A clinical study of patients with central venous catheter associated bloodstream infections in a tertiary care hospital

Background: Central venous access puts the patients at risk of iatrogenic complications and is associated with bloodstream infections. Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus saprophyticus and Methicillin Resistant Staphylococcus aureus (MRSA) are responsible for at least two-thirds of the infections followed by Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Enterococcus spp and Acinetobacter spp. Due to the scarcity of Central Venous Catheter associated Blood Stream Infections (CVC-BSI) data, this study was taken up in our tertiary care hospital. Aims: This study is aimed to study the profile of organisms causing CVC-BSI, assess their antimicrobial susceptibility, the clinical course and outcome.Methods: All subjects whose central venous catheter samples (n=84) were sent for culture and sensitivity during the study period were included in this prospective observational study. The study was done in the Department of Microbiology from July 2019 to December 2019. The catheter tips were streaked onto blood agar plate using Roll plate technique. After biochemical identification of the organisms, antimicrobial susceptibility testing was performed by modified Kirby-Bauer disc diffusion method as per the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: Growth of pathogens was seen in 64.3% (n=54). The common organisms were Coagulase Negative Staphylococcus aureus (CONS) in 27.78% (n=15), Enterococcus spp, Klebsiella pneumoniae in 14.8% each (n=8) and Acinetobacter spp in 11.1% (n=6). Resistance was seen with amoxicillin + clavulanic acid, cefepime, ciprofloxacin and cefoperazone. The organisms were sensitive to levofloxacin, tetracycline and vancomycin.Conclusion: Aseptic precautions taken by the healthcare personnel will bring down the infections and curb the spread of multi-drug resistant hospital acquired infections

A clinical study of uropathogens causing urinary tract infection in children and adolescents in a tertiary care hospital

Background: Urinary Tract Infection (UTI) is one of the common infections in children. Incidence varies with age, race and gender. UTIs have become difficult to treat due to development of resistance among uropathogens. Regional data regarding the common uropathogens and their antimicrobial susceptibility pattern is required to guide the clinicians to start empirical therapy while treating UTIs.Aims: This study is aimed to study the profile of uropathogens causing UTI in children and adolescents, assess their antimicrobial susceptibility, the clinical course and outcome.Methods: All subjects with suspected UTI whose urine samples grew a positive culture of uropathogens were included in this prospective observational study. The study was done in the Department of Microbiology from July 2019 to December 2019. The urine samples were processed by standard methods (using 5% sheep blood agar and MacConkey agar) and antimicrobial susceptibility was performed using the Kirby-Bauer disk diffusion method. The details of the pathogens grown, and their antimicrobial sensitivity and resistance patterns were recorded, and the subjects were followed up during their course in the hospital.Results: A total of 109 urine samples from paediatric and adolescent subjects showed positive cultures (97.32%). UTI was common among toddlers (46.7%). E. coli contributed to 40.3% of the cases, followed by Enterococcus and Klebsiella pneumonaie. E. coli was resistant to amoxicillin + clavulanic acid, cephalosporins and ciprofloxacin. The organisms were sensitive to meropenem, amikacin and piperacillin + tazobactam.Conclusion: Incidence of UTI and the uropathogens causing UTI varies with age. Different uropathogens and their resistance to commonly used antimicrobials is a concern for future treatment options in UTI

Evaluation of different types of chest symptoms for diagnosing pulmonary tuberculosis cases in community surveys

Background: Prevalence of tuberculosis (TB) is an important epidemiological index to measure the load of the disease in a community. A series of disease surveys were undertaken in rural community in Tiruvallur district in Tamilnadu, south India Objective: To investigate the yield of pulmonary tuberculosis (TB) cases by different symptoms status and suggest predominant symptoms for detection of cases in the community based surveys. Methods: Three disease surveys were conducted during 1999-2006, in a random sample of 82,000 adults aged > 15 years to estimate the prevalence and incidence of pulmonary TB. All subjects were screened for chest symptoms and chest radiography. Sputum examination was done among those who were either symptomatic or abnormal on X-ray or both. Cases observed through symptom inquiry were included for analysis. Results: In survey-I, 65.6% had cough of > 14 days and yielded 79.1% of the total cases. In surveys II and III, symptomatic subjects with cough contributed 69.5% and 69.2% of the cases respectively. In survey I, 26.8% had symptoms without cough but with at least chest pain > 1 month contributed 8.4% of total cases. The corresponding proportions in subsequent surveys were 29.3, 11.5%; and 23.4, 11.2% respectively. The number of symptomatics without cough and chest pain but with fever > 1 month was negligible. Conclusion: The relative importance of cough as a predominant symptom was reiterated. The yield of pulmonary TB cases from symptomatics having fever of > 1 month was negligible. Fever may be excluded from the definition of symptomatics for screening the population in community survey

Weight gain in patients with tuberculosis treated under directly observed treatment short-course (DOTS)

Set up: One Tuberculosis Unit (TU) in Tiruvallur district, Tamil Nadu, India where Tuberculosis (TB) patients treated under Directly Observed Treatment Short Course (DOTS) programme. Objective: To identify the effects of weight gain among TB patients at the end of treatment on different factors such as socio-economic and demographic characteristics, smoking and drinking habits, treatment under supervision, the type of DOTS centres and problems in taking drugs. Methods: TB patients registered between May 1999 and December 2004 formed the study population. Multiple regression method was used for the analysis. Results: Among 1557 smear-positive TB patients registered under DOTS programme, the changes in weight ranged from a loss of 4 kgs to a gain of 20 kgs at the end of TB treatment; the average change in weight was 3.22 kgs. The gain in weight at the end of treatment was associated with age (<45 years), DOT at government centres, no problems in taking drugs as reported by patients and cure rate. Conclusion: The findings showed that there is an association between gain in weight with DOT at government centres and cure of patients

Keyword Specific Cloud Computing

It is now a known fact that Internet of things (Iot) and Cloud computing will be the way ahead. Store and transmit of massive amounts of data is on the cards in the coming years which will profoundly affect other areas of everyday life in the next generation. Cloud and Iot are merged together is seen as an enabler of a large number of application scenarios. As an example at the start of 2016 automakers are building a driverless taxi service. Keeping this in mind a novel idea of keyword based Cloud Computing is brought about in this paper which gives out entire data to the user if the user types the keyword of the required entity

Survival of tuberculosis patients treated under DOTS in a rural tuberculosis unit (TU), south India.

Objective: To estimate survival probabilities and identify risk factors for death of tuberculosis (TB) patients during treatment period. Methods: TB patients registered during May 1999 to December 2004 from a rural TB unit (TU) with a population of 580 000 in Tiruvallur district, South India, formed study population. Life table and Cox’s regression methods were used. Results: Of the 3818 TB patients who were initiated on treatment, 96, 94 and 97% of category – I, II and III respectively, were surviving after completion of treatment. Higher death rates were independently associated with patient’s age (45 years), previous history of treatment, alcoholism and initial body weight (<35 kgs). Conclusion: The survival probability was found to be similar in all patients irrespective of categorization. Necessary actions need to be initiated in the programme to improve body weight and abstain from alcoholism

Comparison of the spatial QRS-T angle derived from digital ECGs recorded using conventional electrode placement with that derived from Mason-Likar electrode position

Background: The spatial QRS-T angle is ideally derived from orthogonal leads. We compared the spatial QRS-T angle derived from orthogonal leads reconstructed from digital 12-lead ECGs and from digital Holter ECGs recorded with the Mason-Likar (M-L) electrode positions. Methods and results: Orthogonal leads were constructed by the inverse Dower method and used to calculate spatial QRS-T angle by (1) a vector method and (2) a net amplitude method, in 100 volunteers. Spatial QRS-T angles from standard and M-L ECGs differed significantly (57° ± 18° vs 48° ± 20° respectively using net amplitude method and 53° ± 28° vs 48° ± 23° respectively by vector method; p &lt; 0.001). Difference in amplitudes in leads V4–V6 was also observed between Holter and standard ECGs, probably due to a difference in electrical potential at the central terminal. Conclusion: Mean spatial QRS-T angles derived from standard and M-L lead systems differed by 5°–9°. Though statistically significant, these differences may not be clinically significant

A Clinical study and Management of Cholelithiasis

INTRODUCTION: Among the many distinguished names in Hindu medicine is that of SUSHRUTA, The Father of Indian surger. He compiled the surgical knowledge of his time in his classic ―Sushrata Samhitha. It is believed that this classic was compiled between 800 B.C. and 400 A.D. He described jaundice as-pitta-ashmarijanya‖ meaning a jaundice caused by stone in bile.1It was also known that such jaundice could be caused by wrong diet. 6% of prevelance gall stone was found in India. Diagnosis of gallstone is by proper history and physical examination and combining it with appropriate investigations. With the help of ultrasound we can easily identify gall stones. Because of increase incident of Gall stones and its variable presentations in there is a need for study which can provide prevalence, clinical presentations and management outcomes. AIM OF THE STUDY: 1. To study the age and sex distribution. 2. To study the various modes of presentation. 3. To study safety and efficacy of laparoscopic cholecystectomy in patients of cholelithiasis by comparing with results of open cholecystectomy by comparing use of post-operative analgesia, post-operative hospital stay, wound infection. METHODOLOGY: This dissertation titled as “A clinical study and management of cholelithiasis” is going to conduct at Govt. Royapettah Hospital, KMCH, Chennai-10 for a period of January 2018 to June 2018. About 53 consecutive cases will admit, examine, investigate and operate during the period of January 2018 to June 2018. Detailed history of all the 53 cases will take according to the profoma approved by the guide. Detailed history and examination and relevant investigations done. Risk and complications of the condition as well as surgery has been explain to the patients, concern will take. Preoperative antibiotics will give. In this study sum of the patients undergone open cholecystectomy and some of the patients undergone lap cholecystectomy. Postoperative pain were assessed by VAS. Patients who undergone lap cholecystectomy discharge on the 7th day and open cholecystectomy discharge on the 11th day. Unless any complications. All Patients advise regarding diet, rest and to visit the surgical OPD for regular follow up. In the follow up period attention were given to subject to improvement of the patients with regard to symptoms as well as examination of the operative scar. OBSERVATION: The age incidence of cholelithiasis was more in the 3rd, 4th & 5th decade, with peak incidence in 4th decade of life. 60.4% (32 Patients) were female and 39.6 % (21 Patients) were male. The female to male ratio was 1.52:1. Pain was the commonest presenting symptom presenting in 98% patients. Tenderness in the right hypochondrium was the most common sign present in 100%. The most common complication of cholelithiasis was chronic cholecystitis 80% .LC versus OC (18 cases in open and 35 cases in lap) and found that the mean operating room time was 104 min for OC and 88 min for LC. The conversion rate was 10.5%. The mean duration of hospital stay was 11 days for OC and 8 days for LC. The amount and period of analgesia were significantly less in the LC group. Patients recovered significantly faster after LC. CONCLUSION: The highest age incidence of cholelithiasis was in the 4th decade, even though no age group was exempt from the disease process. The incidence of cholelithiasis was more in females. The commonest symptom was pain and commonest sign was tenderness. The most common complication presenting with symptomatic gall stones was chronic cholecystitis. Laparoscopic cholecystectomy is a safe and effective treatment for most patients with symptomatic gallstones