Effect of vitamin D replacement in chronic obstructive pulmonary disease patients with vitamin D deficiency

Introduction: Vitamin D deficiency is prevalent among patients with chronic obstructive pulmonary disease (COPD) and comes to be more frequent with increased disease severity. We aimed to assess the role of vitamin D supplementation in patients with severe COPD. Patients and methods: We studied 30 patients with severe COPD and vitamin D deficiency. All patients received oral vitamin D3 50,000 IU once weekly for 8 weeks, followed by a daily dose of 800 IU thereafter. Pulmonary function tests, six minute walk test (6MWT), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), C-reactive protein (CRP), and serum vitamin D level were assessed at the start of the study and 1 year later. The frequency of exacerbations was recorded a year before and a year after vitamin D supplementation. Results: The mean serum vitamin D level was 11.80 ± 2.40 ng/dl and reached 55.30 ± 5.65 ng/dl a year after vitamin D intake (p < 0.001). We found a significant improvement in dyspnea scale (p < 0.003), 6MWT (p < 0.001), MVV (p < 0.001), MIP (p = 0.006), MEP (p < 0.001), coupled with a decrease in disease exacerbations (p < 0.001) and CRP (p < 0.001) a year after vitamin D replacement. However, the FEV1 and FVC did not differ significantly. Conclusion: Vitamin D replacement improved dyspnea, physical performance and decreased the frequency of exacerbation in severe COPD patients with vitamin D deficiency

CT-guided biopsy versus conventional Abram’s needle biopsy in malignant pleural effusion

Objective: We aimed to evaluate CT guided biopsy (CTGB) vs. standard closed pleural biopsy (CPB) in the histopathological diagnosis of the type of malignancy in patients with malignant pleural effusion. Patients and methods: We studied 31 patients (21 male and 10 female) with malignant pleural effusion diagnosed by aspiration cytology and admitted to the medical ward of a general teaching hospital over a period of 1 year. Patients were randomized into two groups: group 1 (n = 16) underwent CTGB biopsy and group 2 (n = 15) underwent Abram’s CPB. The diagnostic yield of both methods was compared. Results: The mean age of patients was 54 ± 16 years. History of smoking was obtained in 15 (48.4%) patients. Dyspnea was reported in 22 (71%) and chest pain in 15 (48.4%). Malignant pleural effusion was left-sided in 17 (54.8%), and massive in 21 (67.7%) patients. Of note, CT imaging revealed parietal pleura as a tumor site in 20 (64.5%) patients. Pathological diagnosis of the type of malignancy was achieved in 14 (87.5%) of group 1 using CTGB and 6 (40%) of group 2 patients using Abram’s CPB. The diagnostic value of CTGB was significantly higher than CPB (P = 0.009). Conclusion: CT-guided biopsy was found to be a reliable and safe method in the histopathological diagnosis of malignant pleural effusion. Its diagnostic potential was much superior to the standard closed pleural biopsy

Device-associated infection rates, bacterial resistance, length of stay, and mortality in Kuwait: International Nosocomial Infection Consortium findings

To report the results of the International Infection Control Consortium (INICC) study conducted in Kuwait from November 2013-March 2015. A device-associated health care–acquired infection (DA-HAI) prospective surveillance study in 7 adult, pediatric, and neonatal intensive care units (ICUs) using the U.S. Centers for Disease Control and Prevention's (CDC's) National Healthcare Safety Network (NHSN) definitions and INICC methods. We followed 3,732 adult and pediatric patients for 21,611 bed days and 671 neonatal patients for 4,515 bed days. In the medical-surgical ICUs, the central line–associated bloodstream infection (CLABSI) rate was 3.5 per 1,000 central line days, the ventilator-associated pneumonia (VAP) rate was 4.0 per 1,000 mechanical ventilator days, and the catheter-associated urinary tract infection (CAUTI) rate was 3.3 per 1,000 urinary catheter days; all of them were lower than INICC rates (CLABSI: 4.9; VAP: 16.5; and CAUTI: 5.3) and higher than NHSN rates (CLABSI: 0.9; VAP: 1.1; and CAUTI: 1.2). Resistance of Staphylococcus aureus to oxacillin was 100%, resistance of Acinetobacter baumannii to imipenem and meropenem was 77.6%, and resistance of Klebsiella pneumoniae to imipenem and meropenem was 29.4%. Extra length of stay was 27.1 days for CLABSI, 22.2 days for VAP, and 19.2 days for CAUTI in adult and pediatric ICUs. Extra crude mortality was 19.9% for CLABSI, 30.9% for VAP, and 11.1% for CAUTI in adult and pediatric ICUs. DA-HAI rates in our ICUs are higher than the CDC-NSHN rates and lower than the INICC international rates

Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of ventilator-associated pneumonia in intensive care units of two hospitals in Kuwait

Objective: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach (IMA) on ventilator-associated pneumonia (VAP) rates in three intensive care units (ICUs) from two hospitals in Kuwait City from January 2014 to March 2015.Design: A prospective, before-after study on 2507 adult ICU patients. During baseline, we performed outcome surveillance of VAP applying CDC/NHSN definitions. During intervention, we implemented the IMA through the INICC Surveillance Online System (ISOS), which included: (1) a bundle of infection prevention interventions; (2) education; (3) outcome surveillance; and (4) feedback on VAP rates and consequences. Logistic regression analysis was performed to estimate the effect of the intervention on VAP, controlling for potential bias.Results: During baseline, 1990 mechanical ventilator (MV)-days and 14 VAPs were recorded, accounting for 7.0 VAPs per 1000 MV-days. During intervention, 9786 MV-days and 35 VAPs were recorded, accounting for 3.0 VAPs per 1000 MV-days. The VAP rate was reduced by 57.1% (incidence-density ratio = 0.51; 95% CI = 0.28-0.93; p = 0.042). Logistic regression showed a significant reduction in VAP rate during the intervention phase (OR = 0.39, 95% CI = 0.18-0.83), with 61% effectiveness.Conclusions: Implementing IMA through ISOS was associated with a significant reduction in the VAP rate in Kuwait ICUs.Fil: Al Mousa, Haifaa Hassan. Ministry of Health; KuwaitFil: Omar, Abeer Aly. Ministry of Health; KuwaitFil: Rosenthal, Víctor Daniel. International Nosocomial Infection Control Consortium; ArgentinaFil: Salama, Mona Foda. Mubarak Al Kabir Hospital; Kuwait. University of Mansoura; EgiptoFil: Aly, Nasser Yehia. Farwaniya Hospital; Kuwait. University of Alexandria; EgiptoFil: El Dossoky Noweir, Mohammad. Farwaniya Hospital; KuwaitFil: Rebello, Flavie Maria. Mubarak Al Kabir Hospital; KuwaitFil: Narciso, Dennis Malungcot. Mubarak Al Kabir Hospital; KuwaitFil: Sayed, Amani Fouad. Farwaniya Hospital; KuwaitFil: Kurian, Anu. Farwaniya Hospital; KuwaitFil: George, Sneha Mary. Farwaniya Hospital; KuwaitFil: Mohamed, Amna Mostafa. Farwaniya Hospital; KuwaitFil: Ramapurath, Ruby Jose. Farwaniya Hospital; KuwaitFil: Varghese, Suga Thomas. Farwaniya Hospital; KuwaitFil: Orellano, Pablo Wenceslao. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. International Nosocomial Infection Control Consortium; Argentina. Universidad Tecnológica Nacional; Argentin

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN