Haematological profile and its outcome in different species of malaria: a two year study

Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh, which is also one of the endemic areas for malaria. Several factors have been attributed to increased morbidity and mortality in malaria especially with altered hematological and coagulation parameters playing an important role. The aim of present study was to study the hematological and coagulation abnormalities that correspond to severity and the final outcome.Methods: The present study was carried out on 100 patients admitted during the period of November 2016 to October 2018 at Narayana Medical College and hospital, Nellore. All of these patients were confirmed by Peripheral Smear or MPQBC or Antigen Assay followed by detailed clinical history, physical examination and investigated with hematological and coagulation parameters. Then subsequently required routine and special investigation which was followed by monitoring the outcome of the patients with respect to morbidity and mortality.Results: Out of 100 patients 20 patients had severe anemia (Hb% <7 gm%) and most of them patients were falciparum and mixed infection cases. Thrombocytopenia was observed in 63% of the patients and severe thrombocytopenia (<50,000 mm3) was seen in 12% of the patients. PT and APTT were increased in 18% and 13% of the cases respectively. BT was increased in 5% of the cases. None of the patients expired in this study.Conclusions: severe anemia is a poor prognostic factor and has adverse outcome. Thrombocytopenia, increased PT, APTT does not have any correlation to mortality.

Clinical profile of falciparum, vivax and mixed infections of malaria, from a tertiary care hospital, Coastal Andhra, India

Background: Malaria is a major health problem in many parts of India and some parts of Andhra Pradesh is one of the endemic areas for malaria. The objective was to study clinical profile and outcome of malaria in both species and mixed infection.Methods: Present study was carried out on 100 patients admitted during the period of November 2016 - October 2018 in Narayana medical college and hospital, Nellore. Malaria confirmed by Peripheral thick and thin smear or Antigen Assay underwent detailed clinical history and physical examination. This was followed by monitoring the outcome of the patients with respect to morbidity and mortality.Results: Out Of the 100 patients 58 patients were from rural background, males were predominant, most common age group was 20-30 (34%) followed by 31-40 (31%). Out of 100 patients, 54 patients were falciparum,44 patients had vivax and two had mixed infection. All of the patients had fever followed by chills and rigors (75%), nausea and vomiting (59%), easy fatiguability (28%), pain abdomen (17), cough (14%) in both infections, altered sensorium was seen in only falciparum (20.3%). On clinical examination,70% of the patients had pallor, splenomegaly in 46%, icterus (23%), hepatomegaly (14%) and pedal edema in12 patients were observed. All 0f the patients were treated with appropriate antimalarial drugs for appropriate duration, and all were recovered without any mortality.Conclusions:Malaria is very common disease in our country especially in South India, which is one of the endemic areas. Severe malaria usually caused by the falciparum more than vivax, early diagnosis and treatment decreases the mortality and morbidity.

Burkholderia cepacia an emerging cause of septicaemia, in an intensive care unit from a tertiary care hospital, Nellore, India

Background: Burkholderia cepacia is highly virulent and multidrug resistant organism to cause fatal and serious infections in ICUs leads to rise in mortality and morbidity. aim of present study was to know the prevalence of Burkholderia cepacia in blood stream infection in Intensive Care Unit and to know the drug susceptibility.Methods: This is a prospective study was carried out in the Intensive Care Unit and Department of Microbiology, Narayana Medical College, Nellore, from February to March 2018. As a part of routine investigations Blood, urine, sputum or tracheal secretions sent for culture and sensitivity to the Microbiology laboratory. By conventional method, all the samples were cultured (except blood) onto Blood agar, Chocolate agar and MacConkey, s agar; incubated for 18-24 hours at 37?C. Blood cultures were performed in BACT/ Alert 3D (Biomeriux), only positives were subculture by conventional method. Further analysis was done in culture positive samples only.Results: A total of 448 patients admitted in ICU were included in the study, from them 586 samples were collected. out of which we got 238 culture positives. Among them 19 patients were positive for Burkholderia cepacia, most of them isolated from blood (78.9%), followed by respiratory secretions (21.1%) and none of them were isolated from urine samples. Most of the isolates were sensitive to Meropenam and Tigecycline (89.4%) followed by minocycline (84.2%), ceftazidime (73.6%), levofloxacin (63.1%). While B. cepacia isolates showed high resistance to cefaperazone-sulbactam, ciprofloxacin, ticarcillin-clavulanic acid with (84.2%), (89.4%), (89.4%) respectively.Conclusions: To conclude that, Burkholderia cepacia is one of the emerging causes of septicemia with multidrug resistance, cross contamination may be the root cause so it should be treated quickly and effectively.

Clinical study of hypertensive crisis at a tertiary care hospital of South India

Background: Hypertensive crisis is a severe clinical condition in which sudden increase in arterial blood pressure can lead to acute vascular damage of vital organs. So timely detection, evaluation and adequate treatment are crucial to prevent permanent damage to vital organs. The aim of the present study is to evaluate incidence and clinical presentation of hypertensive crisis in relation to age, sex, severity of hypertension, accompanying symptoms and clinical manifestations.Methods: It is a clinical prospective study done during the period between January to June 2018 at Narayana Medical College, Nellore. All patients who were more than 18 years with blood pressure>180/120 mmHg to the emergency, outpatients, and inpatients were included. A thorough History and clinical examination was done and necessary investigation was sent to the laboratory.Results: The study results indicate that males (64%) were significantly over represented compared to females (36%). Out of 50 patients majority of the subjects belonged to age group of 50-59 years. Out of 50 Patients most common symptom is Headache (48%), Vomiting (48%), Giddiness (38%), Dyspnoea (22%), Loss of consciousness (22%) followed by chest pain (20%), Blurring of vision (20%) and weakness of limbs (14%). Most of the individuals are in the hypertensive emergency (66%) followed by Hypertensive urgency (34%). Out of 50 patients 56% had neurological involvement and 44% had cardiological involvement. Our study states that most of cases were in grade 1retinopathy (8%) followed in order by grade 4 retinopathy (8%), grade 2 retinopathy (6%) and grade 3 retinopathy (6%).Conclusions: The present study concludes that majority of patients present presenting in hypertensive emergency belonged to fifth and sixth decades of age. So, treating physician should rapidly assess the differentiation of hypertensive emergency and hypertensive urgency in order to prevent end organ damage and to prevent further morbidity and mortality.