Endogenous Endophthalmitis in COVID-19 Patients

Intrinsic endophthalmitis is indeed behavior that causes eye disease that spreads into the bloodstream from a distant primary site. The intraocular disease caused by hematogenous microbial proliferation is known as indigenous endophthalmitis. Extrinsic and intrinsic endophthalmitis are the two types of endophthalmitis that exist. The presence of an external point of entry is linked to extrinsic endophthalmitis. Intrinsic endophthalmitis is a kind of septicemia caused by a blood-borne infection. Endophthalmitis is a disease of all the inner coating of the eyeball except the sclera and cornea, which is accompanied by substantial, increasing vitreous swelling. Endophthalmitis is a severe ocular crisis with severe visual and general consequences. An exterior injury of the entrance, such as injury, operation, or an inflamed cornea, is the most prevalent route of entry for potential pathogens. Endophthalmitis has a complex etiology, with many pathogenic species and substantial regional heterogeneity. The treatment of endophthalmitis has evolved dramatically during the last century. Endophthalmitis induced by direct inoculation dissemination of pathogenic microbes is a rare occurrence that occurs most commonly in sick or disadvantaged people. Intravenous medication usage, diabetes mellitus, immunological impairment, cancer, prolonged hospitalization, or systemic antibiotic therapy have all been linked to a 0.04 percent incidence rate. Haden described metastatic endophthalmitis in a seriously sick patient with pneumococcal cerebrospinal encephalopathy treated with intravenously anti-meningococcal serum in the 1918 volume of the Journal Ophthalmology. Endogenous endophthalmitis, unlike extrinsic endophthalmitis, needs comprehensive systemic antibiotic treatment. In indigenous endophthalmitis, the illness originates not in the eye but elsewhere in the body. As a result, it is necessary to obtain comprehensive cultures. Patients are sometimes unable to carry out their functions in society or household. As a rest, the person cannot cope financially and socially in his environment. Many social and influential factors are disturbed, and the patients are often depressed. Cosmetically the surgeries are not satisfying. Artificial prosthetics can be used, but they're seldom of minimum functional importance. Such interventions can be helpful for the patient. The focus should be made to deliberately save the patients and not just the cosmetic value of the surgery. Persons with chronic endophthalmitis had more excellent eyesight than people with symptomatic or subacute endophthalmitis. Improvements in eyesight were observed in individuals with persistent or subacute keratitis several months after the surgery more frequently than in people with symptomatic endophthalmitis. Nevertheless, in 40 percent of the overall all instances with an abrupt start, there have been no improvements or even decrease in visual acuity.

Systemic antibiotic therapy of patients with acute bacterial sinusitis taking into account resistance

Acute rhinosinusitis is one of the most common diseases in the world. According to statistics, about 10 million cases are registered in Russia every year.Acute bacterial rhinosinusitis (ABRS) in most cases develops as a result of an acute respiratory viral disease, proceeds easily and it does not require antibiotic therapy. However, it significantly reduces the patient's quality of life in cases of moderate and severe disease, and in the absence of timely treatment, can lead to intracranial complications (meningitis, encephalitis, intracranial abscesses, etc.) and orbital (reactive edema of the eyelid, phlegmon of the orbit, periorbital abscesses, etc.). To avoid complications, with exacerbation of rhinosinusitis, it is necessary to choose the right antibiotic therapy, taking into account the resistance of the microorganisms that caused the disease.The article describes the differential diagnosticprinciples of bacterial rhinosinusitis according to the latest recommendations and research in this area, the most common antibiotic-resistant pathogens in the practice of an ENT doctor are presented, the issue of choosing the correct systemic antibiotic therapy for the treatment of patients with moderate and severe acute bacterial rhinosinusitis is considered according to modern data on the sensitivity of bacterial pathogens to antibacterial drugs prescribed in the otorhinolaryngologist's practice. The article presents data on a new universal cephalosporin of the 3rd generation (the active ingredient is cefditoren), as a second- and third-line drug, due to its high activity against most causative agents of acute bacterial rhinosinusitis, and clinical observation using the above antibacterial agent within the framework of the considered topics.

Prosthetic joint infections and legal disputes: a threat to the future of prosthetic orthopedics

Prosthetic joint infections (PJI) represent one of the major problems in orthopedic prosthetic surgery. The incidence of PJIs varies according to the site of intervention, and different published case studies report occurrence at 0.5 to 3.0% in the event of first implants, with a significant greater risk in the case of prosthesis revisions. The diagnosis of prosthetic infections is seldom simple, needing a multi-specialist approach, which includes the accurate collection of patient anamnesis, its clinical evaluation, the evaluation of inflammation biomarkers, and the use of imaging techniques. It is essential to identify the bacteria responsible for the infection not only for an accurate diagnosis, but also to select the correct antibiotic treatment. Failure to identify the bacteria involved makes it impossible to establish targeted systemic antibiotic therapy. In developed countries such as Italy, the right to health is guaranteed by the Constitution, where the institutions that provide health services must be staffed by a team of medical professionals that can guarantee the safest possible health pathways. Risk management represents the set of actions aimed at improving the quality of the care provided, the adherence to guidelines and good care practices with the final objective of guaranteeing patients’ safety. All hospitals, including the ones where prosthetic orthopedic surgery is performed, must adopt clinical risk management procedures which, through prospective tools aimed at preventing errors and complications and by retrospective methods, permit the identification of critical points in the different phases of the process and propose actions for improvement. The constant increase in litigation for malpractice in Western countries, especially in Italy, calls for special attention to the problem of PJIs and the in-depth assessment of medico-legal problems, also considering the new legislative initiatives in the field of medical malpractice. Hospitals need to tackle the onset of PJIs in a transparent and linear fashion by constantly informing the patient on their progress.

Emergency management of open fractures

Open fractures are associated with an increased risk of complications, such as infection or nonunion, and present a therapeutic challenge. The incidence of such complications is directly influenced by how they are treated in the first several hours after presentation. As such, the focus of this article is to adopt an evidence-based approach to guide open fracture emergency management and minimise complication rates. Upon initial presentation, the potential for concomitant life-threatening injuries should be investigated and the patient stabilised as necessary. Critical components of emergency management that have been shown to impact on complication rates include initial classification of the fracture, the prompt instigation of broad-spectrum systemic antibiotic therapy, the use of local antibiotics in select cases and copious wound irrigation using sterile saline. As long as antibiosis is attended to appropriately, small delays in wound debridement do not translate to increased complication rates and waiting for an experienced surgical team is recommended. In cases with no severe tissue damage or contamination, primary wound closure results in lower infection rates and can be recommended. In cases where primary closure is not an option, the wound should be sealed to prevent contamination with nosocomial pathogens.

Topical antibiotics for acute rhinosinusitis in children

The authors presented an overview of the existing data on inhalation therapy with antibacterial drugs in acute rhinosinusitis and exacerbation of chronic rhinosinusitis in children. The overview includes general information about the etiology and features of the course of acute rhinosinusitis. It also contains indications for systemic and topical antibiotic therapy in acute rhinosinusitis specified in the Russian clinical guidelines. The advantages of using a combination preparation of thiampheni-col and N-acetylcysteine by inhalation therapy for acute rhinosinusitis in children and adults are considered separately. A clinical case of a 15-year-old female patient with complaints of persistent rhinitis over the past 4-5 years is discussed. Historical information: a patient had a runny nose over the last 4-5 years: persistent, viscous nasal discharge with moderate nasal congestion. Nasal symptoms worsened with episodes of acute respiratory illness, and nasal discharge became mucopurulent. The child was preliminarily diagnosed with chronic rhinosinusitis (incomplete remission), moderate course. To reduce the severity of the symptoms of the disease, which were present at the time of examination, the following were recommended: daily one-to-two irrigation of the nasal cavity with slightly hypertonic (1.5-3%) solutions of sea water, followed by a toilet of the nasal cavity; in case of episodes of colds with the appearance of mucopurulent secretions, inhalation therapy in a pulsating mode of the inhaler with a solution of thiamphenicol and N-acetylcysteine at a dose of 500 mg once a day (in the first half of the day) for the next 10 days and further; the use of a nasal spray of mometasone furoate, 200 mcg per day during inhalation therapy for another 3 weeks. At the follow-up examination after 10 days of treatment, the patient reported a significant decrease in the severity of nasal symptoms, which coincided with an improvement in the rhinoscopic status. It can be concluded that the use of topical antibacterial drugs by inhalation therapy for acute rhinosinusitis, despite all its advantages, is not an equivalent substitute for systemic antibiotic therapy in the treatment of severe and especially complicated forms of the disease. The inhalation therapy is recommended in the presence of indications for systemic antibiotic therapy, since it is an auxiliary method of treatment, the action of which is aimed at enhancing the effect of systemic antibiotics.

Analysis of effectiveness, costs, quality of life, adherence and safety of the use of adalimumab in adults diagnosed with moderate to severe hidradenitis suppurativa: systematic review protocol

Review question / Objective: What evidence is available in longitudinal studies on the use of adalimumab for the treatment of moderate to severe hidradenitis suppurativa in adults with a diagnosis of moderate to severe hidradenitis suppurativa in which systemic antibiotic therapy has been shown to be ineffective and/or in situations where they present intolerance or contraindication to systemic antibiotics, compared to the application of usual care without the use of adalimumab, regarding the reduction in the total count of abscesses and nodules, decreased sensation of pain, therapeutic adherence, increased levels of self-esteem and quality of life, improvement in inflammatory nodules, abscesses and fistulas costs and expenses associated with the treatment of the disease? Condition being studied: Moderate to severe hidradenitis suppurativa.

Adjunctive Use of Intravenous Antibiotic Regional Limb Perfusion in Three Cranes with Distal Limb Infections

Pododermatitis and wing lesions are commonly reported issues in captive crane species. Regional limb perfusion has been used as a treatment for distal limb infections in several avian species, as systemic antibiotic therapy is often prolonged and unrewarding. A black-necked crane (Grus nigricollis), Siberian crane (Leucogeranus leucogeranus), and wattled crane (Bugeranus carunculatus) were treated with amikacin (5–10 mg/kg IV infusion) regional limb perfusion for cellulitis and osteomyelitis of hind limb digits and alular osteomyelitis and septic arthritis of the carpus, respectively, with a range of 1–3 treatments per case. Clinical signs of infection resolved within 10–40 days following regional limb perfusion combined with oral or parental antibiotic therapy. No side effects were observed following regional limb perfusion. This is the first report of regional limb perfusion in cranes and the first report of intravenous regional limb perfusion in a wing of an avian species.

Necrotizing Fasciitis and Diabetic Foot: Results of a Prompt Identification, Surgery and Antibiotic Therapy (P.I.S.A.) Protocol

Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening infection, involving the skin, soft tissue and fascia. We evaluated outcomes of its surgical management in diabetic foot (DF) patients in a tertiary referral centre. We retrospectively searched for NF in the database of our DF Section from 2016 to 2018. All cases were treated according to a multiprofessional integrated protocol, with Prompt Identification, Surgical debridement and systemic Antibiotic therapy (P.I.S.A. Protocol). We analysed short-term evolution (surgical procedures and major amputations), and long-term outcomes (survival and healing rates). Sixty-eight patients were referred to our DF clinic for suspicion of NF. The diagnosis was confirmed in 54 (79.4%; male/female 40/14; type 1/2 diabetes 6/48; age 62.8 ± 8.1 years; duration of diabetes 13.6 ± 10.1 years). According to the microbiological results, cases were classified as Type 1 (33–61.2%), 2 (7−12.9%) and 3 (14–25.9%). No significant differences were observed. All patients underwent a decompressive fasciotomy. Six patients (11.1%) required also a forefoot amputation and 12 (22.2%) a toe or ray amputation. No major amputation was performed in the short-term period. During the follow-up (26 ± 12 months) 46 patients (85%) healed in 94 ± 11 days. Of the remaining 8: 5 (9.2%) died for other reasons before healing, 2 (3.7%) recurred and one (1.9%) required a major amputation. Our experience reveals a relatively high prevalence of NF in DF; despite this, we observed how, when promptly and aggressively treated, NF has a good prognosis and it is not associated with an excess of limb loss and deaths.

In vitro testing of silver-containing spacer in periprosthetic infection management

Deep infection is a serious complication in endoprosthetic surgery. In correlation to the patient local or systemic compromising factors conservative and surgical proceedings has to be evaluated. Systemic antibiotic therapy is the gold standard in infection management. Implanted silver-coated or silver-containing medical devices have been proven to their antimicrobial effectiveness since the 1990s by several investigators. The outcomes showed that long time implantation could cause damaging of the surrounding tissues, especially of adjacent nerves. The aim of our study was to evaluate the release of silver (I) ions from bone cement mixed with either nanosilver particles (AgNPs), different concentrations of silver sulfate (Ag2SO4) or from pure metallic silver strips. Therefore, we choose two methods: the first, called “static model”, was chosen to evaluate the maximal accumulative concentration of silver (I) ions, with the second, called “dynamic model”, we simulated a continuous reduction of the ions. In an additional test design, the different materials were evaluated for their antimicrobial activity using an agar gel diffusion assay. The outcome showed that neither the addition of 1% (w/w) nanosilver nor 0.1% silver sulfate (w/w) to polymethylmethacrylat bone cement has the ability to release silver (I) ions in a bactericidal/antifungal concentration. However, the results also showed that the addition of 0.5% (w/w) and 1% (w/w) silver sulfate (Ag2SO4) to bone cement is an effective amount of silver for use as a temporary spacer.