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REVIEW ARTICLES
Management of swine flu (H1N1 Flu) outbreak and its treatment guidelines
Shatavisa Mukherjee, Sukanta Sen, Prasanna C Nakate, Saibal Moitra
July-September 2015, 2(3):71-78
DOI:10.4103/2225-6482.166066  
In its strongest resurgence since the pandemic of 2009, the influenza type A virus, known as H1N1, has broken out in different parts of India with deaths surpassing 1000 mark and number of affected cases exceeding 18,000 by the end of February 2015. Swine influenza spreads from person to person, either by inhaling the virus or by touching surfaces contaminated with the virus, then touching the mouth or nose. Symptoms occurring in infected human by H1N1 are like any other flu symptoms. Treatment is largely supportive and consists of bed rest, increased fluid consumption, cough suppressants, antipyretics and analgesics for fever and myalgias. Management largely includes the potential use of antiviral agents for patients presenting with illness due to influenza virus infection. If the illness is known or suspected to be due to a zoonotic influenza A virus, oseltamivir or zanamivir are treatment options. For known or suspected infection with avian influenza H5N1 virus, antiviral treatment should follow the World Health Organization (WHO) rapid advice guidelines on pharmacological management of humans infected with highly pathogenic avian influenza A (H5N1) virus. WHO also recommends vaccination of the high-risk group with seasonal influenza vaccine. Vaccination is recommended for health care workers working in close proximity to influenza patients are at higher risk of acquiring the disease. Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. Proper preventive and control measures thus must be ensured. We have only limited treatment options, so rational use of the antiviral agent is very essential to avoid resistance and future complications. Health education and awareness among citizens should be transferred by proper mechanism.
  20,209 1,786 1
Risk factors for community-acquired pneumonia in adults: Recommendations for its prevention
Jordi Almirall, Mateu Serra-Prat, Ignasi Bolibar
April-June 2015, 2(2):32-37
DOI:10.4103/2225-6482.159217  
Community-acquired pneumonia (CAP) remains an important cause of morbidity and mortality in developed countries. The disease is one of the top 10 causes of death and up to the present time, standard aggressive medical care has not resulted in a decrease in mortality. Knowledge of risk factors for CAP is essential to the design of preventive measures to reduce its incidence. Preventive strategies promoting effective vaccines or identifying and acting on modifiable risk factors are of paramount importance in reducing CAP-related death. Most studies have been performed in patients referred for inpatient care or in CAP cases in which a specific pathogen has been identified, but data from population-based studies are scarcer. We present a review of the main risk factors for CAP in adults, classified in the following categories: (a) Comorbidities and their treatments, (b) demographic and socioeconomic factors, (c) lifestyle factors and (d) environmental factors. We conclude with some brief recommendations on preventive measures and vaccination.
  8,497 1,056 9
Community-acquired pneumonia due to gram-negative bacteria
Alejandra Grosso, Angela Famiglietti, Carlos M Luna
October-December 2015, 2(4):117-122
DOI:10.4103/2225-6482.172651  
Community-acquired pneumonia (CAP) is a frequent infectious disease that can be usually treated in an ambulatory setting. A small percentage of these cases require hospitalization and yet it is the leading infectious cause of hospitalization and death in some countries. A number of these infections is caused by gram-negative bacteria (GNB), which have repeatedly been found to bear an adverse prognostic potential. Its incidence is variable (0-9%) and some species carry a special pathogenicity. Enterobacteriaceae in these studies were more commonly isolated than P. aeruginosa while Acinetobacter spp. and B. cepacia were only occasionally described. The present review has the aim to update the current knowledge about the etiology, classifi cation, antimicrobial resistance, diagnosis, and therapy in CAP due to GNB.
  5,290 1,286 1
Noninvasive ventilation for acute respiratory failure due to community-acquired pneumonia: A concise review and update
Antonello Nicolini, Catia Cilloniz, Ines Maria Grazia Piroddi, Paola Faverio
April-June 2015, 2(2):46-50
DOI:10.4103/2225-6482.159224  
Strong evidence supports the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF) to prevent endotracheal intubation (ETI) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and immunocompromised patients. However, weaker evidence supports NIV used in acute respiratory distress syndrome (ARDS) and ARF due to community-acquired pneumonia (CAP) in immunocompetent patients owing to high rates of treatment failure. In all patients, NIV should be applied under close monitoring for signs of treatment failure and, in such case, ETI should be promptly available. A trained team, at an appropriate location, with careful patient selection and optimal choice of devices can optimize NIV outcome. In this short review we examine past and more recent literature regarding the use of NIV in ARF due to CAP, discussing the application of both continuous positive airway pressure (CPAP) and pressure support ventilation (PSV).
  5,748 799 3
EDITORIALS
Pneumococcal disease: Epidemiology and new vaccines
Catia Cilloniz, Antoni Torres
October-December 2014, 1(2):35-43
DOI:10.4103/2225-6482.147647  
Streptococcus pneumoniae causes invasive and noninvasive infections. Among infectious diseases, invasive pneumococcal disease (IPD) is a leading cause of morbidity and mortality in children and adults. Community acquired pneumonia in adults is the main presentation of non-IPD and is the most common infectious source of IPD. The incidence, severity and mortality of pneumococcal disease vary widely depending on several factors, some are host related, and others are organism related. After introduction of the vaccine, rates of pneumococcal disease caused by vaccine serotypes have dramatically decreased among vaccinated children, nonvaccinated children, and adults. However, incidents of pneumococcal disease due to new emerging nonvaccine serotypes and antimicrobial resistance have increased. Continuous monitoring and surveillance studies focused on the clinical and molecular epidemiology of pneumococcal disease will be required to understand the impact of the new vaccines and possible alteration in the pattern of disease presentation.
  3,106 3,259 1
GUIDELINE INTERPRETATION
Interpretation of expert recommendation on diagnosis and treatment of anti-tuberculosis drug-induced liver injury
Feng Li, Shuihua Lu
October-December 2015, 2(4):113-116
DOI:10.4103/2225-6482.172655  
  1,886 3,482 -
REVIEW ARTICLES
Exacerbations of bronchiectasis in adults
Margarida T Redondo, Sebastian Ferri, James D Chalmers
April-June 2016, 3(2):43-50
DOI:10.4103/2225-6482.184910  
Exacerbations are significant events in the course of bronchiectasis. Exacerbations are associated with accelerated lung function decline and deterioration in quality of life (QoL). Prevention of exacerbations is therefore one of the key objectives of management of bronchiectasis. A few treatments have been proven to reduce the risk of exacerbations, but these include the treatment of underlying causes of bronchiectasis and the use of prophylactic antibiotic therapies (macrolides and inhaled antibiotics). Nonantibiotic therapies, such as airway clearance and pulmonary rehabilitation, also play an important role in the prevention of exacerbations. Acute exacerbations are treated with antibiotics directed against the known bronchiectasis pathogens and guided by previous sputum culture results. This emphasizes the importance of screening sputum cultures in stable patients. Assessment of severity is used to determine whether patients should be treated at home or in hospital. Supportive therapy for exacerbations should include airway clearance alongside oxygen, hydration, and treatment of bronchospasm as required. Bronchiectasis is a rapidly developing field and new therapies, both for the prevention of exacerbations and the treatment of acute exacerbations, are currently being developed.
  4,562 473 2
ORIGINAL ARTICLES
Prevalence and antibiogram of hospital acquired-methicillin resistant Staphylococcus aureus and community acquired-methicillin resistant Staphylococcus aureus at a tertiary care hospital National Institute of Medical Sciences
Ameer Abbas, PS Nirwan, Preeti Srivastava
January-March 2015, 2(1):13-15
DOI:10.4103/2225-6482.153857  
Background and Aims: Since 1959, treatment of infections caused by S. aureus included semi synthetic penicillin drugs such as Methicillin. Sooner a year later in 1960 Methicillin resistant S. aureus came into existence. Decade after decade the MRSA strains increased and these bacteria were marked as major cause of nosocomial infections in early 1980s. The invasion of MRSA into community is now day's matter of concern for microbiologist. This study was conducted to detect the prevalence of MRSA resistance and to prepare antibiogram of HA-MRSA and CA-MRSA isolates at our hospital. Materials and Methods: A total of 201 staphylococcus isolates were detected as MRSA. They were then separated into two categories i.e. community acquired MRSA (CA-MRSA) and hospital acquired MRSA (HA-MRSA) according prescribed criteria. Antibiogram was prepared by Kirby- Bauer disk diffusion method. Results: Out of 201 isolates, HA-MRSA prevalence was 143(28.6%) and CA-MRSA was 58(11.6%). The HA-MRSA isolates showed were 10- 30% more resistant when compared to CA-MRSA. All isolates were 100 % sensitive to Vancomycin and Linezolid. Conclusion: We strongly suggest that time to time monitoring of MRSA should be done and proper hand wash must be done to avoid spread of MRSA.
  4,131 601 -
PERSPECTIVE
Phenotyping in bronchiectasis: Are we moving toward a personalized medicine?
Paola Faverio, Stefano Carlo Zucchetti, Edoardo Simonetta, Francesco Amati, Andrea Gramegna, Giovanni Sotgiu, Francesco Blasi, Anthony De Soyza, Stefano Aliberti
October-December 2016, 3(4):96-103
DOI:10.4103/2225-6482.198488  
Bronchiectasis (BE) is a heterogeneous disease. Similarly, to other chronic airway diseases, such as asthma and chronic obstructive pulmonary disease, management of BE patients requires a specific and personalized treatment that depends on many clinical, functional, and microbiological variables. Therefore, developing phenotyping methods that can help clinical and therapeutic choices is of paramount importance. Various methodological approaches have been used to personalize patients' management. In this review, we explore the main tools identified so far to classify and phenotype BE patients, including the approaches based on BE etiologies, disease severity, cluster analysis, and endotyping. We also discuss the strengths and limitations of every approach and highlight the similarities and differences between these studies. Finally, we review the therapeutic implications and clinical management connected with each approach.
  1,802 2,859 -
LETTER TO EDITOR
Biomedical waste management: Responsibility of policy makers, hospital administrators, and health care personnel
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
July-September 2014, 1(1):32-33
DOI:10.4103/2225-6482.141753  
  3,827 330 -
ORIGINAL ARTICLES
Prevalence of multidrug resistance and extended spectrum beta-lactamases among uropathogenic Escherichia coli isolates in a tertiary care hospital in South India: An alarming trend
Chittur Yerat Ranjini, Leela Rani Kasukurthi, Bathala Madhumati, R Rajendran
January-March 2015, 2(1):19-24
DOI:10.4103/2225-6482.153861  
Background and Aims: Escherichia coli is the most common etiological agent in both community acquired and hospital acquired urinary tract infections. Emergence of multidrug resistance (MDR) among E. coli isolates is quite alarming. The aim of this study was to define the current prevalence of MDR and extended spectrum beta-lactamases (ESBL) production among E. coli isolates from urine samples in our hospital. Materials and Methods: Urine samples from 1225 patients were processed for wet mount followed by culture and sensitivity. All the samples were inoculated on to Hi Media Hi chrome agar plates (HiMedia Laboratories Pvt. Ltd., Mumbai, India) and growth showing significant bacteriuria (≥10 5 cfu/ml) were further identified by the standard biochemical procedures and antibiotic sensitivity done as per Clinical and Laboratory Standards Institute guidelines. Detection of ESBL was done by the combined disc method. Percentage of antibiotic resistance and sensitivity and Chi-square test were used. Results: Out of 1225 samples processed, significant bacterial isolates were obtained in 357 (29.1%). The total number of E. coli isolated were 179 (50.1%) of which multidrug resistant E. coli isolates were 148 (82.6%) and 71 (39.66%) were ESBL producers. High degree of resistance was observed to amoxycillin (93.2%) and amoxycillin-clavulanic acid (90.5%). More than 80% sensitivity was seen only to imipenem (98.4%), amikacin (83.3%) and nitrofurantoin (86.6%). Conclusion: Multidrug resistant strains of E. coli are widely prevalent in the community. Antibiotics like imipenem require hospitalization, parenteral administration, drug monitoring for toxicity, all of which incur high cost to the patient and have to be used judiciously.
  3,432 585 4
REVIEW ARTICLE
Cytomegalovirus infection of gastrointestinal tract
Mukesh Nasa, Zubin Sharma, Randhir Sud, Lipika Lipi
January-March 2016, 3(1):4-9
DOI:10.4103/2225-6482.179226  
Gastrointestinal tract infection with CMV can occur from mouth to anal canal. In the immunocompetent subjects, the upper GI tract is most commonly involved while immunocompromised individuals have colon as the most common site of involvement. In a study of CMV infection among AIDS patients, the most common site of CMV infection in the GI tract was the colon (55%), while gastric involvement was reported in 40% of cases. CMV mononucleosis, hepatitis and pneumonitis are among the most common manifestations.' GI tract involvement is common and it is easy to access for taking the diagnostic biopsies. Severity and extent of involvement within the GI tract is variable.
  3,608 331 -
Community-acquired viral pneumonia in human immunodeficiency virus infected patients
Catia Cilloniz, Shinobu Yamamoto, Ernesto Rangel, Antoni Torres
October-December 2014, 1(2):44-52
DOI:10.4103/2225-6482.147652  
Respiratory viruses (RV) have become an important cause of community-acquired pneumonia in immunocompromised patients with the highest rates of morbidity and mortality. The advances in molecular diagnostic methods have increased our understanding of the role of viruses in pneumonia. However, little is known about their impact on patients with human immunodeficiency virus (HIV) infection. In this review, we focus on the most prevalent RV that has been implicated in viral respiratory infections, particularly in pneumonia in HIV infected patients. We discuss the epidemiologic characteristics and clinical presentations of these viral infections and the most appropriate diagnostic approaches and therapies if available.
  2,756 1,155 -
EDITORIALS
Community-acquired pneumonia: Changing paradigms about mortality
Antoni Torres
July-September 2014, 1(1):1-3
DOI:10.4103/2225-6482.141744  
  3,324 480 3
ORIGINAL ARTICLES
Notified or missed cases? An assessment of successful linkage for referred tuberculosis patients in South India
Ramesh Chand Chauhan, Anil Jacob Purty, Zile Singh
October-December 2015, 2(4):137-141
DOI:10.4103/2225-6482.172652  
Background and Objectives: Although tuberculosis (TB) is a notifi able disease in India, most of the cases of TB are either not recorded or reported. Among diagnosed cases, for improving reporting, proper feedback on referral outcome needs to be ensured to all health care providers who refer cases to the public health system. Materials and Methods: All the received feedbacks for TB patients referred for treatment from July 2013 to December 2013 were analyzed. Feedback reports including referral date, the age and sex of patients, type of disease, and date of treatment initiation were examined. Results: Of the total 1,259 referred TB patients during the study period, feedback was received for 54% of them. Only 42.3% (n = 532) of the referred patients were successfully linked at the treatment facility. Seven (0.6%) referred patients died before the initiation of treatment while 3.7% migrated, 2.4% gave the wrong address, 1.0% started private treatment, and 0.6% were nontraceable; in 3.2% cases only was the TB number given. Feedback was signifi cantly associated with sex, age group, type of treatment, disease type, and place of residence. Conclusion: The feedback received for referred patients was poor and for improving the care of TB patients, there is a need to strengthen the feedback mechanism in Revised National Tuberculosis Control Programme (RNTCP) for referred patients.
  3,452 253 -
Detection of ESBL and plasmid-mediated AmpC beta lactamases among the Gram-negative bacterial isolates in diabetic foot ulcer infections
Chittur Yerat Ranjini, Vidhya Rani Rangasamy
April-June 2015, 2(2):57-62
DOI:10.4103/2225-6482.159229  
Background and Aim: Foot ulcers are a significant complication of diabetes mellitus and are usually poly-microbial. Aerobic Gram-negative bacilli are isolated in higher frequency with increasing grade of ulcers, and development of drug resistance is a cause of concern. The aim of our study is to identify the extended spectrum β-lactamases (ESBL) and AmpC β-lactamases among the Gram-negative aerobic bacterial isolates in the different grades of diabetic foot ulcers. Materials and Methods: Pus samples from 104 male and female diabetic patients presenting with grade I to grade V foot ulcers were cultured according to the standard microbiological procedures and antimicrobial sensitivity performed by the Kirby-Bauer disc diffusion method as per CLSI guidelines. MIC 50 of all isolates for Ceftazidime was detected by the agar dilution method. The Gram-negative bacterial isolates were further tested for ESBL and AmpC β-lactamases by the modified double disc synergy test and combined disc method. AmpC disc test was used for the confirmation of AmpC production. Results: Forty-seven isolates exhibited resistance to Ceftazidime phenotypically and 54 isolates had MIC greater than 2 μg/mL. ESBL production was observed in 55.55% of the isolates. AmpC production was seen in 19 isolates (35.18%). No mechanism of cephalosporin resistance was explainable for 5 isolates. Conclusion: The combined disc method was more sensitive in the detection of ESBLs, while the AmpC disc test was an easy way to detect AmpC beta lactamases and can be used for routine screening.
  3,289 409 -
An epidemiological study of health-care-associated infections and their antimicrobial sensitivity pattern in the Al-Qassim region of Kingdom of Saudi Arabia
Sanjay Kumar Gupta, Fahd Khaleefah Al Khaleefah, Ibrahim Saifi Al Harbi
July-December 2017, 4(3):45-50
DOI:10.4103/cai.cai_11_17  
Background: In the USA, up to 2 million health-care-associated infections (HAIs) per year are reported, of which 80,000 are lethal. Materials and Methods: This was a hospital-based observational (retrospective) study. Results: Hospital-wide rate of HAI ranges from 0.35 to 1.96 per thousand patients per day. The most common organism observed in the last 5 years is Acenatobacter (88 [27%]) followed by Pseudomonas aeruginosa (73 [22%]). Significant cases in these 5 years were reported from Intensive Care Unit (157 [48%]) followed by medical wards (males and females) (106 [32%]). The common site reported in the present study is catheter-associated urinary tract infection which was significantly higher (CA-UTI) (152 [46%]) followed by ventilator-associated pneumonia (VAP) (66 [20%]). The common organisms reported to cause UTI are P. aeruginosa (22%) followed by Escherichia coli (19%), and the most common microbial agent associated with VAP is Acenatobacter baumannii (48 [72%]) which was found to be significantly higher. The antibiogram of microorganism responsible for HAI was observed, and 56% isolates of Acinetobacter baumannii were sensitive to aztreonam followed by imipenem 54%, ceftazidime 47%, and amikacin 36%. Another common organism reported was P. aeruginosa, and the majority of isolates of this were sensitive to imipenem 79% followed by amikacin 68%, ceftazidime 53%, aztreonam, and ciprofloxacin 49% and least sensitive to meropenem 9%. Most of the Klebsiella pneumoniae strains during the same period were found to be sensitive to imipenem 94% followed by piperacillin/tazobactam 71%, amikacin 69%, cefepime 59%, and ceftriaxone 56% and least sensitive to nitrofurantoin 11% only. Conclusion: HAI is a big threat for patients' safety and prolongs patients' stay and cost of health care, so effective utilization of hospital data is crucial for prevention and control.
  2,606 933 -
Serum procalcitonin as a predicting value in severity and prognosis of CAP in sickle cell patients
Sherif Refaat Alsayed, Samar Marzouk, Essam Mousa
July-September 2014, 1(1):15-20
DOI:10.4103/2225-6482.141748  
Background: The Pneumonia Severity Index (PSI) and CURB-65 predict outcomes in community acquired pneumonia but have limitations. Materials and Methods: The study evaluated if procalcitonin in community-acquired pneumonia provides prognostic information with the PSI and CURB-65 in sickle cell adult patients. Twenty sickle cell positive adult patients with a clinical and radiographic diagnosis of community acquired pneumonia were scored using PSI and CRUB-65, and measured procalcitonin levels. Results: They were 12 female 60% and 8 males 40%with mean of age 46.0 ΁ 10.26 and were stratified with PSI, CRUB65 and sampled for procalcitonin level for PSI class I (3) patients 15%, class II (10) patients 50%,class III (3) patients 15%, class IV( one) patient 5% & class V (3) patients 15% with mean of 2.55 ΁ 1.276 were CRUB65 0 (2) patients 10% 1 (11) patients 55% two (3) patients 15%, three (4) patients 20%with mean of 1.45 ΁ 0.94 proclacitonin >0.25 (8) patients 40% and >0.50 are (12) patients 60% with mean of 1.098 ΁ 1.346. Conclusion: Procalcitonin levels on admission predict severity of community-acquired pneumonia in sickle cell patients with a similar prognostic accuracy as PSI and CRUB65 and use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high risk patients as sickle cell positive patients, further studies must address whether adding PCT to risk scores can increase their safe implementation in clinical practice. This was the scope for patients with sickle cell.
  3,254 254 -
REVIEW ARTICLES
Research progress in atypical pathogens of community acquired pneumonia
Jiuxin Qu, Bin Cao
July-September 2014, 1(1):11-14
DOI:10.4103/2225-6482.141747  
Atypical pathogen, especially Mycoplasma pneumoniae is a common and important pathogen of community-acquired pneumonia. Physicians should pay more attention on them. Compared with bacteria, the clinical treatment of atypical pathogens is different, as beta-lactams are not effective for atypical pneumonia. Therefore, laboratory diagnostic methods and clinical biology research is particularly important for the diagnosis and treatment of atypical pneumonia. In order to provide more theoretical basis for clinical diagnosis of atypical pathogens infection, we performed a review of the research progress of prevalence, laboratory testing of atypical pathogens related infections.
  2,856 416 -
Cardiovascular complications in patients with community-acquired pneumonia
Marta Di Pasquale, Sonia Henchi, Nicolò Vanoni, Francesco Blasi
April-June 2017, 4(2):23-31
DOI:10.4103/cai.cai_7_17  
Community-acquired pneumonia (CAP) is the most frequent infectious disease, responsible for a great morbidity and mortality worldwide. It is known that poor outcome in CAP patients is not only directly related to pneumonia but also to comorbidities both during hospitalization and long term after discharge. Evidences show a high correlation between acute respiratory infections and increased risk of cardiovascular events (CVEs), such as acute myocardial infarction, arrhythmias, congestive heart failure, and stroke. The excessive systemic inflammatory response is responsible for hypoperfusion and activation of cytokines causing endothelial dysfunction, pro-coagulant effects, and atheroma instability. An established diagnostic tool to identify high-risk patients is not yet available, but cardiovascular biomarkers seem to be more effective than inflammatory molecules. Early identification of patients at higher risk for CVEs is mandatory to treat them effectively with prophylaxis medications, to establish adequate clinical surveillance and prevention with vaccinations. The present article reviews the epidemiology, pathophysiology, clinical presentation, risk factors, diagnosis, outcomes, and prevention of CVEs in patients hospitalized for CAP.
  2,744 524 -
ORIGINAL ARTICLES
Empiric antibiotic treatment of community-acquired pneumonia in Spanish Intensive Care Units: What has changed over the years?
Laura Claverias, Maria Bodí, Alejandro Rodríguez Oviedo
April-June 2016, 3(2):55-60
DOI:10.4103/2225-6482.184915  
Background and Objectives: Appropriate empiric antibiotic therapy in patients with severe community-acquired pneumonia (CAP) is crucial in terms of outcome. International guidelines suggest combination therapy (CT) for CAP patients admitted to Intensive Care Units (ICU). However, that type of combination of antibiotics is not clear. This study aims to determine the empiric antibiotic treatment of severe CAP in two periods. Our hypothesis was that macrolide use has decreased in the recent years. Materials and Methods: We compared in two prospective similarly designed cohort studies (1) CAP in ICU (2000-2002) and (2) H1N1 SEMICYUC (2009-2011) of critically ill patients with CAP: (a) Rate of CT and (b) use of macrolide or quinolones in each period. Demographic, severity of illness and clinical data were recorded. Chi-square test (categorical variables) and Student's t-test (continuous variables) were used. Results are shown as median, standard deviation, odds ratio, and 95% confidence interval. P < 0.05 was considered. Results: We included 1059 patients, 529 (49.9%) in the first period and 530 (50.1%) in the second period. The severity of illness and mortality rate was not different between periods. In overall, 866 (81.7%) received CT and this therapy was more frequent in the second period (85.3% vs. 78.3%, P < 0.003). A significant reduction in macrolide use in the second period was observed (26% vs. 55%; P < 0.01) even in patients with shock. Conclusions: Despite published evidence, CT use with quinolones has increased in the last years in Spanish ICUs.
  2,872 347 -
REVIEW ARTICLES
Severe community-acquired pneumonia: Severity and management
Adamantia Liapikou, Catia Cilloniz
January-March 2015, 2(1):3-7
DOI:10.4103/2225-6482.153855  
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. "Severe CAP'' (sCAP) identifies a group of patients who have severe disease and require Intensive Care Unit admission. Recommendations for antibiotic treatment for sCAP are based on illness severity, frequency of specific pathogens and local microbial resistance patterns. The challenges to patient management include the emergence of the high prevalence of multidrug-resistant in CAP, mainly from institutionalizing patients. A new approach is the evaluation of biomarkers as C-reactive protein, procalcitonin on the diagnosis, prognosis and therapy duration of sCAP with promising results . Implementation of guidelines for CAP treatment should be emphasized in order to increase survival. The benefits of steroid use in patients with severe pneumonia have not been proven yet by current literature.
  2,696 513 -
ORIGINAL ARTICLES
Investigation of jaundice outbreak in a rural area of Odisha, India: Lessons learned and the way forward
Sourabh Paul, Preetam B Mahajan, Vikas Bhatia, Jyoti Ranjan Sahoo, Dillip Kumar Hembram
October-December 2015, 2(4):131-136
DOI:10.4103/2225-6482.172650  
Background and Objectives: Hepatitis, a condition with liver inflammation, mostly follows hepatitis virus infection of different types A, B, C, D, and E. Each year, numerous outbreaks of hepatitis virus are being reported from around the country, more so from the “Empowered Action Group (EAG) States.” The present outbreak investigation was performed in Odisha, India to study the epidemiology, explore the reasons behind it, and suggest preventive measures for the future. Materials and Methods: A team consisting of public health doctors from All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India investigated the hepatitis E outbreak as per standard guidelines in one of the villages of Tangi block in the state of Odisha, using a questionnaire between January 1, 2015 and January 15, 2015. The data were entered and analyzed in Microsoft Excel 2007. Time, place, and person analysis were performed for all case patients. Result: Hepatitis E outbreak occurred between November 16, 2014 and January 1, 2015, affecting 22 individuals. The attack rate was 44/1,000 in the population and young males were mostly infected. Spot map of the outbreak probably points toward point source epidemic. Most of the infected cases had visited allopathic doctors as well as traditional healers. Less than 50% people had some knowledge about the prevention and control of hepatitis virus infection. Open defecation was highly prevalent in the village. The well was the commonest source of drinking water and the condition of wells was non-sanitary. Less than 2% started hand-washing after the end of the outbreak in the community. Conclusion: Focus of outbreak investigation should not restrict only to immediate control but should rather lead to intervention by the health system in the area for construction of community toilets, improved drinking water facilities, and sustained information, education, and communication (IEC) activities to promote personal hygiene and water safety behavior in the community.
  2,690 440 -
CASE REPORT
Bronchiectasis in rare pulmonary diseases: A case series
Ines Maria Grazia Piroddi, Edmundo Rosales, Catia Cilloniz, Adrian Ceccato, Antonello Nicolini
October-December 2016, 3(4):129-134
DOI:10.4103/2225-6482.198500  
Bronchiectasis, defined as permanent dilatation of the airways, usually causes chronic cough and sputum production with intermittent bacterial exacerbations. Bronchiectasis can have a severe impact on quality of life for many patients due to these symptoms. Establishing the cause of bronchiectasis may be difficult. Even with exhaustive clinical, laboratory, and pathologic testing, up to 50-80% of cases of bronchiectasis may still be idiopathic. Congenital bronchiectasis is much rarer than previously considered. A variety of respiratory and systemic diseases such as autoimmune or rheumatologic diseases may be complicated by pathological bronchial dilatation, and therefore various medical specialists will be dealing with the condition in one-way or another. Some bowel diseases are associated with a variety of systemic manifestations including large and small airway involvement: One of the most commonly associated airway diseases is bronchiectasis. On this regard, we report five patients with bronchiectasis and rare diseases admitted to our hospitals since 2012. Patients were recruited over a period of 36 months after opening a bronchiectasis outpatient clinic.
  2,911 152 -
ORIGINAL ARTICLES
A questionnaire survey of stigma related to human immunodeficiency virus infection/acquired immunodeficiency syndrome among healthy population
Meha Jain, Reema Sinha, Sujita Kumar Kar, Mamta Yadav
January-March 2017, 4(1):6-11
DOI:10.4103/2225-6482.203265  
Background and Objectives: Human immunodeficiency virus (HIV)-related stigma is present at all levels which act as critical barriers for effectively addressing it. This also influences the treatment uptake and under or nonparticipation in treatment available. In view of this, the present study was aimed to assess the stigma of otherwise healthy individuals of the community toward HIV infection/acquired immunodeficiency syndrome (AIDS). Methods: The study was conducted on 100 healthy individuals. Their responses were taken on a self-designed semi-structured questionnaire. Results: The results showed that there is more perceived stigma as compared to enacted stigma. Nearly 46% of the individuals feel that HIV-infected persons should be blamed for their illness and 41% individuals feel that they will feel ashamed if they have HIV. It was also seen that older adults. (between 46 and 55 years) had more stigma as compared to the younger adults (between 16 and 25 years). The educated individuals still have stigma to a certain extent. Most of the individuals would like to tell their partner if they were diagnosed with HIV. Participants were divided into two groups on the basis of their level of education. (<12 years of formal education and >12 years of formal education). Stigma related to HIV/AIDS was compared among these two groups, and there was no significant difference in the level of stigma in these distinctly different educational groups. Conclusion: There is still stigma present to a certain extent in the society in the educated and urban individuals. Level of stigma may not be significantly different in people with educational difference. Stigma needs to be addressed for prevention and better management of HIV/AIDS.
  2,711 342 -
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