Functional somatic symptoms in patients with major depressive disorder in a tertiary care hospital

Background: Functional somatic symtpoms are common in patients with major depressive disorder. The aim of the research was to study the prevalence and typology of Functional Somatic Symptoms (FSS) in patients with depression. Methodology: A total of 50 patients participated in the study. They were assessed on Bradford Somatic Symptom inventory for Functional Somatic Symptoms (FSS), Beck Depression Inventory (BDI) for severity of depression, and Comprehensive Psychopathological Rating Scale? anxiety index (CPRS?AI) for anxiety symptoms. Results: The mean age of the study sample was 41.36 years (SD?12.79). Gender distribution was gender distribution (male ? 60% vs. females 40%). Majority of the symptoms were found in married (84%), Hindus (92%), and from nuclear family (58%). A more than half of the patients were from urban background (76%). The mean duration of illness at the time of assessment was 36 months. As per BDI severity score 36% have mild, 38% have moderate and 26% have severe depression. Total mean CPRS-AI is (8.78±4.46).The more common FSS as assessed on Bradford Somatic Inventory were severe headache (88%), feeling tired when not working (86%), lack of energy (weakness) much of the time (84%), pain in legs (82%), aches and pains all over the body (72%), mouth or throat getting dry (72%), head feeling heavy (70%), head feeling hot or burning (68%), pain or tension in neck and shoulder (66%), low back trouble (66%) and sweating a lot (64%). The prevalence and typology of FSS was to a certain extent influenced by the sociodemographic variables and severity of depression. Conclusion: Functional somatic symptoms are highly prevalent in depressed patients and hence deserve more attention while diagnosing depression

Correlation of serum parameters with disease severity, exacerbations and hospitalizations in patients with Non-cystic fibrosis bronchiectasis

Background: The factors essential to define the severity and the prognosis of subjects with NCFB have not been sufficiently assessed. A prospective observational study was conducted to assess the serum parameters, their correlation with BSI (bronchiectasis severity index) and FACED (FEV1% predicted, age, chronic colonization by pseudomonas aeruginosa, extension by radiological assessment and dyspnoea) score in assessing disease severity and respiratory hospitalizations in patients with NCFB.Methods: About 76 clinically stable patients diagnosed as NCFB were included. Data extraction was done using structured proforma. The BSI and FACED scores were calculated. The serum parameters albumin, CRP (C-reactive protein), ANC (Absolute neutrophil count) and Hb (hemoglobin) levels were estimated. The number of exacerbations and hospitalizations during the 6 months follow up period were recorded.Results: The mean value of the serum parameters albumin, CRP, absolute neutrophil count (ANC) and Hb were 3.86 (95% CI 3.77- 3.95), 19.61 (95% CI 15.53 -23.68), 8632.95 (95% CI 7258.5-10068) and 12.3 (95% CI 11.84- 12.74) respectively. There was strong negative correlation between serum albumin and the BSI and FACED score. The mean exacerbations and hospitalizations during the 6 months follow up period were 3.3 (95% CI 2.93-3.65) and 1.14 (95% CI 0.85-1.44) respectively.Conclusions: The serum albumin level exhibited strong correlation and was identified as a variable associated with the BSI and FACED scores. Further studies in this direction are needed for use of serum parameters in severity assessment.

Monitoring Drainage Water Quality during Green Roof Irrigation Trials Using Synthetic Greywater.

Aims: To evaluate the potential for substituting green roof mains water irrigation by irrigation using lightly loaded synthetic greywater. Study Design: The planted green roof system was designed to be operated and tested within a glasshouse. Place and Duration of Study: Schools of Engineering, and Plant Sciences, The University of Reading, for 28 days commencing 28th of May 2012. Methodology: A trial was conducted for comparing two planting schemes using Sedum and Stachys Byzantina and a third unplanted control. The three sets of growing boxes were subdivided between substrate depths of 10 cm and 20 cm. By further subdivision, half of each set were watered using mains water, and half using a synthetic greywater. The soil composition and water quality of the drainage (filtrate) water were monitored. Statistical analysis of the results was conducted. Results: Consistency was observed in influent pH and EC, in both mains and greywater samples. Influent Na concentrations were higher in the greywater samples due to detergent content. The Na mass balance calculations for all boxes showed that some Na mass was unaccounted for when comparing aggregated concentrations in influent, plant tissue and soil with the aggregated Na mass in filtrate, plant tissue and soil water. It was concluded that this was likely to be due to retained/ponded irrigation water in the boxes, difficulties in attaining homogenous box flushing and the underestimation of soil Na. The variation in substrate depth affected all results. The plants themselves seemed to have little significant influence on the measured parameters, with the exception of the accumulation of Na mass in plants irrigated with greywater. Conclusion: No improvement was observed in the quality of the greywater following filtration through the soil matrix. For longer term watering using greywater, a choice of Na resistant species should be considered, although the Sedum species used in this trial showed no recorded adverse growth effects due to Na accumulation.

Incidence, risk factors, microbiology of venous catheter associated bloodstream infections - A prospective study from a tertiary care hospital.

Purpose: Central venous catheters (CVCs) though indispensable in current medical and intensive care treatment, also puts patients at risk of catheter related infection (CRI) resulting in increased morbidity and mortality. We analysed the incidence, risk factors, bacteriological profile and antimicrobial susceptibility pattern of the isolates in central venous catheter associated bloodstream infection (CVC‑BSI) in the intensive care unit (ICU) patients and studied the formation of biofilm in CVCs. Materials and Methods: The following case control study included 115 patients with CVC in situ. Quantitative blood cultures (QBC) and catheter tip cultures were performed for the diagnoses. Direct catheter staining was done for an early diagnosis by acridine orange (AO) and Gram staining methods. Biofilm production in catheters was detected by ‘tissue culture plate’ (TCP) method. The results were analysed using the computer‑based program statistical package for the social sciences (SPSS). Results: In 25/115 patients, definite diagnosis of CVC‑BSI was made. The mean age was 48.44 ± 17.34 years (cases) vs 40.10 ± 18.24 years (controls) and the mean duration of catheterisation was 25.72 ± 8.73 days (cases) vs 11.89 ± 6.38 days (controls). Local signs of infection (erythema, tenderness and oozing) were found more significantly in CVC‑BSI cases. The AO staining was more sensitive and Gram staining of catheters showed higher specificity. Staphylococcus aureus followed by Pseudomonas aeruginosa and non‑albicans Candida were common CVC‑BSI pathogens. Multidrug‑resistant (MDR) strains were isolated in bacterial agents of CVC‑BSI. Non‑albicans Candida and Enterococcus faecalis showed strong biofilm production. Conclusion: The incidence of CVC‑BSI was 21.73% and the rate was 14.59 per 1000 catheter days. Prolonged ICU stay and longer catheterisation were major risk factors. S. aureus was isolated most commonly in CVC‑BSI cases. The menace of multidrug resistance and biofilm formation in CVCs is associated with CVC‑BSI.

Biofilm as a virulence marker in Candida species in Nosocomial blood stream infection and its correlation with antifungal resistance.

Nosocomial blood stream infections (BSI) due to fungi especially Candida is increasing steadily. A two year prospective study was conducted in the S.C.B. Medical College with an aim to evaluate the species distribution, antifungal susceptibility and biofi lm formation of Candida spp. isolated from nosocomial BSIs. 34 Candida spp. were isolated from 359 blood cultures. Antifungal susceptibility was performed by microbroth dilution technique and both visual and spectrophotometric method were used for biofi lm detection. C. tropicalis was the common spp. isolated followed by C. parapsilosis and others. Most (92%) of the isolates were susceptible to Amphoterecin-B and highest resistance was observed against Flucytosine (37%) and Fluconazole(35%). Biofi lm production and antifungal resistance was observed more in nonalbicans Candida spp.

Somatization and health seeking behavior.

Background: Somatization is the state of being symptomatic which is not explained medically associated with psychological distress and health-seeking behavior and is present in at least 10% to 15% in OPD. Methods: 50 patients with long standing history of MUS were evaluated by using modified Bradford inventory. Results: Somatization was most common in younger age, female and lower socio-economical class. Feeling of weakness or lack of energy much of the time in both male and female respectively 94.7% and 96.7% are the most common symptomatic presentation in Somatization during last 2 years, although there were symptomatic differences in males and females. Severity of symptoms was higher among females. 13% of female pts had undergone hysterectomy due to persistent gynecological problems during course of illness. 82% pts had illness of more than 2 years. The mean duration of illness at the time of assessment was 6.8 years. Most of the patients had visited to multiple consultants and underwent many costly diagnostic procedures for their symptoms .Most of the patients after multiple investigations and consultations were not ready to accept psychological origin of their physical illness and continued to see next practitioner as they remained dissatisfied and distressed. One or more physical illness is the common explanation by physicians. Patients presented with somatization has an another diagnosis in significant cases like Major depressive disorder, anxiety disorder, alcohol use disorder. Conclusion: Somatization was common among female, but it was not uncommon in male. Patient suffering from somatization disorder has very high rate of health care utilization and they perceived themselves as severely ill and were willing to undergo multiple hospitalizations, diagnostic studies, and operations, remained dissatisfied. Need to strengthened consultation liaison between physician and psychiatrist.

Prospective study estimating healthcare associated infections in a paediatric hemato-oncology unit of a tertiary care hospital in north India.

Background & objectives: Healthcare associated infections (HAIs) are responsible for morbidity and mortality among immunocompromised and critically ill patients. We undertook this study to estimate the burden of HAIs in the paediatric cancer patients in a tertiary care hospital in north India. Methods: This prospective, observational study, based on active surveillance for a period of 11 months was undertaken in a 4-bedded isolated, cubicle for paediatric cancer patients. Patients who stayed in the cubicle for ≥48 h, were followed prospectively for the development of HAIs. Results: Of the 138 patients, 13 developed 14 episodes of HAIs during the study period. Patient-days calculated were 1273 days. Crude infection rate (CIR) and incidence density (ID) of all HAIs were 9.4/100 patients and 11/1000 patient-days, respectively. Of the 14 episodes of HAIs, seven (50%) were of blood stream infections (HA-BSI), five (36%) of pneumonia (HAP) and two (14%) urinary tract infections (HA-UTI). The CIRs of HA-BSI, HAP and HA-UTI were 5.1, 3.6 and 1.4/100 patients, respectively. The corresponding IDs were 5.5, 3.9 and 1.6/1000 patient-days, respectively. Mean length of stay was significantly higher in patients who developed an HAI [13.8 (range 7-30), median (Interquartile range) 12 (11-14)] vs 7.5 days [range 2-28, median (interquartile range) 7 (5-9); P<0.0001]. Also mortality was significantly higher in patients who developed an HAI [23% (3/13) vs 3% (4/125), P<0.05]. Interpretation & conclusions: The incidence of HAIs in the paediatric cancer patients in the study was 11/1000 patient days, of which HA-BSIs were the commonest. HAIs were associated with an increase in morbidity and mortality amongst this high risk patient population.

Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units

INTRODUCTION: Central venous catheters (CVC) are devices of great importance in health care. The advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (BSI). In spite of its importance, few national studies have addressed this issue. OBJECTIVE: The aim this study was to determine the incidence of BSI in patients with CVC, hospitalized in ICU, as well as the variables associated with this complication. METHODS: Multicentric cohort study carried out at ICUs of three hospitals at Universidade Federal de São Paulo complex. RESULTS: A total of 118 cases of BSI in 11.546 catheters day were observed: 10.22 BSI per 1,000 catheters day. On average, BSI was associated to seven additional days of hospital stay in our study (p < 0.001), with a significant difference between types of catheters. Concerning the place of insertion, there was no statistical difference in BSI rates. CONCLUSION: We concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001). The median duration of catheter use was 14 days among patients with BSI and 9 days in patients without infection (p < 0.001). There was higher prevalence of Gram-negative infections. The risk factors for BSI were utilization of multiple-lumen catheters, duration of catheterization and ICU length of stay.