Predictive Value of Frailty Index in Comparison to Traditional Markers of Sepsis in Predicting Mortality among Elderly Admitted in Tertiary Care Hospital

Introduction: The frailty index’s potential as a prognostic marker of sepsis is so far been untapped. Here we studied the predictive value of frailty index in the elderly with sepsis. Methods: This prospective cohort study was conducted in a tertiary level hospital in North India. The duration of the study was 18 months starting from January 2020 to July 2021. The frailty index was calculated along with traditional markers of sepsis such as sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), and systemic inflammatory response syndrome (SIRS) within 24 hours of admission in elderly patients suspected to have sepsis. The area under the receiver operating characteristic (AUROC) of frailty index, SOFA, qSOFA, and SIRS was compared for in-hospital and 3-month mortality. Results: There was no significant difference between the performance of the frailty index and SOFA (DeLong’s test p = 0.242) in predicting in-hospital mortality, but there was a statistical difference between the AUROC of SOFA score (AUC = 0.548) and frailty in predicting 3-month mortality (DeLong’s test p ?0.001). Conclusion: The frailty index had greater sensitivity and negative predictive value among the other scores in predicting in-hospital mortality, whereas SOFA had higher specificity in predicting in-hospital mortality. The frailty index was superior to SOFA and the other prognostic markers of sepsis in predicting 3-month mortality.

Pattern of dermatoses in the elderly population attending the dermatology clinic at a Tertiary Care Center in South-East Rajasthan

Introduction: The skin acts as the first line of defense for the body against external injuries. With aging, the architecture of the skin undergoes intrinsic changes that impair its capacity for repair. In addition, the aging skin is more susceptible to injury by external stimuli, including ultraviolet rays and environmental pollutants. The combination of these factors predisposes the elderly to a variety of dermatological disorders, including xerosis, pruritus, photoaging, eczematous disorders, and tumors. The elderly (>60 years of age) population in India accounted for 8.6% (104 million) in 2011, and the figure has been projected to increase to 19% by the year 2050. It is imperative to identify the pattern of cutaneous disorders in this population as skin care regimens aimed to improve epidermal function have been shown to be effective inthe prevention and treatment of some of these aging-associated cutaneous disorders. Objectives: The objective of the study was to identify the pattern of dermatoses among the elderly population attending the dermatology clinic at a tertiary care hospital in South?east Rajasthan. Materials and Methods: We conducted a cross-sectional descriptive study of patients above the age of 60 years who attended the dermatology clinic at a tertiary care hospital in South?east Rajasthan from May 2018 to May 2020. A combination of history, physical examination, and clinical investigations (when appropriate) were used to establish the diagnosis. Results: A total of 210 patients were included in this study. Most patients were between the age group of 60–65 years (40.47%). One hundred and thirty?eight were male (65.71%) and 72 were female (34.28%), with a male to female ratio of 1.9:1. Our study demonstrated that xerosis was one of the most common diagnoses seen in 126 cases (60%), followed by eczematous skin conditions seen in 82 cases (39%). Conclusion: The elderly constitute an important part of the population. Cutaneous disorders in the elderly range from mild disorders such as cherry angiomas to dermatological malignancies. Therefore, it is important to recognize the pattern of dermatosis in this population so that appropriate therapeutic and preventive strategies could be implemented.

Ureteric endometriosis masquerading as ureteric neoplasm

Endometriosis is a disease seen in 10-15% of reproductive age women, which involves the pelvic cavity. The urinary tract is affected in 1% cases of pelvic endometriosis, while 0.1-0.4% of ureteric endometriosis which is extremely rare. Ureteric endometriosis poses a diagnostic challenge, as it can be asymptomatic or can present as renal colic. It can lead to a severe burden on kidneys like hydroureteronephrosis, renal atrophy, and irreversible renal failure. Authors report an extremely rare case of ureteric endometriosis in a postmenopausal female, who presented with complaints of lower backache. Radiologically diagnosed as neoplastic ureteric stricture.

Knowledge, attitude and practices regarding World Health Organization surgical safety checklist and the challenges in its implementation at a teaching hospital in North India

Background: The WHO in 2009 published the surgical safety checklist (SSC) for reducing the surgical complications. For its successful implementation it is imperative to identify the current knowledge, attitude and practices of the involved personnel and explore the anticipated barriers. Objective of this study was to evaluate the knowledge, attitude and practices of the participants about the SSC and determine the possible challenges in its implementation.Methods: This study is a descriptive, cross-sectional study involving the use of a pre-tested questionnaire carried out in a teaching hospital. All personnel involved in the operation theater who gave their written consent were enrolled.Results: Awareness regarding the SSC is high and existing practices are favorable towards patient safety amongst Hospital personnel. Attempts should be made to educate all personnel to gain complete knowledge regarding the checklist. The anticipated barriers, of which lack of knowledge was found to be the most prominent, should be dealt with.Conclusions: A strategy aimed at proper education, stepwise implementation, alleviating the hindrances and regular feedbacks can result in decreasing the surgery related complications and morbidities through implementation of the surgical safety checklist.

A rare presentation of invasive mole with an arterio-venous malformation: a case report

Gestational trophoblastic disease comprises of various pathologies with hydatid form mole bring a common etiology. Emergency admissions of patients of gestational trophoblastic disease is very rare. Here we present a case report of an emergency admission of patient with hydatidiform mole and severe bleeding and then was managed for the same during the course of hospital stay.

A questionnaire based study of adverse drug effects of antiepileptic drugs in a tertiary care hospital in Central India

Background: Epilepsy is a common disorder of brain function which affects around 1% of world population. Due to nature of chronicity of this disease, long term medical treatment with Anti-Epileptic Drugs (AEDs) is required to achieve control of the seizures. Antiepileptic drugs are responsible for 5% of ADRs among all of the prescribed drugs. Due to the significant number of adverse drug reactions spontaneous reporting and knowledge about ADRs have gained the importance. Knowledge(K), attitude (A) and practices (P) studies are preferred nowadays so as to have the better understanding and implication of the studies for the benefit of the patients. Therefore, this study was planned to evaluate Knowledge, Attitude and Practices (KAP) regarding Anti-Epileptic Drug (AEDs) therapy in epileptic patients and their relatives and to create awareness regarding the same.Methods: A questionnaire based study for assessment of KAP during a period of 2 months in patients of epilepsy and their relatives.Results: The maximum side effects were seen in central nervous system and functions (80%) followed by dermatological problems (6.57%), visual defects (5.19%), GIT complaints (4.84%) and lastly sexual function impairment (3.34%). Carbamazepine was most commonly prescribed drug followed by phenytoin. Certain gender and age specific adverse events were found. 95% patients were found to be compliant with medicines’ dose and schedule.Conclusions: The chronicity of epilepsy calls for long duration of treatment so consideration and addressing ADRs are essential to maintain compliance among patients.

Drug Utilisation Pattern Of Antidiabetic Drugs Amongst Obese Diabetic Patients In A Tertiary Care Hoapital- An Observational Study

The principal aim of drug utilisation studies (DUS) is to facilitate the rational use of drug in a population.DUS is an essential part of pharmacoepidemiology and pharmacoeconomic as it describes the extent,nature and determinants of drug exposure. Diabetes at present appears as a common non communicable disease. It leads to high morbidity and mortality due to the disease itself and its diverse complications like coronary artery disease, hypertension, renal complication, retinal damage, neurological disorders, incidence of stroke at different sites, generalised infections etc. With such multifactorial background of high prevalence , progressive nature of the disease, availability of multiple therapeutic regimens prescribed on trial and error basis, the treatment is individualised and neither complete nor satisfactory. Objectives: This study was undertaken to analyse the current prescribing pattern in obese patients of type 2 diabetes mellitus with regard to drug/drugs precription ,dose, duration of treatment and frequency of change of drugs. Methods: This is a prospective, parallel group, comparitive observational study. The enrolled obese patients were divided as a)New diabetic b) Old diabetic(<3 years duration). Each category was further divided into four subgroups according to the treatment recieved a)Monotherapy-only Metformin b)Combination therapy- Metformin+another antidiabetic groups,preferably sulfonylureas, alphaglucosidase inhibitors or DPP 4 inhibitors c)Triple therapy( Metformin+SU+Voglibose or Gliptins or Glitazones) d)Insulin with other oral hypoglycemic drugs. Results: In the study of prescribing pattern, it was observed that most prescriptions in this tertiary care hospital were found to be in compliance with the ADA guidelines. Metformin monotherapy was prescribed as initial treatment. Sulphonylureas/ Gliptins / Alpha glucosidase inhibitors/ thiazolidinediones were used as second line therapy mostly anyone, in addition to metformin or as monotherapy according to patient requirement, tolerability and cost.Conclusions: The antidiabetic medications prescribed in this hospital,were found to be in compliance with ADA guidelines with metformin being the first line of treatment followed by sulfonylureas and alphaglucosidase inhibitors

Antibacterial and Pharmacological Evaluation of Fluoroquinolones: A Chemoinformatics Approach

Fluoroquinolone (FQ) antibiotics are an important class of synthetic antibacterial agents. These are the most extensively used drugs for treating bacterial infections in the field of both human and veterinary medicine. Herein, the antibacterial and pharmacological properties of four fluoroquinolones: lomefloxacin, norfloxacin, ciprofloxacin, and ofloxacin have been studied. The objective of this study was to analyze the antibacterial characteristics of the different fluoroquinolones. Also, the pharmacological properties of the compounds including the Lipinski rule of five, absorption, distribution, metabolism, and excretion, LD50, drug likeliness, and toxicity were evaluated. We found that among all four FQ molecules, ofloxacin showed the highest antibacterial activity through in silico assays with a strong interaction (−38.52 kJ/mol) with the antibacterial target protein (topoisomerase-II DNA gyrase enzyme). The pharmacological and pharmacokinetic analysis also showed that the compounds ciprofloxacin, ofloxacin, lomefloxacin and norfloxacin have good pharmacological properties. Notably, ofloxacin was found to possess an IGC50 (concentration needed to inhibit 50% growth) value of 0.286 μg/L against the Tetrahymena pyriformis protozoa. It also tested negative for the Ames toxicity test, showing its non-carcinogenic character.

Maternal and fetal outcome among abruptio placentae cases at a rural tertiary hospital in Karnataka, India: a retrospective analysis.

Background: Placental abruption complicates about 1% of pregnancies and is a leading cause of vaginal bleeding in the latter half of pregnancy. It is also an important cause of perinatal mortality and morbidity. The maternal effect of abruption depends primarily on its severity, whereas its effect on the fetus is determined both by its severity and the gestational age at which it occurs. The Diagnosis was confirmed on the presence of retroplacental clot, which was used to estimate the amount of bleeding and severity of abruption. Patients were managed according to the fetal and maternal conditions and ultrasonography. Methods: The study was carried out for a period of two years from 1st July 2012 to 30th June 2014. The study population included all cases presenting with ante partum hemorrhage to the Department of Obstetrics and Gynecology during the study period. Subjects selected for the study were all cases diagnosed as having abruptio placentae. Results: Total number of women admitted in labor ward between 1st July 2012 to 30th June 2014 was 4956. Among these 138 had abruption placenta. Majority of patients were in the age group 25-30 years. Incidence was higher in multi-parous. Spontaneous vaginal delivery was the mode in most patients (~74%). Major maternal complication seen was Shock, followed by postpartum hemorrhage, altered coagulation profile and renal failure. Eighty four (62.3%) women delivered alive babies while 52(37.7%) were stillborn. Out of these 86 alive born babies four died in early neonatal period due to prematurity. Overall perinatal mortality was 40.5%. Conclusion: In our setup, frequency of abruptio placenta is comparable with local and international literature. Abruptio placenta is associated with high rate of maternal and fetal morbidity and mortality, Because of this association, the conditions predisposing it should be carefully evaluated in order to reduce the occurrence of placental abruption. Unfortunately neither accurate prediction nor prevention of abruption is possible at the present time. Despite advances in medical technology, the diagnosis of abruption is still a clinical one.

Abdominal tuberculosis: a study of 50 cases.

Background: The main type of tuberculosis of interest to any hospital- based surgeon is intestinal, the clinical presentation of which varies from one of an acute abdomen to one of a protracted cause of ill health and morbidity with a notorious reputation for poor response to therapy, both conservative as well as surgical. Low socio- economic status and malnutrition in our country are very important causes of the high prevalence of pulmonary tuberculosis, and with superadded problems of overcrowding and poor access to good sanitation and neglect for medical attention, extra pulmonary forms of tuberculosis also form a sizeable proportion of the case load of tuberculosis. The major source of infection is the open untreated case of pulmonary tuberculosis. Methods: Presented here is a brief account of hospital- based study of the presentation of 50 cases of abdominal tuberculosis and its management in both the acute as well as chronic setting, carried out at the B. Y. L. Nair Municipal Hospital Mumbai. Results: In our study 40% patients presented with signs of intestinal obstruction, 6% with perforative peritonitis, 34% with diffuse or well defined lump and 54% with ascites. All these patients underwent biochemical, radiological and endoscopic investigations. All the cases in this study were put on antitubercular four drug regime. Isoniazid (5mg / kg), Rifampicin (5-10mg/kg), Ethambutol (15mg/kg) and Pyrazinamide (20-25mg/kg) for two months followed by Isoniazid and Rifampicin for seven months. None of the patients developed drug toxicity during treatment. In our study out of 50 patients, 24 patients were treated conservatively. These includes 12 with tuberculous peritonitis (2 of the 12 had associated paraortic lymphadenopathy), 6 with subacute intestinal obstruction, 4 with RIF lump and 2 with colonic pathology) were treated conservatively. 26 patients underwent surgical treatment. Out of these 26 patients, 14 were operated in emergency and 12 were operated electively. Emergency surgeries were performed after correction of fluid electrolyte imbalance. Of the 14 emergency cases, 3 patients underwent resection anastomosis of small bowel, 6 patients underwent right hemicolectomy for iieocaecal tuberculosis. One patient had a stricturoplasty for ileal stricture in addition to right hemicolectomy. One patient underwent a stricturoplasty for ileal stricture and one unstable patient underwent drain insertion under local anaesthesia to drain out contaminated peritoneal fluid. Remaining two patients underwent adhesiolysis. Conclusions: In this study 60% patients had an acute and subacute presentation and 40% patients had a chronic presentation.

Excellent outcome of Aspergillous endophthalmitis in a case of allergic bronchopulmonary aspergillosis.

While invasive aspergillosis occurs typically in severely immunocompromised patients, cases of surgical site infections have been reported in immunocompetent individuals. The purpose is to report an eye with post‑operative Aspergillus endophthalmitis, which achieved a good visual outcome following early and aggressive treatment. A young patient, known case of allergic bronchopulmonary aspergillosis presented to us with post‑cataract surgery endophthalmitis. He was treated with pars plana vitrectomy and intravitreal voriconazole and systemic itraconazole. The patient regained a vision of 20/30 with follow up of 2 years.

Effect of red bull energy drink on auditory reaction time and maximal voluntary contraction.

The use of “Energy Drinks” (ED) is increasing in India. Students specially use these drinks to rejuvenate after strenuous exercises or as a stimulant during exam times. The most common ingredient in EDs is caffeine and a popular ED available and commonly used is Red Bull, containing 80 mg of caffeine in 250ml bottle. The primary aim of this study was to investigate the effects of Red Bull energy drink on Auditory reaction time and Maximal voluntary contraction. A homogeneous group containing twenty medical students (10 males, 10 females) participated in a crossover study in which they were randomized to supplement with Red Bull (2 mg/kg body weight of caffeine) or isoenergetic isovolumetric noncaffeinated control drink (a combination of Appy Fizz, Cranberry juice and soda) separated by 7 days. Maximal voluntary contraction (MVC) was recorded as the highest of the 3 values of maximal isometric force generated from the dominant hand using hand grip dynamometer (Biopac systems). Auditory reaction time (ART) was the average of 10 values of the time interval between the click sound and response by pressing the push button using hand held switch (Biopac systems). The energy and control drinks after one hour of consumption significantly reduced the Auditory reaction time in males (ED 232±59 Vs 204±34 s and Control 223±57 Vs 210±51 s; p<0.05) as well as in females (ED 227±56 Vs 214±48 s and Control 224±45 Vs 215±36 s; p<0.05) but had no effect on MVC in either sex (males ED 381±37 Vs 371±36 and Control 375±61 Vs 363±36 Newton, females ED 227±23 Vs 227±32 and Control 234±46 Vs 228±37 Newton). When compared across the gender groups, there was no significant difference between males and females in the effects of any of the drinks on the ART but there was an overall significantly lower MVC in females compared to males. Both energy drink and the control drink significantly improve the reaction time but may not have any effect on muscular performance. Energy drink per se is no better than control drink, which may indicate that there is no role of caffeine in the beneficial effect seen after the drinks.

Clinical validation of aneroid sphygmomanometer.

Recent concerns about the mercury toxicity and its ill effects on the environment and health has led to widespread use of aneroid manometers. Present study was conducted to analyse whether this change would lead to any systematic shift in measured blood pressure or consistency of blood pressure measurement in clinical setting. The clinical accuracy of the Welch Allyn aneroid sphygmomanometer model 7670-04 was studied against the mercury sphygmomanometer on 83 volunteers from Dehradun. Two blood pressure reading of each study subject was recorded with pretested instruments (aneroid and mercury sphygmomanometer). Data analysis showed the difference of means between the reading of two devices against mean of the observer reading for both systolic (-3.62±4.88) and diastolic (-2.36±3.77) blood pressure were not statistically different. The corresponding values of the SBP and DBP from both the instruments showed significant correlation. Regression analysis of mercury versus aneroid showed regression line (Y = 9.52 + 0.95X for SBP, Y = 0.36 + 0.96X for DBP) significantly different from line of equality (P<0.001). The study has demonstrated that the aneroid device (model: 7670-04) achieved grade B performance according to the British Hypertensive Society criteria.

Effect of gender on correlation of anaemia with body mass index in medical students.

: Nutritional anemia exists globally and cuts across all the sections of the population. Adolescent being formative years in life are more susceptible to nutritional anemia. Considerable changes in growth pattern, lifestyle, dietary habits & behavior are likely to influence the hemoglobin levels among male and females of high income group. Study was done to assess the level of anemia among medical students and it’s relation to Body mass index (BMI) among medical students. 200 healthy medical students at the Himalayan Institute of Medical Sciences belonging to both the sexes were taken in the study. Following consent anthropometry was conducted using standard protocol. Body Mass Index of >/= 18.5 kg/m2 is used to define undernutrition. Hemoglobin was estimated in gram %. Statistical analyses was done using mean .Standard deviation, Student’s t test, and was studied for effect of gender on correlation of anemia with BMI. 8% of the students of MBBS were found to be anemic (Hb <12 g%) with none of the boys having hemoglobin <12 g% .15.5% under nutrition was observed in the medical students with (25.75%) of girls having a BMI of <18.5 kg/m2. A negative association of hemoglobin was found with nutritional status (BMI) (r = –0.59; P = 0.24) in over weight and obese females students. Nutritional anemia and under nutrition exist among female medical students who are literate, and have free access to the nutritive diet in a good healthy environment.

In vitro development of resistance to arsenite and chromium-VI in Lactobacilli strains as perspective attenuation of gastrointestinal disorder.

Inadvertent intake of inorganic arsenic and chromium through drinking water and food causing their toxic insults is a major health problem. Intestinal bacteria including Lactobacilli play important regulatory roles on intestinal homeostasis, and their loss is known to cause gastrointestinal (GI) disorders. Probiotic Lactobacilli resistance to arsenite and chromium-VI could be an important factor for the perspective attenuation of GI-disorders caused by these toxic metals/metalloid. In the present study resistance of arsenite (up to 32 ppm), Cr-VI (up to 64 ppm), and arsenite plus Cr-VI (32 ppm each) were developed under in vitro condition following chronological chronic exposures in Lactobacilli strains. Comparative study of biochemical parameters such as membrane transport enzymes and structural constituents; dehydrogenase and esterase activity tests, which are respective indicators for respiratory and energy producing processes, and the general heterotrophic activity of cells, of resistant strains showed similarities with their respective normal parent strains. The resistant strains were also found to be sensitive to antibiotics. Findings indicate that these resistant probiotic Lactobacilli would be useful in the prophylactic interventions of arsenic and chromium GI-toxicity.

A study on substance abuse among school going male adolescents of Doiwala Block, District Dehradun.

Adolescent boys are recognized as a vulnerable group to substance abuse. The present study has the objective to study the biosocial profile and habit pattern of substance abusers. The study was conducted on 511 male adolescents, students of 10 th to 12 th class from the four intermediate schools of the Doiwala block of Dehradun district. 46.9% students accepted substance abuse. In 75.5% cases, friends were providing the substances. 80.2% substance abusers expressed their desire to quit the habit. The study is indicative of need for developing a supportive environment involving both parents and teachers so that adolescent can decide and sustain with the right choices for healthy life.

Blood pressure lowering, fibrinolysis enhancing and antioxidant activities of Cardamom (Elettaria cardamomum).

Elettaria cardamomum (L.) Maton. (Small cardamom) fruit powder was evaluated for its antihypertensive potential and its effect on some of the cardiovascular risk factors in individuals with stage 1 hypertension. Twenty, newly diagnosed individuals with primary hypertension of stage 1 were administered 3 g of cardamom powder in two divided doses for 12 weeks. Blood pressure was recorded initially and at 4 weeks interval for 3 months. Blood samples were also collected initially and at 4 weeks interval for estimation of lipid profile, fibrinogen and fibrinolysis. Total antioxidant status, however, was assessed initially and at the end of the study. Administration of 3 g cardamom powder significantly (p<0.001) decreased systolic, diastolic and mean blood pressure and significantly (p<0.05) increased fibrinolytic activity at the end of 12th week. Total antioxidant status was also significantly (p<0.05) increased by 90% at the end of 3 months. However, fibrinogen and lipid levels were not significantly altered. All study subjects experienced a feeling of well being without any side-effects. Thus, the present study demonstrates that small cardamom effectively reduces blood pressure, enhances fibrinolysis and improves antioxidant status, without significantly altering blood lipids and fibrinogen levels in stage 1 hypertensive individuals.

Evaluation of dynamic function tests in normal obese individuals.

The study was undertaken to assess the dynamic pulmonary function tests in obese and non obese young adults of Gharwal (Uttrakhand, India) of 20–40 years age group, randomly selected form the employees of Himalayan institute of medical sciences, attendants of the patients at the hospital and also from the nearby community at Jolly grant, Dehradun. The volunteers representing mixed socioeconomic group were categorized into obese cases and non-obese controls as per the standard criteria for Body mass index (BMI). Dynamic pulmonary function tests were carried out with all the standard protocols. Statistical analysis comprised student’s “t” test and linear correlation analysis. The result indicated a significantly lower value of (FVC) forced vital capacity (2.89±0.29) and (FEV1) Forced expiratory volume in 1st sec (2.59±0.25) in obese females. The FVC and FEV1 in the females correlated negatively to the BMI (r = –0.376, P<0.05 and r = –0.359 and P<0.05) and were significant. Dynamic pulmonary function values in males showed a negative correlation but were not statistically significant. This concludes that obesity per se has less effect on the dynamic function tests in obese young adults except in females, but obese individuals presenting with greater morbidity may be more susceptible to altered dynamic pulmonary function test in this age group.