Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

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Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : August | Volume : 4 | Issue : 4 | Page : 2702 - 2706

Screening For Asymptomatic Bacteriuria In Pregnancy: An Evaluation Of Various Screening Tests In Hassan District Hospital, India

GAYATHREE L *, SHETTY S**, DESHPANDE S R***, VENKATESHA D T****

Abstract

Objective: To study the prevalence of asymptomatic bacteriuria (ASB) in pregnant women who attended the Hassan District hospital, Hassan.
Method/Design: The group A- study group subjects were 900 pregnant women of any gestational age who attended the Obstetrics Department for antenatal care. The Group B (control group) consisted of 50 non pregnant women of the fertile age group. Midstream clean catch urine was used to screen for asymptomatic bacteriuria.
Results: Asymptomatic bacteriuria was prevalent in 6.2% of the 900 women who were evaluated in our study. Urine culture was the gold standard for the detection of asymptomatic bacteriuria. Gram’s stain of uncentrifuged urine was found to be the best among the screening tests which were evaluated. There was a higher prevalence of asymptomatic bacteriuria in the IIIrd trimester (61.77%) than in the IInd trimester (32.35%) and the Ist trimester (5.88%).
Conclusions: Screening for asymptomatic bacteriuria in all the three trimesters is necessary to prevent the dangerous complications which are associated with asymptomatic bacteriuria in pregnancy.

Keywords

Asymptomatic bacteriuria in pregnancy, urine culture, Gram’s stain, Escherichia coli.

Introduction
Asymptomatic Bacteriuria is a microbiological diagnosis based on the isolation of a specified quantitative count of bacteria in a properly collected specimen of urine from persons without signs or symptoms, who are referable for urinary tract infection (1). The term asymptomatic bacteriuria (ASB) is used when a bacterial count of the same species over 105/ml in mid-stream clean catch urine on two occasions is detected without symptoms of urinary tract infection. The apparent reduction in immunity of pregnant women appears to encourage the growth of both commensal and non-commensal microorganisms (2). Global prevalence of asymptomatic bacteriuria varies widely and in pregnancy, it is 1.9-9.5% (2).

It is well known that asymptomatic bacteriuria (ASB) indicates the active multiplication of bacteria in the urinary tract and 25% of the affected women are likely to develop acute pyelonephritis in the third trimester, if left untreated. Postpartum investigation is indicated when the urinary tract infection is recurrent (2), (3). The incidence of ASB varies from 2-10%, depending on the socioeconomic status of the patients (4), (5). In one antenatal study (6), in which 9.9% of women took part in at least one screening, the risk of onset of bacteriuria was highest between the 9th and 17th weeks of gestation. The 16th week is the optimal time for a single screen for bacteriuria, which has been calculated, based on the numbers of bacteriuria free gestational weeks gained by the treatment (6).

Importance Of Diagnosis Of ASB
Bacteria originate from the large bowel and colonize in the urinary tract transperineally. The most common infecting organism is Escherichia coli, which is responsible for 75-90% of bacteriuria during pregnancy. Other organisms that have been isolated are Klebsiella, Proteus, Coagulase Negative Staphylococcus and Pseudomonas (7).It is important to identify and treat the infected group, as 40% of the ASBs develop acute symptomatic UTI (8). A positive history of previous UTI may be almost as effective as screening, in predicting UTI in pregnancy (9). Also, there is a good evidence of an association between any type of UTI in pregnancy and sudden unexpected infant death (10).Relapse of UTI is the recurrence of bacteriuria caused by the same organism, usually within 6 weeks of the initial infection. Reinfection is the recurrence of bacteriuria with a different strain of bacteria, after successful eradication of the initial infection (11). Approximately 15% of the patients will have a recurrence during pregnancy and a second course of treatment should be given, based on repeat culture with sensitivity testing.

Material and Methods

This study was conducted from April 2007 to April 2008 in the Microbiology Department, Hassan District Hospital, which is attached to the Hassan Institute of Medical Sciences ; a tertiary care referral centre. Out patients attending the Obstetrics Department were recruited for the yearlong study. Institutional approval and approval from the Institutional Ethics Committee was taken prior to the study. Informed consent was taken from all the patients participating in the study after explaining the study details in the patient’s mother tongue.

Methods
The group A- study group subjects were 900 pregnant women of any gestational age who attended the Obstetrics Department. Only women who fulfilled the criteria of apparently normal health, without any signs or symptoms of UTI, were included in the study. The group B- control group subjects were 50 non-pregnant females of the age group of 18-45 years, without any symptoms or signs of UTI. Certain patients were excluded as per the exclusion criteria described below.

Exclusion Criteria
1) History of UTI symptoms (dysuria, frequency and urgency, etc).
2) Pregnancy induced Diabetes Mellitus/ Hypertension.
3) History of antibiotic therapy in the previous two weeks.
4) Pyrexia.
5) Known congenital anomalies of the urinary tract.
The study group was interviewed and the data was recorded in the approved proforma. The patient’s demographics included age, gestational age, education, socioeconomic status, occupation and parity.

Sample Collection And Processing
About 30ml of clean catch mid-stream urine samples were collected in 100ml sterile wide mouth containers with lids, after giving instructions to the patients regarding the sample collection. The samples were immediately transported to the laboratory and were processed within one hour. In case of delay, the samples were refrigerated at 4oC. The specimens were first processed in the laboratory for culture by the semi quantitative calibrated loop technique and then, other screening methods were performed, which were compared with the culture.

Culture Of The Specimen
The urine was cultured on blood agar, Mac Conkey’s agar and CLED agar. A loopful of well-mixed uncentrifuged urine was streaked onto the surface of the culture plates. Incubation was done aerobically at 35 oC for 18-24hrs. A minimum of 24 hours is necessary to detect uropathogens (12).Pure growth of ≥1×105CFU/ml of one organism was considered to be suggestive of significant bacteriuria. Pure growth between >1×103 and 1×105 CFU/ml was taken as doubtful significance and the culture was repeated, while pure growth of 1×103 CFU/ml was taken as insignificant bacteriuria. Mixed growth of two or more organisms was considered to be contamination (13). Significant bacterial isolates were identified by standard procedures and were subjected to antibiotic susceptibility by the Kirby Bauer’s disc diffusion method.

Gram’s Staining Of Uncentrifuged Urine
A loopful of uncentrifuged, well mixed urine was placed on a grease free slide and it was air dried. Then, the smear was stained by Gram’s stain and was observed under oil immersion. The presence of ≥1 bacteria/Oil immersion field in 20 fields correlated with the diagnosis of significant bacteriuria of ≥105 CFU/ml of urine (14).

Leukocyte Esterase Test And Nitrite Test
Evidence of a host response to infection is the presence of polymorphonuclear leucocytes in the urine. Because inflammatory cells produce Leukocyte esterase, a simple and rapid method that measures this enzyme has been developed. The nitrite reductase test is a screening procedure that looks for the presence of urinary nitrite, an indicator of UTI. Nitrite reducing enzymes that are produced by the most common urinary tract pathogens reduce nitrate to nitrite.13Uncentrifuged urine specimens were tested by the Colorimetric Combur-10 multireagent test (Boehringer Mannheim & Co.) for the presence of nitrite and leukocyte esterase activity. The manufacturer’s instructions were followed.

Statistical Analysis
P values were derived from standard statistical tables and t-values. T-values were calculated by the Student’s “t” test formula for means ± standard deviations of ages. Chi- square test (x2) was applied for t- value derivation, for comparison of the findings in the two groups.

Results

Age-wise distribution of the subjects in Group A and Group B is represented in (Table/Fig 1). There were 690 subjects from Group A in the range of 18 -25 years, whereas there were 24 controls in Group B, with mean ages of 21.59 ± 2.30 and 21.16± 4.24, respectively. In the age ranges of 26 -35 years and 36 -45 years, the mean of the ages and the number of subjects are also shown for both groups A and B in the (Table/Fig 1) (Table/Fig 1). There is statistical significance in the mean of ages of the subjects in both groups A and B, between the ages of 18-35 years. (P value< 0.05). Out of the urine samples from 900 pregnant women, 62 samples of urine (6.8%) and only 1 (2%) out of the 50 controls were positive for culture and had significant bacteriuria (ASB). The number of positive ASB cases in pregnant and non-pregnant women did not show any statistical difference (P value > 0.05) as per the results in (Table/Fig 4), which is shown above. Only 1 of the controls (2%) had significant ASB which was statistically insignificant. Escherichia coli emerged as the most frequent ASB with 32 cases (51.61%), followed by Proteus mirabilis with 9 cases (14.51%), Staphylococcus aureus and Klebsiella pneumoniae with 6 cases (9.67%) each, Acinetobacter spp., with 5 cases (8.05%), Pseudomonas aeruginosa with 3 cases (4.83%) and Enterococcus faecalis with 1 case (1.61%), as enumerated in (Table/Fig 3) and (Table/Fig 4). The control group showed only growth in 1 (2%) sample with Escherichia coli.Urine culture was taken as the gold standard, against which the comparison of various screening tests was done. Statistical formulas were applied and thus sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Gram’s stain of uncentrifuged urine showed a maximum number of true positives (56/62) and a high sensitivity of (90.32%). A minimum number of true positives were seen with the leukocyte esterase test (38/62), with a low sensitivity of 61.29%. The leukocyte esterase test showed maximum false positives (60/62) and a lower number of false positives were seen with the nitrite test (6/62), thereby decreasing and increasing the specificity of the leukocyte esterase test (92.84%) and the nitrite test (99.28%), respectively. Combined nitrite and leukocyte esterase tests gave a low sensitivity of 53.22%, but specificity and positive predictive value were 100%, since no false positives were wrongly identified. The above values are shown in (Table/Fig 5) Table IV and (Table/Fig 6) V respectively.

Discussion

Urinary tract infection (UTI) is one of the most common health problems in pregnancy because of the increase in the sex hormones and anatomical and physiological changes during pregnancy.15-17 The global prevalence of UTI in pregnancy is found to range from 1.9-9.1% as per literature. In our study, we found a prevalence of 6.8%, which was similar to a study in Iran (6.1%)(15) .Studies at Pakistan have showed a prevalence of 4.8% (16) , while Jayalaxmi et al in India showed a prevalence of 7.4% (17).We also found a higher (79.42%) prevalence of asymptomatic bacteriuria in lower socioeconomic groups, as in other studies (15),(16),(17). We found a higher prevalence of asymptomatic bacteriuria in the IIIrd trimester (61.77%) than in the IInd trimester (32.35%) and in the Ist trimester (5.88%) of pregnancy. Hence, we would like to recommend a routine screening for asymptomatic bacteriuria in all the three trimesters of pregnancy as an important measure, in order to avoid the complications of asymptomatic bacteriuria, as observed by Mc Isaac et al (18) , than a single occasion ASB screening in between the 9 and 16th weeks of gestation (6).

Escherichia coli was the most predominant organism in our study 32(51.61%), as reported in various other studies (16),(17). Numerous previous studies have established that the gold standard method for the diagnosis of UTI, as well as ASB, is the urine culture of midstream catch urine (13),(17),(19),(20). It is well known that various other routine screening tests can only poorly detect all culture positive bacteriuria cases in pregnant women (17),(19),(20),(21). In our evaluation of the screening tests like Gram’s stain of uncentrifuged urine, the Leukocyte esterase test and the Nitrite test, we found Gram’s stain of uncentrifuged urine to have a good sensitivity (90.30%), specificity (99.04%), and negative predictive value (98.28%) than other screening tests vis-a -vis urine culture (20),(23),(24). Though the nitrite test alone showed a good specificity (99.28%), it was less sensitive (70.96%) than Gram’s stain (90.32%). Combined Leukocyte esterase and Nitrite tests showed a good specificity (100%) than Gram’s stain (99.04%). Among the screening tests evaluated, we observed that Gram’s stain of uncentrifuged urine was the best screening method for ASB, as in other studies (17).Also, in our opinion, the Dipstick test for Leukocyte esterase and Nitrites can also serve as a rapid screening method for asymptomatic bacteriuria, as its sensitivity and specificity is nearer to that of Gram’s stain and the urine culture.

Conclusion

Asymptomatic bacteriuria was prevalent in 6.2% of the 900 women who were evaluated in our study. Urine culture remained the gold standard for the detection of asymptomatic bacteriuria. Gram’s stain of uncentrifuged urine was observed to be the best among the screening tests which were evaluated. Screening for asymptomatic bacteriuria in all three trimesters is necessary to prevent the dangerous complications which are associated with ASB.

Acknowledgement

We thank the patients who co-operated with us and the staff of the Obstetrics and Microbiology Departments of HIMS hospital. We are grateful to the Director, HIMS for encouraging our research.

References

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Antony J, Schaeffer & Edward .Campbell-Walsh Urology 9th Ed, Wein, Kavoussi, Novick, Partin, Peters Vol I, Saunders Publications ,2007;677-690
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Nicolle LE, Bradley S, Colgan R et al; Infectious Diseases Society of America guidelines for the diagnoses and treatment of ASB in adults. Clin. Infect. Dis 2005; 40:643-54.
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Dutta DC .Urinary Tract Infections.TB of Obstetrics, 6th Ed Reprint. New Central Book Agency (P) Ltd .India. 2006;78-90.
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Norden CW, Kass EH: Bacteriuria in pregnancy:critical appraisal. Ann. Rev. Med 1968; 19:431-70.
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Savage WE, Hajj SN, Kass EH. Demographic and prognostic characteristics of bacteriuria in pregnancy. Medicine (Baltimore) 1967; 46:385-407.
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Stenquist K, Dahlin-Nilsson I, Lidin- Janson G. Bacteriuria in pregnancy. Frequency and risk of acquisition. Am .J. Epidemiology 1989; 129:372-79.
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Davidson J& Bayles C: Medical disorder in Obstetric Practice. Ed by Michael de Swiet 4th Edition: Blackwell Publishing. Pg 198-267., 2002.
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Whalley PJ. Bacteriuria in pregnancy. Am. J. Obst. Gynaecol: 1967; 97:723-78.
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Chng PK, Hall MH. Antenatal prediction of UTI in pregnancy. Br. J. Obstet Gynaecol 1982;89:8-11.
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Gardner A. UTI in pregnancy and sudden unexpected infant death. Lancet 1985; 11:495.
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