scholarly journals Cerebrospinal Fluid Sterilization with Intrathecal Polymyxin in Addition to Parenteral Polymyxin in Nosocomial Acinetobacter Meningitis

2021 ◽  
Vol 15 (7) ◽  
pp. 1550-1552
Author(s):  
Sadia Ishaque ◽  
Ehsan Bari ◽  
Muhammad Shahzad Shamim ◽  
Syed Faisal Mahmood
Keyword(s):  
Cerebrospinal Fluid ◽  
Primary Outcome ◽  
Complete Recovery ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Neurological Deficits ◽  
Intrathecal Therapy ◽  
Acinetobacter Species ◽  
Nosocomial Meningitis ◽  
The Mean

Background: For the last few decades there has been a substantial concern regarding the increasing prevalence of multidrug resistant (MDR) Acinetobacter species in hospitals. Aim: To determine the outcomes with intrathecal polymyxins therapy in patients with multidrug resistant Acinetobacter species nosocomial meningitis. Place and duration of study: This Retrospective study was conducted in the Department of Infectious Diseases, Aga Khan University Hospital, Karachi Pakistan between 2010 and 2014. Methodology: Twenty six patients who developed post neurosurgical MDR Acinetobacter nosocomial meningitis age above 18 were included, while those with polymicrobial meningitis, and those patients who only received intravenous polymyxins were excluded. The primary outcome is ability and time to sterilize the cerebrospinal fluid Results: The mean age was 42.9±11.5 years. Cerebrospinal fluid sterilization was observed in 24 patients in a median of 4 days. One patient made complete recovery, 16 patients recovered with neurological deficits and five patients expired. A trend of early cerebrospinal fluid sterilization was observed in patients with continuous intrathecal therapy. The time to cerebrospinal fluid sterilization is similar with intrathecal colistin or polymyxin. Conclusion: Intrathecal polymyxins are safe and efficacious in the treatment of multidrug resistant nosocomial Acinetobacter species meningitis. Keywords: Intrathecal, Polymyxins, Multidrug resistant, Acinetobacter species, Nosocomial, Meningitis

scholarly journals Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience

2021 ◽  
Vol 9 ◽  
pp. 205031212110011
Author(s):  
Thabit Alotaibi ◽  
Abdulrhman Abuhaimed ◽  
Mohammed Alshahrani ◽  
Ahmed Albdelhady ◽  
Yousef Almubarak ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mortality Rate ◽  
Acinetobacter Baumannii ◽  
Care Setting ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Published Data ◽  
Tertiary Teaching ◽  
The Mean

Background: The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region. Methods: We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors. Results: A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

scholarly journals TUBERCULOUS MENINGITIS;

2017 ◽  
Vol 24 (06) ◽  
pp. 865-868
Author(s):  
Sabir Ali ◽  
Adil Mahmood ◽  
Muhammad Fayyaz ◽  
Faiza Naseem
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Tuberculous Meningitis ◽  
Neurological Deficits ◽  
Significant Morbidity ◽  
Mortality And Morbidity ◽  
Clinical Criteria ◽  
Cerebrospinal Fluid Examination ◽  
The Mean ◽  
Cns Tuberculosis

Background: Central nervous system (CNS) tuberculosis constitutes 6% of alltuberculosis cases and tuberculous meningitis (TBM) is the most serious manifestation. Despiteeffective anti-tuberculous medicines, 20-50% of tuberculous patients die and significant numberof patients have neurological deficits. Failure to initiate anti-tuberculous therapy in the earlystages of the disease may lead to significant morbidity and mortality. Setting: MW-1, MW-III andMW-IV of Bahawal Victoria hospital Bahawalpur. Methods: All patients of tuberculous meningitisdiagnosed on the basis of the clinical criteria and cerebrospinal fluid examination (WBC ≥15,predominant lymphocytes and sugar level ≤40 mg/dl) were included in the study. Age, gender,and GCS level of the patients were recorded. Every patient was observed for mortality withintwo weeks after admission (within ward or enquired on mobile phone if patient was dischargedearly). Results: A total of 73 patients were included in the study. The mean age of patientswas 36.71 years with standard deviation of 17.161 years. Out of 73 patients, 31 (42.47%)patients were male and 42 (57.53%) were female. Out of 73 patients, 12 (16.44%) patients oftuberculous meningitis had mortality while 61 (83.56%) patients had no mortality. Conclusion:Tuberculous meningitis is a chronic illness with relatively high mortality and morbidity. Low levelof consciousness on admission to hospital is an important predictor for mortality.

scholarly journals Neurological symptoms in COVID-19: a cross-sectional monocentric study of hospitalized patients

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Ummehan Ermis ◽  
Marcus Immanuel Rust ◽  
Julia Bungenberg ◽  
Ana Costa ◽  
Michael Dreher ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
Critically Ill ◽  
University Hospital ◽  
Neurological Deficits ◽  
Neurological Manifestations ◽  
Longitudinal Assessment ◽  
Cross Sectional ◽  
Substantial Impact ◽  
Direct Invasion

Abstract Background The SARS-Coronavirus-2 (SARS-CoV-2) invades the respiratory system, causing acute and sometimes severe pulmonary symptoms, but turned out to also act multisystematically with substantial impact on the brain. A growing number of studies suggests a diverse spectrum of neurological manifestations. To investigate the spectrum of symptoms, we here describe the neurological manifestations and complications of patients with proven SARS-CoV-2 infection who have been hospitalized at the RWTH University Hospital Aachen, Germany. Methods Between March and September 2020, we evaluated common symptoms, clinical characteristics, laboratory (including cerebrospinal fluid (CSF) analysis), radiological, and electroencephalography (EEG) data from 53 patients admitted with a positive SARS-CoV-2 polymerase chain reaction (PCR). We used the Montreal Cognitive Assessment Test (MoCA) to screen for cognitive impairment, when feasible. We compared critically ill and non-critically ill patients categorized according to the presence of Acute Respiratory Distress Syndrome (ARDS). Results Major clinical neurological features of hospitalized COVID-19 patients were coordination deficits (74%), cognitive impairment (61.5%), paresis (47%), abnormal reflex status (45%), sensory abnormalities (45%), general muscle weakness and pain (32%), hyposmia (26%), and headache (21%). Patients with ARDS were more severely affected than non-ADRS patients. 29.6% of patients with ARDS presented with subarachnoid bleedings, and 11.1% showed ischemic stroke associated with SARS-CoV-2 infection. Cognitive deficits mainly affected executive functions, attention, language, and delayed memory recall. We obtained cerebrospinal fluid (CSF) by lumbar puncture in nine of the 53 patients, none of which had a positive SARS-CoV-2 PCR. Conclusions In line with previous findings, our results provide evidence for a range of SARS-CoV-2-associated neurological manifestations. 26% of patients reported hyposmia, emphasizing the neuro-invasive potential of SARS-CoV-2, which can enter the olfactory bulb. It can therefore be speculated that neurological manifestations may be caused by direct invasion of the virus in the CNS; however, PCR did not reveal positive intrathecal SARS-CoV-2. Therefore, we hypothesize it is more likely that the para-infectious severe pro-inflammatory impact of COVID-19 is responsible for the neurological deficits including cognitive impairment. Future studies with comprehensive longitudinal assessment of neurological deficits are required to determine potential long-term complications of COVID-19.

The feasibility and utility of an eye movement recording application: a randomized trial (Preprint)

2020 ◽  
Author(s):  
Hee Jin Chang ◽  
Sooyoung Kim ◽  
In-Sun Kwon ◽  
Han Young Yu ◽  
Seong-Hae Jeong
Keyword(s):  
Eye Movement ◽  
Primary Outcome ◽  
Intervention Group ◽  
Mobile App ◽  
Glass System ◽  
University Hospital ◽  
Randomized Controlled ◽  
National University ◽  
The Mean ◽  
Mean Time

BACKGROUND Examination of eye movement both with fixation and without fixation is important in the management of patients with dizziness and imbalance. At present, a device that records eye movement without fixation usually utilizes Frenzel glasses with a desktop-based recording system. This system is inconvenient because Windows devices are large and require substantial power, and no Windows-based mobile phone exists. A mobile device application (app) could address those concerns. OBJECTIVE To assess the efficacy and feasibility of mobile app-based Frenzel tests in dizziness clinics. METHODS We performed an investigator-initiated, blinded-outcome assessor, parallel, randomized controlled crossover trial at Chungnam National University Hospital between August 2019 and October 2019. Certified medical staff were randomly assigned to the intervention group (i.e., a mobile app-based Frenzel glass system, n=15) or the observation group (i.e., a conventional desktop-based Frenzel glass system, n=15); the groups applied the respective systems for the preparation of eye movement recording and switched systems. The primary outcome was the elapsed time in seconds it took the participants to prepare the system for eye recording simulation. The secondary outcomes were perceived stress and satisfaction scores after completion of the operation, as measured by a questionnaire using ten-point Likert scales. RESULTS The mean time of machine preparation for eye recording simulation was reduced by 50% in the mobile app group compared to the desktop group in both study periods (38.0±7.1 vs. 76.0±8.7). We detected no carryover effect. Participants also reported lower stress while using app than while using the desktop system (2.3±1.3 vs. 4.6±2.4; p<0.001). The app obtained a mean overall satisfaction score of 9.2 out of 10. CONCLUSIONS The implementation of an eye movement recording app in a dizziness examination was well adopted by users and decreased the time and stress related to machine operation. CLINICALTRIAL This trial is registered with cris.nih.go.kr under number KCT 0004403.

scholarly journals MIDSHAFT CLAVICLE FRACTURE

2018 ◽  
Vol 25 (01) ◽  
pp. 34-38
Author(s):  
Nusrat Rasheed ◽  
Jagdesh Kumar
Keyword(s):  
Primary Outcome ◽  
Clavicle Fracture ◽  
Primary Outcome Measure ◽  
University Hospital ◽  
The Mean ◽  
Patient’S Outcome ◽  
Study Setting ◽  
Good Pain Control ◽  
Better Than

Introduction: Fracture of clavicle is common, occurring most commonly inmales accounting for approximately 2.5%of all fracture presenting to orthopedic surgeon.1 Thisstudy has been conducted to compare the broad arm sling and figure of eight bandage in thefirst 21 days of treatment with primary outcome measure of pain and disability. Study Design:Comparative study. Setting: Department of orthopedic surgery, Dow International MedicalCollege, Dow University hospital. Period: February 2015-2016. Material and Methods: 60eligible patients with a mean age of (15-60 years) were randomized to conservative treatmentwith either a broad arm sling or figure of eight bandage. After detailed counseling taking informedconsent we did non stratified randomization in blocks of two using the sealed envelope method.Patients were kept in strict follow up to complete the outcome measures the next day and onday seven, fourteen and twenty one. On each visit a Performa was filled known as SPADI havingtwo components of pain and disability and VAS on day one, seven, fourteen and twenty one.Results: Seventy patients were enrolled initially, out of them ten patients were dropped outdue to different reasons. Of the remaining 60 patients 30 were treated with broad arm sling and30 were treated with figure of eight bandage. The two groups were randomized fulfilling theinclusion criteria. The Mean VAS on the first day of treatment in the broad arm sling group was5.433 SD 1.04 (p= 0.034, 95% CI 0.10 -2.46) where as in figure of eight group was 8.9 (SD 10.8).On subsequent visits (Day 7,14,21) VAS of broad arm sling was 3.83, 1.40,1 whereas figure ofeight was 5.76, 4.3, 3.469. This result clearly shows good pain control in broad arm sling groupas compared to the figure of eight group. The mean SPADI on the first day of treatment was94.52(SD 2.273) in broad arm sling group, on the other hand it was 93.87(SD 2.239) in figure ofeight group. In follow up visits of day 7, 14 and 21 score was as follows in broad arm group 3.83(SD 0.79), 1.4(SD 0.49), 1(SD 0.0), it was 5.76(SD 1.04), 4.3(SD 0.740), 3.4(SD0.68) in figure ofeight group. It also shows better result in terms of pain and functional outcome. Conclusion:Fracture clavicle is still managed conservatively in majority of the cases, either with the figure ofeight bandage or polyarm sling. Patient’s outcome in terms of pain management and functionalrange of motion in poly arm sling is better than figure of eight bandage.

Missile Injuries to the Brain Treated by Simple Wound Closure: Results of a Protocol during the Lebanese Conflict

Neurosurgery ◽  
1991 ◽  
Vol 29 (3) ◽  
pp. 380-384 ◽  
Author(s):  
Jamal M. Taha ◽  
Maurice I. Saba ◽  
Jeffrey A. Brown
Keyword(s):  
Cerebrospinal Fluid ◽  
Medical Center ◽  
Neurological Deficits ◽  
American University ◽  
Intracranial Surgery ◽  
Entry Wound ◽  
Bone Fragments ◽  
The Mean ◽  
A Prospective Study ◽  
The Brain

Abstract This is a prospective study of the treatment of penetrating missile injuries to the brain without intracranial surgery carried out at the American University of Beirut Medical Center between 1981 and 1988. Of 600 patients treated for missile injuries to the head. 32 satisfied the study criteria. There were 27 shrapnel and 5 bullet injuries. The mean patient age was 23 years (range, 3-51 years). Twenty patients had intracranial indriven bone fragments. Six patients had exposed brain tissue. The mean follow-up was 3.5 years (range, 1-7.5 years). The superficial entry wound was debrided and closed without drainage in the Emergency Room within a mean of 3 hours (range, 0.5-6 hours), and the patient received methicillin for 14 days. All patients survived and had no or improved neurological deficits. No leakage of the cerebrospinal fluid, infection, or seizures occurred in 31 patients. One patient with indriven bone fragments had leakage of the cerebrospinal fluid and developed seizures and a brain abscess 20 days after the injury. The management of penetrating missile injuries to the brain without intracranial surgery in a select patient population is a reasonable option. This treatment becomes important for a surgeon facing large numbers of casualties, or when operative personnel or resources are limited or unavailable.

scholarly journals Focused Assessment with Sonography in Trauma (FAST) Training for First-Year Resident Physicians at a University Hospital in Japan: A Longitudinal, Observational Study

2020 ◽  
Author(s):  
Koshi Ota ◽  
Koji Oba ◽  
Yuri Ito ◽  
Kanna Ota ◽  
Akira Takasu
Keyword(s):  
Observational Study ◽  
Test Score ◽  
Primary Outcome ◽  
University Hospital ◽  
First Year ◽  
Longitudinal Observational Study ◽  
Fast Training ◽  
Hands On ◽  
The Mean ◽  
Prospective Longitudinal

Abstract Background: Ultrasound training is an essential part of residency programs during emergency medicine (EM) rotations for first-year trainees (postgraduate year 1; PGY1). The Focused Assessment with Sonography for Trauma (FAST) examination to assess for internal bleeding in trauma patients is one of the essential scans, which PGY1 residents must learn during the EM rotation.Method: A prospective, longitudinal, observational study of PGY1 residents during an EM rotation (two months) conducted from April 1, 2019 to March 31, 2020 was performed. The primary outcome was the mean difference between the hands-on FAST examination scores of the first week of the EM rotation and the same hands-on FAST examination scores of the last week of the EM rotation. All PGY1 residents could access the ultrasound machine freely for examining other PGY1 residents and could use it for real patients under supervision of EM physicians.Result: A total of 34 PGY1 residents (male 29, female 5) were recruited and completed the hands-on FAST test in both the first week and the last week of the rotation. The mean test score for the PGY1 residents in the first week was 7.53 (standard deviation [SD] 2.12). The mean test score in the last week was 15.88 (SD 2.46). The primary outcome of this study was the score difference between the first and last weeks (mean 8.35, 95% confidence interval 7.36 - 9.35, P < 0.0001, paired t-test).Conclusion: Hands-on practical FAST training for PGY1 residents during EM rotations significantly improved their FAST test scores.

scholarly journals Nebulised colistin for ventilator-associated pneumonia prevention

2015 ◽  
Vol 46 (6) ◽  
pp. 1732-1739 ◽  
Author(s):  
Marios Karvouniaris ◽  
Demosthenes Makris ◽  
Paris Zygoulis ◽  
Apostolos Triantaris ◽  
Stelios Xitsas ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Controlled Trial ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Incidence Density ◽  
Ventilator Associated Pneumonia ◽  
Open Label ◽  
The University ◽  
Incidence Density Rate ◽  
Density Rate

We evaluated whether prophylactic nebulised colistin could reduce ventilator-associated pneumonia (VAP) rates in an intensive care unit (ICU) setting with prevalent multidrug-resistant (MDR) bacteria.We used a single-centre, two-arm, randomised, open-label, controlled trial in a 12-bed ICU in the University Hospital of Larissa, Greece. Patient inclusion criteria included mechanical ventilation of >48 h. The two arms consisted of prophylaxis with 500 000 U colistin (Col group) or normal saline (NS group), thrice daily, for the first 10 ICU days or until extubation. The primary outcome of the study was the 30-day VAP incidence.In total, 168 patients entered the study. VAP incidence was not different between Col and NS group patients (14 (16.7%)versus25 (29.8%), respectively, p=0.07). Regarding the secondary outcomes, the intervention resulted in a lower VAP incidence density rate (11.4versus25.6, respectively, p<0.01), and less Gram-negative bacteria-VAP (p=0.03) and MDR-VAP (p=0.04). Among VAP patients (n=39), prophylaxis with inhaled colistin improved ICU survival (p=0.016). There was no evidence of increased resistance to colistin or multidrug resistance.Our findings suggest that nebulised colistin had no significant effect on VAP incidence.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

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