Incidence, determinants and outcomes of ventilator associated pneumonia in medical intensive care unit: a prospective cohort study from South Western India

Background: Ventilators are being increasingly used in developing countries as a result of which complications like ventilator associated pneumonia is also increasing. Present study is being undertaken to evaluate the impact of risk factors and their changing trends for Ventilator associated pneumonia.Methods: A prospective observational study was conducted in mechanically ventilated patients of medical intensive care unit from October 2013 to April 2015.Results: In present study 166 patients receiving mechanical ventilation in a medical ICU were observed. Incidence of VAP in present study is 43.5 for 1000 days of mechanical ventilation. The risk factors that were significant in the study are organ failure (p=0.001), emergency intubation (p=0.001), reintubation (p=0.023) and COPD (p=0.026). The common organisms responsible for VAP were Acinetobacter (30%), Klebsiella pneumoniae (27.1%) and Pseudomonas aeruginosa (20%). The mortality was higher in VAP group (31.3%) compared to the non VAP group (15.7%).Conclusions: There is high incidence of VAP in the developing countries. The risk factors that were found to be associated with VAP in the present study were the presence of COPD, reintubation, organ failure and emergency intubation. VAP is associated with significantly increased duration of hospital stay, morbidity and mortality

Quantitative analysis of heart type fatty acid binding protein in early detection of acute coronary syndrome

Background: Coronary heart disease is a major cause of mortality, morbidity and disability in developed countries. Even though coronary heart disease mortality rates worldwide have reduced over the past five decades, coronary heart disease is the major cause of death in one-third of people more than 35 years of age.Many risk factors and biomarkers have been studied in the past and research is on in detecting the acute coronary syndrome at the earliest so that reperfusion therapy can be undertaken as early as possible to save the life of patients. Heart-type fatty acid binding protein is a newer modality of investigation developed for the above purpose.Methods: Single centre cross-sectional observational study was conducted from 1 September 2017 to May 2019 with an aim to study novel cardiac biomarker h-FABP in patients with acute coronary syndrome and compare sensitivity and specificity of the same with that of troponin -T in the early detection of acute coronary events after fulfilling inclusion and exclusion criteria .The data of 80 patients were collected after getting informed consent. The clinical, demographic and investigations were performed as per the hospital protocol and such patients were recorded in the proforma. The additional test heart-type fatty acid binding protein is performed in the triage by collecting patient’s serum and by using point of care analysis machine. Statistical analysis was performed using SPSS version 20.0 and results were obtainedResults: Out of 80 patients selected males were 35 and female are 45. Chest pain was present in 58 people, dyspnoea was in 28, sweating in 40 people, 35 had anterior wall MI, 30 had Inferior wall MI and 15 had global hypokinesia. Median values of h-FABP values were 82 ng/dl, 53.2 ng/dl, 35.3 ng/dl at 0-6 hours, 6-12 hours, and 12-24 hours respectively after the onset of symptoms with a significant p< 0.001. There were major differences between median values between different time groups of symptoms onset. Median troponin T values were 0.061 ng/ml, 0.350 ng/ml, 1.56 ng/ml after 0-6 hours, 6-12 hours and 12-24 hours of onset of symptoms respectively. There was no correlation between h-FABP and troponin-T values.Conclusions: h-FABP rises early in coronary events in first 6 hrs of onset of symptoms of ACS serum levels of h-FABP decreases as time progresses in 24 hours. In comparison troponin-t levels continue to rise as time progresses. h-FABP serum levels can be used as novel marker for early detection of ACS

Post COVID-19 Guillain Barre syndrome with syndrome of inappropriate secretion of antidiuretic hormone

Guillain Barre syndrome (GBS) is a rare but potentially fatal immune mediated disorder of peripheral nerves and nerve roots usually triggered by infections characterized by ascending paralysis with or without sensory symptoms, hyporeflexia to areflexia. Usually preceded by gastrointestinal or respiratory infection. Post COVID-19 neurological manifestation include GBS, transverse myelitis etc., occur at varying incidence rates at various places. Here we report a 42-year-old lady who had COVID-19 recovered presented with quadriparesis with absent deep tendon reflexes with electro-diagnostically proven AMSAN variety of GBS treated successfully with IVIg. Patient was having hyponatremia which was diagnosed to be due to SIADH and was successfully treated with fluid restriction and tolvaptan. This case is being reported due to combination of COVID-19, COVID vaccination shortly before GBS and hyponatremia due to syndrome of inappropriate secretion of antidiuretic hormone (SIADH) which is quite rare combination

MRSA: the leading pathogen of orthopedic infection in a tertiary care hospital, South India

Background: The rate of infection is high and heterogeneous in developing countries. This study aimed to find the rate and pattern of infection in a tertiary care hospital with a goal to improve the infection control practices.Methods: The study was conducted in the orthopedic units of a multispecialty teaching hospital. Medical records of major orthopedic surgery adult patients without immunosuppression state were included. The bacterial culture report of the wound swabs were noted over a period of one year. The bacterial culture testing was performed by a recommended method.Results: Among 2,249 orthopedic surgery patients, 83.7% were males, 49.1% had open wounds during admission and 32.2% patients were infected. Majority (64.2%) of the injuries were in the lower limb with 19.4% patients having undergone multiple surgeries during hospitalization. A total of 946 pathogens were grown from 725 specimens. Staphylococcus aureus was the max- imum (48.4%) followed by Pseudomonas aeruginosa (26.3%) and E coli (16.7%). Among them, 57.3% were Methicillin Resistant Staphylococcus aureus (MRSA) and was the leading pathogen causing infection among orthopedic patients.Conclusion: MRSA infection was high. Consequent to this, an interventional program entitled ‘Extended Infection Control Measures' was designed to reduce the burden of infection.Keywords: MRSA, orthopedic, infection, South India

ACENOCOUMAROL OR WARFARIN: WHICH IS THE CLINICIAN'S ALLY?

ABSTRACTWarfarin and acenocoumarol are commonly prescribed oral anticoagulant drugs that are used in the prevention and treatment of thromboembolicdisorders across the world. Although both these drugs act by a similar mechanism, there are significant differences between them, especially in termsof their half-lives, and more importantly, in their variability in response pharmacogenetically. This case report highlights an instance wherein warfarinproved to provide a much more stable anticoagulant cover, as compared to that provided by acenocoumarol.Keywords: Thrombosis, Bleeding, Antiphospholipid antibody syndrome, Anticoagulant, International normalized ratio

Multidrug and extensively drug-resistant tuberculosis from a general practice perspective

Despite intensive efforts to eradicate the disease, tuberculosis continues to be a major threat to Indian society, with an estimated prevalence of 3.45 million cases in 2006. Emergence of multidrug-resistant tuberculosis has complicated eradication attempts in recent years. Incomplete and/inadequate treatment are the main causes for development of drug resistance. Directly observed therapy, short-course (DOTS) is the World Health Organization (WHO) strategy for worldwide eradication of tuberculosis, and our country achieved 100% coverage for DOTS through the Revised National Tuberculosis Control Program in 2006. For patients with multidrug-resistant tuberculosis, the WHO recommends a DOTS-Plus treatment strategy. Early detection and prompt treatment of multidrug-resistant tuberculosis is crucial to avoid spread of the disease and also because of the chances of development of potentially incurable extensively drug-resistant tuberculosis in these cases. This review discusses the epidemiologic, diagnostic, and therapeutic aspects of multidrug-resistant tuberculosis, and also outlines the role of primary care doctors in the management of this dangerous disease

A RARE INSTANCE OF DIASTASE/PEPSIN–INDUCED HYPERSENSITIVITY REACTION

Diastase/Pepsin combination supplements are very commonly prescribed in clinical practice, mainly in the adult population. The chief indication for such use is indigestion or dyspepsia, wherein concomitant medication with proton pump inhibitors and antiemetics is also advised. Hypersensitivity reactions, though theoretically plausible with the use of digestive enzymes, there are no cases reported in the medical literature, to the best of our knowledge. This is one such case of hypersensitivity secondary to the administration of digestive enzymes in an adult Indian male. Keywords: Digestive enzymes, Rash, Maculopapular, Allerg

MRSA: the leading pathogen of orthopedic infection in a tertiary care hospital, South India

Background: The rate of infection is high and heterogeneous in developing countries. This study aimed to find the rate and pattern of infection in a tertiary care hospital with a goal to improve the infection control practices. Methods: The study was conducted in the orthopedic units of a multispecialty teaching hospital. Medical records of major orthopedic surgery adult patients without immunosuppression state were included. The bacterial culture report of the wound swabs were noted over a period of one year. The bacterial culture testing was performed by a recommended method. Results: Among 2,249 orthopedic surgery patients, 83.7% were males, 49.1% had open wounds during admission and 32.2% patients were infected. Majority (64.2%) of the injuries were in the lower limb with 19.4% patients having undergone multiple surgeries during hospitalization. A total of 946 pathogens were grown from 725 specimens. Staphylococcus aureus was the maximum (48.4%) followed by Pseudomonas aeruginosa (26.3%) and E coli (16.7%). Among them, 57.3% were Methicillin Resistant Staphylococcus aureus (MRSA) and was the leading pathogen causing infection among orthopedic patients. Conclusion: MRSA infection was high. Consequent to this, an interventional program entitled \u2018Extended Infection Control Measures' was designed to reduce the burden of infection. DOI: https://dx.doi.org/10.4314/ahs.v19i1.12 Cite as: Latha T, Anil B, Manjunatha H, Chiranjay M, Elsa D, Baby N, et al. MRSA: the leading pathogen of orthopedic infection in a tertiary care hospital, South India. Afri Health Sci. 2019;19(1). 1393-1401. https://dx.doi.org/10.4314/ahs.v19i1.1

Effect of balance strategies on fall risk in type 2 diabetes mellitus with peripheral neuropathy: a systematic review and meta-analysis

Individuals with type 2 diabetes mellitus with peripheral neuropathy are at a high risk of developing unsteadiness and falls. This systematic review and meta-analysis evaluated the effect of balance strategies on fall risk in these conditions. Records from six electronic databases were reviewed. Only randomized control trials focusing on balance strategies and outcomes linked to fall risk were included. Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Of 2,373 studies, 8 were in-cluded. Risk-of-bias analysis showed that 6 were of good quality, 1 was fair, and 1 was of poor. Meta-analysis of 4 outcome measures was conducted. A meta-analysis of the Berg balance scale (MD 1.08, 95% CI 0.42, 3.19), the functional reach test in centimeters (MD 3.82, 95% CI 0.82, 6.83), the timed up and go test in seconds (MD −1.41, 95% CI −2.14, −0.69), and the one-leg stance test in seconds (right eye open: MD 7.86, 95% CI 1.97, 13.94; left eye open: MD 6.14, 95% CI 2.64, 9.64; right eye closed: MD 2.45, 95% CI 0.61, 4.28; and left eye closed: MD 1.80, 95% CI 0.86, 2.75) It suggested that balance strategies improve fall risk in diabetic neuropathy. The meta-analysis also showed low to very low evidence of a large effect on all the outcomes. The findings of this review show that balance strategies positively influence balancing abilities and reduce fall risk in type 2 diabetes mellitus with peripheral neuropathy

METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS CARRIAGE AMONG HEALTH-CARE PROFESSIONALS OF A TERTIARY CARE HOSPITAL

 Objective: The aim of this study was to find the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carrier status in anterior nares and hands of health-care professionals working in orthopedic wards of a tertiary care hospital and to decolonize them to reduce spread of MRSA to their patients.Methods: The study was conducted in a super specialty, tertiary care teaching hospital. The samples were collected from anterior nares, palm, web spaces, and fingertips of 140 health-care professionals (48 doctors, 74 nurses, and 18 technicians) working in orthopedic wards using sterile pre-moistened swabs. MRSA carrier status was identified by Kirby-Bauer disc diffusion method.Result: Most (76.4%) of the health-care professionals were <30 years of age and 51% were male. MRSA in anterior nares of doctors was 4.3%, nurses 1.4%, and technicians 0.7% and none had MRSA in their hands. Methicillin-sensitive Staphylococcus aureus (MSSA) growth was more among nurses (nurses - 5.7%, doctors - 2.1%, and technicians - 1.4%) in anterior nares. In addition, 1.4% nurses' hands were colonized with MSSA. Both MRSA and MSSA carriers were decolonized effectively and repeat sampling showed no growth.Conclusion: Health-care professionals have a greater chance of transmitting MRSA to patients and orthopedic patients are more susceptible for infection. Although MRSA carrier status was not very high among orthopedic health-care professionals compared to previous studies, it cannot be ignored. Nasal mupirocin and bath with chlorhexidine soap were effective in decolonization. Periodic screening and treatment of colonizers would help in elimination of MRSA carriage