Role of C- reactive proteins in cerebro-spinal fluid in differentiating pyogenic from nonpyogenic meningitis

Background:In developing countries like India meningitis is major cause of morbidity and mortility because of delay in proper diagnosis and consequently delay in proper treatment.  For the appropriate treatment of meningitis, differentiation of various types of meningitis is essential. The diagnosis of meningitis in a govt. hospitals is usually made by examination of CSF, Gram staining, AFB, CSF culture and associated clinical findings. All these laboratory techniques have their limitations. So we need a diagnostic test which is rapid, reliable and cost effective. In the present study we used CRP levels in CSF sample to differentiate pyogenic from non-pyogenic meningitis and to establish a cut off level for CRP.Methods: The study is a hospital based prospective study carried out in the setting of department of pathology, microbiology, casuality and various wards of Netaji Subash Chandra Bose Medical College Jabalpur (M.P) India during November 2014 to October 2015. During study period we took samples (Blood and CSF) from 138 cases of suspected meningitis.Results: Value of CRP was 32.50645±2.032886 in PM cases, 1.543373±0.195181 in TBM cases and VM cases value were 2.420833±0.357502. Statistically significantly higher value was observed with pyogenic meningitis cases compared to TBM and VM cases. (p<0.001).  At 10 U/L cut off value, sensitivity and specificity of CSF- CRP was 93.5% and 94.4% respectively.Conclusions: On the basis of present study we concluded that CRP can be used as a rapid confirmatory test since elevated CRP are highly suggestive of pyogenic meningitis.

Role of multi-detector computed tomography in congenital heart diseases

Background: The study aimed to assess sensitivity, specificity and accuracy of CT scan in diagnosing various cardiovascular anomalies in patients with complex congenital heart disease; to obtain additional information in pre-operative patients, inconclusive on echocardiography; and to compare results of multi-detector computed tomography (MDCT) with cardiac catheter angiography (CCA) in accurately delineating the cardiovascular morphological features and to determine if MDCT can replace diagnostic CCA in evaluation of complex CHD.Methods: In this prospective, comparative, single-centre study, a total 50 patients were included in the study aged between 6 days to 17 years. All patients were referred by pediatric cardiologists between August, 2014 and November, 2016. All patients had undergone initial echocardiography and final diagnosis was confirmed by comparing MDCT data with CCA.Results: Total of 177 cardiovascular anomalies are found in our study of 50 patients out of these 3 cases of VSD and one case of ASD was missed on CT angiography and its overall accuracy as compared to catheter angiography was found to be 97.1% Its accuracy in evaluation of TOF, DORV, TAPVC, TA TGA, COA, right sided aortic arch, MAPVC, persistent SVC, PDA, PS, vascular sling and coronary cameral fistula was 100%.Conclusions: The MDCT is found comparable to CCA in the diagnosis of extra cardiac vascular anomalies but the overall sensitivity in the diagnosis of intra-cardiac anomalies is little lower. It can be used as a substitute to CCA in complex CHD and is very helpful tool in preoperative planning and postoperative follow-up

A case control study on s. uric acid and s. creatinine level in pre-eclampsia patients of a tertiary care hospital in Jabalpur district of Central India

Background: Pre-eclampsia is a multisystem disorder of pregnancy which is characterized by hypertension with proteinuria after 20 weeks of gestation in previously normotensive and non proteinuric pregnant women. Pre-eclampsia associated with intrauterine growth retardation, preterm birth, maternal and perinatal death. Serum creatinine and uric acid has been shown to play a significant role in the pathogenesis of the disease and often precede clinical manifestations. This study compares the serum creatinine and uric acid in pre -eclampsia case and normal pregnant women and to assess its role in pre-eclampsia.Methods: 158 patients of which 79 pre-eclampsia (cases) and 79 (controls) were selected randomly and were matched with their gestational age in patient who Attending ANC clinic at Department of Obstretics and Gynecology in March 2016 to August 2017. Lipid profile was estimated by the Randox imola is a compact fully automated clinical chemistry analyser.Results: Authors observed that pre-eclampsia is more common in young age pregnant women with low socioeconomic status with strenuous activities. The mean age was 24.51±3.707 years. The mean serum creatinine and urice acid value is analysed in pre-eclampia cases and compared with control group showing significantly increase (p<0.0001).Conclusions: Young age, nullyparity, low socio economic status specially labour occupation, with derangment of Serum creatinine in pregnant women were found to be more prone to develop pre-eclampsia. Proper history tacking, examination and estimation of serum creatinine and uric acid may be helpful for early diagnosis and management of pre–eclampsia in order to prevent fetal and maternal complications especially in nulliparous women

Moving the Needle: Changing the Culture Around Professionalism For Faculty As Evaluated by Medical Students

Moving the needle: Changing the culture around professionalism for faculty as evaluated by medical students Rationale Professionalism is an integral aspect of physician growth and development and a core competency in medical education. Clinical experiences and faculty role models are the most powerful determinants of professional behaviors and values in the practice of medicine.1,2 Yet, with significantly greater stress placed on clinical faculty in the last 25 years, there has been increasing concern over an erosion of the attitudes and behaviors of practicing physicians and the resulting negative impact on the professional development of medical students and resident physicians3. Given its importance, faculty professionalism is assessed annually in the American Association of Medical Colleges graduate questionnaire (AAMC GQ) survey of fourth year medical students, providing medical education leaders with data on their performance compared to medical schools nationally, as well as year-over-year trends.. Many schools struggle with faculty professionalism data that is reported through the GQ and their students’ perception of a poorly perceived professional clinical environment. The three schools presenting at this session have received low learning environment scores at different times and have employed interventions to change the culture at their institutions, with varying success, to address the underlying root causes. In this session, we will discuss overall challenges of addressing the learning environment and faculty professionalism. After that, each student will report its GQ data, root causes identified, and interventions to address those root causes. After the presentations, participants will break out into small groups and, using a structured guide, review data from their own schools as well as interventions that have been tried to address those issues. Participants will come together at the end for a facilitated discussion to summarize their conversations and discuss ideas and opportunities to bring to their home institution to improve the learning environment. Learning Objectives • Review the quality improvement approach and interventions that have been shown to be effective at improving professionalism at UC Davis, UC Riverside, and UC San Diego • Develop a list of high-impact interventions that can be utilized to improve professionalism in the learning environment at your institution • Describe your approach to implementation of interventions unique to your institutionand ways in which these incidents can be shared with the broader educational community Session Plan • 10 minutes: Describe why changing professionalism outcomes is a “wicked problem” • 24 minutes: Review the approach and adoption of interventions at UC Davis, UC Riverside, and UC San Diego where these institutions have strived to improve culture of professionalism (8 mins each) • 30 minutes: Breakout sessions where participants discuss professionalism challenges at their home institutions and brainstorm interventions to improve their culture. • 25 minutes: Plenary group discussion to identify consensus approaches and opportunities to enact culture change Products/materials • PPT Experience • Mithu Molla MD – Director of the Learning Environment, Co-Chair Learning Climate Committee, UCD SOM • Sharad Jain MD – Associate Dean for Students, Co-Chair Learning Climate Committee, UCD SOM • Mark Servis MD – Vice Dean for Medical Education, UCD SOM • Christina Granillo, PhD - Director of Academic Success, Chair of the Grievance Committee and co-Chair of our Learning Environment Council • Michelle Daniel, MD, MHPE, FACEP - Vice Dean for Medical Education, Professor of Clinical Emergency Medicine UC San Diego SOM • Emma M Simmons MD, MPH – Senior Associate Dean of Student Affairs, UC Riverside SOM Bibliography 1- Orit Karnieli-Miller, PhD, et al. Medical Students’ Professionalism Narratives: A Window on the Informal and Hidden Curriculum. Academic Medicine, Vol 85, No.1/January 2010 2- Inui TS, et al. A Flag in the Wind: Educating for Professionalism in Medicine. Washington DC: Association of American Medical Colleges; 2003. 3- Swick H, et al. Teaching Professionalism in Undergraduate Medical Education. JAMA, September 1, 1999- Vol 282, No.9 4- Binder R, et al. Preventing and Managing Unprofessionalism in Medical School Faculties. Acad Med. 2015;90:442-446

Clinical profile of patients with prosthetic heart valve thrombosis undergoing fibrinolytic therapy and NYHA class as a predictor of outcome

Background: Prosthetic heart valve thrombosis (PHVT) is a potentially fatal complication of heart valve replacement with mechanical prostheses mainly due to thrombosis.Aim: The study aimed to evaluate the clinical profile of the patients presenting with PHVT undergoing fibrinolytic therapy and analyzing patients with respect to New York Heart Association (NYHA) functional class on presentation and its association with outcome of fibrinolytic therapy.Settings &amp; design: This was prospective, observational study conducted from June, 2016 to April, 2017. Total 133 patients with prosthetic heart valve thrombosis were included. Materials and methods: Routine blood investigations included complete hemogram, liver and renal function tests. Prothrombin time with INR was done on admission. The diagnosis of PHVT was assessed by fluoroscopy and/or echocardiography (transthoracic/transesophageal). Follow-up at 6 months was scheduled for all patients.Statistical analysis: Parametric values between two groups were performed using the independent sample t-test or chi-square test, as appropriate. Univariate and multivariate logistic regression was used to find out factors associated with outcome.Results: All patients received fibrinolytic therapy in which 108 (81.2%) were treated with streptokinase and 25 (18.8%) were treated with urokinase. On presentation, 48.9% patients were in NYHA class III, 41.4% in NYHA class IV and 9.77% in NYHA class II. Fibrinolytic therapy was successful in 105 patients (78.9%) and it failed in 28 patients (21.1%). Mortality in NYHA class II was 0%, NYHA class III was 4.6% and in NYHA class IV was 23.6%. During 6 months follow up prosthetic heart valve thrombosis recurred in 12 (11.43%) patients.Conclusion: From our single centre experience, fibrinolytic therapy is fairly effective first line therapy for prosthetic heart valve thrombosis and NYHA functional class on presentation can predict the outcome of fibrinolytic therapy

Analysis of Soil Water Retention Data Using Artificial Neural Networks

Many studies of water flow and solute transport in the vadose zone require estimates of the unsaturated soil hydraulic properties, including the soil water retention curve (WRC) describing the relationship between soil suction and water content. An artificial neural network (ANN) approach was developed to describe the WRC using observed data from several soils. The ANN approach was found to produce equally or more accurate descriptions of the retention data as compared to several analytical retention functions popularly used in the vadose zone hydrology literature. Given sufficient input data, the ANN approach was also found to closely describe the hysteretic behavior of a soil, including observed scanning wetting and drying curves

Understanding future water challenges in a highly regulated Indian river basin — modelling the impact of climate change on the hydrology of the upper Narmada

The Narmada river basin is a highly regulated catchment in central India, supporting a population of over 16 million people. In such extensively modified hydrological systems, the influence of anthropogenic alterations is often underrepresented or excluded entirely by large-scale hydrological models. The Global Water Availability Assessment (GWAVA) model is applied to the Upper Narmada, with all major dams, water abstractions and irrigation command areas included, which allows for the development of a holistic methodology for the assessment of water resources in the basin. The model is driven with 17 Global Circulation Models (GCMs) from the Coupled Model Intercomparison Project Phase 5 (CMIP5) ensemble to assess the impact of climate change on water resources in the basin for the period 2031–2060. The study finds that the hydrological regime within the basin is likely to intensify over the next half-century as a result of future climate change, causing long-term increases in monsoon season flow across the Upper Narmada. Climate is expected to have little impact on dry season flows, in comparison to water demand intensification over the same period, which may lead to increased water stress in parts of the basin