Clinical Profile and associations of tuberculosis among health care workers in South India

INTRODUCTION : Every year 1.8 million people in India develop tuberculosis (TB). India accounts for one-fifth of the global TB incidence and is estimated to have the highest number of active TB cases amongst the countries of the world. Many hospitals in India handle large number of tuberculosis cases. The emergence of multidrug resistant tuberculosis has been reported to have caused outbreaks among health care workers in many hospitals. Various authorities have recommended measures to prevent the nosocomial transmission of tuberculosis. However scientific data demonstrating the efficacy of these measures is lacking. Delayed diagnosis of active pulmonary TB among hospitalized patients is common and believed to contribute significantly to nosocomial transmission. Various studies reported a risk of infection among workers exposed to patients with tuberculosis that was four to six times higher than the risk among unexposed workers. However the risk of tuberculosis among health care workers varies considerably among and within hospitals. Epidemiological studies are needed to identify the high-risk subgroups among health care workers and to identify potential risk factors for transmission of disease. Such observations would lead to further implementation of cost effective infection control measures and analysis of the efficacy of such measures with respect to developing countries like India. These measures might prevent or retard the nosocomial transmission of tuberculosis to both patients and to health care workers. AIMS AND OBJECTIVES : 1. To identify the risk factors for acquiring tuberculosis among health care workers at a tertiary level teaching hospital in South India. 2. To determine the incidence of tuberculosis among health care workers. 3. To identify the factors associated with a delay in the diagnosis of tuberculosis among health care workers. MATERIALS AND METHODS : RESEARCH PROTOCOL: DESIGN: 1. Prospective and retrospective descriptive cohort study design for determining the incidence of clinical tuberculosis disease among health care workers and to determine the clinical profile of tuberculosis disease among the target population. 2. Case control study design to determine the specific risk factors for acquiring tuberculosis in the target population. Prospectively (from April 2003- August 2004) and retrospectively (from January 1994- March 2003) collected cases will be used. DURATION: From April 2003 to August 2004, a sixteen month period. LOCATION: Departments of General Medicine units I, II and III, Staff Students Health Services. SUBJECTS: INCLUSION CRITERIA: Health care workers employed at Christian medical college hospital, Vellore who are diagnosed to have tuberculosis. EXCLUSION CRITERIA: i. Patients who were diagnosed to have active tuberculosis or have received treatment for tuberculosis prior to joining the health care facility. ii. Patients diagnosed to have tuberculosis during the pre employment screening. iii. Patients who are having a relapse of tuberculosis during the study period and if the index episode is prior to January 1994. RESULTS : The results of the study are summarized here. The results will be presented in three sections. The first section depicts data regarding the clinical profile of health care workers who developed tuberculosis. The second section deals with the associations of a more than median delay in the diagnosis of tuberculosis (case-control study). The third section is a case control study designed to identify the risk factors for developing tuberculosis among the health care workers. CONCLUSIONS : Health care workers had a higher incidence of tuberculosis than the general population. The incidence of tuberculosis disease among health care workers was 314 cases per 100,000 person years. The incidence of sputum positive pulmonary tuberculosis was 111.06 per 100,000 person years. • The main sub type of tuberculosis was sputum positive pulmonary. Among the extra pulmonary cases tuberculous lymphadenitis constituted the majority. • Among health care workers at our institute the only risk factors that were independently associated with tuberculosis were a body mass index <19 Kg/m2 and employment in medical wards. • No occupational subgroups were found to have an independently increased risk for acquiring tuberculosis. • There was a significant delay in diagnosis of cases of tuberculosis. The mean delay was 37.98 days. The delay in the diagnosis of smear positive cases could contribute to nosocomial transmission of tuberculosis

Predictors of Recurrence of Syncope in Patients with Unexplained Syncope undergoing Head Up Tilt Testing: A Study Using Clinical, Hemodynamic and Echocardiographic Variables.

BACKGROUND : Recurrent syncope is a common clinical problem. Head up tilt (HUT) testing reproduces reflex syncope in controlled laboratory settings. Echocardiographic monitoring of parameters including change in fractional shortening (FS) have been used to identify false positive responses on HUT testing. We assessed predictors of recurrent syncope in patients with unexplained recurrent syncope undergoing HUT testing. AIMS : 1. The aim of the study was to characterize the clinical, hemodynamic and echocardiographic variables including LV contractility during tilt in patients with unexplained recurrent syncope undergoing HUT test and to correlate the same with clinical outcomes. OBJECTIVES : 1. To determine the LV contractility during tilt in patients with unexplained recurrent syncope undergoing tilt testing by measuring the LV end diastolic and systolic dimensions and FS, using echocardiography during tilt. 2. To determine if change in FS during HUT test will predict recurrence of syncope during follow up. 3. To determine other significant predictors of recurrent syncope in the study population. 4. To determine the predictors of positive response to HUT test. METHODS : This study is a prospective follow up of a cohort of patients undergoing HUT for unexplained recurrent syncope, with additional monitoring of echocardiographic left ventricular (LV) dimensions/ FS during HUT. The study was performed from Jan 2010 to Jan 2011. Results: Sixty patients underwent HUT testing. Mean age was 46 ± 15 years and median duration of symptoms was 12 months (IQR 6 to 24 months). Thirty five (58.3%) patients had positive HUT response. Mean time to syncope was 31.5± 6.9 minutes. At the end of the tilt phase, FS in the HUT positive group increased significantly from baseline (32.4±0.68% to 37.5±0.64 %, p< 0.001), while FS did not change significantly in the HUT negative group. Ten (16.7%) patients had recurrent syncope on follow up. During HUT test, achieving a maximum heart rate of ≥ 108 beats per minute was predictive of recurrent syncope [OR 8.62 (1.002-73.84), p=0.049] CONCLUSIONS : In patients with a positive response on HUT testing, there is a significant increase in LV FS during tilt as compared to those with a negative response. Patients who have recurrence of syncope on follow up tend to have higher peak heart rate attained during HUT. Hence peak heart rate attained during HUT testing can be used to identify patients at high risk of recurrence of syncope

Role of hydrographical parameters and total organic carbon on mercury allocation along the riverine transect of Beypore, south-west coast of India

1419-1426Distribution of total mercury (THg) was carried out in the sediments of Beypore estuary. The THg concentration in surface sediments varied from 0.03 ppm to 0.17 ppm. The pollution index approach using contamination factor (CF) revealed that the sampling stations are moderately contaminated with respect to mercury. Further, the effects of hydrographical parameters (pH, salinity, dissolved oxygen) and total organic carbon (TOC) of the sediment were studied over the spatial distribution of mercury (Hg). Correlation analysis unveiled THg exhibited significant positive correlations with TOC (R=0.91) and salinity (R=0.744). However significant inverse correlation was observed between pH and Hg (R =-0.93). The C: N ratios suggest that the organic matter is labile in nature. Total organic carbon was found to control the distribution of Hg. It is the first base line study in this estuary

Spatial variability of biochemical composition in coral reef sediments of Kavaratti and Pitti islands, Lakshadweep archipelago

369-378In this study, variability of biochemical composition in the surficial coral reef sediments of Kavaratti and Pitti islands in Lakshadweeep archipelago was investigated. Biochemical composition of sedimentary organic matter from the study area was characterized by the dominance of proteins in Pitti and carbohydrates in Kavaratti over lipids. The percentage ratio of the labile to total organic matter indicated that most of the deposited organic matter was refractory in both environments. The higher PRT:CHO ratios in Pitti sediments compared to that of Kavaratti indicated that in the former there was low dead organic matter accumulation. The lower LPD:CHO ratios estimated for sediments in both islands indicated low quality of labile organic matter to support benthic fauna

Safety and efficacy of hybrid platform design sirolimus eluting stent system in percutaneous coronary intervention in ST elevation myocardial infarction patients at 1 year after treatment

Background: STEMI is among the most complex and dramatic clinical presentation of coronary artery disease. The highest risk of mortality and stent thrombosis is observed in the subjects undergoing primary PCI. Choice of stent is often critical in Primary Angioplasty in Myocardial Infarction. GenXsync (MIV Therapeutics India Ltd, Surat India) is a stent having hybrid stent platform biodegradable polymers with the confidence of Sirolimus. The primary objective of this study was to establish safety and efficacy of GenXsync Sirolimus Eluting hybrid design stent in STEMI.Methods: A total of 73 patients of STEMI undergoing PCI were enrolled from June 2013 to January 2014. The average door to balloon time was 30±0.04 minutes with the minimumbeing15 minutes and maximum of 2 hours 44min. Most of the patients (69/ 73: 94.52%) underwent primary PCI. One patient (1.37%) was taken up for PCI after successful thrombolysis and two patients had to undergo rescue PCI after failed thrombolysis. All subjects underwent PCI with GenXsync Sirolimus Eluting hybrid design stent. Total 79 stents were used (average 1.08±0.38 stent per patient).  The subjects were followed up for one year after discharge.Results: There were 80.82% (59) males, 41.09% (30) diabetic, 27.39% (20) hypertensive, 52.05% (38) current smokers and 2 (2.74%), patients with chronic renal disease. The cardiac history was significantly complex, characterized by prior coronary artery disease in 4 (5.48%), prior MI in 5 (6.85%) including prior PCI in 2 (2.74%), congestive heart failure in 1 (1.37%), ST depression in 71 (97.26%), complete heart block in 4 (5.48%) and left bundle branchblock 1 (1.37%). At admission, 4 (5.4%) patients had cardiac arrest. Among the patients 32 (43.84%), 34 (46.58%), 7 (9.59%) had single, double and triple vessel disease respectively. Average Troponin I was 55.20± 59.34 and by Killip classification, the subjects with class I, class III and class IV were 65 (89.04%), 4 (5.48%), 4 (5.48%) respectively. At discharge there were 3 (3.34%) Major adverse cardiac events and at 1 year, there were 5 (5.48%) major adverse cardiac events. There were no acute stent thromboses. All subjects received dual antiplatelet therapy for one year (Aspirin and one among Clopidogrel, Prasugrel or Ticagrelor at the discretion of the operator). There were total of 2 (2.74%) stent thrombosis events between discharge and 1 year, including in 1 subject who discontinued Antiplatelet therapy within 1 year. None of 4 deaths including 2 cardiac were practically related with the device and procedure. These 4 deaths were due to cardiogenic shock (1), during MVR surgery (1), During surgery on leg, due to major bleeding (1) and Due to pre-existing CHF (1).Conclusions: In contemporary practice of percutaneous coronary intervention in ST Elevation Myocardial Infarction, Genxsync stent was associated with low risks of stent thrombosis and MACE

Cancer burden and alarm signals: a community based study from Kerala, India

Background: Cancer is emerging as a major public health concern in many countries including India. Kerala state has the highest burden of cancer in the country. Objective of this study was to estimate the prevalence of diagnosed cancers, warning signs and selected risk factors of cancer in Kadapra Panchayath of Pathanamthitta district, Kerala.Methods: A total of 16,391 population was covered by door to door survey using a structured questionnaire. The questionnaire collected information on the sociodemographic variables of the residents, source of water supply, warning signs of cancer and details of diagnosed cancer cases.Results: The mean age of the population was 40.9+21 years. The prevalence of diagnosed cases of cancer in our study population was 776/100,000 population. Breast cancer was the most common cancer (43.5%) identified in the population. The prevalence of any warning sign among the study population was 220/100,000 population. Breast lump was the common warning sign identified. Increasing age and female gender were the factors found to be significantly associated with cancer.Conclusions: As prevalence of cancer was found to be high in this population, an active community based screening along with teaching self-breast examination to the women in the community are required. Improving community awareness could help in early diagnosis, treatment and prevention. Soil and water testing for carcinogens is recommended

A characteristic study of humic acids isolated from Arctic fjord sediments

Humic substances are ubiquitous natural materials found in sediments as a product of biochemical transformation reactions representing a significant proportion of organic carbon cycle on earth. This study involves the analysis of humic substances with special emphasis on humic acids (HAs) in sediments collected from the Kongsfjorden System of Arctic region in June, 2017. The characterization of the isolated HAs were done using various spectroscopic techniques viz. UV-visible, Fluorescence, FTIR and NMR. Isolated HAs were also undergone for elemental analysis along with other characterization. The UV spectral analysis results with a lower E4/E6 ratio suggesting the presence of HAs with high degree of aromaticity and condensation. Indications for the presence of hydroxyl, methyl, methylene, carbonyl, carboxyl, phenol, alcohol and amide groups were obtained from the FTIR spectrums of HAs. NMR spectral characteristics also confirm the presence of OH group as well as the presence of CH protons adjacent to C=X, were X can be any electronegative element. This also confirms the presence of carbonyl group which is also evident in the FTIR spectral studies. Presence of aliphatic regions slightly more dominated with long chain and/or alicyclic moieties rather than methyl groups was also inferred from the results of NMR

Dialysis Initiation in Patients With Chronic Coronary Disease and Advanced Chronic Kidney Disease in ISCHEMIA-CKD

BACKGROUND: In participants with concomitant chronic coronary disease and advanced chronic kidney disease (CKD), the effect of treatment strategies on the timing of dialysis initiation is not well characterized. METHODS AND RESULTS: In ISCHEMIA‐CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches–Chronic Kidney Disease), 777 participants with advanced CKD and moderate or severe ischemia were randomized to either an initial invasive or conservative management strategy. Herein, we compare the proportion of randomized participants with non–dialysis‐requiring CKD at baseline (n=362) who initiated dialysis and compare the time to dialysis initiation between invasive versus conservative management arms. Using multivariable Cox regression analysis, we also sought to identify the effect of invasive versus conservative chronic coronary disease management strategies on dialysis initiation. At a median follow‐up of 23 months (25th–75th interquartile range, 14–32 months), dialysis was initiated in 18.9% of participants (36/190) in the invasive strategy and 16.9% of participants (29/172) in the conservative strategy (P=0.22). The median time to dialysis initiation was 6.0 months (interquartile range, 3.0–16.0 months) in the invasive group and 18.2 months (interquartile range, 12.2–25.0 months) in the conservative group (P=0.004), with no difference in procedural acute kidney injury rates between the groups (7.8% versus 5.4%; P=0.26). Baseline clinical factors associated with earlier dialysis initiation were lower baseline estimated glomerular filtration rate (hazard ratio [HR] associated with 5‐unit decrease, 2.08 [95% CI, 1.72–2.56]; P<0.001), diabetes (HR, 2.30 [95% CI, 1.28–4.13]; P=0.005), hypertension (HR, 7.97 [95% CI, 1.09–58.21]; P=0.041), and Hispanic ethnicity (HR, 2.34 [95% CI, 1.22–4.47]; P=0.010). CONCLUSIONS: In participants with non–dialysis‐requiring CKD in ISCHEMIA‐CKD, randomization to an invasive chronic coronary disease management strategy (relative to a conservative chronic coronary disease management strategy) is associated with an accelerated time to initiation of maintenance dialysis for kidney failure

Patient selection for high sensitivity cardiac troponin testing and diagnosis of myocardial infarction: prospective cohort study

Objective: To evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis of myocardial infarction across different healthcare settings. Design: Prospective study of three independent consecutive patient populations presenting to emergency departments. Setting: Secondary and tertiary care hospitals in the United Kingdom and United States. Participants: High sensitivity cardiac troponin I concentrations were measured in 8500 consecutive patients presenting to emergency departments: unselected patients in the UK (n=1054) and two selected populations of patients in whom troponin testing was requested by the attending clinician in the UK (n=5815) and the US (n=1631). The final diagnosis of type 1 or type 2 myocardial infarction or myocardial injury was independently adjudicated. Main outcome measures: Positive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction. Results: Cardiac troponin concentrations were elevated in 13.7% (144/1054) of unselected patients, with a prevalence of 1.6% (17/1054) for type 1 myocardial infarction and a positive predictive value of 11.8% (95% confidence interval 7.0% to 18.2%). In selected patients, in whom troponin testing was guided by the attending clinician, the prevalence and positive predictive value were 14.5% (843/5815) and 59.7% (57.0% to 62.2%) in the UK and 4.2% (68/1631) and 16.4% (13.0% to 20.3%) in the US. Across both selected patient populations, the positive predictive value was highest in patients with chest pain, with ischaemia on the electrocardiogram, and with a history of ischaemic heart disease. Conclusions: When high sensitivity cardiac troponin testing is performed widely or without previous clinical assessment, elevated troponin concentrations are common and predominantly reflect myocardial injury rather than myocardial infarction. These observations highlight how selection of patients for cardiac troponin testing varies across healthcare settings and markedly influences the positive predictive value for a diagnosis of myocardial infarction

Corrigendum to "Overview: oxidant and particle photochemical processes above a south-east Asian tropical rainforest (the OP3 project): introduction, rationale, location characteristics and tools" published in Atmos. Chem. Phys., 10, 169–199, 2010

Author(s): Hewitt, CN; Lee, JD; MacKenzie, AR; Barkley, MP; Carslaw, N; Carver, GD; Chappell, NA; Coe, H; Collier, C; Commane, R; Davies, F; Davison, B; DiCarlo, P; Di Marco, CF; Dorsey, JR; Edwards, PM; Evans, MJ; Fowler, D; Furneaux, KL; Gallagher, M; Guenther, A; Heard, DE; Helfter, C; Hopkins, J; Ingham, T; Irwin, M; Jones, C; Karunaharan, A; Langford, B; Lewis, AC; Lim, SF; MacDonald, SM; Mahajan, AS; Malpass, S; McFiggans, G; Mills, G; Misztal, P; Moller, S; Monks, PS; Nemitz, E; Nicolas-Perea, V; Oetjen, H; Oram, DE; Palmer, PI; Phillips, GJ; Pike, R; Plane, JMC; Pugh, T; Pyle, JA; Reeves, CE; Robinson, NH; Stewart, D; Stone, D; Whalley, LK; Yang,