Etiology and outcome of severe community acquired pneumonia in immunocompetent adults.

BACKGROUND: Community Acquired Pneumonia (CAP) is a commonly encountered disease, one third of which is Severe Community Acquired Pneumonia (SCAP) that can be potentially fatal. There is a paucity of data on etiology and outcome of patients with SCAP in South Asian Population. METHODS: A retrospective cross-sectional study was conducted from March 2002 till December 2008 on patients of 16 years and above who were admitted with the diagnosis of SCAP in accordance to the criteria of American Thoracic Society Guidelines (2001). The patients underwent clinical and diagnostic evaluations to detect the severity of illness as well as the etiology and other risk factors influencing the eventual outcome of SCAP. RESULTS: A total of 189 patients were included in the study. The mean age was 60 ± 18.0 years and 110 (58%) patients were males. The most common isolated pathogens were Staphylococcus aureus (15 patients), Streptococcus pneumoniae (14 patients) and Pseudomonas aeruginosa (9 patients). The highest mortality was seen in patients with Pseudomonas aeruginosa (89%) and Staphylococcus aureus (53%). Overall mortality rate was 51%. On univariate analysis, septic shock (p \u3c0.001), prior antibiotic use (p = 0.04), blood urea nitrogen \u3e 30 mg/dl (p = 0.03), hematocrit \u3c 30% (p = 0.03) and Acute Physiology and Chronic Health Evaluation (APACHE) II score \u3e 20 (p \u3c 0.001) were significantly different between the patients who survived as compared to those who did not. On multivariate analysis, septic shock (p \u3c0.001, OR: 4.70; 95% CI= 2.49-8.87) was found to be independently associated with mortality. CONCLUSION: The microbes causing SCAP in our study are different from the usual spectrum. Staphylococcus aureus and Pseudomonas aeruginosa were the common causative pathogens and associated with high mortality. It is important to establish clinical guidelines for managing SCAP according to the etiologic organisms in our setting

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Interspecific heavy metal variations and bioaccumulation in peafowl (Pavo cristatus)

ABSTRACTThe present study was designed for biomonitoring of heavy metals such as lead (Pb), cadmium (Cd), chromium (Cr), zinc (Zn), nickel (Ni), manganese (Mn) and cobalt (Co) at three selected wildlife parks of Punjab. Soil, water and feed samples analysis revealed the high heavy metals contents in feed (21.59 ± 27.39 and 12.67 ± 23.13) followed by soil (11.80 ± 25.84 and 4.96 ± 10.95) and water (2.93 ± 4.48 and 1.11 ± 1.23) samples at Jallo Wildlife Park and Wildlife Park Bahawalnagar, respectively. At Wildlife Park Murree, heavy metals contamination was recorded highest in feed (10.45 ± 16.35), followed by water (6.26 ± 11.35) and soil samples (5.75 ± 9.54). Feathers samples at all sites showed the highest levels of heavy metals concentrations as 12.21 ± 25.69 at Jallo Wildlife Park, 11.50 ± 25.63 at Wildlife Park Bahawalnagar and 3.35 ± 4.81 at Wildlife Park Murree. Interspecific variation of heavy metals among samples and sites was recorded at P < 0.01, and bioaccumulation of heavy metals in the feathers of captive birds was found in high concentration, making them a good indicator of biomonitoring. In captivity, the birds feeding on homogenous diets and particular environmental conditions can better allow us to understand the bioaccumulation of polymetallic contamination, which can further be generalized to predict the risk of these toxic pollutants on public health