ABSTRACT
BACKGROUND: Recently intravenous (IV) and aerosolized (ASZ) colistin have been used for treating ventilator-associated pneumonia (VAP) due to colistin susceptible multidrug-resistant Gram-negative bacteria (MDR-GNB). Colistin has limited lung penetration. We compared the efficacy and safety of IV-alone versus IV+ASZ-colistin for treating VAP in neonates. METHODS: This retrospective matched case-control study was performed at NICU of the Aga Khan University Hospital, Pakistan between January 2015 and December 2018. Sixteen neonates with MDR-GNB associated VAP received IV-ASZ-colistin and were matched for date of birth, gestational age, birth weight, Apgar score, antenatal steroid history, disease severity, and duration of mechanical ventilation with 16 control neonates who received IV-colistin alone. RESULTS: Both groups had similar MDR-GNB isolates and Acinetobacter baumannii (78%) was the most common pathogen. No colistin-resistant strain was isolated. Duration of IV-colistin and concomitant antibiotics use was significantly (p < 0.05) shorter in the IV-ASZ-colistin group. Significantly (p < 0.05) higher clinical cure and microbial eradication, along with lower ventilatory requirements, mortality rate, and colistin induced nephrotoxicity and electrolyte imbalance was observed in the IV-ASZ-colistin group. CONCLUSIONS: With better lung penetration, ASZ-colistin offers effective and safe microbiological and clinical benefits as adjunctive or alternate treatment of VAP due to colistin susceptible MDR-GNB in neonates.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Colistin/administration & dosage , Pneumonia, Ventilator-Associated/drug therapy , Respiration, Artificial/statistics & numerical data , Administration, Inhalation , Aerosols , Anti-Bacterial Agents/adverse effects , Case-Control Studies , Colistin/adverse effects , Drug Resistance, Multiple, Bacterial , Female , Hospitals, University , Humans , Infant, Newborn , Infusions, Intravenous , Male , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/mortality , Pregnancy , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
OBJECTIVES: Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive-candidiasis (IC). To prevent d-AmB-induced nephrotoxicity, renal protective effect of fluid and electrolyte management has been established among adults; in this study, the authors determined this effect among neonates. METHODS: In this retrospective cohort study, the authors reviewed neonatal medical records, admitted to neonatal intensive care unit and received d-AmB therapy. Patients were divided into, renal-insufficiency-group (RIG) and the non-renal-insufficiency-group (NIG). RESULTS: A total of 90 cases were analyzed, 41 composed RIG and 49 NIG. Renal insufficiency (RI) was developed on 1.7 (0.84) and 7.8 (1.21) days of d-AmB therapy in 26 (63%) and 15 (37%) cases respectively. Bivariate and multivariate analysis demonstrate that >4 m Eq/kg/d sodium intake across all-time points was significantly (p < 0.0001) associated with reduced risk of RI [(phase-I: AOR: 0.96; 95% CI: 0.91-0.99), (phase-II: AOR: 0.84; 95% CI: 0.68-0.92) and (phase-III: AOR: 0.90; 95% CI: 0.86-0.95)]. While adequate fluid intake reduced the likelihood of RI if started before and initial 2 days of d-AmB therapy. CONCLUSIONS: Adequate hydration before and 48 hours after d-AmB therapy and >4 mEq/kg/day sodium intake before and through d-AmB therapy may protect neonatal RI.
Subject(s)
Amphotericin B/adverse effects , Antifungal Agents/adverse effects , Invasive Fungal Infections/drug therapy , Renal Insufficiency/chemically induced , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Cohort Studies , Electrolytes/metabolism , Female , Fluid Therapy/methods , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Male , Pakistan , Renal Insufficiency/epidemiology , Renal Insufficiency/prevention & control , Retrospective Studies , Sodium/administration & dosage , Tertiary HealthcareABSTRACT
Human hand signifies a magnificent and challenging example for scientists and engineers trying to replicate its complex structure and functionality. This paper proposes a bio-mechatronic approach for the design of an anthropomorphic artificial hand capable of performing basic human hand motions with fundamental gripping functionality. The dexterity of the artificial hand is exhibited by imitating the natural motion of the human fingers. Imitation is produced according to the data acquired from the flex sensors attached to the human fingers. In order to have proper gripping, closed-loop control is implemented using the tactile sensors. Feedback for the closed-loop control is provided by force sensing resistors (FSRs), attached on the fingertips of the robotic hand. These sensors also enable handling of fragile objects. The mathematical model is derived using forward kinematics and also simulated on MATLAB to ascertain the position of robotic fingers in 3D space.
