Role of White Blood Cell Count, Immature to Total Ratio and C-Reactive Protein in Early Detection of Clinically Suspected Neonatal Sepsis.

Despite recent advances in neonatal care, early detection of neonatal sepsis still remains challenging. Positive blood culture is the gold standard for definitive diagnosis of neonatal sepsis but is time consuming and demands a well equipped laboratory setting. Therefore, it becomes imperative to evaluate usefulness of white blood cell count, Immature to total (IT) ratio and C-reactive protein as potential markers in the early diagnosis of neonatal sepsis. The objective of the study was to evaluate role of white blood cell count, IT ratio and C-reactive protein in early detection of clinically suspected neonatal sepsis. This cross-sectional descriptive study was conducted from January 2017 to December 2018 at Special Care Newborn Unit (SCANU) of Rangpur Medical College Hospital, Rangpur, Bangladesh. After parental permission and ethical clearance, a total of 70 eligible neonates were included into the study. Estimation of total white blood cell count, IT ratio and C-reactive protein as well as blood culture were done for each case. Significance for Chi-Square test and Pearson's correlation coefficient test was predetermined as p<0.05. Of the total 70 neonates studied, 19(27.14%) were blood culture positive and most common organism was Escherichia coli (7/14, 37.0%). Among individual and combination tests, CRP was highly sensitive (100%) followed by WBC count (74.94%). Highly specific tests in diagnosing sepsis were combination test of IT ratio and CRP (88.23%) followed by combination test of WBC count and CRP (82.35%). Positive predictive value (PPV) was high for combination test of WBC count and CRP (90.90%) followed by combination test of IT ratio and CRP (90.47%). Negative predictive value (NPV) was high in CRP (100.0%) followed by WBC count (89.19%). IT ratio positively correlated with CRP (p=0.002) and there was significant association between raised CRP and WBC count (p=0.005) in neonatal sepsis. Diagnostic role of both individual and combination tests were significant in early detection of clinically suspected neonatal sepsis while awaiting results of blood culture. However, none of the combination tests were able to achieve 100.0% sensitivity.

Risk Factors for Relapse in Childhood Nephrotic Syndrome.

Minimal change nephrotic syndrome is the most common cause of the glomerular disease in children. Despite its high initial response to corticosteroids, relapses are common leading to increased morbidity. Therefore, appraisal of common triggers of relapse becomes an imperative for successful management of childhood nephrotic syndrome. The objective of the study was to identify the risk factors for frequent relapse in childhood nephrotic syndrome. This descriptive cross-sectional study was conducted in the department of Paediatrics, Rangpur Medical College Hospital, Bangladesh from January 2013 to December 2014. A total of 60 patients with relapsed idiopathic childhood nephrotic syndrome fulfilling the selection criteria were enrolled into the study. Serum total protein, serum albumin and urine culture were done. The following potential risk factors for relapse were analyzed using Chi-square test: age at onset of NS, sex, socioeconomic status, atopy, short duration of initial therapy with steriod, serum total protein, serum albumin level and infection. Among 60 patients, short duration of therapy with steriod (<8 weeks) for first attack was significantly higher among frequent relapse (FRNS) cases compared with infrequent relapse (IFRNS) group (63% vs. 27.27%). FRNS group had initial brief period of remission of <6 months, (p=0.04). Difference in mean serum albumin and that of serum total protein between FRNS and IFRNS cases was (1.0±0.66 vs. 2.66±1.6gm/dl) (p<0.0001) and (3.5±1.2 vs. 6.5±2.12gm/dl) (p<0 .0001) respectively. This study concluded that short initial therapy with corticosteroid, brief duration of initial remission; low serum total protein and decreased serum albumin were the risk factors for frequent relapses.

Early clinical experience with the Anaconda re-deployable endograft in 106 patients with abdominal aortic aneurism: the west of Scotland Anaconda registry.

Endovascular repair of abdominal aortic aneurysm is a common procedure and not without complications. The aim of this study was to evaluate the early results of the Anaconda endograft (Vascutek Ltd., Inchinnan, Scotland, UK) in 106 patients in three hospitals in the west of Scotland. A prospective registry of 106 consecutive patients undergoing endoluminal repair of their abdominal aortic aneurysms using the Anaconda device was set up to record the clinical outcomes, with a mean follow-up of two years. There was no 30-day perioperative mortality in the 106 patients. Only type II endoleaks were detected on serial computed tomography scanning at follow-up. Technical success was achieved in 99% (105/106) in this study; one patient was converted to open surgical repair. Two cases of proximal device migration (>1 cm) were detected at one month and 19 months, respectively, with no associated endoleak or sac enlargement. Five cases of endograft limb thrombosis were noted in this study. Our early clinical experience with the Anaconda endograft compares favourably with other commercially available endografts in the treatment of abdominal aortic aneurysms. The main advantages of this device are that it is re-deployable and that it has a magnetic wire system which makes it easy to implant.

Comparison of WHO Clinical Criteria and Radiological Findings of Pneumonia in Children Aged 02-59 Months.

Despite recent advances, pneumonia contributes substantially to childhood mortality in low and middle-income countries. To reduce case fatality, World Health Organization (WHO) adopted a working formula to identify pneumonia clinically in resource constrained setting. Chest X-ray is the gold standard test to diagnose pneumonia but this tool is not readily available or affordable in primary health facility in developing countries even when it is indicated. Objective of the study was to compare WHO clinical criteria and radiological findings of pneumonia in children aged 02-59 months. This cross-sectional observational study was conducted at inpatient department of Paediatrics of Rangpur Medical College Hospital from July 2015 to June 2017. Total 112 patients aged 2 to 59 months fulfilling selection criteria were enrolled into this study. Data were collected and chest X-ray was done for each patient. Data were analyzed through SPSS software (version 16.0). Minimum level of significance was predetermined as p<0.05. Among 112 patients, mean age of chest radiograph positive cases of pneumonia was 7.64±7.08 months and that of negative cases 10.75±10.95 months. There was no statistically significant difference of age (p=0.083) between chest radiography positive and negative cases. Radiological findings were positive in 52(46.43%) cases and negative in 60(53.57%). Fever, cough and fast breathing were present in all patients with sensitivity 100%. Chest indrawing was significantly more (p=0.003) among 52(46.43%) cases who demonstrated positive radiological findings with sensitivity 63.46% (95% CI = 48.96% to 76.37%). There was no statistically significant difference of fever, cough and fast breathing between radiograph positive and negative cases. Chest indrawing was significantly more in radiograph positive cases. The results highlighted the importance of adoption of positive radiograph of WHO guideline to identify pneumonia.

Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19.

An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.

Diagnostic Performance of RBC Indices in Beta Thalassaemia Trait.

Beta thalassaemia trait is one of the most common forms of thalassaemia in Bangladesh. This clinical entity usually remains undiagnosed because they present with mild anaemia or sometimes no anaemia. Determination of trait is the mainstay of prevention of thalassaemia. RBC indices can provide valuable diagnostic tool for beta thalassaemia trait. This was a hospital based cross-sectional, analytical study, done at Department of Paediatrics, Rangpur Medical College Hospital, Rangpur, Bangladesh from July 2014 to June 2016. A total of 150 anaemic children, aged 1-15 years from inpatient and outpatient department were included by purposive sampling. Blood samples were collected and sent to the Department of Biochemistry, Rangpur Medical College to determine the value of RBC indices. Out of 150 anaemic children 37(24.66%) children were diagnosed as E-trait, 9(9%) E-disease 6(4%) as E-Beta thalassaemia, 1(0.66%) had error in the report, a total of 53 children were excluded from the study. Finally, 32(21.3%) children, diagnosed as beta thalassaemia trait and 65(43.33%) children, diagnosed as normal Hb variant, so a total of 97 children were enrolled in this study. Age of the children was 1-15 years. Their mean age was 6.4 years. Male female ratio was 1.15:1. There was significant difference of HbA2 between BTT and non BTT group of participants (p value <0.001). Value of MCV and MCH were significantly greater in BTT than non BTT group (p value <0.05). Sensitivity, Specificity, Positive predictive value, Negative predictive value and Youden index of MCV were 81.25%, 90.76%, 81%, 90% and 71 respectively. Sensitivity, Specificity, Positive predictive value, Negative predictive value and Youden index of MCH were 84.37%, 92.30%, 84%, 92% and 76 respectively.

Performance of Haematological Parameters in Early Diagnosis of Clinically Suspected Neonatal Sepsis.

Neonatal sepsis is one of the major health problems throughout the world and major cause of morbidity and mortality in developing countries. Positive blood culture considers the gold standard for confirmation of neonatal sepsis, but it does not provide rapid diagnosis. So this study was designed to find out the performance of haematological parameters in early diagnosis of neonatal sepsis. The objective of the study was to evaluate the performance of haematological parameters individually and in combination in early diagnosis of neonatal sepsis. It was a cross-sectional study conducted at neonatal ward, SCANU and obstetric ward of Rangpur Medical College Hospital from January 2014 to December 2015. A total of 70 neonates clinically suspected to have features of sepsis were included in this study. Another 70 healthy term neonates were included in the study as reference group. Blood sample were obtained to estimate TLC, ANC, immature neutrophil count, degenerative changes in PMNs, platelet count, I/T and I/M ratio. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the individual test and tests combination were calculated. Among the haematological parameters, performance of combined tests had high sensitivity, specificity, with PPV and NPV. Among the individual tests I/T and I/M ratio had high sensitivity (95%), specificity (85%, 90%), PPV (90%, 75%) and NPV (90%). There were 22 out of 70 neonates (31.42%) who had culture proven sepsis. Among 22 culture proven sepsis most commonly found organism were Escherichia Coli 12(54.5%) followed by Klebsiella 3(13.63%), Proteus 3(13.63%), Staphylococcus aureus 2(9.9%) and Salmonella 2(9.9%). There is no ideal test for diagnosis of early diagnosis of neonatal sepsis haematological parameters is useful adjunct test in identifying clinically suspected neonatal sepsis.

Dipstick Method versus Spot Urinary Protein Creatinine Ratio for Evaluation of Massive Proteinuria in Childhood Nephrotic Syndrome.

Measurement of massive proteinuria is vital for diagnosis of childhood Nephrotic syndrome. Quantification of 24 hours urinary protein is the gold standard test. Dipstick method of urinary protein measurement gives instant result for massive proteinuria. Spot urinary protein creatinine ratio measurement is variable. This was a hospital based prospective cross sectional study done at Department of Paediatric Nephrology, Rangpur Medical College Hospital from January 2014 to December 2015 to evaluate accuracy of dipstick method versus spot urinary protein-creatinine ratio in estimation of massive proteinuria in childhood nephrotic syndrome. Total 100 children diagnosed as Nephrotic syndrome fulfilling the inclusion and exclusion criteria were enrolled into the study. After collection of spot urine sample, proteinuria was estimated by dipstick method and same sample was sent to laboratory for measuring protein creatinine ratio. All data were collected in individual predetermined case record form and analyzed by SPSS version 17.Dipstick had sensitivity 97%, specificity 70%, positive predictive value 96.7%, negative predictive value 77% and efficacy 95%. There was a significant correlation between spot urinary protein creatinine ratio and dipstick testing of Nephrotic range of proteinuria (p<0.05).The dipstick result of proteinuria significantly correlates with spot urinary protein creatinine ratio. Dipstick method of urinary protein measurement yields accurate result instantly.

Intracoronary platelet and monocyte activation status within platelet-monocyte complexes are determinants of inflammation in ST elevation myocardial infarction1.

INTRODUCTION: Platelet Monocyte Complexes (PMCs) are commonly expressed in coronary artery disease but their pathologic significance in ST elevation myocardial infarction (STEMI) is unclear. This study evaluates the relationship between locally activated PMCs and intracoronary inflammation in stable and unstable coronary disease. MATERIAL AND METHODS: Micro catheter aspirated blood samples of 15 STEMI and 7 stable angina patients are collected from the coronary artery (CA), aorta (AO) and right atrium (RA). Samples are labelled with monoclonal antibodies and prepared for flow cytometry. CD 14 and CD 61 double positive cells are identified as PMC. P-selectin expression is identified by additional CD62P positivity and TF expression by additional CD142 positivity. Plasma TNF-alpha and IL-6 are measured using ELISA and CRP is measured in plasma using a high sensitivity automated microparticle enhanced latex turbidimetric immunoassay. RESULTS: No site-specific difference is seen in overall PMC expression in STEMI or stable angina. Surface P-selectin expression in STEMI [median (IQR)] is significantly higher in CA [35.01 (23.15-56.99)] compared with AO [15.99 (10.3-18.85)] or RA [14.02 (10.42-26.08)] (p = 0.003). Intracoronary PMC correlates significantly with intracoronary TNF-alpha (r = 0.87, p = 0.001) and intracoronary IL-6 (r = 0.76, p = 0.03). Bound monocytes within P-selectin positive and tissue factor positive complexes correlate positively with intracoronary TNF-alpha (r = 0.81, p = 0.008 & r = 0.80, p = 0.009 respectively) and IL-6 (r = 0.54, p = 0.16 & r = 0.71, p = 0.05 respectively). No such correlation is observed in the peripheral circulation of STEMI and stable angina patients. CONCLUSION: Inflammation is not attributable to PMC formation per se. However, increased intracoronary P-selectin expression by activated platelets and tissue factor expression by activated monocytes within the complexes are determinants of local intracoronary inflammatory burden in STEMI.

Reuse of pacemaker.

Implantation of a permanent pacemaker is an expensive proposition for the poor patients of our country. Many patients on permanent pacemaker die prematurely due to diseases or conditions not related to pacemaker function. The purpose of this study was to reuse these pacemakers after thorough cleansing and proper sterilisation in other suitable patients and compare the efficiency of the reused pacemakers with that of newly implanted ones. Between April 1979 and April 1992, 642 patients implanted with reused pacemakers were studied. The study population consisted of patients ranging in age from 15-85 years and included patients of both sexes (M:F = 4:1). The mean period of follow-up was 7.5 +/- 5.6 years. Removal and reimplantation of the pulse generators was carried out after obtaining the State Government's approval, informed consent of the donors, relatives and recipients. The functional status of the pulse generators was tested by a "pacing system analyser". The clinical indications for reuse were chronic complete heart block, symptomatic bifascicular heart block, sick sinus syndrome and chronic complete heart block with congestive heart failure, in decreasing order of frequency. In terms of morbidity and mortality, the efficacy of reused pacemakers was highly comparable with that of newly implanted ones. The infection rate in cases of reuse from dead patients was comparable to that in cases of new implantation. However, pacemakers reused in the same patient showed a high rate of infection. With the aid of newer generations of antimicrobials, infection when matched with efficacy and economy (of reuse) does not seem to be a major factor against pacemaker reuse.

Some host factors and seasonal variations in the fatal road traffic accidents occurring in eastern suburban Calcutta.

An extensive study of road traffic accident cases occurring within eastern suburban Calcutta during April 1992 to March 1993 was done. Of which 276 fatal cases having minimum medical aids were taken into consideration to avoid erroneous interpretation. Male pedestrians of age group of 50 years and above were mostly involved during the time period of 5 A.M. to 12 Noon. Fatal Accidents mostly occurred during winter and on the broader roads (Highways) and in majority of cases victims were at fault.