Dapsone hypersensitivity syndrome-rare complication of dapsone therapy

Among several other adverse effects of dapsone therapy, dapsone hypersensitivity syndrome is extremely rare but most life-threatening complication. Here we report a case of severe dapsone hypersensitivity syndrome in a 27-year-old female student diagnosed as immune thrombocytopenic purpura on dapsone therapy who was admitted with remittent fever, lymphadenopathy and skin rash and was managed successfully with drug withdrawal and systemic glucocorticoid therapy. The idea of reporting this case is to recognise the rare potentially life threatening adverse effect of dapsone therapy, its timely diagnosis and favourable outcome with systemic glucocorticoid therapy

Physico-Chemical Characterization Of Sweet Chestnut (Castanea Sativa L.) Starch Grown In Temperate Climate Of Kashmir, India

Studies were conducted to characterize the chestnut starch for physico-chemical properties. Chemical composition of chestnut starch showed low levels of protein and ash indicating purity of starch. The results revealed low water and oil absorption capacity of chestnut starch. Starch showed high swelling power and low solubility index. Swelling power and solubility index of chestnut starch increased with increase in temperature (50–90 °C). The results revealed high initial, peak, setback, breakdown, and final viscosity but low paste development temperature. Transmittance (%) of the starch gel was low and decreased with increasing storage period. The chestnut starch gel showed increase in % water release (syneresis) with increase in time of storage but was less susceptible to repeated cycles of freezing and thawing. Starch was also characterized for granule morphology. Starch granules were of round and oval shapes, some granules showed irregular shape

Prevalence and outcome of infections in intensive care units of a tertiary care hospital in north India.

INTRODUCTION: Infection is a major cause of morbidity and mortality in Intensive Care Units (ICUs), more so in resource limited ICUs of low and lower-middle income countries. However relatively little information is available about epidemiology and outcome of such infections in our part of the world. The point was to provide information about the prevalence and outcome of primary and secondary (nosocomial) infections in ICUs. MATERIAL AND METHODS: 257 adult patients admitted in medical and surgical ICUs over a period of 9 months were enrolled in the study. Patients fulfilling sepsis 3 criteria were categorized under “prevalence of the infections” and patients who developed infections after 48 hours of admission in ICUs were categorized under “secondary (nosocomial) infections”. Sequential Organ Failure Assessment score (SOFA score) was calculated at admission and after 72 hours of ICU stay. The patients were followed for 30 days. RESULTS: Patients were distributed in two groups: 153 (59.5%) medical ICU and 104 surgical ICU patients. Prevalence of primary infection was significantly higher in medical ICU patients (p value < 0.05). A total of 93(60.8%) patients in medical ICU and 50(48.1%) patients in surgical ICU were admitted as primary infections (p value < 0.001). Secondary (nosocomial) infections occurred in 30 (19.6%) patients in medical ICU and 15 (14.4%) patients in surgical ICU (p-value 0.283). The average length of stay was 14 days in patients with nosocomial infections and 3.5 days for patients without secondary infections (p-value < 0.001). Out of total of 188 infected patients, 80 (42.5%) died whereas 17 (24.6%) of the 69 patients without infection expired (p-value 0.008). 112 patients with mean SOFA score of 11.35 ± 2.71 expired while as 145 patients with mean SOFA score of 5.84 ± 1.92 survived (p value < 0.001). CONCLUSIONS: The prevalence of infections was more in medical ICU than in surgical ICU. The nosocomial infections significantly increase the average length of stay in ICUs. Mortality was significantly more in patients admitted with infection in Intensive Care Units. The higher the SOFA score, greater the mortality

Clinico-epidemiological profile of patients with microbial keratitis in Kashmir valley

Purpose: This study was undertaken to provide information on the clinico-epidemiological profile of patients clinically suspected with bacterial and fungal keratitis, who were admitted in the Ophthalmology unit of a tertiary center during a 2 year period. Methods: This is a prospective study of all the patients who were admitted in the eye ward of Government Medical College Srinagar (India) between September 2010 and September 2012. 100 patients of bacterial and fungal corneal keratitis without any history of preexisting ocular or systemic disease were included in the study. All patients were assessed, admitted and completely evaluated in hospital and managed accordingly. Corneal ulcer scrapings were taken at presentation, at the Department of Microbiology. Results: Maximum numbers of patients among males (61.90%) were agricultural workers and among females, 81.08% were housewives. It was seen that majority of patients (79%) presented within 1st week of onset of symptoms and among them growth was seen in 64.6%. Growth was seen in 32cases (72.72%) out of 44 cases who gave a history of trauma whereas growth was seen in 36 cases (64.28%) who did not give a clear history of trauma. Conclusion: Bacterial and fungal keratitis in Kashmir is more prevalent in rural areas, with men being more at risk of developing the disease. There is a seasonal variation in the incidence of the disease; higher cases being reported during the harvesting season. Trauma with organic or vegetable matter is a common preceding factor. Microbiological studies should preferably be carried out in all cases

Prevalence of occult adrenal insufficiency and the prognostic value of a short corticotropin stimulation test in patients with septic shock

Background: Corticosteroid insufficiency in acute illness can be difficult to discern clinically. Occult adrenal insufficiency (i.e., ∆max ≤9 μg/dL) after corticotropin may be associated with a high mortality rate. Objective: To assess the prevalence of occult adrenal insufficiency and the prognostic value of short corticotropin stimulation test in patients with septic shock. Materials and Methods: A total of 30 consecutive patients admitted in the adult intensive care unit of the Sheri Kashmir Institute of Medical Sciences who met the clinical criteria for septic shock were prospectively enrolled in the study. A low dose (1 μg) short corticotropin stimulation test was performed; blood samples were taken before the injection (T0) and 30 (T30) and 60 (T60) minutes afterward. Results: The prevalence of occult adrenal insufficiency was 57%. The 28-day mortality rate was 60% and the median time to death was 12 days. The following seven variables remained independently associated with death: organ system failure scores, simplified acute physiology score II score, mean arterial pressure, low platelet count, PaO 2 :FIO 2 , random baseline cortisol (T0) > 34 μg/dL, and maximum variation after test (∆max) of ≤9 μg/dL. Three different mortality patterns were observed: (I) low (T0 ≤34 μg/dL and ∆max > 9 μg/dL; a 28-day mortality rate of 33%),(II) intermediate (T0 > 34 μg/dL and ∆max> 9 μg/dL or T0 ≤34 μg/dL and ∆max ≤9 μg/dL; a 28-day mortality rate of 71%), and (III) high (T0 > 34 μg/dL and ∆max ≤9 μg/dL; a 28-day mortality rate of 82%). Conclusion: A short corticotropin test using low-dose corticotropin (1 μg) has a good prognostic value. High basal cortisol and a low increase in cortisol on corticotropin stimulation test are predictors of a poor outcome in patients with septic shock

PROTOCOL: Effectiveness of public-private partnerships on educational access and quality of primary and secondary schooling in low- and middle-income countries: A systematic review

This protocol serves as a guiding source for a Campbell registered systematic review aiming to assess the effectiveness of Public-Private Partnerships (PPPs) in education in Low- and Middle-Income Countries (LMICs). The primary question for this review is: What is known about the impact of PPPs on improving access (i.e., enrolment, attendance, drop-out, and completion) and quality (i.e., students’ learning outcomes and teachers’ teaching practices) of primary and secondary schooling in LMICs? Using a predefined search query, we will retrieve studies from various databases including Scopus, Campbell Library, EBSCO Education Research Complete, NBER, Dissertation and Theses Global (ProQuest), along with other sources of grey literature. Covidence will be used for screening and extraction. A bias assessment tool will be used for the included studies. A standardised mean difference (SMD) effect size of Hedges’ g will be calculated for the outcome variables using RevMan. This review will provide updated evidence about the impact of PPP in school education across LMICs, which will be instrumental for policy and practice level decisions for education improvement

Role of Selected miRNAs as Diagnostic and Prognostic Biomarkers in Cardiovascular Diseases, Including Coronary Artery Disease, Myocardial Infarction and Atherosclerosis

Cardiovascular diseases are the leading cause of death worldwide in different cohorts. It is well known that miRNAs have a crucial role in regulating the development of cardiovascular physiology, thus impacting the pathophysiology of heart diseases. MiRNAs also have been reported to be associated with cardiac reactions, leading to myocardial infarction (MCI) and ultimately heart failure (HF). To prevent these heart diseases, proper and timely diagnosis of cardiac dysfunction is pivotal. Though there are many symptoms associated with an irregular heart condition and though there are some biomarkers available that may indicate heart disease, authentic, specific and sensitive markers are the need of the hour. In recent times, miRNAs have proven to be promising candidates in this regard. They are potent biomarkers as they can be easily detected in body fluids (blood, urine, etc.) due to their remarkable stability and presence in apoptotic bodies and exosomes. Existing studies suggest the role of miRNAs as valuable biomarkers. A single biomarker may be insufficient to diagnose coronary artery disease (CAD) or acute myocardial infarction (AMI); thus, a combination of different miRNAs may prove fruitful. Therefore, this review aims to highlight the role of circulating miRNA as diagnostic and prognostic biomarkers in cardiovascular diseases such as coronary artery disease (CAD), myocardial infarction (MI) and atherosclerosis