Priyamvada Roy

Gender Differences in Outcomes of Low Birth Weight and Preterm Neonates: the Male Disadvantage

Various studies conducted worldwide have shown that male neonates have higher rates of mortality and morbidity in the perinatal period compared with females. However, there has been only one study from India on this subject. Therefore, this study was conducted to establish the difference in mortality between males and females among neonates born with two established risk factors of septicaemia--low birth weight (<2.5 kg) and preterm birth (<37 weeks). One hundred and fifty consecutive neonates which were either preterm or had low birth weight were recruited after obtaining informed consent from the parents. Blood culture was done, and the bacterial isolates were identified by standard protocol. Statistically significant association was found between male gender and mortality among culture-positive neonates. Therefore, results of the present study indicate that preterm or low birth weight male neonates have higher likelihood of mortality compared with their female counterparts in the Indian scenario.

Chikungunya: a reemerging infection spreading during 2010 dengue fever outbreak in National Capital Region of India

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Empirical model for estimating dengue incidence using temperature, rainfall, and relative humidity: a 19-year retrospective analysis in East Delhi

OBJECTIVES Aedes mosquitoes are responsible for transmitting the dengue virus. The mosquito lifecycle is known to be influenced by temperature, rainfall, and relative humidity. This retrospective study was planned to investigate whether climatic factors could be used to predict the occurrence of dengue in East Delhi. METHODS The number of monthly dengue cases reported over 19 years was obtained from the laboratory records of our institution. Monthly data of rainfall, temperature, and humidity collected from a local weather station were correlated with the number of monthly reported dengue cases. One-way analysis of variance was used to analyse whether the climatic parameters differed significantly among seasons. Four models were developed using negative binomial generalized linear model analysis. Monthly rainfall, temperature, humidity, were used as independent variables, and the number of dengue cases reported monthly was used as the dependent variable. The first model considered data from the same month, while the other three models involved incorporating data with a lag phase of 1, 2, and 3 months, respectively. RESULTS The greatest number of cases was reported during the post-monsoon period each year. Temperature, rainfall, and humidity varied significantly across the pre-monsoon, monsoon, and post-monsoon periods. The best correlation between these three climatic factors and dengue occurrence was at a time lag of 2 months. CONCLUSIONS This study found that temperature, rainfall, and relative humidity significantly affected dengue occurrence in East Delhi. This weather-based dengue empirical model can forecast potential outbreaks 2-month in advance, providing an early warning system for intensifying dengue control measures.

Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients

Helicobacter pylori (HP) is causally associated with peptic ulcer disease and gastric carcinoma. Determination of the prevalence of HP infection in dyspepsia patients′ in particular geographical area is imperative for the appropriate management of dyspepsia. HP antigen detection in stool is a noninvasive diagnostic test of HP infection. This prospective study was conducted to find out the prevalence of HP infection based on stool antigen testing in dyspeptic patients who had also undergone upper gastrointestinal (GI) endoscopy. This study highlights the high prevalence of HP infection in dyspeptic Indian patients, particularly males, and emphasizes the growing importance of the bacterium causing infection among children. We also found HP stool antigen testing to be superior to upper GI endoscopy for detecting HP infection. Hence, we recommend initial testing for HP stool antigen in dyspeptic patients before initiating treatment and before carrying out any invasive procedure such as endoscopy.

Non-pigmented Strain of Serratia Marcescens: An Unusual Pathogen Causing Pulmonary Infection in a Patient with Malignancy

Serratia marcescens is a member of the family Enterobacteriaceae. It has emerged in recent years as an opportunistic pathogen of nosocomial infections. Some biotypes of Serratia marcescens produce the non-diffusible red pigment prodigiosin. Though both pigmented and non-pigmented biotypes may be pathogenic for humans, the non-pigmented biotypes are more virulent due to cytotoxin production and presence of plasmids mediating antibiotic resistance. However in India only one study done 31 years back has reported on infections caused by non-pigmented strains of Serratia marcescens. We present a case of a patient with squamous cell carcinoma of the left retromolar trigone, soft palate and buccal mucosa, who developed pulmonary infection with non-pigmented strain of Serratia marcescens. According to the available literature, this is the second report on infection with non-pigmented strain of Serratia marcescens from India. It is imperative to accurately detect the non-pigmented biotypes due to their tendency to cause serious and difficult to treat infections.

Multidrug-resistant Staphylococcus hominis subsp. novobiosepticus causing septicemia in patients with malignancy

A new subspecies of Staphylococcus hominis described by Kloos et al. in 1998 and named S. hominis subsp. novobiosepticus (SHN) has been implicated in nosocomial outbreaks. Multidrug resistance, including resistance to novobiocin and oxacillin, is a particularly important feature of SHN. In our institute, we encountered 13 cases of S. hominis subsp. hominis in cancer patients with septicemia, of which seven were methicillin resistant. The isolates were identified by VITEK ® 2 compact automated system, using GP REF 21342 identification card and antimicrobial susceptibility testing card P-628. The biochemical reactions and antibiotic susceptibility pattern of the seven methicillin-resistant isolates were re-analyzed and patient details were re-checked to finally identify them as SHN. The increasing number of cases reporting isolation of SHN from biological specimens point to potential virulence and clinical importance of this bacterium.

Needle Stick Injury among Health Care Workers and Its Aftermath in a Tertiary Care Hospital in East Delhi, India

Needle stick injuries (NSI) present serious occupational threat to healthcare workers (HCW). Due to lack of epidemiological data on NSI in this geographical region, the present study was conducted to estimate incidence rate of NSI, identify factors associated, assess awareness of HCWs and evaluate post-injury sero-reactivity rates. This cross-sectional observational study involved 524 HCWs (151 medical and 373 paramedical staff). A validated questionnaire was filled by investigator using interviewing technique. Blood sample was collected from study subjects who reported NSI within last 28 days, at the time of NSI and subsequently after 1, 3 and 6 months. Screening for HBsAg, anti-HCV and anti-HIV 1/2 antibodies was done using commercially available Enzyme-Linked Immunosorbent Assay Kit. Sixty-three HCWs, comprising mainly of medical staff, gave history of NSI in preceding 28 days. The most frequent procedure leading to NSI included recapping needles and suturing in 28.57%, while commonest root cause was haste in 61.91%. Majority (61.91%, 39/63) suffered from NSI during latter part of their duty hours. None became HBsAg, anti-HCV or HIV seropositive. The proportion of NSI among HCWs who had received training on prevention and management of NSI was significantly lower than those who were untrained. Hence training programs emphasizing on safe techniques must be conducted regularly and HCWs putting in long working hours must be allowed to take breaks. Needle stick injury among health care workers and its aftermath in a tertiary care hospital in East Delhi, India.

Trends in the Epidemiology of Hepatitis B Virus and Hepatitis C Virus Infections at a Tertiary Care Hospital in East Delhi: A 7-Year Retrospective Analysis

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are major global health problems. In 2009, the national Integrated Disease Surveillance Programme (IDSP) began conducting surveillance across all Indian states for epidemic-prone diseases including viral hepatitis. Hence this retrospective study was conducted to identify trend changes in HBV and HCV epidemiology over a period of 7 years at a tertiary care hospital in Delhi. Enzyme-linked immunoassay result entries for Hepatitis B surface antigen (HBsAg) and Hepatitis C antigen and/or anti-HCV antibody were analyzed. The 7-year seroprevalence of HBV and HCV was found to be 3.084% and 5.381% respectively. The seroprevalence of HBsAg was maximum in 2010. Since then the seroprevalence has shown a small decrease. Government of India has included HBV vaccine in the National Universal Immunization Program in the entire country in 2011-12. We consider the reduction in HBsAg seroprevalence to represent a true fall in HBV transmission due to vaccination and/or public consciousness. In the present study, HCV infection appeared to be more common than HBV infection. During last few years, seroprevalence of HCV also increased, which is possibly attributable to an increase in the population of Delhi and a heavy load of the migrant population. These figures may be important for estimation of the disease burden in this region. The study provides a fine reference for future studies, because of the large number of cases investigated over a long period of 7 years and draws attention to the lacunae in ongoing immunization programs.

Sporadic occurrence of cryptococcal meningitis in HIV-seronegative patients: Uncommon etiology?

Cryptococcosis in HIV-seronegative patients is rarely reported from India. This prospective study was conducted to look for cryptococcal meningitis in HIV-seronegative individuals and compare their laboratory features to cryptococcal meningitis in HIV-seropositive patients. Cerebrospinal fluid was collected from 153 suspected cases of meningitis and subjected to India ink preparation, antigen detection, and culture. Nineteen samples tested positive for Cryptococcus neoformans infection. Seventeen and two patients were HIV reactive and nonreactive, respectively. In vitro susceptibility of C. neoformans isolates to fluconazole and amphotericin B was performed using standard broth microdilution method and E-test. Eighteen strains were susceptible to amphotericin B, while fluconazole was reported susceptible in 15 strains. Hence, index of suspicion of C. neoformans infection as possible cause of meningitis must be maintained even in HIV-negative patients. Use of amphotericin B for treating C. neoformans meningitis should be restricted to prevent any increase in resistance.

Anti-cysticercus antibody detection in saliva as a potential diagnostic tool for neurocysticercosis.

Objectives: This study was planned to determine the usefulness of anti-cysticercus IgG antibody detection in saliva for neurocysticercosis (NCC) diagnosis, along with serum C-reactive protein (CRP) level to serve as a surrogate marker. Materials and Methods: In this prospective study of 14 months duration, blood and saliva samples were collected from 40 patients suspected to be suffering from NCC and were subjected to anti-cysticercus IgG antibody detection by ELISA. Serum CRP levels were estimated as acute-phase reactant by high sensitivity CRP ELISA. Results: Anti-cysticercus IgG was detected in serum and saliva of 34 and 30 patients, respectively. Cases positive for salivary antibody were positive for serum antibody and their serum CRP level was higher than normal. Cases negative for salivary antibody had low serum CRP levels. Anti-cysticercus IgG detection in saliva was 88.24% sensitive, 100% specific, and had a positive predictive value of 100% and negative predictive value of 60%. Positive salivary anti-cysticercus IgG and high serum CRP level showed a significant association. Difference between CRP levels of patients positive for anti-cysticercus antibody in both serum and saliva, and patients positive for antibody in serum but not saliva was highly significant. Conclusions: Saliva, being painless and noninvasive, can be used as alternative to serum for NCC diagnosis.