Efficient valorization of feather waste by Bacillus cereus IIPK35 for concomitant production of antioxidant keratin hydrolysate and milk-clotting metallo-serine keratinase

Keratinase production by Bacillus cereus IIPK35 was investigated under solid-state fermentation (SSF) and the maximum titer of 648.28 U/gds was revealed. Feather hydrolysates obtained from SSF exhibited paramount antioxidant properties in ABTS [2,2'-azinobis-(3-ethylbenzothiazoline)-6-sulfonic acid], FRAP [Ferric ion reducing antioxidant power], and DPPH [2,2,-Diphenyl-1-picrylhydrazyl] assay. The keratinase was purified up to homogeneity have a molecular weight of 42 kDa, and showed its stability between pH 6.5-10.0 and temperature 35-60 °C with optimum enzyme activity at pH 9.0 and 55 °C. The catalytic indices viz. Km of 9.8 mg/ml and Vmax of 307.7 μmol/min for keratin were determined. Besides keratin, the enzyme displayed broad and proteolytic activity towards other proteinaceous substrates such as casein, skim milk, gelatin, and bovine serum albumin. Pure keratinase activity was stimulated in presence of Ca²⁺ and Mg²⁺ ions, while it was strongly inhibited by both iodoacetamide and EDTA, indicating it to be a metallo-serine protease in nature. Circular dichroism study endorses the structural stability of the secondary structure at the said range of pH and temperature. The IIPK35 keratinase is non-cytotoxic in nature, shows remarkable storage stability and is stable in presence of Tween 80, Triton X 100, and sodium sulfite. Furthermore, it showed excellent milk clotting potential (107.6 Soxhlet Unit), suggesting its usefulness as an alternative milk clotting agent in the dairy industry. This study unlocks a new gateway for keratinase investigation in SSF using chicken feathers as substrate and biochemical and biophysical characterization of keratinase for better understanding and implication in industrial applications.

Aetiology and trends of rates of stillbirth in a tertiary care hospital in the north of India over 10 years: a retrospective study

OBJECTIVE

To analyse the aetiology of stillbirth and its changing trends in a single tertiary care referral institute of northern India over a 10-year period (2007-2016).

DESIGN

Retrospective study.

SETTING

Tertiary care hospital in the north of India.

SAMPLE

Medical records of all mothers who delivered a stillborn at the institute.

METHODS

Data was collected from monthly and annual perinatal audits and causes of stillbirths were classified using Simplified CODAC classification. Annual reduction rate was calculated by linear regression analysis and Cusick test for the changing trends over 9 years.

MAIN OUTCOME MEASURES

Of 54 160 births, 3678 babies were stillborn. Over 9 years, the annual stillbirth rate has reduced significantly from 73.6 to 62.0 per 1000 total births with an average annual reduction rate of 1%. The most common causes of stillbirths were hypertensive disorders of pregnancy (27.6%), antepartum haemorrhage (19.5%), and congenital anomalies (9.3%).

CONCLUSION

The annual reduction rate (1%) of stillbirth remains low. The aetiology of stillbirths remains unchanged over a 10-year period and hypertensive disorder of pregnancy remains the single most preventable cause of stillbirth.

TWEETABLE ABSTRACT

Analysis of stillbirths over a 10-year period in an Indian institute showed a high but declining trend with annual reduction rate of 1%.

Corticosteroid-associated lupus pancreatitis: a case series and systematic review of the literature

BACKGROUND

Acute pancreatitis is an uncommon complication that occurs in 0.85% to 4% of patients with systemic lupus erythematosus (SLE). In some patients, it occurs within days to weeks of starting medium-to-high dose corticosteroids. The authors have used the term 'corticosteroid-associated lupus pancreatitis' for these patients, and they report a case series and perform a systematic review of previously published reports.

METHODS

For the purpose of this study, corticosteroid-associated lupus pancreatitis was defined as occurrence of acute pancreatitis in patients with SLE (fulfilling the 1997 ACR), within 3 weeks of starting therapy with medium-to-high dose corticosteroids - either newly initiated or escalated from a lower dose. All patients with SLE admitted in the last 2.5 years in a North Indian university hospital were reviewed, and those with pancreatitis who fulfilled the above criteria were included in the case series. For the systematic review, a PUBMED search using the keywords 'lupus' and 'pancreatitis' was performed, and reports in English were reviewed for an association with corticosteroids.

RESULTS

Among 420 admissions of SLE patients, six patients (1.4%) fulfilled criteria for corticosteroid-associated lupus pancreatitis. All were female, with mean age and disease duration of 19.7 ± 3.3 and 3.8 ± 2.5 years respectively. All had active disease and developed acute pancreatitis within 48-72 hours of newly initiating medium-to-high dose corticosteroids (in three patients) or escalating them to medium-high dose (in three patients). After the development of pancreatitis, corticosteroids were continued in all except one patient. In addition, two patients received pulse methylprednisolone, two received pulse cyclophosphamide and one was started on azathioprine. Three patients died during hospitalization, all with severe pancreatitis. On systematic review, among 451 cases of lupus pancreatitis reported, 23 (5%) fulfilled criteria for 'corticosteroid-associated lupus pancreatitis'. A majority of them had pancreatitis within 3 days of starting treatment with medium-to-high dose corticosteroids. The mortality in these patients was 37.5%.

CONCLUSION

In a small but substantial proportion of patients with lupus who develop pancreatitis, it occurs within days to weeks of starting medium-to-high dose corticosteroids. Many of these patients continue to receive corticosteroids, and some receive more aggressive immunosuppression. However, they have significant mortality, and further studies are required to identify appropriate treatment in this subgroup of patients.

Second primary malignancy: A retrospective analysis report from a tertiary cancer center of North India

AIM OF STUDY

We analyzed the data of second primary malignancy (SPM) from one of the tertiary cancer centers of North India, and the basic aim was to retrieve incidence, prognosis, and outcomes.

MATERIALS AND METHODS

A retrospective study was conducted in the Department of Radiation Oncology in a tertiary cancer center between January 1, 2011, and December 31, 2015. A total of 6000 cases of cancer were analyzed, out of which cases who presented with histological proven synchronous SPM were included in this study.

RESULTS

The present study showed three cases (8.1%) of SPM who are attributed to field carcinogenesis. There were five cases in which metachronous malignancy develops in the previous radiation therapy field. There is 26% of synchronous malignancy as compared to 74% of metachronous malignancy. In the present study, most diagnosed synchronous malignancies were carcinoma breast, while in metachronous malignancies, carcinoma breast and gynecological cancers were most common.

CONCLUSIONS

SPMs are not very rare. Hence, pretreatment and follow-up evaluation should be meticulous to rule out SPMs.

Urinary-exosomal miR-2909: A novel pathognomonic trait of prostate cancer severity

The global occurrence of prostate cancer with a range of patient outcome has prompted various investigators to explore novel molecular biomarkers that can precisely detect and track this type of cancer severity. Several studies suggest that micro-RNAs have emerged to act as a new largely unexplored class of biomarkers because of their inherent stability, resilience and recruitment into exosomes present in various human body fluids. With this study, we aim to reveal the nature of urinary-exosomal miR-2909 & miR-615-3p recruitment in patients suffering from either prostate cancer (n=90) or bladder cancer (n=60) as compared to that in either prostate disease-control subjects having benign prostate hyperplasia (n=10) or healthy subjects (n=50). Unlike miR-615-3p, the urinary- exosomal miR-2909 recruitment was not only observed conspicuously in subjects having prostate cancer in comparison to bladder cancer but also the extent of urinary exosomal miR-2909 recruitment showed characteristic variation as a function of prostate cancer aggressiveness as compared to that of either urinary- exosomal miR-615-3p level or existing widely recognised serum prostate specifics antigen (PSA) biomarker of this cancer. In summary, we propose that the extent of urinary exosomal miR-2909 recruitment may provide a potential non-invasive candidate diagnostic marker for the detection of prostate cancer and its aggressiveness.

Are the results from the 2014 UK national survey on the management of diabetic ketoacidosis applicable to individual centres?

BACKGROUND

In 2013 the Joint British Diabetes Societies published an update to their 2010 guideline on the management of diabetic ketoacidosis (DKA). In 2014 a national survey was conducted to assess the management of DKA across the UK using the JBDS or local guidelines. Hospitals were invited to submit data on 5 people presenting with DKA. These data were published in 2016. However, whether those national results were applicable to individual hospitals remains unknown.

AIM

To assess the management of people presenting with DKA at a single hospital and compare the results with the national dataset.

METHODS

Using the identical data collection tool as used in the national survey we collected information on 40 subjects (a total of 52 admissions) admitted with DKA between April 2014 and July 2015.

RESULTS

The data collected locally were very similar to those found in the national dataset. The management of DKA was best during the first few hours after admission, then biochemical and physical monitoring frequency decreased. The number of people who developed hypokalaemia and hypoglycaemia were very similar to the national data. Rates of biochemical improvement were slightly better locally.

CONCLUSIONS

The data from the national DKA survey, even though based on a maximum of 5 people per hospital from across the UK are applicable at a hospital level.

Botryomycosis — a series of six integumentary or visceral cases from India

Botryomycosis is characterized by a chronic suppurative lesion with distinctive fungus-like grains that resemble the sulphur granules of actinomycosis. Both integumentary and visceral forms of the disease are recognized. The visceral involvement occurs predominantly in the lungs. Botryomycosis may develop in apparently healthy individuals as well as the immunologically compromised. Six cases of botryomycosis, affecting various sites in the bodies of immunocompetent individuals, are described. In each of the six cases, the initial clinical diagnosis was of an abscess or malignancy.

Extra-osseous Ewing's sarcoma of the thumb

The hand is an uncommon location for Ewing's tumour of the bone. This paper details the presentation, pathology and management of an extra-osseous Ewing's sarcoma of the thumb in an adult woman. The management entailed a combination of neo-adjuvant chemotherapy and surgical excision, followed by reconstruction with an interposition bone graft from the subcutaneous surface of the ulna.

Angioinvasive pulmonary mucormycosis presenting as multiple bilateral pulmonary nodules in a patient without obvious predisposing factors

Pulmonary mucormycosis is a rare, frequently fatal, fungal infection. It is usually seen in the presence of various immunocompromised states, such as diabetes mellitus, haematological malignancy or renal transplantation. In the absence of underlying predisposing conditions, presentation with infiltrates, consolidation, cavitation and mass lesion have been reported. We describe a 50-year-old man who presented with cough and chest pain for six months. Chest radiograph and computed tomography showed bilateral multiple pulmonary nodules. Surgical lung biopsy revealed angioinvasive mucormycosis. He had complete recovery with amphotericin therapy.

Expression of cytokeratin 20 in urine cytology smears: a potential marker for the detection of urothelial carcinoma

BACKGROUND

Urine cytomorphology is one of the oldest methods for screening and monitoring patients with transitional cell carcinoma (TCC). Sensitivity of urine cytology is relatively low. Ancillary techniques on urine sample may increase the sensitivity.

AIM

To explore the utility of cytokeratin 20 (CK20) immunostaining in identifying malignant cells in urine cytology smears.

MATERIALS AND METHODS

Fourteen cases each of confirmed TCC and benign urinary cytology along with five cases of atypical cells in urine were immunostained with a monoclonal CK20 antibody. Of 14 cases of TCC, 12 showed strong positive staining with the antibody. All benign cases were negative except for a few cases in which the umbrella cells were weakly to moderately positive. In all five cases of atypical urine cytology the atypical cells stained positive with the antibody. These cases were later confirmed as TCC on histopathology of bladder wall biopsy.

CONCLUSION

CK20 is an important biomarker that can be used to identify TCC in urine cytology smears. It is particularly useful in those cases where malignancy cannot be confirmed by morphology alone.

Elevated red cell volume in North Indian students

In a survey for beta-thalassemia carrier status among students in the State of Punjab in India, a surprisingly large number were found to have an elevated red cell volume over 99 fl. The finding was predominantly but not exclusively in females. Similar student surveys from other states showed less macrocytosis. Follow-up tests in a group of affected students were carried out. Volunteers were asked to modify their diet then after six months they were provided with oral vitamin B12. The resulting changes are reported and the implications of the probable vitamin B12 and or folic acid deficiency are considered.

An outbreak of dengue fever in periurban slums of Chandigarh, India, with special reference to entomological and climatic factors

BACKGROUND

Dengue viral infection is one of the most important public health problem in tropical countries.

AIM

An outbreak of dengue fever was investigated in a periurban slum area of Chandigarh, India, during September to December, 2002.

MATERIALS AND METHODS

Blood samples from 218 patients and 30 apparently healthy contacts were tested for dengue-specific immunoglobulin M (IgM) and IgG antibodies including 80 acute samples collected within 5 days of illness were subjected for virus isolation in newborn mice. The average temperature, rainfall, and humidity of the epidemic year were compared with the number of dengue cases.

STATISTICAL ANALYSIS

statistical significance was found out using c2-test.

RESULTS

A total of 76 cases were positive by either dengue IgM capture assay (n = 57) or virus isolation (n = 17) or both (n = 2). Fifteen of nineteen viral isolates subjected for typing by type-specific multiplex reverse transcription-polymerase chain reaction were found to be of dengue virus. High rainfall and humidity with the temperature range from 21 degrees C to 33 degrees C during the months of August and September might have favored the breeding of mosquitoes, thus leading to an increase in the number of dengue cases in October and November, 2002.

CONCLUSION

The present outbreak thus emphasizes the need for continuous sero epidemiological and entomological surveillance for the timely implementation of effective dengue control programme.

Outpatient oral anticoagulant management--an audit of 82 patients

OBJECTIVE

Use of oral anticoagulants for thrombotic diseases has been increasing steadily over the years. Management practices however, are far from uniform. We conducted a retrospective audit among outpatients on oral anticoagulant therapy to assess treatment practices and overall control of anticoagulation.

METHODS

Case records of 82 patients who were on anticoagulant therapy for a minimum duration of three months were reviewed. Information on pre-therapeutic assessment of patients, therapeutic control and complications seen during the course of treatment was recorded.

RESULTS

Case notes of 43 males and 39 females with a mean age of 47.5 +/- 14.6 years, on oral anticoagulant treatment were evaluated. Treatment duration ranged from 3 months to 7 years for a total of 258.7 patient treatment years. Pre-therapeutic assessment of patients was inadequate with only baseline hematological and renal parameters available for most patients. Of a total of 1631 prothrombin time ratios and International Normalized Ratios recorded, only 17.8% were in the therapeutic range with 73% being sub-therapeutic. Sixteen (19.5%) patients had treatment related complications. The number of thrombotic and hemorrhagic events per 100 patient treatment years was 3.4 and 2.7 respectively.

CONCLUSIONS

Pre-therapeutic assessment of patients was inadequate. The overall therapeutic control was poor with patients in a state of underanticoagulation for most period of anticoagulant treatment. The complication rate was also unacceptably high. There is a need to reassess management practices of patients on long term oral anticoagulation with strict adherence to standard accepted guidelines to make this therapy more effective and safer for patients.

Changing trend of SSPE over a period of ten years

Sub acute sclerosing pan-encephalitis (SSPE) is a slowly progressive inflammatory disorder of the central nervous system. A decline in frequency has been noticed in most of the developed countries, whereas it continues to be high in developing countries. Though a number of studies have been carried out, the exact trend of SSPE is still not clear. Hence the present study was carried out to analyze the trend of SSPE over the past ten years in and around Chandigarh. A total of 205 patients with clinical features suggestive of SSPE were enrolled for the study during Jan'92 to Dec. 2001. Measles specific antibodies were detected in blood and CSF by HAI method. 114 patients were found to be positive for measles specific HAI antibody with a male preponderance. The number of SSPE cases were found to be more during the period 1992-95 in comparison to the next 6 years (p < 0.05). The high incidence of SSPE in our country could be due to improper vaccine coverage, poor cold chain maintenance or circulation of atypical measles virus strain.

Spurious rise in the automated platelet count because of bacteria

The era of automation in haematology, although improving the accuracy and precision of results, has also introduced the laboratory haematologist to a vast array of spurious parameters. The identification of these results is important so that inappropriate management decisions are avoided. The case presented here illustrates a spuriously raised automated platelet count resulting from bacterial overgrowth in the blood sample.

Knowledge base of clinicians regarding oral anticoagulant therapy in a teaching institution--a questionnaire survey

AIMS

Maintaining international normalized ratios (INRs) within the therapeutic range for patients on oral anticoagulant therapy is a tough task. Physician practices have a vital bearing on safe management in these patients. We sought to assess the knowledge base of clinicians in our hospital regarding oral anticoagulant treatment.

METHODS

A retrospective review of 3152 consecutive INRs in patients on outpatient oral anticoagulant treatment (OAT) was carried out over a 16 month period. To assess clinician practices, we performed a questionnaire survey (20 questions) on various aspects of OAT among 65 clinicians (response rate--89%).

RESULTS

76.3% of the INRs were in the sub-therapeutic range, 19.1% in the therapeutic range while 4.6% INRs were beyond therapeutic range. Fifty five completed questionnaires were returned by 24 consultants and 35 residents. Knowledge of clinicians regarding the loading dose of the oral anticoagulant, target INR range, the colour of the tablet was not adequate with 21, 28 and 23 correct responses respectively. Documentation of dietary and drug history was inadequate with 13 and 38 responses respectively. Patient education was limited to only verbal information to patients on anticoagulation. Most clinicians performed baseline screens before starting therapy. Although majority of clinicians (41) reported haemorrhagic complications in patients, just under one-third (28.8%) clinicians encountered thrombosis more often. Significant differences between the knowledge of consultants and residents was only found in responses for the correct loading dose (p < 0.0007) and the laboratory methodology in use for PT/INR determination (p < 0.04).

CONCLUSIONS

Knowledge base of clinicians regarding oral anticoagulant management was unsatisfactory. A tendency to under-dose patients was observed. There is need for stricter adherence to accepted guidelines of anticoagulant therapy with particular emphasis on patient education.

Multilocular cystic renal cell carcinoma in a child

Multilocular cystic renal cell carcinoma is an extremely rare condition in adults with no previous case reports in the pediatric age group. The authors report on an 8-year-old girl who underwent nephrectomy for a right-sided renal cystic disease because of extensive involvement of the kidney. Subsequent histopathologic examination findings showed presence of renal cell carcinoma in all the cysts. Awareness of this malignancy in a child is extremely important in the background of recent reports advocating conservative wait and watch management in unilateral renal cystic disease, which has similar clinical and imaging findings.

Antenatal hydronephrosis: ureteral polyp causing ureteropelvic junction obstruction

We describe a rare case of ureteropelvic junction obstruction in a three and a half-year-old boy due to a benign ureteric polyp. This case is being reported due to the rarity of benign neoplasms of the ureter in infants and children and also because the child had been diagnosed antenatally as having hydronephrosis.

Improvement in fresh frozen plasma transfusion practice: results of an outcome audit

Blood components have been in use in clinical practice for many decades now. In spite of fairly clear guidelines regarding their use, inappropriate prescriptions for components are still rampant. We undertook this work to assess the appropriateness of fresh frozen plasma (FFP) transfusions in our hospital. A prospective audit of 504 transfusion orders for 1761 FFP units was conducted over a 6-month period which was followed by a re-audit of 294 FFP prescriptions for 961 units. In the initial audit, we identified 304 (60.3%) prescriptions which were inappropriate according to the British Committee for Standardization in Hematology (BCSH) guidelines. The re-audit performed after an educational campaign among clinicians showed a reduction in inappropriate requests by 26.6%. The specific areas of misuse were FFP transfusions in patients with hypoproteinaemic states (40.5%), anaemia (36.5%), bleeding without coagulation factor deficiency (10.2%) and volume depletion (9.2%). A significant 50.3% of requests in the initial audit and 38.4% in the re-audit were for single- or two-unit transfusions, which were subtherapeutic. FFP transfusions carry the same risks to the patients as any other blood component. Prescribers of these transfusions need to be aware of the clinical setting where their use is appropriate. Local hospital transfusion committees can play a vital role in overseeing transfusion practices to ensure optimal use of blood/component therapy.

An audit of splenectomies in a teaching hospital in North India. Are postsplenectomy guidelines being complied with?

AIMS

Patients with an absent or dysfunctional spleen are at risk of infection by encapsulated and other bacteria. Overwhelming postsplenectomy infection (OPSI) causes most concern because it can result in significant mortality. A retrospective review of splenectomised patients in a tertiary care setting over an eight year period was carried out to determine whether current postsplenectomy guidelines were being followed.

METHODS

The cases were identified from the medical records and pathology files and data such as the reason for splenectomy, the preventive measures taken regarding vaccination, and antibiotic prophylaxis, together with their documentation in the discharge notes were assessed.

RESULTS

Fifty six patients were studied. Trauma, both blunt and penetrating, was the most common reason for splenectomy. Thirty six patients received pneumococcal vaccination, with 20 patients having no mention of vaccination in their case notes. The discharge notes of 50 patients mentioned their splenectomised status; however, documentation of vaccination details in the discharge summary was poor, with only three patients having the relevant information recorded. Documentation of the need for future vaccination and precautions required in the asplenic condition was also lacking. Nine patients had postsplenectomy complications, although there were no cases of OPSI.

CONCLUSIONS

Adherence to standard guidelines for the management of splenectomised patients was unsatisfactory. There is a need for an improvement of the vaccination rate and careful documentation of this important health risk in the discharge summaries. Maintenance of a splenectomy registry could aid in optimising the management of these patients.

Wilms' tumor: transureteral intravesical extension and presentation as urinary retention

The authors report an unusual case of Wilms' tumor. The tumor grew transureterally into the urinary bladder, became dislodged, and presented as recurrent urinary infection with retention of urine after the child underwent nephroureterectomy. Such a presentation has not been reported earlier.

Celiac crisis

Celiac crisis is a life-threatening cause of acute diarrhea and multiple metabolic emergencies. It is extremely rare these days. We successfully managed a 5-year old girl with celiac crisis for multiple metabolic problems viz., hyponatremia, hypokalemia, metabolic acidosis, hyperglycemia and polyuria in Pediatric Intensive Care Unit. Steroid therapy was life saving. The case may serve as a reminder of the condition, which presents a difficult therapeutic challenge.

Subependymomas in children: a report of five cases including two with osseous metaplasia

Subependymomas are highly differentiated slow growing gliomas. They are one of the few gliomas which are biologically benign. They are extremely rare in children. However, after going through the histopathology records of our department of fourteen years (1983-1997) we found that five (20%) cases of subependymomas have been diagnosed in children out of a total of twenty-six subependymomas. Two of our cases showed the presence of osseous metaplasia, a hitherto undescribed finding.

Mucoepidermoid carcinoma of the bronchus: is conservative surgery always justified?

A case of mucoepidermoid carcinoma of the bronchus in a 7-year-old boy is reported. The patient underwent right pneumonectomy. Histologically, the tumor was a low-grade muco-epidermoid carcinoma arising from the bronchus with lymph node metastasis in the drainage area. Presence of lymph node metastasis in this low-grade tumor suggests the possibility of early progression of disease in what has until now been considered a very slow growing tumor. Aggressive surgery may be necessary in these situations.

Olanzapine in the treatment of schizophrenia : an open label comparative clinical trial from north India

The aim of the present study was to assess the efficacy and safety of olanzapine in the treatment of schizophrenic patients. 27 patients were randomly assigned to treatment with olanzapine or haloperidol over 12 weeks. The primary efficacy measure was the mean change from baseline to endpoint in total scores on the Brief Psychiatric Rating Scale (BPRS) and assessing treatment emergent adverse events. Secondary measures were positive symptoms, negative symptoms, general psychopathology depression, anxiety and quality of life. Compared to haloperidol, olanzapine had equal effect in improving overall psychopathology, positive symptoms, and severity of schizophrenic illness. Olanzapine showed supehor improvement on negative symptoms and secondary depressive features. Commonest side effects were weight gain, sleepiness and increased duration of sleep. Olanzapine is effective in improving overall psychopathology including positive symptoms, negative and secondary depressive features in Indian patients with schizophrenia and it is safe and well tolerated at dosage between 5 to 20 mg/day.

Crescentic glomerulonephritis associated with renal cell carcinoma

Various glomerular lesions are described in association with malignancy. We report a rare case of crescentic glomerulonephritis occurring in association with renal cell carcinoma. A granular deposition of immune complexes and complement strongly suggests a tumor associated immune complex glomerulonephritis.

Evaluation of E test for susceptibility testing of Mycobacterium tuberculosis to primary anti tubercular drugs

BACKGROUND & OBJECTIVES

Antimicrobial susceptibility tests for tuberculosis take weeks and delayed therapy can lead to an increase in disease incidence. The E test is a new concept for minimum inhibitory concentrations (MIC) determinations for antimicrobial agents that is based on a predefined antibiotic gradient on a plastic strip calibrated with a continuous logarithmic MIC scale covering 15 two-fold dilutions. The present study was undertaken to evaluate E test strips for susceptibility testing of Mycobacterium tuberculosis.

METHODS

Twenty five clinical isolates of M. tuberculosis were tested for the four first line antitubercular drugs by E test and were compared with standard proportion method. The inoculum turbidity was adjusted to McFarland 3.0 standard and agar plates (Middle brook 7H11 agar) were inoculated and preincubated (37 degrees C in 7-10% CO2) for 24 h after which time, the E test strips were placed on the agar surface which were incubated under same conditions. The MIC was interpreted as the point at which the ellipse intersected the 'E test' strip as described in E test technical guide.

RESULTS

Of the 25 strains, susceptibility as determined by both methods for isoniazid (INH), rifampin, ethambutol and streptomycin was found in 22 (88%), 20 (80%), 24 (96%) and 18 (72%) strains respectively. Agreement between E test and proportion method was 96 per cent for INH, 92 per cent for rifampin and 100 per cent for ethambutol and streptomycin each. However, sensitivity could be predicted after 7-10 days by E test and exact MIC could also be determined.

INTERPRETATION & CONCLUSIONS

E test method was found to be rapid, accurate, reliable and easy to perform. It can be employed for routine susceptibility testing for antitubercular drugs.

Aldosterone-producing adrenocortical adenoma in childhood: a case report

Aldosterone-producing adrenal tumor is an exceptional cause of hypertension in childhood. The authors describe an 11-year-old girl with hypertension and lower limb weakness who had hyperaldosteronism and left adrenocortical adenoma.