Prognostic value of serum albumin and C-reactive protein levels in the elderly for assessing morbidity and mortality in a tertiary care center

Introduction: There is an increased population of elderly globally due to advancement of technology in health care. Elderly individuals are susceptible to various diseases, owing to deficits in nutrition or healthy lifestyle. Serum albumin and C‑reactive protein (CRP) are found to be sensitive to nutritional status as well as inflammation. This study is an attempt to analyze the prognostic value of CRP and serum albumin and analyze its usefulness as a prognostic marker in assessing morbidity and mortality in elderly patients. Methodology: One hundred patients above the age of 65 years and were admitted to the emergency care facilities of our tertiary care center were recruited for the study. Serum albumin and CRP estimation was done on the day of admission along with Charlson Comorbidity Index (CCI), and was follow-up till discharge. Statistical analysis was performed to evaluate relationship between the serum values and CCI scores. Results: It was observed that 83.3% (10/12) of deaths occurred in those with low serum albumin levels, and 91.6% (11/12) with high CRP levels. The hazard ratio shows a 6% increased probability of death with one unit increase in CRP, whereas a one unit increase in serum albumin value decrease the probability of death. Conclusion: The present study concludes that low serum albumin and high CRP levels at the time of admission in the elderly population are associated with high CCI scores, longer hospital stay, and increased risk of mortality, demanding their estimation in the elderly in emergency and acute care facilities.

Auto Transplantation of Ectopically Erupted Premolar: A Case Report.

The autogenous tooth transplantation is a viable option for tooth replacement. The tooth indicated for transplantation depends on the development of its root that should have growth up to two-third with open apex. This condition allows the replacement of lost teeth or ectopically erupted tooth in children and young patients. This case report presents a clinical case of autotransplantation of a premolar in a 19-year-old female, who had the ectopically erupted tooth near the lower molar. The procedure involved transplantation of lingually erupted mandibular right second premolar into the edentulous space of missing premolar. The concept of a traumatic extraction was used, disruption of the root sheath was avoided with the minimal time interval for replacement. After replacement tooth splinting was done and followed for 6 months. The tooth was found nonresponsive, endodontic treatment was done. This report reveals successful transplantation of a mandibular premolar into its own place.

Evaluation of Anxiolytic Activity of Flower Extracts of Tagetes Erecta Linn (Asteraceae) in Rats.

Tagetus erecta (Asteraceae) is a plant with diverse medicinal properties hence the present work was selected to evaluate the anxiolytic activity of aqueous and alcoholic extracts of flowers of T. erecta. Dried flower powder of T. erecta was extracted by maceration process to get alcoholic (AEFTE) and aqueous (AQEFTE) extract. Preliminary phytochemical investigations were carried out to identify various constituents present in AEFTE and AQEFTE. The LD50 studies of AEFTE and AQEFTE were conducted in mice till the highest permitted dose level of 2000 mg/Kg following Up and Down method of OECD Guidelines. From the LD50 2 doses of extract as 1/20th (low) and 1/5th (high) were selected. The anxiolytic activity of AEFTE and AQEFTE was evaluated in laboratory animal models like Elevated plus maze and Light-dark exploration models in rats. Preliminary phytochemical tests revealed that both AEFTE and AQEFTE contained glycosides, phenols, steroids, flavonoids. The LD50 studies revealed that both AEFTE and AQETE did not produced any abnormal behaviour or mortality even at the highest permissible dose of 2000 mg/Kg in mice. The Diazepam (2 mg/kg), AQEFTE and AEFTE (100, 400 mg/kg) were tested on Elevated plus maze and Light dark chamber models. After treated with AFETE and AQEFTE shows significant reduction in anxiety activity with the extracts at low and high doses.

Immunogenicity and safety of an indigenously developed DTPw hepatitis B combination vaccine in Indian infants.

OBJECTIVE: To evaluate the safety and immunogenicity of an indigenous hepatitis B, diphtheria, tetanus and B. pertussis tetravalent vaccine (Shantetra) in comparison with Tritanrix HBTM in healthy Indian infants. DESIGN: Multicentric, randomized, single blind intention-to-treat study with 12-18 weeks of follow up period. SETTING: 5 out patient departments at tertiary care referral centers across India. PARTICIPANTS: 151 infants were randomized in a 2:1 ratio to recruit 101 in the Shantetra and 50 in the Tritanrix HBTM groups respectively. A total of 136 subjects completed the study. No patients were withdrawn from the study due to any adverse effects. INTERVENTIONS: Recruited subjects were randomized to receive three doses of either of the two DTPw-Hepatitis B combination vaccines as per the EPI schedule. MAIN OUTCOME MEASURES: Monitoring the humoral immune response (seroconversion rates) induced by each antigenic component three to six weeks after the last dose of vaccine in both the groups. RESULTS: Seroprotective immune response was observed in 98.9% subjects for diphtheria, tetanus and hepatitis B components in the Shantetra group as compared to 95.5% subjects in the Tritanrix HB group. Anti pertussis antibody response was seen in 89% and 91.1% in the Shantetra and Tritanrix HB groups, respectively. The commonly observed adverse events in both the groups were, pain at injection site, mild fever and transient crying.CONCLUSION:The safety and immunogenicity of indigenously developed DTPwHepatitis B combination vaccine was demonstrated in the present study.

Autoimmune hemolytic anemia complicating disseminated childhood tuberculosis.

An 8-year-old girl presented with severe autoimmune hemolytic anemia (AIHA) in association with mediastinal widening. Biopsy of mediastinal lymph node confirmed the diagnosis of tuberculosis. A diagnosis of disseminated tuberculosis in association with AIHA was made, and the patient was treated with steroids and antitubercular therapy. This is the first report case of AIHA in association with childhood tuberculosis; we also discuss other reported cases of AIHA in association with adult tuberculosis in English literature.

Sertoli Leydig cell tumor with heterologous gastrointestinal epithelium: a case report.

Sertoli Leydig cell tumour (SLCT) of the ovary with the presence of heterologous elements is very unusual. A case of SLCT with virilizing symptoms and androgenic endocrinological profile is presented. The tumor showed presence of heterologous element in the form of mucinous epithelium of the gastrointestinal type.

Disseminated cutaneous rhinosporidiosis in a HIV sero--positive patient.

Rhinosporidiosis is a chronic disease, classically involving the nose and nasopharynx, clinically presenting as polypii. However,disseminated rhinosporidiosis, involving various other sites including lips, conjunctiva, uvula, vagina, larynx. trachea. scalp and skin is also known to occur. A case of rhinosporidiosis, with nasal, oropharyngeal and multiple cutaneous lesions, in a patient who is sero--positive for HIV is reported.

Surgical treatment of total anomalous pulmonary venous connection.

Fourteen infants ranging in age from 18 days to 10 months (median age = 4 months) underwent surgical repair of total anomalous pulmonary venous connection (TAPVC) between September, 1988 and December, 1989. The anomalous drainage was supracardiac in nine, cardiac in two, infracardiac in one and mixed in one. One patient had a complex type of TAPVC. There were two hospital deaths, one a critically ill three week old infant with obstructed infracardiac TAPVC and the other with complex TAPVC. There was no late death. All twelve survivors are in NYHA functional Class 1. Postoperative echocardiography revealed unobstructed pulmonary blood flow in all of them. Surgical correction of TAPVC in infancy has been performed with gratifying results. A high index of suspicion, early diagnosis, prompt referral and an aggressive surgical approach are essential for success in this otherwise lethal condition.

Inhibitory effect of gonadotropin releasing hormone in the uterus of rat.

Estradiol-induced incorporation of radioactive uridine and leucine into the uterus of rat was inhibited by simultaneous treatment with an analogue of gonadotropin releasing hormone. The inhibitory action of gonadotropin releasing hormone was not mediated through modulation of estradiol receptor content. However, estradiol-induced increase in the level of poly(A) polymerase was inhibited by gonadotropin releasing hormone analogue, indicating that the inhibitory effect might involve post-transcriptional phenomenon.