Background: Ventilator-associated pneumonia (VAP) is one of the most common infections in intubated intensive care unit (ICU) patients. Oral care with chlorhexidine is a conventional method for maintaining hygiene. Recently, adjuvant methods have been introduced into routine oral care, including teeth brushing and the application of moisturizing lotion. The objective of this study was to compare the incidence of VAP in critical care patients receiving oral care with and without manual teeth brushing and the application of moisturizers to the mouth.Methods: We conducted a prospective randomized control study comprised of 220 ICU patients between 18 and 65 years of age, and of either sex. The patients were divided into two groups of 110 each. Care for the study group (group S) consisted of chlorhexidine wash, tooth brushing, and moisturizing gel over gums, buccal mucosa, and lips. The control group (group C) was treated with chlorhexidine wash only. The oral assessment was done at 4, 6, 8, and 12 hours using the Beck Oral Assessment Scale (BOAS). Pneumonia was assessed based on abnormal chest x-rays, fever, chest auscultation, endotracheal culture report, and the incidence of VAP, and mortality was observed Results: Abnormal chest x-rays, positive auscultatory findings, fevers, and positive culture reports were significantly reduced in group S compared to these measurements in group C. The incidences of VAP and mortality were also significantly lower in group S compared with the incidences in group C.Conclusions: Oral care with chlorhexidine mouth wash and the adjuvant measures reduced VAP and, consequently mortality and hospital stays. Tooth brushing along with standard oral care provides an additional advantage in the prevention of VAP in mechanically ventilated patients. Compulsory tooth brushing, if included in regular oral care yields better results in terms of decreased incidence of VAP, length of ICU stay, and mortality.

Sheehan syndrome is a rare but potentially serious complication of postpartum haemorrhage. The diagnosis can often be delayed by many years as symptoms may be subtle. We report the case of a 45-year-old woman who presented to the medical emergency unit with acute onset altered sensorium. On further evaluation she was found to have severe hypoglycaemia which was corrected by giving intravenous dextrose. On detailed clinical evaluation, she had a history of agalactia and amenorrhoea following her last pregnancy which was 15 years ago. She had a history of excessive postpartum bleeding during her last delivery. MRI of the brain showed empty sella and hormonal evaluation revealed adenohypophyseal insufficiency as evident from decreased levels of cortisol, thyroid-stimulating hormone, triiodothyronine, free thyroxine, follicle-stimulating hormone, luteinising hormone and prolactin. Based on clinical, radiological and laboratory parameters her final diagnosis was Sheehan syndrome with hypoglycaemia.

No abstract

No abstract

No abstract