Retrospective study of clinical profile and management of patients with swine flu at tertiary care hospital

Background: The first isolation of a swine influenza virus from a human occurred in 1974. There are no unique clinical features that distinguish swine influenza in humans from typical influenza. Thus, clinical course and management were recorded as per a planned pro forma and analysed. This type of study has not been done previously in Himalayan region.Methods: Retrospective observational study done in a group of patients diagnosed with swine flu admitted in department of pulmonary medicine at the tertiary care hospital from November 2016 to July 2017.Results: Out of 30 patients, 53.3% were male, mean age was 48.8±17.7, history of travel or contact to infected person was only 13.3%. Most common symptom recorded was fever (83.3%), followed by dyspnoea, cough, throat pain. Most common co-morbidity was diabetes and presence were significantly associated with admission in an ICU (P<0.05). Bilateral lung infiltrate seen in 53.3% on chest X-ray. Organ involved other than respiratory were renal followed by liver involvement. 40% of patients received corticosteroid for an average of 6days, mostly given in patients with sepsis, septic shock, multi organ involvement. Out of 40%, 16.6% patient expired, 6.6% left against medical advice and 16.6% were discharged, corticosteroid doesn’t help in reducing mortality.Conclusions: A multivariate model to identify independent predictors associated with mortality in swine flu were the use of vasopressor, respiratory failure, requirement of mechanical ventilation and number of organ failure. Use of corticosteroid is controversial

Study of Clinico-Radiological Profile of Patients with Spinal Tuberculosis

Weight, height and a1% to 3% of TB patients have bone or joint disease, and spinal TB typically develops as a secondary infection following a primary infection that has devastating side effects including tubercular&nbsp;spondylodiscitis,&nbsp;spondylitis, collapsing vertebral elements, and even anterior wedging that results in the development of&nbsp;gibbus&nbsp;and kyphosis. Due to its delayed onset and vague symptoms, spinal TB is challenging to diagnose. This study investigates the clinical, radiographic, and resistance trends of spinal tuberculosis in a Tertiary care facility. Material And Methods: The observational cross-sectional research was place from 2020 to 2021. In the research, 54 patients were included. Magnetic resonance imaging (MRI) descriptive statistics were computed to determine the clinical and radiological spectrum. Additionally, we simultaneously collected tissue samples from the spine, evaluated them using Truenat, and used a Z-test to compare two sample proportions using traditional histopathological biopsies. Results: The thoracic and lumbar vertebrae were found to have spinal involvement most commonly, with more than four vertebrae being affected in most instances, according to MRI scans. In 85.19% of the instances, there was vertebral body degradation, in 42.59% there was vertebral collapse, and in 42.59% there was deformity. Of the 54 trial participants, 49 (90.74%) had spinal TB that was treatable with drugs, whereas 5 (9.26%) had the more severe form of the disease. Two individuals had Pre-XDR TB, two had multi-drug resistant TB (H+R) TB resistant to rifampicin and isoniazid and one patient had XDR-TB among those with drug-resistant spinal TB. Conclusion: The majority of the 54 patients who were recruited were male and had a prevalence of muscular spasm and back pain as their first recognized symptoms. The radiographic evaluation showed that 61.1% of the lumbar involvement and 63% of the thoracic involvement both exhibited disc enhancements, cold abscesses, decreased disc space, osteitis indications, cord compression with vertebral collapse, and limited disc space. In our analysis, the posterior portion was more often involved (74.1% of cases). Using the Truenat and Line Probe Assay test, drug-resistant spinal tuberculosis was identified in five out of fifty-four individuals

Skin Prick Test in Naso-Bronchial Allergies: A Cross Sectional Study

Allergy is defined as an overreaction of the immune system in response to the ingestion of certain foreign chemicals. The disease has been found to be more prevalent in males with predilection towards young adults who are less than 40 years of age. Indoor, outdoor or occupational agents are the most common classification for aero-allergens.&nbsp; “Skin Prick Test (SPT)” is the most definite and reliable methodology for diagnosing various allergic diseases which are mediated by IgE, in a patient with Naso-Bronchial allergies. Material and Methods: Cross sectional study was conducted on 120 patients with Naso-Bronchial allergy. Detailed clinical history, examination was done and SPT was performed using 25 allergens.” Results: It was observed that insects were the most common allergen followed by mites, pollens and food respectively. Animal dander was the least common allergen. Amongst insects, Cockroach was the most common. Conclusion: On the basis of this study, we conclude that skin prick test is one of the most reliable, easily accessible and diagnostic test to detect IgE mediated allergic reactions.

Retrospective review of profile of intensive care unit admissions and outcomes in a tertiary care hospital of Himalayan region

Background: An Intensive care unit (ICU) is an area where highest level of care is given with close invasive and non-invasive monitoring to a critically ill patient. Medical audit is must to assess the quality care provided and lay down policies for future. Objectives: To review retrospectively the profile of patients admitted to ICU and assess their outcome.Methods: From January 2016 to December 2016, ICU records of all admissions, referred, discharges, and deaths were utilized for the purpose of this study. Data extracted from the records included age, sex, diagnosis and outcome.Results: A total of 2316 patients were admitted to ICU. Males were 1489 (64.3%) and females were 827 (35.7%). Most of the patients (42.8%) were between 46-70 years. Most of the patients were shifted from emergency (48.5%) and it was associated with better outcome. A total of 49.6% patients were shifted out of ICU in stable condition while mortality was 28.6%. Around 21.8% patients left ICU against Medical advice.Conclusions: Majority patients admitted to ICU were of general medicine and neurosurgery. Survival was inversely related to age. Mortality was not associated with sex. Outcome was also related to the source from where patient was admitted

Adenosine deaminase and interferon-gamma in diagnosis of tubercular pleural effusion

Background: Pleural effusion is a common extrapulmonary manifestation of tuberculosis (TB). The conventional culture suffers from lack of sensitivity. Many pleural fluid markers have been evaluated to diagnose tubercular pleural fluid but none has proved to be an ideal. We have studied Adenosine deaminase (ADA), Interferon gamma (IFN) and their combination for diagnosis of tubercular pleural effusion.Methods: All consecutive patients with pleural effusion were subjected to thoracentesis and segregated into transudative and exudative using Light`s criteria. Patients with exudative pleural effusion were enrolled and divided into two groups. Group-I comprised of patients with tubercular etiology, Group-II- non-tubercular etiology. 45 patients were selected for each group. ADA and IFN in pleural fluid of these patients were measured. The sensitivity, specificity and predictive values were calculated.Results: The  sensitivity, specificity, positive predictive value, negative predictive value of ADA and IFN were 88.89%, 99.85%, 86.96%, 99.87%; 97.78%, 97.78%, 97.78%, 97.78% respectively. Combination of ADA and IFN didn’t improve the sensitivity or specificity compared to IFN alone.Conclusions: Pleural fluid ADA, IFN were found to be useful in differentiating tubercular from non-tubercular patients. Combination of ADA and IFN doesn’t give additional benefit over IFN alone

Miliary tuberculosis in an immunocompetent adolescent

Miliary tuberculosis (TB) is a rare form of TB, seen in approximately 1-2% of all the patients with TB. It represents hematogenous dissemination of uncontrolled TB. Human immunodeficiency virus (HIV) pandemic has led to resurgence of TB in both developed and developing countries. Without treatment, the mortality is near 100%. With early and appropriate treatment; however, mortality can be reduced to &lt;10%. Early diagnosis increases the likelihood of a positive outcome. A 15-year-old boy presented to the outpatient department with complaints of dry cough and fever for 2 months, along with the history of anorexia and weight loss. Clinical workup showed mild pallor, hepatosplenomegaly, and choroid tubercles. Screening for HIV antibodies was negative. X-ray chest showed miliary opacities in the bilateral lung fields. Contrast enhanced computed tomography thorax showed multiple military nodules in both lung fields, tree in bud appearance, and multiple enlarged lymph nodes. The patient was treated with 4 drugs antitubercular treatment along with oral steroids. Follow-up after 1 month showed clinical improvement