Is Regular Probiotic Practice Safe for Management of Sepsis? / 中国结合医学杂志

For decades, the gut has been thought to play an important role in sepsis pathogenesis. Sepsis is a serious life-threatening, chronic condition of an infection caused by dysregulated host immune response in most of the intensive care unit patients. Probiotics have dual roles in polymicrobial sepsis i.e. probiotics may induce sepsis in many cases and may prevent its prognosis in many cases. Experimental evidence from both pre-clinical and clinical studies have demonstrated that probiotic therapy ameliorates various inflammatory mediators such as tumor necrosis factor, interleukin-10 (IL-10), IL-6, etc., in septicemia. In addition, probiotic use was also found to reduce the severity of pathological conditions associated with irritable bowel disorder and prevent development of endocarditis in septicemia. On contrary, probiotic therapy in neonatal and athymic adult mice fail to provide any beneficial effects on mortality and sepsis-induced inflammation. Importantly, in few clinical trials probiotic use was found to aggravate sepsis by promoting inflammatory cascade rather than suppressing it. This review discusses various studies regarding the beneficial or harmful effects associated with probiotic therapy in sepsis.

Progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers

Background: The aims and objectives were to study the progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers.Methods: The study was carried out in TB Sanatorium ITKI, Sadar Hospital Ranchi and RIMS Ranchi. The interview of various health personnel including SAHIYAs was taken using a semi-structured questionnaire based on programmatic management of multi drug resistant tuberculosis guidelines -2016.Results: Among Doctors knowledge level was good compared to other health personnel which had mean value 7.33 (±2.79), laboratory technician 3.45 (±2.64), STS 4.67 (±1.59), Sahiya 2.1 (±0.73). Regarding capacity enhancement level all health personnel needed refresher trainings in which doctors got 4.67 (±1.58), laboratory technician 3.45±2.64, STS 1.72±0.34, and Sahiya 0.5±0.52. Specially sahiya needs training regarding MDR-TB because they are the connecting link between health system and community. Regarding execution level, Doctors got 1.86 (±0.74), laboratory technician 1.64 (±0.56), STS 1.64 (±0.56) and Sahiya (ASHA) 2.2 (±0.44). Sahiya were better than other health personnel at execution level.Conclusions: Advocacy, communication, and social mobilization are important aspects of TB control, Policy makers and administrators should be sensitized for need of adequate and sustained funding for TB control to ensure quality capacity building. They need to provide continuous and quality training of staff at different levels and retention of trained staff and periodic reviews to identify gaps and take corrective steps.

Russel’s score and diabetes mellitus type 2 “finding the association”: a cross sectional study from one of the districts in Bihar, India

Background: Diabetes has been on the rise since last decade or so with prevalence rate changing as more research is being done. India is one of the most burdened country from diabetes specially type 2. With changing life style other diseases are also on the rise and evidence is being generated to find tangible association. One such disease is periodontitis. As evidence from the State of Bihar for association between periodontitis and diabetes mellitus is negligible this study was conducted to find the same.Methods: A cross sectional observational study in community settings was done for three months on 200 diabetic willing participants. Data was generated using a semi structured pretested questionnaire. Data analysis was done using SPSS version 22.0 and statistical measures of central tendency like mean, mode, median and standard deviation were used.  For establishing association chi square tests were used. P values<0.05 were considered to be statistically significant.Results: 61.5% of the participants were male while 65.5% were from rural area. The study population was on an average on the older side with a mean age of 52±12.15 and on the bulky size with a BMI of 28.85±4.08. Authors got the average Russel’s score to be 1.1±1.79. The mean blood sugar level for fasting was 146.40±59.99 and post prandial levels was 211.59±82.49. A Russel score category of established periodontal disease and terminal disease was present in 77.5% of participants having an altered fasting blood sugar level. Majority of the males had established periodontal disease and terminal disease. Patients with elevated postprandial blood sugar levels had more established periodontal disease and terminal disease.Conclusions: Oral health is definitely associated with diabetes mellitus type 2 and its other factors like duration, glycaemic control, blood sugar levels etc. Public awareness regarding this is minimal. More research and awareness regarding this will help in keeping the diabetic population healthy.

Disseminated cutaneous fusariosis in human immunodeficiency virus-infected patient and dramatic response with oral itraconazole

Fusarium species are known to cause disseminated cutaneous lesions in immunocompromised patients. Some cases of fusariosis are reported in patients infected with the human immunodeficiency virus. There are two reports in such patients with systemic comorbidities like lymphoma, neutropenia and infective port-a-catheter. Another reported patient had systemic fusariosis, without skin involvement. Diagnosis and treatment of cutaneous fusariosis is difficult and resistance to antifungals is a problem. Our patient was at an advanced human immunodeficiency virus infection stage with disseminated cutaneous fusariosis, without any systemic involvement, who responded completely to oral itraconazole.