Context: In medicine and health care, empathy is a very important component of relationship between a physician or healthcare provider and patients. Aims: This study was designed to investigate the factors affecting empathy with patient among healthcare provider students using structural equation model. Settings and design: Cross-sectional study Materials and Methods: It was a cross-sectional study to examine the conceptual model based on JSE-HPS. Three hundred ninety-eight students of School of Nursing and Midwifery, Mashhad University of Medical Sciences, Iran participated in the study. They were selected by quota-stratified sampling. The data were collected by JSE-HPS. Statistical analysis used: To examine the conceptual model, and SEM was used for ordinal data using WLSMV in Mplus 6. Results: Findings indicated proper model fit so that “perspective-taking” had a positive effect on “compassionate care”. “Compassionate care” had a positive effect on “standing in patient’s shoes”. Conclusion: The results of this study can improve students’ empathic relationships with patients. The “perspective-taking”, “compassionate care” and “standing in patient’s shoes” must be emphasized in training programs for medical students providing healthcare in order to familiarize them with the importance of empathy and its role in care. Key messages: Empathy is truly the heart of the relationship, Perspective-Taking, Compassionate Care, and Standing in Patient’s Shoes can be taken into account to improve the empathy and establish empathic relationships with patients. Proper environment is expected for improving the disease consequences by establishing empathic relationships.

Introduction: Noninvasive ventilation (NIV) has revolutionized the initial respiratory support provided to a patient in respiratory distress presenting to emergency department. Standardization of NIV practices and safety has always been a matter of concern and debate in emergency medicine. In this study, we tried to assess the clinical outcome of NIV in respiratory failures of varied etiologies. Materials and methods: This study was conducted from August 2017 to August 2018 at our emergency department which is a tertiary care teaching institute. All patients presenting to the ED with shortness of breath were screened for acute respiratory failure and enrolled after confirming the inclusion criteria. Results: Out of the 236 patients presenting with acute respiratory failure, 182 fulfilled the study criteria. However, 154 patients with a mean age of 55.19 + 16.73 years were enrolled in the study. Bilevel PAP was initiated in 103 patients whereas 51 patients received CPAP. 115 (74.67%) NIV trials were successful whereas 36 (23.37%) patients had to be intubated. 32 patients died among the study group among which 3 had not consented for intubation. The in-hospital mortality has been 20.77% whereas the percentage of NIV failure with consequent intubation was 25.32%. Conclusion: In conclusion, our study shows that NIV is not only safe and efficacious but also significantly brings down the requirement of endotracheal intubations and its complications provided proper patient selection and close monitoring is assured.

Background: The burden of infections among burns patients is higher in healthcare settings due to partial or complete loss of skin as a physical barrier among these patients. We intend to present microbiological profile of patients admitted to a tertiary care hospital in South India. Aim: To describe microbiological profile of infections and antimicrobial susceptibility pattern of clinical isolates from burns patients in our tertiary care hospital. Materials and methods: This retrospective analysis was done on consecutive patients admitted with burns over a period of three years at Apollo Specialty Hospitals, a tertiary care facility in Vanagaram, Chennai. Data analysis included clinical isolates from blood, urine, tissue, pus and tracheal aspirate. Types of bloodstream infections, urosepsis and antibiogram are described. Results: Among 219 clinical isolates from various samples, 75% were gram-negative, 19% gram-positive and 6% were yeast like fungi. Among bloodstream infections, 32% were polymicrobial. Urosepsis was observed in 39% patients. Wound infections with sepsis was seen in 39% patients. Gram-negative isolates showed better susceptibility to amikacin, carbapenems, beta lactam – beta lactamase inhibitor combinations. Gram-positive isolates had better susceptibility to macrolides, doxycycline, glycopeptides. Conclusion: The high prevalence of gram-negative, polymicrobial infections and multidrug resistant bacteria noted in our patients and the sensitivity patterns would help with appropriate decision on initial antibiotic therapy. However escalation and de-escalation of antibiotics should be planned based on culture reports.

Background: Role of noninvasive ventilation (NIV) following extubation in patients with acute respiratory failure is debatable. NIV may provide benefit in post surgical patients, but its role in nonsurgical patients is controversial. Materials and methods: PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20^th November 2017) to identify prospective randomized controlled trials, where postextubation NIV has been compared with standard oxygen therapy in adult patients with acute respiratory failure. Results: Data of 1525 patients from 11 randomized trials have been included in this meta-analysis. Two trials used NIV to manage post-extubation respiratory failure. Pooled analysis found that mortality rate at longest available follow-up [OR (95% CI) 0.84 (0.50, 1.42); p = 0.52] and reintubation rate [OR (95% CI) 0.75 (0.51, 1.09); p = 0.13] were similar between NIV and standard oxygen therapy. NIV did not decrease intubation rate when used as preventive modality [OR (95% CI) 0.65 (0.40, 1.06); p = 0.08]. Duration of ICU stay was also similar in the two groups [MD (95% CI) 0.46 (-0.43, 1.36) days; p = 0.3] Conclusion: Post extubation NIV in non- surgical patients with acute respiratory failure does not provide any benefit over conventional oxygen therapy.

Background: B. cepacia is metabolically versatile organism which is not only resistant to many antibiotics but also disinfectants. This makes their survival easy even in restricted areas like intensive care unit (ICU) and management difficult. Aims and objectives: To describe sudden emergence of Burkholderia at a tertiary care centre ICU setting in milieu of colistin usage Materials and methods: Cases were patients with culture proven B.cepacia. They were picked up as non-lactose fermenting, oxidase positive, motile, gram-negative bacilli which was resistant to colistin and aminoglycosides and sensitive to cotrimoxazole. These isolates were further confirmed by both VITEK-2 compact system (Biomerieux, France) and standard bacterial techniques. Colistin consumption data were retrospectively collected from medical store records of hospitals and individual ICU pharmacy records from January 2016 to June 2016, and were expressed as total dialy doses in a month per 1000 patient days (DDD/1000PD) Results: An increase was observed in B. cepacia infection linked to increased consumption of colistin in ICU. Conclusion: Based on these results an increase was observed in B.cepacia infection which correlated with increased consumption of colistin in ICU. We speculate that extensive use of colistin may lead to selection of intrinsically resistant B. cepacia and may facilitate their spread as nosocomial pathogens.

Rhabdomyolysis is a serious medical condition, encountered in the intensive care unit (ICU). The etiology of rhabdomyolysis is often multifactorial. It leads to complications like acute kidney injury and life-threatening electrolyte abnormalities. A high index of suspicion and early institution of therapy is required to prevent complications and improve patient outcomes. Herein, we present the case of a young man with alcohol dependence who presented with fever and altered sensorium. He was found to have rhabdomyolysis and was managed successfully. We also discuss the common causes of rhabdomyolysis and a bedside approach to its management in the ICU.

Saccharomyces cerevisiae or boulardii, also known as baker’s yeast or brewer’s yeast, is normally a nonpathogenic microbe. It is commonly used as a probiotic to prevent antibiotic-associated diarrhea. We present a case of a 77-year-old woman with uncontrolled diabetes who developed Saccharomyces fungemia with use of Saccharomyces containing probiotic after 5 days of treatment. The probiotic was immediately discontinued. The indwelling central line was removed, she was started on amphotericin B and the fungemia resolved. This case report highlights this peculiar complication of probiotic use. We also find it important to increase the awareness amongst the healthcare providers about this likely risk while prescribing probiotics, especially for critically ill patients.

2,4-Dichlorophenoxyacetic acid (2,4-D) is a herbicide with highly toxic effects. Complications occur due to difficulty in diagnosis. Management is only supportive with alkaline diuresis and treatment of complications as there is no specific antidote to this compound.

Stenotrophomonas maltophilia is an emerging gram-negative pathogen that was previously labeled as a colonizer. Nowadays, with multiple antibiotic usage along with certain host factors, infections caused by this organism are getting attention. We hereby report two cases of ventilator-associated pneumonia in postoperative infants by Stenotrophomonas maltophilia in a cardiac intensive care unit (ICU).

Pneumothorax can develop in children being mechanically ventilated for ‘severe acute respiratory distress syndrome’ making the situation worse and challenging for the treating intensivist. There is no evidence on use of ‘airway pressure release ventilation’ mode in children with acute respiratory distress syndrome complicated by pneumothorax. We present a case of a girl who had severe acute respiratory distress syndrome and developed pneumothorax on pressure control ventilation mode. We had to use ‘airway pressure release ventilation’ mode in view of severe refractory hypoxemia. Fortunately, the child responded well and weaned off the ventilator over few days. We suggest that ‘airway pressure release ventilation’ mode may be used successfully in patients with ‘acute respiratory distress syndrome’ complicated by pneumothorax if intensive and close monitoring is done. Key messages: APRV may be a useful mode of ventilation in severe ARDS with pneumothorax