Important differences in epidemiology of candidemia in Indian ICU :
1. High incidence
2. Younger patients (49.7 yr)
3. Early infection (11 days median)
4. Lower Apache score (17.2)
5. Azole resistance (11.8% , MDR 1.9%)
6. High mortality (40℅, Attributable 23%)
7. Vast spectrum (31 spectrum)
A trader was going to Kashi by boat.
*Chapter 1* – Casualty
On the way, his boat started sinking. He saw a fisherman on a nearby boat and asked him to take him aboard and save him. He told the fisherman that otherwise he would drown and die. And that if he took him aboard, then he would give him all his property. The fisherman agreed.
*Chapter 2* – ICU
Once the boat started moving safely towards the shore, the trader regained his senses and started repenting for having offered all his property to the fisherman. Then he told the fisherman that although he was ready to give him all his property, his wife would not agree to it, so he would only give him half of it, as he had to give the other half to his wife and family. For that he was helpless, as they also needed the property. “The fisherman kept silent and continued rowing towards the shore.
*Chapter 3* – Ward
Then the trader wondered why he had offered him half his property. What great thing had he done by saving him from the river? It is his duty to ferry people across, and, after all, protecting others is only humane. He was just doing his duty and would have committed a sin if he had not saved him. He had actually protected the fisherman from committing a sin. So he told the fisherman he would only give him a quarter of his property. The fisherman did not make a sound.
*Epilogue* – At time of discharge
Then, when they reached the shore, the trader gave him a five rupee coin and said “you take this. Have tea for yourself and get some biscuits for your children.’
Later he sued the fisherman because of the abrasion he had sustained while the fisherman pulled him out of water.
He filed a case saying that All problems he has today is because of the abrasion and not because of near drowning.
The court ruled that not only the fisherman was negligent but also money minded.
_*Evidence Based Medicine?*_
Put ice into a glass of water,
the ice floats..
It’s called observational study..
Press the ice down,
and it comes up again..
It’s called experimental study..
Randomize ice and stones,
double blind,and put in two glasses, ice only floats..
This is called RCT..
Metaanalyse all the experiments done with ice and water in the world..
Its called Cochrane data base..
Submit your ice experiments in a conference..
It’s called free paper presentation..
Publish your ice experiments
In a reputed journal..
It’s called _Evidence_..
Put ice in a glass of Vodka,
add a squeeze of lime, little sugar syrup to blunt the stench and savor it..
It’s called _*Evidence Based Medicine*_..
Let’s practice it!!
1. Ventilator-associated pneumonia in the ICU.Crit Care. 2014;18(2):208.
2. Hospital-acquired pneumonia, health care-associated pneumonia, ventilator-associated pneumonia, and ventilator-associated tracheobronchitis: definitions and challenges in trial design. Niederman MS. Clin Infect Dis.2010; 51(S1):S12–S17.
3. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia, Am J Respir Crit Care Med Vol 171. pp 388–416, 2005
4. Recommendations for treatment of hospital-acquired and ventilator-associated pneumonia: review of recent international guidelines. Clinical Infectious Disease. 51(Suppl 1):S42–7.
5. Ventilator-associated pneumonia. Current OpinCrit Care 2009;15: 30–5.
6.Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society