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Introduction: Bacterial Meningitis (BM) is a serious health problem worldwide with high mortality and permanent longterm neurological sequelae. Cerebrospinal Fluid (CSF) analysis is the cornerstone for diagnosing BM, but the lack of specificity creates a difficult clinical scenario for initiating proper treatment. Empiric antibiotic use in patients with suspected meningitis at primary care settings decreases the yield of CSF culture and alters CSF cytological and biochemical findings, making it further difficult to diagnose BM. To overcome this difficulty, there is a need for other biochemical markers with higher sensitivity and specificity. Aim: To determine the diagnostic sensitivity and specificity of Procalcitonin (PCT) in serum and CSF in patients with BM and compare its diagnostic accuracy in both sample types. Materials and Methods: A cross-sectional study was conducted in the Department of Internal Medicine at a tertiary care centre in eastern India from September 2018 to August 2020. A total of 82 adult patients with meningitis were recruited as per the protocol, and CSF analysis was done along with estimation of PCT in serum and CSF. Receiver Operating Characteristics (ROC) curve analysis of serum and CSF PCT was used to determine sensitivity and specificity with a 95% confidence interval. Results: Out of the 82 patients recruited, 30 (36.6%) had BM. CSF PCT with a cut-off value of >0.45 ng/mL had a sensitivity of 86.7% and specificity of 92.3%. The sensitivity of serum PCT with a cut-off value of >0.6 ng/mL was 83.3%, and specificity was 86.5%. There was no statistically significant difference in sensitivity and specificity between CSF and serum PCT in patients with BM (p-value=0.7988). Conclusion: Both serum and CSF PCT were found to have high sensitivity and specificity as markers for diagnosing BM without any statistically significant difference between them. [ABSTRACT FROM AUTHOR]

Introduction: Clinical laboratories play an indispensable role in patient care. Laboratory results help in approximately 70% of medical decision making. Patients are the best source of information on quality of service provided by an Institute, as their feedback can help in future planning and taking corrective action. Aim: To evaluate patient satisfaction with clinical laboratory and phlebotomy services in a National Accreditation Board for Testing and Calibration Laboratories (NABL) accredited laboratory in a tertiary care hospital in Eastern India. Materials and Methods: This was a hospital-based cross-sectional study, conducted from May 2021 to June 2021, on the patients visiting the central laboratory of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha. A total of 265 participants above the age of 18 years were included in the study. They were provided with a feedback questionnaire (13 questions). A 5-point Likert scale rating of very dissatisfied, dissatisfied, neutral, satisfied and very satisfied was used. Descriptive statistics such as number and percentage were used to present the data. Results: Out of the total, 96% was the response rate, hence, the complete questionnaires analysed were of 254 participants (130 males and 124 females). Out of the total 254 participants, 155 (61%) were very satisfied, 61 (24%) were satisfied, 28 (11%) were neutral and 10 (3.93%) were dissatisfied with the overall laboratory services. Laboratory test results were reliable scored very high and was reported to be very satisfactory by 177 participants (69.68%), satisfactory by 51 participants (20.07%) and 165 participants (64.96%) were very satisfied and 58 participants (22.83%) were satisfied with staff courtesy, skill and behaviour. However, none of the participants were very dissatisfied and 10 (4%) were dissatisfied, expected the laboratory services to be little better. For explanation of test results 79 participants (31.10%) were very dissatisfied and another 114 participants (44.88%) were dissatisfied. A total of 34 participants (13.38%) were very dissatisfied and another 50 participants (19.68%) were dissatisfied with the given information about location and time of report collection. Conclusion: Patient satisfaction is an important indicator of the quality of service delivered. The overall satisfaction level with the laboratory service was 85%, showing a majority of the participants were satisfied or very satisfied with the overall services of the laboratory. There is a need to improve on cleanliness and more emphasis is to be laid, on transmission of accurate and adequate information to the patients. [ABSTRACT FROM AUTHOR]

To explore treatment preferences of patients with Hereditary Angioedema (HAE), a debilitating disorder characterized by potentially life-threatening, recurrent episodes of swelling, resulting in significant physical, emotional, and economic burden. With newer oral prophylactic treatments on the horizon, it is important to understand patients' preferences. An online survey was conducted in 2018 among United States (US) adult patients diagnosed with Type I or II HAE. Respondents were recruited anonymously from online panels and social media. Online surveys were completed by 75 patients diagnosed with HAE by a healthcare provider, with a mean of 16.7 years since diagnosis. Most patients (64%) report taking at least one medication for prophylaxis of HAE attacks. While almost all patients surveyed agree it is important to take preventative medication as prescribed, over half (52%) of patients report HAE prophylactic treatment to be burdensome. Despite stating that they like their current medications, 98% of the prophylactic HAE medication users would prefer an oral treatment if available; almost all (96%) prophylaxis users agree that oral preventative medication would fit their life better than an injectable medication, with 67% of users citing convenience as the primary reason to try an oral preventative HAE medication. If a more convenient option were available, nearly all (96%) patients currently not treating their HAE prophylactically would feel encouraged to do so. Most patients with HAE would prefer a newer generation oral prophylactic medication that would decrease treatment burden and allow them to live fuller lives. [ABSTRACT FROM AUTHOR]

Introduction: Medical and laboratory errors can be caused due to many reasons, including communication problem, inadequate training of the staff members, improper identification. Quality indicators can help in objective measurement of errors in various crucial steps. Aim: To determine the nature and frequency of preanalytical, some of the analytical and postanalytical errors in the clinical laboratory with the help of quality indicators. Materials and Methods: This was a retrospective study and data was collected for preanalytical, some of analytical and postanalytical errors from December 2020 to May 2021, from the central laboratory and were classified under various quality indicators. MS excel was used to analyse the data and descriptive statistics such as number and percentage were used to present the data. Results: Out of the total 677,887 samples received from both Outpatient Department (OPD) and Inpatient Department (IPD) in the central laboratory for clinical chemistry, preanalytical error was found in 482 samples (0.071%) and most common was hemolysis and billing errors. Out of total 677,887 samples received repeat testing was done in 287 samples (0.042%), turnaround time (TAT) exceeded in total 2,29,629 samples (33.87%) and transcription errors/amended report were seen in 41 (0.006%). Conclusion: Sample haemolysis, billing errors, insufficient sample and clotted sample are the most common preanalytical errors encountered in clinical laboratory. turnaround time (TAT) was exceeded in one third of the samples. These errors can be minimised by repeated training, annual competency assessment and more automation in preanalytical phase. [ABSTRACT FROM AUTHOR]

The article focuses on the survey of treatment burden and needs of Physician and patient perspectives on the management of hereditary angioedema. Topics discussed include Hereditary angioedema (HAE) is a rare disorder caused by genetic mutations that lead to recurrent episodes Of swelling in various parts of the body; and Prophylactic treatment is common for patients with HAE, and the therapeutic options have expanded in recent years.

Objective: Women pass through many stages throughout her lifetime. Among these phases, pregnancy is crucial phase. If women are not able to cope with this stress, it may lead to adverse outcomes of pregnancy. Early detection of possible depression in pregnant women may lead to decrease in incidence of depression and adverse outcomes of pregnancy. Materials and Methods: The present study was done in an urban primary health center of east Delhi where antenatal and postnatal services are provided. Two hundred pregnant women who attended antenatal clinic for their antenatal checkup were included in the study. Edinburgh postnatal depression scale was used to diagnose possible depression. The presence of a statistically significant difference between possibility of depression in terms of various socioeconomic, obstetric, gender issues, life events, previous psychiatric history and family relationships was ascertained using Chi-square/Fisher's exact test. Logistic regression was carried out to determine important confounding variables. Results: The mean age of participants was 25.32 ± 3.86 years. Of total 200 women, 42 (21%) women were found to be suffering from possible depression. The possibility of depression was found to be significantly higher in literate participants (P = 0.001) and in women who were married after 18 years of age (P = 0.016). Participants who wanted the present pregnancy and whose spouses were alcoholic were found to be associated significantly (P = 0.00). On applying logistic regression, age and abortion history was found to be significant. Conclusion: This study demonstrates that the prevalence of antenatal depression is high in developing countries, and universal screening of depression during antenatal and postnatal period is feasible along with other antenatal and postnatal services provided to them. [ABSTRACT FROM AUTHOR]

Objective: Cervical cancer is one of the major concerns of public health importance in today's world. It is a leading cause of mortality in women of reproductive age group worldwide, mainly in developing countries. Reduction in mortality and morbidity due to cervical cancer is possible through early detection and treatment. The major factors influencing the early detection of cervical cancer are knowledge regarding risk factors, screening, Pap smear, and symptoms among women. Materials and Methods: The present cross-sectional study was carried out to assess the knowledge, attitude, and practice of women about the risk factors, symptoms, and prevention of cervical cancer. Data were obtained from 220 women who visited international trade fair using a pretested self-administered questionnaire. Results: Only 75 study women (50.0%) had ever heard of cervical cancer. The knowledge regarding cervical cancer and its various domains was significantly higher in students and unmarried women. The foul-smelling vaginal discharge was the most common early symptom of cervical cancer according to most of the study women (26, 17.3%). Most of the study women (19, 12.7%) reported tobacco and smoking as the most common risk factor associated with cervical cancer. Only 39 women (26%) had ever heard of cervical cancer screening. Only 27 women (18.0%) ever had Pap smear done in the past and 87 women (58.0%) were willing to undergo cervical cancer screening is offered free of cost. Conclusion: The study demonstrates the lack of awareness in women regarding cervical cancer and its screening modalities. This necessitates spreading awareness regarding early symptoms and risk factors associated with cervical cancer for early detection and treatment initiation. [ABSTRACT FROM AUTHOR]

The article presents the case of a 64-year-old woman ex-smoker who was presented to a clinic due to sudden and persistent loss of peripheral vision in her right eye for a week to discuss widespread cilioretinal perfusion in central retinal artery occlusion.

The article reports on the challenges surrounding the use of Goldmann applanation tonometry (GAT) for measuring intraocular pressure in overweight patients. Topics discussed include use of Perkin's tonometry (PT) measurement for minimizing error in such patients; use of observational study in a hospital glaucoma clinic for the same; and a table depicting intraocular pressure measurements with the Perkins hand-held tonometer.

Background and Aim: Thrombocytopenia is common in people with chronic liver disease, who frequently undergo invasive procedures. To minimize the risk of bleeding, prophylactic platelet transfusions have traditionally been used but carry many risks. The aim of this study was to evaluate the cost-effectiveness of avatrombopag compared with platelet transfusion and lusutrombopag as a treatment for thrombocytopenia in adult patients with chronic liver disease scheduled to undergo a medical procedure., Methods: A decision-tree model was developed from a US payer perspective to capture acute events observed in phase 3 global randomized controlled clinical trials and, to support exploratory analyses, potential longer-term complications resulting from a major bleed or thromboembolic event. Treatment costs were taken from publicly available data sources. The interventions were evaluated in the overall trial populations and in subpopulations with higher and lower baseline platelet counts. Results were presented as incremental cost per platelet transfusion avoided. One-way and probabilistic sensitivity analyses were conducted., Results: In the overall population, avatrombopag reduced the need for platelet transfusions and produced cost-savings compared with platelet transfusion (80% fewer prophylactic platelet transfusions, $4250 lower costs) and lusutrombopag (42% fewer prophylactic platelet transfusions, $5819 lower costs). Similar results were seen in both the higher and lower platelet count subpopulations. The one-way and probabilistic sensitivity analyses found that the use of avatrombopag is cost-saving with the incremental cost-effectiveness ratio in quadrant IV (decreased costs, prophylactic platelet transfusions avoided)., Conclusion: The use of avatrombopag is expected to be cost-saving while reducing the need for prophylactic platelet transfusions compared with platelet transfusion and lusutrombopag., Competing Interests: DM and CB are employees of RTI Health Solutions, Research Triangle Park, NC, USA, which received funding under a research contract with Dova Pharmaceuticals, Durham, NC, USA, to conduct this study. MV is an employee of Dova Pharmaceuticals. KA was an employee of Dova Pharmaceuticals during the study period. RK has received honoraria for consulting and participating in advisory boards for Dova. DD has received honoraria for participating in advisory boards for Dova. All relevant conflict of interests have been reported for each author. The authors report no other conflicts of interest in this work., (© 2020 Mladsi et al.)

Objective: Women pass through many stages throughout her lifetime. Among these phases, pregnancy is crucial phase. If women are not able to cope with this stress, it may lead to adverse outcomes of pregnancy. Early detection of possible depression in pregnant women may lead to decrease in incidence of depression and adverse outcomes of pregnancy., Materials and Methods: The present study was done in an urban primary health center of east Delhi where antenatal and postnatal services are provided. Two hundred pregnant women who attended antenatal clinic for their antenatal checkup were included in the study. Edinburgh postnatal depression scale was used to diagnose possible depression. The presence of a statistically significant difference between possibility of depression in terms of various socioeconomic, obstetric, gender issues, life events, previous psychiatric history and family relationships was ascertained using Chi-square/Fisher's exact test. Logistic regression was carried out to determine important confounding variables., Results: The mean age of participants was 25.32 ± 3.86 years. Of total 200 women, 42 (21%) women were found to be suffering from possible depression. The possibility of depression was found to be significantly higher in literate participants ( P = 0.001) and in women who were married after 18 years of age ( P = 0.016). Participants who wanted the present pregnancy and whose spouses were alcoholic were found to be associated significantly ( P = 0.00). On applying logistic regression, age and abortion history was found to be significant., Conclusion: This study demonstrates that the prevalence of antenatal depression is high in developing countries, and universal screening of depression during antenatal and postnatal period is feasible along with other antenatal and postnatal services provided to them., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Tzu Chi Medical Journal.)

Objective: Cervical cancer is one of the major concerns of public health importance in today's world. It is a leading cause of mortality in women of reproductive age group worldwide, mainly in developing countries. Reduction in mortality and morbidity due to cervical cancer is possible through early detection and treatment. The major factors influencing the early detection of cervical cancer are knowledge regarding risk factors, screening, Pap smear, and symptoms among women., Materials and Methods: The present cross-sectional study was carried out to assess the knowledge, attitude, and practice of women about the risk factors, symptoms, and prevention of cervical cancer. Data were obtained from 220 women who visited international trade fair using a pretested self-administered questionnaire., Results: Only 75 study women (50.0%) had ever heard of cervical cancer. The knowledge regarding cervical cancer and its various domains was significantly higher in students and unmarried women. The foul-smelling vaginal discharge was the most common early symptom of cervical cancer according to most of the study women (26, 17.3%). Most of the study women (19, 12.7%) reported tobacco and smoking as the most common risk factor associated with cervical cancer. Only 39 women (26%) had ever heard of cervical cancer screening. Only 27 women (18.0%) ever had Pap smear done in the past and 87 women (58.0%) were willing to undergo cervical cancer screening is offered free of cost., Conclusion: The study demonstrates the lack of awareness in women regarding cervical cancer and its screening modalities. This necessitates spreading awareness regarding early symptoms and risk factors associated with cervical cancer for early detection and treatment initiation., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Tzu Chi Medical Journal.)

The Health Education Thames Valley (HETV) Ophthalmology training programme holds compulsory weekly afternoon teaching sessions in Oxford. Traditionally, trainees travelled considerable distances to attend this teaching. Commuting is a known stress factor and car use has environmental, monetary and health costs. To reduce trainee costs, travelling time and improve teaching experience, we introduced an interactive and live video link across HETV. Teaching sessions were broadcast live using free videolink software between 3 sites. New hardware cost £200 per site. Attendees completed weekly feedback questionnaires on the videolink over 9 months. Over this period, the deanery had 22 trainees with 12 working outside Oxford. Projected annual travel savings were calculated. On average 10.8 trainees (49.1%) completed weekly questionnaires: 5.1 (range:3-8) were trainees working outside Oxford and 5.6 trainees (range 3-10) working in Oxford. Attendee responses showed on average: 78.6% learnt as much as attending in person; 91.17% felt interaction through the videolink was adequate; and 94.6% remained keen on telecommuting. Of the trainees in Oxford, 26.5% felt that the videolink interfered with the teaching session. The average videolink quality rating was 3.73 (1:poor; 5:excellent). Annually, the videolink will save each trainee working outside Oxford an average of 2120 kilometres in travel and £594 in expenses. Most attendees felt the videolink was a valuable tool in delivering teaching sessions. It eliminates unnecessary journeys and travel related stress. Within HETV, a £600 initial investment for new hardware would save trainees approximately £7128 annually. There is potential in expanding the role of the videolink to allow guest speakers worldwide to easily contribute to teaching sessions, eliminating unnecessary travel. This model could be adapted to postgraduate training programmes nationally to improve trainee wellbeing by reducing travelling time and costs., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Ischemia modified albumin (IMA) is a proven cardiac marker but its role in type 2 diabetes mellitus without vascular complications has not been reported yet. Therefore, IMA was estimated in 60 newly diagnosed patients of type 2 diabetes mellitus and 30 healthy controls along with HbA1c and other investigations (to rule out vascular complications). There was no significant change in IMA levels in type 2 diabetic patients as compared to controls. No correlation could be found between IMA levels and HbA1c. We conclude that IMA levels are not affected in type 2 diabetes mellitus before the onset of vascular complications.