Clinical profile of acute hemorrhagic stroke patients: a study in tertiary care hospital in Northern India

Background: Acute hemorrhagic stroke, a subtype of acute stroke is one of the leading cause of death and major cause of morbidity and mortality throughout the world. The incidence of acute hemorrhagic stroke is increasing with gradual increase in obesity, diabetes mellitus, hyperlipidemia, hypertension and various cardiac problems. This study had been conducted with an objective to study the risk factors and clinical presentation of acute hemorrhagic stroke patients in north-Indian population. Methods: This study was carried out among 100 acute hemorrhagic stroke patients (clinically and radiologically confirmed) irrespective of age and sex admitted to Emergency Department of KGMU, Lucknow after getting clearance from Institutional Ethical Committee(IEC). These patients had been subjected to plane CT (computed tomography) scan brain on admission by the CT scan model 16 slice Brivo 385 for radiological confirmation and to localize the lesion in brain. Data were collected in prescribed protocol.Results: Majority of the patients were in the (50-60) age group with male predominance. Hypertension (62%) was the most common risk factor for acute hemorrhagic stroke followed by Non-veg diet (46%). The commonest clinical feature at presentation was hemiplegia (76%). Majority (47%) of the patients presented with Glasgow Coma Scale (GCS) of (9-12). Cerebral cortex (41%) was the most common site of brain lesion in acute hemorrhagic stroke patients. Conclusion: This study focuses on the clinical profile and risk factors of acute hemorrhagic stroke, by targeting which the burden of this disabling disease can be prevented.

Serum neuronal specific enolase as a biomarker in differentiating the side of brain lesion in acute hemorrhagic stroke: a hospital based study

Background: Neuronal specific Enolase (NSE) is the neuronal form of the glycolytic enzyme enolase. This study has been conducted to see the role of serum NSE in differentiating the side of brain lesion within 24 hours of acute hemorrhagic stroke onset.Methods: The study was conducted in collaboration with the Department of Physiology and Medicine after Ethical clearance from December 2013 to April 2015. Our study group consists of 35 acute hemorrhagic stroke patients (clinically and radio logically confirmed) irrespective of age and sex, admitted in Emergency Unit, Medicine Department within 24 hours of stroke symptom onset. The patients were undergone plain CT scan brain on admission to confirm the diagnosis and the side of the lesion in brain. Serum NSE for these patients was estimated by using NSE Human ELISA Kit, in the Department of Physiology.Results: In this study, serum NSE bears a positive significant correlation to the hematoma volume in brain (r=0.786, p<0.001) and to the National Institute of Health Stroke Scale (NIHSS) (r=0.44, p=0.008). However, there is no significance difference between the serum NSE in right hemispheric brain lesion compared to left hemispheric brain lesion (p=0.597).Conclusions: Serum NSE within 24 hours of stroke onset can reflect the volume of brain lesion and severity of neurological deficit but cannot differentiate the side of brain lesion in these patients.

ANTIMICROBIAL AGENT’S UTILIZATION AND COST PATTERN IN MEDICAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Objective: The objective of this study was to evaluate the utilization and cost pattern of AMAs (Antimicrobial Agents) in the Medical ICU of a tertiary care teaching hospital, and to determine the predictor of antimicrobial number per day. Methods: A prospective cross-sectional study was carried out and a total of 101 patients were studied. The drugs were classified into different groups according to the World Health Organization’s ATC (Anatomical Therapeutic Chemical) Classification System.  Results: The mean [95% confidence interval (CI)] duration of ICU stay was 7.11 (5.70-8.52) days and the mortality rate in the ICU was 42.6%. The AMAs DDD (Defined Daily Dose) per 100 patient days and number of AMAs per prescription were 296.64 and 2.65, respectively. Piperacillin-tazobactam was the most commonly utilized AMAs followed by metronidazole, meropenem, fluconazole, and colistin. The mean number [95% CI] of AMAs, DDD, and cost (INR) per patient were 18.82 (14.05-23.59), 21.09 (15.36-26.81) and 25,827 (18,716-32,939) respectively. The AMAs constituted 88.53% of the total treatment cost. Meropenem was the most costly AMA (32.10% of the total AMAs cost) followed by imipenem-cilastatin (20.50%), colistin (14.65%), piperacillin-tazobactam (8.40%), and clindamycin (4.47%). The independent predictor for the antimicrobial number per day was acute physiology and chronic health evaluation II (APACHE-II) score at admission and nosocomial infections. Conclusion: The AMAs, DDD per 100 patient days, and number per prescription were higher. This leads to a higher cost of AMAs per patient and the AMAs cost out of the total cost as compared to previous studies. We suggest, there is a need to formulate and implement an antimicrobial restriction policy

A study of bone mineral density among people living with HIV in India and its correlation with CD4 count

Background: Data on the prevalence of osteoporosis in HIV patients in Asian population is scarce this study was done to find out the prevalence of osteoporosis in HIV infected patients and its correlation with CD4 counts.Methods: This cross- sectional study was conducted in NACO- ART center of tertiary care hospital. Total 115 HIV patients were included in this study which were divided into ART naive (n= 69) and patients taking ART (n= 46). We analysed BMD by DEXA in 115 HIV positive patients and 78 HIV negative age and sex matched controls. Correlation of BMD with a CD4 count and ART regimen was studied.Results: BMD was found to be low in HIV positive patients. T score in HIV positive patients was significantly lower (p<0.05) as compared to the HIV negative control group. The prevalence of osteopenia and osteoporosis in HIV positive patients was 50.4% and 29.6% respectively, as compared to 23.1% and 2.6% in HIV negative controls. BMD showed relation with CD4 count. We did not find any statistical difference between any ART regimen and BMD.Conclusions: The prevalence of osteopenia and osteoporosis in HIV infected cases was higher as compared to HIV negative controls and higher in ART group as compared to ART naïve group. Low BMD levels show correlation with low CD4 count. We recommend that HIV positive patients especially with advanced stage of disease, low CD4 count should be screened for low BMD by DEXA scan for osteoporosis and managed accordingl

Effect of Tinospora cordifolia as an add - on therapy on the blood glucose levels of patients with Type 2 diabetes

Background: Type 2 diabetes is a fast growing epidemic affecting people globally. Good glycemic control helps in reducing the risk of macro and microvascular complications in diabetics. Alternative medicines have been used since ancient times in India to achieve good glycemic control. Tinospora cordifolia (Tc) is a well reported plant possessing anti-diabetic property. Therefore, we undertook this study to evaluate the effectivity of Tc in reducing the blood glucose levels of Type 2 diabetic patients in the form of add-on therapy.Methods: In the present study, we enrolled 100 Type 2 diabetic patients who met our inclusion criteria. These patients were then randomly divided into two Groups, A and B. Patients in Group A were treated as controls and they continued with their anti-diabetic medications. In Group B, Tc was added to the conventional treatment at a dose of 500 mg 3 times daily along with meals. The fasting and postprandial blood glucose levels and glycosylated hemoglobin (HbA1c) were recorded baseline and after 6 months.Results: During the course of study, we observed a decrease in the fasting, postprandial, and HbA1c levels of the patients. However, this decrease was found to be more statistically significant (p≤0.005) in Group B.Conclusion: The results obtained from the present study conclude that Tc, when given in the form of add-on therapy, was found to be synergistic and effective in the better management of Type 2 diabetes. The drug was well tolerated by the patients and no adverse drug event was recorded

Real-Time Decoding for Fault-Tolerant Quantum Computing: Progress, Challenges and Outlook

Quantum computing is poised to solve practically useful problems which are computationally intractable for classical supercomputers. However, the current generation of quantum computers are limited by errors that may only partially be mitigated by developing higher-quality qubits. Quantum error correction (QEC) will thus be necessary to ensure fault tolerance. QEC protects the logical information by cyclically measuring syndrome information about the errors. An essential part of QEC is the decoder, which uses the syndrome to compute the likely effect of the errors on the logical degrees of freedom and provide a tentative correction. The decoder must be accurate, fast enough to keep pace with the QEC cycle (e.g., on a microsecond timescale for superconducting qubits) and with hard real-time system integration to support logical operations. As such, real-time decoding is essential to realize fault-tolerant quantum computing and to achieve quantum advantage. In this work, we highlight some of the key challenges facing the implementation of real-time decoders while providing a succinct summary of the progress to-date. Furthermore, we lay out our perspective for the future development and provide a possible roadmap for the field of real-time decoding in the next few years. As the quantum hardware is anticipated to scale up, this perspective article will provide a guidance for researchers, focusing on the most pressing issues in real-time decoding and facilitating the development of solutions across quantum and computer science

Efficacy and safety of Tinospora cordifolia (Tc) as an add-on therapy in patients with type-2 diabetes

Background: Type 2 diabetes has become a global epidemic. Tinospora cordifolia is being used in the treatment of type 2 diabetes since ancient times. It is a common misconception that Ayurvedic medicines are always safe. In fact, they also pose serious health risks either in the form of adverse reactions or in the form of drug interactions. Hence this study was undertaken to study the efficacy and safety of Tc on human subjects.Methods: We recruited 40 type 2 diabetic patients who were on oral hypoglycaemic agents. These patients were then randomly divided into two groups, A and B. Patients in group A continued with their anti-diabetic medications while in group B Tc was given at a dose of 500 mg three times daily along with their conventional medications. The fasting and post prandial blood glucose levels, renal function tests and liver function tests were recorded at baseline, 3 months and 6 months.Results: During the course of study we observed a decrease in the fasting and post prandial blood glucose levels of the patients. No significant change was observed in the renal function tests and liver function tests and no other event of any adverse drug reactions were recorded.Conclusion: Tinospora cordifolia (Tc) is effective as an add-on therapy in patients with type-2 diabetes. There is no negative impact of Tc on the renal as well as liver function tests.

Time trends in the incidence of cancer cervix in Karachi South, 1995-2002

Introduction:The objective of the study was to determine the trends of cancer cervix in Karachi South during an eight (1995-2002) year period. Methododology: Cancer cervix cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2002 were analyzed. Trends were studied by analyzing the age standardized incidence rates (ASR)s in 2 time periods, 1995-97 and 1998-2002. Results: Cancer cervix ranked sixth in the 1995-97 period the age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.81 and 3.22. It reached the fifth ranking in the 1998-2002 period with an ASR and CIR of 7.5 and 4.0 per 100,000. Thus between 1995 and 2002, the incidence of cervical cancer registered an approximate 10% increase. The mean age of the cancer cases was 53.3 years (SD 11.6, 95% CI 50.58, 55.96, range 32-85 years) and 50.7 years (SD 11.7, 95% CI 48.8, 52.5, range 51 years) in period 1 and 2 respectively. The morphological components of squamous cell carcinoma and adenocarcinoma remained stable during this period, though a marginally higher component and increasing incidence of adenocarcinoma was observed throughout. A negligible down staging was observed in the 1998-2002 period. Localized malignancy was observed in 30.8% in period 2 as compared to 25.7% in period 1 and the component of carcinoma in situ increased from 0% percent in period 1 to 1.3% in the second period. Despite this two thirds of the cases still presented with a regional or distant spread of disease. Conclusion: Pakistan at present falls into a low risk cancer cervix region. The cause of concern is the steadily increasing incidence especially in the younger birth cohorts, the advanced disease at presentation, insignificant in-situ cancers and no preventive intervention or awareness practices in place

Spontaneous pneumothorax: An unusual complication of pregnancy - A case report and review of literature

Spontaneous pneumothorax complicating pregnancy is rare. Only 55 cases have been reported till now. We describe a case of a 30-year-old Indian woman with spontaneous pneumothorax during her 28th week of pregnancy

Clinical and Radiological Presentations of Various Pulmonary Infections in Hospitalized Diabetes Mellitus Patients: A Prospective, Hospital-Based, Comparative, Case Series Study

Background. Diabetes mellitus is associated with increased rate of respiratory tract infections. The objective was to compare demographic, clinical, serum biochemical, and typical and atypical radiological profiles among hospitalized diabetics and nondiabetics with lower respiratory tract infection. Material and Methods. A prospective, hospital-based, consecutive, comparative observational study of 12-month study duration was conducted. Patients aged 13–90 years diagnosed with lower respiratory tract infection with or without diagnosed diabetes mellitus participated in the study. Demographic, clinical, serum biochemistry, and radiological profiles of diabetics (n=44) and nondiabetics (n=53) were compared. Results. Diabetics were older than nondiabetics at presentation (p<0.0001). Difference in mean random blood sugar (RBS) (p<0.001), fasting blood sugar (FBS) (p<0.001), and postprandial blood sugar (PPBS) (p<0.0001) was significant between diabetics and nondiabetics. Nondiabetics more frequently presented with fever (p=0.0032), chest pain (p=0.0002), and hemoptysis (p=0.01) as compared to diabetics. Diabetics more frequently presented with extreme temperatures (hypothermia or hyperpyrexia) (p=0.022), lower serum sodium levels (p=0.047), and lower partial arterial pressure (p<0.001) than nondiabetics. The mean pneumonia patient outcomes research team (PORT) risk score was higher in diabetics (124.84±41.31) compared to nondiabetics (77.85±39.77) (p<0.001). Diabetics more commonly displayed bilateral lesions with multilobe or lower lobe involvement, the most common type of lesion being exudative. Conclusion. Diabetic patients usually had severe pulmonary infection and poor prognosis as suggested by higher mean PORT risk score. They also more frequently presented with bilateral lesions with multilobe or lower lobe involvement as evidenced by radiography as compared to nondiabetic patients