ABSTRACT
Objectives: To correlate lactate clearance with Pediatric Intensive Care Unit (PICU) mortality. Methods: 45 (mean age 40.15 mo, 60% males) consecutive admissions in the PICU were enrolled between May 2012 to June 2013. Lactate clearance (Lactate level at admission – level 6 hr later x 100 / lactate level at admission) in first 6 hours of hospitalization was correlated to in-hospital mortality and PRISM score. Results: Twelve out of 45 patients died. 90% died among those with delayed/poor clearance (clearance <30%) compared to 8.5% in those with good clearance (clearance >30%) (P<0.001). Lactate clearance <30% predicted mortality with sensitivity of 75%, specificity of 97%, positive predictive value of 90%, and negative predictive value of 91.42%. Predictability was comparable to PRISM score >30. Conclusion: Lactate clearance at six hours correlates with mortality in the PICU.
ABSTRACT
Aim: Depletion of CD4 cell count is a hallmark of disease progression in AIDS. CD4 cell count is essential for physicians to decide about the timing of initiation of antiretroviral therapy (ART) and for prophylaxis of opportunistic infections. WHO has recommended that, absolute lymphocyte count (ALC) of ≤1200/μL can substitute CD4 cell count of ≤200/μL in resource-constrained countries throughout the world. Materials and Methods: This study was undertaken to know whether there is a correlation between CD4 cell count and ALC in HIV-infected individuals. A single sample of blood was withdrawn for ALC and CD4 cell count. The samples received from December 1, 2004 to December 31, 2005 were analyzed. Results: A total of 196 samples were collected from 185 patients. After exclusion, a total of 182 samples were analyzed. Results revealed that male:female ratio was 126:56 and their age ranged from 13 to 67 years. The median ALC was 1747 cells/μL, whereas the CD4 cell count ranged from 5 to 2848. The correlation coefficient between ALC and CD4 cell count was significant (0.714). There were 49 patients with an ALC of ≤1200/μL of whom 77.6% patients had CD4 cell count ≤ 200/μL (true positive) and 22.4% had CD4 cell count > 200/μL (false positive). There were 133 patients with an ALC of >1200/μL of whom 84.2% had CD4 cell count > 200/μL (true negative) and 15.8% had CD4 cell count ≤ 200/μL (false negative). Taking ALC of ≤1200/μL as a predictor of CD4 cell count ≤ 200/μL ,the sensitivity of the test was 64.4% and specificity was 91.1%. The positive predictive value was 77.6%, negative predictive value was 84.2%, and accuracy was 82.4%. Conclusion: We found that an ALC of ≤ 1520/μL has higher sensitivity (78%) for a CD4 cell count of ≤ 200/μL. The ALC was found to be significantly cost-effective in our setup but chances of missing out patients requiring ART was 1 in 5 using the WHO guidelines.
Subject(s)
Adolescent , Adult , Aged , Cost-Benefit Analysis , Female , HIV Infections/diagnosis , HIV Infections/immunology , Humans , Lymphocyte Count/economics , Male , Middle Aged , Sensitivity and Specificity , Young AdultABSTRACT
OBJECTIVES: This paper attempts to validate the programme of structured play lasting 90 minutes a day, for use in orphanages, to check if it can be replicated in other orphanages, with similar results. METHODS: A 2-week workshop on the structured play scheme was conducted at the Missionaries of Charity Orphanage in Delhi, the venue of the original project. 15 MOC sisters from 6 centers attended the workshop. The authors selected the MOC orphanage at Chandigarh to track the benefits of the programme. The development quotient of all the residents between the ages of 6 months - 3 years was assessed by a pediatric-clinical-psychologist using the Development Assessment Scale for Indian Infants (DAS II) scale. A reassessment of all these children was done again 3 months after initiating the programme of structured play here. RESULTS: The mean motor and mental scores at the orphanage in Chandigarh before the start of the intervention were 57.9 and 58.2 respectively. Post intervention assessments showed a rise of 23 points in both the scores. CONCLUSION: The development of children in orphanages rises dramatically after initiating a programme of play. The pre-intervention development scores is similar to that in a pilot study and the benefits after play was also similar. The play programme can be easily replicated in other orphanages with similar results.