Dr. Ritu  Singhal  Md image

Dr. Ritu Singhal Md

320 Lennon Ln
Walnut Creek CA 94598
925 062-2442
Medical School: Other - 1997
Accepts Medicare: Yes
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: A106935
NPI: 1578521928
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Detection of multi-drug resistance & characterization of mutations in Mycobacterium tuberculosis isolates from North- Eastern States of India using GenoType MTBDRplus assay. - The Indian journal of medical research
Information on drug resistance tuberculosis is sparse from North-East (N-E) States of India. We undertook this study to detect multi-drug resistant tuberculosis (MDR-TB) among MDR-TB suspects, and common mutations among MDR-TB cases using GenoType MTBDRplus.All MDR suspect patients deposited sputum samples to peripheral designated microscopy centres (DMC) in North-East States. The district TB officers (DTOs) facilitated the transport of samples collected during January 2012 to August 2012 to our laboratory. The line probe assay to detect common mutations in the rpoB gene for rifampicin (RIF) and katG and inhA genes for isoniazid (INH), respectively was performed on 339 samples or cultures.A total of 553 sputum samples from MDR suspects were received of which, 181 (32.7%) isolates were found to be multi-drug resistant. Missing WT8 along with mutation in codon S531L was commonest pattern for rifampicin resistant isolates (65.1%) and missing WT along with mutations in codon S315T1 of katG gene was commonest pattern for isoniazid resistant isolates (86.2%). Average turn-around time for dispatch of LPA result to these States from cultures and samples was 23.4 and 5.2 days, respectively. INTERPRETATIONS & CONCLUSIONS: The MDR-TB among MDR-TB suspects in North-Eastern States of India was found to be 32.7 per cent. The common mutations obtained for RIF and INH in the region were mostly similar to those reported earlier.
Citrobacter infections in a tertiary care hospital in Northern India. - The Journal of infection
This prospective study was carried out to look for the frequency of isolation of Citrobacter species from clinical specimens and study their antimicrobial susceptibility pattern.Patients from whom Citrobacter species were isolated during routine diagnostic testing from January to December 2004 were included in the study. Isolates were identified by standard biochemical tests. Antimicrobial susceptibility testing was performed by disk diffusion method as per National Committee of Clinical Laboratory Standards (NCCLS) guidelines.Citrobacter species were isolated from a total of 205 patients. Infection was nosocomially acquired in 94.6% patients. One hundred eighty one (88.3%) patients had significant underlying illnesses. Culture yielded Citrobacter koseri in 185 (90.2%) and Citrobacter freundii in 20 (9.8%) patients. The distribution of isolates was as follows: urine (46.2%), respiratory tract (16.3%), blood (15.8%), pus (12.1%) and sterile body fluids (9.3%). Drug resistance was observed to be more in C. koseri as compared to C. freundii.Citrobacter infections are often nosocomially acquired, seen in patients with significant underlying diseases and isolates are commonly drug-resistant. Adoption of hospital infection control practices and a good antibiotic policy may prevent their spread.
Comparative in vitro activity of beta-lactam/beta-lactamase inhibitor combinations against gram negative bacteria. - The Indian journal of medical research
Currently, the use of beta-lactamase inhibitors in combination with beta-lactam antibiotics represents an effective measure to combat a specific resistance mechanism of beta-lactamase producing organisms. Knowledge about the susceptibility profile of bacteria to different combination agents available is essential to guide appropriate treatment of severe infections in hospitalized patients. The present study compares the in vitro activity of three commercially available beta-lactam/beta-lactamase inhibitor combinations (piperacillin/tazobactam, cefoperazone/sulbactam, ticarcillin/clavulanic acid) against beta-lactamase producing gram negative bacteria in a tertiary care hospital in north India.A total of 9004 consecutively isolated extended spectrum beta-lactamase (ESBL) producing gram negative bacteria isolated from various clinical samples from patients admitted to the All India Institute of Medical Sciences, New Delhi, from September 2003 to August 2004 were included in the study. These isolates were screened for ESBL production by the inhibitor based test recommended by the National Committee for Clinical Laboratory Standards (NCCLS). Antibiotic susceptibility testing was carried out by disc diffusion method as per NCCLS guidelines.Of the 9004 isolates tested, 3232 (35.89%) were sensitive and 568 (6.31%) were resistant to all three combination agents, and rest 5204 (57.80%) were resistant to at least one of the combinations. Susceptibility to piperacillin/tazobactam, cefoperazone/sulbactam, and ticarcillin/clavulanic acid was 81.37, 76.06 and 45.48 per cent respectively. Piperacillin/tazobactam exhibited significantly (P<0.05) greater antimicrobial activity against Pseudomonas spp., Escherichia coli and Klebsiella spp. compared to cefoperazone/sulbactam.Overall piperacillin/tazobactam was observed to be the best combination agent followed by cefoperazone/sulbactam in our setting. This difference in activities of these combination agents needs to be evaluated further by ascertaining their efficacy in clinical studies.
Species prevalence and antimicrobial susceptibility of enterococci isolated in a tertiary care hospital of North India. - The Southeast Asian journal of tropical medicine and public health
The present prospective study was carried out to determine the species distribution and antimicrobial susceptibilities of enterococci isolated from clinical samples in a tertiary care hospital of North India. Enterococcus species isolated from blood, urine, pus, sterile fluids and the hospital environment from October 2003 to January 2004 were identified by standard biochemical tests. Antimicrobial susceptibility testing was performed by the disk diffusion method as per NCCLS guidelines. Out of a total of 105 Enterococcus species recovered during the study period, E. faecium (42.90%) and E. faecalis (40.00%) constituted the predominant isolates. Enterococcus faecium was the commonest blood culture isolate while E. faecalis predominated pus and urine samples. Other species isolated were E. mundtii, E dispar, E. durans, E. avium, E. raffinosus and E. gallinarum. High-level aminoglycoside resistance was detected in 73.3% of isolates. Resistance to vancomycin, teicoplanin and linezolid was not detected. Prevalence of a wide variety of Enterococcus species in clinical samples together with their variable antimicrobial susceptibility patterns emphasizes the need for routinely carrying out detailed speciation and in vitro susceptibility testing of enterococcal isolates in the clinical bacteriology laboratory.
Unusual presentation of enteric fever: three cases of splenic and liver abscesses due to Salmonella typhi and Salmonella paratyphi A. - Tropical gastroenterology : official journal of the Digestive Diseases Foundation
Enteric fever is a multisystem disorder caused mainly by Salmonella typhi and Salmonella paratyphi A. It continues to be a major public health problem, especially in developing countries. Unusual presentations of Salmonellosis are rare. We report 3 such cases of young adult males, one of splenic abscess due to Salmonella typhi and one each of liver abscess due to Salmonella typhi and Salmonella paratyphi A. A brief review of the literature pertaining to the cases is also given.
Resistance to oxidative stress in a freshwater fish Channa punctatus after exposure to inorganic arsenic. - Biological trace element research
The biochemical toxicity of arsenic trioxide (AsIII) in a freshwater edible fish Channa punctatus has been studied on exposures ranging from 7 to 90 d. The arsenic concentration increased exponentially in liver, kidney, gills, and muscles of fish up to 60 d of exposure to arsenic. However, arsenic concentration in these tissues declined at 90 d of exposure. This relationship between period of exposure and concentration of arsenic in selected tissues suggests an adaptive response of fish to arsenic. Furthermore, exposure to arsenic-induced lipid peroxidation in these organs increased initially at 7 d of exposure; however, it decreased up to 60 d of exposure but increased again at 90 d of treatment. Values of reduced glutathione (GSH) reflected the observations of lipid peroxidation. The role of GSH in this adaptive response has been discussed.
Modulation of the lipopolysaccharide receptor complex (CD14, TLR4, MD-2) and toll-like receptor 2 in systemic inflammatory response syndrome-positive patients with and without infection: relationship to tolerance. - Shock (Augusta, Ga.)
The lipopolysaccharide (LPS) receptor complex consists of two interacting receptors (CD14 and TLR4) and an associated protein (MD-2). When engaged by LPS, as in gram-negative infection, this complex transduces a signal detected by MyD88 and passed onward by a cascade of the IRAKs, TRAF6, and NIK, resulting in activation of NF-kappaB. A similar cascade, mediated by TLR2, occurs with ligands derived from gram-positive bacteria. In vitro studies of human monocytes have shown that TLR4 mRNA is paradoxically upregulated in response to "tolerizing" doses of LPS. This study evaluated changes in vivo of blood monocyte CD14, TLR4, TLR2, and MD-2 mRNA by reverse transcription followed by real-time polymerase chain reaction in surgical intensive care unit patients and in normal controls. In addition cell-surface receptor expression of TLR2, TLR4, and CD14 was assessed by flow cytometry in patients and normal controls. Inflammation-induced acute tolerance to LPS was evaluated by ex vivo whole blood tumor necrosis factor alpha production and was significantly reduced in patients compared with controls, confirming LPS hyporesponsiveness. Monocyte mRNA and cell-surface receptor expression of TLR4 were increased 2.4-fold (P < 0.05) and 1.7-fold (P <.002), respectively, in patients compared with normal controls. Monocyte TLR2 mRNA, MD-2 mRNA and CD14 and TLR2 cell-surface expression were not significantly changed compared with controls. The present study suggests that the acute inflammatory condition associated with peripheral cellular LPS hyporesponsiveness is neither specific to prior infectious challenge nor can be ascribed to significant alterations in expression of the cell-surface LPS binding complex proteins.
Hereditary combined coagulation factor V and factor VIII deficiency: report of two Indian families from Varanasi. - Indian journal of pathology & microbiology
Hereditary deficiencies of blood coagulation factors usually involve a single protein defect. Herewith we are describing clinical features and laboratory approach for the diagnosis of combined coagulation factor V/VIII deficiency which we encountered in 3 patients from 2 unrelated Hindu families of Varanasi.
Microscopy as a diagnostic tool in pulmonary tuberculosis. - International journal of mycobacteriology
Tuberculosis continues to cast a huge impact on humanity with its high incidence and mortality, especially in developing countries. For tuberculosis case detection, microscopy continues to be indispensible, given its low cost, rapidity, simplicity of procedure and high specificity. Modifications have attempted to improve the sensitivity of microscopy which include: concentration methods such as centrifugation, N-acetyl cysteine-sodium hydroxide, bleach, ammonium sulfate or chitin. Furthermore, classical Ziehl-Neelsen (ZN) staining has been subjected to varying carbol fuchsin concentrations or replaced by Kinyoun staining, fluorescent microscopy or immune-fluorescence. Currently, light emitting diode fluorescence is recognizably the most plausible method as an alternative to ZN staining.Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.
Multidrug-resistant tuberculosis among different types of suspected cases: Study from New Delhi. - The Indian journal of tuberculosis
There are limited data of multidrug-resistant tuberculosis (MDR-TB) diagnosed in various patient categories by implementing Programmatic Management of Drug Resistant TB (PMDT) using line probe assay (LPA) from our country. Samples from presumptive MDR-TB from five districts of New Delhi were subjected to LPA from 1st October 2011 to 31st December 2014. The MDR-TB diagnosed in 4th & 5th month follow-up positives were significantly higher than other categories of the patients. Only 3/232 (2.2%) RIF resistants were diagnosed among smear negative re-treatment cases. The data suggest interim cost-benefit analysis of the program especially among smear negatives retreatment cases.Copyright © 2015. Published by Elsevier B.V.

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