Multidrug Resistant Acinetobacter in Patient with Ventilator Associated Pneumonia: Review Article.

Acinetobacter is a complex genus, with multiple species. Acinetobacterspecies are the common etiology of nosocomial infections, principally nosocomial pneumonia catheter-associated bacteremia and urinary tract infections. Multidrug Resistant (MDR) Ventilator Associated Pneumonia (VAP) by Acinetobacter spp is increasingly reported from different parts of the world. Transmission of Acinetobacter is aid by the organism's environmental stubbornness, resistance to desiccation and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. is primarily by evasion of rapid clearance by the immune system. The capsular polysaccharide is a critical virulence factor that enables immune evasion and lipopolysaccharide triggers septic shock. Conversely, the primary factor of clinical outcome is antibiotic resistance. Acinetobacter spp. has become a discreditable threat for patients on mechanical ventilation. Considering high rate of antibiotic resistance, new preventive and therapeutic alternative pproach for MDR Acinetobacter spp. infections are urgently needed. Worldwide drug esistance in Acinetobacter baumannii is growing. This review article is emphasised on incidence of VAPdue to MDR Acinetobacter, phenotypes, genotypes, associated risk factors and preventive strategy

Clinical Profile and Outcome of H1N1 Influenza Infection at a Tertiary Care Teaching Hospital.

Background: The 2009 flu outbreak in humans, knownas "swine influenza" or H1N1 influenza A, refers toinfluenza A due to a new H1N1 strain called SwineOrigin Influenza Virus A (S-OIV). Global pandemicswith high mortality and morbidity occur when avirulent new viral strain emerges. Aim and Objectives:To study demography, clinical profile and outcome ofH1N1 influenza infection at a tertiary care teachinghospital. Material and Methods: This was aprospective observational study conducted at theteaching hospital during six month period. It was a timest bound study over a period of six months (from 1 Julyth 2018 to 30 December 2018). All suspects with throatswab/nasal swab positive for influenza H1N1 virus byReverse Transcriptase Polymerase Chain Reaction(RT-PCR) with age more than 15 years were includedin the present study. Data were analysed for mean,percentage, standard deviation and Chi square test forquantitative data by using Microsoft Excel spreadsheet. Results: A total 60 patients were admitted withconfirmed diagnosis of H1N1 infection. Out of the 21(35%) were males and 39 (65%) were females,predominated by female gender (p=0.001). The meanage in male (46.14 ± 20.058) was relatively morecompared to female gender (36.33 ± 11.50). The malegender had more co-morbidities and risk factorscompared to female patients (p=0.01) and wasstatistically significant. Out of total 21 male patients 7patients died because of bilateral pneumonia and AcuteRespiratory Distress Syndrome (ARDS) and MultiOrgan Dysfunction (MOD) with case fatality rate of33.33%. Out of total 39 female patients 5 patients diedwith case fatality rate of 12.82%. Conclusion: Thepresent study highlighted the disease burdenassociated with H1N1 infection. The advancing age,male gender, associated co-morbidities and delayedpresentation were the risk factors for mortality inpresent cohort study of H1N1 patients. The communityawareness, early case detection and timelymanagement can reduce the disease burden at large

Study of Electrolyte Disturbances in Dengue Infected Patients

Introduction: Dengue is the most common arboviral diseaseworldwide and is usually endemic, but several epidemics havebeen recorded. Dengue fever is associated with electrolytedisturbances.Material and methods: This study was a cross sectional,descriptive and non interventional study conducted onpatients of Dengue fever, during the period of 18 monthsbetween October 2016 to March 2018 in a tertiary care centre.This study was conducted to find relation between electrolytedisturbances in patients with dengue fever.Results: The majority of the patients 136 (67.32%) weremales while 66 (32.67%) were female patients. The majorityof patients 84.65% were with Dengue fever and 14.35%patients were with Dengue hemorrhagic fever and 0.99%patients were with Dengue shock syndrome. Hyponatremiaand hypokalemia was the frequent electrolyte disturbancesfound in dengue patients. The mean value of serum sodiumwas 133.92mEq/L and of serum potassium was 3.62mEq/L.There exists a positive and significant correlation betweendifference in serum sodium (r = 0.38) and potassium levels(r = 0.41) with Dengue clinical syndrome (DF, DHF, andDSS) which implies that as the difference between the levelsincreases, greater are chances of the Dengue fever towardsDHF or DSS.Conclusions: Hyponatremia was the most frequent electrolytedisturbance and hyperkalemia was least common observed inpatients with Dengue viral infection. Mild hyponatremia andmild hypokalemia were more common among patients ofDengue fever whereas moderate and severe hyponatremia andhypokalemia were more common among Dengue hemorrhagicfever (DHF) and Dengue shock syndrome (DSS).

Amoebic Liver Abscess in Newly Detected HIV Infection

Amoebic Liver Abscess (ALA) is a most commonextraintestinal manifestation of amoebiasis which ismost commonly present with high grade fever withright upper quadrant abdominal pain. Here we present acase of 32 year male patient newly diagnosed as PeopleLiving with HIV/AIDS (PLHIV) with ALA. Patientwas treated with Metronidazole (500 mg 8 hourly) andtherapeutic drainage.

A Study of Serum Uric Acid Levels in Type 2 Diabetes Mellitus Subjects: A Cross Sectional Study

Introduction: Diabetes mellitus is one of the major noncommunicable diseases of which world is experiencing aserious epidemic these recent years. Uric acid serves as anearly indicator of renal complications in diabetes mellituspatients.Material and methods: This was an Observational,descriptive cross sectional study which was conducted duringa period of 18 months (October 2016 and March 2018) Thisstudy was designed to check the levels of serum uric acidand its relation with creatinine, microalbuminuria, HbA1c,fasting and post prandial blood sugar levels in type 2 Diabetessubjects.Results: Study included a total of 120 cases of type 2 Diabetesmellitus, out of which there were 69 males (57.5%) and 51females (42.5%), with a mean age of 59.04 ±13.47 years.Mean FBS was 186.10 ±77.53 mg/dl, with majority of thesubjects having elevated FBS. Mean PPBS of 274.94 ±108.66mg/dl and of HbA1c 8.15 ± 1.7 was observed. The uric acidof majority number of our study participant males (65.22%)had level of ≥ 7.4, with a mean of 9.53 ± 4.38. Mean bloodurea and serum creatinine levels were 46.91 ± 15.13 and 1.44± 0.29 respectively. There was significant association seenbetween uric acid levels and urine albumin, serum creatinine,twenty four hour urinary albumin, FBS and PPBS levels andHbA1c levels.Conclusion: Present study had about two-third subjects withtype 2 Diabetes mellitus with elevated uric acid levels hadmicroalbuminuria and elevated serum creatinine levels.