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Pathak KN, Sen S. Implementing the Updated Guidelines in Routine Clinical Microbiology Reporting [Letter]. Infect Drug Resist 2022; 15:1945-1946. [PMID: 35480053 PMCID: PMC9035451 DOI: 10.2147/idr.s367337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Ketaki Niranjan Pathak
- Department of Microbiology, Symbiosis Medical College for Women (SMCW), Symbiosis International (Deemed University) (SIU), Pune, Maharashtra, India
- Correspondence: Ketaki Niranjan Pathak, Department of Microbiology, Symbiosis Medical College for Women (SMCW), Symbiosis International (Deemed University) (SIU), Lavale, Pune, Maharashtra, India, Tel +91-87888332521, Email
| | - Sourav Sen
- Department of Microbiology, Symbiosis Medical College for Women (SMCW), Symbiosis International (Deemed University) (SIU), Pune, Maharashtra, India
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Lall M, Sen S, Patrikar S, Karade S, Gupta R. Post vaccination antibody titres of hepatitis B surface antigen (anti-HBs) in a mixed cohort of health care workers. Med J Armed Forces India 2022; 78:198-203. [PMID: 35463555 PMCID: PMC9023541 DOI: 10.1016/j.mjafi.2020.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/23/2020] [Indexed: 02/08/2023] Open
Abstract
Background Hepatitis B (HepB) is an important vaccine preventable infection among healthcare workers (HCWs). Vaccination against Hep B virus, remains the foremost preventive approach. This study aims to measure the antibody titres to Hep B surface antigen (anti-HBs) in a mixed cohort of HCWs. It also aims to study the association between time since vaccination and the anti-HBs titres thus evaluating the duration of seroprotection. Methods A total of 200 HCWs, including nursing students (n = 112), nursing staff (n = 49), laboratory technicians (n = 30) and doctors (n = 9) who had received all three doses of the Hep B vaccine and met the inclusion criteria of having taken all three doses of vaccine were included in this study. Anti-HBs titres were estimated by bioMérieux mini VIDAS® automated immunoassay based on the principle of enzyme-linked fluorescence assay. Results Two hundred subjects aged 19 to 52 years were included in the study; mean age was 27.29 ± 0.568 years. Duration since vaccination in the study cohort was ≤ 5 years in 149 (74.5.0%), 6-10 years in 20 (10.0%) and >10 years in 31 (15.5%) subjects. Postvaccination antibody titres were > 100 mIU/ml in 85.0%, 10-100 mIU/ml in 11.0% and ≤ 10 mIU/ml in 3.5%. There was a decline noted in antibody titres as duration after vaccination increased. Increasing age was associated with falling protective titres. Conclusion The study revealed that majority of the HCWs had adequate anti-HBs titres and were protected after vaccination.
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Kumar N, Sen S. Effectiveness of Disc Diffusion Method for Vancomycin Sensitivity Testing of Staphylococcus aureus [Letter]. Infect Drug Resist 2022; 15:1027-1028. [PMID: 35310368 PMCID: PMC8932647 DOI: 10.2147/idr.s363499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Nitin Kumar
- Department of Microbiology, Symbiosis Medical College for Women, Symbiosis International (Deemed University) (SIU), Lavale, Pune, Maharashtra, India
| | - Sourav Sen
- Department of Microbiology, Symbiosis Medical College for Women, Symbiosis International (Deemed University) (SIU), Lavale, Pune, Maharashtra, India
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Giri S, Karade S, Sen S. Genotypic characterization of carbapenem resistant Enterobacterales in clinical isolates from western Maharashtra. Indian J Med Microbiol 2021; 39:500-503. [PMID: 34016469 DOI: 10.1016/j.ijmmb.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To study distribution of carbapenemase genes namely; New Delhi metallo-beta-lactamase (blaNDM), Oxacillinase-48 (blaOXA48), Verona Integron-Encoded Metallo-beta-lactamase (blaVIM) and Imipenemase (blaIMP) in carbapenem resistant Enterobacterales (CRE), isolated from clinical samples. METHOD This cross-sectional study was conducted at a tertiary care hospital of western Maharashtra over six months period. CREs were identified by conventional disc diffusion and modified carbapenem inactivation method (mCIM). A total of 50 consecutive CRE isolates from clinical samples were subjected to home brewed polymerase chain reaction (PCR) for detection of carbapenemases. RESULTS Out of the 50 CRE isolates, at least one of the four carbapenemase genes was detected in 49 (98%) isolates. The frequency of distribution of these genes were NDM 90% (n = 45), OXA48 60% (n = 30) and VIM 12% (n = 6). Dual combination of blaNDM and blaOXA48 (50%) was the commonest pattern observed, which was frequently associated with Klebsiella pneumoniae. CONCLUSIONS The study indicate high prevalence of NDM warranting strict anti-microbial stewardship practices. Surveillance of CRE and resistance mechanism is essential to monitor the trend and take informed decision for appropriate anti-microbial therapy.
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Affiliation(s)
- Suraj Giri
- Department of Microbiology, AFMC, Pune, India
| | | | - Sourav Sen
- Department of Microbiology, AFMC, Pune, India.
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Bobdey S, Kaushik SK, Sahu R, Naithani N, Vaidya R, Sharma M, Vashishtha K, Yadav AK, Sen S, Karade S. Effectiveness of ChAdOx1 nCOV-19 Vaccine: Experience of a tertiary care institute. Med J Armed Forces India 2021; 77:S271-S277. [PMID: 34334893 PMCID: PMC8313083 DOI: 10.1016/j.mjafi.2021.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Background The first dose of the ChAdOx1 nCoV- 19 Corona Virus Vaccine (Covishield) was administered to the eligible beneficiaries of tertiary care institute of Western Maharashtra on 16 Jan 21 and in the past three months almost 97% of the staff has been vaccinated. The present study analyses the incidence of COVID cases in the unvaccinated and vaccinated population of the institute. Methods All Covid 19 infections (RT-PCR positive) from 01 February 21 to 25 April 21 were included in the study and analyzed as per their vaccination status. To assess the COVID 19 transmission in contacts, Secondary Attack Rates (SAR) of the pre-vaccination period (Jun–Oct 20) was compared with the present SAR. Results A total of 113 cases occurred in the study period (01 Feb to 25 Apr 21). Lower number of infections were observed among the fully vaccinated as compared to partially vaccinated and non-vaccinated. The overall vaccine effectiveness was found to be 88.6% (81.55–92.37) and 44.1% (4.55–67.3) in completely and partially vaccinated individuals respectively. Hazard Ratios for getting infected dropped significantly after 28 days of the second dose. The SAR in high risk contacts (HRCs) was found to be 4.25%, which was lower than SAR (20.6%) of pre-vaccination period. Conclusion This is one of the earliest studies in India to report the impact of COVID-19 vaccination. The results indicate that the vaccine provides effective protection against COVID-19 infection. However, given the complex dynamics of vaccination, the role of NPIs and implementation of COVID appropriate behavior cannot be undermined.
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Affiliation(s)
- Saurabh Bobdey
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S K Kaushik
- Professor & Head, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Rajesh Sahu
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Nardeep Naithani
- Director & Commandant, Armed Forces Medical College, Pune, India
| | - Rajesh Vaidya
- Dean & Dy Commandant, Armed Forces Medical College, Pune, India
| | - Mithun Sharma
- Resident, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Kundan Vashishtha
- Resident, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - A K Yadav
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Santosh Karade
- Professor, Department of Microbiology, Armed Forces Medical College, Pune, India
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Karade S, Vishal AK, Sen S, Bewal N, Gupta RM. Probable vertical transmission of severe acute respiratory syndrome coronavirus 2 infection from mother to neonate. Med J Armed Forces India 2021; 77:S490-3. [PMID: 34334918 DOI: 10.1016/j.mjafi.2020.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/30/2020] [Indexed: 02/08/2023] Open
Abstract
The pandemic spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected 188 countries and territories. Altered physiological status during pregnancy makes a mother vulnerable to severe SARS-CoV-2 infection. The virus may be transmitted from mother to baby during antenatal period or postnatal period. Although the primary mode of transmission of the virus is by respiratory droplets, there is emerging evidence of in utero transmission from mother to foetus. In this rare case report, we describe one such episode of probable vertical transmission. To the best of our knowledge, this is the second systematically investigated Indian case, indicating in utero transmission of SARS-CoV-2 from mother to foetus.
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Sen S, Lall M, Faujdar DS, Shergill S, Patrikar S, Kaushik S, Gupta R, Naithani N. Estimating the proportion and IgG antibody response to SARS-CoV-2 in individuals joining a central educational institute from different parts of India by Enzyme-linked immunosorbent assay (ELISA) based serology. Med J Armed Forces India 2021; 77:S366-S372. [PMID: 34334906 PMCID: PMC8313047 DOI: 10.1016/j.mjafi.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/12/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Antibody response to SARS-CoV may be estimated to give trends and patterns emerging in a population during an evolving epidemic. The novel coronavirus has opened a new chapter in the history of pandemics and understanding the disease epidemiology. METHODS The study was a cross-sectional descriptive study. Institutional Ethical clearance and informed consent were taken for participation in the study. The study population included all personnel reporting to the institute for training courses, permanent posting or joining back from leave during the study period of 2 months (16 June to 16 August 2020). The sample size was calculated assuming the prevalence of COVID-19 to be 1% with the absolute precision of 0.5% and 5% level of significance, and finite correction for population size of 500, and the calculated sample size was 377. Inclusion criteria were all personnel reporting to the institute from different states and districts. Exclusion criteria-Any personnel reported for a short visit of lesser than 14 days. Demographic details and details of any likely exposure to a confirmed COVID-19 case were noted. A blood sample was collected, and serological tests were done using ErbaLisa COVID-19 IgG kit by Calbiotech, as per the manufacturer's instructions. RESULTS Overall seropositivity of IgG COVID-19 antibodies was 7.5% (31/413) (95% CI: 5.3-10.4%). Study population (n = 413) comprised of an adult population in the age range of 21 years-53 years, and the mean age was 31.4 years (SD = 6.2 years). CONCLUSION As the personnel joining the institute have come from various parts of the country the study provides an estimation of antibodies against COVID-19.
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Affiliation(s)
- Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Mahima Lall
- Professor, Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Dharamjeet Singh Faujdar
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S.P.S. Shergill
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Seema Patrikar
- Senior Lecturer in Biostatistics, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S.K. Kaushik
- Professor & Head, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - R.M. Gupta
- MG (Med), HQ Western Command, C/o 56 APO, India
| | - Nardeep Naithani
- Director & Commandant, Armed Forces Medical College, Pune, India
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Karade S, Sen S, Shergill SPS, Jani K, Shouche Y, Gupta RM. Whole genome sequence of colistin-resistant Escherichia coli from western India. Med J Armed Forces India 2020; 77:297-301. [PMID: 34305283 DOI: 10.1016/j.mjafi.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/09/2020] [Indexed: 02/05/2023] Open
Abstract
Background With virtually dried out new antibiotic discovery pipeline, emergence and spread of antimicrobial resistance is a cause for global concern. Colistin, a cyclic polypeptide antibiotic, often regarded as last resort for multi drug resistance gram-negative bacteria, is also rendered ineffective by horizontal transfer of resistance genes. Surveillance of colistin resistance in GNB is essential to ascertain molecular epidemiology. Methods Whole genome sequencing (WGS) of an unusual colistin resistant urinary isolate of Escherichia coli was performed using Illumina MiSeq platform using 2x250bp V2 chemistry by following the manufactures protocol (Illumina Inc. USA). Multiple web-based bio-informatic tools were utilized to ascertain antibiotic resistant genes. Results An approximate 5.4 Mb of genome of the urinary isolate AFMC_UC19 was sequenced successfully. Mobile colistin resistance gene (mcr) on the plasmid responsible for horizontal spread was absent in the isolate. Conclusion Colistin resistance has been reported previously in Klebsiella pneumoniae and it is a rare occurrence in Escherichia coli in Indian setting. Although the isolate lack mcr mediated colistin resistance, emergence and spread of colistin resistant in gram-negative bacteria pose a threat.
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Affiliation(s)
- Santosh Karade
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 40, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 40, India
| | - S P S Shergill
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 40, India
| | - Kunal Jani
- Research Associate, National Centre for Microbial Resource, National Centre for Cell Science, Pune, India
| | - Yogesh Shouche
- Principal Investigator & Professor Emeritus, National Centre for Microbial Resource, National Centre for Cell Science, Pune, India
| | - R M Gupta
- Dean & Dy Commandant, Armed Forces Medical College, Pune 40, India
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Sangwan J, Sen S, Gupta RM, Shanmuganandan K, Grewal RS. Immune activation markers in individuals with HIV-1 disease and their correlation with HIV-1 RNA levels in individuals on antiretroviral therapy. Med J Armed Forces India 2020; 76:402-409. [PMID: 33162648 DOI: 10.1016/j.mjafi.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/18/2019] [Indexed: 02/08/2023] Open
Abstract
Background Currently CD4+ T lymphocyte counts and HIV-1 RNA levels are being utilized to predict outcome of human immunodeficiency virus (HIV) disease. Recently, the role of immune activation in HIV disease progression and response to treatment is being investigated. This study focused on the expression of CD38 and HLA-DR on lymphocyte subsets in various groups of HIV-infected individuals and to determine their association with HIV-1 disease progression. Methods Ninety-eight cases of patients with HIV/AIDS in different disease stages and twenty-four healthy HIV-negative individuals were included in the cross-sectional study. Their immune function and abnormal immune activation markers (CD38 & HLA-DR) were detected using a flowcytometer, and HIV-1 RNA levels in individuals receiving antiretroviral drugs were estimated. Results The immune activation marker levels were significantly different between patients with different disease stages (P < 0.001). A significant negative correlation was observed between peripheral blood CD4+ T cell counts and immune activation markers. Also, a significant positive correlation was observed between HIV-1 RNA levels and CD38+CD8+ T lymphocyte. Conclusion Immune activation markers (CD38 & HLA-DR) increase with disease progression. CD38+ on CD8+ T lymphocyte correlates well with HIV1 RNA levels in individuals failing on antiretroviral therapy.
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Affiliation(s)
- Jyoti Sangwan
- Associate Professor (Microbiology), SHKM Government Medical College, Mewat, Haryana, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | | | - K Shanmuganandan
- Professor of Medicine & Rheumatology, Department of General Hospital, Sree Balaji Medical College & Hospital, Chennai, India
| | - Rajan S Grewal
- Director General Medical Services (Air), O/o DGMS (Air), IHQ, Air Headquarter, RK Puram, New Delhi 110066, India
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Sharma A, Agarwal A, Katoch C, Sen S, Gupta RM. Evaluation of a novel sputum processing ReaSLR methodology for improving sensitivity of smear microscopy in clinical samples. Med J Armed Forces India 2020; 78:277-282. [DOI: 10.1016/j.mjafi.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/13/2020] [Indexed: 02/08/2023] Open
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Abstract
The world is currently face to face with a pandemic which is spreading rapidly across the globe caused by SARS-CoV-2, a strain of Coronaviruses (CoVs) belonging to subgenus Sarbecovirus of genus Betacoronavirus. World Health Organisation (WHO) on 11 Feb 20 named this disease caused by SARS-CoV-2 as Covid-19. This pandemic is spreading rapidly and more than 20,00,000 cases have occurred globally. The human Coronaviruses discovered in 1960s were considered potentially harmless endemic viruses with seasonal distribution before late 2002. The CoVs are found in a large number of domestic and wild animals and birds. The first pandemic caused by Coronavirus caused by SARS-CoV was recognized in the late 2002 in Guangdong Province and resulted in widespread morbidity and mortality. This was followed by MERS-CoV which began in 2012 in the Arabian peninsula with multiple outbreaks related to it in various parts of the globe. Various studies have suggested how these viruses made their entry from their natural reservoir bats via intermediate host like civets and camels in case of SARS-CoV and MERS-CoV respectively. The intermediate host of the SARS-CoV-2 still needs to be established. The SARS-CoV-2 has 96.2% similarity to the bat Severe Acute Respiratory Syndrome related-Coronavirus (SARSr-CoV RaTG13). SARS-CoV-2 has been found to be more distant in relation to SARS-CoV (79%) and MERS-CoV (50%). At the whole genome sequence level pangolin CoV and SARSr-CoV RaTG13 show 91.02% and 96.2% similarity with SARS-CoV-2 but the S1 subunit of spike protein of pangolin CoV is more closely related to SARS-CoV-2 than SARSr-CoV RaTG13. The genetic analysis of the currently circulating strains of the pandemic have shown 99.98-100% similarity in their genomes implying a recent shift to humans. The animal source of SARS-CoV-2 needs to be identified to implement control measures in the present pandemic. Also, how the virus moves interspecies will help predict and prevent future pandemics.
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Affiliation(s)
- K B Anand
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - S Karade
- Assistant Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - S Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - R M Gupta
- Professor (Microbiology) & Dean and Deputy Commandant, Armed Forces Medical College, Pune 411040, India
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Gill J, Sen S. Blueprinting of summative theory assessment of undergraduate medical students in microbiology. Med J Armed Forces India 2020; 76:207-212. [PMID: 32476720 PMCID: PMC7244858 DOI: 10.1016/j.mjafi.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/24/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Assessment drives learning. Written assessment of many universities lacks uniformity and validation. Subjectivity influences assessment. Blueprinting has been used as content validity tools. METHODS In this study, last 5-year's Maharashtra University of Health Sciences (MUHS) second year MBBS papers in Microbiology were evaluated for its content validity. Desired weightage to all the topics in microbiology was given by the faculty of Department of the Microbiology. University papers were also evaluated for level of cognitive domain tested. Closed ended feedback from faculty was taken and was statistically evaluated. RESULT Study revealed both overrepresentation and underrepresentation of many topics across all the last 5-year university papers in subject of microbiology. The cognitive dimension tested in question papers as per revised Bloom's taxonomy was merely 8% from Bloom's level 1, 20% from level 2, and 8% from level 3, whereas 64% of the questions were ambiguous. Faculty feedback revealed significant impact (P < 0.05) from blueprinting in microbiology. CONCLUSION Assessment should be aligned to learning objectives, and blueprinting improves content validity.
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Affiliation(s)
- J.S. Gill
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
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Purva M, Randeep G, Rajesh M, Mahesh CM, Sunil G, Subodh K, Sushma S, Naveet W, Pramod G, Arti K, Surbhi K, Omika K, Sonal K, Manoj S, Arunaloke C, Pallab R, Manisha B, Neelam T, Priscilla R, Subaramani K, Ebor J, Veeraraghavan B, Camilla R, Vijayalakshmi N, Vibhor T, Kuldeep S, Pradeep KB, Neeraj G, Daisy K, Vimala V, Chiranjay M, Vandana KE, Muralidhar V, Vijayshri D, Ruchita A, Kanne P, Sukanya S, Chand W, Neeraj G, Sanjay B, Sourav S, Karuna T, Saurabh S, Behera B, Sanjeev S, Thirunarayan MA, Reema N, Lahri S, Raja R, Hirak JR, Sujata B, Desma D, Mammen C, Sudipta M, Manas KR, Gaurav G, Swagata T, Satyajeet M, Anupam D, Tushar SM, Bashir AF, Gulnaz B, Shaista N, Sulochana D, Khuraijam RD, Langpoklakpam CS, Padma D, Anudita B, Ujjwala G, Neeta K, Geeta V, Tanvi S, Shristi J, Prachi V, Mamta L, Prithwis B, Anil CP, Clarissa L, Rajni G, Rushika S, Lata K, Vinod O, Kamini W. Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda. Indian J Med Microbiol 2019; 37:309-317. [PMID: 32003327 DOI: 10.4103/ijmm.ijmm_19_445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.
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Affiliation(s)
- Mathur Purva
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Guleria Randeep
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Malhotra Rajesh
- Department of Orthopedics, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - C Misra Mahesh
- Department of Surgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Gupta Sunil
- Department of Microbiology, Safdarjung Hospital and VMMC, Delhi, India
| | - Kumar Subodh
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Sagar Sushma
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Wig Naveet
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Garg Pramod
- Department of Gastroenterolog, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Kapil Arti
- Department of Microbiology, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Khurana Surbhi
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Katoch Omika
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Katyal Sonal
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Sahu Manoj
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Chakrabarti Arunaloke
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ray Pallab
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Biswal Manisha
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Taneja Neelam
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupali Priscilla
- Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, India
| | - K Subaramani
- Department of Surgery, Christian Medical College and Hospital, Vellore, India
| | - Jacob Ebor
- Department of Pediatrics, Christian Medical College and Hospital, Vellore, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India
| | - Rodrigues Camilla
- Department of Microbiology, P. D. Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Nag Vijayalakshmi
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Tak Vibhor
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Singh Kuldeep
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - K Bhatia Pradeep
- Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gupta Neeraj
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Khera Daisy
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Venkatesh Vimala
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - K E Vandana
- Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Varma Muralidhar
- Department of Medicine, Kasturba Medical College, Manipal, Karnataka, India
| | - Deotale Vijayshri
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Attal Ruchita
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Padmaja Kanne
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sudhaharan Sukanya
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Wattal Chand
- Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, Kolkata, West Bengal, India
| | - Goel Neeraj
- Department of Microbiology, Sir Ganga Ram Hospital, Kolkata, West Bengal, India
| | - Bhattacharya Sanjay
- Department of Microbiology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Sen Sourav
- Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Saigal Saurabh
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Singh Sanjeev
- Department of Infection Control, Amrita School of Medicine, Kochi, Kerala, India
| | - M A Thirunarayan
- Department of Microbiology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Nath Reema
- Department of Microbiology, Assam Medical College, Gwahati, Assam, India
| | - Saikia Lahri
- Department of Microbiology, Guahati Medical College, Gwahati, Assam, India
| | - Ray Raja
- Department of Microbiology, Institute of Post-Graduate Medical Education and Research, and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - J Raj Hirak
- Department of Microbiology, Institute of Post-Graduate Medical Education and Research, and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Baveja Sujata
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - D'Souza Desma
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Chandy Mammen
- Department of Haematology, Tata Medical Center, Kolkata, West Bengal, India
| | - Mukherjee Sudipta
- Department of Critical Care Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - K Roy Manas
- Department of Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Goel Gaurav
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Tripathy Swagata
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Misra Satyajeet
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Dey Anupam
- Department of Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - S Mishra Tushar
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - A Fomda Bashir
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bashir Gulnaz
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nazir Shaista
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Devi Sulochana
- Department of Microbiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - R Devi Khuraijam
- Department of Microbiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - C Singh Langpoklakpam
- Department of Anaesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Das Padma
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Bhargava Anudita
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Gaikwad Ujjwala
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Khandelwal Neeta
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
| | - Vaghela Geeta
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
| | - Sukharamwala Tanvi
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
| | - Jain Shristi
- Department of Critical Care and Respiratory Medicine, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Verma Prachi
- Department of Anaesthesiology and Critical Care, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Lamba Mamta
- Department of Microbiology, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Bhattacharyya Prithwis
- Department of Anaesthesiology and IC, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - C Phukan Anil
- Department of Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Lyngdoh Clarissa
- Department of Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Gaind Rajni
- Department of Microbiology, Safdarjung Hospital and VMMC, Delhi, India
| | - Saksena Rushika
- Department of Microbiology, Safdarjung Hospital and VMMC, Delhi, India
| | - Kapoor Lata
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Ohri Vinod
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Walia Kamini
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
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Karade S, Sen S, Sashindran VK. Absence of Integrase Strand Transfer Inhibitor Associated Resistance in Antiretroviral Therapy Naïve and Experienced Individuals from Western India. AIDS Res Hum Retroviruses 2019; 35:567-571. [PMID: 30793915 DOI: 10.1089/aid.2018.0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The Indian national AIDS control program heavily relies on low cost nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI). With global increase in resistance to these, alternative antiretroviral combinations need to be explored. Owing to higher potency, better efficacy and tolerability, recently WHO recommended integrase strand transfer inhibitor (INSTI) based first-line antiretroviral therapy (ART). There is lack of INSTI resistance surveillance data from India. Thus, there is a need to analyze integrase (IN) gene from primarily HIV-1 subtype C infected Indian population, before widespread introduction of INSTI in first-line ART. Plasma samples were collected from INSTI naïve individuals reporting to ART centre of Pune, India. RNA was extracted and IN gene was amplified by nested polymerase chain reaction (PCR) using prior published primers. PCR product of 867 bp was bi-directionally sequenced and resistance associated mutation were analyzed using Stanford University HIV drug resistance algorithm. A total of 58 HIV-1 sequences from 62 INSTI naïve individuals were successfully genotyped. Of these 58, 40 were ART naïve, newly diagnosed and remaining individuals were on NRTI, NNRTI, or protease inhibitors based failing regimen. The commonest subtype identified in the study was C (93%) followed by A1 (3.5%). A total of 191 (66.31%) fully conserved amino acid (aa) positions were observed in IN gene. Overall there was absence of major INSTI resistance mutation, however, E157Q (13.79%) emerged as common polymorphic mutation. Other accessory mutations were L74IM (34.48%), Q95K (1.72%), and T97A (1.72%). To conclude, this first Indian study on primarily HIV-1 subtype C sequences characterized aa variations in IN gene and indicated absence of major INSTI resistance associated mutations.
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Affiliation(s)
- Santosh Karade
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Sourav Sen
- Department of Microbiology, Armed Forces Medical College, Pune, India
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Karade S, Sen S, Sashindran VK, Sharma P, Kanitkar M. Measles, mumps, and rubella: A cross-sectional study of susceptibility to vaccine-preventable diseases among young people in India. Med J Armed Forces India 2019; 75:70-73. [PMID: 30705481 DOI: 10.1016/j.mjafi.2018.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Global elimination of vaccine preventable diseases, such as measles, mumps and rubella is a priority. Many countries have reported diminishing of antibody titres against these diseases among young population as immunization coverage of adolescents and adults in not monitored. The objective of this study was to determine the susceptibility against measles, mumps and rubella among young adults. METHODS In this cross-sectional study serological evidence of susceptibility to measles, mumps and rubella was determined by qualitative detection of IgG antibody titres by commercially available enzyme linked florescence assay (VIDAS, bioMerieux) in serum samples young adults. RESULTS A total of 335 young individuals (mean age: 20.54 ± 1.37 years) participated voluntarily between May 2017 to September 2018, of which 183 (54.63%) were males. Seroprotection against measles, mumps and rubella were 87.16%, 82.69% and 79.10% respectively. CONCLUSION Serological surveillance is important to monitor immune status in population. Susceptibility of young adults to measles, mumps, and rubella indicates need for booster vaccination. With the recent launch of measles-rubella vaccination campaign in India, country specific data will be required to plan periodicity of such campaign, which in turn would be based on accumulation of susceptible individuals in a community. Lastly, inclusion of mumps vaccine in the national universal immunization program needs consideration.
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Affiliation(s)
- Santosh Karade
- Assistant Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | | | - Punita Sharma
- Principal, College of Nursing, Armed Forces Medical College, Pune 411040, India
| | - Madhuri Kanitkar
- Dean and Deputy Commandant, Armed Forces Medical College, Pune 411040, India
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Ranjan M, Karade S, Sen S, Srinivas V. Pseudohemoptysis in an elderly due to Serratia marcescens pneumonitis. Med J Armed Forces India 2018; 74:383-385. [PMID: 30449928 DOI: 10.1016/j.mjafi.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/13/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
- Manish Ranjan
- Resident, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - Santosh Karade
- Classified Specialist (Microbiology), Trained in Virology & Retrovirology, Command Hospital (Southern Command), Pune 411040, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - V Srinivas
- Consultant and Head, Department of Pathology, Command Hospital (Southern Command), Pune 411040, India
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Sen S. Tuberculosis diagnosis in resource limited settings. Med J Armed Forces India 2018; 74:211-212. [PMID: 30093761 PMCID: PMC6081278 DOI: 10.1016/j.mjafi.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Chandola P, Gupta RM, Lall M, Sen S, Shergill SPS, Dutta V. Molecular detection of blaNDM-1 (New Delhi metallobetalactamase-1) in nosocomial Enterobacteriaceae isolates by nested, multiplex polymerase chain reaction. Med J Armed Forces India 2018; 74:108-115. [PMID: 29692474 DOI: 10.1016/j.mjafi.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/17/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Carbapenems are considered "drugs of last resort" in many life-threatening infections. Advent of carbapenemases like KPC, OXA-48, VIM, IMP, and NDM have greatly affected the efficacy of these drugs, posing serious threat to global health and infection control. NDM bears special significance to the India subcontinent, labeled as place of origin and reservoir. NDM tends to escape detection by routine phenotypic methods, requiring molecular confirmation. This study utilizes nested, multiplex polymerase chain reaction (PCR) for reliable detection of blaNDM-1 in nosocomial Enterobacteriaceae isolates. METHODS This study was conducted to detect prevalence of blaNDM-1, blaIMP, blaVIMand blaKPC genes by multiplex PCR among multidrug/carbapenem-resistant nosocomial Enterobacteriaceae isolates. From March 2013 to April 2014, 100 consecutive non-repeat isolates of Enterobacteriaceae from various inpatient clinical samples were analyzed. Imipenem-resistant isolates identified by Kirby Bauer disk diffusion method with Clinical and Laboratory Standards Institute guidelines were further subjected to nested, multiplex PCR to simultaneously detect blaNDM-1, blaIMP, blaVIMand blaKPC genes. RESULTS Out of 100 isolates, 17 (17%) were found to be imipenem-resistant. blaNDM-1 was detected in all 17 isolates by nested, multiplex PCR. blaVIM was co-carried in 4 isolates while one isolate co-harbored blaIMP with blaNDM-1. Imipenem resistance and NDM-1 carriage was predominant amongst Klebsiella isolates. Maximum NDM-1 producers were isolated from the intensive care unit (70.6%). CONCLUSION NDM-1 prevalence in nosocomial Enterobacteriaceae isolates in our hospital was found to be 17%. A nested, multiplex PCR was used for rapid detection of various carbapenemase genes with high sensitivity and specificity which is essential not only for favorable patient outcome but also for timely implementation of appropriate infection control practices to prevent further spread of such organisms.
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Affiliation(s)
- Parnika Chandola
- Assistant Professor (Microbiology and Molecular Medicine), Army Hospital (R&R), New Delhi 10, India
| | - R M Gupta
- Professor & Consultant (Pathology, Microbiology and Virology), Army Hospital (R&R), New Delhi 10, India
| | - Mahima Lall
- Study Leave (Microbiology), All India Institute of Medical Sciences, New Delhi, India
| | - Sourav Sen
- Professor & Head, Dept of Microbiology, Armed Forces Medical College, Pune 40, India
| | - S P S Shergill
- Assistant Professor (Microbiology and Molecular Medicine), Army Hospital (R&R), New Delhi 10, India
| | - Vibha Dutta
- Commandant, Command Hospital (Central Command), Lucknow, India
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Karade S, Chaturbhuj DN, Sen S, Joshi RK, Kulkarni SS, Shankar S, Gangakhedkar RR. HIV drug resistance following a decade of the free antiretroviral therapy programme in India: A review. Int J Infect Dis 2017; 66:33-41. [PMID: 29128646 DOI: 10.1016/j.ijid.2017.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/12/2017] [Accepted: 10/27/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The objective of this review was to assess the burden of HIV drug resistance mutations (DRM) in Indian adults exposed to first-line antiretroviral therapy (ART) as per national guidelines. METHODS An advanced search of the published literature on HIV drug resistance in India was performed in the PubMed and Scopus databases. Data pertaining to age, sex, CD4 count, viral load, and prevalence of nucleoside reverse transcriptase inhibitor (NRTI)/non-nucleoside reverse transcriptase inhibitor (NNRTI) DRM were extracted from each publication. Year-wise Indian HIV-1 reverse transcriptase (RT) sequences were retrieved from the Los Alamos HIV database and mutation analyses were performed. A time trend analysis of the proportion of sequences showing NRTI resistance mutations among individuals exposed to first-line ART was conducted. RESULTS Overall, 23 studies (1046 unique RT sequences) were identified indicating a prevalence of drug resistance to NRTI and NNRTI. The proportion of RT sequences with any DRM, any NRTI DRM, and any NNRTI DRM was 78.39%, 68.83%, and 73.13%, respectively. The temporal trend analysis of individual DRM from sequences retrieved during 2004-2014 indicated a rising trend in K65R mutations (p=0.013). CONCLUSIONS Although the overall burden of resistance against first-line ART agents remained steady over the study decade, periodic monitoring is essential. There is the need to develop an HIV-1 subtype C-specific resistance database in India.
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Affiliation(s)
- Santosh Karade
- HIV Drug Resistance Laboratory, National AIDS Research Institute (ICMR), Pune, India; Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Devidas N Chaturbhuj
- HIV Drug Resistance Laboratory, National AIDS Research Institute (ICMR), Pune, India; Symbiosis International University, Lavale, Pune, India
| | - Sourav Sen
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Rajneesh K Joshi
- Department of Epidemiology and Biostatistics, National AIDS Research Institute, Pune, India; Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Smita S Kulkarni
- Department of Molecular Virology, National AIDS Research Institute, Pune, India
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Khan ID, Sahni AK, Sen S, Gupta RM, Basu A. Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit. Med J Armed Forces India 2017; 74:358-364. [PMID: 30449922 DOI: 10.1016/j.mjafi.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/31/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prototheca is an emerging, opportunistic, pathogenic, zoonotic achlorophyllous green alga, expanding in pathogenicity and host range, causing localized and disseminated infections. This outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care 30-bedded chemotherapy oncology unit is the first human outbreak to the best of our knowledge. METHODS P. wickerhamii algaemia was confirmed on consecutive isolation. Person to person transmission was hypothesized considering all patients in the unit at risk. Clinico-demographic, diagnostic and treatment profile were correlated. Both manual and automated systems were used for blood culture, isolation, identification and susceptibility of Prototheca. Liposomal amphotericin B was given. Outbreak surveillance of faeces, fingertips and environmental reservoirs, retrospective surveillance during past 15 years and prospective surveillance was continued for two years. RESULTS The outbreak affected 12 neutropenic patients over 50 days. No specific clinical features were noted. The hypothesis could not be substantiated. P. wickerhamii was isolated as yeast-like colonies revealing Gram positive yeast-like cells without budding and pseudohyphae which were confirmed by automated system. Post amphotericin B blood cultures were negative for Prototheca. Surveillance studies were not contributory. CONCLUSION P. wickerhamii has no documented reservoirs or transmission. Endogenous colonization in the gut followed by translocation during chemotherapy induced immunosuppression is likely to cause algaemia and sepsis. Outbreaks are difficult to detect and control as incubation period is variable and clinical presentation is muted, emphasizing the need to strengthen hospital and laboratory based surveillance systems to ensure adequate preparedness, rapid detection and response to outbreaks.
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Affiliation(s)
- I D Khan
- Assistant Professor (Microbiology), Army College of Medical Sciences and Base Hospital, New Delhi 110010, India
| | - A K Sahni
- Brig Med, HQ 15 Corps, c/o 56 APO, India
| | - Sourav Sen
- Professor and Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - R M Gupta
- Consultant and Professor (Microbiology), Affiliated Faculty, Dept of Lab Sciences and Molecular Medicine, Army Hospital (R & R), New Delhi 110001, India
| | - Atoshi Basu
- Consultant, Department of Pathology, Apollo Gleneagles Hospital, Kolkata, India
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Tandel K, Bhatt P, Sen S, Gupta RM, Hazra N, Praharaj A, Kumar S, Sahni A. Burkholderia cepacia pseudobacteremia traced to contaminated antiseptic used for skin antisepsis prior to blood collection. ACTA ACUST UNITED AC 2016; 27:136-40. [DOI: 10.1097/mrm.0000000000000082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Agarwal AK, Sen S, Banerjee D, Srivastava R, Praharaj AK. Distribution of hepatitis B virus genotype and cancer predicting precore and basal core promoter mutations. Med J Armed Forces India 2015; 71:225-32. [PMID: 26288490 DOI: 10.1016/j.mjafi.2015.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic hepatitis B (CHB) infection which is associated with an increased risk of developing liver disease including cirrhosis and hepatocellular carcinoma. Viral factors that may increase the risk for HCC development include HBV DNA level, genotypes, and naturally occurring mutations such as hepatitis B virus precore (PC) (G1896A) and basal core promoter (BCP) A1762T/G1764A double mutations. HBV genotypes and subgenotypes can significantly influence HBeAg seroconversion rates, viremia levels, mutational patterns that could significantly influence the heterogeneity in clinical manifestations and even response to antiviral therapy. METHOD 94 CHB infected individuals with detectable serum HBV DNA levels were studied. HBsAg, HBeAg, anti-HBc IgM antibody estimations were done by ELISA. HBV DNA estimation was done. The HBV genotypes were determined by TSP-PCR and 10 samples randomly selected for DNA sequencing. PC and BCP mutations were determined by DNA sequence analysis of core region. RESULT Of 94 study participant samples with detectable serum HBV DNA levels, 75 were successfully genotyped and sequenced for BCP/PC region. 30/75 (40%) harbored PC and BCP mutations. The total Double mutations of BCP at A1762T/G1764A nucleotide positions, and PC mutation at G1896A nucleotide position were seen in 29.3% and 21.3%, respectively. All 75 isolates were subtype D using TSP-PCR. However, by sequencing 2/10 were subtype A, while 8 were subtype D. CONCLUSION Our study reinforces that D is the predominant genotype in Indian population. It reveals that Indian CHB subjects have increased prevalence of BCP & PC mutations, which possibly may lead to development of HCC.
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Affiliation(s)
- A K Agarwal
- Graded Specialist (Microbiology), INHS Sanjivani, Cochin, India
| | - Sourav Sen
- Senior Adviser (Microbiology & Pathology) and Trained in AIDS & Virology, Army Hospital (R & R), New Delhi, India
| | - Debabrata Banerjee
- Senior Adviser (Medicine & Gastroenterology), Command Hospital (Northern Command), C/O 56 APO, India
| | - Rakesh Srivastava
- Assistant Professor (Microbiology), R D Gardi Medical College, Ujjain, India
| | - A K Praharaj
- Professor and Head (Microbiology), All India Institute of Medical Science, Bhubaneswar, India
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Sen S. Anti-HIV-1 antibody detection in urine. Med J Armed Forces India 2014; 70:396. [PMID: 25382921 DOI: 10.1016/j.mjafi.2014.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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Chandola P, Lall M, Sen S, Bharadwaj R. Outbreak of Pneumocystis jirovecii pneumonia in renal transplant recipients on prophylaxis: Our observation and experience. Indian J Med Microbiol 2014; 32:333-6. [PMID: 25008834 DOI: 10.4103/0255-0857.136594] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Chaudhari CN, Tandel K, Grover N, Sen S, Bhatt P, Sahni AK, Praharaj AK. Heterogeneous vancomycin-intermediate among methicillin resistant Staphylococcus aureus. Med J Armed Forces India 2015; 71:15-8. [PMID: 25609857 DOI: 10.1016/j.mjafi.2014.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 03/19/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hetero-resistance vancomycin intermediate Staphylococcus aureus (hVISA) is phenotype, which on in-vitro susceptibility test is vancomycin susceptible (VSSA) but has a minority population of vancomycin intermediate (VISA). hVISA is responsible for vancomycin treatment failure. Population Analysis Profile- Area under Curve (PAP-AUC) is a test for detection of hVISA; however, this test is unsuitable for clinical microbiology laboratory. Tests, such as Brain Heart Infusion Agar with 6 μg/ml vancomycin (BHIA6V), E test and Macromethod E Test (MET) are available; however reported to have variable results. METHODS 58 clinical isolates of Methicillin resistant S aureus (MRSA) having MIC of vancomycin more than 1 μg/ml by E test and agar dilution were analyzed by PAP-AUC, BHIA6V and MET. RESULT The prevalence of hVISA was 6.9%. hVISA isolates were having vancomycin E test MIC >2 μg/ml. Sensitivity of BHIA6V, MET and E test with MIC >2 μg/ml were 0.75, 0.67 and 1.0 respectively; however, positive predictive values (PPV) were 0.43, 0.4 and 0.27 respectively with PAP-AUC. PAP-AUC ratio correlated with MIC by E test and MET. CONCLUSIONS There is need for screening MRSA isolates showing in-vitro vancomycin susceptibility ≤2 μg/ml by agar dilution method for detection of hVISA. PAP-AUC test is unsuitable for routine laboratory testing. BHIA6V, MET and E test can be used for screening, however have low PPV.
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Patil RT, Gupta RM, Sen S, Tripathy SP, Chaturbhuj DN, Hingankar NK, Paranjape RS. Emergence of drug resistance in human immunodeficiency virus type 1 infected patients from pune, India, at the end of 12 months of first line antiretroviral therapy initiation. ISRN AIDS 2014; 2014:674906. [PMID: 25006528 DOI: 10.1155/2014/674906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/16/2014] [Indexed: 02/05/2023]
Abstract
Introduction. In India, 4,86,173 HIV infected patients are on first line antiretroviral therapy (ART) as of January 2012. HIV drug resistance (HIVDR) is drug and regimen-specific and should be balanced against the benefits of providing a given ART regimen. Material & Methods. The emergence of HIVDR mutations in a cohort of 100 consecutive HIV-1 infected individuals attending ART centre, on first line ART for 12 months, was studied. CD4(+) T-cell counts and plasma HIV-1 RNA level were determined. Result. Out of the 100 HIV-1 infected individuals, 81 showed HIVDR prevention (HIV-1 RNA level < 1000/mL), while the remaining 19 had HIV-1 viral RNA level > 1000/mL. HIVDR genotyping was carried out for individuals with evidence of virologic failure (HIV-1 RNA level > 1000/mL). The most frequent NRTI-associated mutation observed was M184V, while K103N/S was the commonest mutation at NNRTI resistance position. Conclusion. Our study has revealed the emergence of HIVDR in HIV-1 infected patients at the end of 12 months of first line ART initiation. For NRTIs, the prevalence of HIVDR mutations was 9% and 10% for NNRTIs. Our findings will contribute information in evidence-based decision making with reference to first and second line ART delivery and prevention of HIVDR emergence.
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Khan ID, Lall M, Sen S, Ninawe SM, Chandola P. Multiresistant Elizabethkingia meningoseptica infections in tertiary care. Med J Armed Forces India 2015; 71:282-6. [PMID: 26288498 DOI: 10.1016/j.mjafi.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 02/06/2014] [Indexed: 02/05/2023] Open
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Abstract
BACKGROUND There has been increasing attention paid in recent years to the possibility that oral bacterial infection, particularly periodontal disease may influence the initiation and or progression of systemic diseases. These studies confirm the observation that heart disease is the most commonly found systemic condition in patients with periodontal disease. Moreover, the literature has also highlighted substantial evidence indicating the presence of Gram-negative periodontal pathogens in atheromatous plaques. AIM This study intends to investigate the possible association between periodontal health and coronary artery disease by evaluating periodontal status, association between the periodontal plaque and coronary atheromatous plaques for presence of micro-organisms such as, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia. MATERIALS AND METHODS A case-control study was designed with seven patients who had undergone coronary endarterectomy for cardiovascular disease and 28 controls. The periodontal examination for cases was performed 1 day before vascular surgery and the controls were clinically examined. The atheromatous plaque sample collected during endarterectomy and the intraoral plaque samples were subjected to polymerase chain reaction for identification of A. actinomycetemcomitans, P. gingivalis, P. intermedia and T. forsythia. RESULTS The presence of periodontal bacteria DNA in coronary atheromatous plaques and sub-gingival plaque samples of the same patients was confirmed by this study. CONCLUSION A correlation was established between putative bacteria contributing to atheromatous plaques and species associated with periodontal disease. One particularly important study to be carried out is the investigation of a possible clinically meaningful reduction in coronary heart disease resulting from the prevention or treatment of periodontal disease.
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Affiliation(s)
- Saroj K Rath
- Department of Periodontology, Army Dental Centre, Research and Referral Hospital, Delhi Cantonment, New Delhi, India
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Chaudhari CN, Tandel K, Grover N, Bhatt P, Sahni AK, Sen S, Prahraj AK. In vitro vancomycin susceptibility amongst methicillin resistant Staphylococcus aureus. Med J Armed Forces India 2014; 70:215-9. [PMID: 25378772 DOI: 10.1016/j.mjafi.2013.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/23/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vancomycin is drug of choice for treatment of Methicillin Resistant Staphylococcus aureus (MRSA) infections. S. aureus with reduced vancomycin susceptibility (SA-RVS) is on rise. Current guidelines of detection of SA-RVS are based on MIC (Minimum Inhibitory Concentration) by broth or agar dilution methods. Vancomycin MIC by E test (Epsilometer Test) is an alternative. A study was undertaken to know the prevalence of SA-RVS and compare vancomycin MIC by agar dilution and E test. METHODS A prospective study was undertaken at tertiary care hospital; 232 clinical MRSA isolates were included. Vancomycin MIC was undertaken by agar dilution method and E test. RESULTS All isolates were sensitive to Linezolid. Two MRSA isolates had vancomycin MIC ≥4 μg/ml; vancomycin MIC50 and MIC90 of MRSA isolates was 0.5 and 0.2 μg/ml respectively by agar dilution method. There was agreement over 93.5% isolates in vancomycin susceptibility by agar dilution and E test. E test had sensitivity and positive predictive value of 1.0 (CI - 0.34-1.0) and 0.5 (CI - 0.17-0.83) respectively compare to agar dilution method. CONCLUSIONS MRSA isolates continues to be susceptible to vancomycin and Linezolid. E test was found equally suitable in initial screening for vancomycin susceptibility. Due to geographic variation in prevalence, there is need of ongoing surveillance of SA-RVC.
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Affiliation(s)
- C N Chaudhari
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - K Tandel
- Medical Officer (Microbiology), Military Hospital Gwalior, India
| | - N Grover
- Associate Professor, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - P Bhatt
- Resident, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - A K Sahni
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune 411040, India
| | - S Sen
- Senior Advisor (Pathology, Microbiology & Virology), Army Hospital (R&R), Delhi Cantt 10, India
| | - A K Prahraj
- Professor & Head (Microbiology), AIIMS, Bhubaneswar, Orissa, India
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Kumar M, Sen S, Gupta RK, Chaturbhuj D, Tripathy SP, Paranjape RS. Prevalence of drug resistance in human immunodeficiency virus type 1-infected treatment-naive children in Pune, India. AIDS Res Hum Retroviruses 2014; 30:294-8. [PMID: 24387706 DOI: 10.1089/aid.2013.0222] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Abstract We report the presence of drug resistance mutations in 7.4% (2/27) of the treatment-naive, HIV-1-infected children in Pune, India, who had HIV-1 RNA levels >1,000 copies/ml. Nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations, namely A98G and K103N, were observed in two separate sequences. In addition, three study sequences displayed three separate HIV-1 protease minor resistance mutations-L10I, A71T, and T74S. These preliminary data from Pune, India, reporting the presence of HIVDR in treatment-naive, HIV-1-infected children, reinforces the need to conduct large-scale studies to assess the prevalence of primary HIVDR in the pediatric population, which in turn will aid in planning protocols and policies related to antiretroviral treatment for the pediatric population.
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Affiliation(s)
- Mukesh Kumar
- Department of Microbiology, Government Medical College, Haldwani, India
| | - Sourav Sen
- Department of Microbiology, Army Hospital (Research & Referral), Delhi, India
| | - Rakesh K. Gupta
- Department of Pediatrics, Command Hospital (CC), Lucknow, India
| | - Devidas Chaturbhuj
- National AIDS Research Institute (Indian Council of Medical Research), Pune, India
| | - Srikanth P. Tripathy
- National JALMA Institute of Leprosy and Other Mycobacterial Diseases (Indian Council of Medical Research), Agra, India
| | - Ramesh S. Paranjape
- National AIDS Research Institute (Indian Council of Medical Research), Pune, India
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Shrivastava R, Sen S, Banerji D, Praharaj AK, Chopra GS, Gill SS. Assessment of non-invasive models for liver fibrosis in chronic hepatitis B virus related liver disease patients in resource limited settings. INDIAN J PATHOL MICR 2013; 56:196-9. [PMID: 24152493 DOI: 10.4103/0377-4929.120359] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT A total of 350 million individuals are affected by chronic hepatitis B virus infection world-wide. Historically, liver biopsy has been instrumental in adequately assessing patients with chronic liver disease. A number of non-invasive models have been studied world-wide. AIM The aim of this study is to assess the utility of non-invasive mathematical models of liver fibrosis in chronic hepatitis B (CHB). Indian patients in a resource limited setting using routinely performed non-invasive laboratory investigations. SETTINGS AND DESIGN A cross-sectional study carried out at a tertiary care center. SUBJECTS AND METHODS A total of 52 consecutive chronic liver disease patients who underwent percutaneous liver biopsy and 25 healthy controls were enrolled in the study. Routine laboratory investigations included serum aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Gama glutamyl transpeptidase (GGT), total bilirubin, total cholesterol, prothrombin time and platelet count. Three non-invasive models for namely aspartate aminotransferase to platelet ratio index (APRI), Fibrosis 4 (FIB-4) and Forn's index were calculated. Outcomes were compared for the assessment of best predictor of fibrosis by calculating the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each index. STATISTICAL ANALYSIS USED Medcalc online software and by Microsoft Excel Worksheet. Chi-square test was used for significance. P value < 0.05 was taken as significant. RESULTS While the serum levels of AST, ALT and GGT were significantly higher in patients group as compare with the healthy controls (P < 0.01), the platelet counts were significantly lower in patient group as compared to the control group (P < 0.01). Mean value of all 3 indices were significantly higher in patients group as compare with the controls (P < 0.01). CONCLUSIONS Out of the three indices, APRI index with a NPV of 95% appeared to be a better model for excluding significant liver fibrosis while FIB-4 with a PPV of 61% showed fair correlation with significant fibrosis. Thus, these two non-invasive models for predicting of liver fibrosis, namely APRI and FIB-4, can be utilized in combination as screening tools in monitoring of CHB patients, especially in resource limiting settings.
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Affiliation(s)
- Rakesh Shrivastava
- Department of Microbiology, Army Hospital (Research and Referral), New Delhi, India
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Kumar S, Gupta RM, Sen S, Sarkar RS, Philip J, Kotwal A, Sumathi SH. Seroprevalence of human parvovirus B19 in healthy blood donors. Med J Armed Forces India 2013; 69:268-72. [PMID: 24600121 DOI: 10.1016/j.mjafi.2012.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 11/10/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Human parvovirus B19 is an emerging transfusion transmitted infection. Although parvovirus B19 infection is connected with severe complications in some recipients, donor screening is not yet mandatory. To reduce the risk of contamination, plasma-pool screening and exclusion of highly viraemic donations are recommended. In this study the prevalence of parvovirus B19 in healthy blood donors was detected by ELISA. METHODS A total of 1633 samples were screened for IgM and IgG antibodies against parvovirus B19 by ELISA. The initial 540 samples were screened for both IgM and IgG class antibodies and remaining 1093 samples were screened for only IgM class antibodies by ELISA. RESULTS Net prevalence of IgM antibodies to human parvovirus B19 in our study was 7.53% and prevalence of IgG antibodies was 27.96%. Dual positivity (IgG and IgM) was 2.40%. CONCLUSION The seroprevalence of human parvovirus B19 among blood donor population in our study is high, and poses an adverse transfusion risk especially in high-risk group of patients who have no detectable antibodies to B19. Studies with large sample size are needed to validate these results.
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Affiliation(s)
- Satish Kumar
- Classified Specialist (Transfusion Medicine), INHS Asvini, Mumbai, India
| | - R M Gupta
- Senior Advisor (Pathology & Virology), CH (NC), Udhampur, India
| | - Sourav Sen
- Commanding Officer, Military Hospital Paharpur, Gaya, India
| | - R S Sarkar
- Commandant, 151 Base Hospital, C/o 99 APO, India
| | - J Philip
- Associate Professor, Dept of Transfusion Medicine, AFMC, Pune-40, India
| | - Atul Kotwal
- Director AFMS (Medical Research), New Delhi, India
| | - S H Sumathi
- Resident, Dept of Transfusion Medicine, AFMC, Pune-40, India
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Chaturbhuj DN, Deshmukh PS, Hingankar NK, Siddhaarth K, Deshpande SN, Sen S, Kabra S, Paranjape RS, Tripathy SP. Evaluations of an in-house drug resistance method for HIV-1 drug resistance using ViroSeq™ 2.0 genotyping system as a gold standard. J Virol Methods 2013; 189:87-92. [PMID: 23353551 DOI: 10.1016/j.jviromet.2013.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 12/14/2012] [Accepted: 01/02/2013] [Indexed: 02/08/2023]
Abstract
An in-house method was evaluated for its efficiency to detect the HIV-1 drug resistance mutations. This method was compared with the ViroSeq™ Genotyping System 2.0 (Celera Diagnostics, US) a gold standard. Sixty-five stored plasma samples, previously tested for HIV-1 drug resistance using the ViroSeq™ method were used to evaluate the in-house method. Out of the sixty five plasma samples, sixty were HIV-1 positive clinical samples; four samples from the Virology Quality Assessment (VQA) program and one positive control from the ViroSeq™ kit were used in this study. The sequences generated by the ViroSeq™ and an in-house method showed 99.5±0.5% and 99.7±0.4% (mean±SD) nucleotide and amino acid identity, respectively. Out of 214 Stanford HIVdb listed HIV-1 drug resistance mutations in the protease and reverse transcriptase regions, concordance was observed in 203 (94.9%), partial discordance in 11 (5.1%) and complete discordance was absent. The in-house primers are broadly sensitive in genotyping multiple HIV-1 group M subtypes. The amplification sensitivity of the in-house method was 1000 copies/ml. The evaluation of the in-house method provides results comparable with that of ViroSeq™ method thus, making the in-house method suitable for HIV-1 drug resistance testing in the developing countries.
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Affiliation(s)
- Devidas N Chaturbhuj
- National AIDS Research Institute, Plot 73, 'G' Block, M.I.D.C., Bhosari, Pune 411 026, India.
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Sen S, Panda SP, Shanmuganandan K, Gupta R, Praharaj A. Prevalence of occult hepatitis B amongst Indian human immunodeficiency virus type 1 infected individuals-a pilot study. Med J Armed Forces India 2012; 68:16-9. [PMID: 24669033 DOI: 10.1016/s0377-1237(11)60127-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/24/2011] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The diagnosis of hepatitis B is routinely based on the detection of hepatitis B surface antigen (HBsAg) only. However, occult hepatitis B virus (HBV) infection (OBI), which is defined as infection with positive hepatitis B core antibody (anti-HBc) antibodies, positive DNA (deoxyribonucleic acid) PCR (polymerase chain reaction), and undetectable HBsAg, as well as anti-HBs antibodies in serum or plasma of HBV infected individuals, will remain undetected using this screening diagnostic approach of detecting HBsAg. The current study aims in studying the prevalence of the OBI amongst human immunodeficiency virus type 1 (HIV-1) infected individuals who have not been exposed to anti-retroviral therapy. METHOD Estimation of HBsAg, anti-HBs, and anti-HBc total antibody status amongst 100 HIV-1 infected study participants was carried out using enzyme-linked immunosorbent assay (ELISA) kits. Detection of HBV-DNA was carried out by in-house qualitative PCR. CD4 + T lymphocyte counts were analysed using Becton Dickinson's (BD) FACSCount™ system. RESULTS The median age of the HIV-1 infected study population was 35 years (range: 22-67), with the gender distribution being 53 males and 47 females. The mean CD4 T lymphocyte count of the study participants was 210/mm(3). Overall, serological evidence of HBV infection was observed in 28% of the HIV-1 infected study participants. There was 5% seropositivity for HBsAg, of which 2% were additionally positive for HBV-DNA-PCR. "Anti-HBc alone" status was seen in 18% of study participants, this being statistically higher in those with CD4 T lymphocyte counts < 200/mm(3). While there was a single specimen with co-positivity for anti-HBc total antibodies and HBV-DNA, 5% of the in the study population exhibited anti-HBs antibodies positivity, with one sample exhibiting dual positivity for HBsAg and anti-HBs antibodies. CONCLUSION Occult HBV infections may contribute to chronic liver damage, and associ-ated reactivation amongst immunocompromised individuals, HIV-1 in-fected being a subset of them. "Anti-HBc" testing followed by HBV-DNA detection by PCR can be utilised for such populations to detect OBIs. Early detection of hepatitis B viraemia will be important for deciding the antiviral therapeutic protocol so as to avoid evolution of antiviral resistance in the circulating HBV strains in HIV-1 infected individuals harbouring OBIs.
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Affiliation(s)
- Sourav Sen
- Commanding Officer, Military Hospital, Gaya
| | | | - K Shanmuganandan
- Senior Advisor (Medicine & Rheumatology), Army Hospital (R&R), Delhi Cantt
| | - Rm Gupta
- Senior Advisor (Pathology & Microbiology), Command Hospital (NC), Udhampur
| | - Ak Praharaj
- Professor & Head, Department of Microbiology, Pune - 40
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Sen S, Vyas A, Sanghi S, Shanmuganandan K, Gupta RM, Kapila BK, Praharaj AK, Kumar S, Batra RB. Correlation of CD4+ T cell Count with Total Lymphocyte Count, Haemoglobin and Erythrocyte Sedimentation Rate Levels in Human Immunodeficiency Virus Type-1 Disease. Med J Armed Forces India 2011; 67:15-20. [PMID: 27365755 DOI: 10.1016/s0377-1237(11)80005-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 12/13/2010] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Studies in human immunodeficiency virus (HIV) infected adults have demonstrated association of total lymphocyte count (TLC) <1200/mm (3) and subsequent disease progression or mortality. The association of other surrogate makers such as haemoglobin (Hb), and erythrocyte sedimentation rate (ESR) with CD4 count and disease progression has also been suggested. This study was carried out to determine the relationship of CD4-positive T lymphocyte counts with TLC, Hb and ESR in HIV-infected individuals. METHODS The study population comprised of 215 antiretroviral treatment naïve HIV-1 infected adults. The CD4 positive T cell counts, TLC, Hb and ESR of study participants were measured. Spearman's rank order correlation and Receiver Operating Characteristic were used for statistical analyses. RESULT The sensitivity, specificity, positive and negative likelihood ratios for cut-off value of TLC <1200/mm (3) for predicting CD4 counts <200 cells/mm (3) and <350 cells/mm (3) were 9.4 %, 100 %, not measurable and 1.1, and 6.1 %, 98.8 %, 5.13 and 0.95, respectively. The association of Hb (<10,11,12 g/dl and <10,12,14 g/dl for CD4 counts <200 cells/mm (3) and <350 cells/mm (3) , respectively), and ESR (<10, 20 and 30 mm fall after 1 hour) with these two CD4 counts cut-off values were suboptimal. CONCLUSION This study reveals the poor association of TLC, Hb, and ESR with CD4 counts in HIV infected adults, thus highlighting the need to review the utility of these surrogate markers, for predicting CD4 counts in people living with HIV/AIDS.
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Affiliation(s)
- Sourav Sen
- Associate Professor, Department of Microbiology, AFMC, Pune-40
| | | | - Sunil Sanghi
- Classified Specialist (Dermatology), STI & HIV/AIDS, CH (SC), Pune-40
| | - K Shanmuganandan
- Senior Advisor (Med & Rheumat), Army Hospital (R&R), Delhi Cantt
| | - R M Gupta
- Senior Advisor (Pathology & Microbiology), CH (NC)
| | | | - A K Praharaj
- Professor & HOD, Department of Microbiology, AFMC, Pune-40
| | - Satish Kumar
- Associate Professor, Department of Microbiology, AFMC, Pune-40
| | - R B Batra
- Associate Professor, Department of Pathology, AFMC, Pune-40
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Gopalakrishnan S, Sen S, Adhikari JS, Chugh PK, Sekhri T, Rajan S. The role of T-lymphocyte subsets and interleukin-5 blood levels among Indian subjects with autoimmune thyroid disease. Hormones (Athens) 2010; 9:76-81. [PMID: 20363725 DOI: 10.14310/horm.2002.1256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Autoimmune Thyroid Disease (AITD) results from an interaction of exogenous and endogenous factors in a genetically predisposed individual. AITD is being increasingly reported among the Indian population. Lymphocyte subsets and levels of interleukin-5 (IL- 5) were studied in the peripheral blood of patients with AITD. DESIGN Subjects diagnosed with either hyperthyroidism due to Graves' Disease (GD) or with primary hypothyroidism due to Hashimoto's Thyroiditis (HT) were consecutively recruited. Euthyroid controls were also recruited for comparison. Lymphocyte subsets (CD4 and CD8 counts, CD4/CD8 ratio) were evaluated by flow cytometry and IL-5 levels were determined by the sandwich ELISA method. RESULTS Nineteen subjects with GD, 16 subjects with HT and 10 controls were studied. CD4/CD8 ratios were found to be significantly lower only in subjects with HT compared to controls. Serum IL-5 values were significantly higher in both GD and HT in comparison to controls. CONCLUSIONS The study found increased levels of IL-5 and reduction in ratios of CD4/CD8 lymphocytes in the peripheral blood of patients with HT, but only IL-5 was increased in GD. High levels of IL-5 could have resulted in the high titres of antithyroid antibodies and may therefore be considered to play a more significant role than peripheral lymphocytes in the pathogenesis of AITD in the Indian population.
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Sen S, Tripathy S, Sahni A, Gupta R, Kapila K, Chopra G, Chimanpure VM, Patil AA, Paranjape R. Human immunodeficiency virus type 1 gp 41 mutations in proviral DNA among antiretroviral treatment-naive individuals from India. AIDS Res Hum Retroviruses 2009; 25:521-3. [PMID: 19400735 DOI: 10.1089/aid.2008.0244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The HIV-1 gp41 has been identified as an important target for the immune response, for the development of antiviral and vaccine strategies, and for epidemiologic studies. This study describes the HIV-1 env gp41 region mutations, associated with enfuvirtide (ENF) resistance, in proviral DNA from PBMCs in antiretroviral treatment-naive individuals from Pune, India. Twenty-one antiretroviral drug-naive chronically HIV-1-infected individuals were enrolled. The study sequences belonged to subtype C (n = 17), subtype A1 (n = 2), and CRF_AE (n = 2). In subtype B-infected individuals, the various HR1 region substitutions in env gp41 that have been associated with ENF resistance include A30V, L33S/T/V, L34M, G36D/E/S/V, I37T/K/V, V38A/M/E/G, Q39R, Q40H, N42T/D, N43D/K/S, L44M, L45M, R46M, L54M, and Q56K/R as well as N126K and S138A in the HR2 region. The study sequences did not reveal any ENF resistance-associated mutations at env gp41 amino acid positions: 36 to 45. The presence of L54M and Q56K in combination is associated with 5-fold reduced sensitivity to inhibition by ENF. The mutation L54M was seen in seven subtype C and two CRF_AE study sequences. Q56K was observed in a subtype A1 sequence. All the study sequences harbored N42S, a natural polymorphism associated with increased susceptibility to ENF. Of the mutations V38A and N140I, known to provide immunologic gain, the latter was observed in four subtype C sequences. This is the first study from India highlighting the presence of certain mutations in Indian subtype C env gp41, which may play a role in the evolution of subtype-specific variations in the resistance to ENF and associated immune response.
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Affiliation(s)
- Sourav Sen
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - S.P. Tripathy
- Department of Clinical Sciences, National AIDS Research Institute, Pune, India
| | - A.K. Sahni
- Department of Pathology and Immunology, Army Hospital, Delhi, India
| | - R.M. Gupta
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - K. Kapila
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - G.S. Chopra
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | | | - Ajit A. Patil
- Department of Molecular Virology, National AIDS Research Institute, Pune, India
| | - R.S. Paranjape
- Department of Molecular Virology, National AIDS Research Institute, Pune, India
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Abstract
HIV disease is a chronic infection that requires lifelong treatment with the aim of suppressing the circulating viral load in order to improve the host immune status. The development of safe and effective antiretroviral agents with unique resistance profiles or novel mechanisms of action are an important goal for the long-term management of HIV-infected patients. The antiretroviral drug classes include entry and fusion inhibitors, nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, integrase inhibitors, and protease inhibitors. Current antiretroviral therapeutic regimens are associated with the emergence of issues like HIV drug resistance, drug toxicities, associated poor patient adherence to therapy, co-existence of other opportunistic, and blood borne viral infections. Newer antiretroviral agents may provide some alternatives to modulate the therapy as per the requirements of the HIV infected patients.
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Affiliation(s)
- Sourav Sen
- Department of Microbiology, Armed Forces Medical College, Pune, India - 411040.
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Lall M, Gupta RM, Sen S, Kapila K, Tripathy SP, Paranjape RS. Profile of primary resistance in HIV-1-infected treatment-naive individuals from Western India. AIDS Res Hum Retroviruses 2008; 24:987-90. [PMID: 18593351 DOI: 10.1089/aid.2008.0079] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The majority of the HIV drug resistance (HIVDR) testing studies have focused on subtype B virus. The predominance of subtype C in the Indian subcontinent along with greater access to antiretroviral therapy (ART) necessitates studies on HIVDR genotyping. We determined the prevalence of mutations associated with protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and nonnucleoside reverse transcriptase inhibitors (NNRTI) from plasma of 40 antiretroviral drug-naive study participants in Indian HIV-1 pol gene sequences. Of these, 36 sequences belonged to subtype C, two to subtype A1, and two were subtype A1C recombinants. The heterosexual route was the most common route of transmission. Drug resistance-associated mutations were observed in 10% (4/40) of the study participants. The resistance mutation observed in the protease gene was V82A, whereas in the RT gene, M41L, D67N, M184V, and A98G were documented. This is the first study reporting major protease mutations by genotyping in ART-naive individuals from western India.
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Affiliation(s)
- Mahima Lall
- Department of Microbiology, Armed Forces Medical College, Pune, India
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Sen S, Tripathy SP, Patil AA, Chimanpure VM, Paranjape RS. High prevalence of human immunodeficiency virus type 1 drug resistance mutations in antiretroviral treatment-experienced patients from Pune, India. AIDS Res Hum Retroviruses 2007; 23:1303-8. [PMID: 17961120 DOI: 10.1089/aid.2007.0090] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We report one or more HIV resistance mutations in 81.81% of the 33 antiretroviral treatment-experienced study participants with evidence of virologic failure, with M184V being the most commonly observed resistance mutation (69.7%). Two out of four participants with protease inhibitors (PI) experience harbored multiple PI-associated resistance mutations. No resistance mutations were observed in 22 treatment-naive study plasma sequences. All the study pol sequences were subtype C, except one that was subtype A1. On analyzing paired plasma-proviral DNA sequences from 16 treatment-experienced patients, which harbored mutations at positions associated with antiretroviral drug resistance, an 87.5% discordance in reverse transcriptase mutations was seen between the two compartments. Our study highlights the high prevalence of HIV resistance mutations in treatment-experienced patients in Pune, with protease major resistance mutations being reported for the first time from India. The proviral DNA resistance mutation patterns may have an impact on the clinical management of HIV/AIDS.
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Affiliation(s)
- Sourav Sen
- Department of Pathology and Microbiology, Command Hospital, Pune, India 411040
| | - Srikanth P. Tripathy
- Department of Molecular Biology, National AIDS Research Institute, Pune, India 411026
| | - Ajit A. Patil
- Department of Molecular Biology, National AIDS Research Institute, Pune, India 411026
| | | | - Ramesh S. Paranjape
- Department of Molecular Biology, National AIDS Research Institute, Pune, India 411026
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Kurle SN, Gangakhedkar RR, Sen S, Hayatnagarkar SS, Tripathy SP, Paranjape RS. Emergence of NNRTI drug resistance mutations after single-dose nevirapine exposure in HIV type 1 subtype C-infected infants in India. AIDS Res Hum Retroviruses 2007; 23:682-5. [PMID: 17530993 DOI: 10.1089/aid.2006.0167] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A feasibility study for providing single-dose nevirapine (SD-NVP) prophylaxis for prevention of mother-to-child transmission (PMTCT) of HIV infection provided an opportunity to study the emergence of nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutations as a result of single-dose administration. The study aimed at the detection of NNRTI drug resistance mutations arising as a result of SD-NVP. A total of 19 and 13 samples collected at 48 h and 2 months postpartum, respectively, from infants that were given SD-NVP were studied for the presence of NNRTI drug resistance mutations by PCR amplification and sequencing of the HIV-1 pol gene using HIV proviral DNA. The drug resistance mutational analysis of final sequences was carried out using the Stanford University HIV Drug Resistance database (http://hivdb.stanford.edu/hiv). Mutations associated with NNRTI drug resistance were observed in two (10.5%) and six (46.15%) samples at 48 h and at 2 months, respectively. K103N, one of the most common mutations, was not observed in any of the samples. The emergence of NVP resistance must be weighed against the simplicity, efficacy, and cost effectiveness of SD-NVP prophylaxis in PMTCT settings in developing countries.
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Affiliation(s)
- Swarali N Kurle
- Department of Molecular Virology, National AIDS Research Institute, Pune, India
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Sen S, Tripathy SP, Chimanpure VM, Patil AA, Bagul RD, Paranjape RS. Human immunodeficiency virus type 1 drug resistance mutations in peripheral blood mononuclear cell proviral DNA among antiretroviral treatment-naive and treatment-experienced patients from Pune, India. AIDS Res Hum Retroviruses 2007; 23:489-97. [PMID: 17506605 DOI: 10.1089/aid.2006.0221] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The prevalence of HIV drug resistance (HIVDR) mutations in the HIV protease (PR) and reverse transcriptase (RT) genes was estimated from peripheral blood mononuclear cells (PBMCs) in a study population of 25 antiretroviral (ARV) therapy-naive and 50 ARV-experienced chronically infected patients from Pune city, Maharashtra State, western India. Of the 75 study HIV-1 sequences, 73 belonged to subtype C and 2 to subtype A1. On phylogenetic analysis, the study subtype C sequences sub clustered randomly with different Indian and non-Indian subtype C sequences, emphasizing the HIV-1 subtype C pol gene diversity. The heterosexual route was the most common route of transmission (74.67%). There were no observable HIVDR mutations in ARV-naive patients. The ARV-experienced patients had a history of exposure to nucleoside reverse transcriptase inhibitor and nonnucleoside reverse transcriptase inhibitor combinations. At least one HIVDR mutation in RT was observed in 29 (80.55%) of ARV-experienced patients with evidence of failing therapy. M184V was the most common observed HIVDR mutation. No PR major mutations were observed among ARV-experienced patients. A higher prevalence of proviral HIVDR mutations in PBMCs was associated with irregular adherence to therapy (p < 0.05) and HIV-1 RNA levels > 1000 copies/ml (p < 0.001).
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Sen S, Tripathy SP, Paranjape RS. Antiretroviral drug resistance testing. J Postgrad Med 2006; 52:187-93. [PMID: 16855319 DOI: pmid/16855319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
While antiretroviral drugs, those approved for clinical use and others under evaluation, attempt in lowering viral load and boost the host immune system, antiretroviral drug resistance acts as a major impediment in the management of human immune deficiency virus type-1 (HIV-1) infection. Antiretroviral drug resistance testing has become an important tool in the therapeutic management protocol of HIV-1 infection. The reliability and clinical utilities of genotypic and phenotypic assays have been demonstrated. Understanding of complexities of interpretation of genotyping assay, along with updating of lists of mutation and algorithms and determination of clinically relevant cut-offs for phenotypic assays are of paramount importance. The assay results are to be interpreted and applied by experienced HIV practitioners, after taking into consideration the clinical profile of the patient. This review sums up the methods of assay currently available for measuring resistance to antiretroviral drugs and outlines the clinical utility and limitations of these assays.
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Affiliation(s)
- Sourav Sen
- National AIDS Research Institute, (Indian Council of Medical Research), Pune, Maharashtra, India.
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Marwaha RK, Sen S, Tandon N, Sahoo M, Walia RP, Singh S, Ganguly SK, Jain SK. Familial aggregation of autoimmune thyroiditis in first-degree relatives of patients with juvenile autoimmune thyroid disease. Thyroid 2003; 13:297-300. [PMID: 12729480 DOI: 10.1089/105072503321582114] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Several studies have shown aggregation of autoimmune thyroiditis in families by estimation of thyroid antibodies. However, the prevalence by concurrent estimation with fine-needle aspiration cytology (FNAC) and thyroid antibodies has not been previously reported. We therefore studied 222 first-degree relatives (group 1) of 71 index cases diagnosed as lymphocytic thyroiditis on FNAC and 81 family members (group 2) of 23 goitrous children diagnosed as colloid goiter on FNAC for comparison. Successful FNAC conducted in 122 group 1 subjects revealed lymphocytic thyroiditis in 51 (42%), whereas lymphocytic thyroiditis was diagnosed in only 5 goitrous subjects (13%) in group 2. Among group 1 subjects with FNAC-proven lymphocytic thyroiditis, antithyroid peroxidase (TPO) antibodies were found in 35 (67%), while in anti-TPO antibody positive goitrous relatives of group 1, lymphocytic thyroiditis was found in 36 (78%). Eight new cases of overt hypothyroidism and 45 new cases of subclinical hypothyroidism were diagnosed among group 1 subjects. Our study suggests: (1). familial clustering of autoimmune thyroiditis; (2). if only FNAC or thyroid antibodies is used for diagnosis of autoimmune thyroiditis in children, 22%-33% of cases are likely to be missed; and (3). serum thyrotropin (TSH) should be offered to all first-degree relatives of patients with juvenile autoimmune thyroiditis.
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Affiliation(s)
- R K Marwaha
- Department of Endocrinology and Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
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Abstract
A thymoma in the neck region is a rare diagnosis involving a solitary neck nodule that moves with deglutition and is contiguous with the thyroid gland. The authors report an unusual case of a thymoma that accumulated both Tc-99m pertechnetate and Tc-99m MIBI. This is probably the first reported case of a benign neck thymoma concentrating these two radiopharmaceuticals. Thymoma should be added to the gamut of false-positive findings in the neck for thyroidal (with Tc-99m pertechnetate) and malignant (with Tc-99m MIBI) tissue.
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Affiliation(s)
- Kashyap P Lanka
- Institute of Nuclear Medicine and Allied Sciences, Brig. SK Mazumdar Marg, Delhi, India
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