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Background: There is a paucity of literature regarding the microbial etiology of community-acquired pneumonia (CAP) in India. The current study was aimed to study the microbial etiology of hospitalized adults with CAP. Methods: The study was conducted in a 700-bedded North Indian hospital. Consecutive adults admitted with CAP over a period of 2 years from 2013 to 2015 were recruited for the study, and apart from clinical evaluation underwent various microbiological studies in the form of blood culture, sputum culture, urinary antigen for pneumococcus and Legionella, serology for Mycoplasma and Chlamydia and real-time reverse transcriptase polymerase chain reaction for influenza viruses. Radiographic studies were performed in all patients and repeated as required. The patients were treated with standard antibiotic/antiviral therapy and outcomes were recorded. Results: A total of 225 patients (median age: 59 years) were enrolled. Streptococcus pneumoniae was the most common organism found (30.5%), followed by Legionella pneumophila (17.5%), influenza viruses (15.4%), Mycoplasma pneumoniae (7.2%), Chlamydia pneumonia (5.5%), Mycobacterium tuberculosis (4.8%), Klebsiella pneumoniae (4.8%), methicillin-resistant Staphylococcus aureus (3.5%), Pseudomonas aeruginosa (3.1%), methicillin-sensitive S. aureus (1.7%), and Acinetobacter sp. (0.8%) with 4% of patients having multiple pathogens etiologies. High Pneumonia Severity Index score correlated with the severity and outcome of the CAP but was not predictive of any definite etiological pathogen. In-hospital mortality was 8%. Conclusion: Streptococcus pneumoniae, Legionella, and influenza constitute the most common etiological agents for north Indian adults with CAP requiring hospitalization. Appropriate antibiotic therapy and preventive strategies such as influenza and pneumococcal vaccination need to be considered in appropriate groups.

Background: Metabolic bone disease complicating chronic liver disease (CLD) has become a major clinical problem. Methods: Our study was a prospective case control study included 70 cases and 70 controls. Patients with CLD falling in age group of 18 to 65 years constituted cases group. They were thoroughly examined and were subjected to baseline investigations including kidney function test, serum calcium levels, serum phosphorus levels, liver function test, complete blood count, lipid profile. All subjects were subjected to Dual Energy X-ray Absorptiometry (DEXA) Scan (GE Lunar-1 Co. Prototype). Results: The prevalence of osteoporosis in our study at femur neck in the cases was 45.7% vs. 18% in the control group (p=0.001), while at L1-L2 it was 41.4% in cases vs. 15.7 %( p=0.001) in control group. No difference was found when both sites i.e. femur and L1-L2 were compared with each other (p=0.84, chi square of 0.33 in cases and p=0.58, chi square of 1.07 in case of controls).Prevalence of osteoporosis in our study in female cases and controls was higher than male counterparts both at femur and L1-L2. Peripheral DEXA and central DEXA had no difference in detecting osteoporosis among male and female sex. Conclusion: CLD is an independent risk factor for osteoporosis, hence patients who are first time diagnosed CLD should be screened for osteoporosis with central or peripheral DEXA, and subsequently managed to prevent complications and morbidity associated with osteoporosis.

Introduction: Limited data is available on prevalence of extrapancreatic infection, its influence on outcome of pancreatitis. Objectives: To assess the prevalence of extra-pancreatic infections in acute pancreatitis, identify risk factors for development of such infections and influence of extrapancreatic infections on outcome of pancreatitis. Methodology: Patients of acute pancreatitis admitted from June 2013 to July 2015 were recruited in the study. The patients who developed extra-pancreatic infection formed the study group while patients who didn’t develop infections were included in the control group. Both groups were followed and their final outcome was compared. Results: A total of 350 patients comprising of 158 cases and 192 controls were studied. Prevalence of extra pancreatic infections was found in 41.5% with Urinary tract infections (UTI)(14.4 followed by Biliary (10.0%), pulmonary (8.4%), Pulmonary and UTI (3.7%),Injection site infections (2.1%). Predisposing factors for development of extra pancreatic infections and subsequent outcome of acute pancreatitis was found to be influenced by duration of hospital stay (p

Central venous Catherization (CVC) is rarely complicated by pleural effusion. It is usually due to malpositioned catheter. Our patient was a 35-year-old man admitted with Menningoencephalitis.A cervical central vein catheter was placed into his right jugular vein after induction of anaesthesia in Emergency Room. In chest x ray we encountered bilateral pleural effusion and drained it with a chest tube. During following days the patient has daily drainage of almost 1.7 liter of clear yellowish fluid from chest tube. Fluid analysis was not diagnostic. We removed the central vein catheter and plural drainage was stopped.

Spontaneous spinal epidural hematoma (SSEH) is a rare entity. SSEH is an accumulation of blood in the vertebral epidural space in the absence of trauma or iatrogenic procedure like lumbar puncture.The incidence of SSEH has been estimated at 0.1 patients per 100,000 individuals and represents less than 1% of spinal space-occupying lesions .Here we are presenting case of a 65year old female hypertensive on treatment with controlled blood pressure, who presented with sudden onset paraplegia and weakness of muscles of hand, associated with urinary and bowel incontinence that started 6 hours before presenting to Emergency Room .Patient was subjected to MRI spine that revealed a collection in spinal epidural space,hypointense in T1W images and hyperintense in T2W images, extending from C6-C7 to T1-T2 suggestive of acute / subacute epidural hematoma. In our case all possible causes of an epidural haematoma were ruled out by relevant investigations. Patient was subjected to surgical evacuation of hematoma after 48 hours of presentation. Perioperative and Postoperative period was uneventfull . Sensations over involved areas improved. Motor weakness also improved from Grade III to Grade IV+ in bilateral lower limbs and from Grade II to Grade IV in small muscles of hand and triceps, however Patient persisited with urinary incontinence.

Introduction: Traumatic brain injury (TBI) is a major cause of death and disability throughout the world. Commonly used predictors of outcome both individually or in combination include age, Glasgow Coma Scale score, pupillary reactivity, early hypoxia, and hypotension. Most of the studies previously done to examine risk factors for mortality in severe TBI were done in the setting of polytrauma. Aims and Objectives: The aim and objective of this study was to do an in-depth analysis of various factors associated with the management and outcome of patients with isolated TBI admitted in an Intensive Care Unit (ICU). Materials and Methods: A total of seventy adult patients who were admitted to Intensive Critical Care Unit (ICU) with isolated TBI were selected during a 12-month period from January 2016 to December 2016. This is a prospective analytical study and parameters studied included age, sex, cause of admission classified by type of trauma, premorbid functional status, acute and chronic comorbidities, brain noncontrast computed tomography scan data, Glasgow Coma Scale (GCS), hemodynamic status, respiratory status, and mechanical ventilation, blood gases, serum electrolytes, serum glucose, hemoglobin, leukocyte and platelet counts, renal function, and urinary output. Results: The study population consisted of 46 (65.7%) males and 24 (34.2%) females. The mean age was 35.5 years (range, 18–65 years). The most common mode of trauma was road traffic accident (43.6%) followed by fall from height (35.7%). Statistically insignificant relationship (P < 0.05) was seen with sex and mode of injury among survivors and nonsurvivors; however, 61.9% of patients with age ≥40 years died (P < 0.005). Among clinical parameters at admission to ICU, low GCS, hypotension (mean arterial pressure ≤80 mmHg), hypoxia (pO2 ≤60 mmHg, spO2 ≤90 mmHg), and nonreacting pupils were significantly associated with increased mortality (P < 0.05). Conclusion: Isolated TBI still continues to have a good amount of morbidity and mortality which perhaps can be reduced by strict adherence to guidelines of management.