Reliability studies of diagnostic methods in Indian traditional Ayurveda medicine: An overview.

Recently, a need to develop supportive new scientific evidence for contemporary Ayurveda has emerged. One of the research objectives is an assessment of the reliability of diagnoses and treatment. Reliability is a quantitative measure of consistency. It is a crucial issue in classification (such as prakriti classification), method development (pulse diagnosis), quality assurance for diagnosis and treatment and in the conduct of clinical studies. Several reliability studies are conducted in western medicine. The investigation of the reliability of traditional Chinese, Japanese and Sasang medicine diagnoses is in the formative stage. However, reliability studies in Ayurveda are in the preliminary stage. In this paper, examples are provided to illustrate relevant concepts of reliability studies of diagnostic methods and their implication in practice, education, and training. An introduction to reliability estimates and different study designs and statistical analysis is given for future studies in Ayurveda.

HIV Sero-pervalence and Tuberculosis in Uttaranchal.

Setting: Patients of tuberculosis attending the out patient department of Himalayan Institute of Medical Sciences (HIMS), a post graduate institute and a large tertiary care centre in Dehradun. Objective: To study the trend of HIV seropositivity in patients of tuberculosis along with demographic profile, clinical features and associated complications, in patients of HIV-TB co-morbidity. Design: HIV seropositivity was assessed among all tuberculosis patients (pulmonary &extra-pulmonary), diagnosed between January 1999 and August 2005 attending the out patient department of HIMS. Result: HIV seropositivity in tuberculosis patients rose from 1.19% in 1999 to 4.19% in 2005. Out of total 42 HIV seropositive patients, 71.42% were males, 88.09% were married, and 69.04% belonged to rural population. Most common route of HIV transmission was heterosexual (66.67%) followed by blood transfusion (16.67%). 64.28% of the patients had pulmonary tuberculosis and 35.71% had extra-pulmonary tuberculosis. Sputum was positive for Acid Fast Bacilli in 40.74%. Fever was the most common (83.33%) symptom and oral candidiasis (40%) was the most commonly associated complication.

Choice of antibiotic for empirical therapy of acute cystitis in a setting of high antimicrobial resistance.

BACKGROUND: A high prevalence of antimicrobial resistance among urinary isolates in the Garhwal region of Uttaranchal. AIMS: To identify the most appropriate antibiotic for empirical treatment of community-acquired acute cystitis on the basis of local antimicrobial sensitivity profile. SETTINGS AND DESIGN: A prospective clinico-microbiological study including all clinically diagnosed patients with community acquired acute cystitis attending a tertiary care teaching hospital over a period of three years. METHODS AND MATERIAL: Clean-catch midstream urine specimens, from 524 non-pregnant women with community-acquired acute cystitis, were subjected to semi-quantitative culture and antibiotic susceptibility by the Kirby- Bauer disc diffusion method. A survey was also conducted on 30 randomly selected local practitioners, to know the prevalent prescribing habits in this condition. STATISTICAL ANALYSIS: The difference between the susceptibility rates of E. coli isolates to Nitrofurantoin and the other commonly prescribed antibiotics was analysed by applying the z test for proportion. RESULTS: 354 (67.5%) specimens yielded significant growth of E. coli.> 35% of the urinary E.coli isolates were resistant to the fluoroquinolones, which were found to be the most commonly used empirical antibiotics in acute cystitis. Resistance was minimum against Nitrofurantoin (9.3%, 33) and Amikacin (11.0%,39).> 80% of the fluoroquinolone-resistant strains were found to be sensitive to Nitrofurantoin. CONCLUSION: The best in vitro susceptibility profile in our study has been shown by Nitrofurantoin and a significantly high proportion of the urinary E. coli isolates have already developed resistance to the currently prescribed empirical antibiotics, viz. the fluoroquinolones. In view of these in vitro susceptibility patterns, a transition in empirical therapy appears imminent.

A clinicomicrobiological study on the importance of pseudomonas in nosocomially infected ICU patients, with special reference to metallo beta1-lactamase production.

The present study was conducted with a view to assess the burden of pseudomonal infection in ICU patients of a tertiary care teaching hospital in Uttaranchal. Of the 525 patients selected for the study, during a 1-year period, 60 patients developed features of nosocomial infection and among them Pseudomonas was isolated from one or more samples in 18 patients. The isolated strains were speciated and further characterized for determining their antibiogram and for production of beta-lactamase, extended spectrum beta-lactamase and metallo-beta-lactamase enzymes. Pseudomonas aeruginosa was the commonest species isolated (54.54%) and endotracheal suction material showed the highest bacterial yield. Polymyxin B was found to be the most effective antibiotic followed by imipenem and carbenicillin. Though no strain was found to be producing beta-lactamase and extended spectrum beta-lactamase enzymes, a total of 12 strains (54.54%) were metallo-beta-lactamase producers. For all the beta lactam antibiotics, excepting aztreonam, the metallo-beta-lactamase producers showed more resistance compared to the non-producers.

Microbial forensics: a new forensic discipline.

In microbial forensics, researchers work to track down the source of a microbe, whether in a criminal investigation of bioterrorism attacks or a study of naturally occurring disease outbreak. It is interplay of classical microbiology, microbial genomics, phylogenetics and bioinformatics. Although microbes have been used as weapons for centuries, the anthrax letter attacks of 2001 generated great terror in the public and revealed the need to establish "attribution." The benefit is that it might deter at least some potential terrorists and also help in tracing natural outbreaks of disease. Microbial forensic data must hold up not only to the scrutiny of scientists in the health care community, but also to the scrutiny of judges and juries and national policy and decision makers. It poses a great challenge to develop newer techniques as the present techniques like gene sequencing, hybridization, microarray, spectrophotometry, PCR etc. are inadequate. A national microbial forensics plan needs to be developed.