Aims:Urine dipstick analysis is a quick, cheap and a useful test in predicting Urinary Tract Infection (UTI) in hospitalized patients. Our aim is to evaluate the reliability (sensitivity) of urine dipstick analysis against urine culture in the diagnosis of UTI.Materials and Methods:Patients admitted to our hospital suspected of having UTI, with positive urine cultures were included in this study from a 2-year period (January 2011 to December 2012). Dipstick urinalysis was done using multistix 10 SG (Siemens) and clinitek advantus analyzer. The sensitivity of dipstick nitrites, leukocyte esterase and blood in these culture-positive UTI patients was calculated retrospectively.Results:Urine dipstick analysis of 635 urine culture-positive patients was studied. The sensitivity of nitrite alone and leukocyte esterase alone were 23.31% and 48.5%, respectively. The sensitivity of blood alone in positive urine culture was 63.94%, which was the highest sensitivity for a single screening test. The presence of leukocyte esterase and/or blood increased the sensitivity to 72.28%. The sensitivity was found to be the highest when nitrite, leukocyte and blood were considered together.Conclusions:Nitrite test and leukocyte esterase test when used individually is not reliable to rule out UTI. Hence, symptomatic UTI patients with negative dipstick assay should be subjected to urine culture for a proper management.
Immune thrombocytopenia is a relatively rare hematological manifestation in tuberculosis. We report two cases of immune thrombocytopemia, one in sputum positive pulmonary tuberculosis and the other in miliary tuberculosis. Antituberculous drugs and immunosuppressive therapy corrected the thrombocytopenia in both patients. Our case reports stress that tuberculosis should be considered during the evaluation of immune thrombocytopenia, and also highlights the safety of immunosuppressive therapy during active tuberculosis along with antituberculous drugs.
IntroductionMeningitis is a clinical syndrome characterised by infl ammation of the meninges surrounding the brain and the spinal cord. The classic triad of meningitis consists of fever, headache and neck stiffness. 1 Meningitis can be of infective or noninfective aetiology, occurring in any age group, with extremes of age being the most severely affected. The immune-compromised state also has high mortality and morbidity. The overall case fatality rate of bacterial meningitis in adult patients is around 30%. [2][3][4] Although encephalitis by definition involves the brain parenchyma, it may also involve the meninges as well, which is termed as 'meningoencephalitis'. From an epidemiologic and pathophysiologic perspective, encephalitis is distinct from meningitis, though on clinical evaluation both can coexist. The clinical presentation is encephalopathy with diffuse or focal neurological symptoms, including behavioural and personality changes, decreased level of consciousness, neck pain/ stiffness, photophobia, lethargy, generalised or focal seizures, acute confusion or amnesic states, and fl accid paralysis. 5 Organisms responsible for bacterial meningitis are Streptococcus pneumoniae, Neisseria meningitis, Group B streptococci, Listeria monocytogens and Haemophilus infl uenza type b. Most patients recover completely if appropriate antibiotic therapy is instituted promptly. Mycobacterium tuberculosis is another major cause, especially in developing countries. Tuberculous meningitis is a critical disease in terms of fatal outcome and permanent sequelae, requiring rapid diagnosis and treatment. 6 The term aseptic meningitis is used for all types of infl ammation of the brain meninges not caused by pusproducing bacteria. It is usually a benign syndrome. Viral and aseptic meningitis are terms used interchangeably as, not only viruses are a major cause, other noninfective causes are equally attributable to the development of meningitis. Worldwide causes of viral meningitis include enterovirus, herpes, mumps, measles and HIV, with enterovirus being the most common cause of viral meningitis.In the emergency setting differentiating bacterial meningitis from other causes, such as fungal, tuberculous, viral, Background Although there are numerous studies on meningitis and encephalitis separately, literature on meningoencephalitis is sparse. In this study we analysed the clinical pro le of meningoencephalitis and its clinical outcome.Methods Fifty adults diagnosed with meningoencephalitis from July 2014 to July 2015 in a tertiary care hospital in South India were studied prospectively and their clinical presentation, aetiology and outcome were analysed.Results Among 50 patients, 33 (66%) were male; 39 (78%) were <50 years of age. Fever was the most common presenting symptom in 41 out of 50 patients (82%), followed by headache (74%) and altered sensorium (62%); only 18 patients (36%) had all three classical symptoms. Twenty-eight out of 50 patients (56%) did not have neck stiffness. A majority of patients had acute-to-subac...
Background: Gastro esophageal reflux disease is the commonest pathologies encountered by gastroenterologist in day to day practice. Longstanding and untreated gastro esophageal reflux disease can lead to many complications including adenocarcinoma. This study was conducted to evaluate the various symptoms and to analyze the lifestyle and dietary factors influencing gastro esophageal reflux disease which can be modified.Methods: Hundred patients with gastro-esophageal reflux disease of age more than 18 years were enrolled in the study. Various patient details including demographic details, lifestyle information and symptomatology data were analyzed and compared with complications.Results: Mean age of gastro esophageal reflux disease patients was 56.09±15.93 years. Gastro esophageal reflux disease is more prevalent in males than females. Gastro esophageal reflux disease is more frequent in BMI <25, greater number of co morbidities and in non-vegetarians. Mean age of gastro esophageal reflux disease with complications was 67±11.53 years and without complications was 52.64±15.57 years. No strong association of smoking, alcohol, spicy foods, fried foods, citrus fruits, heavy meals, tea/coffee, aerated drinks, sleep disturbance and effect on work was identified in gastro esophageal reflux disease.Conclusions: Classical symptoms of gastro esophageal reflux disease were not present in all the patients. Higher age of the patient infers higher risk of complications. Daily episodes of heartburn, regurgitation and retrosternal chest pain implies higher risk of complications. Presence of Helicobacter pylori in gastro esophageal reflux disease patients signify higher risk of complications.
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