Staphylococcus aureus still the commonest culprit

Background: Sepsis is still one of the most leading cause of death in world. 19 million sepsis (formerly severe sepsis) cases and 5 million sepsis-related deaths are estimated to occur annually. Sepsis is also one of the most common cause of patients getting critically ill and getting admission in intensive care unit. The main focus of this study is to identify the culture isolate from the critically ill patients and to check for the antibiotic sensitivity and resistance and identify if the report has changed the course of treatment and outcome of the patients. Critical illness is a life-threatening multisystem process that can result in significant morbidity or mortality. Critically ill patients are those who have dysfunction or failure of one or more organs/system and depend on survival from advanced instruments of monitoring and therapy. The aim of the study was to identify the causative organism causing sepsis in critically ill patients.Methods: It will be multi central retrospective study which included patients of critical illness of Rohilkhand Medical college, Bareilly, Uttar Pradesh and Varun Arjun Medical college, Shahjanpur, A total of 468 patients were taken for the analysis during period of from August 2018 to November 2019 among of which 324 samples came positive. Samples were taken on day one of the patient’s presentation to the hospital and were analysed in BD BACTEC culture medium. Patient’s data were taken from records available at both the hospitals. Sensitivity was performed using disk diffusion method and the results were compared with the records of patients.Results: Among of samples taken that is 324; 194 were male and 130 were female. Maximum patients which were tested positive for Staphylococcus aureus (n=198). Others included Streptococcus pneumococcus (n=25), Escherichia coli (n=50), Klebsiella oxytoca (n=13), Klebsiella pneumoniae (n=15), Pseudomonas aeruginosa (n=20), and Acinetobacter (n=3). In retrospective analysis of the patients of all 324 cases treatment in approximately 148 patients was changed due to change in the sensitivity of antibiotics.Conclusions: Staphylococcus still dominates the sepsis. It is advisable to add an antibiotic with gram negative if patients count does not improve in first 24 hour.

Comparison of lipid profile in diabetic patients presenting with cardiac diseases

Background: Diabetes mellitus (T2DM) is the most common metabolic disorder in human beings. It is a group of metabolic disorders which causes a decrease in the insulin secretion and /or resistance in its functions and/ or actions. It is the commonest prevalent metabolic disorder which is rapidly increasing all over the world. The purpose of this study was to evaluate the serum lipid levels in diabetic patients who presented to the OPD or the IPD with cardiac diseases.Methods: It was a cross sectional observational study conducted for period of 18 months (June 2018-December 2019). Study was done in 111 patients diagnosed with T2 DM (diagnosed according to ADA criteria) attending OPD and in admitted in the Rohilkhand Medical College and Hospital (RMCH), Bareilly, Uttar Pradesh.Results: A total of 111 patients were taken for this study and in the present study we found that 47.7% patients had Coronary artery disease (CAD), 21.6% had myocardial ischemia (SMI), 36% diastolic dysfunction (DF) and 28,8% had systolic dysfunction (SDF). About half of the patients were above 50 years (50.5%) followed by 40-50 (47.7%) and <40 years were in a small number (1.8%). More than half of the males (56.6%) and 28.6% of females were in 40-50 years of age.Conclusions: We found in our study a significant association of high triglyceride levels with the silent myocardial ischemia (SMI) in diabetic patients but no significant relation with the high levels of cholesterol.

Diabetes changes the outcome of tuberculosis?

Background: Diabetes has become a global epidemic affecting children, adolescents, and adults. It is recognized as a group of heterogeneous disorders with the common elements of hyperglycemia and glucose intolerance, due to insulin deficiency, impaired effectiveness of insulin action, or both. Diabetes mellitus (DM) is classified on the basis of etiology and clinical presentation of the disorder into four types: type 1 diabetes, type 2 diabetes, gestational diabetes, and other specific types. Failures, deaths, relapse rates and favorable outcomes (cured/treatment completed) were comparable in pulmonary tuberculosis (TB) patients with or without DM. It is also documented that in well-controlled diabetes the course of pulmonary tuberculosis is not different from that in patients without diabetes.Methods: Diabetic patients visiting the outpatient department/diabetic clinic of our facility were enrolled after taking written informed consent. The data on socio-demographic and diabetic parameters and examination findings were recorded on proforma as attached.Results: X-ray findings at start of treatment showed that proportion of patient of group I was higher than group II in left site (26.00% versus 8.00%) and proportion of patient of group II was higher than group I in right site (58.00% versus 48.00%) and bilateral (34.00% versus 26.00%), though left side was affected in higher proportion of group I patients as compared to group II but this difference was not found to be statistically significant.Conclusions: Our study concluded that even though the state in which patient presented that is diabetic or non-diabetic the outcome of treatment didn’t change but the earlier one was more associated with complications and also the healing took more time in patients with diabetes

Assessment of the clinic-pathological profile of patients with pancytopenia

Introduction: Pancytopenia is an important clinico-hematological condition encountered in day-to-day clinical practice. Pancytopenia is often very difficult to diagnose and treat often owing to its varied aetiologies, causes might ranging from infections, nutritional deficiencies to malignancies. Materials and Methods: This was a cross-sectional study conducted in Department of General Medicine, Rohilkhand Medical College and Hospital, Bareilly. Patients' information was filled in pro forma, and contains patient's age, gender, clinical features, clinical findings, CBC findings, bone marrow findings, and diagnosis from all patients collected. Detailed clinical history and clinical examination along with blood investigation were carried out. Results: In the present study, the mean level of platelets was 54,000 ± 31,549/μL, with a minimum level of 2000/μL and a maximum level of 130,000/μL, indicating that majority of patients suffered from thrombocytopenia. The mean level of white blood cells (WBCs) was 2873.4 ± 780.4/μL, with a minimum level of 1000/μL and a maximum level of 3860/μL, indicating that all the patients suffered from leukopenia. 30% of patients had normocytic normochromic RBC, 24% had macrocytic normochromic RBC, 22% had macrocytic hyperchromic, 6% had microcytic normochromic, 8% had microcytic hypochromic, and 10% had both macrocytic and microcytic RBCs. Conclusion: Mean values of Hb, WBC & Platelet count was non-significantly higher among female patients comparing to males, though mean value of MCV was non-significantly higher in male patients comparing to females