Background: Leukocytosis, predominantly neutrophilia has previously been described following ST elevation myocardial infarction (STEMI). The exact contribution of this phenomenon to the clinical outcome of STEMI is yet to be shown. We examined cellular inflammatory response to STEMI in the blood by assessing total neutrophil count (TNC), neutrophil to lymphocyte ratio (NLR) and Left ventricular ejection fraction (LVEF) post myocardial infarction and their association with inhospital mortality and/or adverse clinical events. Methods: In this cross-sectional study, 50 patients who were admitted with the diagnosis of acute STEMI at Government medical college and Hospital, Amritsar were studied. The complete blood cell count (CBC) was done in all patients within12-24 hours of the onset of symptoms. Total leukocyte count and differential leukocyte count were performed and neutrophil/lymphocyte ratio (NLR) was calculated. Left ventricular ejection fraction was assessed within one week of MI. Association of cellular response and ejection fraction with the incidence of post-MI mortality/complications like pulmonary edema, cardiogenic shock, arrhythmias and blocks were assessed by using ROC curve analysis and chi square test. Results: In-hospital mortality and post-STEMI complication rate were 8% and 42%, respectively. Total neutrophil count (P=0.029) and Neutrophil to lymphocyte ratio (P=0.001) were predictors of mortality. High NLR (P<0.001) and lower LVEF (P<0.001) were predictors of total complications and cardiogenic shock. Pump failure in the form of acute pulmonary edema (6%) or cardiogenic shock (8%) occurred in 7 (14%) patients. Higher total neutrophil counts (P=0.009), higher NLR (P<0.001) and lower ejection fraction (P<0.001) were predictors of pulmonary edema. The frequency of ventricular tachyarrhythmias (VT/VF) at the first day was associated with higher NLR level (P=0.029).High TNC and low LVEF were predictors for first degree heart block and high NLR was predictor for third degree heart bock and left bundle branch block. Conclusion: A single CBC analysis along with routinely assessed parameter i.e. ejection fraction may help to identify STEMI patients at risk for mortality and heart failure, while neutrophil to lymphocyte ratio is the most valuable in predicting both.
Gram-negative bacilli (GNB) are most frequently isolated bacteria from ascitic fluid aspirate of patients with Spontaneous bacterial peritonitis (SBP). Aetiology of SBP has been changing in recent years with increased involvement of multidrug resistant (MDR) bacteria as a result of production of various β-lactamases. The present study was done for detection of different β-lactamases and their co-existence by noveldisc placement method among GNB isolates from patients with SBP. Disc panel containing ceftazidime (CA), ceftazidime/tazobactam (CA/TZ), cefepime (CFP), ceftazidime/ tazobactam/ cloxacillin (CA/TZ/CLOX), imipenem (IMP) and Mercaptopropionic acid (MPA) was used. Pureextended spectrum β-lactamase (ESBL) production was found in 18 of 42 isolates (42.86%). Maximum ESBL positive isolates were found in E.coli (13 out of 28 isolates).Pure AmpC production was found in 6 of 42 isolates (14.28%).Metallo-βlactamases (MBL) production was found in only 2 of 42 isolates (4.76%). Co-production of ESBL+ AmpC was seen in 3 of 42 isolates (7.145). All ESBL positive isolates showed multidrug resistance pattern. Detection of β-lactamase producing isolates will provide knowledge regarding resistance pattern of bacterial strains in a particular geographical area. This will further help promote appropriate and judicious use of antibiotics.
Introduction: Spontaneous Bacterial Peritonitis (SBP) is common and serious complication of patients with liver cirrhosis and ascites, without an apparent surgically treatable intra abdominal source of infection. Its prevalence ranges from 10% to 30%. Mortality rate was earlier reported more than 90%, but it has now reduced to 30%-50% as a result of rapid diagnosis and prompt initiation of antibiotics. The present study was done to evaluate the various non culture methods for the diagnosis of SBP. Material and Methods: Ascitic fluid sample were collected aseptically from 100 cirrhotic patients with ascites. PMN (polymorphonuclear leukocyte) count was determined by Neubauer's manual counting chamber and Leishman's stain for differential PMN cell counts. Granulocyte esterase activity was detected using LER (Leukocyte esterase reagent) dipstick strips. Results: Out of 100 samples processed, PMN cell count > 250 cells/mm 3 was found in 91% samples by conventional light microscopy. Scale of > 2+ by LER strip was found in 61 samples. Reading of PMN cell count of > 250 cells/mm 3 matched in 60 samples and < 250 cells/mm 3 matched in 8 cells by both microscopy and LER strip test. Sensitivity, specificity, positive predictive value and negative predictive value of LER strip test was 65.9%, 88.89%, 98.36% and 20.51% respectively. Conclusion: LER strips as a screening tool for SBP have advantage of speed, low cost, availability at odd hours, requires no technical expertise and can be performed everywhere. Its high specificity and PPV may help in early institution of empirical antibiotic therapy in patients.
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