COVID-19 disease and comorbidity: an outcome? A study on Indian population in a COVID care hospital

Background: The world has been severely affected by the novel coronavirus disease (Covid-19). Continuously rising number of cases has put a significant strain on healthcare resources of all countries of the world. Preliminary studies show that people suffering from comorbid conditions are at a relatively higher risk of severe disease and poor outcome.Methods: We studied the risk of ICU admission in 152 Covid-19 positive patients with comorbidity compared to those without comorbid conditions. We studied effect of old age (>65 years), male sex, presence of at least one comorbidity, presence of multiple comorbidities, diabetes mellitus, hypertension, CAD, respiratory disease, neurological disease, skin disease, and hypothyroidism on outcome of coronavirus disease with two tailed Student’s t-test, odds ratio, Chi-square test was used to test significance of results at 95% confidence interval 95% (95% CI). Fisher’s test was also used if one expected value (row total × column total/grand total) was less than 5.Results: In this study, 23 (15.13%) required ICU care. We found higher odds of ICU admission in Covid-19 patients in case of presence of comorbid condition (OR=7.3, 95% CI=2.674, 20.038), diabetes mellitus (OR=2.8, 95% CI=1.035, 8.028), hypertension (OR=1.3, 95% CI=0.396, 4.258), coronary artery disease (OR=2.3, 95% CI=0.430, 12.978) and malignancy (OR=6.5, 95% CI=1.516, 28.54). Case fatality rate (CFR) of those with comorbid conditions was higher (7.55) compared to those without comorbidity (3.03).Conclusions: This study shows that presence of comorbid conditions in Covid-19 positive patients results in significantly higher risk of ICU admission and poor outcome

Biochemical markers of tubercular ascites

ABSTRACT The diagnosis of abdominal tuberculosis requires a high index of suspicion due to its vague symptomatology. Early diagnosis of tubercular ascitis is crucial to prevent progression of disease to its advanced stages, thereby preventing the fatal complication like intestinal obstruction, fistulas and peritonitis. The objective of our research work is to evaluate the role of biochemical parameters such as Adenosine Deaminase (ADA), IgG, Lactate, Total protein and albumin, Glucose, Cholesterol and pH in diagnosis of abdominal tuberculosis. Ascitic fluid samples were taken from patients admitted in medicine wards of SSK Hospital after informed consent. A total of 100 patients meeting the selection criteria were enrolled in the study. The biochemical investigations performed for the ascitic fluid samples were Adenosine Deaminase (ADA), IgG against 38 kDa mycobacterial antigen, Lactate, Total protein, albumin, Glucose, Cholesterol and pH. In the 79 patients that had been followed up, with ATT response as a reference, a highly significant association was observed with ascitic fluid assays ADA, IgG, Serum Ascitic Albumin Gradient(SAAG), Cholesterol, Lactate and pH. Adenosine Deaminase (ADA) and IgG against 38 kDa mycobacterial antigen can be used as corroborative markers for diagnosis of extra pulmonary paucibacillary tubercular ascitis where conventional methods like smear microscopy and culture frequently fail to establish the diagnosis

Rapid Detection of Mutation in RRDR of rpo B Gene for Rifampicin Resistance in MDR-Pulmonary Tuberculosis by DNA Sequencing

To detect the site of mutation in RRDR of rpo B gene for rifampicin resistance in MDR-TB by DNA sequencing. 50 MDR-TB patients were enrolled in our study after informed written consent. Mycobacterial DNA was extracted from sputum samples by Universal Sample Processing (USP) method and RRDR of rpo B gene was amplified by PCR using primers RP4T and RP8T and then sequenced by automated DNA sequencing. The nucleotide sequences of RRDR of rpo B gene were compared with the reference sequence. We observed three different types of mutation in the RRDR of rpo B gene. The frequency of mutation in codon 531 (TCG → TTG), 526 (CAC → TAC) and 516 (GAC → GTC) are 60, 26.6 and 6.6% respectively. Of the total cases studied, 6.6% cases, although resistant to rifampicin, did not show any mutation in the RRDR of rpo B gene. Codon 531 (TCG → TTG) is the most common site of mutation in RRDR of rpo B gene for rifampicin resistance in MDR-pulmonary tuberculosis followed by codon 526 (CAC → TAC) and codon 516 (GAC → GTC)

Issues in antifungal stewardship: an opportunity that should not be lost

Many countries have observed an increase in the incidence of invasive fungal infections (IFIs) over the past two decades with emergence of new risk factors and isolation of new fungal pathogens. Early diagnosis and appropriate antifungal treatment remain the cornerstones of successful outcomes. However, due to non-specific clinical presentations and limited availability of rapid diagnostic tests, in more than half of cases antifungal treatment is inappropriate. As a result, the emergence of antifungal resistance both in yeasts and mycelial fungi is becoming increasingly common. The Delhi Chapter of the Indian Association of Medical Microbiologists (IAMM-DC) organized a 1 day workshop in collaboration with BSAC on 10 December 2015 in New Delhi to design a road map towards the development of a robust antifungal stewardship programme in the context of conditions in India. The workshop aimed at developing a road map for optimizing better outcomes in patients with IFIs while minimizing unintended consequences of antifungal use, ultimately leading to reduced healthcare costs and prevention development of resistance to antifungals. The workshop was a conclave of all stakeholders, eminent experts from India and the UK, including clinical microbiologists, critical care specialists and infectious disease physicians. Various issues in managing IFIs were discussed, including epidemiology, diagnostic and therapeutic algorithms in different healthcare settings. At the end of the deliberations, a consensus opinion and key messages were formulated, outlining a step-by-step approach to tackling the growing incidence of IFIs and antifungal resistance, particularly in the Indian scenario