BackgroundCatheter-related bloodstream infection is an important cause of morbidity and mortality in sick neonates (Hodge and Puntis, 2002 Patients: Consecutive neonates in whom peripheral catheter was inserted were recruited. Methods:The insertion site was cleaned with isopropyl alcohol and chlorhexidine for 30 s consecutively. A needleless catheter access device was attached to peripheral catheters. A dedicated observer reviewed the catheter sites regularly for complications. On removal, the tip of the catheter was cut under sterile conditions and sent to the laboratory for culture. Only catheters indwelling for >12 h were sent for culture.Findings: Bacteria were isolated from 22 out of 154 catheter tips. Methicillin-sensitive Staphylococcus aureus (n = 13) was the most common organism constituting more than 50% of isolates. In five out of 22 isolates, the organism from the catheter tip was identical to the one from the skin. Systemic sepsis at enrolment was positively associated with colonisation of peripheral catheter. None of the neonates developed peripheral catheter-related bloodstream infection. Conclusion:When proper infection control measures are in place, risk of peripheral venous catheter-related infection appears extremely low in spite of frequent colonisation of the catheter.

MCQs' based self-assessment at the conclusion of the lecture does not improve the learning among prefinal year medical students. However, this study has shown the usefulness of MCQs based self-assessment among male medical students.

Background: Left ventricular hypertrophy (LVH) detection is vital to the risk stratification of adults at risk of adverse cardiovascular events such as coronary heart disease, cerebrovascular disease, and aortic aneurysms. Electrocardiogram (ECG), a non-invasive, cost-effective instrument has been widely used as a screening tool for LVH. The objective of this study was to determine the diagnostic accuracy of seven frequently used ECG criteria in high-risk Indian adults in comparison with echocardiography. Methods: ECG and transthoracic echocardiography were performed in adults older than 18 years with at least one cardiac risk factor (chronic hypertension, obesity, ischemic heart disease, and type 2 diabetes mellitus). Precision and accuracy were calculated for the various ECG criteria against LVH based on left ventricular mass index (LVMI) and cardiac remodeling by echocardiography. Results: A total of 220 participants were enrolled. Of these, 96 had LVH by echocardiography. There was marked variability in LVH detection by the different ECG criteria: 28 by Sokolow-Lyon criteria, 26 by Cornell criteria, 24 by Lewis criteria, 46 by Scott criteria, eight by Romhilt-Estes criteria, six by Modified Cornell criteria, and only two by Roberts criteria. Agreement statistics between ECG criteria and LVMI showed that none of them had a good agreement for LVH detection. Conclusion: None of the ECG criteria were sensitive enough to rule out ventricular hypertrophy. In the context of cardiac remodeling, the ECG criteria had high sensitivity but low specificity and, hence, limited clinical relevance.

Objective: To determine the effect of splint on the dwell time of peripheral intravenous cannula in neonates. Setting: Level II Neonatal Intensive Care Unit (NICU). Patients: Consecutive babies with presumed need of peripheral intravenous access of at least 24 h. Methods: Enrolled subjects were randomized to “splint” or “splint-less” group. Insertion site was cleaned with Isopropyl alcohol and 2% Chlorhexidine and peripheral intravenous catheter was inserted under strict asepsis. Insertion sites was examined regularly for occurrence of complication which necessitated removal of the catheter. Results: Out of 159 neonates, 80 were allotted to splint group and the rest to splint-less group. Mean dwell time of intravenous line in splint group was 27.68 ± 13.03 h which was significantly less than in splint-less group (32.87 ± 15.79 h, mean difference: 5.11 h, p value: 0.03). Subgroup analysis in preterms showed mean dwell time of 28.54 ± 14.86 h in splint group which was less than that of splint-less group (35.10 ± 16.24 h) ( p value: 0.03). No such difference was noted in the term neonates. Subgroup analysis for catheters put across joints does not show difference in mean dwell times between splint and splint-less groups. Multivariate regression analysis did not identify any variable which independently affected the outcome. Conclusion: Use of splint does not prolong the dwell time of the catheter and is probably harmful in some neonates.

Tuberculin status in adolescents can be read as positive or negative at 24 h, irrespective of their bacillus Calmette-Guérin scar status.