An unusual case of cavitary lung lesion in catheter related blood stream infection

Cavitary lung lesions are commonly caused by Staphylococcus aureus, Klebsiella pneumoniae. Pseudomonas rarely causes such lesion. Here we report a case of cavitary pneumonia due to pseudomonas aeruginosa in the setting of catheter related blood stream infection in a 25-year-old male with crescentic IgA nephropathy who was on immunosuppressive medication

Incidence of gastro-intestinal strongylosis during monsoon seasons in native goat breeds of Kerala

Gastro-intestinal strongylosis is a major parasitic infection in caprine causing reduced performance, irreversible damage and death, which eventually leads to huge economic loss to the producers. The use of anthelmintics as a simple, effective and quick control method against the parasitism by the farmers has been rampant since decades. But its indiscriminate and undue usage invariably paved way to the development of anthelmintic resistance in parasites. It is high time that control strategies are designed so as to utilise chemotherapy appropriately at the time that coincide with heavy incidence of strongylosis. In the present study, a total of 109 goats, comprising of 58 Malabari and 51 Attappady Black goats from an organised farm were screened for the incidence for strongyle infection. The infection was found to be very high throughout the monsoon seasons in Kerala (June to October) with 94.86 ±1.47 per cent. Majority of the animals exhibited very heavy infection with faecal egg count of (FEC) >1500 during the study period. On coproculture, Haemonchus contortus was found to be the most predominant strongyle followed by Oesophagostomum spp. and Trichostrongylus spp

Comparison of outcomes of acute kidney injury in elderly and non-elderly hospitalized patients in a tertiary care hospital in India: a prospective observational study

Background: The prevalence of acute kidney injury (AKI) progressively increases with age. A higher rate of dialysis dependency and mortality is observed in elderly with AKI. Here we have studied the comparison of clinical features, outcomes of AKI between elderly (age ³60 years) and non-elderly AKI patients and their risk factors for mortality. Methods: This prospective observational study enrolled 100 patients with AKI, with elderly and non-elderly in a 1:1 ratio for comparison, from September 2021 to January 2023 at AIIMS Rishikesh in India. Detailed history, clinical examination, relevant laboratory and radiological investigations were done to evaluate for the cause of AKI. Etiological causes, complications of AKI, and in-hospital outcomes were observed. They were given standard treatment and dialysis as per standard indications. We analysed the mortality risk of these groups using the Cox proportional hazards model. Results: The in-hospital mortality rates among these two groups were non-significant (p=0.29). A significantly higher number of patients with non-elderly AKI were HD-dependent at discharge (p=0.027). Elderly patients had significantly lesser complications like uremic encephalopathy and fluid overload compared to non-elderly. There was a significant association between mortality and female gender, intensive care unit (ICU) admissions, hospital-acquired AKI, pre-renal/renal causes, chronic obstructive pulmonary disease (COPD) as comorbidity, multiple organ dysfunction syndrome (MODS), mechanical ventilation requirement, vasopressor support requirement, need for hemodialysis and prolonged ICU stay. Conclusions: Elderly patients with AKI do not experience worse mortality outcomes than non-elderly patients with AKI. Therefore, elderly patients should not be denied timely treatment, solely based on their age

A study evaluation of tubal factors of infertility by hystero-salpingography and diagnostic laparoscopy

Background: Infertility is one of the commonest problems encountered in gynecology. Infertility appears to be a problem in 10-15% of Indian population. Tubal factors account for (20-40%) of infertility. The objective of the study was to demonstrate the role of hystero-salpingography and hystero-laparoscopy in evaluation of tubal factors for female infertility.Methods: Present study was carried out on 70 women attending the gynaecology OPD for investigation of infertility admitted between March 2014 to December 2014 in Gynecology ward, SSG Hospital attached to Government Medical College, Vadodara, Gujarat.Results: Out of 70 patients who underwent HSG tubal block was detected in 34 cases. Out of these 34 cases tubal block was detected only in 17 cases by laparoscopy and chromopertubation. One case which showed patent tubes on HSG had unilateral tubal block on chromopertubation test. Accordingly, sensitivity of HSG for tubal patency comes out to be 0.72, specificity of 0.94, positive predictive value of 97.43%, negative predictive value of 51.61%, positive likelihood ratio of 12.28 and negative likelihood ratio of 0.30.Conclusions: HSG being simple and less invasive technique along with higher specificity and lesser complications. Hystero-laparoscopy is a valuable technique for the complete assessment of female infertility

Impact of Pharmacist Interventions on Proportion of Patients Receiving Non-Indicated Acid Suppressive Therapy upon Discharge: A Systematic Review and Meta-Analysis

ObjectiveConduct a systematic review and meta-analysis to estimate the impact of pharmacy-supported interventions on the proportion of patients discharged from the hospital on inappropriate acid suppressive therapy (AST).MethodsTo identify studies, the following databases were systematically searched on October 14th, 2018 and repeated on September 12th, 2019: Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations and Daily, Embase.com, CINAHL, Web of Science, Cochrane CENTRAL (EBSCO), and ClinicalTrials.gov. Eligible studies consisted of adults, intervention and historical/usual care groups, description of active pharmacy-supported intervention, and proportion of patients discharged on inappropriate AST. Qualitative assessments and quantitative analyses were performed. Modified funnel plot analysis assessed heterogeneity. Preferred reporting items of systematic reviews and meta-analyses (PRISMA) methodology was used to evaluate studies in this review.ResultsSeventeen publications resulting in 16 studies were included in the review. Using random effects model, meta-analysis showed a significant reduction in the odds of being discharged on inappropriate AST from the hospital in the pharmacist-supported intervention arm versus comparator (Odds Ratio 0.33 [95%CI 0.20 to 0.53]), with significant heterogeneity (I2 = 86%). Eleven studies favored pharmacy-supported interventions, four were inconclusive and one favored usual care. Using modified funnel plot analysis, our final evaluation was distilled to 11 studies and revealed a similar outcome (OR 0.36 [95%CI 0.27 to 0.48]), but with less heterogeneity (I2 = 36%).ConclusionThis systematic review and meta-analysis showed that pharmacy-supported interventions were associated with a significantly reduced probability of patients discharged on inappropriate AST. However, heterogeneity was high and may affect interpretation of results. Using funnel plot optimization method, three positive and two negative studies were objectively removed from analyses, resulting in a similar effect size, but with less heterogeneity. To improve study quality, future researchers should consider utilizing a pre-post, multi-arm, prospective design with sampling randomization, training of data extractors (preferably two extractors), re-evaluating a small dataset to check for agreement and providing a comprehensive methodology in subsequent publications

Canine Filarial Infections in a Human Brugia malayi Endemic Area of India

A very high prevalence of microfilaremia of 42.68 per cent out of 164 canine blood samples examined was observed in Cherthala (of Alappuzha district of Kerala state), a known human Brugia malayi endemic area of south India. The species of canine microfilariae were identified as Dirofilaria repens, Brugia malayi, and Acanthocheilonema reconditum. D. repens was the most commonly detected species followed by B. pahangi. D. immitis was not detected in any of the samples examined. Based on molecular techniques, microfilariae with histochemical staining pattern of “local staining at anal pore and diffuse staining at central body” was identified as D. repens in addition to those showing acid phosphatase activity only at the anal pore. Even though B. malayi like acid phosphatase activity was observed in few dogs examined, they were identified as genetically closer to B. pahangi. Hence, the possibility of dogs acting as reservoirs of human B. malayi in this area was ruled out