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   2016| March  | Volume 143 | Issue 3  
    Online since May 19, 2016

 
 
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ORIGINAL ARTICLES
A study on pre-XDR & XDR tuberculosis & their prevalent genotypes in clinical isolates of Mycobacterium tuberculosis in north India
Parul Singhal, Pratima Dixit, Pooja Singh, Indu Jaiswal, Mastan Singh, Amita Jain
March 2016, 143(3):341-347
DOI:10.4103/0971-5916.182625  PMID:27241648
Background & objectives: Pre-extensively drug resistant (pre-XDR) and extensively drug resistant tuberculosis (XDR-TB) have been areas of growing concern, and are posing threat to global efforts of TB control. The present study was planned to study the presence of pre-XDR and XDR Mycobacterium tuberculosis and their genotypes in clinical isolates obtained from previously treated cases of pulmonary TB. Methods: A total of 219 isolates obtained from previously treated cases of pulmonary TB were subjected to first-line (streptomycin, isoniazid, rifampicin and ethambutol) and second-line (ofloxacin, kanamycin, capreomycin and amikacin) drug susceptibility testing on solid Lowenstein-Jensen medium by proportion method. Genotyping was done for pre-XDR and XDR-TB isolates using 12 loci Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats (MIRU-VNTR). Results: Multi-drug resistance was observed in 39.7 per cent (87/219) isolates. pre-XDR and XDR M. tuberculosis isolates amongst 87 multi-drug resistant (MDR) TB isolates were 43 (49.4%) and 10 (11.4%), respectively. Two most dominant genotypes among pre-XDR and XDR M. tuberculosis isolates were Beijing and Delhi/CAS types. Interpretation & conclusions: Resistance to second-line anti-tubercular drugs should be routinely assessed in areas endemic for TB. Similar genotype patterns were seen in pre-XDR and XDR-TB isolates. Beijing and Delhi/CAS were predominant genotypes.
  14 1,348 440
High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India
Michelle Kermode, Amenla Nuken, Gajendra Kumar Medhi, Brogen Singh Akoijam, H Umesh Sharma, Jagadish Mahanta
March 2016, 143(3):348-356
DOI:10.4103/0971-5916.182626  PMID:27241649
Background & objectives: It is well documented that the Northeast state of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection. Methods: Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection. Results: HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection. Interpretation & conclusions: The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.
  6 1,029 321
Evaluation of epidermal growth factor receptor mutations based on mutation specific immunohistochemistry in non-small cell lung cancer: A preliminary study
Deepali Jain, Sobuhi Iqbal, Ritika Walia, Prabhat Malik, Sunu Cyriac, Sandeep R Mathur, Mehar C Sharma, Karan Madan, Anant Mohan, Ashu Bhalla, Sushmita Pathy, Lalit Kumar, Randeep Guleria
March 2016, 143(3):308-314
DOI:10.4103/0971-5916.182621  PMID:27241644
Background & objectives: Studies have shown that immunohistochemical (IHC) staining using epidermal growth factor receptor (EGFR) mutation specific antibodies, is an easy and cost-effective, screening method compared with molecular techniques. The purpose of present study was to assess the percentage positivity of IHC using EGFR mutation specific antibodies in lung biopsy samples from patients with primary lung adenocarcinoma (ADC). Methods: Two hundred and six biopsies of primary lung ADC were subjected to EGFR mutation specific antibodies against del E746-A750 and L858R. Detection of EGFR mutation done by high resolution melting analysis (HRM) was used as gold standard. A concordance was established between molecular and IHC results. Frequency of IHC positivity was assessed. Results: Of the 206 patients, 129 were male and 77 were female patients, with a mean age of 54.1 yr. Fifty five (26.6%) patients (36 men; 19 women) showed positivity for IHC of del E746-A750 (33) and L858R (22). HRM results were available in 14 patients which showed EGFR mutations in correspondence with del E746-750 or L858R in 64.2 per cent cases. Positive cases on HRM were further confirmed by DNA sequencing and fragment analysis. Three patients showed exon[20] variation. Two cases were negative for mutation. The genotype of del E746-750 mutation was more common than L858R. A concordance was established between molecular mutation and IHC in 85.7 per cent cases. Interpretation & conclusions: In this preliminary study from India mutation specific IHC was used for assessment of mutation status of EGFR. Although the number tested was small, a good concordance was observed between molecular EGFR mutation and IHC expression. IHC methodology is a potentially useful tool to guide clinicians for personalized treatment in lung ADC, especially where facilities for molecular analysis are not readily available and for use in small biopsies where material is scant for molecular tests.
  6 1,409 411
Association between rs9930506 polymorphism of the fat mass & obesity-associated (FTO) gene & onset of obesity in Polish adults
Malgorzata Wrzosek, Anna Zakrzewska, Lech Ruczko, Beata Jabłonowska-Lietz, Grażyna Nowicka
March 2016, 143(3):281-287
DOI:10.4103/0971-5916.182617  PMID:27241640
Background & objectives: The fat mass and obesity-associated (FTO) gene is known to be associated with obesity. However, no data are available on the relation between FTO rs9930506 polymorphism and obesity in Polish population. The aim of this study was to evaluate an association between rs9930506 variants of the FTO gene and obesity in Polish adults. Methods: The study group consisted of 442 adults, aged 33.9 ±12.7 yr, with mean BMI 27.2 ± 5.4 kg/m2. The following variables were determined for each subject: fasting blood glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides. Real-time PCR was used to detect the A/G alleles of the rs9939506 polymorphism in the FTO gene. An association between the rs9930506 polymorphism and obesity was determined using codominant, dominant, and recessive models. The odds ratio (OR) was calculated to determine the risk of obesity associated with this polymorphism. Results: It was observed that the presence of FTO rs9939506 G allele was associated with increased risk for obesity and this association was found significant in both recessive (OR = 1.72, P = 0.014) and co-dominant (OR = 1.36, P = 0.031) models of inheritance. The FTO rs9939506 GG homozygotes had a significantly higher BMI than those with other genotypes. Interpretation & conclusions: This study shows that FTO rs9939506 GG genotype is related to higher BMI and is associated with obesity in Polish adults.
  5 1,326 400
REVIEW ARTICLE
Stem cells to replace or regenerate the diabetic pancreas: Huge potential & existing hurdles
Deepa Bhartiya
March 2016, 143(3):267-274
DOI:10.4103/0971-5916.182615  PMID:27241638
Various stem cell sources are being explored to treat diabetes since the proof-of-concept for cell therapy was laid down by transplanting cadaveric islets as a part of Edmonton protocol in 2000. Human embryonic stem (hES) cells derived pancreatic progenitors have got US-FDA approval to be used in clinical trials to treat type 1 diabetes mellitus (T1DM). However, these progenitors more closely resemble their foetal counterparts and thus whether they will provide long-term regeneration of adult human pancreas remains to be demonstrated. In addition to lifestyle changes and administration of insulin sensitizers, regeneration of islets from endogenous pancreatic stem cells may benefit T2DM patients. The true identity of pancreatic stem cells, whether these exist or not, whether regeneration involves reduplication of existing islets or ductal epithelial cells transdifferentiate, remains a highly controversial area. We have recently demonstrated that a novel population of very small embryonic-like stem cells (VSELs) is involved during regeneration of adult mouse pancreas after partial-pancreatectomy. VSELs (pluripotent stem cells in adult organs) should be appreciated as an alternative for regenerative medicine as these are autologous (thus immune rejection issues do not exist) with no associated risk of teratoma formation. T2DM is a result of VSELs dysfunction with age and uncontrolled proliferation of VSELs possibly results in pancreatic cancer. Extensive brainstorming and financial support are required to exploit the potential of endogenous VSELs to regenerate the pancreas in a patient with diabetes.
  5 2,169 738
COMMENTARIES
Is fat mass & obesity-associated (FTO) gene master regulator of obesity ?
Balraj Mittal, Apurva Srivastava, Neena Srivastava
March 2016, 143(3):264-266
DOI:10.4103/0971-5916.182614  PMID:27241637
  4 1,303 422
ORIGINAL ARTICLES
Comparison of body composition in persons with epilepsy on conventional & new antiepileptic drugs
Sudhir Chandra Sarangi, Manjari Tripathi, Ashish Kumar Kakkar, Yogendra Kumar Gupta
March 2016, 143(3):323-330
DOI:10.4103/0971-5916.182623  PMID:27241646
Background & objectives: Certain antiepileptic drugs (AEDs) such as valproic acid (VPA) are known to affect body weight, and lipid profile. However, evidences regarding effects of AEDs on the body composition are deficient. This cross-sectional study compared the body composition and lipid profile among patients with epilepsy on newer and conventional AEDs. Methods: The patients with epilepsy (n=109) on treatment with conventional and newer AEDs (levetiracetam, lamotrigine and clobazam) for > 6 months were enrolled. Of these, 70 were on monotherapy: levetiracetam (n=12), VPA (n=16), carbamazepine (n=20) and phenytoin (n=22) and the remaining on polytherapy. Their body composition [body fat mass, lean dry mass (LDM), total body water (TBW), intracellular water (ICW), extracellular water (ECW) and basal metabolic rate (BMR) was estimated and biochemical parameters were assessed. Results: Levetiracetam group had no significant difference with VPA, carbamazepine, phenytoin and control groups, except low LDM (17.8±2.4) than VPA groups (20.2±2.7, p<0.05). In comparison with control, AEDs monotherapy groups had no significant difference, except higher LDM and ECW in VPA group. Among groups based on conventional and newer AEDs, there was no significant difference in body composition parameters except for higher LDM (as % of BW) in conventional AEDs only treated group than control (p<0.01). Interpretation & conclusions: The alterations observed in body composition with valproic acid in contrast to other AEDs like levetiracetam, carbamazepine and phenytoin could affect treatment response in epilepsy especially in subjects with already altered body composition status like obese and thin frail patients, which needs to be established by prospective studies (CTRI/2013/05/003701).
  4 1,225 486
Demographic profile, host, disease & viral predictive factors of response in patients with chronic hepatitis C virus infection at a tertiary care hospital in north India
Sreejith Vasudevan, Shalimar , Amit Kavimandan, Nancy Kalra, Baibaswata Nayak, Bhaskar Thakur, Prasenjit Das, Siddhartha Datta Gupta, Subrat Kumar Panda, Subrat Kumar Acharya
March 2016, 143(3):331-340
DOI:10.4103/0971-5916.182624  PMID:27241647
Background & objectives: Standard of care for chronic hepatitis C (CHC) in India is peginterferon and ribavirin (RBV). The response to treatment in real life stetting is unclear. The objectives of this study were to evaluate the demographic profile and assess the virological response and predictors of response in CHC patients. Methods: Consecutive patients with CHC were included in this study. Detailed clinical history, risk factors, and predictive factors of response were noted. Patients were treated with peginterferon α2b (1.5 µg/kg/wk) and RBV (12 mg/kg/day) for 6 to 18 months based on response. Results: A total of 211 patients were included in the analysis, mean age 40.6±12.3 yr, 144 (68%) were males and 71 (34%) had compensated cirrhosis. Commonest risk factor for acquiring CHC was previous transfusion and surgery (51%). Genotype 3 (72%) was most common followed by genotype 1 (23%). Overall sustained virologic response (SVR) was 64 per cent [95% CI 57.1%-70.4%]. The SVR was 66.5 per cent [95% CI 58.34-73.89%] for genotype 3 and 61.2 per cent [95% CI 46.23 to 74.80%] for genotype 1. Non-cirrhotics had better SVR rates compared to cirrhotics (76 vs 41%, p<0.001). On multivariate analysis, BMI ≥23 kg/m2, HOMA-IR ≥2, compliance (≤80%), and fibrosis >2 were predictors of low SVR. Interpretation & conclusions: Genotype 3 was the commonest HCV genotype. The commonest source of infection was previous transfusion and surgery. SVR rates for genotypes 3 were better than genotype 1 patients. Predictors of non-response were high BMI, insulin resistance, significant fibrosis and inadequate compliance.
  4 894 302
Prevalence of α-thalassaemia genotypes in pregnant women in northern Thailand
Somphon Pharephan, Pannee Sirivatanapa, Sanit Makonkawkeyoon, Wirote Tuntiwechapikul, Luksana Makonkawkeyoon
March 2016, 143(3):315-322
DOI:10.4103/0971-5916.182622  PMID:27241645
Background & objectives: Alpha-thalassaemias are genetic disorders with high prevalence in northern Thailand. However, common genotypes and current data on the prevalence of α-thalassaemias have not been reported in this region. Therefore, the objective of the present study was to determine the prevalence of α-thalassaemia genotypes in pregnant women in northern Thailand. Methods: Genomic DNA was extracted from blood samples of pregnant women who came to Maharaj Nakorn Chiang Mai University Hospital during July 2009 to 2010. The common deletion and point mutation genotypes of α-thalassaemia were evaluated by gap- polymerase chain reaction (PCR) and PCR with restriction fragment length polymorphism (RFLP). Results: Genotypes of 638 pregnant women were: 409 samples (64.11%) being normal subjects (αα/αα) and 229 samples (35.89%) with α-thalassaemias. these 229 samples could be classified into deletional HbH disease (--SEA/-α3.7) for 18 samples (2.82%); heterozygous α0-thalassaemia --SEA type (--SEA/αα)) for 78 (12.23%); heterozygous α+-thalassaemia - α3.7 type (-α3.7/αα) for 99 (15.52%); homozygous α+-thalassaemia - α3.7 type (-α3.7/- α3.7) for five (0.78%); heterozygous α+-thalassaemia - α4.2 type (-α4.2/αα) for two (0.31%); and heterozygous HbCS (αCSα/αα) for 27 (4.23%) cases. Interpretation & conclusions: The prevalence of α-thalassaemias in pregnant women in northern Thailand was high. This finding supports the implementation of the prevention and control of this common genetic disorder by screening for α-thalassaemia genotypes.
  3 1,113 408
Serum levels of phosphorylated heat shock protein 27 (pHSP27) are associated with bone mineral density in pre- & postmenopausal women: A pilot study
Bhavna Daswani, Shubhangi Gavali, Meena Desai, Anushree Patil, M Ikram Khatkhatay
March 2016, 143(3):288-296
DOI:10.4103/0971-5916.182618  PMID:27241641
Background & objectives: Phosphorylated heat shock protein 27 (pHSP27) has been implicated in the pathogenesis of osteoporosis. oxidative stress and proinflammatory cytokines, which are known to be involved in aetiology of osteoporosis, can trigger HSP27 phosphorylation. Since pHSP27 is present in circulation, it was hypothesized that serum pHSP27 would be elevated in low bone mineral density (BMD) condition and might serve as an indicator of osteoporosis/osteopenia. Hence, the aim of this study was to examine serum levels of pHSP27 in relation with BMD in pre- and postmenopausal women. Methods: Premenopausal (30 to 40 yr) and postmenopausal (50 to 60 yr) women having either low BMD (osteopenia/osteoporosis) or high BMD were selected (n=80) from a prospective cohort (n=200). Serum levels of pHSP27; along with levels of oestradiol, malondialdehyde, total antioxidant capacity, interleukin (IL)-1, IL-6, tumour necrosis factor - alpha, (TNF-α), c-telopeptide fragments of collagen type I (CTX-1) and osteocalcin were estimated. Results: The serum levels of pHSP27 were significantly elevated in low BMD groups in premenopausal and postmenopausal categories (p<0.05). It also exhibited a significant odds ratio (OR) to differentiate between low and high BMD in both premenopausal (OR=1.734, p=0.013) and postmenopausal (OR=1.463, p=0.042) categories. Additionally, area under the curve to predict low BMD was non-significantly higher for pHSP27 than CTX-1 in premenopausal and postmenopausal categories. Interpretation & conclusions: This study highlights a novel relation between serum pHSP27 and BMD in Indian women however, these findings need to be confirmed in larger studies.
  3 892 306
CORRESPONDENCES
Staphylococcal Cassette Chromosome mec (SCCmec) typing of clinical isolates of coagulase-negative staphylocci (CoNS) from a tertiary care hospital in New Delhi, India
Arnab Ghosh, Yogesh Singh, Arti Kapil, Benu Dhawan
March 2016, 143(3):365-370
DOI:10.4103/0971-5916.182629  PMID:27241652
  2 1,078 292
ORIGINAL ARTICLES
Spared nerve injury model to study orofacial pain
Daniel Humberto Pozza, José Manuel Castro-Lopes, Fani Lourença Neto, António Avelino
March 2016, 143(3):297-302
DOI:10.4103/0971-5916.182619  PMID:27241642
Background & objectives: There are many difficulties in generating and testing orofacial pain in animal models. Thus, only a few and limited models that mimic the human condition are available. The aim of the present research was to develop a new model of trigeminal pain by using a spared nerve injury (SNI) surgical approach in the rat face (SNI-face). Methods: Under anaesthesia, a small incision was made in the infraorbital region of adult male Wistar rats. Three of the main infraorbital nerve branches were tightly ligated and a 2 mm segment distal to the ligation was resected. Control rats were sham-operated by exposing the nerves. Chemical hyperalgesia was evaluated 15 days after the surgery by analyzing the time spent in face grooming activity and the number of head withdrawals in response to the orofacial formalin test. Results: SNI-face rats presented a significant increase of the formalin-induced pain-related behaviours evaluated both in the acute and tonic phases (expected biphasic pattern), in comparison to sham controls. Interpretation & conclusions: The SNI-face model in the rat appears to be a valid approach to evaluate experimental trigeminal pain. Ongoing studies will test the usefulness of this model to evaluate therapeutic strategies for the treatment of orofacial pain.
  2 1,058 300
STUDENT IJMR
Methicillin resistance & inducible clindamycin resistance in Staphylococcus aureus
Soumyadeep Ghosh, Mandira Banerjee
March 2016, 143(3):362-364
DOI:10.4103/0971-5916.182628  PMID:27241651
Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) isolates with inducible clindamycin resistance (iCR) are resistant to erythromycin and sensitive to clindamycin on routine testing and inducible clindamycin resistance can only be identified by D-test. This study was aimed to detect methicillin resistance and iCR among S. aureus isolates, effectiveness of some commonly used antibiotics and correlation between methicillin resistance and iCR. Methods: The present cross-sectional study included 46 S. aureus isolates subjected to Kirby-Bauer's disk diffusion method for antibiotic susceptibility testing (AST) to estimate MRSA and resistance to some commonly used antibiotics. D-test was employed to detect iCR. Results: Eleven of the 46 (23.9%) isolates tested were MRSA. Overall, 19 (41.3%) isolates showed of iCR. Vancomycin and linezolid were found to be 100 per cent effective. A positive Karl-Pearson's coefficient of correlation (0.89) between methicillin resistance and iCR was obtained. Interpretation & conclusions: Detection of iCR is important for the use of clindamycin in MRSA infections. Methicillin resistance and iCR appear to be clinically unrelated.
  2 1,532 622
CLINICAL IMAGES
Turner like dysmorphia as presenting feature of Type-II Mayer-Rokitansky-Kuster-Hauser syndrome
Deep Dutta, Anil Taneja
March 2016, 143(3):378-379
DOI:10.4103/0971-5916.182635  PMID:27241658
  1 1,124 259
CORRESPONDENCES
Prevalence of hypertension & prehypertension among school children
Avinash Sharma, Sagar Bhattad, Pankaj Kumar
March 2016, 143(3):376-376
DOI:10.4103/0971-5916.182633  PMID:27241656
  1 768 312
Methicillin resistant Staphylococcus aureus (MRSA) in Malwa region of Punjab (North-West India)
Neerja Jindal, Rubina Malhotra, Pragati Grover, Seema Singh, Renu Bansal, Satvir Kaur
March 2016, 143(3):371-372
DOI:10.4103/0971-5916.182630  PMID:27241653
  1 839 278
ORIGINAL ARTICLES
Extracellular matrix protein 1 gene (ECM1) mutations in nine Iranian families with lipoid proteinosis
Farzad Izadi, Frouzandeh Mahjoubi, Mohammad Farhadi, Samira Kalayinia, Ali Bidmeshkipour, Mohammad Moein Tavakoli, Sara Samanian
March 2016, 143(3):303-307
DOI:10.4103/0971-5916.182620  PMID:27241643
Background & objectives: Lipoid proteinosis (LP) is an autosomal recessive disease. Clinical characteristics of this disease are hoarse voice, scarring of the skin, brain calcifications, and eyelid papules (moniliform blepharosis). Mutations in the ECM1 gene on 1q21.2 are responsible for this disease. This study was conducted to investigate the mutation spectrum of ECM1 gene in nine Iranian families having at least one LP patient diagnosed clinically. Methods: The entire ECM1 gene was screened using PCR and direct sequencing in nine Iranian families with 12 suspected LP patients who were referred to the clinic, along with their parents and siblings. Thirty healthy individuals were included as controls. Results: In only one patient a homozygous G>A transition at nucleotide c.806 in exon 7 was detected. A G>A substitution at nucleotide 1243 in exon 8 that changes glycine (GGT) to serine (AGT) was observed in most of our patients. Furthermore, in one patient there was a change in the sequence of intron 8, the A>T transition in nucleotide 4307. In addition, in two cases (one patient and one healthy mother with affected child) there was a C (4249) deletion in intron 8. Interpretation & conclusions: Our results indicate that although mutation in ECM1gene is responsible for lipoid proteinosis, it is likely that this is not the only gene causing this disease and probably other genes may be involved in the pathogenesis of the LP disease.
  1 789 235
Feasibility study of a novel intraosseous device in adult human cadavers
Sandeep Singh, Praveen Aggarwal, Rakesh Lodha, Ramesh Agarwal, Arun Kr Gupta, Renu Dhingra, Jayant Sitaram Karve, Srinivas Kiran Jaggu, Balram Bhargava
March 2016, 143(3):275-280
DOI:10.4103/0971-5916.182616  PMID:27241639
Background & objectives: Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers. Methods: The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers. Subjective parameters of loss of resistance, stable needle hold, easy needle withdrawal and any damage to the device were evaluated during the study. The insertion time was the objective parameter measured. Four sets of radiographs per insertion confirmed the position of the needle and identified complications. Results: A single physician performed 12 IO access procedures using the same device. Penetration of proximal and/or distal tibia was achieved in all instances. It was successful in the first attempt in eight (66.7%) and during second attempt in the remaining. The mean time to insertion was 4.1 ± 3.1 sec. Appropriate insertion of needle in the intra-medullary space of bone was confirmed with radiological examination in 10 (83.3%) insertions. In two occasions after penetrating the cortical layer of bone, the device overshot the intra-medullary space, as detected by radiological examination. Device got bent during insertion in one instance. There was no evidence of needle breakage or bone fracture. The needle could be withdrawn effortlessly in all instances. Interpretation & conclusions: The novel IO device could successfully penetrate the adult cadaver bones in most cases. Further studies are needed to confirm these results on a large sample.
  1 1,267 386
BOOK REVIEWS
Medicine and law

March 2016, 143(3):384-385
DOI:10.4103/0971-5916.182638  
  - 502 185
Aging: Facts and theories

March 2016, 143(3):385-386
DOI:10.4103/0971-5916.182639  
  - 502 212
History of allergy

March 2016, 143(3):386-387
DOI:10.4103/0971-5916.182640  
  - 589 216
CLINICAL IMAGES
Plexiform neurofibromatosis type 1
Surendra K Sharma, Abhishek Sharma
March 2016, 143(3):380-380
DOI:10.4103/0971-5916.182636  PMID:27241659
  - 1,114 294
COMMENTARIES
Challenges in the use of intraosseous access
Peter Hallas
March 2016, 143(3):261-263
DOI:10.4103/0971-5916.182613  PMID:27241636
  - 1,005 348
CORRESPONDENCES
Authors' response
Prasanta Kr Borah, Utpala Devi, Dipankar Biswas, Hem C Kalita, Meenakshi Sharma, Jagadish Mahanta
March 2016, 143(3):377-377
DOI:10.4103/0971-5916.182634  PMID:27241657
  - 520 158
Wiser to prevent childhood obesity
Pravin Rathi, Sunil Pawar, Qais Contractor
March 2016, 143(3):373-373
DOI:10.4103/0971-5916.182631  PMID:27241654
  - 719 237
Authors' response
Rajendra Pradeepa, Ranjit Mohan Anjana, Shashank R Joshi, Anil Bhansali, Mohan Deepa, Prashant P Joshi, Vinay K Dhandania, Sri Venkata Madhu, Paturi Vishnupriya Rao, Loganathan Geetha, Radhakrishnan Subashini, Ranjit Unnikrishnan, Deepak Kumar Shukla, Tanvir Kaur, Viswanathan Mohan, Ashok Kumar Das, for the ICMR-INDIAB Collaborative Study Group
March 2016, 143(3):374-375
DOI:10.4103/0971-5916.182632  PMID:27241655
  - 628 180
EDITORIAL
Unite all the services against childhood tuberculosis
RP Gie
March 2016, 143(3):259-260
DOI:10.4103/0971-5916.182612  PMID:27241635
  - 851 308
OBITUARY
Dr Vasanthapuram Kumaraswami (1950-2016)
Lalit Kant, MS Jawahar
March 2016, 143(3):381-383
DOI:10.4103/0971-5916.182637  PMID:27241660
  - 770 281
ORIGINAL ARTICLES
Emergence of vanA gene among vancomycin-resistant enterococci in a tertiary care hospital of North - East India
Chimanjita Phukan, Mangala Lahkar, Swapnil Ranotkar, Kandarpa K Saikia
March 2016, 143(3):357-361
DOI:10.4103/0971-5916.182627  PMID:27241650
Background & objectives: Vancomycin-resistant enterococci (VRE) have become one of the most challenging nosocomial pathogens with the rapid spread of the multi-drug resistant strain with limited therapeutic options. It is a matter of concern due to its ability to transfer vancomycin resistant gene to other organisms. The present study was undertaken to determine the emergence of vancomycin-resistant enterococci and the vanA gene among the isolates in a tertiary care hospital of North-East India. Methods: A total of 67 consecutive enterococcal isolates from different clinical samples were collected and identified by using the standard methods. Antibiogram was done by disk diffusion method and VRE was screened by the disk diffusion and vancomycin supplement agar dilution method. The minimum inhibitory concentration (MIC) value for vancomycin was determined by E-test. The VRE isolates were analyzed by PCR for vanA gene. Results: A total of 54 (81%) Enterococcus faecalis and 13 (19%) E. faecium were detected among the clinical isolates and 16 (24%) were VRE. The VRE isolates were multidrug resistant and linezolid resistance was also found to be in three. MIC range to vancomycin was 16-32 µg/ml among the VRE. The vanA gene was found in nine of 16 VRE isolates. Interpretation & conclusions: Emergence of VRE and presence of vanA in a tertiary care hospital setting in North-East India indicate toward a need for implementing infection control policies and active surveillance.
  - 1,326 366
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