Background The World Health Organization recommends that Isoniazid Preventive Therapy (IPT) should be administered to all People living with Human immunodeficiency virus (PLHIV) not currently suffering from tuberculosis (TB) to reduce the incidence of the same. The objectives of this study were to determine the incidence of PLHIV who contracted TB after receiving 6 months of IPT (followed up for ≥ 2 years), the incidence of PLHIV who developed tuberculosis when not on IPT, and the occurrence of adverse drug reactions due to IPT. Methods A Retrospective Cohort study was conducted in two ART centers in Mangalore, which included PLHIV who had completed 6 months of IPT from January 2017 to May 2018 and were followed up until May 2020; patients in the comparison group consisted of those attending ART centers during the same period who did not receive IPT. These data were retrieved from the case files of these patients from June to November 2020, entered into MS Excel, and analyzed using statistical package for social science (SPSS) version 25. Results The study included 1014 patients: 525 (51.8%) received IPT and 489 (48.2%) did not. Eight (1.5%) patients developed TB after IPT completion compared to 32 (6.5%) patients who developed TB from the non-IPT group. There was a 77% reduction in the incidence of developing TB in those patients who received IPT as compared to those who haven’t receive IPT (RR of 0.23, p value <0.0001). The reason for stopping IPT were due to side effects of IPT, experienced by 77 (14.6%) patients. Conclusions This study indicated that the completion of IPT significantly reduced the TB burden, showing significant protection against TB for a minimum duration of 2 years. Thus, implementation of IPT should be strengthened, and strict compliance should be ensured to reduce TB infection among PLHIV.
Background : Cardiovascular diseases (CVD) are one of the leading cause of death and disabilities in the world. The global burden of deaths due to CAD has been estimated as 7.4 million. Indian subcontinent has the highest burden of CAD in the world accounting for the maximum morbidity from CAD. It has been noted that Indian population are at a higher risk of developing CAD at an earlier age and hence it is of paramount importance to gather data on CAD profile of the Indian population.
Objective : To study the clinical profile of Coronary Artery Disease (CAD) cases in the Indian population and compare trends with respect to risk factors and outcome.
Methodology : Case based retrospective cross sectional study was done. Study population included all complete case sheets with the diagnosis of CAD over the years 2010-11 and 2015-16. Information from prerecorded case sheets were entered into a structured data collection sheet which was further analyzed using SPSS version 20. Results were expressed in percentages, means and graphs.
Results: The study included 373 CAD patients. Majority of patients fell within the age bracket of 55-65yrs with a means age of 58.74±12.84yrs. Amongst the study population 28.68% patients were females and 71.31%were males. A decreasing mean age was observed from the years 2010-11 and 2015-16. Similarly trend was noted with respect to sex based incidence of CAD over the years where the percentage of female population affected rose from 25.8% to 32%. 24.3% of patients were found to be diabetic and 38.2% were found to be hypertensive. About 40.2% were smokers and 34.4% were alcoholics.
Conclusion : Our study population showed congruence with the established trends of conventional risk factors but Diabetes mellitus tends to be of more importance as a modifiable risk factor. This warrants more robust public health intervention to raise awareness and implement practices that could potentially reduce the risk of CAD burden
Introduction: Appendicitis is a common cause of acute abdomen and appendectomy is the treatment of choice, which can be done either by open or laparoscopic approach. Controversies till exist as to which is the better choice among the two surgical procedures for treating appendicitis. So, this study was conducted to compare the laparoscopic appendectomy with open appendectomy.
Materials and Methods: This study was done in a tertiary care medical hospital in South Karnataka. 100 consecutive patients who were diagnosed to have appendicitis and requiring surgical intervention were selected after obtaining their informed consent to participate in the study. 50 patients each were randomly chosen to undergo either open or laparoscopic appendectomy. Data was collected from each patient on the basis of clinical, preoperative findings as well as postoperative recovery and follow up. Statistical analysis was done using SPSS Version 14.0.
Results: 59% of patients were male and 60% were under 25 years of age. Nausea and vomiting were the common symptoms. Laparoscopic appendectomy took more time than open appendectomy (42.8 mins Vs 54.3 mins). Pain was significantly lower in laparoscopic appendectomy compared to open appendectomy. Post operative complications, length of stay, time to return back to work were all lesser among patients who underwent laparoscopic appendectomy.
Conclusion: The laparoscopic appendectomy was better than open appendectomy with respect to wound infection rate, pain score, lesser use of antibiotics and analgesics, duration of postoperative hospital stay and return to normal activity.
Background: Rickettsial diseases are reemerging in many parts of our country. Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi. It is difficult to diagnose Scrub typhus because of nonspecific clinical presentation and lack of availability of specific tests (ELISA) in all centres. Aim: Our aim was to study the clinical features, lab parameters and outcome of patients diagnosed with Scrub typhus. Materials and Methods: A retrospective hospital based study was done in Mangalore (Karnataka) to identify cases of scrub typhus. Patients who had an acute febrile illness and IgM antibodies against O. tsutsugamushi were included in our study. Results: 10 cases of Scrub typhus were identified. Among them 7(70%) patients were females and 3(30%) were males. Major symptoms on admission were fever10(100%), dyspnea or cough-2(20%), rashes1(10%), altered sensorium1(10%). The major signs were fever10(100%), eschar 2(20%), and signs of meningial irritation in 1(10%). Lab parameters showed leukocytosis in 4(40%), thrombocytopenia in 3(30%), raised liver enzymes in 3(30%) and renal failure in 3(30%). Chest X-ray showed consolidation in 2(20%) patients. There was no mortality in our study. Conclusion: Scrub typhus can present with varying clinical manifestations and eschar can be absent in majority of cases as shown in our study. Therefore diagnosis should be based on a high index of suspicion and empirical treatment with doxycycline must be started whenever there is a strong suspicion of Scrub typhus. Asian Journal of Medical Science, Volume-5(3) 2014: 108-111 http://dx.doi.org/10.3126/ajms.v5i3.9213
Background: Rickettsial diseases are reemerging in many parts of our country. Scrub typhus is a rickettsial disease caused by Orientia tsutsugamushi. It is difficult to diagnose Scrub typhus because of nonspecific clinical presentation and lack of availability of specific tests (ELISA) in all centres. Aim: Our aim was to study the clinical features, lab parameters and outcome of patients diagnosed with Scrub typhus. Materials and Methods: A retrospective hospital based study was done in Mangalore (Karnataka) to identify cases of scrub typhus. Patients who had an acute febrile illness and IgM antibodies against O. tsutsugamushi were included in our study. Results: 10 cases of Scrub typhus were identified. Among them 7(70%) patients were females and 3(30%) were males. Major symptoms on admission were fever10(100%), dyspnea or cough-2(20%), rashes1(10%), altered sensorium1(10%). The major signs were fever10(100%), eschar 2(20%), and signs of meningial irritation in 1(10%). Lab parameters showed leukocytosis in 4(40%), thrombocytopenia in 3(30%), raised liver enzymes in 3(30%) and renal failure in 3(30%). Chest X-ray showed consolidation in 2(20%) patients. There was no mortality in our study. Conclusion: Scrub typhus can present with varying clinical manifestations and eschar can be absent in majority of cases as shown in our study. Therefore diagnosis should be based on a high index of suspicion and empirical treatment with doxycycline must be started whenever there is a strong suspicion of Scrub typhus. Asian Journal of Medical Science, Volume-5(3) 2014: 108-111 http://dx.doi.org/10.3126/ajms.v5i3.9213
Background and objective- Heart rate variability (HRV) is a noninvasive electrocardiographic marker reflecting the activity of the sympathetic and vagal components of the autonomic nervous system on the sinus node of the heart. Decreased HRV is a risk factor for both arrhythmic and non-arrhythmic deaths following acute myocardial infarction (MI) .Our aim was to find out the utility of heart rate variability (during deep breathing over 1 minute ) in predicting end point cardiac events (risk stratification) in patients after an episode of acute myocardial infarction.
Material and methods- Bedside heart rate variability (HRV) during deep breathing was assessed in 100 patients after a first episode of myocardial infarction.. This test was performed between 6-48 hours after the first attack of myocardial infarction. We defined low HRV as HRV < 10 beats/minute. The patients were followed up over a duration of 3 months to document end point cardiac events. Statistical analysis was done using the student ‘t’ test .
Results- Heart rate variability (HRV) < 10 beats/minute was seen in 44 (44%) patients. 16 patients died in the follow up period. Among the 16 patients who died 15 (93.75%) patients had HRV < 10 beats/minute.
Conclusion- Heart rate variability (HRV) during deep breathing is a simple, cost effective bedside test in risk stratification of patients who present with myocardial infarction.
Background and objective-Sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents are first generation drug-eluting stents (DES) used to treat patients with ischemic heart disease. Drug-eluting stents (DES) have reduced the occurrence of restenosis and major adverse cardiac events (MACE) when compared with bare metal stents. Our aim was to assess the safety and mid-term clinical outcomes of stenting with Sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) for the treatment of coronary artery disease in our routine practice.
Material and methods- The study population consisted of 100 patients who had undergone drug eluting stent implantation. Patients were eligible for enrollment if they had symptomatic coronary artery disease or positive exercise testing, and angiographic evidence of single or multivessel disease with a target lesion stenosis of ≥ 70%. Patients were followed-up for 6 months. The efficacy and safety of the procedure, in-hospital clinical outcome and the occurrence of major adverse cardiac events in the first 6 months were assessed. Statistical analysis was done.
Results-All patients survived after stent implantation.1 (1%) patient experienced acute ST elevation myocardial infarction during follow up. Recurrent angina pectoris was observed in 5 (5%) patients (2 stable angina pectoris and 3 unstable angina pectoris).The 6month rate of MACE in our study was 1%.
Conclusion-The results of the present study indicate that drug eluting stents could be implanted with a very high success rate and have encouraging mid-term clinical results.
Toxoplasmosis is caused by infection with the obligate intracellular parasite Toxoplasma gondii. Toxoplasmosis is generally a late complication of HIV infection and usually occurs in patients with CD4 + T-cell counts below 200/μl. Co-trimoxazole (trimethoprim plus sulfamethoxazole) is the most common drug used in India for the treatment of AIDS-associated cerebral toxoplasmosis. Other alternative drugs used for the treatment of cerebral toxoplasmosis
are clindamycin plus pyrimethamine and clarithromycin with
pyrimethamine.
A 30-year-old male known case of retroviral disease presented to Kasturba Medical College, India, with complaints of fever, headache and vomiting. Computed tomography scan of his brain showed irregular ring enhancing lesion in the right basal ganglia. Toxoplasma serology revealed raised IgG antibody levels. Based on
the CT features and serology, diagnosis of cerebral toxoplasmosis was made. He was treated with clindamycin alone as he had history of sulfonamide allergy. The patient was symptomatically better after 48 hours. After 21 days, repeat CT of brain was done which was normal. The patient showed good clinical improvement within 48 hours and the lesion resolved completely within 3 weeks. The authors recommend using clindamycin without pyrimethamine
in resource poor settings and in patients who do not tolerate sulfa drugs.
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