poster name & discipline designation abstract title
TRANSCRIPT
Poster No.
Discipline Name & Department
Designation Abstract Title Authors
JR-45 Medicine
Dr. Vishakh C Keri Deptt. Of Infectious Diseases Medicine & Microbiology
Junior Resident
Impact of early organism identification by MALDI TOF MS on antibiotic prescription pattern and clinical outcomes
Keri C Vishakh , Das Kumar Bimal , Sood Rita, Wig Naveet, Kapil Arti, Sreenivas, Xess Immaculata, Soneja Manish, Mohapatra Sarita
JR-33A
Medicine Dr Bharath Deptt. of Medicine
Junior Resident
Clinical, laboratory and treatment profile of SLE patients who had in hospital mortality in AIIMS over a period of 5 years – Retrospective observational study,
Dr Prabhat Kumar, Dr Manish Soneja, Dr Piyush Ranjan, Dr Naveet Wig, Dr Ashutosh Biswas, Dr Bharath
JR-35 Medicine Dr. Aditya Nayan Junior resident
A clinico-epidemiological study of acute undifferentiated febrile illness with special reference to scrub typhus and leptospirosis
Dr. A Nayan, R S Jadon
JR-36 Medicine Dr. AK Pius Aswin Junior resident
TO STUDY CURRENT PRACTICES OF MANAGEMENT OF BACTERIAL UTI IN PATIENTS
Dr. AK Pius Aswin, Arvind Kumar, Neeraj Nischal, Wig Naveet, Biswas Ashutosh, Mohapatra Sarita, Khan MA, Kumar Sanjay
JR-37A
Medicine Dr. Manasvini Bhatt
Junior resident
Myocarditis in dengue: A prospective observational study
Bhatt M1, Soneja M1, Farooqui FA2, Vikram NK1, Biswas A1, Roy A2, Wig N1
JR-41 Medicine Dr. Pankaj Chaudhary
Junior resident
Outcome of implementation of guidelines on artificial airway maintenance and tube care in mechanically ventilated patients in medicine
Pankaj Chaudhary 1 , Naveet wig 2
JR-42 Medicine Dr. Sagnik Biswas, Deptt. of Medicine
Junior Resident
N-Terminal pro-BNP is an independent predictor of mortality in patients with sepsis
Biswas S1, Soneja M1, Kumar A1,Nischal N1, Sreenivas V3, Roy A2, Biswas A1, Wig N1.
JR-43 Medicine Dr. Sameer Samad Deptt. of Medicine and Microbiology
Junior Resident
INCIDENCE OF RESPIRATORY SYNCYTIAL VIRUS INFECTION IN ADULTS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANT
Samad Abdul Sameer1, Dar Lalit2, Kumar Lalit3, Chaudhary Aashish4, Ray Animesh5, Brijwal Megha6
JR-44 Medicine Dr. Sanchit Kumar Junior resident
ENDOTHELIAL DYSFUNCTION WITH DIFFERENT GRADES OF OBESITY IN PATIENTS WITH MODERATE TO SEVERE OBSTRUCTIVE SLEEP APNEA
Dr. Pankaj Chaudhary,Dr. Naveet Wig
JR-46 Medicine Dr.Harsh Sahu Junior resident
Effect of implementation of protocol based nutrition therapy in medical ICU
Sahu Harsh, Soneja Manish, Singh Namrata, Shalimar, Kalaivani M., RayAnimesh, RanjanPiyush, Vikram Kishore Naval, BiswasAshutosh, Wig Naveet.
JR-34 Medicine Dr Devada sindhu Junior Resident
Spectrum of invasive fungal infection in a tertiary care hospital in North India
Dr Devada Sindhu, Dr Pankaj Jorwal, Dr Ashutosh Biswas, Dr Manish Soneja
JR-45
Title : Impact of early organism identification by MALDI TOF MS on antibiotic
prescription pattern and clinical outcomes.
(MALDI TOF MS – Matrix Assisted Laser Desorption Ionization Time Of Flight Mass Spectometry )
Name of the authors : Keri C Vishakh , Das Kumar Bimal , Sood Rita , Wig Naveet , Kapil Arti , Sreenivas ,
Xess Immaculata , Soneja Manish , Mohapatra Sarita .
Affiliation :
Presenting author : Dr Vishakh C Keri
Email : [email protected]
Abstract Body
Introduction: Rapid detection of the organism with early institution of targeted antimicrobials with rational combinations reduces antimicrobial resistance. This can be achieved through newer diagnostic modalities like MALDI–TOF for early and accurate identification of organisms .This approach will not only reduce antibiotic usage and improve antibiotic prescription practices but will also improve clinical outcomes in patients .
The conventional processing involves culturing of the organisms which takes around 24hrs followed by
biochemical identification after 18-24 hrs , totalling to around 36-48hrs . MALDI TOF gives an edge
over conventional processing by directly identifying the cultured organism without the help of
biochemical’s saving around 18-24hrs or even more. It thus is a tool for rapid, accurate, and cost-
effective identification modality for cultured bacteria and fungi. The earlier diagnosis achieved by
MALDI- TOF was associated with both a reduction in length of stay and in hospital costs .
Objectives :
Primary
• To determine time to first antibiotic modification post culture positivity
• To observe the antibiotic prescription pattern in Medicine department with the available
culture report
Secondary:
• To compare clinical outcomes in the patients with antibiotic modification with respect to time
to first antibiotic modification.
Materials and methods
A) Study type: A Pre-Post Test Quasi Experimental Study.
B) Study Setting: Department of Medicine and Department of Microbiology
C) Sample size: 50 in each group
D) Study Population: Patients in Medicine ward and ICU with positive cultures.
E) Inclusion criteria:
Patients admitted in Medicine ward and Medicine ICU.
Age > 14 yrs
Biological samples of such patients should be culture positive .
F) Exclusion criteria :
Patients or their relatives refusing to give consent.
Multiple prior positive culture from a different site .
Materials and methods (WORKING ALGORITHM)
PHASE 1- Conventional reporting (MALDI TOF with Antibiotic sensitivity) - Evaluation of current practice
of reporting, antimicrobial usage and clinical outcomes
• Time to first antibiotic modification post culture positivity will be noted from the nurses records.
• Antibiotic prescription pattern will be assessed
• Antibiogram will be prepared
• Clinical outcomes will be recorded.
PHASE 2 – Earlier reporting of the organism using MALDI TOF
• Organisms will be identified using MALDI TOF on the same day of culture positivity and
communicated to the physician.
• Case files of these patients will be reviewed and appropriate antibiotic recommendations will be
made based on the available antibiogram .
• Compliance and adherence to recommendation and the reasons for non adherence will be
noted .
• Time to first antibiotic modification post culture positivity will be noted.
• Antibiotic prescription pattern will be assessed
• Clinical outcomes of patients will be recorded
Results :Currently only the pre intervention phase results have been submitted as the post intervention
phase is still on going.
Out of the 50 patients , 22 had lower respiratory tract infection , 10 had urinary tract infection , 11 had
blood stream infection and , 7 had purulent infection . Average time when report was available post
culture positivity was 29 hrs 36 min . The empirical antibiotic which the patients were receiving when
the culture report was available largely included Piperacillin tazobactum (42%) and Teicoplanin (32%) .
Most common among LRTI , UTI , BSI and pus groups included Acinetobacter(50%) , Escherichia coli
(50%) , Enterococcus faecium(27.3%) , Pseudomonas (42.8%) . Interpretation of the antibiogram
revealed 78.5% of the acinetobacterisolates were Cefaperozonesulbactum sensitive. Imipenem was
better for Klebsiella(50%),Pseudomonas(87.5%),E.coli(75 %) . Piperacillin tazobactum was still a sensitive
drug amongst (75%) of the E.coli isolates . 20.5% (8/39)all the gram negative isolates were only colistin
sensitive – Klebsiella(50%) , Acinetobacter (37.5%) ,Pseudomonas (12.5%) , none of the Ecoli . However
no linezolid resistance was identified among the gram positive isolates . Average time to first antibiotic
modification post availability of report was35hrs 13 mins and post culture positivity was 64hrs 49 mins (
includes reporting delay and delay due to sensitivity reporting). Antibiotic modification was made in
(31/50) 62% of the patients after culture report was available . Amongst the modification , partial
modification (45.16%) was the most common where a gram positive or an atypical cover was continued .
In the no modification group (18/19) 94.7% were discharged as there was no delay and patient were
either improving or receiving right antibiotics . Amongst the 31 patients in whom modification was made
16 died and 15 got discharged with a significant delay in time to modification of 90 hrs 51 mins (Death)
and 54hrs 27 mins (Discharge) respectively .
Conclusion : There is a significant burden of resistance microbes causing poor clinical outcomes and
early initiation of antibiotics in such patients can significantly improve outcomes . Practical utility of
MALDI TOF to see if early identification actually helps in earlier prescription modification and better
clinical outcomes will be assessed in the post intervention phase .
JR-33A
Title: Clinical, laboratory and treatment profile of SLE patients who had in hospital
mortality in AIIMS over a period of 5 years – Retrospective observational study
Author’s Names: Dr Bharath, Dr Prabhat Kumar, Dr Manish Soneja, Dr Piyush Ranjan, Dr Naveet Wig,
DrAshutosh Biswas.
Institution Name: All India Institute of Medical Sciences (AIIMS), New Delhi
Presenting Author: Dr Bharath
Introduction:
SLE is the most common autoimmune condition that affects young and middle aged population,
especially females. Due to its initial non-specific and varied clinical symptoms, the disease is very
difficult to diagnose in initial state, especially in primary and secondary level health care systems. Due to
chronicity of disease and prolonged treatment, difficult to maintain good compliance. Frequent flare in
disease activity and severe infection secondary to disease activity itself or due to immunosuppression
treatment is very common. Most of the patient who are referred to our institute will having active
disease with flare and multi organ involvement or complicated clinical condition due to severe infection.
Understanding the demographic and clinical profile of these patients at admission and their in hospital
course along withtreatment institutedin hospital with their outcome is necessary to understand more
about this disease.
Aims:
To study the clinic-epidemiological profile, lab parameters and disease course of SLE patients, who
expired during hospital admission in last 5 years.
Method
This is a retrospective study conducted in All India Institute of Medical Science, New Delhi. Study
included all SLE patients who had in hospital mortality between January 2014 and December 2018.
Ethical clearance was taken from the Institute ethics committee. Records of study patients were taken
from MRD. All SLE patients who had in-hospital mortality and were admitted for at least 2 days were
remained in the study. Study population was divided into 2 groups; group 1 included patients who had
mortality due to disease flare and group 2 included patients who had mortality due to systemic
infection.
Results:
A total 53 patientswere studied.Most of the patient in the study were females (96%). The mean age of
patient in group 1 was 29.1 years and 32.3 years in group 2.The median duration of SLE diagnosis was 2
months. The most common symptom at the time of admission was fever (69.8%). Based on the clinic-
radiological/microbiological findings and work up for active flare (C3, C4 & anti-ds DNA) we found that
28 patient had died because of SLE flare only (Group 1) and 25 patients died due to SLE flare along with
infection (Group 2). All patient had SLEDAI score > 3, suggestive of lupus flare. The most common
symptom at the time of admission was fever (69.8%), followed by arthralgia (66%), dyspnea (56%),
oliguria (50.1%), cough (43.4%), anasarca (37.7%), psychosis (35.7%), seizure (33.9%), oral ulcer (32%),
photosensitivity (28%), skin rash (26.4%), myalgia (22.6%), malar rash (20.7%) and alopecia (20.7%).
Median duration of hospital stay was 7 days. Almost half of the patient (47.1%) were on steroid therapy
in last three months before admission.
Kidney was the most common organ involved in the study cohort (84.9%). The most common infection
was bacterial pneumonia (17) followed by urosepsis (2), fungal endocarditis (1), disseminated fungal
infection (1), tuberculous empyema (1) and disseminated tuberculosis (1).Hospital acquired pneumonia
was suspected in 7 patients. A. baumannii was isolated from 7 patients.Methylprednisolone pulse
therapy was given to 26 patients and oral prednisolone was given to 28 patients. Intravenous
cyclophosphamide (12), Intravenous immunoglobulin (5), Mycophenolate (5), Plasma exchange (3) and
rituximab (1) were other treatment modalities used in these patients. The number of patients
undergoing hemodialysis were significantly more in group 2 (16 vs 5, p=0.001).
Conclusion: Mortality due to SLE occurred in younger patients in our study cohort and were due to
disease flare and in half of these patients clinical course was complicated by infection. This is unlike in
western countries, where mortality occurs at later age due to complication of treatment and RRT.
JR-35
A clinico-epidemiological study of acute undifferentiated febrile illness with
special reference to scrub typhus and leptospirosis
Authors
A Nayan , R S Jadon
Junior resident, Department of Medicine, AIIMS, New Delhi
Assistant Professor, Department of Medicine, AIIMS, New Delhi
Abstract
Acute undifferentiated febrile illness (AUFI- fever less than 14 days) is one of the major causes of
seeking heath care in tropical countries like India. Scrub typhus and leptospirosis are two important
causes of acute undifferentiated fever which have protean manifestations and many a times fatal if not
recognised and treated early. We conducted prospective observational study enrolling 376 patients of
age >14 years admitted in the Department of Medicine AIIMS, New Delhi during the period from
February 2017 to October 2018 and looked for the demographic, clinical and aetiological profile of these
patients. Patients with dengue fever were highest (35 %). Scrub typhus and leptospirosis were 11 % and
5 % respectively. Severe disease and systemic complications were common in both the diseases. Late
presentation (>9 days), headache, jaundice, GCS <10/15, shock at presentation, bilirubin >3 mg/dl and
raised transaminases >3 times normal were associated with severe scrub typhus while eschar and
myalgia were associated with less severe disease. Among the patients of leptospirosis, nausea, myalgia,
cough, breathlessness, altered sensorium, seizures, bleeding manifestations, hepatosplenomegaly were
found more in patient of severe disease, however, they were statistically insignificant.
JR-36
TO STUDY CURRENT PRACTICES OF MANAGEMENT OF BACTERIAL UTI IN PATIENTS AT AIIMS, NEW DELHI Pius Aswin AK1 Kumar Arvind 2 Nischal Neeraj2 Wig Naveet3 Biswas Ashutosh3 Mohapatra Sarita 4 Khan MA5 Kumar Sanjay6 1. Junior Resident, Department of Medicine, All India Institute of Medical sciences, New Delhi 2.Assistant Professor, Department of Medicine, All India Institute of Medical sciences, New Delhi 3.Professor, Department of Medicine, All India Institute of Medical sciences, New Delhi 4. Assistant Professor, Department of Microbiology, All India Institute of Medical sciences, New Delhi 5. Assistant Professor, Department of Biostatistics, All India Institute of Medical sciences, New Delhi 6. Assistant Professor, Department of Urology, All India Institute of Medical sciences, New Delhi Presenting author: Dr.Aswin Pius AK aswinakpius@gmailcom Corresponding author: Dr.Arvind Kumar [email protected] Abstract Introduction Urinary Tract Infection is a common infection worldwide with an estimated global incidence of 150 million cases per year.Among elderly patients admitted with sepsis in ICU UTI contributes to 21.2%.The incidence of UTI in pregnant female in India is around 3.3%.UTI is the most common cause of bacteremia in post transplant patients and mortality is around 11%.UTI is also a common cause of infection in neutropenic patients, patients on chemotherapeutic agents and patients undergoing Urological procedures.CAUTI(Catheter Associated Urinary Tract Infection)contributes to 30 to 40% of all hospital acquired infections.Prompt treatment with appropriate antibiotics is critical to prevent complications of UTI in these patients.Studying the etiology,risk factors,clinical features associated with UTI together with antibiotic susceptibility pattern and antibiotic usage against these uropathogens helps in identifying the loop holes in current treatment of UTI and further narrowing down a physician’s view in clinical suspicion and appropriate antibiotic usage.Limited such studies are conducted in a tertiary care center. Aims and Objectives Primary objective was to study practices of empirical and culture based antibiotics usage for treatment of culture positive bacterial UTI and to study distribution,antibiotic susceptibility pattern of bacterial pathogens causing UTI Secondary objective To study clinical and epidemiological profile of patients having UTI Materials and Methods Type of study was Prospective observational cross sectional study.200 Patients greater than 14 years of age with culture positive UTI diagnosed and treated under department of Medicine,Geriatric Medicine(IPD and OPD), Urosurgery and Microbiology were included in the study.Clinical profile of the
patients,organism grown in the culture with their antibiotic susceptibility pattern,empirical and culture based antibiotics prescribed to these patients were noted.Outcome was measured using resolution of the primary symptoms and UTI symptom score.Distribution of different uropathogens,risk factors,clinical symptoms,antibiotics usage(empirically and culture based)associated with UTI was studied.An antibiogram was made based on the susceptibility pattern to antibiotics. Results UTI was most common in middle aged females.In all age group,UTI occurs more commonly in females except in elderly age group where it was common in elderly males.Most important risk factors were indwelling urinary catheter,diabetes,immunosuppressive state.The most common symptom was dysuria and fever.In CAUTI patients the most important symptom was fever rather than dysuria.Most common uropathogen was E.coli followed by Klebsiella.Most common empirical antibiotic used in OPD and IPD patients were Nitrofurantoin,Pipercillin –Tazobactum.The most sensitive oral antibiotic for OPD patients was Nitrofurantoin.The most sensitive antibiotic for IPD patients was Imipenem.One of the most important finding in this study was high level of resistance to Meropenem,Pipercillin-Tazobactum and levofloxacin,which was commonly used antibiotics to treat UTI in our setting. Conclusion Klebsiella is emerging as a very important cause of UTI,which could be a grave situation as this bacteria had a high level of resistance. Mostly empirical antibiotic prescription was adequate in OPD patients as it was in coherence with the Antibiogram for OPD patients observed in this study.However the selection of empirical antibiotics(Pipercillin-Tazobactum,Levofloxacin and Meropenem)in IPD settings was not found to be adequate and needs some review in our setting. Imipenem is found to be the best resort in this study.
JR-37A
Title: Myocarditis in dengue: A prospective observational study
Name of Authors: Bhatt M1, Soneja M1, Farooqui FA2, Vikram NK1, Biswas A1, Roy A2, Wig N1
Affiliations:
1 Department of Medicine, All India Institute of Medical Sciences, New Delhi
2 Department of Cardiology, All India Institute of Medical Sciences, New Delhi
Presenting Author:
Name: Dr. Manasvini Bhatt
Email: [email protected]
Corresponding Author:
Name: Dr. Manish Soneja
Email: [email protected]
Myocarditis in dengue: A prospective observational study
Introduction:
Cardiac involvement is not an uncommon manifestation in dengue fever. It is underdiagnosed due to a
low index of clinical suspicion, overlapping clinical manifestations such as tachycardia, hypotension,
tissue hypoperfusion and pulmonary edema due to capillary leak associated with dengue, and lack of
routine screening. The frequency of subclinical dengue myocarditis and its relative contribution to the
hemodynamic instability in severe dengue remains unknown.
Aims and Objectives:
To study the prevalence of myocarditis and clinical outcomes among admitted patients with dengue in
medical wards/ICU.
Materials and Methods:
A prospective observational study was carried out in admitted patients with age between 18–65 years
having confirmed dengue (NS1/IgM serology). Patients on medications affecting heat rhythm/ rate, pre-
existing heart disease and patients with electrolyte abnormalities potentially affecting heart
rate/rhythm were excluded. Permission was taken from Institute Ethics Committee.
The baseline demographic, clinical and laboratory parameters were collected for all patients. A baseline
ECG was done at admission and every second day till discharge/ death. Trop-I and NT-proBNP were done
at baseline and repeated only if ECG changes suggested some abnormality. The cardiac enzymes were
measured using enzyme-linked fluorescent assay (VIDAS, bioMérieux, France). Cardiac enzyme was
considered to be elevated if cTnI more than 19 ng/mL and/or NT-proBNP more than 450 ng/L (age < 50
years), 900 ng/L (age 50–75 years), and 1800 ng/L (age > 75 years). The above point-of-care system has
been validated as part of critical care pathway to detect MI. All patients with elevated cardiac enzymes
underwent 2-dimensional echocardiography. A left ventricular ejection fraction (LVEF) of <50% was
considered depressed. Diagnosis of myocarditis was as per ESC 2013 criteria. Fluid management was as
per WHO guidelines (2009).
Results:
A total of 183 patients were recruited with median age of 29 years (IQR 21, 37) and 31% were females.
Dengue with warning signs was present in 80 (44%) and severe dengue in 45 (25%) patients. Cardiac
enzymes were elevated in 27 (15%) patients (cTnI in 25 and NT-proBNP in 22). Among these 27 patients,
11 [6% (2.6-9.4, 95% CI)] had echocardiographic evidence and diagnosed as having myocarditis
according to ESC 2013 criteria. Clinical features of fluid overload were more common in myocarditis
group [8 (73%) vs 4 (2%), p= <0.01]. The length of hospital stay in myocarditis group was 6.1±3.9 days
compared to 4.9±2.1 days (p=0.08) in the other group. Overall, 5 (2.7%) patients expired, all of them had
myocarditis (5/11= 45%). All the expired patients had severe dengue at presentation, 1 was a known
hypertensive, 2 patients developed hospital acquired pneumonia and 1 patient had malaria co-infection.
Among patients with raised cardiac enzymes and normal echo (n=16), 3 patients developed clinical signs
of fluid overload compared with only 1 out of 156 patients without raised cardiac enzymes (p< 0.01).
Conclusion:
Myocarditis in dengue is not uncommon and it leads to increased morbidity and mortality. Patients with
isolated elevation of cardiac enzymes without echocardiographic evidence of myocarditis, are more
likely to develop fluid overload during IV fluid therapy.
JR-41
Outcome of implementation of guidelines on artificial airway maintenance and tube care in
mechanically ventilated patients in medicine department at AIIMS, New Delhi
Authors
Pankaj Chaudhary1, Naveet wig2
1Junior resident, Department of Medicine, AIIMS, New Delhi
2Professor, Department of Medicine, AIIMS, New Delhi
Abstract
BACKGROUND: Little is known about the incidence of and risk factors for adverse effects from
endotracheal suctioning. We studied the incidence and risk factors, and evaluated the effect of
suctioning practice guidelines.
METHODS: During a 6 months period, in 50 mechanically ventilated subjects, we recorded the adverse
effects of suctioning procedures. Then practice guideline were implemented and 6 months later, during
another 6 months period we recorded adverse effects of suctioning procedure in 50 mechanically
ventilated subjects.
RESULTS: In the first period, adverse effects occurred frequently: oxygen desaturation in 18% of
subjects, hemorrhagic secretions in 42% of subjects, blood pressure change in 4% of subjects and heart
rate change in 6% of subjects. After guideline implementation, all complications, both separately and all
together, were reduced. Oxygen desaturation decreased from 18% to 0 (p= 0.003), hemorrhagic
secretions from 42% to 22 % (p=0.032).The use of guidelines was independently associated with fewer
complications.
CONCLUSIONS: Endotracheal suctioning frequently induces adverse effects. Their incidence can be
reduced by the implementation of suctioning guidelines.
JR-42
Submission of abstract for the First Annual AIIMS Research Day
Title: N-Terminal pro-BNP is an independent predictor of mortality in patients with sepsis
Name of Authors: Biswas S1, Soneja M1, Kumar A1,Nischal N1, Sreenivas V3, Roy A2, Biswas A1, Wig N1.
Affiliations:
1 Department of Medicine, All India Institute of Medical Sciences, New Delhi
2 Department of Cardiology, All India Institute of Medical Sciences, New Delhi
3 Department of Biostatistics, All India Institute of Medical Sciences, New Delhi
Presenting Author:
Name:Dr.Sagnik Biswas
Email:[email protected]
Corresponding Author:
Name:Dr. Manish Soneja
Email:[email protected]
Abstract
Introduction
Cardiovascular dysfunction is seen in upto 59% casesof sepsis. The spectrum of involvement
encompasses distributive shock, left ventricular dysfunction and dysrhythmias.This study aimed to
evaluate the role of the cardiac enzymes, N-Terminal pro-BNP (NT-proBNP) and cardiac troponin-I
(cTnI)aspredictors of outcomes in patients with sepsis.
Aims and Objectives:
Primary objective was to study the role of NT-proBNP and cTnI in predicting outcomesof patients with
sepsis as compared to conventional severity of illness (SOI) scoring systems, namely APACHE-II and
SAPS-II. Secondary objectives includestudying the effect of combining NT-proBNP and cTnI with the SOI
scoring systems in predicting outcome of patients with sepsis.
Materials and Methods:
This was a prospective observational study carried out in a medical ICU over 2 years. Patients with a
diagnosis of new onset sepsis/septic shock were included in the study. Considering a type 1 error (alpha)
to be 0.05 and type 2 erro rate (beta ) to be 0.80, the expected sample size was kept at 78. Known cases
of chronic kidney disease, heart failure, coronary artery disease were excluded. Baseline
demographic,APACHE-II, SAPS-II score, hematologic and biochemical parameters were noted. Serum NT-
proBNP and cTnI were done at 24and 72 hours along with echocardiography. Serial SOFA values from
admission were noted. The patient was followed up till terminal event or discharge.
Results:
A total of 78 patients were enrolled (47% females).Mean age was 45.4±17.4 years.Mean APACHE-II
score was 19.8±9.6, SAPS was 44.8±17.2 and SOFA(Day1) 7.2±3.8. Predictive mortality was 35±20% and
37±31% for APACHE-II and SAPS-II respectively. Mortality rate in the study was 52.5% (41/78 patients).
NT-proBNP was significantly higher in non-survivors (median: 5811pg/ml at 24 hours and 8448.5 pg/ml
at 72 hours respectively)with values over 4300 pg/ml at 24 hours (sensitivity: 65.8% and specificity:
64.8%, AUC: 0.69, PPV: 70%, NPV: 64%) and 5229 pg/ml at 72 hours (sensitivity: 85.29% and specificity
83.78%, AUC: 0.848, PPV: 82.9%, NPV: 86.1%) associated with higher mortality (p<0.05). cTnI was higher
among non survivors than survivors, but the difference was not significant. APACHE-IIgreater than 20
and NT-proBNPgreater than 4300 pg/ml predicted a poor outcome in 51.2% cases compared to 14.6%
cases with only APACHE-IIgreater than 20. Combining SAPS-II greater than 45 on admission with NT-
proBNP greater than 4300pg/ml predicted a poor outcome in 53.6% cases as compared to 9.76% cases
with only SAPS-IIgreater than 45. Thus predictive values of the SOI scoring systems are improved by
combining them with NT-proBNP(p<0.05). Echocardiography revealed higher prevalence of diastolic
dysfunction among non-survivors with ahigher E/A ratio at 24 hours (≥0.90, sensitivity 70% and
specificity 85%, AUC:0.84) and at 72 hours (≥0.90, sensitivity 72.97% and specificity 73.5%, AUC:0.84)
associated with better outcomes (p<0.05). Logistic regression analysis revealed presence of shock and
NT-proBNP value at 72 hours to be independent predictors of mortality.
Conclusion:
NT-proBNP values are increased in patients of sepsis and is an independent predictor of mortality. The
combination of NT-proBNP with APACHE-II and SAPS-II score improves its ability to identify patients with
poorer outcome.
JR-43
INCIDENCE OF RESPIRATORY SYNCYTIAL VIRUS INFECTION IN ADULTS FOLLOWING
HEMATOPOIETIC STEM CELL TRANSPLANT
Samad Abdul Sameer, Dar Lalit, Kumar Lalit, Chaudhary Aashish, Ray Animesh, Brijwal Megha
Department of Medicine and Microbiology - Infectious Diseases, AIIMS, New Delhi
Department of Microbiology, AIIMS, New Delhi
Department of Medical Oncology, IRCH, AIIMS, New Delhi
Department of Microbiology, AIIMS, New Delhi
Department of Medicine, AIIMS, New Delhi
Department of Microbiology, AIIMS, New Delhi
All India Institute of Medical Sciences, New Delhi
Presenting Author: Sameer Abdul Samad
Corresponding Author: Prof. Lalit Dar
[email protected], [email protected] Introduction: More than 1800 hematopoietic stem cell transplants are done in India every year. Infection due to Respiratory syncytial virus causes significant morbidity and mortality in them. Progression from URI to LRTI occurs in 30% - 40% of HSCT recipients with consequent mortality close to 50% which is significantly higher than pneumonias caused by other respiratory viruses. While several studies on RSV infection have been done on paediatric stem cell transplant recipients, data on the same in adults is deficient. We have conducted this study in an effort to estimate the disease burden in adults which will help in undertaking screening, preventive and treatment measures in the future. Aim & Objectives: Aim: To estimate disease burden due to Respiratory Syncytial Virus in adults in the first eighteen months following Hematopoietic Stem Cell Transplant. Primary Objective: To study incidence of acute respiratory infection due to RSV in adults following hematopoietic stem cell transplantation by real time RT-PCR. Secondary Objectives: To identify the subgroups of RSV in these patients. To analyze the presenting clinical features of this infection
Materials and Methods: We followed up 50 adults who underwent hematopoietic stem cell transplant at our institute for a maximum period of eighteen months post-transplant, recruitment having started from January 2017. Patients were followed up personally during their hospital stay at our institute and telephonically thereafter for any episode of acute respiratory tract infection. Variables collected included the symptoms and signs at presentation as well as basic hematological and radiological investigations among others. Nasal and throat swabs from acutely symptomatic patients were taken and tested for RSV by real time RT PCR using QIAGEN test kit. Results: Two samples came positive for RSV, both of which belonged to subtype B, out of 64 tested episodes of ARI.The incidence of RSV infection in post HSCT adult patients calculated from our study is 5.68 per 100 patient years or 5.68% per year. The ISI-RSV scores of one of the patients was 11(high risk of progression to LRTI) and patient did develop LRTI. Another patient who developed RSV URI had ISI-RSV score of 1 and there was no progression to LRTI. Both of them recovered without targeted treatment against RSV. Conclusion: There is significant incidence of RSV infection in adults after hematopoietic stem cell transplantation. Spontaneous resolution seen in our study could be related to lesser virulence of the RSV-B subtype. However, the treating team should keep high index of suspicion and test promptly by RT-PCR whenever suspected. ISI-RSV scoring can be used to predict progression to LRTI, and targeted therapeutic measures against RSV which are currently infrequently used in this population in India need to be instituted. Limitations of our study include small sample size and lesser rate of positivity. Further studies need to be done in India and should focus on therapeutic interventions to prevent/treat progression to LRTI.
JR-44
ENDOTHELIAL DYSFUNCTION WITH DIFFERENT GRADES OF OBESITY IN PATIENTS WITH
MODERATE TO SEVERE OBSTRUCTIVE SLEEP APNEA
Background
Obstructive sleep apnea (OSA) is associated with endothelial dysfunction that isa major predictor of late
cardiovascular events. Despite the high prevalence of coexistence of OSA and obesity,how much each of
these influence endothelial dysfunction in OSA patients in not known. The aim of this cross-sectional
study was to determine whether increasing obesity in patients with different grades of OSA had poorer
endothelial function.
Methods
20 patients with OSA and obesity without any other comorbidities underwent EndoPat testing. The
following commonly used cut-offs for apnea-hypopnea index (AHI) were used to define 3 categories of
disease severity: AHI < 15 (no OSA or mild OSA), 15 ≤ AHI < 30 (moderate OSA), and AHI ≥ 30 (severe
OSA). Only moderate and severe OSA were included. Primary outcome was the correlation between BMI
and reactive hyperemia index (RHI), a validated assessment of endothelial function while secondary
outcomes included correlation with other anthropometric and biochemical parameters.
Results
A total of 197 patients were screened out of which 8/20 have been recruited. 50% of patients had
moderate OSA and 50% had severe OSA. Increasing OSA severity and increasing obesity as measured by
BMI was not associated with a significant decrease in RHI - Pearson correlation coefficient (R) between
BMI and RHI was 0.34 (p = 0.745). Subsequent interim analysis of RHI with other parameters showed a
significant correlation of subscapular skinfold thickness with RHI (R = -0.72, P = 0.04) and total
cholesterol with RHI (R = 0.734, P = 0.03).
Conclusions
In preliminary analysis, in patients with moderate to severe OSA, increasing obesity does not
independently increase endothelial dysfunction.
0
0.5
1
1.5
2
2.5
3
3.5
4
25 30 35 40 45
BMI vs RHIR
HI
0
0.5
1
1.5
2
2.5
3
3.5
4
0 20 40 60 80 100 120 140
AHI vs RHI
RH
I
0
0.5
1
1.5
2
2.5
3
3.5
4
0 10 20 30 40 50 60
RH
I
SSFT (mm)
SSFT vs RHI
R = -0.72P = 0.04
0
0.5
1
1.5
2
2.5
3
3.5
4
100 120 140 160 180 200 220
RH
I
TC
TC vs RHI
R = 0.734P = 0.03
JR-46
Title- Effect of implementation of protocol based nutrition therapy in medical ICU
Name Of author-
Sahu Harsh, Soneja Manish, Singh Namrata, Shalimar, Kalaivani M., RayAnimesh, RanjanPiyush, Vikram Kishore Naval, BiswasAshutosh, Wig Naveet.
Affiliation
Junior Resident, Department of Medicine, AIIMS, New Delhi
Associate Professor, Department of Medicine, AIIMS, New Delhi
Associate Professor, Department of Gastroenterology, AIIMS, New Delhi
Dietician, Department of Gastroenterology, AIIMS, New Delhi
Scientist, Department of Biostatistics, AIIMS, New Delhi
Assistant Professor, Department of Medicine, AIIMS, New Delhi
Professor, Department of Medicine, AIIMS, New Delhi
Presenting Author-
Name- Dr Harsh Sahu
Email- [email protected]
Corresponding Author –
Name- Dr Manish Soneja
Email [email protected]
Introduction-
Critical illness is a catabolic state with increased nutritional requirements. This increase in requirement is generally not met by optimal nutritional therapy resulting in malnutrition in these patients. Fulfilling this increased requirement may improve clinical outcomes.
Aims and objectives
This study aimed to examine the ongoing nutritional practices and effect of implementation of protocol-based practices in medical ICU of a tertiary care center.
Materials and Methods
This was a quasi-experimental (pre-test, post-test) study design conducted in three phases. First, pre-intervention phase (8months) identified ongoing practices of nutrition therapy. Second, intervention phase(4months) createdawareness regarding protocol-based nutrition therapy with the help of posters, group discussions, discussions on social media like whatsup. In third, post-intervention phase (8months),effect of implementation of protocol on end points was observed.Study included patients >14years, admitted in medicine ICU with expected ICU stay >3 days and fit for nasogastric or naso-enteric feeding. Patients who were pregnant, or with intestinal obstruction or ileus or contraindication to nasogastric tube were excluded.
Results
50 patients were recruited in phases 1 and 3.Both groups had similar age, disease severity (APACHE 2 score) and nutritional status (modified NUTRIC score). Modified NUTRIC score was high (≥5) in both pre-intervention (64%) and post-intervention (56%) groups. There was no significant difference in timing of starting enteral nutrition in both groups. Proportion of patients prescribed energy in target range increased in post-intervention phase (74%) compared to pre intervention group (58.7%) (p value-0.07). Significantly more patients were prescribed protein in target range in post intervention group(64%) compared to preintervention group (28%) (p value <0.01). Also more patients achieved energy and protein target in post-intervention group (62% and 54% respectively) compared to pre-intervention group (26% and 4% respectively) (p value <0.01 and <0.01 respectively). There was no significant difference between two phases in ICU stay, hospital stay, 28day mortality, ICU mortality and in-hospital mortality.
Conclusions
Large proportions of patients in medical ICU are at high risk for malnutrition. Implementation of protocol for nutrition therapy improves prescription and delivery of nutrition. No significant differences in short term clinical outcomes like mortality, duration of hospital stay were observed. Long term follow up studies including assessment of functional status should be planned.
Conflict of interest- None
JR-34
Spectrum of invasive fungal infection in a tertiary care hospital in NorthIndia
Authors:Dr Devada sindhu, Dr Pankaj jorwal, Dr Ashutosh Biswas,Dr Manish Soneja
ABSTRACT
Background: The estimation of epidemiological and microbiological data of invasive fungal infection
from general population is challenging.
Materials/methods: Data on invasive fungal infection were collected in AIIMS, New Delhi, a tertiary
care hospital in North India. The 2008 European Organisation for Research and Treatment of
Cancer/Mycoses Study Group definition criteria were used. It was a crossectional observational study.
Relationships between categorical variables were tested using the chi-square test or Fisher exact test,
and relationships between continuous variables were tested using the Student t test or the Wilcoxon
signed-rank test. Survival curves were derived from Kaplan-Meier estimates. The log-rank test was
used to compare survival
distributions between subgroups.
Results: A total of 110 cases(95 proven, 15 probable), mostly in men (57%) , in 30-50 years (mean
age,41 ±17.8) were recorded. DM represented 52%, CKD 20%, autoimmune diseases 13.6% and
hematological malignancy 4.5% of the cases. The median time between first symptom and diagnosis
was 10 days. The organism isolated in blood samples were Candida sp 18 cases. Most common were
C parapsilosis 7 cases, C glabrata 4 cases and C albicans 2 cases. In respiratory samples common
was Aspergillus sp followed by Zygomyces. Amongst the Aspergillus sp 14 were probable and 24
were putative pulmonary aspergillosis according to the Blot’s criteria for invasive pulmonary
aspergillosis. The most common among them were A fumigatus 23 cases(60.5%) , A flavus 7 cases, A
terreus 6 cases and A niger 2 cases. Treatment consisted of antifungals received by 93% (n=102)
patients. The mortality was 67.6%. The sixty-day survival rate was 37%. It was reduced in cases of
disseminated crytococcosis compared with aspergillosis (P<0.0009), survival was reduced in cases of
autoimmune diseases compared with diabetes mellitus (P < .0118).
Conclusions: This study over a duration of 18 months shows varied clinical presentation of invasive
fungal infection with a high prevalence of pulmonary aspergillosis and mortality significantly
influenced by risk factors.
Authors:
1.Dr Devada Sindhu
Junior resident
Department of medicine
2. Dr Pankaj Jorwal
Assistant professor
Department of medicine
Department of medicine
3.Dr Ashutosh biswas
Professor
Department of medicine
4.Dr Manish Soneja
Associate professor
Department of medicine