Unique temperature patterns in 24-h continuous tympanic temperature in tuberculosis.

Body temperature monitoring in most healthcare institutions is limited to checking the presence or absence of fever. Our present study evaluated the 24h continuous tympanic temperature pattern in patients with fever in order to detect typical patterns seen in tuberculosis (TB). This observational study was conducted on 81 undifferentiated fever patients whose recordings were stored using the TherCom device. Unique temperature patterns were analysed and compared. TB patients exhibited a unique temperature pattern, namely a slow temperature elevation followed by slow temperature fall seen in 78.5% (22/28) compared to 24.52% (13/53) of non-TB patients. Recognition of this pattern may therefore be useful as a valuable diagnostic aid in the early diagnosis of TB.

Classification of Infectious and Noninfectious Diseases Using Artificial Neural Networks from 24-Hour Continuous Tympanic Temperature Data of Patients with Undifferentiated Fever.

Fever is one of the major clinical symptoms of undifferentiated fever cases. Early diagnosis of undifferentiated fever is a challenging task for the physician. The aim of this study was to classify infectious and noninfectious diseases from 24-hour continuous tympanic temperature recordings of patients with undifferentiated fever using a machine learning algorithm (artificial neural network). This was an observational study conducted in 103 patients who presented with undifferentiated fever. Twenty-four-hour continuous tympanic temperature was recorded from each patient. Features were extracted from temperature signals and classified into infectious and noninfectious diseases using an artificial neural network (ANN). The ANN classifier provided the highest accuracy at 91.3% for differentiating infectious and noninfectious diseases from undifferentiated fever cases. Significant kappa agreement (κ = 0.777) was found between the final diagnosis as determined by the physician and the classification obtained using an ANN classifier. Based on our results, we conclude that the continuous 24-hour temperature monitoring and application of an ANN classifier provides a simple noninvasive and inexpensive supplementary diagnostic method to differentiate infectious and noninfectious diseases.

Evaluation of antimicrobial and physical properties of orthodontic composite resin modified by addition of antimicrobial agents--an in-vitro study.

INTRODUCTION: This study was designed to investigate the antimicrobial and physical properties of orthodontic composite resin modified by the addition of antimicrobial agents. METHODS: Unite bonding adhesive (3M Unitek, Monrovia, Calif), a chemically cured composite resin, modified by the addition of benzalkonium chloride (BAC), chlorhexidine, and triclosan in concentrations of 0.1 wt%, 0.2 wt%, and 0.3 wt%, respectively, was formed into tablets for testing. The tablets of each group and a control group were subjected to the agar plate diffusion test to measure the zone of bacterial inhibition. In addition, they were incubated for 24 hours in tryptic soy broth inoculated with Streptococcus mutans and examined for bacterial growth. A total of 80 extracted premolars were collected and divided into 2 sets of 40 teeth each. Stainless steel Begg brackets were bonded by using control and experimental composites. A universal testing machine was used to determine shear bond strength. The first set of teeth was tested after 24 hours and the second set after 25 days of storage in distilled water. Time-dependent release of antimicrobial agents from the modified composites was monitored spectrophotometrically. RESULTS AND CONCLUSIONS: The findings indicated that (1) addition of BAC to the orthodontic composite resin enhanced its antimicrobial properties, (2) there was no significant difference in the bond strengths of the control and the experimental resin tested after 24 hours and 25 days, and (3) maximum release of BAC from the modified resin was higher than that of chlorhexidine or triclosan, and was much higher than the minimum inhibitory concentration level.

Bacterial contamination and decontamination of toothbrushes after use.

The purpose of this study was to determine the extent of bacterial contamination of toothbrushes after use and the efficacy of chlorhexidine and Listerine in decontaminating toothbrushes. The effectiveness of covering a toothbrush head with a plastic cap in preventing contamination was also evaluated. It was found that 70% of the used toothbrushes were heavily contaminated with different pathogenic microorganisms. Use of a cap leads to growth of opportunistic microorganisms like Pseudomonas aeruginosa, which may cause infection in the oral cavity. Overnight immersion of a toothbrush in chlorhexidine gluconate (0.2%) was found to be highly effective in preventing such microbial contamination.

A Predictive Model to Classify Undifferentiated Fever Cases Based on Twenty-Four-Hour Continuous Tympanic Temperature Recording.

Diagnosis of undifferentiated fever is a major challenging task to the physician which often remains undiagnosed and delays the treatment. The aim of the study was to record and analyze a 24-hour continuous tympanic temperature and evaluate its utility in the diagnosis of undifferentiated fevers. This was an observational study conducted in the Kasturba Medical College and Hospitals, Mangaluru, India. A total of ninety-six (n = 96) patients were presented with undifferentiated fever. Their tympanic temperature was recorded continuously for 24 hours. Temperature data were preprocessed and various signal characteristic features were extracted and trained in classification machine learning algorithms using MATLAB software. The quadratic support vector machine algorithm yielded an overall accuracy of 71.9% in differentiating the fevers into four major categories, namely, tuberculosis, intracellular bacterial infections, dengue fever, and noninfectious diseases. The area under ROC curve for tuberculosis, intracellular bacterial infections, dengue fever, and noninfectious diseases was found to be 0.961, 0.801, 0.815, and 0.818, respectively. Good agreement was observed [kappa = 0.618 (p < 0.001, 95% CI (0.498-0.737))] between the actual diagnosis of cases and the quadratic support vector machine learning algorithm. The 24-hour continuous tympanic temperature recording with supervised machine learning algorithm appears to be a promising noninvasive and reliable diagnostic tool.

Healthcare-Associated Methicillin-Resistant Staphylococcus aureus: Clinical characteristics and antibiotic resistance profile with emphasis on macrolide-lincosamide-streptogramin B resistance.

OBJECTIVES: Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-streptogramin B (MLSB) phenotypes and vancomycin. METHODS: This cross-sectional study was carried out between February 2014 and February 2015 across four tertiary care hospitals in Mangalore, South India. Healthcare-associated infections among 291 inpatients at these hospitals were identified according to the Centers for Disease Control and Prevention guidelines. Clinical specimens were collected based on infection type. S. aureus and MRSA isolates were identified and antibiotic susceptibility tests performed using the Kirby-Bauer disk diffusion method. The minimum inhibitory concentration of vancomycin was determined using the Agar dilution method and inducible clindamycin resistance was detected with a double-disk diffusion test (D-test). RESULTS: Out of 291 healthcare-associated S. aureus cases, 88 were MRSA (30.2%). Of these, 54.6% were skin and soft tissue infections. All of the isolates were susceptible to teicoplanin and linezolid. Four MRSA isolates exhibited intermediate resistance to vancomycin (4.6%). Of the MRSA strains, 10 (11.4%) were constitutive MLSB phenotypes, 31 (35.2%) were inducible MLSB phenotypes and 14 (15.9%) were macrolide-streptogramin B phenotypes. CONCLUSION: Healthcare-associated MRSA multidrug resistance was alarmingly high. In routine antibiotic susceptibility testing, a D-test should always be performed if an isolate is resistant to erythromycin but susceptible to clindamycin. Determination of the minimum inhibitory concentration of vancomycin is necessary when treating patients with MRSA infections.

Comparison of Conventional Mercury Thermometer and Continuous TherCom® Temperature Recording in Hospitalized Patients.

INTRODUCTION: Detection of accurate body temperature fluctu-ations in hospitalized patients is crucial for appropriate clinical decision-making. The accuracy and reliability of body temperature assessment may significantly affect the proper treatment. AIM: To compare the conventional and continuous body temperature recordings in hospitalized patients. MATERIALS AND METHODS: This cross-sectional study was carried out at a tertiary care centre and study included 55 patients aged between 18-65 years with a history of fever admitted to a tertiary care hospital. A noninvasive continuous temperature recording was done using TherCom® device through tympanic temperature probe at tympanic site at one-minute intervals for 24 hours. The conventional temperatures were recorded in the axilla using mercury thermometer at specific time intervals at 12:00 noon, 8:00 PM and 5:00 AM. Peak temperature differences between continuous and conventional methods were compared by applying Independent sample t-test. Intra class Correlation Coefficient (ICC) test was performed to assess the reliability between two temperature-monitoring methods. A p<0.05 was considered as significant. RESULTS: The average peak temperature by non-invasive continuous recording method was 39.07°C ±0.76°C while it was 37.55°C ±0.62°C by the conventional method. A significant temperature difference of 1.52°C [p<0.001;95% CI(1.26-1.78)] was observed between continuous and conventional temperature methods. Intra class Correlation Coefficient (ICC) between continuous and conventional temperature readings at 12:00 noon was α= 0.540, which had moderate reliability. The corresponding coefficients at 8:00 PM and 5:00 AM were α=0.425 and 0.435, respectively, which had poor reliability. CONCLUSION: The conventional recording of temperature is routinely practiced and does not reflect the true temperature fluctuations. However, the continuous non-invasive temperature recording is simple, inexpensive and a better tool for recording the actual temperature changes.

Bisalbuminemia in a Hypothyroid Patient with Diabetes: A Case Report.

Bisalbuminemia is a rarely encountered anomaly characterized by presence of bifid albumin bands or a single widened albumin band in electrophoretogram. Inherited bisalbuminemia is quite rare and inherited as an autosomal dominant form. The acquired form of bisalbuminemia is usually transient and may be observed during long term beta lactam antibiotic therapy, acute pancreatitis, myeloma and nephrotic syndrome. This is a case of bisalbuminemia in 61-year-old diabetic female with hypothyroidism came with acute exacerbation of bronchial asthma.

Molecular characterization and clinical significance of New Delhi metallo-beta-lactamases-1 producing Escherichia coli recovered from a South Indian tertiary care hospital.

CONTEXT: The increased rate of infection by New Delhi metallo-beta-lactamases-1 (NDM1) producing Escherichia coli is a major concern since they show a high rate of drug resistance and are responsible for mortality and morbidity. AIMS: To characterize the NDM1 producing E. coli isolates and their impact on patients' clinical outcome. SETTINGS AND DESIGN: This descriptive study was carried out in a multi-specialty tertiary care hospital. MATERIALS AND METHODS: Three hundred nonrepeat strains of E. coli from inpatients were included in the study. Modified Hodge test and metallo-beta-lactamases (MBL) e-test were performed to detect carbapenemase and MBL activity. Polymerase chain reaction (PCR) technique was performed to detect NDM1. NDM1 positive isolates were further tested for plasmid mediated AmpC, blaCTX , blaSHV , blaTEM genes and also for phylogrouping by PCR methods. Treatment and patients' clinical outcome were also analyzed. RESULTS: Out of 300 isolates, 21 (7%) were MBL producers by phenotypic methods. Of this, 17 (81%) were NDM1 positives, among the NDM1 producers 6 (35%) isolates were belongs to phylogroups D followed by A 5 (29%), B1 4 (24%) and B2 2 (12%), 15 (88%) isolates were blaCTX-M positive suggestive of extended-spectrum beta lactamase producing strain and 7 (47%) were positive with CIT type of AmpC. With the follow-up of the patients, it was found that 12 (71%) recovered and 3 (18%) developed relapses, and mortality was seen in 2 (12%) patients. CONCLUSIONS: NDM1 producing isolates showed a high degree of drug resistance but can be treated with suitable antimicrobials, in the majority. Early detection and choice of appropriate antibiotics may help in reducing mortality and morbidity.

Effect of trace elements on surface hydrophobicity and adherence of Escherichia coli to uroepithelial cells.

Trace elements have significant effect on the physiology of bacteria. Variation in the concentration of trace elements may affect the expression of virulence by microorganisms. The effect of trace elements on hydrophobicity and adherence of E.coli to uroepithelial cells was studied. Increasing concentrations of Ca2+, Mg2+, Fe3+ and Zn2+ significantly decreased the surface hydrophobicity. Toxic trace elements like Co2+, Cu2+, Mn2+ and Ni2+ did not alter surface hydrophobicity. With regards to adherence of E.coli to uroepithelial cells, only Mg2+ had significant effect. Toxic trace elements decreased the rate of cell adherence. The pathogenic strains of E.coli showed higher surface hydrophobicity and better cell adherence compared to the nonpathogenic strains. There was good correlation between surface hydrophobicity and cell adherence at higher concentrations (0.1 to 0.2mM) of Fe2+ and Zn2+. The results indicated that trace elements can significantly affect surface hydrophobicity and adherence of E.coli to uroepithelial cells. Such effect may have a significant impact on the initial stages of bacterial infection.

Oral Microflora: A Comparative Study in HIV and Normal Patients.

The study was designed to compare the oral microbiota in normal and HIV-infected individuals. The study tries to establish a significant shift in oral microflora in HIV-infected patients. Antibiotic sensitivity testing was performed to establish any rise in resistance against the antibiotics. It was a two and half year prospective study conducted in a tertiary care centre. The study group consisted of eighty subjects divided into two groups of control and HIV. The age range for this group was 9-75 years. The mean age in this group was 39.7 years. The male:female ratio was 2.75:1. Tuberculosis was the most common opportunistic infection in patients with HIV infection. The most common commensal micro organism isolated was the Viridans streptococci in 60% followed by Streptococcus pneumoniae in 23.33%. HIV Group: The most common commensal micro organism isolated was the Viridans streptococci in 42%; this was followed by the Micrococci spp. in 22% cases. S. pneumoniae was isolated in 6% of cases. The colony count for Viridans streptococci showed a heavy growth in 55.56% of cases in controls whereas the same in HIV group was 62.5%. Micrococcus spp. was isolated from 11 subjects in HIV group while it was not isolated from the controls. 50% subjects in the HIV group showed a heavy growth of Klebsiella spp. whereas controls showed only moderate and scanty growth. In patients with CD4+ T cell count less than 50 cells/µl we found a heavy colonization of the oral cavity with Micrococcus spp., Acinetobacter and Klebsiella spp. Viridans streptococcus was not isolated in any of the patients with CD4+ T cell count less than 50 cells/µl. As CD4+ T cells counts improved to 51-100 cells/µl Viridans streptococcus colonies returned and 37.5% patients showed a heavy growth. Micrococcus spp. colonies were isolated till the CD4+ T cells improved up to 300 cells/µl. At counts > 300 cells/µl the oral microbiota became comparable to that of the controls. Many of the opportunistic infections in HIV are caused by commensal bacteria which are otherwise harmless in a normal individual. Our study is unique in that such a study of the oral commensals in HIV patients has never been reported. We found an increased colonization of the oral cavity by Micrococcus spp. which is a normal commensal of the skin.

Urinary tract infection due to Enterobacter sakazakii.

Enterobacter sakazakii is a rare but important cause of necrotizing enterocolitis, bloodstream infection and central nervous system infections in humans, with mortality rates of 40-80%. It has not been reported to cause urinary tract infection. We report a case of urinary tract infection due to E. sakazakii in a 63-year-old lady with chronic renal failure.

An autopsy case of renal candidiasis.

Systemic candidiasis is the most frequently encountered opportunistic fungal infection, the kidneys being primarily affected in 80% of the cases. Most of the cases are fatal, diagnosed either very late for effective therapeutic intervention or are documented only at postmortem examination. We, herein, report a case of renal candidiasis in an elderly male who died in the hospital while undergoing treatment for head injury and multiple fractures sustained following a road traffic incident. Renal candidiasis with fungal balls obstructing the pelvicalyceal system was diagnosed at autopsy, which may have contributed to death.

Methicillin-resistant Staphylococcus aureus in community-acquired pyoderma.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. It can also cause community-acquired infections. Indian reports about MRSA in community-acquired infections are rare. AIM: To evaluate the rate of MRSA in community-acquired pyoderma and the nasal colonisation with S. aureus in such patients. METHODS: Two hundred and fifty patients with community-acquired pyoderma, who attended outreach camps around Mangalore, south India between January 2000 and July 2001, were studied. Swabs collected from the skin lesions and anterior nares were inoculated onto blood agar and MacConkey's agar. Antimicrobial sensitivity testing was performed using Kirby-Bauer disk diffusion, agar dilution, and agar screen. RESULTS: Of 250 pyoderma cases, S. aureus was isolated from 202 (80.8%) patients. Twenty-two (10.9%) S. aureus isolates were methicillin resistant, 179 (88.6%) were resistant to penicillin, and 114 (56.4%) were resistant to erythromycin. S. aureus colonization in the anterior nares was observed in 136 (54.4%) cases, 11.8% of which were MRSA. Antibiograms of clinical isolates of S. aureus matched with nasal isolates in 99 (49%) cases. CONCLUSION: The emergence of MRSA in the community is a warning. A high nasal carriage rate may contribute to recurrent pyoderma. A correct antimicrobial policy and the avoidance of inappropriate antimicrobial usage are mandatory to reduce the spread of MRSA in the community.