Acute kidney injury (AKI) is a common disorder worldwide that is associated with severe morbidity, mortality and cost. If managed adequately and in a timely manner, the majority of these cases are preventable, treatable and often reversible with simple measures. We conducted a two years prospective study of patients admitted to medical and surgical units of a tertiary care center in Central India to identify the causes of Hospital Acquired AKI (HAAKI) and its impact on patient outcomes. HAAKI occurred in 215 of 9,800 patients (2.1%). Sepsis (75; 34.88%), volume depletion and hypo perfusion (62; 28.83%), drugs (50; 23.25%), multifactorial (18; 8.37%) and radiocontrast agents (9; 4.2%) were the causes of HAAKI. Thirty-nine percent of patients had complete recovery and 9.3% had partial recovery of renal function. The overall inhospital mortality due to HAAKI was 41.86%. On multivariate analysis, oliguria, multi-organ failure, metabolic acidosis, anemia, and sepsis showed significant association with in-hospital mortality. The mortality and morbidity associated with HAAKI mandates the need for active measures to decrease its incidence. Knowledge of incidence and risk factors is crucial because it drives local and international efforts on detection and treatment. To the best of our knowledge, no epidemiological study has been conducted or published on HAAKI from the Central India.

Background: Initial empirical therapy of ventilator-associated pneumonia (VAP), which is based on organisms recovered, can be modified based on the knowledge of local microbiological data, patient characteristics, and sensitivity pattern of expected pathogens at the institution. Aim of this study was conducted to observe the regional the incidence of VAP among mechanically ventilated patients.Methods: All the patients who conformed to the inclusion criteria of the study, and who were in the ICU settings and put on ventilatory support, underwent vigorous aseptic precautions and later on developed VAP were taken into the study.Results: Total 374 admitted patients were needed mechanically ventilation. Among 31 developed LRTI. The Overall incidence rate of VAP was computed to be 8.2% with highest rate among patients of age group 31-50 years. The incidence rates of VAP were found highest for Acinetobacter (54.8%) with second highest mortality (47%) whereas maximum mortality (66.66%) was caused by Klebsiella, the second most common incidence of VAP. Twenty-one patients developed early VAP whereas remaining 10 subjects developed late VAP. Mortality was higher between early VAP (57.14%) compared to the late VAP cases (30%). Majority of organisms were sensitive to Cefoperazone + Sulbactum (29), Imipenem (24) and Meropenem (22).Conclusions: Despite advances in diagnostic and treatment modalities of VAP, its management still continues to be a challenge for clinicians. The findings emerging out of this investigation will help in initial selection of antibiotics for the empiric treatment of VAP. Later on, therapy can be modified based on the knowledge of pattern and profile of VAP patients along with sensitivity pattern of expected pathogens.

<p class="abstract"><strong>Background:</strong> In patients with acute exacerbations of COPD, endotracheal intubation and complications associated with mechanical ventilation may be evaded using non-invasive ventilation.<strong> </strong>The aim of the study was to analyse the effectiveness of NPPV for hypercapnic respiratory failure secondary to acute exacerbation of COPD in India.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, 63 cases of hypercapnic respiratory failure secondary to acute exacerbation of COPD admitted in the intensive care unit during 2011-13 formed the study population. Standard therapy was initiated in all the patients. Patients who failed to improve with standard therapy alone were given a trial of non invasive ventilation. Non invasively ventilated patients, showing significantly improvement in their clinical status and arterial blood gas parameters were discharged. Patients who failed to show significant improvement with NPPV were given invasive ventilation.</p><p class="abstract"><strong>Results:</strong> Standard therapy was initiated in 63 patients on admission but 25 patients failed to improve with standard therapy alone. Out of the total 25 patients non invasively ventilated, 22 patients showed significantly improvement. Significant improvement in the Mean pH, Mean paCO2 and Mean paHCO3 in both standard therapy and non invasive ventilation group. Success rate was found to be highest (88%) in standard therapy + noninvasive ventilation treatment modality group.</p><p class="abstract"><strong>Conclusions: </strong>NIV is an effective tool in hypercapnic respiratory failure secondary to acute exacerbation of COPD and its early initiation would improve the clinical status and respiratory acidosis.</p>

No abstract

Background: Degenerative lumbar canal stenosis presents with low backache. Ligamentum flavum hypertrophy secondary to vitamin D deficiency causes central canal stenosis. This is a common presentation in obese females residing in North India. Case presentation:We present the case of a young, obese, north Indian 32-year-old female, who had a history of chronic low mild backache, with reduced spine mobility, with MRI lumbosacral scan revealing grade I spondylolisthesis with spondylolysis seen at L4 over L5 and ligamentum flavum and facetal hypertrophy. Further workup showed raised serum parathormone (PTH) and deficient serum 25-OH Vitamin D total levels. Hypovitaminosis D was responsible for the ligamentum flavum hypertrophy and secondary lumbar canal stenosis. She was discharged on Vitamin D replenishment regimen.Conclusions: Vitamin D deficiency is coexistent with low backache, secondary to degenerative lumbar canal stenosis.