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Background: The high incidence and antimicrobial resistance among the pathogens causing neonatal sepsis is alarming. In addition to substantial immediate mortality, survivors of infections in the neonatal period are at increased risk of long-term disability. The present study was conducted to know the bacteriological profile and risk factors associated with culture proven neonatal sepsis in a peri urban population.Methods: This study was conducted over a period of 4 year (2015-2019). On clinical suspicion, blood culture specimens were sent to microbiology laboratory. The organisms isolated from blood cultures were identified and tested for antimicrobial susceptibility. As part of infection control practices, environmental samples from the neonatal intensive care units were tested.Results: Of 907 blood cultures of neonates received in the microbiology laboratory, 20.7% were culture positive. Majority of the episodes occurred at or before 72 hours of life (81.4%). 54.3% were Gram positive cocci including Coagulase negative Staphylococci, Staphylococcus aureus and Enterococcus spp. The common Gram-negative pathogens included Escherichia coli, Klebsiella spp. and Pseudomonas spp. Common risk factors involved were preterm birth, low birth weight, premature rupture of membrane, prolonged labour and iatrogenic causes.Conclusions: The early signs of sepsis are often subtle and nonspecific. Therefore, a high index of suspicion is needed for early diagnosis. Rapid, reliable detection and appropriate case management can save lives of many new-borns.
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Background: Tuberculosis is an old disease and has deep social impact on the society. It is a re-emergent killer disease with rise in MDR and XDR strains. DOTS strategy under RNTCP has had a substantial impact over the past two decades. Treatment compliance is one of the key factors determining success of TB control program. The objective of this study was to find out the compliance rate with DOTS and factors responsible for non-compliance in the district.Methods: A cross-sectional study was carried out using structured questionnaire in a tuberculosis unit of Chandauli district, Uttar Pradesh. 100 tuberculosis patients aged ≥15 years registered for TB treatment were enrolled in the study.Results: Out of the 100 patients interviewed, majority of patients (95%) complied. The main reasons for non-compliance were improvement in symptoms after initial doses leading to discontinuation of therapy, and side effects of drugs. One of the defaulter migrated, so he could not be traced. Among factors influencing compliance to DOTS most important was strong monitoring.Conclusions: Health education and easy accessibility of healthcare services are required to further improve the compliance of TB treatment. Internet tools and social security schemes can play essential role in increasing awareness and strengthening the monitoring program
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Background: Non-alcoholic fatty liver disease (NAFLD) is closely associated with metabolic syndrome. NAFLD is considered a disease of no consequence. Data on the effect of NAFLD on renal dysfunction in T2DM is sparse. Author aimed to study the association of NAFLD with CKD in Indian T2DM subjects.Methods: In an observational cross-sectional study at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India from February 2017 to March 2018. 197 out of 268 randomly selected type 2 diabetes mellitus (T2DM) subjects were selected for the study after considering the inclusion and exclusion criteria. CKD was defined as estimated GFR <60 ml/min per 1.73 m2 and/or albumin to creatinine ratio ≥30 mg/g. NAFLD was diagnosed using ultrasonography. The association between NAFLD and CKD was analyzed using SPSS (version 24.0).Results: On ultrasonography 133 (67.5%) T2DM subjects had NAFLD. Diabetic with NAFLD (133, 67.51%) had significantly more history of hypertension (p 0.006), higher systolic (p 0.03) and diastolic BP (p 0.009), higher BMI (p <0.001), waist circumference (p <0.001), fasting glucose (p 0.03), triglyceride (p<0.001) and higher urinary albumin-to-creatinine ratio (p <0.001). Diabetics with CKD (61, 30.96%), were older (p 0.03), hypertensive (p <0.001) and had higher fasting glucose (p 0.003). Subjects with CKD had a higher prevalence of underlying NAFLD (78.69% vs 62.5%, p 0.03) as compared with diabetics with no CKD. T2DM subjects with NAFLD had more than two times (OR 2.88 (1.1-6.78), p 0.03) the risk of developing CKD after multivariate analysis as compared to subjects without NAFLD.Conclusions: NAFLD is a risk factor for development of CKD in patients of type 2 diabetes mellitus. Screening and early preventive measures may go long way in reducing morbidity.
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Background: Spontaneous bacterial peritonitis (SBP) is common complication of cirrhosis caused by bacterial translocation. Bacterial colonization and overgrowth may occur in GI tract on suppression of gastric acid secretion. Beta-blockers have been postulated to reduce intestinal permeability. There is no significant Indian study to evaluate association of PPI with SBP in cirrhotic ascites. We aimed to assess the effect of PPI in cirrhotic patients decompensated with ascites.Methods: A retrospective case control study (January 2016 to April 2018), evaluated subjects with cirrhosis and ascites. Two study groups of cirrhotic subjects with and without SBP were formed. In each of the two study groups, 143 subjects, were enrolled by matching for age, year of admission, Child-Pugh-Turcotte (CTP) class after considering the inclusion and exclusion criteria. PPI use and various other correlates were compared in both study groups. SPSS ver 24.0 was used for statistical analysis.Results: About 69.23% subjects were using PPI prior to admission in SBP group, which was significant compared to only 31.47% in cirrhotics without SBP (p 0.003). On multivariate analysis PPI use was an independent risk factor for SBP (OR 2.24, 95% CI: 1.01-4.24; p value 0.033) and beta blocker use was protective (OR 0.58; 95% CI: 0.4-0.8; p 0.001).Conclusions: PPI use doubles the risk of development of SBP in cirrhotics decompensated with ascites. In contrast, Beta blockers use significantly lowers the risk of SBP.
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Background: Upper gastrointestinal bleed (UGIB) and dyspepsia are the commonest indications for an upper GI endoscopy (UGIE), which has the potential to provide both diagnostic and therapeutic intervention. Alarm symptoms in patients with dyspepsia need proper evaluation.Methods: In an observational hospital-based study, 5117 patient undergoing upper GI endoscopy were evaluated at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. Detailed clinical and endoscopic profile was evaluated for subjects with dyspepsia and UGIB. Statistical analysis was done using SPSS version 21.0.Results: Dyspepsia (2887, 56.41%) followed by upper GI bleed (1124, 21.97%) were the most common indications for UGIE. In subjects presenting with UGIB, most patients had both hematemesis with Malena (48.04%), 48.93% were chronic alcoholics and nearly one fourth (26.96%) were on NSAIDS. Variceal bleeding (52.94%), followed by peptic ulcer bleed (13.43%) were the most common causes of bleed. In subjects undergoing UGIE for dyspepsia, 37.41% revealed no endoscopic lesion followed by gastro-duodenitis (25.01%). Peptic ulcer was cause of dyspepsia in 18.05% and was significantly more in those with alarm symptoms (<0.001). Alarm symptoms in dyspepsia has a significant high likelihood of finding a malignant lesion on endoscopic evaluation (p 0.013).Conclusions: Variceal bleed is the most common cause of UGIB in the adult Indian population. In patients with dyspepsia, presence of alarm symptoms is significantly associated with organic lesion on endoscopy. Although the incidence of malignancy is low, endoscopy in more than 50years subjects presenting with dyspepsia may help in early diagnosis and reducing morbidity.