India with 217 participants, which grew up to 540 by 2018. Materials and Methods: In 2014, 4 analytes per year were sent for 3 exercises, i.e. smear culture and serology. 2018 onwards PT analytes were increased from 4 to 12 and comparative performance of techniques analysed. Results: Out of the 22 smears sent for gram staining, ZN staining, Kinyoun staining and Albert staining, completely correct results ranged between 29.55% - 79.9%, 94.3% - 99.2%, 35.5% & 93.8%, respectively. Correct results for culture isolate identification & susceptibility testing and serology exercises varied between 70 & 92.4% and 73.1 & 98.59%, respectively. In the year 2018, 470 responses were received for bacterial culture identification & antibiotic susceptibility testing out of which manual and automated systems were used by 54% & 46% and 52.5% & 47.5% participants, respectively. Techniques used in BBV assays for HBsAg, HCV & HIV found all methods like ELISA, ELFA, CLIA and Card Test performing similarly. The major challenges in running the EQA program included requirement of large amount of specimens for PT item preparation, stability in hot and humid conditions and timely delivery of PT challenges in remote parts of the country. Conclusion: A large number of the participating laboratories (77%) had an overall score of >80% for all exercises, demonstrating acceptable baseline performance of EQAS registered laboratories. However, continued EQAS participation could further improve the quality of results.
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Five Indian patients presenting with unilateral vitreous hemorrhage (VH) underwent pars plana vitrectomy (PPV) and were found to have lesions suggestive of peripheral exudative hemorrhagic chorioretinopathy (PEHCR). All eyes had extensive sub-retinal hemorrhage; three also showed an elevated mass lesion. The temporal retina anterior to the equator was the most commonly affected site. Exudative manifestations were absent in all. No recurrences occurred over a mean follow-up of 17.5 months. Although PEHCR is reported to be rare in Asians, this series demonstrates that it can present as VH in Indians as well. Unless the macula has irreversible damage, a favorable outcome can be obtained with PPV alone.
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Postoperative opacification of a hydrophilic acrylic intraocular lens (IOL) is an uncommon complication. A 57-year-old diabetic female who had undergone phacoemulsification with IOL implantation in her right eye 16 years back presented with diminution of vision in the same eye for 3 years. Significant IOL opacification was observed clinically and anterior segment optical coherence tomography clearly delineated the intraoptic deposits, sparing the haptics, and edges of the optic. IOL explant and exchange was performed leading to restoration of visual acuity to 6/9. Histochemical evaluation of the IOL confirmed that the hydrophilic acrylic IOL optic had calcium deposits.
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Purpose: The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT). Methods: A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed. Results: Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 ?m) in eyes with macular involvement than those without it (243.8 ± 19.3 ?m). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively. Conclusion: While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.
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OBJECTIVES: (1) To detect cervical intraepithelial neoplasia (CIN) using Papanicolaou test (PAP test), visual tests (visual inspection after the application of acetic acid [VIA], visual inspection after the application of Lugol’s iodine [VILI]), colposcopy, and biopsy. (2) To study the biomarker p16INK4A expression by immunostaining. MATERIALS AND METHODS: Experimental study was conducted from November 2009 to April 2011. 1500 women were screened for cancer cervix using conventional PAP test, VIA, and VILI. Sensitivity, specificity, positive, and negative predictive values of these tests were calculated individually, sequentially, and in parallel. Women having positive results underwent colposcopy and biopsy if required. p16INK4Aexpression in biopsy samples was studied using immunohistochemistry. RESULTS: All test positive cases (n = 235) underwent colposcopy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PAP with atypical squamous cells of undetermined significance (ASCUS) as cut‑off was 40%, 99.25%, 35.25%, and 99.39%; VIA was 60%, 93.06%, 8.03%, and 99.56% and VILI was 80%, 86.06%, 5.4%, and 99.76%, respectively. When PAP, VIA, and VILI were used in parallel sensitivity, specificity, PPV, and NPV improved to 100%, 85.18%, 6.38%, and 100%, respectively. Colposcopic abnormalities were detected in 83 and biopsy proven CIN in 15. p16INK4A expression was seen in eight of 15 CIN cases. CONCLUSIONS: (1) PAP test and visual techniques are complementary. (2) p16INK4Aexpression was seen in majority of CIN 2 lesions suggesting a higher grade lesion.
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Context: Antimicrobial use has been associated with increasing antimicrobial resistance. There is an urgent need for judicious use of antimicrobials. Informational feedback has been shown to result in changes in behavioural practices of physicians in certain healthcare settings. We conducted this study to see if the passive informational feedback can reduce in antimicrobial usage in a tertiary care centre. Aims: The study was undertaken to evaluate if the feedback to clinicians on their own antibiotic prescription results in any change in their antibiotic prescription habits. Settings and Design: The study was conducted at a tertiary care setting involving 33 units of different specialties. These units were split into 10 groups based on specialty and were allocated randomly to the control (16 units) and intervention (17 units) arms of the study. This study was a prospective intervention to assess the effect of prescribing feedback on clinical prescribing practices. Materials and Methods: In the intervention arm, information on resistance rates and antibiotic‑prescribing patterns was provided to all doctors. Behavioural change was assessed by comparing baseline prescribing rates of each unit with prescribing rates after the intervention. In the control arm, only information on monthly resistance rates was provided. Statistical Analysis: Change in the antimicrobial prescribing rates in the treatment group was assessed by using a Student’s t‑test. Results: The mean antibiotic use for all the specialties was 189 DDDs/100BDs. The prospective intervention did not elicit any effect on the antibiotic prescribing practices of the physicians. Low prescribers continued to prescribe antibiotics at a low rate, and high prescribers continued to prescribe at a high rate. Conclusions: In view of unfavourable results of passive intervention in the above study, active intervention may be more effective.
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Purpose: Enteric fever is a major public health problem in developing countries like India. An early and accurate diagnosis is necessary for a prompt and effective treatment. We have evaluated the diagnostic accuracy of two Rapid Salmonella‑IgM tests (Typhidot‑IgM and Enteroscreen‑IgM) as compared to blood culture in rapid and early diagnosis of enteric fever. Materials and Methods: A total of 2,699 patients’ serum samples were tested by Rapid Salmonella‑IgM tests and blood culture. Patients were divided into two groups. Test group—patients with enteric fever and blood culture positives for Salmonella Typhi; and three types of Controls, i.e. patients with non‑enteric fever illnesses, normal healthy controls and patients positive for S. Paratyphi‑ A. In addition to this we have also evaluated the significance of positive Salmonella‑IgM tests among blood culture‑negative cases. Results: The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the Typhidot‑IgM test and Enteroscreen‑IgM test considering blood culture as gold standard were 97.29% and 88.13%, 97.40% and 87.83%, 98.18% and 92.03%, 96.15% and 82.27%, respectively. Typhidot‑IgM test was found to be significantly more sensitive and specific as compared to Enteroscreen‑IgM. Among blood culture‑negative patients, Rapid Salmonella‑IgM tests detected 72.25% additional cases of enteric fever. Although the Rapid Salmonella‑IgM tests are meant to diagnose S. Typhi only, but these tests detect S. Paratyphi‑ A also. Thirty‑eight patients who were blood culture‑positive for S. Paratyphi‑ A were also positive by Rapid Salmonella‑IgM tests. Conclusion: Rapid Salmonella‑IgM tests offer an advantage of increased sensitivity, rapidity, early diagnosis and simplicity over blood culture.
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Background: Hepatitis C virus (HCV) infection causes signifi cant morbidity and mortality in patients of end stage renal disease (ESRD) on haemodialysis (HD). Stringent screening methods can help in its early diagnosis. Objective: The study addresses the utility of real-time quantitative polymerase chain reaction (RQ-PCR) in the diagnosis and monitoring of HCV infection especially on seronegative and normal serum alanine aminotransferase (ALT) HD patients. Material and Methods: This retrospective study was carried out from January 2010 to December 2012. Patients of ESRD on maintenance HD and on whom all the three assays HCV antibody serology, PCR and ALT were done were included in the study (n = 123). Group 1 (n = 57), comprised of patients with negative serology and normal ALT, and Group 2 (n = 66), had either raised ALT and or a positive or equivocal serology. Results: Out of the 123 cases studied, HCV serology was positive in 36.5% (45), ALT raised in 18.6% (23) and PCR positive in 67.4% (83) cases. PCR positivity was signifi cantly higher than serology and raised ALT. Group 2 had a signifi cantly higher PCR positivity than Group 1 (P = 0.0004), but 50.9% patients of Group 1, were also PCR positive and 69% of them had a high viral count of >8 × 105 IU/ml at the time of detection. Conclusion: Regular routine screening of HCV by RQ-PCR in ESRD patients can help in early diagnosis of HCV infection in patients with low index of suspicion.
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Awareness of the fecal carriage of ESBL bacteria is very important for the clinicians, microbiologists, infection control practitioners and epidemiologists. Worldwide, the data shows that the presence of these bacteria pose a serious threat to both community and the hospital settings. So this study for the detection of fecal carriage of ESBL producing bacteria is pertinent for framing antibiotic and infection control policy.
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AIM: To determine the socio-demographic characteristics of cancer patients. MATERIALS AND METHODS: Review of the Cancer registry, and patient interview. Information on socio-demographic profile, medical history, family history and previous treatment, if any, was retrieved from the patient. If the patient couldn’t be contacted then information was taken from pathology/radiotherapy or medical records department. RESULTS: A total of 684 patients participated in the study. More than 40% of males and 53.7% of females were illiterate, P < 0.05. The majority (33.5%) of participants were of low socioeconomic status. The most frequently reported cancer (ca) in males it was ca lung (40.9) and ca oesophagus (9.8). In females most common cancer were ca breast (23.9) followed by ca cervix (11.7).
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Demography , Family Characteristics , Female , Follow-Up Studies , Humans , India/epidemiology , Male , Middle Aged , Neoplasms/diagnosis , Neoplasms/epidemiology , Neoplasms/prevention & control , Prognosis , Registries , Socioeconomic Factors , Tertiary Care Centers , Young AdultABSTRACT
Purpose: Molecular methods which allow rapid detection of tuberculosis as well as drug resistance directly from clinical samples have become the most popular diagnostic methodology with the emergence of multidrug resistant tuberculosis. The aim of the present study was to evaluate the performance of a line probe assay, GenoType MTBDRplus for the rapid detection of Mycobacterium tuberculosis and mutations causing rifampicin and INH resistance directly in smear positive pulmonary specimens and also in M. tuberculosis isolates grown from various clinical specimens. Materials and Methods: The MTBDRplus assay was done directly on 37 smear positive pulmonary specimens and also on 69 M. tuberculosis isolates obtained by rapid automated culture using Bact/Alert 3D. The results were compared with phenotypic drug susceptibility testing (1% proportion method) using Bact/Alert 3D. Results: The sensitivity and specificity for detection of resistance to rifampicin was 100% and 97.3%, and to INH was 91.9% and 98.4%, respectively, in comparison with the phenotypic drug susceptibility testing. Conclusion : MTBDRplus assay had good sensitivity and specificity with turn around time of less than 48 hours. It may be a useful tool for rapid detection of multidrug resistant tuberculosis at a tertiary care centre.
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Antitubercular Agents/pharmacology , Bacteriological Techniques/methods , DNA, Bacterial/genetics , Drug Resistance, Multiple, Bacterial , Genotype , Hospitals , Humans , India , Isoniazid/pharmacology , Molecular Diagnostic Techniques/methods , Mutation, Missense , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Mycobacterium tuberculosis/isolation & purification , Rifampin/pharmacology , Sensitivity and Specificity , Tuberculosis, Multidrug-Resistant/diagnosisABSTRACT
OBJECTIVE: To evaluate all steps of pulse polio immunization on special sub national immunization day. METHODS: On a sub-national immunization day (SNID), 120 booths were randomly selected from 662 booths by probability proportionate to size (PPS) sampling technique. RESULTS: It was observed that attendance in the district level meeting was thin (30%). 34% workers were doing this work for the first time without any training. 40% of the vaccinators were neither working according to micro plan nor were same as mentioned in the micro plan. Supervision too was found deficient. CONCLUSION: In a sustained and long drawn programme like IPPI, sustaining the interest and motivation of health personnel is paramount. This paper emphasises the importance of continued re-orientation training to keep them motivated and updated.