Prevalence of obesity, hypertension and metabolic abnormalities in patients receiving long term cART: a case control study from South India

Background: Combination antiretroviral therapy (cART) has improved the quality of life and survival of HIV-infected individuals. However, the long term intake of these drugs is associated with multiple metabolic abnormalities eventually leading to increased risk for cardiovascular morbidity and mortality.Methods: Forty five HIV-infected individuals who are on cART having CD4+ cell count of >200 cells/mm3 for at least 2 years were recruited as cases. Age and gender matched, otherwise healthy individuals were taken as controls. Both cases and controls were compared for the prevalence of obesity, abdominal obesity, hypertension, diabetes mellitus and lipid abnormalities.Results: We found higher prevalence of obesity (33.3% vs 26.7%), abdominal obesity (33.3% vs 17.8%), hypertension (33.3% vs 20%), impaired fasting glucose (IFG) (37.7% vs 8.9%), diabetes mellitus (26.7% vs 24.4%), high total cholesterol (33.3% vs 22.2%) and low HDL cholesterol (60% vs 46.7%) among cases compared to controls. The statistically significant difference was noted only for IFG (cases = 17, 37.7%, controls = 4, 8.9%, p value = 0.002). Low HDL cholesterol was the most common metabolic abnormality found in 27 (60%) cases and 21 (46.7%) controls.Conclusions: HIV-infected individuals receiving long term cART have higher prevalence of obesity, hypertension and dysregulations in glucose and lipid metabolism compared to general population and hence, the diagnosis and management of these abnormalities is very important to prevent cardiovascular morbidity and mortality

The study of risk factors and prognostic indicators in patients with bacteremia due to ESBL producing organisms

Background: There is a growing incidence of extended-spectrum beta-lactamases (ESBL) infections worldwide. ESBL bacteremias have been associated with poor outcomes, higher costs and increased durations of hospital stay. The objective of the study was to identify the risk factors in these patients along with antibiotic susceptibility patterns to help identify the patients with poorer prognosis and in guiding treatment decisions more effectively.Methods: An observational case-control study conducted in a tertiary care hospital in south India over a duration of 18 months. Cases were defined as an adult in-patient who had infection with blood cultures showing growth of ESBL-producing bacteria. A total of 70 patients were included in the study group and subjected to evaluation to determine the risk factors, prognostic indicators and the antibiotic susceptibility.Results: The major risk factors for ESBL-bacteremia identified were prior admission, prior antibiotic usage, prior Foleys catheter and the presence of a vascular catheter. Pneumonia as the source of bacteremia and requirement of mechanical ventilation were identified as indicators of poor prognosis. Carbapenems, cefoperazone-sulbactam and piperacillin-tazobactam showed excellent sensitivity against ESBL-bacteremia.Conclusions: The findings of this study emphasizes the importance of recognizing ESBL-bacteremias in patients with risk factors, so that patients who are at risk to have a worse prognosis can be promptly started on a susceptible antibiotic

Role of Four-Chamber Heart Ultrasound Images in Automatic Assessment of Fetal Heart: A Systematic Understanding

The fetal echocardiogram is useful for monitoring and diagnosing cardiovascular diseases in the fetus in utero. Importantly, it can be used for assessing prenatal congenital heart disease, for which timely intervention can improve the unborn child's outcomes. In this regard, artificial intelligence (AI) can be used for the automatic analysis of fetal heart ultrasound images. This study reviews nondeep and deep learning approaches for assessing the fetal heart using standard four-chamber ultrasound images. The state-of-the-art techniques in the field are described and discussed. The compendium demonstrates the capability of automatic assessment of the fetal heart using AI technology. This work can serve as a resource for research in the field

Local Preserving Class Separation Framework to Identify Gestational Diabetes Mellitus Mother Using Ultrasound Fetal Cardiac Image

In the presence of gestational diabetes mellitus (GDM), the fetus is exposed to a hyperinsulinemia environment. This environment can cause a wide range of metabolic and fetal cardiac structural alterations. Fetal myocardial hypertrophy predominantly affecting the interventricular septum possesses a morphology of disarray similar to hypertrophic cardiomyopathy, and may be present in some GDM neonates after birth. Myocardial thickness may increase in GDM fetuses independent of glycemic control status and fetal weight. Fetal echocardiography performed on fetuses with GDM helps in assessing cardiac structure and function, and to diagnose myocardial hypertrophy. There are few studies in the literature which have established evidence for morphologic variation associated with cardiac hypertrophy among fetuses of GDM mothers. In this study, fetal ultrasound images of normal, pregestational diabetes mellitus (preGDM) and GDM mothers were used to develop a computer aided diagnostic (CAD) tool. We proposed a new method called local preserving class separation (LPCS) framework to preserve the geometrical configuration of normal and preGDM/GDM subjects. The generated shearlet based texture features under LPCS framework showed promising results compared with deep learning algorithms. The proposed method achieved a maximum accuracy of 98.15% using a support vector machine (SVM) classifier. Hence, this paradigm can be helpful to physicians in detecting fetal myocardial hypertrophy in preGDM/GDM mothers

A rare case of recurrent pregnancy loss associated with high-titer positivity for perinuclear anti-neutrophilic cytoplasmic antibodies

We present a case of recurrent pregnancy loss associated with unusual constellation of utoimmunity-related features such as hypertension, severe hrombocytopenia, hypothyroidism and persistent high titers of perinuclear antineutrophilic cytoplasmic antibodies. Her clinical features did not fit into a particular diagnosis of vasculitides, systemic lupus erythematosis (SLE) or other known autoimmune diseases where this autoantibody is found in high titers. We report the unusual association of this autoantibody with recurrent early fetal demise in this case

Paraquat – Boon or bane? A retrospective study of paraquat poisoning and outcomes in a tertiary care center in South India

Setting: Paraquat is a highly toxic, herbicide, extensively used in various parts of India. There is no effective treatment for paraquat poison and carries a very high mortality. In India, this compound can be misused for harmful purposes. Objective: A retrospective time-bound descriptive study of paraquat-consumed patients was conducted at Kasturba Hospital, Manipal, from January 1, 2014 to January 31, 2016. Materials and Methods: All the data were analyzed using the SPSS version 16. All the categorical data are expressed in terms of frequency and percentage. Continuous normal variables were expressed in terms of mean ± standard deviation, and skewed variables were expressed in terms of median and quartiles. Chi-square test was used to find the association between the categorical independent variables across the outcome in survivors, nonsurvivors, and those patients who were discharged from the hospital against medical advice. Similarly, Fisher's exact test was performed for those variables, for which 20% of the expected cell count was <5%. Kruskal–Wallis test was used to compare the relationship between the continuous skewed variables across the outcome. Results: A total of 55 paraquat-consumed patients were admitted, out of which 67.27% (n = 37) of patients were men. Only 32.7% (n = 18) of patients were farmers. Oral ulcers were seen in 43.6% (n = 24) of patients. About 65.5% (n = 36) of patients underwent hemoperfusion, 27.3% (n = 15) of patients survived, 47.3% (n = 26) of patients expired, and 25.5% (n = 14) of patients were discharged against medical advice in a critical condition. The presence of respiratory failure, hypotension, need for ventilator supportive therapy, the elevation of levels of blood urea, serum creatinine, and liver enzymes AST and ALT levels were statistically significant in three groups (P < 0.001). Conclusion: Paraquat poisoning is highly fatal. Treatment is expensive and available only in tertiary care hospitals in India. Central and state governments should ensure that it should not be readily accessible to ordinary people and it should be banned progressively

The study of risk factors and prognostic indicators in patients with bacteremia due to ESBL producing organisms

Background: There is a growing incidence of extended-spectrum beta-lactamases (ESBL) infections worldwide. ESBL bacteremias have been associated with poor outcomes, higher costs and increased durations of hospital stay. The objective of the study was to identify the risk factors in these patients along with antibiotic susceptibility patterns to help identify the patients with poorer prognosis and in guiding treatment decisions more effectively.Methods: An observational case-control study conducted in a tertiary care hospital in south India over a duration of 18 months. Cases were defined as an adult in-patient who had infection with blood cultures showing growth of ESBL-producing bacteria. A total of 70 patients were included in the study group and subjected to evaluation to determine the risk factors, prognostic indicators and the antibiotic susceptibility.Results: The major risk factors for ESBL-bacteremia identified were prior admission, prior antibiotic usage, prior Foleys catheter and the presence of a vascular catheter. Pneumonia as the source of bacteremia and requirement of mechanical ventilation were identified as indicators of poor prognosis. Carbapenems, cefoperazone-sulbactam and piperacillin-tazobactam showed excellent sensitivity against ESBL-bacteremia.Conclusions: The findings of this study emphasizes the importance of recognizing ESBL-bacteremias in patients with risk factors, so that patients who are at risk to have a worse prognosis can be promptly started on a susceptible antibiotic

Predictors of mortality in adult patients with dengue: a study from South India

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets &lt;20,000/mm3 was 10.41% (10/96), ALT &gt;200 was 13.04% (6/46), AST&gt;200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age &gt;40 years, presence of hypotension, platelets &lt;20000 cells/mm3, ALT&gt;200U/L, AST&gt;200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value &lt;0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required

Predictors of mortality in adult patients with dengue: a study from South India

Background: Dengue is one of the important causes of acute febrile illnesses in India. Dengue can be a fatal disease, however there are no reliable markers which can predict mortality among these patients.Methods: A prospective cross sectional study was done in patients who were admitted to a tertiary care hospital with features of dengue fever. A total of 364 patients with IgM dengue serology positive were included in the study. Relevant clinical and laboratory parameters were collected from all patients. Association between clinico-laboratory parameters with mortality was studied using appropriate statistical methods.Results: Among the 364 patients recruited in this study, 14 (3.85%) patients died. Mortality among patients with age group 18-40 years was 2.04%, in patients aged above 40 years was 7.56%. Mortality among patients with hypotension was 42.42% (14 out of 33), bleeding manifestations was 15.38% (8/52), platelets &lt;20,000/mm3 was 10.41% (10/96), ALT &gt;200 was 13.04% (6/46), AST&gt;200 was 12.34% (10/81), prolonged prothrombin time was 60%(12/20), renal failure was 28%(14/50), encephalopathy was 31.57% (6/19), multi organ dysfunction syndrome(MODS) was 43.33% (13/30), acute respiratory distress syndrome (ARDS) was 45.45% (5/11), pleural effusion was 7.5% (6/80).Conclusions: The overall mortality in the present study was 3.85%. Following variables were associated with increased risk of death among the dengue patients: Age &gt;40 years, presence of hypotension, platelets &lt;20000 cells/mm3, ALT&gt;200U/L, AST&gt;200U/L, prolonged prothrombin time, presence of renal failure, encephalopathy, MODS, ARDS and bleeding tendency (p value &lt;0.05). Early identification of factors associated with mortality can help to make appropriate decision on care required