Cross-country transport and isolation and identification of Streptococcus pneumoniae by use of alternate sources of blood supplemented media among laboratories in India

Background: The isolation of S. pneumoniae (Sp) depends on specimen integrity / transport, media and expertise. The non-availability of sheep blood agar poses a challenge in identification of colonial morphology and identification in India. Methods: Laboratories processed swabs containing either pure Sp or Sp in mixed cultures with a second (confounding) bacterium shipped across the country in cold conditions. Duplicate set of swabs was shipped back to the central laboratory to assess the impact of shipping on culture viability. The identical swab was cultured on sheep, human blood and one additional agar plate used in the laboratory. Results: 46/60(77%) of cultures containing only Sp were correctly identified. In specimens where Sp was present in mixed culture, the proportion of isolates in which Sp was correctly identified varied, with most variability attributed to the particular confounding organism rather than the media. There was no discernible impact of temperature-controlled (4-6°C) transport on the isolation of Sp from culture swabs. Conclusions: The study clearly elucidates the ability of laboratories for isolation of S. pneumoniae on human blood agar in resource limited settings. The results highlight the difficulties inherent in correctly identifying pathogens in mixed cultures in needs improvement using standardized tests across the study centers. The study also reaffirms the ability to transport biological specimens over long geographical distances without loss.

Technology: An aid to clinical judgement.

Complete removal of renal cell tumor with thrombus which extends above the diaphragm often necessitates use of cardiopulmonary bypass. Transesophageal echocardiography (TEE) can play an important role in delineating the extent of tumor growth. We describe a patient with renal cell carcinoma with thrombosis invading into the right ventricle and its complete removal with the aid of TEE.

Direct drug susceptibility testing of Mycobacterium tuberculosis to primary anti-tubercular drugs by nitrate reductase assay.

Objectives: Traditional drug susceptibility testing for Mycobacterium tuberculosis takes weeks and/or expensive. In this study, we evaluated nitrate reductase assay for drug susceptibility testing which is faster than the visual detection of colonies. Materials and Methods: 32 clinical specimens (direct microscopy positive for AFB with 1+, 2+ or 3+ grading) were decontaminated and the sediment was inoculated onto the L-J medium with INH or Rifampicin incorporated with Potassium nitrate and the same medium without antibiotics at 1;10 dilution as control. After 2 weeks, the control was first tested for color change with addition of nitrate reductase reagents. If found positive, the media with antibiotics were tested and compared. Futher incubation was done if the control was found to be negative. The results obtained was compared with standard direct proportion method for drug susceptibility testing. Results: Resistance of isolates as shown by both methods for INH and Rifampicin was 37.5% and 31.3% respectively. The results showed that NRA and proportion method do not differ significantly ( P < 0.05 for both drugs). Thus an excellent agreement between the results of NRA and proportion method was found for two primary anti-tubercular drugs, 87.5% for INH and 97% for Rifampicin. Conclusion: Nitrate reductase assay is a rapid and inexpensive method for susceptibility testing of M. tuberculosis for primary anti-tubercular drugs and could be an alternative to existing methods, particularly in resource poor settings.

Microbiologically influenced corrosion in petroleum product pipelines--a review.

Microbiologically influenced corrosion is responsible for most of the internal corrosion problems in oil transportation pipelines and storage tanks. One problematic area in treating gas lines is the occurrence of the stratification of water in the line. Under these conditions, corrosion inhibitors do not come into contact properly and oil and inhibitors undergo degradation. The role of bacteria on oil degradation, the consequences of oil degradation in fuel systems and its influence on corrosion have been explained in detail. Besides, factors influencing on degradation of oil and corrosion inhibitors have also been discussed. Mechanism of microbiologically influenced corrosion in oil pipeline has been explained. Many of the misapplication of biocides/inhibitors occur mainly because the characteristics of biocides/inhibitors are not considered before use in pipeline industry. List of biocides and monitoring programme have been collected from literature and presented.

A hospital based study of hepatitis E by serology.

Hepatitis E virus is recently recognised as an important cause of non-A, non-B hepatitis. A total of 569 serum samples were screened for HEV between April 1997 and March 2000, by a commercially available HEV IgM capture ELISA. The diagnosis was invariably acute viral hepatitis for differential diagnosis of jaundice. The percentage of seropositivity was found to be 18.8% in confirmed Hepatitis E cases.

Shone's Anomaly - A Case Report.

Shone's anomaly, a rare congenital cardiac malformation consists of multiple levels of left heart obstruction - supravalvar mitral ring, parachute mitral value, subaortic stenosis and coarctation of the aorta. Although they present with a wide spectrum of major anatomical and haemodynamic abnormalities, a satisfactory outcome is possible for most patients. The operative mortality and outcome is affected by the severity of mitral value disease and the need for multiple operative procedures. We report one such case with this anomaly who presented to us in the third decade. He underwent a two - stage procedure in a single sitting successfully.

Urinary IgG antibody capture particles adherence test for detecting HIV antibodies: a preliminary report.

It is known that antibodies to HIV are secreted in urine and saliva. IgG antibody capture particle adherence test (GACPAT) has been shown to provide accurate results for antibodies in urine. The aim of the study was to study the sensitivity and specificity of this test in our settings. 114 urine samples were collected from both HIV positive and HIV negative patients and were analysed using GACPAT. The test has a sensitivity of 92.3% and specificity of 100%. We feel that this test has a definite role in our country especially for surveillance purposes.

Anaesthetic management of acquired non malignant tracheo-oesophageal fistula.

Acquired non malignant tracheo-oesophageal fistula is an uncommon complication of endotracheal intubation and tracheostomy. Patients are usually diagnosed while on mechanical ventilation. The rationale of management is to prevent pulmonary contamination, maintain nutrition and achieve spontaneous ventilation prior to surgical repair. Cautious management of the airway is required during tracheal reconstruction. We present a case of non malignant tracheo-oesophageal fistula in which repair was achieved by primary closure of the tracheal and oesophageal defects.

A bypass technique for aneurysms of descending aorta.

Uniformity of opinion does not exist regarding optimal surgical strategy for descending aortic aneurysms. We present a surgical technique for bypass during aortic cross clamp while operating on such aneurysms. Five patients have undergone surgery using this technique. All of them are alive, doing well with no complications.