Study of nosocomial primary bloodstream infections in a pediatric intensive care unit

Bloodstream infections (BSI) are the commonest cause of nosocomial infections (NI) in PICU. Knowledge about their magnitude, risk factors and outcome are important in devising appropriate prevention and control measures. Our objective was to study the incidence, etiology, risk factors and outcome of primary BSI in PICU. A prospective cohort of 285 patients consecutively admitted to PICU from July 2003-04, having a stay of >48 h, were enrolled and monitored for BSI till discharge from ICU or death. Primary BSI was defined as per CDC criteria 1988. Data of patients with BSI was compared with those without BSI with respect to demographic details, PRISM III, primary diagnosis, nutritional status, device utilization and invasive procedures to identify risk factors for BSI. Variables significant on univariate analysis were subjected to multiple logistic regression analysis. Outcome was measured as length of PICU stay (LOS) and survival or death. There were 116 episodes of primary BSI in 86 (30%) patients; the incidence being 31.2 episodes/1000 patient days. The mean age of the patients with BSI was 3.7 +/- 3.5 years. Predominant isolates were Gram-negative (53.5%); Klebsiella pneumoniae (n = 21) being the commonest. Staphylococcus aureus (n = 18) was the most common Gram-positive organism. Seven of the 9 (77.8%) yeast isolates were Candida tropicalis. Younger age, higher PRISM III, lower hemoglobin, pre-existing infection, higher frequency and duration of device utilization (CVC, urinary catheter, endotracheal tube, mechanical ventilation) were significant risk factors on univariate analysis. On multiple logistic regressions, hemoglobin (OR 1.24, 95% CI 1.1-1.4, p = 0.002) duration of urinary catheter (OR 0.91, 95% CI 0.84-0.98, p = 0.015) and pre-existing infection (OR 0.46, 95% CI 0.23-0.93, p = 0.03) were independent risk factors for primary BSI. The median LOS was significantly longer in patients with BSI compared to those without (16 vs. 7 days, p = 0.0001) 47% of patients with BSI died as compared to 26% deaths in the whole cohort (p = 0.002). Just over half the cases of BSI in our PICU were caused by Gram-negative bacteria. Lower hemoglobin, pre-existing infection and prolonged duration of urinary catheter were independent risk factors identified on multivariate analysis. BSI was associated with significantly higher mortality and longer stay in our PICU.

Studies on anti-inflammatory effect of aqueous extract of leaves of Holoptelea integrifolia, Planch. in rats

OBJECTIVES

The purpose of the present study was to investigate the anti-inflammatory properties of aqueous extract of the leaves of H. integrifolia, Planch.

MATERIALS AND METHODS

The hind paw edema was produced in rats by subplanter injection of carageenan. The aqueous extract of H. integrifolia, Planch. (AHI) at dose (250 and 500 mg/kg p.o) was given to observe % inhibition of paw edema which were comparable with indomethacin (10 mg/kg p.o) used as a reference drug.

RESULTS

The extract administered orally at doses of 250 and 500 mglkg p.o produced a significant (P < 0.05) dose dependent inhibition of edema formation

CONCLUSIONS

A significant % inhibition of paw edema by the aqueous extract of leaves of H. integrifolia, Planch. and its almost nearby same % inhibition with indomethacin suggest its usefulness as an anti-inflammatory agent.

Linezolid-A Review of Analytical Methods in Pharmaceuticals and Biological Matrices

Bacterial resistance to antibiotics is a growing phenomenon in the world. Considering the relevance of antimicrobials for population and the reduction in the registration of new antimicrobials by regulatory agencies, proper quality control is required to minimize the spread of bacterial resistance and ensure the effectiveness of a treatment, as well as safety for the patient. The recent addition to the antimicrobial world is the oxazolidinone classes of antibiotics, especially useful to treat infections caused by Gram-positive bacteria. Eperezolid and linezolid (LIN) are the two members of the oxazolidinone class of antibiotics. LIN was the first oxazolidinone approved by the Food and Drug Administration. The present review focuses on the analytical methods for the assessment of LIN in pharmaceuticals and biological matrices. The critical validation parameters like the linearity, limit of detection, limit of quantification are discussed for the individual method. Also the critical quality attributes like the sensitivity and the sample preparation techniques for bioanalytical methods are also discussed. Furthermore, some future trends that can be incorporated in the determination of similar drugs are also suggested.

Adult onset Langerhans cell histiocytosis of the orbit--a case report

PURPOSE

To report an interesting case of adult onset Langerhans cell histiocytosis in a 41-year-old male with clinicopathological correlation.

DESIGN

Interventional case report.

MATERIALS AND METHODS

A 41-year-old male presented with an ill-defined mass occupying the temporal quadrant of the left orbit. Computerized tomography revealed an ill-defined extraconal mass involving the superolateral aspect of the left orbit with areas of osteolysis involving the lateral and superior orbital walls. The mass excised at orbitotomy showed microscopic features consistent with Langerhans cell histiocytosis. Immunohistochemistry with CD-68 macrophage marker and S-100 was positive, confirming the diagnosis. Treatment included oral steroids and radiotherapy. At 6 months follow-up, he developed a punched-out lytic lesion in the left parietal calvarium. He again received external beam radiotherapy. At 14 months follow-up, he is doing well with no recurrences.

CONCLUSIONS

Adult onset Langerhans cell histiocytosis, though rare, should be included in the differential diagnosis of lytic lesions of the lateral orbital wall in an adult patient.

Comparison of Diagnostic Efficacy of Visual Inspection of Cervix with Acetic Acid and Pap Smear for Prevention of Cervical Cancer: Is VIA Superseding Pap Smear?

Objectives

To estimate diagnostic efficacy of visual inspection with acetic acid (VIA) in comparison to Pap smear.

Methods

This cross-sectional study was carried over a period of 24 months on 200 women attending colposcopy clinic at KLES Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum, India. All women enrolled in study underwent Pap smear, VIA, colposcopy and biopsy. The sensitivity, specificity, PPV, NPV, false-positive rate and false-negative rate were calculated for VIA, Pap smear and colposcopy with biopsy as the reference standard.

Results

In our study, sensitivity and specificity of VIA were found to be 86.95% and 72.51% respectively, and that of Pap smear 37.68% and 92.36% respectively. Colposcopy showed higher sensitivity (94.20%) and specificity (94.65%).

Conclusion

VIA is a suitable primary screening procedure alternative to Pap smear as it has high sensitivity and negative predictive value.

Obstetric acute kidney injury; a three year experience at a medical college hospital in north karnataka, India

INTRODUCTION

Acute kidney injury is a rare and sometimes fatal complication of pregnancy, the incidence of which has been declining worldwide, though still high in developing countries. There are recent observations of increasing incidence in some developed countries attributed to hypertensive disorders of pregnancy.

MATERIALS AND METHODS

In this study, we have analysed the records of all patients referred to the dialysis unit of a medical college hospital in Karnataka for acute kidney injury related to pregnancy. AKIN (Acute Kidney Injury Network) criteria for the diagnosis of acute kidney injury were adapted. Age, parity, gestational age, causative factors for acute kidney injury, mode of delivery, access to antenatal care, operative procedures, blood component transfusions, number of haemodialysis, time for initiation of haemodialysis, duration of hospital stay and mortality were analysed by finding mean, standard deviation and standard error.

RESULTS

Fifteen patients out of 21563 who delivered in our hospital developed acute kidney injury. These (n=15) were out of 149 patients of acute kidney injury of various aetiologies who underwent haemodialysis between 2012 and 2014. Of these two were unregistered for antenatal care. Ten were multiparous, Eleven were from rural background, one had home delivery, six had vaginal delivery, seven had caesarean section and two had second trimester abortion. Placental abruption with intrauterine death was the commonest Cause in 9 out of 15 cases. All had severe anaemia. Patients received a mean of 3.9 (SD+/- 2.4) sessions of haemodialysis. Eleven patients recovered completely, two died and two left against medical advice.

CONCLUSION

Obstetric acute kidney injury is associated with poor access to antenatal care, multiparity and rural background. Placental abruption is the commonest cause of obstetric acute kidney injury. Blood component transfusions, avoidance of nephrotoxic drugs and early initiation of haemodialysis are associated with better outcome.

Analytical and Bioanalytical Techniques for the Quantification of the Calcium Channel Blocker - Amlodipine: A Critical Review

Hypertension is a condition in which blood pressure is elevated to an extent where benefit is obtained from blood pressure lowering. The risk of complications is proportional to the level that blood pressure raises. Calcium channel blockers are a class of compounds used in the treatment of hypertension. The dihydropyridine (DHP) group, a subclass of the calcium channel blocker works almost exclusively on L-type calcium channels in the peripheral arterioles and reduce blood pressure by reducing total peripheral resistant. Long acting DHP is preferred because they are more convenient for patients and avoid the large fluctuations in plasma drug concentration which are associated with side effects. Amlodipine is the most distinct DHP and the most popular. The drug was patented in the year 1986 and its commercial sale began by 1990. The current article provides a state of art about the analytical and bioanalytical techniques available for the quantification of drug as a single entity and in combined pharmaceutical formulations between 1989 and 2019.

Dermal toxicity of hexachlorocyclohexane (HCH) in rabbit

Application of HCH (25 mg/kg) on dorsal, ventral and thigh regions of the skin of male rabbits resulted in poisoning and mortality of animals. Morphological changes in skin, liver, kidney, testes and cerebellum together with highly significant alterations in serum and liver enzymatic activity and residue in blood suggested that absorption of HCH and its toxicity could be severe when the pesticide comes in contact with the skin of thigh region of body.

Thermal spray processes influencing surface chemistry and in-vitro hemocompatibility of hydroxyapatite-based orthopedic implants

Orthopedic implants made from titanium are a popular choice in the medical field because of their remarkable strength-to-weight ratio. Nevertheless, they may not interact well with human blood, resulting in thrombosis and hemolysis. In fact, non-hemocompatibility is believed to be responsible for about 31 % of medical device failures in the US alone, requiring painful and expensive revision surgery. To address this issue, bioactive hydroxyapatite coatings are applied to Ti-6Al-4V implants using thermal spray techniques. However, the temperature used during thermal processing impacts the coating's surface properties, affecting the mechanical and biological properties. Furthermore, the effectiveness of HA coatings on titanium for orthopedic applications has not been validated by biocompatibility tests, particularly hemocompatibility. In this study, we aimed to investigate the relative efficacy of three thermal spray processes of different temperature ranges: Atmospheric plasma spray (APS) (high temperature), Flame spray (FS) (moderate temperature), and High-Velocity Oxy-Fuel spray (HVOF) (low temperature), and study their impact on coating's surface properties, affecting blood components and implant's strength. The crystallinity of the HA coating increased by 32 % with a decrease in the operating temperature (APS < FS < HVOF). HVOF coating exhibited a ~ 34 % and ~ 120 % improvement in adhesion strength and ~ 31 % and 59 % increment in hardness compared to APS and FS coating, respectively, attributed to its low porosity, low coating thickness (~55 μm), and high degree of crystallinity. The HVOF coating showcased a significant increase in non-hemolytic behavior, with hemolysis rates ~8 and ~ 11 times lower than APS and FS coatings, respectively, owing to its smooth texture and high degree of crystallinity (p < 0.05). Furthermore, the HVOF coating exhibited minimal blood clotting based on the whole blood clotting assay, again confirmed by PT and aPTT assays showing delayed clotting time, indicating its non-thrombogenic behavior. The number of platelets adhered to the three coatings showed no significant difference compared to Ti-6Al-4V. APS and FS coatings showed low platelet activation, unlike HVOF coating and titanium, which revealed round platelets, similar to the negative control. Neither titanium nor HA coatings exhibited antibacterial properties, which may be due to their high affinity for organic substances, which promotes bacterial adhesion and replication. Among the three thermal processes, HVOF coating displayed good apatite growth, non-hemolytic, and non-thrombogenicity with no platelet activation owing to its low processing temperature, high degree of crystallinity (89.7 %), hydrophilicity, smooth (~4 μm) and dense (~97 %) microstructural properties. The results demonstrated that the HVOF-HA coating presented in this work meets the hemocompatible requirements and shows promise for prospective application as an orthopedic implant. Furthermore, this study has the potential to significantly reduce the use of animals in in-vivo research and improve their welfare while also cutting costs.

Effect of Surface Chemistry on Hemolysis, Thrombogenicity, and Toxicity of Carbon Nanotube Doped Thermally Sprayed Hydroxyapatite Implants

Assessing blood compatibility is crucial before in vivo procedures and is considered more reliable than many in vitro tests. This study examines the physiochemical properties and blood compatibility of bioactive powders ((0.5-2 wt % carbon nanotube (CNT)/alumina)-20 wt %)) produced through a heterocoagulation colloidal technique followed by ball milling with hydroxyapatite (HAp). The 1 wt % CNT composite demonstrated a surface charge ∼5 times higher than HAp at pH 7.4, with a value of -11 mV compared to -2 mV. This increase in electrostatic charge is desirable for achieving hemocompatibility, as evidenced by a range of blood compatibility assessments, including hemolysis, blood clotting, platelet adhesion, platelet activation, and coagulation assays (prothrombin time (PT) and activated partial thrombin time (aPTT)). The 1 wt % CNT composite exhibited hemolysis ranging from 2 to 7%, indicating its hemocompatibility. In the blood clot investigation, the absorbance values for 1-2 wt % CNT samples were 0.927 ± 0.038 and 1.184 ± 0.128, respectively, indicating their nonthrombogenicity. Additionally, the percentage of platelet adhered on the 1 wt % CNT sample (∼5.67%) showed a ∼2.5-fold decrement compared to the clinically used negative control, polypropylene (∼13.73%). The PT and aPTT experiments showed no difference in the coagulation time for CNT samples even at higher concentrations, unlike HAC2 (80 mg). In conclusion, the 1 wt % CNT sample was nontoxic to human blood, making it more hemocompatible, nonhemolytic, and nonthrombogenic than other samples. This reliable study reduces the need for additional in vitro and in vivo studies before clinical trials, saving time and cost.

Multiple tuberculomas and cavitating pulmonary tuberculosis in an infant

A five-month-old infant presented with fever and cough for 3 weeks. She was diagnosed with multiple tuberculomas and cavitating pulmonary tuberculosis. She was a household contact of an open case of tuberculosis (TB) and developed severe disease, although she had received the Bacillus Calmette-Guérin (BCG) vaccine and had no primary or secondary immunodeficiency. In infants, due to low levels of cell mediated immunity, tuberculosis can be severe and dissemination of tuberculosis to the central nervous system (CNS) can occur very early without following the usual time frame. CNS TB may not have symptoms in the early stages in infants and may require neuroimaging for diagnosis. This is the youngest child that has been reported with multiple CNS tuberculomas.