Apollo Institute of Medical science and Research

Jubilee Hills, India

Apollo Institute of Medical science and Research

Jubilee Hills, India
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Singh J.,Pushpagiri Institute of Medical Science and Research Center | Sundaresan S.,Apollo Institute of Medical Science and Research | Manoharan A.,Kanchi Kamakoti CHILDS Trust Hospital | Shet A.,Johns Hopkins University
Vaccine | Year: 2017

Background: Streptococcus pneumoniae is a leading cause of childhood diseases that result in significant morbidity and mortality in India. Commercially licensed and available pneumococcal conjugate vaccines (PCVs) include ten (PCV-10) and 13 (PCV-13) pneumococcal serotypes. Vaccines with other serotype combinations are under development. Reviewing and reporting trends and distribution of pneumococcal serotypes causing invasive pneumococcal disease in India will be useful for policy making as PCV is being introduced into India's universal immunization program. Methods: We conducted a systematic literature review of hospital based observational studies (both peer reviewed and gray literature published in English) from India available from January 1990 to December 2016. Studies that documented data on the prevalence of serotype distribution and the antimicrobial resistance pattern of S. pneumoniae in children. ≤. 5. years of age were included. Result: We screened a total number of 116 studies, of which 109 studies were excluded. Final analysis included seven studies. The most frequent pneumococcal serotypes causing invasive disease among children. ≤. 5. years were 14, 1, 19F, 6B, 5, 6A, 9V and 23F. Serotype 14 and 19A were represented in most of the geographical regions studied in the reviewed articles. Currently available PCV formulations included 67.3-78.4% of all serotypes contributing to IPD among Indian children. ≤. 5. years. Pneumococcal resistance to trimethoprim/sulfamethoxazole, erythromycin, penicillin, chloramphenicol, levofloxacin and cefotaxime was seen in 81%, 37%, 10%, 8%, 6% and 4% of all pneumococcal isolates respectively, while vancomycin resistance was not reported. Conclusion: The present review demonstrates that up to 78.4% of reported invasive pneumococcal disease in children. ≤. 5. years in India are currently caused by serotypes that are included in the available licensed PCVs. However, sentinel surveillance must be continued in representative parts of the country to assess the changing trends in distribution of pneumococcal serotypes and their implication for vaccine selection and rollout in India. © 2017 Elsevier Ltd.


Narasimhan P.,University of New South Wales | MacIntyre C.R.,University of New South Wales | Mathai D.,Apollo Institute of Medical science and Research | Wood J.,University of New South Wales
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2017

Background: We aimed to compare TB transmission rates between case and community households in Vellore, South India. Methods: 359 household contacts (HHC) and 363 community contacts (CC) were assessed with tuberculin skin test (TST) and QuantiFERON TB Gold In-Tube test (QFT) between August 2010 and September 2011. Concordance test and multivariate risk factor assessment were conducted using logistic regression adjusted for clustering. Results: Latent TB infection (LTBI) positivity was similar between the two groups using both tests, with only moderate concordance observed between QFT and TST. Children of HHC (<15 years) were at a higher risk for LTBI (odds of 2.37 [1.15-4.89] and 3.02 [1.22-7.45] for TST and QFT respectively). Among adults, both age in decades (odds of 1.33 [1.14-1.15] and 1.16 [1.02-1.32] for TST and QFT, respectively) and the interaction of male gender, smoking and alcohol consumption (odds of 4.06 [1.38-11.93] and 2.59 [1.19-5.64] for TST and QFT, respectively), were associated with increased risk of LTBI. Conclusions: This study provides estimates of TB infection rates accounting for both community and household exposure that contribute to understanding of TB transmission in this setting. We suggest that assessment of risk factors for infection need increased examination as prophylactic treatment of LTBI are being considered. © The Author 2017.


Khalid M.A.,Apollo Institute of Medical science and Research | Venkatesulu B.,Sri Venkateswara College of Engineering | Narayana B.L.,Kurnool Medical College
Journal of Indian Academy of Forensic Medicine | Year: 2016

Burn deaths have tremendous medicolegal importance as they are one of the commonest causes of unnatural deaths in India. The purpose of this study was to record and evaluate the epidemiological and medicolegal aspects of fatal burn injuries retrospectively. An analysis of autopsy records revealed 742 (18.3%) cases of burn injuries among total autopsies done over 5 years period (2010 - 2014) in the mortuary of department of Forensic Medicine, S V Medical College, Tirupati. The majority of victims were females (62.8%), with the age group 21-40 years (57.4%) being predominantly affected. Married victims (78.3%) outnumbered unmarried. Thermal burns, 673 cases (90.7%) was commonly noted with explosion of kerosene stove in 238 (32.1%) being the predominant cause of fire. Mortality was higher in victims with 51-75% of TBSA burn with septicemia, 219 cases (29.5%) being the leading cause of death, followed by hypovolemic shock, 192cases (25.9%). Majority of the cases were accidental, 605 (81.5%), followed by suicidal, 89 (12%) and homicidal deaths 46(6.5%), respectively.


Ramanathan K.,Unit 1 and Infectious Diseases | Mathai D.,Apollo Institute of Medical science and Research | Baruah K.,National Vector Borne Diseases Control Program
Indian Journal of Medical Microbiology | Year: 2013

Incidence of dengue is reported to be influenced by climatic factors. The objective of this study is to assess the association of local climate with dengue incidence, in two geographically distinct districts in Tamil Nadu. The study uses climate data, rainfall and mean maximum and minimum temperature to assess its association if any, with dengue incidence in two districts of Tamil Nadu, South India. According to this study while precipitation levels have an effect on dengue incidence in Tamil Nadu, non-climatic factors such as presence of breeding sites, vector control and surveillance are important issues that need to be addressed.


Daley P.,Memorial University of Newfoundland | Jagannathan V.,Christian Medical College | John K.R.,SRM University | Sarojini J.,Christian Medical College | And 7 more authors.
The Lancet Infectious Diseases | Year: 2015

Background: Vitamin D has immunomodulatory effects that might aid clearance of mycobacterial infection. We aimed to assess whether vitamin D supplementation would reduce time to sputum culture conversion in patients with active tuberculosis. Methods: We did this randomised, double-blind, placebo-controlled, superiority trial at 13 sites in India. Treatment-naive patients who were sputum-smear positive, HIV negative, and had pulmonary tuberculosis were randomly assigned (1:1), with centrally labelled, serially numbered bottles, to receive standard active tuberculosis treatment with either supplemental high-dose oral vitamin D3 (four doses of 2·5 mg at weeks 0, 2, 4, and 6) or placebo. Neither the patients nor the clinical and laboratory investigators and personnel were aware of treatment assignment. The primary efficacy outcome was time to sputum culture conversion. Analysis was by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00366470. Findings: Between Jan 20, 2010, and Aug 23, 2011, we randomly assigned 247 participants to the vitamin D group (n=121) or the placebo group (n=126), of whom 211 participants (n=101 and n=110, respectively) were included in the primary efficacy analysis. Median time to culture conversion in the vitamin D group was 43·0 days (95% CI 33·3-52·8) versus 42·0 days (33·9-50·1) in the placebo group (log-rank p=0·95). Three (2%) patients died in the vitamin D group and one (1%) patient died in the placebo group; no death was considered attributable to the study intervention. No patients had hypercalcaemia. Interpretation: Our findings show that vitamin D supplementation did not reduce time to sputum culture conversion. Further studies should investigate the role of vitamin D in prevention or reactivation of tuberculosis infection. Funding: Dalhousie University and Infectious Diseases Training and Research Centre. © 2015 Elsevier Ltd.


Aleksandrowicz L.,University of Toronto | Malhotra V.,University of Toronto | Dikshit R.,Tata Memorial Hospital | Gupta P.C.,Healis Sekhsaria Institute for Public Health | And 10 more authors.
BMC Medicine | Year: 2014

Background: Verbal autopsy (VA) has been proposed to determine the cause of death (COD) distributions in settings where most deaths occur without medical attention or certification. We develop performance criteria for VA-based COD systems and apply these to the Registrar General of India's ongoing, nationally-representative Indian Million Death Study (MDS).Methods: Performance criteria include a low ill-defined proportion of deaths before old age; reproducibility, including consistency of COD distributions with independent resampling; differences in COD distribution of hospital, home, urban or rural deaths; age-, sex- and time-specific plausibility of specific diseases; stability and repeatability of dual physician coding; and the ability of the mortality classification system to capture a wide range of conditions.Results: The introduction of the MDS in India reduced the proportion of ill-defined deaths before age 70 years from 13% to 4%. The cause-specific mortality fractions (CSMFs) at ages 5 to 69 years for independently resampled deaths and the MDS were very similar across 19 disease categories. By contrast, CSMFs at these ages differed between hospital and home deaths and between urban and rural deaths. Thus, reliance mostly on urban or hospital data can distort national estimates of CODs. Age-, sex- and time-specific patterns for various diseases were plausible. Initial physician agreement on COD occurred about two-thirds of the time. The MDS COD classification system was able to capture more eligible records than alternative classification systems. By these metrics, the Indian MDS performs well for deaths prior to age 70 years. The key implication for low- and middle-income countries where medical certification of death remains uncommon is to implement COD surveys that randomly sample all deaths, use simple but high-quality field work with built-in resampling, and use electronic rather than paper systems to expedite field work and coding.Conclusions: Simple criteria can evaluate the performance of VA-based COD systems. Despite the misclassification of VA, the MDS demonstrates that national surveys of CODs using VA are an order of magnitude better than the limited COD data previously available. © 2014 Aleksandrowicz et al.; licensee BioMed Central Ltd.


PubMed | Win Vision Eye Hospitals, Vasan Eye Care, Apollo Institute of Medical science and Research, GHR Micro Diagnostics and Medivision Eye and Health Care Center
Type: | Journal: Mycoses | Year: 2016

Fungal keratitis due to Schizophyllum commune is very rare. In this study, we report the clinical and microbiological profile of five patients with fungal keratitis due to S. commune. Direct microscopic examination of corneal scrapings from all five patients showed septate branching hyaline fungal filaments. Similarly, in all five patients Sabouraud dextrose agar (SDA) plates inoculated with corneal scrapings showed white, cottony colonies on the second day of incubation. Lactophenol cotton blue stained wet preparation of 7-day-old colonies on SDA revealed clamp connections and no spores. The fungus was identified by its characteristic clamp connections, fan-shaped bracket fruiting body with pinkish-grey longitudinally split-radiating gills. The phenotypic identification of one of the five isolates further conformed by ITS sequencing. Treatment outcome was available for two of the five patients; in these two patients, the keratitis resolved with topical natamycin.


Anuradha M.,Apollo Institute of Medical science and Research
Journal of Clinical and Diagnostic Research | Year: 2014

Leclercia adecarboxylata is usually isolated as a part of polymicrobial cultures in immunocompetent patients, and as a pure culture in immunocompromised persons. Although generally sensitive to most antibiotics, there are reports of resistant strains. Two case reports of L. adecarboxylata isolation in the lab in pure culture in immunocompetent persons are presented here, L adecarboxylata being isolated from a vaginal swab in the first case and from a gluteal abscess in the second case. Both the isolates were sensitive to most of the antibiotics tested. © 2014, Journal of Clinical and Diagnostic Research. All ights reseved.


Krishna Veni D.V.,Apollo Institute of Medical science and Research
International Journal of Pharma and Bio Sciences | Year: 2013

The study was undertaken to observe the gender based variation in serum bilirubin levels in neonatal Hyperbilirubinemia. A total of seventy nine healthy full term infants (50 females and 29 males) in age group of 1-7 days, who presented with visible nonhemolytic hyperbilirubinemia were analyzed. There was no significant difference in maternal age, gestational age, birth weight and perinatal age in between male and female infants. Total bilirubin levels were high both in female and male infants and there was no significant difference between them. But the direct bilirubin levels were significantly high in female infants compared to male infants during the neonatal period.


Sen S.,Apollo Institute of Medical science and Research | Bathini P.,Apollo Institute of Medical science and Research
Journal of Clinical and Diagnostic Research | Year: 2015

Introduction: Managing postoperative pain efficiently is one important therapeutic challenge in the hospitals. Combination use of analgesics is in vogue, where in drugs from the opioid and non-opioid group are given synergistically. The aim of this study is to audit the use of different analgesics on the first postoperative day. Effort has been made to look into the drug or drug combinations used and other factors associated with their use. Materials and Methods: Retrospective, cross sectional observational study was conducted over a period of 11 months in a tertiary care teaching hospital at Hyderabad with approval from institutional ethics committee. Medical records of 649 patients on the first postoperative day were analysed for analgesics by various indicators.Results: Average number of drugs per encounter was 4.23. Percentage of patients prescribed drugs from national essential drug list/WHO was 81.94%. Most common analgesic (monotherapy) prescribed was tramadol followed by diclofenac and the most common combination drugs prescribed were tramadol+Paracetamol. The most common route of administration was intravenous. All the drugs except piroxicam, were in the lower limit of the recommended daily dose. Conclusion: The present study gives an idea of the overall pattern of analgesic drug use in postoperative patients. The drug combinations used, the most common single use drug can be made out. The health professionals can be encouraged to prescribe by generic name and from the National List of Essential Medicines NLEMs. © 2015, Journal of Clinical and Diagnostic Research. All Rights Reserved.

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