ABSTRACT
BACKGROUND: Heart failure (HF) patients are at a greater risk for nosocomial infections due to their higher prevalence of comorbidities, readmission rates, and prolonged hospital stays. Clostridioides difficile infection (CDI) remains a common nosocomial infection in hospitalized patients. AIM: To identify patients with a diagnosis of acute HF and stratified based on the presence of CDI, using the National Inpatient Sample (NIS) database from 2016 to 2020. METHODS: Adjusted odds ratios (aOR) of in-hospital outcomes were calculated, and a propensity-matched analysis was performed. FINDINGS: Of 536,595 acute HF hospitalizations in this timeframe, 3030 were also diagnosed with CDI (0.56%). Patients with acute HF and CDI had significantly higher in-hospital mortality (adjusted odds ratio: (aOR): 1.91), cardiac arrest (aOR: 1.66), and use of mechanical circulatory support (MCS) (aOR 2.42). In propensity-matched analysis, in-hospital mortality (13.71 vs 8.44%; P=0.005), septic shock (7.54 vs 3.33%; P=0.002), and use of MCS (7.19 vs 3.68%; P=0.009) were significantly higher in HF patients with CDI than without. Coexisting neurological disease (aOR: 3.74) and liver disease (aOR: 2.97) showed the strongest association as independent predictors of mortality. HF patients with CDI had longer hospital stays (14.45 ± 19.40 vs 5.44 ± 7.10 days; P<0.0001) and higher inflation-adjusted total hospital costs ($186,225 ± 376,485 vs $60,740 ± 153,992; P<0.001) compared to those without CDI. CONCLUSION: The occurrence of concomitant CDI in patients admitted with acute HF exacerbation is associated with worse in-hospital outcomes and deaths as well as longer hospitalizations and greater financial cost.
Subject(s)
Clostridioides difficile , Clostridium Infections , Heart Failure , Humans , Inpatients , Hospitalization , Clostridium Infections/diagnosis , Heart Failure/complications , Heart Failure/epidemiology , Retrospective StudiesABSTRACT
BACKGROUND: Hepatitis B e antigen negative chronic hepatitis (e(-) CHB) with detectable levels of hepatitis B virus DNA (HBV DNA) in serum has been reported in cases from Asia. This study was undertaken to find out prevalence e(-)CHB and to correlate its presence with the clinical status and severity of the illness in cases of chronic liver disease in India. METHODS: All patients of infective hepatitis, who were hepatitis B surface antigen (HBsAg) positive by enzyme-linked immunosorbent assay (ELISA), were evaluated with liver function tests and HBeAg and antiHBe antibody studies. Polymerase chain reaction (PCR) test was carried out to detect HBV DNA qualitatively. RESULT: Out of 2064 samples tested by ELISA, 429 (20.78 %) were HBsAg positive. HBV DNA (qualitative) was performed on all 429 patients and 74 (17.2%) were HBV DNA positive. Of these only 42 (56.75 %) tested positive for HBeAg. Overall, 8.3 % of HBeAg negative patients (32/384) were viraemic with evidence of chronic liver disease/clinical cirrhosis and alteration of transaminase levels, while three cases (0.84 %) HBeAg positive cases did not show presence of HBV DNA. CONCLUSION: This study shows e(-)CHB prevalence rate of 8.3% in patients with HBV infection in India. Since HBeAg negative patients had detectable levels of HBV DNA as seen in HBeAg positive patients, benefit of antiviral therapy should be given to them. Population studies on e(-) CHB cases are needed to determine its true prevalence, natural course and response to therapy.
Subject(s)
Clinical Competence , Gastritis/pathology , Medical Audit , Pathology, Clinical/education , Chronic Disease , Humans , IndiaABSTRACT
We report an unusual case of Whipple's disease diagnosed with help from the patient himself. The patient presented with rash resembling dermatitis herpetiformis, constipation, and intermittent diarrhea. A suspicion of celiac disease led to duodenal biopsy, which showed features of Whipple's disease on histology and electron microscopy.
Subject(s)
Celiac Disease/pathology , Whipple Disease/drug therapy , Whipple Disease/pathology , Anti-Bacterial Agents/therapeutic use , Biopsy, Needle , Celiac Disease/diagnosis , Diagnosis, Differential , Endoscopy, Gastrointestinal , Follow-Up Studies , Humans , Immunohistochemistry , Intestinal Mucosa/pathology , Male , Middle Aged , Risk Assessment , Severity of Illness Index , Treatment Outcome , Whipple Disease/diagnosisABSTRACT
INTRODUCTION: Although acute hepatitis E virus (HEV) infection is known to induce IgM and IgG humoral host immune responses, little is known about occurrence of cellular responses in this infection. We looked for evidence of lymphocyte sensitization to HEV peptides in patients with acute HEV infection. METHODS: peripheral blood lymphocytes were obtained from patients with acute hepatitis E and healthy controls. Proliferation of these lymphocytes in the presence of each of seven peptides with amino acid sequences corresponding to open reading frames 2 and 3 proteins of HEV (3 and 4 peptides, respectively) were studied; no peptide was added to control wells. Proliferative responses with stimulation indices exceeding 3.0 were taken as positive. RESULTS: More patients showed reactivity to two or more HEV peptides than did controls (11/21 vs 5/22, p<0.05). Reactivity to one peptide corresponding to open reading frame 2 of HEV was more frequent in patients than in controls (7/21 vs 1/22, p<0.05). CONCLUSION: Our results show that lymphocytes of patients with acute hepatitis E show sensitization to HEV peptides. This may have significance in understanding the pathogenetic mechanisms of liver injury in this infection.
Subject(s)
Hepatitis E/immunology , Acute Disease , Adult , Case-Control Studies , Female , Humans , Immunity, Cellular , Leukocytes, Mononuclear/immunology , Lymphocytes/immunology , MaleABSTRACT
Thirty patients with unicompartmental osteoarthritis of the knee and genu varum deformity ranging from 2 degrees to 15 degrees were treated with high tibial osteotomy by using a medial open wedge, stabilized and distracted with our fixator. Pain relief and correction of deformity were achieved in all except two cases.
