ABSTRACT
Ventilator associated pneumonia [VAP] is a type of nosocomial pneumonia associated with increased morbidity and mortality. Awareness about the risk factors can be used to implement simple and effective preventive measures.To determine the factors associated with development of VAP and its mierobial profile among patients admitted to ICUs. A nested case-cohort study was conducted at Al-Hussein university hospital in Cairo city, Egypt for a period of 6 months from the 1[st] of March 2013 to the end of August 2013. Patients who were on mechanical ventilation [MV] for more than 48 hours were monitored at frequent intervals fordevelopment of VAP. Samples obtained by endotracheal aspiration were ccultured on Blood agar -Chocolate agar - MacConkey agar, plates of which were incubated at 37c for 24 hours. The isolated organism was identified by morphological and biochemical identification. Of the 73 samples which were taken from endotracheal tubes of the patients, 42 cases were diagnosed as VAP with an incidence rate of 57.5%. Early onset VAP occurred in 36 [85.7%], while late onset VAP was observed in the remaining 6 patients [14.3%]. Escherichia coli [40.5%] followedby Klebsiella pneumonia [23.8%] were the most commonly isolated pathogens. Univariate analysis showed that the duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H[2] blocker use were the risk factors associated with VAP [p < 0.05], Logistic regression revealed duration of MV as an independent risk factor for VAP. The incidence of ventilator pneumonia is high in our study. VAP was significantly related to duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H[2] blocker use
ABSTRACT
Se presenta una especies portadora de un mioblastoma (tumor de células granulares) de la la mama, tumor poco frecuente y de importante diagnóstico diferencial con el cáncer de mama, debido a su gran semejanza clínica e imagenológica. Se trata de una paciente de 66 años de edad con nódulo de 3 centímetros de diámetro en mama derecha, de 6 meses de evolución, de consistencia pétrea, bien definido, no doloroso y con cambios en la piel subyacente, con estudio mamográfico: BI-rads 4. Se realiza biopsia incisional que reporto: Mioblastoma (Tumor de células granulares). En conclusión el mioblastoma representa un reto diagnóstico para el cirujano general debido debido a su semejanza con patología neoplásica. Se debe tener en cuenta al momento de la evaluación de pacientes con nódulos mamarios, en cuyo caso es de suma importancia el estudio anatomopatológico
Subject(s)
Humans , Male , Aged , Breast , Neoplasms, Muscle Tissue , General Surgery , VenezuelaABSTRACT
OBJECTIVE: To analyze the clinical results of a group of young and elderly diabetic patients on ambulatory peritoneal dialysis at a large comprehensive tertiary care community hospital in San Juan, Puerto Rico in relation to rehabilitation characteristics, compliance, complications and survival. DESIGN: The medical records of all patients with a diagnosis of diabetes mellitus trained between June 1985 and June 1992 were reviewed. This group of patients was subdivided according to age, in young (20-50 years) and elderly (50 or over). A comparable number of nondiabetics were selected at random for each of the two age groups. MAIN OUTCOME MEASURES: The patient were studied for age, sex, need of assistance from a partner during dialysis, causes of transfer and hospitalizations, peritonitis, rehabilitation, patients compliance and outcome including mortality. RESULTS: Young diabetics versus non-diabetics: There were 45 patients in the diabetic group (37.8 percent females) and 57 in the non-diabetic group (54.4percent female) with a total observation time of 52.52 patient-months among the diabetics and 82.17 patient-months in the non-diabetic. Mean age of the diabetic patient was 39.9 +/- 8.8 and 36.7 +/- 8.7 for the non-diabetic...