Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents

SUMMARYVancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6–6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3–10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0–4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.

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RETINAL CHANGES IN MYOPIC PATIENTS AT A TERTIARY CARE CENTRE IN EASTERN INDIA

10.36106/ijar/4310527 ◽

2021 ◽

pp. 23-25

Author(s):

Pampa Halder ◽

Madhavi Madhavi ◽

Manas Bandyopadhyay

Keyword(s):

High Myopia ◽

Tertiary Care ◽

Tertiary Care Centre ◽

Increased Risk ◽

Peripapillary Atrophy ◽

Retinal Tears ◽

Lattice Degeneration ◽

Relationship Of ◽

The Relationship ◽

Retinal Complications

Background: Myopia is a major cause of visual impairment in both the developed and the developing world. Its prevalence ranges between 83% to 97% and the prevalence of high myopia ranges between 7% and 22%. Individuals with high myopia have increased risk of retinal complications which can be potentially sight threatening. Aims And Objectives: To determine the prevalence and types of retinal changes in patients with myopia and the relationship of the retinal changes with the severity of myopia. Materials And Methods: Patients attending the outpatient department having myopia and age more than 8 years were selected for the study. They underwent dilated fundoscopy (direct and indirect ophthalmoscopy) to record the various retinal changes. Results: Tessellated fundus (58.5%) and peripapillary atrophy (40.5%) were the most common ndings. Temporal crescent (21.5%), lattice degeneration (16.5%), white with or without pressure (11%), retinal tears (4%) and retinal detachment (2%) were also seen. No changes were observed in 22% of the eyes. Conclusion: Myopic individuals should be educated on the symptoms of various complications and seek care immediately if symptoms arise

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A STUDY ON THE RELATIONSHIP OF DEVIATED NASAL SEPTUM WITH MIDDLE EAR PRESSURE AMONG PATIENTS TREATED IN A TERTIARY CARE CENTRE

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2017/268 ◽

2017 ◽

Vol 6 (16) ◽

pp. 1235-1238

Author(s):

Rajesh R

Keyword(s):

Middle Ear ◽

Nasal Septum ◽

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Deviated Nasal Septum ◽

Middle Ear Pressure ◽

Relationship Of ◽

The Relationship

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A PROSPECTIVE OBSERVATIONAL STUDY OF CLINICAL PROFILE IN ETIOLOGY OF ANEMIA IN ELDERLY-A HOSPITAL BASED STUDY IN A TERTIARY CARE CENTRE IN SOUTH INDIA

International Journal of Advanced Research ◽

10.21474/ijar01/13508 ◽

2021 ◽

Vol 9 (09) ◽

pp. 961-972

Author(s):

K. Shivaraju ◽

◽

Karanam Sai Arun ◽

Mandhala Saikrishna ◽

◽

...

Keyword(s):

Tertiary Care ◽

The Elderly ◽

Moderate Degree ◽

Care Hospital ◽

Tertiary Care Centre ◽

Total Study Population ◽

Study Population ◽

Poor Outcomes ◽

One Year ◽

Severe Degree

Background: Anemia is often considered as a normal physiological process that occurs with aging. but recently since past 2 decades anemia of any degree is being recognized as significant independent contributor to morbidity mortality and frailty in elderly patients. It is easy to overlook anemia in elderly as symptoms of anemia like fatigue, SOB etc are often attributed to aging process itself. many evidences accumulated states that anemia of any degree reflects poor health and increased vulnerability to poor outcomes. Materials and methods: This study was conducted in the department of internal medicine in a tertiary care hospital over a period of one year with sample size of 362 subjects satisfying the inclusion and exclusion criteria after taking the consent form. Results: Moderate degree anaemia was the commonest around, 65.6% followed by severe degree anemia 20.1%. Easy fatigability was the commonest symptom and pallor was the commonest sign of anaemia in elderly. Anemia is not always a consequence of aging. Anemia of unexplained etiology constituted 15.97% of total study population. Conclusion: Anaemia in elderly is a challenge and has to be approached in an organized manner for appropriate diagnosis and evaluation to look into its cause and plan management to improve the quality of life of the elderly persons.An effort should always be made to reach etiological diagnosis before instituting specific therapy.

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MATERNALAND PERINATAL OUTCOMES WITH COVID-19: A TERTIARY CARE CENTRE STUDY

10.36106/ijsr/4001043 ◽

2021 ◽

pp. 31-32

Author(s):

Sweety Sinha ◽

Anjana Sinha ◽

Ankita Ankita

Keyword(s):

Pregnant Women ◽

Tertiary Care ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Neonatal Infection ◽

Fetal Distress ◽

Rt Pcr ◽

Tertiary Care Centre ◽

Polymerase Chain ◽

Poor Outcomes

Background: With the exponential increase in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) worldwide, an increasing proportion of pregnant women are now infected during their pregnancy. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The aim of this study was to summarize the maternal and perinatal outcomes of pregnant women infected with COVID-19 during their pregnancy. Methods:Eligibility criteria included pregnant women positive for COVID-19 as detected by real-time polymerase chain reaction (PCR). Results: Atotal of 40 pregnant women positive for COVID-19 as conrmed by RT-PCR, were included in the study. 5% cases had preterm deliveries and LSCS was the preferred mode of delivery in 28 of 40 i.e., 70% cases. There was a tendency for low Apgar score at birth, higher rates of fetal distress, meconium, NICU admissions. There was one IUD only in this study. The treatment patterns of COVID-19 infection among pregnant women during their pregnancy or following delivery was mostly supportive in the form of oxygen and antibiotic therapy. Conclusions: Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 were reported. Vertical transmission of the COVID-19 could not be ruled out. Pregnant infected women had different symptoms, and they were given mostly supportive treatments than the general infected population. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.

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The Relationship of Chronic Fatigue to Psychiatric Illness in Community, Primary Care and Tertiary Care Samples

Ciba Foundation Symposium 173 - Chronic Fatigue Syndrome - Novartis Foundation Symposia ◽

10.1002/9780470514382.ch12 ◽

2007 ◽

pp. 193-211 ◽

Cited By ~ 1

Author(s):

Wayne J. Katon ◽

Edward A. Walker

Keyword(s):

Primary Care ◽

Psychiatric Illness ◽

Tertiary Care ◽

Chronic Fatigue ◽

Relationship Of ◽

The Relationship

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2315. The Relationship of Pre-Hospital Functional Status and Clinical Outcomes in Patients with Laboratory-Confirmed RSV Infection: Active Population-Based Surveillance, 2017–2019

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1993 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S794-S794

Author(s):

Angela Branche ◽

Lisa Saiman ◽

Edward E Walsh ◽

Ann R Falsey ◽

William Sieling ◽

...

Keyword(s):

Multivariate Analysis ◽

Functional Status ◽

Clinical Outcomes ◽

Demographic Data ◽

Patient Characteristics ◽

Population Based ◽

Active Population ◽

Rsv Infection ◽

Relationship Of ◽

The Relationship

Abstract Background Respiratory syncytial virus (RSV) infection is a common cause of acute respiratory infection (ARI) in adults. Prospective surveillance enables collection of representative data on demographic and clinical characteristics. Few data of this kind are available for adults hospitalized with RSV infection. We used active population-based surveillance to identify patients with laboratory-confirmed RSV infection and evaluated demographic characteristics and clinical outcomes. Methods Hospitalized adults ≥ 18 years old residing in a predefined catchment area with ≥ 2 ARI symptoms or exacerbation of underlying cardiopulmonary disease were screened for eligibility during October 2017–April 2018 and October 2018–April 2019 in 3 hospitals in Rochester, NY and New York City. Respiratory specimens were tested for RSV using PCR assays. Clinical and demographic data were abstracted from the medical record. Multivariate analysis was used to evaluate the relationship of patient characteristics with clinical outcomes. Results 8,217 hospitalized adults were screened and 9.4% positive for RSV infection. Preliminary clinical and demographic data were available for 348 patients including 14% 18–49 years, 28% 50–64 years and 58% > 65 years. Mean age was 68 years and 60% were female (Figure 1). Patients had a mean of 3 co-morbidities, with diabetes (40%), chronic obstructive pulmonary disease (30%), chronic kidney disease (28%), congestive heart failure (28%), coronary artery disease (25%) and asthma (24%) the most common co-morbidities (Figure 2). Median hospital length of stay was 6 days (IQR 4–10), 13% of patients were admitted to the ICU, 5% were mechanically ventilated and 5% died during admission and 12% within 6 months. In multivariate analysis having > 3 comorbidities, cardiac disease or a lower baseline functional status measured by activities of daily living scores was significantly associated with 6-month mortality. Conclusion The majority of hospitalized patients with RSV infection were older adults with ≥ 3 chronic comorbid conditions. Baseline functional status may be predictive of worse clinical outcomes in patients with RSV infection. These insights into patient characteristics and clinical outcomes will provide information for prevention programs. Disclosures All authors: No reported disclosures.

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Cesarean scar defect and its association with clinical symptoms, uterine position and the number of cesarean sections

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204293 ◽

2020 ◽

Vol 9 (10) ◽

pp. 4091

Author(s):

Madhangi V. B. ◽

Ramany C.

Keyword(s):

Clinical Symptoms ◽

Transvaginal Ultrasound ◽

Multiple Logistic Regression Analysis ◽

Tertiary Care ◽

Cesarean Sections ◽

History Of ◽

Caesarean Scar Defect ◽

Relationship Of ◽

The Relationship

Background: Caesarean scar defect (CSD), also called isthmocele or niche is a long-term complication, which can be asymptomatic or can give rise to chronic pelvic pain, dyspareunia and postmenstrual spotting. The objective of this study was to assess the association of CSD with clinical symptoms, position of the uterus and the number of caesarean sections.Methods: This was a prospective observational study done at a tertiary care teaching hospital from January 2019 to December 2019. The study included women with history of previous one or more caesarean sections with demonstrable CSD on transvaginal ultrasound. Various scar dimensions noted were width and depth of the scar. A deficiency ratio was calculated as a ratio of residual myometrium at the scar to the adjacent myometrium.Univariate analysis was done to assess the relationship of clinical symptoms with the defect parameters and number of previous caesarean sections. Multiple logistic regression analysis was done to find out the association between symptoms and number of previous caesarean sections with the scar defect dimensions.Results: The width, depth and deficiency ratio of the CSD were significantly higher in study subjects with a greater number of caesarean sections. Retroflexed uteri had larger CSD. There was no association of clinical features with the defect dimensions and the position of the uterus.Conclusions: CSD dimensions and deficiency ratio correlate with the number of previous caesarean sections and the position of the uterus. There was no association of clinical symptoms with the defect parameters.

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Analysis of Vancomycin-Resistant Enterococci in Hemato-Oncological Patients

Antibiotics ◽

10.3390/antibiotics9110785 ◽

2020 ◽

Vol 9 (11) ◽

pp. 785

Author(s):

Kristýna Hricová ◽

Taťána Štosová ◽

Pavla Kučová ◽

Kateřina Fišerová ◽

Jan Bardoň ◽

...

Keyword(s):

Surface Protein ◽

Ionization Time ◽

Flight Mass Spectrometry ◽

Vancomycin Resistant Enterococci ◽

Oncological Patients ◽

Genes Encoding ◽

Unique Restriction ◽

Vancomycin Resistant ◽

Relationship Of ◽

The Relationship

Enterococci are important bacterial pathogens, and their significance is even greater in the case of vancomycin-resistant enterococci (VRE). The study analyzed the presence of VRE in the gastrointestinal tract (GIT) of hemato-oncological patients. Active screening using selective agars yielded VRE for phenotypic and genotypic analyses. Isolated strains were identified with MALDI-TOF MS, (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry) their susceptibility to antibiotics was tested, and resistance genes (vanA, vanB, vanC-1, vanC2-C3) and genes encoding virulence factors (asa1, gelE, cylA, esp, hyl) were detected. Pulsed-field gel electrophoresis was used to assess the relationship of the isolated strains. Over a period of three years, 103 VanA-type VRE were identified in 1405 hemato-oncological patients. The most frequently detected virulence factor was extracellular surface protein (84%), followed by hyaluronidase (40%). Unique restriction profiles were observed in 33% of strains; clonality was detected in 67% of isolates. The study found that 7% of hemato-oncological patients carried VRE in their GIT. In all cases, the species identified was Enterococcus faecium. No clone persisted for the entire 3-year study period. However, genetically different clusters were observed for shorter periods of time, no longer than eight months, with identical VRE spreading among patients.

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