Hospital-based Prospective Study Research Articles

Thrombocytopenia in Plasmodium vivax Malaria: A Report from a Sub-zonal Hospital in Western Rajasthan

Abstract Background: Malaria continues to be a major public health problem in India. Vivax malaria is being increasingly seen with thrombocytopenia. The reported prevalence of the same has been extremely variable and its significance is not well established. This study was conducted to ascertain the prevalence and severity of thrombocytopenia in vivax malaria and assess the outcome of cases with severe thrombocytopenia. A secondary objective was to compare the clinical and laboratory profile of cases of vivax malaria with falciparum malaria and mixed infection. Materials and Methods: This hospital-based prospective study was carried out in the department of general medicine at a sub-zonal hospital in Western Rajasthan in the year 2022. Consecutive febrile patients with a diagnosis of malaria were included in the study after ruling out coexistent alternate infections. Results: A total of 396 cases were enrolled. Ninety-nine percent of patients were male. The mean age of the study group was 32.1 years. A total of 328 (90.8%) out of 361 vivax malaria cases had thrombocytopenia (platelet count <150 × 103 μL) with 26.5% having severe thrombocytopenia (platelet count <50 × 103 μL). The mean defervescence duration was 44.4 h in vivax malaria. 3.4% of severe vivax malaria cases required intensive care unit care due to hypotension, respiratory distress, and multiorgan dysfunction, and none of them had any bleeding manifestations. All cases recovered well after standard treatment. There was a significant statistical difference between the mean platelet count among the three types of malaria: vivax, falciparum, and mixed (vivax + falciparum infections) (P = 0.03). Similarly, on applying Chi-square test, there was a significant difference in severe thrombocytopenia across the groups (P = 0.01). Conclusion: There is a high prevalence of thrombocytopenia in vivax malaria including severe thrombocytopenia. In the majority of cases, this thrombocytopenia does not result in any adverse event, and cases respond well to conventional treatment. Clinicians need to be aware of the extent and severity of thrombocytopenia in vivax malaria and rule out this treatable condition in endemic areas with a high prevalence of other coexistent infections causing thrombocytopenia.

Utilization of blood and blood components in the department of clinical hematology of a tertiary care hospital: A prospective hospital-based study

Background: To have proper utilization of blood and its components adherence to established guidelines is essential. Hence, periodic review of blood components is necessary to improve transfusion practices and decrease the inappropriateness of blood components. Aims and Objectives: Our study aims to assess the utilization and appropriateness of blood and blood components in the Department of Clinical Hematology SKIMS, Soura, Srinagar. Materials and Methods: This prospective observational study was conducted in the Department of Blood Transfusion and Immunohematology, SKIMS, Soura, Srinagar, over a period of 1 year from August 2020 to July 2021 on patients admitted in Clinical Hematology requiring transfusion therapy. The number of all blood and blood component units supplied over a period of 1 year was assessed. The usage of different types of blood component was recorded and correlated with the patient’s diagnosis and indications for transfusion. Results: A total of 250 patients were transfused with 2099 blood and blood components, among them 64.32% (1350) units were used appropriately and 35.68% (749) units were used inappropriately. Transfusions of packed red blood cells were found to be inappropriate in patients with asymptomatic chronic anemia with Hemoglobin >7 g/dL. Fresh frozen plasma was given inappropriately in cases of bleeding without derangement of coagulation tests. Inappropriate use of platelets was seen in patients who had received platelets prophylactically with platelet count above 10,000/μL. Conclusion: Proper implementation of guidelines for the use of various blood components would help reduce their inappropriateness.

A study of non-invasive predictors of esophageal varices in patients with cirrhosis of liver – A cross-sectional study

Background: Current guidelines advise that patients diagnosed with liver cirrhosis undergo screening through upper gastrointestinal endoscopy to detect esophageal varices (EV). Prophylactic measures should be taken for those with large varices on diagnosis and during follow-up. However, this poses a dual challenge, both social and medical, as the number of cirrhotic patients rises while the availability of endoscopy units remains limited. Aims and Objectives: In this study, we aim to evaluate the diagnostic accuracy of the non-invasive predictors such as spleen size, platelet count (PC), and PC/spleen diameter (PC/SD) ratio for the diagnosis of EV. Materials and Methods: This hospital-based prospective observational study was done in the SDM College of Medical Sciences and Hospital, Dharwad, among 50 patients with cirrhosis of liver. Results: Among the 50 patients studied males pre-dominated the study with 80%. Out of the study population, 70% of the patients had varices. For a cutoff point of PC/SD ratio 916, the sensitivity was 71.42% and specificity was 93.3%. For a cutoff value of PC of 1.32 lakhs, the sensitivity was 71.42%, and the specificity was 73.3%. For a cutoff value of the longest SD of 12.40 cm, the sensitivity was 94.30%, and specificity was 33.3%. Conclusion: These non-invasive predictors can be useful screening tools for the diagnosis of EV. These can be effective for the initiation of prophylactic treatment when the endoscopy facility is not available.

Diagnostic accuracy of cerebroplacental ratio in anticipating adverse perinatal outcome in uncomplicated appropriate for gestational age pregnancies at term

Abstract Introduction: Anticipating which babies are in danger of experiencing poor outcomes during the perinatal period in uncomplicated appropriate for gestational age (AGA) pregnancies at term is difficult in obstetric practice. Cerebroplacental ratio (CPR) is emerging as a significant indicator of negative perinatal results. The current study sought to establish how effective CPR is in predicting negative perinatal outcomes in term uncomplicated AGA pregnancies. Materials and Methods: This study was a hospital-based prospective observational cohort study conducted at a single center. Patients were chosen depending on different criteria for inclusion and exclusion. A prenatal ultrasound with a color Doppler scan was carried out to calculate CPR. Patients were grouped according to their last CPR measurement before delivery into either normal CPR or pathological CPR categories. Doppler results did not impact clinical decisions and delivery followed institutional protocols. After childbirth, data on the outcome of the perinatal period were obtained from the patients’ medical records. Negative perinatal outcomes were assessed through the delivery method, APGAR score, perinatal morbidity, and perinatal mortality. These outcomes were correlated with CPR. Results: The research included 605 women, separated into normal and pathological CPR groups. Of these, 153 (25.3%) were classified in the pathological CPR category, whereas 452 (74.7%) exhibited normal CPR. In our study, there were 138 patients who experienced adverse perinatal outcomes in the pathological CPR group, whereas 44 patients had such outcomes in the normal CPR group. The diagnostic accuracy of pathological CPR to predict any negative perinatal result was 90.25%. Conclusions: CPR shows potential in detecting fetuses at risk in full-term uncomplicated AGA pregnancies.

Natural course and predictors of consciousness recovery in children with prolonged disorder of consciousness

Prolonged disorder of consciousness (DoC) is a rising challenge. Pediatric data on diagnosis and prognosis of prolonged DoC were too limited and heterogeneous, making it difficult to define the natural course and evaluate the prognosis. The present study explored the emergence from the Minimally Conscious State (eMCS) incidence at different months postinjury drawing the natural course, and detected the predictors of the incidence in children with prolonged DoC. A hospital-based prospective cohort study was conducted. Kaplan–Meier curves, as well as univariate and multivariate COX regression analysis, were performed. The study enrolled 383 pediatric DoC individuals, including 220 males (57.4%), with an average age of 3.9 (1.9–7.3) years. The median duration between onset and rehabilitation is 30.0 (21.0–46.0) days. At enrollment, the ratio of vegetative state/unresponsive wakefulness syndrome (VS/WUS) to MCS is 78.9%–21.1%. Traumatic brain injury and infection are the major etiologies (36.8% and 37.1%, respectively), followed by hypoxia cerebral injury (12.3%). For children with prolonged DoC, the cumulative incidence of eMCS at months 3, 6, 12, and 24 was 0.510, 0.652, 0.731, 0.784 VS 0.290, 0.418, 0.539, 0.603 in the traumatic VS non-traumatic subgroup, respectively. For children in a persistent vegetative state (PVS), the cumulative incidence of emergence at months in 3, 6, 12, 24, 36 and 48 was testified as 0.439, 0.591, 0.683, 0.724, 0.743 and 0.743 in the traumatic subgroup, and 0.204, 0.349, 0.469, 0.534, 0.589 and 0.620 in the non-traumatic subgroup. Participants who exhibit any of the following four demographical and/or clinical characteristics—namely, older than 4 years at onset, accepted rehabilitation within 28 days of onset, remained MCS at enrollment, or with etiology of traumatic brain injuries—had a significantly positive outcome of consciousness recovery (eMCS). Moreover, both prolongation of the central somatosensory conductive time (CCT) (level 2) and absence of N20 (level 3) independently predict a negative outcome. In children with prolonged DoC, we found that 12 months postinjury was critical to eMCS, and a preferred timepoint to define chronic vegetative state (VS). The characteristics including age, etiology, time before rehabilitation, consciousness state, and SEP results were useful predictors of conscious recovery.Trial registration Registered 06/11/2018, the registration number is chiCTR1800019330 (chictr.org.cn). Registered prospectively.

Neonatal sepsis-a peek into our findings in Northwest Nigeria: a prospective study

BackgroundNeonatal sepsis is still a global health concern as it contributes to a high burden of neonatal morbidity and mortality especially in developing countries. The aim of the study is to give an insight into neonatal sepsis: risk factors, sepsis types, clinical features, pathogen burden with their antibiotic sensitivities, and outcome of admission in our facility. The study was a prospective hospital-based study conducted over 10 months, October 2018–July 2019.ResultOf the 248 term neonates with features of sepsis enrolled in the study 94 (37.9%) were confirmed to have sepsis. Late-onset sepsis LOS (68%) was found to be the most common, and most of the neonates were delivered elsewhere. Clinical features were non-specific for both early-onset (EOS) and LOS and include fever, jaundice, poor suck, and depressed primitive reflexes. Infections were mostly caused by gram-negative bacteria, and while Staphylococcus aureus was the single most common isolate for both EOS and LOS. Antibiotic sensitivity was highest with ciprofloxacin for both EOS and LOS. Mortality was high at 14.9% and was mostly contributed to by Staphylococcus aureus infection.ConclusionNeonatal sepsis is still a burden with mostly non-specific clinical features. The local prevalent organisms were Staphylococcus aureus, Enterobacter agglomerans and Klebsiella pneumonia with good antibiotic susceptibility to ciprofloxacin. Most presented with late-onset sepsis and therefore infection is likely to be community-acquired which to a great extent can be prevented with robust public health interventions.

Comparative analysis of computed tomography severity indices in predicting the severity and clinical outcome in patients with acute pancreatitis

Background: Acute pancreatitis (AP) has unpredictable severity. Its management is based on initial assessment of disease severity. It ranges from mild interstitial to severe necrotic form; the latter is associated with poor prognosis. Contrast-enhanced computed tomography (CT) of the abdomen is the gold standard in early detection of pancreatic necrosis and in assessing the severity of AP. Two CT grading systems exist to assess the severity of AP: CT severity Index (CSI) and modified CSI (MCSI). This study compares the usefulness of these two systems in predicting the severity and clinical outcome in AP in comparison with Ranson’s criteria and clinical outcome parameters. Methods: This is a prospective hospital-based screening study of 80 patients aged >12 years with clinical diagnosis of AP who underwent contrast-enhanced CT study of the abdomen. Comparative analysis between MCSI and CSI with Ranson’s criteria and clinical outcome parameters was assessed by Chi-Squared test. Results: The accuracy of CSI and MCSI in predicting the requirement of critical care, superadded infection, multiple organ dysfunction syndrome (MODS) and requirement of intervention were 73.0%, 64.5%, 69.8% 60.9% and 77.2%, 76.0%, 74.4% & 56.6% respectively. Area under the curve for MCSI score was significantly higher (AUC: 0.861; 95% CI: 0.736-0.986) than CSI score (AUC:0.815;95% CI:0.749-0.941). MCSI and CSI showed significant correlation with Ranson’s criteria; however, MCSI correlation was better (r:0.53; p<0.01) than CSI (r:0.35;p:0.04). Conclusion: CSI and MCSI are better predictors of severity, clinical outcome and mortality compared with Ranson’s criteria, with MCSI being more accurate and better predictor than CSI. The accuracy of MCSI is better than CSI for prediction of requirement of critical care, development of superadded infection and development of MODS in AP. However, CSI and MCSI have low accuracy in predicting intervention in AP.

Periconceptional maternal supplement intake and human embryonic growth, development, and birth outcomes: the Rotterdam Periconception Cohort.

Is periconceptional multiple-micronutrient supplement (MMS) use including folic acid (FA) compared to FA use only associated with increased embryonic growth, development, and birth weight in a high-risk population? Women with MMS intake show no significant differences in first-trimester morphological embryo development, but increased first-trimester embryonic growth trajectories and fewer neonates born small for gestational age (SGA), less than the 3rd percentile (<p3), compared to women using only FA. Periconceptional maternal FA intake in the general population is associated with increased embryonic and fetal growth, and reduced risks of neural tube defects, other congenital malformations, low birth weight, and neonates born SGA. A prospective tertiary hospital-based cohort study (the Rotterdam Periconceptional Cohort) was conducted from January 2010 to December 2020. We included 1076 women from the Rotterdam Periconceptional Cohort, before 10 weeks of pregnancy with follow-up until delivery. Embryonic growth was assessed by measurement of crown-rump length (CRL) and embryonic volume (EV), and embryonic morphology was described by Carnegie stages using longitudinal three-dimensional ultrasound scans and virtual reality techniques. Birth outcomes were extracted from medical records. General characteristics and supplement use were extracted from research questionnaires. This study showed increased embryonic growth trajectories (adjusted models, CRL: β = 0.052, 95% CI 0.012-0.090, EV: β = 0.022, 95% CI 0.002-0.042) in women using MMS compared to those using only FA. Moreover, a 45% reduced risk of a neonate-born SGA (<p3) was shown in women using MMS compared to FA users (adjusted OR = 0.546, 95% CI 0.308, 0.969). Embryonic morphological development (Carnegie stages) and the occurrence of miscarriages did not differ between women using MMS or solely FA. Following the heterogeneity of the composition and dose of MMS preparations, it is unclear which specific micronutrient, combination, or dose explains the increased embryonic growth trajectory and reduction in risk for SGA. This also hampers the possibility of differentiating between the effects of FA alone or as a component of MMS. Our findings emphasize the importance of periconceptional maternal MMS use as a potential preventative intervention against reduced embryonic growth and neonates born SGA. Therefore, we recommend the periconceptional use of MMS in women at risk of inadequate micronutrient intake. However, awareness of potentially harmful side effects of high doses and combinations of micronutrients is essential, therefore the optimal composition and dose need to be investigated, and careful surveillance is recommended. This research was funded by the Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands, and the ZonMw grant Open Competition 2018 (09120011910046). The authors declare that they have no conflict of interest. NTR4356.

Clinico-microbiological evaluation of post-cesarean surgical site infections

Objectives: With increasing rates of cesarean section (CS), the incidence of post-operative complications is bound to increase, which includes surgical site infections (SSIs), being one of the common and distressing complication. This study was aimed to evaluate the various determinants of post-CS SSI, their clinical spectrum, prevalent microbiology, and their susceptibility and resistance patterns. Materials and Methods: This was a prospective longitudinal hospital-based study undertaken in Government Medical College and Hospital (GMCH), Chandigarh. Six hundred and eighty-eight patients were included from April, 2021, to September, 2022, and were followed up till 42nd day post-procedure. Results: The incidence of SSI in the study was 3.49%. The risk factors identified were gestational diabetes mellitus (GDM), thrombocytopenia, chorioamnionitis, prolonged labor, multiple per vaginum examinations, prolonged surgery, post-partum hemorrhage, and blood and blood product transfusions. Most patients presented on or after day 8 of surgery with discharge from the wound site being the most common presentation. Staphylococcus aureus emerged as the most prevalent organism and out of five patients having S. aureus, three had methicillin-resistant S. aureus. Linezolid was found to be the most susceptible antibiotic, whereas ciprofloxacin was mostly resistant among the prevalent isolates. Conclusion: Some of these determinants are modifiable such as GDM and thrombocytopenia and if detected and managed early may help in reducing the risk of developing SSI. Linezolid must be used empirically for treatment of SSI until the reporting of culture and sensitivity is done because routine antibiotics used for antibiotic prophylaxis in CS were found to be highly resistant. Periodic analysis of clinical spectrum and culture and sensitivity patterns is imperative for the early diagnosis and appropriate empirical management of SSI.

A Cohort Study to Evaluate the Effect of Nutritional Intervention on Severe Acute Malnutrition Children Admitted to A Nutritional Rehabilitation Centre in A Tertiary Care Hospital in Central Gujarat, India

Background: Undernutrition is one of the most concerning health and development issues in India as well as in the world. Nutritional rehabilitation centres (NRC) were started by Government of India to control severe acute malnutrition. The aim is to assess the effect of nutrition interventional measures for severe acute malnutrition (SAM) children admitted at NRC through selected anthropometric indicators. Methodology: A hospital-based prospective cohort study was conducted at NRC of SSG Hospital, Vadodara, Gujarat from April to September 2022, all children of 6-60 months of age admitted during this period were observed during their stay with three follow-ups after discharge at 15 days interval. The data was entered in Microsoft Excel and was analysed using Medcalc Software. Results: A total of 76 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and 3 follow-ups (ANOVA=141, p&lt;0.001); difference of mid upper arm circumference (MUAC) (ANOVA=84.2, p&lt;0.001) and difference of height (ANOVA=43.3. p&lt;0.001) at admission, discharge and follow-up were also statistically significant. Conclusions: NRCs have had a positive impact on the selected anthropometric indicators of severe malnourished children but lag behind proper follow-up visits.

Cleft Lip Surgery in Sudan: Clinical Presentations, Early Outcomes, and Patient and Professional Satisfaction: A sub-Saharan African experience

BackgroundCleft lip and palate are the most common congenital craniofacial anomalies. They account for approximately 13% of all congenital anomalies. ObjectivesTo study the presentation of cleft lip and the early results of surgical repair among patients who presented to our centers. MethodsThis was a hospital-based prospective cohort study of 72 patients who underwent cleft lip repair in Sudan. ResultsThe commonest age group was between 10–18 months. The male-to-female ratio was 2:1, and a family history of cleft lip was found in 2.8% of patients. The cleft lip was complete in 81.9%, incomplete in 12.5%, and hybrid in 5.6% of patients. Associated cleft palate was observed in 54 patients. Associated syndromes were found in 10 patients. The surgery was carried out in most patients at 9 months or less; in 4 patients, it was more than 18 months. Achievement of reasonable lip repair was moderate (50% collectively). High achievement was observed for criteria, such as accurate union (90.3%), and sub-moderate achievement in even vermillion border and cupid's bow (44%), low nose symmetry (30.6%), and quality of scar (18.1%). Early complications were reported at the rate of 13.9%. Patient satisfaction was 59.7%; however, the professionals showed higher satisfaction levels (66.7%). The anthropometric measurements of normal infants were moderately similar to those of the infants who underwent surgery. ConclusionThe patients with cleft lip showed early presentation, with a predominance of the male gender and left side pattern. The preliminary outcome of cleft lip repair was moderate, with variations in different criteria. Patient and professional satisfaction were above average.

An Extensive Analysis and Comparison of Bone Marrow Aspiration and Bone Marrow Trephine Biopsy at a Tertiary Care Hospital in Jharkhand for Various Hematological and Non-hematological Illnesses.

Background Bone marrow examination (BME) is an indispensable diagnostic tool to evaluate various hematological and non-hematological disorders. Bone marrow aspirate cytology and bone marrow trephine biopsy, even though performed simultaneously, are assessed at different points in time due to different processing methods. Aims and objective This study aims to assess and compare the role of bone marrow aspiration and trephine biopsy to formulate an effective and rapid method for diagnosing a wide spectrum ofvarious hematological and non-hematological disorders. Materials and methods The approach of our study was a hospital-based prospective study conducted on 200 patients over a period of 1 year. The role of bone marrow aspiration and a trephine biopsy is to formulate an effective and rapid method for diagnosing a wide spectrum of hematological and non-hematological disorders. Results In our study, a total of 200 cases were studied, of whom 119 patients were male and 81 were female. The most common finding was erythroid hyperplasia, comprising 40 (20%) cases, followed by hypoplastic marrow, comprising 28 (14%) cases. Subsequently, there were 19 (9.5%) cases of acute leukemia, while 15 (7.5%) cases of chronic myeloid leukemia (CML) in the chronic phase were found. In our study, bone marrow aspirate and bone marrow trephine biopsy were found to positively correlate in 137 (68.5%) of the cases. Conclusion Bone marrow aspiration alone is sufficient for the diagnosis of megaloblastic anemia and most of the hematological malignancies. Bone marrow trephine biopsy is more appropriate for the detection of disorders of focal marrow involvement such as lymphoproliferative disorders and staging of lymphomas, metastatic cancers, granulomatous lesions, and hypoplastic marrow. However, it is strongly recommended that both procedures should be done simultaneously to ensure maximum diagnostic accuracy.

Ocular biometric characteristics of Han ethnicity in Tianjin and Uyghur ethnicity in Xinjiang undergoing cataract surgery.

To analyze and compare the differences among ocular biometric parameters in Han and Uyghur populations undergoing cataract surgery. In this hospital-based prospective study, 410 patients undergoing cataract surgery (226 Han patients in Tianjin and 184 Uyghur patients in Xinjiang) were enrolled. The differences in axial length (AL), anterior chamber depth (ACD), keratometry [steep K (Ks) and flat K (Kf)], and corneal astigmatism (CA) measured using IOL Master 700 were compared between Han and Uyghur patients. The average age of Han patients was higher than that of Uyghur patients (70.22±8.54 vs 63.04±9.56y, P<0.001). After adjusting for age factors, Han patients had longer AL (23.51±1.05 vs 22.86±0.92 mm, P<0.001), deeper ACD (3.06±0.44 vs 2.97±0.37 mm, P=0.001), greater Kf (43.95±1.40 vs 43.42±1.69 D, P=0.001), steeper Ks (45.00±1.47 vs 44.26±1.71 D, P=0.001), and higher CA (1.04±0.68 vs 0.79±0.65, P=0.025) than Uyghur patients. Intra-ethnic male patients had longer AL, deeper ACD, and lower keratometry than female patients; however, CA between the sexes was almost similar. In the correlation analysis, we observed a positive correlation between AL and ACD in patients of both ethnicities (rHan =0.48, rUyghur =0.44, P<0.001), while AL was negatively correlated with Kf (rHan =-0.42, rUyghur =-0.64, P<0.001) and Ks (rHan =-0.38, rUyghur =-0.66, P<0.001). Additionally, Kf was positively correlated with Ks (rHan =0.89, rUyghur =0.93, P<0.001). There are differences in ocular biometric parameters between individuals of Han ethnicity in Tianjin and those of Uyghur ethnicity in Xinjiang undergoing cataract surgery. These ethnic variances can enhance our understanding of ocular diseases related to these parameters and provide guidance for surgical procedures.

Enhancing participant understanding and ethical considerations in clinical trial biospecimen research: Insights from an oncology setting in India

This study explores the KAP of clinical trial participants on the use of surplus biospecimens for future research in Indian oncology trials. A hospital-based prospective study was conducted among 112 oncology clinical trial participants. Non-probability purposive sampling technique was used to recruit the participants. This study captured their socio-demographic information and pre and post-KAP assessment by using self-administered questionnaires and its highlights ethical concerns and the lack of global guidelines. The main goal is to understand participants’ understanding and opinions on sample collection, utilization, and storage, as well as the ethical implications. SPSS software used for statistical analysis to evaluate pre and post-intervention KAP scores using frequency, percentage, mean difference, standard deviation, and applied paired t-test and Wilcoxon signed ranks test to assess Different KAP Levels. The study analyzed knowledge, attitude, and practice levels among oncology clinical trial participants using statistical tests. Pre-test to post-test comparisons showed significant increases in knowledge (p &lt; 0.001, Wilcoxon Signed Ranks Test), attitude (p &lt; 0.001, paired-samples t-test), and practice (p &lt; 0.001), highlighting the intervention’s effectiveness. This study highlights the effectiveness of interventions in improving the knowledge, attitude, and practice (KAP) of oncology clinical trial participants in India regarding the use of surplus biospecimens, emphasizing the importance of standardized guidelines in global oncology trials.

Identification of Dominant Leptospira Serogroups among Leptospirosis Cases and Their Clinical Outcomes: A Prospective Hospital-Based Study in Mangaluru, India.

Leptospirosis is a reemerging zoonotic disease of worldwide significance, endemic to the southern region of India, with clinical manifestations similar to other febrile illnesses; hence, it is often misdiagnosed and underreported. Inadequate information about the disease burden and the regional circulating serogroups contributes to its neglected disease status. This study aimed to identify the infecting Leptospira serogroup in the coastal region of Mangaluru and study the clinical symptoms and outcome among leptospirosis patients. Serum samples were collected from 30 patients with confirmed leptospirosis admitted to a tertiary care center in Mangaluru and screened by microscopic agglutination test (MAT) for the infecting serogroup. The clinical profile of these cases was reviewed, and data regarding epidemiological factors such as age, sex, complications, and mortality were recorded. The MAT identified a higher occurrence of serogroup Bataviae (n = 7, 43.75%) and serogroup Australis (n = 5, 31.25%) compared with other serogroups screened in this study population. Patients were aged 16 to 65 years, with a predominance of males. The clinical presentation of leptospirosis ranged from a mild febrile illness to multiorgan failure. Fever (n = 29, 96%) was the common clinical presentation, followed by myalgia, nausea, and abdominal pain. Acute kidney injury, acute respiratory distress syndrome, and multiple organ dysfunction syndrome were the common complications observed. Determining the circulating serogroup is necessary to understand the epidemiology and diversity of Leptospira serogroups among animals and humans to strategize appropriate preventive measures.

Maximum surgical blood ordering schedule for elective surgical procedures in Omdurman teaching hospital, Sudan

BackgroundThe need for blood during a surgical procedure is greater than what blood banks are able to provide. There is an excessive amount of blood being ordered for elective surgeries, surpassing the actual requirements. Only 30% of the cross matched blood is actually used in these surgeries. The accuracy of estimating the transfusion needs before a surgical procedure can be determined by looking at the cross match to transfusion ratio and the transfusion index. “These indicators play a crucial role in developing the maximum surgical blood ordering schedule; in this study, these indicators were tested.”Aim of studyIs to determine the efficiency of blood ordering and transfusion practices for patients undergoing elective surgeries.MethodsThis study is a prospective cross-sectional hospital-based study done at Omdurman Teaching Hospital-Sudan. Conducted for the duration of 6 months period from July to December 2019.The study participants were patients who underwent elective surgical procedures in general surgery and Urology departments as total coverage sample over a period of study duration. Ethical clearance obtained from ethical committee of Sudan Medical Specialization Board.ResultsTwo hundreds seven patients included in this study, the amount of blood units requested were 443-unit, cross matching for 98.6% (n 437) of units were done. Only 100 unit were Transfused (22,8%). The calculated CT ratio was 4.4, transfusion index was 1.6 and transfusion probability was 29.9%.ConclusionTransfusion probability and transfusion index of the present study were optimal but comparatively higher than the standard guidelines as most of the cross matched blood was not utilized.

Role of Serum Ferritin as a Predictor of Dengue Severity: A Prospective Observational Study From India.

Early detection of dengue fever progression to severe form using simple measurable tests is crucial for initiating appropriate supportive therapy. This study aimed to assess whether serum ferritin is an indicator of severity in dengue patients. This hospital-based prospective observational study was done on 70 patients admitted in wards and intensive care unit (ICU) of Aditya Birla Memorial Hospital, Pune, India, and Jaipur Golden Hospital, Delhi, India, satisfying inclusion criteria during the study period. Dengue cases were classified as those who had non-structural protein 1 (NS1) positivity on days 2-8 and/or positive immunoglobulin M (IgM) on days 6-10, while those with other confirmed diagnoses were considered as other febrile illnesses. The outcome of this study was to see an association between serum ferritin levels and severity of illness, condition at the time of discharge/death, and the length of hospitalization. Mean serum ferritin (ng/mL), platelet count (cells/mm3), and hospital stay (in days) were 1469.43±297.53, 17289.29±8254.47, and 6.01±3.90, respectively. Subjects with severe dengue had significantly higher mean serum ferritin levels and median hospital stays compared to those with non-severe dengue (p<0.05). A moderate (Pearson correlation coefficient ρ=-0.35, p=0.0027) negative correlation was found between serum ferritin level and platelet count whereas a moderate (ρ=0.50, p=0.0000) positive correlation was found between serum ferritin level and hospital stay. Serum ferritin levels can be used as a tool to help differentiate between severe and non-severe dengue.

Antiseizure adverse drug reaction and associated factors among epileptic patients at Jimma Medical Center: a prospective observational study

A growing body of evidence suggests that adverse drug reactions (ADRs) are a major cause of morbidity and mortality in the healthcare system. Fifteen to twenty-five percent of patients with epilepsy discontinued antiseizure drugs (ASDs) within 6 months of therapy owing to intolerable adverse drug reactions. In Ethiopia, the prevalence of antiseizure adverse drug reactions and associated factors was not extensively conducted in advanced settings like Jimma Medical Centers. Hence, the objective of this study is to assess patterns of adverse drug reactions and associated factors among ambulatory epileptic patients at tertiary hospitals in Ethiopia. A hospital-based prospective observational study was spanned for 1 year. Two hundred ninety patients were consecutively recruited into the study from all epileptic patients attending the ambulatory clinic. Relevant data were collected through patient interviews and medical chart reviews. The causality assessment was done by using the Naranjo Probability Scale. Epi-Data manager version 4.6.0.4 was used for data entry and statistical analysis was performed by Statistical Package for Social Science version 25.0 (SPSS). Stepwise backward logistic regression analysis was done to identify factors that increase the risk of antiseizure adverse drug reactions. The mean (± SD) age of the participants were 29.91(± 11.26) years. The overall prevalence of ADR was 33.8% (95% CI 29.2–39.9%). A total of 110 adverse drug reactions were identified among 98 patients with an average of 1.12 per patient. ADRs were frequently reported with phenobarbital (52.04%) and phenytoin (34.70%). The commonly identified adverse drug reactions were epigastric pain (27.55%) and central nervous system drowsiness (23.46%). Comorbidity (AOR = 5.91, 95% CI (2.14–16.32), seizure-free period of fewer than 2 years (AOR = 1.94, 95% CI (1.18–3.19), and polytherapy (AOR = 1.35, 95% CI (1.80–2.26) were significantly associated with adverse drug reactions. This trial had a comparatively high percentage of adverse medication reactions. Adverse medication reactions were more common in patients with polytherapy, comorbidities, and seizure-free durations less than two years. Therefore, medical practitioners should advise patients who exhibit these traits on how to reduce or avoid bad drug responses or provide comfort in the event of small incidents.

Effect of apremilast on cardiovascular risk in psoriasis patients in comparison with methotrexate

Background: Psoriasis is a common chronically relapsing inflammatory disorder with cutaneous and rheumatologic manifestations characterized by an increase in risk of cardiovascular diseases. Chronic inflammation in psoriatic patients predisposes them to cardiovascular morbidity. This study was done to compare the change in cardiovascular risk factors who are taking apremilast and methotrexate. Aims and objectives: The aims of this study were as follows: (1) To evaluate the effect on biochemical parameters pertaining to cardiovascular risk in psoriasis patients after 12 weeks of treatment with apremilast in comparison with methotrexate. (2) To compare the efficacy of methotrexate with apremilast in treating chronic plaque psoriasis. Materials and Methods: This hospital-based prospective cohort study included 40 newly diagnosed cases of psoriasis who were divided into two groups – group A (receiving methotrexate) and group B (receiving apremilast) and were assessed at baseline and after 12 weeks. The outcome was assessed on the basis of psoriasis area and severity index score and the biochemical parameters. Results: We found a significant decrease in triglycerides, high sensitivity C-reactive protein, and low-density lipoprotein levels in psoriasis patients taking methotrexate and high-density lipoprotein in the apremilast group. Conclusion: On comparing the two drugs, methotrexate is considered to have more cardioprotective action.

Assessing Clinical Techniques and Diagnostic Injections for Distinguishing Neuropathic and Inflammatory Heel Pain: A Prospective Hospital-Based Study

One in ten people will experience inferior heel pain at some point in their lives, along with plantar heel pain, which is a frequent ailment in the general population. Most experts agree that plantar fasciitis results from persistent inflammation and recurrent partial tears at this enthesis. This study's goal is to assess the effectiveness of using clinical techniques and diagnostic injections to distinguish between neuropathic and inflammatory heel pain. This is a hospital-based prospective study (analytical study) that was performed over a period of 18 months from December 2018. After the approval of the ethical committee, the study was conducted in the Department of Orthopaedics OPD, Krishna Institute of Medical Sciences University Karad. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments have failed. On one-week, one-month and three months follow up; in all nine neuropathic cases there was already a significant reduction in pain severity (p&lt;0.05).