149 research outputs found
Development of a mortality prediction formula due to sepsis/severe sepsis in a medical intensive care unit
No full textBackground: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. Materials and Methods: Patients fulfilling the Infectious Disease Society of America criteria of sepsis within the medical intensive care unit (ICU) were included over two years. Apart from baseline hematological, biochemical, and metabolic parameters, Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II and III (SAPS II and SAPS III), and Sequential Organ Function Assessment (SOFA) scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Results: One hundred patients were enrolled over two years (54% males). The overall mortality was 53%, (69.5% in females, 38.8% in males (P < 0.01). Mortality was 65.7%, 55.7%, and 33.3% in patients with septic shock, severe sepsis, and sepsis, respectively. Patients who died were significantly older than the survivors (mean age, 57.37 ± 20.42 years and 44.29 ± 15.53 years respectively, P < 0.01). Nonsurvivors were significantly more anemic and had higher APACHE II, SAPS II, SAPS III, and SOFA scores. The presence of acute respiratory distress syndrome and renal dysfunction were associated with higher mortality (75% and 70.2%, respectively). There was no significant difference in the duration of mechanical ventilation or ICU stay between survivors and nonsurvivors. On multivariate analysis, significant predictors of mortality with odds ratio greater than 2 included the presence of anemia, SAPS II score greater than 35, SAPS III score greater than 47, and SOFA score greater than 6 at day 1 of admission. Conclusion: Several demographic and laboratory parameters as well as composite critical illness scoring systems are reliable early predictors of mortality in sepsis. A sepsis mortality prediction formula (AIIMS Sepsis Score) based on SAPS II, SAPS III, and SOFA scores and hemoglobin has greater predictive power than these scoring methods individually. Routine use of critical illness scoring systems and a composite mortality prediction formula may provide useful early prognostic information in sepsis/severe sepsis
Emerg Infect Dis
No full textPlasmodium infections are co-endemic with infections caused by other agents of acute febrile illnesses, such as dengue virus (DENV), chikungunya virus, Leptospira spp., and Orientia tsutsugamushi. However, co-infections may influence disease severity, treatment outcomes, and development of drug resistance. When we analyzed cases of acute febrile illness at the All India Institute of Medical Sciences, New Delhi, India, from July 2017 through September 2018, we found that most patients with malaria harbored co-infections (Plasmodium mixed species and other pathogens). DENV was the most common malaria co-infection (44% of total infections). DENV serotype 4 was associated with mild malaria, and Leptospira was associated with severe malaria. We also found the presence of P. knowlesi in our study population. Therefore, in areas with a large number of severe malaria cases, diagnostic screening for all 4 DENV serotypes, Leptospira, and all Plasmodium species should be performed
Seroprevalence of neutralizing antibodies to adenovirus type 5 among children in India: implications for recombinant adenovirus-based vaccines
No full textWe determined the levels of adenovirus 5 (Ad5) neutralizing antibodies in children in India less than 2 years of age. The results clearly show an age-dependent increase in Ad5-specific immunity, with 7- to 12-month-old children having the lowest levels of Ad5 immunity. This opens up the scope for the use of recombinant Ad5-based vaccines in this age group
The Leukocyte Count, Immature Granulocyte Count and Immediate Outcome in Head Injury Patients
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Impact of chemotherapy on symptom profile, oxidant-antioxidant balance and nutritional status in non-small cell Lung Cancer
No full textBackground: Lung cancer is associated with an oxidant-antioxidant imbalance that is implicated in tumor progression. However, the association of this imbalance on disease burden and treatment response is unclear. The effect of chemotherapy on oxidative stress, antioxidant status, and nutritional profile in patients with advanced nonsmall cell lung cancer (NSCLC) was prospectively evaluated. Subjects and Methods: Patients with confirmed cytological/histological diagnosis of NSCLC were recruited. Performance status was determined using the Eastern Cooperative Oncology Group grading and the Karnofsky Performance Scale. Skin fold anthropometry was done for nutritional assessment. All patients received chemotherapy with intravenous carboplatin and paclitaxel at three-weekly intervals. Response was assessed after four cycles by repeat imaging. Plasma levels of total antioxidant status (TAS), malondialdehyde (MDA), and glutathione peroxidase (GPx) levels were estimated using commercially available kits, and the change was correlated with clinical outcome, response to chemotherapy, performance status, and nutritional profile. Results: Thirty-five cases were studied (92% males), with a mean (SD) age of 56.2 (9.3) years. Following treatment, majority of patients demonstrated stable disease (n = 15 [42%]), followed by partial response (29%), progressive disease (22%), and complete remission (6%). Significant improvement occurred in respiratory symptoms. Body fat declined while subscapular skinfold thickness and 6-min walk distance increased. Spirometric values and performance status remained unchanged. GPx levels declined significantly while no notable change was observed in MDA and TAS levels. Conclusions: Chemotherapy for NSCLC improves symptoms, nutritional status, and exercise capacity but worsens the antioxidant status
Agreement of Two Different Laboratory Methods Used to Measure Electrolytes
No full textABSTRACT
Aim: The aim of our study was to do an agreement analysis of two different laboratory methods used to measure electrolytes i.e., between the ISE based Beckman Coulter Synchron CX9 PRO Biochemistry analyzer and RAL′s Ion3 Flame Photometer (Técnica para el Laboratorio, Barcelona, Spain), in serum samples.
Materials and Methods: This cross sectional study was done over a period of three months from September′09 through December′09 on routine biochemistry samples. A total of 6492 samples were received for routine biochemistry analysis from those 630 blood samples were randomly processed for this study. Two ml of sample was taken in a plain gel tube (LABTECH Disposables, Ahmedabad, India), centrifuged and further processed using both systems within one hour of the sampling to obtain the Na and K concentrations in the samples. The bias and variability of differences in measured values were analyzed according to Bland and Altman method.
Results: Flame photometry method has drawbacks such as low throughput, requires manual operation, is a time consuming procedure. Ion selective electrodes technique is a more universal method for the high throughput determination of electrolytes in physiological samples; Beckman Coulter Synchron CX9 PRO is an example of such a system. The mean difference between the two methods (standard minus test) and 95% limits of agreement for sodium in serum was -7.8±17.3 (-42.2 to 26.6) and in urine was -22±41 (-104 to 60). Similarly, the mean difference between the two methods for potassium values in serum was found to be -0.25±0.75 (-1.75 to 1.25) and in urine was -5.3±38.9 (-83.1 to 72.5). With 95% confidence interval, the value of sodium and potassium as determined by both the methods lie between the upper and lower limit showing 95% limits of agreement.
Conclusion: Good degree of agreement was seen on comparing the two methods for measuring the electrolytes; the use of Synchron CX9 in place of Flame photometer for electrolyte analysis in serum and urine is justified or use the two interchangeably.</jats:p
Indian system of medicine used concurrently with standard conventional medicine improves quality of life in patients of cardio vascular diseases (C.V.D)
No full text314-321Worldwide there is increased shift towards usage of traditional medicine in patients of chronic diseases like Cardio Vascular Disorders. In India, these medicines are used concurrently. Objective of the study was to ascertain prevalence and effect of concurrent traditional drug therapy with standard pharmacotherapy in patients with CVD. The present study used a cross sectional study design to assess the prevalence and a prospective cohort design to assess the effect of concurrent Ayurvedic medicines with standard pharmacotherapy in terms of quality of life. After screening 600 patients, 128 were found taking such medicines. Out of these, 100 were recruited as cases (Group-I), while 100 who were matched in terms of age, body mass index, ejection fraction, and receiving standard therapy only were recruited as controls (Group-II). Assessment parameters included demographic, biochemical, ejection fraction through echocardiography, distance covered in six Minute walk Test (6MWT), Quality of Life (QOL) through Kansas City Cardio-myopathy Questionnaire (KCCQ) and Seattle Angina Questionnaire (SAQ) with follow up at 6 months. Prakriti as mentioned in Ayurveda was also assessed using a questionnaire. Both groups were comparable at base line. Total 87 in Group-I and 91 in Group-II completed the study. Further, 76% patients were diagnosed with heart failure (HF) and 24% with coronary artery disease (CAD). There was no change in distance covered in 6MWT in both HF or CAD groups. But there was improvement in all cases in domains of KCCQ and SAQ as compared to controls. To conclude, concurrent use of traditional medicine with standard conventional care in CVD may improve quality of life in cardiovascular disorders
Why Statistical Modelling in Outcome Prediction in Patients with Traumatic Brain Injury is Essential?: In Indian context
No full textDevelopment and temporal external validation of a simple risk score tool for prediction of outcomes after severe head injury based on admission characteristics from level-1 trauma centre of India using retrospectively collected data
No full textObjective To develop and validate a simple risk scores chart to estimate the probability of poor outcomes in patients with severe head injury (HI).Design Retrospective.Setting Level-1, government-funded trauma centre, India.Participants Patients with severe HI admitted to the neurosurgery intensive care unit during 19 May 2010–31 December 2011 (n=946) for the model development and further, data from same centre with same inclusion criteria from 1 January 2012 to 31 July 2012 (n=284) for the external validation of the model.Outcome(s) In-hospital mortality and unfavourable outcome at 6 months.Results A total of 39.5% and 70.7% had in-hospital mortality and unfavourable outcome, respectively, in the development data set. The multivariable logistic regression analysis of routinely collected admission characteristics revealed that for in-hospital mortality, age (51–60, >60 years), motor score (1, 2, 4), pupillary reactivity (none), presence of hypotension, basal cistern effaced, traumatic subarachnoid haemorrhage/intraventricular haematoma and for unfavourable outcome, age (41–50, 51–60, >60 years), motor score (1–4), pupillary reactivity (none, one), unequal limb movement, presence of hypotension were the independent predictors as its 95% confidence interval (CI) of odds ratio (OR)_did not contain one. The discriminative ability (area under the receiver operating characteristic curve (95% CI)) of the score chart for in-hospital mortality and 6 months outcome was excellent in the development data set (0.890 (0.867 to 912) and 0.894 (0.869 to 0.918), respectively), internal validation data set using bootstrap resampling method (0.889 (0.867 to 909) and 0.893 (0.867 to 0.915), respectively) and external validation data set (0.871 (0.825 to 916) and 0.887 (0.842 to 0.932), respectively). Calibration showed good agreement between observed outcome rates and predicted risks in development and external validation data set (p>0.05).Conclusion For clinical decision making, we can use of these score charts in predicting outcomes in new patients with severe HI in India and similar settings
Proton magnetic resonance spectroscopy of brain to study the cerebral abnormalities in COPD patients: A case control study in North India
No full textBackground: To investigate changes in the cerebral metabolism of nondiabetic and normolipidaemic patients with chronic obstructive pulmonary disease (COPD) using localised in vivo proton magnetic resonance spectroscopy (H MRS), and to correlate these with the severity of disease. Methods: Twenty-eight symptomatic COPD patients and 19 healthy controls underwent 1H MRS of brain, pulmonary function testing and respiratory muscle strength evaluation. The parieto-temporal and occipital regions were localised for H MRS. The metabolic ratios of N-acetyl aspartate to cretinine (NAA/Cr) and choline containing compound to creatinine (Cho/Cr) were calculated by integrating area under the each peak. Results: The mean value of NAA/Cr and Cho/Cr in parieto-temporal area in COPD patients were (1.86± 0.54) and (0.77± 0.23), respectively. The mean values of NAA/Cr and Cho/Cr in occipital area in COPD patients were (1.75±
0.44) and (0.61± 0.25), respectively. Compared with healthy control subjects, the mean values of Cho/Cr in COPD patients were lower, both in parieto-temporal (0.77±
0.23 vs 0.89± 0.35; p=0.17) and occipital (0.61±
0.25± vs0.67± 0.08; p = 0.36) areas of the brain. Conclusions: The cerebral metabolism, pulmonary function testing and respiratory muscle strength altered in symptomatic COPD patients. The clinical significance of cerebral metabolic changes in COPD patients needs to be further investigated
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