Gandhi Medical College (founded 14 September 1954) is a medical college in Hyderabad, India affiliated with Kaloji Narayana Rao University of Health Sciences. The college was originally affiliated to NTR University of Health Sciences.
This study aimed to assess the evolution of aerobic bacterial flora among ICU patients and its association with healthcare-associated infections in a tertiary care hospital. A total of 52 patients were selected from the medical, surgical, and burn and plastic surgery ICUs. A total of 764 skin swabs were collected from four sites, namely the fingertips and webs, dorsum of the hand, axilla, and anterior nares on days 1, 2, 3, 4, and 7. Of the total swabs collected, 484 (63.4%) were identified to have WHO priority pathogens and potentially pathogenic bacteria. A total of 650 isolated microorganisms were isolated from the 484 swabs, comprising both WHO priority pathogens and potentially pathogenic bacteria. Fingertips and webs were found to have the highest pathogenic burden of these 650 microorganisms (27.7%, n=180), with WHO priority pathogens comprising 20.5% (n=37) and extended-spectrum beta-lactamase (ESBL)-producing carbapenem-resistant (CRP-R) Enterobacteriaceae being the most prevalent (9.4%, n=17). Other potentially pathogenic bacteria accounted for 79.4% (n=143), led by vancomycin-sensitive methicillin-resistant Staphylococcus aureus (MRSA) (26.7%, n=48). On day 1 of hospitalization, the total culture count was 208, and on day 7, it was 100. The critical WHO priority pathogen colonization on day 1 increased significantly from 6.7% (n=14) to 27% (n=27) by day 7 (p<0.05). The burn and plastic surgery ICU (total n of swabs collected=152) had the highest microbial load, with Pseudomonas aeruginosa (30.2%, n=47) and carbapenem-resistant strains being predominant. This study reveals that colonization of multidrug-resistant organisms increases with prolonged hospitalization in ICUs, highlighting the need for strict infection control protocols. Regular monitoring and effective hygiene practices can reduce the spread of hospital-acquired infections (HAIs) and improve patient outcomes.
With the global rise in diabetes prevalence, the burden of diabetic kidney disease (DKD) is projected to escalate substantially, contributing to increased morbidity, mortality, and healthcare costs. This narrative review aims to synthesize contemporary evidence on guideline-directed medical therapy (GDMT) for DKD, with a specific focus on primary prevention, secondary prevention, and real-world implementation of evidence-based pharmacologic and non-pharmacologic strategies to mitigate renal and cardiovascular risk. A comprehensive literature review (published 2012-2025) was conducted, integrating international clinical guidelines, landmark randomized controlled trials, meta-analyses, and implementation studies addressing the prevention and management of DKD. Recent advances in GDMT have reshaped the therapeutic landscape of DKD. Lifestyle interventions - including dietary optimization, regular physical activity, and smoking cessation - demonstrate meaningful renoprotective and cardiometabolic benefits. Pharmacologic therapies, such as renin-angiotensin system (RAS) blockade, sodium-glucose co-transporter 2 (SGLT2) inhibitors, nonsteroidal mineralocorticoid receptor antagonists (MRAs), and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have shown robust efficacy in reducing albuminuria, slowing estimated glomerular filtration rate (eGFR) decline, and lowering cardiovascular events. Landmark trials report relative risk reductions of approximately 30-40% in kidney disease progression with SGLT2 inhibitors and 18-23% reductions in renal and cardiovascular composite outcomes with finerenone and GLP-1 RAs. Despite strong guideline endorsement, real-world uptake of GDMT remains suboptimal, particularly in low-resource healthcare settings. Early detection through routine eGFR and urine albumin-to-creatinine ratio screening, combined with timely initiation and sustained implementation of GDMT, offers the most effective strategy to alter the natural history of DKD. Integrating lifestyle modification with optimized pharmacotherapy is essential to reducing long-term renal and cardiovascular complications.
Objective This study aimed to evaluate the effectiveness of the Renal Angina Index (RAI) in predicting acute kidney injury (AKI) among pediatric ICU (PICU) patients. Methods This prospective observational study, conducted at Gandhi Medical College, Bhopal, from September 2022 to February 2024, included 300 PICU patients aged one month to 13 years. RAI was calculated 24 hours post-admission, and its correlation with the development of AKI after 24 hours of admission was analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY). Results The mean patient age was 36.16 months (standard deviation (SD): 15.08); 50.7% were male. AKI occurred in 5% of patients. Mortality increased significantly across RAI categories: 0% (low-risk), 7.5% (moderate-risk), and 68.8% (high-risk) (p < 0.001). RAI at 24 hours demonstrated excellent discriminatory ability with an area under the curve (AUC) of 0.87; 95% confidence interval (CI): 0.80-0.94. At a threshold ≥ 8, RAI showed 81.8% sensitivity and 97.2% specificity, with a 75.0% positive predictive value (PPV). Strong associations existed between RAI and vasopressor support, PRISM (Pediatric Risk of Mortality) scores, and KDIGO (Kidney Disease: Improving Global Outcomes)-documented AKI (all p < 0.001). Conclusions RAI can predict AKI in critically ill pediatric patients, enabling early intervention. The 24-hour assessment provides valuable prognostic information for patient risk stratification.
