scholarly journals Pediatric Tuberculosis in Young Children in India: A Prospective Study

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Sanjay K. Jain ◽  
Alvaro Ordonez ◽  
Aarti Kinikar ◽  
Nikhil Gupte ◽  
Madhuri Thakar ◽  
...  
Keyword(s):  
Young Children ◽  
Small Sample Size ◽  
Tertiary Hospital ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Small Sample ◽  
Vulnerable Population ◽  
Poor Outcomes ◽  
Pediatric Tuberculosis ◽  
A Prospective Study

Background. India has one of the highest tuberculosis (TB) burdens globally. However, few studies have focused on TB in young children, a vulnerable population, where lack of early diagnosis results in poor outcomes.Methods. Young children (≤5 years) with suspected TB were prospectively enrolled at a tertiary hospital in Pune, India. Detailed clinical evaluation, HIV testing, mycobacterial cultures, and drug susceptibility testing were performed.Results. 223 children with suspected TB were enrolled. The median age was 31 months, 46% were female, 86% had received BCG, 57% were malnourished, and 10% were HIV positive. 12% had TB disease (definite or probable), 35% did not have TB, while TB could not be ruled out in 53%. Extrapulmonary disease was noted in 46%, which was predominantly meningeal. Tuberculin skin test (TST) was positive in 20% of children with TB. Four of 7 (57%) children with culture-confirmed TB harbored drug-resistant (DR) strains of whom 2 (50%) were multi-DR (MDR). In adjusted analyses, HIV infection, positive TST, and exposure to household smoke were found to be significantly associated with children with TB (P≤0.04). Mortality (at 1 year) was 3 of 26 (12%) and 1 of 79 (1%), respectively, in children with TB and those without TB (P< 0.05).Conclusions. Diagnosis of TB is challenging in young children, with high rates of extra-pulmonary and meningeal disease. While the data on DR-TB are limited by the small sample size, they are however concerning, and additional studies are needed to more accurately define the prevalence of DR strains in this vulnerable population.

scholarly journals Mycobacterium Tuberculosis Strain Lineage in Mixed Tribal Population Across India and Andaman Nicobar Island

2021 ◽  
Author(s):  
Azger Dusthackeer V. N. ◽  
Azger Dusthackeer V. N. ◽  
Ashok Kumar ◽  
Kannappan Kannappan Sucharitha ◽  
S. Shivakumar ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Drug Susceptibility Testing ◽  
Small Sample ◽  
Clinical Isolates ◽  
Nicobar Island ◽  
Tribal Population ◽  
Indian States ◽  
Mdr Tb

Abstract In India, the tribal population constitutes almost 8.6% of the nation’s total population. This study attempts to provide information pertaining to the TB strain diversity, its public health implications, and distribution among the tribal population in 10 Indian states and Andaman & Nicobar (A&N) Island. Clinical isolates were received from 66 villages (10 states and island). A total of 78 M. tuberculosis clinical isolates were received from 10 different states and A&N Island. Among these, 16 different strains were observed. The major M. tuberculosis strains spoligotype belong to the Beijing, CAS1_DELHI, and EAI5 family followed by EAI1_SOM, EAI6_BGD1, LAM3, LAM6, LAM9, T1, T2, U strains. Drug-susceptibility testing (DST) results showed almost 15.4% of clinical isolates found to be resistant to isoniazid (INH) or rifampicin (RMP) + INH. Predominant multidrug-resistant tuberculosis (MDR-TB) isolates seem to be Beijing strain. Beijing, CAS1_DELHI, EAI3_IND, and EAI5 were the principal strains infecting mixed tribal populations across India. Despite the small sample size, this study has demonstrated higher diversity among the TB strains with significant MDR-TB findings. Prevalence of Beijing MDR-TB strains in Central, Southern, Eastern India and A&N Island indicates the transmission of the TB strains.

Peripheral Nerve Injury in Thoracic Surgery Detected by Automated Somatosensory Evoked Potential Monitoring

2020 ◽  
Vol 24 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Theodore J. Cios ◽  
Shane M. Barre ◽  
Sandeep Pradhan ◽  
S. Michael Roberts
Keyword(s):  
Peripheral Nerve ◽  
Thoracic Surgery ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Small Sample Size ◽  
Tertiary Hospital ◽  
Small Sample ◽  
Motor Deficits ◽  
Study Objective ◽  
Evoked Potential Monitoring

Study Objective. Our objectives were to estimate the incidence of symptoms of peripheral nerve injury (sPNI) in thoracic surgical patients undergoing video-assisted thoracic surgery or open thoracotomy and to determine whether intraoperative somatosensory evoked potentials (SSEPs) waveform changes correlate with postoperative peripheral neuropathic symptoms. Methods. We conducted a prospective observational study in the operating room of a tertiary hospital. We measured SSEPs intraoperatively and assessed patients for sPNI postoperatively. Results. Forty-four patients consented. Six were excluded from analysis. We found that 42% (95% confidence interval [CI] = 26% to 57%) of patients undergoing thoracic surgery had significant changes in SSEP amplitude and latency. Furthermore, 16% (95% CI = 4% to 28%) of patients had new postoperative symptoms of sensory or motor deficits in an upper extremity. We calculated a sensitivity of 66.7% (95% CI = 29.0% to 100%) and a specificity of 50% (95% CI = 33% to 67.3%) for the identification of sPNI based on automated intraoperative SSEP changes. Conclusions. We identified the incidence of SSEP changes in thoracic surgery (42%) and the incidence of postoperative sPNI after thoracic surgery (16%). We identified a positive correlation between intraoperative SSEP changes and postoperative sPNI, which after multivariate analysis was not significant given the small sample size of the study. By the time sensory and/or motor changes are detected postoperatively, it may be too late to reverse the nerve damage. Future versions of the EPAD device could provide anesthesiologists a way to monitor for the development of sPNI, and make changes before a potential injury becomes permanent.

scholarly journals Will Septal Correction Surgery for Deviated Nasal Septum Improve the Sense of Smell? A Prospective Study

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Neelima Gupta ◽  
P. P. Singh ◽  
Rahul Kumar Bagla
Keyword(s):  
Nasal Septum ◽  
Small Sample Size ◽  
Small Sample ◽  
Septal Deviation ◽  
Olfactory Function ◽  
Deviated Nasal Septum ◽  
Sense Of Smell ◽  
Correction Surgery ◽  
Olfactory Impairment ◽  
A Prospective Study

Background and Objectives. Nasal obstruction due to deviated nasal septum is a common problem bringing a patient to an otorhinolaryngologist. Occasionally, these patients may also complain of olfactory impairment. We proposed to study the effect of septal deviation on the lateralised olfactory function and the change in olfaction after surgery of the septum (septoplasty).Methods. Forty-one patients with deviated nasal septum were evaluated for nasal airflow, olfactory score, and nasal symptomatology. Septoplasty was done under local anesthesia. Pre- and postoperative olfactory scores, airflow and olfactory scores, and nasal symptomatology and olfactory scores were compared and correlated.Results. The range of preoperative composite olfactory score (COS) on the side of septal deviation was 4–14 (mean7.90±2.234) and on the nonobstructed side was 9–18 (mean14.49±2.378). Severity of deviated nasal septum and preoperative COS of diseased side were correlated and the correlation was found to be significant (rho = −0.690,p=0.000(<0.001)). The preoperative mean COS (7.90±2.234) was compared with the postoperative mean COS (12.39±3.687) and the improvement was found to be statistically significant (p=0.000(<0.001)).Conclusion. We found improvement in olfactory function in 70.6% patients after surgery, no change in 20.1%, and reduced function in 7.6%. With the limitation of a small sample size and a potential repeat testing bias, we would conclude that correction of nasal septal deviation may lead to improvement in sense of smell.

Dotlike hemosiderin spots on T2*-weighted magnetic resonance imaging as a predictor of stroke recurrence: a prospective study

2004 ◽  
Vol 101 (6) ◽  
pp. 915-920 ◽  
Author(s):  
Toshio Imaizumi ◽  
Yoshifumi Horita ◽  
Yuji Hashimoto ◽  
Jun Niwa
Keyword(s):  
Magnetic Resonance ◽  
Small Vessel Disease ◽  
Small Sample Size ◽  
Pearson Correlation ◽  
Small Sample ◽  
Stroke Recurrence ◽  
Amyloid Angiopathy ◽  
Content Type ◽  
A Prospective Study ◽  
Fine Print

Object. Microangiopathy associated with hypertension is a notable cause of cerebral small vessel disease (SVD), including deep intracerebral hemorrhage (ICH) and lacunar infarct. Dotlike low-intensity spots (dotlike hemosiderin spots: dotHSs) on T2*-weighted magnetic resonance (MR) images have been histologically diagnosed as old cerebral microbleeds associated with lipohyalinosis, amyloid angiopathy, or other microangiopathies and located in deep or subcortical regions. The aim of this study was to determine whether dotHSs indicate the severity of microangiopathy, and if so, whether large numbers of deep dotHSs are associated with SVD recurrence. Methods. The authors prospectively analyzed the number of dotHSs in 337 patients—191 men and 146 women with a mean age of 66 ± 10.4 years (range 37–94 years)—with SVD (199 ICHs and 138 lacunar infarcts) who had been consecutively admitted to Hakodate Municipal Hospital. The follow-up period was 3.5 to 42 months (22.5 ± 13.1 months). Patients were divided into two groups based on the recurrence. The hazard ratio (HR) for recurrence was estimated based on the Cox proportional hazard model by using the number of deep and subcortical dotHSs as well as other factors. Of 337 patients, 20 were readmitted with recurrence. Results of a multivariate analysis revealed an elevated rate of recurrence in patients with many subcortical dotHSs (≥ 5, HR 4.36, p = 0.0019) or a history of ICH (HR 3.82, p = 0.014). A trend toward a positive correlation (Pearson correlation coefficient 0.548, p < 0.0001) was found between the number of deep and subcortical dotHSs. Conclusions. Although a small sample size limited the power of analyses, the findings indicate that a large number of subcortical dotHSs may predict SVD recurrence.

POST-OPERATIVE COMPLICATIONS FOLLOWING ARTHROSCOPIC ACL RECONSTRUCTION USING VARIOUS GRAFTS; A PROSPECTIVE STUDY

2021 ◽  
pp. 48-50
Author(s):  
Himanshu Patel ◽  
Kashif Iqbal ◽  
Deependra Chourey ◽  
Manoj Kumar ◽  
Abhishek Pathak
Keyword(s):  
Acl Reconstruction ◽  
Small Sample Size ◽  
Cruciate Ligament ◽  
Deep Infection ◽  
Small Sample ◽  
Bptb Graft ◽  
Operative Complications ◽  
A Prospective Study ◽  
Post Operative Complications

Anterior cruciate ligament tear is a common occurrence and with advent of arthroscopic ligament reconstruction, the surgery is minimally invasive with good functional outcomes. The aim of this study is to evaluate the post-operative complications following arthroscopic ACLreconstruction. In this study we tried to analyse the post-operative complications in patients with arthroscopic ACL reconstructions using various autografts. The autografts used in this study were Bone patellar tendon bone graft, hamstring graft and peroneus graft. 26 patients were included in the study. 2 patients lost to follow up. The study result comprised of 24 patients. there were 45.8% of the patients who were below the age of 25 years whereas 54.2% patients were older than 25 years. Only 3 females were recruited in the present study, accounting for 12.5% of the total patients of the study. Majority 87.5% were males. Majority of the recruited patients were having right sided knee injury (54.2%) whereas remaining (45.8%) were having left sided injury. Majority of the patients were treated using hamstring and peroneus grafts (41.7%). 16.7% patients were treated with BPTB graft. There were 16.7% patients who developed deep infection after the surgery. Out of these, 30% were with hamstring grafts and 25% were with BPTB graft. 41.7% patients didn't develop any complications afterwards. 12.5% patients complained of post-operative knee pain. 16.7% patients reported occurrence of supercial infection. There are no signicant differences among complications for different grafts used in this study. The study concluded that arthroscopic ACL reconstruction is a safe surgical procedure with no signicant differences for various autograft options in terms of complications. The study is limited by small sample size and short follow up.

scholarly journals Improved contamination control for a rapid phage-based rifampicin resistance test for Mycobacterium tuberculosis

2007 ◽  
Vol 56 (10) ◽  
pp. 1334-1339 ◽  
Author(s):  
Richard Mole ◽  
Andre Trollip ◽  
Celeste Abrahams ◽  
Marlein Bosman ◽  
Heidi Albert
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Susceptibility Testing ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Rifampicin Resistance ◽  
Contamination Control ◽  
Conventional Culture ◽  
Sensitivity Specificity ◽  
A Prospective Study

A prospective study was conducted of the rapid FASTPlaque-Response test for determination of rifampicin resistance in Mycobacterium tuberculosis with and without the addition of an antimicrobial supplement containing nystatin, oxacillin and aztreonam (NOA) to control specimen-related contamination. A total of 631 smear-positive sputum specimens was tested. The age of specimens ranged from 0 to 21 days. The NOA antimicrobial was effective at controlling contamination, with 4.1 % of specimens contaminated when the NOA antimicrobial supplement was used compared with 13.9 % contamination without NOA. Overall levels of interpretability of the test with NOA were 87.8 % with specimens of ≤3 days and 79.0 % for all specimens. This compared with 70.1 and 73.8 % readable results, respectively, from conventional culture-based drug susceptibility testing (DST). Sensitivity, specificity and overall accuracy of the FASTPlaque-Response test for rifampicin resistance were 98.1, 96.3 and 96.6 %, respectively, for all specimens with NOA, and 93.2, 96.3 and 95.9 % without NOA, when compared with resolved conventional DST results. Inclusion of the NOA supplement reduced contamination, increased the number of interpretable results and did not adversely affect the performance of the FASTPlaque-Response test. Thus, the use of NOA improves the robustness of the test, facilitating its wider implementation.

scholarly journals Correlation of serum magnesium levels in eclampsia with pritchard and single dose magnesium sulphate regimen

2019 ◽  
Vol 8 (9) ◽  
pp. 3732
Author(s):  
Shreya M. S. ◽  
Nayana D. H.
Keyword(s):  
Single Dose ◽  
Magnesium Sulphate ◽  
Dose Regimen ◽  
Perinatal Outcome ◽  
Small Sample Size ◽  
Serum Magnesium ◽  
Tertiary Hospital ◽  
Small Sample ◽  
T Test ◽  
Significant Difference

Background: Magnesium sulphate is anticonvulsant of choice for eclampsia. Single dose magnesium sulphate therapy was tried for the management of Eclampsia and Imminent Eclampsia considering the low body mass index of Indian population.Methods: A prospective interventional study comprising of total 80 patients having either eclampsia or imminent eclampsia, to whom the Pritchard or a single dose MgSO4 was given alternatively in a tertiary hospital   from October 2014 to October 2017. Serum magnesium levels, maternal and perinatal outcome and recurrence of convulsions were evaluated using Student- t test and chi square test.Results: Mean Serum Magnesium levels in eclampsia and imminent eclampsia group at 0 min, 30 min, 4 hours in Pritchard regimen were 1.96mg/dl, 5.85mg/dl, 4.68mg/dl while in single dose regimen it was 1.78mg/dl, 462mg/dl, 3.63mg/dl respectively. Those who received Pritchard regimen showed higher level of Serum magnesium levels at 30 minutes and 4 hours than those receiving single dose. By applying T-test it was found that there is a significant difference in serum magnesium levels range in both group but no statistical difference in the control of convulsions in both groups.Conclusions: With increased and almost widespread use of magnesium sulfate in obstetrics there has been concerns regarding its safety. In the study, although P-values are not significant because of small sample size, there is considerable difference in serum magnesium levels 30 min and 4 hours, recurrence of convulsions and maternal morbidity between Pritchard regimen and single dose regimen. The goal which was achieved with Pritchard regimen previously, now can be achieved with single dose regimen in Indian women. Single dose magnesium sulphate is safe and effective in controlling convulsions with improved maternal and perinatal outcome.

scholarly journals Clinical Impact on Tuberculosis Treatment Outcomes of Discordance Between Molecular and Growth-Based Assays for Rifampin Resistance, California 2003–2013

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Neha S. Shah ◽  
SY Grace Lin ◽  
Pennan M. Barry ◽  
Yi-Ning Cheng ◽  
Gisela Schecter ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Demographic Data ◽  
Clinical Importance ◽  
Drug Susceptibility ◽  
Drug Susceptibility Testing ◽  
Successful Outcome ◽  
Treatment Regimens ◽  
Initial Regimen ◽  
Rpob Mutation ◽  
Poor Outcomes

Abstract Background.  Data from international settings suggest that isolates of Mycobacterium tuberculosis with rpoB mutations testing phenotypically susceptible to rifampin (RIF) may have clinical significance. We analyzed treatment outcomes of California patients with discordant molecular-phenotypic RIF results. Methods.  We included tuberculosis (TB) patients, during 2003–2013, whose specimens tested RIF susceptible phenotypically but had a rpoB mutation determined by pyrosequencing. Demographic data were abstracted from the California TB registry. Phenotypic drug-susceptibility testing, medical history, treatment, and outcomes were abstracted from medical records. Results.  Of 3330 isolates tested, 413 specimens had a rpoB mutation (12.4%). Of these, 16 (3.9%) had molecular-phenotypic discordant RIF results. Seven mutations were identified: 511Pro, 516Phe, 526Asn, 526Ser (AGC and TCC), 526Cys, and 533Pro. Fourteen (88%) had isoniazid (INH) resistance, 6 of whom were also phenotypically resistant to ethambutol (EMB) and/or pyrazinamide (PZA). Five patients (25%), 1 with 511Pro and 4 with 526Asn, relapsed or failed treatment. The initial regimen for 3 patients was RIF, PZA, and EMB; 1 patient received RIF, PZA, EMB, and a fluoroquinolone (FQN); and 1 patient received RIF, EMB, FQN, and some second-line medications. Upon retreatment with an expanded regimen, 3 (75%) patients completed treatment, 1 patient moved before treatment completion, and 1 patient continues on treatment. The remaining 11 patients had a successful outcome with 9 having received a FQN and/or a rifamycin. Conclusions.  Rifampin molecular-phenotypic discordance was rare, and most isolates had INH resistance. Patients who did not receive an expanded regimen had poor outcomes. These mutations may have clinical importance, and expanded treatment regimens should be considered.

scholarly journals Anti-RSV prophylaxis efficacy for infants and young children with cystic fibrosis in Ireland

2015 ◽  
Vol 10 ◽  
Author(s):  
Barry Linnane ◽  
Miranda G. Kiernan ◽  
Nuala H. O’Connell ◽  
Linda Kearse ◽  
Colum P. Dunne
Keyword(s):  
Cystic Fibrosis ◽  
Small Sample Size ◽  
Tertiary Hospital ◽  
Small Sample ◽  
Control Group ◽  
Study Cohort ◽  
Exact Test ◽  
Related Hospitalisation ◽  
Syncytial Virus ◽  
Randomised Controlled

Rationale: There is limited evidence supporting the routine use of palivizumab in paediatric cystic fibrosis (CF) patients to reduce respiratory syncytial virus (RSV) infection and related hospitalisation. Despite this, anti-RSV prophylaxis is increasingly common. This is the first report from Ireland regarding palivizumab outcomes for children with CF, under 2 years old, despite the greatest prevalence of CF globally. Methods: An audit was performed at a tertiary hospital in Ireland’s mid-West to document all children with CF, <24 months old, who received palivizumab over a five year period and comparision made with all eligible children for the prior five year period who had not received the product (also CF patients). Palivizumab was administered to both cohorts in their first year of life. Hospitalisation rates were compared using Fisher’s exact test. Incidence of RSV and Pseudomonas aeruginosa infection was recorded. Results: A total of 19 patients who received palivizumab were included in the study; comparision was made with a retrospective control group of 30 patients. Prophylactic palivizumab did not prevent hospitalisation for 10/19 patients, 3 of whom were affected by RSV. This was significantly greater than in the control group, where no hospitalisations were recorded (p < 0.0001). P. aeruginosa was isolated in one case from the study cohort, while no P. aeruginosa was detected in the control group. Conclusions: This study, the first of its kind from Ireland where CF prevalence is highest, does not provide unequivocal support for prophylactic use of palivizumab in CF patients under 2 years. Despite being derived from a small sample size, based on these data and complementary clinical observation, we have discontinued such prophylaxis. However, should reported incidence of RSV-related hospitalisation increase, there is scientific plausibility for appropriately powered, randomised, controlled trials of palivizumab.

Ethics Committees in Italy: A Survey on a Sample of Oncologists

2003 ◽  
Vol 89 (2) ◽  
pp. 189-192 ◽  
Author(s):  
Paola Mosconi ◽  
Giovanni Apolone ◽  
Giovanna Cattaneo ◽  
Livia Pomodoro ◽  
Silvio Garattini
Keyword(s):  
Medical Ethics ◽  
Small Sample Size ◽  
Empirical Studies ◽  
Ethics Committees ◽  
Small Sample ◽  
Educational Activities ◽  
New Guidelines ◽  
Time Required ◽  
A Prospective Study ◽  
And Training

Aims and background The mission of physicians and the purpose of clinical research may give rise to a conflict between medical ethics and human rights. All the recommendations, directives and laws regarding experimental interventions require a formal protocol, approval from an ethics committee (EC), and written informed consent from potential participants. In Italy new guidelines on handling submissions to EC were published in 1998. One year later, there was a feeling among people involved in EC activities that the immediate impact of the new rules (ie, decentralization and emphasis on pharmacological aspects of the studies) was negative. A prospective study was launched to evaluate oncologists’ opinions on Italian EC functioning. Methods and study design A questionnaire was administered twice to 110 oncologists involved in two multicenter trials. Nine questions were included regarding the following aspects: presence of an EC at hospital level, personal experience with an EC, average time required for the evaluation of proposals submitted, and level of satisfaction with important functions of the EC. Results Responses were received from 93 (first survey) and 69 (second survey) clinicians. In both surveys clinicians reported they were satisfied with the scientific and ethical aspects of EC functioning but dissatisfied with educational activities and training as well as bureaucratic and clerical requirements. At the second survey, the mean time required for evaluation after the submission of a study protocol was about 2.4 months and the level of dissatisfaction was still high for some critical aspects such as bureaucracy (44%) and educational activities and training (64%). Analysis of the change over time documented small differences (from -8% to +7%) in all aspects evaluated. Conclusions Despite the limitations of the present study, ie, the small sample size and the intrinsic characteristics of the Italian setting, the findings add empirical evidence regarding the functioning of local EC and clinical researchers’ opinions. This experience confirms that empirical studies on medical ethics are feasible and may produce useful information to facilitate the implementation of EC in the medical and lay community.

Sign in / Sign up

Export Citation Format

Share Document