Clinico-microbiological Profile and Outcomes of Asymptomatic Bacteriuria in Pregnancy.

Background: Asymptomatic bacteriuria (ASB) during pregnancy can lead to symptomatic urinary tract infection (UTI), with increased fetal and maternal morbidity and mortality. We evaluated the incidence, clinical and microbiological profile, and outcome of ASB in pregnant women attending our antenatal clinic. Materials and Methods: This prospective study was conducted on 3769 pregnant women in a routine antenatal clinic at a tertiary care center. Participants were divided into two groups, ASB and non-bacteriuria. Data were collected in a standard proforma and analyzed using the software Statistical Package for the Social Sciences (SPSS) v. 20. Results: The incidence of ASB was 3.29% (124/3769). Majority of the women were in the age group of 21-30 years (78.76%, n = 89). Escherichia coli (61.06%) was the most common organism isolated. Maternal anemia (30.08% and 2.93% in the ASB and non-bacteriuria groups, respectively), low birth weight (LBW; 42.5% and 27.98% in the ASB and non-bacteriuria groups, respectively), intrauterine death (4.4% and 1.4% in the ASB and non-bacteriuria groups, respectively), and preterm delivery (37.2% and 22.31% in the ASB and non-bacteriuria groups, respectively) were were associated with ASB (P = 0.001). Conclusion: ASB was associated with maternal anemia, preterm delivery, intrauterine death, and LBW. Early detection and treatment of ASB may result in favorable maternal outcome.

Study of hypothalamo pituitary adrenal axis in frail elderly subjects.

BACKGROUND: Frail elderly people are at increased risk of death and disability from minor environmental stresses such as infection because they do not have the reserves to respond and maintain adequate homeostasis Studies have shown that elderly patients had a significantly smaller response to ACTH stimulation test. Due to paucity of data regarding HPA axis functioning in frail elderly in Indian studies, we assessed the adrenocortical response to ACTH stimulation test in frail elderly subjects. OBJECTIVES: To assess the basal serum cortisol levels and serum cortisol response to 1 mcg ACTH stimulation test in frail elderly subjects. METHODOLOGY: Case control study. Elderly patients visiting OPD or admitted at M.S.Ramaiah hospital from September 2007 to August 2009 were classified into 2 groups. Those fulfilling the criteria of frailty above 65 yrs were taken as cases, non frail elderly were taken as controls. 40 cases and 20 controls were included. RESULTS: Equal number of hospitalized and out patient subjects were studied (20 in each group). Mean age was 75.35 years in hospitalized frails, 69.6 years in out patient frails, 68.3 years in controls. M: F ratio was 1:1. 45% of cases had frailty index of 4. A delta rise of > 9 mcg/dl (after 1 mcg ACTH stimulation test) was seen in 10 cases (25%) of frail elderly as compared to 16 controls(80%) indicating a possible adrenal insufficiency in remaining 30 cases (75%). The mean duration of hospital stay was 5.6 days. Frail elderly with poor ACTH response had poor quality of life as measured by activities of daily living score (p = .026). CONCLUSION: Frail elderly individuals have adrenal insufficiency (subclinical hypocortisolemia) compared to healthy elderly subjects, thereby indicating a poorer response to ACTH stimulation test may influence outcome during acute illness. Frail elderly with poor ACTH response had poor quality of life as measured by activities of daily living score (p = .026). Hyponatremia and hypotension co related well with state of adrenal insufficiency.

A study to assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy: Medical records-based audit.

Introduction: COVID-19 infection caused by SARS-Corona virus-2 (SARS-CoV-2) has caused large number of infections and mortality globally. There are no proven medications to prevent and treat COVID-19, nevertheless several potential pharmacotherapeutic agents have been tried. Remdesivir was found to be effective in few studies. Aims: To assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy. Methodology: This study was conducted in a tertiary hospital in South India after the approval of the Institutional ethical committee. It was a medical records-based retrospective, longitudinal study. Medical records of the inpatients with confirmed COVID-19 infection were reviewed from the period of June 15, 2020 to September 15, 2020. This study was conducted to assess the clinical and laboratory profile and outcome in the patients admitted with moderate and severe COVID-19 disease who received Remdesivir. Statistical Analysis: The analysis was done using SPSS Inc. released 2009, PASW statistics for Windows version 18.0, Chicago. Results: One hundred eleven (N = 111) patients were included in the study. 56 patients received the conventional treatment (Hydroxychloroquine HCQ) and 55 patients received Remdesivir. It was seen that among patients treated with HCQ, 24 (42.9%) required non-invasive ventilation and seven (12.7%) patients treated with Remdesivir required it (P = 0.001). It was noticed that the mean duration of hospitalization was 16.6 days in HCQ group and was 11.4 days in Remdesivir group (P = 0.021). Conclusion: The study demonstrates that Remdesivir does have benefit in reducing the mortality and duration of hospital stay. There was reduced requirement of non-invasive and invasive ventilation among patients treated with Remdesivir.

Assessment of Functions of the Autonomic Nervous System in the Elderly with Different Comorbid Factors.

Background Studies in healthy elderly patients have shown the prevalence of autonomic dysfunction (AD) in the range of 20 to 30%. However, there is paucity in data pertaining to AD in the elderly in the Indian context. Objective To assess the prevalence of AD in the elderly irrespective of their comorbidity status. Methods A total of 141 elderly patients with or without comorbidities/symptoms of AD were included. Demographic and clinical details of the patients were recorded. Autonomic function tests (AFTs) such as deep breathing test, Valsalva ratio, orthostatic heart rate (OHR), isometric handgrip test, and orthostatic blood pressure were performed based on Ewing's battery of tests. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of AFTs were evaluated. Results Most patients ( n = 85) were aged between 60 and 69 years, with a male predominance (58.87%). Hypertension and diabetes mellitus were the most common comorbidities. Postural hypotension was the most common symptom of AD. With advancing age, symptoms of AD manifested significantly more. Overall, 73.8% of patients had AD, of whom 45.4% had early AD. Number of AD symptoms, glycated hemoglobin (HbA1c) level, and comorbid factors (diabetes and hypertension) were significantly associated with the results of AFTs ( p < 0.05). AFTs were highly significant with respect to the results obtained ( p < 0.001). Deep breathing test, abnormal in majority of study patients, has a sensitivity of 93.3% and OHR has a specificity of 81.1% to determine AD. Conclusion The study concludes that age itself is an independent predictor of AD, which increases in severity if associated with comorbidities.

Clinical Profiles of Elderly Patients Presenting with Persistent Dizziness.

BACKGROUND: Dizziness among elderly patients is primarily treated in emergency and primary care centers. However, the causes and comorbidities responsible for dizziness in the elderly may differ in tertiary health care centers. OBJECTIVE: To determine the subtypes of persistent dizziness and to evaluate the number of contributory causes of dizziness among elderly patients. METHODS AND MATERIALS: This observational cross-sectional study comprised of 130 patients aged >60 years. A detailed history of existing comorbidities was obtained. A standardized comprehensive evaluation of all patients was done using an International Delphi procedure. Data from each patient was independently reviewed for major and contributory causes of dizziness. Chi square test was used to find the association between dizziness and various contributing factors. RESULTS: Presyncope was the most frequent dizziness subtype (71.5%). Majority of patients showed one dizziness subtype (54.6%) and three contributory causes of dizziness (40.6%). An adverse effect of drug was the most common contributory cause for dizziness (20%). The most frequent underlying cause of dizziness was noted to be cardiovascular disease (40%), followed by peripheral vestibular disease (22.3%) and neurological disease (19%). Sixty six percent of the patients were identified with more than one contributing cause for dizziness. CONCLUSION: Primary care physicians need to anticipate that many elderly dizzy patients can have more than one cause of dizziness. A systematic and planned approach can help the clinician to effectively treat dizziness in the elderly.

Arterial hypoxemia in patients with cirrhosis of liver.

INTRODUCTION: Mild hypoxia has been seen in approximately one third of patients with chronic liver disease. Development of hypoxemia in patients with chronic liver disease, modifies the line of management and worsens the prognosis of the disease. Hence an early detection of hypoxemia in these patients is essential. Hypoxemia results from various causes in patients with chronic liver disease. Hepato pulmonary syndrome is an important cause in a patient with hypoxemia and chronic liver disease. Development of this complication in chronic liver disease indicates a poorer prognosis in these patients. Chronic liver disease is also known to be associated with pulmonary manifestations that affect both the pleural space and lung parenchyma. This study was undertaken to study the prevalence of hypoxemia and assess the prognosis in patients with chronic liver disease. MATERIALS AND METHODS: Fourty three patients aged 18 years and above with evidence of cirrhosis, admitted under the department of Medicine and Gastroenterology, were included in the study. A detailed history was taken and clinical examination were done in all patients. All patients underwent ultrasonography, LFT, biochemical tests and upper gastrointestinal endoscopy to confirm chronic liver disease, portal hypertension and varices, if any chest X-ray, 2-D transthoracic echocardiogram, viral studies and pulmonary function tests. The patients in whom arterial hypoxemia was detected with a positive contrast echocardiogram were considered to have hepato pulmonary syndrome. RESULTS: Six out of the 43 patients (13.9%) included in the study had hypo-xemia. Among these 6 patients with hypoxemia, 3 were found to have contrast enhanced echocardiographic evidence of intra pulmonary vascular dilatations and diagnosed hepato pulmonary syndrome. The other 3 patients had evidence of both, interstitial lung disease and pleural effusion contributing to hypoxemia. The patients with hepato pulmonary syndrome had a significant P (A-a) O2 gradient, died during the study period, indicating a poorer prognosis. CONCLUSIONS: We conclude that identification of hypoxemia and its aetiology in patients with chronic liver disease is essential. Identification of hepato pulmonary syndrome is important, as it carries a poor prognosis in patients with chronic liver disease.

Characteristics of anemia in elderly: a hospital based study in South India.

Anemia is a common concern in older people and can have significant morbidity and mortality. Because anemia is a sign, not a diagnosis, an evaluation is almost always warranted to identify the underlying cause. The purpose of this study was to study the clinical profile of elderly patients with anemia and to study characteristics of hematological types of anemia in such patients as well as the closest possible etiological profile. Hundred patients above the age of 60 years were included in the study. Clinical profile with laboratory studies of Hemoglobin and diagnostic tests to fix the etiology. Majority of patients had normocytic blood picture. Renal failure was the most common underlying chronic disease. Significant number of patients were on non steroidal anti-inflammatory drugs which could contribute to the anaemia. 14% of the patients had an underlying malignancy. 73.3% of the patients in the microcytic group had an underlying GI lesion on endoscopy. Identifying anemia as an important aspect of a comprehensive geriatric assessment is absolutely essential further to clinical detection. Confirming the type of anemia is critical to direct the investigation for profiling the etiology since it is well known that the treatment of anemia goes a long way in improving the overall outcome and quality of life.

Heidenhain variant of Creutzfeldt-Jakob disease: An autopsy study from India.

Prion diseases are rare, progressive and fatal neurodegenerative diseases characterized by long incubation period and short clinical course. We present a rare case of Heidenhain variant of Creutzfeldt-Jakob disease, occurring in a 55-year-old lady presenting with dementia, cortical blindness, and myoclonic jerks. She succumbed to the disease within 8 weeks of onset of symptoms. MRI revealed hyperintense signals on T2WI and fluid attenuated inversion recovery (FLAIR) images in basal ganglia and fronto-temporal and parietal cortex, sparing thalamus, striate cortex and globus pallidum. Abundant abnormal prion protein deposits (PrP(sc)) were detected in caudate, putamen, thalamus, cingulate and striate cortex, in comparison to frontal and parietal cortex while no deposits were found in globus pallidum. MRI changes did not correlate with degree of spongy change, gliosis or prion protein deposition. The cause for abnormal signal changes in MRI and FLAIR images remains unclear.

Cytokine profile in elderly patients with sepsis.

CONTEXT: Sepsis is a serious health problem in the elderly with a high degree of mortality. There is very limited data available in elderly subjects regarding the markers for sepsis. Development of good markers will help in overall management and prediction of sepsis. OBJECTIVES: Serial estimation of Interleukin-6 (IL-6) and Tumor Necrosis Factor-Alpha (TNF-alpha) and their correlation with mortality in sepsis in elderly patients and to determine the influence of gender on cytokine production and mortality in elderly patients with sepsis. SETTINGS AND DESIGN: The prospective study was conducted at our tertiary care center from April 2007 to September 2008. Elderly Patients satisfying the Systemic Inflammatory Response Syndrome (SIRS) criteria were included. METHODS AND MATERIAL: TNF-alpha and IL-6 were estimated in 30 elderly patients admitted to our intensive care unit with SIRS and sepsis. The estimations were done on day 1, 3 and 7 of admission. STATISTICAL ANALYSIS USED: Student and paired 't' tests, and ANOVA, which were further followed up by post-hoc 't' tests with Bonferroni correction using SPSS. RESULTS: Reducing levels of IL-6 levels from day 1 to 7 was found in the survivor group. TNF-alpha level was significantly low on day 1 in the nonsurvivor female group. CONCLUSIONS: Serial estimation of cytokines in elderly patients with sepsis will help in prediction of mortality. Female gender was an independent predictor of increased morality in critically ill patients with sepsis.