The number of Coronavirus Disease-19 (COVID-19) cases are on a rise globally due to the highly contagious nature of its causative agent Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). Physiological and Immunological changes during pregnancy may put pregnant women at increased risk for severe COVID-19 respiratory infection which may require Intensive care. Along with medical management, physiotherapy interventions namely patient education, relaxation, breathing exercises, positioning in bed, and mobility exercises are an integral part of acute care set up. The aim of this report is to share our experience as a frontline physiotherapist working as an integral part of the medical team in a dedicated COVID-19 Government Tertiary Care Hospital in Mumbai. It highlights physiotherapy management of a COVID-19 patient, in her 24th week of gestation, in an Acute Care Set Up.
Background:Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU.Materials and Methods:It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months. We studied clinical profile and outcome of 120 adult patients who developed VAP/HAP during the study period. We also analyzed the causative organisms, antibiotic sensitivity, and resistance pattern in these patients.Results:Out of 120 patients, 29 patients were HAP and 91 patients were VAP. Mortality was 60% (72), and development of VAP and requirement of mechanical ventilation showed significant association with mortality (P < 0.00001). Most common organism causing HAP was Staphylococcus aureus (43.4%) and VAP was Klebsiella pneumoniae (49%). Maximum antibiotic sensitivity was found to piperacillin + tazobactam (58.8%), followed by imipenem (49.5%) and meropenem (41.8%), whereas maximum antibiotic resistance was found to cefepime (95.1%), followed by ceftazidime and amoxicillin (91.2%).Conclusion:Nosocomial pneumonia showed high incidence (17.44%) and mortality (60%). Common organisms identified were S. aureus and K. pneumoniae. Resistance was high for commonly used antibiotics and high antibiotic sensitivity for piperacillin + tazobactam and carbapenem.
Background and aimThrombocytopenia in pregnancy varies from benign to severe with fetomaternal complications. We aimed to evaluate thrombocytopenia in pregnant Indian females in third trimester mainly during labor and delivery.Materials and methodsIt was a prospective observational study done in a tertiary care teaching public hospital over 1 year. Consecutive 150 pregnant patients admitted to labor ward with thrombocytopenia were analyzed for etiology of thrombocytopenia, severity, mode of delivery, type of anesthesia, and fetomaternal complications. SPSS version 17 was used for the analysis.ResultsMost common cause of thrombocytopenia was preeclampsia 50 (33.3%) and preeclampsia with hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLP syndrome) 31 (20.7%) together followed by gestational 42 (28%). Infectious causes such as malaria, dengue, and leptospirosis were found in 19 patients (12.7%). Moderate to severe thrombocytopenia was seen in preeclampsia, preeclampsia with HELLP syndrome, and infectious etiology. Eleven patients (7.3%) developed antepartum hemorrhage (APH), 24 (16%) postpartum hemorrhage (PPH), 12 (8%) required ICU admission, and 3 (2%) mortalities were noted. Fifteen neonates (10%) needed ICU admission. Complications were observed in preeclampsia with HELLP syndrome (82%) and infectious causes (18%) and none in gestational. Sixty-eight patients underwent lower segment cesarean section (LSCS), among them 41 (27.3%) were given spinal anesthesia (SA) and none of them developed any neurological complications.ConclusionStudy widened the spectrum of causes for thrombocytopenia in pregnant patients. Preeclampsia with or without HELLP syndrome and vector-borne infections such as malaria, dengue, and leptospirosis were found to be very important causes of moderate to severe thrombocytopenia and were associated with complications. Spinal anesthesia is safe in parturients with mild thrombocytopenia. Awareness and vigilance about thrombocytopenia is vital to reduce maternal morbidity and mortality.How to cite this articleHarde M, Bhadade R, deSouza R, Jhingan M. Thrombocytopenia in Pregnancy Nearing Term: A Clinical Analysis. IJCCM 2019;23(11):503–508.
The entire world is in the grip of COVID-19. India is under lockdown since 24th March 2020. On 19th April 2020 our Institute, a Tertiary Care Hospital, was declared as COVID-19 dedicated Hospital by the Municipal Corporation of Greater Mumbai.13th May onwards, Physiotherapy School & Centre, an integral part of the above mentioned institute, was called upon to offer their services to the COVID-19 patients. This paper aims to share our physiotherapy professional experiences and challenges faced as front liners in treating critically ill patients with COVID-19 admitted in Intensive Care Unit through case series of 4 patients.
Introduction: The Guillian Barre syndrome (GBS) is characterised by acute areflexic paralysis with albumincytological dissociation. Study was undertaken to analyze the electrophysiological studies, clinical profile and outcome of GBS at our institute. Material and Methods: This study was a hospital based descriptive and prospective study was conducted on patients admitted in the Medical intensive care unit. Patients with age more than 18 years, irrespective of their sex, diagnosed as GBS, fulfilling the criteria as modified by Asbury were included in the current study. Association between qualitative variables was assessed by Chi-Square test. Quantitative data was represented using mean ± SD, median. Results: Out of 50 enrolled, 21 patients belonged to age 21 to 40. 33 pts were male and 17 pts were female, 7 patients expired. Two peak of occurrence of GBS was found in age one in age group 21 to 41years and another in age more than 51 years.13 patients had history of antecedent infection. 35 patients had albumin-cytological dissociation. As per the results of nerve conduction study, patients were categorized in the following 3 groups AMAN-24, AIDP-14 and ASMAN-12. Conclusions: The independent predictors for the need of mechanical ventilation were history of breathlessness on admission, SBC of equal to or less than 10, upper or lower limb power of less than or equal to 2 (P valve <0.01). The predictors of poor outcome were presence of sepsis, need for mechanical ventilation, VAP, SBC of < 10 and lower limb power < 2.
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