[Study of characteristics, risk factors and outcome for ventilator associated pneumonia in neonatal intensive care unit patient]

Ventilator Associated Pneumonia [VAP], developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit [NICU], over a period of one year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP.105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The primary outcome measure was the development of VAP. Secondary outcome measures were length of mechanical ventilation, NICU length of stay, hospital cost, and death. Thirty eight patients were enrolled [58% were boys and 42% were girls].42% of neonates developed VAP. The most common VAP organisms identified were Acinetobacter baumanni [43%]. On multiple regression analysis, duration of mechanical ventilation was associated with VAP [P=0.00]. Patients with VAP had greater need for mechanical ventilation [18.7 vs 6 median days], longer NICU length of stay [39 vs 21.5 median days] and higher total median hospital costs [79.5 vs 52 million rials] than those without VAP. The mortality rate was not different between two groups. In mechanically ventilated neonates, those with VAP had a prolonged need for mechanical ventilation, a longer NICU stay, and a higher hospital costs. Longer mechanical ventilation was associated with an increased risk of developing VAP in these patients. Developing of VAP didn't increase mortality in patients.

Frequency of Dermatophytoses

Dermatophytosis is a fungal infection caused by dermatophytes, which have the ability to invade keratinized tissues such as hair, nail and skin. Epidemiology of the disease depends on age as well as prevailing hygiene, socioeconomic status and cultural conditions. This descriptive study was conducted from March 2006 to March 2007 at Mashhad University of Medical Sciences, on 599 patients with suspected cutaneous fungal infection at Dermatology Clinic of Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran. Direct examination of smears and culture on SCC were used to diagnose the infection in mycology labs of Ghaem Hospital and Mashhad branch of ACECR. Overall, 384 patients had fungal infection [64.1%], out of which 137 cases were suffering from dermatophytosis. Numbers of male and female cases were 91 and 46 respectively [p= 0.002]. Maximum infection rate found in 21-30 years age group and tinea corporis was the most common dermatophytic infection [56.2%] followed by tinea cruris [20.4%] and tinea pedis [13.8%]. The frequencies of etiological agents isolated from patients were as follows: Tricophyton rubrum, 44.5%; Epidermophyton floccosum, 21.9%; Tricophyton mentagrophyte, 11%; Tricophyton verrucosum, 7.3% and Microsporum canis, 7.3%. Since high prevalence of dermatophytosis reported in this study, public education on the potential risk factors, diagnosis and treatment of the disease are recommended and more studies to determine the main agents of dermatophytosis in other regions of our country are necessary