Clinical and biochemical profile of hyponatremia and the role of vaptans in comparison to other standard modalities of therapy

Background: This study, conducted from August 2014 to August 2015, investigated hyponatremia in 228 in-hospital patients, aiming to discern its clinical and biochemical features and compare the efficacy of vaptans against standard treatments. The null hypothesis assumed no significant disparity in outcomes, while the alternate hypothesis posited otherwise. Methods: Using an open-label, non-blinded, observational, prospective comparative design, we assessed 228 hyponatremia patients. We scrutinized their clinical and biochemical profiles and made comparisons between moderate and profound hyponatremia cases, along with different treatment approaches. Results: Our findings revealed that patients aged 61-80, primarily females, dominated the cohort. Moderate hyponatremia occurred in 56.6% of cases, with severe hyponatremia in 43.4%. Common symptoms included drowsiness, nausea, and vomiting. Euvolemic hyponatremia was predominantly due to SIADH, while heart failure led to most hypervolemic cases. Various treatments were employed, with fluid restriction and normal saline being common. Tolvaptan and 1.6% hypertonic saline significantly increased serum sodium levels at 24 and 48 hours. Hospital stay duration didn’t significantly differ, and no osmotic demyelination cases emerged. Mortality stood at 10.5%, notably higher in profound hyponatremia cases. Conclusions: This study provides insights into hyponatremia’s clinical and biochemical aspects and compares vaptans to standard treatments. Tolvaptan and hypertonic saline displayed promise in raising serum sodium levels. Nevertheless, further research is warranted to validate these findings and explore additional factors impacting hyponatremia treatment outcomes

SEROVAR PROFILE AND DETECTION OF INVA VIRULENCE GENE AMONG NON-TYPHOIDAL SALMONELLAE SEROVARS ISOLATED FROM ACUTE GASTROENTERITIS CASES IN COASTAL KARNATAKA, SOUTHERN INDIA

  Objective: Non-typhoidal salmonellosis is one of the leading zoonosis in the world caused by non-typhoidal Salmonella (NTS). Invasive infections with NTS serovars occurs due to the presence of virulence genes like invA along with the immunosuppressive conditions of the patient. The study was conducted to isolate and identify the NTS serovars and their antimicrobial resistance profile from patients with diarrhea and also to detect the virulence marker – invA gene among these NTS serovars.Methods: A prospective cross-sectional study was conducted from January 2015 to December 2016 at the Enteric Diseases Division, Kasturba Medical College, Manipal. 1218 fecal specimens were collected from patients with diarrhea and before antibiotic treatment. NTS serovars were identified, serotyped and then screened for the presence of invA virulence gene.Results: A total of 33 (2.7%) NTS was isolated. Salmonella typhimurium (33.34%) was predominant followed by Salmonella oslo (30.3%). Out of 33 NTS, invA was positive for 28 isolates (84.8%) of which 25 (89.3%) patients were febrile which was statistically significant (p=0.000).Conclusion: Non-typhoidal salmonellosis is an emerging global infection among immunocompromised patients. Our study showed an association between the invA gene and febrile illness among the patients suffering. Thus, this study highlights the importance of invA as a significant marker for bloodstream invasion

Multidrug and extensively drug-resistant tuberculosis from a general practice perspective

Despite intensive efforts to eradicate the disease, tuberculosis continues to be a major threat to Indian society, with an estimated prevalence of 3.45 million cases in 2006. Emergence of multidrug-resistant tuberculosis has complicated eradication attempts in recent years. Incomplete and/inadequate treatment are the main causes for development of drug resistance. Directly observed therapy, short-course (DOTS) is the World Health Organization (WHO) strategy for worldwide eradication of tuberculosis, and our country achieved 100% coverage for DOTS through the Revised National Tuberculosis Control Program in 2006. For patients with multidrug-resistant tuberculosis, the WHO recommends a DOTS-Plus treatment strategy. Early detection and prompt treatment of multidrug-resistant tuberculosis is crucial to avoid spread of the disease and also because of the chances of development of potentially incurable extensively drug-resistant tuberculosis in these cases. This review discusses the epidemiologic, diagnostic, and therapeutic aspects of multidrug-resistant tuberculosis, and also outlines the role of primary care doctors in the management of this dangerous disease

BERBERINE HYDROCHLORIDE COULD PROVE TO BE A PROMISING BULLET AGAINST CLOSTRIDIUM DIFFICILE INFECTION: A PRELIMINARY STUDY FROM SOUTH INDIA

Objective: Recurrent Clostridium difficile infection (CDI) and the emergence of strains with reduced susceptibility to metronidazole and vancomycinwarrants alternative therapy. Hence, we tested the potential efficacy of the natural compound berberine hydrochloride (BBRHCl) against toxigenicC. difficile.Methods: Three representative polymerase chain reaction confirmed, toxin-positive strains were included in the study. Pulsed-field gel electrophoresis(PFGE) profile and antibiogram of the strains were analyzed along with 10 other toxin positive isolates. Efficacy of BBRHCl against toxigenic C. difficilewas determined using agar diffusion by punch well method.Results: PFGE grouped the test strains into three clusters with unique susceptibility pattern toward standard antibiotics. BBRHCl was efficaciousagainst the test strains at a concentration ranging between 6.25 μg/ml and 10 mg/ml. BBRHCl's breakpoint point inhibitory zone diameter wasequivalent (p<0.001) to the epidemiological cutoff values for teicoplanin, vancomycin and 2% black seed oil. Although the predicted concentration ofBBRHCl for breakpoint zone diameter equivalent to European Committee on Antimicrobial Susceptibility Testing's epidemiological cutoff value formetronidazole was observed to fall outside the tested concentration range; it was still within the safe dosage for humans.Conclusion: The present study is promising in considering BBRHCl as a potent substitute or adjunct not only for metronidazole, vancomycin andteicoplanin but also for natural compounds like 2% black seed oil for managing resistant cases of CDI. Owing to BBRHCl's direct antibacterial and antiinflammatoryaction, further investigations will aid in the proper characterization of the therapeutic effects of similar plant compounds, to developsafe and effective drugs against the epidemiological outbreak of CDI

Non-typhoidal salmonellosis: Detection of genes responsible for virulence: A hospital-based study from Manipal, India.

Background: Non-typhoidal Salmonella (NTS) is one of the four critical worldwide reasons for diarrhoeal infections and causes a noted zoonotic infection termed non-typhoidal salmonellosis. Non-typhoidal salmonellosis generally causes self-limited gastroenteritis, whereas in immunocompromised conditions can result in invasive infections. Aim and Objectives: To detect the likely NTS serovars causing non-typhoidal Salmonellosis and their virulence genes. Material and Methods: This is a prospective cross-sectional research work carried out at the Enteric Diseases Division, Central Research Lab, Kasturba Medical College, Manipal from January 2016 - June 2018. Stool samples were collected from patients with diarrhoea admitted to the tertiary care centre in Udupi district, India. Stool samples were processed according to the World Health Organisation laboratory protocol. Non-typhoidal Salmonella isolated were subjected to PCR for the detection of virulence genes. Results: Of the 1599 diarrheal samples processed, 55 NTS were isolated with a prevalence of 3.43 %. invA gene was existent in 83.6% of the isolates, spvC gene in 61.8%, stn in 100% sopB in 96.4% and sefA in 5.45%. Conclusion: The presence of virulence genes among NTS increases the complications of non-typhoidal salmonellosis. Routine antimicrobial susceptibility tests for salmonellae should be carried out and then reported to prevent the associated morbidity and mortality

Psychometric performance of the Kannada version of sarcopenia quality of life questionnaire (SarQoL®)

Abstract Background The Sarcopenia Quality of Life (SarQoL®) is a patient reported quality-of-life questionnaire specific to sarcopenia. In the Indian context, its availability is limited to Hindi, Marathi and Bengali vernacular languages. Aims This study aimed to translate, cross-culturally adapt the SarQoL® questionnaire into Kannada and investigate its psychometric properties. Methods The SarQoL®-English version was translated into Kannada with the developer’s permission and in accordance with their requirements. To validate the discriminative power, internal consistency and floor and ceiling effect of the SarQoL®-Kannada questionnaire were assessed in the first step. In the second step, the construct validity and the test–retest reliability of the SarQoL®-Kannada was determined. Result There was no difficulty in the translation process. A total of n = 114 participants (sarcopenic participants n = 45 and n = 69 non-sarcopenic participants) were included. The good discriminative power of the SarQoL®-Kannada questionnaire {quality of life for sarcopenic subjects [56.43 ± 11.32] vs. non-sarcopenic ones [79.38 ± 8.16], p < 0.001}. High internal consistency (Cronbach’s alpha coefficient was 0.904) and no ceiling/ floor effect were reflected. Excellent test–retest reliability (intraclass correlation coefficient was 0.97, 95% CI 0.92–0.98) were found. A good convergent and divergent validity with similar and different domains of WHOQOL-BREF was observed, while EQ-5D-3L had good convergent and weak divergent validity. Conclusion The SarQoL®-Kannada questionnaire is valid, consistent and reliable for the measurement of quality of life of sarcopenic participants. SarQoL®-Kannada questionnaire is now available to be used in clinical practice and as a treatment outcome indicator in research

Bracing for the pandemic: The udupi-manipal experience

COVID-19 was an unprecedented pandemic of our lifetime. Uncertainties were part of daily life and were the only certainty. Bracing for this pandemic at the level of a hospital was challenging. From infection control to patient management, from training healthcare workers to taking care of them, from public education to fighting fake news and misinformation, the pandemic presented with unique challenges and opportunities. This paper briefly discusses some of the important areas of focus and the experience of a dedicated COVID-19 hospital and the district during the pandemic

Electronic collaboration toward social health outcomes

This is an illustrative process description of a collaborative project utilizing a multidisciplinary approach. The requirement for collaboration originated in an attempt to optimally answer the needs of individual patients and health professionals for information to allow them to achieve better health outcomes. This chapter introduces the problem statement through the auto-ethnographic reflections of three project developers. These reflections illustrate individual experiential agendas that initiated electronic collaboration among diverse stakeholders in the health care network. Each reflection also illustrates the sequence of events in a collaborative process beginning at the individual level and growing through the interaction of multiple individuals including patients, their relatives, health professionals, and other actors in the care giving network. This chapter describes how collaboration was sustained and further developed into an operational model