MICROBIOLOGICAL PATTERN OF VENTILATOR ASSOCIATED PNEUMONIA.

BACKGROUND: Ventilator associated pneumonia (VAP) is an important and common complication of mechanically ventilated patients. It is the leading cause of morbidity and mortality in Intensive Care Units (ICU) worldwide. The aim of study was to determine the pattern of bacteria involved in VAP in intensive care unit of Jinnah hospital Lahore. METHODS: It was descriptive case series study, conducted over a period of one year on mechanically ventilated 50 patients. American Thoracic Society (ATS) guidelines recommend quantitative/semi-quantitative culture of endotracheal aspirates (ETA) or bronchoscopic aspirates/washing from the infected lung segments for the diagnosis of VAP. Hence this study was conducted to identify the types of bacteria involved in VAP in our ICU. Patients enrolled were clinically and radiologically suspected VAP, admitted in the ICU of Jinnah Hospital/Allama Iqbal Medical College (AIMC) Lahore. Bronchial washings were taken with the help of Fiber optic bronchoscope. Wherever bronchoscopy was not possible, subglottic secretions were collected with the help of sterilized catheter and sucker. Collected samples were sent to the Pathology laboratory of AIMC for aerobic culture and sensitivity. RESULTS: Major pathogenic bacteria isolated were Gram negative (74%). Among this group E. coli, Pseudomonas, Klebsiella and Acinetobacter were the commonest organisms. Gram positive bacteria were 20%, Staphylococcus aureus (MRSA) and beta-haemolyticus streptococci were the major isolate. In 4% cases mixed growth and in 2% cases no growth was reported. CONCLUSION: Major pathogenic organisms of VAP in our ICU are Gram negative bacteria. The Bacteriological culture of endobroncheal aspirates is helpful in the diagnosis and management of VAP. Emperic antibiotic therapy for VAP should cover Gram negative organisms.

Removal of iodine by dry adsorbents in filtered containment venting system after 10 years of Fukushima accident.

Radioactive iodine is a hazardous fission product and a major concern for public health. Special attention is paid to iodine out of 80 fission products because of its short half-life of 8.02 days, high activity, and potential health hazards like its irreversible accumulation in thyroid gland and ability to cause thyroid cancer locally. Radioactive iodine can get released in the form of aerosols (cesium iodide), elemental iodine, and organic iodide after a nuclear accident and can cause off-site and on-site contamination. Filtered containment venting system (FCVS) is a safety system whose main objective is mitigation of severe accidents via controlled venting and removal of different forms of iodine to ensure safety of people and environment. After nuclear accidents like Fukushima, extensive research has been done on the removal of iodine by using dry scrubbers. This review paper presents research status of iodine removal by dry adsorbents especially after 10 years of Fukushima to assess the progress, research gap, and challenges that require more attention. A good adsorbent should be cost-effective; it should have high selective adsorption towards iodine, high thermal and chemical stability, and good loading capacity; and its adsorption should remain unaffected by aging and the presence of inhibitors like CO, NO2, CH3Cl, H2O, and Cl2 and radiation. Research on different dry adsorbents was discussed, and their capability as a potential filter for FCVS was reviewed on the basis of all the above-mentioned features. Metal fiber filters have been widely used for removal of aerosols especially micro- and nanoscale aerosols. For designing a metal fiber filter, optimal size or combination of sizes of fibers, number of layers, and loading capacity of filter should be decided according to feasibility and requirement. Balance between flow resistance and removal efficiency is also very important. Sand bed filters were successful in retention of aerosols, but they showed low trapping of iodine and no trapping of methyl iodide at all. For iodine and methyl iodide removal, many adsorbents like activated carbon, zeolites, metal organic frameworks (MOFs), porous organic frameworks (POPs), silica, aerogels, titanosilicates, etc. have been used. Impregnated activated carbon showed good results but low auto-ignition temperature and decline in adsorption due to aging and inhibitors like NOx made them less suitable. Silver zeolites have been very successful in methyl iodide and iodine removal, but they are expensive and affected by presence of CO. Titanosilicates, macroreticular resins, and chalcogels were also studied and they showed good adsorption capacities, but their thermal stability was low. Other adsorbents like silica, MOFs, aerogels, and POPs also showed promising results for iodine adsorption and good thermal stability, but very limited or no research is available on their performance in severe accident conditions. This review will be very helpful for researchers to understand the merits and demerits of different types of dry adsorbents, the important operating parameters that need optimization for designing an efficient scrubber, margin of research, and foreseeable challenges in removal of different forms of iodine.

The utility of remdesivir in SARS-CoV-2: A single tertiary care center experience from a developing country.

BACKGROUND: Remdesivir is a monophosphoramidate prodrug of an adenosine analog, and it has a broad-spectrum antiviral activity against paramyxoviruses, flaviviruses, and coronaviruses. Remdesivir is associated with decreased hospital stay and improved outcomes in coronavirus- disease 2019 (COVID-19). METHODOLOGY: Of 846 suspected COVID-19 patients admitted to the hospital, 612 SARS-CoV-2 nasopharyngeal RT-PCR positive patients were evaluated for enrollment in this prospective cohort study. 159 RT-PCR positive patients were given remdesivir. Their clinical, biochemical parameters, hospital stay, and outcomes related to morbidity and mortality were followed. RESULTS: Out of the 159 patients, 141 recovered after remdesivir use. The Chi-square test for independence examined the relation between the day of the first dose, dose of remdesivir, and clinical outcome. The standardized case fatality ratio (CFR) in the 453 hospitalized patients who did not receive remdesivir was 32.89% (N = 149) as compared to 11.32% (N = 18) in the patients who received remdesivir. These findings are in keeping with the therapeutic value of remdesivir in symptomatic SARS-CoV-2 infection of varying severity. CONCLUSION: The use of remdesivir is associated with a decrease in the severity of the SARS-CoV-2 infection. Its use is also associated with a decreased length of hospital stay and lower mortality than the patients who did not receive remdesivir.

A Comparison of Disease Severity and Outcomes in COVID-19 Cases Taking Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers Versus Other Antihypertensive Drugs.

Objective In this study, we aimed to compare the severity and outcomes in hypertensive patients presenting with coronavirus disease 2019 (COVID-19) who were taking angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and those who were on other antihypertensive drugs. Methods This retrospective cohort study involved 182 hypertensive patients who presented with COVID-19 infection. The study population comprised 91 patients who were taking ACEIs/ARBs (group A) and 91 patients who were taking other antihypertensive drugs such as ß-blockers (BBs), calcium channel blockers (CCBs), or thiazides (group B). All patients were provided the same type of treatment for the management of COVID-19. We recorded the data related to demographic and anthropometric variables as well as clinical symptoms during the treatment period. Disease severity and hospital mortality were the primary study endpoints. Results There was no significant difference in COVID-19-related outcomes between the groups except for the severity of lung infiltration on chest X-rays. There were 37 (41.1%) patients having >50% lung infiltration in group A and 53 (58.2%) in group B (p-value: 0.02). Severe disease was diagnosed in 37 (40.7%) patients in group A compared to 39 (42.7%) patients in group B (p-value: 0.76). In-hospital mortality was noted in 17 (18.7%) patients in group A and 22 (24.2%) patients in group B (p-value: 0.36). Conclusion Based on our results, we did not find any significant association between the use of ACEIs/ARBs and either the severity of COVID-19 infection necessitating admission to ICU or in-hospital mortality.