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Background: Low cardiac output is a common complication following cardiac surgery and it is associated with higher mortality in the pediatric population. A gold standard method for cardiac output (CO) monitoring in the pediatric population is lacking. The present study was conducted to validate cardiac output and cardiac index measured by transthoracic echocardiography and Pressure recording analytical method, a continuous pulse contour method, MostCare Up in postoperative pediatric cardiac surgical patients. Materials and Methods: This was a prospective observational clinical study conducted at a tertiary care hospital. A total of 23 pediatric patients weighed between 2 and 20 kg who had undergone elective cardiac surgery were included in the study. Results: Spearman抯 correlation coefficient of CO between transthoracic echocardiography (TTE) and Pressure Recording Analytical Method (PRAM) showed of positive correlation (r = 0.69, 95% Confidence interval 0.59?0.77, P < 0.0001) Linear regression equations for CO between TTE and PRAM were y = 0.55 + 0.88x (R2 = 0.46, P < 0.0001). (y = PRAM, x = TTE), respectively. Bland? Altman plot for CO between TTE and PRAM showed a bias of ?0.397 with limits of the agreement being ?2.01 to 1.22. Polar plot analysis showed an angular bias of 6.55� with radial limits of the agreement being ?21.46 to 34.58 for CO and angular bias of 6.22� with radial limits of the agreement being ?22.4 to 34.84 for CI. Conclusion: PRAM has shown good trending ability for cardiac output. However, values measured by PRAM are not interchangeable with the values measured by transthoracic echocardiography.
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Background: Taenia solium infections in humans include the infection by the adult tapeworm, these infections are of public health concern and are among the most important afflictions of humans who live in areas of poverty in the developing world and least developed countries. T. solium, a zoonotic disease, transmitted between pigs and humans and among humans, is common in developing countries. Aims and Objectives: The aim of the study was to estimate the detection rate of T. solium taeniasis among patients and random community screening with an indication of intestinal parasitic infection by routine stool examination. Materials and Methods: Stool samples were collected from the community and patients. Those who were willing, samples were screened for the cysts/ova/egg by direct microscopic examination by saline, iodine, concentration technique, and modified acid fast staining, were performed to differentiate species of T. solium and Taenia saginata. Results: Overall samples were 2030, out of which 870 stool samples were from community field screening 585 (28.81%) were positive. 1160 from tertiary care center, 668 (32.90%) were positive gave a total prevalence of intestinal parasitic infection of 61.72%. The prevalence of T. solium taeniasis was 194 (9.55%) out of which 92 (4.53%) were from community and 102 (5.02%) were from tertiary care center. Conclusion: The high prevalence of intestinal parasitic infestation might be due to the poor sanitary, contaminated water, and lack of education that is prevalent in the studied region as in other pockets in rural India. Our study showed the usefulness of the Ziehl-Neelsen modified acid-fast stain for identification of Taenia species.
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Purpose: The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention. Methods: It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three?port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection. Results: In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re?procedure but was lost for follow?up. The anatomical success was 83.33% on the first surgery. Conclusion: The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated.
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Background: The infection due to the COVID-19 virus has shown to cause diverse set of manifestations and effects in various people across the world. Pregnancy being a dynamic, physiological condition of the human body, nudges one to question what happens if a pregnant woman is infected with the COVID-19 virus? Hence, the study aims to probe this very question. Aim and Objectives: The aim of this study was to study the effect of COVID-19 virus infection on pregnancy and its outcomes. Materials and Methods: We did a retrospective review of medical records of 28 pregnant ladies who were admitted in the tertiary care hospital, Mysuru between March 2020 and February 2021. All 28 pregnant ladies were tested positive for severe acute coronavirus disease by use of quantitative RTPCR on samples obtained from nose and throat. The procedure was followed according to ICMR guidelines of collection of samples and reporting of COVID-19 infection. The clinical findings, laboratory findings, and the fetal and maternal outcomes of 28 pregnant ladies were obtained from medical record section of the institution. The reports were entered in excel sheet and subjected to statistical analysis using SPSS version 20. Results: One out of 28 showed maternal death during COVID-19 pandemic. There was one case with abortion which was reported. Twenty out of 28 had normal deliveries and three women had LSCS. Neonatal outcomes seem to be within normal limits with no adverse complications as a consequence of COVID-19 maternal infection. Conclusion: It is seen that COVID-19 infection behaves in a similar fashion to general population and that morbid states may trigger adversity in mother rather than the fetus. It is also noted that due to the effect of the chaos caused by the pandemic, documentation of the cases was incomplete. Transfer of cases depending on status of infection to other hospitals hindered the tracking of these cases. Discharge against medical advice was also observed due to panic of being in a hospital during an ongoing pandemic.
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Background : Meliodosis is an infection by Burkholderia Pseudomallei, is now endemic in India. It can have varied clinical manifestations. We report a case of Meliodosis in a diabetic patient presented as multiple Splenic Abcesses. Case Report : A 56-year-old male patient, manual labour, diabetic with uncontrolled glycemic levels presented with prolonged Fever and abdominal pain which on evaluation revealed multiple Splenic Abscesses. Culture of aspirate from abscess grew Burkholderia Pseudomallei. He improved with appropriate antibiotic therapy and Splenectomy. Conclusion : The case is presented to highlight the importance of making early clinical and microbiological diagnosis for a better outcome
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Background: There is evidence to suggest that lack of physical activity, a common experience among adults, can negatively impact executive functions such as attention, memory, and decision making. Trataka can improve eye deformity, executive ability, willpower, and relaxation. Trataka may also have a protective effect on the brain, reducing inflammation and the risk of neurodegenerative diseases. The immediate effect of Trataka on executive Aim of the study: Material & methods: function among adults. Forthy healthy Adults to observe the immediate effects of thirty minute trataka regimen for one day. Participants were recruited through convenient sampling and were between the ages of 18-40. The study used a single group pre-post design. After single trataka session Results: showed that 11.59% significant increase (P< 0.05) in total attempted score on DLST. Similarly, there was 11.48% significant increase (P = 0.05). and there was 16.6% increase in (P> 0.05) in wrong attempt scores. After single trataka session it showed that 22.48% significant increase (P< 0.01) in total attempted score on SLCT. Similarly, there was 22.71% significant increase (P = 0.01) in NS. However, there was 70.58% reduction in wrong attempt score which was highly significant (P = 0.001). the available evi Conclusion: dence suggests that the practice of single session trataka has a positive on executive function among adults.
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INTRODUCTION Surgical site infections (SSI) are one of the terrifying nosocomial infections that affecting surgical patients and cause a compromise to the quality of health care provided in the hospital. Nearly 5% of people who undergo surgeries might develop SSI, which can have serious consequences and even be deadly. To identify the microbiological profile of explant AIM: culture from suture materials and its correlation in development of SSI in the same patient. Infected and non-infected METHODOLOGY: suture materials that were removed aseptically from the patients were collected and transported to the Microbiology laboratory in sterile BHI broth.With the isolated colonies obtained. Identification was performed by standard microbiological technique and antimicrobial susceptibility testing was done. The culture reports of the swab collected from the pus/ exudate from the surgical site and the suture were compared. This was a prospective cross sectional study for a duration of 6 months. A sum of 190 isolates RESULTS: were obtained from 182 suture samples. 156(86%) suture materials had growth [monomicrobial (70%) polymicrobial growth (16%)] while 26(14%) had no growth. 7 different suture materials were employed in this study. Isolated organisms were gram positive bacilli (n=20), gram positive cocci (n=82), gram negative bacilli (n=87) and fungi (n=1). Escherichia coli, Klebsiella pneumoniae (n=19) and CONS (n=71) were commonly isolated gram negative organisms. The least common organism grown colonizing the suture material was Klebsiella oxytoca, Citrobacter species, Candida species, Enterococcus faecalis and Enterococcus species (n=1, 0.5%). Isolates like Escherichia coli (n=5), Klebsiella pneumoniae (n=2) and Acinetobacter species, Staphylococcus aureus (n=1) were found to have multiple drug resistance in the suture thread culture. SSI was seen eight cases (4.3%) and in two of them, the microorganism isolated from the surgical site and suture material was identical. Out of 190 isolates in this study, 96 DISCUSSION isolates (CONS-71, Streptococcus-4, Diphtheriods-2, Aerobic spore bearers-18, Candida-1) were members of normal flora of the skin which shows 50.5% of the suture materials were colonized by normal flora. The current study shows that ability of bacteria to adhere varies between different suture materials. Overall, the adhesion of bacteria to 3-0 Ethilon (10.4%) was found to be lower compared to 3-0 vicryl No 1,3 Prolene, 2-0 Ethilon and Silk. Suture thread must be taken out as soon as possible since opportunistic infections could result from the skin's regular flora.
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Background: Mental health of a medical student remains affected throughout training due to long study and working hours, extensive course content, examinations, peer competition, uninspiring environments, sleep deprivation. Objectives of this study were to estimate the proportion of Depression, Anxiety and Stress among Women medical undergraduate students and to determine the association between the Depression, Anxiety, Stress and Socio demographic factors among Women medical undergraduate students. Materials and methods: This were a cross sectional Study conducted among First, second, third and fourth year MBBS students of SVIMS - Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh. Medical students who were present and willing to participate voluntarily on the day of data collection were included. Sample size calculated was 375. Information collected was socio-demographic details and Depression Anxiety Stress scale [DASS 42] was used to assess depression, anxiety and stress levels. Results: The present study assessed Depression, Anxiety and Stress among 588 medical undergraduates, by DASS 42 scale which revealed prevalence of depression was 34.7%, anxiety 44% and stress 30.3% and their significance association with year of study, not satisfied/partially satisfied with own education, less consump-tion water, less sleeping hours and hours of usage of gadgets. Conclusion: The present study found that prevalence of depression 34.7%, anxiety 44% and stress 30.3% among medical undergraduates. Medical students under strain are either unaware of their situation or reluc-tant to seek help.
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Introduction : Fournier抯 Gangrene is a rapidly progressive necrotising faciitis affecting the genital region, perineum, perianal region and the abdominal wall. It can have an adverse effect on the functional and psychological aspects of the patient. Many flaps are available for the defect coverage. Aim : The aim of this prospective study was to analyse the effectiveness of laterally based medial thigh flap for scrotal reconstruction. This is a fasciocutaneous flap just below the Scrotum which covers moderate to large sized scrotal defects successfully. Methods and Materials : This study was done at a teaching hospital in South India on patients with major scrotal defects secondary to Fournier抯 Gangrene. Ten patients with major scrotal defects secondary to Fournier抯 gangrene were subjected to reconstruction of scrotum by medial thigh fasciocutaneous flap. Results and Conclusions : All ten flaps survived and provided a durable and aesthetic cover for exposed testes. Only one flap had necrosis of distal 2cm, which was successfully managed by secondary suturing. The donor areas were primarily covered with placement of a small graft near the base of the flap, which healed well with an inconspicuous scar. In conclusion, the laterally based medial thigh fasciocutaneous flap provides excellent closure for extensive scrotal skin loss. It is a robust flap, easy to mobilise, rarely undergoes necrosis, provides a sensate cover with excellent aesthetic results. The technique is simple, less time consuming and can be easily incorporated by plastic Surgeons and General Surgeons
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Introduction: Monteggia fracture dislocation is a rare and severe injury of both paediatric and adult forearm and elbow.It was described for the first time by GIOVANNI BATTISTA MONTEGGIA in 1840,who reported two cases of fracture of the proximal third of ulna with conjoint ventral dislocation of the proximal radius. In 1967 JOSE LUIS BADO published a classification scheme of monteggia lesion based on the direction of the dislocation of radial head,this anatomical classification was suitable for both adults and children .Monteggia fracture dislocations constitute about 1% – 2% of all forearm fractures . Monteggia fractures remain challenging paediatric injuries because of difficulties in diagnosis , propensity for instability and complexity of late reconstruction. More than 50% of these fracture dislocation are misdiagnosed in children and leads to dysfunction of elbow joint. The fixation and stabilization of ulna fracture will automatically reduce the radial head dislocation. The aim of this study is to evaluate a group of paediatric patients with Monteggia lesion and its equivalents treated by percutaneous fixation of proximal third ulna fracture with k wire after reduction of fracture ulna and dislocated radio capitular joint under c-arm guidance. Materials and methods We treated 18 children of age ranging between 6 to 12 years with Monteggia fracture dislocation of the forearm with percutaneous fixation of the proximal third fracture of ulna with k wires after reduction of fracture and dislocated radio-capitular joint under C-arm control.The elbow is immobilized in fiexion with plaster of paris slab and bandage for a period of four weeks and mobilization of elbow is started after four weeks. By the end of 8 weeks K-wire removed. All fractures are fixed with in twenty four hours. The results Results : are good, there is no incidents of any stiffness. Range of movements of elbow and forearm are well preserved.The function of elbow and forearm are satisfactory.Conclusion:A good outcome after Monteggia injury in a child requires early diagnosis and prompt stable anatomical reduction of the ulna fracture and this can be achieved through stabilization of ulna by percutaneous intramedullary k wires.
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Background: Contraception is the intentional use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. Progesterone only injectables are highly effective in preventing in pregnancy as they do not rely on daily usage of contraceptions as such as oral contraceptive pills and barrier methods. Injection depot-medroxyprogesterone acetate (DMPA) is an effective contraceptive method in lactating mother and postabortal patients. Aims and Objectives: The aims of this study were to study utilization pattern, acceptance, effectiveness, and adverse effects of DMPA in postpartum and postabortal women. Materials and Methods: It was a prospective and observational single-center study and was conducted at tertiary care teaching hospital. The data were collected in patient received Inj. DMPA 150 mg intra muscularly immediately after abortion and delivery before discharge. The follow-up was done after administration of DMPA (usually every 3 months). Results: In this study, 56 (53.34%) patients were in the age group of 18–25 years, while 38 (36.19%) patients were 26–35 years whereas 11 (10.47%) were more than 36 years. Out of 105 patients, 12 patients were administered only one injection, 16 patients administered two injections and 16 patients given three injections of DMPA. Common adverse effects of DMPA are irregular bleeding (43.8%), amenorrhea (22.8%), and heavy bleeding (5.7%). Out of 24 patient who developed amenorrhea after injections of DMPA, total 11 patients had amenorrhea after fourth injection, 5 patients after first injection, and 2 patients after second injection of DMPA. Average time for return of fertility after last injection of DMPA was 9 months. Conclusion: DMPA is very effective contraceptive and apart from menstrual troubles that there are no significant major side (weight gain, mood changes, etc.) effects related to its use. DMPA may cause a delay in the return of fertility, the return of fertility takes 7–10 months from date of last injection, but it is completely reversible.
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Background: Premenstrual syndrome (PMS) is a condition that most women experience during the luteal phase of their menstrual cycle. It usually abates at the commencement of the periods. During this period, apart from physical discomfort, some women experience psychological and behavioral changes as well, which can disturb their lives. Various studies have been conducted on PMS and its effect on an individual with respect to body mass index and exercise, but very few studies are available on the association of diet with PMS. Therefore, we are evaluating the relationship between dietary pattern and PMS morbidity. Aims and Objectives: The aims of this study were to determine the prevalence of PMS and its severity in different age groups of women and compare its association with vegetarians and non-vegetarians. Materials and Methods: This is a cross-sectional study conducted among the staff and students of East Point College of Medical Sciences and Research Center. Data were collected using a well formulated, structured, and pre-tested questionnaire, which had questions on diet patterns and PMS symptoms. Results: PMS was found to be more prevalent in young women (18–25 years) (57%) compared to older women (26–49 years) (43%), and the symptoms were slightly more severe among vegetarians (9%), compared to non-vegetarians (5%). There was no correlation between severity and body mass index. Conclusion: PMS is one of the most common gynecological complaints in young women. Although PMS is not a serious disorder, it can definitely change the quality of life for many women and affect their mental health and productivity. Creating awareness among young adolescents to lead a healthy lifestyle with changes in their diet and physical activity can improve the condition.
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Background: Sciatic nerve is a mixed nerve which provide sensory and motor supply for skin and muscles of the lower limb by tibial and common peroneal nerve. Anatomical variations of sciatic nerve at high division have been reported by various authors. The path of the sciatic nerve is important while administration of intramuscular injection to prevent nerve injury and nerve blockage failure during anesthesia. This knowledge of high division helps in different surgical approach for sciatic nerve injury or hip dislocation. Aims and Objectives: The aim of the study was to describe incidences of high division variation of Sciatic nerve and different types in cadavers during routine dissection schedule. Materials and Methods: The study was conducted during routine dissection schedule in anatomy department for first MBBS students to observe sciatic nerve course in 30 gluteal regions from 15 adult cadavers fixed by formalin. Location of sciatic nerve in relation to piriformis muscle and its division whether in single nerve sheath or separate sheath and types was recorded. Results: In 12 cadavers (80%), sciatic nerve course found normal which leaves pelvis at inferior border of piriformis muscle and bifurcate in terminal branches tibial nerve and common peroneal nerve as it approaches at the apex of popliteal fossa. In 3 cadavers (20%), two male and one female, we found high division of sciatic nerve where terminal branches, tibial nerve, and common peroneal nerve leave the pelvis below piriformis separately in different sheaths. Conclusion: Knowledge of variations-related high division of sciatic nerve would help surgeons during different interventions related to sciatic nerve and for preventing further complications.
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Background: Airway formation is one of the earliest events in development of respiratory system. However, maturation of airway continues well in post-natal life. The trachea has framework of incomplete ring of hyaline cartilage united by fibrous tissue and smooth muscle through which air conduction takes place. The trachea-bronchial mucosa is target for host of airborne toxic agents; bacterial and viral agents, allergens, reactive gases, aerosols, and irritant particles. This fascinates many workers for detailed study of epithelium or lining air passage. Aims and Objectives: The present study was undertaken to document normal developmental microscopic structure of tracheal cartilage in fetuses of different age group (gestational ages between 12th and 40th weeks) and to compare the difference between different age groups. Materials and Methods: Tissues from trachea of various age group fetuses were collected, processed, and stained with H and E and Masson’s trichrome. Results: Development of tracheal cartilage was observed into three trimesters. The 2nd and 3rd trimesters were further divided in the early 2nd (13th–16th weeks), mid-2nd (17th–20th weeks), late 2nd (21st–24th weeks), early 3rd (25th–28th weeks), mid-3rd (29th–32nd weeks), and late 3rd (33rd–40th weeks) phases. Conclusion: Perichondrium of cartilage had shown well-marked outer fibrous layer with increased vascularity by late 2nd to early 3rd trimester. Well-marked inner cellular layer of perichondrium was noticed by 3rd trimester, while cartilage had shown active chondrocytes by late 2nd to early 3rd trimester. At the late 3rd trimester, typical hyaline cartilage had shown chondrocytes in cell nest surrounded by territorial matrix.
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Abstract Objective: To compare two polyethylene bags in preventing admission hypothermia in preterm infants born at <34 weeks gestation. Method: Quasi-randomized unblinded clinical trial conducted at a level III neonatal unit between June 2018 to September 2019. The authors assign infants between 240/7 and 336/7 weeks' gestation to receive NeoHelpTM bag (intervention group) or a usual plastic bag (control group). The primary outcome was admission hypothermia, considering an axillary temperature at admission to the neonatal unit of <36.0 °C. Hyperthermia was considered if the admission temperature reached 37.5 °Cor more. Results: The authors evaluated 171 preterm infants (76, intervention group; 95, control group). The rate of admission hypothermia was significantly lower in the intervention group (2.6% vs. 14.7%, p = 0.007), with an 86% reduction in the admission hypothermia rate (OR, 0.14; 95% CI, 0.03-0.64), particularly for infants weighing >1000 g and >28 weeks gestation. The intervention group also had a higher median of temperature at admission - 36.8 °C (interquartile range 36.5-37.1) vs. 36.5 °C (interquartile range 36.1-36.9 °C), p = 0.001, and showed à higher hyperthermia rate (9.2% vs. 1.0%, p = 0.023). Birth weight was also associated to the outcome, and it represented a 30% chance reduction for every 100-g increase (OR, 0.997; 95% CI, 0.996-0.999). The in-hospital mortality rate was similar between groups. Conclusion: The intervention polyethylene bag was more effective in preventing admission hypothermia. Nonetheless, the risk of hyperthermia is a concern during its use.
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The present investigation recorded that the average litter size was 2.03 per doe and the prolificacy rate being 202.92%. The result indicates that the litter size proportion for single, twin and triplet were 28.3%, 40.4% and 31.3% respectively. The present study revealed substantial phenotypic variations among the goats bearing single, twin and triplet foetus. Based on stepwise discriminant function to find out month wise phenotypic descriptors, some important linear traits namely Punch girth (PG), Body Weight (BW), Rump Length (RL), Croup Height (CrH), Clearance of Sternum (CS), Distance between Tuber coxae (DTC), Distance between Trochanter major (DTM), Head-Rump Length (HRL), Body Length (BL), Curved Head-Rump Length (HRCL), Heart girth (HG, Pelvic Triangle (PLVT) and Wither Height (WH); were identified to be significant in discriminating the foetal numbers between groups. Out of these, HRL measurement might be considered as one of the best indicator for higher Litter Size (LZ) during the second, third, fourth, fifth parity. Other best suitable phenotypic descriptors like BL, CS, PG, PLVT and BW could be used to predict probable kidding size.
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The present investigation recorded that the average litter size was 2.03 per doe and the prolificacy rate being 202.92%. The result indicates that the litter size proportion for single, twin and triplet were 28.3%, 40.4% and 31.3% respectively. There was a tendency of increasing body weight with higher litter size and such variation was highly significant (P<0.01). The result revealed that the overall mean age of first estrus was 209.08±2.06 days. Maximum age of first conception was 226.18±5.39 days when the animal gave single birth and the minimum AC was 216.65±4.9 days when it produced triplet indicating that failure of conception was more in single bearing does. Service period were recorded to very significantly (P<0.01) among different litter bearing groups, the highest value was observed in triplet producing does (80.88±4.68 days). This is an important finding to understand that, less Age of Puberty (AP), Age at 1stConception (AC), Days Open (DO) & Kidding Interval (KI) has prominent benefit for multiple foetuses and thus achieving economic benefit.
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Serum hormone level was estimated to find out FSH, LH and total estrogen for all the animals under three treatment groups from 20 to 55 week. The FSH level (from 0.56 to 1.32 ng/ml; 0.91 to 1.91 ng/ml and 0.46 to 1.36 ng/ml for first, second and third treatment group, respectively) was higher in the second group; and third group had lowest level out of the three groups. The serum LH level (0.46 to 1.40 ng/ml and 0.27 to 1.91 ng/dl in first and second treatment group, respectively) showed similar pattern like FSH. The total estrogen was higher in the first treatment group (1.08 to 4.2 pg/ml) than that of the second group (0.14 to 2.30pg/ml) and third group ((0.04 to 2.37 pg/ml)). The serum biochemical profiles of the animals under three groups were estimated by serum glucose, total protein in blood and serum cholesterol levels. The glucose level varied from 65.66 to 77.11, 50.03 to 63.78 and 55.22 to 68.66 mg/dl for the first, second and third group, respectively, with higher value at the time of service. The total protein level did not vary much among the animals under three treatment groups (64.45 to 78.55 g/l). The serum cholesterol level varied between 50.17 to 110.05 mg/dl among all the animals irrespective of groups. During prepubertal period this value was low, but it was higher during pubertal period, time of several other services and towards pregnancy for all groups of animals. Regarding the serum trace mineral status, serum copper level showed higher value from 7 months onwards; serum zinc and iron level were almost similar in first and second group; and the third group showed lower value for all the trace minerals. All the good effects noticed in the first treatment group were due to the non-hormonal factors applied to them through nutrition and buck. The effects in the second group of animals was due to the nutritional effect, whereas, the third group showed poor performance without any support from nutrition and social interaction through buck.
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Background: Sepsis diagnosis and management is aided by the use of newer biomarkers like procalcitonin and presepsin. For prognostication, presepsin may be better than procalcitonin. Methodology: Ninety-two participants, suspected to be suffering from sepsis of varied etiologies were included in this study at the time of their presentation to the emergency health services. Presepsin and procalcitonin were estimated and the patient followed up till discharge or death. Receiver operating curve (ROC) curves, sensitivity, specificity, and positive and negative likelihood ratios were calculated. Association between these markers and mortality was estimated. Results: Out of 92 participants enrolled on day 1, 73 survived till day 3. Patients who had thrombocytopenia, high neutrophil counts, and elevated levels of bilirubin, urea, presepsin, and procalcitonin were associated with poor outcomes. Presepsin and procalcitonin levels increased significantly from day 0 to day 3 in the nonsurvivor group as compared to the survivor group. On comparing the ROC curve of presepsin and procalcitonin, the area under the curve (AUC) of presepsin was more than procalcitonin, signifying that it was a better biomarker of mortality due to sepsis. At a cutoff value of 1.47 ng/dL, presepsin was a predictor of mortality in sepsis [odds ratio (OR) = 14]. It had similar sensitivity but better specificity than procalcitonin in predicting mortality.
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Background: Delay in diagnosis and treatment enhances tuberculosis (TB) transmission and mortality. Understanding causes for delay can help in TB elimination by 2025, the stated goal of India. Objectives: Estimate diagnostic and treatment delay in Ernakulam district of Kerala, identify associated factors, and determine health-seeking behavior and knowledge regarding TB among new pulmonary TB patients. Materials and Methods: Community-based cross-sectional study among the new pulmonary TB patients registered under Revised National TB Control Program. Patients interviewed in-person and data collected using pretested semi-structured questionnaire. Descriptive statistics expressed as frequency, percent, interquartile range, median, and mean. The Chi?square test was used to assess statistical significance (P < 0.05) of association. Backward conditional method logistic regression done using variables with P < 0.2 in univariate analysis and adjusting for possible confounders. Results: Two hundred and twenty-nine patients interviewed and the median patient, health-care system, and treatment delay were 25 days, 22 days, and 1 day, respectively. While the patient delay (>30 days) and treatment delay (>2 days) were seen in 47.6% and 41% of patients, respectively, health?care system delay was seen in 79.9% of the patients. Choosing pharmacy for initial treatment (adjusted odds ratio [aOR] = 5.217), unskilled occupation (aOR = 3.717), female gender (aOR = 3.467), previously not heard about TB (aOR = 3.410), and lower education level (aOR = 2.774) were the independent predictors of the patient delay. Visiting two or more doctors (aOR = 5.855) and initially visiting a doctor of undergraduate qualification (aOR = 3.650) were the independent predictors of health?care system delay. The diagnosis in private sector (aOR = 8.989), not being admitted (aOR = 3.441), and age above 60 years (aOR = 0.394) was the independent predictors of treatment delay. Conclusion: Initial treatment from pharmacy, consulting multiple physicians, and diagnosis by private sector cause significant delay in diagnosis and treatment of pulmonary TB.