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1.
Article | IMSEAR | ID: sea-204864

ABSTRACT

Climate change is possibly the most significant environmental challenge and possess serious threats to sustainable development in the world and more so in developing countries. Impact of climate change affects ecosystems, water resources, food and health. To adapt to the change and overcome the threats of climate change several climate-resilient agro-technologies have been introduced under the National Innovations on Climate Resilient Agriculture (NICRA) Project. The present study was conducted in Lakhimpur District of Assam to measure the extent of adoption of the climate-resilient agro-technologies introduced under the NICRA Project by the participant and non-participant farmers. A total of 160 farmers, 80 NICRA participant farmers and 80 non-participant farmers were interviewed. Findings revealed that the majority of the participant farmers (68.75 per cent) had a medium extent of adoption followed by 17.50 per cent with a low extent of adoption of climate-resilient agro-technologies. Only 13.75 per cent of the participant farmers were found to have a high level of adoption of climate-resilient agro-technologies. Among the non-participant farmers, majority of them (75.00 per cent) had a low extent of adoption followed by 17.50 per cent with a medium extent of adoption of climate-resilient agro-technologies. Only a very small proportion of them (7.50 per cent) had a high extent of adoption of climate-resilient agro-technologies.

2.
Article | IMSEAR | ID: sea-205613

ABSTRACT

Background: The first-line treatment for locally advanced squamous cell carcinoma of head-and-neck cancer is concurrent chemoradiation, which is the standard of care. Concurrent chemoradiation improved locoregional control but little impact on distance metastases. Induction chemotherapy (IC) can reduce local disease and distance metastases. Objectives: The purpose of our study is to compare the outcome of disease and toxicity between IC followed by concurrent chemo-radiation and only concurrent chemoradiation in patients of locally advanced unresectable head-and-neck cancer. Materials and Methods: A total of 37 patients were included in IC followed by concurrent chemoradiotherapy group. IC was administered with injection paclitaxel, injection carboplatin, and injection 5-fluorouracil for three cycles. Thirty-six patients were included in Arm B, concurrent chemoradiation group. The total dose of radiation was given in both the Arms 66 Gy in 33 fractions, five fractions per week for 6.3 weeks with concurrent chemotherapy injection cisplatin 40 mg/m2 weekly. Results: Grade 4 skin reaction was 2 (7%) in Arm A and 1 (3.3%) in Arm B. Grade 3 febrile neutropenia was 1 (3.4%) in Arm A and no Grade 3 febrile neutropenia was seen in Arm B. Grade 3 thrombocytopenia was 1 (3.4%) in Arm A and 2 (6.6%) in Arm B. Complete response of disease after 6 months of completion of treatment was 19 (65.5%) in Arm A and 18 (60%) in Arm B. Conclusion: Our study showed no significant difference in disease response regarding locoregional disease control between two groups but distance recurrence can be reduced with IC with manageable toxicity.

5.
Article | IMSEAR | ID: sea-196431

ABSTRACT

Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSGT) is a rare, aggressive tumor with many histological mimickers. Herein, we have documented our experience of three cases of CCSGT and reviewed the literature. The index cases were identified in male patients in their twenties, one in jejunum and two in the distal colon. Histomorphological examination revealed the characteristic heterogeneous histomorphology with patchy immunohistochemical positivity with S100 protein and negative melanocytic markers. The fluorescence in-situ hybridization test showed translocation of the EWSR1 (22q12) gene in >80% tumor cells. While one of our patients died after 2 years with lung metastasis, the other two patients are still alive on 1.5 years and 3 months follow up, respectively. CCSGT is a rare malignant tumor of the gastrointestinal tract. Although characteristic morphology, use of a judicial panel of immunohistochemical stains, and translocation study for EWSR1 gene can establish the diagnosis, experience in adjuvant therapy is still limited.

6.
Article in English | WPRIM | ID: wpr-822278

ABSTRACT

@#Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years followup, functional result was satisfactory.

7.
Article | IMSEAR | ID: sea-205576

ABSTRACT

Background: Worldwide, leading cause of cancer mortality is lung cancer. Approximately 63,000/year new lung cancer cases reported in India. Around 80–85% of patients of lung cancer is non-small cell histology (non-small cell lung cancer) and over >90% of patients presented locally advanced and metastatic disease. Hence, in these patients, population curative treatment approach with radiotherapy (RT) and chemotherapy in most of the time is non-viable option yielding short survival and relatively poor prognosis. In majority of such cases, the only aim of treatment remains palliative, the main aim is to improve quality of life. Although there are other medical management of symptoms palliation, radiation therapy is the cheapest option, quite effective, time efficient, and well tolerated in providing relief from symptoms. The rate of palliation of symptoms is quite high for chest pain and hemoptysis at 60–80%, whereas cough and dyspnea are improved in only 50–70%. For intrathoracic disease with obstructive symptoms, 30 Gy/10# over 2 weeks are generally recommended. Patients with poor performance status, advanced age, and associated comorbidity at the time of diagnosis, for which daily RT over 2–3 weeks is logistically difficult, 1–2 fractions have been utilized with good results. There are multiple randomized trials showed that both short and long RT course were equally effective for symptoms control. Aims and Objectives: The aims of our study are to compare the outcome, symptom control and assess toxicity profile in locally advanced lung cancer patient with 17 Gy/2 fractions (8.5 Gy/fraction, × 2 fractions) only on Saturdays over 2 weeks versus 30 Gy/10 fractions (3 Gy/fraction) over 2 weeks and to compare quality of life. Materials and Methods: This study was a single-institutional, prospective, open-labeled, randomized controlled study. Eligible patients were age ≥18 years with histopathologically proven lung carcinoma which was inoperable Stage III or IV disease and too locally advanced to curative concurrent chemoradiation, pulmonary symptoms attributable to the primary tumor, Eastern Cooperative Oncology Group (ECOG) performance status ≤3, and adequate hematologic (hemoglobin >10 g/dl; absolute neutrophil count >1500; platelet count >100,000/ml; and hepatic and renal function calculated creatinine >60 ml/min). Patients with bleeding diathesis, emphysematous bullae, poor respiratory function or reserve, pregnancy, and ECOG performance status >3 were excluded from the study. Results: Age, stage, histopathology, and pre-treatment symptoms score between two groups were comparable and statistically not significant. Pain in chest due to lung cancer was decreased in both arms due to treatment (at treatment completion Arm A = 47.62 and Arm B = 38.09). However, at the 2nd follow-up, difference between two arms was statistically significant where Arm A = 27.78 and Arm B = 15.00; P = 0.005. Global health status of patients in this study was improved in both arms due to treatment. Physical functioning emotional functioning, role functioning, global health status, cognitive functioning, and social functioning were improved in both arms due to treatment and kept improving during follow-up, but difference between two arms was not significance. Conclusions: Although overall symptom palliation, toxicity profile, and quality of life parameters are almost equal in both arms, patients with short expected survival, 8.5 Gy × 2 fractions would be preferable, limiting the number of hospital visit to a minimum. On the other hand, 3 Gy × 10 fractions schedule can be chosen for those patients with longer expected survival and better ECOG status, due to prolong duration of palliative response.

8.
Article | IMSEAR | ID: sea-196391

ABSTRACT

Background: It is hypothesized that the duodenal mucosal damage in patients with celiac disease (CeD) is caused by the mucosa-infiltrating lymphoid cells. This study aimed to analyze the immune effective and regulatory T (Treg) cells in duodenal biopsies from treatment-naive adult patients with CeD having different histological grades and controls. Patients and Methods: Dual-color immunohistochemical staining was done in a total of 234 duodenal biopsies, including 132 controls and 102 adult patients with CeD using CD20, CD3:CD4, CD3:CD8, CD4:FoxP3, CD8:FoxP3, and TCR??:TCR?? antibodies. The density of these lymphoid cells in lamina propria and mucosal epithelium was compared between controls and CeD, with different modified Marsh grades. Results: Densities of CD4+ T cells in lamina propria and CD8+?? intraepithelial lymphocytes (IELs) were significantly more in biopsies from patients with CeD, than in controls. An increasing linear pattern of IELs, CD3+ T cells, and CD20+ B cells was observed with increasing grades of villous abnormalities. Although CD8+ FoxP3+ Treg cells were significantly more in biopsies from patients with CeD, there was no significant difference in CD4+ FoxP3+ Treg cell infiltrate between both the groups. Conclusion: Our finding in this observational study generates interest to study the local intestinal mucosal immunity in CeD in detail. A study to prove the failure of CD4+ FoxP3+ Treg cell recruitment in CeD and its direct functional impact may yield valuable information regarding loss of mucosal tolerance.

9.
Article | IMSEAR | ID: sea-191995

ABSTRACT

In the 2nd edition of Community Medicine Buster compilation of 17 university questions all over India to cover wide range of questions for undergraduates, Post graduate students and Researchers. Chapter wise long essay questions along with short notes and relevant questions chronological arranged for the reader, they will feel that they are reading a book with all sorts of questions in question answer form. Moreover, it is an examination preparatory book for the 3rd professional part -1 students. This chapter wise different university questions unique in India.

10.
Article | IMSEAR | ID: sea-205470

ABSTRACT

Background: Lung cancer is the most common cancer diagnosed worldwide. Tobacco smoking is the most important environmental factor associated with the development of lung cancer. However, a large number of patients with lung cancer have no history of smoking frequently among female patients. There are no enough data in Eastern India regarding epidemiological study of lung cancer. Objectives: The aim of our study was to evaluate the prevalence and pattern of lung cancer in our institution (NRS Medical College and Hospital). Materials and Methods: Our study was a retrospective analysis of prospectively collected data for newly diagnosed adult patients. All patients were registered only after lung cancer diagnosis was confirmed by histopathological and/or cytological examination. The following information was collected from the database such as age, sex, smoking status and histological type, disease location, and stage. Results: A number of male patients were 786 (82%) and a number of female patients were 172 (18%). 692 (72.2%) patients had a history of smoking and 266 (27.8%) patients had no history of smoking in their life. Among the non-smoker patients, female patients were 147 (55.3%) and male patients were 119 (44.7%). 80% of patients came from rural areas and 20% of patients came from urban areas. In our study; histologically, the adenocarcinoma was 398 (41.6%) found most prevalent which is followed by squamous cell carcinoma 365 (38.1%). Conclusion: Adenocarcinoma lung with the right upper lobe involvement was prevalent in our study and non-smoker female patients were predominant. The major etiological factor was smoking. Awareness in the society is needed about cancerous effect of tobacco smoking for reducing the incidence of lung cancer.

11.
Indian J Med Microbiol ; 2019 Jun; 37(2): 292-295
Article | IMSEAR | ID: sea-198877

ABSTRACT

To the best of our knowledge, this is the first case of multifocal hepatic abscesses in a young immunocompetent adult from India, which was successfully treated with hepatectomy and short course of oral antibiotic regimen. Publishing further such case reports will provide more clarity regarding the clinical significance of the disease, including associated risk factors and appropriate treatment.

12.
Indian J Med Microbiol ; 2019 Jun; 37(2): 255-262
Article | IMSEAR | ID: sea-198868

ABSTRACT

Background: Identification of 14 high-risk human papillomavirus (HR-HPV) is immensely important in elucidating molecular epidemiology, patient monitoring and evidence-based treatment. There is paucity of such data from Chhattisgarh state of Central India. The present study has evaluated tagging oligonucleotide cleavage and extension-mediated Anyplex HR-HPV genotyping assay in identification of 14 HR-HPV genotypes attributable to premalignant and malignant cervical lesion in comparison to GP5+/6+ assay, cytology and colposcopy. Materials and Methods: A total of 185 clinically suspected cases of premalignant and malignant cervical lesion were investigated by HR-HPV genotyping, GP5+/6+, cytology and colposcopy. Results: Genotyping assay showed clinical sensitivity and specificity of 86.5% (confidence interval [CI]: 80.7–91.0) and 100% (CI: 86.3–100) respectively and found noninferior to GP5+/6+ assay (P > 0.05). HR-HPV prevalence was 76.3%, 88.4%, 94.8%, 100% and 100% among cervical intraepithelial neoplasia (CIN) Grade I–III, squamous cell carcinoma and adenocarcinoma cases, respectively. The four most common genotypes detected in CIN I–III were HPV 16 (63.9%), HPV 39 (15.0%), HPV 18 (6.0%) and HPV 33 (5.3%). In cervical cancer (CC) cases, HPV 16 (44.4%), HPV 39 (11.1%), dual infection of HPV 16, 18 (11.1%) and triple infection of HPV 16, 18, 33 (11.1%) were the four most identified genotypic aetiologies. A novel coinfection of HR-HPV 35, 39 were found in two and one cases of CIN I and II. Finding of HPV 39 as the second most prevalent genotype was unusual and underscores the importance of genotyping screening. Conclusion: Anyplex HR-HPV assay is arguably the useful assay for better patient management and can be useful for HR-HPV screening by its unique individual genotype identification of all HR-HPV. Finding of HPV 16, 39, 18, 33 and coinfection of 16,18 and 16, 18, 33 in CIN and CC would help vaccine manufacturer to design specific future HPV polyvalent vaccine preparation to curb down the CC-associated mortality.

13.
Article | IMSEAR | ID: sea-205436

ABSTRACT

Ewing’s sarcoma (ES) and primitive neuroectodermal tumor (PNET) resemble each other and commonly affect the skeletal system. Extraskeletal ES/PNET is a rare neoplasm. Here, we report a case of primary vulvar ES in an 18-year-old adolescent girl confirmed by histopathology and immunohistochemistry, who underwent surgery followed by adjuvant chemotherapy. Following 1 year of chemotherapy, she presented with multiple cranial nerve palsies (VI, IX, X, and XII). Contrast tomography of the base of the skull and nasopharynx showed a heterogeneous mass lesion involving the base of skull, sphenoid sinus, and left nasopharynx. Biopsy from the left nasopharyngeal mass revealed it to be well-differentiated squamous cell carcinoma, which was initially thought of metastasis to the base of the skull. In spite of its aggressive nature, a patient of primary sarcoma presenting with a second lesion should be adequately investigated before considering it as a metastatic lesion.

14.
Article | IMSEAR | ID: sea-205417

ABSTRACT

Background: The worldwide epidemiology of lung cancer is ever changing, and non-squamous non-small-cell lung cancer (NSCLC) in never-smoking women has been gradually increasing. In Indian population, adenocarcinoma lung was more common in never smoker persons. Approximately 70–80% of lung cancer cases are NSCLC. Most of NSCLC patients present with advanced disease or brain metastasis. The prognosis of patients with advanced NSCLC is generally considered poor, with a median survival of 9–11 months and a 2-year survival around 20–30%. There are no enough data in Eastern India regarding disease response, treatment-related toxicity, overall survival, and progression-free survival in advanced adenocarcinoma lung treated with chemotherapy and radiotherapy. Objectives: The objectives of this study were to compare disease response, toxicity, overall survival, and progression-free survival in advanced adenocarcinoma lung treated as first line with pemetrexed/carboplatin versus paclitaxel/carboplatin. Materials and Methods: A total of 123 patients were placed in Group A and another 117 in Group B (stage III disease). Group A patients were treated with pemetrexed 500 mg/m2 and carboplatin area under the concentration (AUC) 6 every 3 week. Group B patients were treated with carboplatin at dose AUC 6 and paclitaxel 200 mg/m2 administered 3 weekly. Dose of radiation was planned 60 Gy in 30# for 6 weeks in conventional fractionation schedule 3 weeks after completion of chemotherapy. Results: Hematological toxicities were Grade 3 anemia 27 (22%) in Group A and 29 (24.8%) Group B, Grade 3 neutropenia 34 (27.6%) in Group A and 33 (28.2%) in Group B, and Grade 4 neutropenia 5 (4%) in Group A and 4 (3.4%) in Group B. Grade 3 sensory neuropathy was seen in Group B 17 (14.5%). There was no Grade 3 or Grade 4 sensory neuropathy in Group A. Grade 3 fatigue was seen in Group B 19 (16.2%). Grade 3 diarrhea was seen 9 (7.3%) in Group A and 8 (6.8%) in Group B. Overall response rate was 63 (51.2%) in Group A and 43 (36.8%) in Group B. The complete response of disease was 19 (15.4%) in Group A and 6 (5.1%) in Group B. The partial response was 44 (34.6%) in Group A and 37 (31.6%) in Group B. Stable disease was 41 (33.3%) in Group A and 51 (43.6%) in Group B. The progressive disease was 19 (15.4%) in Group A and 23 (19.6%) in Group B. Median overall survival was 14.6 months in Group A and 14.4 months in Group B. Conclusion: In our study, pemetrexed/carboplatin provides better efficacy and tolerance, a reduced need for supportive therapies, and more convenient administration than paclitaxel/carboplatin for the first-line treatment of patients with advanced adenocarcinoma lung.

15.
Indian J Med Microbiol ; 2019 Mar; 37(1): 95-98
Article | IMSEAR | ID: sea-198842

ABSTRACT

There is a need of a relatively simple and inexpensive method for the determination of relative potency of various generic brands of antibiotics in comparison to original products. The current study describes an agar diffusion method which can be performed in any microbiology laboratory, is cheap (costs $2 per test) and its results can be available after overnight incubation. The results show that neither all generics are reliable nor are all generic antibiotics of poor quality.

16.
Article | IMSEAR | ID: sea-184856

ABSTRACT

Aim: To assess the utility of frozen section in this recent scenario of improved patient care Methods: In our study we analysed the efficacy of frozen section in 135 cases over a period of one and half years including thyroid, ovary, east, parotid,lymph node, margin assessment in colon malignancy by comparing it with histopathology, considering the latter as gold standard. Results:We found the overall accuracy of frozen section to be 85.37% with a sensitivity of 85.3% and soecificity of 84.6% in thyroid cases. In case of ovarian tumours frozen section had 90.91%sensitivity and 97.96% specificity for malignant tumours. Conclusion:Understanding the limitations, frozen section can be used as a reliable intraoperative tool.

17.
Article | IMSEAR | ID: sea-205400

ABSTRACT

Background: Esophageal carcinoma is high prevalence in Asia, including India and most of the patients present in advanced and inoperable stage. Most of the patients have poor nutritional status and low performance status. These patients are unable to tolerate radical treatment. Prognosis of these patients is very poor. There are no enough data of prospective study in palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy in Eastern India. Objectives: The main objective of our study was palliation of dysphagia of the patients with inoperable esophageal carcinoma with radiotherapy. Materials and Methods: The study was done with 43 patients with histopathologically proven squamous cell carcinoma and/or adenocarcinoma at thoracic esophagus, intraluminal brachytherapy feasible. Patients were received external beam radiotherapy palliative dose 30 Gy in 10 fractions for 2 weeks followed by intraluminal high-dose rate brachytherapy 6 Gy per fraction per week for 2 weeks. Results: In our study, the mean age of the patients was 58 years (age range 48 years–70 years). 1 month after completion of intraluminal brachytherapy, a number of patients with improvement of dysphagia were 34 (79%). The improvement of dysphagia was maintained 25 (73.5%) patients at 3-month completion of treatment and 14 (56%) patients at 6-month completion of treatment. The median duration of dysphagia relief was 5.2 months. Post-radiotherapy complications as chest pain were seen in 10 (23.2%) patients, esophageal strictures were developed in 7 (16.3%) patients, ulcerations were in 4 (9.3%) patients, and esophageal fistula was developed in 1 (2.3%) patient. Conclusion: The patients with advanced inoperable or metastatic esophageal carcinoma and poor performance status, palliative radiotherapy are effective modality of treatment for the improvement of dysphagia.

18.
J Genet ; 2019 Feb; 98: 1-6
Article | IMSEAR | ID: sea-215379

ABSTRACT

Yak, an economically important bovine species considered as lifeline of the Himalaya. Indeed, this gigantic bovine is neglected because of the scientific intervention for its conservation as well as research documentation for a long time. Amelogenin is an essential protein for tooth enamel which eutherian mammals contain two copies in both X and Y chromosome each. In bovine, the deletion of a fragment of the nucleotide sequence in Y chromosome copy of exon 6 made Amelogenin an excellent sex-specific marker. Thus, an attempt was made to use the gene as an advanced molecular marker of sexing of the yak to improve breeding strategies and reproduction. The present study confirmed that the polymerase chain reaction amplification of the Amelogenin gene with a unique primer is useful in sex identification of the yak. The test is further refined with qPCR validation by quantifying the DNA copy number of the Amelogenin gene in male and female. We observed a high level of sequence polymorphisms of AMELX and AMELY in yak considered as novel identification. These tests can be further extended into several other specialized fields includingforensics, meat production and processing, and quality control.

19.
Article in English | WPRIM | ID: wpr-822814

ABSTRACT

@#Background: Astrocytic gliomas are the most common primary brain tumors that developed from glial origin. The angiogenic cell population from brain tumor enhances the recruitment of circulating cancer stem cells homing towards tumor site. Objectives: This study aimed to investigate the tumor angiogenic cell population that stained with CD133+ and VEGFA+ markers and its association with circulating cancer stem cell (CD133+/VEGFR2-) population in the peripheral blood mononuclear cells (PBMCs) of astrocytic glioma patients.Methods: A total of 22 astrocytic glioma patients from Hospital Universiti Sains Malaysia who consented to the study were included. Tumors (n=22) were sliced and stained with CD133+ and VEGFA+ angiogenic markers and counter stained with DAPI. The circulating cancer stem cells (CD133+/VEGFR2-) in PBMCs (n=22) were quantified using FACS based on the expression of CD133 and VEGFR2 markers. The paired t-test and Pearson correlation were used for the data analysis.Results: The percentage of angiogenic cell population was significantly higher in brain tumor compared to adjacent normal brain tissue (1.25 ± 0.96% vs. 0.74 ± 0.68%; paired t-test=2.855; df=21, p = 0.009). Positive correlation was found between the angiogenic cells of brain tumor tissue and adjacent normal brain tissue (Pearson correlation, r = 0.53, p = 0.011). Significant positive correlation was found between angiogenic cells in glioma tumor and cancer stem cells in peripheral circulating systems of astrocytic glioma patients (Pearson correlation, r = 0.42, p = 0.049).Conclusion: Angiogenic cells in the brain tumor resident promote the recruitment of circulating cancer stem cells homing to the tumor site and induce the proliferation and growth of the tumor in astrocytic glioma patients.

20.
Article | IMSEAR | ID: sea-196208

ABSTRACT

Background: Ventilator-associated pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection. The etiology of VAP and their antimicrobial susceptibility pattern varies with different patient populations and types of ICUs. Materials and Methods: An observational cross-sectional study was performed over a period of 2 years in a tertiary care hospital to determine the various etiological agents causing VAP and to detect the presence of multidrug-resistant (MDR) pathogens in these VAP patients. Combination disk method, Modified Hodge test, ethylenediaminetetraacetic acid disk synergy test, and AmpC disk test were performed for the detection of extended-spectrum beta-lactamase (ESBL), carbapenemases, metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: The prevalence of VAP was 35%. Enterobacteriaceae (66.66%) and Staphylococcus aureus (20%) were common in early-onset VAP, while nonfermenters (50%) and Enterobacteriaceae (40.61%) were predominant from late-onset VAP. Nearly 60.87% of the bacterial pathogens were MDR. ESBL was produced by 21.74% of Enterobacteriaceae. AmpC ?-lactamase was positive in 35.29% nonfermenters and 26.08% Enterobacteriaceae. MBL was positive in 17.64% nonfermenters and 17.39% Enterobacteriaceae. Among the S. aureus isolates, 75% were cefoxitin resistant. Prior antibiotic therapy (P = 0.001) and hospitalization of 5 days or more (P = 0.001) were independent risk factors for VAP by MDR pathogens. polymyxin B, tigecycline, and vancomycin were the most sensitive drugs for Gram-negative and positive isolates respectively from VAP. Statistical Analysis: SPSS for Windows Version SPSS 17.0 (SPSS Inc., Chicago, IL, USA) and Chi-square with Yates correction. Conclusion: Late-onset VAP is increasingly associated with MDR pathogens. Treatment with polymyxin B, tigecycline, and vancomycin should be kept as last-line reserve drugs against most of the MDR pathogens.

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