ABSTRACT
Introduction: The mainstay of therapy for patients sufferingfrom beta thalassemia major is regular blood transfusionand chelation therapy due to constraints in bone marrowtransplantation. The present study was conducted to estimatethe prevalence of transfusion-transmitted infections (TTIs)in multitransfused patients of thalassemia major and todetermine the association with relation to the number of bloodtransfusions received.Material and Methods: This study was conducted inDepartment of Microbiology on 126 β- thalassemiamajor patients registered for regular blood transfusions atThalassemia Day Care Centre attached to Department ofPediatrics, Government Medical College, Amritsar, Punjabfrom January to July 2018. The patient’s serum sampleswere screened for TTIs i.e. Human Immunodeficiency Virus(HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV).Seropositivity screening for HBV and HCV was done by rapidImmunochromatographic test and confirmed by enzymelinked immunosorbent assays. (ELISA) while for HIV as perNACO guidelines.Results: Out of 126 patients, 14.28% (18/126) were seroreactive for TTIs. Of these sero-reactive patients, 13.4%(17/126) were positive for anti-HCV antibody, 0.79% (1/126)positive for HBsAg and none (0) for anti HIV antibody. Ofthe anti-HCV reactive cases, 70.5% (12 out of 17) were>12years of age, 58.8% (10 out of 17) had received morethan 250 transfusions, and 23.5% (4 out of 17) had receivedtransfusions between 100 to 250. Anti-HCV seroreactivitywas thus found to increase with the age and increase in thenumber of transfusions received.Conclusion: It is concluded that HCV is the most prevalentTTI in multi-transfused children with thalassemia major andstringent pre-transfusion screening of blood for anti-HCVmust be introduced in blood centers. HBV vaccination shouldalso be done before the start of transfusion regimen or as soonas possible after diagnosis of thalassemia.
ABSTRACT
Ideal diagnosis and treatment strategies are difficult to define for Neonatal Septicemia and vary across the institutions. Clinical diagnosis is difficult because of early non-specific features. Mortality and morbidity due to sepsis can be prevented with early diagnosis and rational timely management. Non specific markers include CRP, leucopenia, Absolute Neutrophil Count, micro ESR (µ-ESR) , Procalcitonin etc. Amongst these CRP is easily available at many labs and is cost effective. Blood culture is considered as gold standard for diagnosis but it is costly and time consuming. Therefore, present study was done to compare and evaluate the CRP results with the blood culture reports and to provide a feasible, rapid and a relative economic method to diagnose neonatal septicemia. Methods: This Prospective Observational Study was done in the Pediatrics and Microbiology Departments of Government Medical College, Amritsar from 1st January 2017 to 31st December 2017. 270 neonates admitted with clinical suspicion of neonatal sepsis were included in this study. Neonates who received antibiotics prior to admission, with alternative diagnosis and/or with congenital malformations were excluded from the study. Blood culture was sent before starting antibiotics. CRP was done qualitatively by rapid slide latex agglutination method. Data analysis was carried out using computer software IBM SPSS and a p value of <0.05 taken as statistically significant. Results: We observed that 50.74% cases of neonatal sepsis were culture positive. CRP came out as a good predictor of sepsis with sensitivity, specificity, PPV, NPV and diagnostic accuracy of 83.9%, 34.5%, 56.93%, 67.64% and 66.78% respectively. Conclusion: Serum CRP can therefore be employed as a rapid screening test for neonatal sepsis.
ABSTRACT
Clostridium difficile is a gram positive spore forming bacilli which can be normally present in human colon in some individuals. It can cause clostridium difficile infection which can lead to Clostridium difficile associated disease(CDAD) which is manifested by diarrhoea and in fulminant cases by pseudomembranous colitis and can lead to death. Disruption of normal intestinal flora by antimicrobials and lowering of immunity leads to its overgrowth and disease manifestations. Aims And Objectives: 1. To find the prevalence of clostridium difficile in stool samples of patients presenting with antibiotic associated diarrhoea. 2. To find the risk factors associated with the disease. Methods: The study was conducted from January 2017 to June 2018 on 131 stools samples of patients who developed diarrhoea after three days of starting antibiotics by ELISA based method for detection of Toxin A/B. Results: Out of 131 stool samples analysed, 6 samples (4.58%)were found to be positive for toxin A/B. Correlation between use of third generation cephalosporin and toxin positivity was found to be insignificant. Significant correlation was found between use of chemotherapeutic agents and toxin positivity. It was also found that advanced age was also significant risk factor for development of CDAD. Conclusion: The present study proves that Cdifficile should be kept in mind as an etiological agent in cases of antibiotic associated diarrhoea. Risk factors include advancing age, use of chemotherapeutic agents and antibiotic exposure. To prevent C difficile infection, unnecessary use of antibiotics should be stopped and screening of stools for Toxin analysis in cases of antibiotic associated diarrhoea should be done so that it can be diagnosed and treatment isstarted at the earliest.