Prognostic utility of neutrophil gelatinase associated lipocalin in cardiac ICU: A prospective study

Our study aims to evaluate the role of neutrophil gelatinase associated lipocalin (NGAL) as an early surrogate marker in predicting acute kidney injury (AKI) and mortality in cardiac ICU patients. The study was conducted at SRN Hospital, excluding those with known renal diseases. Out of 152 patients, 56 developed AKI (cases) and 96 were our controls. Higher NGAL was associated with increased mortality rates (P ¼ 0.0201 and 0.0255 for serum and urinary NGAL respectively). Our study concluded that NGAL measurement at admission may be a boon in improving the outcome of cardiac ICU patients

Seroprevalence of hepatitis C virus among patients at a tertiary health care centre in Rajasthan, India

Background: To ascertain the prevalence of Hepatitis C infection among patients visiting a tertiary care center in Jaipur, Rajasthan.Methods: An observation analytic study was done at a tertiary care center affiliated to Medical College with retrospective analysis of the hospital data of two calendar years. During this period HCV infection screening (anti-HCV) was offered to every suspected patient admitted in hospital and every pregnant women visiting antenatal care clinic.Results: The study prevalence of HCV infection was 0.05% (13/25311). The prevalence was more in female (0.03%) than male (0.02%). The study prevalence of anti-HCV among pregnant female was 0.02% (3/16224). Maximum positive cases (4/13, 30.77% positive cases) were in the age group of 21-30 years (sexually active group) and >50 years age group while minimum positivity was found in children (00 case, 0-20 years age).Conclusions: In this study, prevalence of HCV infection was 0.05%. The study prevalence of HCV among pregnant females was 0.02%. Maximum positive cases (4/13, 30.77% positive cases) were in the age group of >50 years and 21-30 years. This study aids in view to strengthen proper screening for HCV infection to reduce HCV related morbidity and mortality

A study on drug utilization pattern of antihypertensive drugs in hypertensive diabetic patients

Background: Hypertension management is of paramount importance in diabetic patients for reduction of cardiovascular and other complications. The objective of the present study was to assess prescribing pattern of antihypertensive drugs in hypertensive type 2 diabetic patients and evaluate them by comparing with Eighth Joint National Committee (JNC-8) hypertension treatment guidelines.Methods: A prospective observational study was carried out on 110 hypertensive type 2 diabetic patients of age 41-80 years visiting outpatient department of Medicine at G.S. Medical College and Hospital, UP, India for 4 months. JNC-8 hypertension management guideline was considered while evaluating the prescribed drugs. All the relevant data was collected from the prescription card of the patient on a preformed performa and analyzed using descriptive statistics.Results: Total of 176 drugs was prescribed to the study patients among which two drug combination therapy (55.45%) was mostly used. The most common group prescribed was angiotensin receptor blocker (ARB) (29.45%) and ARB+CCB (calcium channel blockers) (34.92%) were the commonest fixed drug combination. Overall, it was amlodipine (21.47%) that was most frequently prescribed among all antihypertensive drugs.Conclusions: ARB was the most commonest class, ARB+CCB was the most frequent fixed drug combination prescribed to the study patient while amlodipine was the highly utilized individual antihypertensive drug in the study. Prescriptions evaluation revealed that 94.88% prescription were rational and were in accordance with the JNC-8 hypertension treatment guidelines except the use of beta blockers (5.12%).

Study of neurological deficits in patients with tuberculous meningitis and its association with urodynamic study

Background: Tuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. The objective of this study was to study neurological symptoms in TBM patients using clinical diagnosis and MRI of spine and comparing with urodynamic study.Methods: Fifty one patients diagnosed with TBM were studied in Neurology Department of KGM Medical University, Lucknow. Uroflowmetry and urodynamic study were done to divide the patients into normal and abnormal. A detailed history taking, general physical and neurological examination using MRI spinal cord was done and recorded on a predesigned proforma.Results: Visual impairment, hemiparesis, paraparesis, abnormal tone and reflexes in lower limbs showed significant association with abnormality in urodynamic study. MRI spine showed significant relationship of spinal meningeal enhancement, lumbosacral arachnoiditis, with abnormal urodynamic study.Conclusions: We found a significant association between neurological symptoms and abnormal urodynamic

Prevalence and clinical significance of microalbuminuria and hypoxemia in patients with chronic obstructive pulmonary disease

Background: Microalbuminuria is a sign of glomerular dysfunction in general and sign of tubulointerstitial disease to a lesser extent. Hypoxia induces endothelial cell to release a number of different vasoactive agents including endotheline-1, platelet derived growth factor (PDGF), nitric oxide; that causes endothelial injury and lead to microalbuminuria. This study was aimed to assess the prevalence of microalbuminuria in COPD patients and assess the Relationship of microalbuminuria with the disease severity in the forms of FEV1, PaO2, PaCO2, and BODE INDEX in COPD patients.Methods: Total 130 COPD patients were included in our cross sectional study. Total patients were divided into two groups, 1st group was COPD with microalbuminuria while 2nd group was COPD without microalbuminuria. Lung function test, 6 min walk distance, arterial blood pressure (BP), BODE index, arterial blood gases, fasting and post prandial plasma glucose and kidney function tests were measured. Screening for microalbuminuria was done by measuring urinary microalbumin in a random spot urine collection.Results: The prevalence of microalbuminuria was 29.23% in patients of COPD. As compared with COPD without microalbuminuria group, COPD with microalbuminuria group were more hypoxic (12% vs 74%, P=0.0001 ), more hypercapnic (22% vs 84%, p=0.00001) and most of the patients with grade III (16% vs 34%, p=0.00001) or grade IV (19% vs 47%, p=0.00001) severity (according to GOLD criteria).Conclusions: Patients with severe COPD with hypoxemia or hypercapnia were significantly associated with microalbuminuria.

Human immunodeficiency virus and HBV co-infection: independent entities, together by coincidence?

Background: To ascertain the prevalence of HBV among HIV-infected, treatment- naïve patients visiting a tertiary care centre in Jaipur, Rajasthan, India.Methods: An observation analytic study was done at a tertiary care centre affiliated to medical college with retrospective analysis of the hospital data of 30 calendar months. During this period routine diagnostic screening of HIV infection and HBV infection was offered to every suspected patient admitted in hospital and every pregnant woman visiting antenatal care clinic. Patients with documentary evidence of HIV infection and history of Hepatitis B vaccination in last 30 days are not screened for these infections at our centre. The HIV screening was done as per NACO guidelines. The HBV screening was done using commercially available enzyme linked immunosorbent assay kits (ELISA) for detection of surface antigen (HBsAg).Results: The study prevalence of HIV infection was 0.11% (40/35289). The prevalence was more in male (0.45%) than females (0.06%). HBV was not detected in any of the HIV positive patient in this study. The study prevalence of HIV among pregnant females was 0.05% (10/22026).Conclusions: In this study, prevalence of HIV infection was 0.11%. The study prevalence of HIV among pregnant females was 0.05%. Other than pregnant women, maximum positive cases (13/30, 43.33% positive cases) were in the age group of 25-34 years (sexually active group). No patient had HIV and HBV co-infection.

Renal resistivity index is inversely proportional to estimated glomerular filtration rate in chronic kidney disease

Background: Renal resistive index (RRI) measured by Doppler ultrasonography has been associated with severity, rate of progression and mortality in chronic renal failure. Parameters like renal vascular resistance, filtration fraction and effective renal plasma flow have been associated with renal resistivity index in chronic kidney disease patients.Methods: This hospital based cross-sectional study was conducted from April 2016 to August 2017. 100 patients with chronic kidney disease were enrolled. RRI was calculated from the blood flow velocities observed during Doppler examinations of the segmental arteries and estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Spearman Rank-Order Correlation Coefficient was used.Results: A Significant inverse correlation was observed between RRI and eGFR (r= -0.347, p =0.0004). It was also observed that older age (r= 0.297), higher systolic blood pressure (r= 0.365), lower levels of hemoglobin (r= -0.34 for males and r= -0.353 for females) were observed to correlate with higher values of RRI in advanced CKD stages.Conclusions: RRI correlated inversely with eGFR in chronic kidney disease and hence was directly related to the severity of the disease.

Comparison of the efficacy of triple blockade, double blockade and single blockade of RAAS in non diabetic chronic kidney disease

Background: Although dual blockade of the renin-angiotensin-aldosterone system with the combination of an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker is generally well established as a treatment for nephropathy, this treatment is not fully effective in some patients.Methods: A prospective observational study was done on 600 chronic kidney disease patients during July 2012 to August 2014 to compare the efficacy of triple blockade, double blockade and single blockade of renin-angiotensin-aldosterone system in non diabetic chronic kidney disease.Results: At the end of the study, 24 hours urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0268) was found significant. Similarly, on comparing group II and group III, p value (0.0160) was again found significant.Conclusions: Triple blockade of the renin-angiotensin-aldosterone system was effective for the treatment of proteinuria in patients with non-diabetic nephropathy whose increased urinary protein had not responded sufficiently to a dual blockade.

Comparison between the efficacy of double blockade and single blockade of RAAS in diabetic kidney disease

Background: Diabetic kidney disease is associated with high morbidity and cardiovascular mortality. A number of guidelines and recommendations have been issued over the years recommending the use of renin angiotensin aldosterone system blockade in the management of diabetic kidney disease.Methods: A prospective observational study was done on 750 diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the efficacy of double blockade and single blocked of renin angiotensin aldosterone system in diabetic kidney disease.Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0268) was found significant. Similarly, on comparing group II and group III, p value (0.0278) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (0.0496) while comparing group II and group III, p value (0.0419) was again significant.Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than mono-therapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate in diabetic kidney disease patients. Novel potassium-lowering therapies are shown to effective compensate the hyperkalemia risk associated with renin angiotensin aldosterone system blockade use in people with diabetic kidney disease, offering promise for more adequate therapy and greater renal and cardiovascular risk protection in the future.

Nephro protection property of double blockade versus single blocked of RAAS in delaying the progression of CKD

Background: Dual renin angiotensin aldosterone system blockade using angiotensin receptor blockers in combination with angiotensin converting enzyme inhibitors is reported to improve proteinuria in non-diabetic patients.Methods: A prospective observational study was done on 810 non-diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the nephro protection property of double blockade and single blocked of renin angiotensin aldosterone system in delaying the progression of chronic kidney disease.Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0001) was found significant. Similarly, on comparing group II and group III, p value (0.003) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (<0.0496) while comparing group II and group III, p value (0.0419) was again significant.Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than monotherapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate. Newer potassium lowering therapies can effectively and safely correct hyperkalemia and maintain normokalemia in patients receiving background treatment with renin angiotensin aldosterone system blockade. However, the use of new potassium binders for cardiovascular and renal risk reduction with combined renin angiotensin aldosterone system blockade therapy will require phase III trials.

Incidence of tuberculosis in nondialysis-requiring CKD patients

Background: Tuberculosis is a common infection of chronic kidney disease patients in developing countries.Methods: A retrospective study of 2960 non-dialysis requiring chronic kidney disease patients was made to determine the incidence and understand the demographic features of patients that lead to the development of tuberculosis on the basis of cell count, routine, ADA estimation, ZN stain, culture and PCR.Results: Between Jan 2000 and March 2017, the incidence of tuberculosis in no dialysis-requiring chronic kidney disease group was 10.3% in which pulmonary tuberculosis was 3.9% while extrapulmonary tuberculosis was 6.4%. Among extrapulmonary tuberculosis, 52% positivity was seen in pleural effusion, 16.40% in ascetic fluid, 10.10% in lymphnodes, 7.4% in urinary tract, and 3.7% in CSF, 2.6% in pericardial fluid, 1.6% in adrenal tissue and 1.1% in spine. ZN stain was positive in 48.6%, culture isolated mycobacterium 98.3%, PCR 93.4%, the mean ADA levels was 22.90+11.24 IU/ml and 60.49+07.24 IU/ml in CSF and body fluids respectively. Outcome analysis revealed 15.4% mortality rate in diagnosed tuberculosis cases while maximum loss of life was seen in diabetic patients.Conclusions:In the present study we observed 10.3% incidence of tuberculosis among nondialysis-requiring chronic kidney disease patients. Extrapulmonary form of tuberculosis predominates over pulmonary form. Unusual presentation and lococalization of symptoms should not be overlooked. Prompt and early diagnosis of tuberculosis is especially required in endemic areas.

Use of Generic Vs Branded Drugs in Enteric Fever – A Prospective and Comparative Study

Background: The concept of generic prescription is widely accepted in various parts of the world. Nevertheless, it has failed to gain popularity in India due to factors such as non-availability and distrust on the product quality. Aim: To study cost-effective and cost-benefit analysis of antibiotic prescription in patients who had enteric fever and were given intravenous ceftriaxone.   Methods: This was a prospective observational study conducted in a tertiary care cenre at World College of Medical Science and Research, Jhajjar, Haryana. 65 patients who have been diagnosed with enteric fever and were prescribed ceftriaxone were studied and their prescriptions were analyzed. 5 brands of most commonly prescribed ceftriaxone injections were chosen to analyse cost effective and cost-benefit analysis. Results: Out of 65 patients, 40 were females and 25 were males, diagnosed with enteric fever. Maximum number of patients were seen between age group of 36-50 years (38) and minimum patients belonged to age group of more than 65 years. Analysis of prescriptions revealed that majority of the patients were prescribed Branded drugs 53 (82%) than were prescribed generic drugs 12 (18%). The analysis of the cost of single dose of inj. ceftriaxone revealed that branded drugs were 8.52 % to 180.81% more in comparison with generic IV ceftriaxone. Conclusion: The cost of most commonly prescribed branded drugs was significantly higher than generic drug and prescribing branded drugs was associated with failure to take complete treatment as prescribed by treating physician.

Prescribing Pattern of Antimicrobial Agents in Pelvic Inflammatory Disease - A Hospital Based Prospective Study

Pelvic inflammatory diseases (PID) is a noteworthy wellbeing concern prompting significant gynecological grimness among ladies in conceptive age gathering. Along these lines this review was attempted to dissect the medicine example of Antimicrobial Agents in patients experiencing Pelvic Inflammatory Diseases. Methods: A cross-sectional study was conducted at the Department of Gynecology & Obstetrics of World College of Medical Science and Research, Jhajjar, Haryana; for a period of 5 months during December 2016 to April 2017. A total of 210 prescriptions of clinically diagnosed PID cases from Outpatient Department (OPD) and Inpatient Department (IPD) were collected and analyzed in the department of Pharmacology based on Drug utilization WHO indicators. Results: Average number of AMAs per prescription was 2.26. Majority of patients prescribed were Antifungals (n=112, P=23.57%) followed by Fluoroquinolones (n=102, P=21.47%), Aminoglycosides (19.36%), Nitroimidazoles (16.0 %) and Doxycyclines (P=15.78%). Urinary antiseptics were the least prescribed class (3.78%). Individually, most commonly used agents of these is Clotrimazole + Tinidazole followed by Doxycycline and least prescribed was Nitrofurantoin. Conclusions: There was minimal difference between defined recommendations in standard treatment guidelines and the clinical use of antimicrobial agents. The only lacking part of this study was lesser use of generic drugs.

Haematological profile of 21 patients with hairy cell leukaemia in a tertiary care centre of north India.

Background & objectives: Hairy cell leukaemia (HCL) is a B cell neoplasm which constitutes around 2 per cent of all the lymphoid leukaemias. It has a characteristic morphology and immunophenotypic profile. It is important to distinguish HCL from other B cell lymphoproliferative disorders due to availability of different chemotherapeutic agents. This study presents clinical, haematological and immunophenotypic profile of patients with HCL seen over a period of four years in a tertiary care hospital in north India. Methods: Twenty one cases of hairy cell leukaemia were analyzed for their clinical details, haemogram, bone marrow examination and immunophenotypic findings. Results: Age of the patients ranged from 28-76 yr with male predominance. Weakness and fever were commonest presentations. Splenomegaly, hepatomegaly, lymphadenopathy were seen in decreasing order of frequency. Anaemia was noted in all 21 patients, leukopenia in 15 and thrombocytopenia in 19 cases. Fourteen patients were pancytopenic. Bone marrow examination showed typical hairy cells in all cases. Immunophenotyping showed expression of CD19, CD20, CD103, CD25 and CD11c in all cases, while positivity was seen for CD79b in 93.7 per cent, kappa light chain restriction in 60 per cent and lambda in 40 per cent cases. Notably, 20 per cent showed CD10 and 12 per cent showed CD23 expression. Interpretation & conclusions: This study reveals some unusual findings in otherwise classical disease entity, like absence of palpable spleen, presence of lymphadenopathy, normal or elevated leukocyte counts, expression of CD10, which at times could be diagnostically challenging.

Female adnexal tumor of probable Wolffian origin.

Female adnexal tumor of probable Wolffi an origin (FATWO) is a rare neoplasm arising from the remnants of the mesonephric duct. We report here a case of FATWO in a 70-year-old woman arising from the broad ligament and confi rmed on immunohistochemistry. Most of these tumors behave in a benign fashion but certain histological features like hypercellularity, cellular pleomorphism and nuclear atypia as seen in the index case may increase the rate of recurrence and metastasis. Therefore, close follow-up is recommended for FATWO.

Floppy iris syndrome with oral imipramine: A case series.

Intraoperative floppy iris syndrome (IFIS) has commonly been seen with long-term use of α1-adrenoceptor blocking agents. We observed IFIS in three patients during phacoemulsification due to oral imipramine therapy. The three patients took imipramine for 25 years, 10 months and 1 year, respectively. However, only the first patient was on oral therapy at the time of surgery, while the other two patients had stopped 4 months and 2 months prior to undergoing phacoemulsification. The first and third patients developed complete IFIS features, while the second had only partial IFIS characteristics. Phacoemulsification could be completed in all three patients without any complication. None of these patients had history of taking any of the α1-adrenoceptor blocking agents. This is the first anecdotal report of IFIS with the oral use of imipramine and hence further evidences are required to ascertain the association of oral imipramine therapy and IFIS. However, ophthalmologists undertaking phacoemulsification on patients on imipramine therapy should be alert for the occurrence of IFIS.

Efficacy of intraoperative vancomycin in irrigating solutions on aqueous contamination during phacoemulsification.

PURPOSE: To study the efficacy of adding vancomycin in irrigating solutions, in comparison to topical antibiotic given preoperatively for a day, during phacoemulsification, in reducing the anterior chamber (AC) contamination. SETTINGS AND DESIGN: This was a prospective, interventional, hospital-based study. MATERIALS AND METHODS: This was a study involving 400 eyes of 400 paitens, undergoing routine phacoemulsification between January 2004 and June 2006. The patients were non-randomly assigned to two groups: Group 1 included 180 patients, who received topical ciprofloxacin eye-drops (four-hourly) for a day preoperatively and Group 2 included 220 patients, who underwent phacoemulsification with vancomycin (20 microg/ml) in the irrigating solution. Anterior chamber aspirate obtained at the end of the surgery was sent for microbial workup. The number of positive cultures in both the groups was determined. STATISTICAL ANALYSIS: This was performed using Chi-square test. Results: Aqueous samples showed microbial growth in 38 (21.1%) out of 180 eyes in Group 1 and in 17 (7.7%) out of 220 eyes in Group 2 ( P = 0.001). Coagulase-negative staphylococcus was the most common organism in both the groups. Aqueous samples from four eyes in group 1 showed multiple organisms, while none of the sample from group 2 showed more than one organism. None of the eyes in either group showed fungal contamination. One patient in Group 1 developed endophthalmitis, and the causative organism was Alcaligenes faecalis. All patients were followed up for a minimum of six months (range: 6 to 14 months and mean: 9.3 months). CONCLUSION: Addition of vancomycin in irrigating solutions is more efficacious in reducing AC contamination in comparison to topical antibiotic administered a day preoperatively.