The Importance of Serial Time Point Quantitative Assessment of Cardiac Troponin I in the Diagnosis of Acute Myocardial Damage.

OBJECTIVE: The present study was aimed to establish a threshold value for cardiac troponin I (cTnI) for nonacute coronary syndrome (ACS) participants from the local population and also to determine the importance of serial time point estimation of cTnI in acute myocardial infarction (AMI), non-ST-elevated MI (NSTEMI), and unstable angina cases. METHODS: The present study included 194 cases, admitted in ICCU with the complaint of anginal pain; 31 were diagnosed with AMI with typical electrocardiography (ECG) changes; whereas, 48 cases were diagnosed with NSTEMI. The latter group of cases was selected for the time point study of cTnI release at 0-4 h, 6-12 h, 72 h, and 144 h of admission. cTnI levels were assessed using the Abbott ARCHITECT i1000SR system. RESULTS: ACS was clinically ruled out in 98 cases, and cTnI level for them was used to decide cTnI threshold for the non-ACS group. cTnI level was checked in 17 cases of unstable angina. The threshold value of cTnI for non-ACS participants was 0.1 ng/ml and can be considered as cut-off value for the regional population. The data suggested that the peak of cTnI levels in most of the AMI cases reached during 6-12 h. The cTnI levels were lower than 0.1 ng/ml, and no significant change in ECG was noticed in 17 cases of unstable angina. CONCLUSION: The present study suggested that the repeat of cTnI assay after 4-6 h of admission is required if the initial value is <3 ng/ml.

Cardiac troponin I: A potent biomarker for myocardial damage assessment following high voltage electric burn.

Myocardial infarction (MI) following high voltage electric burn is very rare, and its pathogenesis remains controversial. Electrical burns represent only 4% of all burns. Hence, clinical managements have taken a slow pace in developing. The recent guidelines laid down by the cardiology societies include cardiac troponin I (cTnI) as the gold standard marker for the assessment of myocardial damage assessment. Two patients were admitted to our hospital at the different time with the same kind of high voltage electric burn. Both patients had complained with chest discomfort during admission, and cardiac parameter assessment was done for both the patients. cTnI was also measured for both patients, and marked increase in the values was seen within 5 h of onset of myocardial damage and got into normal range within 72 h. Myocardial damage following electric burn needs to be suspected and assessed as early as possible. Hence, cTnI should be the valuable tool to detect the severity of myocardial damage incurred in the electric burn cases.

In vitro activity of daptomycin & linezolid against methicillin resistant Staphylococcus aureus & vancomycin resistant enterococci isolated from hospitalized cases in Central India.

BACKGROUND & OBJECTIVES: Growing incidence of methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enteroccoci (VRE) is posing a therapeutic problem due to limited drug options. Therefore, the present study was undertaken to check susceptibility of MRSA and VRE isolates against new antimicrobials such as daptomycin and linezolid. METHODS: A total of 586 Gram-positive isolates comprising 442 S. aureus and 144 enterococci isolated from hospitalized cases included in the study, were subjected to in vitro antimicrobial susceptibility testing by disc diffusion method. One hundred twenty four enterococci obtained from rectal swabs of neonates were also included. Minimum inhibitory concentration (MIC) was determined for daptomycin, linezolid, vancomycin and teicoplanin against 50 each isolates of MRSA and VRE by E strip. RESULTS: Among the staphylococci, 326 (73.85%) isolates were MRSA. MIC for vancomycin and teicoplanin among MRSA was ≤ 3 µg/ml. MIC for daptomycin among MRSA was found to be in the range of 0.064-1.5 µg/ml. Percentage of VRE among clinical samples was 14.29 per cent while it was 47.06 per cent among enterococci from rectal swabs of neonates. MIC was >256 µg/ml for vancomycin among VRE and was associated with van A genotype. MIC range for daptomycin among VRE was 0.38-3 µg/ml. MIC for linezolid among MRSA and VRE was in the range of 0.25 to 1 and 0.38 -1.5 µg/ml, respectively. INTERPRETATION & CONCLUSIONS: The present study showed a rise in MIC to vancomycin for sizable number of MRSA and growing percentage of VRE at our centre. Daptomycin and linezolid showed 100 per cent activity against MRSA and VRE.

A comparative study of the effect of different topical agents on burn wound infections.

BACKGROUND: Topical agents are used to treat burn wound infections. AIMS AND OBJECTIVE: The present work was aimed to find out the in vitro efficacy of different topical agents against burn wound pathogens. SETTINGS AND DESIGN: Randomly selected gram-positive (29) and gram-negative bacterial (119) isolates from burn wound cases admitted in burn unit of Choithram Hospital and Research Centre, Indore, were included in the in vitro activity testing for silver nitrate, silver sulphadiazine (SSD), chlorhexidine, cetrimide, nitrofuran, soframycin, betadine, benzalkonium chloride and honey by growth inhibition on agar medium. MATERIALS AND METHODS: Multidrug-resistant isolates of gram-positive and gram-negative bacteria were checked for different topical agents. 1% topical agent was mixed with Mueller-Hinton agar. Two microlitres of bacterial suspension adjusted to 0.5 McFarland turbidity standard was spread over the topical agent containing plates. The plates without the topical agent were used as control plates. The plates were incubated for 48 h at 37°C. RESULTS: SSD (148/148), silver nitrate (148/148) and chlorhexidine (148/148) showed excellent activity against all the pathogens. Neosporin had poor activity against Pseudomonas aeruginosa, (4/44) Proteus spp. (2/4) and group D streptococci (1/4). Betadine did not show activity against the bacterial isolates in the presence of organic matter. Honey did not exert any antimicrobial activity under the study conditions. CONCLUSION: SSD, silver nitrate and chlorhexidine have excellent activity against all the bacterial pathogens and could be used empirically, while identification of the infective agent is required for selecting the alternative topical agents such as nitrofuran, soframycin, and benzalkonium chloride.

Augmentation in zone of inhibition of cefoperazone/cefoperazone+ sulbactum compares well with the clinical laboratory standard institute standard extended spectrum beta-lactamase detection method as well as the polymerase chain reaction method.

BACKGROUND: With increased prevalence of extended spectrum beta-lactamase (ESBL) in hospital practice globally, reporting of extended spectrum beta-lactamase along with drug susceptibility test is expected from clinical microbiology laboratory. The aim was to evaluate cefoperazone and cefoperazone+sulbactum disc for phenotypic detection of extended spectrum beta-lactamase among E. coli and Klebsiella spp. isolates. METHODOLOGY: A total of 948 clinical specimens were analysed which included 496 E. coli and 392 Klebsiella pneumoniae. For confirmation of extended spectrum beta-lactamase ceftazidime/ceftazidime+clavulanidc acid and cefotaxime/ cefotaxime+clavulanic acid discs were used as recommended by Clinical Laboratory Standard Institute (CLSI). Simultaneously randomly selected 100 isolates, each of E. coli and Klebsiella spp. were identified for extended spectrum beta-lactamase genes coding for the TEM, SHV and CTX by polymerase chain reaction (PCR). The results were compared with cefoperazone/cefoperazone+sulbactum disc diffusion method. RESULT: Phenotypic characterization identified a high extended spectrum beta-lactamase rate. Four hundred out of 496 (80.64%) E. coli and 392 out of 452 Klebsiella spp.(86.7%) were positive for extended spectrum beta-lactamase by the Clinical Laboratory Standard Institute method. The increase in zone size of cefoprazone/cefoperazone+sulbactum (≥ 5 mm) was seen for all the isolates of E. coli and Klebsiella spp. which were confirmed as extended spectrum beta-lactamase by Clinical Laboratory Standard Institute as well as polymerase chain reaction (PCR) method. CONCLUSION: cefoperazone/cefoperazone+sulbactum disc diffusion showed 100% concordance with extended spectrum beta-lactamase detection by ceftazidime/ ceftazidime+clavulanidc cefotaxime/cefotaxime+clavulanic acid disc diffusion method and polymerase chain reaction.

Ciprofloxacin therapy for typhoid fever needs reconsideration.

Outbreaks of multidrug-resistant Salmonella enterica serotype Typhi in the Indian subcontinent in the late 1980s resulted in the failure of conventional drugs, and ciprofloxacin became the firstline drug to treat enteric fever. However, reduced susceptibility to ciprofloxacin, reported widely since 1994, has posed a therapeutic difficulty. The aim of the present work was to review the situation of drug resistance among S. enterica serotype Typhi in central India from 1988 to 2005. A minimum inhibitory concentration (MIC) study for ciprofloxacin was carried out by the agar dilution method on 314 stock cultures preserved since 1988. The MIC for ciprofloxacin was < or = 0.125 mg/l for the 50 isolates isolated during 1989-1994, but during 1998-1999, 60% of the 50 isolates showed MIC > 0.125 mg/l, while in 2002-2003, 82.5 % of the 97 isolates had MIC > 0.125 mg/l and 35% had MIC > 1 mg/l (high-level resistance). In 2004-2005, 88.2% of the 77 isolates had MIC > 0.125 mg/l and 15% had MIC > 1 mg/l (high-level resistance). Sixty-four isolates showing MIC > 1 mg/l with the agar dilution method were also checked by Epsilometer test (E-test, AB Biodisk, Solna, Sweden). Based on the data, it is suggested to withdraw ciprofloxacin as a therapeutic agent for enteric fever. Fortunately, multiple drug resistance, with concurrent resistance to chloramphenicol, cotrimoxazole, and ampicillin, which had reached more than 90% in 1990-1991, started declining over the years and was as low as 5.6% in 2004-2005. According to these observations, older drugs such as chloramphenicol, cotrimoxazole, and ampicillin could be recalled to treat enteric fever.

Helium-neon and nitrogen laser irradiation accelerates the phagocytic activity of human monocytes.

OBJECTIVE: Intracellular survival of mycobacteria within monocytes is a crucial stage in the pathogenesis of tuberculosis. The aim was to check intracellular survival of Mycobacterium fortuitum within the human monocytes exposed to He-Ne and nitrogen laser irradiation. BACKGROUND DATA: Tuberculosis remains one of the most important infectious diseases for developing countries. Low-level laser therapy (LLLT) has been tried to treat tubercular cavitory lung disease with encouraging results. The in vitro photobiological effect of low level laser radiation on the intracellular mycobacteria needs to be evaluated before we could go for large clinical trials. METHODS: The aliquots of human monocytes from peripheral blood of healthy volunteers and tuberculosis cases were exposed to He-Ne or nitrogen laser beam. The non-irradiated monocytes from the same source served as controls. The monocytes were then challenged with M. fortuitum, and surviving mycobacteria within monocytes were subjected to viable counts. RESULTS: Enhanced killing of mycobacterial cells was seen among monocytes exposed to He-Ne and nitrogen laser irradiation. CONCLUSIONS: He-Ne and nitrogen laser irradiation activates the monocytes to increase intracellular killing of mycobacteria.

In vitro effect of nitrogen and He-Ne laser on the apoptosis of human polymorphonuclear cells from burn cases and healthy volunteers.

OBJECTIVE: The aim of this study was to examine the effect of He-Ne and nitrogen lasers on the apoptosis of PMN in normal versus burn patients. BACKGROUND DATA: Nitrogen and He-Ne laser exposure increases the apoptotic death rate for human macrophages. Inflammation is a major consequence of thermal injury, and polymorphonuclear cell (PMN) infiltration exacerbates inflammatory process through the release of proinflammatory cytokines. The apoptotic death instead of necrotic death of PMN under the situation may help to resolve inflammation. METHODS: Ten healthy volunteers and 10 burn cases (30-50% burn surface) were included in the study. The PMN was separated by dextran sedimentation and density gradient centrifugation before suspending in RPMI-1640 medium supplemented with autologus serum. The cell suspension aliquoted in microwells was exposed to nitrogen (wavelength of 337 nm with power output of 3 mW) and He-Ne (LGN model no. 111, Russia, wavelength of 632.8 nm with power output of 3 mW) lasers for 10 and 5 min. The wells not exposed to laser were used as controls. After 24-36 h of incubation, the apoptotic rates were measured as percentage by morphological studies on acridine orange-ethidium bromide stained preparation using fluorescent microscope. RESULTS: Percentage of apoptotic death increases from 32.9% (SD +/- 4.14) in control PMN to 41.97% (SD +/- 14) in PMN exposed to nitrogen laser for 5 min and further increased to 62.7% (SD +/- 15.11) with nitrogen laser exposure for 10 min. He-Ne laser exposure for 10 min increased apoptotic cell percentage to 41.9%. Increased apoptosis in PMN exposed to nitrogen laser was statistically significant (p < 0.03) both for PMN from healthy subjects and burn cases. It was significantly elevated (p = 0.005) only for PMN from healthy volunteers exposed to He-Ne laser for 10 min but not among He-Ne exposed PMN from burn cases. CONCLUSIONS: These observations support the therapeutic application of nitrogen laser to reduce inflammation and improve wound healing for burn cases.

Practical limitations of disinfection of body fluid spills with 10,000 ppm sodium hypochlorite (NaOCl).

The purpose of this study was to monitor disinfection with 10,000 ppm sodium hypochlorite for decontamination of common hospital spills. Simulated spills deliberately contaminated with 10(8) bacterial challenges were used for the study. Results showed greater than 5 log reduction in the challenge bacteria for all spills (serum, pus, sputum, csf, ascitic fluid, urine, and stool) except blood. Disinfection was satisfactory for blood contaminated with gram-negative bacteria, but not for staphylococci. As a practical procedure, surfaces contaminated from gross spillage of human body fluids should first be contained with absorbent materials, then disinfected with hypochlorite.