EPTB comprises 10-15% of all TB cases in developing countries. Diagnosis of TB from body fluids like pleural, peritoneal and cerebrospinal fluid (CSF) is challenging as all these fluid samples possess very few bacilli.: To determine the role of adenosine deaminase (ADA) assay for reliable prediction of EPTB from different body fluids, particularly in low-resource areas with high disease prevalence. This prospective study was out in a rural medical college hospital. An enzymatic deamination method in a kinetic manner was used to monitor the ADA activity. The study processed 100 serum samples from 50 Suspected TB patients and 50 from the control group and 100 samples of body fluids from 50 Suspected TB patients and 50 control samples. Data were recorded in MS Excel sheets, and statistical analysis was performed using MS Office software. Out of 50 serum samples from the suspected TB patient and control groups, 48 (96%) and 17 (34%) were positive for ADA, respectively. Out of 50 samples of body fluids obtained from both suspected TB patients and the control group, 16 (32%) and 3 (06%) were positive for ADA, respectively.Serum ADA positivity was significantly high in suspected TB patients as compared to the control group In our study,observations suggest that serum and serosal fluid Adenosine deaminase (ADA) measurement has good prediction potential for EPTB. Hence, it can be used as a supportive surrogate marker for challenging to diagnose extrapulmonary TB. ADA activity in body fluids is also a sensitive biomarker, especially when combined with serum ADA levels and may become a routine investigation for early detection of extrapulmonary TB. Serum and serosal fluid Adenosine deaminase (ADA) measurements have good prediction potential for PTB & EPTB.
BACKGROUNDMechanical ventilation can increase the risk of VAP 7 -21 times and 10% -25% of patients undergoing mechanical ventilation develop pneumonia. The aetiological agents of VAP vary with different patient populations and types of ICUs. Prompt administration of appropriate antibiotics seems to be the only intervention that alters outcome once the diagnosis is established. MATERIALS AND METHODSThis is a descriptive study with seventy-four non-repetitive endotracheal aspirate from patients who were on mechanical ventilation for more than 48 hrs. and in whom ventilator associated pneumonia was suspected using modified CPIS score and quantitative culture was confirmed using modified two-fold dilution scheme. Kirby-Bauer disk diffusion method was adopted for antimicrobial susceptibility testing. RESULTSThe most common isolate was pseudomonas aeruginosa (27%) followed by Acinetobacter spp. (20.3%), Klebsiella spp. (16.2%) and E. coli (12%). Among gram positive bacteria in our study, only Staphylococcus aureus (9.5%) was isolated. Amikacin and levofloxacin were found to be better against non-fermenters; 10% were carbapenemase producers, MDR isolates were observed in enterobacteriaceae members. MRSA was found in 28.6%. CONCLUSIONIn conclusion, the incidence of VAP and the prevalence of multidrug resistant microorganisms were quite high in our ICU setup. A local surveillance program at each centre is essential, as the knowledge of local resistant patterns is vital for selecting the appropriate agents for treating infections. BACKGROUNDVentilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after the initiation of endotracheal intubation and mechanical ventilation (MV) including pneumonia developing even after extubation. 1 Mechanical ventilation can increase the risk of VAP 7 -21 times and 10% -25% of patients undergoing mechanical ventilation develop pneumonia. 2 It results in high mortality and morbidity, prolonged lengths of hospitalisation and also increased cost of hospitalisation. The mortality rates for VAP range from 20% to 75% according to the study population. 3 Accurate data on aetiologic agents and the epidemiology of VAP are limited by the lack of a 'gold standard' for diagnosis. However, regardless of the diagnostic technique used, there have been dramatic variations in the distribution of pathogens and drug resistance patterns. Because early and
Purpose : Transverse myelitis is an inammatory disorder with acute or subacute spinal cord dysfunction, characterized by motor, sensory, bladder and bowel involvement1 . Longitudinal extensive transverse myelopathy (LETM) is a spinal cord lesion involving three or more vertebral segments2.Most common etiology is Neuromyelitis optica (NMO), followed by infective, neoplastic, autoimmune diseases and connective tissue disorders, neoplasms and spinal cord trauma.3 This study assess the demographic, clinical, radiological and immunological characteristics and compares the aquaporin-4 positive versus negative in relation to clinical and radiological features. :This is a hospital based prospective Method case study that includes forty two patients presented to Neurology Department in tertiary care hospital, Hyderabad between October 2019 to November 202. The patients were studied for demographic prole, clinical presentation, blood serology,CSF studies and neuroimaging as per standard protocol. Patients with chronic progressive disease not fullling LETM criteria were excluded. : Mean age of onset was 36.5 ± Results 12.9 years. Most common complaints were sensory, followed by bowel/bladder involvement, motor weakness. Most common etiology was NMOSD (55%) Seropositive 57%, seronegative 43%. Non-NMOSD group comprised of Idiopathic (24 %), ADEM (7%), SACD (7%) and MS (5 %) and systemic autoimmune disorders (2%). Spinal cord MR imaging in NMOSD showed cervical spine involvement in 21.7 % patients, cervicodorsal spine in 43.4%,dorsal spine involvement 17.3%. Radiologically Central full thickness pattern involving >1/2 transverse segment of cord was seen with NMOSD & ADEM. Marginal & posterior in MS. Posterior/ posterolateral in SACD. 8 had positive ANA of which 75% in NMOSD group. In our NMOSD cohort, certain clinico-radiological features were predicitve of seropositivity: female predominance; paroxysmal tonic spasms; unexplained recurrent hiccups, nausea or vomiting (Area postrema syndrome); relapsing course predominantly cervico-dorsal cord involvement , bright spotty lesions and T1 hypointense lesions on spinal MRI. In this Conclusion: study, NMOSD was the commonest cause of LETM. Female sex, paroxysmal tonic spasms, cervico-dorsal cord involvement, bright spotty lesions on MRI are features favoring seropositive NMOSD. Even topographical analysis, extent of lesions on MRI and contrast pattern may also give clues to the differential diagnosis. On axial topography, bright spotty lesions favour seropositive NMOSD, postero lateral pattern suggest SACD whereas posterior & marginal pattern suggests MS
Urinary tract infections (UTIs) are among the most prevalent nosocomial and community-acquired bacterial diseases in humans, with E.coli being the most typical pathogen isolated. To detect the prevalence of virulence factors like haemolysin, haemagglutination of human erythrocytes with its effect of D-mannose, and cell surface hydrophobicity, the antibiotic sensitivity pattern and ESBL production in urinary isolates of E.coli obtained from clinical samples. We included the E.coli isolates obtained from a midstream urine sample for the study. Virulence factors like haemolysin, hemagglutination and salt aggregation were detected as per standard protocols. Antibiotic sensitivity testing was performed by the Kirby Bauer disc diffusion method. Extended-spectrum beta-lactamase (ESBL) production was seen by the combined disc diffusion method on Muller Hinton agar as per CLSI guidelines. A total of 103 E.coli isolates were tested, and among them, 24(23.30%) produced haemolysin, 65(63.10%) produced hemagglutination and 38(36.89%) had salt aggregation properties. Most isolates obtained were resistant to beta-lactam antibiotics but showed high sensitivity towards antibiotics like chloramphenicol, meropenem, amikacin, imipenem and nitrofurantoin. Around 48% of them were ESBL producers. The common virulence factors associated with UTI were P-fimbriae (MRHA), haemolysin production, cell surface hydrophobicity and type-1 fimbriae. Because of the emerging drug resistance among UPEC, therapy should be advocated as far as possible after obtaining the culture and sensitivity results to determine exact aetiology and susceptibility patterns. The sensitivity to nitrofurantoin is very high, suggesting that antibiotic recycling will help clinicians treat UPEC.
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