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Evaluation of contacts of tuberculosis for active or latent tuberculosis and factors associated with management

Sat, 01 Jan 2022 00:00:00 GMT

Title: Evaluation of contacts of tuberculosis for active or latent tuberculosis and factors associated with management Authors: Sagarika N Suresh Abstract: BACKGROUND: Tuberculosis is an infectious disease resulting from infection with the Mycobacterium tuberculosis (MTB) bacilli. Latent tuberculosis infection (LTBI) refers to a state in which individuals harbor a persistent immunological reaction to MTB antigens in the absence of symptoms of active tuberculosis. Household contacts, in particular, face the highest risk due to prolonged and repeated exposure within shared living spaces. It is estimated that approximately. Among individuals with latent tuberculosis infection, an estimated 5–10% will eventually transition to active tuberculosis over the span of their lifetime. Tuberculosis preventive therapy significantly reduces the likelihood of transitioning from tuberculosis infection to clinically active disease. While the early detection and management of active disease remain a central focus of the public health strategy, targeted identification and management of latent tuberculosis particularly among populations at elevated risk, notably household contacts of patients with active tuberculosis are essential components of tuberculosis elimination efforts.

Comparison of ventilator associated pneumonia between pulmonary and non-pulmonary indications for mechanical ventilation

Sat, 01 Jan 2022 00:00:00 GMT

Title: Comparison of ventilator associated pneumonia between pulmonary and non-pulmonary indications for mechanical ventilation Authors: Pothireddy manisha reddy Abstract: BACKGROUND: Ventilator associated pneumonia (VAP) is among the most prevalent illnesses that are acquired in hospitals. VAP develops in about 10% of patients who need mechanical breathing, with a 20–50% fatality rate world wide. In India, the incidence has been estimated to be around 27%. VAP is defined as pneumonia or infection in lung parenchyma acquired in patients after invasive mechanical ventilation after 48–72 hours. It is associated with high morbidity, mortality, prolonged hospital stay, and cost of treatment. The indications for mechanical ventilation could be due to pulmonary or non-pulmonary causes like, acute hypoxemic respiratory failure, hypoventilation, hemodynamic compromise, cardiorespiratory arrest, stroke, traumatic brain injury, and the incidence of VAP in these conditions differs accordingly. There are various scores available for early diagnosis of VAP and to predict the outcomes and mortality of the patients on mechanical ventilation. While the Clinical Pulmonary Infection Score (CPIS) aids in diagnosis of VAP, Sequential organ function assessment (SOFA) score is a widely used tool for predicting mortality in septic ICU patients, whereas Acute physiology and chronic health evaluation (APACHE II) score predicts the outcome and duration of Mechanical ventilation

Correlation between hepatic wave form changes on doppler ultrasound and severity of disease in cirrhotic patients

Sat, 01 Jan 2022 00:00:00 GMT

Title: Correlation between hepatic wave form changes on doppler ultrasound and severity of disease in cirrhotic patients Authors: Syed sumaiya latheef Abstract: Background: Liver cirrhosis represents the end-stage of various chronic liver diseases characterized by progressive fibrosis and hemodynamic alterations. Doppler ultrasonography offers a non-invasive method to assess these vascular changes through hepatic vein waveform patterns. This study aimed to evaluate the correlation between hepatic vein waveform changes and disease severity in cirrhotic patients and determine its diagnostic utility. Methods: This prospective study included 140 patients with established liver cirrhosis who underwent Doppler ultrasound examination of hepatic veins. Waveform patterns were classified as triphasic, biphasic, or monophasic and correlated with Child-Pugh classification and clinical-laboratory parameters. Statistical analysis was performed to evaluate associations and diagnostic performance. Results: The study population comprised 59.3% males and 40.7% females, with 45% of patients in the 41-60 years age group. Child-Pugh classification revealed 22.9% Class A, 25% Class B, and 52.1% Class C patients. Hepatic vein waveforms were distributed as monophasic (38.6%), biphasic (36.4%), and triphasic (25%). A highly significant association (p<0.001) was found between waveform patterns and Child-Pugh classification, with 70.4% of monophasic and 68.6% of biphasic waveforms occurring in Class C patients, while 57.1% of triphasic waveforms were seen in Class A patients. A significant association (p=0.008) was also observed between waveform patterns and patient age. Diagnostic performance analysis showed 100% sensitivity and negative predictive value with 52.2% specificity and 69.5% positive predictive value. Conclusion: Hepatic vein waveform assessment by Doppler ultrasound provides a reliable non-invasive marker of disease severity in cirrhotic patients, showing excellent correlation with Child-Pugh classification. The high sensitivity and negative predictive value make this a valuable screening tool, particularly for ruling out advanced cirrhosis. Integration of hepatic vein waveform assessment into routine ultrasound evaluation offers prognostic information without increasing procedure complexity or cost.

Role of doppler ultrasound in evaluation of arteriovenous hemodialysis fistula and maturation, complications of hemodialysis vascular access

Sat, 01 Jan 2022 00:00:00 GMT

Title: Role of doppler ultrasound in evaluation of arteriovenous hemodialysis fistula and maturation, complications of hemodialysis vascular access Authors: Polavarapu Prama Abstract: Introduction: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis due to its superior long-term patency and lower complication rates. However, primary failure and delayed maturation remain significant challenges. Doppler ultrasound offers a non-invasive method for evaluating vascular anatomy and hemodynamics, potentially improving AVF outcomes. This study aimed to assess the utility of Doppler ultrasound in evaluating AVF maturation and predicting complications in hemodialysis patients. Methods: This prospective study included 109 patients undergoing AVF creation for hemodialysis access. Preoperative Doppler ultrasound was performed to assess cephalic vein and radial artery diameters and flow parameters. Postoperative evaluations were conducted on day 1, day 7, and at 4 weeks to monitor vein diameter, flow rates, and complications. Patients were followed until successful cannulation or determination of primary failure. Results: The cohort comprised 57.8% males with a mean age of 52.4 years. Diabetes mellitus (54.1%) and hypertension (52.3%) were the predominant comorbidities. Preoperative mean cephalic vein diameter was 1.98±0.58 mm, increasing to 9.07±0.75 mm at 4 weeks post- operation. Fistula flow rates progressively increased from 261.1±106.3 ml/min on day 1 to 689.7±138.09 ml/min at 4 weeks. By 4 weeks, 51.4% of AVFs achieved adequate maturation. Primary failure occurred in 24.8% of cases and was significantly associated with diabetes, hypertension, smaller preoperative vessel diameters, and lower flow rates at 4 weeks (p<0.001). The mean time to maturation was 38.03±6.8 days, with first successful cannulation at 50.4±8.1 days. Thrombosis (9.17%), infection (5.5%), and stenosis (1.83%) were the most common complications, all being significantly more prevalent in the primary failure group. Conclusion: Doppler ultrasound parameters, particularly preoperative vessel diameters and 4- week flow rates, are significant predictors of AVF maturation and primary failure. Routine ultrasound evaluation facilitates optimal vascular access planning, timely detection of complications, and improved AVF outcomes in hemodialysis patients.