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BACKGROUND: Urinalysis is one of the earliest methods used to screen and detect patients with kidney diseases. It also helps to monitor and assess the severity of the disease process in already diagnosed patients. Microscopy plays a vital role in routine urinalysis and gives more information when analyzed together with chemical strip tests. Introduction of automation of the conventional methods of urinalysis has reduced the disadvantages of manual methods in terms of accuracy of results and turnaround time. METHOD: Aim of the present study is to evaluate the performance of an automatic urinalysis system – FUS-100 (which in cooperates an automatic urine chemistry analyzer H-800) manufactured by Dirui Industrial Co. Ltd., China in patients with renal diseases and compare the results of microscopy with manual microscopic analysis. In addition, our study aims to find out the possibility of safely reducing the number of manual microscopy analyses by cross-interpretation of the results generated by FUS-100 automated urine particle analyzer with manual methods. The urine sediments of five hundred urine samples were examined by these two methods. RESULT Automation of urine analysis decreases the turnaround time and is less labour intensive leading to better accuracy and precision. CONCLUSION Preanalytical errors related to centrifugation and sediment preparation are prevented in automation. Our study tends to suggest that automation of urine microscopy therefore is a more standardized procedure and makes urine microscopy a more objective investigation.

Introduction: Klebsiella is an important opportunistic pathogen that is found to be the causative of hospital acquired pneumonia, urinary tract infections, skin and soft tissue infections and bacteremia. It has developed resistance to most of the currently used antibiotics and even resistance to higher antibiotics like carbapenems is on the rise. Hospital acquired infections caused by multidrug resistant strains of Klebsiella species are associated with high rates of morbidity and mortality. Aim: To assess the diversity and state of resistance of K. pneumoniae to antibiotics in a tertiary care centre. Materials and Methods: Klebsiella strains were isolated from clinical samples received in microbiology laboratory in a tertiary care centre and were identified by standard biochemical techniques. 368 Klebsiella strains were included in the study. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method following CLSI guidelines. Quality control was performed by using standard strain E. coli ATCC 25922. Results: 13.16% of strains isolated from clinical samples were found to be Klebsiella species. Out of 368 Klebsiella strains 42% were resistant to Ceftriaxone, 46% to Cotrimoxazole, 52% to Amoxycillin-clavulanicacid. Resistance to Meropenem & Piperacillin-Tazobactum was 10% & 12% respectively. Conclusion: Detection of drug resistance mechanisms, formulation of a good antibiotic policy and a proper antibiotic stewardship program should be incorporated to combat emerging multidrug resistance which is a global threat. Keywords:Multidrug resistance, Klebsiella, Kirby-Bauer disk diffusion method

Introduction: Pseudomonas have now a days become a major cause of nosocomial and community acquired infections. They are widely distributed in the hospital environment which makes them difficult to eradicate. P.aeruginosa has become the leading cause of hospital acquired infection because of its recent trend to gain resistance to most of the drugs used against it causing a multidrug resistance. Therefore it is necessary to know the changing pattern so as to achieve a good therapy for pseudomonas infection. Therefore this study was conducted to determine the antimicrobial resistance pattern of P.aeruginosa with different parameters from the patients attending the tertiary level hospital in Chennai. Objective: The aim of the study was to enumerate the antimicrobial sensitivity pattern of Pseudomonas infection from various samples in a tertiary care hospital. Materials and Methods: The study was carried out in Microbiology department of a tertiary care hospital during the period of February 2016 to January 2017. A total of 93 non repetitive clinical isolates of P.aeruginosa were collected from different samples. Result: In the present study the males 51(54.8%) were more affected than females 42(45.2%).Age distribution showed more to be affected among adults of age 40 and above. Amikacin, Ciprofloxacin and Gentamicin shows 96.8% sensitivity. Among Cephalosporins highest resistance was observed among 1st generation cefazolin (83.9%) followed by 2nd generation Cefotaxime (17.2%) and Ceftazidime (23.7%) the least was seen among 4th generation Cefepime which showed 6.5% resistance.All isolates were sensitive to Imipenem. Conclusion: Restriction of antibiotic usage must be formatted by each institution, to combat the emergence of multi drug resistant P. aeruginosa. Imipenem was the only anti-pseudomonal drug against which all isolates of P. aeruginosa were fully sensitive. We recommend a restricted and a more rational use of this drug in this hospital setting Keywords: P

Aim: To compare the incidence of unintended sciatic nerve block following pudendal nerve block in the interligamentous plane with two different volumes of ropivacaine for post hemorrhoidectomy pain. Materials and Methods: 30 patients undergoing hemorrhoidectomy were enrolled for the study and randomly divided into two groups. Prior to the block a scout scan was performed and the pudendal artery, nerve and the sciatic nerve were identified in the interligamentous plane. All the patients received bilateral pudendal nerve block under ultrasound guidance with 5ml of 0.25% ropivacaine in group 1 and 10 ml in group 2. The spread of local anaesthetic to the ipsilateral sciatic nerve was noted under ultrasound imaging. The time of first rescue analgesia (FRA) and total analgesic requirement(TAR) were noted in both groups. The overall patient satisfaction was assessed with a three point scale.The unintended motor and sensory block of the sciatic nerve was noted. Results: The right pudendal artery was visualized in all cases where but left pudendal artery was not visualized in 1 case. The right & left pudendal nerve was visualized in 40% & 46.7% of cases in group I and 40% in both sides of group 2. The incidence of spread of drug towards the right and left sciatic nerve was more in group II (73.3% & 66.6%) than group I (40% & 33.3%). Statistically significant difference was not noted in the time for FRA (P value 0.684) & TAR (P value 0.579). There was no clinically significant sciatic nerve block. Conclusion: We conclude that less volume of local anaesthetic can achieve effective pudendal nerve block minimizing the spread to ipsilateral sciatic nerve.

Enteric fever has emerged as an important infectious disease in the early 19th century. This study is carried out in search of an accurate diagnostic method enabling direct observation of antibody binding to antigen profiles, avoiding problems with non-specific antibody binding. To develop an inhouse immunoblot method for detection of anti salmonella antibody against antigens like LPS and S.typhi culture filtrates and compare with Widal in search of an accurate diagnostic assay for typhoid fever. Cross-sectional comparative study for a period of 1 year in a tertiary care hospital. 100 cases having clinical suspicion of typhoid fever and 40 controls (20 healthy persons and 20 non- typhoidal febrile patients) were studied. Subjects were investigated by blood culture, Widal test and Immunoblot and the results were compared. SPSS version 20 was used to analyze the results.Out of 100 cases 58(58%) were positive by widal and 74(74%) by immunoblot.Sensitivity and Specificity was found to be 58%, 85% for widal and 74%, 95% for Immunoblot respectively.Positive and negative predictive values were found to be 90.63%, 44.74% for widal and 97.37%, 59.38% for Immunoblot.Immunoblotting procedure incorporating Salmonella typhi culture filtrates is found to be more sensitive than the Widal agglutination assay for providing evidence of infection with Salmonella typhi.

Objective Stellate ganglion (SG) block can provide pain relief in sympathetically mediated painful conditions. SG block at the sixth cervical (C6) vertebra level through lateral approach under the ultrasonogram (USG) guidance is very safe but may spare the fibres supplying the upper limb. When the drug is given at the C6 subfascially, it spreads along the cervical sympathetic chain, blocking the head/neck and upper limb. In this study, we assessed the efficacy of the SG block given at the C6 level after confirming the subfascial needle position under USG and downward spread of dye under fluoroscopy. Methods Ten patients with sympathetically mediated painful conditions belonging to the American Society of Anesthesiologists (ASA) Class I and II and aged between 18 and 60 years were included in the study. The SG was approached laterally under the USG guidance, and the dye was injected after confirming the subfascial needle position. A downward spread of dye was confirmed on fluoroscope, and 4 mL of 0.25% of bupivacaine with 40 mg of methylprednisolone was injected. Patients were assessed in terms of the pain relief, an increase in axillary temperature and adverse events after 30 minutes. A statistical analysis was done with Student's t-test and paired samples t-test. Results There was a statistically significant reduction in the post-block pain scores with the rise in temperature in the ipsilateral arm (p=0.000). The dye spread was observed from the fourth cervical vertebra to the first thoracic vertebra in all patients. Transient hoarseness was seen in 20% of patients, and the sensation of a lump was seen in 10% of patients. Conclusion We conclude that SG can be blocked effectively and safely through the lateral approach at the C6 level under ultrasonogram and fluoroscopic guidance.

Objective: Typhoid fever is one of the major public health problems in developing countries including India. A simple, reliable, rapid, and earlydiagnostic test has been one of the important needs of the clinicians. The present study was carried out to compare the Widal test and typhoidimmunoglobulin M (IgM) and immunoglobulin G (IgG) rapid test in diagnosing of Salmonella typhi infection.Methods: A total of 100 cases having clinical suspicion of typhoid fever and 40 controls (20 healthy persons and 20 non-typhoidal febrile patients)were studied. Participants were investigated by blood culture, clot culture, Widal test, and typhoid IgM and IgG rapid test, and the results werecompared.Results: Typhoid IgM and IgG test was positive for IgM in 70 cases and IgG for 6 cases of typhoid fever compared to Widal test which showed only58 positive cases. The sensitivity, specificity, positive, and negative predictive value of typhoid IgM was found as 70%, 90%, 94.59%, and 54.55%,respectively. On the other hand, corresponding values for Widal test were 58%, 85%, 90.63%, and 44.74%, respectively.Conclusion: In the present study, the typhoid IgM and IgG yielded remarkable high sensitivity and specificity to diagnose typhoid fever in the firstweek of illness, so it is recommended to use the test in small and less equipped laboratories as a complementary test to Widal.Keywords: Widal, Typhoid immunoglobulin M/immunoglobulin G, Typhoid fever, Blood culture.