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1.
Water Sci Technol ; 80(3): 418-425, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31596253

RESUMO

There are hundreds of full-scale upflow anaerobic sludge blanket (UASB) reactors in operation in various parts of the tropical world, notably in India and Latin America, Brazil being the holder of the largest park of anaerobic reactors for sewage treatment in the world. Despite the recognized advantages of UASB reactors, there are problems that have prevented their maximum operational performance. Neglecting the existence and delaying the solution of these challenges can jeopardize the important advances made to date, impacting the future of anaerobic technology in Brazil and in other countries. This work aims to evaluate the operational performance of five full-scale UASB reactors in Brazil, taking into account a monitoring period ranging between two and six years. The main observed design, construction, and operational constraints are discussed. Some outlooks for important upcoming developments are also provided, considering that most of the observed drawbacks can be tackled without significant increases on reactor costs.


Assuntos
Esgotos , Eliminação de Resíduos Líquidos , Anaerobiose , Reatores Biológicos , Brasil , Índia
3.
J Assoc Physicians India ; 67(10): 14-19, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571445

RESUMO

Background: Teneligliptin is widely prescribed dipeptidyl peptidase-4 inhibitor (DPP-4i) in India because of its economical pricing. However, there is no headto-head trial comparing teneligliptin with any other DPP-4i in Indian setting. We evaluated the efficacy and safety of teneligliptin versus sitagliptin as add-on to metformin and/or sulfonylureas in patients with type 2 diabetes mellitus (T2DM). Methods: This prospective, open-label, randomized, active-controlled study enrolled 76 patients (1:1) at 2 centres. Patients received teneligliptin 20 mg or sitagliptin 100 mg orally once daily for 12 weeks as add-on to ongoing metformin or sulfonylurea therapy. Primary endpoint was mean change in glycosylated hemoglobin (HbA1c) from baseline at week 12. Results: Both arms were comparable (p>0.05) at baseline in terms of age, gender, metformin daily dose, sulfonylurea use, HbA1c, fasting and postprandial blood glucose (FBG and PPBG). At the end of 12 weeks, statistically significant reductions were observed in both teneligliptin and sitagliptin arms in HbA1c (-1.19 ± 1.16% p<0.0001 and -0.92 ± 0.95%, p<0.0001), in FBG (-28.3 ± 63.0 mg/dL, p= 0.01 and -22.9 ± 47.4 mg/dL, p=0.006) and PPBG (-41.3 ± 85.4 mg/dL, p=0.006 and -54.7 ± 85.6 mg/dL, p=0.0005). The reductions in all glycemic parameters were similar between the arms. Both gliptins were well-tolerated with no difference in the number of adverse events. There was no change in QT/QTc intervals or other ECG parameters at week 12 in both arms. In post-hoc comparison, percentage of patients achieving target HbA1c <7% (as per American Diabetes Association guidelines) at week 12 favored teneligliptin arm over sitagliptin arm (33.3% vs. 19.4% patients). Conclusion: Teneligliptin provided similar glycemic control as compared to sitagliptin and reduced HbA1c, FBG and PPBG values significantly within 12 weeks of treatment. Both gliptins were found to be safe and well-tolerated in Indian patients with T2DM.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Hipoglicemiantes/uso terapêutico , Pirazóis/uso terapêutico , Fosfato de Sitagliptina/uso terapêutico , Tiazolidinas/uso terapêutico , Método Duplo-Cego , Quimioterapia Combinada , Humanos , Índia , Estudos Prospectivos
4.
J Assoc Physicians India ; 67(10): 20-24, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571446

RESUMO

Background: Polycythemia is characterized by rise in hemoglobin and hematocrit, either as a result of hematopoietic clonal expansion (Vera) or secondary to hypoxic stimuli (secondary polycythemia).It is of great importance to detect early and identify the type of polycythemia and also asses the thrombotic risk so that timely and appropriate treatment can be given. The present study aims to characterize the different presentations and complications of polycythemia, evaluate genetic factors and differences between the two categories of polycythemia in ethnic Goan subjects. Aims and objectives: 1. To identify common presentations and etiologies of polycythemia 2. To evaluate and compare the differences in clinical features, hematological parameters and complications of polycythemia in primary (vera) and secondary polycythemia 3. To study the profile of JAK 2 V617F mutation in Goan patients with polycythemia Vera. Materials and Methods: This was a retrospective observational cohort study, conducted at the Department of Internal Medicine, Goa Medical College, a tertiary care, teaching institute in the state of Goa. We analysed clinical and laboratory data of patients of polycythemia due to all causes (polycythemia Vera and secondary causes) previously admitted or following up at the hospital from January 2014 to December 2017. In each of these 2 groups, we studied the various clinical parameters including the age at presentation,sex,residence, symptomatology and clinical findings,presence of hypertension, as well as complications arising due to polycythemia (past and at present) hematological data including Hb,HCT, total WBC count, absolute neutrophil count, RBC and platelet count, ESR, rouleaux formation, EPO levels and JAK 2 V617F mutation analysis (done by real time PCR technique) and requirement of phlebotomies in the last 4 years. Commonest clinical presentations and complications arising due to polycythemia, in each group were analysed and compared. Results: A total of 44 patients were included in the study out of which 33 were males. Polycythemia Vera was seen in 43.18% while secondary causes were seen in 56.8 % patients. Patients with Vera were found to be more symptomatic with higher levels of mean Hb, HCT, cell counts and with a higher requirement of phlebotomy and more thrombotic complications. Amongst Vera group, patients having high WBC count, increased Rouleau formation, and JAK2 positivity were found to be more prone for thrombosis. Hypertension was frequently seen to be associated with both groups. Obstructive sleep apnea followed by COPD was found to be the commonest causes of secondary polycythemia. Conclusion: Our study revealed that patients with polycythemia Vera are more symptomatic and have a higher requirement of phlebotomy and a higher thrombotic tendency (arterial being more common than venous) as compared to the secondary polycythemia owing to a higher hyperviscocity in the former. Leukocytosis and JAK 2 617F positivity were found to be important predictors of thrombotic risk. Hypertension was found to be frequently associated with Vera as well as in secondary causes due to OSA.


Assuntos
Policitemia/epidemiologia , Estudos de Coortes , Humanos , Índia , Masculino , Policitemia Vera , Estudos Retrospectivos , Centros de Atenção Terciária
5.
J Assoc Physicians India ; 67(10): 26-28, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571447

RESUMO

Snake bite is one of the major public health problems in India. Venom induced consumption coagulopathy(VICC) is the commonest coagulopathy resulting from viper bites. Anti-snake venom(ASV) is the only mainstay therapy in the management of snake bite. Despite anti-venom being efficacious and bonding to multiple toxins in the venom, there are number of reasons it may not be effective. The most important being irreversible toxic effects cannot be reversed by antivenom to toxin after damage has occurred, such as clotting factor deficiencies resulting from VICC. This study was done to evaluate the efficacy of use of anti-snake venom and ASV with fresh frozen plasma (FFP) in haemotoxic snake bites in a tertiary care hospital. Total 500 patients admitted during period from January 2010- April 2017 with history of snake bite. vasculotoxic[278], neurotoxic[126], localtoxic[64] and nontoxic[32]. Overall outcome in term of time recovery, renal complications, and death better in ASV plus FFP group. The complications due to snake bite were minimum, if anti snake venom was administered within first 4 hours.


Assuntos
Coagulação Intravascular Disseminada , Mordeduras de Serpentes/terapia , Antivenenos , Humanos , Índia , Venenos de Serpentes
6.
J Assoc Physicians India ; 67(10): 33-36, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571449

RESUMO

Background and Objectives: Thyroid disorders in elderly population are of prime importance as it has emphasis on various metabolic activity and disease states. There is limited data regarding the prevalence of thyroid disorders in elderly from India. This study was an attempt to assess the thyroid function tests in elderly population and to correlate them with clinical symptoms. Methodology: This one year hospital based prospective cross sectional study was done in outpatient Department, Department of General Medicine and Geriatric Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi on a total of 100 elderly patients who presented for regular checkups with clinical suspicion of thyroid disorders from January 2017 to December 2017. The selected patients were investigated for T3, T4, TSH and thyroid antibodies. Results: Majority of the patients were females (67%), the male to female ratio was 1:2.03. The mean age was 67.69±7.21 years. The mean T3 levels were 1.32±0.88 ng/mL, the mean T4 levels were 7.69±4.13 µg/mL and mean TSH levels were 12.31±22.82 mcIU/mL. The mean TPO antibodies were noted as 95.97±211.82 IU/mL. Thyroid abnormalities were diagnosed in 28% of the patients and hypothyroidism was the most common thyroid abnormality noted in 12% of the patients. No association was found between thyroid abnormalities and sex (p=0.349) as well as age (p=0.946). Easy fatiguability (94%) and generalized weakness (93%) were the common clinical complaints and mild pallor was the common clinical sign noted in 26% of the patients followed by dry/coarse skin in 25% of the patients. Thyroid abnormalities were significantly associated with easy fatiguability, generalized weakness, swelling of limb/face, weight gain, constipation and with clinical signs of pallor, dry/coarse skin, hoarseness, ankle jerk and oedema. Family history of thyroid disorders was reported by 47% of the patients and it was significantly associated with of thyroid disorders (p=0.001). Conclusion and Interpretation: There is higher incidence of thyroid abnormalities among elderly population in the study area and overt hypothyroidism is the common thyroid abnormality.


Assuntos
Testes de Função Tireóidea , Tireotropina , Idoso , Estudos Transversais , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
J Assoc Physicians India ; 67(10): 44-47, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571452

RESUMO

Introduction: Diabetes is one of the expensive diseases due to its chronic nature and gradual involvement of multiple organs, Moreover loss of economic productivity further enhances the cost of care. Several factors were reported to have impact on overall economic burden in diabetic patients. So, the present study aims to determine influence of various socio-demographic and clinical factors on expenditure of diabetes care among patients residing in resettlement colony of East Delhi. Methodology: A community based one year longitudinal study was conducted in Kalyanpuri area of East Delhi. All the diabetes patients aged 25 years and who were the permanent residents of Kalyanpuri, attending the Diabetic Clinic of a government hospital in November-December 2014 were selected for the study. A pre-tested semi-structured interview schedule was used as study tool. Each subject was followed up 3 monthly from January to December 2015. Results: Data of 150 study subjects was analyzed. Out of 150 subjects 45(30 %) were male and 105 (70%) female. Overall mean age of study subjects was 53 ± 10 years Among socio-demographic factors, Expenditure on diabetes care showed significant association with male gender and among clinical factors, longer duration since diagnosis, use of Insulin with Oral Hypoglycemic drugs, hospitalization and utilization of private care has shown positive association with expenditure on diabetes care. Conclusion: The present study concludes that there is need of better provisioning of services for diabetes care in government health facilities to cater needs of growing diabetic population..


Assuntos
Diabetes Mellitus/terapia , Gastos em Saúde , Adulto , Diabetes Mellitus/economia , Feminino , Humanos , Índia , Insulina , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
8.
J Assoc Physicians India ; 67(10): 57-61, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571454

RESUMO

Background and objectives: Idiopathic pulmonary arterial hypertension (IPAH) is rare disorder of unknown aetiology associated with poor survival. Disease severity assessment by various prognostic factors play important role in management of these patients. The aim of our study was to assess various factors and their natural history and course of disease in Indian population. Material and Methods: We followed 27 patients of IPAH after complete work up of exclusion of other causes of pulmonary hypertension and analysed various demographic, echocardiographic and haemodynamic parameters and their correlation with mortality. Results: A total of 27 patients (14 new and 13 previously diagnosed) were followed for mean duration of 18 months. At time of data analysis, 11 patients were alive and 16 patients died with overall mortality rate of 59.25%. Among various factors, presence of pericardial effusion (p=0.005), pulmonary artery acceleration time (PAAT) (p = 0.005), tricuspid Annular Plane Systolic Excursion (TAPSE) (p = 0.0004), heart rate (p=0.031), mean blood pressure (p =0.017), right atrial pressure (p=0.045), mean pulmonary artery pressure (PAP) (p=0.039) and six minute walk distance (p= 0.0002) were significantly associated with mortality. On multivariate cox proportional hazard analysis, PAAT (p =0.034), TAPSE (p=0.003) and six minute walk distance (p=0.002) remained significant predictors of mortality. Conclusion: Idiopathic pulmonary arterial hypertension is associated with poor prognosis and survival despite advancements of disease specific therapies. Higher mortality in our study is due to delayed presentation and diagnosis. Also lack of availability of prostacyclins and lung transplantation in advanced stages of disease contribute to higher mortality in Indian setup. Non-invasive echocardiographic factors and six minute walk distance are important prognostic factors that help in disease severity stratification to identify patients in need of intensive medical management.


Assuntos
Hipertensão Pulmonar Primária Familiar/diagnóstico , Humanos , Hipertensão Pulmonar , Índia , Prognóstico , Função Ventricular Direita
9.
J Assoc Physicians India ; 67(10): 61-64, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571455

RESUMO

Background: As per WHO Global TB report (2018), 10.0 million people developed TB in 2017. India accounted for 20 % of world cases. Globally, 3.5 % of new cases and 18% of previously treated cases had MDR-TB. Corresponding figures for India are 2.8 % and 12 %. Among cases of MDR-TB in 2017, 8.5% were estimated to have XDR-TB. Drug resistant TB cases are on rise and needs planning and research for its treatment and control. Materials and Methods: A retrospective study was conducted on MDR-TB and XDR-TB patients to evaluate social and demographic profile of these patients in Bihar. Results: A total of 700 (530 males and 170 females) MDR-TB and 51 (40 males and 11 females) XDR-TB patients were analyzed, which revealed 293 (41.86 %) patients of MDR-TB and 23 (45.10 %) patients of XDR-TB in the age group of 15 to 25 years. Mean age of MDR-TB patients in this age group was 20.52 years and for XDR-TB 21.17 years. Conclusion: Drug Resistant Tuberculosis Control Programme should focus adequately on youth in state of Bihar, India.


Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adolescente , Adulto , Antituberculosos , Demografia , Tuberculose Extensivamente Resistente a Medicamentos/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Estudos Retrospectivos , Adulto Jovem
10.
J Assoc Physicians India ; 67(10): 70-72, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571457

RESUMO

Guidelines to diagnose Gestational Diabetes Mellitus (GDM) have changed a number of times from O'Sullivan and Mahan, Carpenter and Coustan, World Health Organization, American Diabetes Association to that of International Association of Diabetes in Pregnancy Study Group (IADPSG). The IADPSG guideline was based on Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study which was performed in caucasian population only and thus literally cannot be considered as international. Recently a study commented that this guideline needs revision for standardization of this strategy for diagnosing GDM. Based on a prospective study, Diabetes in Pregnancy Study Group India (DIPSI) recommended A single step procedure of diagnosing GDM with 2hr PG > 140 mg/dl after 75g of oral glucose administered irrespective of the last meal timing. This guideline has been approved by the Ministry of Health Government of India, WHO, IDF and Federation of Gynaecologists and Obstetricians Society (FIGO). National Institute of Clinical Excellence (NICE) also recognises cut off value, 2hr PG > 140 mg/dl based on a study in multi ethnic population of UK. Hence, we can safely conclude, A Single Step procedure has settled the criteria for diagnosing GDM.


Assuntos
Diabetes Gestacional/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Hiperglicemia , Índia , Gravidez , Estudos Prospectivos
12.
J Assoc Physicians India ; 67(10): 75-76, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31571459

RESUMO

A good quality research requires the incorporation of good ethical practices throughout the conduct of the study. An efficient Ethics Committee will facilitate such a research at the site, and can achieve the major objective of ICH-GCP (International Conference on Harmonisation -Good Clinical Practice) guidelines. Awareness of the changing rules among the stakeholders of clinical studies will ensure good clinical practice by safeguarding and protecting the rights, safety and well-being of the research participants. The draft of the New Drugs and Clinical Trials Rules was published in the Gazette of India by central government on March 19, 2019. Keeping abreast of the latest rules are essential for the uninterrupted conduct of clinical studies. We sought to give a summary of important changes in the new rules and to assess those rules from ethical perspective.


Assuntos
Ensaios Clínicos como Assunto , Comissão de Ética , Preparações Farmacêuticas , Índia
15.
Waste Manag ; 99: 79-89, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473484

RESUMO

The world population is becoming more urbanized, wealthier but also more wasteful. The resolution of the problem of ever increasing amounts of solid waste is not yet a priority in many developing countries where informal organization has managed to partially tackle the problem. In this article we explore the interface between formal and informal waste management in the BRICS countries (Brazil, Russia, India, China and South Africa). The aim of this article is to comparatively evaluate the main challenges of urban solid waste management for the BRICS from an institutional point of view. Based on a literature review, interviews with experts on the BRICS and a search for relevant legislation and formal institutions, evidence of informal institutions and the informal economy's role following New Institutional Economics was considered. The results indicate that while in Brazil and South Africa there is a state incentive to formalize scavenging for more efficient outcomes, Russia shows a significant blind-spot on the issue, China apparently awaits a technological solution to the problem, and India's cultural, ethnic and caste-based divide of society make recent policies aimed at improving waste pickers' conditions challenging to enforce. This research has shown that it is not as much an issue of enforcement of the (often recent) legislations, but rather one of cultural and informal organizational factors, that play into the issue of continued problems concerning waste management. For achieving waste management policy goals, we suggest a more open multi-stakeholder approach to the inclusion of informal organizations in public waste management.


Assuntos
Gerenciamento de Resíduos , Brasil , China , Índia , Federação Russa , África do Sul
16.
Rev Inst Med Trop Sao Paulo ; 61: e52, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531630

RESUMO

In 2018, Bhutan reported 54 cases of malaria, of which six were indigenous, 14 introduced and 34 imported. Considering the continuous reduction in the number of indigenous cases, Bhutan plans to eliminate malaria by 2025 under the Bhutan Malaria Elimination Strategy. The study was conducted to assess the presence of asymptomatic plasmodial infection in both, Bhutanese population living in malaria-risk areas and in migrant workers to guide the elimination strategies. A cross-sectional study was conducted from April to May 2016 in 750 Bhutanese people and 473 migrant workers. Plasmodium falciparum and Plasmodium vivax infections were investigated by using a rapid diagnostic test (RDT) and the polymerase chain reaction (PCR). Prevalence of asymptomatic plasmodial infection based on PCR was 0.27% (95% CI: 0.05-1.07%) among Bhutanese people with a mean age of 43 years old. The proportions of males and females were 45% and 55%, respectively. Among migrant workers, the prevalence of asymptomatic plasmodial infection was 0.42% (95% CI: 0.07-1.69%) with a mean age of 30 years old. The majority of migrant workers were from the neighboring Indian State of West Bengal (57.51%), followed by Assam (12.26%). RDT in both study groups did not detect any plasmodial infection. The presence of a low prevalence of asymptomatic plasmodial infection indicates that the current elimination strategies and interventions are effective.


Assuntos
Malária Falciparum/diagnóstico , Malária Vivax/diagnóstico , Infecções Assintomáticas , Butão/epidemiologia , Estudos Transversais , Feminino , Humanos , Índia , Malária Falciparum/epidemiologia , Malária Falciparum/prevenção & controle , Malária Vivax/epidemiologia , Malária Vivax/prevenção & controle , Masculino , Reação em Cadeia da Polimerase , Prevalência , Migrantes
17.
Niger J Clin Pract ; 22(9): 1208-1212, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489855

RESUMO

Background: The upper aerodigestive tract (UAT) includes the nose and paranasal sinuses, oral cavity, pharynx, larynx, and salivary glands. Cancers of the UAT constitute approximately 4% of all malignancies. In this study, the varied nature of the UAT cancers was studied to find out their incidence, etiology, and clinicopathological correlations. Materials and Methods: This prospective, observational, and clinicopathological study was conducted on 100 patients who were presented at outdoor in the Department of ENT, Government Medical College/Rajindra Hospital, Patiala, Punjab, India, from October 2016 to October 2018. Proven cases of UAT cancers were taken up and reviewed to gather data on multiple clinicopathological variables, such as age, sex, predisposing factors, and site of pathology. Histopathological differentiation was noted after conducting a biopsy. Results: Most patients of UAT cancers were in the age group of 40-70 years. Maximum incidence was among males (82%) compared to females (28%). The most common predisposing factor was alcohol + smoking (28%), followed by alcohol + chewing tobacco (25%). The most common symptom in the oral cavity was ulcer and odynophagia (38%) each. In oropharyngeal cancers, dysphagia (92%) was the most common symptom. In laryngeal cancers, dyspnea (68%) and hoarseness of voice (32%) were the most common. The most common site involved in UAT cancers was the oral cavity (31%), followed by oropharynx (28%), larynx (22%), hypopharynx (7%), and salivary gland (5%). The most common histopathological type was squamous cell carcinoma (SCC) (90%). Most of the ulceroproliferative and exophytic growth was moderately differentiated SCC on histopathology. Conclusion: Studies are essential for education and awareness aimed at reducing exposure to habit-forming substances.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Laríngeas/patologia , Neoplasias Bucais/patologia , Neoplasias Otorrinolaringológicas/patologia , Fumar/efeitos adversos , Fumar Tabaco/efeitos adversos , Tabaco sem Fumaça/efeitos adversos , Adulto , Idoso , Carcinoma de Células Escamosas/epidemiologia , Causalidade , Feminino , Humanos , Incidência , Índia/epidemiologia , Neoplasias Laríngeas/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/epidemiologia , Neoplasias Otorrinolaringológicas/epidemiologia , Estudos Prospectivos , Distribuição por Sexo
18.
J Assoc Physicians India ; 67(8): 14-18, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562710

RESUMO

Background: Intracerebral Hemorrhage (ICH) is one of the most common causes of morbidity and mortality worldwide accounting for 10-15 % of all strokes types. ICH score is a validated tool to predict mortality and morbidity at 30 day follow up period. Objective: : To prospectively evaluate the predictive utility of ICH score in patients presenting with Acute ICH on discharge,30 days and 60 days follow-up period. Design: Prospective observational study. Materials and Method: This study was conducted in the Department of Neurology, Government Medical College, Kota, Rajasthan, India from January 2016 to August 2016. 120 consecutive patients presenting with acute ICH were studied. Data collected included demographics, clinical parameters, cranial Computed Tomography(CT) findings and ICH score on presentation. Primary outcome was defined as mortality/morbidity during hospitalisation, on discharge, 30 days and 60 days follow-up. Modified Rankin score (mRS) was used to assess the outcome. Statistical analysis used: SPSS 19 statistical software. Results: Of the total 120 patients with Acute ICH(108 supratentorial and 12 infratentorial) studied, 48(40%) patients died during hospitalisation. Mean age was 66.9 ± 13.5 Years. Hydrocephalus, midline shift and IV extension on presenting CT scan was observed in 20 (16.6%), 44 (36.6%) and 48 (40%)patients respectively. The independent predictors of increased mortality with statistical significance (p<0.001) were presence of vomiting, seizures, loss of consciousness, lower GCS (≤ 8), higher ICH score and ventilator requirement. Statistically significant (p≤0.001) radiological features associated with mortality included infratentorial location, presence of hydrocephalus,higher midline shift (58.3% vs 22.2% OR=2.6), intraventricular extension of hematoma and a higher baseline hematoma volume. ICH score on admission was significantly (p<0.001) positively correlated with the mRS score on discharge (R=0.667), 1 month (R=0.66) and 2 months (R=0.765) follow-up. Conclusion: ICH Score is a useful tool to predict outcome during hospitalisation, on discharge, 1 month and 2 month follow-up. We suggest that ICH score assessment and documentation should become standard procedure in acute care and follow up of patients with Intracerebral Hemorrhage.


Assuntos
Hemorragia Cerebral/epidemiologia , Alta do Paciente , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Índia , Pessoa de Meia-Idade , Estudos Prospectivos
19.
J Assoc Physicians India ; 67(8): 26-30, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562712

RESUMO

Background: : Systemic sclerosis (SSc) is a demyelinating disease of skin, subcutaneous tissue, muscles and internal organs, with fibrosis as an important pathological event. Aim: : To understand cytokine interplay of IL-1ß, IL-4 and IL-6 and their association with disease activity in treatment naïve active cases of systemic sclerosis from Western India. Methods: Twenty-five SSc patients as per ACR-EULAR 2013 criteria (classified based on pulmonary fibrosis and generalized fibrosis) and 25 age-sex matched controls were enrolled. Serum cytokine levels of IL-1ß, IL-4 and IL-6 were assessed by multiplex bead based immunoassay. Results: Ten patients had Interstitial lung disease (ILD), whereas, 16 patients had generalized fibrosis. Anti-nuclear antibodies were seen in 22 patients (88%); antiScl70 in 15 patients (60%) and anti-Centromere antibodies in 5 patients (20%). Serum levels of IL-1ß in patients were significantly higher than healthy controls (p=0.0006). IL-4 levels in all SSc patients were marginally raised (p=0.0102), while IL-6 levels were significantly raised (p<0.0001). IL-4 was found to be significantly raised in SSc patients with ILD (p=0.021) as compared to patients without ILD. IL-1ß (p=0.0293) and IL-4 (p<0.0001) were significantly higher in SSc patients with fibrosis. On the contrary, IL-6 levels in patients with fibrosis were found to be lower than in patients without fibrosis. Conclusion: Significantly raised cytokine levels among treatment naïve systemic sclerosis patients were found to be associated with higher disease severity in our study. Higher levels of IL-1ß and IL-6 indicated an active inflammatory status, whereas significantly raised IL-4 levels indicated at higher fibrotic activity.


Assuntos
Citocinas/metabolismo , Fibrose , Doenças Pulmonares Intersticiais , Escleroderma Sistêmico , Humanos , Índia
20.
J Assoc Physicians India ; 67(8): 31-34, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562713

RESUMO

Background: To evaluate the diagnostic accuracy of the Xpert MTB/RIF assay for the detection of M. tuberculosis in pulmonary and extra pulmonary specimens and to compare it with conventional techniques. Methods: A prospective study was conducted with the introduction of GeneXpert in a tertiary care hospital which relied on microscopy and culture for diagnosis of tuberculosis. All patients for whom geneXpert was ordered by the physician were included in the study. Samples which did not have accompanying microscopy or MGIT culture requests were excluded from the analysis of the results. Sensitivity and specificity of GeneXpert was calculated using liquid culture as the reference test. Results: Xpert MTB/RIF assay was performed on 742 samples of which 116 were positive for Mycobacterium tuberculosis. Rifampicin resistance was seen in 6 samples. The pulmonary samples showed a positivity rate of 16.8% while 17.1% of the extrapulmonary samples were positive by GeneXpert. A comparative analysis of microscopy, liquid culture and GeneXpert could be done for 88 samples. Of the 88 geneXpert positive samples, 42 were positive by smear microscopy and MGIT culture while 46 showed discordant results. Of these, 18 samples were positive by geneXpert but showed no growth in MGIT culture. 15 of these patients had undergone anti-tuberculous treatment (ATT) within the past 12 months. The sensitivity of geneXpert was 89.7% and specificity was 95.1% when compared to liquid culture as a gold standard. Sensitivity for extrapulmonary samples was 85.7% and specificity was 98.05%. Conclusion: To conclude, though GeneXpert detects tuberculosis within the shortest possible time, it still suffers from intermediate level sensitivity, which makes culture facilities relevant even in settings that offer an Xpert/Rif assay.


Assuntos
Bioensaio/métodos , Mycobacterium tuberculosis , Centros de Atenção Terciária , Tuberculose/diagnóstico , Farmacorresistência Bacteriana/genética , Humanos , Índia , Microscopia , Estudos Prospectivos , Rifampina , Sensibilidade e Especificidade , Escarro , Tuberculose/microbiologia
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