A study on catheter associated blood stream infections at a tertiary care hospital of Bihar

Introduction: Intravascular catheters are indispensable in modern-day medical practice, particularly in intensive care units (ICUs). The incidence of CRBSI varies considerably by type of catheter, frequency of catheter manipulation, and patient related factors (e.g., underlying disease and acuity of illness). Materials and Methods: It was case-control study conducted in the Department of Microbiology, Darbhanga Medical College, Laheriasri, Bihar, India from January 2020 to December 2020. The number of participants in this study was 100 cases and 100 controls. Patients aged >18 yrs, admitted in intensive care units with intravascular catheters, were included. Skin was cleaned with 70% alcohol prior to catheter removal. Drying was avoided by sealing the tube and transporting the same to the laboratory as soon as possible. In blood processing, blood was collected within 48 hours of catheter collection under all aseptic precautions in a BacT bottle and analyzed using the BacT ALERT system. Antibiotic sensitivity pattern was done by Kirby-Bauer disk diffusion method as recommended by Clinical Laboratory Standard Institute (CLSI). Statistical analyses were done using SPSS 16.0 and strength of association is expressed as odds ratio which was derived using logistic regression analysis. Results: Out of 100 samples, 81% of the isolates were bacteria, while 17% of the pathogens were Candida species and only 2% were polymicrobial. While majority (70.4%, 19/27) of the organism of CRBSI was Gram positive, majority (61.6%, 45/73) of the organism of CRLI were Gram negative.The commonest pathogen of CRBSI was Staphylococcus aureus (12/27) and the least common was Acinetobacter baumannii (1/27). Candida spp. Conclusions: The increasing rate of CRBSI is a matter of concern to our hospital set up. This work will help both the clinicians as well as microbiologists in better management of patients as well as in prevention of nosocomial bloodstream infection, especially due to multidrug resistant organisms

Herbal enema: At the cost of colon

Various colonic side-effects of herbal enema have been reported in literature ranging from mild abdominal discomfort to self-limiting haemorrhagic colitis. It rarely requires blood transfusion or subtotal colectomy. We report a 57-year-old male patient developing severe ileo-colitis with persistent massive rectal bleeding immediately after herbal enema administration for the treatment of chronic constipation and was resistant to conservative management. Patient was managed successfully with emergency total laparoscopic colectomy. Post-operative recovery of the patient was excellent

Pharmacological management of neuropathic pain in India: A consensus statement from Indian experts

Neuropathic pain (NeP) constitutes a major pain-related disorder, which is often underdiagnosed and undertreated. Adverse physical, psychological, and economic consequences associated with NeP lead to poor quality of life. Burden of NeP in developing countries like India is colossal. Various international guidelines provide effective approaches to diagnose and manage NeP. However, differences in the genetic makeup of Indian population can result in subtle differences in clinical response, considering their low body weight, drug metabolism ability, and pain perception. Similarly, treatment-related adverse effects may also vary. Practice of Indian physicians may also differ for choice of drugs based on their availability and affordability. In the absence of country-specific guidelines, this document could serve as a guiding tool for health-care providers, ensuring uniformity in the treatment of NeP. Thus, applicability of all recommendations from any of these guidelines in Indian setting demands careful evaluation. Clinical experience of Indian physicians suggests that there are lot many challenges (e.g., busy outpatient departments, nonavailability of screening questionnaires in regional languages, and availability and affordability of medications) faced by them when managing NeP. In addition, in India, there are no country-specific guidelines that would help them to address these challenges. The objective for this consensus was to develop an expert opinion guideline to harmonize the management of NeP in India. The expert panel consisted of experts from various specialties such as pain medicine, anesthesiology, diabetology, neurology, and orthopedics. The panel critically reviewed the existing literature evidence and guideline recommendations to provide India-specific consensus on the management of NeP. The final consensus document was reviewed and approved by all the experts. This expert opinion consensus will help health-care professionals as a guiding tool for effective management of NeP in India. Use of Douleur Neuropathique 4 (DN4) questionnaire for NeP screening should be routine in day-to-day clinical practice. For effective utilization of DN4 questionnaire, it should be converted to regional language. If DN4 questionnaire screening fails to identify NeP, it should not be disregarded and should not replace the sound clinical judgment from the treating physician. Diagnostic tests may be considered as a supplement to clinical judgment. Cost-effective treatment should be the initial choice. Dosing should be individualized based on efficacy and tolerability. Tricyclic antidepressants (TCAs), gabapentinoids, and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be considered among initial choices. Tramadol can be considered as a second-line add-on treatment for NeP if there is partial response to the first-line agent either alone or in combination. Fixed-dose combination (FDC) of gabapentinoids such as pregabalin (75 mg) with TCA such as nortriptyline (10 mg) is synergistic and improves treatment adherence. Among other treatments, Vitamin B12 (methylcobalamin) can be used either alone or in combination for the management of NeP. Use of Vitamin D and steroids should be limited to specific NeP in individual cases. Referral to pain specialists can be considered if two drugs fail to provide relief in NeP