Predictors of treatment failure in severe pneumonia treated with Ampicillin in tertiary care center

Background: Pneumonia affects 156 million children under five years every year and is the leading cause of mortality in this age group. It emphasizes the need to identify high risk factors for Treatment Failure so as to treat them aggressively. The objective of this study was to assess factors influencing treatment failure in severe pneumonia treated with Ampicillin.Methods: Prospective observational study, in which 235 children with severe pneumonia between 2 months to 60 months were enrolled and started with intravenous Ampicillin as per WHO protocol. If no clinical improvement was seen after 48 hours, it was taken as treatment failure and managed accordingly.Results: Among 235 children, 43(18.2%) did not respond to Ampicillin. Among treatment failure cases males were 20 (46.5%) and females were 23 (53.6%). All the following parameters were statistically significant(p<0.05). Majority of 23(53.4%) were between 2 to 12 months. 13(30.2%) were incompletely immunized. MAM were 23(53.4%) and 22(51.1%) cases had signs of Rickets. 34(79.1%) had Anemia out of which 22(64%) had moderate anemia. 39(90.6%) children had fever and hypoxia at admission.Conclusions: Infancy, malnutrition, severity of anemia, rickets, lack of immunization, hypoxia at baseline were significant predictors of treatment failure in severe pneumonia. Strengthening immunization and improving nutritional status may improve the outcome. Children with above risk factors require vigilant monitoring.

Proportion of Refractive Error and Its Associated Factors among High School Students in South India.

Background: School children are a high risk population for refractive errors (REs). Uncorrected REs can adversely affect the learning abilities and mental development of school children. Objectives: This cross sectional study was conducted to observe the proportion of cases diagnosed with REs, to determine factors associated with it, to find out the practices of students in preventing these risk factors and to assess the perception towards visual aids among students with REs in schools of an urban area. Methods: This study was done in Mangalore city in February 2013. 482 high school children were interviewed using a structured interview schedule. RE was ascertained based on records of previous diagnosis by Ophthalmologist. Data was analyzed by Chi-square test and binary logistic regression analysis. Results: The prevalence of already diagnosed cases of RE was 94(19.5%). Most of these cases had myopia 92(97.9%). Two cases were of hypermetropia. Mean age of onset of RE was 10.2±2.1 years. Only 19(20.2%) cases were first detected in schools in spite of functioning school health services at all the surveyed schools. RE cases were significantly more in private schools in comparison to government schools (P<0.001). Risk factors significantly associated with RE were history of RE among siblings (P<0.001), inadequate reading distance (P=0.011) and doing homework with inadequate illumination (P=0.021). One third of students with RE were irregular in eye examinations. Conclusion: Proportion of REs was high among school students. Education of students on healthy postural habits and good illumination while studying at home is essential to prevent REs in this population.

Ebola virus disease: Getting to know a new emerging foe.

Viral hemorrhagic fevers have been at the top of the severity scale in terms of morbidity and mortality among human beings. Many of the viruses have their reservoirs in animal kingdom and from time to time they get introduced to humans and cause sporadic outbreaks and epidemics. Thousands of people from the Western African region have already succumbed to the complications due to Ebola virus infection.</p> <p>The South East Asian region including India has been affected by several outbreaks of communicable diseases like SARS, bird flu, swine flu etc. The current outbreak has been a global concern due to its spread beyond the African continent. WHO has declared EVD as an international health emergency and worldwide efforts have been enhanced to escalate research to find a vaccine or cure for the disease.

Evaluation of scoring system in cytological diagnosis and management of breast lesion with review of literature.

Background: Fine needle aspiration cytology (FNAC) breast is generally considered as a rapid, reliable, and safe diagnostic tool to distinguish non-neoplastic from neoplastic breast lesions. Masood's Scoring Index has been proposed to help in sub-grouping of breast lesions so as to help in surgical management. Aims: To assess the accuracy of Modified Masood's Scoring Index (MMSI) in the diagnosis of benign and malignant breast lesions in patients with palpable breast lump, and review of literature. Settings and Design: A prospective study from a tertiary care center. Material and Methods: This prospective study included a total of 100 cases, both females and males, with palpable breast lump, in the age range of 10-80 years, over a period of 2 years from January 2007 to 2009, who underwent FNAC. They were cytologically grouped into five categories as suggested by Masood et al, and confirmed by histopathology. Results: Evaluation of Masood Scoring Index led to modification (Modified Masood Scoring Index; MMSI) by shifting score 9 from Group I to Group II, thus increasing the diagnostic accuracy of the breast lesions. Conclusions: MMSI was found to be a useful, easily reproducible scoring method of breast lesions to improve diagnostic accuracy of nonproliferative breast disease and proliferative breast disease without atypia cases, as the prognosis and treatment of these cases varies.

1/f correlations in viral genomes--a Fast-Fourier Transformation (FFT) Study.

We have studied the presence of long-range correlations in the complete genomes of ten different dsDNA viruses and Saccharomyces cerevisiae (bakers' yeast) chromosome I. We have also studied the correlation between the distribution of the gene length and the domain of "1/f region" of their genomes. Linear regression analysis was done for the power-law region of these organisms and the slope values obtained were approximately -1, which signify the existence of "1/f noise" in the low and medium (intermediate) frequency regions. This suggests the presence of long-range correlations in their genomes. The presence of 1/f noise in a given frequency interval indicates the existence of a fractal (self-similar) structure in the corresponding range of wavelengths. The results of our study suggest that genes have correlations within themselves, and the correlations appear to be related with the scaling exponent alpha.

Genetic fine structure analysis of helicobacter pylori isolates before and after treatment.

BACKGROUND: Eradication of H. pylori infection cures peptic ulcer disease and conversely, relapse is associated with reappearance of H. pylori infection. However, it is not clear whether the recurrence of ulcers following H. pylori eradication is due to recrudescence (identical strain) of the previous infection or as a result of exogenous reinfection (different strain) by another strain. The aim of the present study was to analyze the FAFLP patterns of pre and post treatment H. pylori samples to check if the recurrence was due to recrudescence or reinfection. MATERIALS AND METHODS: 24 of 30 duodenal ulcer (DU) subjects screened for H. pylori infection were positive for H. pylori infection. The treatment regime included pantoprazole, ciprofloxacin and amoxicillin. The patients were called for a repeat endoscopy after one month and screened for H. pylori infection. FAFLP analysis and PCR for the cagA and vacA gene was performed for the pre and post treatment samples. RESULTS: Of the 24 positive H.pylori patients, only 6 were negative after treatment and the remaining 18 were positive for H.pylori infection. The analysis of the pre and post treatment samples of the 18 patients showed that the FAFLP profiles of the initial and follow-up pools were similar to one another. CONCLUSION: It can be concluded that in the present series of patients, reinfection was due to recrudescence of infection due to incomplete eradication. The study also suggests that DNA fingerprinting by FAFLP provides discriminatory and complementary data for identifying strains of H. pylori while monitoring therapy.