Background: Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia associated with increased morbidity and mortality. Awareness about the risk factors can be used to implement simple and effective preventive measures. Objectives: To determine the factors associated with development of VAP and its microbial profile among patients admitted to ICUs. Methods: A nested case-cohort study was conducted at Al-Hussein university hospital in Cairo city, Egypt for a period of 6 months from the 1 st of March 2013 to the end of August 2013. Patients who were on mechanical ventilation (MV) for more than 48 hours were monitored at frequent intervals for development of VAP. Samples obtained by endotracheal aspiration were ccultured on Blood agar-Chocolate agar-MacConkey agar, plates of which were incubated at 37c for 24 hours. The isolated organism was identified by morphological and biochemical identification. Results: Of the 73 samples which were taken from endotracheal tubes of the patients, 42 cases were diagnosed as VAP with an incidence rate of 57.5%. Early onset VAP occurred in 36 (85.7%), while late onset VAP was observed in the remaining 6 patients(14.3%). Escherichia coli (40.5%) followed by Klebsiella pneumoniae (23.8%) were the most commonly isolated pathogens. Univariate analysis showed that the duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H2 blocker use were the risk factors associated with VAP (p < 0.05). Logistic regression revealed duration of MV as an independent risk factor for VAP. Conclusion: The incidence of ventilator pneumonia is high in our study. VAP was significantly related to duration of MV and ICU stay, re-intubation, supine head position, impaired consciousness, steroids use and H2 blocker use.

Article information Background: Diabetes mellitus [DM] and thyroid dysfunction are the most commonly coexistent disorders. Hypo-and hyperthyroidism are causes of dysglycemia. However, the relation between normal thyroid hormone levels and insulin resistance [IR] is unclear. The aim of the work: This study aimed to examine the association between the normal values of thyroid hormones and glucose metabolism and to investigate whether improvement of metabolic status can restore thyroid function in patients with uncontrolled type-2 diabetes mellitus [T2DM]. Patients and Methods: This study was a retrospective observational study. A total of 120 euthyroid participants were recruited. They were classified into four groups: Normal glucose tolerance [NGT, n =28], Prediabetes [n=32], well controlled DM [T2DM with glycated hemoglobin [HbA1c] ≤ 7%, n =26], and uncontrolled DM [T2DM with HbA1c > 7%, n = 34]. The results were compared between groups and the changes before and after treatment in uncontrolled DM group were observed and documented. Results: A total sample of 120 participants showed that mean age of DM uncontrolled patients was 40.2± 19.5 and there were no significant differences among groups regarding their age, body mass index [BMI], blood pressure [BP]. However, groups showed significant differences regarding cholesterol, free t4, serum glucose, two hours post prandial glucose, HbA1c, fasting insulin and insulin resistance. Regression analysis revealed that BMI, HbA1C, low density lipoprotein [LDL], triglycerides [TG] and total thyroxine [TT4] had statistically significant association with insulin resistance. there is statistically significant difference between uncontrolled DM patients before and after treatment regarding HbA1C and glucose. Conclusion: Reduced levels of free thyroid hormones [although in normal range] were significantly associated with high levels of serum glucose and HOMA-IR. There was significant improvement of blood glucose levels and insulin resistance.