Laboratory tests that may be done include:
levels, aggressive blood pressure control,
angiotensin II inhibition, and dietary protein
restriction. Additional therapeutic targets include microalbuminuria and macroproteinuria. An
The levels of these tests will increase as kidney
approach to each of these parameters is discussed
damage gets worse. Other laboratory tests that
1. Tight blood glucose control
The DCCT (Diabetes Control and Complications
Trial) demonstrated the importance of tight blood
glucose control in slowing the development of
proteinuria in Type 1 diabetics. In this regard,
patients randomized to tight glucose control
(HbA1C levels < 6.5%) versus regular control (8-
A kidney biopsy confirms the diagnosis. However,
9%), demonstrated 39 and 54% lower rates of
clinical diagnosis can be done without a biopsy if
the following three conditions are met with:
macroalbuminuria, respectively, over the two years of the trial.
Similarly the UKPDS(United Kingdom Prospective
Diabetes Study) in Type II diabetes showed a 25%
3. No other kidney or renal tract disease
risk reduction in microvascular complication in
A biopsy may be done, however, if there is any
2. Blood pressure control
Diabetics with heavy proteinuria, but lacking the
Hypertension in diabetic patient may be due to
disease for a sufficient period of time and/or
coexisting “essential” hypertension, or due to
retinopathy, may require renal biopsy. These
myriad of other secondary causes, such as renal
p a t i e n t s m a y s u f f e r f r o m p r i m a r y
vascular disease. Isolated systolic hypertension
has been attributed to the loss of elastic
nephropathy, or other glomerular diseases.
compliance of atherosclerotic large vessels. Both
Diabetic glomerulopathy is the most common
systolic and diastolic hypertension markedly
cause of nephrotic syndrome. Thus, early in the
course of the disease, the serum creatinine is
nephropathy and aggressive antihypertensive
normal despite heavy proteinuria (> 3 grams/24
management is able to greatly decrease the rate
hours). In this regard, a diabetic patient
of fall of GFR. Appropriate antihypertensive
presenting with elevated serum creatinine in the
intervention can significantly reduce mortality
absence of macroscopic proteinuria should
from 94 to 45% and a reduction in the need for
suggest additional diagnostic possibilities (such as
dialysis and transplantation from 73 to 31% 16
other glomerulopathies) . The diagnostic utility of
years after development of overt nephropathy.
proteinuria is less useful in patients treated with
Choice of antihypertensive therapy:-
angiotensin converting enzyme inhibitors (ACEi)
or angiotensin II receptor blockers (ARBs), since both classes of drugs are known to reduce
Use of ACEI and ARBs as these may lead to
hyperkalemia in patients of advanced renal
MEDICAL THERAPY OF DIABETIC NEPHROPATHY :
The medical therapy of diabetic glomerulo-
ACEI are contraindicated in bilateral renal
sclerosis includes strict control of blood glucose
macroproteinuria and renal failure. American
Targets for blood pressure control:-
Diabetic Association (ADA) guidelines suggest assessing for microalbuminuria (normal < 30
• <130/80 mm hg in absence of proteinuria
mg/24 hours or less 30 mcg/mg creatinine for
• <125/75 mm hg in presence of proteinuria.
a spot urine collection) at the time of diagnosis
3. Angiotensin II inhibition :
The ACE inhibitor
in all type 2 diabetics, in all type I diabetics with
trial in diabetic nephropathy was the first
disease duration > 5 yrs, and annually
randomized, placebo controlled trial that
showed the beneficial effect of ACE inhibitors
aggressive therapy of microalbuminuria, taken
i n t h e t r e a t m e n t o f d i a b e t i c
along with angiotensin II inhibition, is
glomerulosclerosis. Subsequent studies have
expected to slow disease progression.
Heavy proteinuria is a risk factor for progressive
a re f i rs t l i n e t h e ra p y fo r d i a b e t i c
renal failure, 16 including diabetic nephropathy.
glomerulosclerosis, but ARBs are regarded by
There is abundant evidence that abrogating
some as equivalent. The beneficial effect of
proteinuria with dietary and antihypertensive
angiotensin II inhibition may result from:
interventions, and/or ACE inhibitors, 1 and/or
a) a decline in glomerular hypertension (with
proteinuric states. In this regard, combination
therapy with both ACE inhibitors and ARBs may
provide benefit over ACE inhibitors alone.
Finally, nephrotic diabetics treated with ACE inhibition, and exhibiting a reduction in
c) a decrease in angiotensin II stimulated
proteinuria to < 1 gm / day, demonstrated stable
renal function for up to 8 to 15 years. Taken
4. Dietary protein restriction :
In some reports,
together, therapeutic measures directed at
dietary protein restriction has been shown to
reducing macroscopic proteinuria would be
slow the loss of GFR in proteinuric diabetics,
expected to slow the progression of diabetic
although the data are not conclusive. Protein
nephropathy, and angiotensin II inhibition is the
restricted diets (0.6-0.8 g/kg body wt/day)
mainstay of therapy for attaining that goal.
Other aspects of treatment :
progressive renal disease includes prevention of
proteinuria, and glomerulo-sclerosis, and
renal osteodystrophy with sodium and phosphate
restriction and use of phosphate binders,
treatment and prevention of anaemia etc.
5. Microalbuminuria :
Avoidance of nephrotoxic drugs in proteinuric
diabetic patients will prevent form onset of acute
proteinuria. Macroscopic proteinuria is a
major risk factor for progression to ESRD, thus measures to reverse microalbuminuria may
Radiocontrast media are nephrotoxic in diabetic
retard development of clinical nephropathy.
nephropathy and careful hydration is mandatory
Patients with microalbuminuria treated with
Survival analysis shows the two modalities are
Insulin metabolism in CKD :
Unutilized insulin is
comparable with regard to patient outcome.
excreted by kidney normally which accumulates
However, when compared to non-diabetics, diabetic patients on dialysis do substantially
in CKD. So if we fail to reduce insulin dose as
worse, with five-year survival rates as low as 5%
kidney disease progresses, patients will
for elderly type 2 diabetics. With meticulous
experience hypoglycaemia. So reducing insulin
management, others have shown three-year
dose and switching to short acting insulin
survival rates as high as 58%. .The reasons for
analogues is recommended in this situation. It is
poor survival rates relate to the high incidence of
recommended to avoid long acting Insulins in CKD
preexisting cardiovascular disease, late referral
both for predialysis care, as well as vascular access
Oral antidiabetic drug:
97% of the most
placement, malnutrition, and co-existing vascular
commonly used oral antidiabetic drug Metformin
problems (in particular, peripheral vascular
is excreted by normal kidney within 12 hrs. In CKD
disease with associated ischemic toes and feet).
it will accumulate and lead to lactic acidosis, a
Furthermore, diabetes and smoking have been
shown to be significant risk factors for
So metformin should be stopped when the eGFR is
atherosclerotic heart disease in dialysis patients,
<35 ml/mt/1.73 m correlates to serum creatinine
similar to what is seen in the general population.
o f a p p r o x m i m a t e l y 1 . 7 m g / d l . O l d e r
The anemia of chronic renal disease may further
sulfonylurea(SU) are excreted mainly through
complicate the course of patients with significant
kidney. Only 10% of second line SU are excreted by
coronary artery disease. Taken together, these
kidney but are long acting and may accumulate in
data suggest that the survival of diabetic patients
CKD, so we must be cautious while using these.
Meglitinides and Thiazolidinediones are not
aggressive attention to risk factors for
c a rd i o va s c u l a r d i s e a s e ( hy p e r te n s i o n ,
dyslipidemia, smoking, etc.), awareness and therapy of diabetic foot problems, and early
Monitoring glycaemic control in CKD :
nephrology referral (as GFR falls or with
disease develops, the turnover of red blood cells
progressive proteinuria) for vascular access
becomes abnormal. Usually there is prolonged life
span of RBCs, perhaps because the person is anaemic. So hemoglobin has more time to
2. Peritoneal dialysis :
The second option for renal
become glycated. In such conditions HbA1
replacement therapy in diabetic patients with
kidney disease may be falsely high. Hb may also be
ESRD, is peritoneal dialysis. When compared to
carbamylated with some of the waste products,
hemodialysis, fewer patients are treated with peritoneal dialysis. Patients opting for peritoneal
dialysis tend to be healthier and more involved in
compounds will interfere with the measurement
their medical care. While no clear survival
of HbA1c. This is one more reason for HbA1 cto be
advantage for peritoneal or hemodialysis has
falsely high. Correction of anaemia may lead to
been demonstrated, patients treated with
peritoneal dialysis may experience labile blood
Renal replacement therapy:
glucose levels (attributed to the high glucose
1. Hemodialysis :
Hemodialysis and peritoneal
concentrations inherent to PD dialysate) and
dialysis are the two forms of dialysis used to treat
increased risk of malnutrition (secondary to
diabetic patients with end stage renal disease.
excessive protein losses in dialysate effluent).
3. Transplantation :
By far the best treatment for
ESRD from diabetes is kidney transplantation.
The rising incidence of diabetes means that
Kidney transplantation in diabetics with end-stage
clinicians can expect to find an increased rate of
renal disease may include kidney transplantation
diabetic nephropathy, and increasing numbers of
a l o n e , o r c o m b i n e d k i d n e y - p a n c r e a s
patients requiring renal replacement therapy.
transplantation. The former treats renal failure,
Understanding the natural history of diabetic
the latter both renal failure and diabetes. Patient
nephropathy, the early recognition of diabetic
survival following kidney transplantation without
complications, and timely initiation of therapy to
a pancreas has consistently been demonstrated to
slow progression are cornerstones in the
be superior to any form of dialysis. Data from the
management of this condition. Aggressive
Organ Procurement and Transplantation Network
treatment of hyperglycemia and hypertension,
reported one-, three-, and five-year patient
the use of angiotensin II inhibitors, and timely
survival rates for transplanted diabetics of 90, 79
therapy of micro and macroproteinuria are
and 66%, respectively. This compares to a two
essential features of optimal therapy. For patients
year survival rate in diabetic patients on
hemodialysis of 58%. The improved survival of
replacement options include dialysis and kidney
renal transplant patients over those treated with
transplantation, with transplantation conferring a
hemodialysis must be interpreted in light of the
fact that they are selected for transplantation,
whereas patients with extensive co-morbidities
1. Strojek K et al, Nephropathyof type 2
tend to remain on dialysis. Living donor
diabetes: Evidence for hereditary factor.
transplants confer an allograft survival advantage
over cadaveric donors, with three-year allograft
2. Hostetter T, Rennke H, Brenner B. The case
survival rates of 88 and 78% for living and
cadaveric donor transplants, respectively.
initiation and progression of diabetic and
However, both modalities are superior to dialysis
with three year patient survival rates of
a p p r o x i m a t e l y 8 8 - 9 4 % .
transplantation is renal transplantation that is
performed prior to instituting dialysis. Preemptive
receptors in the pathogenesis of diabetic
transplantation may confer a survival advantage
nephropathy. Kidney Int . 1997; 52:S7-S11.
that is superior to transplanting patients on
4. Brownlee M. Biochemistry and molecular
dialysis. In this regard, the time spent on dialysis
prior to transplantation portends worse survival
rates for patients. For example, in patients on
5. Parving H, Smidt U, Andersen A, Svendsen
dialysis < 6 months, 12-24 months, or >48 months
had mortality rates of 21%, 41%, and 72%,
kidney function in diabetic nephropathy.
survival was seen in cadaveric transplants
performed in patients receiving hemodialysis for
more than two years prior to the transplant. In
those studies, the allograft survival rate was only
7. Anjali, Jacob J J, Nephropathy in Diabetes;
8. Carstens S, Hebert L, Garancis J, Piering W,
17. Zeller K, Whittaker E, Sullivan L, et al. Effect
diabetic glomerulosclerosis: recognition
progression of renal failure in patients with
insulin-dependent diabetes mellitus.
9. Brenner BM. Regarding: “Management of
18. Klahr S, Levey AS, Beck GJ, et al. The effects
glomerular proteinuria: a commentary.” J
of dietary protein restriction and blood-
chronic renal disease. Modification of Diet
10. Lewis E, Hunsicker L, Bain R, Rohde R. The
inhibition in diabetic nephropathy. N Engl J
19. Molitch ME, DeFronzo RA, Franz MJ, et al.
11. Lewis EJ, Lewis JB. ACE inhibitors versus
angiotensin receptor blockers in diabetic
nephropathy: is there a winner? J Am Soc
20. Breyer JA, Bain RP, Evans JK, et al.
12. Hostetter T. Prevention of end-stage renal
disease due to type 2 diabetes. N Engl J
13. Zatz R, Bunn B, Meyer T, Anderson S,
The Collaborative Study Group. Kidney Int.
o f d i a b e t i c g l o m e r u l o p a t h y b y
21. Peterson JC, Adler S, Burkart JM, et al.
p h a r m a co l o g i ca l a m e l i o rat i o n o f
Blood pressure control, proteinuria, and
14. Wilmer WA, Rovin BH, Hebert CJ, Rao SV,
Ann Intern Med. 1995; 123(10):754-62.
Am Soc Nephrol. 2003; 14(12):3217-32.
Mortensen J, Gomis R, Andersen S, Arner P.
15. Nahman N, Kronenberger J, Sferra T, Clark
K. Transcriptional activation of the TGF-b
gene by angiotensin II: implications for
23. Lewis EJ, Hunsicker LG, Clarke WR, et al.
Renoprotective effect of the angiotensin-
16. Siegert A, Ritz E, Orth S, Wagner J.
receptor antagonist irbesartan in patients
with nephropathy due to type 2 diabetes.
growth factor receptors by angiotensin II
24. Jacobsen P, Andersen S, Rossing K, Jensen
dialysed diabetic patients: a prospective
BR, Parving HH. Dual blockade of the renin-
25. Wilmer WA, Hebert LA, Lewis EJ, et al.
Remission of nephrotic syndrome in type 1
31. Xue JL, Everson SE, Constantini EG, et al.
diabetes: long-term follow-up of patients
Peritoneal and hemodialysis: II. Mortality
characteristics. Kidney Int. 2002; 61(2):741-6.
26. Mashall S etal, Chronic kidney Disease in
32. Organ Procurement and Transplantation
Diabetes Update. Proceedings 2009; 21-28
33. Meier-Kriesche HU, Port FK, Ojo AO, et al.
27. Locatelli F, Pozzoni P, Del Vecchio L. Renal
Effect of waiting time on renal transplant
outcome. Kidney Int. 2000; 58(3):1311-7.
diabetes and end-stage renal disease. J Am
34. Mange KC, Joffe MM, Feldman HI. Effect of
Soc Nephrol. 2004; 15 Suppl 1:S25-9.
the use or nonuse of long-term dialysis on
28. Schwenger V, Zeier M, Ritz E. How can the
35. Kasiske BL, Snyder JJ, Matas AJ, Ellison MD,
29. Koch M, Kutkuhn B, Grabensee B, Ritz E.
history of stroke are predictors of death in
Original PapersPrevalence of phage types & biotypes among Salmonella Typhi and Salmonella Paratyphi A isolates from Rourkela, Orissa.
Address for communication :
Seshadri S Bhattacharya, Usha Das
Ispat General Hospital, Rourkela, Orissa.
Email: [email protected]
fever in India. However, isolation of Salmonella
Aim of this study was to highlight the changes in
enterica serotype Paratyphi A causing the same
prevalence of phage types encountered among
disease have been reported with an increasing
Salmonella isolates from Rourkela. Besides S.
Typhi as the main causative agent of enteric fever,
S.Typhi causing enteric fever since 1996, whereas
S. Paratyphi A has also been emerging with
isolation of S.Paratyphi A causing the same
increasing rate as the other causative agent of
disease has been encountered in this place since
enteric fever from different parts of India
including Rourkela. This retrospective study was
Phage typing is a major means of epidemiological
carried out between September 2005 and August
tracing as strains within a particular serotype may
2006 with 1454 patients attending out-patient-
be differentiated into a number of phage types,
departments (OPD) and wards of Ispat General
and may help to define groups of persons who
Hospital, Rourkela, India. Phage typing and
have been infected with the same strain from the
biotyping was performed for randomly chosen
same source. Again, combination of biotyping
isolates of S. Typhi (N=36) and S. Paratyphi A
with phage typing gives a finer discrimination of
(N=12). A distinctive change has been noticed in
strains in tracing out the source of infection. The
the prevalence of phage types compared to their
prevalence pattern reported earlier. Phage type
epidemiological tracing had been documented
40 was the most commonly encountered phage
since 1982 in different parts of India.
among S. Typhi isolates followed by type E1.
Phage typing and biotyping of both Salmonella
Susceptibility testing was performed for all 112
Typhi and Salmonella Paratyphi A had been
isolates of Salmonella including 48 strains chosen
reported from Rourkela in 2006 and 2007. There
randomly for phage typing and biotyping. Though
was a noticeable change in the prevalence pattern
4-5% of Salmonella isolates showed resistance to
of phage types encountered among S.Typhi
ciprofloxacin, they were highly sensitive to both
isolates in 2005-2006 in comparison to the phage
a m i n o g l yco s i d e s a n d t h i rd ge n e rat i o n
types found in 2004-2005. In this retrospective,
cephalosporins. Diversity among the phage types
hospital based study, we have highlighted the
changes in the prevalence pattern of phage types
probably due to the diverse origin of those
and biotypes among the Salmonella isolates
phages. Salmonella enteric serotype Typhi is the
chosen randomly. The susceptibility pattern of
most commonly occurring causative agent of
Salmonella isolates including the typed strains
have also been reported in this communication.
Materials & methods
Prevalence; Phage typing; Biotypes; Randomly
This study was conducted between September
chosen; Susceptibility testing; Diversity.
2005 and August 2006. A total of 1454 patients
attending out-patient departments (OPDs) and
Salmonella enteric serotype Typhi is the most
wards of Paediatric and Medicine departments of
commonly occurring causative agent of enteric
Ispat General Hospital , Rourkela, Orissa,
suspected of having enteric fever or pyrexia of
the patients, 768 were males (52.81%) and 686
unknown origin (PUO) were included in this study.
A total of 1454 blood samples were included in
Of 1454 patients, 112 were positive for Salmonella
this study. Irrespective of repeat sample we have
isolates giving a per cent positivity of 7.70. Of 112
taken into account only one sample from each patient. Only positive isolation was considered for
Host organism Phage type Biotype No. of isolates
the patients having both positive and negative
Clinical samples of blood were collected in brain
heart infusion broth with sterile precautions and
incubated aerobically at 37 C for 48 hours. Three
subcultures were done on blood agar, MacConkey
agar and Salmonella-Shigella agar and incubated
aerobically at 37 C for 18-24 hours. In negative
cases subcultures were done for one week.
Isolation of S. Typhi and S. Paratyphi A was
Phage types encountered among S. Typhi and S. Paratyphi
A isolates in Rourkela between September 2005 and August 2006.
Identification of these two serotypes was established by biochemical and serological testing
with factor sera. Antibiotic susceptibility testing
was performed by Kirby Bauer disk diffusion
method, with the modifications recommended
by the National Committee for Clinical Laboratory
Standards (NCCLS). Antimicrobials agents tested
were ampicillin, co-trimoxazole, chloromycetin,
gentamicin, amikacin, ciprofloxacin, cephotaxime
Randomly selected strains of both S. Typhi andS. Paratyphi A were sent to the National
Susceptibility pattern of S. Typhi and S. Paratyphi
Salmonella Phage Typing Centre, Lady Hardinge
A isolates in Rourkela between September 2005 and August 2006.
Medical College, New Delhi, India, for phage
Salmonella isolates, 92 were S. Typhi strains and
remaining 20 were S. Paratyphi A strains. Almost
75 per cent of isolates were from pediatric population, among which 52.38% were boys and
Out of 1454 patients, 1052 were children (72.35%)
and remaining 402 were adults (27.65%). Among
In 2004-2005, the predominant phage type
Host organism Phage type Biotype No. of isolates
encountered among S. Typhi strains was E1,
followed by phage type A (Table 1). In the present
study (2005-2006), predominant phage type
encountered among S. Typhi isolates was 40,
which itself is a rare and exotic phage type in India.
Second most common phage type of S. Typhi
isolates in this study was E1 and number of Vi-Negative strains was 4 (Table 2). In both the
studies mentioned, the predominant phage type
found among S. Paratyphi A strains was type 6,
Phage types encountered among S. Typhi ans S. Paratyphi
A isolates in Rourkela between September 2004 and August 2005.
followed by phage types of either 4 or 1.
Most of the phage types of S. Typhi isolates
phage type 40, which itself is a rare and exotic
belonged to biotype I, except for phage type 40
phage type of S. Typhi in India. It is worth
and USV-2. All the phage types of S. Paratyphi A
mentioning that two more rare and exotic phage
isolates belonged to biotype II (Table 2).
types of multi-drug resistant (MDR) S. Typhi strains, namely type 51 and type 28, caused
Ampicillin and chloramphenicol sensitivity among
outbreaks in Kolkata and Mumbai respectively,1,12
S. Typhi isolates was found very high in our study,
but in case of phage type 40, most of the strains
though 40-45% of S. Paratyphi A isolates showed
were not multi-drug resistant. Emergence of Vi-
resistance to these antimicrobials (Table 3).
negative strains among S. Typhi isolates in
Isolates of both S. Typhi and S. Paratyphi A showed
Rourkela was another important finding during
remarkably high susceptibility to gentamicin and
amikacin. Resistance to ciprofloxacin was 4-5% among the isolates of S. Typhi and S. Paratyphi A.
Till date, not many study-reports are available
Susceptibility to cefotaxime and ceftriaxone was
regarding phage typing and biotyping of S.
very high among the isolates of both S. Typhi and
Paratyphi A. A study among the patients (coming
from Indian subcontinents) in Kuwait reported that 66% of S. Paratyphi A isolates belonged to
Randomly chosen strains of both S.Typhi and S.
phage type I. Another study from Nagpur also
Paratyphi A for phage typing and biotyping were
showed that the prevalent phage type among S.
Paratyphi A isolates from the local population was
antimicrobials used in our study. Out of 36 isolates
type I. The most commonly encountered phage
of S. Typhi, only 2 strains showed resistance to
type of S. Paratyphi A isolates from Rourkela was
type 6, a finding which hardly got any other
cephotaxime. Out of 12 strains of S. Paratyphi A
contemporary reference in India. From 1992 to
randomly chosen for phage typing and biotyping,
2003, commonest biotype of S. Paratyphi A in
only 3 strains showed resistance to ampicillin, co-
trimoxazole and chloramphenicol. Interestingly,
phages of S. Paratyphi A belonged to biotype II.
all these 3 MDR strains of S. Paratyphi A belonged
S. Typhi strains isolated from Kolkata, Nagpur and
Phage typing is one of the most important means
accounted for 44.4% of S. Typhi isolates and
of epidemiological tracing. In 1982-89, the order
of frequency of phage types in north and central
Susceptibility pattern to ampicillin and
India was A, E, O, while in south the second chloramphenicol were very encouraging for
onwards , E1 became the most commonly phage
was not that much inspiring for S.Paratyphi A
type except in south India, where phage type O
isolates in this study. In this study, differences in
was the predominant type. In 1992, the order of
per cent susceptibility between S. Typhi and
frequency had become E1, O, A throughout the
country. However, there was hardly any report of
phage type O from any part of the country since
statistically significant (P<0.05), whereas for the
rest of the antimicrobials tested, differences in per
In our findings of phage types encountered among
cent susceptibility were found insignificant
S. Typhi strains from Rourkela, E1 was the most
(P>0.05). Although 4-5% resistance to
commonly occurring phage type in 2004-2005
ciprofloxacin among Salmonella isolates was a
matter of concern, very high susceptibility of
2005-2006. One strikingly different finding in
those strains to aminoglycosides (gentamicin and
2005-2006 study was the highest occurrence of
amikacin) and third generation cephalosporins
(cephotaxime and ceftriaxone) was highly
encouraging, and can be used judiciously in case
Churchill Livingstone, 1984: 456-81.
9. Baron EJ, Peterson LR, Finegold SM. Bailey
A diversity among phage types of S. Typhi isolates
and Scott s Diagnostic Microbiology. 9 ed.
has been noticed, though in case of S. Paratyphi A,
St. Louis, Missouri : Mosby, 1994 : 362-85.
mostly phage type 6 was encountered. This
10. Bauer AW, Kirby WM, Sherris JC and Truck
diversity of phage types observed in this eastern
M. Antibiotic susceptibility testing by a
part of India might be due to the diverse origin of
standardized single disc method. Am J Clin
these phage types. The diversity of origin of these
phages again may be due to the migration of
11. National Committee for Clinical Laboratory
population to and from Rourkela, an industrial
(steel) township, with respect to other parts of the
antimicrobial disc susceptibility tests, 6 ed.
country.6 Further studies are required regarding
the epidemiological tracing especially for the
National Committee for Clinical Laboratory
exotic phage type 40 of S. Typhi isolates.
12. Saha MR, Palit A, Chatterjee NS, Dutta P,
Mitra U and Bhattacharya SK. A prospective
1. Pillai PK, Prakash K. Current status of drug
resistance and phage types of Salmonella
Salmonella enterica serotype Typhi isolated
typhi in India. Indian J Med Res 1993; 97:
from hospitalized children in Kolkata, India.
Indian J Med Res 2003; 117 : 201-204.
13. Panigrahi D, Chugh TD, West PWJ, Dimitrov
Multidrug resistant Salmonella serotypes.
TZ, Groover S and Metha G. Antimicrobial
Indian J Med Microbiol 1999; 17(2): 88-90.
susceptibility, Phage typing and Plasmid
3. Sood S, Kapil A, Dash N, Das BK, Goel V and
Seth P. Paratyphoid fever in India. Emerg
paratyphi A strains isolated in Kuwait. Med
14. Tankhiwale SS, Agrawal G, Jalgaonkar SV. An
Pandey A, Dey AB. Drug-resistant Salmonella
enterica serotype Paratyphi A in patients
with enteric fever. Indian J Med Res 2003;
5. Bhattacharya SS, Das Usha. Occurrence of
15. Chopra GS, Basu SK and Bhattacharya SR.
Orissa. Indian J Med Res 2000; 111 : 75-76.
Present Phage types and Antibiotic susceptibility of Salmonellae. Indian J Pathol
6. Bhattacharya SS, Das Usha. A sudden rise in
16. Agarwal V, Brahmne RB, Dhanvijay AG,
infection in Rourkela, Orissa. Indian J Med
Antibiogram, phage types and biotypes of
7. Das Usha, Bhattacharya SS. Antibiogram,
Salmonella Typhi isolated in Nagpur. Indian J
phage typing & biotyping of Salmonella
17. Kumar R, Aneja KR, Punia AK, Roy P, Sharma
Rourkela, Orissa. Indian J Med Res 2006; 124
biotypes, phage types and drug resistance of
8. Sleigh JD, Duguid JP. Salmonella. In: Collee
Salmonella Typhi in Ludhiana during 1980-
JG, Fraser AG, Marmion BP, eds. Practical
1999. Indian J Med Res 2001; 113: 175-180.
A CCWHC Technical Bulletin: Drug Residues in Wild Meat – Addressing A Public Health Concern Veterinary drugs play a valuable role in wildlife management and research. They are usedwidely for a variety of reasons, in particular, the capture and restraint of wild animals (Table 1). However, the availability and use of veterinary drugs is threatened if government regulations or thepublic t
CASODEX® (bicalutamide) TABLETS DESCRIPTION CASODEX® (bicalutamide) Tablets for oral administration contain 50 mg of bicalutamide, a non-steroidal antiandrogen with no other known endocrine activity. The chemical name is propanamide, N-[4-cyano-3-(trifluoromethyl)phenyl]-3-[(4-fluorophenyl)sulfonyl]-2-hydroxy-2- methyl-,(+-). The structural and empirical formulas are: Bicalut