Microbiology of Post-Cardiac Surgery Infections in Children with Congenital Heart Diseases, A Single-Center Experience, Mashhad, Iran

Background: Children who have undergone cardiac surgeries due to congenital heart disease are prone to various kinds of infections. Objectives: This study was done to investigate the prevalence of nosocomial infections and microbiology of post-cardiac surgery infections in pediatric patients with congenital heart disease (CHD). Methods: In this cross-sectional study, the epidemiology and microbiology of post-cardiac surgery for pediatric patients with CHD at Imam Reza Hospital of Mashhad University of Medical Sciences between 2014 and 2017 were investigated. Demographic and clinical information was recorded, and the findings were analyzed using SPSS 16. Results: Out of 1128 patients with open heart surgery during the four years of the study, 135 patients, including 80 males (60.1%) and 55 females (39.9%) with a mean age of 8.06 ± 3.86 months, were enrolled in the study. The prevalence of infection was 11.96%. The most common isolated bacteria were Acinetobacter (19/135, 14.1%), Pseudomonas spp. (13/135, 9.6%), and Enterobacter (13/135, 9.6%) as Gram-negative ones and Corynebacterium diphtheria (10/135, 7.4%) and Staphylococcus epidermidis (10/135, 7.4%) as Gram-positive types. Candida albicans (14/135, 10.4%) were also the most frequent fungi. The frequency of infection-causing masses did not differ significantly between different cardiac abnormalities (P = 0.831), sex (P = 0.621), age (P = 0.571), and weight (P = 0.786) groups. Also, the duration of hospitalization, intubation, bypass time, and urinary catheterization in positive culture cases were significantly longer than in negative cases. Conclusions: In our study, the most common infections in children who underwent heart surgery were Acinetobacter, C. albicans, Pseudomonas, and Enterobacter. It is suggested to reduce the hospitalization, intubation, bypass, and urinary catheterization time to reduce nosocomial infections in these patients and decrease treatment costs.

Occurrence and Severity of Catheter-Related Bladder Discomfort of General Anesthesia Plus Epidural Anesthesia vs. General Anesthesia in Abdominal Operation With Urinary Catheterization: A Randomized, Controlled Study

Background: This randomized, controlled study aimed to investigate the effect of general anesthesia plus epidural anesthesia on catheter-related bladder discomfort (CRBD) in patients who underwent abdominal operation with urinary catheterization.Methods: A total of 150 patients scheduled for abdominal operation under anesthesia with urinary catheterization were randomized to receive general anesthesia plus epidural anesthesia (N = 74, GA + EA group) or general anesthesia (N = 76, GA group). The occurrence and severity of CRBD, systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded at 0 hour (h), 0.5, 1, and 3 h after tracheal extubation. Besides, postoperative adverse events were assessed.Results: The occurrence and severity of CRBD at 0, 0.5, 1, and 3 h were all reduced in GA + EA group compared to GA group (all P < 0.05). Meanwhile, subgroup analyses showed that the reduction of occurrence and severity of CRBD in GA + EA group compared to GA group was more obvious in male patients and patients ≥50 years. Besides, SBP at 0, 0.5, 1, and 3 h, as well as DBP at 0, 0.5, and 3 h were all decreased in GA + EA group compared to GA group (all P < 0.05), while HR was increased at 0 h in GA + EA group compared to GA group (P = 0.034). Moreover, the occurrence of pain, severity of pain and occurrence of vomiting were similar between GA + EA group and GA group (all P > 0.05).Conclusion: General anesthesia plus epidural anesthesia decreases CRBD occurrence and severity with tolerable safety compared with general anesthesia in patients who undergo abdominal operation with urinary catheterization.

Was President Andrew Jackson Overcharged? An Economic Evaluation of 19th Century Surgical Charges for Urologic Procedures and their Comparison to the Modern, RVU Era

Objectives Surgical billing is as old as the profession of surgery but there is no published data that has characterized changes in surgical fees over history. Surgical remuneration has been better studied in the Medicare era of relative value units (RVUs)-based payment but what surgeons charged in the American 18th and 19th centuries is unknown. President Andrew Jackson underwent surgery by Dr. James Hall for a hydrocele in 1832 and was billed, and then paid, $30. Our initial objective was to determine the appropriateness of Dr. Hall’s surgical billing for that era. We then wished to determine historical trends in physician billing for similar urologic procedures in the 18th-19th centuries compared to the current RVU era, correcting for inflation. Methods Published fee tables from 18th and 19th century regional medical societies, prevailing charge data from the Center for Medicare Services (CMS) from 1967-1985, and published RVU values and conversion numbers from 1992-2020 (CMS) were used for analysis. To correct for inflation, we used a published consumer price index (CPI) for 1774-2020 indexed to 2020 US dollars. Mann-Whitney U-tests were used to compare unpaired differences without parametric assumptions. Results A total of 43 fee tables from 18 states from 1818-1898 were identified. The $30 charge to President Jackson for hydrocele surgery was similar to other states’ medical society recommendations of the early 1830s. Over the 19th century, there was an insignificant increase in the low-end fee pricing for hydrocele surgery of $18.4 +/- 17.9 in 1818-1840 versus $28.70 +/- 36.83 from 1880-1890 (p > .05), adjusting for inflation. Similarly, for initial male urinary catheterization, the mean surgical fee of $4.28 +/- 1.25 in 1818-1850 was similar to the $4.75 +/- 5.62 mean surgical fee in 1851-1900 (p>.05). Adjusting to 2020 dollars, however, reimbursement for urinary catheterization in 1818-1850, 1850-1900, 1975-1984, and 1992-2020 was $113.04 +/- 38.06, $131.20 +/- 169.53, $73.87 +/- 2.38, and $23.05 +/- 4.69, respectively (p<.01). of 11%. Conclusions Dr. James Hall, physician to 10 US Presidents, appropriately billed the 7th President for what would be now described as a hydrocele drainage and scarification. Fees for that procedure remained stable or decreased throughout the 19th century. Surgical fees for male urinary catheterization, however, decreased 82% from the 1840s to the 2020s, correcting for inflation.

Epidemiology of urinary candidiasis and antifungal susceptibility pattern of various Candida species at a rural tertiary health care centre of Puducherry, South India- An observational study

Urinary tract infection (UTI) is a common health problem across the globe. Although majority of them are bacterial in origin, there has been an increasing trend in the incidence of UTI due to the yeast like fungi, . UTI due to are in large proportion noscomially acquired and of growing concern is the development of resistance to the commonly used azole group of drugs for their treatment. Since the resistance is more commonly reported among non- albicans , routine species identification and antifungal susceptibility testing is crucial for successful clinical outcomes. This study was conducted to analyse the distribution and risk factors associated with Urinary candidiasis and also to determine the resistance patterns of different to various antifungal agents using phenotypic methods. : A hospital based observational study was conducted from September 2016 to December 2017 on patients presenting with symptomatic UTI. isolates were speciated using phenotypic methods like germ tube test and growth character on chromagar . Antifungal susceptibility to fluconazole, voriconazole, ketoconazole and amphotericin B were determined using disc diffusion method. All data were anlyzed using EpiData Analysis software version 2.2.2.186. A total of 101 were isolated. The incidence of Urinary candidiasis was more among females (66.4%) than in males (33.6%). People above 50 years (38.6%) were commonly affected followed by people in the age group of 21-30 years (22.7%). The incidence among hospitalized patients was 86.7% and urinary catheterization (43.5%) was the most commonly associated risk factor. The most common isolates were tropicalis (31.6%) followed by albicans (21.7%). The overall resistance patterns among various were 50.5%, 32.7%, 19.9% and 2% for fluconazole, ketoconazole, voriconazole and amphotericin B respectively. Hospitalization and urinary catheterization are the important risk factors for developing urinary candidiasis. The antifungal susceptibility varies among different and hence, identification of to species level along with antifungal susceptibility testing should be practiced as a routine in all clinical mycology laboratories.