Multidrug-resistant sepsis (MDR) is a pressing concern in intensive care unit (ICU) settings, specifically among geriatric patients who experience age-related immune system changes and comorbidities. The aim of this review is to explore the clinical impact of MDR sepsis in geriatric ICU patients and shed light on healthcare challenges associated with its management. We conducted a comprehensive literature search using the National Center for Biotechnology Information (NCBI) and Google Scholar search engines. Our search incorporated keywords such as “multidrug-resistant sepsis” OR “MDR sepsis”, “geriatric ICU patients” OR “elderly ICU patients”, and “complications”, “healthcare burdens”, “diagnostic challenges”, and “healthcare challenges” associated with MDR sepsis in “ICU patients” and “geriatric/elderly ICU patients”. This review explores the specific risk factors contributing to MDR sepsis, the complexities of diagnostic challenges, and the healthcare burden faced by elderly ICU patients. Notably, the elderly population bears a higher burden of MDR sepsis (57.5%), influenced by various factors, including comorbidities, immunosuppression, age-related immune changes, and resource-limited ICU settings. Furthermore, sepsis imposes a significant economic burden on healthcare systems, with annual costs exceeding $27 billion in the USA. These findings underscore the urgency of addressing MDR sepsis in geriatric ICU patients and the need for tailored interventions to improve outcomes and reduce healthcare costs.

Introduction: Newborn screening (NBS) is an essential public health initiative for early diagnosis of inborn errors of metabolism (IEM), where timely intervention can reduce morbidity and mortality. While routine in developed countries, NBS is not widely practised in India. This study aimed to implement NBS programme in a tertiary care hospital in South India and validate predetermined cut-off values tailored to the regional population. Methods: Between 2020 and 2022, 5157 neonates were screened for congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH), cystic fibrosis (CF), glucose-6-phosphate dehydrogenase (G6PD) deficiency (G6PDD), phenylketonuria (PKU), galactosemia and biotinidase deficiency. Screening was performed using dissociation-enhanced lanthanide fluorescent immunoassay technology on Victor2D platform (Revvity). Markers assessed included 17-α-OH progesterone, neonatal thyroid stimulating hormone, total galactose, immunoreactive trypsinogen, G6PD enzyme, biotinidase enzyme and phenylalanine levels. Data analysis was conducted using R V.4.1.1 software. Results: Of the 5157 neonates, the recall rates were consistent with those reported in similar studies. However, only 26.7% of screen-positive newborns returned for retesting, indicating a significant gap in awareness about IEMs and the importance of follow-up. Of these, none were diagnosed with CAH; however, four were found to have CH, two had galactosemia, three had G6PDD, one had CF, one had PKU and none had biotinidase deficiency. The confirmed cases were promptly treated and monitored regularly. The distribution of each marker’s values fell within 2.5th–97.5th percentiles suggesting consistency. Conclusion: The reference ranges provided by the manufacturer appear valid in the Indian context. A key challenge identified was low follow-up compliance for screen-positive infants, highlighting the need for enhanced public education on IEM and NBS. Future research will focus on determining the incidence of IEMs and improving parental awareness and follow-up rates.

Context Venous or arterial blood is used for the estimation of electrolytes in neonates in neonatal intensive care unit (NICU). In addition to the measurement of blood gases and bicarbonate in the arterial blood, arterial blood gas analysis also estimates electrolytes thus circumventing the need to collect a venous sample for electrolytes. The literature survey revealed studies comparing the electrolyte levels in arterial and venous blood in adults and older children, but to our knowledge none were found in neonates, hence the study. Aims The aim of the study is to compare the electrolytes in arterial and venous samples in neonates in a critical care set up and derive in-house prediction equation to correlate the arterial and venous electrolytes. Settings and Design Hospital-based, retrospective cross-sectional study done in critically ill neonates. Materials and Methods All the newborns (age ≤28 days) admitted in NICU from July 2016 to June 2018 were selected for the study and data collected with the help of Hospital Information System. Statistical Analysis MedCalc and NCSS 12 (trial version) software was used. Deming Regression and Bland Altman analysis were performed. Results A strong positive correlation between the arterial and venous blood electrolytes observed. An in-house prediction equation was derived for the venous electrolytes. Deming regression analysis showed that only potassium levels are statistically equivalent between the instruments and the sample type. Bland Altman Analysis between the arterial and venous electrolytes showed a mean difference which was well within the accepted Clinical Laboratory Improvement Amendment guidelines. Conclusion The electrolyte levels estimated by arterial blood in neonates can be used in an interchangeable manner only for potassium levels, whereas sodium and chloride estimation necessitates one to be cautious.

Introduction: This study aimed to identify laboratory errors at the earliest through Sigma-metric analysis and to evaluate quality management of analytical processes. Methods: Sigma-metrics and Quality Goal Index (QGI) were calculated by harvesting the IQC and EQC data of an accredited laboratory for 31 biochemical parameters run on Roche Cobas6000 and e411. Those with Sigma ≤ 2 were further analysed by applying the various Westgard rules, as suggested Results: Nearly 13 chemistry analytes showed world-class performance with Sigma >6 and most of the immunoassay parameters showed marginal performance with sigma >2 ≤ 6. Sodium, Chloride, Total T4, Beta-HCG and TSH were found to have Sigma <2 indicating unacceptable performance. A significant improvement was observed in the Sigma-metrics analysis after performing the root cause analysis Conclusion: Sigma-metric analyses the quality management of various analytical processes in biochemistry. The poor assay performance will be picked up by the Root cause analysis and Quality Goal Indices calculation. With the help of RCA and QGI, we plan to increase the resource management by decreasing the frequency of QC runs.

Background: Premenstrual dysphoric disorder (PMDD) is a condition that affects nearly 3–9% of the women in the reproductive age during the luteal phase of each menstrual cycle characterized by symptoms varying in severity and affecting the quality of life. Earlier research studies conducted have reported independent relationships between PvuII-ESR1-polymorphism and psychological traits in PMDD and risk for cognitive, behavioral, and affective symptoms. However, as the studies are few in number and the results are not consistent, there is a need for our study to link between the PvuII-ESR1gene and PMDD. Methodology: All nonpregnant women aged between 18 and 45 years and attending the OBG or Medicine or Psychiatry OPD for a routine health checkup were recruited into the study. The cross-sectional study recruited 35 samples each in the control and PMDD groups using a validated screening PMDD Assessment Scale Questionnaire (PMDDASQ). Mann–Whitney’s U test and Chi-square test were used to calculate P values for the continuous and categorical variables. Tetra-primer–amplification refractory mutation system–polymerase chain reaction was used to identify the PvuII-ESR1gene polymorphism after isolation of genomic DNA from the whole blood. Results: Data-Analysis Pak tool and Med-Calc software were used for data analysis. The PvuII-ESR1 genotype distribution was in Hardy–Weinberg equilibrium in both PMDD and controls. The PMDDASQ scoring showed a significance with P ≤ 0.05. Pearson’s Chi-Squared test performed for genotypes and alleles did not show any significant association with the phenotype. Conclusion: PvuII-ESR1 SNP (T/C rs2234693) does not show any association with phenotype between the control and PMDD. However, PMDDAS questionnaire can be used to differentiate the women who are controls from PMDD.