Difficult weaning in delayed onset diaphragmatic hernia

Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI) can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support

Difficult weaning in delayed onset diaphragmatic hernia

Diaphragmatic injuries are relatively rare and result from either blunt or penetrating trauma. Regardless of the mechanism, diagnosis is often missed and high index of suspicion is vital. The clinical signs associated with a diaphragmatic hernia can range from no outward signs to immediately life-threatening respiratory compromise. Establishing the clinical diagnosis of diaphragmatic injuries (DI) can be challenging as it is often clinically occult. Accurate diagnosis is critical since missed DI may result in grave sequelae due to herniation and strangulation of displaced intra-abdominal organs. We present a case of polytrauma with rib fracture and delayed appearance of diaphragmatic hernia manifesting as difficult weaning from ventilatory support

Emergency treatment of a snake bite: Pearls from literature

Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. This occupational hazard is no more an issue restricted to a particular part of the world; it has become a global issue. Accurate statistics of the incidence of snakebite and its morbidity and mortality throughout the world does not exist; however, it is certain to be higher than what is reported. This is because even today most of the victims initially approach traditional healers for treatment and many are not even registered in the hospital. Hence, registering such patients is an important goal if we are to have accurate statistics and reduce the morbidity and mortality due to snakebite. World Health Organization/South East Asian Region Organisation (WHO/SEARO) has published guidelines, specific for the South East Asian region, for the clinical management of snakebites. The same guidelines may be applied for managing snakebite patients in other parts of the world also, since no other professional body has come up with any other evidence-based guidelines. In this article we highlight the incidence and clinical features of different types of snakebite and the management guidelines as per the WHO/SEARO recommendation

Effect of Bamboo Essential Oil on the Oxidative Stability, Microbial Attributes and Sensory Quality of Chicken Meatballs

This study explores the efficacy of bamboo essential oil (BEO) incorporated at 15 ppm (T1, BEO-I) and 30 ppm (T2, BEO-II) on the overall physicochemical and oxidative stability, microbial deterioration, and sensory acceptability of meatballs stored for 20 days under refrigerated conditions. Analysis of various parameters, including physicochemical quality, color (CIE L*, CIE a* and CIE b*), generation of oxidative products (TBARS), microbial growth, and sensory acceptability of meatballs were evaluated at 5-day intervals. In addition, the total phenolics and flavonoid content of BEO were estimated, and fatty acids were determined by Gas chromatography (GC.) To gain insights into the biological activities of the BEO, antioxidant assays were determined in vitro using various methods. The antibacterial activity of BEO was also evaluated against Gram-positive (Staphylococcus aureus and Bacillus subtilis) and Gram-negative (Vibrio cholera, Salmonella Typhimurium, Shigella flexneri, Proteus vulgaris, Escherichia coli and Klebsiella pneumoniae) bacterial strains. The BEO contained a good quantity of total phenolics and flavonoids. In addition, the oil exhibited very potent antioxidant activity scavenging reactive oxygen and other such species, effectively showing IC50 at a very minimal concentration. Further, the BEO exhibited a strong antibacterial effect with MICs within 2 µL and MBCs from 5 to 7 µL for Gram-positive as well as Gram-negative bacteria, respectively. At both the concentrations used, BEO did not show any negative effect on the color of cooked meatballs but rather increased the microbiological and oxidative stability during the overall storage period. Meatballs treated with BEO had considerably reduced oxidative changes in terms of TBARS levels compared to the control. The total viable microbial count was lowest in BEO-treated meatballs and the highest in control. Both control and treated meatballs had a desirable flavor and good acceptability. The sensory attributes and aroma of treated meatballs were better and acceptable during the storage study, whereas the control samples were disliked by the panelists on 15th day. From this study, it can be concluded that bamboo essential oil could be used as a benign and non-toxic preservative to improve the quality and shelf life of cooked meatballs stored under refrigerated conditions

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically