Clinical, biochemical and haematological changes in leptospirosis

Background: Leptospirosis is a globally important zoonotic disease caused by pathogenic leptospira. Leptospira species are spirochetes belonging to the order spirochetes and the family leptospiraceae. Present study is done to find out the incidence of thrombocytopenia in leptospirosis and to correlate it with other parameters like renal dysfunction, hepatic dysfunction and bleeding manifestation.Methods: Study includes 51 clinically suspected and diagnosed cases of leptospirosis, in Government hospital, South Gujarat, during a period from January 2017 to December 2017. Clinical signs and symptoms and complications, biochemical profile like bilirubin and creatinine, haematological profile like Hb, WBC count and platelet count were recorded. Thrombocytopenia was defined as a platelet count below 1,50,000/cmm.Results: The present study includes 51 cases of Leptospirosis. Age ranged from 16 years to 61 years (male-39 and Females-12) There were 38 (74.5%) cases with thrombocytopenia and 13 (25.4%) cases with normal platelet count. Out of 38 thrombocytopenic cases, 32 (84.2%) cases had renal dysfunction, 26 (68.4%) cases had hepatic dysfunction and 16 (42.1%) cases had pulmonary haemorrhage. Among 13 cases with normal platelet count, 8 (61.5%) cases had hepatic dysfunction and 7 (53.8%) cases had renal dysfunction and 3 (23%) cases had pulmonary haemorrhage.Conclusions: Thrombocytopenia is a frequent complication (present in more than half of the patient) in leptospirosis and associated with more frequent and more severe complications. Therefore, early recognition of thrombocytopenia is recommended to prevent complications and mortality in leptospirosis

Antimicrobial Property of Silver Nanoparticles: Effects of Concentration and Temperature on Bacterial Isolates

Importance of hospital environment in patient-care has been recognized widely in infection prevention and control. Inappropriate antibiotic use led to emergence of resistant strains that are difficult to treat with the available antibiotics. Progress in nanotechnology led to enhancement of nanoparticles with physicochemical characteristics and functionality that overcomes the constraints of common antimicrobials. Aim was to investigate effective antimicrobial role of Silver nanoparticle (Ag-NPs) against clinically important bacterial strains and observe effects of varying storage temperatures on Ag-NPs antimicrobial activity. Different concentrations of Ag-NPs were tested against Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii using diffusion method. Zone of inhibition (ZOI) for each organism was directly proportional to concentration of Ag-NPs used. Mean ZOI values at different concentrations were significantly different for all organisms with p-value <0.001 for E. coli, S. aureus, P. aeruginosa and 0.004 for A. baumannii. Variation in storage temperature hardly showed any effects on the antimicrobial property of the Ag-NPs. Scanning electron microscopy (SEM) showed morphological and size variations in Ag-NPs exposed cells when compared to control strains, especially for S. aureus, E. coli and P. aeruginosa. Damaged cell membrane areas can be clearly distinguished in E. coli and P. aeruginosa thus suggesting bacterial membrane disruption. These finding can help design a larger study where Ag-NPs can be used in various medical instruments which are usually kept at room temperatures. Also, outcomes of this study may help in designing proper implants, prosthesis and equipment coated with minimum concentration of nanoparticles that might be considered safe for medical applications

Association between gastrointestinal events and compliance with osteoporosis therapy

AbstractPurposeThe aim of this study was to estimate the rate of gastrointestinal (GI) events, and association between GI events and compliance with osteoporosis therapy among osteoporotic women.MethodsA retrospective cohort study using a large administrative claims database in the United States from 2001 through 2010 was conducted. We studied women ≥55years old who were continuously enrolled in a health plan for at least 2years, a baseline year before and a follow-up year after the date of the first prescription of oral bisphosphonate as the first oral osteoporosis treatment. Compliance with osteoporosis therapy was measured using the medication possession ratio (MPR), with compliance defined as MPR ≥0.8. Multivariate logistic regression was used to assess the association between occurrence of GI events and compliance with osteoporosis therapy after controlling for demographic and clinical characteristics.ResultsA sample consisting of 75,593 women taking at least one oral bisphosphonate with mean (SD) age of 64 (8) years was identified. A total of 21,142 (28%) patients experienced at least one GI event during the follow-up period. Only 31,306 (41%) patients were compliant with osteoporosis therapy. Patients who experienced GI events after initiation of oral bisphosphonates were 29% less likely to adhere to osteoporosis therapy as compared to patients who did not experience GI events (odds ratio [95% CI], 0.71 [0.69–0.74]; P<.001).ConclusionsLess than half of the patients were compliant with osteoporosis therapy within one year after initiating oral bisphosphonates, and the likelihood of compliance was significantly lower by 29% among women with GI events

Proportion of Osteoporotic Women Remaining at Risk for Fracture Despite Adherence to Oral Bisphosphonates

Background Adherence to oral bisphosphonates is often low, but even adherent patients may remain at elevated fracture risk. The goal of this study was to estimate the proportion of bisphosphonate-adherent women remaining at high risk of fracture. Methods A retrospective cohort of women aged 50 years and older, adherent to oral bisphosphonates for at least two years was identified, and data were extracted from a multi-system health information exchange. Adherence was defined as having a dispensed medication possession ratio ≥ 0.8. The primary outcome was clinical occurrence of: low trauma fracture (months 7–36), persistent T-score ≤ − 2.5 (months 13–36), decrease in bone mineral density (BMD) at any skeletal site ≥ 5%, or the composite of any one of these outcomes. Results Of 7435 adherent women, 3110 had either pre- or post-adherent DXA data. In the full cohort, 7% had an incident osteoporotic fracture. In 601 women having both pre- and post-adherent DXA to evaluate BMD change, 6% had fractures, 22% had a post-treatment T-score ≤ − 2.5, and 16% had BMD decrease by ≥ 5%. The composite outcomes occurred in 35%. Incident fracture was predicted by age, previous fracture, and a variety of co-morbidities, but not by race, glucocorticoid treatment or type of bisphosphonate. Conclusion Despite bisphosphonate adherence, 7% had incident osteoporotic fractures and 35% had either fracture, decreases in BMD, or persistent osteoporotic BMD, representing a substantial proportion of treated patients in clinical practices remaining at risk for future fractures. Further studies are required to determine the best achievable goals for osteoporosis therapy, and which patients would benefit from alternate therapies

Diabetes ambulatory care-sensitive hospitalizations, care organization, and medication adherence

A retrospective cohort analysis using Indiana Medicaid claims, enrollment, and encounter data was conducted to determine the number and rate of ambulatory care sensitive conditions hospitalizations (ACSCH) that reflect quality of ambulatory diabetes care. ACSCH were identified based on the Agency for Healthcare Research and Quality Prevention Quality Indicators for diabetes short-term complications, uncontrolled diabetes, long-term complications and amputations. Association between care organization under Medicaid and likelihood of having an ACSCH, and association between adherence to oral diabetes medications and likelihood of having an ACSCH were assessed. Sample inclusion criteria were being age 18 years or older, diabetes diagnosis prior to January 2009, and continuous eligibility in 2008. Exclusion criteria were a nursing home stay, no claims, or death in 2008. Each individual was placed in one of four groups, one group each for those continuously in fee-for-service, care management, or managed care, and one group for those who switched care organization in 2008. A sample of 47,443 persons, with mean age of 53 years, 68% female and, 77% white was identified. Overall, there were 1,514 ACSCH, 31.91 (95% C. I.: 30.4 - 33.5) per 1,000 individuals with diabetes. Logistic regression assessed association between Medicaid sub-program and likelihood of ACSCH adjusting for age, gender, ethnicity, marital status, diabetes type, mental illness, hypertension, coronary artery disease, foot specific conditions and Charlson Comorbidity Index. Individuals in care management were more likely than those in fee-for-service to have ACSCH for short-term complications (OR=2.3, p=0.0001). Individuals in managed care were more likely than those in fee-for-service to have ACSCH for short-term complications (OR= 1.7, P= 0.015), but less likely to have ACSCH for uncontrolled diabetes (OR=0.3, p=0.045) or for long-term complications (OR=0.5, P=0.039). Persons who switched care organization were more likely to have ACSCH for short-term complications (OR=3.2, P=0.0001) and for amputations (OR=2.0, P=0.001). When overall total risk of any ACSCH regardless of type was examined, individuals that switched care organization had higher overall risk of non-cause specific ACSCH (OR=2.0, P=0.0001) than those in feefor- service and individuals in Hoosier Healthwise were less likely to have a non-cause specific ACSCH (OR=0.5, P=0.040) than those in fee-for-service. Examination of association between medication adherence and hospitalization for ACSCH was restricted to individuals 18 to 64 years old due to unavailability of Medicare Part D prescription claims for persons over 64 years old. Patients using insulin therapy also were excluded due to lack of a fixed regimen. A multivariate conditional logistic regression model was used to examine the association between medication adherence, based on proportion of days covered over 6 month and 12 month periods, and likelihood of having an ACSCH after adjusting for age, gender, ethnicity, marital status, mental illness, hypertension, coronary artery disease, foot specific conditions and Charlson comorbidity index. Individuals were classified as non-adherent to their medication regimens if proportion of days covered in the relevant interval was less than 80 percent. Based on 6-month adherence, there was no significant association between being classified as non-adherent in a 6-month interval and risk of hospitalization for ACSCH (OR = 1.93, P = 0.1099). However, analysis of 12-month adherence revealed that individuals who were nonadherent in a 12-month interval were significantly more likely than adherent individuals to have an ACSCH (OR = 4.45, P = 0.003). Transitions between Medicaid care organizations significantly influence likelihood of having an ACSCH. Continuity of care may be critical. Factors that may influence transitions or disruption of care may be identified that may provide useful information regarding the quality of care provided in this population. Care Coordination within Managed Care may be effective in individuals having a lesser likelihood of hospitalization for uncontrolled diabetes and long-term complications than Traditional Medicaid. Higher level of medication adherence was associated with lower likelihood of hospitalization for ACSCH. The findings add to the evidence that medication adherence is necessary to reduce the risk of hospitalizations for ACSCH. Future studies may focus on various interventions that can improve medication adherence for better patient outcomes. Moreover, reasons for medication non-adherence may be examined and strategies may need to be developed to improve access to medications for patients with diabetes

A Case Report of Cervical Embroynal Rhabdomyosarcoma Treated with Multimodality Approach

Abstract: Embryonal rhabdomyosarcoma of the female genital tract is a rare and highly malignant entity. It is usually diagnosed in adolescence, in contrast to vaginal rhabdomyosarcoma, which occurs mostly in infants. With the advent of multimodality treatment, prognosis seems to be improved. We report a case of a 20-year old young female presenting with a protruding mass from vaginal introitus and irregular bleeding. Polypectomy was done and microscopic findings were confirmed as a cervical embryonalrms.Neoadjuvant chemotherapy showed excellent response, after which Total Abdominal Hysterectomy and bilateral Lymphadenectomy was done. Histopathology showed embroyonalrhabdomyosarcoma involving cervical lip, infiltrating more than half thickness of cervical wall.Patient was treated with post-operative radiotherapy and she is on regular follow-up. The presence of a cervical polyp in an adolescent is a gynecological oddity and should be histologically examined. The prognosis of the cervical embryonal RMS depends on clinical and histological features. The current treatment protocols are based on trials.Patients with unfavorableprognosis characteristics, the multimodality approach including surgery, adjuvant chemo and radiotherapy can be effective. Otherwise, surgery alone can be effectively proposed

Nosocomial Infections and Role of Nanotechnology

Nosocomial infections, termed hospital-acquired infections (HAIs), are acquired from a healthcare or hospital setting. HAI is mainly caused by bacteria, such as Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Enterococci spp., Methicillin-resistant Staphylococcus aureus (MRSA), and many more. Due to growing antibacterial resistance, nanotechnology has paved the way for more potent and sensitive methods of detecting and treating bacterial infections. Nanoparticles have been used with molecular beacons for identifying bactericidal activities, targeting drug delivery, and anti-fouling coatings, etc. This review addresses the looming threat of nosocomial infections, with a focus on the Indian scenario, and major initiatives taken by medical bodies and hospitals in spreading awareness and training. Further, this review focuses on the potential role nanotechnology can play in combating the spread of these infections

Association of gastrointestinal events with osteoporosis treatment initiation and treatment compliance in Germany: An observational study

Background: Gastrointestinal (GI) events are common in postmenopausal women treated for osteoporosis. The influence of GI events on treatment initiation and treatment compliance is the subject of ongoing research. Objective: The objectives of this study were (i) to determine the association of GI events with receipt of treatment in patients newly diagnosed with osteoporosis, and (ii) among treated patients, to determine the association of GI events with treatment compliance. Methods: This was a retrospective analysis of claims data carried out in Germany using the Mediplus database. Data were collected from January 1992 through December 2010. The dual-objective study design required two distinct cohorts. Cohort 1 comprised women aged ≥55 with a diagnosis of osteoporosis. GI events were recorded for the 12 month periods before and after the date of diagnosis. Time-varying Cox regression and discrete choice models were used, respectively, to assess the association of post-diagnosis GI events with the initiation of pharmacologic treatment (yes versus no) and the type of treatment initiated (bisphosphonates versus non-bisphosphonates). Cohort 2 comprised women aged ≥55 who initiated an oral bisphosphonate (alendronate, ibandronate, or risedronate). GI events were recorded for the 12 month periods before and after the date of bisphosphonate initiation, and a logistic regression model was employed to determine if pre-treatment or post-treatment GI events were associated with patient compliance, defined as a medication possession ratio (MPR) of ≥60%, with sensitivity analyses at MPR ≥ 80%. Results: In cohort 1 (N = 18,813), 13.8% of patients had GI events in the pre-diagnosis period, and 14.8% had GI events in the post-diagnosis period. Among the patients with post-diagnosis GI events, 93.2% remained untreated during the post-index year, 6.2% were treated with bisphosphonates, and 0.6% received non-bisphosphonates. The respective percentages in patients without post-diagnosis GI events were 81.3%, 16.7%, and 1.9%. A post-diagnosis GI event decreased the likelihood of receiving any osteoporosis treatment (versus no treatment) by 83% (HR 0.17, 95% CI 0.14–0.20) and also decreased the likelihood of receiving a bisphosphonate (versus a non-bisphosphonate) by 39% (OR 0.61, 95% CI 0.54–0.68). In cohort 2 (N = 6040), 17.1% of patients had GI events in the year before treatment initiation, and 19.1% had GI events in the year after treatment initiation. At 12 months post-treatment initiation, GI events were more frequent in patients with pre-treatment GI events (53.2%) than in those without pre-treatment GI events (12.0%). Post-treatment GI events decreased the likelihood of attaining compliance defined as an MPR ≥ 60% (OR 0.84, 95% CI 0.73–0.97) but not an MPR ≥ 80% (OR 0.91, 95% CI 0.79–1.06). Conclusions: In German women newly diagnosed with osteoporosis, GI events decreased the likelihood of receiving treatment and were associated with the choice of treatment. In women initiating oral bisphosphonates, post-treatment GI events were associated with reduced patient compliance. Keywords: Osteoporosis, Postmenopausal, Bisphosphonates, Germany, Gastrointestinal diseases, Patient compliance, Medication adherenc