A randomized, double-blind, parallel and placebo-controlled clinical study to evaluate the efficacy and safety of KaraCalm™: a dietary supplement to support sleep and manage stress

Background: KaraCalm™ is a novel polyherbal formulation obtained from the combination of Valeriana officinalis extract, Passiflora incarnata extract, Ocimum sanctum extract, Ziziphus jujuba extract, Rosmarinus officinalis extract, and Nigella sativa extract. The objective of the present investigation was to assess the efficacy and safety of KaraCalm™ to manage stress and improve sleep in healthy subjects in a randomized, double-blind, placebo-controlled clinical study. Methods: A total of 60 healthy volunteers were randomized into two groups, with 30 subjects in the KaraCalm™ group and 30 in the placebo group. Participants were asked to take KaraCalm™ 500 mg or placebo once daily for 56 days. As primary outcomes, sleep analysis was performed by using Actiwatch, while stress level was evaluated with the Perceived Stress Scale (PSS) scores from baseline to the end of the study period. Serum cortisol, and hs-CRP from baseline to the end of the study period were assessed as secondary endpoints. Results: An increase in overall sleep quality was observed in the KaraCalm™ group compared to the placebo as measured by total sleep time, onset latency, wake after sleep onset minutes, and number of awakenings. There was also a reduction in PSS scores in the KaraCalm™ group from baseline to the end of the study, indicating reduced stress levels. A significant reduction in Serum cortisol and hs-C-reactive protein (CRP) levels in the KaraCalm™ group from baseline to the end of the study further supported the effectiveness of KaraCalm™ in reducing stress. There was no significant change in the safety analyses of the patients in the intervention group when assessed from the start of the study to the end. Conclusions: KaraCalm™ can be considered a safe and effective dietary herbal Supplement to reduce stress and improve sleep quality.

Socio-demographic and behavioural profile of HIV positive patients visiting ICTC at a tertiary care hospital in North India

Background: Fast track approach is being followed by UNAIDS in order to achieve the aim of ending AIDS epidemic by 2030. It is important to keep a check on new infections and gather information about the HIV trends of the new cases. This study was planned to analyze the socio-demographic details, associated high risk behaviours and common routes of transmission of new cases. Methods: Data of new HIV positive patients coming to the ICTC centre during the study period was collected. The HIV positive patients were counselled by the counsellor after taking informed consent. The socio demographic details of the patients were shared by the counsellor. Results: Total 92 HIV positive patients were enrolled. Out of 92, 64 were males and 28 were females. Out of 92, 12 were illiterate. Most common route of transmission was found to be heterosexual route followed by blood transfusion. Of 92 patients, 36 were direct walk in clients and 56 were referred to ICTC. Most common high risk behaviour amongst HIV positive people is unsafe sexual practice with non-regular/casual partners, and homemakers are mostly secondarily infected from their reactive spouses. Conclusions: The most common high-risk behaviour (HRB) amongst HIV positive people is unsafe sexual practice with non-regular/casual partners, and innocent homemakers are mostly secondarily infected from their reactive spouses. Thus, there is a need to further spread awareness amongst women about the HRB and risk of HIV. Sharing of results between partners needs to be encouraged in order to prevent HIV transmission.

The role of color Doppler and multidetector CT angiography in evaluation of peripheral arterial diseases of lower limb

Background: Characterized by atheromatous narrowing and hardening of arteries supplying blood to the legs and feet. Diabetes, along with other risk factors such as hypertension and smoking, exacerbates the prevalence and severity of PAD, leading to decreased blood flow and subsequent tissue injury. The prevalence of PAD in diabetics rises with age, underscoring the importance of early detection and management strategies. Methods: This study aims to evaluate the efficacy of color Doppler and MDCT Angiography in assessing lower limb peripheral arterial diseases. Conducted over twenty-four months, the cross-sectional study involved clinically suspected symptomatic cases aged 30 years and above, presenting at a tertiary care center. Patients underwent thorough clinical examination and demographic assessment before undergoing Color Doppler flowmetric studies and MDCT angiography. Results: Results revealed that color Doppler, with its ability to measure wall thickness and vascular flow, demonstrated promising diagnostic efficacy compared to MDCT angiography. Additionally, follow-up records of patients undergoing medical or surgical interventions provided valuable insights into the practical utility of these imaging modalities in guiding clinical management decisions. Conclusions: Overall, this study underscores the importance of non-invasive imaging techniques in diagnosing and evaluating the progression of peripheral arterial diseases. It suggests that Color Doppler Ultrasound, with its accessibility, low cost, and radiation-free nature, could serve as a suitable alternative to MDCT Angiography for assessing arterial characteristics in patients with PAD.

Smartphone addiction: impact on health and well-being

This study explores the increasing prevalence and negative impacts of excessive smartphone use. It emphasizes the detrimental effects on academic performance, mental health, and physical well-being, highlighting the need for intervention strategies. The review aims to summarize evidence demonstrating the significant influence of smartphone addiction on dietary behavior and lifestyle, as well as the complex interplay between mobile phone usage patterns and mental health outcomes. The document suggests that mindfulness practices, self-reflection, and seeking professional help can be effective strategies to combat smartphone addiction. Through a systematic literature search using databases like Google Scholar, NIH, and PubMed, the review gathers information on smartphone addiction's effects on health, academics, and adolescence. The conclusion calls for longitudinal studies to track the long-term impact of smartphone usage on academic performance and overall well-being. It recommends identifying at-risk groups for intervention and promoting responsible smartphone usage to prevent adverse effects. Overall, the document underscores the importance of understanding the factors contributing to smartphone addiction and implementing measures to foster genuine human interactions, balance technology use, and mitigate the hazards of smartphone addiction among adolescents.

Assessment of alcohol use and its associated factors among adults residing at Dakshina Kannada district, Karnataka, India

Background: Alcohol consumption was accepted social practice since ancient times. Presently, alcohol consumption is pervasive and has been consistently increasing throughout the world. Alcohol consumption is considered as world’s third largest risk factor for the occurrence of disease and disability. The objective of the study was to assess the burden of alcohol use and the factors associated for the alcohol consumption among adults residing at Dakshina Kannada district. Methods: This community based cross sectional study was conducted among adults aged more than 18 years in Dakshina Kannada district to assess the burden and correlates of alcohol consumption. A total of 355 participants were selected randomly and data was collected by using pretested questionnaire which includes sociodemographic details, alcohol use disorders identification test (AUDIT) questionnaire and associated factors. Data was analyzed by using SPSS software and the statistical significance level was fixed at p<0.05. Results: The prevalence of alcohol use was 30.7%, and it was higher among males (37.1%) compared to females (8.8%). Even the alcohol use was higher among those participants, who were employed, tobacco users and was having any existing disease. As per AUDIT risk level, maximum (49.5%) alcohol users belonged to low risk (zone I) with AUDIT score less than 8. Conclusions: The burden of alcohol consumption among adults in Dakshina Kannada district is nearly one -third of the population, which is quite high. The highest prevalence was found among males and tobacco users.

Yoga as an adjunct therapy in elderly patients of chronic constipation

Background: Constipation being very prevalent and common complaint in elderly people, an effective measure is needed to get the relief along with drugs for constipation used by clinicians. Our aim was to search out the potential applicability and effectiveness of yoga. Methods: 30 elderly patients visiting medicine OPD for chronic constipation were included in study. Yoga group (15) was offered selected yogic practices in addition to drugs and control group drugs only. Patients kept record of drug intake on paper for 2 months of study. Data was obtained by using CAS score and frequency of drug intake. Data were analysed using t test. Results: Baseline CAS scores for the yoga and control groups were 11.92±1.59 and 12.07±1.68 respectively. Post yoga CAS score for the yoga and control groups were 3.50±1.40 and 4.14±1.5 respectively. Frequency of drug intake in yoga and control groups in first month of yoga was 17.57±2.31 and 19.14±2.38 respectively. In 4th month of yoga practice frequency of drug intake in yoga and control groups was 11.07±2.16 and 18.35±2.56, which was highly significant. Conclusions: Selected yoga practices can be used as an adjuvant therapy to treat chronic constipation in case of elderly. They can be effective in decreasing drug requirement in patients of chronic constipation. Yoga practices should be advised for patients of chronic constipation.

Knowledge, attitudes and practice among healthcare workers towards COVID-19 in a tertiary care centre in north India

Background: Coronavirus disease pandemic has affected the entire world and till date, there is no definitive cure for it with prevention of infection and knowledge about the disease being the only proven effective methods to contain it. Healthcare workers (HCWs) are highly susceptible to getting infected and their knowledge about COVID-19 infection has been known to be inversely proportional to the rates of COVID-19 infection. Methods: Cross-sectional questionnaire-based study assessing knowledge, attitude and practices towards COVID-19 preventive measures was carried out amongst HCWs at a tertiary care hospital in North India. Results: Around 95% of HCWs had received training regarding COVID-19 infection and more than 95% HCWs had adequate knowledge about COVID-19 infection. More than 95% HCWs experienced anxiety and fear while monitoring and treating COVID-19 patients. 85% HCWs felt that there is sufficient awareness in the society regarding COVID-19 infection. Most of the respondents followed correct practices for avoidance of COVID-19 infection with around 90% respondents using face masks and practicing frequent hand washing. Social distancing and avoidance of large gatherings was practiced by around 95% respondents. More than 95% respondents had either taken COVID-19 vaccine or wish to take it. Conclusions: The study suggested that the majority of HCWs had good knowledge and positive attitude toward COVID-19 but there are still some lacunae present in the knowledge regarding prevention of COVID 19 infection. Further education and training are required for HCWs so as to fight COVID and prevent its spread in a better way.

Efficacy and safety of dexlansoprazole: a comprehensive review

Gastroesophageal reflux disease (GERD) remains prevalent in medical practice. Proton pump inhibitors (PPIs) are the primary treatment, yet limitations exist. Dexlansoprazole modified release (MR), an R-enantiomer of lansoprazole, offers high efficacy. Its dual release in the duodenum and small intestine yields two peak concentrations at different times (2- and 5-hours post-administration), ensuring the longest maintenance of drug concentration and proton pump inhibitory effect among all PPIs. Dexlansoprazole MR effectively heals erosive esophagitis, maintains healed esophageal mucosa, and controls NERD symptoms. It also improves nocturnal heartburn, GERD-related sleep disturbances, and bothersome regurgitation. Importantly, it maintains good plasma concentration regardless of food intake, enabling flexible dosing. Furthermore, it does not significantly affect clopidogrel metabolism or platelet inhibition, eliminating the need for dose adjustments when co-prescribed. This review highlights dexlansoprazole's unique attributes, pharmacokinetics, advantages, and safety in comparison to traditional PPIs.

Quality of life of occupants of old age homes of a northern Indian province

Background: Although a physiological phenomenon, ageing has enormous bearing on all the dimensions of health. Against age-old tradition, India is also witnessing a rapid increase in nuclearization of families. Increase in old age homes (OAHs) has been proportional to rising number of admissions in such institutions. In order to understand the phenomenon in a holistic way, the present study evaluated the quality of life of occupants such facilities in state of Himachal Pradesh. Methods: A descriptive cross-sectional study was conducted to capture quality of life among the occupants of all seven OAHs of the State. Data was collected using World Health Organisation quality of life-Bref (WHOQOL-Bref) instrument consisting of four domains, individual domain and overall scores were compiled; and analysed using appropriate statistical techniques. Results: The mean WHOQOL-BREF score for a total of 145 study participants was 46.6±3 with highest score for environmental domain (49.1±4.7) and least for physical domain (44.0±5.2). Significant higher overall quality of life score was observed for comparatively younger participants, males, more educated individuals, those having a companion prior to the settlement, those having more satisfaction with facilities and lesser morbidities. Conclusions: Considering increasing elderly population proportion, there is a need for increase in number of facilities with standardized infrastructure, staff and facilities; so that quality of life can be maintained and sustained. Being a vulnerable and deprived section of the society, it is imperative that such individuals live out the final stage of their life with quality, dignity and much neglected self-respect.

Maternal health disparities in district Jhansi, Uttar Pradesh: a time series analysis using health management information system records

This study focused on investigating the status of maternal health in Jhansi District, Uttar Pradesh, India. A comprehensive analysis of data obtained from the health management information system (HMIS) spanning the period from 2010 to 2020. The findings of this study indicate notable fluctuations in the percentage of first-trimester ANC registrations, accompanied by an overall improvement in compliance with the recommended number of ANC checkups. In addition, the study identifies a growing inclination towards institutional deliveries and increased utilization of cesarean section (C-section) procedures. This study emphasizes the urgent and continued implementation of measures to enhance timely access to ANC services and to ensure the presence of skilled birth attendants during all childbirths. These insights are of substantial significance to policymakers and healthcare providers in their efforts to advance maternal healthcare services, diminish maternal mortality rates, and enhance women’s overall well-being in Jhansi District, Uttar Pradesh, India. The study recommends reinforcing ANC services, promoting collaborative initiatives to improve maternal health outcomes, and establishing clear guidelines and regular quality audits to ensure the appropriate utilization of C-sections.

Correlation of serum ferritin, LDH, CRP with chest findings- CT severity index in COVID-19 patients

Background: The COVID-19 pandemic is caused by a highly infectious virus primarily transmitted from person to person. The initial clinical manifestations of the condition are non-specific, characterized by the presence of fever and cough. These symptoms may resolve independently or escalate to acute respiratory distress syndrome (ARDS), multiple organ failure, and ultimately, mortality. Methods: The research was conducted at Moolchand Khairatiram Hospital in the COVID-19 wards and ICU in New Delhi. The blood samples were collected and then analyzed to evaluate the following parameters: C-reactive protein (CRP), serum ferritin, and LDH are the three biomarkers of interest. The statistical significance threshold was established at a p value of less than 0.05. Results: The study included 200 patients, 49% of whom were male and 51% of whom were female. A link was discovered between the outcome and the CT severity index. Patients who had a CT severity index of 21-25 died at the highest rate. The CT severity index and ferritin were found to have a significant relationship, with patients with elevated ferritin levels reporting the highest CT severity index scores. Conclusions: A statistically significant association was observed between the CT severity index and the outcome, with the highest mortality rate observed in patients who had a CT severity index of 21-25. The parameters above are crucial in assessing the condition and predicting the outcome of individuals afflicted with COVID-19.

Causal ambiguity: deciphering the etiology of secondary thrombotic microangiopathy with systemic lupus erythematosus and vivax malaria

Hemolytic uremic syndrome (HUS) falls under the spectrum of thrombotic microangiopathy (TMA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and thrombi in small vessels leading to end-organ damage. It's classified into typical HUS (caused by Shiga toxin-producing E. coli), atypical HUS (due to uncontrolled complement activation), and secondary HUS (sHUS) linked with coexisting conditions. We present a compelling case of a 21-year-old female with fever, jaundice, anemia, thrombocytopenia, and oliguric acute kidney injury (AKI), ultimately diagnosed with Plasmodium vivax malaria. Despite adequate antimalarial therapy, the patient's clinical trajectory remained intricate, characterized by sustained hematological abnormalities and renal dysfunction. A comprehensive assessment revealed Coombs-negative hemolytic anemia. Subsequently, a renal biopsy confirmed TMA. Considering the rarity of vivax malaria causing TMA, an autoimmune workup was conducted, suggesting systemic lupus erythematosus (SLE). Systemic autoimmune disease-associated HUS (SAID-HUS) is a rare entity that exhibits diverse clinical presentations, with SLE being best-described etiology in literature. SLE-associated HUS was considered and was managed with steroids and hydroxychloroquine resulting in significant renal and hematological improvement. This report underscores significance of assessing autoimmune factors in case of secondary TMA, while also shedding light on evolving understanding of vivax malaria's potential relationship with TMA.

Postural assessment of children with spastic cerebral palsy: a cross-sectional study

Background: Children with cerebral palsy (CP) exhibit gait difficulties, posture alignment issues when standing, and issues with body orientation in space as a result of both primary and secondary CP deficits. The purpose of this study was to analyze the posture of children with spastic diplegic CP. Methods: The 17 subjects of age group 3-10 years with GMFCS scale I-II of CP were taken in the study and compared with age matched control group of 17 typical development (TD) children. The postural assessment was carried out using the photographic method. Angles like the head angle, angle of hip joint, angle of ankle joint were calculated with the help of Matlab script. Results: The Pearson's correlation was utilised to examine the relationship between various postural angles in the CP group while the t-test was used to analyse differences between the two groups. The two groups were found to differ in every measure but horizontal alignment of acromion (HAAC), angle of hip (AH), angle of knee (AK), angle of ankle (AA), scapular alignment right and left (SAR) (SAL) were significantly different in CP group rather than TD group (p<0.01) and postural angles were found to be significantly correlated in CP group (p<0.01). Conclusions: The postural angles in children with spastic CP are deviated from the normal angle. Correct analysis of posture gives us a tool to identify the altered biomechanics and further design an intervention program which will address the mal-aligned structures.

Pancreatic tuberculosis mimicking as pancreatic malignancy: Surgeon's dilemma

Pancreatic tuberculosis is a rare form of Tuberculosis (TB) which requires a high index of suspicion to diagnose. Here, we report a case of middle-aged gentleman presenting with abdominal pain and constitutional symptoms who was diagnosed with pancreatic tuberculosis on imaging, which was confirmed by Fine Needle Aspiration (FNA) from the lesion. The patient was given Anti-Tubercular Treatment (ATT) as per conventional protocol. Follow-up showed recovery from the entity. A review of patient presentation, patho-physiology, diagnosis, and management of pancreatic tuberculosis is mentioned in this article.

Diagnostic utility of special stains in defining the spectrum of maxillofacial pathologies

Background: The Fine needle aspiration cytology (FNAC) is considered as a valuable and distinguished diagnostic test in the initial assessment of the patients presenting with a mass in the head and neck region or when a recurrence is suspected after previous treatment. Aims: This study was therefore designed to elucidate the efficacy of FNAC as an alternate diagnostic tool to histopathology in head and neck swellings and evaluation of staining efficacy of PAP and MGG stain over Haematoxylin and eosin (H and E) in routine cytopathological smears. Settings and Design: The study was conducted in the Department of Oral and Maxillofacial Pathology, where FNAC samples were collected from 150 patients with head and neck swellings. Materials and Methods: All the slides were stained with H and E, Papanicolaou (PAP), and May Grunewald Giemsa (MGG) stains. The cytopathological diagnosis was compared with histopathological diagnosis based on H and E stained sections obtained from paraffin-embedded formalin-fixed biopsy specimen of benign and malignant neoplasms. Statistical Analysis Used: The resulting data were analyzed using SPSS software version 19. Differences between the variables were analyzed using Pearson Chi-square test and Kruskal–Wallis test wherever applicable. Results: The FNAC as a diagnostic tool has sensitivity of 84.8%, 72.72%, and 78.78%, specificity of 62.5%, 75%, and 75%, and accuracy of 80.48%, 73.14%, and 78.04% in H and E, MGG, and PAP stain, respectively. PAP stain was the most efficient stain when all qualitative parameters are taken into consideration with maximum sensitivity and specificity for achieving definitive cytodiagnosis. Conclusions: The FNAC is an inexpensive and minimally invasive technique to diagnose different types of head and neck swellings and complement histopathological diagnosis.

A case report on primigravida with myasthenia gravis: outcome of pregnancy

Primigravida refers to a woman who is pregnant for the first time. It is a unique experience for the woman. Usually, any minor alignment during this time will lead to anxiety. The prevalence rate of myasthenia gravis in pregnancy is 1 in 20,000. The main reason behind the cause of the disease is improper secretion of acetylcholine, huge secretion of cholinesterase, and non-responsive muscle fibers. The purpose of this case study is to introduce the outcome of pregnancy with myasthenia gravis. This case was taken at X private hospital. A 27-year-old primigravida woman with 38 weeks of pregnancy was the first known case of myasthenia gravis. She was diagnosed with myasthenia gravis thymic hyperplasia in November 2020. The patient is then managed with a surgical procedure, i.e., thymectomy, on 18 September 2021. The patient was receiving distinon (pyridostigmine) 60 mg. It requires the intraoperative collaboration of the neurology and obstetrics departments in managing myasthenia gravis during pregnancy. A successful elective caesarean section was done on the patient's request under spinal anaesthesia on 13 April 2023. The male newborn, with a birth weight of 2.825 gm was delivered. The newborn was transferred to the NICU for further surveillance and did not show any sign of muscular weakness. The baby was healthy at the time of discharge.

Determination of the bioavailability and biodistribution of a single dose of oral cholecalciferol/Calcirol® soft gelatin capsule by pharmacoscintigraphy- CalSci study

Background: It is required to study the bioavailability and biodistribution of specific cholecalciferol formulation before prescribing. Pharmacoscintigraphy is an established radiological-imaging technique that is used to map various drug formulations as they traverses the human body (biodistribution) in real-time. We evaluated the bioavailability and biodistribution pattern, transit time, and gastrointestinal clearance of a single dose of Calcirol® soft gelatin capsule 60,000 IU [an oral cholecalciferol (vitamin D) formulation] using pharmacoscintigraphy. Methods: Six male healthy adult volunteers were administered a single oral dose of Calcirol® soft gelatin capsule labelled with technetium-99m. Post-dosing, serial venous blood samples were collected till day 27 for the estimation of the plasma levels of 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol levels. Different pharmacokinetic parameters were calculated. Sequential static gamma imaging was performed to evaluate the biodistribution of Calcirol® soft gelatin capsule. Descriptive statistics was used. Various pharmacokinetic parameters were calculated from the concentration-time curves. Statistical analysis was carried out using Student’s t-test. Suitable multivariate analysis was performed based on the distribution of data. All statistical analyses were performed using SAS® Software (v 9.4). Results: The overall absorption of Calcirol® soft gelatin capsule was 93.23%, which was fully from the small intestine. It led to achieving a sufficient level of 25-hydroxycholecalciferol (>60 ng/ml) within 6 hours of oral intake. The levels of plasma 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol increased (maximum around 6 and 18 days, respectively). The small intestinal residence time was around 16 hours. No adverse event was noted. Conclusions: This was the first pharmacoscintigraphy study in the world which demonstrated the favourable bio-distribution of the Calcirol softgels supporting its role in vitamin D supplementation.

Central nervous system manifestations in HIV: magnetic resonance imaging pictorial review

Human immunodeficiency virus (HIV) is a member of the Retroviridae (retrovirus) family. It is associated with immunodeficiency, neurological diseases and neoplasms. With the use of antiretroviral therapy (ART), the prognosis of people who are infected with HIV has improved, and the incidence of HIV-related central nervous system (CNS) diseases has markedly decreased. In spite of that the mortality from HIV-related CNS diseases remains significant. Magnetic resonance imaging (MRI) has improved the perspective for people with HIV with the help of early diagnosis and prompt treatment. There are various conditions which come under the spectrum of CNS manifestations of HIV for e.g., HIV encephalopathy, progressive multifocal leukoencephalopathy (PML), HIV-related primary CNS lymphoma (PCNSL), CNS toxoplasmosis, other diseases caused by opportunistic infections like CNS cryptococcosis, CNS tuberculosis and immune reconstitution inflammatory syndrome (IRIS). Each condition shows certain specific MRI features which aid in diagnosis. Although, distinguishing between HIV-related CNS diseases based on imaging alone is sometimes difficult, in this review, we discuss the spectrum and imaging features that can contribute to their early differentiation.

Histomorphological spectrum of meningeal tumours and its association with MIB-1 labelling index

Background: Meningiomas are extremely common, slow growing tumours originating from meningeal covering of brain and spinal cord. They are mostly encountered in middle or later adult life. Females are affected more commonly than males. Grading of meningiomas based on histological features has certain limitations in predicting exact biological behavior hence ancillary studies like immunohistochemistry can be used to predict the nature of the lesion. Methods: This prospective cross-sectional study was conducted in pathology department in our institute. Total 105 cases, diagnosed as meningioma between October 2019 to May 2021 were included in the study. Immuno-staining was performed using MIB-1 antibody against ki67 antigen. Various statistical test methods like chi square test, unpaired t test and spearman’s rho correlation were used to evaluate the significant value. Results: Among 105 patients analysed there were 78.09% females (mean LI 4.01±3.25%) and 21.91% males (mean LI 3.17±2.64%). Mean age of presentation was 53.14 years and most common subtype was transitional meningioma with 51.43% cases. Histological grading revealed 95.24% WHO grade 1 tumor (mean LI- 3.33±2.22%), 4.76% WHO grade 2 (mean LI- 13.80±2.28%) and no case of WHO grade 3. There was correlation between values of MIB-1 LI and histological grade. Some differences for MIB-1 labelling index were found among the subtypes of meningioma of same grade. Conclusions: The MIB-1 is one important tool in addition to routine histological evaluation. High MIB-1 LI indicates higher grade of meningioma.

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as markers of early sepsis and mortality in pediatric burns: a prospective evaluation

Background: Delay in the diagnosis of sepsis in pediatric burns results in advertently high mortality and morbidity. Our study aimed at evaluating the role of two upcoming biomarkers- neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR)- as predictors of early sepsis and mortality in this group of patients. Methods: This was a prospective study conducted at a tertiary care burn centre of northern India over 18 months. 90 pediatric burn cases, aged 1-16 years, presenting within 24 hours of burns, with >10% body surface area of thermal burns/scalds were included in the study. Cell counts were measured on day 1, 3, 5 and 7 of burns. Patients were followed up till discharge, 30th post burn day or death, whichever was earlier. Results: Sepsis was clinically present in 49 cases out of 90 (54.44%) with 30% median total body surface area (TBSA) of burns. Mortality was seen in 31cases out of 90 (34.44%) with 35% median TBSA burns. Higher PLR levels were seen in the sepsis group. NLR and PLR were also elevated in the survival group. Both parameters were found to be reliable markers of sepsis as well as mortality, particularly on days 5 and 7, in this cohort of patients. Conclusions: Indices like NLR and PLR, which can easily be derived from complete blood count, have potential utility as determinants of both sepsis and mortality in children afflicted with thermal injuries.