BackgroundUniversal human immunodeficiency virus (HIV) screening remains low in many clinical practices despite published guidelines recommending screening for all patients between ages 13–65. Electronic clinical decision support tools have improved screening rates for many chronic diseases. We designed a quality improvement project to improve the rate of universal HIV screening of adult patients in a Midwest primary care practice using a clinical decision support tool.MethodsWe conducted this quality improvement project in Rochester, Minnesota from January 1, 2014 to December 31, 2014. Baseline primary care practice HIV screening data were acquired from January 1, 2014 to April 30, 2014. We surveyed providers and educated them about current CDC recommended screening guidelines. We then added an HIV screening alert to an existing electronic clinical decision support tool and post-intervention HIV screening rates were obtained from May 1, 2014 to December 31, 2014. The primary quality outcome being assessed was change in universal HIV screening rates.ResultsTwelve thousand five hundred ninety-six unique patients were eligible for HIV screening in 2014; 327 were screened for HIV. 6,070 and 6,526 patients were seen before and after the intervention, respectively. 1.80 % of eligible patients and 3.34 % of eligible patients were screened prior to and after the intervention, respectively (difference of −1.54 % [−2.1 %, −0.99 %], p < 0.0001); OR 1.89 (1.50, 2.38). Prior to the intervention, African Americans were more likely to have been screened for HIV (OR 3.86 (2.22, 6.71; p < 0.001) than Whites, but this effect decreased significantly after the intervention (OR 1.90 (1.12, 3.21; p = 0.03).ConclusionsThese data showed that an electronic alert almost doubled the rates of universal HIV screening by primary care providers in a Midwestern practice and reduced racial disparities, but there is still substantial room for improvement in universal screening practices. Opportunities for universal HIV screening remain abundant, as many providers either do not understand the importance of screening average risk patients or do not remember to discuss it. Alerts to remind providers of current guidelines and help identify screening opportunities can be helpful.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0320-5) contains supplementary material, which is available to authorized users.

BACKGROUND Neonatal sepsis is one of the major causes of morbidity and mortality in neonates. The spectrum of bacterial pathogens causes Neonatal sepsis and their antibiotic sensitivity patterns vary from hospital to hospital. The objectives of this study is to detect the bacterial profile in Neonatal sepsis and their antibiotic sensitivity pattern in neonates admitted in our Neonatal Intensive Care Unit (NICU). MATERIALS AND METHODSThis is a descriptive study carried out in the NICU of Department of Paediatrics-Andhra Medical College-King George HospitalVisakhapatnam between July 2016 and December 2016 (6 months). During the study period, blood specimens for culture were drawn from 304 patients admitted for suspected Neonatal sepsis. Neonates were evaluated for bacterial aetiological agents by blood culture and their antimicrobial sensitivity pattern was analysed. RESULTSThe Blood culture was positive in 51.97% (158/304) of neonates with suspected sepsis, of which 59.49% (94/158) isolates were Gram-negative organisms. The common isolates were Klebsiella (25.95%), S. aureus (20.25%) and E. coli (13.29%). Both Gramnegative and Gram-positive organisms were found resistant to commonly used antibiotics such as Ampicillin, Cefotaxime and Ceftriaxone. Majority of the isolates in our study showed highest sensitivity to Piperacillin + Tazobactam, Gentamicin and Cefoperazone + Sulbactam. CONCLUSIONOur study revealed Gram-negative organisms constituted the major group of isolates and Klebsiella being the most predominant organism causing neonatal sepsis in our institute. Both Gram-negative and Gram-positive organisms were found resistant to commonly used antibiotics. Hence, we suggest the institute should formulate an antibiotic policy regarding rational use of antibiotics and implement a surveillance programme on antibiotic resistance.

BACKGROUNDScrub typhus is an important cause of acute febrile illness caused by Orientia tsutsugamushi with uncertain pathogenesis, but presents as a systemic vasculitis like infection resulting in wide range of clinical manifestations and complications. Though it is endemic in many parts of India, Scrub typhus is grossly underdiagnosed partly because of lack of awareness among clinicians and partly due to poor availability of standardized diagnostic tests in tropical areas. We studied the clinical and epidemiological profile of paediatric scrub typhus patients.

BACKGROUND: Cutis laxa (Dermatomegaly) -rare heterogeneous group of an orphan disease related to connective tissues, affecting many organ systems of human body requiring a multidisciplinary approach.

CONTEXT (BACKGROUND)India accounts for highest number of annual births (25.6 million) and neonatal deaths (0.76 million or 30% global burden). There is paucity of published data on new born health care from our country. We studied the morbidity profile of newborns admitted in our NICU. MATERIAL AND METHODSThis retrospective study on the morbidity profile of newborns was conducted at Neonatal Intensive Care Unit (NICU) of a tertiary care teaching hospital -King George Hospital, Visakhapatnam between May 2014 and April 2016 (2 years). All neonates admitted in our NICU during the above period were reviewed regarding place of birth, gestational age, birth weight, primary diagnosis at admission and other associated comorbidities. AIMTo study the morbidity profile in our NICU, a tertiary care teaching hospital during 2 years study period. RESULTSIn the present study, the data of 5755 neonates who were admitted in our NICU were analysed. Out of them 2994 (52.02%) were inborn and 2761 were out-born (47.98%). In our study population slight male preponderance, more number of pre-term babies (3513, 61.05%) that too gestational age between 34-37 weeks (2299, 39.95%) occupied the major share. In our study, the major cause of morbidity was RDS 1127 (19.58%) followed by HIE/birth asphyxia 1053 (18.30%), neonatal jaundice 920 (15.99%), sepsis 673 (11.70%) and miscellaneous causes 784 (13.62%) out of 5755. In our study, about 81 babies (1.41%) had major congenital malformations.

BACKGROUNDScrub typhus (Tsutsugamushi fever) is a zoonotic disease among Rickettsial infections, wherein man is an accidental host. Scrub typhus is an important and widespread cause of acute febrile illness in rural areas of Asian and Northern Australia. In the preantibiotic era, the mortality rates as high as 42% were reported. Scrub typhus is very responsive to treatment with timely and appropriate antibiotics. The disease still causes a significant rise of death in rural areas, where effective treatment is unavailable or delayed. Scrub typhus is grossly underdiagnosed, especially in India due to lack of awareness among clinicians and also due to lack of diagnostic tests. In our study, we studied the investigatory profile and treatment outcome in paediatric Scrub typhus patients.

Context (Back ground) Acute Rheumatic fever and Rheumatic heart disease are the most common acquired childhood heart disease in India. It is well established that 2 D Echo cardiography is more sensitive in picking up minor degrees of valvular regurgitation than clinical examination. AIMS & OBJECTIVES:To study the clinical profile of "Rheumatic Fever and Rheumatic heart disease" & correlate it with Echocardiographic findings in Children under 15 years age group presenting to a tertiary care hospital. MATERIALS AND METHODS OF STUDY: Thirty six cases of Acute Rheumatic fever, which includes eight cases of first attack and twenty eight cases of reactivation of Rheumatic fever were studied over a period of two years in paediatric medical wards, King George Hospital, Visakhapatnam. The revised (1992) modified Jones criteria with the 1988 WHO modification was taken as a criterion to diagnose Acute Rheumatic fever. RESULTS: Peak age of Acute Rheumatic fever and Chronic Rheumatic heart disease is between 5-10 years (55.8%). No sex variation has been observed. Fever and joint involvement are the most common clinical manifestations (87.5%each) in first attack cases. Active carditis (75%) the second most common manifestation, followed by arthralgia (25%) and sore throat (25%), chorea, chest pain, abdominal pain were infrequent manifestations found to be 12.5% each. None of the cases had Erythema marginatum. CONCLUSION: In the present study the clinical findings were correlated with that of previous studies and Echocardiographic findings were correlated well as far as moderate to severe lesions. Further Echocardiography was proved to be more sensitive in detecting even trivial or mild aortic regurgitation and mitral or aortic stenosis.

BACKGROUND:Apert syndrome is a rare autosomal dominant Mendelian disorder characterized by a set of recognizable patterns of human malformations, having paediatric, plastic surgical, Ortholpaedic and Dental implications requiring early recognition & effective management strategies for good Cosmetic and functional out-come.