Spectrum of ventilator associated pneumonia with effect on intensive care unit's patient outcome

Objective: To evaluate the spectrum of ventilator-associated pneumonia [VAP] and relation of length of intensive care unit [ICU] stay, patient's age and gender on the likelihood of being discharged from the ICU

Study Design: A cross sectional study

Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan over a period of 12 months extending, from Apr 2015 to Apr 2016

Material and Methods: We included 470 patients out of whom only 106 patients were diagnosed with VAP while on mechanical ventilation in ICU for >48 hours. A positive culture of tracheo-bronchial secretions, with any one of these; >48-h infiltrate on chest radiograph, fever of >38.3[degree]C, leukocytosis of >12 x 10[9]/ml and increase in tracheo-bronchial secretions established the diagnosis of VAP

Results: The mean age of the male and female patients was 49.8 +/- 18 years and 50.6 +/- 21.4 years respectively with 16.6 +/- 13 days as the mean duration of ICU stay. About 30.2% VAP patients had Acinetobacterbaumanni with 96.8% sensitivity to colistin, 27.4% patients had Klebsiella pneumonia with 72% and 62% sensitivity to colistin and carbapenems respectively and 15.1% patients had methicillin-resistant Staphylococcus aureus with 100% sensitivity to vancomycin. There was an increased incidence 60.4% of late-onset VAP compared to 39.6% early onset VAP. The overall mortality in VAP patients was 28.6%

Conclusion: We recommend the empirical combination therapy of colistin, carbapenem, and vancomycin in VAP. No statistical significant association was found between length of ICU stay and patient's mortality. The odds of getting discharged were found to be 3.2 times greater for male participants as opposed to female patients. Decreasing age was associated with an increased likelihood of being discharged

Assessment of level of awareness and knowledge of interventional radiology among medical students at a Pakistani institution

Objectives: To evaluate the level of knowledge and interest in Interventional Radiology [IR] among medical students at a Pakistani Medical Institution

Methods: After ethical review board approval, a cross sectional study was conducted based on a survey distributed among 600 medical students at a Pakistani 5 year medical school. 288 [48%] responses were received. Survey was based on 16 questions assessing knowledge, interest and perception of Interventional Radiology

Results: Among 288 respondents, 112 [39%] reported poor knowledge regarding IR; 132 [45%] had never been exposed to IR. Only 46 [16%] students chose to consider a career in IR. Main reasons for not considering a career in IR were lack of knowledge [49%] or lack of interest [34%]. Hundred students [34%] could correctly identify at least one IR procedure; 192 [66%] students were unclear regarding routine duties of Interventional Radiologist as part of a multidisciplinary team; 192 [66%] students stated that a 2 week radiology rotation would be sufficient; 168 [58%] stated that a mandatory 2 week core rotation in IR should be incorporated. IR lectures were rated as the most effective means of learning

Conclusion: Although level of knowledge and exposure to IR among medical students was suboptimal, they showed interest in learning more about this specialty. This deficit needs to be addressed in the undergraduate medical curriculum, not only to attract future innovators for continued growth of this specialty, but also to increase awareness among future referring physicians