Background Neonatal sepsis is a major contributor to neonatal mortality in India. Blood culture, the gold standard for the diagnosis of sepsis takes 48–72 h while the serological markers have suboptimal diagnostic test characteristics. Perfusion index (PI) is a real time, non-invasive marker that can detect microcirculatory changes before other clinical manifestation of sepsis. Objective To determine the diagnostic accuracy of PI in detecting hospital-acquired sepsis before overt clinical manifestations. Study design A prospective observational study conducted in the Neonatal Intensive Care Unit (NICU) of a tertiary care hospital. Participants Preterm neonates admitted to NICU. Methods PI was continuously monitored in all enrolled neonates. Clinical sepsis was defined using the NeonatalKrankenhaus-Infektions-Surveillance-System (NeoKISS). The time of fall of PI below 0.88 and time of clinical sepsis as per NeoKISS were noted and the difference was calculated. Results Among 65 preterm neonates (gestational age: 31.5 ± 2.6 weeks, birth weight: 1350, IQR 1100–1700 g), a total of 86 events of suspected sepsis were noted, of which 69 were sepsis screen positive. Fifteen events were associated with culture positive sepsis. PI yielded a sensitivity of 89.47% (95% CI 78.48–96.04%), specificity of 56% (95% CI 34.93–75.60%), positive predictive value of 82.26% (95% CI 74.70–87.92%) and negative predictive value of 70% (95% CI 50.36–84.29%) in detection of hospital-acquired sepsis. Conclusion PI might serve as an early, non-invasive marker of hospital-acquired sepsis in preterm neonates.
Statin use has been linked with new-onset diabetes mellitus (NODM). In the present systematic review, we aimed to determine the incidence of NODM with statin use by assessing and summarizing the data generated by different systematic reviews and metaanalyses published on this topic. We conducted a systematic review of systematic reviews and meta-analyses using a pre-defined study protocol. Two authors independently performed a literature search using PubMed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies reporting data on statin use and NODM incidence and screened and extracted data for the outcomes of interest. The Assessing the Methodological Auality of Systematic Reviews 2 (AMSTAR 2) checklist was used to evaluate the quality of the included systematic reviews and meta-analyses. The initial search yielded 621 potential records, and 16 relevant systematic reviews and meta-analyses were included in the present systematic review. The included studies showed an increase in the risk of NODM with statin use. In particular, rosuvastatin and atorvastatin were associated with NODM in many systematic reviews or meta-analyses; however, pravastatin and pitavastatin were found to be associated with lower or no risk. We observed a positive trend of development of NODM with statin use became more evident with advancing years as more number of studies were added. Intensive doses of statins and use in older subjects were found to be important risk factors for NODM. Finally, the quality assessment revealed that the included systematic reviews and metaanalyses were of critically low or low quality. We concluded that statin use carries a risk of causing NODM. Statins should not be discouraged in anticipation of NODM. However, glycaemic monitoring should be encouraged with the on-going statin therapy. Furthermore, clinical studies addressing the use of statins and the incidence of NODM as their primary objective should be planned.
Background and Objective: In India, widely consumed food items are rarely supplemented with vitamin D3. Indians do not take use of unlimited sunshine which can synthesize vitamin D in their body. Deficiency of vitamin D can lead to rickets, osteoporosis along withcardiovascular diseases, asthma, diabetes mellitus, cancer and autoimmune diseases. It was planned to estimate vitamin D (25-OH- Vitamin D3) in normal population. Methods: 25-OH-Vitamin D3 was estimated in three hundred males with equal number of females with the age range of 2- 80 years. They were divided into four groups depending upon their age. In 53.7% of normal population was found to be having vitamin D lower than 30 ng/ml. The deficiency was more prevalent in females as compared to males. Vitamin D level was significantly lower at the age groups of 2-20 and at 61-80 than other groups (i.e. 21-40 and 41-60 years).Interpretation: Most Indians do not get adequate sun exposure to produce required amount of vitamin D. People use sunscreen and to have fairer complexion, they avoid having use of sunshine. The public needs to be made aware of benefits of vitamin D. JMS 2016; 19(1):18-20
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