Phenotypic Detection of Carbapenem Resistance in Clinical Isolates of Acinetobacter Baumanii in Kanchipuram.

Acinctobacter species are common non fermentative gram negative bacilli isolated in clinical laboratory most frequently encountered species. Acinetobacter resistance is develop due to acquired resistance. Because of frequent multidrug resistance isolates carbapenems have become important for treating resistant strains. There is a need for rapid screening & detection of MBL in Acinetobacter to modify the treatment. The present study was aim to determine the resistance of A.baumanii complese to various classes of drugs and to carbapenems and MBL production. Samples such as urine, blood, sputum, pus & body fluids. All samples were processed as per CLSI guidelines. Meropenem resistant strains were screened for carbapenemase and MBL production. Out of 92 Acinetobacter 85 (92.39%) were Acinetobacter baumanii. More than 80% resistance is seen in 3rd generation Cephalosporins. Out of 21 meropenem resistant strains 14 were carbapenemase positive and 3 were MBL producers. Our study shows raising trend of multidrug resistance and carbapenem. This will help in early detection and better treatment modalities. Abbreviations: MRSA–Methicillin resistant Staphylococcus aureus, ESBL – Extended sputum β - lactamases GNB – Gram negative bacilli, MDR – Multi drug resistance

Parental influence on the spectrum of type 2 diabetes in the offspring among Indians.

AIM: Familial aggregation of type 2 diabetes and its vascular complications is strong in Indians. In this study, we have analysed whether the age of the parent at birth of the offspring had any influence on the age at diagnosis of diabetes and age at onset of microvascular complications in the diabetic offspring. METHODS: Families with either a type 2 diabetic father or mother and a type 2 diabetic offspring, all of whom had been tested at our centre were included in this study (n = 300, father--122, mother--178, offspring male --201, female--99). Anthropometric details, age at diagnosis of diabetes, age at onset of complications and duration of diabetes were recorded. All relevant clinical and investigatory tests were done and appropriate statistical analyses were done. RESULTS: Age at onset of diabetes was lower in the offspring than in their parents at least by a decade. The age at diagnosis of diabetes in the offspring was determined inversely by the age of the parent at childbirth (p<0.001) and positively by the age of onset of diabetes and the presence of complications in the parents (both p<0.0001). Moreover, the age at diagnosis of complications in the offspring were determined inversely by the age of the parent at childbirth (p=0.0001) and positively by the age of onset of complications in the parents (p=0.0009). DISCUSSION: A younger parental age at childbirth was protective to the offspring in that the offspring developed diabetes and the complications at an older age.

Plasma homocysteine concentration and coronary artery disease in Asian Indians.

OBJECTIVE: This study was done (a) to evaluate the relationship between the plasma total homocysteine (tHcy) levels and coronary artery disease (CAD) in Asian Indians and (b) to see the relationship between tHcy and glucose intolerance. METHODS: Fasting concentrations of plasma tHcy was measured in 137 men, aged > or = 25 years who underwent coronary angiography while investigating for chest pain. Among them 71 had no CAD and 66 had CAD. Fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c) were estimated. Total Hcy was measured using the Elisa method (Axis Biochemicals ASA-Oslo, Norway) in fasting EDTA plasma. RESULTS: The subjects with CAD were significantly older but had similar body mass index (BMI), waist-hip ratio (WHR), FPG and HbA1c values compared with the non-CAD subjects (P < 0.001). The median tHcy and the percentages of abnormal values were similar in non-CAD and CAD groups. No significant differences were seen in the four subgroups with respect to the mean tHcy or the percentage of abnormal values. The highest tHcy values were seen in the non-diabetic, non-CAD group (group 1--control). CONCLUSION: This preliminary data indicates that tHcy concentrations are not elevated in subjects with CAD and probably there is no association between total homocysteine and CAD in Indians. Homocysteine values were not influenced by the glucose tolerance status. Measurement of homocysteine concentrations may be more appropriate when the blood levels of vitamin B12 and folate are also measured.

Is increased apolipoprotein B-A major factor enhancing the risk of coronary artery disease in type 2 diabetes?

OBJECTIVES: An association of Apolipoprotein B (Apo B) with coronary artery disease (CAD) independent of LDL cholesterol (LDLc) concentrations has been reported in white population. This analysis was taken up to study whether the higher CAD risk in Asian Indians with diabetes could be explained by possible alterations in Apo B and Apolipoprotein A1 (Apo A1) concentrations. METHODS: The study group consisted of four hundred and forty seven men aged > or = 25 years, 167 with CAD and 280 with no CAD, classified by coronary angiography. Plasma lipid profile including total cholesterol, LDLc, Apo A1 and Apo B were done. Glucose tolerance was evaluated in all. RESULTS: Age, BMI, Apo B, and Apo A1 were significantly associated with CAD in a multiple regression analysis. Hyper Apo B was more common than hyper LDLc in CAD (73.6% vs 20.4%, chi2 = 157, P < 0.001). Apo B concentrations were increased in diabetic subjects even in the presence of normal levels of LDLc and in the absence of CAD. CONCLUSIONS: The study has shown that the apolipoproteins B and A1 provide better information regarding the risk of CAD. Apo B abnormalities exist in large percentages of CAD subjects despite having normal levels of LDLc. Diabetes per se enhances the Apo B concentrations and this could probably be one of the mechanisms of accelerated CAD in diabetes. Hyper Apo B may be an index of CAD risk.

Difference in body fat percentage does not explain the gender dimorphism in leptin in Asian Indians.

OBJECTIVE: Leptin is a hormone probably having regulatory function on energy intake and metabolic activities in humans. The study was done: (a) To determine the relation of leptin with the body fat% in Indians, (b) To see whether the differences in body fat accounted for the gender differences in the concentration of leptin and (c) to look for the effect of diabetes on the levels of leptin. METHODS: Glucose tolerance was determined by oral glucose tolerance test (GTT) in 87 subjects with no known history of diabetes. Leptin was estimated by radio immuno assay. Age, height, weight, waist and hip circumferences were noted. Body mass index (BMI, weight kg/height m2) and waist:hip ratio (WHR) were calculated. The body fat % was estimated by bioelectrical impedance analysis. RESULTS: Leptin correlated with log fat % and BMI, body weight and waist circumference in different categories of glucose tolerance (Pearson's correlation test). Leptin values were higher in women than in men even after correcting for the body fat % indicating that the gender dimorphism was not explained by the higher fat % in women. The geometric mean of leptin concentration in men was 3.6 ng/ml and in women 10.9 ng/ml (P < 0.0001). Leptin level were not influenced by the status of glucose tolerance. Gender showed a significant effect on leptin concentration (F = 11.0, df = 1.39, P = 0.002) after adjusting for the effect of covariates i.e. percentage of fat (log), BMI, age, WHR and 2 h plasma glucose by ANCOVA. None of the covariates except BMI (P < 0.0001) showed significant correlation with leptin. The total variance explained was 68.4%. CONCLUSION: We conclude that (1) Plasma leptin is strongly correlated to the body fat content (2) the gender dimorphism of leptin is not explained by the differences in fat percentage and (3) hyperglycemia does not influence plasma leptin levels.