ABSTRACT
Background: Scrub typhus a zoonotic disease caused by gram negative bacteria O. tsutsugamushi, is endemic in Himachal Pradesh. This illness occurs mainly in monsoon and post monsoon season. study design of this study was conducted in a tertiary care centre in Himachal Pradesh between July 2015 and June 2016. All the indoor patients with age above 18 years with a diagnosis of scrub typhus were included in this study.Results: Out of total 180 patients, 130 were female patients. Most patients were in the age group 21-30 (23.3%). All the patients presented with history of fever, but 54 patients presented with high grade fever. Other Most common symptom was chills and rigours (81%), followed by vomiting and headache each 32%, cough 31%. On examination 21% patients had eschar,14% patients had lymphadenopathy. Most number of patients presented in the month of September (51.6%), followed by August (33.3%).Conclusion: Scrub typhus being an important differential of acute undifferentiated fever in this region, should not be missed by primary care physicians, as once multi organ dysfunction sets in, mortality rate starts rising. So, there is a high need of sensitization of doctors and people about this illness so that early diagnosis and early treatment can be ensured.
ABSTRACT
Background: Many of the ILDs are difficult to differentiate on clinical examination and history as they have similar clinical features. Symptom complex is not beyond that of respiratory symptoms. The objective was to study the clinical picture and spirometry pattern of the patients having interstitial lung disease.Methods: Hospital based cross sectional study was carried out among 73 cases of ILDs. Data related to history, clinical examination was recorded. Six minute walk test and spirometry was carried out. The data was analysed using proportions.Results: Incidence of Idiopathic pulmonary fibrosis (IPF) increased with age. Exertional dyspnea (100%) and cough (95.9%) were the commonest presenting symptoms amongst ILD patients. End inspiratory fine crackles (95.1%) and clubbing (67.1%) are the predominant clinical signs. Mean BMI of various ILDs patients were 24.86±8.2 Kg/m² in NSIP followed by 22.9±4.6 in sarcoidosis 21.9±6.4 and 20.8±3.94 in IPF and in Cryptogenic Organizing Pneumonias 19.34±1.8 Kg/M². Serum ACE level was raised in 69.2% patients of sarcoidosis. 81 % of patients could successfully perform 6 Minute Walk Test. Among those who could perform, average desaturation was 8.11% in sarcoidosis, 7.52% in IPF, 6.0% In Hypersensitivity Pneumonitis, 5.75% in NSIP and 4.75% in CTD associated ILDs patients. Raised C Reactive Protein label was consistent (45.2%) in ILDs, maximum in HP (63%) and 2 out of 3 patients with COP and 3 out of 5 patients of CTD associated ILDs. 17.8% cases had positive serum ANA, maximum in IPF.Conclusions: Idiopathic pulmonary fibrosis (IPF) was the commonest Interstitial Lung disease present in 39.7% of 73 cases followed by sarcoidosis in 17.9%, cases.
ABSTRACT
Background: Since, Revised National Tuberculosis Control Programme (RNTCP) relies on sputum microscopy for diagnosis, categorization of patients and assessment of treatment, the credibility, success and sustainability of the programme depends on the lab networks. The objectives of this study were to Quality assurance of Sputum Microscopy under RNTCP in Tuberculosis Unit.Methods: A cross-sectional analytic study was conducted at DMC ML Chest hospital, DMC LLRM Hospital and DMC ESI Hospital. On-site evaluation was conducted once a month by Senior Tuberculosis Lab. Supervisor (STLS) of the DMCs (First Controller). This visit included a comprehensive assessment of laboratory safety procedure, conditions of equipment as well as technical components of AFB smear microscopy which includes prepare, staining and reading of smears. This also included examination of five positive and five negative smears in unblinded manner, to observe the quality of smear and staining as well as condition of microscope at each DMCs. A check list prepared for collection and analysis of standard data to point out remedial action.Results: The overall slide positivity rate (SPR) was 20.17% and 23.99% for ZN-stained slides and fluorescence stained slides respectively. On-site evaluation of all DMCs revealed a good result except of DMC- LLR in maintenance of microscope and well organized and clean working areas. The overall concordance for RBRC slides result of ZN-stained slides was 98.64% and overall discordance was 1.35%. The overall agreement in the re-reading of fluorescent stained slides was 100%. The overall sensitivity, specificity, positive predictive value and negative predictive value of blinded re-checked fluorescence stained slides were 100% each respectively.Conclusions: The overall performance of all DMCs is acceptable