RESUMO
Background Ventilator-associated pneumonia (VAP) is a critical concern in the intensive care unit (ICU), with significant implications for patient outcomes. This retrospective cross-sectional study aimed to determine the prevalence of VAP in an ICU of a developing country, identify the predominant etiological factors, assess patient outcomes, and underscore the need for tailored interventions in high-risk patient groups. Methods This retrospective cross-sectional study included 589 ICU patients who underwent ventilator-assisted breathing for over 48 hours. Among them, 151 developed VAP. The diagnosis was made on clinical, laboratory, and radiological findings, and tracheal aspirate cultures. Exclusions included pediatric patients, less than 48 hours of ventilation, and pre-existing lung infections. Patient data encompassed gender, age, comorbidities, outcomes, admission reasons, isolated microorganisms, and clinical findings. Results 151 patients out of the 589 developed VAP. The age of the patients ranged between 31 to 69 years and the mean age was 45.43 ± 8.92 years. Clinical diagnoses upon ICU admission varied, including sepsis, trauma, stroke, and metabolic disorders. Chest X-rays commonly revealed atelectasis (19.2%), consolidation (21.9%), pleural effusion (11.9%), and lobar pneumonia (45.7%). Tracheal aspirate cultures predominantly isolated multidrug-resistant gram-negative rods, with methicillin-resistant gram-positive cocci and fungal pneumonia prevalent in neutropenic sepsis cases. Notably, only 54 (35.8%) of patients survived, with significantly poorer outcomes observed in sepsis, neutropenic sepsis, and stroke cases compared to trauma and post-operative admissions. Conclusion Multidrug-resistant organisms and the spread of nosocomial infections are the predominant causes of VAP in the ICU. This emphasizes the urgent need for multifaceted interventions to prevent and manage VAP effectively. Developing and implementing targeted strategies, considering the unique challenges faced in resource-constrained healthcare settings can aid in decreasing the mortality associated with it.
RESUMO
Glacier mass balance is inextricably linked to annual meteorological conditions and is a key indicator for assessing the ice reserves of a glacier. As a result, a number of studies have estimated glacier mass balance using different methods. Here, we have used the improved accumulation area-ratio (IAAR) method to study the mass balance of the Nehnar glacier from 2000 to 2020. This study also aims to study the spatiotemporal behavior and other dynamics of the glacier. Results have shown that the glacier has continuously lost its ice reserves throughout the studied period though at a lower rate since 2010. Its annual specific mass balance has changed from - 50.10 ± 3 cm w.e in 2000 to - 59.46 ± 3 cm w.e. in 2020. The equilibrium line altitude (ELA) of the glacier rose by 90 m and has shifted from 4260 masl in 2000 to 4350 masl in 2020. The glacier has shrunk from an area of 1.64 km2 in 2000 to 1.38 km2 in 2020 losing nearly 16% of its area. The study highlights the need for continued monitoring of glacier mass balance to better understand and predict the effects of climate change. These findings have important implications for the future of glacier retreat and water reserves of the Jhelum basin.
