Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 21 adult intensive-care units from 10 cities in India: Findings of the International Nosocomial Infection Control Consortium (INICC)
Mehta Y.,Medicity |
Jaggi N.,Artemis Health |
Rosenthal V.D.,International Nosocomial Infection Control Consortium |
Rodrigues C.,Hinduja National Hospital and Medical Research Center |
And 11 more authors.
Epidemiology and Infection | Year: 2013
We report on the effect of the International Nosocomial Infection Control Consortium's (INICC) multidimensional approach for the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 21 intensive-care units (ICUs), from 14 hospitals in 10 Indian cities. A quasi-experimental study was conducted, which was divided into baseline and intervention periods. During baseline, prospective surveillance of VAP was performed applying the Centers for Disease Control and Prevention/National Healthcare Safety Network definitions and INICC methods. During intervention, our approach in each ICU included a bundle of interventions, education, outcome and process surveillance, and feedback of VAP rates and performance. Crude stratified rates were calculated, and by using random-effects Poisson regression to allow for clustering by ICU, the incidence rate ratio for each time period compared with the 3-month baseline was determined. The VAP rate was 17·43/1000 mechanical ventilator days during baseline, and 10·81 for intervention, showing a 38% VAP rate reduction (relative risk 0·62, 95% confidence interval 0·5-0·78, PÂ =Â 0·0001). Copyright © Cambridge University Press 2013.
Tripathy S.,Kalinga Institute of Medical science |
Routray P.K.,Kalinga Institute of Medical science |
Mohapatra A.K.,Kalinga Hospital |
Mohapatra M.,Kalinga Hospital |
Dash S.C.,Kalinga Institute of Medical science
Journal of Medical Toxicology | Year: 2010
Introduction: Russell's viper is a commonly encountered venomous snake in India. Morbidity and mortality following envenomation and the treatment thereof are frequent. We report a rarely seen complication after a treated Russell's viper bite. Case Report: A 36-year-old male farmer received 30 vials polyvalent anti-snake venom after a viper bite to his right leg. Improvement in initial hematemesis and circulatory shock was followed by acute renal failure managed with regular hemodialysis. He displayed no abnormalities on neurological examination at admission. Fourth day onwards his neurologic status started deteriorating with development of behavioral abnormalities, hemi-spatial neglect of left upper limb, paralysis of left facial nerve, left upper limb, and right lower limb. Acute disseminated encephalomyelitis was confirmed on magnetic resonance imaging (MRI) of brain with typical spectroscopic characteristics. High dose methyl prednisolone was administered and a rapid recovery followed. Conclusion: Russels viper bite followed by treatment with antivenom may be complicated by the development of immune complex mediated demyelination and development of acute disseminated encephalomyelitis. MRI spectroscopy helps in early identification of demyelination and in a definite diagnosis. Treatment with corticosteroids was associated with resolution of symptoms in this case. © 2010 American College of Medical Toxicology.
Rout S.K.,Kalinga Institute of Medical science |
Rout S.K.,Kalinga Hospital |
Lath M.K.,Kalinga Hospital |
Lath M.K.,Hi Technology Medical College
Journal of Craniofacial Surgery | Year: 2013
Supernumerary nostril is a rare congenital anomaly that is classified under duplication of nose. Only 32 cases have been reported so far in the English literature. We attended to an adult female having supernumerary nostril. Surgical correction with minimum intervention was planned, keeping an option of open tip rhinoplasty as backup in case the patient needs it later. She was satisfied with the outcome in spite of having little asymmetry of her nostrils. This case is being reported here as an addition to the published list and the literature reviewed in this context. Copyright © 2013 by Mutaz B. Habal, MD.
Pradhan D.,University of Pittsburgh |
Pattnaik N.,Kalinga Hospital |
Silowash R.,University of Pittsburgh |
Mohanty S.K.,Core Diagnostics
Pathology Research and Practice | Year: 2015
IgG4-related disease (IgG4-RD) is a recently recognized systemic autoimmune disorder characterized by high levels of serum IgG4 and dense infiltration of IgG4-positive plasma cells in multiple organs. The condition was first described as a disease of the pancreas, and has since been recognized in various organ systems including the kidneys. IgG4 related kidney disease (IgG4-RKD) signifies any form of renal involvement by IgG4-RD. The most common renal involvement by IgG4-RD is tubulointerstitial nephritis. Glomerular disease, in particular membranous glomerulonephritis, may also be seen. Other co-existent glomerular diseases such as IgA nephropathy, membranoproliferative glomerulonephritis, and mesangioproliferative immune complex glomerulonephritis may be identified. IgG4-related plasma cell arteritis has also been noted in the kidney. As with IgG4-RD in general, IgG4 related kidney disease (IgG4-RKD) usually occurs in middle-aged to elderly men. Common findings in IgG4-RKD are plasma cell-rich interstitial inflammatory infiltrate either in a focal or diffuse pattern with increased IgG4+ plasma cells, expansile swirling interstitial fibrosis, high levels of serum IgG and IgG4, hypocomplementemia, high serum IgE levels and/or peripheral blood eosinophilia. By immunofluorescence, most of the cases show IgG4 dominant tubular basement membrane immune complex deposits. Similar to IgG4-RD, IgG4-RKD often shows a rapid response to steroid therapy. In this review, we discuss the current knowledge on IgG4-RKD and its clinical relevance. © 2015 Elsevier GmbH.
PubMed | Kalinga Hospital, Core Diagnostics and University of Pittsburgh
Type: Journal Article | Journal: Pathology, research and practice | Year: 2015
IgG4-related disease (IgG4-RD) is a recently recognized systemic autoimmune disorder characterized by high levels of serum IgG4 and dense infiltration of IgG4-positive plasma cells in multiple organs. The condition was first described as a disease of the pancreas, and has since been recognized in various organ systems including the kidneys. IgG4 related kidney disease (IgG4-RKD) signifies any form of renal involvement by IgG4-RD. The most common renal involvement by IgG4-RD is tubulointerstitial nephritis. Glomerular disease, in particular membranous glomerulonephritis, may also be seen. Other co-existent glomerular diseases such as IgA nephropathy, membranoproliferative glomerulonephritis, and mesangioproliferative immune complex glomerulonephritis may be identified. IgG4-related plasma cell arteritis has also been noted in the kidney. As with IgG4-RD in general, IgG4 related kidney disease (IgG4-RKD) usually occurs in middle-aged to elderly men. Common findings in IgG4-RKD are plasma cell-rich interstitial inflammatory infiltrate either in a focal or diffuse pattern with increased IgG4+ plasma cells, expansile swirling interstitial fibrosis, high levels of serum IgG and IgG4, hypocomplementemia, high serum IgE levels and/or peripheral blood eosinophilia. By immunofluorescence, most of the cases show IgG4 dominant tubular basement membrane immune complex deposits. Similar to IgG4-RD, IgG4-RKD often shows a rapid response to steroid therapy. In this review, we discuss the current knowledge on IgG4-RKD and its clinical relevance.
PubMed | Kalinga Hospital, Manipal Hospital, Medwin Hospital, National Institute of Mental Health and Neuro Sciences and Vikram Hospital
Type: Journal Article | Journal: Neurology India | Year: 2016
We present a retrospective study of distal anterior cerebral artery (DACA) aneurysms operated at our institute.From 1988 to 2013, a total of 132 DACA aneurysms were managed surgically. The retrospective data of these patients was collected and analysed.They comprised 6.2% of all 2137 aneurysms operated during the same period. The mean age at presentation was 48.3 years (range: 24-77 years) and the male: female ratio was 1:2. The notable symptom in 114 (86.4%) patients was headache, in 94 (71.2%) was loss of consciousness, in 25 (18.9%) was seizures, and in 17 (12.9%) was limb weakness. There were 99 (75%) patients in World Federation of Neurosurgical Societies (WFNS) grade <3 at admission. On plain computed tomography (CT) scan, intracerebral hemorrhage was seen in 49 (37.1%) and intraventricular hemorrhage in 23 (17.4%) patients. The most common site of aneurysm was the pericallosal (A3 segment) artery noted in 65 (49.2%) patients. Multiple aneurysms were observed in 16 (12.1%) cases. The mean timing of surgery from the first ictus was 17.8 days. The delay was due to a late referral, poor general condition, recurrent bleeding, and worse WFNS grade at presentation. Aneurysms were operated through the following approaches: parasaggital craniotomy in 61 (46.2%), bifrontal craniotomy in 64 (48.5%), and frontotemporal craniotomy in 7 (5.3%). Aneurysms could be successfully clipped in 93.2% of the cases. Postoperative mortality was 8 (6%). The follow-up data was available for 83 (62.9%) patients. The mean duration of follow-up was 15.1 months (1-70 months), with more than 41 (31%) patients having a follow-up of more than 6 months. A favorable outcome (good recovery or moderate disability) was seen in 71 (85.5%) cases.A meticulous attention to the surgical technique provides gratifying results in DACA aneurysms even in patients who present initially in a compromised clinical status.
Nalini A.,National Institute of Mental Health and Neuro Sciences |
Gayathri N.,National Institute of Mental Health and Neuro Sciences |
Thaha F.,National Institute of Mental Health and Neuro Sciences |
Das S.,Kalinga Hospital |
Shylashree S.,National Institute of Mental Health and Neuro Sciences
Neurology India | Year: 2010
Background: Sarcoglycanopathies are a group or autosomal recessive muscular dystrophies designated as α, β, γ, or δ sarcogycanopathy. Materials and Methods: It is a retrospective analysis of case series. Results: Sixty six patients immunohistochemically confirmed to have sarcoglycan deficiency were included in the analysis. The study period extended from 1997-2008. The male to female ratio was 1.5:1. Mean age at the onset of muscle complaints was 6.2±3.7 years (range 1-18). Mean age at evaluation was 10.0±4.8 years (range 3-31). Mean duration of illness was 47.02±44.80 months (range 3-325). Onset in the first decade was seen in 59 (89.4%) and 25 (42.4%) of these had onset before five years of age. The remaining seven (10.6%) had onset in second decade and none after 20 years of age. Consanguinity was present in 54 (81.8%). In 34 of 66 cases only α-SG was carried out and this had shown total absence of staining in all fibers. In the remaining 32 cases where the entire panel was performed, absence of all sarcoglycans was noted in 10 (15.1%), isolated α-SG deficiency in 7 (10.6%), isolated β-SG deficiency in 6 (9.1%), and isolated γ-SG deficiency in 3 (4.5%). Combination deficiency was also observed: absence of α and β (n=4), β and γ (n=2), and α and γ (n=1). Conclusions: Our series was a large series and with predominantly pediatric age group. Sarcoglycanopathy should be particularly suspected in a child born to consanguineous parents and who presents with proximal muscle weakness and calf hypertrophy, elevated CK level, and myopathic pattern on EMG.
Sahu S.,Kalinga Hospital |
Mohanty N.K.,Kalinga Hospital |
Rath J.,Kalinga Hospital |
Patnaik S.B.,Kalinga Hospital
Singapore Medical Journal | Year: 2010
Introduction: Malaria remains a major health concern in tropical and subtropical countries. A large number of cases of malaria have been reported from the State of Orissa, India. Severe malaria cases are reported throughout the year, but they are more common during the high transmission season. The last decade has witnessed a changing pattern of presentations and complications across the country. Severe falciparum malaria is an important cause of multiple organ failure in Indian intensive care unit (ICU) patients. Methods: All patients with severe falciparum malaria above the age of 14 years admitted to the ICU were included in this study. The clinical spectrum of severe falciparum malaria in a tertiary care level III ICU was analysed from December 1998 to June 2008. In all, there were 301 patients with severe malaria admitted to the ICU during that period. Results: Most patients (66.9 percent) had a history of fever for less than seven days. The age distribution of the patients was 38.24 +/- 14.24 years. The Sequential Organ Failure Assessment score at admission to the ICU was 10.44 +/- 4.26. The median duration of ICU stay was three days (range 0-15 days) and 42 percent of the patients required ventilator support. Approximately 48 percent and 42 percent of patients required blood component transfusion and renal replacement therapy, respectively. The rate of single organ involvement was relatively low and multi-organ dysfunction was very common. Jaundice with acute renal failure (ARF) was the most common presentation (13.28 percent), followed by cerebral malaria with jaundice and ARF (6.37 percent), and jaundice, ARF and acute respiratory distress syndrome (ARDS) (5.31 percent). The overall mortality rate was 35.4 percent. Multivariate logistic regression analysis was conducted to estimate the association of the complications with mortality. Shock, ARF, seizure and ARDS were associated with higher mortality. Conclusion: Severe falciparum malaria is a common cause of multi-organ failure in the ICUs in eastern India. There has been no change in the pattern of presentations over the last ten years in the east Indian state of Orissa. Apart from early diagnosis and treatment, good supportive care is the mainstay for better outcome in these cases.
PubMed | Kalinga Hospital
Type: Case Reports | Journal: The Journal of craniofacial surgery | Year: 2013
Pleomorphic adenoma is the most common tumor arising from the parotid salivary gland. In most instances, it involves the superficial part of the gland rarely affecting the deep part, which often presents as a swelling on the lateral pharyngeal wall. The neoplastic process involving the superficial and the deep part of the same gland is extremely unusual. We had a patient who presented to our clinic with a recurrent swelling of his left parotid gland with a diagnosis of pleomorphic adenoma. On a computed tomographic scan, it was found to involve both the superficial and deep parts of the gland. The gland was excised completely, preserving the facial nerve and all its branches. A histopathologic study of the specimen confirmed the diagnosis and extent of the disease.
PubMed | Kalinga Hospital
Type: Journal Article | Journal: Acta cytologica | Year: 2016
The incidence of primary small cell carcinoma (SCC) of the urinary bladder is extremely rare. We sought to analyze the cytologic and immunophenotypic features of SCC of the urinary bladder in urine and reassert the importance of cytologic examination of urine specimens for diagnosis of this tumor.We studied the clinical and cytomorphologic features in the presurgical urine specimens (4 voided urine and 2 bladder-washing specimens) of histopathologically and immunohistochemically proven cases of SCC of the urinary bladder.There were 6 cases, all males, with an age range of 61-81 years. On cytologic and histopathologic examination, typical SCC morphology was present in all cases. On immunohistochemistry, synaptophysin and CD56 were positive in all 6 cases, while chromogranin was positive in only 3. The Ki-67 labeling index ranged from 30 to 100%.SCC should be kept in the differential diagnosis, when high-grade urothelial carcinoma is suspected in a urine cytology specimen, as this distinction has important therapeutic and prognostic implications. Therefore, a careful observation and, if required, the use of an appropriate immunocytochemical panel on the presurgical urine specimens can lead to a correct diagnosis.