Profile of Acute Kidney Injury in Hospitalized Children with Idiopathic Nephrotic Syndrome

Objective: To determine the incidence, risk factors and outcome of acute kidney injury (AKI)in hospitalized children with nephrotic syndrome. Methods: All consecutive hospitalizedchildren (aged 1-14 years) with diagnosis of nephrotic syndrome between February 2016 andJanuary 2017 were enrolled for the study.Children (aged 1-14 years) with features ofnephritis, underlying secondary causes of nephrotic syndrome as well as children admittedfor diagnostic renal biopsy and intravenous cyclophosphamide or rituximab infusion wereexcluded. Results: A total of 73 children (81 admissions) were enrolled; incidence of AKI was16% (95% CI, 9-23). On multivariate logistic regression analysis, furosemide infusion wasobserved as an independent risk factor for acute kidney injury (OR 23; 95% CI, 3-141;P<0.001). Out of 13 children with AKI, three died. Conclusions: Acute kidney injury inhospitalized children with nephrotic syndrome has high risk of mortality. Children receivingfurosemide infusion should be closely monitored for occurrence of acute kidney injury.

Research orientation in Ayurveda educational institutions: Challenges and the way forward

This paper examines the scenario of research orientation in Ayurveda educational institutions of India.We demonstrate through the data obtained by searching the SCOPUS that the actual research outputby these institutions is not very significant in terms of number of publications. While a lack of researchexpertise and infrastructure is one contributing factor to this status, a lack of questioning attitude is morecrucial one. Mushrooming of new colleges, laxity in regulations, corruption, lack of atmosphere forethical and quality research make the problem more complex. We show, with the help of SCOPUS Data,that the recent trend of establishing stand-alone institutions of Ayurveda may not help in invigoratingresearch activities since the research contributions from such institutions have always been very poor.Instead, we suggest that existing stand-alone institutions of Ayurveda be merged with other establishedCentral/State universities or other Medical colleges. The data demonstrates that the research output hasbeen always significant when an institution has many experts working in different streams of sciencewithin, than when the institutions have only Ayurveda experts. We also take up the question of designingthe clinical trials that are suitable for Ayurveda and propose an algorithm that may be considered forresearch in educational institutions, at least at doctoral level. We further enlist a set of recommendationsthat could potentially change the scenario. Evidence-informed policy making, inducting clinicians intothe education system, making the curricula more attractive by including recent advances, introducingefficient faculty training programs, and rigorous implementation of the existing regulations - are some ofthe key recommendations we have made.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Biofilm production and multidrug resistant bacterial isolates in ventilator associated pneumonia

Context: Ventilator-associated pneumonia is the second most common complication among all types of nosocomial infections. Mechanical ventilation predisposes to formation of a biofilm which worsens the prognosis because of increased multidrug resistant isolates implicated in formation of biofilm. Aim of the Study: The study was conducted to find out the relationship between duration of mechanical ventilation, biofilm formation, and antibiotic resistance among VAPpathogens. Study Design and Methods: A descriptive analytical study of 150 clinically suspected VAPpatients was done. Patients were divided into Group I and II based on intubation duration for 1–5 days and more than 6 days, respectively. Endotracheal aspirate was collected from clinically diagnosed cases and processed as per standard microbiological techniques. Bacterial counts ? 106 CFU/ mLfor quantitative cultures were considered significant. Biofilm production was detected by tissue culture plate method. Multivariate analysis was done to find out the association of the various factors. Results: Klebsiella pneumoniae was the predominant bacteria isolated followed by Acinetobacterbaumannii. Among Gram negative bacteria 66.8% were ?-lactamase producers. In biofilm production by tissue culture method, Group I patients, 72.4% of the isolates showed either strong / moderate biofilm formation and in Group II patients, 92.3% of the isolates showed either strong / moderate biofilm formation. Multivariate analysis revealed that bacteria isolated from VAPoccurring after 5 days of mechanical ventilation among prior antibiotic-treated patients were resistant to all the antibiotics tested. Conclusion: Bacterial aetiology, prolonged intubation, biofilm formation, and drug resistance have ramification on outcome of VAP. Hence removal of ET tube in regular intervals should be considered with a proper choice of antimicrobial treatment or using ETtube coated with drugs/ biomaterials that discourage biofilm formation may be explored.