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ORIGINAL ARTICLE
Monika Sharma, Shelly Sehgal, Shashi S Sudhan, Konika Razdan, Bharti Pandita, Mamta Sharma

Epidemiology and Genotypes of Hepatitis C Virus: A First Study from Jammu (J&K), India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:9-14][No of Hits : 216]


ABSTRACT

Background and objectives: Globally, around 200 million people are infected with hepatitis C virus (HCV). India contributes a big proportion of HCV burden with the prevalence estimated between 0.5 and 1.5%. Northeastern tribal populations and areas of Punjab represent the HCV infection hotspots, while in Western and Southern parts of the country, the prevalence is lower. The distribution of HCV genotypes is highly variable. This study was particularly planned to attain knowledge of the prevalent HCV genotypes in Jammu province of Jammu and Kashmir (J&K) state.

Materials and methods: Blood samples of patients attending the Department of Medicine, Government Medical College (GMC), Jammu and Kashmir, India, for HCV testing were subjected to serological test at Department of Microbiology, GMC, Jammu. The serum samples were tested for anti-HCV antibodies by enzyme-linked immunosorbent assay (ELISA) and positive samples were subjected to genotyping.

Conclusion: Of the 396 samples tested, 33 (8.33%) were found to be HCV positive and 23 of these were included for genotyping. Genotypes 3 and 1 were detected in this region and this was in accordance with other national studies. There is a need for larger field studies to better understand the HCV epidemiology and identify higher prevalence areas and also the distribution of genotypes of HCV. This, being a maiden study from this region, will shed light to allow apposite choice and target efforts for better management of the disease and reduce the burden of chronic liver disease due to HCV.

Keywords: Chronic liver disease, Genotyping, Hepatitis C virus, Seroprevalence.

How to cite this article: Sharma M, Sehgal S, Sudhan SS, Razdan K, Pandita B, Sharma M. Epidemiology and Genotypes of Hepatitis C Virus: A First Study from Jammu (J&K), India. J Gastrointest Infect 2017;7(1):9-14.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Piyush Harchand, Veenu Gupta, Gautam Ahluwalia, Rajoo S Chhina

Clinical and Bacteriological Profile of Spontaneous Bacterial Peritonitis in Cirrhotic Patients

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:15-20][No of Hits : 194]


ABSTRACT

Background and objectives: Spontaneous bacterial peritonitis (SBP) is a frequent complication in patients with chronic liver disease and ascites. This can develop slowly and insidiously or remain clinically unrecognized until the appearance of symptoms. The mortality rate after a single episode ranges from 20 to 40%, and early diagnosis is required for adequate treatment and prevention of new episodes. The aim was to study the clinicobacteriological profile of SBP and its variants in patients of cirrhosis.

Materials and methods: This prospective study was conducted on cirrhotic patients with ascites admitted in a tertiary care hospital. Basic demographics, symptoms, and clinical signs of patients were recorded. Diagnostic paracentesis was done for ascitic fluid cytology and culture. Identification and antimicrobial susceptibility of the isolates was done in VITEK system.

Results: Of a total of 113 cirrhotic patients, 58 (51.3%) were diagnosed with SBP. Culture-negative neutrocytic ascites (CNNA) was the commonest presentation. The most common symptoms were abdominal distension followed by fatigue, anorexia, and jaundice. Majority of patients belonged to Child- Pugh’s Grade C. Of 58 cases of SBP, 22 were culture positive. Gram-negative isolates were predominant (77.3%). Escherichia coli was the commonest isolate. Gram-negative isolates were highly susceptible to colistin followed by tigecycline, amikacin, and carbapenems; 59% of the isolates were multidrug resistant (MDR) and 13.6% were extensively drug resistant (XDR).

Interpretation and conclusion: Prevalence of SBP in cirrhotic patients was 51.3% and Gram-negative isolates were predominant. Ascitic fluid culture and susceptibility testing can lead to accurate diagnosis of SBP and can guide for treatment as resistance to antibiotic is common.

Keywords: Bacterascites, Cirrhosis, Culture-negative neutrocytic ascites, Serum ascites albumin gradient, Spontaneous bacterial peritonitis.

How to cite this article: Harchand P, Gupta V, Ahluwalia G, Chhina RS. Clinical and Bacteriological Profile of Spontaneous Bacterial Peritonitis in Cirrhotic Patients. J Gastrointest Infect 2017;7(1):15-20.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Rumpa Saha, Stuti Kaushik, Kavita Gupta, Shukla Das

Human Infection with Hymenolepis diminuta: First Case Report from North India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:36-37][No of Hits : 177]


ABSTRACT

The parasite Hymenolepis diminuta commonly infests rodents, and human cases have been reported from all corners of India, save North India. There is a need to create awareness about its association with human disease as it is completely curable after treatment. We describe two cases of human infection due to H. diminuta in a 24-year-old woman and her son. These two cases were diagnosed on routine microscopy wet mount preparation and subsequently were successfully treated with medication. A detailed description of this disease in terms of epidemiology, clinical presentation, and effective treatment is dependent upon prompt diagnosis and reporting of all such cases.

Keywords: Diarrhea, Hymenolepis diminuta, Praziquantel, Rat tapeworm.

How to cite this article: Saha R, Kaushik S, Gupta K, Das S. Human Infection with Hymenolepis diminuta: First Case Report from North India. J Gastrointest Infect 2017;7(1):36-37.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Velmurugan Anitharaj, Dhandapany Gunasekaran, Jothimani Pradeep, Selvaraj Stephen

Gastrointestinal Manifestations of Scrub Typhus in Children and Adults from Puducherry and Neighboring Tamil Nadu State, India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:1-4][No of Hits : 165]


ABSTRACT

Scrub typhus (ST) is reported from almost every Indian state. In our tertiary care teaching hospital at Puducherry, we looked for gastrointestinal (GI) manifestations of ST in children as well as adults and correlated with laboratory findings. We examined 588 serum samples for immunoglobulin M (IgM) antibody against Orientia tsutsugamushi by enzyme-linked immunosorbent assay (ELISA) and observed that 335 (56.97%) of these clinically suspected ST patients were positive, comprising 134 children and 201 adults. Statistically significant (p ≤ 0.05) number of adults had nausea (p = 0.000) and abdominal pain (p = 0.020) than children. Similar trend was observed in adults with reference to increased liver enzymes (aspartate aminotransferase/ alanine aminotransferase/alkaline phosphatase; p = 0.000), creatinine (>1.0 mg/dL; p = 0.007), and platelet count (.1.5 lakhs/mm3; p = 0.026). Rash in children is the only statistically significant manifestation than adults (p = 0.03). More number of children were positive than adults, but without any statistical significance, with reference to other parameters like cough/expectoration (p = 0.735), hepatomegaly (p = 0.730), and eschar (p = 0.721).

Keywords: Gastrointestinal symptoms, Orientia tsutsugamushi, Scrub typhus, Scrub typhus immunoglobulin M enzyme-linked immunosorbent assay.

How to cite this article: Anitharaj V, Gunasekaran D, Pradeep J, Stephen S. Gastrointestinal Manifestations of Scrub Typhus in Children and Adults from Puducherry and Neighboring Tamil Nadu State, India. J Gastrointest Infect 2017;7(1):1-4.

Source of support: Indian Council of Medical Research (ICMR) New Delhi (Iris Id No. 2008-08180, File no 30/3/41/2008/ECD-II) and Mahatma Gandhi Medical College & Research Institute, Puducherry, Sri Balaji Vidyapeeth University, Puducherry, India.

Conflict of interest: None


 
ORIGINAL ARTICLE
Ritu Garg, Varsha A Singh

Bacteriological Profile and Antimicrobial Susceptibility Pattern of Intra-abdominal Infections: A Study from a Tertiary Care Hospital of North India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:21-25][No of Hits : 157]


ABSTRACT

Background and objectives: Intra-abdominal infections (IAIs) are associated with significant morbidity and mortality. Pathogenic isolates and emerging resistance to commonly used antimicrobials have been a matter of concern in IAIs. In the present study, bacteriological profile and antimicrobial susceptibility of isolates from IAIs were investigated.

Materials and methods: A total of 145 samples (ascitic fluids, n = 56; bile, n = 20; and pus, n = 36) were collected from suspected IAI of patients reporting to the hospital and cultured. Identification of the isolates was done using standard identification protocol. Antimicrobial susceptibility was performed by Kirby-Bauer disk diffusion method and interpretation was done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: Of 145 samples, 112 were culture positive and 33 were sterile. Gram-negative organisms (n = 85) outnumbered the Gram-positive organisms (n = 27). Among the Gramnegative organisms, Escherichia coli (n = 31) was the most commonly isolated organism followed by Klebsiella sp. (n = 19), Acinetobacter sp. (n = 14), Pseudomonas sp. (n = 10), Proteus sp. (n = 5), Citrobacter sp. (n = 3), and Enterobacter sp. (n = 3). Among the Gram-positive bacteria, the most common organism was Staphylococcus aureus (n = 19) followed by Enterococcus faecalis (n = 8). Gram-negative bacilli showed significant resistance to almost all of the commonly used antibiotics. The rate of methicillin-resistant S. aureus (MRSA) was 36.84%.

Conclusion: Prompt starting of empirical antimicrobials based on the local susceptibility pattern, followed by modification of treatment in accordance with the antimicrobial susceptibility report can significantly reduce the morbidity and the mortality associated with IAIs.

Keywords: Emerging resistance, Empirical antimicrobials, Intra-abdominal infections.

How to cite this article: Garg R, Singh VA. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Intra-abdominal Infections: A Study from a Tertiary Care Hospital of North India. J Gastrointest Infect 2017;7(1):21-25.

Source of support: Nil

Conflict of interest: None


 
CASE REPORT
Ramya Raghavan, Jharna Mandal, Chanaveerappa Bammigatti, Gangadhar Rao

Vibrio vulnificus: An Unusual Isolate from a Case of Eosinophilic Enteritis

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:38-40][No of Hits : 140]


ABSTRACT

The report describe a case of Vibrio vulnificus isolated from a patient with eosinophilic enteritis and hence convey the importance of vibriosis and its transmission.

Keywords: Diarrhea, Shellfish, Vibrio vulnificus

How to cite this article: Raghavan R, Mandal J, Bammigatti C, Rao G. Vibrio vulnificus: An Unusual Isolate from a Case of Eosinophilic Enteritis. J Gastrointest Infect 2017;7(1):38-40.

Source of support: Nil

Conflict of interest: None


 
RESEARCH NEWS SCAN
Anshul Sood

Databases for Antimicrobial Resistance Genes and Mobile Genetic Elements in Gut Microbiome

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:41-42][No of Hits : 139]


ABSTRACT

The human gut microbiota forms a large reservoir of antimicrobial resistance (AMR) genes. Also a number of these bacteria are endowed with metabolic potentials and added advantages which are often provided by mobile genetic elements (MGE). MGEs carry out extensive horizontal gene transfer (HGT) in gut and are believed to be agents of open source evolution. Regardless of their medical importance and biological significance, MGEs from the gut microbiome have not been methodically characterized. This research news scan highlights the Intestinal microbiome mobile element database (ImmeDB) associated with the collection, classification, and annotation of MGEs from gut microbiome using a novel “deletion-based” Split Read Insertion Detection (SRID) method. The database can help us screen already identified genomes for the validation and detection of new MGEs

Keywords: Antimicrobial resistance, Intestinal microbiome mobile element database, Mobile genetic elements, Split read insertion detection.

How to cite this article: Sood A. Databases for Antimicrobial Resistance Genes and Mobile Genetic Elements in Gut Microbiome. J Gastrointest Infect 2017;7(1):41-42.

Source of support: Nil

Conflict of interest: None


 
ORIGINAL ARTICLE
Shweta Chitkara, Deepinder Chhina, Veenu Gupta, Rajesh Mahajan

A Clinical and Epidemiological Profile of Seropositive Cases of Leptospirosis in a Tertiary Care Hospital in Ludhiana City, India

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:5-8][No of Hits : 132]


ABSTRACT

Introduction: Leptospirosis, an infectious disease caused by spirochetes Leptospira, is the most widespread zoonosis in the world. Humans acquire infection through contact with the urine of infected or carrier animals, either directly or through contaminated water or soil. There are only few reports documenting the serological evidence of leptospirosis in northern India.

Aims and objectives: To determine the seroprevalence of leptospirosis among febrile patients and to study their clinical and laboratory profile.

Materials and methods: It is a prospective study conducted over a period of 1 year from April 2015 to March 2016. Febrile patients with clinical suspicion of leptospirosis admitted in the hospital were included in the study. Leptospira immunoglobulin M (IgM) antibodies in the serum samples were detected by enzyme-linked immunosorbent assay (ELISA) to confirm the diagnosis. Serologically confirmed patients of leptospirosis were studied for their clinical presentation and laboratory parameters.

Results: The seroprevalence of leptospirosis in this study was 4% (147/3,661). Leptospirosis was most prevalent in the age group of 46 to 55 years. Male predominance was seen. Maximum number of cases was seen in the months of August and September. Common clinical manifestations were jaundice (57.1%), abdominal pain (40.1%), abdominal distension (27.2%), and myalgia (28.5%). Hepatomegaly (53%) was the predominant clinical sign observed. Laboratory parameters revealed leukocytosis (68.7%), thrombocytopenia (52.3%), and transaminitis (78.2%). Hepatic failure (20.4%) was the most common complication.

Conclusion: Seroprevalence of leptospirosis among febrile cases was 4%, indicating male predominance and seasonal variation. There is the need to review the importance of adding leptospirosis to differential diagnosis of febrile illness.

Keywords: Clinical profile, Enzyme-linked immunosorbent assay, Leptospirosis, Seroprevalence.

How to cite this article: Chitkara S, Chhina D, Gupta V, Mahajan R. A Clinical and Epidemiological Profile of Seropositive Cases of Leptospirosis in a Tertiary Care Hospital in Ludhiana City, India. J Gastrointest Infect 2017;7(1):5-8.

Source of support: Institutional funds

Conflict of interest: None


 
REVIEW ARTICLE
Vishwa M Katoch

Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:26-31][No of Hits : 131]


ABSTRACT

Abdominal tuberculosis (TB) is an important public health problem in developing countries. Because of overlap in the signs and symptoms of the chronic mycobacterial diseases like intestinal tuberculosis (ITB), Crohn’s disease (CD), ulcerative colitis, and other inflammatory diseases, there is a need to arrive at a specific diagnosis. Several investigations like computed tomography scan, different endoscopy procedures, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert, laparoscopy, etc., are being increasingly used to diagnose TB. Advances in imaging methods and direct access to affected sites by endoscopy have made significant contribution in improving the diagnosis. A combined evaluation of clinical features, endoscopy, histology, and response to treatment has been recommended to differentiate between CD and ITB. Various studies show that clinical features and histopathology, especially granuloma characteristics, have a major role in moving toward specific diagnosis of these conditions. Development of a large number of probes and gene amplification (different variants of PCR and isothermal methods) for TB and other mycobacteria has provided very powerful tools. If used properly they can significantly help in arriving at specific diagnosis of chronic mycobacterial diseases of intestinal tract. Detection of mycobacterial genetic/antigenic components in biopsies by in situ hybridization (ISH), in situ PCR, and immunohistochemistry (IHC) has been observed to be quite useful in differentiating ITB from CD. A number of newer methods based on expression of angiotensin converting enzyme (ACE), aptamers and biosensors have already appeared on the horizon and have potential diagnostic as well as therapeutic value for various forms of TB including abdominal TB. While many of these approaches/techniques have shown promise, they have not been adequately studied to become part of diagnostic strategy for clinical settings in countries like India.

Keywords: Crohn’s disease, Diagnostic methods, Immunohistochemistry, In situ hybridization, In situ polymerase chain reaction, Intestinal tuberculosis, Probes.

How to cite this article: Katoch VM. Advances in Methods for Diagnosis of Chronic Mycobacterial Infections of Gastrointestinal Tract. J Gastrointest Infect 2017;7(1):26-31.

Source of support: Nil

Conflict of interest: None


 
REVIEW ARTICLE
Alisha Chaubal, Nirav Pipaliya, Prabha Sawant

Amebic Abscess—Is it still a Common Entity?

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:32-35][No of Hits : 127]


ABSTRACT

Amebic liver abscess is the most common extraintestinal manifestation of amebiasis. It is seen most frequently in the fourth and fifth decades of life and is more common among adult men and alcoholics. The infection is primarily transmitted by food and water contamination. It presents commonly with fever and right hypochondriac pain but can present with complications like rupture into the pleural and peritoneal cavity or with abdominal vein thrombosis. The infection still responds well to nitroimidazoles, which remain the mainstay of treatment. In India, the epidemiology and presentation of amebic abscess have not changed over the years and it still is the major cause of liver abscesses.

Keywords: Amebic, Liver abscess, Metronidazole.

How to cite this article: Chaubal A, Pipaliya N, Sawant P. Amebic Abscess—Is it still a Common Entity? J Gastrointest Infect 2017; 7(1):32-35.

Source of support: Nil

Conflict of interest: None


 
Editorial
Chetana Vaishnavi

Editorial

[Year:2017] [Month:January-December] [Volumn:7 ] [Number:1] [Pages:42] [Pages No:iv][No of Hits : 111]


ABSTRACT

It gives me immense pleasure to announce that the Journal of Gastrointestinal Infections, the official publication of the Gastrointestinal Infection Society of India, has been assigned to M/s Jaypee Brothers Medical Publishers, New Delhi, for publishing and distributing the journal worldwide, both in print and electronic media. Every issue of the journal will be hosted online at www.jaypeejournals.com by the Publishers.


 
REVIEW ARTICLE
Preeti Chaudhary, Varsha Gupta, Atul Sachdev

Pattern of antibiotic resistance in Helicobacter pylori

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:16-21][No of Hits : 48]


ABSTRACT

Antibiotic resistance has been an emerging concern for common bacterial infections worldwide. Helicobacter pylori,commonly associated with chronic bacterial infections, is also included in bacteria with drug resistant problems. Its infection, once considered curable, is now becoming a matter of grave concern with rising antibiotic resistant patterns reported worldwide. Resistance is mainly reported to the key antibiotics in the treatment of infection i.e. metronidazole and clarithromycin, and to a lesser extent to amoxicillin and tetracyclin, thereby decreasing the cure rates of the combination therapies used. Recently resistance to quinolones has also been reported.

How to cite this article: Chaudhary P, Gupta V, Sachdev A. Pattern of antibiotic resistance in Helicobacter pylori. J Gastrointest Infect, 2016; 6:16-21.

Received: 14-08-2015

Accepted: 13-01-2016


 
CASE REPORT
Prerna Goyal, Omesh Goyal, Deepinder Chhina, Pavneet Kaur, Aminder Singh, Rajoo Singh Chhina

Esophageal candidiasis in an immunocompetent host: case report and review of literature

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:54-56][No of Hits : 37]


ABSTRACT

Infection by Candida species is the most common cause of infectious esophagitis in adults. Esophageal candidiasis (EC) occurs most commonly in immunocompromised hosts, such as those with human immunodeficiency virus infection. However, EC may also occur in immunocompetent individuals with or without apparent predisposing risk factors and symptoms. We report a case of EC incidentally discovered in an immunocompetent middle age male who underwent esophagogastro- duodenoscopy for dyspeptic symptoms. The only potential risk factor was long-term use of alcohol. Treatment with fluconazole led to complete resolution of EC.

Keywords: Esophageal candidiasis, fluconazole, immunocompetent

How to cite this article: Goyal P, Goyal O, Chhina D, Kaur P, Singh A, Chhina RS. Esophageal candidiasis in an immunocompetent host: case report and review of literature. J Gastrointest Infect, 2016; 6:54-56

Received: 19-07-2016

Accepted: 18-10-2016


 
REVIEW ARTICLE
Anshul Sood, Chetana Vaishnavi

Non-antibiotic management for Clostridium difficile infection

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:3-11][No of Hits : 36]


ABSTRACT

Clostridium difficile infection (CDI) is a key cause of diarrheal illness due to outbreaks by the hypervirulent C. difficile NAP1/027 strain. The mainstay and time-honored antibiotic therapies for the management of CDI apart from killing C. difficile, also disturbs the standard healthy gut flora leading to dysbiosis. Mismanagement of antibiotics has led to a widespread increase in antibiotic resistance which has jeopardized the efficacy of antibiotics. This article has shed some light on the present-day vista of non-antibiotic approaches to combat CDI which include bacteriotherapy (fecal microbiota transplant, probiotics, non-toxigenic C. difficile spores), immunoglobulin therapy (monoclonal antibodies, polyclonal antibodies, bovine antibodies, whey protein concentrate, colostrum, C. difficile vaccine), photodynamic therapy and other miscellaneous therapies like the use of adsorbents, prebiotics and corticosteroids.

Keywords: Bacteriotherapy, immunoglobulin therapy, photodynamic therapy

How to cite this article: Sood A, Vaishnavi C. Nonantibiotic management for Clostridium difficile infection. J Gastrointest Infect, 2016; 6: 3-11

Received: 14-03-2016

Accepted: 22-08-2016


 
ORIGINAL ARTICLE
Geeta Shukla, Nisha Goyal, Vivek Sharma

Probiotic Lactobacillus rhamnosus GG inhibits the adhesion of Giardia intestinalis to murine enterocytes: An in vitro study

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:45-49][No of Hits : 26]


ABSTRACT

Background and Objectives: Giardiasis mainly affects young children causing diarrhea, malnutrition and growth retardation. Due to adverse effects of antiprotozoal treatment such as low compliance with drug therapy, reinfestation, occurrence of resistant strains, headache and metallic taste, the use of natural live bacteriotherapy has been studied. The study was designed to investigate in vitro the colonizing ability of probiotic Lactobacillus rhamnosus GG (LGG) viz-a-viz its ability to inhibit the adherence of Giardia trophozoites to murine enterocytes under conditions simulating the intestinal environment.

Materials and methods: Murine enterocytes were harvested and incubated with Giardia trophozoites either prior or simultaneously with probiotic LGG to assess the adhesion using scanning electron microscopy.

Results: It was observed that 15% of Giardia trophozoites adhered to enterocytes at 37°C in Hank’s Balanced Salt Solution, after 1h of incubation. However, coincubation of murine enterocytes with probiotic LGG either 30 min prior or simultaneously with Giardia trophozoites led to 23-27% reduction in the adherence of Giardia trophozoites compared with 46% adherence in the absence of LGG. Further, scanning electron microscopy also showed in vitro inhibition of Giardia trophozoites to murine enterocytes due to probiotic supplementation.

Interpretations and conclusion: The data suggest the colonizing ability of probiotic LGG to murine enterocytes that modulates murine giardiasis mainly by displacing the Giardia trophozoites.

Keywords: Giardiasis, mouse enterocytes, probiotic, scanning electron microscopy

How to cite this article: Shukla G, Goyal N and Sharma V. Probiotic Lactobacillus rhamnosus GG inhibits the adhesion of Giardia intestinalis to murine enterocytes: An in vitro study. J Gastrointest Infect, 2016; 6:45-49

Received: 24-09-2015

Accepted: 08-02-2016


 
BRIEF COMMUNICATION
Stuti Kaushik, Rumpa Saha, Shukla Das, V G Ramachandran, Ashish Goel

SSU rRNA target amplification of intestinal microsporidia: A sensitive diagnostic tool for accurate estimate of its prevalence

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:50-53][No of Hits : 25]


ABSTRACT

The diagnosis of intestinal microsporidiosis has traditionally relied on light microscopy. Western literature shows PCR to be more sensitive and specific. The present study was conducted to assess the prevalence of enteric microsporidiosis in HIV seropositive patients using PCR. Five percent stool samples were found to be positive for microsporidia by pan microsporidia primers and found to be Enterocytozoon bieneusi on amplification using species specific primers. Microsporidia is grossly under-reported in our country and there is a dire need to institute measures to detect this organism particularly in HIV infected individuals to abate morbidity and mortality due to this organism.

Keywords: Diarrhea, Encephalitozoon, Enterocytozoon bieneusi, HIV, microsporidia

How to cite this article: Kaushik S, Saha R, Das S, Ramachandran VG, Goel A. SSU rRNAtarget amplification of intestinal microsporidia: A sensitive diagnostic tool for accurate estimate of its prevalence. J Gastrointest Infect, 2016; 6:50-53

Received: 12-07-2016

Accepted: 08-09-2016


 
REVIEW ARTICLE
Varsha Gupta, Gursimran Mohi

Opportunistic agents causing diarrhea in AIDS

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:22-31][No of Hits : 21]


ABSTRACT

Opportunistic infections (OIs) in Human Immunodeficiency Virus (HIV) infection continue to cause morbidity and mortality in HIV infected patients. Virtually all OIs occur when the CD4+T cell count is less than 200/mm3. The gastrointestinal (GI) tract is a common site for clinical expression of HIV. Diarrhea is the most common GI symptom in HIV/AIDS. Prevalence ranges from 0.9% to 14%. Diarrhea may be the presenting symptom of lymphoma and Kaposi’s sarcoma. It may affect up to 40-50% of those taking anti-retroviral therapy (ART) and can be induced by other medications. It may also be the result of HIV-associated enteropathy. The agents can be classified as bacterial, parasitic, viral and fungal agents. Almost all bacterial diarrheic agents can cause diarrhea in HIV infected patients, including Clostridium difficile. Intracellular parasites like Isospora belli, Cryptosporidium parvum and Cyclospora are the main causative agents of diarrhea in HIV positive patients. Cytomegalovirus is an AIDS defining opportunistic infection. Candida is the main fungal agent of diarrhea in AIDS. Despite the availability of ART, OIs are common in India as HIV-infected persons in India present with an OI as the initial indicator of their disease. Some of them are aware of their HIV infection but do not take ART and some patients are enrolled in HIV care and prescribed ART but do not attain an adequate virologic and immunologic cure. Thus awareness about optimal strategies for diagnosis, prevention and treatment of OIs in GI tract is essential to provide comprehensive, high quality care for these patients.

Keywords: Diarrhea, gastrointestinal tract, HIV/AIDS, opportunistic infections

How to cite this article: Gupta V, Mohi G. Opportunistic agents causing diarrhea in HIV. J Gastrointest Infect, 2016; 6:22-31

Received: 20-09-2016

Accepted: 18-11-2016


 
ORIGINAL ARTICLE
Purbasha Bera, Shukla Das, Rumpa Saha, Vishnampettai G. Ramachandran, Dheeraj Shah

Prevalence of cryptosporidiosis in children with diarrhea and its correlation with mucosal immunity

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:39-44][No of Hits : 19]


ABSTRACT

Background and objectives: Cryptosporidium is a recognized cause of diarrhea, particularly among children, in developing countries. Cryptosporidium diarrheal episode impinges heavily on the quantitative effector mucosal responses of subsets of T cell population, especially within the gut cytokines. The current study aims to estimate the prevalence of cryptosporidiosis in children of age ≤ 5 years old and also compared IL-10 and IFN-γ levels in immunocompetent children responding to gut infection with Cryptosporidium.

Materials and methods: Diarrheal stool specimens from 175 young children (≤ 5 years) were collected. Kinyoun’s acid fast staining was performed for identification of Cryptosporidium. ELISA was performed for antigen detection of Cryptosporidium and cytokine (IFN-γ and IL-10) analysis. For comparison a total of 30 stool samples from age and sex matched healthy children were also tested for IFN-γ and IL-10.

Results: Cryptosporidium oocysts were found in 7 (4.0%) out of 175 children whereas 48 (27.4%) children suffering from diarrhea had Cryptosporidium antigen. A marker of a proinflammatory immune response, IFN-γ and the counterregulatory cytokine IL-10 was also exclusively elevated in the patient population (p <001).

Interpretations and conclusion: Cryptosporidium is present in a significant portion of children suffering from diarrhea in our setting. Antigen detection has much higher isolation rate than Kinyoun’s acid fast staining. Results suggest that the Th response adapted at controlling cryptosporidial infection may be a dynamic one in which there is a strong early Th-1 response which later shifts to Th-2 response to facilitate parasite removal and to limit the infection.

Keywords: Cryptosporidium, immunocompetent children, mucosal immunity

How to cite this article: Bera P, Das S, Saha R, Ramachandran VG, Shah D. Prevalence of Cryptosporidiosis in children with diarrhea and its correlation with mucosal immunity. J Gastrointest Infect, 2016; 6: 39-44

Received: 06-02-2016

Accepted: 20-07-2016


 
REVIEW ARTICLE
Prateik Poddar, Prabha Sawant

Helicobacter pylori: past, present and future

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:12-15][No of Hits : 18]


ABSTRACT

Helicobacter pylori is an organism that is a worldwide cause of significant morbidity and mortality. There has been a sea change in our understanding and hence diagnosis and treatment of this ubiquitous bacterium over the last few years and more is in the offing. Though it still affects over half the world’s population, there has been an identification of genes and epigenetic motifs which can modify disease expression and cancer occurrence with Helicobacter infection. Newer diagnostic modalities like urine antibody analysis, immune-chromatographic culture methods, pepsinogen assays and micro-RNAdetection promise earlier identification of more virulent forms. Advances in endoscopy have also incorporated Chromo-endoscopy, Narrow Band Imaging, Confocal endomicroscopy and Raman spectroscopy for diagnosis of H. pylori infections with greater accuracy. Advent of genotype drug resistance assays and newer therapeutic regimens have afforded greater efficacy in eradicating this infection. An interesting area of research is novel drug delivery systems, like the gastro-retentive systems, which have increased efficacy of existing drugs against Helicobacter. Vaccine development is also underway with ongoing animal trials on EPIVAC vaccine among others, showing some benefits. Though there is still a long way to go, all these newer modalities hold out hope for the possibility of a reduction in the burden associated with this wide spread infection.

Keywords: Diagnostic modalities, Endoscopy, Helicobacter pylori,Treatment strategies

How to cite this article: Poddar P. Helicobacter pylori: past, present and future. J Gastrointest Infect, 2016; 12-15

Received: 22-03-2016

Accepted: 11-05-2016


 
EDITORIAL
Mamaun Al Mahtab, Sheikh Mohammad Fazle Akbar

Hepatitis B virus-related liver diseases: Identity and evidence-based control strategy

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:1-2][No of Hits : 18]


ABSTRACT

Hepatitis B virus (HBV), a member of Hepadnaviridae family, represents a small virus of about 3200 bp and infects human and higher primates. Although the virus is hepatotrophic in nature, it has been detected in many organs and tissues including blood of infected human. HBV infection is universal in nature and about 2 billion people of the world have been infected with the HBV at some point of their life.

How to cite this article: Mahtab MA, Akbar SMF. Hepatitis B virus-related liver diseases: Identity and evidence-based control strategy. J Gastrointest Infect, 2016; 6:1-2

Received: 19-02-2016

Accepted: 23-03-2016


 
RESEARCH NEWS SCAN
Anshul Sood

HuMiX: The artificial gut

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:57][No of Hits : 18]


ABSTRACT

Human gut is an open system that encounters widerange of diet-derived compounds and numerous microorganisms making it a complex system to explore. Alterations in intestinal morphology and dysbiosis lead to several gastrointestinal (GI) ailments and other disorders. In the present scenario metagenomics is considered as an important discipline to study the correlation of human microbiome with the health and disease.

How to cite this article: Sood A. HuMiX - The artificial gut. J Gastrointest Infect, 2016; 6:57

Received: 9-10-2016

Accepted: 10-12-2016


 
ORIGINAL ARTICLE
Yogita Verma, Ekta Gupta, Harsha Vardhan Reddy, Neha Ballani, Meenu Bajpai, Ajeet Singh Bhadoria

Human parvovirus B19 co-infection aggravates liver dysfunction in patients with chronic hepatitis B infection

[Year:2016] [Month:January-December] [Volumn:6 ] [Number:1] [Pages:57] [Pages No:32-38][No of Hits : 13]


ABSTRACT

Background and objectives: Human parvovirus B19 (B19) has been reported to be detected in the sera of patients with acute or chronic hepatitis. The aim of this study was to investigate the prevalence of parvovirus B19 in patients with chronic hepatitis B virus (CHB) and hepatitis C virus (CHC) infection and understand its clinical significance.

Materials and methods: Plasma samples from 40 adult chronic hepatitis patients (20 CHB and 20 CHC) and 20 healthy blood donors were investigated for antibodies to B19 (IgM and IgG both). Active viremia was confirmed in IgM positive patients by real time PCR for parvovirus B19.

Results: IgG antibodies to B19 were seen in 5 (25%) CHB, 10 (50%) CHC and 10(50%) healthy controls. IgM antibodies to B19 were seen in 3 (15%) CHB, 5 (25%) CHC and 1 (5%) controls. The liver dysfunction was significantly higher in B19 co-infected CHB patients. The serum ALT levels (Median 416.0, IQR 64.0-496.6 IU/L) and AST levels (Median 325, IQR 61.00- 380.00 IU/L) among B19 co-infected CHB patients were significantly higher than serum ALT levels (Median 43.0, IQR 33.0-61.5 IU/L) (p=0.023) and serum AST levels (Median 31 (26.50-53.00) IU/L) (p=0.013) in CHB mono-infected patients However the difference in serum bilirubin levels was not significant amongst the two groups (p=0.25). No aggravation of liver dysfunction was seen in B19 co-infected CHC patients.

Interpretation and conclusions: Parvovirus B19 is prevalent equally amongst HBV, HCV infected and healthy population. Co-infection of B19 with HCV did not increase the frequency of liver dysfunction but it definitely aggravates the liver dysfunction in CHB co-infected patients.

Keywords: Chronic hepatitis B infection, chronic hepatitis C infection, parvovirus B19 infection

How to cite this article: Verma Y, Gupta E, Reddy HV, Ballani N, Bajpai M, Bhadoria AS. Human parvovirus B19 co-infection aggravates liver dysfunction in patients with chronic Hepatitis B infection. J Gastrointest Infect, 2016; 6:32-36

Received: 19-02-2016

Accepted: 22-03-2016


 
CASE REPORT
Shoket Chowdry, Sandeep Dogra, Bella Mahajan

An accidental endoscopic finding __ Trichuris trichiura. A case report and review of the literature

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:54-56][No of Hits : 27]


ABSTRACT

Trichuris trichiura, commonly referred to as a whipworm, has a worldwide distribution, particularly among countries with warm and humid climates. This parasite is carried by nearly one quarter of the world population especially less-developed countries. Poor hygiene is associated with trichuriasis transmission, and children are especially vulnerable because of their high exposure to risk factors. This is especially true in developing countries, where poor sanitary conditions correlate with heavy disease burden and infections. Only patients with heavy parasite burden become symptomatic. The diagnosis is typically confirmed by detection of T. trichiura eggs on examination of a stool sample. This case report deals with a patient with trichuriasis who were diagnosed by detection of the parasite on colonoscopy. Thus colonoscopy might be a useful diagnostic tool, especially in symptomatic patients who are infected by only a few male worms with no eggs in the stool and thus are not diagnosed by conventional methods.

Keywords: Colonoscopy, trichuriasis, Trichuris trichiura

How to cite this article: Chowdry S, Dogra S, Mahajan B. An accidental endoscopic finding—Trichuris trichiura. A case report and review of the literature. J Gastrointest Infect, 2015; 5: 54-56.

Received: 29-08-2015

Accepted: 05-12-2015


 
ORIGINAL ARTICLE
Deepinder Kaur, Veenu Gupta, Rajoo Singh Chhina, Daaman Sharma, Charu Arora, Rama Gupta

Microbiological profile of biliary tract infections

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:20-23][No of Hits : 26]


ABSTRACT

Background and objectives: Bacterial infection of biliary tract may cause severe inflammatory response or sepsis. An immediate bile culture and appropriate antibiotic administration are important to control the biliary tract infection. The objective of the study was to study the microbial profile and antibiotic sensitivity pattern in patients with biliary tract infection.

Materials and methods: Fifty suspected cases of biliary tract infection admitted to the Department of Gastroenterology were enrolled. Bile samples from these patients were aseptically collected and sent to the Department of Microbiology. Samples were processed in automated BACTEC or BacT/ALERT system. Further identification and antimicrobial susceptibility testing was done by VITEK-2 system.

Results: Of the 50 suspected cases of biliary tract infection, the majority were male patients and in the age group of 51-60 years. Growth was obtained in 22 (44%) bile samples. The organisms obtained were Escherichia coli (40%), Klebsiella spp. (20%), Pseudomonas spp. (16%), and coagulase-negative Staphylococci (8%). All Gram negative isolates were susceptible to tigecycline and colistin. A high susceptibility was seen to amikacin and carbapenems while low susceptibility was seen to others. All the Gram positive organisms were sensitive to vancomycin, teicoplanin and linezolid with low sensitivity to penicillin.

Interpretation and conclusion: E. coli is the most common organism isolated from bile. Antimicrobial sensitivity patterns require a revision of empiric antibiotic therapy policy in cholangitis. Early detection and determination of antimicrobial susceptibility pattern is important to reduce the mortality and morbidity associated with bile fluid infections.

Keywords: Antimicrobial susceptibility, bile culture, Gram negative bacteria

How to cite this article: Kaur D, Gupta V, Chhina RS, Sharma D, Arora C, Gupta R. Microbiological profile of biliary tract infections. J Gastrointest Infect, 2015; 5: 20-23.

Received: 29-07-2015

Accepted: 24-09-2015


 
CASE REPORT
Uma Debi, Abhinaya Shankar, MV Kartik, Kaushal Kishor Prasad, BR Thapa

An unusual case of small intestinal tuberculosis with enteroenteric fistula: A case report

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:46-49][No of Hits : 22]


ABSTRACT

Tuberculosis is a very common condition which at times can present with distinctly atypical findings. In the vast majority of the presenting cases it can pose diagnostic challenge to both the clinician and the radiologist due to its nonspecific clinical manifestations and lack of pathognomonic radiological signs But being a treatable disease utmost care needs to be exercised in establishing this diagnosis. We report a rare radiological finding in a case of small intestinal tuberculosis which confounded the initial diagnosis necessitating pathological proof of tubercular enteroenteric fistula. Following fine needle aspiration cytology, the patient was started on anti-tubercular treatment and conservatively managed. The patient showed significant improvement in clinical symptoms after 3 months and resolution on completion of the treatment.

Keywords: Enteroenteric fistula, FNAC, intestinal tuberculosis, ultrasonography

How to cite this article: Debi U, Shankar A, Kartik MV, Prasad KK, Thapa BR. An unusual case of small intestinal tuberculosis with enteroenteric fistula: A case report. J Gastrointest Infect, 2015; 5: 46-49.

Received: 09-08-2015

Accepted: 16-11-2015


 
REVIEW ARTICLE
Praveen P. Balgir, Baljinder Kaur, Tejinder Kaur

Gut microbiome dysbiosis in metabolic disorders: implications for probiotics as prospective investigational new drugs

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:5-12][No of Hits : 20]


ABSTRACT

Gut microbiome has been analysed using metagenomics approach which combines the power of genomics, bioinformatics, and systems biology, providing new ways to access the microbial world. Gut microbiome evolves from the pre-birth exposure onwards in a child, as a result of its interaction with its environment; and is apparently influenced by various environmental factors all through the life, most important being diet and its composition. Metagenomic analysis of gut microbial communities of a malnourished and a healthy child revealed an abundance of enteric pathogens leading to intestinal inflammation and nutrient malabsorption. The change in diet from vegetarian to non-vegetarian also influences the composition and dynamics of the intestinal microbes.
Gut microbiota have been observed to vary with age due to physiological changes in the gastrointestinal tract, modifications in lifestyle, nutritional behavior and weakened functionality of the host immune system. Studies in apparently healthy individuals and patients suffering from intestinal or metabolic disorders revealed differential microbiome compositions, proving that an imbalance of gut microflora leads to dysbiosis which is the major cause of metabolic disorders such as irritable bowel syndrome (IBS), obesity, diarrhea, etc. The investigational studies are trying to assess the relationship between intestinal microbiota dysbiosis and various metabolic diseases. Nutritional interventions in the form of probiotics and prebiotics as investigational new drugs (INDs) are being assessed for correcting dysbiosis in disease states. The current paper focuses on the recent knowledge and databases for the same with pointers to future investigations as the need of the hour studies.

Keywords: Dysbiosis, malnutrition, metagenome, microbiome, probiotic

How to cite this article: Balgir PP, Kaur B, Kaur T. Gut microbiome dysbiosis in metabolic disorders: Implications for probiotics as prospective investigational new drugs. J Gastrointest Infect, 2015; 5: 5-12.

Received: 16-07-2015

Accepted: 24-09-2015


 
ORIGINAL ARTICLE
Veenu Gupta, Deepinder Kaur, Manisha Aggarwal, Jaspreet Kaur, Priyam Chawla, Jyoti Chaudhary

Changing resistance pattern of Shigella isolates over a period of five years

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:38-41][No of Hits : 19]


ABSTRACT

Background and objectives: Diarrheal diseases are an important cause of morbidity and mortality in children in developing countries. Among diarrheagenic agents, Shigella should be emphasized because of its prevalence and the severity of the associated disease. The present study was done to study the prevalence and antimicrobial susceptibility pattern of Shigella isolates in stool.

Materials and methods: Stool samples were collected from cases of dysentery and diarrhea in the laboratory from Jan 2009 to Dec 2013. The specimens were processed and inoculated as per standard protocol. The susceptibility of Shigella serogroups to different antibiotics was done as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Antibiotic susceptibility between different Shigella serogroups was compared and trends of drug resistance to various antimicrobial agents over a period of five years was seen.

Results: Of a total of 6117 samples, Shigella serogroups were isolated in 74 (1.2%) samples. S. flexneri was the most common serogoup identified followed by S. boydii and S. sonnei. Yearwise isolation of Shigella serogroups was 1.58% in 2009 which decreased to 0.38% in 2013. All Shigella serogroups showed higher sensitivity to ciprofloxacin as compared to nalidixic acid, cotrimoxazole and ampicillin.

Interpretation and conclusion: There is a significant increase in resistance to several commonly used antimicrobial agents. The rapid increase in ciprofloxacin resistance, especially in S. flexneri, is a major cause of concern. The results suggest reconsideration of the empiric use of these antimicrobial agents for the treatment of shigellosis.

Keywords: Antimicrobial resistance, diarrhea, Shigella

How to cite this article: Gupta V, Kaur D, Aggarwal M, Kaur J, Chawla P, Chaudhary J. Changing resistance pattern of Shigella isolates over a period of five years. J Gastrointest Infect, 2015; 5:38-41.

Received: 27-07-2015

Accepted: 26-10-2015


 
ORIGINAL ARTICLE
Omesh Goyal, Prerna Goyal, Deepinder Kaur, Rajoo Singh Chhina

Treatment results and factors affecting sustained virological response in chronic hepatitis C patients in Northern India

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:24-30][No of Hits : 18]


ABSTRACT

Background and Objectives: Chronic hepatitis C (CHC) is a major cause of liver-related morbidity and mortality. Data on the treatment outcomes of CHC with pegylated interferon plus ribavirin (PEG-RBV) in Indian patients are limited. This study aimed to evaluate the efficacy, safety and factors associated with sustained virological response (SVR) in CHC patients treated with PEG-RBV in northern India.

Materials and Methods: Consecutive treatment naïve patients with CHC infection treated with PEG-RBV combination therapy between January 2011 and December 2014 were included. Patients with cirrhosis and other contraindications were excluded.

Results: Of the total 108 patients enrolled, 102 (94.4%) patients completed the treatment (mean age- 43 ±12.7 years; 62% males). The mean BMI was 23.9 ± 4.2 and mean ALT was 85.7 ± 68 IU/L. HCV viral load >4,00,000 IU/ml was present in 45.4%. The most common genotype was 3 (69.4%; n=75), followed by genotype 1 (26.8%; n=29) and genotype 4 (3.7%; n=4). By intention-to-treat analysis, the overall SVR rate was 94.4% (102/108). In genotype 1 patients it was 86.2% (25/29) and 98.7% (74/75) (p=02) in genotype 3 patients. On multivariate analysis, non-genotype 3 infection predicted lower SVR.

Interpretation and Conclusions: SVR rates in CHC patients treated in northern India with PEG-RBV therapy in our study (86.2% for genotype 1 and 98.7% in genotype 3) were better than those reported in western and other Indian studies. Better patient compliance, better monitoring and better management of adverse events lead to superior treatment outcomes.

Keywords: Chronic hepatitis C, pegylated interferon, ribavirin

How to cite this article: Goyal O, Goyal P, Kaur D, Chhina RS. Treatment results and factors affecting sustained virological response in chronic hepatitis C patients in northern India. J Gastrointest Infect, 2015; 5:24-30.

Received: 12-05-2015

Accepted: 02-09-2015


 
EDITORIAL
Chetana Vaishnavi

Diagnostic options for gastrointestinal tuberculosis 1-4

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:1-4][No of Hits : 17]


ABSTRACT

Tuberculosis is a major public health problem throughout the world and particularly in developing countries like India. Both human (Mycobacterium tuberculosis) as well as bovine (M. bovis) strains have been responsible for tuberculosis. In addition, atypical mycobacterium viz. M. avium and M. intracellulare can also cause tuberculosis. The disease is known to be associated with poverty, deprivation and immunodeficiency.

How to cite this article: Vaishnavi C. Diagnostic options for gastrointestinal tuberculosis. J Gastrointest Infect, 2015; 5 : 1-4.

Received: 09-09-2015

Accepted: 14-10-2015


 
BRIEF COMMUNICATION
Mamatha Ballal, Suganthi Martena Devadas, Vignesh Shetty, Sohan Bangera

Microbiological spectrum of diarrhea in HIV infected patients – a cross-sectional study from a rural cohort population of coastal South India.

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:42-45][No of Hits : 17]


ABSTRACT

Diarrheal diseases continue to play a major role in the lives of the HIV positive people impacting negatively on the quality of life. Currently only a few studies on intestinal parasites and diarrhea in HIV patients are available from South India. We took up this study to evaluate the prevalence of such infections in HIV patients and to emphasize the importance of stool examination for parasites. A total of 73 stool samples from HIV patients with diarrhea (Jan 2012 - Dec 2012) were processed according to the standard protocol. Of the total 73 cases, 65.75% were with chronic diarrhea and the remaining 34.24% presented with acute diarrhea. Of the 32 (43.83%) intestinal pathogens isolated, 27 (84.37%) were coccidian parasites and the remaining were bacterial agents. Knowledge about the different pattern of pathogens can often guide appropriate therapy to HIV patients. There is an urgent need to interpret the scientific findings into sustainable prevention programs and improve public health policy.

Keywords: Coccidian parasites, diarrhea, enteric pathogens, HIV/AIDS.

How to cite this article: Ballal M, Devadas SM, Shetty V, Bangera S. Microbiological spectrum of diarrhea in HIV infected patients - a cross-sectional study from a rural cohort population of coastal South India. J Gastrointest Infect, 2015; 5:42-45.

Received: 30-07-2015

Accepted: 24-09-2015


 
RESEARCH NEWS SCAN
Anshul Sood

Approaches to abate antibiotic resistance

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:57][No of Hits : 17]


ABSTRACT

Antibiotics, one of the wonder discoveries of all times have now become a global health crisis due to the emergence of antibiotic resistance. On Oct, 8, 2015, Dr. Margaret Chan, the Director-General of the World Health Organization, in a meeting in Berlin with G7 Health Ministers has rightly said, “The world is heading towards a post-antibiotic era in which common infections will once again kill”.

How to cite this article: Sood A. Approaches to abate antibiotic resistance. J Gastrointest Infect, 2015; 5:57.

Received: 09-10-2015

Accepted: 10-11-2015


 
CASE REPORT
Pravat K Thatoi, Sagar Khadanga, Ujjawal Khurana, Dharmendra Dugar, Shakti P Satapathy, T Karuna

Ileo-cecal mucormycosis in an immune competent adult: Treating successfully a rare disease with high mortality

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:50-53][No of Hits : 15]


ABSTRACT

Mucormycosis is common in immunocompromised patients. Among the various clinical spectrum of mucormycosis gastrointestinal mucormycosis has been documented in about seven percent of cases, more commonly in pediatric population. In large studies (mostly in immunocompromised) the mortality has been documented even up to 100%. Only nine cases have been described so far in immune competent adults globally including ours. We present here a case of successful treatment of ileo-cecal mucormycosis in an immunocompetent middle age man from eastern part of India. This case will enlighten the clinicians and broaden their vision of differential diagnosis while dealing with cases of non- specific pain abdomen. This case also highlights the importance of microbiological studies in addition to conventional biopsy and histopathology alone.

Keywords: Gastrointestinal mucormycosis, Ileo-cecal, Immunocompetent

How to cite this article: Thatoi PK, Khadanga S, Khurana U, Dugar D, Satapathy SP, Karuna T. Ileo-cecal mucormycosis in an immune competent adult: Treating successfully a rare disease with high mortality. J Gastrointest Infect, 2015; 5: 50-53.

Received: 29-08-2015

Accepted: 17-10-2015


 
REVIEW ARTICLE
Chetana Vaishnavi

Campylobacter infections and Guillain Barre´ syndrome

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:13-19][No of Hits : 15]


ABSTRACT

Guillain Barreì syndrome (GBS) is a serious disorder of the peripheral nerves preceded by a recognized acute infectious illness. Campylobacter jejuni has been recognized as an important pathogen precipitating GBS and the structure of C. jejuni lipooligosaccharide (LOS) might have a role in the outcome of infection. The development of GBS and Miller Fisher syndrome has been reported to be due to expression of a GM1 like LOS in class A strains and GQ1b like LOS in class B strains of C. jejuni respectively. Virulence of C. jejuni, subtle differences in the interaction between different strains with the host T lymphocyte receptor and MHC class II and host susceptibility may have a role to play in the development of GBS. A humoral immunopathogenic mechanism for GBS has been envisaged as the disease develops 1 to 3 weeks after C. jejuni infection. Antibodies to C. jejuni may remain elevated for several weeks after acute infection. Host susceptibility factors are also important in the pathogenesis of GBS as this disease occurs within families. Association between the occurrence of GBS and a particular HLA type has been envisaged, but studies to prove it are inconclusive. Despite our increasing understanding of the pathophysiology of GBS, the triggering event leading to the disease is still indeed a great puzzle. This review describes the in-depth association of Campylobacter infections with GBS.

Keywords: Campylobacter, GBS , lipooligosaccharide

How to cite this article: Vaishnavi C. Campylobacter infections and Guillain Barreì syndrome. J Gastrointest Infect, 2015; 5: 13-19.

Received: 02-06-2015

Accepted: 14-07-2015


 
ORIGINAL ARTICLE
Omesh Goyal, Subhadra Prashar, Sandeep Puri

Hepatic dysfunction in falciparum and vivax malaria in Northern India

[Year:2015] [Month:January-December] [Volumn:5 ] [Number:1] [Pages:57] [Pages No:31-37][No of Hits : 14]


ABSTRACT

Background and Objectives: Hepatic dysfunction is known to occur in Plasmodium falciparum malaria with varied incidence in different regions. Recent studies report liver involvement in P. vivax infection also. It is important to know about this entity in order to recognize it early and offer prompt and specific treatment. The present study aimed to assess the incidence, pattern, severity and outcome of hepatic dysfunction in cases of P. falciparum and P. vivax malaria admitted to a tertiary care hospital in northern India.

Materials and Methods: This retrospective study included all hospitalized patients diagnosed to have malaria from January 2013 to December 2013. Their clinical and biochemical parameters, complications and outcome were recorded.

Results: Of 115 patients included, 85(73.9%) had P. vivax infection and 30 (26.1%) had P. falciparum infection. The mean age was 36.7±16.1 years and male:female ratio was 2.7:1. Hepatic dysfunction was seen in 31.8%(27/85) patients of vivax malaria and 50%(15/30) patients of falciparum malaria (p=0.082). The mean bilirubin, AST and ALT in patients with hepatic dysfunction were 7.7 ±7.3 mg/dL, 97.1 ±103.3 IU/L and 72.3 ±87.8 IU/L respectively. Patients with falciparum malaria had significantly higher levels of mean bilirubin, AST, urea and creatinine. Patients with hepatic dysfunction had higher rate of complications like renal failure, shock, acute respiratory distress syndrome, and mortality.

Interpretation and conclusion: Hepatic dysfunction was more common and more severe in patients with P. falciparum malaria compared to P. vivax malaria. Patients with hepatic dysfunction had higher rates of complications and higher mortality.

Keywords: Falciparum malaria, hepatic dysfunction, vivax malaria

How to cite this article: Goyal O, Prashar S, Puri S. Hepatic dysfunction in falciparum and vivax malaria in northern India. J Gastrointest Infect, 2015; 5:31-37.

Received: 04-08-2015

Accepted: 02-09-2015


 
Original Article
Priyam Chawla, Deepinder Kaur, Rajoo Singh Chhina, Veenu Gupta, Jyoti Chaudhary, Manisha Aggarwal

Etiology and antimicrobial susceptibility profile of isolates from ascitic fluid of patients with spontaneous bacterial peritonitis

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:47-50][No of Hits : 41]


ABSTRACT

Background & Objectives: Ascitic fluid infections are frequent complications among patients of cirrhosis with ascities, of which spontaneous bacterial peritonitis (SBP) is the most common and potentially fatal. This study was planned to know the etiology and current antibiotic susceptibility profile of the isolates from the SBPpatients.

Material and Methods: A total of 50 cases of SBP from cirrhosis patients with ascites were enrolled in this study. Samples were processed in automated Bactec or Bac-T /Alert. Further identification & antimicrobial susceptibility testing was done by VITEK-2 system.

Results: Most common organism isolated was Escherichia coli (40%) followed by Coagulase negative Staphylococci, Klebsiella pneumonia and Acinetobacter baumanii. Among all Gram negative isolates, 94.7% were sensitive to tigecycline, 92.1% sensitive to colistin. It also showed high susceptibility to amikacin and carbapenems while low susceptibility was seen to others. All the gram positive organisms were sensitive to vancomycin & linezolid and show moderate sensitivity to ciprofloxacin, tetracycline, cotrimoxazole, and gentamycin. Low sensitivity was seen to penicillin. Methicillin resistant coagulase negative Staphylococci (MRCoNS) were seen in 4 (57%) isolates.

Interpretation & Conclusion: Escherichia coli is the most common cause of SBP. Antimicrobial resistance is increasing therefore early detection and determination of antimicrobial susceptibility pattern is important to reduce the mortality and morbidity associated with ascitic fluid infections.

Keywords: Spontaneous bacterial peritonitis, ascitic fluid


 
Case Report
Shilpa Arora, Parwinder Singh, Deepak Arora, Navneet Kaur, Neetika Kalra, Neerja Jindal

Endoscopic diagnosis of hookworm infection that caused anaemia: A case report from Malwa region, Punjab

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:56-58][No of Hits : 35]


ABSTRACT

Hookworm is one of the important soil-transmitted helminthes and is usually diagnosed by characteristic clinical findings such as anaemia and laboratory investigations like blood examination showing eosinophilia and stool microscopic examination showing characteristic egg morphology. A40-year-old man complained of epigastric pain and passage of black coloured stools for 2 months. There was no eosinophilia and stool was positive for occult blood but no helminthic egg was detected microscopically. Under the impression of peptic ulcer disease with chronic blood loss, upper gastrointestinal endoscopy was performed. Many worms were found in the duodenum incidentally by endoscopy & were identified as Necator americanus and successfully eradicated by mebendazole treatment. It is always crucial to do repeated stool examinations and to observe the duodenum carefully by endoscopy where parasite infestation is suspected clinically.

Keywords: Endoscopy, hookworm, duodenum


 
Original Article
Sukhminderjit Kaur, Divya Walia

Enteric bacterial contamination in ready to eat food products and their resistance to commonly used antimicrobials

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:36-39][No of Hits : 18]


ABSTRACT

Background & Objectives: There is an increasing tendency among people for the consumption of ready to eat food, especially among urban people, which increases the risk of food-borne diseases. The prevalence of antimicrobial resistance among food-borne pathogens has increased during recent decades. The present study was conducted to isolate various enteric bacterial pathogens from ready to eat food samples sold in local market and to check their susceptibility to commonly used antimicrobials.

Material & Methods: For the isolation of enteropathogens, 50 different ready to eat foods were collected from retail market of Chandigarh, India and its periphery. The samples were inoculated on MacConkey agar after serial dilutions and isolates obtained were identified morphologically and biochemically using standard procedures. Their susceptibility to commonly used antimicrobials was checked.

Results: A total of 57 bacterial isolates were obtained which included E.coli (42%), Klebsiella spp. (25%), Salmonella spp. (9%), Enterobacter spp. (9%), Pseudomonas spp. (5%), Shigella spp. (4%) and Proteus spp. (4%). The isolates showed highest rate of resistance towards amoxicillin followed by norfloxacin and nalidixic acid.

Interpretation & Conclusion: All of the isolated bacteria showed resistance to two or more antibiotics studied. The prevalence of antibiotic resistance among food-borne pathogens is a major threat which may pose difficulty in further treatment.

Keywords: Antibiotic resistance, enteropathogens, food borne pathogens


 
Original Article
Praveen Rishi, Tanya Sathu, Aman Preet Singh, Simran Preet

Evaluation of antibacterial and anti-inflammatory potential of Withania somnifera (ashwagandha) against Salmonella enterica serovar Typhimurium

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:23-32][No of Hits : 16]


ABSTRACT

Background & Objectives: The usual approach to treat Salmonella infections has been the use of conventional antibiotics, but the emergence of MDR (multidrug-resistant) strains and their undesirable effects has diverted the scientific interest towards the use of natural antibacterial and anti-inflammatory compounds. In this context, Withania somnifera (ashwagandha) is one such alternative, which has been safely used for centuries in Indian Ayurvedic medicine for the treatment of various ailments. The present study was therefore, planned to evaluate the antibacterial, anti-inflammatory (edema) and immuno-modulatory potential of the purified whole root extract of Withania somnifera against Salmonella enterica serovar Typhimurium.

Material and Methods: Female inbred BALB/c mice, 4-6 weeks old (16-22 gm in weight), were procured from the Central Animal House, Panjab University, Chandigarh (India).

Results: Well-diffusion assay and CFU (colony forming units) enumeration confirmed the in-vitro inhibitory potential of Withania somnifera. The anti-inflammatory potential of ashwagandha was confirmed by mouse paw oedema test and flicking response. Further, a significant decrease in MDA (malondialdehyde) and increase in SOD (superoxide dismutase) levels revealed the modulatory effects of ashwagandha in terms of macrophage functions. Withania somnifera also demonstrated excellent in-vivo potency against serovar Typhimurium as evident by reduction in the number of Salmonellae in the liver, spleen and intestine along with histological studies.

Interpretations & Conclusion : From the present study, it may be concluded that Withania somnifera possesses strong antibacterial as well as anti-inflammatory potential against Salmonella enterica serovar Typhimurium as evidenced by in-vitro, ex-vivo and in-vivo tests.

Keywords:Ashwagandha, antibacterial activity, ex-vivo, immuno-modulatory, in-vitro, in-vivo, minimum inhibitory concentration.


 
Original Article
Neelam Taneja, Manisha Biswal, Pooja Rao,Garima Sangar, Prashant Sood and Shivapriya

Ciprofloxacin resistant Shigella flexneri in India- A new therapeutic challenge

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:33-35][No of Hits : 15]


ABSTRACT

Background & Objective: Fluoroquinlones (FQ) have been highly effective drugs for treatment of shigellosis all over the world. Ciprofloxacin resistance in Shigella flexneri has emerged as a therapeutic challenge in our region. Here, we report clinical presentation of patients in whom S. flexneri was isolated from stool specimens as well as trends of ciprofloxacin susceptibility for the period 2000-2005.

Material and Methods: Stool samples were cultured and shigella spp. were identified using standard methods Antibiotic susceptibility was performed in accordance with Clinical Laboratory Standards (CLSI). Minimum inhibitory concentration (MIC) studies were performed by using the agar dilution technique of CLSI and E test. Patients’ clinical details and response to therapy were noted. Plasmid profile of ciprofloxacin resistant strains was performed by the rapid alkaline lysis method. Conjugation experiments were done to determine whether quinolone resistance was transferable to E .coliJ 53 Rif R.

Results : From 995 stool samples submitted from 1st Jan 2005 to 31st Dec 2005, 53 shigellae were isolated. S. flexneri (31 isolates, 60.7%) was the predominant isolate, followed by S. dysenteriae (7), S .sonnei and S. boydii (6 each) and 3 (nonagglutinable). Isolates from 23 out of 28 patients (82%) with S.flexneri shigellosis showed ciprofloxacin resistance (MIC>4). Seven patients infected with S.flexneri did not show any response to either ciprofloxacin/ ofloxacin, but 3 patients responded to ceftriaxone & 4 patients respond to combination of amikacin & ciprofloxacin. Three patients showed a partial response, 2 relapsed after an initial response. Over a period of five years, a trend towards increasing MIC was noticed. Though the increase in MIC values appears gradual for MIC <4, a sharp peak is noticed for MIC>4 in 2005. Though plasmids of 2, 4 and 1.8 Kb were transferred to E coli, the E coli conjugants were susceptible to ciprofloxacin, thereby confirming that ciprofloxacin resistance was not plasmid mediated

Interpretation & Conclusion: There is a great immediate need for an effective oral agent that can be safely used for treatment of children with shigellosis along with continued surveillance required at regional and national level.

Keywords : Shigella flexneri, Ciprofloxacin resistance, India


 
Editorial
Deepinder Kaur, Omesh Goyal

Spontaneous bacterial infections in cirrhosis-peritonitis and beyond

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:1-3][No of Hits : 15]


ABSTRACT

Patients with liver cirrhosis have high morbidity and mortality due to either direct complications of the loss of liver function and/or portal hypertension such as jaundice, encephalopathy, variceal hemorrhage or indirect complications like hepatorenal syndrome and hepatocellular carcinoma.


 
Original Article
Kamlesh Thakur, Anuradha Sood, Subhash Chand Jaryal, Puneet Kumar Gupta, Smriti Chauhan

Identification of bacterial pathogens and their antibiogram from ascitic fluid in a rural tertiary care hospital of north India

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:19-22][No of Hits : 13]


ABSTRACT

Background & Objectives: The familiarity on the part of the clinician with ascitic fluid interpretation and with ascitic fluid characteristics in various diseases will increase the chances of controlling ascites early. The definite diagnosis of spontaneous bacterial peritonitis (SBP) is based on clinical evidence, neutrophil count and positive ascitic fluid culture. The objective of this study was to identify the bacterial agents from ascitic fluid and to determine their antibiotic resistance profile.

Material and Methods: Aretrospective analysis of 132 ascitic fluid specimens collected for direct Gram’s staining and culture during March 2012 to April 2013 was performed. The antibiotic susceptibility testing was done as per Clinical laboratory Standard Institute guidelines. The extended-spectrum beta-lactamase (ESBL) production in Gram negative isolates were determined.

Results :On Gram’s staining, microorganisms with pus cells were seen in 20.4% and culture was positive in 37.8% of samples. Most of the isolates were Gram negative (70%). Among Gram negative isolates, E. coli was most common isolate (74%) followed by Acinetobacter spp. (11.6%), Enterobacter spp.(5.8%), Pseudomonas aeruginosa (5.8%) and Klebsiella oxytoca (2.9%). Among Gram positive isolates, Staphylococcus aureus, Enterococcus faecalis and coagulase negative staphylococci were 73.3%, 20% and 6.7% respectively. ESBLs were detected among 17.6% of E. coli and 30.5% of Klebsiella oxytoca isolates and all were multidrug resistant. All the strains were found to be sensitive to imipenem.

Interpretation & Conclusion: The knowledge of presumptive causative organism and their antibiotic resistance profile will help the clinician in choosing empirical antibiotic therapy in suspected patients of SBP.

Keywords:Ascitic fluid, culture, sensitivity, spontaneous bacterial peritonitis.


 
Review Article
Chetana Vaishnavi

An overview of bacterial diarrheas

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:4-11][No of Hits : 12]


ABSTRACT

Diarrhea is a major public health problem in developing countries resulting in heavy economic burden. Various pathogenic bacteria affect the gastrointestinal tract and produce abdominal cramps, nausea, vomiting and diarrhea. These bacteria are mainly acquired through contaminated water and food. The important ones among them are Vibrios, Escherichia coli, Staphylococcus, Salmonella, Shigella, Bacillus cereus, Campylobacter, Clostridia, Yersinia, Klebsiella and Aeromonas. Proper sewage disposal and other sanitary hygiene such as proper hand washing must be maintained in the community in order to prevent diarrhea, as ingestion of fecal contaminated water is the primary route of transmission of the pathogens. Safe drinking water is another requisite to fight against the problem of diarrhea. Adequate chlorination of water easily kills organisms such as that of cholera and safeguards against bacterial diarrhea. Salads prepared from materials washed in contaminated water or handled by unhygienic hands are also important vehicles of transmission of pathogenic bacteria. Reheating of refrigerated food kept at room temperature for a very long time also perpetuates spores and may lead to food poisoning. All these preventive measures when taken into account can help to reduce the burden of diarrheal episodes. However despite preventive measures if diarrhea occurs, restoration of fluid and electrolyte balance in the form of oral rehydration therapy is of paramount importance in the management of the illness.


 
Review Article
Varsha Gupta, Manpreet Kaur

Association of reactive arthritis with enteric pathogens

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:16-18][No of Hits : 11]


ABSTRACT

Reactive arthritis (ReA) also known as post infectious arthritis, affects 1-4% of people days to weeks after being infected by an enteric, urogenital or upper respiratory infection. The most common enteric bacterial pathogens that have been associated with ReA include Salmonella, Shigella, Campylobacter, enterotoxigenic Escherichia coli and Yersinia. It is quite necessary to determine the burden of ReA due to enteric infections using standard criteria. The clinician should investigate for the evidence of previous bacterial infections. In addition, it is very important to carry follow-up studies of patients with enteric infection so as to clarify the association of ReAwith enteric pathogens. No curative treatment for reactive arthritis (ReA) exists. Instead, treatment aims at relieving symptoms and is based on symptom severity. Prevention of enteric and genitourinary bacterial infections is the best option.


 
Original Article
Veenu Gupta , Deepinder Kaur, Rajoo Singh Chhina , Jyoti Chaudhary, Manisha Aggarwal, Kanwaldeep Lyall

Trends of hepatitis A & E infection in a tertiary care hospital of north India

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:44-46][No of Hits : 10]


ABSTRACT

Background & Objectives: Acute viral hepatitis (AVH) is a systemic infection affecting the liver predominantly. It is a major public health problem in India and other developing nations having inadequate sanitary conditions. This study was undertaken to determine the trends of Hepatitis A & E & their coinfection in a tertiary care hospital so that appropriate management of cases as well as prevention can be planned.

Material & Methods : Over a 2-year period, a total of 5894 serum samples were collected from clinically suspected cases of hepatitis. The serum samples were screened for IgM anti-HAV and IgM anti-HEV. Seasonal variation & age group wise seropositivity of hepatitis A& E was studied.

Results: Out of the total 5894 samples screened, the percentage positivity of Hepatitis A was 6.7%, 6.2% and Hepatits E was 14.1%, 13.9% respectively in 2012 & 2013. Of both Hepatitis A & E positive cases, males outnumbered females. Majority of HAV positive cases were children whereas majority of hepatitis E positive cases were adults.

Interpretation & Conclusion: The prevalence of HEVwas more than HAVin enterally transmitted viruses, making them a major public health problem in our area. Seasonal trends of infection were observed in addition, co-infection though infrequent, but still detected in many cases.


 
Case Report
Thakur Gurung, Limci Gupta

A potential pitfall in appendix: An interesting case

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:59-60][No of Hits : 9]


ABSTRACT

Food material including seeds can be a very common presentation in the appendicectomy specimens. On histological examination they can sometimes be mistaken as worms or their ova. Here we discuss the differentials and differentiating features of common parasites, ova and plant material/seeds found in appendix specimens. A female presented in the emergency unit with abdominal pain, whose diagnostic laproscopy with appendicectomy was done and histology of the appendix showed food material with plant cell matrix along with moderate acute inflammation in the mucosa. Therefore these should be clearly identified in histology by looking at their morphology which can help us in diagnosing and managing the patient appropriately.

Keywords: Appendix, histology, parasites


 
Case Report
Rama Gupta, Rajdeep Singh Chhina, Deepinder Kaur, Kavita Saggar, Jaspreet Kaur

Primary tubercular appendicitis with perforation

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:61-62][No of Hits : 9]


ABSTRACT

Tubercular appendicitis is surprisingly rare, even in countries where this infection is endemic. We report a case of isolated tubercular appendicitis with atypical presentation. A39 year male patient presented with abdominal pain and mild fever. On the basis of Ultrasonography and CECT findings, the patient was diagnosed as a case of appendicitis with perforation.Percutaneous (PC) drainage of the fluid revealed acid fast bacilli however no detectable tubercular focus was found elsewhere in the body. The patient was managed conservatively. Preoperative diagnosis of primary tubercular appendicitis is rarely made. It needs high index of suspicion. It should always be confirmed by histopathology.

Keywords: tubercular, appendicitis, ZN staining.


 
Brief Communication
Mamatha Ballal, Suganthi Martena Devdas, Nishanth Bhat

Changing trends of antibiotic susceptibility pattern among Vibrio Cholera 01 serovars from sporadic cases in coastal Karnataka, south India

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:51-53][No of Hits : 9]


ABSTRACT

Changing patterns of antibiotic sensitivity of V. cholerae is a major concern as Multiple-Antibiotic-Resistant (MAR) V. cholerae isolates are being reported from various parts of the world. The study was conducted to analyze the prevalence and antibiotic resistance pattern of V. cholerae O1. Samples were processed according to the standard guidelines. Sporadic outbreaks occurred in June 2004 and March 2010. Antibiotic resistance was seen in the strains isolated. Alarge number of cholera epidemics have been associated with MAR strains of V. cholerae. This makes it imperative that all isolates be constantly subjected to susceptibility testing and resistance patterns to each antibiotic be monitored.

Keywords: Aeromonas hydrophila, Vibrio cholerae Inaba,Vibrio cholerae Ogawa, Tetracycline


 
Brief Communication
Deepinder Kaur, Kanwal Deep Singh, Veenu Gupta, Rama Gupta, Jaspreet Kaur, Charu Arora

Comparison of direct detection of Mycobacterium tuberculosis complex by Gen probe and culture for the diagnosis of abdominal tuberculosis

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:54-55][No of Hits : 8]


ABSTRACT

Abdominal tuberculosis is a most common type of extra-pulmonary tuberculosis. Abdominal tuberculosis can occur primarily or it can be secondary to a tubercular focus elsewhere in the body. Atotal of 153 samples (gastrointestinal biopsies and ascitic fluid) were processed and direct microscopy, culture and Amplified Mycobacterium Tuberculosis Direct Test (AMTDT) were performed. Comparative analysis of the results was done. The overall positivity by culture was 1.3% and by AMTDTwas 5.2%.


 
Review Article
Amandeep Kaur Anand, Sandeep Dogra

Listeriosis in pregnancy: A deadly and under diagnosed gastrointestinal infection

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:12-15][No of Hits : 8]


ABSTRACT

Human listeriosis, a dreaded gastrointestinal disease of the West has surfaced in the last two decades in India, and there have been a series of reports on sporadic cases. The causative organism, Listeria monocytogenes is an intracellular Gram-positive bacillus ubiquitous in soil and vegetation. It is responsible for cases and outbreaks of febrile gastrointestinal disease in otherwise healthy people and invasive listeriosis, which usually affects pregnant women, newborns & the elderly. Immunocompromised individuals and pregnant women have been identified as major risk factors for listeriosis. It is about 20 times more common in pregnant women than in the general population. It causes mild illness in mothers, but can be devastating to the fetus, in some cases leading to severe disease or fetal death. It may cause abortion, premature labour, fetal death or neonatal morbidity in the form of septicemia and meningitis. This review is an attempt to sensitize clinicians especially obstetricians to include listeriosis as a differential diagnosis in patients with high suspicion and institute early antimicrobial therapy. Also there is need to press upon proper counseling of pregnant women for preventive measures against this deadly infection.

Keywords: Listeriosis, Listeria monocytogenes, pregnancy, neonates


 
Original Article
Ajit Sood, Vandana Midha, Omesh Goyal

Genotypic distribution and associated disease pattern of hepatitis C virus in northern India

[Year:2014] [Month:January-December] [Volumn:4 ] [Number:1] [Pages:62] [Pages No:40-43][No of Hits : 4]


ABSTRACT

Background & Objectives : Hepatitis C virus (HCV) genotype has emerged as an independent factor for disease progression, and it also influences the duration and response to anti-viral therapy. HCV genotypic distribution varies geographically. This retrospective analysis was performed to study the genotypic distribution of chronic hepatitis C and its effect on disease presentation in northern Indian population.

Material and Methods: All treatment eligible patients with HCV infection presenting to the gastroenterology outpatient department at our institute between January 2004 and December 2013 were enrolled.

Results: A total of 1202 patients with hepatitis C virus infection were included. The mean age of patients was 41.5 ±11.8 years and 70% were males. The mean ALTlevel was 106.4 ± 85.4 IU/Land high viral load was present in 50.7%. Evidence of cirrhosis was present in 22.5%. The most common genotype was genotype 3 (80.1%), followed by genotype 1 (15.4%), genotype 4 (1.4%) and genotype 2 (0.5%). All the clinical and biochemical characteristics in genotype 1 and 3 patients were similar except that a significantly higher proportion of patients with genotype 1 had a high viral load. The percentage of cirrhotic patients among genotype 1 was 25.9% as compared to 22.2% among genotype 3.

Interpretation & Conclusion: Genotype 3 is the most prevalent genotype in the HCV infected patients in northern India, followed by genotype 1. There was no significant difference in disease presentation among genotype 1 and 3 patients.

Keywords: Hepatitis C virus, genotype


 
Original Article
Jyoti Goad, Sushma Bharrhan, Neha Garg, Praveen Rishi

Antibacterial and immunomodulatory effect of cell free supernatant of Lactobacillus plantarum against Shigella flexneri

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:33-40][No of Hits : 57]


ABSTRACT

Background & Objectives: Shigellosis is endemic throughout theworld causing great deal ofmorbidity andmortality. Emergence of antibiotic resistance and lack of vaccine against Shigella, necessitates exploitation of alternative strategies to combat Shigella infection. The present studywas undertaken to evaluate the effect of cell free supernatant (CFS) from Lactobacillus plantarum (L. plantarum) against Shigella flexneri (S. flexneri).

Methods: The effect of CFS from Lactobacillus plantarum against S. flexneri was studied in terms of agar well diffusion assay, time kill assay, adherence inhibition andmacrophage functions.

Results: It was found that CFS inhibits S. flexneri as indicated by zone of inhibition and continuous decrease in the CFU/ml for 16 hours of incubation period. A decrease in the number of Shigella cells adhering to mouse intestinal cells was also observed in the presence of CFS. Cell free supernatant could significantly decrease the levels of malondialdehyde (MDA) and nitrite. Levels of lactate dehydrogenase (LDH) and Tumor necrosis factor-a (TNF-a) were almost restored in the presence of CFS. The study revealed correlation between LDH andMDA levels, as well as between nitrite and TNF-a levels suggesting the immunomodulatory effects of CFS in addition to its antibacterial property against Shigella.

Interpretation and Conclusions: Regular intake of probiotic food supplements may prove to be beneficial against enteric infections due to sustained release of antimicrobials.

Keywords: Cell free supernatant, Drug resistance, Lactobacillus plantarum, S. flexneri


 
Review Article
Sunil Kumar Gupta, Amanjot Kaur Arora, Jasveen Kaur, Veenu Gupta, Deepinder Kaur

Skin as amirror of gastrointestinal diseases

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:19-27][No of Hits : 23]


ABSTRACT

The closely related origins of the skin and the gastrointestinal systemmake for a fascinating grouping of diseases with concomitant involvement of these two important organ systems. The dermatologicmanifestationsmay precede clinically evident gastrointestinal disease and help in early diagnosis, saving unnecessarywastage of time and resources. In this overview,we review the cutaneousmanifestations of various hereditary, neoplastic and inflammatory gastrointestinal diseases including the various polyposis syndromes, hereditary colorectal cancers, inflammatory bowel diseases, etc. Dermatologic manifestations of acute and chronic hepatic and pancreatic diseases have also been discussed. This review underscores the importance of collaboration between dermatologists and gastroenterologists for better and efficient management of the affected patients.

Keywords: Gastrointestinal diseases, Genodermatoses, Hepatitis, Inflammatory bowel disease, Pancreatic diseases, Polyposis syndromes


 
Brief Communication
Rupinder K Bakshi, Geeta Walia, Shikha Jain

Seroprevalence and risk factors of hepatitis B and hepatitis C virus infections among patientswith chronic liver diseases

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:61-63][No of Hits : 23]


ABSTRACT

Introduction & Objectives : Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases worldwide. Because the two hepatotropic viruses share same modes of transmission, co-infection with the two viruses is not uncommon, especially in areas with a high prevalence of HBV infection and among people at high risk for parenteral infection.

Material & Methods: This study was conducted from January- December 2011 during which 170 blood samples were collected frompatients suffering fromchronic liver diseases (CLD) (chronic hepatitis or cirrhosis) admitted in Medicine Department. Five ml venous blood sample was collected and processed in Department of Microbiology. HBsAg was detected by using Hepacard Test and anti HCV was detected by using HCV Tridot - rapid visual test (J. Mitra & Co. Ltd.).

Results: Among 170 patients with CLD, HBsAg seropositivity was 28% (47/170) while anti-HCV seropositivity was 41% (70/170). Co-infection of HBsAg and anti-HCV was 3.5% (6/170). In patients with alcoholic hepatitis/ cirrhosis, seropositivity of HBsAg&anti-HCV was 19.4%&29.0%respectivelywhile in patientswith non alcoholic chronic hepatitis/cirrhosis, it was 23.1% &48.1% respectively.

Interpretation and Conclusion : Seroprevalence of HBsAg & anti-HCV in patients with CLD was 28% and 41% respectively whereas co-infection of HBsAg & anti-HCV was 3.5%.

Keywords: Hepatitis B virus, Hepatitis C virus, Hepatocellular carcinoma


 
Original Article
Ashima Kaura, Vishal, H. S. Pannu, Deepinder Kaur, Amandeep, Rajoo Singh Chhina

Profile and outcome of liver diseases in pregnancy -Ahospital based study

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:41-44][No of Hits : 22]


ABSTRACT

Background & Objective: Liver disease in pregnancy can have serious consequences. We studied the profile of liver disease in pregnant women and its correlation with outcome of pregnancy during the hospital stay in a tertiary care hospital.

Methods: Pregnantwomen with liver disease admitted in the departments ofMedicine,Gastroenterology andObstetrics & Gynaecology between January 2011 and June 2012 in a tertiary care hospital of North India were evaluated for various parameters.

Results: Out of 2663 pregnant women, 92 patients (3.45%) were diagnosed to have liver disease. Acute viral hepatitis (AVH) was found in 42 (45.6%) and pregnancy specific liver disease in 39 (42.4%) patients. Hypertensive disorder of pregnancy including HELLP Syndrome (Hemolysis, Elevated liver enzymes, Low platelet count) was seen in 27 patients (29.3%). Four patients had leptospirosis and hepatitis E co-infection.Overallmaternal and perinatal mortality was 7.6% (7/92) and 25% (23/92) respectively.

Interpretation and Conclusion : Acute viral hepatitis (45.6%) was the most common cause of liver disease in pregnancy in our study.

Keywords: Hepatitis, Liver disease,Maternal mortality


 
Original Article
Sukhminderjit Kaur, Madhu Sharma

Inhibitory potential of Lactobacillus species isolated fromfermented dairy products against Escherichia coli and Staphylococcus aureus

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:45-50][No of Hits : 21]


ABSTRACT

Background & Objectives: Probiotics exert a strong antagonistic activity against many microorganisms including food spoilage organisms and enteropathogens. Lactobacilli find increasing acceptance as probiotics by showing its beneficial effects. Keeping in view the benefits of probiotics in literature, the present study was planned to isolate Lactobacillus spp. from different fermented dairy products and to study the inhibitory potential against biofilm forming bacteria viz. Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus).

Methods: Lactobacillus spp. were isolated from different fermented dairy products and characterized. The antimicrobial activity of each Lactobacillus spp. was checked by agar well diffusion and overlay methods. The strains showing inhibitions in these assays were further used to detect biofilminhibition against E. coli and S. aureus bymicrotiter plate biofilmassaymethod.

Results: A total of 21 samples were studied of which pure growth was observed in 67% and mixed growth was observed in 33% of the samples. Of 18 isolates obtained, 45% belonged to Lactobacillus plantarum (L. plantarum), 33% were Lactobacillus acidophilus (L. acidophilus) and 22% comprised of Lactobacillus fermentum (L. fermentum). Ten isolates showed inhibition against E.coli and 9 isolates showed inhibitory activity against S. aureus in agar well diffusion assay and overlay method. In microtiter plate biofilm assay, the absorbance values were less in the wells where E. coli and S. aureus were mixed with the Lactobacillus broth.

Interpretation and Conclusions: The Lactobacillus strains showing inhibitory activities against the pathogens can be used as probiotics or as starter culture in food fermentations after confirming other attributes.

Keywords: Bacteriocins, Biofilm, Lactobacillus, Probiotics


 
Mini Review
Rohit Rao, G Gopla Rao

Klebsiella pneumoniae liver abscess: An old bug in a new bottle?

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:2-5][No of Hits : 18]


ABSTRACT

Klebsiella pneumonaine (K. pneumonaine) has a long history. It is less well known that Danish Scientist has Christian Gram (1853-1938) When working in Carl Friedlander’s (a German baceriologist) laboratory, devlopved the technique now knownas Gram staining in 1883 (published in 1884) not to distinguish between one group of bacteria from another but to enable bacteria to be seen more readily in stained sections of mammalian tissues.


 
Editorial
Deepinder Kaur, Rajoo Singh Chhina

Probiotics in health and disease

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:1-2][No of Hits : 16]


ABSTRACT

Proviotics, the term that literally means “for life” was first introduced in 1953 by Werner Kolkith. Russian Nobel Laureate ElieMetchnikoff, proposed the idea that ingestingmicrobes could have beneficial effects for human beings. Themodern definition drafted by the Joint expert consultation of the Food andAgriculturalOrganization of theUnited Nations and the World Health Organization in 2001 defined probiotics as “livemicroorganisms,whichwhen consumed in adequate amounts, confer a health benefit on the host”. Studies of metagenomics and the human microbiome will expand the knowledge on the composition of microbiota of the humans. The speciality of gastroenterology will be unanimously benefited from the ability to rationally modify the microbiota with the use of antibiotics, probiotics or prebiotics.Antibiotics will be used to suppress the undesirable effects of microbiome. Probiotics will introduce the microbial components which are beneficial to humans while prebiotics will be used to enhance the proliferation of these beneficial microbes.


 
Review Article
Kamal Arora, Deepinder Kaur, Rajoo Singh Chhina

Probiotics in neonatology: can it be adopted as a standard of care?

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:12-18][No of Hits : 15]


ABSTRACT

Probiotics aremicro-organisms that confer health benefits to the host. There is a growing body of evidence documenting the immune-modulatory ability of probiotic bacteria. The need for probiotic formulations has been appreciated for the health benefits in “topping up your good bacteria” or indeed in an attempt to normalise the dysbiotic microbiota associated with immunopathology. This review will focus on the use of probiotics in clinical practice, particularly related to neonatal practice, including explanations of what they are and how they work. Evidence for the health benefits of consuming probiotic bacteria are examined in several clinical conditions. Lastlywe have tried to solve the debated question that “should probiotics be used as standard of care in neonatal practice?”

Key Points
1. Probiotics are enterally administered live “good” micro-organisms that colonise the gastrointestinal tract tomodulate the functions of the innatemicrobial community and immune syste.
2. Thismay result in significant health benefits; for example enteral probiotic supplementation significantly reduces both severe necrotising enterocolitis and all-causemortality in preterminfants.
3. There is a debate on routine enteral probiotic supplementation for all preterm infants. Others advise caution pending results fromlarge clinical trials designed to address issues regarding safety and efficacy in the smallest, most vulnerable newborn population.
4. Probioticsmay also reduce atopic eczema in high-risk infantswhen administered to themother during pregnancy and to the infant post-natally and improve feeding tolerance in neonates.


 
Original Article
Chetana Vaishnavi, Prashant Kapoor, Sukhminderjit Kaur, Ibrahim Masoodi, Rakesh Kochhar

Retrospective assessment of fecal myeloperoxidase activity in Clostridium difficile associated diarrhea

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:28-32][No of Hits : 15]


ABSTRACT

Background & Objective: Immune defense cells such as polymorphonuclear (PMN) leucocytes and monocytes are present in the colonic mucosa and aid in local inflammatory response. Myeloperoxidase (MPO) abundantly present in immune defense cells gets released upon neutrophil activation. Clostridium difficile is an anaerobic bacteriumresponsible for nosocomial diarrhea and severe colitis.

Methods: A retrospective study was undertaken to quantify the presence of colonic inflammation by evaluation of fecal MPO activity as an adjunct to C. difficile diarrhea. A total of 560 patients with nosocomial diarrhea and 123 healthy subjects with no diarrhea formed the basis of our investigation. C. difficile was investigated either by stool culture (n=351) or by C. difficile toxin (CDT) assay (n=209) using purified anti-toxin A and anti-toxin B. MPO activitywas measured using dianisidine hydrogen peroxidase.

Results: MPO was positive in 76.8% of patient samples. Chi square test for MPO analysis showed that it was significantly distributed over positive and negative values. A total of 115 stool cultures were positive for various organisms, of which 91 were also MPO positive. There were 38 C. difficile culture positive of which 34 were also MPO positive. MPO activity in relation to CDT assay showed that 43% were positive for both CDT and MPO. When control samples were analyzed, MPO was positive in 11.7% with C. difficile growing in 4/30 (13%) of the cultured samples. CDT was negative in the remaining control samples.

Interpretation and Conclusion: High levels ofMPOmay signal the acuity of the disease and indicate inflammation. FecalMPO is a simple, inexpensive and objective tool for assessing the degree of acute inflammation in the intestine.

Keywords: C. difficile culture, C. difficile toxin, fecal MPO


 
Mini Review
Nidhi Singla, Shivani Garg, Varsha Gupta, Jagdish Chander

Hepatitis C:An overview of its laboratory diagnosis

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:9-11][No of Hits : 13]


ABSTRACT

Hepatitis C virus (HCV) is a heterogeneous virus with multiple genotypes. It has a slowly progressive course with a fatal outcome. Chronic infection with HCV is a major cause of liver cancer. Diagnosing the disease early at an early stage is necessary so as to prevent its progression to chronicity. Screening for anti-HCV IgG antibody can be done by a number of immunoassays but at the same time it becomes difficult to differentiate between acute and chronic infection. To overcome this problem nucleic acid testing for detecting HCV ribonucleic acid (RNA) can be used as themainstay for diagnosing the infection.

Keywords: Anti-HCV antibody, Hepatitis C virus, NucleicAcid testing


 
Case Report
Omesh Goyal, Rajdeep Singh Chhina, Kanwaldeep Singh, Jasdeep Singh, Rama Gupta, Kavita Saggar

Clostridium difficile infection presenting as acute abdomen

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:66-68][No of Hits : 12]


ABSTRACT

Clostridium difficile infection (CDI) is an important cause of infectious nosocomial diarrhoea. Widespread use of antibiotics has led to a dramatic rise in the incidence of CDI. However, a majority of the CDI cases are either misdiagnosed or undiagnosed because of low clinical suspicion or the use of diagnostic tests with low sensitivity. Although occurrence of diarrhoea in a patient who has recently received antibiotics is an important clue to the diagnosis of CDI, presentation of CDIwith non-diarrheal symptoms like fever, pain abdomen or abdominal distention is known. We report a case of a 65 years old male who presented with acute abdomen in surgical emergency, was diagnosed to have CDI, and was successfully treated with vancomycin.

Keywords: Acute abdomen, C.difficile infection, pseudomembranous colitis


 
Case Report
Maninder Kaur, Aruna Aggarwal

Nocardia in psoas abscess: Arare presentation

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:69-71][No of Hits : 12]


ABSTRACT

We report a case of primary psoas abscess caused by Nocardia in an immunocompetent patient who presented with low back ache with pain radiating to both legs. A suspicion of nocardiosis was made based on Gram’s staining and modified acid fast stain ofmaterial obtained by ultrasound guided aspiration. The patient showed remarkable recovery after treatment with co-trimoxazole. Quick identification by simple Gram’s staining and modified acid fast staining helped in timely diagnosis and treatment of the patient.

Keywords: Immunocompetent, Nocardia, Psoas abscess


 
Original Article
Ashish Ahuja, Jasdeep Singh, Jaspreet Kaur, Ravinder Pal Singh

Final clinical outcome after interventional procedures in enteric perforations with peritonitis

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:55-60][No of Hits : 12]


ABSTRACT

Background & Objectives: Enteric fever is a major challenge in developing countries and perforation peritonitis is a major cause of morbidity and mortality. The main aim of this study was to compare and evaluate the various operative procedures performed in enteric perforation and to find out the ideal operative procedure (if any) in the treatment of enteric perforation with peritonitis.

Material & Methods: The study was conducted over a period of 3 &anp; 1/2 years (2 years retrospective and 1&1/2 years prospective) on 150 patients presentingwith enteric perforation.All patientswere treated as a surgical emergency and given broad-spectrum antibiotic coverage, naso-gastric aspiration, fluid and electrolyte management prior to surgery. Patients were kept on regular follow-up for the next 6 months after treatment.

Results: In our study, 93%of the procedures belonged to one of the two categories i.e. ileostomy or primary closure. Ileo-tranverse bypass and resection-anastomosis were done in 4% and 3% of the patients respectively. The total mortality was 11% & the incidence was more in ileostomy group (17.9%) as compared to the primary closure group (6.7%). The difference in mortality between the ileostomy and primary closure group reached least statistically significant value (p<0.1).

Interpretation and Conclusions: Aggressive resuscitation and early surgery is the key to successful management of enteric perforation. Primary closure should be the treatment of choice in enteric perforation. Ileostomy should be done if there are major risk factors for post-operative fecal fistula formation.

Keywords: Abdominal distension, Enteric fever, Pain abdomen, Perforation, Peritonitis


 
Brief Communication
Madhu Sharma, Aparna, Sarita Yadav, Uma Chaudhary, Aakanksha

Detection of Clostridium difficile toxins A & B

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:64-65][No of Hits : 11]


ABSTRACT

Clostridium difficile (C.difficile) is responsible for nosocomial diarrhoea and is themajor cause of pseudomembranous colitis. Incidence of C. difficile associated diarrhoea (CDAD) has increased in recent years and is associated with high mortality of 24-38%. Forty nine stool samples received were screened for the presence of C. difficile toxinA & B by ELISA, out of which 10 samples were positive for both the toxins. Therefore, CDAD needs to be diagnosed early in hospital settings so that cases can be treated early and spread can be prevented.

Keywords: CDAD, C. difficile, toxin


 
Original Article
Pandey V, Shubhada C, Ajantha GS, Kulkarni RD

Comparison of enterococcal colonization of gut in hospitalized and non-hospitalized patients

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:51-54][No of Hits : 9]


ABSTRACT

Background & objectives: Enterococci areGram-positive diplococci especially known to cause hospital associated infections. Intrinsic and acquired drug resistance is an important character of this organismand it is ranked next to E. coli in hospital associated infections.1Hospitalization and use of antibiotics increases their number,making the hospitalized patients prone to develop infections posing a therapeutic challenge to the treating clinicians.Astudy was, therefore, undertaken to compare enterococcal colonization in the outpatient and inpatient subjects.

Methods: Stool / rectal swab samples from 109 hospitalized and 58 outpatients were collected and evaluated for presence of enterococci. Standard biochemical and physiological tests were used for identification. The antibiotic sensitivity test was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results were analysed statistically.

Results: A total of 109 rectal swabs / stool samples from IPD cases and 58 stool samples from OPD group yielded 90.8%(99 of 109) and 37.9%(22 of 58) growth of enterococci respectively. Of the 109 IPD cases, all were receiving antibioticswhile only 32 of 58OPD patientswere receiving antibiotics.All isolateswere sensitive to vancomycin.The carriage of enterococci in IPD cases was significantly higher compared to the OPD cases.

Interpretation and Conclusions: Enterococcal colonization increases with hospitalization and use of antibiotics. The cliniciansmust be aware of this phenomenon so as to avoid hospital associated infections by enterococci, especially in the light of their intrinsic and acquired drug resistance.

Keywords: Antibiotics, colonization, enterococci, hospital infection, rectal swab, stool culture


 
Mini Review
Varsha Gupta, Ritu Garg

Antibiotic associated diarrhoea

[Year:2013] [Month:January-December] [Volumn:3 ] [Number:1] [Pages:71] [Pages No:6-8][No of Hits : 9]


ABSTRACT

Antibiotic associated diarrhea (AAD) is defined as diarrhea that occurs in associationwith the administration of antibiotics.


 
Original Article
Vandana Kaushal, Veenu Gupta, Deepinder Chhina

Relationship between serumHepatitis B virus (HBV) DNA levels and HBeAg status in patientswithHepatitis B virus infection

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:43-45][No of Hits : 51]


ABSTRACT

Background: Hepatitis B is one of the most common types of viral hepatitis in the world. For the last thirty years, only serological markers and liver function test have been utilized to monitor the disease progression and treatment response until the emergence of molecular detection methods. Hepatitis B V DNA quantitation is used extensively world wide for the diagnosis andmonitoring of treatment ofHepatitis B virus (HBV) infection. The aim of this study was to quantitate HBV-DNA by Real time PCR method and to compare the results with HBeAg detection in Hepatitis B patients.

Material andMethods: Seventy one serumsamples of patients with hepatitis (all HBsAg positive) were the subjects of this study. Serum HBV DNA of all these samples was detected by COBAS TaqMan real time PCR and HBeAg by ELISA.

Results: Amongst Hepatitis B group patients, serum HBV DNA was detected in 61 out of 71 patients (85.9%). HBeAg was positive in 21% of patients (15/71).Majority of the HBeAg positive patients had a significantly higher serum HBV DNA levels than HBeAg negative patients.

Conclusion: HBeAg status did not necessarily reflect HBV-DNA level in the serum, as 46/71 (64.7%) in the Hepatitis B group were positive for HBV DNA but negative for HBeAg.

Keywords: Hepatitis B, HBV-DNA, HBeAg, Real time-PCR


 
Original Article
Simran Preet, Ram Prakash Tiwari, Praveen Rishi

Stability of antimicrobial activity of cryptdin-2 against selected pathogens under physiological conditions

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:30-37][No of Hits : 38]


ABSTRACT

Background and Objective:An initial step prior to clinical development of any therapeutically active peptide is to evaluate its stability under physiological conditions.As cationic antimicrobial peptides have been reported to lose their activity under physiological conditions, present study was done to evaluate the stability of antimicrobial activity of cryptdin-2 (a Paneth cell antimicrobial peptide) against Salmonella Typhimurium, Yersinia enterocolitica and Staphylococcus aureus in the presence and absence of physiological concentrations of bile salts, monovalent and divalent cations, trypsin as well as at various pH values.

Methods: The antimicrobial activity of cryptdin-2 under various physiological conditions against Salmonella Typhimurium NCTC 74, Yersinia enterocolitica and Staphylococcus aureus was evaluated by use of a modified broth dilution technique

Results: Interestingly, the activity of the peptide against the Gramnegative strainswas augmented by bile salts while no change in the activity against S. aureus was observed. Though there was a decrease in activity with increasing concentrations of metal ions, the activity was not completely lost. The peptide was able to sustain its activity against all the three test strains at physiological concentrations of trypsin.At pH8, no change in activitywas observed against Y. enterocolitica and S. Typhimurium while it was found to be reduced against S. aureus.

Interpretation and Conclusion: The study provides data showing the stability of the peptide under the physiological conditions and indicates towards the possibility of developing it as an alternate strategy to combat bacterial pathogens.

Keywords: antimicrobial activity, bacterial pathogens, cryptdin-2, physiological conditions, stability.


 
Original Article
Amit Bery, Rajoo Singh Chhina, Hardeep Sahota, Sandeep Puri, Jaswinder Singh Sandhu, Rajdeep Singh Chhina

Clinical Profile ofHepatorenal Syndrome:AProspective Study

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:38-42][No of Hits : 36]


ABSTRACT

Background and Objectives : The clinical profile of hepatorenal syndrome (HRS) patients admitted in a tertiary care hospital of Punjab was studied.

Methods : In this prospective study all the patients of chronic liver disease with renal involvement fulfilling the International Ascites Club criteria of HRS were evaluated over a period of one and a half year.

Result : Forty-two patients were diagnosed to have HRS and were included in the study. The incidence of HRS was 0.275%of hospitalmedical admissions.Alcoholic cirrhosis was the etiology in 71.5%of patients.Most of the patients ofHRS received a combination of dopamine, albumin and terlipressin. Themortality ratewas found to be approximately 60%. Variables amongst survival versus non-survival groups were analyzed. Oliguria and hepatic encephalopathy weremore predominant in non-survival group. Serumbilirubin, hypoalbuminemia, hyponatremia, coagulopathy and urine osmolalitywas higher in non-survival group. Patients with Child-Pugh Score less than 10 had a better survival.

Conclusion : The poor prognostic factors in non-survival group were presence of ascites, severe jaundice, hepatic encephalopathy, alcohol abuse, hypoalbuminemia, progressive renal failure and a Child-Pugh Score > 10. Thus, HRS is not uncommon and needs proper diagnosis and prompt treatment to ensure better outcome.

Keywords : Hepatorenal syndrome, outcome, survival


 
Review Article
Omesh Goyal, Deepinder Kaur, Rajdeep Singh, Pooja Suri, Prerna Goyal

Hepatobiliary Ascariasis

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:17-23][No of Hits : 32]


ABSTRACT

Ascaris lumbricoides is one of the commonest human parasitic infestations in the developing world. Most of the ascaris infections are asymptomatic and clinical disease ismainly restricted to subjectswith heavywormload. Biliary migration of the wormcan lead to a wide variety of clinical syndromes and concomitant complications necessitating early diagnosis andmanagement. Various disease presentations include biliary colic, obstructive jaundice, acalculous cholecystitis, choledocholithiasis, pancreatitis, cholangitis, biliary strictures and hepatic abscesses. While laboratory tests are non-specific, radiological investigations demonstrate features highly suggestive of biliary ascariasis. The vast majority of patients respond to conservative measures. Endoscopic therapy is necessary in cases which fail to respond to conservative measures or in patients presenting with complicated disease.Worms visible at the ampulla may be extracted endoscopically prior to attempting more intrusive forms of therapy. Sphincterotomy should be avoided for worm extraction since an open biliary sphincter facilitates future disease recurrences should worm reinfestation occur. Recurrence of the disease is frequent due to re-infestations. Wormeradication with anti-helminthic therapy is essential after biliary disease resolution.

Keywords : Ascaris lumbricoides, ERCP, Hepatobiliary ascariasis


 
Case Report
Kusum Sharma, Suma Appannanavar, Shiv Kumar, Aman Sharma, Meera Sharma

Post operative Mycobacterium fortuitum infection following laparoscopic inguinal hernia repair:Acase report

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:62-64][No of Hits : 29]


ABSTRACT

Rapidly growing mycobacteria (RGM) are ubiquitous in nature and are associated with opportunistic nosocomial infections requiring prolonged and multiple antibiotics. Here we report a PCR confirmed case of M. fortuitum complex infection in a post laproscopic inguinal hernia repair using prolene mesh. To the best of our knowledge we have for the first time evaluated the role of PCR using specific primers for the diagnosis of M. fortuitum complex both fromclinical samples and fromculture isolate.A62 year old physician developed low grade fever and pain over the right iliac fossa after an inguinal hernia repair.Mycobacteriological investigation revealed M. fortuitum infection. Subsequently using specific primer, M. fortuitum complexDNAwas demonstrated both in clinical sample and culture isolate. Patient was startedwith clarithromycin, doxycycline and streptomycin. Thus, PCR is a promising tool for the rapid diagnosis of difficult to treat infections caused by M. fortuitum complex.

Key words: Inguinal hernia. Mycobacterium fortuitum, PCR, Post laparoscopic


 
Editorial
Varsha Gupta, Preeti Behl

Non Typhoidal Salmonellosis (NTS) :AGlobal concern

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:1-2][No of Hits : 26]


ABSTRACT

Salmonellosis is a public health problem worldwide. It is caused by enteroinvasive bacteria belonging to the genus Salmonella. Medically Salmonellae have been classified into typhoidal (S.Typhi, S.ParatyphiA, S.Paratyphi B) and nontyphoidal (eg; S.Typhimuriumand S. Enteritidis). Non-Typhoidal Salmonella (NTS) species are important foodborne pathogens worldwide. Their widespread distribution in the environment; increasing prevalence in the global food chain; virulence and adaptability have an enormousmedical, public health, and economic impact worldwide. In India, Typhimuriumand Enteritidis are the commonest nontyphoidal serotypes, but occurrence of rare serotypes like S.Worthington, S. Wien, S. Virchow, and S. Dublin have been reported in literature.


 
Original Article
Pooja Suri, Deepinder Chhina, Veenu Gupta, Jasdeep Singh, Puneet Chopra, Rajdeep Singh, Rajoo Singh Chhina

Seroprevalence of Parenterally and Enterally TransmittedHepatitis Viruses in a Tertiary CareHospital of North India -ATwo Year Study

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:46-51][No of Hits : 21]


ABSTRACT

Background & Objectives : Viral hepatitis is one of the major health concerns in developing countries like India. The present study was undertaken to find out the prevalence of hepatitis B, hepatitis C, hepatitisAand hepatitis E in our area and to compare it with National and International data.

Methods:Atotal of 34,551 serumsamples received over a period of two years (Jan 2010 to Dec 2011) fromvarious wards and intensive care units (ICUs) were processed in the Department of Microbiology for different markers of viral hepatitis. Out of these, 13,570 serum samples were tested for the presence of HBsAg, 13,566 for anti HCV antibodies, 3,871 for anti HAV IgMand 3,584 for anti HEV IgMantibodies by enzyme linked immunosorbent assay (ELISA).

Results : The percentage positivity for hepatitis B, hepatitis C hepatitisAand hepatitis E was 5.95%, 13.25%, 6.32% and 15.43%respectively in 2010 and 5.62%, 14.27%, 6.56%and 23.53%respectively in 2011.The overall prevalence of viral hepatitis was more in males as compared to females.

Interpretation & Conclusion : The prevalence of hepatitis C was more than hepatitis B among the parenterally transmitted viruses while the prevalence of hepatitis E was more than hepatitisAin enterally transmitted viruses, in both the years making them a major public health problem in our area.

KeyWords: HAV,HBV,HCV,HEV, viral hepatitis


 
Original Article
B. Uppal, M. Matlani

Enteric pathogens in pediatric patients-AThreeYear Study from a tertiary careHospital of North India

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:52-55][No of Hits : 21]


ABSTRACT

Acute diarrhea is a common problem in children in developing countries like India leading to hospitalization. The objective of the studywas to assess the etiological agents causing diarrhea in children and their sensitivity patterns to various antimicrobials. This study was carried out from January 2007- December 2009 on 860 pediatric patients attending the out patients department or admitted in thewards of LokNayakHospital,New Delhi with gastroenteritis. Eight hundred and sixty stool samples were collected and examined for various pathogens.
Enteric pathogens were isolated from 321 (37.2%) samples. Parasitic pathogens were observed in 67 (7.79%) stool samples. V.cholerae was the most commonly isolated bacteria 134/321 (41.74%), followed by Shigella 90/321 (28.03%) and E.coli 86 (27.79%). Salmonella spp. (1.5%) and Aeromonas hydrophila (1.86%) were isolated less frequently. Resistance to amoxycillin was observed in 99% of Vibrio, 95% of E. coli, 58% of Shigella and 20% of Salmonella species. Variable degree of resistance ranging from 0% in Salmonella to 69% in E. coli was observed against ciprofloxacin, while resistance to nalidixic acid was observed in more than 90% of all types of bacterial pathogens. Resistance to ceftriaxone, cefotaxime and gentamicin was less common. Identification of the etiological agent of diarrhea in children is very important as it can help in the institution of appropriate therapy and the reduction ofmorbidity andmortality in these patients.

Keywords : Salmonella, V.cholerae, paediatric


 
Brief Communication
Deepinder Chhina, Rama Gupta, Pooja Suri, Kanwaldeep Singh, Amarjeet Kaur, Rajoo S Chhina

Sensitivity pattern of Salmonella serotypes from a tertiary care hospital of Punjab

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:59-61][No of Hits : 19]


ABSTRACT

Enteric fever is classically caused by S. Typhi& S. Paratyphi A, B & C and it is known to be endemic in India. For optimal patient care, precise information on antibiotic susceptibility pattern is required.Hence, this studywas undertaken to know the antimicrobial sensitivity profile of Salmonella serotypes isolated fromblood in a tertiary care hospital of Punjab. All the blood samples received from January 2010 - December 2011 were processed by automated blood culture systems (BACTEC 9240/BacT-Alert 3D). Identification and antimicrobial susceptibility pattern of Salmonella strains was studied by automated identification system (MicroScanWalk-Away/ VITEK 2). Out of a total of 35854 blood samples, 5234 (14.6%) samples were found to be positive for bacterial growth, of which 363 (6.93%) were Salmonella spp. Of these, 281 (77.4%) were S. Typhi and 82 (22.6%) were S. Paratyphi A. Only 2 (0.7%) isolates of S. Typhi were found resistant to ampicillin and trimethoprim-sulfamethoxazole, and 5 (1.8%) were resistant to ciprofloxacin&levofloxacin.All the S. Typhi isolates were sensitive to 3rd generation cephalosporins. S. Paratyphi A isolateswere sensitive (100%) to all the drugs, except trimethoprim-sulphamethoxazole (97.6%)&ceftriaxone (98.8%). Though multi drug resistant Salmonella are being reported fromvarious parts of India, in our region the Salmonella isolates are still susceptible to the commonly used drugs.

Keywords : Antimicrobial sensitivity, Enteric fever, Salmonella ParatyphiA, Salmonella Typhi


 
Review Article
Shobha Sehgal, Biman Saikia

Common Variable Immune Deficiency (CVID) and Gastrointestinal Infections:Areview

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:12-16][No of Hits : 17]


ABSTRACT

Common variable immune deficiency (CVID) is thought to be the secondmost common immune deficiency disease (PID) next to selective IgA deficiency, accounting for 80% of cases of PID. The major components of the disorder are immune defects with onset after 24 months of age and presentation usually in young adulthood.


 
Original Article
Chetana Vaishnavi, Akshita Kapila, Meenakshi Singh, Kartar Singh

Clostridium difficile toxin assay by purified specific antitoxins coated to latex beads

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:24-29][No of Hits : 16]


ABSTRACT

Backround & Objective: Clostridium difficile associated disease (CDAD) is a matter of grave concern in the hospital environments due to antimicrobial usage.

Methods: We investigated the clinical and demographic profile of patients whose fecal sampleswere received in our laboratory and correlated the same with their C. difficile toxin (CDT) status. Six hundred twenty nine consecutive and non-repeat fecal samples were subjected to CDT assay using purified anti-toxin A and anti-toxin B coated to latex beads. Semi-quantitative titrations were carried out with the positive samples with a doubling dilution method. Clinical and demographic profile of each patient was recorded. During analysis the patients were assigned to two groups (i) Group 1 comprised of those receiving antibiotics and/or other drugs and (ii) Group 2 of those not receiving any drug.

Results: The age of the patients ranged froma few days to 93 years. Predominant clinical symptoms were diarrhoea (98.7%), abdominal pain (35.9%) and fever (49.8%). CDT was positive in 45.8%with titers ranging from1 in 5 to 1 in 2560. CDT positivity was highly influenced by prior antibiotic and drug intake (p<0.05). Fever was present in 43.4%and abdominal pain in 35.5%of CDT positive cases. CDT positivitywas also significantly associated with age below2 years (p<0.001) and between 41-55 years (p<0.01).CDT positivitywas highly associated with gastrointestinal diseases (32.5%) and age.

Interpretation & conclusion: Readily available clinical and basic laboratory data are useful for correlation with severity of CDAD.

Keywords: Clinical presentation, Clostridium difficile, patient demographics, toxin assay.


 
Brief Communication
Rama Gupta, Deepinder Chhina, Pooja Suri

Seroprevalence of Leptospirosis in a Tertiary Care Hospital - ARetrospective Study

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:56-58][No of Hits : 14]


ABSTRACT

Leptospirosis is a zoonotic disease with worldwide distribution. There is paucity of data about prevalence of this disease in North India. Thus, this studywas undertaken to estimate the seroprevalence of leptospirosis in our region. A total of 3179 blood samples frompatients suspected of leptospirosis were subjected to IgMELISA (PanBio). The seroprevalence of leptospirosis in our area was found to be 20.7%.

Keywords: IgM ELISA, Leptospirosis, Seroprevalence


 
Review Article
Anita Chakravarti and Bineeta Kashyap

Viral diarrhea in developing countries-Current scenario

[Year:2012] [Month:January-December] [Volumn:2 ] [Number:1] [Pages:64] [Pages No:3-11][No of Hits : 13]


ABSTRACT

The impact of diarrheal disease worldwide is immense, with children under five years of age in developing countries are most often affected.1,2,3,4 In the developed world, the impact of the illness is seen in its high morbidity and hospitalization that this illness necessitates.5,6,7,8 Although targeted interventions like improved sanitation, breast-feeding and introductiontreatment programs based on oral rehydration therapy, have decreased the mortality rate associated with infection due to bacterial andparasitic agents, they have been less effective in reducingviral-associatedmorbidity andmortality.


 
REVIEW ARTICLE
Monika Sharma, Hitakshi Singh and Rohit Sharma.

Probiotics: a Sweet Leap Towards Health

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:16-24][No of Hits : 29]



 
ORIGINAL ARTICLE
SC Metgud, Shashank Purwar

Prevalence of intestinal sporozoan parasites in HIV & AIDS patients in & around Belgaum.

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:35-40][No of Hits : 29]



 
INSTRUCTION

Journal Of Gastrointestinal Infections

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:][No of Hits : 24]



 
REVIEW ARTICLE
Sukhminder ji Kaur, Chetana Vaishnavi

Tight junction changes and histopathologic features in Clostridium difficile infection.

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:3-7][No of Hits : 22]



 
ORIGINAL ARTICLE
Sumeeta Khurana, Kusum Sharma, Nancy Malla

An increasing trend of Amoebiasis in North India — A 20 year study of Amoebasis Seroprevalence.

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:32-34][No of Hits : 19]



 
BRIEF COMMUNICATION
Vijaya D, Nagaratnamma T, Harsha TR, Nataraj CM.

Prevalence of intestinal Coccidian parasites in AIDS patients with Chronic diarrhoea

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:46-48][No of Hits : 19]



 
BRIEF COMMUNICATION
RD Kulkarni, Ajantha GS, Amruthkishan Upadhya, Satish Patil, Anuradha kalabhavi, Praveen Shetty, Shubhada C, Pavithra jain, Dutta S.

Antibiotic Susceptibility patterns of the three bacterial enteric pathogens isolated form a tertiary care hospital

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:43-45][No of Hits : 18]



 
CASE REPORT
Beena Antony, Hilda Pinto, Bibin Scaria, Rekha B

Salmonella Typhimurium food poisoning in mangalore due to consumption of squid- a report

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:56-58][No of Hits : 17]



 
BRIEF COMMUNICATION
Deepinder Kaur, Omesh Goyal, Rajdeep S Chhina, Prerna Goyal, Rajoo Singh Chhina.

Gastro-intestinal and hepatic manifestations of Dengue infection

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:51-53][No of Hits : 17]



 
CASE REPORT
Prabha Desikan, Yashwant Kumar, Nikita Panwalkar, Aruna jain.

Salmonella Weltevreden - an Enteric Pathhogen, Isolated from Skin Ulcer

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:54-55][No of Hits : 16]



 
BRIEF COMMUNICATION
Sumeeta Khurana, Shiv Shekhar Chatterjee, Harinderpal Singh Bhatti, Nancy Malla

Pseudoparasites masquerading as parasites: Experience at a tertiary care centre of North India

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:49-50][No of Hits : 15]



 
CASE REPORT
Pooja Suri, Deepinder Chhina, Puneet Chopra, Jasdeep Singh, Jagdeep Whig

Hyperinfection Syndrome in a patient with Acute Lymphoblastic Leukemia

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:59-61][No of Hits : 15]



 
REVIEW ARTICLE
Kashi Nath Prasad, SK Shukla, A Saxena

Host genetic polymorphisms as risks for gastric cancer and peptic ulcer disease in addition to Helicobacter pylori infection.

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:8-15][No of Hits : 15]



 
ORIGINAL ARTICLE
Sushma Bharrhan, Kanwaljit Chopra, Ashwani Koul, Praveen Rishi

Quercetin prevents nuclear changes and ameliorates alcoholic liver injury in rats.

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:25-31][No of Hits : 14]



 
BRIEF COMMUNICATION
Veenu Gupta, Deephinder Chinna, Pooja Suri, Benika kajla, Shipra Galhotra

Prevalence and antibiotic susceptibility profile of Shigellos at a tertiary care centre

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:41-42][No of Hits : 14]



 
EDITORIAL
Varsha Gupta, Neha Bansal

Intestinal tuberculosis: a diagnostic dilemma

[Year:2011] [Month:January-December] [Volumn:1 ] [Number:1] [Pages:61] [Pages No:1-2][No of Hits : 13]




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