Search

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.

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.

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.

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.

We performed a case control study of 108 patients for the risk of uncontrolled hypertension Housing insecurity, a part of material needs insecurity is an independent predictor of uncontrolled hypertension (adjusted odds ratio 29.9, 1.2-734). Food insecurity, cost related medication underuse and housing instability were seen in 32.4%, 33.3%.and 39.8% of our study subjects respectively. On average patients had 6 stressful life events, which was not different among those with different levels of blood pressure control. We did not find correlation with 24-urine sodium excretion, a reflection of salt intake and hypertension control. The average hypertensive subject was taking more than 10 grams of sodium per day, far higher than recommended.