Association Between Serum Testosterone and Serum PSA Among Men With and Without Partial Androgen Deficiency.

Serum prostatic specific antigen (PSA) and serum testosterone levels share an undefined relationship with each other, with many conflicting studies showing both positive and negative correlation between them. Our aim was to assess association between serum PSA and serum testosterone in healthy men with normal testosterone levels and men with partial androgen deficiency (PADAM). A cross sectional study was conducted at a teaching hospital setting where serum testosterone and aging male symptom scale (AMS) scores along with PSA were studied in 255 men (> 50 years) with and without PADAM. Mean total testosterone and serum PSA was 9.35 ± 1.33 nmol/L, 1.96 ± 0.76 ng/mL in males with PADAM and 15.30 ± 1.95 nmol/L, 1.85 ± 0.73 ng/mL respectively in males without PADAM. No significant relationship was observed between serum PSA and serum testosterone levels among healthy males irrespective of PADAM in the study population. We suggest, there is no need to adjust PSA values for biopsy decisions according to testosterone levels.

Structure and Li+ dynamics of Sb-doped Li7La3Zr2O12 fast lithium ion conductors.

Antimony-doped lithium stuffed garnets Li(7-x)La3Zr(2-x)Sb(x)O12 (x = 0.2-1.0) prepared using a conventional solid state reaction method are characterized using Powder X-ray Diffraction (PXRD), Scanning Electron Microscopy (SEM), Energy Dispersive Analysis by X-ray (EDAX), AC Impedance spectroscopy, Magic Angle Spinning Nuclear Magnetic Resonance (MAS NMR) and Raman spectroscopic techniques. PXRD confirms the formation of a garnet-like structure with cubic symmetry for the entire selected compositional range. Among the investigated compounds, the compound with an Sb content corresponding to x = 0.4, i.e. Li6.6La3Zr1.6Sb0.4O12 exhibits the maximum total (bulk + grain boundary) ionic conductivity of 7.7 × 10(-4) S cm(-1) at 30 °C. The shape of the imaginary part of the modulus spectra suggests that the relaxation processes are non-Debye in nature. The full width at half maximum (FWHM) for the master modulus curve of Li6.6La3Zr1.6Sb0.4O12 is found to be the smallest among the investigated lithium garnets. The full width at half maximum (FWHM) of the (7)Li MAS NMR spectrum for the composition Li6.6La3Zr1.6Sb0.4O12 is the smallest among the investigated compounds. Raman data collected for the compounds in this series indicates an increase of Li(+) occupancy in the tetrahedrally coordinated site with an associated decrease of Li(+) occupancy in the octahedrally coordinated site during an increase of x in Li(7-x)La3Zr(2-x)Sb(x)O12. The present investigation reveals that the optimal Li(+) concentration required to achieve the maximum room-temperature Li(+) conductivity in Li(7-x)La3Zr(2-x)Sb(x)O12 lithium stuffed garnet is around x = 0.4.

Life time risk for development of ten major cancers in India and its trends over the years 1982 to 2000.

BACKGROUND: Understanding cancer magnitude, risk and trends will be of help in cancer control programs. AIM: To study trends in cumulative risk up to 64 years of age as lifetime risk of developing major cancers in India during the years 1982 to 2000. DESIGN: Retrospective. SETTING: Secondary sources of cancer-registration data. MATERIALS AND METHODS: Data on age-specific cancer-incidence rates were collected for patients 0-64 years of age of either sex for 10 major cancer sites from the National Cancer Registry Program (NCRP) reports of India from Mumbai, Chennai, Bangalore, Bhopal and Delhi; and Barshi registries for the years 1982 or 1988 to 2000. STATISTICAL ANALYSIS: Cumulative risks computed for lifetime development of cancer. Linear trends were studied using simple linear regressions. RESULTS: The lifetime risk among females for the 10 cancer sites ranged from 0.02 to 3.3% and from 0.04 to 2.4% for the years 1982 and 2000 respectively; whereas among males, it ranged from 0.04 to 0.89% and from 0.05 to 0.95% respectively. Significant (P<0.05) increasing trends were observed for breast, non-Hodgkin's lymphoma (NHL), gallbladder, thyroid and ovary cancers among females; while declining trends were observed for cervix, mouth, stomach, esophagus and tongue cancers. Among males, significant (P<0.05) increasing trends wre observed for NHL and prostate cancer; whereas declining trends were observed for stomach, liver, hypopharynx and tongue cancers. Cancers of mouth and esophagus showed increasing trends (P<0.05) in some regions and declining trends (P<0.05) in some other. CONCLUSION: Significant and higher rates of positive trends in lifetime cancer risks for breast cancer among females and for NHL among both sexes were observed.

Oral cancer statistics in India on the basis of first report of 29 population-based cancer registries.

OBJECTIVES: To summarize and provide an overview of age-specific oral cancer incidence reported in 29 population-based cancer registry in India. MATERIALS AND METHODS: Secondary data on age-adjusted rates (AARs) of incidence of oral cancer and other associated sites for all ages (0-75 years) were collected from the report of the National Cancer Registry Programme 2012-2014 in 29 population-based control registries. RESULTS: Among both males and females, mouth cancer had maximum Age adjusted incidence rates (64.8) in the central zone, while oropharynx cancer had minimum AAR (0) in all regions. CONCLUSION: Oral cancer incidence increases with age with typical pattern of cancer of associated sites of oral cavity seen in the northeast region.

Device optimization of CO2 gas sensor using planar technology.

A planar type Li+ ion based potentiometric CO2 micro gas sensor of size 2 x 3 mm has been fabricated on alumina substrate by combining thin and thick film technology. The heater, electrodes and electrolyte were deposited by thin film deposition technique and the sensing and reference electrodes were printed by silk screen printing technology. The optimal thickness and sintering temperature of electrolyte are 1.2 microm and 775 degrees C. The sensor with Li2CO3 and 20 mol% BaCO3 not only exhibits a good Nernstian behavior but also consistent results over a long time at 450 degrees C in dry as well as 70% RH humidity condition between 160-5000 ppm CO2 concentrations. The spreading effect of the sensing and reference materials was controlled by the addition of Al2O3:B2O3 (1:2 mol%) glass.

Under diagnosis of asthma in school children and its related factors.

A cross-sectional study was carried out on one thousand school children studying in three public schools of Delhi and Haryana between 10 to 17 year age group over the period of one year (2001-02). It aimed in studying under diagnosis of asthma in school children and its related factors. Questionnaires including details of medical, social, environmental factors precipitating asthma were filled by the parents and class teachers. Pulmonary function test (PFT) was performed. Based on questionnaires and PFT results, children were grouped as labeled and unlabeled asthmatics. Cough was found to be equally prevalent in both the groups while wheezing and shortness of breath were independent and significant factors associated with getting a physician diagnosis.

Prevalence & pattern of respiratory diseases including Tuberculosis in elderly in Ghaziabad - Delhi - NCR.

Elderly population is continuously increasing all over the world including India. Old age is associated with significant prevalence of chronic illnesses. Population based study to find prevalence & pattern of respiratory diseases in elderly in India is difficult to find. Present study was done in an urban locality of Ghaziabad inhabited mainly by low socio - economic status population. Two part questionnaire was used as main tool. Through part one 1522 elderly were screened for respiratory disease. Respiratory disease was confirmed & diagnosed by part two of questionnaire, physical examination & necessary investigations. Prevalence of respiratory diseases was 18.8% in this study. Prevalence of respiratory diseases was almost double in elderly males as compared to females. COPD was most prevalent respiratory disease followed by Bronchial asthma.

X-ray crystallographic studies on C-phycocyanins from cyanobacteria from different habitats: marine and freshwater.

C-phycocyanins from three cyanobacterial cultures of freshwater and marine habitat, Spirulina, Phormidium and Lyngbya spp., were purified to homogeneity and crystallized using the hanging-drop vapour-diffusion method. Blue-coloured crystals in different crystal forms, monoclinic and hexagonal, were obtained for the three species. The crystals took 1-12 weeks to grow to full size using polyethylene glycols of different molecular weights as precipitants. The amino-acid sequences of these proteins show high similarity to other known C-phycocyanins from related organisms; however, the C-phycocyanins reported here showed different biochemical and biophysical properties, i.e. molecular weight, stability etc. The X-ray diffraction data were collected at resolutions of 3.0 A for the monoclinic and 3.2 and 3.6 A for the hexagonal forms. The unit-cell parameters corresponding to the monoclinic space group P2(1) are a = 107.33, b = 115.64, c = 183.26 A, beta = 90.03 degrees for Spirulina sp. C-phycocyanin and are similar for crystals of Phormidium and Lyngbya spp. C-phycocyanins. Crystals belonging to the hexagonal space group P6(3), with unit-cell parameters a = b = 154.97, c = 40.35 A and a = b = 151.96, c = 39.06 A, were also obtained for the C-phycocyanins from Spirulina and Lyngbya spp., respectively. The estimated solvent content is around 50% for the monoclinic crystals of all three species assuming the presence of two hexamers per asymmetric unit. The solvent content is 66.5 and 64.1% for the hexagonal crystals of C-phycocyanin from Spirulina and Lyngbya spp. assuming the presence of one alphabeta monomer per asymmetric unit.

Chiral modification of copper exchanged zeolite-Y with cinchonidine and its application in the asymmetric Henry reaction.

Chirally modified Cu(2+) exchanged zeolite-Y was synthesized by direct adsorption of cinchonidine under ambient conditions. The chirally modified materials were characterized using various spectrochemical and physicochemical techniques viz. BET, FTIR, MAS ((1)H and (13)C NMR), XPS, SEM, cyclic voltammetry and PXRD. Characteristic peaks of cinchonidine observed in the supported materials confirmed the adsorption of cinchonidine and its coordination with the Cu(2+) active site on copper exchanged zeolite-Y. (13)C SSNMR and XPS analysis however confirmed for the half encapsulation process, only the quinoline ring of cinchonidine gets coordinated to the internal metal sites via the N atom while the quinuclidine moiety extends out of the host surface. Cinchonidine supported Cu(2+)-Y zeolites were found to exhibit good catalytic performance in the asymmetric Henry reaction. (1)H SSNMR studies also confirmed the protonation of the N atom of the quinuclidine ring during the course of the Henry reaction. Heterogeneous chiral catalysts were effective for up to two consecutive cycles. Leaching of cinchonidine after the second cycle was found to have a negative result in the catalytic performance.

HSV-IgA serum antibodies in cervical intraepithelial neoplasia and invasive cancer patients, and in their spouses: a case control study.

Class-specific IgG and IgA antibodies to HSV were assayed in women with CIN (76), invasive cancer (52) (histological diagnosis) and age-matched controls (119), employing HSV-2-infected HEp-2 cells as antigen during IFA assay. We observed an elevated geometric mean titre (GMT) of serum antibody (IgG five-to eight-fold and IgA four-to five-fold) for the entire spectrum of cervical lesions, as compared to controls. The odds of finding HSV-IgA antibodies were highest with CIN III (OR = 22.0), followed by invasive carcinoma, and CIN I & II (OR = 9.5 and 5.2), respectively. Furthermore, the investigations with respect to married couples (husbands and wives) who volunteered to participate in this study (33 cases and 47 control group) also indicated relatively high antibody titres and increased frequency of HSV sero positivity amongst husbands of cases as compared to their wives, as well as the control group males and females. The contribution of HSV infection in women and/or their husbands to the risk of developing abnormal cervical lesions was analysed after adjusting for the same in respective counterparts. It was observed that the risk was increased 14-fold with HSV-IgA positivity of women, and that HSV-IgA positivity of husbands (male partners) further increased the risk 16-fold. This preliminary observation shows the importance of serum HSV-IgA antibodies as a risk indicator in cervical precancer and cancer lesions in women without a history of recent genital herpes lesions. The serum HSV-IgA may also be taken as an indicator of "high risk" males.

Significance of inflammatory cervical smears.

Two hundred and fifty-seven women attending a Maternal and Child Health Centre (MCH) were examined for different colposcopic and histological patterns associated with cervical inflammation as detected by cytology and for their association with different gynaecological infections. The cytodiagnosis revealed inflammation in 207 women (80.5%) and non-inflammation in 49 (19.5%); one smear was inadequate for evaluation. Fifty-six per cent of the women with inflammation and 20% with non-inflammation had an atypical transformation zone (ATZ), the risk of ATZ being 4.9-fold higher in those with inflammation. Biopsies from 128 women with abnormal colposcopy revealed morphological changes suggestive of human papillomavirus (HPV) in 89 (69.5%) and dysplasia of varying grades in 8 (6.3%). Seventy per cent of histologically diagnosed HPV lesions stained immunohistochemically, whereas 84% reacted with a biotinylated Pan-HPV probe by DNA in situ hybridization (DISH). In addition to HPV, chlamydia (OR 15.6, 95% CI 2.2, 311.6), T. vaginalis (OR 18.4), bacterial vaginosis (OR 24.7, 95% CI 3.5, 492) and herpes simplex virus (OR 4.9, 95% CI 1.4, 20.9) were significantly associated with inflammatory smears. Of 11 dysplasias detected by colposcopy and confirmed by biopsy, 8 (72.7%) had inflammatory cytology in the initial Pap smears. Thus a large proportion of women with inflammatory smears had multiple gynaecological infections and may be at increased risk of developing preneoplastic or neoplastic changes. Furthermore, they risk transmitting the infections to their partners.

Classification of nutritional status as 'Z score' or per cent of reference median--does it alter mortality prediction in malnourished children?

The objective of the study was to evaluate, using a prospective cohort study, whether classification of nutritional status by 'Z score' or per cent of reference median alters the prediction of death in malnourished children. The subjects were children with diarrhoea requiring hospitalization due to moderate or severe dehydration and/or associated complications. There were 382 participants under 5 years of age, of whom 37 died (cases), 320 were discharged in a satisfactory condition (controls) and 25 left before diarrhoea was completely cured (lost to follow-up--excluded). Rehydrated weight and recumbent length (under 2 years) or standing height were recorded and the three indices (weight for age, height for age and weight for height) derived as both 'Z scores' and per cents of reference National Centre for Health Statistics (NCHS) medians. Logistic regression, sensitivity specificity curves and Zda test for normalized distances were used to compare the relative utility of these two classification methods in identifying children with a high risk of dying. The per cent of reference median and 'Z scores' were highly correlated (r = 0.9540, 0.9787 and 0.9667, respectively). Both methods yielded virtually identical results in predicting death of malnourished children for all the three indices. It was concluded that 'Z score' and per cent classification of nutrition are equally efficient in predicting death of malnourished children.

Clinical presentation of gynecologic infections among Indian women.

OBJECTIVE: To study the clinical presentation of different gynecologic infections among Indian women. METHODS: This was a cross-sectional study of 257 women that included clinical, cytologic, colposcopic, and microbiologic screening for various gynecologic infections. RESULTS: Human papillomavirus (HPV) was the leading infection, affecting 127 (49.4%) women; however, overt warts were only seen in seven (2.7%) patients. Women infected with HPV had a 60.3-fold higher risk of developing a bleeding ectopia compared to those with other infections; women with an unhealthy cervix and cervical ectopias also had an increased risk of HPV infection (7.6- and 2.8-fold, respectively). Bacterial vaginosis, detected in 33.5% of the women studied, had an increased risk of bleeding ectopia (9.3-fold), cervical ectopia (3.1-fold), cervicitis (2.9-fold), vaginitis (6.9-fold), and cervical hypertrophy (2.1-fold). Chlamydial infection, detected in 23.3% of the patient population, was associated with an eightfold increase in the risk of an unhealthy cervix and a fourfold increase in risk of a hypertrophied cervix. Immunoglobulin-A antibodies to the herpes simplex virus were detected in 53 (20.6%) women. More than half (55.2%) of the women had two or more infections, and the mean delay of seeking medical treatment was 7-13 months. CONCLUSION: The specific finding of bleeding cervices was associated with HPV and bacterial vaginosis, hypertrophied cervices with chlamydia and bacterial vaginosis, and unhealthy cervices with chlamydia and HPV infections.

Biological behavior and etiology of inflammatory cervical smears.

Two hundred and fifty-seven consecutive women attending a major maternal and child health (MCH) center were studied clinically, colposcopically, cytologically, and microbiologically for different gynecologic infections. Out of 257 cases, 207 (80.5%) had inflammatory cervical smears, of which 183 (88.4%) were infected with one or more genital tract infections. Bacterial vaginosis (risk, 22.6-fold), chlamydia (risk, 21.6-fold), and human papillomavirus (HPV) (risk, 13.5-fold) were independently associated with inflammatory smears. In addition, significantly higher proportions of women with inflammatory smears had cervical ectopies (28.5% vs. 10.2%) and bleeding ectopies (30.9% vs. 4.1%) as compared to noninflammatory smears. Women infected with bacterial/parasitic genital infections were given specific treatment. These women were followed up at regular intervals to assess the efficacy of antimicrobial therapy. During follow-up examination, only 26 women (12.6%) showed negative smears. Sixteen women developed squamous intraepithelial lesions (SIL) during follow-up, and 163 women had persistent inflammatory smears. Multivariate analysis revealed that persistent inflammatory smears were associated with herpes simplex virus (HSV) infection, as revealed through detection of IgA antibodies to HSV (risk, 11.5-fold). Progression of SIL was associated with HPV infection (risk, 17.6 fold). Thus, inflammatory smears are associated with different types of infection, most of which do not respond to antimicrobial therapy.

Early detection of cervical cancer through acetic acid application--an aided visual inspection.

OBJECTIVE: To assess the sensitivity and specificity of visual inspection of cervix for detection of precancerous and early cancerous lesions of cervix. METHODS: In a Maternal and Child Health Care setting of New Delhi women underwent a detailed pelvic examination, visual inspection of cervix after 5% acetic acid application, cytology (pap smear), detailed colposcopic examination and colposcopic directed biopsy when indicated. RESULTS: Findings of aided visual inspection using 5% acetic acid and of cytology were evaluated among symptomatic 402 women against colposcopic findings and/or histologic reports. Seventy-three mild dysplasias, 50 moderate dysplasias, 45 severe dysplasias/Carcinoma in-situ and 40 early invasive cancerous cases were diagnosed histologically. The sensitivity of cytology (75.3%) was higher compared to that of acetic acid application (52.0%) for mild dysplasias. On the other hand, the sensitivity for detecting moderate dysplasias was 78% for cytology and 81.6% for acetic acid; for severe dysplasias/carcinoma in-situ it was 73.3% for cytology and 86.7% for acetic acid. For invasive cancers sensitivity for acetic acid application and cytology (95% for both modalities) was comparable. The specificity of cytology (99%) was higher compared to that of acetic acid application (94.3%). The false positive rate for cytology was 1.0% as against 5.7% for acetic acid application. The results of acetic acid application also showed a remarkable improvement in the sensitivity of unaided visual inspection for early cancerous lesion which was about 60% for early cancerous lesion and only 12% for mild dysplastic and 20% for moderate and severe dysplastic lesions in our earlier experience. It also reduced the false positive rates from 12% by unaided visual inspection to 5.7% by acetic acid application. Furthermore, cost of detection of one true lesion through acetic acid application (Rs.1689.00) was much lower as compared to the cost involved in cytology detected true lesions (Rs.2227.00). Visual inspection without acetic acid incurred Rs.6608.60 for detection of true lesion. CONCLUSION: Screening for cervical precancerous and cancerous lesions using visual inspection aided by acetic acid may be a suitable low-cost and a feasible alternative modality for control of cervical cancer in a resource poor setting.

Colposcopy as a tool for detection of human papillomavirus infection of uterine cervix in the setting of high prevalence of gynaecologic infections.

A cross sectional study involving 257 women from the Maternal and Child Health Centre (MCH) in Delhi was initiated for screening clinically, cytologically, colposcopically, and microbiologically for several gynaecologic infections. Eighty percent of the women had one or more gynaecologic infections and 31.1% had three or more infections. Cytology revealed changes suggestive of condyloma in 3 (1.2%) women only, while colposcopic examination suggested HPV changes in 117 (45.5%) women. A very high proportion of colposcopically detected lesions (78.6%) had evidence of HPV related changes in histology. The specificity of these lesions were further confirmed by Pan HPV DNA in-situ hybridisation, when 84% of the colposcopy is a valuable tool for detecting subclinical HPV lesions in a setting with high prevalence of gynaecologic infections.

Simple predictors to differentiate acute asthma from ARI in children: implications for refining case management in the ARI Control Programme.

There is a considerable overlap in the clinical presentation of acute asthma and ARI. According to the current ARI Control Programme recommendations, a child with cough and rapid breathing is overtreated for ARI (pneumonia) with antibiotics and undertreated for asthma with bronchodilators. The present study, therefore, evaluated simple predictors to differentiate these two conditions to refine the recommended case management. In a case control comparison, children between 6 to 60 months age who presented with cough and rapid breathing due to acute asthma (n = 100) and ARI (n = 100) were evaluated. Only 34% of asthmatics had an audible wheeze. Significant independent predictors on multiple logistic regression analysis were number of earlier similar attacks and fever (or temperature). The best predictor for asthma was two or more earlier similar episodes (sensitivity 84%, specificity 84%) followed by temperature < 37.6 degrees C (sensitivity 73% and specificity 84%). Absence of fever, audible wheeze and a family history of asthma had excellent specificities (98-100%) but low sensitivities (20-34%). It is concluded that simple clinical predictors can differentiate acute asthma and ARI. The recommended case management can, therefore, be refined by either: (i) Prescribing bronchodilators and no antibiotics with two or more earlier similar episodes of cough and rapid breathing; or (ii) To further minimize undertreatment for pneumonia, prescribing bronchodilators as above, but denying antibiotics in such cases only if there is audible wheeze or family history of asthma or no fever.

Clinical predictors of hospitalization in an acute attack of bronchial asthma.

The present study was undertaken to identify the clinical predictors of hospitalization in an acute attack of bronchial asthma in subjects aged 2-12 years. Seventy five children with an acute attack of bronchial asthma were evaluated. A detailed clinical history and examination was recorded and baseline investigations sent before starting therapy. All subjects were treated with injection adrenaline (two doses) and those who did not respond were hospitalized. Twenty subjects who were hospitalized were compared with 32 cases who were discharged and did not have a relapse on follow up. After multivariate analysis, the factors independently predictive of hospitalization were, pulsus paradoxus (> 10 mm Hg; OR = 1.02), younger age (below 5 years, OR = 0.98) and severe accessory muscle use (OR = 89.6). Presence of any 2 of these 3 clinical predictors has a high sensitivity (90%) and specificity (96%). The investigative variables significant after multivariate analysis were low pH (OR = 0.00) and polymorphonuclear leucocytosis (> 70%) on peripheral smear (OR = 1.12). The sensitivity of this model was similar (90%) but specificity was lower (90.6%). The addition of investigative variables to clinical model did not improve the predictability. It is concluded that it is possible to identify at presentation, children with acute bronchial asthma who require hospitalization and clinical variables are sufficient for this purpose.

Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.

OBJECTIVE: To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI). DESIGN: Prospective cohort study. SETTING: Urban tertiary care teaching hospital. METHODS: 201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework. RESULTS: The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality). CONCLUSION: Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.

PIP: In a prospective cohort study (1993-94) conducted at a tertiary care teaching hospital in New Delhi, India, the predictors of mortality in 201 children 2 weeks to 5 years of age admitted with acute lower respiratory infection (ALRI) were investigated. There were 21 deaths in this series, for a case fatality rate of 10.45%. Mortality was inversely associated with age. Multivariate logistic regression identified the following significant predictors of mortality: age less than 12 months (odds ratio (OR), 23.1), inability to feed (OR, 6.2), associated loose stools (OR, 5.1), weight-for-age Z score under 3 (OR, 3.9), short duration of fever (OR, 1.2), and bandemia (OR, 1.1). The clinical and investigative criteria set forth in the World Health Organization (WHO) guidelines successfully identified 91% of children with ALRI. The case fatality rate was related to the severity of the WHO classification: pneumonia, 0%; severe pneumonia, 8.7%; and very severe pneumonia, 47.0%. However, 2 of the 18 children without any pneumonia died. At present, children under 2 months of age are designated as high-risk ALRI cases and targeted for close monitoring, referral, and therapy. The finding of this study of a 23-fold increased risk of mortality in children under 12 months of age suggests this cut-off should be expanded to 12 months.

Evaluation of risk factors for fatal neonatal sepsis.

OBJECTIVE: To evaluate risk factors for fatal neonatal sepsis. DESIGN: Prospective study. SETTING: Referral neonatal unit of a teaching hospital. SUBJECTS: 171 neonates admitted with sepsis. METHODS: Clinical examination and investigations on the day of admission were recorded and the neonates followed up to determine the final outcome. RESULTS: The overall fatality was 48.5%. In the univariate analysis, the factors significantly associated with death were weight, gestational age, age at onset of sepsis, hypothermia, requirement of IPPV, presence of refractory septic shock, neutropenia, metabolic acidosis and raised prothrombin time. However, in the multivariate analysis, only neutropenia, metabolic acidosis, increased prothrombin time and refractory septic shock retained their significance. The adjusted odd's ratio (95% confidence interval) were 0.095 (0.04 = 0.22), 1.14 (1.04-1.25), 1.04 (1.002-1.08) and 11.82 (5.47-69.40), respectively. CONCLUSION: Even in a setting with high fatality rates, high risk of mortality in neonatal sepsis can be identified and targeted for intensive intervention.