scholarly journals Accuracy of the hematological scoring system (HSS) for the diagnosis of neonatal sepsis in Tertiary Care Hospital.

2020 ◽  
Vol 27 (04) ◽  
pp. 742-745
Author(s):  
Muhammad Asghar Ali ◽  
Ali Hammad ◽  
Hafiz Muhammad Anwar
Keyword(s):  
Neonatal Sepsis ◽  
Scoring System ◽  
Tertiary Care ◽  
High Sensitivity ◽  
P Value ◽  
Care Hospital ◽  
Predictive Values ◽  
Early Diagnose ◽  
Sensitivity Specificity ◽  
Culture Positive

Objectives: Neonatal sepsis is a known and significant contributor to newborn morbidity and mortality. We conducted this study to find out the efficiency of hematological scoring system (HSS) in predicting neonatal sepsis. Study Design: Prospective study. Setting: Neonatology Unit of Civil Hospital, Bahawalpur. Period: 1st July 2018 to 31st December 2018. Materials & Methods: A total of 100 neonates having high probability of sepsis were admitted and evaluated in NICU, Institution’s pathological lab was the center for all the workups. Sensitivity, specificity, positive predictive values (PPVs) along with negative predictive values (NPVs) were calculated for different study parameters. P value < 0.05 was considered as significant. Results: Amongst a total of 100 neonates, 62 (62.0%) were males and 38 (38.0%) females. There were 32 (32.0%) preterm while 68 (68.0%) term neonates. Culture positive cases were found to be 33 (33.0%) whereas CRP was noted reactive in 62 (62.0%) cases. Neonatal age as preterm, culture positive neonates (p < 0.001) as well as CRP as reactive were found to be significantly associated with HSS > 5. Immature to total neutrophil ratio (I:T) as well as Immature to mature neutrophil ratio (I:M) had the highest sensitivity and specificity. Conclusion: HSS is a simple to use and efficient method that can be used to early diagnose and treat cases of neonatal sepsis. HSS has a high sensitivity as well specificity as high scores of HSS highlight sepsis.

scholarly journals Evaluation of HiCrome KPC Agar for the Screening of Carbapenem-Resistant Enterobacterales Colonization in the ICU Setting of a Tertiary Care Hospital

2021 ◽  
Author(s):  
Ashoka Mahapatra ◽  
K Nikitha ◽  
Sutapa Rath ◽  
Bijayini Behera ◽  
Kavita Gupta
Keyword(s):  
Tertiary Care ◽  
High Sensitivity ◽  
Care Hospital ◽  
Predictive Values ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Rectal Swabs ◽  
Control And Prevention ◽  
Indian Setting ◽  
Sensitivity Specificity

Abstract Background Spread of carbapenem-resistant Enterobacterales (CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome Klebsiella pneumoniae carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference. Methods Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria). Results Using CDC method, total 41 CRE isolates were recovered comprising of 29 E scherichia coli, 11 Klebsiella, and 1 Enterobacter spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were E. coli, 15 Klebsiella, and 1 Enterobacter sp. Statistical Analysis Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference. Conclusion HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.

scholarly journals Diagnostic and Prognostic Validity of Proadrenomedullin among Neonates with Sepsis in Tertiary Care Hospitals of Southern India

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Raja Kannan ◽  
Suchetha S. Rao ◽  
Prasanna Mithra ◽  
B. Dhanashree ◽  
Shantharam Baliga ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Neonatal Sepsis ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Predictive Values ◽  
Clinical Sepsis ◽  
A Value ◽  
Sepsis Screen ◽  
Sensitivity Specificity

Introduction. To evaluate Proadrenomedullin (Pro-ADM) as the diagnostic and prognostic marker in neonatal sepsis. Materials and Methods. In this cross-sectional study, Pro-ADM levels were estimated in 54 neonates with clinical sepsis and positive sepsis screen (cases) and 54 controls without clinical sepsis. Repeat Pro-ADM levels were estimated after 72 hours in cases. Pro-ADM levels were compared with the clinical outcome. Results and Discussion. Median Pro-ADM levels in cases were 31.8 (IQR: 27.8-39.4) pmol/ml which was significantly higher than controls 5.1 (IQR; 3.1-7.7) pmol/ml. From the constructed ROC curve, a value of 14.5 pmol/ml was taken as the cut-off for sepsis. Pro-ADM had 100% sensitivity, specificity, and positive predictive values (PPV) in detecting sepsis at 14.5 pmol/ml. Among cases, a decrease in Pro-ADM level by 10 pmol/ml was associated with 99% survival. Pro-ADM value of 35 pmol/ml had 100% specificity and PPV in predicting mortality. Conclusion. Pro-ADM can be used as a single biomarker for detecting neonatal sepsis, predicting clinical outcome and prognosis.

scholarly journals ULTRASONOGRAPHY

2008 ◽  
Vol 15 (01) ◽  
pp. 26-32
Author(s):  
TAHIR MALIK ◽  
ZAFAR AMIN ◽  
TAHIR MALIK
Keyword(s):  
Acute Abdomen ◽  
Imaging Modality ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Cost Effective ◽  
Military Hospital ◽  
Care Hospital ◽  
Radiation Hazards ◽  
Sensitivity Specificity

) To determine the role of ultrasonography as the primaryimaging modality in patients of acute abdomen. (2) To evaluate the sensitivity, specificity, positive and negativepredictive value of ultrasonography in acute abdomen. Design: A hospital based descriptive study. Setting: InCombined Military Hospital Lahore which is a tertiary care hospital. Period: From 1 Jan 2003 to 30 Dec 2003. stSubjects: A total of 100 consecutive patients of acute abdomen were selected for the study. There were 61 malepatients and 39 female patients. The patients’ age ranged from 02 years to 70 years. Ultrasonography was done usingALOKA SSD-5500 machine with high resolution probes. Results: During my study of patients of acute abdomen mostcommon conditions encountered were renal colic due to renal and ureteric stones followed by gut perforation,cholecystitis, appendicitis and cholelithiasis. My study revealed a sensitivity of 79.7% and specificity of 88.4% ofultrasonography in patients with acute abdomen. The positive predictive value was 95.1% and a negative predictivevalue was 60.5%. Conclusion: Ultrasonography helped in prompt decision making in most of the cases of acuteabdomen with a high sensitivity and specificity in skilled and experienced hands, as well as high positive predictivevalue. Hence, in our setup it can be used as a primary imaging modality for patients presenting with acute abdomenin any age group, as it is readily available, cost effective and free of any radiation hazards. Ultrasonography not onlyhelps in diagnosing the cause of pain but also ruling out other possibilities.

scholarly journals Diagnostic accuracy of GeneXpert MTB/RIF assay for detection of tubercular pleural effusion

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0251618
Author(s):  
Jyoti Jain ◽  
Pooja Jadhao ◽  
Shashank Banait ◽  
Preetam Salunkhe
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Tertiary Care ◽  
Public Health Problem ◽  
P Value ◽  
Care Hospital ◽  
Reference Standard ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Composite Reference Standard

India has been engaged in tuberculosis (TB) control activities for over 50 years and yet TB continues to remain India’s important public health problem. The present study was conducted to compare the performance of GeneXpert MTB/RIF (GXpert) assay with composite reference standard in diagnosing cases of tubercular pleural effusion (TPE) and to evaluate the reliability of rifampicin resistance. A cross-sectional study was performed in a Department of Medicine of a rural teaching tertiary care hospital in central India. In all consecutive patients with pleural effusion on chest radiograph presenting to Department of Medicine, GXpert assay and composite reference standard was performed to evaluate the diagnostic accuracy of GXpert assay for detecting TPE in comparison to composite reference standard. Standard formulae were used to calculate the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (LR+) and negative likelihood ratios (LR-). Mc-Nemar’s test was applied to compare variables. All comparisons were two-tailed. We considered the difference to be statistically significant if the P value was less than 0.05. The sensitivity of the GXpert assay in diagnosing TPE was 16.6% among 158 study participants, the specificity was 100% and diagnostic accuracy was 52.5% which was statistically significant (p value < 0.05). It had a PPV of 100% (95%CI: 88.3% - 100%) and a NPV of 47.5% (95%CI: 39.3% - 55.7%). The LR+ and LR-were 23.5 (95%CI: 1.43–38.6) and 0.83 (95%CI: 0.76–0.91) respectively. GXpert assay has a very high specificity in diagnosing TPE but has a low sensitivity. In comparison to composite reference standard Thus its clinical utility is limited when used as a standalone test. A physician’s clinical acumen in combination with routine pleural fluid analysis should be the key factor in the diagnosis of TPE in clinically and radiologically suspected patients, especially in high TB burden countries.

scholarly journals Effectiveness of a Two-Step Testing Algorithm for Reliable and Cost-Effective Detection of Clostridium difficile Infection in a Tertiary Care Hospital in Saudi Arabia

2019 ◽  
Vol 7 (1) ◽  
pp. 6
Author(s):  
Mohammed Qutub ◽  
Prasanth Govindan ◽  
Anupama Vattappillil
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Tertiary Care ◽  
Care Hospital ◽  
Predictive Values ◽  
Stool Samples ◽  
Step Algorithm ◽  
Testing Algorithm ◽  
Sensitivity Specificity ◽  
Pcr Test

The aim of this study was to evaluate the effectiveness of a two-step algorithm for the detection of Clostridium difficile infection. Setting and Design: A two-step testing algorithm was evaluated for testing stool samples from patients suspected of Clostridium difficile infection (CDI). A total of 103 stool specimens were tested using the C. diff Quik Chek Complete enzyme immunoassay (EIA) test and the Xpert C. difficile PCR test. A two-step algorithm was implemented, and data from 3518 patient samples tested during a two-year period after implementation were analyzed to evaluate the effectiveness. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of the Quik Chek Complete EIA test were calculated using the Xpert C. difficile PCR test as a reference method. The sensitivity, specificity, PPV, and NPV of the Quik Chek Complete EIA test for C. difficile toxin were 46.7%, 100%, 100%, and 91%, respectively. The two-step algorithm, which combined the Quik Chek Complete EIA with Xpert C. difficile PCR, improved the sensitivity and also provided rapid detection. When algorithm-based testing was performed daily, there was a 66% reduction in turnaround time compared to batch testing using a lengthy ELISA procedure. Postimplementation data analysis showed that almost 89% of the samples could be reported immediately by initial screening with Quik Chek Complete EIA. Only 11% of the samples gave discrepant results and required PCR confirmation. According to our results, the two-step algorithm is an effective tool for the rapid and reliable detection of toxigenic C. difficile from stool samples.

scholarly journals Feasibility of The Use of Neutrophil To Lymphocyte Ratio (NLR) As An Adjunct To Cytology To Suggest Thyroid Malignancy: A Prospective Study

2021 ◽  
Author(s):  
Pawan Kumar Tiwari ◽  
Biju Varghese ◽  
Arunjeet KK ◽  
Pankaj P Rao ◽  
Dronacharya Routh
Keyword(s):  
Tertiary Care ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Neutrophil To Lymphocyte Ratio ◽  
P Value ◽  
Care Hospital ◽  
Thyroid Malignancy ◽  
Class Iii ◽  
Lymphocyte Ratio ◽  
Area Under Roc Curve

Abstract Background: Inflammation is known to be associated with cancer development and progression. NLR is a simple and efficient marker of inflammation in numerous malignancies. Aim: The study aimed to investigate usefulness of neutrophil to lymphocyte ratio (NLR) as an adjunct to Fine needle aspiration cytology (FNAC) to suggest thyroid malignancy confirmed by histopathological report post operatively in Bethesda class III, IV & V.Methods: Prospective observational study at a tertiary care hospital over 2 years.Results: NLR in the benign group and malignant group were 1.75+0.23 and 2.19+0.29 (mean + SD) respectively (p-value <0.001). Area under ROC curve plotted was 0.823 (p-value <0.001), with recommended cut-off of 1.9. Relatively high sensitivity and specificity at 87.5 % and 82.5% implies excellent diagnostic accuracy.Conclusion: NLR with a value of 1.9 or higher is recommended as predictor of malignancy in thyroid nodule.

scholarly journals Validation of Modified Paediatric Triage Score in a Tertiary Care Hospital

2020 ◽  
Author(s):  
Bandya Sahoo ◽  
Reshmi Mishra ◽  
Mukesh Kumar Jain ◽  
Sibabratta Patnaik
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Scoring System ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Clinical Variables ◽  
Icu Admission ◽  
Physical Variables

Introduction: The global burden of paediatric mortality is high and majority of the deaths are preventable by providing timely access to specialised emergency care. An appropriate triage in a busy emergency department can identify the sickest patient for early intervention. Aim: To develop a simple score based on physical variables alone and assess its validation so as to predict Intensive Care Unit (ICU) admission. Materials and Methods: This prospective hospital based study included 936 children, aged 1 month to 18 years. Baseline demographic data along with clinical variables were noted in a pre-designed proforma at the time of admission. A scoring system was developed based on severity of various clinical variables i.e., heart rate, respiratory rate, respiratory effort, Oxygen Saturation (SpO2), Capillary Refill Time (CFT), temperature, level of consciousness and behaviour. The outcome i.e., admission to ward or Pediatric Intensive Care Unit (PICU) of the patient was correlated with the study variables and total score. An association of modified PETS with the PICU admission was done using Chi-square test. A p-value of <0.01 was considered as statistically significant. Results: The modified Paediatric Triage Score (PETS) which is developed based on eight physical variables, is reliable in discriminating the children with ward and ICU admission. A score of ≥6 leads to 14.8 times higher risk of getting admitted to ICU as compared to a child with score of <6. A cut-off of ≥6 for modified PETS score has a sensitivity of 79.6% and specificity of 79.2% in predicting ICU admission. Conclusion: This simple clinically developed scoring system based on physical variables alone with an optimal cut-off of ≥6 can predict severity of illness and need for PICU admission in Emergency Department with acceptable validity and can serve as a potentially excellent screening tool.

scholarly journals Changing trends of antibiotic resistance in neonatal sepsis in a tertiary care hospital

2017 ◽  
Vol 6 (6) ◽  
pp. 1344
Author(s):  
Pauline Packiaseeli S. ◽  
Ashok Kumar T.
Keyword(s):  
Antibiotic Resistance ◽  
Neonatal Sepsis ◽  
Tertiary Care ◽  
Resistance Pattern ◽  
P Value ◽  
Care Hospital ◽  
Coagulase Negative Staphylococci ◽  
Neonatal Deaths ◽  
Amoxicillin Clavulanic Acid ◽  
Rational Use Of Antibiotics

Background: Sepsis and other infections cause 15% neonatal deaths in India. The present study is to determine the resistance pattern of pathogens causing neonatal sepsis and to provide antibiogram to pediatricians for better patient management.Methods: Positive Blood culture reports of neonatal sepsis cases detected during the years 2014 and 2015 were studied. The antibiotic resistance of the organisms found during the years 2014 and 2015 were compared by calculating the probability (p value) using the standard formula.Results: Coagulase negative staphylococci (CONS) was the most common organism in 2014 whereas pseudomonas was predominant in 2015.Resistance of CONS to amoxycillin and ceftrioxone has significantly increased in 2015.Also resistance of CONS to vancomycin was noted. Resistance of Pseudomonas to cefuroxime, ceftazidime and amoxicillin/clavulanuic acid combination were increased but not significantly. There was also emerging resistance of pseudomonas to gentamicin and amikacin. Resistance of acinetobacter to cefuroxime, ceftrioxone and gentamicin has increased in 2015 but not significantly. Citrobacter showed a significant increase in resistance to amoxicillin/clavulanic acid combination (p=0.006).Conclusions: Bacterial spectrum causing neonatal sepsis varies in different regions, varies in the same site during different time periods, also their antibiotic resistance pattern varies in different regions and changes constantly. Increase in resistance to commonly used antibiotics stress the need of rational use of antibiotics.

scholarly journals Brixia Chest X-ray Scoring System in Critically Ill Patients with COVID-19 Pneumonia for Determining Outcomes

2021 ◽  
Author(s):  
Nishant Agrawal ◽  
Samruddhi Dhanaji Chougale ◽  
Prashant Jedge ◽  
Shivakumar Iyer ◽  
John Dsouza
Keyword(s):  
Scoring System ◽  
Early Stage ◽  
Tertiary Care ◽  
Categorical Variables ◽  
P Value ◽  
Care Hospital ◽  
X Ray ◽  
Lung Abnormalities ◽  
Chest X Ray ◽  
The Mean

Introduction: In early stage of disease of Coronavirus Disease 2019 (COVID-19) infection chest Computed Tomography (CT) imaging is considered as the most effective method for detecting lung abnormalities. A Brixia Chest X-ray (CXR) scoring system which uses an 18-point severity scale to grade lung abnormalities due to COVID-19 was developed to improve the risk stratification for infected patients. Aim: To ascertain the validity of Brixia scoring system and to measure the outcome in COVID-19 patients. Materials and Methods: A retrospective study was conducted from 1st April 2020 to 31st July 2020, at a tertiary care hospital in India. Baseline CXR of COVID-19 patients were scored based on Brixia scoring system. The lungs were divided into six equal zones. Subsequently, scores (from 0-3) were assigned to each zone, based on lung abnormalities. A group comparison was implemented using Chi-Square test for categorical variables. Whereas an independent t-test was applied for continuous variables that followed normal distribution. Results: The study included 130 patients. The mean age was 57.09±13.73 years, 70.8% patients included were males. Out of 130 patients, 79 patients died. Among patients who died the mean CXR score was calculated to be 12.13±2.50. The mean CXR score was calculated to be 11.18±2.30 in patients who recovered and got discharged. During the process of comparison of CXR scores with the outcomes, the t-value came out to be 2.20 and the resulting p-value was 0.03 (statistically significant). Conclusion: Brixia score more than 12 was associated with increased mortality due to COVID-19, with p-value of 0.03.

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