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Introduction: Tuberculous meningitis remains the most severe and devastating form of tuberculosis with relatively severe morbidity and mortality. Risk factors for TB meningitis have not focused on the role of the BCG vaccine or social and food insecurity which are known to have a role in pulmonary TB. Methods: We prospectively conducted a Case-Control study among 65 patients with TB meningitis and 41 controls with other forms of meningitis. We evaluated the role of the BCG vaccine, the Household Food Insecurity Access Scale (HFIAS) and the Social Readjustment Rating Scale (SRRS) to look for food and social stress respectively. We also evaluated the known risk factors for TB meningitis including age, HIV co-infection, alcoholism, malignancies, use of immunosuppression, head injury among others. A bivariate followed by multivariate regression analysis was performed. Results: The presence of BCG scar was seen in 64.6 percent of patients with Tuberculous meningitis and 61.0 percent of control (P= 0.71). There was no difference in the size of the scars (P= 0.45) . Household food insecurity using the Household Food Insecurity Access Scale (HFIAS) ( a positive answer in any of the 9 items) was present in 16.9% of the patients in the TBM group and in 14.6% of the patients in the control group. (P= 0.75). Social stress assessed using the Social Readjustment Rating Score (< 150 suggest no social stress, 150 – 300 moderate social stress,> 300 high social stress) showed that a majority of the patients in both the groups reports no social stress. Only 9.8% of patients in the TBM group and 18.5% in the control group reports moderate presence of social stress whereas none of the patients had severe social stress. Logistic regression analysis suggested that only higher BMI was associated with lesser incidence of Tuberculous meningitis, odds ratio 0.83 (95% confidence interval of 0.73 – 0.930) and individuals performing clerical and unskilled and under-skilled jobs- odds ratio 0.13 (95% confidence interval of 0.02 – 0.93) had lower risk for TB Meningitis. Conclusions: In our sample of TB meningitis patients the BCG vaccine, food insecurity nor social stress appear to be risk factors. Bigger BMI and certain occupations appear to be possibly protective. [ABSTRACT FROM AUTHOR]

Introduction: Posterior circulation stroke (PCS) is often diagnosed late and long-term outcomes have not been described in South India. We wished to study clinical features, long-term outcomes, and independent predictors of the same. Materials and Methods: We conducted a prospective cohort study in PCS patients from January 2014 to May 2017. Morbidity and mortality at discharge, at 3 months and 6 months was studied. Univariate and multivariate analysis of predictors of poor outcome as well as the survival analysis was computed. Results: We recruited 291 PCS during the study period; prevalence of PCS among all strokes was 12.9% in 2014. The mean age was 53.34 years (standard deviation 13.34). Young strokes constituted 28.8%. The common comorbidities were hypertension 72%, diabetes mellitus 52.6%, smoking 38.5%, and dyslipidemia 32.6%. The common presenting symptoms were giddiness 79%, unsteadiness 75.35%, ataxia 56%, motor deficits 48.8% and nausea and vomiting 43%. Most were Ischemic strokes (86.5%); 10.3% gave a history of preceding TIAs. Common arteries involved were posterior cerebral 45%, posterior inferior cerebellar 38%, and basilar artery 19.2%. Among ischemic strokes, large artery atherosclerosis was 50.8%. Dysphagia was seen in 32.6% and sepsis in 19.2%; post stroke pain in 23%, followed by cognition decline in 10.3%. Bad outcome (modifies Rankins score 4-6) was 16.8% at discharge, 16.4% at 1 month, 14.4% at 3 months, and 13.8% at 6 months. Independent predictors of bad outcomes at 6 months were baseline National Institute of Health Stroke Scale (NIHSS) score (Odds ratio [OR] 1615.59 confidence interval [CI] 27.64-94447.7), invasive ventilation (OR 7.77 CI 1.57-38.43), sepsis (OR 17.22 CI 1.45-204.08), and basilar artery involvement (OR 19.98 CI 1.67-238.81). Baseline NIHSS scores between 0 and 5 suggest a good outcome while scores more than 13 suggest a bad outcome at 6 months. At 6 months, half are unemployed. Conclusions: The prevalence, clinical features, and comorbidities were also similar to previous studies. There was good survival at 6 months. NIHSS score is useful in predicting poor outcomes. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is associated with significant morbidity and mortality. There is an increase in the proportion of non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA) but there is a sparsity of data about the long-term outcome of patients with NSTEMI managed by internists. The long-term outcome and predictors of mortality of individuals with NSTEMI, managed by internists were the subject of the present study. Methods: This is a prospective observational cohort study of patients admitted under the internal medicine units with ACS. One hundred forty participants were recruited from April 2016 to July 2017. The various clinical outcomes and all-cause mortality at discharge, 1 month and 6 months were recorded. Results: During the study, 132 patients had NTSEMI/UA while 8 had ST-elevation myocardial infarction; 53.2% were men. The mean age was 63.6 ± 11.8 years for NSTEMI/UA. The mean duration of onset of symptoms to primary care was 29.14 ± 34.6 h; 39 (27.9%) presented beyond 48 h. The most frequent comorbidities observed were diabetes mellitus 96 (68.6%), hypertension 94 (67.1%), and dyslipidemia 44 (31.4%). Fifty-two (37.1%) required respiratory support. All patients received Antiplatelet agents and statins. Mortality rates were 9.1%, 13.4%, and 16.1% at discharge, 1-month, and 6 month following admission. The median survival was 161 (147-175) days. Dyslipidemia (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.26, 1.15, P = 0.110) and smoking (HR: 2.16, 95% CI: 1.16-4.02, P = 0.015) were identified as risk factors which predicted mortality. Conclusions: Mortality rates following NSTEMI, managed by internists at our tertiary care hospital was similar to various national and international registries. Smoking and dyslipidemia were predictors of mortality. [ABSTRACT FROM AUTHOR]

Objectives: Primary objective: The incidence of deep vein thrombosis in patients admitted to a medical ward. Methods: We conducted a prospective cohort to assess the incidence of deep vein thrombosis in patients admitted in a medical of our tertiary care center between October 2014 and May 2015. We excluded patients who had a preexisting deep vein thrombosis or a pulmonary embolism and patients on therapeutic anticoagulation. A bedside ultrasound machine was used for screening for deep vein thrombosis in the internal jugular, axillary, femoral, and popliteal veins. Noncompressibility of the vein compared to the artery was suggestive of thrombosis. Results: Among the 43 patients included in the study, 3 (6.98%) patients developed deep vein thrombosis. The incidence density is 7.48 per 1000 patient-days. One patient developed a central venous catheter-associated deep vein thrombosis. Multivariate analysis showed that the duration of hospital stay of more than 7 days was associated with a higher risk of development of deep vein thrombosis (odds ratio: 1.17 [confidence interval: 1.016-1.349]). Conclusions: The incidence of deep vein thrombosis among patients admitted in a medical ward of a tertiary care hospital in South India was 7.48 per 1000 patient-days. Hospital admission of more than 7 days was found to be a significant independent risk factor for development of deep vein thrombosis in our study. [ABSTRACT FROM AUTHOR]

Background: Although sepsis is a well-known cause of in-hospital mortality, data on long term outcomes are scarce. Aim: This study aims to estimate the cumulative 5-year mortality among patients with infection requiring admission. Methods: This was a cohort study done in tertiary care center in South India, with recruitment of those admitted with an infection between January 1st, 2009 and July 31st, 2014 in a medical unit. The patients were followed up by telephonic call or case record review. Kaplan-Meier survival curve was plotted and Cox-proportional hazard model was used as multivariable analysis to identify the independent risk factors of long-term mortality. Results: One thousand four hundred and fifty three patients were followed up in this cohort study. The mean survival by Kaplan-Meier survival analysis was 3.78 years (95% confidence interval [CI] 3.33, 4.22) in quick sepsis-related organ failure assessment (qSOFA) score positive patients and 6.07 years (95% CI 5.73, 6.41) in qSOFA negative patients which was statistically significant by the log-rank test. The cumulative 1-year mortality was 44.9% and 21.8% for qSOFA score of 2 or more and nonsepsis patients, respectively. The median survival of qSOFA score of 2 or more patients was 0.75 years (95% CI 0-2.1 years). The mortality among sepsis patients at discharge, 1 year, 5 and 8 years was 38.2%, 44.9%, 47.4%, and 47.8%, respectively. Cox regression analysis showed age hazard ratio (HR) 1.02 (1.01, 1.04), male gender 1.45 (1.03, 2.04), >qSOFA score HR 1.89 (1.32, 2.72), Charlson Comorbidity Index HR 1.29 (1.14, 1.46), respiratory tract infection HR 1.81 (1.10, 2.95), and inotrope requirement HR 3.24 (1.98, 5.29) were the independent predictors of long-term mortality. Conclusions: The median survival of patients with possible infection with qSOFA score of 2 or more patients was 0.75 years (95% CI 0-2.1 years). Older age, male gender, qSOFA score of 2 or more, Charlson Comorbidity Index, respiratory tract infection, and inotrope requirement HR 3.24 were the independent predictors of long-term mortality. [ABSTRACT FROM AUTHOR]

Background and Objectives: The study was aimed to evaluate the role of stress, lifestyle as well as traditional risk factors in the development of hypertension among health-care workers (HCWs). Methods: This nested case--control study was done at a tertiary care university teaching hospital in South India. Cases were hospital employees diagnosed with hypertension and who were taking antihypertensive medications. Controls were age- and sex-matched HCWs who were not diagnosed with hypertension. They were identified preferably in the same department where its case was presently working. One hundred and twenty-eight cases and 128 controls were enrolled. We collected data on risk factors for hypertension, physical activity, diet, and stress. Those significant on the bivariate analysis were entered into a logistic regression analysis. Results and Interpretation: In the logistic regression, we found that living in a joint family (2 siblings and their families), family history of hypertension, family history of diabetes mellitus, and family history of ischemic heart disease were independently predictive of hypertension developing in the study HCWs. Occasional or regular walking/cycling to work and milk consumption were independent factors that protected against the development of hypertension. Extra added salt to food and stress more than normal in any domain tested were not associated with the development of hypertension in our cohort. Conclusions: HCWs have some novel and other similar risk factors to general population for developing hypertension. Simple preventive measures seem effective. Neither stress nor self-reported salt consumption seemed to play a role in the development of hypertension. [ABSTRACT FROM AUTHOR]

Background and Objectives: Upper urinary tract infections (UTIs) that require in-patient care can be expensive. Comorbid conditions such as diabetes as well as UTI due to extended-spectrum beta-lactamase (ESBL) producing bacteria may affect costs. The quality of life of patients with this condition has not been described. Methods: This was a cost of illness study that prospectively evaluated patients admitted with upper UTI to a medical ward in a tertiary care hospital. Direct medical and nonmedical costs, indirect costs were collected to make the total cost per admission. Quality of life was assessed using the World Health Organization Quality of Life-BREF score. We also compared costs between those with and without diabetes or ESBL infection. Results: Between March 2016 and July 2017, 92 eligible patients were included in the study. The average age was 55.8 years; two thirds were diabetics. The mean overall cost of a single admission for upper UTI was INR.88, 330.2 (1370.4 USD). This was INR.96, 193.0 (1492.6 USD) and INR.1, 03,154.9 (1600.4 USD) among those with diabetes mellitus and ESBL infection, respectively. The cost was higher among those with diabetes and ESBL than those without; this difference reached statistically significance for the ESBL group. The quality of life was affected in all domains; the psychological being most affected among diabetics and ESBL infected. Conclusions: The mean total cost of admission for an upper UTI in a tertiary care hospital in South India was INR 88,330 (1370.4 USD). This is higher if the patient has diabetes or ESBL organism causing the UTI. Quality of life is clearly reduced especially in the psychological domain. [ABSTRACT FROM AUTHOR]