scholarly journals Clinical profile of sepsis and choice of antimicrobials in babies admitted to special newborn care unit Kalaburagi

2021 ◽  
Author(s):  
Revanasiddappa Bhosgi ◽  
Kirankumar Harwalkar
Keyword(s):  
Blood Culture ◽  
Complete Blood Count ◽  
Early Recognition ◽  
Early Stage ◽  
Newborn Care ◽  
Neonatal Morbidity ◽  
Blood Parameters ◽  
Clinical Suspicion ◽  
High Index ◽  
Clinical Sepsis

Background: Sepsis is one of the common clinical conditions seen in neonates. Sepsis being major cause of neonatal morbidity and mortality in neonates, early recognition and treatment with antibiotics remains a mainstay of NICU protocols for neonatologists.Methods: It is a hospital based retrospective study conducted from July 2019 to February 2020 in GIMS, Kalaburagi. Neonates with suspicion of clinical sepsis were investigated for complete blood count (CBC), C-reactive protein (CRP) and blood culture (BC). Antibiotics were started based on CBC and CRP reports, or on high index of clinical suspicion. Based on common organisms isolated in previous 3 months statistics, antibiotics were decided. On confirmation by blood culture, antibiotics were changed as per blood culture report.Results: Out of 100 neonates, CRP was positive in  80 (70%) neonates, BC showed growth among 24 (24%) neonates. Although neonates had clinical sepsis, CRP was negative in 20 (10%), 76 (76%) did not show any kind of growth on BC. Mortality was seen in 04 (5%) neonates with only CRP positive, 02 (08%) neonates with only BC growth, 02 (10%) neonates with both CRP positive and BC growth, 02 (03%) neonates with CRP positive but no growth on BC. Clinical features were from subtle to severe.Conclusions: Although CRP and blood culture confirmation remains one of the main diagnostic parameter in sepsis, as mortality is seen among neonates with negative blood parameters, high  index of clinical suspicion is essential to treat sepsis at an early stage.

Interleukin-6: A Sensitive Parameter for the Early Diagnosis of Neonatal Bacterial Infection

PEDIATRICS ◽  
1994 ◽  
Vol 93 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Christian Buck ◽  
Julia Bundschu ◽  
Peter Bartmann ◽  
Frank Pohlandt ◽  
Harald Gallati
Keyword(s):  
Blood Culture ◽  
Early Diagnosis ◽  
Bacterial Infection ◽  
Interleukin 6 ◽  
Early Recognition ◽  
Critical Role ◽  
Neonatal Infection ◽  
Clinical Sepsis ◽  
Sensitive Parameter ◽  
Culture Positive

Objective. Early recognition is important for the successful treatment and outcome of neonatal infections. As interleukin-6 (Il-6) plays a critical role in the induction of C-reactive protein (CRP) synthesis in the liver, it was hypothesized that this cytokine could be detected earlier in blood than the CRP during the course of bacterial infection. Design. In a prospective study of 298 newborns who were admitted to the nursery unit, CRP levels, blood cell count with differential, and Il-6 levels were determined at the time of admission and 24 hours after admission. Seventy-six newborns were excluded from the study because of incomplete or incorrect blood sampling. Results. The remaining 222 newborns were assigned to one of five groups: 11 newborns with blood culture-positive sepsis (sensitivity of Il-6 on admission 73%), 15 newborns with clinical sepsis (sensitivity of Il-6 on admission 87%), 41 newborns with infection (sensitivity of Il-6 on admission 68%), and 54 newborns without clinical and laboratory evidence of infection (specificity 78%). The remaining 101 newborns were defined as a mixed group because the diagnosis of neonatal infection could not clearly be made. Seventy-five percent of infected newborns had negative Il-6 levels 24 hours after admission. Of the 18 infected newborns with negative Il-6 levels on admission, 10 newborns had elevated CRP levels, suggesting that Il-6 was already negative because of the short half-life of Il-6. Sensitivity of Il-6 in CRP-negative newborns on admission was 100% in newborns with blood culture-positive and clinical sepsis. Il-6 was more sensitive than CRP in infected newborns on admission (73% vs 58%). Conclusion. Il-6 is a sensitive parameter for diagnosing neonatal bacterial infection. The combination of CRP and Il-6 seems to be the ideal tool for the early diagnosis of neonatal infection.

scholarly journals Modified hematological sepsis score in early diagnosis of neonatal sepsis

2017 ◽  
Vol 5 (8) ◽  
pp. 3573
Author(s):  
Vani Krishnamurthy ◽  
Deepti Thandaveshwar ◽  
Srinivasa Murthy Doreswamy
Keyword(s):  
Blood Culture ◽  
Early Diagnosis ◽  
Neonatal Sepsis ◽  
Complete Blood Count ◽  
Early Stage ◽  
Clinical Signs ◽  
Likelihood Ratios ◽  
Diagnostic Ability ◽  
Ability Tests ◽  
Sepsis Score

Background: Diagnosis of neonatal sepsis at an early stage substantially reduces the mortality. The clinician often relies on laboratory parameters to support the clinical suspicion. As blood culture takes time and yield is low, hematological and biochemical parameters often guide to the diagnosis and management. Rodwell’s Hematological sepsis score (HSS) has a reasonable sensitivity but low specificity. Some of the parameters included in that scoring system are repetitive of same pathogenic mechanism. A modified HSS was developed by the authors by removing the repetitive parameters, increasing the weightage for low neutrophil count and adding a new parameter - nucleated RBC. Objective of the study was to compare the diagnostic ability of the modified hematological sepsis score with Rodwell’s hematological sepsis score.Methods: Prospective analytical study conducted in a tertiary level hospital. Neonates admitted to NICU and had complete blood count done were included. Babies with clinical signs of systemic inflammatory response syndrome and evidence of organ dysfunction were considered septic. They were classified as proven sepsis if the blood culture was positive. All the samples were scored for both HSS and modified HSS. The sensitivity, specificity and other diagnostic ability tests were compared between the two scoring systems.Results: Total of 75 neonates were enrolled. 25 of them had sepsis and three had blood culture positive. At a score of 3, the sensitivity and specificity of HSS was 80 and 70% and that of Modified HSS was 84 and 82% respectively.Conclusions: Modified hematological score improves the specificity and likelihood ratios without decreasing the sensitivity in early diagnosis of neonatal sepsis.

Cytokeratin 7 and Copper Stains Facilitate Diagnosis of Small Duct Primary Sclerosing Cholangitis

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S125-S125
Author(s):  
A Wilhelm ◽  
H L Stevenson ◽  
K Kline
Keyword(s):  
Liver Biopsy ◽  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Early Recognition ◽  
Clinical Suspicion ◽  
Cytokeratin 7 ◽  
Ductular Reaction ◽  
Elevated Alkaline Phosphatase ◽  
Pattern Of Injury ◽  
Small Duct

Abstract Introduction/Objective Classic primary sclerosing cholangitis (PSC) involves extrahepatic and/or intrahepatic biliary ducts with segmental biliary strictures and dilatations that often allow the diagnosis to be made via cholangiogram. Small duct PSC (sdPSC) is a rare subtype that presents similarly with a cholestatic pattern of injury, yet due to the small size of involved ducts, a cholangiogram is non-diagnostic and diagnosis is dependent on clinical suspicion and liver biopsy. The histopathological features of sdPSC are often subtle and may easily be overlooked. Diagnosis of this entity- though difficult- is important, as early recognition can facilitate the identification of associated disease processes and life-threatening complications. Methods/Case Report We encountered a 33-year-old female presenting with intermittent pruritis, episodes of jaundice, and persistently elevated alkaline phosphatase who was misdiagnosed with only fatty liver at an outside institution. Evaluation with MRCP showed no abnormalities within the biliary tract and a liver biopsy was performed to aid in the diagnosis. The H&E and trichrome findings of atrophic bile ducts and some peribiliary sclerosis were extremely subtle and may have been overlooked without clinical suspicion. Cytokeratin 7 (CK7) highlighted cholangiolar metaplasia in hepatocytes and the bile ductular reaction that occurs in cholestatic disease states. A Rhodamine copper stain showed periportal deposition suggestive of chronic biliary obstruction. Use of CK7 and copper stains supported the presence of chronic biliary injury and suboptimal bile flow, confirming the diagnosis of sdPSC. Results (if a Case Study enter NA) NA Conclusion Diagnosis of sdPSC has historically relied on H&E and trichrome stains. In this case, the findings on H&E and trichrome stains were non-diagnostic, while the use of CK7 and copper stains confirmed the diagnosis of sdPSC. We recommend using CK7 and copper stains to evaluate for sdPSC.

scholarly journals Epidemiological features and medical care-seeking process of patients with COVID-19 in Wuhan, China

2020 ◽  
Vol 6 (2) ◽  
pp. 00142-2020 ◽  
Author(s):  
Jing Hua ◽  
Rongzhang Chen ◽  
Liming Zhao ◽  
Xiaodong Wu ◽  
Qian Guo ◽  
...  
Keyword(s):  
Medical Care ◽  
Early Recognition ◽  
Early Stage ◽  
Evaluation Process ◽  
Clinical Information ◽  
Healthcare Setting ◽  
Care Seeking ◽  
Medical Visit ◽  
Illness Onset ◽  
Clinical Recovery

BackgroundWe aimed to investigate the epidemiological and clinical features, and medical care-seeking process of patients with the 2019 coronavirus disease (COVID-19) in Wuhan, China, to provide useful information to contain COVID-19 in other places with similar outbreaks of the virus.MethodsWe collected epidemiological and clinical information of patients with COVID-19 admitted to a makeshift Fangcang hospital between 7 and 26 February, 2020. The waiting time of each step during the medical care-seeking process was also analysed.ResultsOf the 205 patients with COVID-19 infection, 31% had presumed transmission from a family member. 10% of patients had hospital-related transmission. It took as long as a median of 6 days from the first medical visit to receive the COVID-19 nucleic acid test and 10 days from the first medical visit to hospital admission, indicating early recognition of COVID-19 was not achieved at the early stage of the outbreak, although these delays were shortened later. After clinical recovery from COVID-19, which took a mean of 21 days from illness onset, there was still a substantial proportion of patients who had persistent SARS-CoV-2 infection.ConclusionsThe diagnostic evaluation process of suspected patients needs to be accelerated at the epicentre of the outbreak and early isolation of infected patients in a healthcare setting rather than at home is urgently required to stop the spread of the virus. Clinical recovery is not an appropriate criterion to release isolated patients and as long as 4 weeks' isolation for patients with COVID-19 is not enough to prevent the spread of the virus.

scholarly journals Glucocorticoid-Induced Avascular Bone Necrosis: Diagnosis and Management

2012 ◽  
Vol 6 (1) ◽  
pp. 449-457 ◽  
Author(s):  
KL Chan ◽  
CC Mok
Keyword(s):  
Early Recognition ◽  
Early Stage ◽  
Weight Bearing ◽  
Plain Radiograph ◽  
Core Decompression ◽  
Bone Necrosis ◽  
Avascular Bone Necrosis ◽  
Magnetic Resonance Imaging Mri ◽  
High Index Of Suspicion

Glucocorticoid use is one of the most important causes of avascular bone necrosis (AVN). The pathogenesis of glucocorticoid-induced AVN is not fully understood but postulated mechanisms include fat hypertrophy, fat emboli and intravascular coagulation that cause impedance of blood supply to the bones. Data regarding the relationship between AVN and dosage, route of administration and treatment duration of glucocorticoids are conflicting, with some studies demonstrating the cumulative dose of glucocorticoid being the most important determining factor. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease. Currently, there is no consensus on whether universal screening of asymptomatic AVN should be performed for long-term glucocorticoid users. A high index of suspicion should be exhibited for bone and joint pain at typical sites. Magnetic resonance imaging (MRI) or bone scintigraphy is more sensitive than plain radiograph for diagnosing early-stage AVN. Conservative management of AVN includes rest and reduction of weight bearing. Minimization of glucocorticoid dose or a complete withdrawal of the drug should be considered if the underlying conditions allow. The efficacy of bisphosphonates in reducing the rate of collapse of femoral head in AVN is controversial. Surgical therapy of AVN includes core decompression, osteotomy, bone grafting and joint replacement. Recent advances in the treatment of AVN include the use of tantalum rod and the development of more wear resistant bearing surface in hip arthroplasty.

scholarly journals Solid Pseudopapillary Neoplasm of Pancreas In A 35 Year Old Lady

2018 ◽  
Vol 9 (1) ◽  
pp. 31-34
Author(s):  
Sadia Imdad ◽  
Pankaj Kumar Saha ◽  
Md Mustafizur Rahman ◽  
Md Mozammal Hoque ◽  
Krishna Pada Saha ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Young Female ◽  
Clinical Suspicion ◽  
High Index ◽  
Rare Entity ◽  
Solid Pseudopapillary Neoplasm ◽  
Treatment Protocols ◽  
Female Patients ◽  
Proper Diagnosis

Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity; therefore proper diagnosis, evaluation and formulation of treatment protocols is difficult. The commonest presenting symptom is abdominal pain. This article presents a case of solid pseudopapillary neoplasm of pancreas in a 35 years old lady. A high index of clinical suspicion is necessary to suspect and diagnose SPN. This diagnosis should be borne in mind when young female patients present with a pancreatic mass.J Shaheed Suhrawardy Med Coll, June 2017, Vol.9(1); 31-34

scholarly journals Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

2020 ◽  
Vol 7 (6) ◽  
pp. 1213
Author(s):  
Rashmi Patil ◽  
Chikkanarasareddy P. S. ◽  
Mallesh K.
Keyword(s):  
Septic Shock ◽  
Clinical Decision Making ◽  
Early Recognition ◽  
Early Stage ◽  
Therapeutic Option ◽  
Lactate Clearance ◽  
Plasma Lactate ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

scholarly journals Development and Clinical Validation of a Droplet Digital PCR Method for Detection of Acinetobacter baumannii and Klebsiella pneumonia in Patients with Suspected Bloodstream Infections

2021 ◽  
Author(s):  
Yang Zheng ◽  
Jun Jin ◽  
Ziqiang Shao ◽  
Jingquan Liu ◽  
Run Zhang ◽  
...  
Keyword(s):  
Blood Culture ◽  
Acinetobacter Baumannii ◽  
Limit Of Detection ◽  
Early Stage ◽  
Bloodstream Infections ◽  
Digital Pcr ◽  
Droplet Digital Pcr ◽  
Klebsiella Pneumonia ◽  
Clinical Validation ◽  
Blood Samples

The relatively long turnaround time and low sensitivity of traditional blood culture may delay the effective antibiotic therapy in patients with bloodstream infection (BSI). To reduce the morbidity and mortality of BSI, a rapid and sensitive pathogen detection method is urgently required. Acinetobacter baumannii and Klebsiella pneumonia are two major microorganisms responsible for BSI. Here we reported a novel droplet digital PCR (ddPCR) method that can detect A. baumannii and K. pneumonia in whole blood samples within 4 h, with a specificity of 100% for each strain and limit of detection at 0.93 copies/microliter for A. baumannii and 0.27 copies/microliter for K. pneumonia. Clinical validation in 170 patients with suspected BSIs showed that, compared with blood culture that reported 4 (2.4%) A. baumannii cases and 7 (4.1%) K. pneumonia cases, ddPCR detected 23 (13.5%) A. baumannii cases, 26 (15.3%) K. pneumonia cases, and 4 (2.4%) dual infection cases, including the 11 positive patients reported by blood culture. In addition, the positive patients reported by ddPCR alone (n = 42) had significantly lower serum concentrations of procalcitonin and lactate, SOFA and APACHE II scores, and 28-day mortality than those reported by both blood culture and ddPCR (n = 11), suggesting that patients with less severe manifestations can potentially benefit from the guidance of ddPCR results. In conclusion, our study suggests that ddPCR represents a sensitive and rapid method to identify causal pathogens in blood samples and to guide the treatment decisions in the early stage of BSI.

scholarly journals Prevalence of Malnutrition Inflammation Complex Syndrome among Patients on Maintenance Haemodialysis at Muhimbili National Hospital in Tanzania: A Cross-Sectional Study

2020 ◽  
Author(s):  
Puneet Kishore Bramania ◽  
Paschal Ruggajo ◽  
Rimal Bramania ◽  
Muhiddin Mahmoud ◽  
Francis Fredrick Furia
Keyword(s):  
Total Cholesterol ◽  
Complete Blood Count ◽  
Early Recognition ◽  
Cross Sectional Study ◽  
Dar Es Salaam ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Cross Sectional ◽  
Reverse Epidemiology ◽  
Maintenance Haemodialysis

Abstract Background: Malnutrition, inflammation, and the combination thereof are predictors of poor outcomes in haemodialysis patients. Malnutrition Inflammation Complex Syndrome (MICS) is an accelerator of atherosclerosis and portends high mortality. Early recognition and treatment of MICS may help to improve the clinical outlook of such patients. This study investigated the prevalence of MICS and its associated factors among patients on maintenance haemodialysis at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Methods: This was a prospective cross-sectional observational study done among 160 adult patients on maintenance haemodialysis at MNH in 2019. All participants provided written informed consent. Questionnaires were used to collect data and patients’ blood was tested for complete blood count (CBC), C-reactive protein (CRP), ferritin, transferrin, creatinine, urea, total cholesterol, and albumin. The Malnutrition Inflammation Score was used to assess MICS and its severity. Data analysis was done using the SPSS 20 software. Results: Of the 160 patients included in the study, 111 (69.4%) were male. The mean age (±SD) of patients and mean duration (±SD) on haemodialysis were 52.2(13.3) years and 22(18) months respectively. MICS was prevalent in 46.3% (mild in 24.4% and moderate to severe in 21.9%). Long-term haemodialysis (>4years) was an independent predictor of MICS [Adjusted Odds Ratio, AOR 5.04 (95% CI: 1.33–19.2), p<0.05]. Hypercholesterolaemia was a negative predictor of MICS [AOR 0.11 (95% CI: 0.01-0.97), p<0.05]. Patients with MICS had significantly lower mean body mass index, serum albumin, total cholesterol, transferrin, haemoglobin, and creatinine levels. The presence of MICS was higher in underweight patients and those who had inflammation. Haemodialysis adequacy did not correlate with MICS. Conclusion: Malnutrition Inflammation Complex Syndrome is relatively common among patients on haemodialysis in Dar es Salaam, Tanzania. Our study has shown a longer duration on haemodialysis to be associated with the occurrence of MICS; on the contrary, having hypercholesterolaemia seems to be protective against MICS consistent with the concept of reverse epidemiology. Patients on haemodialysis should be assessed regularly for malnutrition and inflammation and should receive appropriate and timely treatment to reduce the burden of associated morbidity, and mortality to these patients.

Early Recognition of Suspicious Activity for Crime Prevention

2018 ◽  
pp. 2139-2165
Author(s):  
M. Kalaiselvi Geetha ◽  
J. Arunnehru ◽  
A. Geetha
Keyword(s):  
Crime Prevention ◽  
Early Recognition ◽  
Early Stage ◽  
Criminal Activity ◽  
Automatic Identification ◽  
Early Prediction ◽  
Interest Point ◽  
Prediction Problem ◽  
Novel Approach ◽  
2D And 3D

Automatic identification and early prediction of suspicious human activities are of significant importance in video surveillance research. By recognizing and predicting a criminal activity at an early stage, regrettable incidents can be avoided. Initially, an action recognition framework is developed for identifying the suspicious actions using interest point based 2D and 3D features and transform based approaches. This is subsequently followed by a novel approach for predicting the suspicious actions for crime prevention in real-world scenario. The prediction problem is formulated probabilistically and a novel approach that employs the mixture models for prediction is introduced. The developed system yields promising results for predicting the actions in real-time.

Sign in / Sign up

Export Citation Format

Share Document