scholarly journals Prevalence of Nontuberculous Mycobacteria among Extrapulmonary Tuberculosis Cases in Tertiary Care Centers in Northern India

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
A. K. Maurya ◽  
V. L. Nag ◽  
S. Kant ◽  
R. A. S. Kushwaha ◽  
M. Kumar ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Nontuberculous Mycobacteria ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Rapid Identification ◽  
Northern India ◽  
Tertiary Care Centers ◽  
Tertiary Care Hospitals ◽  
Culture Positive ◽  
Final Confirmation

The reports of nontuberculous mycobacteria (NTM) associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catalase assay. BIO-LINE SD Ag MPT64 TB test and final identification and differentiation between MTBC and different species of NTM were further confirmed by GenoType Mycobacterium CM/AS assay. 71 cases (9.3%) were positive for AFB by ZN staining and 227 cases (30.1%) were positive for mycobacteria by culture. Niacin production and catalase activity were negative in 62/227 (27.4%) strains and after using a panel of different biochemicals and final confirmation by GenoType Mycobacterium CM assay. Out of 227 cultures tested, 165 (72.6%) strains were confirmed asM. tuberculosiscomplex, and 62 (27.4%) were confirmed as NTM. The most common NTM species identified wereM. fortuitum17 (27.5%) andM. intracellulare13 (20.9%). The rapid identification of NTM species may help in targeted therapy and management of the diseases.

REFERRAL PATTERN AND OUTCOMES OF NEONATES FROM SECONDARY CARE SETTING OF AGA KHAN UNIVERSITY HOSPITAL TO TERTIARY CARE CENTERS IN PAKISTAN

2021 ◽  
pp. 1-13
Author(s):  
Suneeta khemani ◽  
Nazia Shamim ◽  
Adnan Mirza ◽  
Nadia Muhammad ◽  
Safdar Kagazwala ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Neonatal Mortality ◽  
Secondary Care ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
P Value ◽  
Tertiary Care Centers ◽  
Tertiary Care Hospitals

ABSTRACT:Objective: To determine the reasons of neonatal referrals from secondary care settings of Aga Khan University Hospital (AKUH) to tertiary care centers of Karachi, Pakistan and to assess the neonatal outcomes for referred cases. Methodology: This retrospective observational study was conducted at AKUH from July 2015 tjune 2019. All neonates born after 32 weeks of gestation at AKUH secondary care(Kharadar, Garden & Karimabad)and referred to tertiary care hospitals were consecutively enrolled. The reason for referral, i.e. surgical intervention, respiratory support, care of prematurity; need of mechanical ventilation, referral place and neonatal outcomes like discharge in stable condition, left against medical advice (LAMA) and mortality, were noted. Results: Of 348 referred cases, 306 (87.9%)were reported alive. neonatal mortality was reported in 42 (12.1%) of the cases. Of these 306 alive participants, 284 (92.81%) were discharged from the hospital whereas 22 (7.18%) LAMA. Of 348 patients, the referral place of most of the patients was outside AKU,i.e.189(56.3%).The need of mechanical ventilation was reported in, 63 (18.1%) patients. A significant association of mechanical ventilation in tertiary centers was observed in neonates born with low APGAR score at 1 and 5 min (p-value <0.001), shorter duration of stay at secondary care(p-value 0.007),and aggressive resuscitation requirement at birth (p-value <0.001). Conclusion: Most common reasons for referral of newborns to tertiary care hospital was respiratory diseases requiring respiratory support and surgical intervention. Neonatal mortality noted for referrals made to AKUH were much less as compared to cases referred to other tertiary care hospitals. Continuous...  

scholarly journals Management Practices of Head and Neck Cancer in Chinese Tertiary Care Hospitals: A Multicenter Questionnaire-Based Survey Among Oncologists

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482090226
Author(s):  
Zhao Anwei ◽  
Sun Xin ◽  
Tang Qiao Fei ◽  
Jin Ziyu ◽  
Fa-Yu Liu
Keyword(s):  
Head And Neck Cancer ◽  
Targeted Therapy ◽  
Head And Neck ◽  
Neck Cancer ◽  
Management Practices ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Tertiary Care Hospitals

This survey was conducted to determine the head and neck cancer (HNC) treatment strategies followed by oncologists in Chinese hospitals. It was a questionnaire-based survey, conducted from October 2017 to January 2018 in 100 random tertiary hospitals in 21 cities of China to elicit information from oncologists on the management practices for treating HNC in China. A validated, structured questionnaire was used for formal investigation with oncologists. The questions regarding HNC types, treatment strategies used for locally advanced head and neck cancer (LA HNC) and recurrent/metastatic head and neck cancer (r/m HNC), diagnosis and prognostic factors were included. The results were presented as percentages. Among the 272 oncologists, 93.4% were from tertiary care hospitals, with 35.3% and 36.4% patients from radiotherapy (RT) and oncology department, respectively. Nasopharyngeal carcinoma was the most commonly treated type of HNC according to 65.1% oncologists. Patients aged >75 years have worse prognosis and 65% oncologists corroborated that age of the patients influences treatment decision. Most of the oncologists (77.6%) preferred chemotherapy (CT) + anti–epidermal growth factor receptor targeted therapy as the first-line therapy for r/m HNC. Approximately 95% of oncologists considered induction chemotherapy (ICT) to retain organ functions and tumor shrinkage and 43.4% preferred ICT followed by chemoradiotherapy or ICT combined with RT followed by targeted therapy for LA HNC. For the management of HNC, Chinese oncologists recommended ICT with RT and targeted therapy for LA HNC and CT regimen combined with targeted therapy for r/m HNC.

scholarly journals Evaluation of the Xpert MTB/RIF Ultra Assay for Direct Detection ofMycobacterium tuberculosisComplex in Smear-Negative Extrapulmonary Samples

2018 ◽  
Vol 56 (9) ◽  
Author(s):  
Daniel Perez-Risco ◽  
David Rodriguez-Temporal ◽  
Ivan Valledor-Sanchez ◽  
Fernando Alcaide
Keyword(s):  
Nontuberculous Mycobacteria ◽  
Direct Detection ◽  
Extrapulmonary Tuberculosis ◽  
High Sensitivity ◽  
Rapid Diagnosis ◽  
Clinical Samples ◽  
Content Type ◽  
Smear Negative ◽  
Culture Positive ◽  
Culture Negative

ABSTRACTThe rapid detection ofMycobacterium tuberculosiscomplex (MTUBC) in clinical samples is essential for successful treatment. New techniques such as real-time PCR have been developed in order to facilitate rapid diagnosis, but their sensitivity is low in extrapulmonary specimens, due to the low bacillary load in such samples. A next-generation assay has recently been developed to try to overcome this limitation. The aim of this study was to analyze the effectiveness of the Xpert MTB/RIF Ultra (GX-Ultra) for the detection of MTUBC DNA in 108 smear-negative extrapulmonary specimens that were MTUBC culture positive. In addition, 40 extrapulmonary culture-negative samples and 20 samples with nontuberculous mycobacteria were tested to evaluate the specificity of the assay. All samples were collected between May 1999 and May 2017. The GX-Ultra detected DNA of MTUBC in 82 extrapulmonary specimens that were MTUBC culture positive (75.9% sensitivity; 95% confidence interval [CI], 66.6 to 83.4%). The assay was negative for all clinical specimens that were MTUBC culture negative and the samples with nontuberculous mycobacteria (100% specificity). Furthermore, two (1.8%) samples presented mutations related to rifampin resistance. The highest sensitivity was obtained in samples of lymph nodes (94.1%) and nonsterile fluids (93.7%), followed by tissue specimens (86.6%), stool material (80%), abscess aspirates (64.7%), and sterile fluids (60.5%). Pleural fluids, one of the least optimal samples for detecting DNA of MTUBC, were GX-Ultra positive in 10/21 (47.6%) of cases. In summary, GX-Ultra showed excellent specificity and high sensitivity in paubacillary specimens, making it a useful tool for rapid diagnosis of extrapulmonary tuberculosis.

scholarly journals Comparison of MGIT 960 with Lowenstein Jensen Media for Recovery of Mycobacteria from Extrapulmonary Specimens in Southern India

2021 ◽  
Author(s):  
Kalpana Thangavelu ◽  
Imola Jamir ◽  
Kalaiarasan Ellappan ◽  
Krishnapriya Krishnakumariamma ◽  
Pallam Gopichand ◽  
...  
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Smear Microscopy ◽  
Care Hospital ◽  
Lowenstein Jensen ◽  
Time To Detection ◽  
Culture Positive ◽  
Indicator Tubes ◽  
Growth Indicator

Introduction: Prevalence of Extrapulmonary Tuberculosis (EPTB) due to Mycobacteriumtuberculosis and Non-Tuberculous Mycobacteria (NTM) are on the rise especially in a developing country like India. Smear Microscopy (SM) is commonly used for detection of mycobacteria. Due to the paucibacillary nature in the extrapulmonary specimens SM pose a problem in detection. Though molecular methods are increasingly used now-a-days but there are possibilities that these reactions may get inhibited due to the presence of inhibitors in the extrapulmonary specimens. Aim: To compare Mycobacterium Growth Indicator Tubes (MGIT 960) with Lowenstein Jensen (LJ) medium for the detection of mycobacteria. Materials and Methods: The current prospective study was conducted on 1879 extrapulmonary specimens collected from a tertiary care hospital during the study period from July 2018 to March 2020. Specimens were subjected to Ziehl Neelsen (ZN) staining and Auramine Phenol (AP) staining. Culture was done in both LJ media and MGIT 960 culture. Positive mycobacterial cultures were subjected to MPT64 Immunochromatographic Test (ICT). Data were analysed using the Statistical Package for Social Sciences (SPSS®) for Windows® release 21.0 (SPSS Inc., Chicago, IL, USA). Results: A total of 129 (6.9%) and 105 (5.6%) mycobacteria was isolated by MGIT 960 and by LJ culture respectively among 1879 extrapulmonary specimens. MGIT 960 identified 118 (91.5%) as Mycobacterium tuberculosis complex and 11 (8.5%) as NTM among the total mycobacteria isolated. Out of 105 mycobacteria grown by LJ culture, 95 (90.5%) and 10 (9.5%) were identified as Mycobacterium tuberculosis and NTM, respectively. The rate of contamination associated with MGIT 960 and LJ culture was 4.6% and 4.3% respectively. The Time to Detection (TTD) was found to be significantly shorter for isolation of Mycobacterium tuberculosis by MGIT 960 culture compared to LJ culture. Conclusion: In the current study, authors compared MGIT 960 with solid LJ culture for recovery of both Mycobacterium tuberculosisComplex and NTM from extrapulmonary specimens and authors found increased recovery by MGIT 960 compared to LJ culture and also shorter duration of detection for Mycobacterium tuberculosis by MGIT 960 with comparable contamination rates.

Comparison of the clinical features, treatment patterns, and tumor mutations of patients with intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 580-580
Author(s):  
Leon Pappas ◽  
Stephanie Reyes ◽  
Aishwarya Lanka ◽  
Rachna T. Shroff ◽  
Tri Minh Le ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Clinical Features ◽  
Systemic Therapy ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Treatment Patterns ◽  
Patient Treatment ◽  
R1 Resection ◽  
Tertiary Care Centers ◽  
Mutation Profiling

580 Background: Though studies indicate that the genomic profiles of ICC and ECC are distinct, the clinical features that differentiate them still remain to be well characterized. The purpose of this study was to further analyze these differences and patient treatment patterns in a multi-center cohort. Methods: A retrospective chart review was performed at 8 institutions on patients (pts) with ICC or ECC diagnosed after June 2009. Data on demographics, risk factors, treatments, pathology and overall survival (OS) were collected. Tumor genotyping results from CLIA-certified tissue assays were analyzed. Fisher’s exact, Wilcoxon rank sum and log-rank tests were used to compare sub-groups. Results: In a database of 737 pts with cholangiocarcinoma, 538(73%) had ICC and 199(27%) had ECC. Pts with ICC more often presented in later stages, had tumors > 5cm at resection (p < 0.0001) and had metastases to the liver, lymph nodes, lung and/or bone (p < 0.01). Pts with ICC more often received liver directed therapy, targeted therapy and multiple lines of systemic therapy and they more often enrolled in a clinical trial (all p < 0.01). Pts with ECC were more likely to be male, undergo surgery, receive adjuvant chemotherapy and/or chemoradiation (all p < 0.05). Mutation profiling performed in 381 (52%) pts (ICC/ECC = 301/80) showed that pts with ICC were more likely to have IDH1 mutations and FGFR2 fusions, whereas pts with ECC were more likely to have KRAS, APC, SMAD4, WNT, TGFb and TP53 mutations (all < 0.05). Factors that did not differ significantly between pts with ICC and ECC include race, rates of primary sclerosing cholangitis, median diagnosis CA19-9 levels and R1 resection rate. Median OS from diagnosis was 18.9 months in ICC and 17.3 months in ECC (p = 0.8471). Conclusions: While pts with ICC and ECC have some similarities in their clinical features, differences in metastases patterns and molecular profiling significantly impact their management such that pts with ICC receive more liver-directed therapy, targeted therapy and more lines of systemic therapy. Further prospective studies are needed as referral patterns to tertiary care centers may have impacted these results.

scholarly journals Molecular typing and profiling of topoisomerase mutations causing resistance to ciprofloxacin and levofloxacin inElizabethkingiaspecies

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5608 ◽  
Author(s):  
Ming-Jr Jian ◽  
Yun-Hsiang Cheng ◽  
Cherng-Lih Perng ◽  
Hung-Sheng Shang
Keyword(s):  
Random Amplified Polymorphic Dna ◽  
Tertiary Care ◽  
Resistance Mechanism ◽  
Gene Mutations ◽  
Resistance Mechanisms ◽  
Rapid Identification ◽  
Fluoroquinolone Resistance ◽  
Dilution Method ◽  
Single Mutation ◽  
Tertiary Care Centers

ObjectivesSeveralElizabethkingiaspecies often exhibit extensive antibiotic resistance, causing infections associated with severe morbidity and high mortality rates worldwide. In this study, we determined fluoroquinolone susceptibility profiles of clinicalElizabethkingiaspp. isolates and investigated the resistance mechanisms.MethodsIn 2017–2018, 131Elizabethkingiaspp. isolates were recovered from specimens collected at tertiary care centers in northern Taiwan. Initial species identification using the Vitek MS system and subsequent verification by 16S rRNA sequencing confirmed the presence ofElizabethkingia anophelis(n= 111),E. miricola(n= 11), andE. meningoseptica(n= 9). Fluoroquinolone susceptibility was determined using the microbroth dilution method, and fluoroquinolone resistance genes were analyzed by sequencing.ResultsAmongElizabethkingiaspp. isolates, 91% and 77% were resistant to ciprofloxacin and levofloxacin, respectively. The most prevalent alterations were two single mutations in GyrA, Ser83Ile, and Ser83Arg, detected in 76% of the isolates exhibiting fluoroquinolone MIC between 8 and 128 μg/ml. Another GyrA single mutation, Asp87Asn, was identified in two quinolone-resistantE. miricolastrains. None of the isolates had alterations in GyrB, ParC, or ParE. We developed a high-resolution melting assay for rapid identification of the prevalentgyrAgene mutations. The genetic relationship between the isolates was evaluated by random amplified polymorphic DNA PCR that yielded diverse pulsotypes, indicating the absence of any temporal or spatial overlap among the patients during hospitalization.ConclusionOur analysis of fluoroquinolone-resistantElizabethkingiaspp. isolates provides information for further research on the variations of the resistance mechanism and potential clinical guidance for infection management.

scholarly journals Nonadherence to antiretroviral therapy among people living with HIV/AIDS attending two tertiary care hospitals in district of northern India

2016 ◽  
Vol 41 (1) ◽  
pp. 55 ◽  
Author(s):  
Mukesh Shukla ◽  
Monika Agarwal ◽  
JaiVir Singh ◽  
AnilKumar Tripathi ◽  
AnandKumar Srivastava ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Tertiary Care ◽  
People Living With Hiv ◽  
Northern India ◽  
Living With Hiv ◽  
Tertiary Care Hospitals ◽  
Hiv Aids

scholarly journals Profiles of Extrapulmonary Nontuberculous Mycobacteria Infections and Predictors for Species: A Multicenter Retrospective Study

Pathogens ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 949
Author(s):  
Jung Ho Kim ◽  
In Young Jung ◽  
Je Eun Song ◽  
Eun Jin Kim ◽  
Jun Hyoung Kim ◽  
...  
Keyword(s):  
Nontuberculous Mycobacteria ◽  
Tertiary Care ◽  
Treatment Regimens ◽  
Female Sex ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Male Sex ◽  
The Difference ◽  
Tertiary Care Centers ◽  
Post Hoc

Extrapulmonary nontuberculous mycobacteria (NTM) infections contribute to morbidity and mortality worldwide. However, studies about extrapulmonary NTM infections have been limited. Therefore, we aim to describe the diversity of extrapulmonary NTM infections and identify predictors for species. Information regarding diversity of NTM isolates, antimicrobial susceptibility testing, treatment regimens, and outcomes were collected from four tertiary care centers in South Korea. Comparisons were made between patients with rapidly growing mycobacteria (RGM) and slowly growing mycobacteria (SGM) infections. A total of 117 patients (46 males vs. 71 females) were included. Skin and soft tissue infections (SSTIs) predominated (34.2%), followed by bone and joint infections (28.2%). In SSTIs, RGM species were predominantly identified (26/28, 92.9%), whereas SGM species were mainly identified in bone and joint infections (18/26, 69.2%), and the difference of isolated sites was verified by a post hoc test (p < 0.001). Multivariable regression analysis revealed that male sex (vs. female sex; OR 5.30, CI 1.35–24.26, p = 0.020) and bone and joint infections (vs. SSTIs; OR 18.10, CI 3.28–157.07, p = 0.002) were predictors of SGM infections, whereas the opposite was observed for RGM infections. Bone and joint infections and male sex were predictors for SGM infections, whereas SSTIs and female sex were predictors for RGM infections.

Sign in / Sign up

Export Citation Format

Share Document