The Significance of Serum C-Reactive Protein Estimation in Acute Meningitis in Adults

INTRODUCTION: The evolution of clinical signs and symptoms produced by meningitis or encephalitis varies greatly. Few conditions in medicine require as rapid and accurate therapeutic intervention as acute pyogenic meningitis and viral meningitis, yet meningitis can also occur in chronic and recurrent forms. The major problem presented by patients with meningitis is rapid determination of its aetiology, the specific basis on which selection of potentially effective antimicrobial therapy is predicted. Thus, the clinician must sort out the form of clinical presentation, assess the rapidity of its evolution, and make a specific aetiological diagnosis. The examination of cerebrospinal fluid is an essential and often critical tool in the evaluation and management of patients with meningitis. If interpreted carefully, the cerebrospinal fluid (CSF) analysis, can be very helpful in guiding the diagnostic evaluation and management of patients. Although examination of a Gram’s stain of spinal fluid often defines the causative agent, this is not always the case. Cultures have the draw back of the time required, 24 to 48 hours or more to become positive, an unacceptable delay in initiating the treatment. AIM OF THE STUDY: To evaluate the efficacy of serum C-Reactive Protein in differentiating bacterial meningitis from viral meningitis. MATERIALS AND METHODS: Fifty cases with definite clinical signs and symptoms of acute meningitis admitted in Govt. Stanley Hospital, Chennai during the period August 2005 to September 2006 were taken up for the study. The results were correlated with the results of S-CRP levels and the cases were differentiated into bacterial meningitis or meningitis due to other causes. Inclusion Criteria: 1. Above 12 years of age. 2. History suggestive of meningitis. 3. Neck Rigidity. CONCLUSION: 1. Estimation of C-reactive protein in serum is the cheapest, sensitive and specific test to differentiate bacterial from viral infections. 2. It is a simple qualitative as well as quantitative test and can be done as a bed side investigation. 3. With serum C-reactive protein, a definite aetiological diagnosis can be made rapidly at the time of admission itself. 4. A serum CRP level of less that 6 mg/l with clinical signs of meningeal infection is a definite indicator of viral meningitis. 5. A serum CRP level of more than 48 mg/l with clinical signs of meningeal infection is a definite indication of bacterial meningitis. 6. Preadmission treatment with steroids cause a fall in CRP levels in bacterial meningitis. 7. Serum CRP has 68% predictive value in adults. 8. The rapid differentiation facilitates an early, accurate and appropriate therapy thereby reducing the morality and morbidity rates, the overall cost of the treatment and the duration of hospitalization. 9. Serum CRP can be used as the best and most sensitive bedside prognostic indicator of bacterial infections. 10. Meningeal infections have a definite male predominance. 11. Altered level of consciousness at the time of admission is associated with bad prognosis and high case fatality rate (28%). 12. Fever is the commonest presenting feature followed by altered sensorium, symptoms of increased intracranial tension and seizure. Among neurological deficits, hemiparesis, VIth cranial nerve palsy and VIIth cranial nerve palsy were found to be common. 13. The earlier the recognition of bacterial meningitis and more rapid the institution of antimicrobial therapy the better the chance of a favourable outcome. 14. Therefore, the serum C-reactive protein estimation is most useful in differentiating bacterial meningitis from viral meningitis, especially for developing countries like India, even in peripheral health centres

Prevalence of Comorbid Conditions in Relation to Severity of Asthma

INTRODUCTION: Childhood Asthma has emerged perhaps as the commonest chronic medical problem treated by pediatricians all over the world. what was originally thought to be a disorder affecting only adults has emerged as a very significant problem affecting the child’s life style and day to day activities including schooling, sports and recreation. The incidence of asthma is increasing alarmingly in the past few decades1. Because asthma is a complex and heterogenous disease with many phenotypic expressions through the course of childhood, it is challenging to characterize. First the clinical manifestations of asthma are non specific and many children wheeze during the first few years of life. But only a few of these children develop persistent wheezing and clinical asthma2. Approximately 60% are transient wheezes who outgrow their disease by 5 years of age. DEFINITION OF ASTHMA: The manner in which asthma has been defined has changed significantly over time. ·1.In 1950’s asthma was defined as a disease characterized by airflow obstruction that could resolve spontaneously or following therapy3. 2. In 1960’s asthma was viewed as an episodic disease in which airflow obstruction was caused by bronchial hyper responsiveness4. 3. In 1970’s the concept of preventing bronchospasm and managing disease progression was considered. 4.In 1990’s asthma was redefined as a chronic inflammatory disease characterized by reversible airflow obstruction and bronchial hyper responsiveness. AIM OF THE STUDY: 1. To assess the prevalence of specific co-morbid conditions like (a) Allergic rhinitis, (b) Sinusitis and (c) Gastroesophageal reflux disease in children with asthma 2. Association of these conditions in relation to severity of asthma. DISCUSSION: AGE AND SEX DISTRIBUTION OF ASTHMA: Most of the children with asthma were in the age group of 6-8 years, although they were more or less equally distributed. The male : female ratio is 1.22 : 1, although no statistical significance was found. FAMILY HISTORY OF ASTHMA / ATOPY: The children with asthma with family History of Asthma / Atopy were 66 out of 159. The distribution of them among first degree and second degree relatives were 35 and 31 respectively. The relationship of family History of asthma/atopy with different grades of asthma was not statistically significant. But several studies like A.Ten Brinke et al10., have shown that patients with frequent asthma exacerbations (Severe asthma) more often had family history of asthma/atopy which was statistically significant. SEVERITY OF ASTHMA: The distribution of asthma was less in Grade IV (Severe Persistent) - 4.4 %. Several studies including Irwin et al11, that were done in adult patients with asthma have shown more or less equal distribution among different grades of asthma. CONCLUSION: 1. This study concludes that the prevalence of Allergic Rhinitis and sinusitis was greater in children with asthma. 2. There is a higher prevalence of Allergic rhinitis and sinusitis among moderate /severe asthma than mild group of children with asthma, implicating that these factors could contribute to the severity of asthma and its exacerbations. 3. So all the children diagnosed as bronchial asthma, particularly moderate persistent and severe persistent asthma should be evaluated for the presence of co-morbid conditions, which if treated simultaneously will result in less asthma exacerbations with a greater improvement in their quality of life including schooling, sports and recreation

Modulation of cardiac sodium channel variants by Fyn tyrosine kinase

Spannungabhängige Natriumkanäle sind sehr große Membranproteine. In Säugetieren werden sie von zehn Genen kodiert. Natriumkanäle spielen eine wichtige Rolle in erregbaren Zellen und sie sind deshalb ein wichtiger Angriffspunkt für Arzneistoffe und Toxine. NaV1.5 ist der spannungsabhängige Natriumkanal im Herzen, wo er für die rasche Depolarisationsphase im Aktionspotential verantwortlich ist und auch an der Reizweiterleitung beteiligt ist. Von den neun Spleißvarianten von NaV1.5 sind vier funktionell. Die Spleißvariante ΔQ1077 und die Q1077Present Variante des kardialen Natriumkanals sind in 45% bzw. 25% der Bevölkerung anzutreffen. Kardiale Natriumkanäle werden durch unterschiedliche intrazelluläre Proteine moduliert. Tyrosinkinasen sind eine der potenten Modulatoren verschiedener Ionenkanäle. Fyn, das zur Src Tyrosinkinase-Familie gehört, moduliert verschiedene Natriumkanal-Isoformen auf unterschiedliche Weise. Die mit den Q1077Present und ΔQ1077 Varianten erhaltenen Ergebnisse zeigten unterschiedliche Inaktivierung in Gegenwart katalytisch aktiver FynCA. Während die Q1077Present Variante die Inaktivierungskurve in die depolarisierende Richtung verschob, trat die halbmaximale Inaktivierung bei ΔQ1077 bei negativeren Potentialen auf, ähnlich wie beim neuronalen Natriumkanal NaV1.2. Die durch FynCA bedingte Verschiebung der Inaktivierungskurve in der Q1077Present Variante war vergleichbar mit der durch FynCA hervorgerufenen Modulation in der hH1 polymorphen kardialen Natriumkanal-Variante. Mit der Kinase-toten Mutante FynKD kam es weder bei ΔQ1077 noch bei Q1077Present zu einer Verschiebung der Inaktivierungskurven. Weiters konnte in beiden Varianten die durch FynCA bedingte Verschiebung der Inaktivierungskurven durch den Src Tyrosinkinase-Hemmer PP2 aufgehoben werden. Die Aktivierungkurven beider Varianten, Q1077Present und ΔQ1077, wurden durch FynCA nicht beeinflusst. Eine Sequenzanalyse aller Natriumkanal-Isoformen zeigte, dass Glutamin in Position 1077 in einer der drei für NaV1.5 einzigartigen Sequenzen in der intrazellulären Schleife liegt, die die Domänen DII und DIII verbindet und die "Natriumionentransport-assoziierte" Region bildet. Eine Punktmutation in Position 1077 von Glutamin zu Alanin, Lysin, Tyrosin oder Prolin verschob die Inaktivierungskurven in Gegenwart von FynCA zu negativeren Potentialen. Es konnte eine lineare Korrelation zwischen dem Ausmaß der Verschiebung der Inaktivierungskurven durch FynCA und der hydrophoben Eigenschaft der Aminosäuren-Seitenketten beobachtet werden. Mögliche SH2 und SH3 Bindungsstellen für Fyn im kardialen Natriumkanal wurden ebenfalls identifiziert. Fünf spezifische, prolinreiche Motive, die als SH3 Bindungsstelle für Fyn im kardialen Natriumkanal fungieren könnten, wurden aufgefunden. Mögliche SH2 Bindungsmotive für Fyn wurden im C-Terminus von NaV1.5 identifiziert. Diese Daten tragen zum Verständnis der Rolle des Q1077 und den angrenzenden Aminosäuren bei. Die intrazelluläre Schleife LDII-DIII des kardialen Natriumkanals, die sich wesentlich von der anderer Natriumkanal-Isoformen unterscheidet, bildet eine der "Natriumionentransport-assoziierten" Regionen. Deshalb spielt LDII-DIII eine wichtige Rolle bei der Bindung intrazellulärer Signalmoleküle an den Natriumkanal.Voltage-gated sodium channels are very large membrane proteins. They are encoded by ten genes in mammals. Sodium channels are a crucial component of excitable tissues; hence, they are a target for various drugs and toxins. NaV1.5 is the cardiac voltage-gated sodium channel involved in the rapid depolarizing phase of the cardiac action potential. This isoform is also involved in the propagation of electrical impulses in the heart. Out of nine Nav1.5 splice variants, four of them were functional. The splice variant ∆Q1077 and Q1077Present variant of NaV1.5 are present in 45% and 25 % of human population, respectively. Cardiac sodium channels are modulated by different intracellular proteins. Tyrosine kinases are one of the potent intracellular modulators of ion channels. Fyn, a member of the Src tyrosine kinase family, modulates sodium channel isoforms distinctly. Results on the Q1077Present and the ΔQ1077 variants show different steady-state inactivation in presence of catalytic active FynCA. While the Q1077Present variant shifted the inactivation curve to more depolarizing potentials, the ΔQ1077 variant shifted the inactivation curve to more hyperpolarizing potentials, similar to neuronal sodium channel NaV1.2. The Fyn-induced shift in inactivation of Q1077Present was similar to the modulation observed in the hH1 polymorphic cardiac sodium channel variant with Fyn. The Src tyrosine kinase inhibitor PP2 reversed back the shifts caused by FynCA in both Q1077Present and ΔQ1077 cardiac sodium channel variants. Moreover, the kinase dead mutant FynKD did not shift both the ΔQ1077 and Q1077Present inactivation curves. The activation curves of both Q1077Present and ΔQ1077 were not affected by active Fyn. Sequence analysis of all the sodium channel isoforms reveal that the Q1077glutamine is present in one the three unique sequences in the intracellular loop connecting the domain DII and DIII, which forms the ‘sodium ion transport associated’ region. Point mutation at position 1077 from glutamine to alanine, lysine, tyrosine and proline shifted the inactivation curves to more hyperpolarizing potentials with FynCA. Linear correlation was observed between the hyperpolarizing shift caused by FynCA and the hydrophobicity of the amino acids’ side chains. Putative SH2 and SH3 binding sites for Fyn in the cardiac sodium channel were also determined. Five unique proline-rich motifs were identified, which are potential SH3 binding sites for Fyn in the cardiac sodium channel. Putative SH2 binding motifs for Fyn were found in the C-terminal of Nav1.5. These data will be pertinent in understanding the role of Q1077 and its surrounding amino acids. The intracellular loop LDII-DIII, which is distinct in cardiac sodium channels from other sodium channel isoforms, forms one of the ‘sodium ion transport associated’ regions. Thus, LDII-DIII plays a pivotal role in regulating cardiac sodium channel binding to various intracellular signaling molecules

Percutaneous cannulation of central veins in neonates: Its safety and feasibility: Audit of 75 neonatal insertions

Introduction: Central venous catheters (CVC) have become an integral part in the care of children in intensive care settings. However,their use in neonates is limited due to inherent difficulties in insertion and associated complications. Objective: We present ourexperience in the use of CVC by percutaneous cannulation in neonates. Materials and Methods: A total of 75 cases of neonatalpercutaneous central venous cannulation inserted over a period of 6-month from March 2014 to August 2014. Data regarding age,indication for central line insertion, site of insertion, complications related to central line insertion, duration of catheter days, werecollected. Results: Of the 75 neonates, 49 were male and 26 were female. Age group ranged from 14 to 30 days with a median of21 days. Weight ranged from 750 g to 3.5 kg with an average of 1.9 kg. The internal jugular vein was accessed in 45 (60%), followed byfemoral 26 (34.6%) and subclavian in 4 (5.3%) cases. Successful percutaneous cannulation was achieved in all and the median catheterdays were 12 days. The longest catheter patency was 46 days in one neonate. The most common indication for placement was failureof peripheral venous access (78%). The main complications encountered were catheter displacement (12%) and catheter malposition(9.3%). Catheter induced sepsis was seen in 7 (9.3%) neonates. Conclusion: Percutaneous cannulation of central veins in neonates isfeasible, and safe, with acceptable morbidity. Ultrasound guided central line insertions is becoming the gold standard in neonates, as theentire vascular anatomy is delineated and variations in anatomy clearly identified; hence avoiding multiple attempts and complications.Contrast injected X-rays confirmation even when the catheter is radio-opaque is effective in accurate tip identification and helps inpreventing tip related complications

The impact of stress on low level employees of star hotels with special reference to chennai

Stress is normal parts of life that can either help us learn and grow or can cause us significant problems. It is a condition or feeling experienced when a person perceives that “demands exceed the personal and social resources the individual is able to mobilize.” The extra-organizational stress, organizational stress and group stress were perceived to be the stressful. The study helps to identify the level of stress, stress due to changing work place, sources of stress at work and provide suitable suggestions to reduce it. The study considering as descriptive study, the primary data’s are collected from the low level employees of Hotel Savera. The sample size is taken for the study is 113. The data are collected through scheduled that are having 28 questions. 5 point scale is used to find out the factors for stress. The statistical tool chi-square is used for analyzing the data. The major findings are Extra-organizational and group stress mostly affected the stress level the suggestions are made based on the findings. The management can reduce the stress among the employees through conducting various programs like vocational tours, cultural programs, sports, classes for yoga and meditations, meeting, and counseling