Enteral Nutritional supplementation in mechanically ventillated patients with organophosphorus poisoning: A randomized controlled trial

AIM : To study the effect of early enteral nutritional supplementation in intubated patients with OP posioning admitted to the medical ICU of a tertiary care hospital. METHODS : Design of study: Randomized controlled trial, not blinded. Outcomes: The primary outcome was the frequency of hospital acquired infections. Secondary outcomes were mortality, duration on ventilator, length of stay and feeding related complications. RESULTS : The difference in total calories recieved was statistically significant. The primary and secondary outcomes were assessed in 59 patients. There were no differences in the rate of hospital acquired infections between the two groups. Stratification of patients according to average daily caloric intake also failed to demonstrate any benefit for the higher calorie group. Duration of stay in ICU and in hospital, and duration on ventilator showed insignificant trends towards better results for those patients not enterally fed. Tracheostomy was associated with prolonged hospital stay in both groups. Mortality was not affected by enteral feeding. Feeding related complications were less common than in other studies. Early enteral feeding was found to be safe in this population. CONCLUSION: In patients admitted with organophosphorus poisoning needing mechanical ventilation, early enteral nutritional supplementation is safe but is not associated with improvement in incidence of infectious complications or mortality. It may prolong the duration on ventilator and the length of stay

Carcinoma of gall bladder presenting as dermatomyositis

Cancer-related muscle diseases are usually paraneoplastic disorders. Dermatomyositis (DM) is a type of inflammatory myopathy that is strongly associated with a broad range of malignant disorders. The malignancy can occur before, concomitantly or after the onset of myositis. The malignancies most commonly associated with DM are carcinomas of ovary, lung, stomach, colorectal and pancreas, as well as non-Hodgkin′s lymphoma. An association of DM with carcinoma of the gall bladder (GB) is extremely rare with only two previously reported cases in the literature. We report a case of carcinoma of GB with DM as the paraneoplastic manifestation

Enterococcal Bacteremia is Associated with Prolonged Stay in the Medical Intensive Care Unit

Background: Although enterococci are relatively common nosocomial pathogens in surgical intensive care units (ICUs), their significance in blood cultures from patients in the medical ICU is unclear. Materials and Methods: In this retrospective study spanning 2 years, the clinical and microbiological characteristics of enterococcal bacteremia among medical ICU patients were evaluated. Results: Of 1325 admissions, 35 with enterococcal bacteremia accounted for 14.8% of positive blood cultures. They were significantly older (P=0.03) and had various co-morbidities. Most had vascular (96.9%) and urinary (85.3%) catheters, and 67.7% were mechanically ventilated. In addition to blood, enterococci were isolated from vascular catheters (8.6%) and other sites (20%), while no focus was identified in 77% of patients. Prior use of broad-spectrum antimicrobials was nearly universal. All isolates tested were sensitive to vancomycin and linezolid. Resistance to ampicillin and gentamicin were 44.7% and 52.6%, respectively. Compared with other medical ICU patients, patients with enterococcal bacteremia had a longer ICU stay (P<0.0001) and a trend toward higher ICU mortality (P=0.08). Conclusions: Enterococcal bacteremia is an important nosocomial infection in the medical ICU, with a predilection for older patients with multiple comorbidities. Its occurrence is associated with a significantly longer ICU stay and a trend to a higher mortality. The choice of antibiotics should be dictated by local susceptibility data

Carcinoma of gall bladder presenting as dermatomyositis

Cancer-related muscle diseases are usually paraneoplastic disorders. Dermatomyositis (DM) is a type of inflammatory myopathy that is strongly associated with a broad range of malignant disorders. The malignancy can occur before, concomitantly or after the onset of myositis. The malignancies most commonly associated with DM are carcinomas of ovary, lung, stomach, colorectal and pancreas, as well as non-Hodgkin’s lymphoma. An association of DM with carcinoma of the gall bladder (GB) is extremely rare with only two previously reported cases in the literature. We report a case of carcinoma of GB with DM as the paraneoplastic manifestation