Journal Issue: Volume: 29, No. 2, August, 2007
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Management of acute respiratory distress syndrome
(Institute of Medicine, 2007) Bhattarai, BK
Abstract
Background: Managing patients with acute respiratory distress syndrome (ARDS) still remains a challenge to the intensivists despite huge accumulation of basic and clinical data and better understanding in its management. The evolution of the concept of ventilator associated lung injury (VALI) in mechanically ventilated patients with ARDS has changed the approach to ventilatory management. Survival of the patients with ARDS may be improved by modifying the mechanical ventilation such that VALI is kept to a minimum. Protective strategy in mechanical ventilation with limited volume and pressure is the only accepted treatment or supportive measure shown to affect the outcome in ARDS patients. Low tidal volume ventilation has been recommended for every patient with ARDS to be used routinely. Protective ventilatory strategy has been accepted as a new gold standard and is being used to evaluate and compare other techniques and modalities. Use of approaches such as prone position ventilation, inhaled nitric oxide and surfactant has failed to improve survival in clinical studies. But these approaches may confer benefits if used in conjunction with the protective strategy.
Keywords: Acute respiratory distress syndrome (ARDS), Protective ventilatory strategy, Ventilator associated lung injury (VALI)
Epidemiology of chronic liver disease mortality in community population
(Institute of Medicine, 2007) Turin, TC; Rumana, N
Abstract
Background: Liver disease is an important cause of morbidity and mortality in the United States. Currently, up to 2% of all deaths are attributable to liver disease. The economic burden associated with liver disease is also substantial. There are still significant gaps in the current understanding of the epidemiology and burden of liver disease at the population level.
Materials and Methods: We studied chronic liver disease (CLD) and cirrhosis deaths among a community population of the state of Wisconsin for the duration of 1999-2005 to estimate the mortality and disease burden of CLD. Data information was gathered from the population based public data source; Wisconsin Interactive Statistics on Health.
Results: A total of 3024 deaths were recorded due to CLD the study period of 1999-2005. The mortality rate was 7.92 per 100,000 person-year (95%CI :7.64–8.21). Male had higher mortality compared to female. Though statistically insignificant, a trend of increase in mortality rate was observed from 1999 (4.81, 95%CI:4.17–5.44) to 2005 (6.02, 95%CI:5.33–6.21).
Conclusion: The findings were suggestive that the death due to CLD causes noteworthy burden for the population in terms of years of potential life lost. Prevention programme addressing this very problem should be accentuated.
Keywords: chronic liver disease, cirrhosis, mortality, disease-burden
Bacteriological profile of patients with infective endocarditis
(Institute of Medicine, 2007) Kandel, NP; Banyal, SR; Koirala, B; KC, MB; Shrestha, S
Abstract
Introduction: The term infective endocarditis (IE) denotes infection of the endothelial surface of the heart and implies the physical presence of microorganisms in lesions. Although the heart valves are commonly affected the disease may also occur within the septal defects or in the mural endocarditis1 .IE is uncommon disease but it is fatal in untreated cases. This study was carried out in Shahid Gangalal National Heart Centre (SGNHC), Bansbari, Kathmandu during 30 October 2003 to 30 June 2004 among 34 patients diagnosed as definite cases of IE.
Materials and Methods: Blood culture for bacteria & antibiotic sensitivity tests were performed for each patient using standard microbiological protocol in Laboratory of SANHC. Echocardiography was done for each patient to confirm the case of IE. Questionnaires were fulfilled to get additional informations regarding the patients.
Results: We found positive blood culture in 14 (41.12%) out of 34. The frequency of isolated organisms were Viridans streptococci in 6 (42.85%) cases, Staphylococcus aureus in 3 (21.43%) cases, Pseudomonas aeruginosa in 2 (14.28%) case and Coagulase negative and Staphylococci (CONS) in 3 (24.41%) cases among positive blood culture. All Gram positive bacteria were susceptible penicillin, gentamicin, cephotaxime, ceftriaxone, vancomycin and ciprofloxacin. Only less than 50% of Gram positive bacteria were susceptible to Amoxicillin, Ampicillin, Erythromycin and Cotrimoxazole. All Gram negative bacteria were susceptible to Ciprofloxacin, Tetracycline, Cotrimoxazole and Cephotaxime. Only 50% of Gram negative bacteria were susceptible to Gentamicin. Ampicillin and Amoxicillin were found to be resistant with all Gram negative bacteria. Echocardiography records revealed vegetation in 27 (79.42%) cases of whom blood culture was positive in 12 (44.44%).
Conclusion: Blood culture and echocardiography are very useful for diagnosis and treatment of cases of IE.
Keywords: Infective endocarditis, echocardiography, antibiotic susceptibility test