Introduction: Placement of peripheral venous catheter is a common requirement for the neonates requiring intensive care unit admissions. This simple procedure can sometimes lead to catastrophic complications such as peripheral tissue ischemia/gangrene. This is particularly common in preterm neonates. Effective treatment is very important to prevent long-term sequelae or need for amputation. Nitroglycerin (NTG) is a potent smooth muscle relaxant and improves vascular flow. Case Report: Here, we report a case of neonatal digital gangrene which was successfully treated with topical NTG with no adverse outcome. Discussion: Topical NTG is a potential treatment option for neonatal peripheral gangrene.
Introduction: Bacteremia and septicemia is life threatening condition resulting in major cause of mortality and morbidity. The aim of study was to determine the etiology of bacteremia and septicemia with antibiotic sensitivity profile of those organisms. Methods: A prospective study was carried out among the suspected cases from both inpatient and outpatient of TUTH from October 2009 - March 2010. Blood samples were collected and processed according to standard methodology. Results: Out of 2259 samples only 237 (10.49 %) showed bacterial growth. The most common isolates among Salmonella group was Salmonella enterica serotype typhi 71(29.95%) followed by Salmonella enterica serotype Paratyphi A 45 (18.98%). Among non Salmonella group Pseudomonas aeruginosa 34 (14.34%), Klebsiella pneumoniae 22(9.28%), Acinetobacter spp 15 (6.32%), Citrobacter spp 5 (2.10%), Escherichia coli 3 (1.26%) while Staphylococcus aureus 34 (14.3%) was most common followed by Enterococcus spp 3 (1.26%), Streptococcus spp 2 (0.84%), Coagulase Negative Staphylococcus 2 (0.84%) and Listeria spp 1 (0.42%) among Gram Positive organisms. Antibiogram revealed Cefotaxime, Ceftazidime, Azithromycin and Chloramphenicol for Salmonella group while for non Salmonella Imipenem, Meropenem and Amikacin as most effective antibiotics while Clindamycin, Ciprofloxacin and Ofloxacin for gram positive. Conclusion: Gram negative bacteria was the predominant organism causing bacteremia and septicemia. Among them salmonella typhi and salmonella paratyphi were the leading aetiology.
Livestock owners may come across large number of sources and channels of information but pursue only a few of them for seeking knowledge and information. The data was collected from 120 tribal livestock owners’ families of Pindwara and Abu road Tehsils of Sirohi district. It was observed that veterinary hospitals, farmer meeting and demonstration were perceived as most credible channels of information by the livestock owners with MPS 81.94, 73.33 and 70.00 respectively. This was followed by training MPS 67.22, field trip MPS 62.77 and exhibition MPS 61.94. Further the TV MPS 57.20, radio MPS 55.83 and Newspaper MPS 37.75 were trusted by relatively less number of livestock owners of the study area. The study was recommended that the measures can be taken by the concern agencies to further improve the access and availability of more trustworthy and competent sources and channels in the area which was used by the livestock owners.
Origin of coronary arteries from the opposite sinus of Valsalva is rare and origin from a single ostium is extremely rare. Patients with these anomalies may have myocardial ischemia because of altered ostial configuration, exit angulation from the aorta, the course between great arteries, and atherosclerosis. Usually, these anomalies are diagnosed during coronary angiography either by computed tomography or catheter-based. Management depends upon the coronary anomaly and associated clinical condition.
Background Heart failure affects almost 64 million people, with more than half of it constituting heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are in the first line for HFrEF, but no head-to-head trials are available. Moreover, growth differentiation factor-15 (GDF-15) has been demonstrated as a promising prognostic marker, specifically for HFrEF, but has not been explored much. Methods This pragmatic randomised controlled trial recruits 100 patients with HFrEF (ejection fraction <40%) of New York Heart Association (NYHA) II–III and allocates them in a 1:1 ratio to the dapagliflozin and sacubitril/valsartan groups. The primary objective is to assess the difference in N-terminal pro-brain natriuretic peptide serum levels at the end of 16 weeks. The secondary efficacy objectives are to assess GDF-15, Kansas City Cardiomyopathy Questionnaire-overall summary score and estimated glomerular filtration rate. Patients will be assessed at baseline, fourth week and 16th week after randomisation. As health technology assessment practices widely differ in countries, cost assessment is a vital factor to consider. The cost needed to treat one cardiovascular event is also compared between both groups. The occurrence of safety events will also be evaluated at each follow-up point. Conclusion This pragmatic study aims to compare the efficacy, safety and cost-effectiveness of dapagliflozin versus sacubitril/valsartan in patients with HFrEF in real-world settings. The study aims to provide clinicians with data to make informed decisions regarding the preferred drug class. Additionally, examining the impact of ARNI and SGLT2i on GDF-15 levels could offer better insights into prognosis among patients with HFrEF. Ethics and dissemination This study involves human participants and was approved by Institutional Ethics Committee at AlIMS Jodhpur with reference number AIIMS/IEC/2023/5842 approved this study. Participants gave informed consent to participate in the study before taking part. The research findings will be disseminated via closed group discussions at the site of study, scientific conferences, peer-reviewed published manuscripts, and social media. Trial registration number CTRI/2023/12/060772.
Introduction: The prevalence of systemic hypertension has increased considerably in India over the past few decades from 5 percent to between 20-40 percent in urban population and 12-17 percent in rural population. Although there is availability of numerous affordable antihypertensive drugs, hypertension is still poorly controlled, leading to an epidemic of non-communicable diseases. Drug nonadherence is implicated as a major factor responsible for poorly controlled hypertension. Aim: This study was undertaken to gather data regarding drug adherence among hypertensive cohort and factors responsible for poor adherence. Methods: We prospectively studied 1468 hypertensive patients at a tertiary care hospital. Assessment of antihypertensive medication adherence was determined using the instrument validated by Morisky et al. Poor medication adherence was defined as answering yes to three or more of eight questions. Office reading and 24-hr ABPM were used to assess the level of hypertension control. Result: The mean age of the included patients was 61.2 ± 10.6 years and 63.5 % were male. Among the studied cohort, 55.8 % (819 out of 1468) patients were highly adherent to antihypertensive medication and adequate BP control was achieved in only 39.10 % (574 out of 1468) patients. Independent predictors of drug non-adherence in a multivariate analysis model were illiteracy (hazard ratio [HR] 3.06; 95% confidence interval [CI], 1.31-7.16), low socioeconomic status (HR 2.6; 95% CI, 1.28-4.89), presence of drug side effect (HR 1.7; 95% CI, 1.54-1.95), number of drugs (HR 1.8; 95% CI, 1.4-2.2), number of years on treatment (HR 1.4; 95% CI, 1.1-1.8), incognizant of long term risk of uncontrolled hypertension (HR 1.5; 95% CI, 1.31-1.74), irregular BP monitoring (HR 1.3; 95% CI, 1.1-1.6), and associated CKD and/or DM (HR 2.74; 95% CI, 1.065-7.05) Conclusion: Antihypertensive drug non adherence is a prevalent behavior among patients and since many of the attributed factors are modifiable, they signal opportunities to improve adherence, and thus, BP control in clinical practice
'%3e%3cg id='e'%3e%3cg id='c' fill='none' stroke='%23fff' stroke-width='2'%3e%3cpath id='b' d='M0 1h26M1 10V5h8v4h8V5h-5M4 9h2m20 0h-5V5h8m0-5v9h8V0m-4 0v9' transform='scale(1.4)'/%3e%3cpath id='a' d='M0 7h9m1 0h9' transform='scale(2.8)'/%3e%3cuse xlink:href='%23a' y='120'/%3e%3cuse xlink:href='%23b' y='145.2'/%3e%3c/g%3e%3cg id='d'%3e%3cuse xlink:href='%23c' x='56'/%3e%3cuse xlink:href='%23c' x='112'/%3e%3cuse xlink:href='%23c' x='168'/%3e%3c/g%3e%3c/g%3e%3cuse xlink:href='%23d' x='168'/%3e%3cuse xlink:href='%23e' x='392'/%3e%3c/g%3e%3cg fill='%23da0000' transform='matrix(45 0 0 45 315 180)'%3e%3cg id='f'%3e%3cpath d='M-.548.836A.912.912 0 0 0 .329-.722 1 1 0 0 1-.548.836'/%3e%3cpath d='M.618.661A.764.764 0 0 0 .422-.74 1 1 0 0 1 .618.661M0 1l-.05-1L0-.787a.31.31 0 0 0 .118.099V-.1l-.04.993zM-.02-.85 0-.831a.144.144 0 0 0 .252-.137A.136.136 0 0 1 0-.925'/%3e%3c/g%3e%3cuse xlink:href='%23f' transform='scale(-1 1)'/%3e%3c/g%3e%3c/svg%3e)
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)