Cranial nerve involvement in meningitis is not uncommon and readily treatable if addressed at the earliest. Hospital admissions due to meningitis is quite common in developing countries like India.Here we present a study about clinical profile of meningitis patients with cranial nerve involvement and its significance in day to day practice. This study is conducted from a tertiary care centre of South India. The present study can aid in differentiation of types of meningitis and arrive at proper diagnosis especially in resource limited settings. Materials and Methods: The study was conducted for a period of three consecutive years with a sample size of 150 patients. It is a cross sectional descriptive study where in data was collected and analysed among various variables necessary. Patients with symptoms of meningitis and involvement of either of twelve cranial nerves were taken into consideration. Necessary investigations and examinations were done. Results: Cranial nerve involvement was most commonly seen in tubercular meningitis as compared to other types of meningitis. 6 th cranial nerve was most commonly involved followed by 3 rd , 2 nd , 8 th and 7 th respectively. Fever and neck stiffness were seen in considerable number of patients of meningitis with cranial nerve palsy and especially in less than 45 years of age. Conclusion: Tubercular meningitis should be the first differential diagnosis in a patient presenting with symptoms of meningitis (or fever) with cranial nerve palsy. Presence of only papilledema without cranial nerve palsy warrants to exclude other causes.
BACKGROUND AND OBJECTIVES: Nosocomial pneumonia (NP) is defined as parenchymal lung infection, occurring after the first 48 hours of hospital admission. Ventilator Associated Pneumonia (VAP) is the most common cause of nosocomial pneumonia. The clinical presentation and organisms causing the VAP are different in different set ups. Hence early diagnosis and management of these patients will decrease morbidity and also the mortality. AIM OF STUDY: Is to find the most common organism, sensitivity, and clinical profile of the patients suffering from VAP. MATERIALS AND METHODS: All patients on mechanical ventilation admitted in Intensive Care Units (ICU) of Basaweshwar Teaching and General Hospital attached to M.R.M.C Gulbarga for approximately 2 years from September 2010 to June 2012 were considered. Patients under study were those satisfying inclusion criteria and a detail history and clinical examination of the selected patients was taken. RESULTS: 224 patients were put on mechanical ventilator during the study period of them 60 patients developed VAP. Out of 60patients, 29 developed early onset and 31 developed late onset VAP. The most common sign in early onset VAP was crepitation (83%) and late onset were fever and tachycardia (61%). Commonest organism isolated in early onset VAP was Pseudomonas and Staphylococcus aureus (21%) and Pseudomonas (52%) in late onset. Piperacillin, meropenem and vancomycin were the most common antibiotics for which cultures were sensitive in early onset VAP, as compared to meropenem, vancomycin and levofloxacin in late onset VAP. Commonest risk factors in early and late onset VAP was use of H2 blockers (97% and 100%) respectively. late onset VAP had very high mortality rate of 71% as compared to only 17% in early onset VAP. CONCLUSION: Keen observation, clinical, radiological examination and culture sensitivity of respiratory secretions of ventilated patients in ICU would help to detect early onset of VAP. This early detection helps to administer the appropriate antibiotics which will reduce the morbidity, duration of hospital stay and mortality.
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