RESUMO
BACKGROUND: Leptospirosis presents with highly variable clinical manifestations affecting different organ systems in different individuals. The presentation ranges from an asymptomatic or mild disease to a severe disease associated with multiorgan failure and higher mortality. Leptospirosis is highly underreported due to a lack of diagnostic modalities and less suspicion among clinicians. METHODOLOGY: We present this single-center retrospective case series of 12 cases, which include various common and uncommon scenarios by which the disease can present and can be missed due to lack of suspicion. The study contains individual patient characteristics including demographic, laboratory, clinical, and treatment data. The association between these variables and mortality was analyzed using p-values and results were described. A p-value of<0.05 was considered statistically significant. RESULTS: A total of 12 cases were included in the study. The male-to-female ratio was 3:1. The mean age was higher (37.75±9.81 years) in cases who died than those who recovered (34.25±14.09). Factors like history of alcoholism, presence of chronic liver disease (CLD), jaundice, acute renal failure, requirement of dialysis, and requirement of intensive care were significantly associated with increased risk of death (odds ratio >1, p-value <0.05). The most common symptom of presentation was fever in 11 (91.66%) cases. Jaundice and renal failure were significantly associated with death (odds ratio 1.2, p-value 0.04). The requirement of intensive care treatment (odds ratio 2.1, p-value 0.05) and dialysis (odds ratio 39.66, p-value 0.03) were also significantly associated with death. The percentage of death was lower in the group of patients who received combination antibiotic therapy. CONCLUSION: Leptospirosis has varied presentations in different individuals and the diagnosis can be missed due to lack of specific signs and symptoms. Severe diseases involving multiple organs and preexisting comorbidities are associated with higher mortality rates. Timely diagnosis and treatment are necessary to reduce mortality and increase survival.
RESUMO
Background Helicobacter pylori is one of the most common bacterial pathogens in humans. It is a microaerophilic bacteria with multiple unipolar flagella. It is associated with the development of various lesions like chronic gastritis, gastric ulcers, adenocarcinoma, and mucosa-associated lymphomas. The aim of this study was a comparative evaluation of the rapid urease test (RUT) and polymerase chain reaction (PCR) in gastric biopsy and aspirates for the detection of H. pylori infection and to further determine the sensitivity and specificity of RUT and PCR. Method Endoscopic guided biopsy tissue and gastric aspirate specimens were collected from 110 patients with symptoms like gastritis, dyspepsia, etc., and subjected to RUT and PCR for detection of H. pylori infection. Results A total of 110 samples, including both biopsy tissue (77) and gastric aspirate (33) were subjected to RUT and PCR. RUT for biopsy tissue showed the highest sensitivity (97.18%), compared to gastric aspirate (78.94%). Comparing RUT with PCR, the sensitivity and specificity of PCR were 93.33% and 90.0%, respectively. The positive predictive value (PPV) of PCR was 97.67%, the negative predictive value (NPV) was 75.0%, and the accuracy was 92.73%. Conclusion The present study showed that RUT is a rapid and accurate invasive test for the detection of Helicobacter pylori infection in biopsy tissue as compared to gastric aspirate specimens, which are more sensitive to PCR. The study also showed that biopsy tissue was found to be a superior specimen for the detection of Helicobacter pylori as compared to gastric aspirate.
RESUMO
BACKGROUND: Tuberculous peritonitis is difficult to diagnose due to its non-specific clinical manifestations and lack of proper diagnostic modalities. Current meta-analysis was performed to find the overall diagnostic accuracy of adenosine deaminase (ADA) in diagnosing tuberculous peritonitis. MATERIALS AND METHODS: PubMed, Google Scholar, and Cochrane library were searched to retrieve the published studies which assessed the role of ascitic fluid ADA in diagnosing tuberculous peritonitis from Jan 1980 to June 2022. This meta-analysis included 20 studies and 2,291 participants after fulfilling the inclusion criteria. RESULTS: The pooled sensitivity was 0.90 (95% confidence interval [CI]: 0.85 - 0.94) and pooled specificity was 0.94 (95% CI: 0.92 - 0.95). The positive likelihood ratio was 15.20 (95% CI: 11.70 - 19.80), negative likelihood ratio was 0.10 (95% CI: 0.07 - 0.16) and diagnostic odds ratio was 149 (95% CI: 86 - 255). The area under the summary receiver operating characteristic curve was 0.97. Cut- off value and sample size were found to be the sources of heterogeneity in the mete-regression analysis. CONCLUSION: Ascitic fluid ADA is a useful test for the diagnosis of tuberculous peritonitis with good sensitivity and specificity however, with very low certainty of evidence evaluated by Grading of Recommendations, Assessment, Development and Evaluation approach. Further well- designed studies are needed to validate the diagnostic accuracy of ascitic fluid ADA for tuberculous peritonitis.
RESUMO
There is lack of consistent surrogate markers of kidney function to identify established disease, especially in early stages of CKD. Creatinine remains within normal levels until a significant reduction in renal function has occured. Cystatin C appears to be unaffected by muscle mass, diet, or gender. Its clearance is only by glomerular filtration. The plasma concentration is not influenced by inflammation or liver disease. It is not affected by optical interferences. Considering these benefits, it is more useful when trying to detect mild to moderate impairment of kidney function. MATERIAL: An observational, analytical study was conducted over a duration of 18 months. The study participants were divided into 2 groups based on eGFR. OBSERVATION: 67.5% patients had raised Cystatin C as compared to only 12.5% who had raised Creatinine. In our study, we found that Serum Creatinine (r=-0.85, p< 0.001) was better than Cystatin C (r=-0.55, p< 0.001) in all stages of CKD. However, in patients with eGFR ≥ 60 ml/min/m2. Cystatin C (r = -0.68, p<0.001) was a more sensitive marker to detect renal dysfunction at an early stage as compared to Serum Creatinine (r = -0.48, p<0.001). Overall, the AUC (Area Under the Curve) for Serum Creatinine is more than Cystatin C. However, in patients with eGFR≥ 60ml/ min/1.73m2, AUC for cystatin C is more. Thus, Cystatin C is more sensitive than Serum Creatinine to detect early renal dysfunction. CONCLUSION: We found out that both serum creatinine and serum cystatin C were significantly increased across CKD groups but cystatin C is a better predictor of CKD than creatinine in stages with eGFR≥60 ml/min/1.73 m2 as serum cystatin C was found to be raised contrary to serum creatinine which was within normal limits, although in stages with eGFR<60 ml/min/1.73 m2 there was no significant difference between the two. We found out that normal serum creatinine levels during the stage of kidney disease with eGFR≥60 ml/min/1.73 m2 does not necessarily mean normal renal function. Cystatin C should be encouraged as a screening tool for early renal impairment in the patient as the risk of developing CKD, especially in long-standing hypertensive and diabetic patients as an adjunct to creatinine estimation. It should also be included in the management protocol for these patients.
