Demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India

Purpose: To study the demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India. Methods: This retrospective case series included review of medical records of pediatric patients (0–16 years) diagnosed with infectious keratitis in a tertiary care center of North India during December 2011 to January 2017 was done. Demographic details, predisposing factors, microbiological investigations, and clinical outcomes were analyzed. Results: In this time period, 104 eyes of 104 children had a diagnosis of infectious keratitis. Culture was obtained for all 104 eyes and was positive in eighty eight eyes (84.2%). The most common causative factor was trauma, seen in 77 eyes (74%). Bacteria was the most common agent isolated in culture (54.2%) followed by fungi (40.8%) and acanthamoeba (2.1%). Successful healing of the keratitis with appropriate medical treatment occurred in 84 (80.7%) eyes, while 13 (12.5%) eyes required therapeutic keratoplasty. Of the 80 eyes with documentation of both preliminary and final visual acuity, improvement of two lines was seen in 35 eyes (43.7%), stayed the same in and worsened in 17 eyes (21%). Mean time to resolution of infection on medical treatment for bacteria was 23.65 ± 4.78 days, fungi 32 ± 5.19 days, and acanthamoeba 53.67 ± 4.78 days. Conclusion: Gram positive organism is the most common etiological agent of keratitis in children in our study population which is in contrast to pediatric infective keratitis study conducted by Aruljyothi et al. in South India (2011--2013). Though less in number than bacterial keratitis, fungus also remains an important causative agent. Along with early diagnosis and immediate medical intervention, it is important to identify regional profile of organisms and risk factors for good visual and anatomical outcome.

Revisiting the role of the slit-skin smear in the diagnosis of Indian post-kala-azar dermal leishmaniasis

Background: Post kala azar dermal leishmaniasis (PKDL) is a neglected dermatosis that develops as a sequel to kala azar after apparent complete treatment. Being a non life threatening condition, patients often delay treatment thereby maintaining a reservoir of infection. The diagnosis of PKDL rests on the demonstration of the parasite in tissue smears, immune diagnosis by detection of parasite antigen or antibody in blood, or detection and quantitation of parasite DNA in tissue specimens. Sophisticated molecular tests are not only expensive but also need skilled hands and expensive equipment. To be useful, diagnostic methods must be accurate, simple and affordable for the population for which they are intended. Aims: This study was designed to assess functionality and operational feasibility of slit-skin smear examination. Methods: Sensitivity and specificity was evaluated by performing slit-skin smear and histo-pathological examination in 46 PKDL patients and the results were compared with the parasite load in both the slit aspirate and tissue biopsy specimens by performing quantitative Real-time PCR (Q-PCR). Results: The slit-skin smear examination was more sensitive than tissue biopsy microscopy. The parasite loads significantly differed among various types of clinical lesions (P < 0.05). The threshold of parasite load for detection by SSS microscopy was 4 parasites/μl in slit aspirate and 60 parasites/μg tissue DNA in tissue biopsy while that for tissue microscopy was 63 parasites/μl and 502 parasites/μg tissue DNA respectively. As detection of Leishmania donovani bodies may be challenging in inexperienced hands, the microscopic structure of these has been detailed along with a comprehensive discussion of pre analytical, analytical and post analytical variables affecting its identification. To facilitate the diagnosis of PKDL, some scenarios have been suggested taking into consideration the clinical, epidemiological, immunological and microscopic aspects. Conclusion: Such evidence based medicine helps minimize intuition, systematize clinical experience and provides a diagnostic rationale as sufficient grounds for a clinical decision.

Analysis of blood smear examination results of fever patients in Jiangsu Province from 2010 to 2016 / 中国血吸虫病防治杂志

To analyze the working conditions and evaluate the effectiveness of blood smear examinations in fever patients after the start of national malaria elimination program (NMEP), and explore the suitable strategy for malaria diagnosis and surveillance in NMEP, so as to provide the evidence for the development and adaptation of malaria elimination strategies and measures in Jiangsu Province.The data of malaria epidemic situation reported by network, fever patients’ blood test tables, and epidemiological surveys of malaria cases were collected and statistically analyzed by SPSS 16.0 in Jiangsu Province from 2010 to 2016.A total of 2 367 cases of malaria cases were reported from 2010 to 2016. Among the 3 691 188 person-times of fever patients tested, there were 2 252 positives (0.06%). The number of blood tests of fever patients decreased from 742 900 in 2010 to 277 000 in 2016. At the same time, the positive rate increased from 0.04% in 2010 to 0.16% in 2016. The positive rate of blood tests of fever patients in 2016 was significantly higher than that in 2010 (χ2 = 161.61, P < 0.01). From 2010 to 2016 in Jiangsu province, the centers for disease control and prevention of cities and counties, that completed the blood review within 3 days, deleted 273 negative cases. In 2010, the centers for disease control and prevention of cities and counties deleted 61 negative cases, but in 2016, the centers deleted only 14 negative cases, and the negative rate of blood review in 2010 was significantly higher than that in 2016 (χ2 = 22.99, P < 0.01).A large number of blood smear examinations have been tested in fever patients in Jiangsu Province. It not only conforms to the strong monitoring system requirements issued by World Health Organization (WHO) in malaria elimination, but also provides the evidence for no local malaria case in Jiangsu since 2012.

Prevalence and spectrum of anemia among 3920 pediatric in-patients A cross sectional study.

Background: Anemia is one the common hematological laboratory abnormality in pediatric practice. To this reason we have studied the prevalence and spectrum of anemia among pediatric in-patients whom were admitted in a tertiary care hospital in Andhra Pradesh. Materials and methods: The present cross sectional study was done in the Department of Pathology at tertiary care hospital for two years. All pediatric patients with anemia due to clinically suspected or proven cases of leukemia were included. Patients with other causes of anemia such as chronic infection and systemic disorders were excluded. The study was based on peripheral smear examination and bone marrow aspiration cytology reports. Clinical details of these patients were recorded. Anemia and leukemias were grouped and classified based on the morphological type of the FAB classification. Data was extracted from patient case records and laboratory reports. Data management was done using Microsoft excel spreadsheet and statistical analysis using SPSS-16. Actual numbers and percentages were used as descriptive statistics. Results: A total of 3920 patients were admitted in pediatric ward. Among them, 212/3920 (5.4%) were being the hematological diseases, 170/212 (80.2%) being anemic due to causes other than leukemia’s and 42/212 (19.8%) were anemia due to leukemia’s. Among the 170 cases, the anemia due to Iron, Folate and B12 deficiency was 163 cases (76.88%) of total cases and seven cases (3.31%) were hemolytic anemia’s. Among these 42 leukemia cases, acute lymphoblastic leukemia’s were 32 (76.2%) AML were 19.04% (8) and CML was 4.76% (2). Conclusion: The commonest type of anemia noticed was the microcytic hypochromic anemia due to nutritional deficiency, followed by macrocytic anemia. 20% anemias were due to leukemias. The Neeraja P, Reddy CB. Prevalence and spectrum of anemia among 3920 pediatric in-patients – A cross sectional study. IAIM, 2016; 3(4): 11-14. Page 12 commonest acute leukemia noted was ALL (L1 type). There is seasonal raise of anemia incidences was also noticed between June and September, of which cause is not known. Nutritional anemias can be preventable and treatable effectively through better mother and child health care policies.

APPLICABILITY OF ADOPTING MORPHOLOGICAL PATTERNS IN PEDIATRIC ANEMIAS AS ETIOLOGICAL INDICATORS

Background: Pediatric anemia is a global phenomenon. The magnitude of this problem gets exaggerated in developing countries like India wherein majority of the population are vulnerable since they live in rural areas and come under low socio-economic status. Though pediatric anemias can be diagnosed by simple blood tests like complete hemogram and peripheral smear examination, the evaluation of underlying etiological factor to initiate appropriate therapy involves expensive work up which may not be affordable in a rural setup. This need-based study of pediatric anemia was conducted to determine the morphological patterns of anemia by simple baseline investigations and to detect the related etiologic factor. Methodology: The probable etiological factors contributing to the anemias were diagnosed by determining the morphological patterns using simple baseline investigations like complete hemogram and peripheral blood examination and treated accordingly. Conclusion: The etiology of microcytic hypochromic anemia was found out to be iron deficiency as confirmed by serum iron profile studies. Presence of dimorphic anemia suggested combined nutritional deficiency of Iron, vitamin B12 deficiency or folate. Hemolytic anemias detected by routine hematological investigations were confirmed by serum electrophoresis. Morphological examination of red blood cells on peripheral smear examination is thus an effective, simple and cost effective method to determine the etiology of various types of anemia.

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

A microscopic examination of an appropriately prepared and well-stained blood smear by a knowledgeable laboratory professional is necessary and clinically useful in a number of circumstances and for a variety of reasons. In this article, an attempt is made to delineate the purpose and criteria for blood smear examination in a variety of circumstances that are encountered in everyday laboratory hematology practice. A blood smear scan serves to at least (a) verify the flagged automated hematology results and (b) determine if a manual differential leukocyte count needs to be performed. Blood smear examination/manual differential leukocyte count with complete blood count (CBC) provides the complete hematologic picture of the case, at least from the morphologic standpoint. Blood smear review with or without interpretation serves to ensure that no clinically significant finding is missed, besides providing diagnosis or diagnostic clue(s), particularly if and when interpreted by a physician.

Perceptions and concerns of women undergoing Pap smear examination in a tertiary care hospital of India.

Background: Cervical cancer is one of the major causes of deaths due to cancer among women in India. Pap smear is one of the best methods to detect early changes in cervix. However, there is lack of data on awareness level of women about Pap smear and various risk factors for cervical cancer. Objectives: To study the awareness about various risk factors for cervical cancer, health-seeking behavior and hygienic practices among women and to assess the distress experienced by these women before the Pap smear examination. Materials and Methods: This cross-sectional study was carried out on women coming for a Pap smear examination in a tertiary teaching hospital in New Delhi. A pretested interview schedule was used to get information after obtaining their informed consent. Results: Fifty-seven percent stated that they did not consult a doctor when they noticed the symptoms the first time. Sixty-one percent did not know what a cervical cancer is and a same percentage of women did not know what a Pap smear examination was. Older age group, Muslim and literate women had higher number of abnormal Pap smear results. Women who reported being stressed in their lives had higher number of abnormal smears as compared to women who claimed to lead a stress free life. Poor hygienic practices among these women from urban areas were also associated with abnormal Pap smear results. Conclusion: The study concluded that factors such as poor awareness, shyness, poor hygiene, and old age could be responsible for abnormal Pap smears and this needs special attention in cancer prevention activities of the government.

A pilot study of same day sputum smear examination, its feasibility and usefulness in diagnosis of Pulmonary TB.

Introduction'. A large number of tuberculosis cases are continuously being reported from India and other developing countries leading to high morbidity and mortality. In spite of many newer tests available for diagnosing a case of tuberculosis, smear microscopy of sputum is still the preferred test under programmatic conditions. The current national and international guidelines recommend two sputum smear examinations in two days for diagnosing cases of tuberculosis, which is time consuming, tedious, needs multiple visits, leading to high dropout of infectious cases. In the background of existing limitations of smear microscopy, we attempted to complete the diagnosis of tuberculosis on same day by serial collection of the spot sputum specimen and analyze its advantages, feasibility and viability. Material & Methods: The study was undertaken by the Department of Microbiology, Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases during May 2010 to April 2011. Sputum specimens were collected from 330 randomly selected tuberculosis suspects who attended OPD of hospital, patients submitted spot and home collected morning sputum sample in a standard method and spot and additional spot sputum(X- spot) collected one hour after the flrst spot sample as per the proposed front loading method. All the samples received were stained by acid fast Ziehl-Neelsen (ZN) stain and examined on the same day. The sputum sample was pooled and cultured in Lowenstein Jensen (U) media in duplicate set of bottles. The results of two different microscopic methods were compared with the gold standard culture test. Results: Out of the total 330 TB suspects, 70.60% were males and 29.39% females. The most common complaint was of cough with sputum (88.18%), chest pain (70.21%), fever (55.15%) and loss of appetite (43.03%). Upon examining the total sputum slides, 18.48 % were positive for acid fast bacilli. The smear positivity was 61/330(l8.48%) by standard methods and in proposed new method 43/330(13.03%). Sensitivity of the standard and proposed new method smear microscopy was 58.25% and 40.07% respectively and specificity was 99.55% in both the methods. Conclusion: Same day smear microscopy for diagnosing tuberculosis by a proposed new method of smear examination in the case of suspected tuberculosis seems not a promising step towards improving the quality of sputum smear examination. The results of sensitivity and specificity of the two approaches were not similar. More than eighty per cent responded in favour of same day sputum delivery system and getting result on same day. This study can be confirmed on larger scale and preference of patients can be examined in peripheral laboratory also before taking it up for consideration in the national tuberculosis programme.

Japan's national tuberculosis control strategies with economic considerations

We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese, strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.

Japan\rqs National Tuberculosis Control Strategies with Economic Considerations

We made a bibliographic search for Japanese and non-Japanese literature on tuberculosis control programs to study the current public health policies for tuberculosis control in Japan especially in regard to cost-effectiveness. Then, we compared the Japanese strategies for tuberculosis control with those in other countries including the United States, and those recommended by World Health Organization (WHO). The current trend of tuberculosis incidence in the Japanese community demonstrates major differences from the situation that had prompted installation of tuberculosis control measures several decades ago. The tuberculosis control measures should be targeted to the elderly people (over 65 years old) because of the following three aspects. (1) A continuing decline of tuberculosis in the young Japanese population, particularly children who might attain benefits from BCG immunization; (2) The enhancement of the prevalence among the elderly people who are not covered by a uniform national surveillance strategy; (3) Cost-ineffectiveness of Mass Miniature Radiography (MMR) being used as a means to screen for tuberculosis. The cost-effectiveness issue must be considered more seriously, and the WHO recommendations especially in regard with the DOTS (directly-observed treatment, short course) strategy need to be incorporated more effectively into the national program since the incidence of drug resistant tuberculosis in Japan has been recently increasing. Finally, we propose to limit BCG immunization further and to discontinue annual MMR in the young population, and instead to develop effective strategies of both active and passive case finding in the elderly through public and community health services.

A study of patients infested with trichomonas vaginalis uncovered by pap smear examination.

Pap smears examination of 5,995 woman at Cytological Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, from January 3, 1983 to February 28, 1983, revealed 216 cases (3.6%) harbouring Trichomonas vaginalis. Their ages ranged from 16-67 years with the mean age of 33.9+9.5 years. 63.9% had clinical diagnosis of check-up, 5.5% Trichomoniasis, 5.1% leucorrhea, 4.2% vaginitis and 3.7% myoma uteri. Concurrent cytological findings included mycosis 0.9%, gonorrhea 0.5%, herpes simplex progenitalis 0.9%, nonkeratinizing squamous cell carcinoma of the uterine cervix 0.9% and inflammatory cellular changes 99.5%. It is conceivable that these patients with Trichomonas vaginalis infestation ought to pursue the follow-up examination or surveillance for possible inflammatory cellular changes leading to future occurrence of or association with cervical cancer.