Arijit Majumdar

A web-based electronic health care system for the treatment of pediatric HIV

HIV infection is one of the major health problems in todays world, especially in a developing country like India. The impact of HIV on the pediatric population is no less dreadful. Pediatric HIV is a subset of HIV which requires special attention. Efficient information management is one of the key issues in pediatric HIV treatment. Electronic Health Record (EHR) plays an important role in patient information management. In India, there is no availability of EHR system in the current Government hospital setup for pediatric HIV. To meet this requirement we have developed a web based EHR system to support treating pediatric HIV. The EHR is developed based on an existing web based telemedicine system iMedik, developed at IIT Kharagpur. In this paper we discuss the basic requirements to design an EHR for the treatment of pediatric HIV in India and how our proposed system fulfills those requirements to deliver better patient care. We also discuss different features of the EHR, system architecture and the security aspects of the system.

Importance of normal values of CSF parameters in term versus preterm neonates

Background: Evaluation of the cerebrospinal fluid (CSF) white blood cell (WBC) count and glucose and protein concentrations is used to assess the probability of the presence of central nervous system (CNS) infection. Although normal values are well established for CSF cell counts and protein and glucose contents in children and adults, this is not the case for neonates. Aims: The purpose of this study was to evaluate the composition of noninfected CSF obtained by nontraumatic lumbar puncture in neonates (age<28 days), specifically distinguishing CSF profiles of those term babies compared with those premature infants. Materials and Methods: The CSF samples obtained by lumbar puncture from 120 neonates were examined by routine procedures. Results: By comparing CSF parameters between term gestation neonate group with premature neonate one, nontraumatic puncture, there was no statistically significant difference (P<0.05) in the mean WBC (P=0.6). The mean protein concentration was significantly greater in those premature neonates (P<0.04). The mean glucose concentration was also analogous in both groups (P=0.5). Conclusion: The CSF profile, like any other laboratory determination, should be evaluated within the clinical context of the individual case.

Importance of medium time in case of device-associated infection

Background: Intensive Therapeutic Units (ITUs) are unfortunately the epicenters of hospital acquired infection (HAIs). Limited data is available regarding the burden of HAIs in Indian ITU, especially median time of its detection, prevalent organisms and its resistance patterns. We conducted a prospective surveillance aimed to determine the occurrence of device associated infections (DAIs) rate, magnitude of device associated infection cases per 1000 bed days, incidence of infections per 1000 device days and median time for detection of DAIs. Study population was taken from a 25 bedded intensive therapeutic unit (ITU), of a government teaching hospital in India. Methods: A prospective cohort study was performed over two years duration from June 2011 to May 2013. Total 596 patients who were admitted in the ITU for more than 48 hours were followed until discharge. CDC/NNIS system definitions for DAIs were used and rates were calculated. Data were analyzed with descriptive statistics. Results: Cumulative incidence rate of HAIs was 23.15 (138/596) and isolated DAIs was 19.96 (119/596). There was high device utilization mainly for urinary catheter (.838) and IV catheter (.742) than ventilator (.310) but the incidence density was more in ventilator associated infection(VAP-7.38%) than catheter associated urinary tract infection (CAUTI-7.21%) and catheter related blood stream infection (CRBSI-5.37%). Chi-square value for MV(mechanical ventilation) was found 42.59 (<0.001) and ODD Ratio (OR) was 6.8 at CI 3.44-13.67. For urinary catheter(UC) and IVCatheter Chi-square value was 1.13 and 1.94. OR was 1.67 (0.61-4.93) and 4.71 (0.67-94.03). Median time of acquiring VAP, UTI, BSI were maximum in between (9 to 11 days), (17 to 20 days) and (12 to 14) days respectively; indicates requirement of regular follow up of devices within thisZ periods. Major pathogens for VAP Klebsiella (28%), Acinetobacter(26.3%) and Pseudomonus (21%). For CAUTI Staphylococcus aureus (18.7%), pseudomonas and Klebsiella (14.6%) each. CRBSI mainly by gram positive Staphylococcus aureus (24.2%) and Coagulase negative Staphylococcus (12.1%), Acinetobacter (18.2%) and Staphylococcus aureus (15.2%). Conclusion: Although the distribution of pathogens was similar to previous reports, a high rate of device associated infection in ITU can be prevented by regular follow-up of devices, early change of invasive devices within its median time of infection or to avoid unnecessarily prolong use.

Diagnostic outcome of bone marrow aspiration in a pediatric center in Kolkata, India

Objectives: To study the spectrum of hematological disorders in children at a tertiary care centre in Kolkata, India. Settings: This study was conducted at the department of Paediarics and the department of Pathology of Dr. B. C. Roy PGIPS, Kolkata. The study period was from January 2012 to December, 2014. Methods: A retrospective analysis of charts of those patients who underwent bone marrow examination (aspiration) was made. Charts were analyzed in detail regarding history, examination and investigations. All findings were entered on a standard proforma. Results: BMA from 200 patients were analyzed. Nutritional anemia contributed highest number of cases among the nonneoplastic group. Acute lymphoblastic leukemia was the commonest malignant hematological disorder in the present study. Conclusion: Common haematologic disorders in our setting are nutritional anaemias and leukaemias. There is need to expand the scope of laboratory investigations beyond morphology.

Device-associated infection rates and median length of acquiring device-associated infection in an intensive therapeutic unit of an Indian hospital

Background: Hospital acquired infection (HAIs) nowadays is one of the leading causes of mortality in the ITU. Limited data is available regarding burden of HAIs specially device associated infections (DAIs) in Indian ITU. This study was aimed at determining the occurrence of DAIs including magnitude of device associated infections per 100 hospital admission, magnitude of device associated infection cases per 1000 bed days, incidence of infections per 1000 device days, median time for detection of DAIs, prevalent organisms and their antibiogram. Patients included in this study were taken from a 25 bedded intensive therapeutic unit (ITU), in a hospital in India. Methods: A prospective surveillance was performed over two years duration from July 2011 to June 2013. 578 patients were followed until discharge who admitted to this ITU and stay for more than 48 hours. HAIs were identified according to the CDC/NNIS definition. Data were analyzed with descriptive statistics. Results: The incidence rate for DAIs was 19.55%(113/578). More than 50% were associated with different comorbid illness mainly malignancy (47%). The device utilization was very high in case of urinary catheter (0.838) and IV catheter (0.742) but the incidence density was maximum in case of ventilator associated pneumonia (VAP = 13.89%). Median time of acquiring VAP, CAUTI, CRBSI were maximum in between (9 to 14 days), (16 to 21 days) and (12 to 17) days respectively demands need for regular follow up of this devices within that periods. Major pathogens for VAP were Klebsiella (28.95%), Acinetobacter (26.3%); CA-UTI mostly caused by E. coli (18.2%). CRBSI mainly caused by MRSA (25.9%), Acinetobacter (18.5%). Conclusion: A high rate of device associated infections, particularly VAP, were observed in this study. One of the main strategy to prevent nosocomial infections in the ITU is early change of invasive devices based on its median time of infection and to avoid its unnecessary prolong use.

Alpha fetoprotein producing adenocarcinoma, a rare but unique subtype of gastric epithelial malignancy

Hepatoid adenocarcinoma is one of the rarest tumors of the stomach. These tumors produce alpha-fetoprotein (AFP), which can be used as a diagnostic marker. The prognosis is poor compared to conventional adenocarcinoma of the stomach. A case of AFP-producing hepatoid adenocarcinoma stomach in a 55-year-old woman is presented. The patient underwent partial gastrectomy. We focus on the clinical features, imaging, histopathological and biochemical characteristics of the hepatoid variety of adenocarcinoma stomach.

Hematologic scoring system (HSS): A guide to decide judicious use of antibiotics in neonatal septicemia in developing countries

Background: Septicemia is one of the major causes of neonatal morbidity and mortality. Objective- The objective of our study was to determine the role of hematologic scoring system (HSS) in early diagnosis of neonatal septicemia and provide an effective guideline in decision making regarding judicious use of antibiotics. Materials and Methods: The study was done taking 60 neonates admitted in the hospital. The hematological parameters were studied in all of them. Blood cultures were performed as gold standard for diagnosing septicemia. Results: Analysis of the hematologic profiles in the light of the HSS found that an abnormal immature to total neutrophil (I:T) ratio followed by an abnormal immature to mature neutrophil (I:M) ratio were the most sensitive indicators in identifying infants with sepsis. The study also found that the higher the score the greater the certainty of sepsis being present. The score ≥ 4 was more reliable as a screening tool than any individual hematological parameter. Conclusion : HSS is rapid, easy to perform, cost-effective screening tool for early diagnosis of neonatal sepsis and thereby helps in making of decisions regarding judicious use of antibiotics.