Background: Acute lower respiratory tract infection is a major cause of death in under five years of age, and anemia is the commonest co-factor in pediatric patients seeking medical advice especially in developing countries.

Objective: To identify clinical factors that predict which patients presenting to the ED with pneumonia will require respiratory isolation for suspected tuberculosis and to evaluate a protocol for rapid identification of patients at risk for pulmonary tuberculosis (PTB). Methods: To identify potential clinical indicators of FTB, a case-control study was performed using patients admitted to an urban teaching hospital with the ED diagnosis of pneumonia (derivation sample). These predictors were then evaluated in a separate prospective observational study of 103 patients admitted to the same institution from July 1994 to February 1995. Adult patients with the admitting diagnosis of pneumonia were admitted to a respiratory isolation bed if they met 1 of the following criteria: 1) HIV-positive or unknown HIV status with a history of injection drug use; 2) chest x-ray consistent with PTB; or 3) pneumonia with 1 of the following: PPD conversion within 2 years, recent exposure to PTB, previous PTB, or hemoptysis. Patients who did not meet isolation criteria were admitted to the medical ward and had a PPD and anergy panel placed. Those who were anergic or PPD-positive were transferred to respiratory isolation. Results: Predictor variables identified during the first study phase were incorporated into the isolation guidelines noted above. Only 36 of 50 (72%) PTB patients were admitted to an isolation bed during this phase. During the second phase, 103 patients were admitted with the ED diagnosis of pneumonia-rule out PTB; 22 patients (22%) were culture-confirmed positive for PTB. The guidelines predicted PTB as follows: sensitivity, 0.96 (95% CI, 0.88-1.0); specificity, 0.14 (95% CI, 0.08-0.24); positive predictive value, 0.23 (95% CI, 0.17-0.35); and negative predictive value, 0.92 (95% CI, 0.77-1.0). The 1 patient who was not isolated was found to be anergic after 48 hours and subsequently isolated. Conclusion: Respiratory isolation guidelines for patients admitted from the ED with pneumonia were developed and validated. These guidelines provide satisfactory guidance for isolation of patients at risk for PTB in a high-FTB-prevalence population. Key words: respiratory isolation; tuberculosis; emergency department; infectious disease; occupational disease; nosocomial infection. TB in 1991, 4,410 (17%) were reported in New York.' Despite recent progress, New York continues to be the epicenter of tuberculosis in the United States. In 1995, the New York City Department of Health reported a case rate nearly 4 times higher than the national a~e r a g e .~ In the hospital setting, unrecognized cases of PTB place health care workers, patients, and visitors at risk for nosocomial exposure. Pearson et al. showed that health care workers on a general medicine ward had a PPD skin test conversion rate of 27% when exposed to culture-confirmed TB patient^.^ A recent CDC/American Hospital Association survey revealed nosocomial PTB transmission in 2% of the patients and 13% of the health care workers who responded.' If FTB is not suspe...

Background: Health care professionals are a high risk group for H1N1 and it is important for them to have correct knowledge about the disease in order to be able to prevent themselves from the disease. Objectives: To assess the knowledge, attitude and practices regarding H1N1 pandemic influenza among the health care providers working at a tertiary care hospital. Methodology: Data was collected from 279 health care providers who were selected by convenience sampling. Results: Overall the participants had some/sufficient knowledge about the disease. 44.8% of the study participants had received training on hand hygiene while only 24% had received training on the use of personal protective equipment. Only 54.8 % of the study participants were vaccinated against H1N1. Conclusion: It was seen that there were some gaps in the knowledge about the disease. Educational and training programmes for health care providers should be conducted regularly.

Objectives:This observational study was done to describe the clinical profile, and delays in diagnosing cystic fibrosis (CF) disease in Kashmir, India.Materials and Methods:A total of 6758 patients between the ages of 0 and 19 years were registered over a period of 1 year. Out of these, 150 patients suspected of having CF, on clinical grounds, were subjected to pilocarpine iontophoresis, and later on genetic evaluation. Apart from these specific tests, these patients were subjected to laboratory tests like blood counts, blood sugar, KFT, LFT, pancreatic function test, serum electrolytes, and chloride, urine, throat swab, blood culture, ABG analysis, chest and paranasal X-rays. In addition, sonographic evaluation of abdominal organs was carried out to know the status of internal organs. A polymerase chain reaction (PCR)-based test was used for the identification of CF mutation.Results:CF was diagnosed in three (0.8%) patients. Median age of presentation of CF was 78 months. Family history suggestive of CF was present in one (33.3%) and consanguinity in three (100%) patients. Common clinical manifestations at the time of presentation included recurrent pneumonia in three (100%), failure to thrive in three (100%), recurrent diarrhea in one (33.3%) patients. General physical examination showed pallor in three (100%), malnutrition in three (100%), and clubbing in two (66.7%) patients. Examination of respiratory tract revealed hyperinflation in two (66.7%), rhinitis in two (66.7%), and creptations in two (66.7%) patients. Sonography of abdominal organs revealed pancreatic cysts in one (33.3%), hyperechoeic and increased liver span in two (66.7%), and small gallbladder in one (33.3%). Staphylococcus aureus was cultured from sputum in one (33.3%), pseudomonas aeruginosa in one (33.3%) patients. Delta F508 mutation was present in one (33.3%) patient.Conclusion:CF may be more common in Kashmir and other parts of Asia, than indicated by our study; diagnosis is often considerably delayed when the disease is identified solely on clinical grounds. It would be advisable to raise the index of suspicion about CF.

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Background: Management of critically ill obstetric women at an ICU is a challenge to both physicians and obstetricians due to physiological adaptations and progress of diseases during pregnancy and puerperium. There has been a striking association between the number of maternal deaths and the accessibility to ICU care. Obstetric patients get admitted to the ICU approximately at 0.1-0.9% times of all deliveries. Objective was to evaluate the occurrence, indication and outcome of patients admitted in the ICU of an obstetric tertiary care hospital.Methods: This retrospective study was carried out from August 2020 to January 2021 at Lalla Ded Hospital, a tertiary care Obstetrics and Gynaecology Hospital of Kashmir valley. Data for this study was collected retrospectively from hospital records. The demographic details, indication for ICU admission, co-morbidities, ante natal care records were noted on admission to the ICU.Results: The total ICU admission during this time period was 212 (1.44%) with obstetric patients being 194 (91.5%) and gynaecologic patients 18 (8.5%). Obstetric haemorrhage (38.2) followed by hypertensive disorders of pregnancy (24.1%) were the most common indications for ICU admission. 26.9% patients needed mechanical ventilation during ICU admission.Conclusions: Analysing intensive care unit utilization during pregnancy can be an accepted approach to identify severe and near miss maternal morbidity. Development and upliftment of primary health care facilities with involvement of multi-disciplinary teams and referral of high risk pregnancies to higher health centres is the key to decrease maternal mortality and morbidity.