Tertiary Care Hospital In North India Research Articles

Cardiac injury in organophosphate poisoning after acute ingestion.

Sparse data and conflicting evidence exist on the prevalence and prognosis of organophosphate (OP)-related cardiac toxicity. We aimed to characterize the cardiac abnormalities of OP after an acute cholinergic crisis in adults without previous cardiovascular conditions. We did a prospective observational study in a tertiary-care hospital of north India (Postgraduate Institute of Medical Education and Research, Chandigarh) in 74 patients aged ≥ 13years admitted with acute OP poisoning after self-ingestion. A systemic evaluation, including clinical characteristics, electrocardiography, and echocardiography, was performed to estimate the prevalence and prognosis of cardiac injury. A rate-corrected QT interval was calculated using Bazett's method, and >440 milliseconds was used to define prolongation. Chlorpyrifos was the most commonly ingested OP (n=29). The patients had a similar occurrence of hypotension (n=10) and hypertension (n=9) at admission, and electrocardiography demonstrated sinus tachycardia in 38 (51.3%) and sinus bradycardia in one case. During the hospital stay, 3 out of 74 patients had a prolonged rate-corrected QT interval (457, 468, and 461 milliseconds), and one patient developed supraventricular tachycardia. Eight (10.8%) patients developed the intermediate syndrome, and six (8.1%) died. None of the hemodynamic or electrocardiographic abnormalities was associated with in-hospital mortality or intermediate syndrome development on univariant analysis. Baseline echocardiography at hospital discharge was performed in 27 patients (admitted during 2018) and normal in all except mild tricuspid regurgitation in one. At a 6-month follow-up, 23 cases were available for cardiovascular screening (including echocardiography) and had a normal evaluation. Cardiac toxicity is uncommon after acute OP self-ingestion and lacks prognostic significance.

Mutations in two component system (PhoPQ and PmrAB) in colistin resistant Klebsiella pneumoniae from North Indian tertiary care hospital.

Colistin resistance in Gram negative bacteria is mainly attributed to chromosomal mutations in Two Component Systems(TCS) PhoPQ and PmrAB and plasmid-borne genes(mcr and its variants). The aim of this study was to understand the molecular basis of colistin resistance in Klebsiella pneumoniae and determine clonal transmission, in a North Indian tertiary care hospital over a 2.5 year period. Antimicrobial susceptibility was determined by Vitek and colistin resistance was confirmed by broth microdilution. Carbapenemases(blaKPC, blaVIM, blaIMP, blaNDM, blaOXA-48) and mcr-1 screening was done by PCR. Mutations in chromosomal genes mgrB, phoP, phoQ, pmrA, pmrB were analysed. Sequence typing was performed by Multilocus sequence typing(MLST). OXA-48 was detected in thirteen isolates while three isolates co-expressed OXA-48 and NDM. The mcr-1 gene was absent in all 16 isolates. Deleterious mutations in mgrB included insertion sequences IS903 and ISkpn26 and a premature stop codon. A total of 18 point mutations were identified in PhoPQ and PmrAB TCS; of which, novel mutations were reported in phoQ (K46E, L322V, D152N, F373L, R249G), pmrB (P159R) and pmrA (D149L). Six different sequence types ST231, ST147, ST395, ST42, ST14 and ST101 were identified. Phylogenetic analysis showed that sequence types ST14, ST395 and ST147 are closely related to ST101 and all identified sequence types had a common ancestor ST231. Colistin resistance in K. pneumoniae was attributed to mutations in PhoPQ and PmrAB TCS, while location specific distribution of strains indicates clonal transmission. The results of this study will help in formulation of effective infection prevention and antimicrobial development strategies.

Feto-maternal and renal outcomes of nephrotic syndrome in pregnancy.

Proteinuria can range from subnephrotic to nephrotic amounts during pregnancy, though nephrotic syndrome (NS) is rare (0.012%-0.025%). Without a renal biopsy, this distinction may be difficult at times. The objective of our study was assessing about renal and feto-maternal outcomes of these patients. This study was done in a tertiary-care hospital in north India from 2010 to 2019. We included all pregnant women with nephrotic-range proteinuria, with no signs or symptoms suggestive of pre-eclampsia. We studied their treatment modalities, renal, maternal, and fetal outcomes. Eighteen eligible pregnant women diagnosed with NS with no features suggestive of pre-eclampsia or associated comorbidities were included. The gestational age of presentation was 23.2 ± 1.36 weeks. The average proteinuria was 4.38 ± 0.76 g/day. The patients were managed conservatively without kidney biopsy. About 16.7% of pregnancies had worsening of hypertension and acute kidney injury which recovered after delivery. Anasarca was troublesome for four patients requiring fresh-frozen plasma infusion. All were managed conservatively; however, five patients were started on empirical immunosuppression, all five with steroids, while two required the addition of calcineurin inhibitors as well. All had live births, but 25.7% each had preterm and intrauterine growth restriction while one required neonatal intensive care unit admission. The degree of proteinuria had an impact on maternal and fetal outcomes, especially on risk to pre-eclampsia. NS during pregnancy needs evaluation and counseling. Majority of them can be managed conservatively yet specific therapies can safely be tried among symptomatic ones. Despite good outcomes, a sizeable risk to maternal and fetal complications can occur.

Epidemiology of Brachial Plexus Injury in North Indian Tertiary Care Hospital: A Retrospective Study

Introduction: Epidemiological studies on Brachial Plexus Injuries (BPI) are in limited numbers. Such epidemiological factors can be different in different countries. Aim: To determine the epidemiological factors on brachial plexus injuries in North Indian tertiary care hospital. Materials and Methods: A retrospective observational study was conducted in which all patients of brachial plexus injury who underwent surgery for same in Department of Plastic Surgery of a tertiary care hospital in Lucknow, Uttar Pradesh, India from January 2017 to December 2019 were included. Those who were managed conservatively were excluded from study. Their demographic and epidemiological factors like type of injury, limb involvement, nature of trauma were evaluated. Data was tabulated and results were expressed in terms of numbers and percentages. Results: There were total 221 patients,out of which 147 patients had pan brachial plexus involvement and 74 patients suffered from partial involvement of brachial plexus roots. Majority of the patients had their right upper limb involved (n=139). Motor cycle accidents (n=155) were the primary cause followed by four wheeler accident (n=25) and fall from height (n=18). Conclusion: Brachial plexus injury is a challenge for surgeons. Road Traffic Accidents are the dominant cause of these injuries and among them motorcycle accidents remained the major cause.

Gastrointestinal Tuberculosis - A Retrospective Observational Study in a North Indian Tertiary Care Hospital

Background and Aims: Tuberculosis is one of the most common infectious diseases affecting the world’s population in general, and the Indian population in particular, across all age groups, causing significant morbidity, mortality and economic outfall. Uttar Pradesh (UP) being the most populous state of India contributes to the major burden of pulmonary as well as extra-pulmonary tuberculosis. This study was aimed to analyze the patients of gastrointestinal tuberculosis, particularly their clinical presentations and various surgical options undertaken in such patients. Materials and Methods: All the patients with gastrointestinal tuberculosis, more than 16 years of age were studied in this two and a half years retrospective study conducted at a tertiary care hospital in Western UP. Results: Ninety-three patients of gastrointestinal tuberculosis, ranging from 16-81 years were studied with most of them being in their third decade of life. Males constituted 62.4% and females 37.6% of the total patients (M: F ratio, 1.6:1). Abdominal discomfort and/or pain and weight loss were the most common presenting features. The Ileocecal area was the most common site involved in the gastrointestinal lumen whereas the retropancreatic and pancreaticoduodenal complex was the most common area involved among the solid organs of the gastrointestinal/ hepatopancreatic biliary system. Surgical intervention was required in 53 patients and all but one patient were treated with an Antitubercular treatment (ATT) regimen. Conclusion: Tuberculosis of the gastrointestinal and hepatopancreatic biliary system affects a large proportion of our country’s population, particularly in endemic areas. Patients with gastrointestinal tuberculosis usually neglect their symptoms for a long time and present late with complications, thus need surgical interventions. Therefore, a high degree of suspicion is required so that early diagnosis and treatment can be provided to such patients for a better outcome.

THE COMPLICATIONS OF CSOM : OUR EXPERIENCE

Abstract Context: Chronic Suppurative Otitis Media (CSOM) is a commonly encountered middle ear disease resulting in morbid complications and squeals. It is broadly classied into safe and unsafe type; in which unsafe CSOM is commonly associated with complications due to the bone erosion effect of cholesteatoma and super added infections. The rise in antibiotic use has reduced the incidence of complications but the current practice of unscientic administration of antimicrobial agents has made the microbiome resistant, ironically increasing the rate of certain complications. Aim: This study was conducted to prole the complications in unsafe CSOM. Material and Methods: A record based cross sectional study was conducted between January 2015 and October 2018 on 241 cases of unsafe CSOM at a tertiary care hospital in North India. Results: Out of 241 cases 14% presented with complications. Of these 76.6% had extra c ranial compli cation and 23.33% had intracranial complications. Conclusion: Mastoid abscess and meningitis were the most frequently encountered extra and intra cranial complications respectively. Judicious use of antibiotics will go a long way in reducing the morbidity due to the disease. Keywords: CSOM; Extra cranial complications; Intra cranial complications.

Clinico - Hematological Profile of Nutritional Anaemia among Adolescent Girls in Rural Area

Anaemia in adolescent girls contributes to prenatal morbidity and mortality in the future. The present study was undertaken with the aim of studying the clinical-haematological profile of anaemia in adolescent girls in the North Indian tertiary care hospital. Among 380 adolescent girls, hemoglobin concentration was less than 12 gm/dl among 172 (45.3%) girls which was classified as anemia. 91 (52.9%) girls were classified as having mild anemia (Hb- 11.0 to 11.9 gm/dl), 69 (40.1%) had moderate anemia (Hb- 8.0 to 10.9 gm/dl) and 12 (7.0%) girls had severe anemia (Hb- less than 8 gm/dl). Most common cause of anaemia was iron deficiency anaemia. Mean age of study participants was 14 years with Standard deviation of 2.73. In the present study, prevalence of anemia increases with increase in socio- economic class of study participants. Prevalence of anemia was more in underweight girls in comparison to those girls who had normal range of BMI.

English

English

Craniosynostosis in an Indian Scenario: A Long-term Follow-up.

We have reviewed the outcomes of management of craniosynostosis patients and evaluated changes in these outcomes as the experience was gained. The study is a retrospective chart review of the 169 patients operated on for various craniosyntoses in the hospital, for the last 25 years from January 1995 to July 2019. The whole spectrum of craniosynostoses patients have been operated on and followed up for up to 20 years. All the patients underwent open surgery involving fronto-orbital advancement and remodelling of the deformed calvarium. It was noted that all the syndromic patients required more than one operation, whereas the non-syndromic patients had a stable result after a single surgery. Craniofacial surgery has now truly arrived in India. Our experience with management of craniosynostosis at PGIMER, Chandigarh, has shown an acceptable morbidity and mortality which is at par with the global standards.

Attitude and beliefs about surgical safety checklist in a North Indian tertiary care hospital, a decade later of World Health Organisation checklist

Background: Avoidable surgical complications account for a large proportion of preventable medical injuries and deaths globally. Surgical safety checklist (SSCL) is evidence‑based, internationally accepted valid instrument, which has been found to reduce postoperative morbidity and mortality; the benefits of which are most striking in low and middle‑income countries (LMICs) Despite implementation in many hospitals throughout the country, there is still lack of awareness and concern in many LMICS health care facilities towards SSCL and its use, even after a decade of World Health Organisation (WHO) checklist. Methods: This was a single centre e-survey to assess the knowledge, attitudes and beliefs about the WHO‑surgical checklist, in which 65.4% (138) surgeons, 25.1% (53) anaesthetists and 9.5% (20) nurses participated. Results: Majority believed that the use of SSCL improves the safety of procedures, improves communication amongst theatre staff and will result in a reduction in errors in theatre, yet there was no commitment for the use of SSCL. Although all theatre personnel support implementation and use of SSCL; however, hierarchical issues, lack of administrative support, lack of training, logistics and timing, high patient volume and overburdened residents, lack of co‑ordinator or leadership role and shortage of workforce can be impediment to effective use. Discussion: Nurses and junior doctors play a crucial role. Commitment rather than compliance and teamwork will be the key, ably supported by education and training which should be mandatory for all operation theatre stakeholders. Therefore, any measure that can potentially improve patient safety should be embraced and benefits of SSCL be told to motivate them and enhance participation for patient safety. Committed leadership, knowledge sharing and periodic trainings, interdisciplinary communication, feedback and regular audits can define and determine effective implementation process.

Utility of neutrophil-to-lymphocyte ratio, triglycerides, and high-density lipoprotein cholesterol in assessing the severity of coronary artery disease

Context: Coronary artery disease (CAD) occurs as a consequence of dyslipidemia and chronic inflammation. Cardiovascular disease mortality is on the rise in India. Aims: Explore the utility of simple markers such as neutrophil-to-lymphocyte ratio (NLR) and triglyceride/high-density lipoprotein cholesterol (TG/HDLc) ratio, to study the extent of coronary lesions as seen on angiography. Settings and Design: Observational study in a tertiary-care hospital in North-India. Methodology: Coronary angiograms of 126 outpatients were graded as per Friesinger Index. Lipid profile was analyzed for each patient, along with complete blood count parameters, including total leukocyte count (TLC), absolute neutrophil, and lymphocyte counts and mean platelet volume (MPV). Statistical Analysis Used:Comparison of groups was done using a Mann–Whitney U test, of continuous variables using a correlation coefficient, and of categorical variables using a Chi-square test, and odds ratios were estimated. Receiver operator characteristic curves were constructed, and cutoffs were obtained. Results: TG/HDLc-ratio was associated with severe coronary lesions (Friesinger-Index ≥5) [odds ratio (OR): 3.46; 95% confidence interval (CI): 1.32–9.10], which was stronger than the association of TG [OR: 3.15; 95%CI: 1.33–7.42] or HDLc [OR: 1.86; 95%CI: 0.81–3.82] alone. No association existed for total or low-density lipoprotein cholesterol. NLR was significantly higher among patients with severe lesions. NLR and MPV were significantly correlated with TG/HDLc ratio. Area under curve for TG/HDLc ratio and NLR was 73.7 and 60.8. Cutoff values were 2.53 (Sensitivity (SN) = 83.1%, Specificity (SP) = 56.7%) and 1.84 (SN = 61.0%, SP = 49.3%), respectively. Conclusions: TG/HDLc ratio and NLR are associated with CAD severity, more so than TG or HDLc alone, or TLC. They are easily accessible and inexpensive markers that may be utilized in identifying patients at risk for heart disease.

Current Trends of Surface Versus Core Bacterial Flora among Recurrent Tonsillitis Patients in a North Indian Tertiary Care Hospital

Current Trends of Surface Versus Core Bacterial Flora among Recurrent Tonsillitis Patients in a North Indian Tertiary Care Hospital

Dengue infection in North India: An experience of a tertiary care center from 2012 to 2017.

Objective:Recently, an alarming rise of dengue has been seen in India which remains a major public health concern. This study has been designed for a comprehensive overview of the epidemiology, gender, age, area distribution, symptomology, and seasonal variability.Materials and Methods:Retrospective analysis of 900 suspected dengue cases of all age groups of either sex from 2012 to 2017 at a North Indian tertiary care hospital revealed 461 (51.22%) cases seropositive for dengue.Results:The age group of 20–30 years was the most affected group with male predominance. The urban population was more affected as 75.05%, and maximum cases were detected in October month followed by November. Common abnormal laboratory parameters were thrombocytopenia (99.1%), hepatic dysfunction (59%), and leukopenia (26.68%). Two uncommon findings, pancytopenia and pancreatic dysfunction were reported in 7 and 3 cases respectively.Conclusion:Dengue infection in India has evolved rapidly, and regular outbreaks have been observed with a changing epidemiology, as the disease is rapidly spreading from urban to rural areas with increasing atypical manifestations.

Spectrum of skin lesions including skin adnexal tumors in a North Indian tertiary care hospital

Abstract Aims: This study was undertaken in a tertiary care hospital in North Indian state of Uttar Pradesh to evaluate the pattern of skin diseases and various skin neoplasms in biopsy specimens. Material and Methods: A retrospective analysis of 109 skin biopsies was undertaken. The neoplasms were categorised as per International Classification of World Health Organization. Results: Keratinous cyst (59 cases) was the most common non- neoplastic skin lesion and it represented 79.7% of non- neoplastic skin lesions. The most common neoplastic skin lesions were soft tissue tumors of vascular origin encompassing pyogenic granuloma which was 34.2% of skin tumors. Commonest malignant neoplasm was squamous cell carcinoma which is categorized under classification of keratinocytic tumors of skin. Conclusion: Histopathological examination is essential for the diagnosis and classification of various skin lesions including skin tumors which helps in proper treatment of the patient. Keywords: Dermatological, Keratinocytic, Follicular. Introduction Dermatological disorders are very common. They may be intrinsic to the skin or may arise as manifestations of systemic disease.[1] Despite the advances in molecular techniques, diagnosis and prognosis, morphology is still the basis of diagnosis for most neoplasms and many inflammatory skin lesions.[2] It is necessary that clinical differential diagnosis be correlated with gross and microscopic observations in order to render a clinically relevant diagnosis.[3] The pattern of skin diseases varies from country to country and various geographical regions of the same country.[4] Skin tumors encompass a wide variety of benign and malignant neoplasms of skin and subcutis that are classified and differentiated as keratinocytic, melanocytic, appendageal, haemato-lymphoid and soft tissue tumors.[5] This study was based on evaluating all the non-neoplastic skin lesions as well as benign and malignant tumors

Comparision of Ilizarov Ring Fixator and Rail Fixator in Infected Nonunion of Long Bones: A Retrospective Followup Study.

Background:About 70 million trauma injuries that occur annually, around the world. More than 4.5 million open fractures occur per year in India. Long bone fractures nonunion (NU) rate varies from 2% to 7%. The management of open fracture is challenging for the orthopedic surgeon. The conventional protocol of management of compound fracture are debridement, temporary stabilization by external fixators, wound and definitive management. Very few prospective studies have been done comparing Illizarov and RF in infected nonunion. Thus we performed a retrospective study to compare the acceptance, complications, and functional outcome of Ilizarov ring fixator (IRF) and rail fixator (RF) in the treatment of infected NU.Materials and Methods:A retrospective cohort study of fifty infected long bone NU patients, who consulted Orthopedics Department of a tertiary care hospital of North-India from 2010 to 2014 was undertaken. Patients were divided into two Groups (Gp) of 25 each: one group was treated with IRF, another with RF and both followed for one year. Results were analyzed as per the ASAMI criteria (Association for the Study and Application of Methods of Illizarov) and complications as per Paley's classification. Patient's satisfaction was assessed by Visual Analog Scale (VAS) ranging from 0 to 100 mm.Results:Majority of the patients were in age group of 31- 45 years males with right sided involvement with previously treated infected NU of tibia involving distal one-third. According to VAS score, patients had mild to moderate pain in 13 cases in Gp-IRF and in 16 cases in Gp-RF, whereas severe pain was present in 12 cases of Gp-IRF and 9 cases of Gp-RF. Pin tract infection and pain were the commonest complication. Mean bone gap was 7.76 cm and 5.78 cm; average total treatment time was 17.64 and 13.40 months in Gp-IRF and Gp-RF, respectively. Duration of IRF application was more than RF (P < 0.01). Both the limbs were equated in 20 cases (80%) in Gp-IRF and 18 cases (72%) in Gp-RF. Results were found to be excellent in 7 (28%) and 8 (32%), good in 8 (32%) and 13 (52%), and fair in 10 (40%) and 4 (16%) cases in Gp-IRF and Gp-RF, respectively. Bony union achieved in 100% cases. Treatment index was 68.45 days/cm and 64.29 days/cm in Gp-IRF and Gp-RF, respectively.Conclusion:In view of the patient acceptance, functional outcome and complications, rail fixator shows a better result than Ilizarov.

Clinico-epidemiological study of leprosy from a North Indian tertiary care hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Leprosy was eliminated as a public health problem in India in 2005. Yet, more than 60% of all new cases of leprosy are reported from India.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective analysis of the records of patients attending the leprosy clinic of the Dermatology Out Patient Department was done for a period of one year from May 2017 to April 2018. The data was analysed for clinical and epidemiological characteristics of the patients.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 225 patients visited the leprosy clinic during the study period. Almost half of all patients (47.1%) were aged between 21-40 years. Among the patients were 32 children (14.2%) below 16 years. There were 60 patients (26.6%) suffering from paucibacillary disease and 158 patients (70.2%) had multibacillary disease. Seven patients (3.2%) presented with other forms of leprosy like historic leprosy and pure neuritic leprosy. Borderline lepromatous leprosy was found to be the commonest subtype seen in 86 patients (38.2%). There were 152 males (67.6%) and 73 females (32.4%). The male female ratio was 2.08:1. A total of 118 patients (52.4%) were from rural background and 107 (47.6%) hailed from urban areas. Multibacillary disease was seen in 83.6% of the total females compared to 63.8% of males.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Leprosy may be down but is not yet out. The high proportion of children diagnosed with leprosy is a warning regarding the active transmission of the disease in the community. Continued efforts are required to prevent the disease from making a resurgence.&lt;/p&gt;

A study to evaluate compliance in patients of diabetes mellitus in a North-Indian tertiary care hospital

Background: The objective of the study was to determine level of adherence and recognize various causative factors which can affect the compliance in the diabetic patients.Methods: This was an observational study. The study was conducted by enrolling patients of the outpatient department of Medicine of Rajindra Hospital, Government Medical College, Patiala, Punjab. To assess adherence, a questionnaire was administered to the patients - Morisky Medication Adherence Scale (MMAS) -8 item questionnaire. The various factors affecting compliance was determined by a researcher made questionnaire.Results: Out of a total of 100 subjects, age range extended from 18 years to 80 years. The mean age was 57.52±12.33years. 51% of patients were females and 49% was males. Analysis of MMAS- 8 item scores of patients showed that 52% of patients had low adherence, 29% had medium while 19% had high adherence to the treatment. Only 30% patients were compliant i.e. with HbA1C value of 7 or less while 70% patients were non-compliant i.e. with HbA1C value of more than 7.Conclusions: Compliance to medical treatment is influenced by a myriad of factors. In order to promote compliance, it is necessary to increase awareness about the disease, possible complications and treatment guidelines among patients as well as their family members.

Drug Utilization Study on Hypertensive Patients and Assessment of Medication Adherence to Jnc-8 Guidelines in North Indian Tertiary Care Hospital: A Cross-Sectional Study

Drug Utilization Study on Hypertensive Patients and Assessment of Medication Adherence to Jnc-8 Guidelines in North Indian Tertiary Care Hospital: A Cross-Sectional Study

Safety and efficacy of abatacept among patients with refractory rheumatoid arthritis: Experience from a North Indian Tertiary Care Hospital

Background: T-cells are pathogenic in rheumatoid arthritis (RA) and have an important role in persistent synovitis, even in established disease. Modulation of T-cell activity by blocking of costimulatory signals has been known to suppress inflammation and improves prognosis in RA. This study aims to assess the effect of costimulation blockade with Abatacept in patients with RA who were refractory to conventional synthetic/biological disease modifying anti-rheumatoid drugs (csDMARDs, bDMARDs). Methods: In this prospective study, 63 patients with active disease, measured by the European League Against Rheumatism (EULAR) disease activity score (DAS28-erythrocyte sedimentation rate [ESR]) ≥3.2, who had failed conventional therapy with at least 2 csDMARDs and/or antitumour necrosis factor (anti-TNF) agents (Infliximab/Etanercept) either standalone, or in combination, were initiated on Abatacept in fixed doses, which was given on days 1,15, and 29 and repeated every 28 days for 11 months, after taking informed consent. Biomarkers comprising ESR and DAS28-ESR score were measured at baseline and repeated at the end of 3, 6, and 12 months. The primary end-point was the achievement of remission as defined by DAS28-ESR score ≤ 2.6. Results: Sixty-three patients completed 6 monthly follow-up whereas 57 patients completed 12 months follow-up (90% follow-up rate). DAS28-ESR declined significantly at 3 months (P = 0) and improvements were sustained at 6th and 12th month. Treatment was discontinued in three patients due to inadequate response, and three patients were lost to follow-up. Nearly 52.6% patients achieved primary end-point. Most common adverse effects reported during the study period were headache (14.2%) and upper respiratory tract infection (9.5%). Conclusions: Abatacept is an effective and well-tolerated treatment option for Indian RA patients with an inadequate response to csDMARDs and TNF antagonists.

Prevalence of Multidrug-Resistant Pathogens and Their Antibiotic Susceptibility Pattern from Late-Onset Ventilator-Associated Pneumonia Patients from a Tertiary-Care Hospital in North India

Background: Ventilator-associated pneumonia (VAP) is seen as being most common in critically ill patients in intensive care units. Diagnostic protocol is challenging and the treatment is often difficult. Incorrectly selected antibiotic therapy further leads to the emergence of multidrug-resistant (MDR) organisms. Materials and Methods: The present prospective study was conducted to study patients of VAP with the aim of determining the aerobic bacterial etiological agents, antimicrobial susceptibility patterns, and molecular detection of MBL (metallo beta lactamase) genes. The antimicrobial susceptibility of the isolates by the disc diffusion method and the detection of various drug-resistance mechanisms was done. The minimum inhibitory concentration (MIC) based on E-test was determined along with the molecular analysis by polymerase chain reaction for detection of MBL genes (IMP and VIM). Results: Out of a total of 372 patients admitted in intensive care unit during the time period (March 2010 to February 2013), 40 patients were finally diagnosed as having late-onset VAP. Among the study isolates (69, due to polymicrobial infection), the maximum isolates were Acinetobacter spp. (32) followed by Pseudomonas aeruginosa (18), Klebsiella pneumoniae (8), and others. MDR was high with 34% of Acinetobacter and 50% of Pseudomonas strains being MBL producers. Among Staphylococcus aureus, 50% strains were methicillin resistant. On molecular analysis, eight of the Acinetobacter and six of the Pseudomonas isolates came out to be positive for VIM 2 gene, whereas IMP was not detected in any of the isolates. Conclusion: The present study emphasizes the threat of MDR in VAP patients from ICU as the treatment options are limited. The knowledge of prevailing organisms, resistance mechanisms, and their antibiotic profile can go a long way in deciding appropriate empirical therapy.