WRITE A BETTER STORY OF YOUR LIFE 
Dr.T.V.Rao MD We all wish to be New with many matters, few try and very few succeed in the matters, little I made with the few great books, and in many classics many Authors have a reason to impress on many Read More Books, For me Books are wonderful for creating new thoughts and stimulating great ideas. I had a lot of vacuum with struggles the Jobs, never losing confidence in myself and the Job did it in my life. But several years ago, I started again reading fiction true stories related to life and living and histories. These stories really got me out of my daily headspace and activated my idea generator. Even if you can't make the time for a novel, go hunt down a bookstore on store and spend an hour browsing. You'll find plenty of thought stimulation. I realized life is a struggle to live and let live many around us, If I wish to know what is happening in the world how people just spending time the worth in life, If you wish to improve, At the end of reading a chapter analyze what is the true content which makes us to think, ON Structure and ideas in the book what breeds creativity. Simple exercises can get your brain working in a focused manner to yield great ideas I wish all professionals and even Medical men should never forget to read the life of HELEN KELLER, American educator Helen Keller overcame the adversity of being blind and deaf to become one of the 20th century's leading humanitarians, as well as co-founder of the ACLU S, true story As Keller grew into childhood, she developed a limited method of communication with her companion, Martha Washington, the young daughter of the family cook. The two had created a type of sign language, and by the time Keller was 7, they had invented more than 60 signs to communicate with each other. After college, Keller set out to learn more about the world and how she could help improve the lives of others. News of her story spread beyond Massachusetts and New England. She became a well-known celebrity and lecturer by sharing her experiences with audiences, and working on behalf of others living with disabilities. Helen Keller is story which inspires many Keller stood as a powerful example of how determination, hard work, and imagination can allow an individual to triumph over adversity. By overcoming difficult conditions with a great deal of persistence, she grew into a respected and world-renowned activist who labored for the betterment of others. Think about our lives we have plenty of TIME the great gift of GOD equal to all, think to read a new idea, which do NOT need money but great determination to improve our lives, why not we try. One of the most powerful realizations that you can have is you, through your choices, determine the direction of your life. Nature (genes) and nurture (upbringing, environment) will have a very powerful influence, but they do not determine your destiny. Your destiny is self-determined through your choices. It just means we are writing our future try life with great ideas, your something useful to many in the world.
JUST START LIVING WITH NEW IDEAS WRITE A BETTER STORY OF YOUR LIFE
Dr.T.V.Rao MD

THE PURPOSE WE LIVE IN THE WORLD- The life is a long process; however, the ups and downs will influence us to joyous or sorrowful. Every day is a challenge, no day is equal to other however we are influenced by our actions of the past and future is guided by present It is as impossible to live life without purpose as it is to accurately define the purpose for which you live Over many lifetimes, we accumulate many give-and-take accounts that are a direct result of our deeds and actions. In Hinduism, it is Karma and Dharma Hinduism says you are only the real account holder of all your actions, however none escaped. The accounts may be positive or negative contributions depending on the positive or negative nature of our actions. As a rule of thumb, in the current era approximately 70% of our lives are destined not within our control and 30% of our lives are governed by our own freewill. All major events in our life are by and large destined. These events include our birth, the family we are born into, the person or persons we marry, the children we have, serious illnesses and the time of our death. The happiness and pain that we give and receive from loved ones and acquaintances are by and large simply a case of prior give-and-take accounts directing the way relationships unravel and play out. Only by giving life a purpose can you make the best out of it. Just try to be limitless in fulfilling purpose of your life, and God certainly gives more opportunities Otherwise you can simply choose to be a slave to your job, your religion, and narrow circumstances we live. Good actions are certain to expand our purpose in LIFE
WE ALL CAN TRY ?
Dr.T.V.Rao MD

LABORATORY BIOSAFTEY IN EBOLA AND MAR BURG VIRUS SPECIMENS ,
Post graduate question in Microbiology - recent advances Given the nature of the work at the lab, CFIA said it's choosing stricter procedures to protect employees, including:

Enhancing the suit testing procedures.
Shortening the life cycle of suits to fewer than 5 years and even shorter for animal work.
Improving documentation and record keeping for entry/exit procedures from the lab.
Enhancing the training of bio containment Laboratory staff and improving the tracking system to monitor trainee BSL-4 builds upon the containment requirements of BSL-3 and is the highest level of biological safety. There are a small number of BSL-4 labs in the United States and around the world. The microbes in a BSL-4 lab are dangerous and exotic, posing a high risk of aerosol-transmitted infections. Infections caused by these microbes are frequently fatal and without treatment or vaccines. Two examples of microbes worked with in a BSL-4 laboratory include Ebola and Marburg viruses.
In addition to BSL-3 considerations, BSL-4 laboratories have the following containment requirements:
Laboratory practices
• Change clothing before entering.
• Shower upon exiting.
• Decontaminate all materials before exiting.
Safety equipment
• All work with the microbe must be performed within an appropriate Class III BSC , or by wearing a full body, air-supplied, positive pressure suit.
Facility construction
• The laboratory is in a separate building or in an isolated and restricted zone of the building.
• The laboratory has dedicated supply and exhaust air, as well as vacuum lines and decontamination systems.
Photo courtesy Where Art Meets Science: A Lens on the CDC HOW MICROBIOLOGISTS WORK WITH EBOLA VIRUS DECOMMISSIONED Biosaftey level four
Infectious Diseases
Dr.T.V.Rao MD Freelance reporter

LABORATORY HAZARDS WITH MYCOBACTERIUM TUBERCULOSIS - PREVENTION 
Dr.T.V.Rao MD 
A topic of interest for Diagnostic Microbiology graduates and postgraduates It was a opportunity to be moderator with Dr Chug MD at CARE HOSPITAL HYDERABAD and one living legend in Medical Microbiology, and I was enlightened to hear his lecture on incidence of Mycobacterium infections in the family members of the health care workers, apart from the infections to health care workers with hundreds of medical colleges in India few are lucky to work availability of Biosaftey , I never forget a open spat with a professor who assumes to be authority on tuberculosis with questionable authenticity who says that we need not much worry with tuberculosis otherwise science do not develop in our college, and I think this a tragic statement and hardly anybody supported my idea and the candidate working with the specimens was infected with tuberculosis, and ultimately no body to contest the happenings, 
Mycobacterium tuberculosis is definite health hazard and laboratory personal at greater risk M. tuberculosis is endemic worldwide and a leading cause of disability and death; an estimated one-third of the world’s population is latently infected with TB. Isolates which are multi-drug resistant (MDR-TB), being resistant to at least isoniazid and rifampicin, and extensively drug-resistant (XDR-TB) are complicating the treatment regimes for this disease. A global movement, the Stop TB Partnership, strives to create a tuberculosis-free world by 2050. Many initial infections with M. tuberculosis go unnoticed; only 5-10% of people infected with M. tuberculosis become sick or infectious during their lifetime.
Laboratory Acquired Infections
Laboratory acquired infections with M. tuberculosis are the fourth most commonly reported. Infection can result from accidental inoculation, exposure to aerosols and infectious droplets, ingestion, and direct contact of mucous membranes with infectious materials. . Additionally, infectious bacteria may survive in heat-fixed smears or be aerosolized during the preparation of frozen sections and during the handling of liquid cultures.
Laboratory Practices
The appropriate bio safety level (BSL) practices and facilities will depend on the biological material that the laboratory is manipulating. Bio safety level 2 practices and facilities, at a minimum, must be used for activities involving primary cultures of sputum and preparing smears from clinical material. As a result of the low infectious dose (10 CFU), specimens from suspected or known cases of tuberculosis must be considered as potentially Bio safety level 3 practices and facilities must be used when preparing or manipulating cultures and with experimental animal studies involving M. tuberculosis, or any subspecies of the M. tuberculosis complex Infections BSL-3 builds upon the containment requirements of BSL-2. If you work in a lab that is designated BSL-3, the microbes there can be either indigenous or exotic, and they can cause serious or potentially lethal disease through respiratory transmission. Respiratory transmission is the inhalation route of exposure. One example of a microbe that is typically worked with in a BSL-3 laboratory is Mycobacterium tuberculosis, the bacteria that causes tuberculosis. 
However it is expensive to buy the Biosaftey level 3 and many cannot afford however with few compromises we in India must start using the BSL 2 to save many in work area dealing with Mycobacterium with increasing MDR strain 
Microbiology departments are truly neglected and we take matters casual way as there are no regulations to help the laboratory personal working in the diagnostic Microbiology 
Resources and Post graduates to read more at 
Mycobacterium tuberculosis Environmental health and Safety – Iowa University 
CDC safety guidelines on Mycobacterium tuberculosis 
Photo courtesy CDC 1 Biosaftey level 2
Photo 2 Dr T.V.Rao MD on Google 
Photo 3 CDC resource Biosaftey level 3 
Dr.T.V.Rao MD Freelance reporter on Microbiology

A GREAT OLD MESSAGE FROM WILLIAM OSLER TO MEDICAL STUDENTS Today we live in a conflicting world WHERE PROFIT AND LOSS MATTERS than life, of course in many occasions, India has many great Doctors and Paramedics serve the society with LIMITED POSSIBILITIES Unfortunately the society is incited by Media and press Today the Medical profession under scanner, our Medical education under vigilance and we and every Doctor certainly at unease with life, and above all we have a mushrooming of Medical colleges, with falling standards , I am always in contact with my committed medical students , who continue to be torch bearers to the future of medicine, and always optimistic they carry the spirit of the profession It is time to remember the life as it matters to any one Justice Osler wrote his own epitaph, “that I taught medical students in the ward” He can still teach us today.
William Osler was not just a great man of his times but speaks to us today in the dilemmas that we face about a way of practice and life. Despite having no modern diagnostics and relying only upon his eyes, his stethoscope, and a microscope, his approach to diagnosis and of dealing with patients remains fresh and energizing to anyone who would open his volumes and read his writings. Living within the transition years that gave way to a new order of the ethical hierarchy, he certainly reflects more the paternalism of the day, but there is no one who has undergone the scrutiny of years without blemish as has Sir William. Osler keenly recognized that much of the practical aspects of what he taught would be overthrown within a decade, but the way he practiced and lived and the practice of “virtue ethics” remains undiminished. To understand what Osler has to say to us today, 100 years later, is to listen to his own “way of life”:
I have three personal ideals. One, to do the day's work well and not to bother about tomorrow…. The second has been to act the Golden Rule, as far as in my lay, towards my professional brethren and towards the patients committed to my care … and the 3rd has been to cultivate such a measure of equanimity as would enable me to bear success with humility, the affection of my friends without pride, and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man
Source - Can Osler teach us about 21st-century medical ethics?
Mark W. Millard, MD Proc (Bayl Univ Med Cent). 2011 Jul; 24(3) PMC
Shared by Dr.T.V.Rao MD

WHY TO IGNROE THE WORLD WE LIVE 
First they ignore you, then they laugh at you, then they fight you, then you win.
Mahatma Gandhi
No body happy with system today wherever we are placed, everybody has own self-interests and lack of interest to contribute in turn will creates many conflicts of interests however we cannot mend the system to our selfish interests and needs; A bad day is just a bad day. It comes and it goes. Choose not to make it anything more. You will find that it’s necessary to let some things go simply for the reason that they’re heavy on your heart and soul. However we need to work WITH dedication and commitment to change the system anyhow very few are committed to the job, today many of us live in zone of comfort. I was just reading a good conversation I’m sitting here thinking about the dozens of happy, successful people I know like him who ignore stereotypes, negativity, and naysayers, and go against the grain to make a difference by doing things their own way… the right way. It is highly we should learn the art of IGNORING many matters, so don’t fear the judgments of others; you know in your heart that you are and what’s true to you. You don’t have to be someone else to impress and inspire people. Unanticipated troubles are necessary evils that push you forward, because they eventually end, but the lessons and growth you gain from them last a lifetime.
Let them be impressed and inspired by the real YOU, Life is a beautiful circle. You’re strong because you know your weaknesses. You’re wise because you’ve been foolish. However many progress in life with megalomaniac attitude and system ignore them as incurable people. Behind every beautiful day, there has been some kind of struggle. You fall, you rise, and you make mistakes, you live, you learn. You’re human, not perfect. You’ve been hurt, but you’re alive. Think of what a precious privilege it is to be alive today – to breathe, to think, to enjoy, and to chase the things you love. Sometimes there is sadness in our journey, but there is also lots of beauty. You must keep putting one foot in front of the other even when it hurts, for you will never know what is waiting for you just around the bend. Keep your mind focused on the goodness, on the possibilities and on your most treasured goals. What begins in your mind ends up in your life, and many philosophies teach we alone create destiny thing big to do good things in life, rest all vanishes Think continually of the way you would like to be, let these thoughts drive your actions, and your reality will reliably catch up with your thinking. t’s OK to listen to others, but not at the full expense of your own intuition. When we are really helpless in the system try to concentrate on better things in life, Work on something that requires your concentration. Whenever I am surrounded by negative people I just read at least a positive though, and look at a helpless person how is thriving to live the system mere survival , Be sure that positive thoughts are portable, and demands the use of two hands and your eyes. This will make the other person think you are busy and will try to avoid interrupting you. Ignore the jealous, I ignore the malicious, I ignore the ignorant, and I ignore the paranoid, LIFE IS LONG TO LIVE WHEN YOU DO NOT THINK OF DOING BETTER THINGS IN LIFE. TODAY IS A WONDERFUL OPPORTUNITY TRY DOING SOMETHING TODAY – TOMORROW IS ??????? 
More at 9 Things Happy, Successful People Choose to Ignore
WRITTEN BY MARC CHERNOFF 
DR.T.V.RAO MD PROFESSOR OF MICROBIOLOGY FREELANCE WRITER

ion, However with the proliferation of Internet and Multimedia choosing what to teach is real questions which hunts many and teachers are as confused as our own students, Much of what students learn from their greatest teachers is not detailed on a syllabus, truly we should try our passion to learn and teach the matters and skills in a interesting and adoptable fashion. Making your classroom an exciting environment for learning will hold the students’ fascination, and students learn best when they are both challenged and interested. However in spite of digital resources and many advancing technologies and multimedia we need teachers as Teachers are founts of experience. Great teachers do it all.. Across all ages, languages, ethnicity, and subjects, teachers are, and need to be, some of the most widely skilled people around, in order to be successful Highly successful teachers made the pupil to face the realities of REAL TIME ISSUES,
Dr.T.V.Rao MD
,

RESEARCH PROCESS IN THESIS WRITING IN MEDICINE Dentistry AND NURSING
Dr.T.V.Rao MD Every Student in Medical, Dental and Nursing Profession who wishes to do a Post Graduate studies has to be competent to do a research related to his chosen ideas to improve his career , and can be benefiting the society. Today it is very important to think of improving the skills with your day to practices, and will be helpful if you can incorporate in your dissertation The greater challenge continues to be limitation with exploring the matters in humans, as the first principle is do no harm to the chosen patient, where the ethical issues to be addressed before one can proceed to perform the research, formulate and present before the competent authority to get the enrolled degrees, Any research done without documentation will be void so the presenting the research process remain the essential element in work. The scientific research process is a multiple-step process where the steps are interlinked with the other steps in the process and your interaction with many in the workplace ,a great art to be perfected
Medical postgraduates cannot spare longer hours on research alone they have many clinical responsibilities , However the Preclinical and para clinical will have much time to go into depth of the matters, and certainly put greater dedication to complete the process, When starting your research you may or may not have a clear question but by starting with an idea and formulating this idea into a question you will be able to review the literature already written on this topic which will likely help you to refine and narrow your questions or give you ideas for new research questions you may not have thought about previously.

A typical research process comprises the following stages:

1 Selecting the research topic You are expected to state that you have selected the research topic due to professional , career and personal interests in the area and this statement must be true. always try looking for new ideas than copying the old matters ,
2 Formulating research aim, objectives and research questions or developing hypothesis It is critically important to get your research questions or hypotheses confirmed by your supervisor before moving forward with the work. And you have to greater steps of Statistical formulation scientific committee and Institutional ethical committee, Sometimes going through all evaluations difficult but don't worry , it will teach many things research is the really difficult part of our education
3 Conducting the literature review. It can be mentioned that the literature has proved to be the longest stage in the research process Read through articles published in the recent past not more than 5 years, old however older literature help more in basic sciences as basics to human life remain more static than the clinical topics which are moving than one imagines,
4 Selecting methods of data collection Here comes true role of your Guide and Professors and co guides , It is certainly the responsibility of the guides and students should present the data at frequent intervals and get the log book signed.
5 Collecting the primary data- Primary data collection needs to be preceded by a great level of preparation and you should start discussing the matters with you statistician who can judge whether you are going in the right direction are not
6 Data analysis Try to analyse after completing at least 50 % of the research process as you still have Time to correct and try going to scientific and statistical committee, and valuable time can be saved if the matters go wrong
7 Reaching conclusions -Completing the research-The first draft of your dissertation needs to be prepared at least one month before the submission deadline. This is because you will need to have sufficient amount of time to address feedback of your supervisor or guide and who finally takes the responsibility of approving your thesis
Research Philosophy You need to specify the research philosophy of your study. Your research philosophy can be pragmatism, positivism, realism or interpretivism
Read more at Research Process- Research Methodology and changing trends in incorporating research in education

Dr.T.V.Rao MD
Chairperson IEC Azeezia Medical Institutions Kollam Kerala

TESTING VANCOMYCIN RESISTANCE WITH DISC DIFFUSION METHOD- Is the disk diffusion technique still a valid technique for studies of antimicrobial susceptibility with Vancomycin?
Dr.T.V.Rao MD TOPIC OF INTEREST TO POST GRADUATES IN MICROBIOLOGY
Since the late 1980s, strains of vancomycin-resistant enterococci (VRE) have emerged as significant causes of nosocomial infections and colonization's with increasing frequency in every part of the world We all at many laboratories test the Vancomycin resistance by Kirby Bauer methods and report as sensitive or resistant, It was way back that a published research by JANA M. SWENSON,*et al JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 1989,reported we noticed that for several strains of the enterococci we had tested, MICs of vancomycin were 8 to 16 ktg/ml, yet the strains looked susceptible with the disk diffusion test, with zones of 17 to 18 mm (unpublished data). Because of this and because of the apparent current increase in vancomycin resistance, we initiated studies to determine whether the standard disk diffusion test yielded accurate results for vancomycin and enterococci. The published research in 1988 stands good today, that we are truy missing the resistance in Vancomycin by doing a disc diffusion testing and reporting, it certainly matters in patients with enterococcal infections producing a Bacterial endocarditis, Staphylococcus too have become much restiance to Vancomycin and we lack facilities to do MIC for all the isolates as it stands it today to think about improvements in antibiograms with testing of Vancomycin
Testing for Vancomycin Susceptibility
The current CLSI recommendation is that MIC tests should be performed to determine the susceptibility of staphylococci to vancomycin. The disk test does not differentiate vancomycin-susceptible isolates of S. aureus from vancomycin-intermediate strains.
Disk diffusion will detect S. aureus isolates containing the VanA vancomycin-resistance gene (VRSA). These isolates will show no zone of inhibition around the disk (zone = 6mm); their identification should be confirmed. Isolates producing vancomycin zones > 7mm should not be reported as susceptible without performing a vancomycin MIC test.
Recommended methods are CLSI Broth Microdilution, Agar Dilution, and Etest® with inoculum prepared to match McFarland 0.5 turbidity standard. The Etest® is considered the most discriminatory of these methods as it allows for visualization of small colonies around zones of inhibition. A pure culture MUST be used. Repeat test for confirmation.
The CLSI recommends that the inoculum should be prepared using the direct suspension method and plates incubated for a full 24 hours in ambient air at 35° C.
Screening for vancomycin resistance in Staphylococci (MIC > 8 µg/mL) can be performed utilizing a vancomycin agar screening plate – BHI (brain heart infusion) agar containing 6 mg/mL vancomycin. However testing on BHI screening agar does not reliably detect all vancomycin intermediate S. aureus strains.
USE OF VITEK 2 We are all much progressing with use Vitek 2 as, Vitek systems have been widely adopted by many microbiology laboratories for the rapid identification and determination of susceptibilities of pathogens, including VRE strains. In order not only to treat VRE-infected patients but also to implement appropriate control measures to prevent the spread of VRE strains, rapid and accurate identification of VRE-colonized patients is essential. N. Yamane et al. evaluated several automated methods, such as the Microscan conventional- and rapid-panel methods and Vitek GPS-TA cards, and found that every automated method tested was shown to yield a high error rate. Recently, H. P. Entdz et al. pointed out that newly developed Vitek GPS-101 cards with 45 wells have been significantly improved and that they successfully detected all of the VRE strains with the vanB genotype tested (15 out of 15 strains)
References and Microbiologists to learn more from
1 Problems with the Disk Diffusion Test for Detection of Vancomycin Resistance in Enterococci JANA M. SWENSON,* BERTHA C. HILL, AND CLYDE THORNSBERRY Antimicrobics Investigation Branch, Hospital Infections Program, Center for Infectious Di JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 1989, p. 2140-2142
2 Online laboratory continuing education for clinical laboratories and med techs
3 Limitations of Vitek GPS-418 Cards in Exact Detection of Vancomycin-Resistant Enterococci with thevanB Genotyp Tadashi Okabe1J. Clin. Microbiol. June 2000 vol. 38 no. 6 2409-2411 Dr.T.V.Rao MD Professor of Microbiology

What it means the word enrich “To make fuller, more meaningful, or more rewarding” The life is a continuous process to live and survive and few of us find joy of living in the world with full of conflicts, and competition everywhere. Education in life is about understanding, Training is about putting what you know into practice. Enriching means what we know is the best of art to survive and popular. Education in life is about understanding. Training is about putting what you know into practice. I find trying every day for betterment with enrichment is my real goal in life made many of my efforts to succeed. First we must find some sense of balance and well-being, then you can continue on a lifelong adventure of enrichment. One of the most wonderful aspects of living from the heart is how it enhances the positive-feeling textures of life. When my heart is open, life tastes better, the roses in the garden look more vibrant, the family members look dear the scents of trees are sweeter and the warm-warmheartedness of friends touches me more deeply.
Once we are settled in a safe, comfortable home, and are working at developing hopefulness and appreciation in your life, it will be much easier to begin to enrich our life, however our basic needs must be met first, then you can build on and enrich your life. Many teachers have many conflicts than many educated people with more narrow circumstances they live. just try Educate yourself - read more and learn more, educate yourself about important issues .Indulge your creativity - paint, write, draw, take photographs, sculpt, draw your ideas, design or decorate your home or anything, let your creative side run free, just something new with your computer and put your ideas to many for betterment. It really helped me to develop many talents with my little computer I made many programmes to benefit many Medical communities. Never forget our creative ideas are immortal and naturally you have many followers, and many competitors, it is fine? I have many challenges and competitors however which inspires for my betterment. There are no absolute ideas about betterment everyone is different, and what may be enriching to one person may be simply boring or even harmful to another - don't let anyone force you into their way of enrichment or betterment if it doesn't feel right to you. Inside of each of us is a thinker and a poet, let them out sometimes, let them have outlets, they can benefit every other area of your life. Follow your own path, learn to trust yourself, learn to listen to your own conscience - it will usually help to guide you to enrichment. When you find you cannot do much to progress, start with a new life Through learning to reconnect with your heart by putting your heart qualities like love, appreciation, compassion, and forgiveness, you reactivate your spirit, which increases the feeling textures of your experience, bringing you more positive feelings, such as joy and happiness. Just read a quote by Oscar Wilde "Ordinary riches can be stolen, real riches cannot. In your soul are infinitely precious things that cannot be taken from you." JUST PUT YOUR HEART TO THE WORK YOU DO AND YOU HAVE MADE IT?
Dr.T.V.Rao MD Professor of Microbiology Freelance writer

LABORATORY ERRORS - THINK BEFORE YOU SIGN 
Dr.T.V.Rao MD “Error is Human and Correction is DIVINE ” –Health care services have benefited from countless technological advances and truly laboratory medicine contributed the best that, if on the one hand contribute to a better quality of life, on the other hand increased the risk of incidents that lead to unnecessary harm to patients: the adverse events (AEs) Recently there were great discussions who will sign the Laboratory reports it only clarifies the administrative and regulatory issues, it is certain that everyone fights for the rights, for survival. We have no regulatory authority truly functioning on Laboratory matters IT WAS FREE FOR ALL, whatever said and done laboratories are areas most prone for errors, Laboratory testing is a highly complex process and a clinician can diagnose a complex case with great experience and we cannot perform laboratory test without right reagents and well-trained technologists, although laboratory services are relatively safe, they are not as safe as they could or should be. Although tens of thousands of people around the world suffer harm, many times disabling, and even die because of unsafe acts in health care, little is known about frequency of occurrence Clinical laboratories have long focused their attention on quality control methods and quality assessment programs dealing with analytical aspects of testing. Today many wish to get credited with NABL / NABH assessments However, a growing body of evidence accumulated in recent decades demonstrates that quality in clinical laboratories cannot be assured by merely focusing on purely analytical aspects, Our system of working truly lacks many matters and materials and many complain on ac-creditors are more documentation evaluators than many realities, and several shortages has a regular process, I wish to restrict to Diagnostic Microbiology Defining an error means Many mistakes in the Total Testing Process are called "laboratory errors", although these may be due to poor communication, action taken by others involved in the testing process (e.g., physicians, nurses and phlebotomist s), if we look at the laboratory requests at least 70% of the requests do not contain any information for the purpose of testing and their provisional diagnosis, or poorly designed processes, and many times in teaching hospitals the student nurses are assigned to collect the specimens and ultimately Microbiology reports are erratic results when an improper specimen is collected all of which are beyond the laboratory's control. We send many requests to send the specimens with few clinical details, and it rarely works even in teaching hospitals at the end there is evidence that laboratory information is only partially utilized. Some clinicians do not remember they requested the tests, and in due process the matters become casual, Iam sincere at least 50% of the laboratory results are not even collected, However we also become indifferent and used to clear the accumulated reports and odd intervals, When I was a House surgeon in 1972 it was the duty of us to collect the reports from laboratory and present before our learned teachers, It is certainly happening in many good Institutions
A lot of people strive to make their microbiology laboratory “error free”. Whilst this could be said to be an admirable goal, maybe we need to think about what we wish for a little further. A progressive laboratory is going to make errors. You cannot introduce a new software system into the lab without making mistakes. You cannot develop a new assay without going through a teething process. You cannot develop an electronic requesting system without going through a lot of trial and error first.
METHOD TO CORRECT THE ERRORS - Recent document from the International Organization for Standardization (ISO) recommends a new, broader definition of the term "laboratory error" and a classification of errors according to different criteria. In a modern approach to total quality, centered on patients' needs and satisfaction, the risk of errors and mistakes in pre- and post-examination steps must be minimized to guarantee the total quality of laboratory services According to norm ISO 22367:2008(8), identification of errors or incidents must be made through reviews of internal audits, incident notification reports, improvement opportunities and prospective processes of risk analysis. Further investigations aimed at increasing knowledge about impacts of laboratory errors on patient safety must suit concepts on actual and potential AEs, as well as their severity, to the International Classification for Patient Safety of WHO. (at least with this earlier document we can make matters work in orderly fashion)
BEST CHOICE TO LIVE WITH OPTIMISM IN LABORATORY MEDIICNE - Of course we should try and anticipate where errors might happen, as well as analyzing ones that have occurred in order to reduce the chances of them happening again We certainly cannot improve by blame game as Microbiology is system needs many materials, agents, and above all humans to produce the desired results In the laboratory setting we also have to make a lot of decisions every day, and of course mistakes will be made. When they are made it is important to first ask, “How can we stop this happening again”, before even considering “Who?”.
I WISH LABORATORIES CERTAINLY IMPROVE IF WE HAVE TALENTED MINDS THAN GOSSIPING TONGUES IT IS TRULY THE PROBLEM IN MANY TEACHING HOSPITALS? I MANY BE CORRECTED IF I AM WRONG,
-
Ref 1 Errors in clinical laboratories or errors in laboratory medicine? Pub MED
Ref 2 Laboratory errors, adverse events and research methodologies: a systematic review Wilson ShcolnikI; Walter MendesII Jornal Brasileiro de Patologia e Medicina Laboratorial On-line version ISSN 1678-4774
3 “The paradox of the error free laboratory…” Microbiology matters Michael
Dr.T.V.Rao MD Freelance reporter on Infectious diseases,

THE STORY OF HAND WASHING
DR.T.V.RAO MD
Ignaz Philip Semmelweis (1818-1867) championed the importance of hand washing among the medical professional. Yet there is no other procedure which is simple and cost effective in preventing the spread of infections in hospital environment. Throughout the nineteenth century, physicians were realizing the value of soap as a medicinal agent. In the History of Medicine,A well-known protagonist of soap was scientist and educator Ignaz Phillipp Semmelweis, who in 1847 discovered the infectious etiology of puerperal fever and therefore required medical students to wash their hands before they examined patients. Semmelweis encouraged his colleagues to adopt his antiseptic methods, telling them, "while we talk, talk, talk, gentlemen, women are dying. I am not asking anything world-shaking. I am asking you only to wash.… For God's sake, wash your hands." In a circular handed out in Budapest during the summer of 1865, he implored new mothers: "Unless everything that touches you is washed with soap and water and then chlorine solution, you will die and your child with you!" It is utmost important duty of every medical, paramedical and nursing staff to educate, promote and monitor hand washing. In spite of more than a century of knowledge many times, this simple procedure is ignored by the many senior staff. The simple procedure of hand washing is the best prayer in prevention of infections in a hospital, continues to be the best remedy in reducing the hospital acquired infections.
The basis of spread of infections in hospital is that microbes are commonly exchanged from patients to patients, patients to medical staff and medical staff to patients
In the above methods of spread our hands play a great role in transmission of infections. By simple procedure of hand washing the chain of events in spread can be minimized.
Methods of hand washing
1. Social hand washing
2. Hygienic hand washing or disinfection
3. Surgical hand washing
1. Social hand washing
Most commonly practiced procedure involves vigorous mechanical friction applied to all surfaces of hand using simple plain (toilet) soap and water for 15-20 seconds. If no running water is available store water in a clean container, close lid and only necessary amount drawn to the needs with a clean mug. After washing, dry hands with tissue paper or a clean towel. Never use a common towel as the very purpose of washing is lost when you do a clean procedure on the patients.
2. Hygienic hand washing and disinfection
Hand washing using a disinfectant as 4% chlorhexidine gluconate- detergent or Povidone- Iodine detergent solution (containing 0.75% available Iodine and alcohol) is preferred.
The following types of alcohols can be added such as Ethanol- 70% or Isopropanol-70% to 0.5% chlorhexidine or povidone.
3. Surgical hand washing
Hand washing practiced more intensely, usually done before surgical procedures or any interventions.
Soap/ liquid detergent used with warm water. Washing extends up to elbow apart from washing fingers and palms. Practical Tips in Hand Washing
Use soap and water (if possible mild warm water) Vigorously rub your hands together until you have generated lather.
Scrub your wrist between your fingers, under our nails, around the tips and palms of the hands, practice this for 15-20 seconds and rinse and dry your hands with clean towel.
In view of configuration of hands certain areas of the hands are relatively less cleared of microbes than other surrounding areas.
Common infections spread by unclean hands:
1. Drug Resistant Staphylococci
2. Clostridium spp.
3. Salmonella, E.coli, Shigella, Hepatitis A&E.
4. When you are working in ICU and ICCU the patients are invariably on broad spectrum antibiotics and colonized with multi drug resistant bacteria. Your dedicated effort in hand washing will save the lives of serious patients, from infection.
5. In the era of AIDS and Hepatitis B infection all the blood and body secretions are identified as health risk to all medical/paramedical staff. Hand washing is included as primary importance in the universal precautions.
6. Wearing a glove is not a total protection in handling infectious cases. Even the new gloves contain micro holes. Washing is equally important after you remove gloves.
. Your children can be effectively protected from infection if you teach simple hand washing, even in school after attending a toilet or before taking food. It is observed that in schools with good washing facilities the children are less likely to be sick with infection from communicable diseases.
Our goals in hand washing promotion Experience has shown that most effective way to increase hand washing is to have physicians, surgeons, senior paramedical staff and other respected individuals as role Most experts in infection control and epidemiology maintain that hand washing remains the most powerful defense against infections. Microbes are all around us, and can spread anywhere: the office phone, door handles, shopping baskets, money, even the button you push when you call for an elevator. You can unknowingly come into contact with germs. One simple rub of the eye or bite of a sandwich using unwashed hands can introduce any number of illnesses into your body. Teaches to consistently wash their hands and encourage others to do so, means everybody has a role.
Social hand washing is also an important procedure to be explained to all the patient attendants. As even attendants get infected while serving and may take home the infection or bring some infections from outside when they attend the patients.
Dr.T.V.Rao MD Professor of microbiology Freelance writer

BETTER CHOICES TO LIFE -Modernity brought many great things and comforts, and life remain the same in depth of thinking and more spice of fear is added to everyone losing the present status of comfort zone, Stress continues to be the most ingredient added to every one's life as said “Don’t fear failure so much that you refuse to try new things. The saddest summary of life contains three descriptions: could have, might have, and should have.” Learn to think, speak, and live as an abundant person. Turn off the news. Today much of new channels are Views and conflicts with self interests and rarely contain positive sense to live better, try not forgetting to Eliminate negative people from you life, they are born to destroy the better things in life, Celebrate what you have. Be generous. The good religious teaching are what you give the world certainly comes back to you in many forms, as we see today many rich live a pitiable miserly life do die in poor state, and do not know whom the wealth belongs 
Focus your attention on being ready, willing, and prepared for the beauty, wonder, connections, good fortune, and favorable circumstances that are yours if you are willing to work and be open to it.you have the power to do what it takes to break through any obstacles that stand in the way of yourself, your dreams, and your happiness. We are fortunate as Doctors and teachers give in hope to many in trying circumstances, creating HOPE never costs anything but initiates hope for many success in life Not to forget as said Eleanor Roosevelt “The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.” ―
Dr.T.V.Rao MD

MICROBIOLOGICAL (ENVIRONMENTAL) SURVEILLANCE IN HOSPITALS -
Postgraduate question in Public Health Nursing IN EUROPEAN UNION Most common question to health care workers what are the best practices to keep the Hospitals hygienic and safe for the patients, who live in environment for the prolonged periods.The Protocols associated with scientific surveillance and decontamination of surfaces with chemical disinfectants Several monitoring strategies exist, which range from simple visual inspection, to microbiologic testing of surface contamination, to technologic innovations that measure the adequacy of surface cleaning. As the variety of options for cleaning, disinfecting, and monitoring grow, hospitals are faced with many choices, but limited evidence exists on the comparative effectiveness of these interventions, especially related to HAI rates within the hospital. This Technical Brief is designed to summarize and map the current evidence base addressing EC to prevent HAIs and highlight future research needs
Surveillance- Microbiologic Methods
Microbiologic methods have been used to evaluate microbial contamination of environmental surfaces. Methods typically utilize swab cultures, in which a moistened sterile swab is used to sample a surface and then inoculate agar, often with broth enrichment. Swab cultures are easy to use and are often used to sample irregular surfaces, medical equipment, and healthcare workers’ hands. Swab cultures are most often used to identify specific pathogens during epidemiologic investigation of an outbreak We do in instances when there are outbreaks of infections with MRSA VRE and MDR associated enterobacteriaceae . Importantly, the use of aerobic culture (with or without enumerating colony counts) is the only method that can provide information about the viability of our pathogens of interest (e.g. MRSA, VRE). Another method for sampling is the use of Rodac contact plates, which are small petri plates filled with agar. Sampling of flat environmental surfaces is performed via direct application of the plate to the surface, with the surface area typically measuring 25 cm2 . Advantages of contact plates include ease of use and standardization of an approach for quantitative measurement (e.g., results are often expressed as colony-forming units per cm2 ). However, contact plates can be expensive and allow for sampling of only a small area per plate. We in many teaching Hospitals use 9 cm petri dishes embedded with blood agar and they are exposed to specified time and yet many matters are arbitrary and not calculated to utmost precision
An overall limitation of methods utilizing ACCs is the lack of accepted criteria for defining a surface as “clean” using ACCs. Additional limitations include the cost of processing (e.g., identifying isolates in the microbiology laboratory), delay in results, small sample area per swab or slide, and the need to determine precleaning levels of microbial contamination for each object or surface being evaluated. In addition, clinical microbiology laboratories do not always perform quality-control assessments in use of ACCs, including maintenance of certification for environmental microbiologic testing. As such, testing using microbiologic methods for environmental monitoring in the hospital setting could benefit from oversight by a certified environmental microbiology laboratory.
NEWER TECHNOLOGIES IN SURVEILLANCE Polymerase Chain Reaction–Based Technology Polymerase chain reaction (PCR)–based assays for assessing EC are currently investigational. PCR-based assays offer rapid turnaround time for detecting the presence of specific organisms (e.g., MRSA, C. difficile) and are performed in the microbiology laboratory following sampling of surfaces, usually via swabs. However, these assays currently do not differentiate between the presence of viable versus nonviable microorganisms. As these technologies become less expensive, they may have a larger role in assessing effectiveness of cleaning and disinfection, particularly in the outbreak setting.
A wide variety of cleaning agents and disinfection technologies are commercially available, each with potential benefits and disadvantages. Additionally, hospitals often monitor the quality of room cleaning and disinfection to ensure that surfaces have been treated appropriately
Assessing Contamination Following Environmental Cleaning
Clinical and environmental services staff are faced with distinct challenges as pathogens are capable of surviving for prolonged periods of time on environmental surfaces and may be transmitted to new room occupants following discharge of colonized or infected patients, even when terminal cleaning has been performed. Effective strategies must therefore be put in place to assess the effectiveness of environmental cleaning and disinfection in healthcare settings to reduce HAIs.
Yet most of developing countries lack resources to studies at regular basis and matter are evaluated whenever there is a higher incidence of hospital associated infections

Health care workers and Microbiologists should read from extensive article with best resources for research and hospital safety
Environmental Cleaning for the Technical Brief Number 22 Prevention of Healthcare-Associated Infections Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov
Dr.T.V.Rao MD Freelance reporter on Infectious Diseases

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DO WE NEED A ANTI-BACTERIAL SOAP / CHEMICAL DISINFECTANTS AND HOT WATER TO WASH HANDS IN DOMESTIC/SOCIAL/ AND ROUTINE USE - 
Dr.T.V.Rao MD It was a occasion to share the thoughts with one of the post graduate Nursing student from US
TWO QUESTIONS
1 IS IT AN ABSOLUTE NECESSITY TO USE ANTIBACTERIAL SOAPS AND LIQUIDS IN DOMESTIC/ AND SCHOOL USE
2 DO WE NEED HOT WATER TO WASH OUR HANDS Now many believe that we should use a Antibacterial soaps to kill the germs on our hands, forgetting the antibacterial soaps kills many normal flora which are living in harmony with us and certainly helping to prevent colonization of pathogens on our healthy skin , Today, more than 75 percent of liquid soaps available in our departmental store aisles contain some type of antibacterial ingredient. Although triclosan is the most common, some antibacterial products contain alcohol, chloroxylenol ,( DETTOL )benzalkonium chloride and other antibacterial agents,. And so much advertised in multimedia TV impressing the audience to use Antibacterial soaps and antiseptic solution,
Regular Soap
Regular soap is designed to decrease water’s surface tension and to lift dirt and oils off the surfaces so that it can be easily rinsed away. Though regular soap does not contain added antibacterial chemicals, it is effective in getting rid of bacteria and other germs.
Pros of Regular Soap
Antibacterial soaps are no more effective than regular soap and water for killing disease-causing germs, ( CDC.)
Regular soap tends to be less expensive than antibacterial soap and hand sanitizers.
Regular soap won’t kill healthy bacteria on the skin’s surface.
Cons of Regular Soap
People may not wash hands thoroughly enough for regular soap to kill pathogenic bacteria.
FDA Clarifies
The FDA has said there is “no evidence” that antimicrobial soap products keep people healthier than regular soap. The agency now requires manufacturers of antibacterial products to prove the chemicals are safe for long-term daily use and that they do a better job of keeping people well than washing hands with regular soap and water. Overuse of antibacterial products can reduce the amount of healthy bacteria on a person’s skin, which can make antibiotics less effective in the fight against new strains of bacteria, called superbugs
If you use any Antibacterial for regular hand washing reduced the normal flora and encourages the pathogens and drug resistant bacterial pathogens
DO WE NEED HOT WATER TO WASH HANDS -. The US Food and Drug Administration, for example, requires that restaurants have sinks that deploy water that’s at least 38°C (100°F) for their employees However we do not get the facility in much of our wash room in restaurants and in Hospitals too .But hot water doesn’t clean hands any better than H2O at tepid temperatures—at least according to new research (paywall) from scientists at Rutgers University.When you’re washing your hands, water temperature doesn’t matter as much as scrubbing time
The only factor that does seem to matter is how much time you spend scrubbing.
SOAP WATER AND COMMON SENSE AND THROUGH WASHING MATTERS THAN MANY CHEMICALS USED UNNECESSARILY
The US Food and Drug Administration on Friday banned several key chemicals in hand soap, warning of health risks and saying they were not more effective than ordinary soap. The FDA move took aim at 19 ingredients including the two most common, triclosan and triclocarban, which are widely included in liquid and bar antibacterial soaps despite fears they damage the immune system. “Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water,” said Janet Woodcock, director of the FDA’s drugs division. “In fact, some data suggests that antibacterial ingredients may do more harm than good over the long-term.” The ban does not include hand disinfectant products used in hospitals and other medical centers, the FDA said.
Certainly we are spending so much on Antibacterial soaps and solutions without the true rationalism, However we have no controlling authority to put the matters in order
Irrational use OF disinfectants for hand washing certain to create many SUPERBUGS
Many Modern schools are discouraging the students to carry their own disinfectant hand washing solutions to promote traditional hand washing with soap and water
MILLIONS OF RUPEES ARE WASTED IN INDIA ON UNNECESSARY USE OF ANTIBACTERIAL HAND WASHES
Ref Antibacterial Soap vs. Regular Soap: Which One Is Better?
by Blank Children's Hospital Blank Children's HospitalDes Moines, IA 50309
2US bans antibacterial soap chemicals over health risks Posed

DOCUMENTATION AND AUDITING OF INFECTIONS IN INTENSIVE CARE UNITS
A postgraduate topic for Microbiologists , Critical care specialists
Dr.T.V.Rao MD
Infection is a major cause of morbidity and mortality among patients admitted in intensive care units (ICUs). The application of the principles and the practice of Clinical Microbiology for ICU patients can significantly improve clinical outcome..Today there is growing awareness on Multidrug resistance in bacterial and fungal isolates, in Critical care patients, and many times the cause of death is multiorgan failure can be mostly due drug resistant pneumonia, the situation no different in developing and developed world, We in India even in Teaching Hospitals have few resources, Nosocomial infections due to intensive care unit (ICU) microbes only include secondary endogenous and exogenous infections. Infection control targets the three types of infection mainly due to potential pathogens. For tertiary care/referral hospitals, a substantial percentage of patients are transferred from community hospitals outside the local area and many primary treating physicians exhaust all the new generation antibiotics and referred when matters go wrong . Under these circumstances, resistance surveillance data from these areas would help select presumptive therapy or change existing therapy.I fought for many reasons with the system, that we cannot take appropriate faster decisions without automation and cooperation of clinicians and Microbiologists, It is most important to know every patient referred from periphery is at threat with failed antibiotic treatments, The most important happening in our country,. Need of the hour continues that we should save the antibiotics with rationalistic reasons and truly missing link as the use of antimicrobial drugs in day-to-day practice is sub optimal and directly responsible for multidrug resistance in a number of common pathogens. The factor that converts antimicrobial therapy from "empirical" to "rational" is in vitro susceptibility testing and reporting. However, if these tests are either not conducted or conducted poorly, they are not useful clinically and may create a false sense that therapy is rationally guided, I certain that 90% of the laboratories lack the standard protocols and advance technologies and many times im appropriately done Antibiograms, The teaching medical colleges and institutions can help the matters in many helping and training the local population on consequences of irrational use of Antibiotics We hope that the concept of "empiric antimicrobial therapy" would be changed to that of "presumptive antimicrobial therapy" based on host factors, common pathogens, and known susceptibility patterns in any given region.
TRULY HYGIENE MATTERS -An increase in the number of hospitalized patients who are infected with or colonized by gram-negative non fermenting bacilli that display multidrug resistance characteristics has been observed over recent decades. This issue has received attention, particularly from personnel within infection control committees and health services that consider patients' clinical conditions and the variety of therapeutic approaches applied within health units

NEED FOR AUDIT - Audit and Research Details of the numbers of cases treated, illness severity, age, outcome and treatments, must be recorded. and discussed to reduce mortality and morbidity The figures should be analysed at regular intervals both as an indication of therapeutic achievement and for administrative purposes. In-house audit must be a regular feature and incorporated in Hospital Infection control .discussions Ref Evaluating Antibiograms To Monitor Drug Resistance Mohamed El-Azizi, etal Emerg Infect Dis. 2005 Aug; 11(8): 1301–1302.
Dr.T.V.Rao MD Freelance reporter on Infectious diseases Pan African resources

HOW MEDICAL TEACHERS CHEAT THE SYSTEM Today's Medical education is loaded many challenges It is open corruption and malpractices have taken over the Medical educational system like any other profession, The Ministry of Health wish to improve the matters, and bring in transparency Teachers cheating if open for observation and correction -Traditionally, students have been the group most associated with cheating. However, changes in the opportunities and higher salaries and materialistic benefits , have resulted in a strange turn of events. Increasingly it is teachers and other college administrators that have some of the strongest incentives and best opportunities to cheat, rather than the students. It was advanced phenomenon in many educational Institutions and Universities in many developed countries and today it is a creeping phenomenon in India and getting worse in many Professional colleges and universities, Many of our Medical Colleges with mushrooming has created much bigger cheating beyond imagination, and Medical council of India never went to the realities of the shortage of faculty to handle the matters, We see many rich and associated with management's become even Professors without even teaching a single class, The real reason many Medical and many other educational Insitionaon fail because of corrupt and inefficient teachers Cheating, in this context, may take many forms. Teachers may fabricate or inflate test scores, change incorrect answers on student test forms, or even provide answers in advance of a test. Make their own choices to evaluate students violating the university regulations Colleges may turn a blind eye to suspicious gains in test scores, suppress or deny the existence of reports on cheating, and otherwise obstruct attempts to uncover either individual or systemic cheating., Many medical colleges are running without a component and full time Principals and it is unfortunate and Toms and Dics will take over the administration and act as everything they simply fit for nothing and create more Toms to lick their shoes, and ultimately the system suffers, and no competent person has any choice to express the facts, and create parallel administration with near and dear, ultimately many Private medical colleges are left with rotten lot which they continue their legacy till they retire or perish in the system, However today many Private college no law only law of attraction to money and many of our teachers and even administrators lead the system as power brokers, and NEXT to proving to be hurdle for many students trained in the bad system

Asymptomatic Bacteriuria does it stand good or not in Diagnosis of Urinary tract infections?
THINK HOW GOOD WE ARE REPORTING URINARY TRACT INFECTIONS?
Dr.T.V.Rao MD
Urinary tract infection (UTI) is one of the most common diseases, occurring from the neonate up to geriatric age groups. Forty to 50% of adult women have a history of at least one UTI, However UTI is a major cause of Gram-negative sepsis in hospitalized patients and after renal transplantation With prolongation of life with advances in Medicine and Technology we are certain to have more challenges when we evaluate chronic Urinary Tract Infections, If you with reporting on table difference of opinion of colleagues is high and everyone has his or her own interpretations, At least 15 to 20 % of the established growth on culture plate opinions differ, Although there are general guidelines concerning diagnosis and classification of urinary tract infections, there are wide variations in clinical practice. There are both errors which are frequently committed and mysteries that are still unsolved Practical test methods
Interpretation of Urine Culture: Bacteria are frequently noted on urinalysis and cultured from urine specimens. The presence of bacteria in the urine may indicate one of 3 conditions: 1) specimen contamination; 2) urinary tract infection (UTI); or 3) clinical significance of a urine culture these conditions must each be considered and classification should be based upon history and exam findings coupled with urine findings. Specimen contamination should always be considered as this is common, particularly in female patients. High numbers of squamous cells on the urinalysis (>20) suggests contamination and results of the culture should generally be ignored.
The term "significant bacteriuria" was intended by Kass to provide a means of differentiating between contamination in the voided specimen and true urinary infection. It was based on the reasonable assumption that... the common pathogens of the urinary tract multiply in the urine and, therefore, when bacteria are deposited in the urine, they tend to multiply to very large numbers, usually exceeding 106 colonies per milliliter The distinction between bacteriuria and contamination is "based on an analysis of the distribution of bacterial counts in nonbacteriuric and bacteriuric populations," so that, as Kass himself makes clear, there is no specific bacterial number for use in the detection of bacteriuria, but, rather, a degree of probability that a given colony count signifies either bacteriuria or contamination in a voided specimen. Thus, the concept of "significant bacteriuria" at the level of 100,000 colonies/ml is very useful in
The gold standard for a urine test is to perform a bacteriological urine culture, with identification of the pathogen, with quantification and sensitivity testing. To test whether the patient has a UTI at all, orientating indirect methods are often used in practice to detect the bacteria or inflammation (dip sticks). The bacterial count may be assessed by urine microscopy and immersion culture media.
Significant bacteriuria does it stand good or not is matter of interest. The utility and consistency of the criterion of ≥105 colony-forming units per milliliter (cfu. /ml) of clean-catch urine for the diagnosis of UTI has been validated repeatedly. In children, rapid and reliable diagnosis of UTI is mandatory. Here, UTI is defined as bacterial count ≥104 cfu. /ml urine, accompanied by microscopical examination of the urine to exclude vaginal contamination (because such contamination frequently results in false-positive culture tests).
Asymptomatic Bacteriuria
Patients with positive urine cultures who lack symptoms of a UTI have the diagnosis of asymptomatic bacteriuria. ASBU is more common in some patient populations and the prevalence increases with advancing age. It is also associated with sexual activity in young women. Patients with impaired urinary voiding or indwelling urinary devices have a much higher prevalence of ASBU.to screen and treat for asymptomatic bacteriuria:
• Pregnant women (at least once in early pregnancy)
• Patients prior to a urologic procedure for which mucosal bleeding is anticipated (i.e. TURP, etc.)
• Kidney transplant patients are a group where the data is unclear and no recommendation can
be made
Who not to screen or treat for asymptomatic bacteriuria?
• Premenopausal, non-pregnant women
• Diabetic women
Older persons living in the community
• Elderly institutionalized residents of long-term care facilities
• Spinal cord-injured patients
• Patients with an indwelling urethral catheter (do not treat asymptomatic funguria either ) Unfortunately many patients with ASBU receive treatment which they do not benefit from and in fact are likely harmed by. The unnecessary treatment of ASBU can lead to antibiotic resistance, adverse drug effects, C. difficile infection, and contribute unnecessarily to the costs of medical care.
HOWEVER, CLINICIANS TAKE THEIR OWN DECISION MAKING As Active management is important because under some circumstances urinary tract infections may cause permanent renal scarring. Imaging procedures are a cornerstone for critical evaluation of urinary tract infections.
References Common errors in diagnosis and management of urinary tract infection. I: Pathophysiology and diagnostic techniques Martina Franz Walter H. Hörl Nephrology Dialysis and Transplantation Oxford academic
Dr.T.V.Rao MD @ Created as online resource for Clinical Microbiology

WHAT IS A B C OF GOOD TEACHING? -Can anyone be a great teacher? Quite simply, no. There are certain attributes a person must embody in order to be a great teacher. Next question — Are great teachers born and not made? Though some people definitely possess an innate “gift” for teaching, most great teachers were not born. They were made! The teacher makes a difference to the students from the text books they read and what they see in the Internet, Teaching is age old tradition not know too well to many of us, everything in life of a teacher is a new experience, and I believe no one can be too confident with everything, I realized life is a matter of learning and constant up gradation of knowledge, and transfer the best of us to the Students, in the best of my experience only the art of making matters simple, is the only expectations in the world as every subject is getting, more and more complicated. My best loved teachers are most simple and humble people who never assumed as something great and they educated us with best of the traditions with human values. All teachers want to be better, don’t they? And since no one has ever finished learning to teach, continued improvement is a priority of any effective teacher. I always wishes to be teacher with many ideals, however all may not work however I always more when I used, Short words Short sentences Short paragraphs No jargon's, Cut all cliches Prefer active to passive tense. Do not be too much imposing, “Students won’t care how much you know until they know how much you care” is as true today as it has always been. The simple act of greeting with affection and sincerity makes the difference which made us to near to the heart. Appear happy and enthusiastic and interested. As teachers, as role models, we are often actors on a stage. Is everything we teach the most exciting and interesting thing we've ever taught? No. But the students shouldn't know that. But the students can’t know that. If students don’t believe that you’re happy to be teaching them and enthusiastic about what you’re teaching, they won’t buy into your lessons. You can’t expect them to be any more enthusiastic than YOU are. Unenthusiastic teachers have classrooms of students who are every bit as unenthusiastic. Many years of experience proves, As educators we must teach our young ones with PASSION. We all medical teachers should try our best of teaching practicable and improving the skills of our pupil. Make lessons meaningful. Students don’t want to learn what they can’t relate to. Period! You don’t have to change your content. Just change the way you teach your content. When teaching anything, simply ask yourself, “Why is this skill important to the students?” Then teach that way. Do not share your personal problems in life with students it will make a man of no privacy. Great teachers do not allow their personal problems to bleed into their teaching. In simplest terms, they don’t impose their moods on their students. Be a man of humor Great teachers have a sense of humor, and they share it daily with their students. Great teachers continually strive to make learning fun, relevant, interesting, challenging and engaging. In the classrooms of great teachers, students are encouraged to question, discuss, debate, experiment, invent and make lots of mistakes. When we make a mistake, do not try to hide the mistakes Great teachers are not perfect teachers. When they make mistakes, they act as good role models do, admitting their mistakes, learning from these mistakes and offering apologies if necessary. Not surprisingly, great teachers are also some of the most humble people you will ever meet. They are the real difference-makers in education. Many of them do not even realize just how exceptional they really are. Or if they do, they’re just too eager and humble to admit it. Never forget life is a matter of learning and teaching better skills to our students Bertrand Russell says that man has outdone animals because he has 'acquired' skills. It is so interesting to notice that the physical evolution has played such an important role. The man will be really evolved when this extends to his inner world. The truly great teacher is the one who will help the Students to know himself and accept whatever he knows and then motivates him to pursue his strengths and learn modesty to take help in his weaknesses. Be a good actor in life Great teachers understand that they are actors on a stage. Yes, actors. They are performers capable of entertaining, capturing and enrapturing their audiences every day. Their enthusiasm is contagious, and they act as though everything they teach is their favorite thing to teach. Today's educational system is for rapid change everyone cannot be a teacher especially when educational systems are coming up major changes. Only teachers with skills and competency will survive and rest are forgotten sooner than Later?
Dr.T.V.Rao MD Professor of Microbiology Freelance writer

DIGITAL LITERACY - IN MEDICAL EDUCATION - Today we read more negative discussions on Medical and Paramedical education in the country, many try to explore to make accountability of the faculty by so many options, How truly the reforms work is question loaded with many limitations. Today we live in a most competitive world and the truth of life is progress and achievements it is all possible with creativity , what you know today is certainly outdated tomorrow, The success of life is going forward with knowledge and try improving the matters, As we see the newer generation of Medical students are progressive and you say any new world they google it, it just means we are dependent on online resources, Today our connected smartphone has become a nearest tool to reach the world of change and knowledge, Cornell University offers a definition that works, but seems a bit limited, and dated as well: “Digital literacy is the ability to find, evaluate, utilize, share, and create content using information technologies and the Internet.” WHAT MEDICAL STUDENTS NEED OF DIGITAL LITERACY The profession of practicing medicine is based on communication, and as social media and other digital technologies play a major role in today’s communication, ,. The value of social media has been demonstrated several times in medicine and health care, therefore it is time to prepare medical students for the conditions they will have to face when they graduate, If we look to our social Media as with Facebook and Twitter we have most updated contents and we can connect with best in the profession as we look to many best in USA few are interested in copyright they all know their role in the world of education is limited and wish to share as much they know of as they are outdated tomorrow if they not share with as many as possible
INDIAN MEDICAL EDUCATION NEEDS TO IMPROVE DIGITAL LITERACY A well-designed course, improved by constant evaluation-based feedback, can be suitable for preparing students for the massive use of the Internet, social media platforms, and digital technologies. New approaches must be applied in modern medical education in order to teach students new skills. Such curriculum that put emphasis on reaching students on the online channels they use in their studies and everyday lives introduce them to the world of empowered patients and prepare them to deal with the digital world. It is a great need that digital literacy must be included in the medical curriculum, in a vast country with many medical colleges, and few teachers with modern thinking on Medicine
Ref Google Resources on Digital literacy
Dr.T.V.Rao MD .

TIME TO RETHINK ON MD (microbiology} DEGREES? We have more than 1.3 Billion population with few facilities to practice a scientific Microbiology we have just 450 ( Approximately ) medical colleges, old ones are Government run, with few funds to improve the matters, I happened to be student of one of the oldest medical college in India and love to visit at least once in 3 years to see any new developments, nothing truly happened for many decades with lack of funds, and train the best of the lot of the merit students, We never though cared for development of better diagnostic microbiology practices, My more than 25 years of association with Medical colleges truly disappoints, in most of the Medical colleges, Microbiology continues to be least developed and least funded, hardly we find few interested with matters, and many spend least time with improving the departments. However, some researchers think that poor training has left microbiologists unaware of how best to interpret test results and gradually many MBBS qualified people do not wish to join the MD course in Microbiology, and we find many private medical colleges no candidates to take up the postgraduate course. It is certain that we will have few MD’s in Medical Microbiology, If we are at the table for reporting we are quite helpless we have few facilities to do even critical things, one has to agree that many of laboratory workers are missing the presence of carbapenemase-producing bacteria in samples. “The specialists, they know there is a problem. those who are not specialists use media that are not always very well adapted to this screening, a true phenomenon in most private laboratories they just work for profit, and manned by least qualified in technicians, and many new generation of antibiotics are randomly tested and physicians believe to prescribe the false laboratory results, clinicians have become master of the game with prescriptions of new generation of antibiotics, ultimately majority have switched to new generation of Antibiotics, or truly speaking last generation of Antibiotics leaving few options in critical times. Whether one agrees or not use of the Antibiotics has gone the wrong way and truly ANTIBIOTICS FREE FOR ALL Now everybody started to control the matters on Antibiotic resistance and implications of misuse of antibiotics, Efforts to detect and halt the global spread of drug-resistant bacteria are being hindered by a poor understanding of the limitations of crucial laboratory tests. However I always emphasize Microbiology is a team effort, and good investments in testing for optimal testing of Antibiograms, However EVERYBODY WAS HAPPY WITH THE DEVELOPING PRODUCING THE ANTIBIOTICS AND THE INDUSTRY Grown beyond imagination, and unhealthy competition to sell lured the Physicians for more prescriptions of Antibiotics, however Antibiotic prescription have led to many short cuts, and few facilities to control the spread of the infections Even many teaching hospitals have least facilities to control the spread as infected patients need to be isolated quickly to avoid spreading infections, the failure to identify antibiotic-resistant pathogens is increasing the risk of untreatable outbreaks, Poor training in use of tests allows ‘superbugs’ to evade surveillance. For some patients, we are already in the era of the septic ward where there is no effective antibacterial therapy available, and all that health professionals can do is observe to see if the patient recovers or die
NEED FOR RETHINK ON MD MICROBIOLOGY - We are awarding MD degrees after spending 3 years in a Medical college, with few or no facilities, and unless a specialty is made academic and clinically trained, no sensible person likes to join the MD examination, We are aware the syllabus not revised at all for many decades practically concentrate on the tests done by even BSc Laboratory technicians and unless a specialty is made academic and clinically trained, no sensible person likes to join the MD in the coming years, I wish the Ministry of health should make the curriculum more useful in practical sense to make the Microbiologists as treating Physicians of the Infectious disease , The present syllabus is made when there were no technicians and technologists and today we have many paramedical force to assist the qualified Medical Microbiologists ultimately a MD in Microbiology has become a degree that neither serve the Hospital practice or Good laboratory,
TIME TO REVIEW THE FATE OF MD MICROBIOLOGY
Dr.T.V.Rao MD Former Professor of Microbiology