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1.
Lung India ; 41(1): 63-66, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-38165311

RESUMEN

Airway mucormycosis is a fatal opportunistic infection typically seen in immunocompromised individuals. In this case report, we present an unusual instance of tracheal stenosis in a patient with diabetes mellitus who had recently recovered from coronavirus 2019 (COVID-19). Our patient was a 69-year-old male with poorly controlled type-II diabetes mellitus, on oral hypoglycemic agents, who had successfully completed treatment for COVID-19. Approximately one month later, he developed a cough, fever and breathlessness. Several factors, including advanced age, history of smoking and tobacco chewing, the nodular appearance of the trachea on bronchoscopy, hypermetabolic wall of the trachea on positron emission tomography scan and dysplasia on biopsy, initially raised suspicion of malignancy. However, repeated biopsies from multiple sites confirmed the diagnosis of tracheal mucormycosis. The patient was treated with amphotericin-B and posaconazole. We extensively reviewed the literature and found only 14 reported cases to discuss compared to ours.

5.
Expert Rev Vaccines ; 22(1): 180-185, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-36688599

RESUMEN

OBJECTIVES: To boost COVID-19 vaccine uptake, an innovative 'vaccinate my village' (VMV) strategy using door-to-door vaccination by Health Surveillance Assistants (HSA) was adopted. In this study, we assessed the impact of the 'vaccinate my village' strategy on COVID-19 vaccine uptake. METHODS: This was a cross-sectional review of the data on COVID-19 vaccination obtained from the Ministry of Health, Malawi, from 11 March 2021 to September 2022. RESULTS: From March 2021-4 September 2022,091,551 COVID-19 vaccine doses were administered, out of which 2,253,546 were administered over just six months as a part of VMV as compared to 1,838,005 doses were administered over 13 months as a part of other strategies. The proportion of Malawi's population receiving at least one dose of the COVID-19 vaccine increased substantially from 4.66 to 15.4 with the implementation of the VMV strategy (p = 0.0001). District-wise coverage of the COVID-19 vaccine also increased significantly after its implementation (p = 0.0001). CONCLUSIONS: Door-to-door vaccination involving HSAs benefitted the COVID-19 vaccination program in Malawi by ensuring accessibility, availability, and acceptability.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Humanos , Malaui/epidemiología , Estudios Transversales , COVID-19/prevención & control , Vacunación
6.
Vaccine X ; 12: 100239, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36407821

RESUMEN

Objectives: A country's immunization system's effectiveness depends on its supply chain's efficacy. To assess the challenges of maintaining an efficient vaccine supply chain, Malawi conducted its assessment using The EVM2.0 tool (Effective Vaccine Management). Methods: It is a cross-sectional study in which all EVM requirements were assessed between September and October 2021. Data were collected from eighty-two randomly selected sites using the site selection tool of the EVM. Data were entered into the EVM assessment tool 2.0 version 1.12 for analysis. This tool generates performance indicators and criteria scores for assessed sites, compared with a WHO minimum score of 80%. Results: Overall criteria scores across all levels of the immunization supply chain showed a statistically significant mean difference of 5.92 (t = 2.58, P = 0.02). Comparative overall mean criteria scores across different levels of the immunization supply chain showed no statistically significant difference for primary (p = 0.76), sub-national (p = 0.69), and lowest distribution stores (p = 0.12). However, a substantial gap was found in the overall mean scores of the health facility's service point (SP) (t = 4.12, P = 0.001). The overall category scores across all immunization supply chain levels did not show a statistically significant difference. However, among individual category scores, Infrastructure (76 %), Equipment (67 %), Policies and procedures (62 %), Financial (47 %), and Resources (64 %) were found to be below the WHO minimum score. Conclusion: Though the 2021 Malawi EVM assessment findings are promising, they still identified the gaps to be improved to ensure the vaccine availability in the right amount, at the right time, and at the right cost.

8.
Cureus ; 14(9): e29381, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36304365

RESUMEN

Early diagnosis and treatment are associated with better outcomes in oncology. We reviewed the existing literature using the search terms "low dose computed tomography" and "lung cancer screening" for systematic reviews, metanalyses, and randomized as well as non-randomized clinical trials in PubMed from January 1, 1963 to April 30, 2022. The studies were heterogeneous and included people with different age groups, smoking histories, and other specific risk scores for lung cancer screening. Based on the available evidence, almost all the guidelines recommend screening for lung cancer by annual low dose CT (LDCT) in populations over 50 to 55 years of age, who are either current smokers or have left smoking less than 15 years back with more than 20 to 30 pack-years of smoking. "LDCT screening" can reduce lung cancer mortality if carried out judiciously in countries with adequate resources and infrastructure.

10.
Urol Oncol ; 40(10): 462, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-35995697
11.
Vaccine ; 40(35): 5089-5094, 2022 08 19.
Artículo en Inglés | MEDLINE | ID: mdl-35871867

RESUMEN

OBJECTIVES: To establish the impact of "Covid-19 Vaccination express" (CVE) on vaccine uptake in Malawi. DESIGN: Retrospective cross-sectional study to compare the daily vaccine administration rate in CVE and routine covid vaccination (RCV). RCV data was collected from March 2021 to October 2021. The data regarding CVE was collected from 5 November 2021 to 31 December 2021. Data was collected regarding (1) the total number and type of vaccine doses administered and (2) Demographic details like age, gender, occupation, presence of comorbidities, the first dose, or the second dose of the people who received a vaccine. RESULTS: From March-December 2021, a total of 1,866,623 COVID-19 vaccine doses were administered, out of which 1,290,145 doses were administered at a mean daily vaccination rate of 1854 (95 % CI: 1292-2415) doses as a part of RCV, and 576,478 doses were administered at a mean daily vaccination rate of 3312 (95 % CI: 2377-4248) doses as a part of CVE. Comparing the mean daily doses (Astra Zeneca, AZ doses 1 & 2) administered in the CVE and RCV showed that the mean daily doses of AZ vaccine administered were significantly higher in the CVE (p < 0.05). CONCLUSION: CVE successfully increased the uptake of the Covid-19 vaccine.


Asunto(s)
COVID-19 , Vacunas , COVID-19/prevención & control , Vacunas contra la COVID-19 , Estudios Transversales , Humanos , Malaui/epidemiología , Estudios Retrospectivos , Vacunación
12.
Front Public Health ; 8: 585850, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33425835

RESUMEN

Objectives: The present study is aimed at estimating patient flow dynamic parameters and requirement for hospital beds. Second, the effects of age and gender on parameters were evaluated. Patients and Methods: In this retrospective cohort study, 987 COVID-19 patients were enrolled from SMS Medical College, Jaipur (Rajasthan, India). The survival analysis was carried out from February 29 through May 19, 2020, for two hazards: Hazard 1 was hospital discharge, and Hazard 2 was hospital death. The starting point for survival analysis of the two hazards was considered to be hospital admission. The survival curves were estimated and additional effects of age and gender were evaluated using Cox proportional hazard regression analysis. Results: The Kaplan Meier estimates of lengths of hospital stay (median = 10 days, IQR = 5-15 days) and median survival rate (more than 60 days due to a large amount of censored data) were obtained. The Cox model for Hazard 1 showed no significant effect of age and gender on duration of hospital stay. Similarly, the Cox model 2 showed no significant difference of age and gender on survival rate. The case fatality rate of 8.1%, recovery rate of 78.8%, mortality rate of 0.10 per 100 person-days, and hospital admission rate of 0.35 per 100,000 person-days were estimated. Conclusion: The study estimates hospital bed requirements based on median length of hospital stay and hospital admission rate. Furthermore, the study concludes there are no effects of age and gender on average length of hospital stay and no effects of age and gender on survival time in above-60 age groups.


Asunto(s)
COVID-19 , Tiempo de Internación , Modelos Estadísticos , Alta del Paciente , Tasa de Supervivencia , COVID-19/diagnóstico , COVID-19/mortalidad , Toma de Decisiones , Femenino , Hospitalización , Humanos , India , Estudios Retrospectivos , Factores de Tiempo
13.
J Lab Physicians ; 10(1): 121-123, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29403221

RESUMEN

Granulicatella adiacens is a nutritionally variant streptococcus species. These bacteria are rarely isolated in the laboratory due to their fastidious growth requirements. These have been mostly reported from bloodstream infections, infective endocarditis, infections of orbit, nasolacrimal duct and breast implants. Here, we are reporting two cases of subcutaneous abscesses caused by G. adiacens. In first case, it was isolated from abscess around elbow joint and second case was a suprapatellar abscess. We have also reviewed the published data concerning diagnosis and antimicrobial susceptibility pattern of Granulicatella infections and included some Indian cases.

14.
J Antimicrob Chemother ; 72(4): 969-974, 2017 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-27999053

RESUMEN

Many countries have observed an increase in the incidence of invasive fungal infections (IFIs) over the past two decades with emergence of new risk factors and isolation of new fungal pathogens. Early diagnosis and appropriate antifungal treatment remain the cornerstones of successful outcomes. However, due to non-specific clinical presentations and limited availability of rapid diagnostic tests, in more than half of cases antifungal treatment is inappropriate. As a result, the emergence of antifungal resistance both in yeasts and mycelial fungi is becoming increasingly common. The Delhi Chapter of the Indian Association of Medical Microbiologists (IAMM-DC) organized a 1 day workshop in collaboration with BSAC on 10 December 2015 in New Delhi to design a road map towards the development of a robust antifungal stewardship programme in the context of conditions in India. The workshop aimed at developing a road map for optimizing better outcomes in patients with IFIs while minimizing unintended consequences of antifungal use, ultimately leading to reduced healthcare costs and prevention development of resistance to antifungals. The workshop was a conclave of all stakeholders, eminent experts from India and the UK, including clinical microbiologists, critical care specialists and infectious disease physicians. Various issues in managing IFIs were discussed, including epidemiology, diagnostic and therapeutic algorithms in different healthcare settings. At the end of the deliberations, a consensus opinion and key messages were formulated, outlining a step-by-step approach to tackling the growing incidence of IFIs and antifungal resistance, particularly in the Indian scenario.


Asunto(s)
Antifúngicos/uso terapéutico , Farmacorresistencia Fúngica , Utilización de Medicamentos/normas , Política de Salud , Micosis/tratamiento farmacológico , Humanos , India , Reino Unido
15.
Heart Views ; 17(2): 62-5, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27512534

RESUMEN

Thrombotic events are relatively common in high altitude areas and known to occur in young soldiers working at high altitude without usual risk factors associated with thrombosis at sea-level. However, till now, cases with thrombotic events were reported only in lowlanders staying at high altitude. These two cases of pulmonary embolism demonstrate that thrombotic events can occur in highlanders after a prolonged stay at the extreme altitude.

17.
Avicenna J Med ; 3(2): 48-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23930242

RESUMEN

This is a case report of a 28-year-old male patient with severe traumatic brain injury and Glasgow coma scale score = 8: E2 M5 VT, who required a tracheotomy for airway protection. On day 5, a surgical tracheotomy was performed with size 8 tracheotomy tube (TT). On the 4(th) day of post-tracheostomy, he developed a sudden onset respiratory distress while on T-piece. Immediate fiber optic bronchoscopy revealed almost a complete closure of TT due to posterior tracheal wall indrawing into the TT with every inspiratory effort.

19.
Indian J Gastroenterol ; 31(5): 243-52, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22932963

RESUMEN

BACKGROUND: Severe acute pancreatitis (SAP) is a disease with high morbidity and mortality. We undertook a study of patients with SAP admitted to the intensive care unit (ICU) of a tertiary referral hospital. METHODS: Between 2002 and 2007, 50 patients with SAP were admitted in our intensive care unit (ICU). Data were collected from their medical records and their clinical profile, course and outcome were retrospectively analyzed. Patients were categorized into survivor and nonsurvivor groups, and were further classified based on interventions such as percutaneous drainage and surgical necrosectomy. RESULTS: SAP contributed 5 % of total ICU admissions during the study period. Median age of survivors (n = 20) was 34 against 44 years in nonsurvivors (n = 30). Median Acute Physiology and Chronic Health Evaluation (APACHE) II score in nonsurvivors was 16.5 (8-32) vs. 12.5 (5-20) in survivors (p = 0.002). Patients with APACHE II score ≥12 had mortality >80 % compared to 23 % with score <12 (p < 0.001). Median Sequential Organ Failure Assessment (SOFA) scores on admission and on days 3, 7, 14, and 21 were significantly higher in nonsurvivors compared to survivors (p < 0.05). Mean (SD) intraabdominal pressure was 23 (3.37) mmHg in nonsurvivors vs. 19.05 (2.51) in survivors (p < 0.05). Patients with renal failure had significant mortality (p < 0.001). Length of ICU stay, requirement for vasopressor, total parenteral nutrition, and the amount of blood and blood product transfusions differed significantly between patients with and without intervention. CONCLUSIONS: APACHE II and SOFA scores and other clinical data correlated with outcome in SAP admitted to ICU.


Asunto(s)
Causas de Muerte , Mortalidad Hospitalaria/tendencias , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Aguda Necrotizante/mortalidad , Adulto , Distribución de Chi-Cuadrado , Estudios de Cohortes , Cuidados Críticos/métodos , Enfermedad Crítica , Femenino , Humanos , India , Masculino , Auditoría Médica , Persona de Mediana Edad , Pancreatitis Aguda Necrotizante/terapia , Admisión del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Centros de Atención Terciaria
20.
Lung India ; 29(1): 81-2, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22345923
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