Poster Session : PS 0598 ; Critical Care Medicine ; Respiratory Failure in Severe Neuroparalytic Snake Bite - Experience of A North Indian Tertiary Care Hospital

( Arjun Khanna ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Poisonous snake bites are a common, life threatening emergency in tropical Asian countries like India. The aim was to treat patients with neuroparalytic snake bite using polyvalent Anti snake venom(ASV) along with ventilatory support and to assess outcome with respect to hospital survival, duration of mechanical ventilation, amount of ASV given and complications if any, associated with mechanical ventilation or ASV. Methods: The study included 58 patients with severe neurotoxic snake bite who required mechanical ventilation for respiratory failure. They were administered 200 ml of polyvalent ASV. Outcome measures studied included hospital survival, duration of mechanical ventilation, amount of ASV given and complications associated with mechanical ventilation or ASV administration. Result: All patients were administered an initial bolus dose of 200 ml ASV, followed by repeated doses of 100 ml ASV every six hours until the patient showed signs of neurological recovery. Mean total dose of ASV administered was 412 ml. All patients were initially ventilated using Assist control(A/C) mode of ventilation. Mean duration of ventilation on A/C mode was 30.89 hours. 56 patients were weaned off successfully using pressure support mode. Mean duration of weaning was 7 hours. 4 patients developed Ventilator associated pneumonia 2 patients expired, one due to ventilator associated pneumonia and the other due to septicaemia. 56 patients who survived did not have any residual neurological defi cit clinically. Conclusion: We conclude that in the management of neurotoxic snake bite, administration of a high initial bolus dose of 200 ml ASV and repeated doses of 100 ml ASV every six hours until signs of neurological recovery, supported by Assist control mode of ventilation resulted in an early recovery, a reduced total dose of ASV consumed, reduced the duration of mechanical ventilation, reduced the incidence of complications and thus, was much more cost effective.

Slide Session : OS-RES-08 ; Oncology : Ventilator Associated Pneumonia - Incidence, Antibiogram of Pathogens Isolated and Clinical Outcome

( Arjun Khanna ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Ventilator associated pneumonia (VAP) is an important cause of morbidity and mortality in mechanically ventilated patients globally. The aim of this study was to fi nd out the incidence of VAP at our institution, to evaluate the antibiotic sensitivity pattern of microorganisms isolated and to assess clinical outcome in VAP. Methods: A total of 107 patients who were not having pneumonia at presentation and who were mechanically ventilated for more than 48 hours for various indications were included in the study. APACHE II score of fi rst day was recorded. The diagnosis of VAP was established using clinical pulmonary infection score of more than 6. Gram staining and culture sensitivity using Kirby -Bauer disc diffusion method was performed on all endotracheal aspirates and antibiotic therapy modifi ed accordingly. The results were analysed to determine the incidence and clinical outcome in VAP. Results: 30 out of 107 patients (28.03%) developed VAP.25 patients developed late onset VAP while 5 developed early onset VAP. Most common isolates were Pseudomonas aeruginosa (9 isolates) followed by MRSA (8isolates), Klebsiella pnueumoniae( 7 isolates) and Acinetobacter baumanii(6 isolates). Klebsiella pnueumoniae and Acinetobacter baumanii were found to be most lethal. Most isolates of Klebsiella were extended spectrum Beta Lactamase producing and all Acinetobacter were carbapenem resistant. Mortality in VAP was 46.67% and correlated well with a higher mean APACHE II score of 18.3 as compared to a mortality of 28.57 in non VAP group with a low mean APACHE II score of 13.1. Conclusion: The development of VAP was associated with increased morbidity and mortality and a higher mean APACHE II score at admission. The incidence of multidrug resistant pathogens is rising and therefore it is important to identify them as this information will help in the selection of an appropriate antibiotic regimen and decrease the treatment costs and improve outcome.

The Burden of Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases: A Non-Western Perspective

( Kartik Deshmukh ),( Arjun Khanna ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.2

Implications of Managing Chronic Obstructive Pulmonary Disease in Cardiovascular Diseases

( Kartik Deshmukh ),( Arjun Khanna ) 대한결핵 및 호흡기학회 2021 Tuberculosis and Respiratory Diseases Vol.84 No.1

Globally, cardiovascular diseases and chronic obstructive pulmonary disease (COPD) are the leading causes of the non-communicable disease burden. Overlapping symptoms such as breathing difficulty and fatigue, with a lack of awareness about COPD among physicians, are key reasons for under-diagnosis and resulting sub-optimal care relative to COPD. Much has been published in the past on the pathogenesis and implications of cardiovascular comorbidities in COPD. However, a comprehensive review of the prevalence and impact of COPD management in commonly encountered cardiac diseases is lacking. The purpose of this study was to summarize the current knowledge regarding the prevalence of COPD in heart failure, ischemic heart disease, and atrial fibrillation. We also discuss the real-life clinical presentation and practical implications of managing COPD in cardiac diseases. We searched PubMed, Scopus, EMBASE, and Google Scholar for studies published 1981-May 2020 reporting the prevalence of COPD in the three specified cardiac diseases. COPD has high prevalence in heart failure, atrial fibrillation, and ischemic heart disease. Despite this, COPD remains under-diagnosed and under-managed in the majority of patients with cardiac diseases. The clinical implications of the diagnosis of COPD in cardiac disease includes the recognition of hyperinflation (a treatable trait), implementation of acute exacerbations of COPD (AECOPD) prevention strategies, and reducing the risk of overuse of diuretics. The pharmacological agents for the management of COPD have shown a beneficial effect on cardiac functions and mortality. The appropriate management of COPD improves the cardiovascular outcomes by reducing hyperinflation and preventing AECOPD, thus reducing the risk of mortality, improving exercise tolerance, and quality of life.

Role of tea catechins in prevention of aging and age-related disorders

Pawan Kumar Maurya,Arjun Khanna 셀메드 세포교정의약학회 2012 셀메드 (CellMed) Vol.2 No.1

Tea polyphenols especially catechins have long been studied for their antioxidant and radical scavenging properties. Scientists throughout the world have investigated the usefulness of the regular green tea consumption in several disease conditions. In-vitro and in-vivo experiments on catechins especially epigallocatechingallate have revealed a significant role in many ways. Reactive oxygen species have been increasingly implicated in the pathogenesis of many diseases and important biological processes. Toxic effects of these oxidants, commonly referred to as oxidative stress, can cause cellular damage by oxidizing nucleic acids, proteins, and membrane lipids. Oxidative stress has been related to aging and age related disorders. It is found that in a wide variety of pathological processes, including cancer, atherosclerosis, neurological degeneration, Alzheimer’s disease, ageing and autoimmune disorders, oxidative stress has its implications. Catechins have been reported to be useful in combating aging and age related disorders like cancer, cardiovascular disorders and neurodegenerative diseases. In this mini review we will discuss such studies done across the globe.