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Nisar O, Nisar S, Khattak Haroon Ur Rashid S, Ibne Ali Jaffari SM, Haider Z, Fatima F, Zahra SE, Ijaz AH, Kaneez M, Shairwani GK. Clinical and Etiological Exploration of Ventilator-Associated Pneumonia in the Intensive Care Unit of a Developing Country. Cureus 2023; 15:e47515. [PMID: 38021960 PMCID: PMC10664342 DOI: 10.7759/cureus.47515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ventilator-associated pneumonia (VAP) is a critical concern in the intensive care unit (ICU), with significant implications for patient outcomes. This retrospective cross-sectional study aimed to determine the prevalence of VAP in an ICU of a developing country, identify the predominant etiological factors, assess patient outcomes, and underscore the need for tailored interventions in high-risk patient groups. Methods This retrospective cross-sectional study included 589 ICU patients who underwent ventilator-assisted breathing for over 48 hours. Among them, 151 developed VAP. The diagnosis was made on clinical, laboratory, and radiological findings, and tracheal aspirate cultures. Exclusions included pediatric patients, less than 48 hours of ventilation, and pre-existing lung infections. Patient data encompassed gender, age, comorbidities, outcomes, admission reasons, isolated microorganisms, and clinical findings. Results 151 patients out of the 589 developed VAP. The age of the patients ranged between 31 to 69 years and the mean age was 45.43 ± 8.92 years. Clinical diagnoses upon ICU admission varied, including sepsis, trauma, stroke, and metabolic disorders. Chest X-rays commonly revealed atelectasis (19.2%), consolidation (21.9%), pleural effusion (11.9%), and lobar pneumonia (45.7%). Tracheal aspirate cultures predominantly isolated multidrug-resistant gram-negative rods, with methicillin-resistant gram-positive cocci and fungal pneumonia prevalent in neutropenic sepsis cases. Notably, only 54 (35.8%) of patients survived, with significantly poorer outcomes observed in sepsis, neutropenic sepsis, and stroke cases compared to trauma and post-operative admissions. Conclusion Multidrug-resistant organisms and the spread of nosocomial infections are the predominant causes of VAP in the ICU. This emphasizes the urgent need for multifaceted interventions to prevent and manage VAP effectively. Developing and implementing targeted strategies, considering the unique challenges faced in resource-constrained healthcare settings can aid in decreasing the mortality associated with it.
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Affiliation(s)
- Omar Nisar
- Internal Medicine, Shalamar Medical and Dental College, Lahore, PAK
| | - Samaha Nisar
- Internal Medicine, Shalamar Medical and Dental College, Lahore, PAK
| | | | | | - Zaki Haider
- Internal Medicine, Rashid Latif Medical College, Lahore, PAK
| | - Fiza Fatima
- Internal Medicine, Shalamar Medical and Dental College, Lahore, PAK
| | - Shan E Zahra
- Internal Medicine, Rashid Latif Medical College, Lahore, PAK
| | - Ali Hassan Ijaz
- Internal Medicine, Faisalabad Medical University, Faisalabad, PAK
| | - Mehwish Kaneez
- Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
- Pediatrics, Rawalpindi Medical University, Rawalpindi, PAK
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Kalariya Y, Kumar A, Ullah A, Umair A, Neha F, Madhurita F, Varagantiwar V, Ibne Ali Jaffari SM, Ahmad A, Aman M, Sapna F, Varrassi G, Kumar S, Khatri M. Integrative Medicine Approaches: Bridging the Gap Between Conventional and Renal Complementary Therapies. Cureus 2023; 15:e46033. [PMID: 37900457 PMCID: PMC10602936 DOI: 10.7759/cureus.46033] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
The global incidence of renal disorders is on the rise, demanding the implementation of novel and comprehensive strategies for patient care. The present study demonstrates the significance of renal health, offering a comprehensive comprehension of renal physiology and the escalating load of renal illnesses. The relevance of controlling renal illnesses is underscored by a thorough examination of conventional treatments, which encompass pharmaceutical interventions, dialysis, and transplantation. Subsequently, the story redirects its attention towards complementary therapies, classifying them into several categories, such as herbal medicine, acupuncture, dietary supplements, and mind-body activities, among various others. This paper presents a comprehensive examination of the available information, providing a critical study of the effectiveness and safety of alternative therapies in renal care. This study focuses on the central idea of integrative medicine, distinguished by its patient-centered and holistic approach and its seamless integration of conventional and complementary therapies. This study examines several integrative care models, using case studies to illustrate successful integrative approaches that have enhanced patient outcomes. The review thoroughly examines the current body of literature on integrative renal care, including meta-analyses, systematic reviews, and notable research discoveries. This study highlights the need for further research to address knowledge gaps and explore areas that require additional examination. These findings emphasize the importance of future research endeavors in this crucial sector. In addition, the paper thoroughly examines the safety issues and regulatory factors pertaining to complementary therapies, underscoring the importance of making educated decisions and maintaining diligent monitoring to safeguard patients' well-being. Integrating patient perspectives, experiences, and shared decision-making is essential to the integrated healthcare process, promoting a collaborative and patient-centered approach. The study culminates by providing a concise overview of the primary discoveries and delineating the ramifications of implementing therapeutic procedures. This statement underscores the considerable potential of integrative medicine in augmenting renal care, ultimately leading to enhanced patient outcomes and an improved overall quality of life for persons with renal diseases. Also, this literature review provides a thorough and knowledgeable examination of the incorporation of conventional and complementary therapies in the context of renal health. It gives valuable perspectives for healthcare practitioners, researchers, and policymakers interested in enhancing care strategies for individuals with renal conditions.
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Affiliation(s)
| | - Ajay Kumar
- Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | - Atta Ullah
- Internal Medicine, Cavan General Hospital, Cavan, IRL
- Internal Medicine, Khyber Teaching Hospital (KTH), Peshawar, PAK
| | - Ahmed Umair
- Medicine, Fatima Memorial College of Medicine and Dentistry, Lahore, PAK
| | - Fnu Neha
- Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Fnu Madhurita
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, PAK
| | | | | | | | - Mateen Aman
- Medicine, Shanxi Medical University, Jinzhong, CHN
| | - Fnu Sapna
- Pathology, Albert Einstein College of Medicine, Bronx, USA
| | | | - Satesh Kumar
- Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK
| | - Mahima Khatri
- Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK
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Ibne Ali Jaffari SM, Hashmi M, Hashmi AW, Nisar S, Ashraf H, Tariq G, Farooq A, Awan J, Zaidi SMJ, Kaneez M. Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt's Lymphoma. Cureus 2023; 15:e40365. [PMID: 37456486 PMCID: PMC10340133 DOI: 10.7759/cureus.40365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Background Burkitt's lymphoma (BL) in the pediatric population has significant burden in developing countries. Infection-related complications during the induction chemotherapy phase pose a major challenge and contribute to high mortality rates due to a severely immunocompromised state. However, there is scarce data on the etiologies and optimal management strategies for infection-related mortality in pediatric BL patients, especially in developing countries like Pakistan. Methods This is a cross-sectional study that included a total of 116 pediatric patients with intermediate-risk BL. All patients were treated based on the Children's Cancer and Leukaemia Group (CCLG) 2020 guidelines. Data on patient demographics, presenting symptoms, diagnosis, infectious etiologies, and outcomes were collected. Infection-related complications and mortality were monitored during the induction chemotherapy period. The results of relevant culture reports were tabulated and data were analyzed. Results Among the 116 included patients, 61.1% were males with a mean age of 4.83 ± 2.12 years. Abdominal BL was the most common anatomical location. During the induction period, 66 patients (56.9%) had culture-proven infections, resulting in 33 deaths (28.4%). Fever was the predominant presenting symptom in all patients, followed by vomiting (57.6%), loose stools (42.4%), and cough (18.2%). Neutropenic colitis, sepsis, pneumonia, and meningitis were among the diagnosed infections. Hospital-acquired bacterial infections, including multi-drug resistant gram-negative and gram-positive organisms, were the main cause of mortality, with fungal infections and cytomegalovirus viremia also identified in a few patients. Conclusions This study highlights the urgent need for improved management strategies in pediatric BL patients in Pakistan to reduce infection-related complications and mortality rates, emphasizing the importance of context-specific approaches for infection prevention and management.
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Affiliation(s)
| | - Masooma Hashmi
- Internal Medicine, Walsall Manor Hospital, Royal Wolverhampton NHS Trust, Walsall, GBR
| | | | - Samaha Nisar
- Pediatrics, Shalamar Medical and Dental College, Lahore, PAK
| | - Hafsa Ashraf
- Pediatrics, Shalamar Medical and Dental College, Lahore, PAK
| | - Ghufran Tariq
- Pediatrics, Arif Memorial Teaching Hospital, Lahore, PAK
| | - Arslan Farooq
- Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Javeria Awan
- Pediatrics, Rawalpindi Medical University, Rawalpindi, PAK
| | - Syed Muhammad Jawad Zaidi
- Pediatrics, Holy Family Hospital, Rawalpindi, PAK
- Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mehwish Kaneez
- Pediatrics, Holy Family Hospital, Rawalpindi, PAK
- Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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