Deaths from nosocomial infections: Experience in a university hospital and a community hospital

To assess the importance of nosocomial infections as a contributory cause of death in patients who die in the hospital, we studied the hospital course of 100 consecutive patients who died at Columbia-Presbyterian Medical Center and 100 consecutive patients who died at Hackensack Hospital. The epidemiologic patterns of infection were similar although the institutions provide care for different types of patients. There were 88 nosocomial infections in 63 patients. When the nosocomial infection was causally related or contributed to death, infection of the lower respiratory tract was predominant in 31 of 52 (60 per cent) instances. When the nosocomial infection was unrelated to death, urinary tract infection was predominant in 13 of 36 (36 per cent) infections. Among those who died with nosocomial infection, 42 of 63 (67 per cent) patients were terminal on admission and were typically in their 60's with metastatic carcinoma. The 21 patients who were not terminal on admission were typically in their late 70's and had complications of arteriosclerotic cardiovascular disease. Pneumonia was the most frequent nosocomial infection related to death. There is need to devise a pneumonia prevention program that identifies those at high risk and reduces the chance of aspiration of pharyngeal secretions and spread of virulent bacteria from person to person.     

Neurocysticercosis in a north Indian hospital

In endemic regions, neurocysticercosis (NCC) is the most commonly diagnosed parasitic disease of the central nervous system, and the most common cause of convulsions and hydrocephalus in adults. During January 2000-December 2006, serum samples collected from patients presenting with various manifestations with a clinical diagnosis of cysticercosis and/or relevant computed tomography findings were subjected to an enzyme-linked immunosorbent assay test for NCC. Anti-cysticercus antibodies were detected in 155 of the 1096 (14.1%) cases. Generalized seizure (33.9%) was the most common presenting symptom. Solitary lesion (74.2%) was the most common radiological finding. This study provides an assessment of the epidemiology of NCC in Delhi and stresses the need for its prevention.     

Pleural exudate in a tropical hospital

In one hundred consecutive patients with non-purulent pleural exudates without apparent cause, the final diagnosis was tuberculosis in 58, malignancy in 20, pyogenic infection in four, cardiomyopathy in two, pulmonary infarction in one. The aetiology remained unknown in 15. The technique of "semi-open" pleural biopsy was performed under local anaesthesia. It accurately detected 70% of cancer and 69% of tuberculosis cases with a 9% complication rate and no mortality. Tuberculosis was seen at all ages but mainly between 20 and 39 yrs, where it represented 75% of cases. In this age group, malignancy was relatively rare: 10% of cases. In our environment of limited facilities, early chemotherapy trial for tuberculosis is justified for unknown pleural exudates in patients below the age of 40 yrs.     

Tetanus in a rural Ethiopian hospital

Despite the widespread availability of a safe and effective vaccine, tetanus continues to be a significant public health problem in the developing countries.