RESUMEN
Background: Intensive care units (ICUs) have become hubs of nosocomial infections worldwide. There has been a continuous rise in the development of antimicrobial resistance among ICU-acquired infections. Particularly, the Gram-negative bacteria implicated in ICU-acquired infections have become resistant to the majority of the antibiotics leading to a critical therapeutic problem. The present study was conducted to determine the antimicrobial resistance pattern of microorganisms causing nosocomial infections (ventilator- associated pneumonia [VAP], central line-associated bloodstream infection [CLABSI], and catheter-associated urinary tract infection [CAUTI]) in a multidisciplinary ICU. Materials and Methods: This prospective observational cohort study included the patients with ICU stay ? 48 h and any of the ICU-acquired infections: VAP, CLABSI, or CAUTI. The appropriate specimen was collected as per the standard procedure and cultured. The antimicrobial susceptibility of all the bacterial isolates recovered from the samples was performed according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. The antimicrobial resistance data were analyzed using WHONET Microbiology Laboratory Database software 5.6 (WHONET 5.6). Results: Gram-negative microorganisms were the principal pathogens causing various infections in the ICU, out of which Pseudomonas aeruginosa and Klebsiella pneumonia were the commonest. Most of the Gram- negative bacteria showed a high degree of resistance to the majority of the antibiotics. Colistin was observed to be the most effective antimicrobial for Gram-negative pathogens followed by doripenem, meropenem, and tigecycline. The majority of Staphylococcus aureus isolates (71.4%) were methicillin-resistant S. aureus; however, all were sensitive to vancomycin and linezolid. Vancomycin-resistant Enterococci constituted 43% of Enterococcus isolates and were sensitive to linezolid and tigecycline. Conclusion: Antimicrobial resistance was very high among the pathogens causing nosocomial infections in the ICU, especially Gram-negative bacteria demonstrated a substantially high degree of resistance to the majority of the antibiotics. Antibiotic stewardship will help control the emergence of multidrug-resistant microbes.
RESUMEN
Celiac disease is a common malabsorptive disorder in the Indian subcontinent and autoimmune dysfunction of thyroid and pancreas is frequently encountered along with. Chronic Calcific pancreatitis is a unique entity commonly seen in alcoholics but very rare in a patient of celiac disease. This case report includes the interesting constellation of calcific pancreatitis with celiac disease in a young adult male patient known case of insulin dependent diabetes and hypothyroidism. We believe it to be the only case report from north India. A 32 year old Indian male patient known case of Diabetes and hypothyroidism presented with features of malabsorption and was diagnosed with Celiac disease and calcific pancreatitis on imaging. The symptoms and insulin requirement also improved with the treatment of Celiac disease. Although a common involvement of pancreas in celiac disease, calcific pancreatitis is a rare finding and improvement of both the insulin requirement and malabsorptive symptoms with the treatment of celiac disease and pancreatitis vice-a-versa.
RESUMEN
Background: Pulmonary hypertension in chronic obstructive pulmonary disease (COPD) due to chronic alveolar hypoxia is probably the main contributor to the pathogenesis of pulmonary hypertension in COPD. Angiotensin II is a potent vasoconstrictor in renin angiotensin aldosterone system (RAAS), it has been shown to promote growth response in vascular smooth muscle cell contributing towards pulmonary hypertension. So, the Echocardiographicaliy measured MPAP and its correlation with RAAS in patients of COPD was evaluated.Methods: A prospective observational study was done in 32 patients with COPD and 10 age matched healthy, non-smoker subject included as controls. Stable patients requiring no change in their medication in the previous four weeks and not having had an acute exacerbation in that period were included. MPAP was calculated. Measurement of Ang II and aldosterone was done.Results: Thirty-two cases of COPD, meeting inclusion criteria were enrolled comprising of 32 males and the mean age of patients �d was (55.6 �.8), while mean age of controls � 2sd was 49.60 �56. Arterial blood gas analysis, PaO2 was ranged from (mean�d 75.44�.1), PaCo2 ranged from (mean �d 41.36�79) and SpO2 ranged from (mean�d 94.03 2�.74). Mean �d of plasma Ang II in COPD cases was (4.9�8) ng/dl, significantly higher in comparison with controls (p < 0.001). Mean �d of plasma ACE activity was (51.12�.9) in COPD. Mean �d of plasma aldosterone was (182.35�4.2) in COPD cases with significant (p<0.01). The MPAP in COPD cases was (mean�d 34.53�70).Conclusions: Use of Doppler has the advantage of being noninvasive and has been shown to be extremely reproducible in evaluation of MPAP and CO. The increased level of Ang II with increase MPAP in the present study would suggest that this may be a suitable model for investigating effects of novel vasodilator drugs for the treatment of pulmonary hypertension developed due to COPD.