ABSTRACT BACKGROUND: Pneumonia is a common cause for hospital admissions and in-hospital mortality. Mortality in pneumonia is accelerated in the presence of co-morbid conditions. Diabetes mellitus being the most common co-morbid condition due to its high prevalence, we studied the effect of diabetes on the clinical profile of pneumonia in comparison with those without pneumonia. METHODS: We randomly selected 60 patients of pneumonia over a period of 1 year among whom, 30 were diabetics and 30 were non-diabetics. A thorough clinical history and examination was carried out. Laboratory investigations including, microbiological, radiological, haematological investigations were carried out. Patients were followed up until their hospital stay (death or discharge). Results were analysed and compared between diabetic and non diabetic group with reference to age, sex, underlying concomitant disease, clinical features, complications, organisms, PSI scoring and mortality. Clinical data was compared with the observations of various other workers RESULTS: Poly-microbial etiology (20%), multi-lobe involvement (66.7%), complications, duration of hospital stay (12.30±4 vs 9.10±5.24 days) and PSI score was significantly higher among diabetics compared with non-diabetics. There was not statistical significant difference in mortality between diabetics (23.3%) and non diabetics (10%). Mortality in diabetics was more common in patients with age > 60yrs. Complications were more common in diabetic group like pleural effusion (6.7%), septic shock (20%), MODS, renal failure, VF (3.3% each) and cardiac arrest (6.7%). No relation was found with sex, duration of hospital stay, bacteremia, pleural effusion, signs of consolidation with mortality. CONCLUSION: In patients with pneumonia, Diabetes Mellitus is associated with poor prognosis, polymicrobial etiology, multilobe involvement, increased ICU admissions, increased severity in the form of high PSI score and mortality. This study suggests that this adverse outcome is more attributable to the underlying circumstances of patients than to uncommon microbiological findings. Certainly age, prior co morbidities as well as multilobe infiltrates have already been related to poor prognosis; however, in this study, diabetes also remained a significant prognostic factor of mortality in patients with pneumonia.
Abstract Introduction:Triple test (mammography, Fine needle aspiration cytology and physical examination) can be used accurately in patients presenting with palpable breast masses. We studied the sensitivity, specificity and predictive values of the three components.Aims and Objectives:This study aimed at the assessment of palpable breast masses in north Indian women using triple test.Materials and Methods: Prospectively for one year 52 female patients who presented with a palpable breast lump were assessed using all three components of the triple test.Results:Physical examination showed 57.14% sensitivity, 100% specificity and 100% positive predictive value. Fine needle aspiration cytology (FNAC) showed 71.43% sensitivity, 96.97% specificity and 90.91% positive predictive value whereas mammography revealed 50% sensitivity, 100% specificity and 100% positive predictive value. The overall predictive value of the triple test score was 94.87%Conclusions:Triple Test i.e. combined physical, radiologic and cytological diagnosis is more sensitive and specific than any procedure used alone. The study shows that when TT is concordant i.e. TTS score is more than 6, the final treatment may be ensued without confirmatory biopsy.
Abstract Purpose: This study was done to analyze the frequency, extent and methods of microbiological surveillance of OT, efficiency, microbicidal activity of product X, advantages of special air filters, air quality , rate and factors contributing to SSI . Materials & methods: Surveillance was done in two conventional OTs (GH) and two with special air filters(private) by settle plate, air sampler and surface swab for aerobe & anaerobe, from day 1- 6 in the morning & evening , after formalin and product X. Microbicidal activity of product X was tested against common isolates. Results: By settle plate or air sampler, the cfu were less with product X compared to formalin, the M- cfu were less than E- cfu and the cfu in the private OTs were less compared to GH. There was no gradual decrease or increase of cfu from day 1 to 6.Organisms isolated were Acinetobacter baumanii, CoNS, MSSA and micrococci in GH, aerobic spore forming bacilli and micrococci in private. RCM was negative for Clostridium tetani in all four OTs. SSI was 14% in GH and Nil in private. Microbicidal activity of product X was good at 1% concentration within 10 mts. Conclusion: Air sampler measures the microbial burden more accurately.. Settle plate is a direct indicator of SSI risk. Clostridium tetani as an indicator of air quality may be limited to special situations only.. Peptone water swabs indicate the seriousness of the contaminant. Newer less toxic disinfectants are alternative to formalin. Correlation between microbial burden and SSI by any method is not absolute.
ABSTRACT Context: The study helps to make antibiotic policy in neonatal septicemia.ObjectiveThe present study was undertaken to investigate the high incidence of multidrug resistant β lactamases producing Gram-negative bacilli causing neonatal septicemia along with their antimicrobial sensitivity pattern Design & SettingThe eighteen months prospective study was conducted from June 2011 to Dec 2012. The Blood samples from the suspected neonatal septicemias were processed in the Department of Microbiology SGRDIMSR Amritsar. After identification and antibiotic susceptibility testing, beta-lactamases were detected as per CLSI guidelines.ResultsIn 235 blood cultures 37.87% (89/235) positivity was seen. Out of them, 55.05% were Gram positive and 43.82% were Gram negative isolates while Candida was 1.12%.Among S. aureus 62.0% were MRSA while 37.93% were MSSA. CONS were 40.8%. Klebsiella (25.64%) was predominant gram negative isolate followed by Enterobacter (20.51%), Acinetobacter (17.94%), Pseudomonas (15.38%), E coli (12.8%) and Citrobacter (7.69%).69.23% were lactamases producer gram negative isolates. Maximum 80.0% was in Klebsiella followed by 71.42% Acinetobacter, 66.67% in Citrobacter and Pseudomonas spp 62.5% Enterobacter, and 60.0% in E coli. ESBL producers were maximum 45.74% followed by co-producers of MBL + AmpC 18.5%,ESBL+AmpC 14.8%, ESBL+MBL11.12%,AmpC and MBL 7.4%.ConclusionsThe varying microbiological pattern of neonatal septicaemia warrants the need for periodic review of neonatal sepsis as the knowledge of the pathogens and their antibiotic susceptibility would be a useful guide in the antibiotic therapy This will also facilitate infection control interventions like hand hygiene, patient isolation and contact precautions.
ABSTRACT Background: Antitubercular drugs just like other drugs used in clinical practice are not free from ADRs(Adverse drug reactions).The added problem is that combination of drugs are used for prolonged periods of time. Moreover the ADRs to drugs used is one of the major reasons for patient default, hence leading to emergence of resistant organisms. Identification of the ADR profile of drugs in a hospital setup can be useful for the prevention, early detection and management of ADRs.