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Nelson G.E.,Johns Hopkins University | Mave V.,Johns Hopkins University | Mave V.,BJMC Clinical Trials Unit | Gupta A.,Johns Hopkins University
BioMed Research International | Year: 2014

Sepsis is a serious infection and still a common cause of morbidity and mortality in resource-limited settings such as India. Even when microbiologic diagnostics are available, bacteremia is only identified in a proportion of patients who present with sepsis and bloodstream infections. Biomarkers have been used in a variety of disease processes and can help aid in diagnosing bacterial infections. There have been numerous biomarkers investigated to aid with diagnosis and prognostication in sepsis with the majority suffering from lack of sensitivity or specificity. Procalcitonin has been heralded as the biomarker that holds the most promise for bloodstream infections. Data are emerging in India, and in this review, we focus on the current data of biomarkers in sepsis with particular attention to how biomarkers could be used to augment diagnosis and treatment in India. © 2014 George E. Nelson et al.


Jubulis J.,Johns Hopkins University | Jubulis J.,Maine Medical Center | Kinikar A.,Byramji Jeejeebhoy Medical College BJMC | Ithape M.,BJMC Clinical Trials Unit | And 10 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2014

SETTING: India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases. OBJECTIVE: To assess the association between novel modifiable risk factors and TB in Indian children. DESIGN: Cases were children aged ≤5 years with c onfirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged ≤5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (IAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2). RESULTS: Sixty cases and 118 controls were enrolled.Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03-91.81), household food insecurity (aOR 11.55, 95%CI 3.33-40.15) and IAP exposure (aOR 2.67, 95%CI 1.02-6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38-2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and IAP remained associated with TB. CONCLUSIONS: Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB. © 2014 The Union.

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