Multifocal Skeletal Tuberculosis

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Severe hypertension in pediatric diabetic ketoacidosis – a case report and review of literature

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus in children. Despite the presence of dehydration, hypertension occurs in a significant proportion of children with DKA. There is a lack of clarity in the literature regarding the management of hypertension in patients with paediatric DKA. Herein, we report the case of an adolescent boy who presented with DKA and severe hypertension. His neurological status was closely monitored. There was a gradual decline in his blood pressure with an improvement in the pH over the next 72 hours. The combination of severe DKA and hypertension can be a challenging clinical dilemma, especially regarding fluid management. Studies on severe DKA in children are exacting, given the rarity of this condition. A multi-centre study is suggested to provide a meaningful analysis of this aspect of DKA

Advancing sepsis clinical research: harnessing transcriptomics for an omics-based strategy - a comprehensive scoping review

Sepsis continues to be recognized as a significant global health challenge across all ages and is characterized by a complex pathophysiology. In this scoping review, PRISMA-ScR guidelines were adhered to, and a transcriptomic methodology was adopted, with the protocol registered on the Open Science Framework. We hypothesized that gene expression analysis could provide a foundation for establishing a clinical research framework for sepsis. A comprehensive search of the PubMed database was conducted with a particular focus on original research and systematic reviews of transcriptomic sepsis studies published between 2012 and 2022. Both coding and non-coding gene expression studies have been included in this review. An effort was made to enhance the understanding of sepsis at the mRNA gene expression level by applying a systems biology approach through transcriptomic analysis. Seven crucial components related to sepsis research were addressed in this study: endotyping (n = 64), biomarker (n = 409), definition (n = 0), diagnosis (n = 1098), progression (n = 124), severity (n = 451), and benchmark (n = 62). These components were classified into two groups, with one focusing on Biomarkers and Endotypes and the other oriented towards clinical aspects. Our review of the selected studies revealed a compelling association between gene transcripts and clinical sepsis, reinforcing the proposed research framework. Nevertheless, challenges have arisen from the lack of consensus in the sepsis terminology employed in research studies and the absence of a comprehensive definition of sepsis. There is a gap in the alignment between the notion of sepsis as a clinical phenomenon and that of laboratory indicators. It is potentially responsible for the variable number of patients within each category. Ideally, future studies should incorporate a transcriptomic perspective. The integration of transcriptomic data with clinical endpoints holds significant potential for advancing sepsis research, facilitating a consensus-driven approach, and enabling the precision management of sepsis

A Comparative Study of Widal Test and Immunochromatographic Assay for Rapid Diagnosis of Typhoid Fever and Molecular Analysis of Plasmid Mediated Quinolone Resistance in Clinical Isolates in a Tertiary Care Centre

Salmonella enterica subspecies enterica serovar Typhi, the human specific, causative agent of typhoid fever, is one of the most common infectious disease in developing countries like India. Widal test is assosciated with numerous limitations ,but is still considered and extensively used as the diagnostic tool in our area. The bacteriological identification by blood culture is the best confirmative test of typhoid fever. The present study was carried out in Tirunelveli Medical College and Hospital, Tirunelveli for a period of one year from June 2017 to July 2018. A total number of 100 clinically suspected typhoid fever patients’ blood samples was taken and blood culture, widal test and Immunochromatographic tests done. We have assessed the reliability of ICT for the early diagnosis of typhoid fever when compared to the widal test. The antibiotic sensitivity and resistance pattern of the isolates were detected by disc diffusion method and subsequently the PMQR pattern of these isolates were detected by PCR. A total of 14 Salmonella Typhi were isolated from 100 clinically suspected typhoid cases. A total of 47 samples were tested positive in widal test. Out of this only one sample was positive for blood culture (True positivity rate – 2.1% and True negativity rate – 75.4%). Out of 26 samples positive for IgM, 10 samples were positive for blood culture (True positivity rate – 38.5%). Out of 74 samples that was negative for IgM, only 4 samples were found to be positive for blood culture (True negativity rate – 94.6%). Most isolates were sensitive to azithromycin (85.7%), ciprofloxacin (57.1%) and pefloxacin (50%). 42.9% sensitivity to Ceftriaxone and Nalidixic acid, 74.3% were resistant to Chloramphenicol and Cotrimoxazole and 85.7% were Ampicillin resistant. Molecular characterisation done, to determine whether fluoroquinolone resistance was plasmid mediated. The two resistant isolates of S.Typhi were found to be positive for plasmid mediated quinolone resistance gene qnr A. No mutations were detected in qnrB gene. In conclsion, the study implies that rapid ICT tests offers increased sensitivity, rapidity and simplicity over blood culture and Widal test, and can be used as a reliable, alternate early diagnostic tool to the most commonly used serological tests. The antibiotic sensitivity pattern in this area shows a shift towards decrease in the previous presumptions of absolute fluroquinolones resistance pattern. This hence encourages us tointurn implement the rational use of fluroquinolones again, in the treatment protocol for typhoid fever

A Study of Prevalence and Clinical Implication of Hypocalcemia in Malaria

It was a cross sectional study, conducted at department of General Medicine, Government Stanley Medical College, Chennai from March 2016 to August 2016. The aim of our study was to determine the prevalence and clinical profile of hypocalcemia (mean serum calcium, symptoms and QTc prolongation) in different types of malarial fever. 110 patients of malarial fever were studied. History and detailed clinical examination was done with special emphasis on signs and symptoms of complicated malaria and hypocalcaemia. Malarial patients were stratified into 2 groups according to the severity of the disease – complicated and uncomplicated malaria. Patients were also stratified into 3 groups according to the species of plasmodium parasite causing the disease. Patients with P.falciparum infection, P.vivax infection and mixed infection (P.falciparum +P.vivax) constituted the 3 groups. Blood was collected from the patient for serum calcium at the time of admission and within 7 days of onset of fever. Serum calcium was measured in central lab by Arsenazo method (reference range-8.8-10.5mg/dl). Total serum calcium level was analyzed in each patients. Total calcium level of 0.44 sec was considered as prolonged QTc for this study. Data collected were analysed using professional statistic package of windows. Chi square test was used for analysing categorical variables. One way ANOVA was applied to assess the difference between the mean where there were more than two categories. Values of p < 0.05 was found to be statistically significant. We have summarized the results as follows: Prevalence of hypocalcemia in malaria was found to be 55.5% in our study. Hypocalcemia was more prevalent in complicated malaria than uncomplicated malaria. Among different types of malaria, prevalence of hypocalcemia was highest in falciparum malaria. Complicated falciparum malaria showed highest prevalence of hypocalcemia. Status of complexity of malaria was not found to be related to occurrence of hypocalcemia in any types of malaria. Lowest mean serum calcium was observed in complicated falciparum malaria while highest mean serum calcium was seen in uncomplicated mixed malarial infection. Prevalence of QTc prolongation in malaria was found to be 49.1%. 72.1% of patients with hypocalcemia had prolonged QTc. Prevalence of QTc prolongation was found to be more in complicated malaria than uncomplicated malaria. 90% of complicated malarial patients with QTc prolongation were found to have hypocalcemia. QTc prolongation was most prevalent in complicated falciparum malaria. 83.3% of those with QTc prolongation had hypocalcemia. Longest QTc was observed in complicated falciparum malaria while shortest was in uncomplicated vivax malaria. There was no significant difference in QTc between different types of malaria. Prevalence of muscle spasm in malaria was found to be 20%. Muscle spasm was most prevalent in complicated falciparum malaria. Prevalence of numbness in malaria was 1.8%. There was no statistically significant difference of prevalence of hypocalcemia in malaria between males and females

Study of Drug induced skin reactions in the patients attending outpatient Department of Dermatology

Adverse drug reaction is any noxious change which is suspected to be due to drug, occurs at doses normally used in humans for prophylaxis, diagnosis, therapy of disease or for modification of physiological function. Adverse drug reactions cause both morbidity and mortality. Drug induced skin reactions are the most common type of adverse drug reaction and clinical presentation varies. We investigated the profile of drug induced skin reactions in the patients attending outpatient department of Dermatology, Kilpauk Medical College and Hospital, from September 2011 to February 2013. Data were recorded in WHO Suspected adverse reaction report form and analyzed statistically by Chi-square test. Causality and severity of adverse drug reaction were done. In conclusion, analyzing 100 ADRs men were more affected than female. Drug rash was the most common drug induced skin reaction. The suspected drug causing more reactions was Antibacterial agent. Hence ADR data base studies conducted across multiple centres provide early warning signals in preventing adverse drug reactions

To study the effectiveness of oral azithromycin as compared to parenteral ceftriaxone in the treatment of uncomplicated enteric fever.

OBJECTIVE: To compare the effectiveness of oral Azithromycin and intravenous Ceftriaxone in the treatment of uncomplicated enteric fever in children. METHODS: One hundred and twenty six children with proved enteric fever were enrolled in this study. They were randomized into two treatment groups. One group received oral Azithromycin (20mg/kg/day) and the other group received parenteral Ceftriaxone (75mg/kg/day), both of which were given for a duration of 7 days. The study population was observed for fever defervescence, duration of hospital stay and relapse. (In our study, 60 out of the 63 children in the Azithromycin group had defervesced within 7days of treatment whereas the remaining 3 crossed over. None in the Azithromycin group had relapsed. In the Ceftriaxone group, 59 out of the 63 children defervesced within 7days of treatment whereas remaining 4 cases were termed as treatment failures and required longer duration of the same drug. RESULTS: The mean time for defervescence was 3.68±2.109 and 4.08±1.903days in the Azithromycin group and Ceftriaxone group respectively. The mean duration of hospital stay was 7.35±2.604day in the Azithromycin group and 9.44±0.249days in the Ceftriaxone group. Among the 4 treatment failures in Ceftriaxone group, 2 cases relapsed within 4week follow up period. There was no relapse in the Azithromycin group. CONCLUSION: Oral Azithromycin is as effective as intravenous Ceftriaxone in treating uncomplicated typhoid fever in children with respect to fever defervescence, duration of hospital stay and relapse