ABSTRACT
Background: Significant burn injuries induce a state of immunosuppression that predisposes patients to infectious complications, thus the rate of nosocomial infections are higher. Rapidly merging multidrug resistant among the various isolate in indoor burn patients are depending on time-line becoming serious threat for managing therapeutically. Objective of this study is to determine the aetiological factor, prevalence, antimicrobial susceptibility pattern and emerging nosocomial pathogens.Methods: A prospective study was carried in burn ward of K.L.E.’s Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum for the period of 1 year. Pair of wound swab were collected from patient having burnt more than 30% (RULE OF NINE) on 3rd day of stay. Sample were collected aseptically from 30 patients and processed by convectional culture and biochemical identification procedures and tested against commonly used antibiotics.Results: 30 patients that fall under inclusive criteria were enrolled in the study. The total burn surface area (TBSA) ranges from 30-82%. The ratio of female to male patient suffering burn wound in our study is 1.5:1. Aetiology of burn is heat (moist/dry) mostly. Depending upon degree of burn, most of patient suffered from 20 degree (superficial to deep) injury. From 30 swab cultures, 42 isolates were identified during the study in which mixed were 66.66% and one is fungi. The most commonly isolated is Pseudomonas aeruginosa (45.24%) then Klebsiella pneumoniae (19.04%), Acinetobacter spp. (14.28%), Staphylococccus aureus (11.90%). Among gram positive isolates, isolates are found to be most resistant to Erythromycin (100%) and Co-trimoxazole (100%) and sensitive to Vancomycin (71.42%). Among gram negative isolates are found to be most resistant to Gentamicin (91.65%), Ciprofloxacin (82.35%), Ceftazidime (82.35%) and sensitive to Meropenem (52.95%), Piperacillin (35.30%), Carbenicillin (29.41%).Conclusions: Pseudomonas aeruginosa was found to be the most common isolate. The nature of microbial wound colonization and flora changes with time should be taken into consideration in empirical antimicrobial therapy.
ABSTRACT
Background: Healthcare Associated Infections (HAIs) are a major cause of high morbidity, disability, mortality and rising costs for health systems. Preventing the HAI risk by planning and implementing effective preventive strategies is important to safeguard patient health. Handwashing is one of the fundamental measures for preventing transmission of hospital-acquired infections.Methods: This cross-sectional observational study was conducted in the surgical ICU from January to February 2018 to evaluate the presence of adhesion to the different aspects of HH. Inclusion criteria included all nurses and allied healthcare workers of surgical ICU while all other HCWs were excluded. Two observers collected all HH data. During this analysis, 3000 HH opportunities were observed. HH compliance was tested for all 5 moments as per WHO guidelines. Data thus collected were entered into a computer-based spreadsheet for analysis using SPSS statistical software (version 20) (IBM Corp., NY, USA).Results: Overall hand hygiene compliance observed as per WHO Guidelines was 79.8%. Nurses had an adherence rate of 77.8%; allied staff adherence was 81.8%. Nurses’ compliance after touching patient surroundings was lowest at 60.7%. 96% staff was aware of the facts like diseases prevented by hand washing, ideal duration of HH, reduction of health care associated infections.Conclusions: Overall, the involved ICUs showed low levels of adherence to best hygiene practices with overall compliance of 79.2%. This suggests the need to implement immediate strategies for infection control in the ICUs. A multidisciplinary intervention could be effective in preventing and control the HAI risk.
ABSTRACT
BACKGROUND: Gemcitabine plus cisplatin has been established as a standard chemotherapy regimen for advanced biliary tract cancers (BTCs) based on the phase III UK ABC-02 study, which included all types of biliary cancers. There is very limited data regarding the effectiveness of known chemotherapeutic regimens especially in IHCC. METHODS: Records of 63 patients diagnosis of IHCC who received Gemcitabine and Carboplatin (G-C Regimen) chemotherapy as a first line were retrospectively reviewed. The primary aim of this study was to assess the response rate of gemcitabine carboplatin-based chemotherapy as a first line therapy in advanced intrahepatic cholangiocarcinoma (IHCC). The secondary objectives were to assess toxicity, progression free survival and overall survival. RESULTS: There were 38 men and 25 women in our study with a median age of 56.75 years (range 31–78 years). Of the 38+25= 63 patients, 21 patients (33.8%) progressed, 5 patients (8.06%) had complete response, 25 patients (40.3%) had partial response, 12 patients (19.3%) had stable disease. Overall response rate was 48.36% and tumor control rate was 67.6%. Progression free survival was 5.3 months and overall survival of 10.3 months was seen. The most common grade 3–4 toxicities were anemia, neutropenia, and thrombocytopenia. Most common nonhematological toxicity was fatigue. CONCLUSION: Gemcitabine in combination with carboplatin has activity against advanced IHCC. Our results are comparable with other gemcitabine carboplatin studies as well as gemcitabine cisplatin-based studies.
ABSTRACT
Hepatic Osteodystrophy (HO) is a generic definition for the metabolic bone disease that may occur in individuals with chronic liver disease. Hepatic Osteodystrophy is an important but frequently overlooked complication, seen in chronic liver disease patients. This review article illustrates its significance, various causes and methods to diagnose this complication and recent advances and recommendations to treat Hepatic Osteodystrophy. Two distinct bone metabolic processes, osteoporosis (OP) and osteomalacia (OM) are combined together in various proportions in HO syndromes. It has been described in association with most types of chronic liver disease both cholestatic and non-cholestatic. Primary biliary cirrhosis (PBC) is the condition causing osteopenia more frequently, but other cholestatic liver diseases like primary sclerosing cholangitis (PSC), haemochromatosis and alcoholic liver disease are also frequently associated with this disorder. The pathogenesis of bone disease in both adults and children with chronic cholestasis is not completely understood. There has been considerable disagreement regarding the relative importance of osteomalacia versus osteoporosis as the factors leading to osteopenia of liver disease. It can significantly affect morbidity, and quality of life of these patients. Fractures are also associated with an excess mortality. Bone mineral density measurement is the best way to assess the presence and severity of osteopenia in CLD patients, while laboratory tests give important information about the metabolic status of the bone. Since advanced HO is difficult to treat and adversely affects both the quality of life and the long-term prognosis of patients with chronic liver disease, special care is required in order to prevent the development of clinical bone disease in individuals with advanced hepatic disease. Conclusion: Hepatic Osteodystrophy is under-recognized and less attended complication of CLD. Multiple factors contribute to the development of hepatic Osteodystrophy. Newer diagnostic modalities have improved the detection of HO and Vitamin D repletion, calcium supplementation and Bisphosphonates seem promising. The best course of management for these patients is to review the individual risk factors for osteoporosis, obtain a bone mass measurement, and prescribe age and disease-specific therapies.