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Biomedical subjects

D S Chitnis

Publications and source records attributed to D S Chitnis.

At least 19 recordsLinked to original sources
PubMed2005

In vitro susceptibility to meropenem and other antimicrobial agents among gram-negative bacilli isolated from hospitalized patients in central India.

BACKGROUND: Growing multiple drug resistance among gram-negative bacilli among hospitalized patients is a serious therapeutic problem, and the aim of the study was to assess the situation in our hospital. METHODS: Antimicrobial susceptibility testing with the disk method was carried out on 1,533 isolates of gram-negative bacilli from urine, pus, body fluid and blood from hospitalized patients. RESULTS: Seventeen percent of isolates were susceptible only to meropenem and either to piperacillin + tazobactam, to cefoperazone + sulbactam or to both. Eleven percent of isolates were susceptible only to meropenem and 6% were resistant to all antimicrobial agents including meropenem. CONCLUSION: Growing multiple drug resistance among gram-negative bacilli in hospital practice demands a rigid antibiotic policy and strict infection control measures.

Anti-Bacterial Agents↗
PubMed2005

Biomedical waste in laboratory medicine: audit and management.

Pathology, microbiology, blood bank and other diagnostic laboratories generate sizable amount of biomedical waste (BMW). The audit of the BMW is required for planning proper strategies. The audit in our laboratory revealed 8 kgs anatomical waste, 600 kgs microbiology waste, 220 kgs waste sharps, 15 kgs soiled waste, 111 kgs solid waste, 480 litres liquid waste along with 33,000 litres per month liquid waste generated from labware washing and laboratory cleaning and 162 litres of chemical waste per month. Section wise details are described in the text. Needle sharps are collected in puncture proof containers and the needles autoclaved before sending to needle pit. The glass forms the major sharp category and is disinfected with hypochlorite before washing/recycling. All microbiology waste along with containers/plates/tubes are autoclaved before recycling/disposal. The problem of formalin fixed anatomical waste as histology specimens is pointed out. The formalin containing tissues cannot be sent for incineration for the fear of toxic gas release and the guidelines by the Biomedical waste rule makers need to be amended for the issue. The discarded/infected blood units in blood bank need to be autoclaved before disposal since chemical treatments are difficult or inefficient. The liquid waste management needs more attention and effluent treatment facility needs to be viewed seriously for hospital in general. The segregation of waste at source is the key step and reduction, reuse and recycling should be considered in proper perspectives.

Hospitals↗
PubMed2005

Elisa kit evaluation for IGG and IGM antibodies to A-60 tubercular protein antigen.

AIMS: The purpose of this study is to evaluate the A-60 antigen-based enzyme-linked immuno sorbent assay (ELISA) test for its sensitivity, specificity, and other related statistical parameters. SETTINGS AND DESIGN: Sera from 114 healthy volunteers, 105 bacteriologically confirmed cases of pulmonary tuberculosis (PTB), 59 sera from family contacts of PTB, and 40 sera from cases of lung infections other than tuberculosis collected from September to December 2003 were used for the kit evaluation. METHODS AND MATERIALS: Enzyme-linked immuno sorbent assay test using tuberculosis A-60 antigen-based kit manufactured by Anda Biologicals, France was used for the evaluation. STATISTICAL ANALYSIS: Differences in the optical density (OD) values for immunoglobulins G (IgG), and immunoglobulins M (IgM) antibodies in various groups were studied using t-test. RESULTS: On the basis of the findings the threshold value was setup as 400 U for IgG and mean OD for sera from healthy volunteers +2SD as the threshold for IgM. The sensitivity was 80% and specificity 95.8% for the IgG antibody test. The efficiency and predictive values were also high. The sensitivity for IgM was low (28.5%) but the specificity was high (95.7%). None of the 40 nontubercular lung infection cases were positive for the IgG and IgM antibody test for A-60, whereas five and three cases of 59 family contacts of PTB were positive for IgG and IgM antibody test. The test reproducibility was good for both IgG and IgM. CONCLUSION: IgG antibody test using A-60 antigen has good sensitivity and specificity, whereas IgM antibody test had high specificity but low sensitivity. Multicentric trials suggested evaluation of the diagnostic utility of the test for the extra-PTB.

Adult↗
PubMed2004

Bacterial population changes in hospital effluent treatment plant in central India.

Hospital effluent with its high content of multidrug resistant (MDR) enterobacteria and the presence of enteric pathogens could pose a grave problem for the community. It was planned at our tertiary care hospital in central India to study the population changes at various steps of effluent treatment plant (ETP) like collection, aeration, clarification, liquid sludge, dried sludge, high-pressure filter and treated wastewater. The study included viable bacterial counts, coliform counts, staphylococcal, enterococcal, Pseudomonas and multiple drug resistant (MDR) gram negative bacterial counts in the different stages of ETP. In order to study the distribution of bacteria as free floating in liquid and adherent to suspended particles, enumeration of the bacteria in the filterate and the sediment was also carried out. The effluent input showed 55% of the 8.6 x 10(6)/ml bacteria as coliforms and E. coli which was a typical of fecal flora. The prevalence of MDR coliforms was 0.26%. The substantial reduction (> 3log) was seen for the effluent coming from the clarifier. The bulk of the bacteria in the hospital effluent remains firmly adhered to solid particles; aeration and clarification removes bulk of the bacteria by physical processes like flocculation. The treated liquid effluent still contains sizeable loads of MDR bacteria and inactivation by procedure such as chlorination is required. The bacteria get concentrated in sludge and a greater concentration of chlorine is required for decontamination.

Bacteria↗
PubMed2004

Modified blood supplemented Lowenstein Jensen medium improves recovery of mycobacteria from sputum samples.

Lowenstein Jensen medium containing 3% human blood in CPDA anticoagulant was compared with plain LJ medium for mycobacterial growth using 565 sputum samples. Mycobacterial growth appeared on both the media in case of 148 samples. However, growth was faster by one week and colony size larger over blood supplemented LJ in 53 of the 145 culture positives. Additional 12 samples which showed no growth on plain LJ could grow only on LJ supplemented with blood. While 3 samples revealed scanty growth on plain LJ alone. The experience suggests that two LJ slants; one plain and the other supplemented with blood be in inoculated routinely to increase speed of growth and recovery of mycobacteria from clinical samples.

Bacteriological Techniques↗
PubMed2003

Current status of drug resistance among gram-negative bacilli isolated from admitted cases in a tertiary care centre.

AIMS: To study the prevalence of drug resistance among gram-negative bacilli and susceptibility to the Cefoperazone + Sulbactam and Piperacillin + Tazobactam combination among the hospital isolates resistant to all other antimicrobial agents. METHODS: A total of 367 gram-negative bacilli isolated from various pathological samples were tested for susceptibility to antimicrobial agent by the disc diffusion technique and 300 isolates of gram-negative bacilli which were resistant to all the other antibiotics were checked for sensitivity to piperacillin + tazobactam and cefoperazone + sulbactam combination. RESULTS: Resistance to ampicillin and amoxicillin + clavulanic acid ranged from (72.1-83.8%) which was highest. Resistance to cotrimoxazole, gentamicin, netilmycin, quinolones and all the generation of cephalsporins was often above 50%. piperacillin + tazobactam combination had the lowest incidence of resistance (14 to 20.5%). CONCLUSION: Drug resistance for most of the antimicrobial agents was greater than 50% including the various generations of cephalosporins. Inefficiency of amoxicillin + clavulanic acid (resistance among 72-79.5% isolates) suggests the presence of extended spectrum beta-lactamases among the isolates. Addition of sulbactam to cefoperazone showed increased activity (resistance 27 to 34%) but piperacillin + tazobactam was the most effective combination in vitro.

Anti-Bacterial Agents↗
PubMed2002

Prevalence of fungal meningitis among HIV positive & negative subjects in Indore (MP state).

The aim of the study was to find out the prevalence of fungal meningitis among AIDS cases and to assess the prognosis of fungal meningitis among HIV positive & negative subjects. The study comprised of 15 & 10 cases of fungal meningitis among HIV positive & negative subjects respectively during the study period 1992-2001. India ink preparation and Gram's staining procedures were carried out on the centrifuged CSF deposits. The CSF deposits were also used for bacterial and fungal culture. In the present study the prevalence of fungal meningitis was noted among 15 (3.1%) of 483 AIDS cases. Twelve of them had cryptococcal meningitis while 3 were infected with Candida albicans. Four AIDS cases presented fungal meningitis as a primary opportunistic infection and HIV status was confirmed in 4 of them after the diagnosis of fungal meningitis. 13 of the 15 cases were in the age group 26-40 yrs while one was 55 yrs old and the other 16 month old child; these two cases had blood transfusion transmitted and vertically transmitted mode of HIV transmission respectively. Further, only two of 15 cases were females and both acquired HIV infection through blood transfusion. Overall prognosis of fungal meningitis was poor among HIV positives and 7 of the 15 cases died in hospital within 2-3 weeks after diagnosis of cryptococcal meningitis. Among HIV negative subjects, ten cases of fungal meningitis (3 with Candida albicans and 7 with Cryptococcous neoformans) were noted at our end and nine of them had immunocompromised status (3 cases of renal transplant on immunosuppressives, 3 cases neonates/infant and 2 diabetic subjects. The fungal meningitis is one of the important causes of morbidity & mortality among immunocompromised among HIV positive subjects.

AIDS-Related Opportunistic Infections↗
PubMed2001

Viral hepatitis during pregnancy.

OBJECTIVE: A great degree of controversy prevails over the existing reports on the severity and outcome of acute viral hepatitis (AVH) during pregnancy. The present study describes the outcome of AVH associated with pregnancy. A correlation was also assessed for gestation period, viral etiology and outcome of AVH. METHOD: The serum samples of 273 females with viral hepatitis (age group 18--23 years) were included in the study. Among them, 127 females were pregnant and 146 were non-pregnant cases (as a control group). The sera were screened for seromarkers of the hepatitis A virus (HAV) through to the hepatitis E virus (HEV) by the latest available generation ELISA kits. Among the 127 pregnant females, 83 were AVH cases, while 44 were fulminant hepatic failure (FHF) cases. Among the 146 non-pregnant females, 129 were AVH and 17 were FHF cases. RESULT: Among the AVH pregnant females, 73 (57.5%) had HEV infection. Fifty-eight percent of the HEV infected pregnant females were associated with FHF. Among non-pregnant females HEV was documented in 67 (46%) cases. HBV infection was observed in 19% and 18% of the pregnant and non-pregnant females, respectively. Twenty percent of the pregnant and 33% of the non-pregnant females remained non-reactive for seromarkers of HAV-HEV. The mortality rate was highest (56%) among HEV infected FHF cases during third trimester of pregnancy. The chi(2) test was applied to check the statistical significance for the differences over the prevalence in various groups. CONCLUSION: In the present study, HEV was found to be the chief etiological agent, associated with higher morbidity and mortality. However, the incidence of HEV in pregnant females was not significantly different from non-pregnant females. The prevalence of HAV, HCV and HDV were very low in the study. An increased incidence of FHF was noted among HEV infected pregnant females, while infection with an agent other than A-E was commonly associated with FHF among non-pregnant females.

Acute Disease↗
PubMed2001

Drug resistance among tubercle bacilli from pulmonary tuberculosis cases in central India.

An estimate of drug resistance is extremely important in the epidemiology and control of tuberculosis. Data on drug resistance among mycobacterial isolates from sputum samples analysed at Microbiology dept. of Choithram Hospital and Research Centre, Indore, M.P. is presented here. Drug sensitivity testing was carried out on 1426 Mycobacterial isolates by the method of proportion using critical concentration in Lowenstein Jensen medium. Resistance for Isoniazid, streptomycin, and pyrazinamide was found to be high (54.2%, 41.5% and 50% respectively) and was followed by resistance to rifampin (25%) and ethambutol (22%). Resistance for kanamycin, p-aminosalicylic acid, thiacetazone and ciprofloxacin was much lower (18%, 13%, 6.5% and 3.6% respectively). Only 12% of the isolates were sensitive to all the anti-TB drugs while resistance to two, three, and four or more drugs was in the range of 20-25%. Pattern wise, simultaneous resistance to INF and Rifampin with or without resistance to other drugs was observed in 8.1% while resistance for Isoniazid + pyrazinamide and Isoniazid + streptomycin was 11.9 and 11.5% respectively. Resistance for Isoniazid + ethambutol was the lowest (5.1%). Growing multiple drug resistance among tubercle bacilli warrant urgent attention in tuberculosis control programme.

Antitubercular Agents↗
PubMed2001

Smears from rat liver suspension as modified substrate for antinuclear antibody test.

Immunofluorescence still remains a standard method for documenting antinuclear antibodies (ANA). Cryostat cut sections of rodent liver or Hep2 cell nuclei have been used as substrate in the test but are often difficult to arrange in laboratories in developing countries. Hence, a modification was developed using smears from rat liver suspensions. The smears were compared with the cryostat cut sections over 338 sera samples of suspected cases of collagen diseases, rheumatoid arthritis, thyroid disorders, hepatitis B, enteric fever, tuberculosis and normal subjects. The sera from suspected collagen diseases cases were also compared with ANA test using Hep2 cells. The modified smear technique was well comparable and the clarity of the immunofluorescence was even better than for cryostat cut sections. Using the modified smear technique 272 sera out of 2,851 sera gave positive test for ANA. The homogenous, speckled and peripheral patterns were seen for 203, 66 and 3 samples respectively. To conclude: The smears prepared from homogenised rat liver suspension and fixed like bacterial smears offer a very convenient and reliable tissue substrate for ANA test.

Animals↗
PubMed2000

Studies on blood factors responsible for rise in ESR.

Rise in ESR following inflammation processes is well known. However, the exact factors in blood responsible for the rise remain largely unknown. The present experimental work on mixing of plasma from pulmonary tuberculosis cases with RBCs from healthy volunteers indicates that ESR rising properties reside in plasma and not in RBCs. Levels of C-reactive proteins (CRP) are also known to rise following inflammation and hence CRP could contribute to rise in ESR. However, absorption of C-reactive protein from the plasma does not reduce the ESR and suggests that C-reactive proteins are not directly involved in raising ESR. Further experimental work was carried out to see whether cytokines released by mononuclear cells are responsible. However, cell culture supernatants added to whole blood samples did not cause rise in ESR. The ESR rising substances in plasma were non-dialysable and thus were of larger molecular weight.

Blood Sedimentation↗
PubMed1999

Acridine orange stained blood wet mounts for fluorescent detection of malaria.

The age old Romanowsky stained thick blood smear examination for malarial parasites may fail to reveal the low parasitaemia. The commercial 'QBC' like acridine orange stained capillary tube preparation has a limitation of precise species identification and the detection of extra-erythrocytic parasites. Hence, the present study was aimed to improve malarial parasite detection by using acridine orange to stain large blood drops in the form of wet coverglass mounts. The acridine orange stained blood wet mounts over 2420 suspected malaria cases from Indore city were examined under fluorescent microscope and the results compared with the Leishman's stained thick blood smears in a blind study. The positivity of malarial parasites reported by the modified acridine orange staining was 248 against 109 by Leishman's stained thick blood smears. The modified acridine orange stained method is simple, instant and more efficient, requires less scanning time and skill, allows scanning of larger blood volume (75 ul) at lower magnification and the morphological details at higher magnification helps to make the precise species identification.

Acridine Orange↗
PubMed1997

100 years of Widal test & its reappraisal in an endemic area.

A reappraisal of the Widal test was made for its diagnostic utility in typhoid fever in an endemic area of Central India. The significant basal antibody level in the normal population based on 1200 voluntary/relative blood donors at the cut-off titre of 80 or above was observed in 13.83 and 8.0 per cent for 'O' and 'H' antigens of Salmonella typhi respectively. A retrospective study (1991-1995) over 138 bacteriologically proven cases of typhoid showed a positivity of 64.49 and 78.26 per cent respectively for 'O' and 'H' antibodies at the titre of 80 or above and 44.2 and 63.04 per cent at the titre of 160 and above. The retrospective data also showed a greater positivity (46.41%) in 1991 which decreased to 25 per cent in 1995 and appeared to follow the incidence of multi drug resistant S. typhi over the period. The detection of 'H' antibodies is no less important than the 'O' antibodies in the present study. Our data bring out the diagnostic limitations of Widal test done on single samples collected in the early phase of illness (4-10 days) from patients suspected to have typhoid in an endemic area of Central India.

Antigens, Bacterial↗
PubMed1997

Haemagglutination system for the simultaneous detection of LPS and anti LPS antibodies of S.typhi.

In view of the limitations of Widal test for the diagnosis of typhoid, haemagglutination test using sensitized sheep red blood cells was designed at our laboratory. The test gave only 1.8% positivity at 1:40 dilution among 500 normal persons. Eighteen of the 30 culture proven cases gave the HA test positive while the positivity was 62.5% among suspected cases of typhoid. Thus, the anti LPS haemagglutination test showed a sensitivity of 60% and specificity of 98.2%. The positive predictive value and negative predictive value were 66.66% and 96.7% respectively. The haemagglutination inhibition test was also developed for the detection of LPS antigen of S. typhi in the serum samples of typhoid cases and could detect 1.5625 micrograms/ mL of S. typhi LPS antigen but failed to detect LPS in the sera of bacteriologically proven cases of typhoid. However, it could detect the growth of simulated blood cultures of S. typhi within one hour of inoculation and did not give any cross reactions with other bacterial cultures. The data suggest that the haemagglutination test could be a good adjunct for Widal test and the haemagglutination inhibition test could help the early detection of S. typhi in culture.

Antibodies, Bacterial↗