Serodiagnosis of dengue virus infection in patients presenting to a tertiary care hospital

Dengue is an acute infectious disease of viral etiology. It is probably one of the most important arthropod borne viral disease in terms of human morbidity and mortality. The spectrum of disease ranges from self-limited dengue fever to more severe forms of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Laboratory diagnosis of dengue virus infection mainly depends on detection of virus specific antibodies. The aim of the study was to correlate the serological results with clinical presentation in patients with a diagnosis of dengue. Eleven out of 15 (73.3%) patients with DHF and DSS had secondary antibody response and mortality was 100% in these patients.     

Study of serum VEGF levels in patients with severe dengue infection admitted in a tertiary care hospital in Kolkata

Dengue is the most common arboviral infection globally, but its pathogenesis is poorly explored. Vascular endothelial growth factor (VEGF) has an essential role in the host defense against viral infection. However, not much information is available regarding its status in dengue patients from the eastern zone of India. In the present investigation, the level of VEGF was investigated for its possible utility as a dengue severity marker. Accordingly, confirmed dengue cases were enrolled during 2016-2018. Serum from all the study subjects was subjected to the standard enzyme-linked immunosorbent assay test for VEGF analysis. In addition, we assessed the association of VEGF to dengue severity. The study revealed that VEGF titers (P < .0001) were significantly increased in severe dengue (SD) patients in contrast to those with a milder form of dengue. An association was obtained between VEGF and increased SGOT (r = 0.517 with P < .0001) while VEGF had a negative correlation with platelets in SD patients (r = −0.331 with P = .001). Enhanced VEGF titers along with decreased platelets had a good association with SD. The investigation revealed that high VEGF titers are novel indicators of dengue severity. However, our results must be verified in a study evaluating a larger number of dengue patients.     

Secular trends of nocardia infection over 15 years in a tertiary care hospital

AIMS: To assess the incidence of nocardia infection over 15 years in a tertiary care hospital. METHODS: Over a 15 year period, Nocardia spp were isolated from 20 patients hospitalised at the Geneva University Hospitals, Switzerland. RESULTS: Sixteen patients had one or more underlying conditions. The median time between symptom onset and diagnosis was 30 days. The most common initial unconfirmed diagnosis was pulmonary tuberculosis (four). The lung was involved in 16 cases, followed by the central nervous system (two) and skin (two); one patient had disseminated infection. The most common species identified was N asteroides. In vitro susceptibility testing was performed on 14 of 20 strains. All strains were susceptible to imipenem and amikacin. Initial treatment with trimethoprim/sulfamethoxazole (TMP/SMX) was started in 14 patients, although five patients had to be switched to another treatment because of side effects or lack of efficacy. A cure was observed in 15 patients, death in three, and relapse or complications in two. CONCLUSIONS: Nocardiosis can become a severe infection and mainly affects profoundly immunocompromised patients. Differential diagnosis often delays the time to diagnosis, which worsens the outcome. New diagnostic tools, such as the polymerase chain reaction, could provide more rapid and reliable results. TMT/SMX was the most commonly prescribed treatment, but needed to be changed for another treatment because of side effects or lack of efficacy in a considerable proportion of patients. Imipenem should be used as an alternative treatment for severely ill patients, and the sulfa combination for less severe infections.     

Economic analysis of costs associated with a Respiratory Intensive Care Unit in a tertiary care teaching hospital in Northern India

Background:

There is a paucity of cost analytical studies from resource constrained developing countries defining intensive care costs and their containment.

Objective:

Economic analysis of costs in a Respiratory Intensive Care Unit (RICU) of a tertiary care teaching hospital in northern India.

Materials and Methods:

A prospective study was conducted in 74 patients admitted in the RICU. Costs were segregated into fixed and variable costs. Total and categorized costs averaged per day and costs incurred on the first day of the RICU stay were calculated. Correlation of the costs was performed with the length of stay, length of mechanical ventilation, survival, and therapeutic intervention scoring system-28 (TISS-28).

Results:

The total cost per day was Indian rupees (INR) 10,364 (US $ 222). 46.4% of the total cost was borne by hospital and rest by patients. The mean cost represented 36.8% of the total cost and 69.8% of the variable cost. Expenditure on personnel salary constituted 37% of the total costs and 86% of the fixed cost. Length of stay in RICU was significantly higher in nonsurvivors (14.73 ± 13.6 days) vs. survivors (8.3 ± 7.8 days) (P < 0.05). The TISS-28 score points in survivors was 30.6 vs. nonsurvivors 69.2 per nurse (P < 0.05) correlating strongly with the total cost (r = 0.91).

Conclusion:

Although considerably less expensive than in economically developed countries, intensive care in India remains expensive relative to the cost of living. The cost block methodology provides a framework for cost estimation, aids resource allocation and allows international comparisons of economic models.     

Cryptosporidiosis in a tertiary care hospital in Andhra Pradesh

Enteric protozoal parasitic infection has become an important cause of morbidity in children and adults. In the developing countries the association of Cryptosporidium with acute and persistent diarrhoea has been striking. Stool samples from 1002 patients (800 adults and 202 children) suffering from diarrhoea or other gastrointestinal symptoms were examined for the presence of Cryptosporidium parvum oocysts by modified Ziehl Neelsen stained smears. C. parvum was detected in 2.99% of children and 0.12% adults. Other parasites detected were E. histolytica (6.18%), G. lamblia (1.49%), A. lumbricoides (1.49%), hookworm (1.39%), Strongyloides stercoralis (0.39%), and Taenia (0.09%).     

Psychiatric aspects of patients with HIV infection in the general hospital

The study describes the psychiatric disorders found in 100 HIV-positive patients, in different stages of the illness, at the psychiatric consultation service of a general hospital in Madrid. Eighty-five percent of the sample fell within the intravenous drug addicts risk group, which coincides with the epidemiological characteristics of Spain's HIV-positive population. The most frequently noted psychiatric diagnosis was substance dependence disorder (41%), followed by organic mental disorder (29%), adjustment disorder (15%), and affective disorder (5%). Fifteen percent of the subjects had depressive symptoms, and 11% expressed suicidal ideation. A follow-up conducted on part of the sample showed a development towards dementia, emphasizing diagnostic difficulties in the initial evaluation of these patients.     

Epidemiology of candidemia in a Turkish tertiary care hospital

In order to determine the local epidemiology of candidemia, Candida strains isolated between 1994 and 2000 were identified to species level; antifungal resistance patterns and DNA fingerprints were analyzed. Identification of Candida strains (n: 140) was performed with germ tube test and carbohydrate assimilation reactions. Minimal inhibitory concentrations were determined using a commercial test for 5-flucytosine and the broth macrodilution method according to NCCLS for fluconazole and amphotericin B. Molecular relatedness was determined by restriction endonuclease analysis of genomic DNA followed by probe hybridization. C. albicans (37.2%), C. parapsilosis (32.2%), and C. tropicalis (12.2%) comprised 114 (81.4%) of 140 isolates. Susceptibility tests did not reveal resistance to amphotericin B in any of the Candida isolates. Fluconazole resistance was detected in one isolate of C. krusei, and 5-flucytosine resistance in two C. tropicalis isolates and one C. albicans isolate. Significantly higher frequency of clusters with identical strains in C. parapsilosis and C. tropicalis was detected compared to C. albicans. Pediatric wards are particularly important in the nosocomial transmission of non-albicans candida species.     

Influenza B viral load analysis in patients with acute respiratory infection from a tertiary hospital in Brazil

Currently, 2 genotypes of Influenza B viruses (IFB) are cocirculating in humans: Victoria (VIC) and Yamagata (YAM). Infection and viral load (VL) were analyzed in 105 genotyped IFB (59 VIC and 46 YAM) out of 3452 respiratory samples from immunodepressed (ID), immunocompetent (IC) including outpatients (OP) and hospitalized patients (HP) attended during 2001-2013 at São Paulo Hospital. VL (Log₁₀ RNA copies/mL) calculation was possible in 78 samples (47 VIC, 31 YAM). The age group of 12 to 18 years presented the highest detection (14.13%). Rates of infection among groups were of 3.67% (IC), 1.68% (ID), 3.50% (OP), 0.6% (HP), and VLs varied from 2.8 to 10.13 with no difference regarding age, immune status, and disease severity. From 10 OP vaccinated against influenza, 8 (7 children, 1 ID) received a matching strain shot (VIC), and 2 a monovalent influenza A H1N1pdm09. Those patients presented a VL of 6.31 ± 1.62 (mean ± SD). IFB infection rates follow an age pattern, but VL seems not to be related to frequency or clinical outcome. IFB patients with previous immunization could point to some protection for VIC infections since there was no HP. Other immunological aspects, such as lineage infection immune priming, previous infections, and vaccinations, should be further investigated.