Clinicopathological association of mucormycosis in COVID 19 pandemic

Context: Coinfection and superadded infections in patients with coronavirus disease 2019 (COVID-19) has been reported on multiple series. The emerging second wave of the pandemic has come with a lot of changes, especially in developing countries like India. One of such changes is sudden, significant rise in mucormycosis cases. Aims: To find out clinicopathological association of invasive mucormycosis with COVID-19 infection status and immunocompromised state. Settings and Design: A cross-sectional study done at a tertiary care centre. Methods and Material: All cases admitted in the dedicated mucormycosis ward between 1-06-2021 and 15-06-2021 were included in the study. The cases were admitted with suspicion of mucormycosis. The histopathological results were correlated with KOH mount and radiological reports. The clinicopathological association of occurrence of mucormycosis in post-covid and non-COVID patients along with other risk factors. Statistical Analysis Used: Odds ratio, chi square test were used to find the association using MS Excel 2010 and SPSS. Results: Thirty-six (81.82%) cases were of the post-COVID status, and 8 cases were non-COVID status. Out of 36 post-COVID patients, 33 (91.67%) showed evidence of invasive mucormycosis and of 8 non-COVIDpatients, 7 had evidence of mucormycosis (odds ratio = 1.57). Out of the total diagnosed cases of mucormycosis, 21 (52.5%) patients were known cases of diabetes mellitus (DM), and 7 (17.5%) cases of newly diagnosed hyperglycemia. Thirty (75%) patients out of 40 had some form of immunocompromised state. This shows statistically significant association of DM and immunocompromised state with the occurrence of mucormycosis in post-COVID patients (chi square value2 = 6.891, P value = 0.008). Twenty-five patients had the history of steroid use during the treatment of COVID-19. Conclusions: The infection with COVID-19 definitely increases the odds of contracting mucormycosis, but most of the cases had diabetes mellitus. So, it is possible that COVID-19 virus predisposes individuals to invasive fungal infection by precipitating DM.

Prevalence, severity, and trends in drug therapy of COVID-19 breakthrough infection at L-3 COVID Hospital, Bareilly: A cross-sectional study

Background: The COVID-19 pandemic has led to dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems, and the world of work. The availability of a safe and effective vaccine for COVID-19 is well recognized as an additional tool to contribute to the control of the pandemic. Although vaccines proved efficacious in preventing infection, yet some cases of post-vaccination breakthrough infections (BTIs) have been reported, raising concerns about the efficacy and safety of COVID vaccines. Aim and Objectives: This study was aimed to investigate the occurrence of BTIs among the vaccinated healthcare workers (HCWs), to analyze the severity of their disease and to know the trends in drug therapy. Materials and Methods: This was a retrospective cross-sectional study. Data were obtained by a predesigned questionnaire and was distributed through Google platform. Details of time, severity of BTIs and the trends in drug therapy among the vaccinated healthcare workers (HCWs) was evaluated and statistically analyzed. Results: A total of 616 HCWs participated in the study, out of which 553 were vaccinated and 63 of them were unvaccinated. About 15%, that is, 85/553 of the vaccinated HCWs developed BTI. Case rate was lesser (12.9%) in fully vaccinated HCWs as compared to partially vaccinated HCWs (19.5%). Most BTI cases (94%) suffered mild to moderate severity of symptoms and were managed in home isolation with medicines (mainly paracetamol, azithromycin, and doxycycline). Only five out of 85 BTI cases developed severe disease and needed hospitalization. Conclusion: BTIs after COVID-19 vaccination are uncommon and typically present with mild symptoms. Thus, vaccination along with hand sanitization, wearing of masks, and maintaining social distancing has provided hope in combating the pandemic.

A study of adverse drug reactions in patients receiving treatment for multidrug-resistant tuberculosis in a tertiary care center

Background: The emergence of multidrug-resistant tuberculosis (MDR-TB) (defined as resistance to at least isoniazid and rifampin) poses a threat to global TB control. Second line drugs are frequently associated with very high rates of unacceptable adverse drug reactions (ADRs), needing frequent interruption and change of regimen. Different studies have stated varying incidence of these adverse effects leading to discontinuation of ATT. Aims and Objectives: This study intends to find out the occurrence of side effects of anti-TB drugs in patients receiving MDR treatment. Material and Methods: The present prospective cross-sectional observational study was carried out at Drug-Resistant TB Center at Govt. Medical College Kota for a period of July 2018 to June 2019. Patients with adverse events after the introduction of treatment of MDR-TB were included in the study. We monitored the patients with adverse events after starting treatment till the patients were admitted and later followed up by recalling the patients at monthly intervals. Results: Out of total 148 patients majority patients (64.81%) were in the young age group (20–39 years) with male: female ratio 2:1. Out of the 148 patients, 112 patients developed at least one or more types of ADR and a total of 15 types of ADR. Gastrointestinal upset was the most common ADR reported (62.16%) followed by joint pain (41.89%) and headache (36.48%). About 60.74% of all ADRs were managed by symptomatic treatment. 32 (21.62%) patients required change of regimen.Twelve patients (8%) discontinued treatment due to adverse reactions. Conclusion: Treatment of MDR-TB with second-line antitubercular drugs is associated with high rate of adverse effects experienced in more than half of patient in this study. Ototoxicity and neuropsychiatric symptoms are major adverse effects lead to important drug withdrawl from the regimen. The health care professionals should be alert during the intensive phase of the treatment, identify symptoms at the earliest and hence help in minimizing morbidity.

Squamous Papilloma of Tongue – A Case Report

Oral Squamous papilloma presents as a cauliflower like growth in oral mucosa which in 50 % cases has been associated with HPV 6 and 11. We report a 51-year-old male patient who presented with a large white coloured pedunculated growth on tongue measuring 4cm×2.5cm × 2cm. Lesion was excised surgically with no recurrence within 3-month of follow- up.

Emergency Medical Service (EMS) Belt

Background:Emergency medical service has been a well-know n subject of discussion in India where the population is vast and the health care system is inadequate. Essential drugs are a category of drugs that are needed during the golden hour of saving a patient’s life. It becomes necessary that time, when a simple drug can save the life of a patient, a competent health care provider, is needed to administer the drug to the patient. In such a situation, any health care provider in the vicinity of the person who needs medical assistance must get an alert so that the health care provider can reach the site of the emergency and provide assistance. EMS belt is a system in which with the help of a mobile application, any person in case of a medical emergency can get service from a nearby health care provider within a few minutes. The concept is to raise an alarm alerting the nearby health care practitioners about the person in need of medical assistance. This concept is promising with the advantage that it doesn’t need any special manufacturing of the device. Conducting trials on this concept shall yield good observations and produce hopes for a cost-effective EMS system in India.

Morphometric Analysis Of Typical Thoracic Vertebrae And Its Clinical Relevance

Background: The frequent surgical interventions of thoracic spine are more common due to a wide array oftraumatic, degenerative and neoplastic diseases. For successful surgical management of these conditions, adetailed anatomical knowledge of the thoracic vertebrae is required.Aim: The aim of this study was to present a morphometric reference database for Pedicle morphometry of typicalthoracic vertebrae in Indian population.Material and methods: The study was conducted on 120 dry human typical (T2-T8) thoracic vertebrae selectedfrom the bone bank of the Department of Anatomy, SGT Medical College Hospital and research institute, Gurugram.Linear measurements of the vertebrae were taken with the help of digital Vernier caliper .Statistical Analysis:Mean and standard deviation of the morphometric parameters taken into account were analyzed. The comparisonof morphometric dimensions of the right and left sides was performed using Student’s t-test and p-value wascalculated.Results: The morphometric analysis of the thoracic vertebrae demonstrated that the Pedicle height (PH) was10.35 ± 1.22 mm and Pedicle Width (PW) was 5.65±2.06mm.Conclusion: The results provide a comprehensive database for more accurate modelling and design of vertebralbody implants and instrumentations for Indian population.

Intergeneric grafting for enhanced growth, yield and nutrient acquisition in greenhouse cucumber during winter

Aim: The objective of the present study was to evaluate the performance (based on growth, yield, quality, and nutrient acquisition) of commercial greenhouse cucumber (Cucumis sativus) grafted onto different locally available species as rootstocks during winter. Methodology: The performance of cucumber cv. Infinity as scion was tested onto selected genotypes of three species of genus Cucurbita (pumpkin, squash and figleaf gourd), one each of Lagenaria (bottle gourd) and Cucumis (muskmelon) used as rootstocks. Plant growth, fruit yield and quality characteristics, and nutrient acquisition efficiency of rootstocks studied under prevailing sub-optimal temperatures during winter inside unheated greenhouse. Results: The highest fruit yield was obtained in intergeneric cucumber grafting onto figleaf gourd followed by bottle gourd rootstocks, with increase in total yield of 30 and 10%, respectively over non-grafted cucumber. Fruit dry matter content in muskmelon grafted plants and titratable acidity in figleaf gourd and muskmelon grafted plants were also increased. Interpretation: The improved performance of cucumber onto the cucurbit rootstocks, especially figleaf gourd was related to the increased root dry mass, root/shoot ratio and rootstock-stem thickness. This was also associated with the enhanced leaf nutrient status provided by vigorous root system of figleaf gourd rootstock under prevailing sub-optimal temperature.

Endovascular Management of Acute Superior Mesenteric Artery Thrombosis in a Delayed Setting

Acute mesenteric ischemia [AMI] is a life-threatening situation, the diagnosis of which is often missed in early stages. Late diagnosis often precludes endovascular management as the primary treatment. The authors here present a case of seven days history of acute mesenteric ischemia in a young female, who not just benefited from endovascular management, but also a major surgical intervention was avoided andwas discharged from the hospital uneventfully. The decision to consider a patient for endovascular management in a late stage, requires a good interdisciplinary communication and successful outcome in such a scenario is rarely achieved.

Simple multiplex RT-PCR for identifying common fusion BCR-ABL transcript types and evaluation of molecular response of the a2b2 and a2b3 transcripts to Imatinib resistance in North Indian chronic myeloid leukemia patients.

INTRODUCTION: Chronic myeloid leukemia (CML) is characterized by the Philadelphia chromosome, an abnormally shortened chromosome 22. It is the result of a reciprocal translocation of chromosomes 9 and 22, creating BCR‑ABL fusion transcripts, b3a2, b2a2, and e1a2. The aim of our study was to determine the type of BCR‑ABL fusion transcripts for molecular diagnosis and investigate the frequency of BCR‑ABL fusion transcripts in CML patients by multiplex RT‑PCR in CML. MATERIALS AND METHODS: A single reaction with multiple primers multiplex PCR was used to detect and investigate the type and frequency in 200 CML patients among which 116, 33, and 51 were in CP, AP, and BC phase, respectively. RESULTS: The study included 200 CML patients, among whom breakpoints in b3a2, b2a2 transcripts were detected in 68% and 24%, respectively, while 8% of the patients showed both b3a2/b2a2. A statistically significant difference was seen between frequency of BCR‑ABL fusion transcripts and gender (P = 0.03), molecular response (P = 0.04), and hematological response (P = 0.05). However, there was no correlation found between frequencies of BCR‑/ABL fusion transcripts and other clinicopathological parameters like age, type of therapy, thrombocytopenia, and white blood cell count. CONCLUSION: Multiplex reverse transcriptase‑polymerase chain reaction is useful and saves time in the detection of BCR‑ABL variants; the occurrence of these transcripts associated with CML can assist in prognosis and treatment of disease.

Evaluation of Patients of Acute Pain in Abdomen Attending the Emergency Medicine Department at SSG Hospital, Baroda.

Background: Present study was aimed to study the clinical pattern, etiology and management outcomes of patients presenting with acute pain in abdomen in the Emergency Medicine Department (EMD), SSG Hospital. Aims: 1) To study Acute Pain in Abdomen, and various clinical presentation of acute abdominal pain in patients attending casualty at S.S.G.hospital. 2) to compare clinical judgment with radiological, intraoperative, and histopathological findings. Methods: A prospective observational study of total 700 patients was carried out from January 2013 to October 2013. All patients of acute pain in abdomen, except pregnant women & penetrating /blunt abdominal injury, comes to EMD in the casualty, at SSG Hospital were included. Results: Majority of female patients presented with generalised, colicky (predominantly) or dull aching pain, in mild to moderate intensity, within three days of onset of pain; while majority of male patients presented with generalised, dull aching (predominantly) or colicky pain, in severe to excruciating intensity, after the three days of onset of abdominal pain. Conclusion: In our study, majority of patients presenting to EMD with Abdominal Pain were male and belong to age group of 21-50 years. Patients with generalised abdominal pain and Left Upper Quadrant pain were found to be having Nonspecific Abdominal Pain. Patients diagnosed as Acute Pancreatitis had come with pain in periumbilical area, Epigastric region, & back; while patients with Right Upper Quadrant, Right Lower Quadrant and Flank pain turned out to be Acute Cholecystitis, Acute Appendicitis, and Ureteric Colic, respectively. Patients with generalised abdominal pain, nausea, vomiting and fever were found to be having Acute Appendicitis. Patients diagnosed as Bowel Obstruction had come with Abdominal Distension and Constipation; with anorexia, were diagnosed Nonspecific Abdominal Pain; with jaundice, were diagnosed Liver Abscess; with burning micturition, all were diagnosed Nonspecific Abdominal Pain.

Faculty Perception and Attitude on Problem Based Learning (PBL) in Medical College from Central India.

Background: PBL is an innovative teaching learning method that enhances intrinsic motivation, promotes self learning, encourages clinical reasoning, and develops longlasting memory. It is an established leading educational innovative method in medical sciences throughout the world. In India, it is used by only few institutions. The reason may be the lack of awareness or negative perception on PBL. Aims: To study the response of medical faculty on PBL. Material and Methods: The study was conducted at the Index Medical College Hospital and Research Centre, Indore, India. The introductory sensitizing lecture cum discussion was organized on PBL. Pre-Test, Post-Test and feedback data from the faculty was encoded in numerical variables and analyzed by the SPSS. Results: Fifty eight faculty participated, 82.14% were entry and junior level, 80.34% didn’t attend any course on medical education, 94.6% have not attended any kind of formal training on PBL, 78.5% desired to acquire special training and 83.9% were in the favor of PBL. There was significant improvement in the knowledge of faculty on PBL as evidenced by post test and feedback data (Unpaired t test P value equals to 0.0009). Conclusion: The faculty’s attitude was receptive on implementation of the PBL but majority of them required special training which can be conducted by the medical education department of the institute with the collaboration and support of other institutions that run the PBL in their curriculum. It should be integral part of the PBL implementation programme at institute.

Comparison of effectiveness of acupuncture therapy and conventional drug therapy on psychological profile of migraine patien.

Migraine is a painful condition in which patients suffer from recurrent episodes of disabling pain, which could be very severe and can lead to grave psychological disturbances. There is no curative treatment for migraine, but there are various treatment modalities, though, with conflicting reports on their efficacy. This study was conducted to compare the effectiveness of electro acupuncture therapy and the conventional drug therapy on the psychological profile of migraneurs based on the assessment of quality of life and disability parameters. Migraneurs (n=60) were recruited from the Psychiatry and Neurology OPD, Guru Tegh Bahadur Hospital, Delhi. Following a written consent, migraneurs were randomly allocated into 2 study groups – Group A received 10 sittings of electro acupuncture on selected acupuncture points over a period of 30 days, while for the same duration the Group D received a conventional drug therapy in the form of oral flunarizine 20 mg OD along with paracetamol 500 mg SOS. The patients were assessed twice, before and after completion of the treatment programme (30 days). The quality of life was assessed with WHOQOL BREF (WHO Quality of Life Biomedical Research and Education Foundation) questionnaire and the disability was assessed with MIDAS (Migraine Disability Assessment) questionnaire. Statistical analysis was performed using repeated measure’s ANOVA with Tukey’s test. Migraneurs were found to have lower quality of life and higher disability scores but following the treatment regimes, the 2 study groups showed a significant improvement in both the parameters studied. It was however observed, that the acupuncture group showed a better response and was thus found to be more effective as compared to the drug group (P=0.005 to 0.000). We thus conclude that acupuncture is a better treatment option than the conventional drug therapy in not only relieving the pain of migraine but in also improving the psychological profile in migraneurs. Hence its use should be encouraged as an alternative/adjunct treatment for migraine.

Virulence attributes of Helicobacter pylori isolates & their association with gastroduodenal disease.

Background & objectives Certain genotype(s) of Helicobacter pylori strains may play important role in the development of gastric cancer (GC) and peptic ulcer disease (PUD). This study was undertaken to investigate the association of cagA, cagA3/ region subtypes, babA2 and vacA genotypes of H. pylori with GC, PUD and non-ulcer dyspepsia (NUD) as there are no such studies from India. Methods A total of 348 consecutive adult patients (NUD 241, PUD 45, GC 62) undergoing upper gastrointestinal endoscopy between September 2002 and May 2007 in a tertiary referral centre at Lucknow, north India, were enrolled. H. pylori infection was diagnosed by rapid urease test, culture, histopathology and PCR. Genotyping for cagA, cagA3/ subtypes, babA2 and vacA was performed by PCR using sequence specific primers. Results H. pylori infection was higher in patients with PUD than with GC (80 vs. 56.5%, P < 0.01) and NUD (80 vs. 55.2%, P= 0.002). cagA positive H. pylori isolates were detected in 80 per cent in GC, 83.3 per cent in PUD and 76.7 per cent in NUD with no significant difference among them. Only A subtype of cagA3/ was detected and its distribution in GC, PUD and NUD was 68.8, 69.4 and 52.6 per cent respectively. Presence of babA2 genotype was 31.4 per cent and it had significant association with PUD when compared with NUD (52.8 vs. 26.3%, P<0.003). On univariate regression analysis, s1a allele was associated with GC (P<0.050) and s1a/m2 vacA genotype with both GC (P=0.014) and PUD (P=0.016). Interpretation & conclusions H. pylori infection was strongly associated with PUD with a very high proportion of patients with GC have s1a allele and s1a/m2 vacA genotype. Both s1a/m2 vacA genotype and babA2 are associated with PUD. The study shows that different virulence attributes of H. pylori are involved in different gastroduodenal disorders.

The development of intrapulmonary arteriovenous shunts as a poor prognostic factor following surgery for biliary atresia.

Background & Aims: Chronic liver disease requiring liver transplantation is a common occurrence following corrective surgery for extrahepatic biliary atresia (EHBA). The formation of intrapulmonary arteriovenous shunts (IPS) is a well-known feature of chronic liver disease. The aim of this study was to investigate the development of IPS and its prognostic significance in postoperative patients with EHBA. Methods: Fourteen patients who underwent Kasai’s portoenterostomy during 1993-2005 were included in the study. The clinical features, hepatobiliary scintigraphy and biochemical liver function tests were recorded. A transthoracic contrast enhanced echocardiogram using a four-chamber view was performed in all patients within a week of the Kasai’s procedure by injecting 5 mL of hand-agitated saline solution into a peripheral vein. The opacification of microbubbles in the left atrium 3-6 minutes after their emergence in the right atrium was considered diagnostic of IPS. The contrast enhanced echocardiogram was repeated 6 months after the Kasai’s procedure in all patients Results: Nine patients were clinically asymptomatic after surgery. HIDA scan was excretory in all 14 patients at the time of the study, although 5 patients were jaundiced. The serum bilirubin increased in 2 patients after surgery; both these patients were jaundiced and developed ascites and 1 expired one year after surgery. Contrast enhanced echocardiogram was negative for IPS in all 14 initially. In the follow-up evaluation the only patient who died was the one who had developed IPS. Conclusions: There is a risk of developing IPS following a failed Kasai’s portoenterostomy in patients of EHBA. Contrast enhanced echocardiography can be used to serially monitor these patients for early detection of this complication. It can be used to predict prognosis after hepatic portoenterostomy and can be extremely useful in selecting patients who will need liver transplant on priority.

Impact of different doses of lead on internal organs of quails.

Lead (Pb) is the most ancient poison known to man. In the present study, amount of accumulation of Pb in liver, kidney, ovary and testes of rain quail was studied using different doses of lead. Spectrophotometric analysis of heavy metal treated organs was carried out to determine the amount of metal accumulation in these organs. LD50 value was 4 ppm. Dose of lead was given in three ranges of low, medium and high. It was observed that testes (< or =6.8 x 10(-6)) mgkg(-1)day(-1) and ovary (< or =7.5 x 10(-6)) mgkg(-1)day(-1), accumulated low amount from different doses when given continuously for 21 days. In contrast to this, liver (< or =9.2 x 10(-6)) mgkg(-1)day(-1) and kidney (< or =9.3 x 10(-6)) mgkg(-1)day(-1) accumulated the maximum amount of metal when treated for the same number of days. This study is quite unique and astonishing as the period for intoxication is short (21 days) as compared to the long ones (91 days and above). Our results show that generally metal accumulation is highest in liver, while it is low in gonad.

Effect of prenatal exposure of alcohol in the morphology of developing rat embryo.

The objective this study was to observe the morphological changes in developing rat embryo exposed to alcohol in utero. Virgin female Wistar rats in experimental group (n=15) were given 20% (v/v) alcohol two weeks before mating and throughout the gestational period through oral route. The controls (n=15) were also maintained and were given the tap water. On gestational day 15 (GD15) and 19 (GD19), five rats from each group were sacrificed by cervical dislocation and the abdomen was incised to expose the uterine horn. The number of implantation sites and resorptions were counted and recorded. The body weight and length of the fetuses were also recorded. The litter size and body weight of the newborn were also recorded at the time of birth from the remaining dam. The incidence of resorption was higher in alcohol treated group than in control which was found to be 25% and 8.7% at days 15 and 19 respectively. The body weight and length of fetuses were found to be decreased and was significant at GD15 (p<0.001 for weight and p<0.05 for length). Similarly, the litter size and body weight of newborn were also found to be decreased significantly (p<0.05 for litter size and p<0.01 for body weight). The present study shows that the maternal consumption of alcohol during pregnancy has adverse effect on fetal viability and development of growing embryo.

Effect of methotrexate (MTX) administration on spermatogenesis: an experimental on animal model.

An experiment was conducted to observe histomorphometric and cellular toxicity on rat testes after sixty days of methotrexate administration intraperitoneally (ip). Total 30 adult male rats were divided into one control and two experimental groups containing 10 rats in each group. Experimental groups received methotrexate in two different doses i.e 25 ig and 50 ig, whereas control one received normal saline intraperitoneally. At the end of the experiment, animals were sacrificed and testes were processed for paraffin sectioning and stained in haematoxylin and eosin. Further microscopic study of seminiferous tubules, interstitial spaces, primary spermatocytes and spermatids were carriedout. Results revealed decreased diameter of seminiferous tubules, increased interstiial spaces in experimental groups in dose dependent manner and found to be statistically significant (p < 0.05) as well as distortion of morphology of Leydig cells in experimental group. Therefore, it can be concluded that these qualitative and quantitative changes in male gonads may alter the reproductive performance of animals.

Nosocomial pneumonia in a pediatric intensive care unit.

BACKGROUND: Nosocomial pneumonia (NP) is the second most common hospital acquired infection. Understanding the pattern of occurrence, risk factors and etiological agents of NP in a PICU, is essential for developing effective infection control measures. This prospective observational study was conducted in a PICU of a tertiary care teaching hospital, to determine the incidence, etiology and risk factors for NP. MATERIALS AND METHODS: Patients admitted to the PICU, over a period of 1 year who had endotracheal (ET) intubation, were enrolled consecutively into the study. Demographic details were recorded at the time of inclusion. Diagnosis of NP was based on CDC criteria (1988).Semiquantiative assay of endotracheal aspirate (ETA) with a colony count of > 10(5) cfu/mL was taken as evidence of infection. Colonisation was defined as isolation of organism with <10(5) cfu/mL. Age, nutritional status, number and duration of intubations, duration of mechanical ventilation, sedation, nasogastric feeding were the risk factors studied for development of NP. Intubation attempts of more than one were defined as reintubation. Risk factors found significant on univariate analysis, were subjected to multiple regression analysis to determine the most important predictors of NP. RESULTS: The study group comprised of 72 children with a median age of 3.7 years and boys: girls ratio of 1.9:1.Twenty two of 72 (30.5%) developed NP; the predominant isolates from ETA were Acinetobacter anitratus(12), Pseudomonas aeruginosa (5), Klebsiella sp(3) and Staphylococcus aureus and E.coli(1) each. Additionally 18(39%) had evidence of ET colonization, with Acinetobacter sp being the commonest 9(50%). Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP.On multiple regression analysis, reintubation was the only independent risk factor for NP(OR 0.72, 95%CI 0.55-0.94).Overall mortality was 21%(15/72);7(47%)of these deaths were secondary to NP. CONCLUSIONS: NP developed in nearly one third of the intubated patients; Gram negative organisms were the predominant etiological agents and associated with high mortality. Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP.