BACKGROUND Leptospirosis is a globally prevalent zoonotic disease with a significant burden in tropical and subtropical regions,including India.Despite its high fatality rate and endemic nature,the disease remains und...BACKGROUND Leptospirosis is a globally prevalent zoonotic disease with a significant burden in tropical and subtropical regions,including India.Despite its high fatality rate and endemic nature,the disease remains underreported in many areas,particularly in Northern India.AIM To analyze the demography,clinical presentation,complications,and mortality risk factors in presumptive leptospirosis patients admitted to a tertiary care hospital over the last 7 years from the Himalayan and Sub-Himalayan regions of Northern India.METHODS A retrospective analysis was conducted on hospital records of patients admitted with leptospirosis at the All India Institute of Medical Sciences,Rishikesh,between January 2018 and December 2024.Diagnosis was based on the Modified Faine’s Criteria and laboratory confirmation via IgM enzyme-linked immu-nosorbent assay(ELISA)and other diagnostic tests.Statistical analysis,including logistic regression,was performed to determine mortality predictors.RESULTS A total of 62 patients were included in the study.The most common symptoms were fever(98.39%),myalgia(41.94%),and jaundice(20.97%).Thrombocytopenia was the most frequent complication,occurring in 72.58%of cases,followed by hepatic involvement(62.9%)and acute kidney injury(40.32%).Multiorgan dys-function syndrome was present in 66.13%of cases,with 19.35%developing acute respiratory distress syndrome(ARDS).The overall mortality rate was 20.97%,with a higher but non-significant mortality trend in the Himalayan region(35%vs 14.29%,P=0.094).Logistic regression analysis revealed that no categorical predictor alone was statistically significant.However,ARDS had a high odds ratio(OR=2.10),suggesting clinical importance despite variability.Jaundice(OR=2.28,P=0.383)and creatinine levels(OR=2.12,P=0.1029)showed a possible trend toward increased mortality,despite statistical variability.Higher international normalized ratio levels(OR=0.33,P=0.0662)were suggestive of a protective effect.CONCLUSION Leptospirosis remains a severe and often fatal disease in Himalayan and sub-Himalayan regions,particularly in hilly areas,where underreporting and delayed diagnosis contribute to poor outcomes.Mortality was highest(33.33%)in cases with multiorgan involvement,particularly affecting the liver,kidneys,and lungs.We did not identify any statistically significant mortality predictors.Although the study did not assess the impact of timely diagnosis,improving healthcare accessibility in hilly regions may facilitate earlier detection and intervention,potentially reducing mortality.展开更多
BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies...BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies,or disease progression itself.We present a case of an advanced human immunodeficiency virus(HIV)patient with chronic diarrhoea,significant weight loss,and antiretroviral therapy(ART)non-compliance,highlighting the diagnostic dilemma between HIV wasting syndrome,OIs,and malignancy.CASE SUMMARY A 36-year-old female,diagnosed with HIV five years ago on family screening,presented with three months of profuse watery diarrhoea,associated with crampy abdominal pain and weight loss(14 kg,30%in 3 months).She was non-compliant with ART.There was no history of recent travel,food contamination,or tuberculosis contact.Fever episodes were mild and transient.Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly.Genital examination was unremarkable.Routine investigations revealed severe anaemia and confirmed PLHIV status.CD4 count was<36 cells/μL.Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis.After ruling out OIs,ART was restarted.With treatment,her diarrhoea resolved,and she tolerated oral intake.Nutritional support was provided,and she was discharged in stable condition with ART,prophylactic antibiotics,and followup instructions for further evaluation.CONCLUSION In ART-noncompliant PLHIV with chronic diarrhoea,distinguishing between HIV wasting syndrome,OIs(Cryptosporidium,Mycobacterium avium complex,cytomegalovirus colitis)and malignancies(non-Hodgkin lymphoma and anal carcinoma)are critical.Gradual CD4 decline,systemic inflammation,and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy.Early recognition and management,including ART reinitiation and nutritional support,are crucial for prognosis.展开更多
BACKGROUND Antimicrobial resistance(AMR)is an escalating global health threat,disproportionately impacting low-income and middle-income countries like India.The rise of multidrug-resistant organisms(MDROs)complicates ...BACKGROUND Antimicrobial resistance(AMR)is an escalating global health threat,disproportionately impacting low-income and middle-income countries like India.The rise of multidrug-resistant organisms(MDROs)complicates treatment,increases healthcare costs,and contributes to higher morbidity and mortality.In India,factors such as antibiotic misuse,over-the-counter availability,and self-medication have exacerbated this crisis.Despite the urgency,regional data on MDRO prevalence remains limited.AIM To assess the burden and distribution of MDRO infections identified at a tertiary healthcare institute in North India.METHODS This cross-sectional study analyzed inpatient data from All India Institute of Medical Sciences(AIIMS)Rishikesh using the E-hospital database from May 2021 to February 2024,except 2022.All inpatients with culture-confirmed MDRO infections were included.Patient charts and discharge summaries were reviewed.Data analysis was performed using Jamovi software,with descriptive statistics summarizing demographics.Theχ²test was used to assess associations between MDROs and various factors.Ethical approval was obtained,and patient confidentiality was maintained.RESULTS This study included 820 participants having 1106 MDROs.The majority of patients were aged 35-64 years,with a male predominance(57.6%).Most cases were from Uttar Pradesh(49.1%)and Uttarakhand(47.6%),with Bijnor and Haridwar districts reporting the highest burden from their respective states.Klebsiella pneumoniae(K.pneumoniae)(30.6%),Acinetobacter baumannii(16.7%),and Escherichia coli(E.coli)(16.7%)were the most common MDROs.Urine was the most frequent sample type(51.0%),with K.pneumoniae as the leading pathogen.Infections varied significantly across departments(P<0.001),with General Medicine and Surgery reporting the highest burden.E.coli and Klebsiella spp.were most prevalent in these departments respectively.MDRO prevalence fluctuated over time,with significant variations by quarter(P<0.001).Following the second coronavirus disease 2019 wave,there was a rapid surge in MDROs,which stabilized after approximately three months.The overall mortality among patients harboring MDROs was 25.9%.CONCLUSION This study highlights the burden of MDROs among patients at AIIMS Rishikesh,with K.pneumoniae as the predominant pathogen.Strengthening antimicrobial stewardship and infection control measures is essential to combat rising AMR,with department-specific,and pathogen-specific stewardships.展开更多
BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safel...BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.展开更多
BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effecti...BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.展开更多
BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or ...BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.展开更多
BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted ...BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health.Despite negative results for tropical fever infections,he had neutrophilic leucocytosis,acute kidney injury,and chest imaging findings suggestive of bilateral consolidations.On day two,he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia,and communityacquired pneumonia.Despite treatment with broad-spectrum antibiotics,he did not respond and succumbed to death on day five.CONCLUSION This case highlights that clinicians/public should be aware of MDR communityacquired pneumonia,bacteraemia,and endocarditis which ultimately culminate in high rates of morbidity and mortality.Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities.Simultaneously,route cause analysis of communityacquired MDR/XDR pathogens is a global need.展开更多
BACKGROUND The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance(AMR),which is a global public health concern.India has particularly high rates of AMR,posing a threat to effecti...BACKGROUND The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance(AMR),which is a global public health concern.India has particularly high rates of AMR,posing a threat to effective treatment.The World Health Or-ganization(WHO)Access,Watch,Reserve(AWaRe)classification system was introduced to address this issue and guide appropriate antibiotic prescribing.However,there is a lack of studies examining the prescribing patterns of antimi-crobials using the AWaRe classification,especially in North India.Therefore,this study aimed to assess the prescribing patterns of antimicrobials using the WHO AWaRe classification in a tertiary care centre in North India.Ophthalmology,Obstetrics and Gynecology).Metronidazole and ceftriaxone were the most prescribed antibiotics.According to the AWaRe classification,57.61%of antibiotics fell under the Access category,38.27%in Watch,and 4.11%in Reserve.Most Access antibiotics were prescribed within the Medicine department,and the same department also exhibited a higher frequency of Watch antibiotics prescriptions.The questionnaire survey showed that only a third of participants were aware of the AWaRe classification,and there was a lack of knowledge regarding AMR and the potential impact of AWaRe usage.RESULTS The research was carried out in accordance with the methodology presented in Figure 1.A total of n=123 patients were enrolled in this study,with each of them receiving antibiotic prescriptions.The majority of these prescriptions were issued to inpatients(75.4%),and both the Medicine and Surgical departments were equally represented,accounting for 49.6%and 50.4%,respectively.Among the healthcare providers responsible for prescribing antibiotics,72%were Junior Residents,18.7%were Senior Residents,and 9.3%were Consultants.These findings have been summarized in Table 1.The prescriptions included 27 different antibiotics,with metronidazole being the most prescribed(19%)followed by ceftriaxone(17%).The mean number of antibiotics used per patient was 1.84±0.83.The mean duration of antibiotics prescribed was 6.63±3.83 days.The maximum number of antibiotics prescribed per patient was five.According to the AWaRe classification,57.61%of antibiotics fell under the Access,38.27%in Watch,and 4.11%in Reserve categories,suggesting appropriate antibiotic selection according to these criteria.The distribution of antibiotics prescribed according to the WHO AWaRe categories is presented in Figure 2.The difference in prescribing frequencies amongst departments can be noted.Most of the antibiotics prescribed in the Access category were from the Medicine department(75.4%),followed by Surgery(24.6%).For Watch antibiotics,Medicine had a higher proportion(63.4%)compared to Surgery(36.6%).In terms of seniority,Junior Residents prescribed the highest number of antibiotics for both Access and Watch categories in Medicine and Surgery departments.Senior residents and Consultants prescribed a lower number of antibiotics in all categories and departments.Only a few antibiotics were prescribed in the Reserve category,with most prescriptions being from the Medicine department.The study also evaluated the Knowledge and Awareness of Healthcare professionals towards the WHO AWaRe classi-fication through a questionnaire survey.A total of 93 participants responded to the survey.Among them,most parti-cipants were Junior Residents(69.9%),followed by Senior Residents(25.8%)and Faculty(4.3%).When enquired if they knew about the WHO AWaRe classification only 33.3%of the participants responded positively.Of those who were aware of the AWaRe classification,the most common source of information was the internet(31.2%),followed by the antimicrobial policy of their institution(15.1%)as seen in Table 2.The survey results on the knowledge and awareness of AMR among healthcare professionals are also presented in Tables 3 and 4.Out of the 93 participants,68(73.1%)agreed that the emergence of AMR is inevitable,while only 13(14.0%)disagreed that AWaRe usage will result in the inability to treat serious infections.Additionally,58(62.4%)agreed that it will lead to lengthier hospital stays,43(46.2%)agreed that the success of chemotherapy and major surgery will be hampered,and the majority also agreed that its use will lead to increased cost of treatment and increased mortality rates.Regarding the utilization of AWaRe in the hospital summarized in Tables 4 and 5,35.5%of the participants agreed that it should be used,while only 2.2%disagreed.Additionally,34.4%agreed that AWaRe reduces adverse effects of inappro-priate prescription.However,37.6%of the participants considered that AWaRe threatens a clinician's autonomy and 30.1%thought that its use can delay treatment.Additionally,the DDD of each drug was also evaluated.The usage of various antimicrobial drugs in a hospital setting,along with their daily doses and DDD according to the WHO's Anatomical Therapeutic Chemical classification system was calculated.Some of the important findings include high usage rates of ceftriaxone and metronidazole,and relatively low usage rates of drugs like colistin and clindamycin.Additionally,some drugs had wider ranges than others.Comparison of WHO defined DDD with Daily Drug dose(Mean)in the studied prescriptions is represented in the Clustered Bar chart in Figure 3.Finally,the Mean Daily Drug Dose for prescribed drugs was compared with WHO defined DDD for each drug using a Student’s T test.The mean daily drug dose of amoxy/clav was significantly higher than the WHO DDD(1.8 vs 1.50,P=0.014),while the mean daily drug dose of metronidazole and doxycycline were significantly lower than the WHO DDD(P<0.001 and P=0.008,respectively).The mean daily drug dose of piperacillin/tazobactam,amikacin,clindamycin,and levofloxacin did not show significant differences compared to the WHO DDD(P>0.05).CONCLUSION This research indicates an appropriate proportion of prescriptions falling under the Access category(57.61%),suggesting appropriate antibiotic selection,a significant proportion also belongs to the Watch category(38.27%),emphasizing the need for greater caution to prevent the escalation of AMR.There is a moderate level of awareness among healthcare professionals about AMR and the steps being taken to tackle it,highlighting the gap in implementation of policies and need for more steps to be taken in spreading the knowledge about the subject.However,there is a significant difference between the WHO DDD and the prescribed daily dose in the analysed prescriptions suggesting overuse and underuse of antibiotics.展开更多
BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not m...BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community.Therefore,it must be ensured that researchers are wellversed in the GCP.But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIM To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODS This is a cross-sectional study.A self-structured questionnaire about GCP,after expert validations,was circulated among researchers,at a tertiary healthcare institute,All India Institute of Medical Sciences(AIIMS),Rishikesh.A total of 59 individuals,who were selected by universal sampling,participated in the study.All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects,except residents and faculty,and are still a part of the institute have been included in the study.The study was approved by the Institutional Ethics Committee of AIIMS,Rishikesh.We used descriptive analysis and the Chi-squared test to analyze data.P value<0.05 was considered significant.RESULTS Out of 59 participants,only 11(18.6%)were certified for GCP.Most of the participants(64.4%)had“Average”knowledge,33.9%had“Good”knowledge and 1.7%had“Poor”knowledge.Only 49%of participants had satisfactory practices related to GCP.There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board(P=0.010),confidentiality&privacy(P=0.011),and participant safety&adverse events(P<0.001).There was also a significant difference in knowledge of research misconduct(P=0.024)and participant safety&adverse events(P=0.011)based on certification of GCP.There was a notable difference in the practices related to recruitment&retention on the basis of current academic position(P<0.001)and certification of GCP(P=0.023).We also observed a considerable difference between the knowledge and practices of GCP among the participants(P=0.013).CONCLUSION Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP.This can be addressed by holding training sessions focusing on these particular domains.展开更多
BACKGROUND Eosinophilia and related organ damage are extensively studied hot topics among rare disorders.Any addition to the cohort of available case reports of the same will be adding knowledge for better management ...BACKGROUND Eosinophilia and related organ damage are extensively studied hot topics among rare disorders.Any addition to the cohort of available case reports of the same will be adding knowledge for better management of this less known entity.CASE SUMMARY In this article,we describe a 27-year-old Indo-Aryan man who presented with abdominal pain,abdominal distension,and loose stools for variable days.He had splinter hemorrhages in the majority of fingernails.He was diagnosed with predominant eosinophilic gastrointestinal involvement with bowel obstruction and ascites,and was managed with intravenous immunoglobulin.He was subsequently treated with oral low dose steroid therapy and responded completely.CONCLUSION Our experience is evidence that prompt management of this hypereosinophilic lethal gastrointestinal(all three layers)infiltrative disease provides a cure and avoids complications.Splinter nail hemorrhages may be seen in the same disease.展开更多
BACKGROUND The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus has become a pandemic for the last 2 years.Inflammatory response to the virus leads to organ dysfunction and death.Predicting the severit...BACKGROUND The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus has become a pandemic for the last 2 years.Inflammatory response to the virus leads to organ dysfunction and death.Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM.AIM To investigate the correlation of the serology(IgM and IgG)with reverse transcriptase polymerase chain reaction(RT-PCR)status,disease severity[mild to critical],intensive care unit(ICU)admission,septic shock,acute kidney injury,and in-hospital mortality.METHODS We conducted a longitudinal study to correlate serum SARS-CoV-2 immunoglobulin M(IgM)and immunoglobulin G(IgG)serology with clinical outcomes in coronavirus disease 2019(COVID-19)patients.We analyzed patient data from March to December 2020 for those who were admitted at All India Institute of Medical Sciences Rishikesh.Clinical and laboratory data of these patients were collected from the e-hospital portal and analyzed.A correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software.RESULTS Out of 494 patients,the mean age of patients was 48.95±16.40 years and there were more male patients in the study(66.0%).The patients were classified as mild-moderate 328(67.1%),severe 131(26.8%),and critical 30(6.1%).The mean duration from symptom onset to serology testing was 19.87±30.53 d.In-hospital mortality was observed in 25.1%of patients.The seropositivity rate(i.e.,either IgG or IgM>10 AU)was 50%.IgM levels(AU/mL)(W=33428.000,P≤0.001)and IgG levels(AU/mL)(W=39256.500,P≤0.001),with the median IgM/IgG levels(AU/mL),were highest in the RT-PCR-Positive group compared to RT-PCR-Negative clinical COVID-19.There was no significant difference between the two groups in terms of all other clinical outcomes(disease severity,septic shock,ICU admission,mechanical ventilation,and mortality).CONCLUSION The study showed that serology levels are high in RT-PCR positive group compared to clinical COVID-19.However,serology cannot be useful for the prediction of disease outcomes.The study also highlights the importance of doing serology at a particular time as antibody titers vary with the duration of the disease.In week intervals there was a significant correlation between clinical outcomes and serology on week 3.展开更多
Leishmaniasis is a vector-borne parasitic disease affecting millions of people worldwide.However,in the last decade,the number of cases has been reduced from well-documented endemic parts,but sporadic cases have been ...Leishmaniasis is a vector-borne parasitic disease affecting millions of people worldwide.However,in the last decade,the number of cases has been reduced from well-documented endemic parts,but sporadic cases have been reported widely from various non-endemic areas,especially from the southern Himalayan zone.This raises concerns about the emergence of new ecological niches.This warrants a critical evaluation of key factors causing this rapid spread and possibly indigenous transmission.This mini-review article is aimed to briefly address the parasite,the vector,and the environmental aspects in the transmission of leishmaniasis in these new foci against a background of worldwide endemic leishmaniasis with a special focus on the southern Himalayan zone.As the lack of knowledge about the causative parasites,vectors,reservoir hosts,atypical presentations,and their management make the problem serious and may lead to the emergence of public health issues.The present works also reviewed the existing information regarding clinical variations,diagnostic methods,treatment,its outcome,and ignite for further research in these aspects of the disease.展开更多
文摘BACKGROUND Leptospirosis is a globally prevalent zoonotic disease with a significant burden in tropical and subtropical regions,including India.Despite its high fatality rate and endemic nature,the disease remains underreported in many areas,particularly in Northern India.AIM To analyze the demography,clinical presentation,complications,and mortality risk factors in presumptive leptospirosis patients admitted to a tertiary care hospital over the last 7 years from the Himalayan and Sub-Himalayan regions of Northern India.METHODS A retrospective analysis was conducted on hospital records of patients admitted with leptospirosis at the All India Institute of Medical Sciences,Rishikesh,between January 2018 and December 2024.Diagnosis was based on the Modified Faine’s Criteria and laboratory confirmation via IgM enzyme-linked immu-nosorbent assay(ELISA)and other diagnostic tests.Statistical analysis,including logistic regression,was performed to determine mortality predictors.RESULTS A total of 62 patients were included in the study.The most common symptoms were fever(98.39%),myalgia(41.94%),and jaundice(20.97%).Thrombocytopenia was the most frequent complication,occurring in 72.58%of cases,followed by hepatic involvement(62.9%)and acute kidney injury(40.32%).Multiorgan dys-function syndrome was present in 66.13%of cases,with 19.35%developing acute respiratory distress syndrome(ARDS).The overall mortality rate was 20.97%,with a higher but non-significant mortality trend in the Himalayan region(35%vs 14.29%,P=0.094).Logistic regression analysis revealed that no categorical predictor alone was statistically significant.However,ARDS had a high odds ratio(OR=2.10),suggesting clinical importance despite variability.Jaundice(OR=2.28,P=0.383)and creatinine levels(OR=2.12,P=0.1029)showed a possible trend toward increased mortality,despite statistical variability.Higher international normalized ratio levels(OR=0.33,P=0.0662)were suggestive of a protective effect.CONCLUSION Leptospirosis remains a severe and often fatal disease in Himalayan and sub-Himalayan regions,particularly in hilly areas,where underreporting and delayed diagnosis contribute to poor outcomes.Mortality was highest(33.33%)in cases with multiorgan involvement,particularly affecting the liver,kidneys,and lungs.We did not identify any statistically significant mortality predictors.Although the study did not assess the impact of timely diagnosis,improving healthcare accessibility in hilly regions may facilitate earlier detection and intervention,potentially reducing mortality.
文摘BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies,or disease progression itself.We present a case of an advanced human immunodeficiency virus(HIV)patient with chronic diarrhoea,significant weight loss,and antiretroviral therapy(ART)non-compliance,highlighting the diagnostic dilemma between HIV wasting syndrome,OIs,and malignancy.CASE SUMMARY A 36-year-old female,diagnosed with HIV five years ago on family screening,presented with three months of profuse watery diarrhoea,associated with crampy abdominal pain and weight loss(14 kg,30%in 3 months).She was non-compliant with ART.There was no history of recent travel,food contamination,or tuberculosis contact.Fever episodes were mild and transient.Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly.Genital examination was unremarkable.Routine investigations revealed severe anaemia and confirmed PLHIV status.CD4 count was<36 cells/μL.Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis.After ruling out OIs,ART was restarted.With treatment,her diarrhoea resolved,and she tolerated oral intake.Nutritional support was provided,and she was discharged in stable condition with ART,prophylactic antibiotics,and followup instructions for further evaluation.CONCLUSION In ART-noncompliant PLHIV with chronic diarrhoea,distinguishing between HIV wasting syndrome,OIs(Cryptosporidium,Mycobacterium avium complex,cytomegalovirus colitis)and malignancies(non-Hodgkin lymphoma and anal carcinoma)are critical.Gradual CD4 decline,systemic inflammation,and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy.Early recognition and management,including ART reinitiation and nutritional support,are crucial for prognosis.
文摘BACKGROUND Antimicrobial resistance(AMR)is an escalating global health threat,disproportionately impacting low-income and middle-income countries like India.The rise of multidrug-resistant organisms(MDROs)complicates treatment,increases healthcare costs,and contributes to higher morbidity and mortality.In India,factors such as antibiotic misuse,over-the-counter availability,and self-medication have exacerbated this crisis.Despite the urgency,regional data on MDRO prevalence remains limited.AIM To assess the burden and distribution of MDRO infections identified at a tertiary healthcare institute in North India.METHODS This cross-sectional study analyzed inpatient data from All India Institute of Medical Sciences(AIIMS)Rishikesh using the E-hospital database from May 2021 to February 2024,except 2022.All inpatients with culture-confirmed MDRO infections were included.Patient charts and discharge summaries were reviewed.Data analysis was performed using Jamovi software,with descriptive statistics summarizing demographics.Theχ²test was used to assess associations between MDROs and various factors.Ethical approval was obtained,and patient confidentiality was maintained.RESULTS This study included 820 participants having 1106 MDROs.The majority of patients were aged 35-64 years,with a male predominance(57.6%).Most cases were from Uttar Pradesh(49.1%)and Uttarakhand(47.6%),with Bijnor and Haridwar districts reporting the highest burden from their respective states.Klebsiella pneumoniae(K.pneumoniae)(30.6%),Acinetobacter baumannii(16.7%),and Escherichia coli(E.coli)(16.7%)were the most common MDROs.Urine was the most frequent sample type(51.0%),with K.pneumoniae as the leading pathogen.Infections varied significantly across departments(P<0.001),with General Medicine and Surgery reporting the highest burden.E.coli and Klebsiella spp.were most prevalent in these departments respectively.MDRO prevalence fluctuated over time,with significant variations by quarter(P<0.001).Following the second coronavirus disease 2019 wave,there was a rapid surge in MDROs,which stabilized after approximately three months.The overall mortality among patients harboring MDROs was 25.9%.CONCLUSION This study highlights the burden of MDROs among patients at AIIMS Rishikesh,with K.pneumoniae as the predominant pathogen.Strengthening antimicrobial stewardship and infection control measures is essential to combat rising AMR,with department-specific,and pathogen-specific stewardships.
文摘BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.
文摘BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.
文摘BACKGROUND Fever of unknown origin(FUO)remains a diagnostic challenge and was originally defined in 1961.Its classic criteria include fever≥38.3°C(≥101°F)on multiple occasions,fever lasting three weeks or longer,and a diagnosis after one week of inpatient evaluation.However,these criteria may not fully encompass the varied clinical presentations seen in resource-limited settings such as India.The adaptation of FUO definitions to local healthcare contexts is crucial for enhancing diagnostic accuracy and optimizing patient outcomes.AIM To investigate the applicability of revised FUO criteria in a tertiary care setting in India.METHODS This longitudinal-exploratory study at All India Institute of Medical Sciences Rishikesh(January 2018–December 2022)analyzed 228 adult patients with fever≥99.1°F lasting over three days.Patients diagnosed within three days of admission were excluded.Data were collected retrospectively and prospectively using predefined FUO definitions based on durations of nondiagnosis(3-21 days,>21 days),temperature ranges(99.1°F-100.9°F,≥101°F),and hospitalization durations(3-7 days,>7 days).Descriptive statistics and comparative tests(Fisher's exact test,χ2 test)evaluated outcomes across definitions.RESULTS Among the proposed FUO definitions,Definition B(fever lasting 3-21 days,temperatures between 99.1°F-100.9°F,hospitalization>7 days)predominated(40.8%),while only 2.2%met the classical criteria.Notably,36.5%of Definition B patients remained undiagnosed after 7-10 days,despite 94%undergoing diagnostic workups within 21 days.Infection emerged as the leading etiology across definitions,without significant variation in outcomes or mortality during hospitalization(χ2=27.937,P=0.142).CONCLUSION Adapting FUO criteria to local contexts improves diagnostic accuracy and treatment.Definition B(40.8%prevalence)showed practical utility,with higher mortality in patients discharged on empirical'Anti-tuberculosis therapy'.
文摘BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health.Despite negative results for tropical fever infections,he had neutrophilic leucocytosis,acute kidney injury,and chest imaging findings suggestive of bilateral consolidations.On day two,he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia,and communityacquired pneumonia.Despite treatment with broad-spectrum antibiotics,he did not respond and succumbed to death on day five.CONCLUSION This case highlights that clinicians/public should be aware of MDR communityacquired pneumonia,bacteraemia,and endocarditis which ultimately culminate in high rates of morbidity and mortality.Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities.Simultaneously,route cause analysis of communityacquired MDR/XDR pathogens is a global need.
文摘BACKGROUND The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance(AMR),which is a global public health concern.India has particularly high rates of AMR,posing a threat to effective treatment.The World Health Or-ganization(WHO)Access,Watch,Reserve(AWaRe)classification system was introduced to address this issue and guide appropriate antibiotic prescribing.However,there is a lack of studies examining the prescribing patterns of antimi-crobials using the AWaRe classification,especially in North India.Therefore,this study aimed to assess the prescribing patterns of antimicrobials using the WHO AWaRe classification in a tertiary care centre in North India.Ophthalmology,Obstetrics and Gynecology).Metronidazole and ceftriaxone were the most prescribed antibiotics.According to the AWaRe classification,57.61%of antibiotics fell under the Access category,38.27%in Watch,and 4.11%in Reserve.Most Access antibiotics were prescribed within the Medicine department,and the same department also exhibited a higher frequency of Watch antibiotics prescriptions.The questionnaire survey showed that only a third of participants were aware of the AWaRe classification,and there was a lack of knowledge regarding AMR and the potential impact of AWaRe usage.RESULTS The research was carried out in accordance with the methodology presented in Figure 1.A total of n=123 patients were enrolled in this study,with each of them receiving antibiotic prescriptions.The majority of these prescriptions were issued to inpatients(75.4%),and both the Medicine and Surgical departments were equally represented,accounting for 49.6%and 50.4%,respectively.Among the healthcare providers responsible for prescribing antibiotics,72%were Junior Residents,18.7%were Senior Residents,and 9.3%were Consultants.These findings have been summarized in Table 1.The prescriptions included 27 different antibiotics,with metronidazole being the most prescribed(19%)followed by ceftriaxone(17%).The mean number of antibiotics used per patient was 1.84±0.83.The mean duration of antibiotics prescribed was 6.63±3.83 days.The maximum number of antibiotics prescribed per patient was five.According to the AWaRe classification,57.61%of antibiotics fell under the Access,38.27%in Watch,and 4.11%in Reserve categories,suggesting appropriate antibiotic selection according to these criteria.The distribution of antibiotics prescribed according to the WHO AWaRe categories is presented in Figure 2.The difference in prescribing frequencies amongst departments can be noted.Most of the antibiotics prescribed in the Access category were from the Medicine department(75.4%),followed by Surgery(24.6%).For Watch antibiotics,Medicine had a higher proportion(63.4%)compared to Surgery(36.6%).In terms of seniority,Junior Residents prescribed the highest number of antibiotics for both Access and Watch categories in Medicine and Surgery departments.Senior residents and Consultants prescribed a lower number of antibiotics in all categories and departments.Only a few antibiotics were prescribed in the Reserve category,with most prescriptions being from the Medicine department.The study also evaluated the Knowledge and Awareness of Healthcare professionals towards the WHO AWaRe classi-fication through a questionnaire survey.A total of 93 participants responded to the survey.Among them,most parti-cipants were Junior Residents(69.9%),followed by Senior Residents(25.8%)and Faculty(4.3%).When enquired if they knew about the WHO AWaRe classification only 33.3%of the participants responded positively.Of those who were aware of the AWaRe classification,the most common source of information was the internet(31.2%),followed by the antimicrobial policy of their institution(15.1%)as seen in Table 2.The survey results on the knowledge and awareness of AMR among healthcare professionals are also presented in Tables 3 and 4.Out of the 93 participants,68(73.1%)agreed that the emergence of AMR is inevitable,while only 13(14.0%)disagreed that AWaRe usage will result in the inability to treat serious infections.Additionally,58(62.4%)agreed that it will lead to lengthier hospital stays,43(46.2%)agreed that the success of chemotherapy and major surgery will be hampered,and the majority also agreed that its use will lead to increased cost of treatment and increased mortality rates.Regarding the utilization of AWaRe in the hospital summarized in Tables 4 and 5,35.5%of the participants agreed that it should be used,while only 2.2%disagreed.Additionally,34.4%agreed that AWaRe reduces adverse effects of inappro-priate prescription.However,37.6%of the participants considered that AWaRe threatens a clinician's autonomy and 30.1%thought that its use can delay treatment.Additionally,the DDD of each drug was also evaluated.The usage of various antimicrobial drugs in a hospital setting,along with their daily doses and DDD according to the WHO's Anatomical Therapeutic Chemical classification system was calculated.Some of the important findings include high usage rates of ceftriaxone and metronidazole,and relatively low usage rates of drugs like colistin and clindamycin.Additionally,some drugs had wider ranges than others.Comparison of WHO defined DDD with Daily Drug dose(Mean)in the studied prescriptions is represented in the Clustered Bar chart in Figure 3.Finally,the Mean Daily Drug Dose for prescribed drugs was compared with WHO defined DDD for each drug using a Student’s T test.The mean daily drug dose of amoxy/clav was significantly higher than the WHO DDD(1.8 vs 1.50,P=0.014),while the mean daily drug dose of metronidazole and doxycycline were significantly lower than the WHO DDD(P<0.001 and P=0.008,respectively).The mean daily drug dose of piperacillin/tazobactam,amikacin,clindamycin,and levofloxacin did not show significant differences compared to the WHO DDD(P>0.05).CONCLUSION This research indicates an appropriate proportion of prescriptions falling under the Access category(57.61%),suggesting appropriate antibiotic selection,a significant proportion also belongs to the Watch category(38.27%),emphasizing the need for greater caution to prevent the escalation of AMR.There is a moderate level of awareness among healthcare professionals about AMR and the steps being taken to tackle it,highlighting the gap in implementation of policies and need for more steps to be taken in spreading the knowledge about the subject.However,there is a significant difference between the WHO DDD and the prescribed daily dose in the analysed prescriptions suggesting overuse and underuse of antibiotics.
文摘BACKGROUND Good clinical practice(GCP)is put in place to protect human participants in clinical trials as well as to ensure the quality of research.Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community.Therefore,it must be ensured that researchers are wellversed in the GCP.But not much is known about the knowledge and practices of the GCP in the medical colleges of North India.AIM To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants.METHODS This is a cross-sectional study.A self-structured questionnaire about GCP,after expert validations,was circulated among researchers,at a tertiary healthcare institute,All India Institute of Medical Sciences(AIIMS),Rishikesh.A total of 59 individuals,who were selected by universal sampling,participated in the study.All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects,except residents and faculty,and are still a part of the institute have been included in the study.The study was approved by the Institutional Ethics Committee of AIIMS,Rishikesh.We used descriptive analysis and the Chi-squared test to analyze data.P value<0.05 was considered significant.RESULTS Out of 59 participants,only 11(18.6%)were certified for GCP.Most of the participants(64.4%)had“Average”knowledge,33.9%had“Good”knowledge and 1.7%had“Poor”knowledge.Only 49%of participants had satisfactory practices related to GCP.There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board(P=0.010),confidentiality&privacy(P=0.011),and participant safety&adverse events(P<0.001).There was also a significant difference in knowledge of research misconduct(P=0.024)and participant safety&adverse events(P=0.011)based on certification of GCP.There was a notable difference in the practices related to recruitment&retention on the basis of current academic position(P<0.001)and certification of GCP(P=0.023).We also observed a considerable difference between the knowledge and practices of GCP among the participants(P=0.013).CONCLUSION Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP.This can be addressed by holding training sessions focusing on these particular domains.
文摘BACKGROUND Eosinophilia and related organ damage are extensively studied hot topics among rare disorders.Any addition to the cohort of available case reports of the same will be adding knowledge for better management of this less known entity.CASE SUMMARY In this article,we describe a 27-year-old Indo-Aryan man who presented with abdominal pain,abdominal distension,and loose stools for variable days.He had splinter hemorrhages in the majority of fingernails.He was diagnosed with predominant eosinophilic gastrointestinal involvement with bowel obstruction and ascites,and was managed with intravenous immunoglobulin.He was subsequently treated with oral low dose steroid therapy and responded completely.CONCLUSION Our experience is evidence that prompt management of this hypereosinophilic lethal gastrointestinal(all three layers)infiltrative disease provides a cure and avoids complications.Splinter nail hemorrhages may be seen in the same disease.
文摘BACKGROUND The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus has become a pandemic for the last 2 years.Inflammatory response to the virus leads to organ dysfunction and death.Predicting the severity of inflammatory response helps in managing critical patients using serology tests IgG and IgM.AIM To investigate the correlation of the serology(IgM and IgG)with reverse transcriptase polymerase chain reaction(RT-PCR)status,disease severity[mild to critical],intensive care unit(ICU)admission,septic shock,acute kidney injury,and in-hospital mortality.METHODS We conducted a longitudinal study to correlate serum SARS-CoV-2 immunoglobulin M(IgM)and immunoglobulin G(IgG)serology with clinical outcomes in coronavirus disease 2019(COVID-19)patients.We analyzed patient data from March to December 2020 for those who were admitted at All India Institute of Medical Sciences Rishikesh.Clinical and laboratory data of these patients were collected from the e-hospital portal and analyzed.A correlation was seen with clinical outcomes and was assessed using MS Excel 2010 and SPSS software.RESULTS Out of 494 patients,the mean age of patients was 48.95±16.40 years and there were more male patients in the study(66.0%).The patients were classified as mild-moderate 328(67.1%),severe 131(26.8%),and critical 30(6.1%).The mean duration from symptom onset to serology testing was 19.87±30.53 d.In-hospital mortality was observed in 25.1%of patients.The seropositivity rate(i.e.,either IgG or IgM>10 AU)was 50%.IgM levels(AU/mL)(W=33428.000,P≤0.001)and IgG levels(AU/mL)(W=39256.500,P≤0.001),with the median IgM/IgG levels(AU/mL),were highest in the RT-PCR-Positive group compared to RT-PCR-Negative clinical COVID-19.There was no significant difference between the two groups in terms of all other clinical outcomes(disease severity,septic shock,ICU admission,mechanical ventilation,and mortality).CONCLUSION The study showed that serology levels are high in RT-PCR positive group compared to clinical COVID-19.However,serology cannot be useful for the prediction of disease outcomes.The study also highlights the importance of doing serology at a particular time as antibody titers vary with the duration of the disease.In week intervals there was a significant correlation between clinical outcomes and serology on week 3.
文摘Leishmaniasis is a vector-borne parasitic disease affecting millions of people worldwide.However,in the last decade,the number of cases has been reduced from well-documented endemic parts,but sporadic cases have been reported widely from various non-endemic areas,especially from the southern Himalayan zone.This raises concerns about the emergence of new ecological niches.This warrants a critical evaluation of key factors causing this rapid spread and possibly indigenous transmission.This mini-review article is aimed to briefly address the parasite,the vector,and the environmental aspects in the transmission of leishmaniasis in these new foci against a background of worldwide endemic leishmaniasis with a special focus on the southern Himalayan zone.As the lack of knowledge about the causative parasites,vectors,reservoir hosts,atypical presentations,and their management make the problem serious and may lead to the emergence of public health issues.The present works also reviewed the existing information regarding clinical variations,diagnostic methods,treatment,its outcome,and ignite for further research in these aspects of the disease.
