European Journal of Molecular & Clinical Medicine

Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged.  VAP can cause patients to have difficulty weaning off the ventilator and to stay in the hospital longer, which results in a huge financial burden to patients and a huge demand for medical resources. Several strategies, such as drugs including chlorhexidine, b-lactam antibiotics and probiotics, have been used to prevent VAP in clinic. The incidence and the mortality rate of VAP have been decreased with the development of preventative strategies in the past decades, but VAP remains one of the most common causes of nosocomial infections and death in the intensive care unit. Current challenges in the management of VAP involved the lack of a gold standard for diagnosis, the absence of effective preventative strategies, and the rise in antibiotic resistance. Therefore, in order to reduce the incidence of VAP and improve the outcome of patients with mechanical ventilation, it is necessary to clarify the risk factors of VAP for clinical prevention and control of VAP. This article reviews the risk factors of VAP occurrence reported in recent years, including patient characteristics, increased mechanical ventilation time and prolonged length of hospital stay, disorders of consciousness, burns, comorbidities, prior antibiotic therapy, invasive operations, and mentions the corresponding preventive measures. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.

OBJECTIVES

Study of covid 19 obstetric cases admitted in maternal intensive care unit.
To study the fetomaternal outcome of covid 19 pregnant women

METHODS

This was an observational study carried out in the department of Obstetrics and Gynecology at Gandhi hospital, a tertiary care centre in Telangana. 100 women were taken into the study based on COVID19 test status.

RESULTS
Among 100 covid patients who were admitted into maternal intensive care unit, were in the range of 17 to 35years. Most (64%) of the patients were primigravida and majority (64%) of them were admitted in third trimester. 36 patients were without any co-morbidity, 38 patients belong to hypertensive disorders, 12 patients had anemia. High sugars and heart disease complicating pregnancy cases were also admitted.Inflammatory markers were raised in covid patients. All the patients had elevated CRP. Serum ferritin was raised in 53patients, LDH was raised in 46patients and 24patients were having raised D-Dimer.70% patients were managed with NIV.38% patient’s babies were admitted into NICU due to respiratory distress, low birth weight and seizures. Among 100 patients, 62% patients were discharged with good outcome and 38% patients were died.
CONCLUSION
Covid 19 during pregnancy may happen without identifiable risk factors. Although the risk of poor maternal and perinatal outcome increases when intensive care unit admission is required, adequate respiratory support adapted to the clinical status and interdisciplinary management of critical cases may not only lead to maternal recovery, but also an improvement in neonatal outcomes.

Introduction: Respiratory diseases are reportedly the major forefront runner in causing the morbidity and mortality globally thus imposing great global health burden. , the present study was undertaken to assess the spectrum of pulmonary disease affecting the persons admitted to respiratory intensive care unit.
Materials and Methodology: For the study purpose, 120 subjects with various respiratory illnesses who were admitted in RICU were included. A written informed consent was obtained from all the study participants after briefly explaining the study protocols to the study subjects. Complete demographic detail for each of the study participants that include past medical and surgical history, family history, as well as history of present illness. The statistical analysis of the data was done using SPSS version 11.0 for windows.
Results: The age of participating patients ranged between 32 to 72 years. The number of male subjects was 76 and number of female subjects was 44. The lowest number of patients were seen with Bronchiectasis (n=8). The results on comparing were found to be statistically non-significant. (p>0.05)
Conclusion: This study provided enough support to show that bronchial asthma, pulmonary tuberculosis, COPD are considered to the most common and frequent nosocomial infections among those patients admitted in RICU. But future research are needed to be carried forward the study in a nurturing manner for the betterment

Aim: To study the antimicrobial resistance pattern in an intensive care unitsetting of atertiary care hospital.

Background: Clostridium difficile (C. difficile) is the most common antibiotic-associated diarrhoea agent in selected patients. C. difficile strains are classified as toxigenic or non-toxigenic based on their ability to produce toxins.
Aim: The frequency of C. difficile and CDAD among patients in a tertiary hospital in Patna, India was investigated in this study.
Methods: From the patients, a total of 233 diarrheal samples were extracted. The samples were cultivated on Clostridium difficile medium with cycloserine (500 mg/L), cefoxitin (16 mg/L), and lysozyme (5mg/L) and 5 per cent defibrinated sheep blood. Polymerase chain reaction (PCR) of the 16s rRNA gene identified the isolates as C. difficile, as did the presence of toxins genes (tcdA, tcdB, cdtA, and cdtB). The toxin production of isolates was then assessed using Rapid Card (CerTest BioTech SL Spain).
Results: C. difficile was identified from 49 (21%) of the 233 samples tested. The total isolates were classified as A^-/B^-/GDH^‑ (48.97%), A⁺/B^-/GDH^- (28%), A⁺/B⁺/GDH^‑ (20.4%) and A⁺/B⁺/GDH⁺ (2%) types. Both types of C.difficile, A^-/B^-/GDH^‑and A⁺/B^-/GDH^-, which account for 77.5 per cent of all isolates, were both unable to generate the toxin (nontoxigenic). However, A⁺/B⁺/GDH⁺ and A⁺/B⁺/GDH^‑ (22.5%), were able to manufacture toxin or were toxigenic.
Conclusion: The prevalence of C. difficile was approximately 21%, and only 22.4 percent of C. difficile isolates were capable of producing toxins. C. difficile A⁺/B⁺/GDH^± are likely to be toxigenic and linked to C. difficile-associated diarrhoea (CDAD). Furthermore, approximately 4.7 percent of hospitalised patients had CDAD, which is greater than the rates reported in developed countries. Notably, 28% of the isolates were C. difficile A⁺/B^-/GDH^-, which only possesses tcdA genes but does not produce toxin

Background: Aspiration pneumonia and pneumonia are the most common cause of ARDS in direct lung injury whereas sepsis is the most common cause of ARDS in Indirect lung injury. The aim of this study to assess the clinic-etiological profile and prognostic indicators in critically ill patients who develop acute respiratory distress syndrome (ARDS) in medical intensive care unit.
Materials& Methods: A hospital based prospective study done on 50 ARDS patients those were admitted in the medical ICU over a period of one year at SMS Medical College, Jaipur, Rajasthan, India. Baseline characteristics including comorbidities, routine investigations, initial SOFA Scores & APACHE II (Acute Physiology & Chronic Health Evaluation) score was evaluated. Descriptive & Statistical analysis and interpretation of the data collected is done by using SPSS version 22.0 with mean and standard deviations computed.
Results: Among 50 patients, 27 patients represent the male group and 23 patients represent the female group. Diabetes mellitus (36%) and SHT (20%) having a higher prevalence. Breathlessness and fever were the most common symptoms. Gender comparison of mean Fio2/Pao2 ratio, MAP, Initial SOFA and APACHE II scores are shown in table 4 showing a higher Fio2 requirement in female group when compared to the male group and more or less equal with the remaining variables. The mean duration of hospital stay was longer in the female group when compared to the male group (table 4). The mortality rate in our study was 16.0% (8 patients).
Conclusion: The incidence of ARDS studies in India are very few and lacking. Early identification and etiology work up for ARDS with timely administration of antibiotics/ antivirals or antimalarial drugs is necessary for the improvement in survival rates in view of increased morbidity and mortality associated with ARDS.

Aim: The aim of the present study to compare the vital parameters and biomarkers in
predicting the outcome of patients in Covid ICU.
Methods: 200 patient were divided in to two groups, Group A of those who expired and
Group B of the survivors. The mean for each parameter was calculated and compared
among the two groups and based on which p value was calculated for each parameter
undertaken in clinical evaluation. Blood reports of investigations assessing the levels of
biomarkers like Procalcitonin (PCT), C- Reactive Protein (CRP), D-dimer, Ferritin,
Lactate dehydrogenase (LDH) and Interleukin-6 (IL-6) sent on first day and last day of
hospitalisation in covid ICU were collected for Group A (Expired) and Group B (Survived)
and master chart was prepared.
Results: The study population comprised of 200 confirmed Covid-19 cases, among which
those expired (Group A) were 103, and those who survived (Group B) were 97. The mean
age difference was statistically significant (p value = 0.003). The mean Heart Rate on day
of admission was statistically significant (p value = 0.005). The mean Heart Rate on last
day of hospitalisation difference was statistically significant (p value = 0.001). The
Median PCT levels along with along with its interquartile range in Group A (Expired)
versus Group B (Survivors) on day of admission the difference was statistically significant
(p value < 0.001). The Median Ferritin levels along with its interquartile range in Group A
(Expired) versus Group B (Survivors) on day of admission the difference was statistically
significant (p value < 0.0003). The Median Ferritin levels along with its interquartile range
in Group A (Expired) versus Group B (Survivors) on last day of hospitalisation the
difference was statistically significant (p value < 0.001).

Background:Early diagnosis and treatment are very important to reduce the rates
of morbidity and mortality related to Inborn errors of metabolism .The present
study aimedto detect the inborn errors of metabolism early among neonates.This
was a cross sectional study was carried out at neonatal intensive care unit in
pediatric department at Zagazig university children hospital. This study involved
114 neonates who were subjected to full medical history, thorough clinical
examination and laboratory investigations which included Complete blood count,
Coagulation profile ,C-reactive protein ,procalcitonin, Liver and renal function
tests , Serum levels of electrolytes, Plasma ammonia and lactate, Urine organic acid
analysis, Extended metabolic screening, Blood gas and serum anion gab and Blood
glucose level. Results:About 53.5% of the studied groups were males and 46.5%
were females. As regards mode of delivery 74.6% were by CS and 25.4% by NVD.
Also, 30.7% had positive consanguinity, 12.3% had sibling death, and 3.5% have
similar condition. History of abortion was found in 22.8% and genetic disease was
in 2.6% of the studied group. The main clinical presentations among the studied
group were RD, Encephalopathy and hypotonia. Only 6.1% of the studied group
had positive culture metabolic acidosis was detected only in 9.6% of the studied
group. About 90.4% of the studied group was alive and 9.6% were died.
Conclusion: IEM disorders are not rare disease in high-risk neonates with
attentions to consanguinity which is a common tradition in our country. The
manifestations of metabolic disorders are common, and many physicians
misdiagnose them as they are unaware about these disorders.