A CASE REPORT OF APLASIA CUTIS CONGENITA TYPE VI: BART'S SYNDROME

Aplasia cutis congenita type VI (Barts syndrome), is a rare genetic disorder characterized by congenital localized absence of skin, formation of blisters (epidermolysisbullosa), and nail abnormalities. In this report, we present a rare case of aplasia cutis congenita type VI (Barts syndrome) in a newborn malebaby with the absence of a skin layer over the anterior right leg, slightly below the patella (kneecap) and around the ankle joint.On the second day, the affected areas developed blisters characterizing epidermolysisbullosa.Laboratory investigationswere all normal. The patients wound was managed conservatively with dressing and topical antibiotic ointments.

176. Topical Antibiotic and Antiseptic Use in the Operating Room: An Opportunity for Antimicrobial Stewardship?

Background Data suggest that topical antibiotic and antiseptic use in the operating room is common but not commonly monitored by antimicrobial stewardship programs. Although some data suggest a benefit in certain surgical procedures, the CDC and WHO advise against the routine use of topical antibiotics in surgery due to uncertainty and heterogeneity in the overall data. Methods We conducted a retrospective 28-day period prevalence study of topical antibiotic and antiseptic use during surgical procedures performed in the operating room by 6 surgical specialties at a tertiary care medical center. For the subset of patients undergoing orthopedic surgeries, we evaluated the types of topical antibiotics received and the rates of surgical site infections (SSI) and adverse drug events within 28 days of the procedure. Results Of 744 surgical procedures reviewed, topical antibiotics were used in 127 (17.1%), topical antiseptics in 71 (9.5%), and both in 18 (2.4%) (Table 1). Antiseptic use was higher in orthopedics relative to all other surgical specialties while topical antibiotic use was higher in neurosurgery. Hand, vascular and plastics had distinguishably lower use. In the orthopedic subgroup, after exclusions, 218 procedures were evaluated. Topical antibiotics were used in 42 (19.2%). Topical antibiotic therapy was more likely to be administered if prosthetic material was implanted, the procedure was emergent, or if a Staphylococcus aureus infection was present. Vancomycin was the most commonly used topical antibiotic and powder was the most commonly used type of application. As shown in table 2, SSI occurred more often when both topical antibiotics and antiseptics were applied; however, SSI events were relatively uncommon, and these were more likely to have infection present at the time of surgery. Adverse events were rare. Conclusion In our institution we noted significant variability in use of topical antibiotic and antiseptic therapy among surgical specialties as well as within the orthopedic surgical specialty. Although opportunities to standardize use/nonuse of these therapies exist, this may be challenging due to the uncertainty and heterogeneity of currently available data. Disclosures All Authors: No reported disclosures

Acute otitis externa in children: causes, diagnosis, treatment, clinical report

Acute otitis externa is a common disease in the pediatric population, characterized by diffuse inflammation of the external auditory canal. Typical symptoms of acute otitis externa include otology, itching, congestion, and a feeling of fullness in the sore ear. In the case of active inflammation, the process can go to the tympanic membrane, and acute otitis media will join the external one. Primary therapy for diffuse uncomplicated acute otitis externa should include a local antimicrobial drug, without systemic antibiotic therapy. Topical therapy with antibacterial drugs in combination with anesthetics is the most rational. A clinical case of a 12-year-old patient with acute diffuse otitis externa and otitis media with effusion; acute nasopharyngitis; and adenoiditis, which was established based on anamnesis and clinical data is presented. Complex therapy was prescribed, which included local antibiotic therapy with a complex topical drug for the treatment of imperforated otitis externa and imperforated otitis media. At reexamination 5 days later, the patient demonstrated positive dynamics, pain in the left ear was eliminated. In cases of uncomplicated diffuse otitis externa, as well as in cases of its combination with otitis media with effusion, topical antibiotic therapy is a major priority. It should be borne in mind that the topical medication is more effective with the cleansing of the external auditory canal from inflammatory secretion. If it is used correctly, it would provide positive dynamics without systemic antibiotic prescription. It preserves the microbiome and mobilizes the body’s defenses. The application of complex topical antibiotic drugs can be widely recommended in pediatric practice.

Lipoma Removal Surgery in White-Rumped Shama (Kittacincla malabarica macraoura)

Lipoma in birds is a benign tumor of adipose cells that often occurs in the subcutaneous area. White-rumped shama, more than three years old, was rushed to the puskesmas with symptoms of decreased activity and singing ability. The results of the examination were two round, multi-focal masses, firmly demarcated, yellowish in color with a soft, chewy consistency measuring ± 4 x 2 x 1 cm on the chest and ± 1 x 1 x 1 cm. in the abdominal area, firmly attached to the subcutaneous layer since six months ago, and getting bigger. The feathers around the mass are shed and vascularized on the surface of the mass. Surgery was performed because the mass suspected of being a tumor growing rapidly and causing pain. It was fasted two hours before surgery and the anesthetic used was a combination of ketamine HCl and xylazine. Postoperative therapy using the antibiotic enrofloxacin, ketoprofen analgesics, 0.9% NaCl fluid therapy and topical antibiotic gentamicin ointment. The tumor that has been successfully removed is yellowish in color with several areas of hyperemia and an oily surface. The results of histopathological examination characterized by the presence of adipose cells that appeared to proliferate well confirmed that the tumor was a lipoma.

ASSESSMENT OF INTRAOCULAR PRESSURE FOLLOWING THE INTRAVITREAL INJECTION OF ANTI-VEGF

Objective: The objective of the study is to assess the frequency of raised IOP after intravitreal injection of Anti VEGF by using an applanation tonometer. Methods: Each patients who fulfil the presence criteria were nominated by the researcher through ‘the outpatient department (OPD) of ophthalmology, Jinnah Post Graduate Medical Center. Performa was filled. Aim and process of study was explained to all patients. Conversant consent was reserved. Model ocular inspection, including IOP was done. By using either a 30-or 32-gauge needle, 1.25 ml bevacizumab (Avastin) were administered by the researcher under the direct supervision of consultant. Patients were consistently sterilely prepped, that was comprised incerted of topical antibiotic and anesthetic drops, supplement of a lid speculum. Later pointing the injection place on the sclera with a caliper calculating 3.0 to 3.5 mm after limbus, conjunctiva was expatriate somewhat through a sterile cotton-tipped applicator immediately earlier ingoing the eye by a needle. Later injection, place was occluded provisionally it was amended through a sterile cotton-tipped applicator while the needle remained inhibited from the eye. Since the needle was inhibited, a drop of anesthetic was employed on the cornea and IOP was measured. Then next IOP interpretation was measured later 1day of intravitreal Avastin. All pressures were measured using the applantation tonometry. IOPs were measured earlier intravitreal Avastin "baseline IOP" and instantly following injection "T0" and 1day next injection. Results: 235 Patients exactly nominated for the research study. Intravitreal Injection, Bevacizumab was applied in 235 Eyes of overstated 235 patients. Elsewhere of the 235 patients, 133 males and 102 females, Their ages ranged from 30-70 y (mean 52.02 y. The most shared sign intravitreal with bevacizumab, diabetic retinopathy observed in 114 (48.5%) patients, indicated by exudative ARMD in 70 (29.7%) patients, BRVO in 12 (5%) patients, Myopic CNV23(9.7) with CRVO observed in 11 (4.6%) patients, Eale’s sickness in 2(0.85%) patients even as Idiopathic CNV was observed in only 3 (1%) patient. Of the 235 patients, 118 (50.2%) patients with right eye suffered, 117(49.7%) patients with left eye suffered. After 24 h of intravitreal Bevacizumab Raised IOP was observed in only 3 (1.28) patient and 232(98.2) patient IOP was in the normal range. According to our study, the result of stratification with respect to age, side of the eye and gender is not significant as p-value for age (0.838), gender (0.723) and side of the eye (0.556), respectively. Conclusion: In our study, frequency of raised IOP after anti VEGF were found 3(1.28) patient out of 232 (98.2). Anti-VEGF treatment is the foundation for the management of numerous retinal illnesses. Notwithstanding its capable effectiveness in uncertain the sickness and refining, vision for the patients, intravitreal injection of anti-VEGF products may be related with overwhelming problems. To diminish the risk cautious care to the injection method and suitable post-injection observing are essential.

127Topical antibiotics used to prevent infection in the ICU: an accidental natural herd exposure experiment

Background Multiple studies of topical antibiotics applied to ICU patients appear to show potent infection prevention effects versus studies of other interventions. However, the effect is less apparent for studies using non-concurrent (NCC) versus concurrent controls (CC) implying the possibility of a herd effect. Methods 206 studies of infection prevention among ICU patients, sourced from 15 systematic reviews were stratified into those using topical antibiotics with NCC versus with CC versus studies of other prevention methods. The event rates were summarised using generalized estimating equations and compared to other studies without an intervention (literature benchmark). Results The summary effect sizes for pneumonia and mortality prevention derived in the systematic reviews were replicated. The mean ICU mortality incidence for topical antibiotic study CC control groups (28.5%; 95% CI, 25.0-32.3; n = 41) is higher versus a literature benchmark (23.7%; 19.2%-28.5%; n = 34), versus NCC control groups (23.5%; 19.3-28.3; n = 14) and versus topical antibiotic intervention groups (24.4%; 22.1 – 26.9; n = 62). In meta-regression models adjusted for group mean age and publication year, CC group membership within a topical antibiotic study remains associated with higher mortality (p = 0.027). Conclusions Within topical antibiotic studies, the CC control group mortality incidences are inexplicably high, whereas the intervention group incidences are paradoxically similar to a literature-derived benchmark. Key messages An adverse herd effect is apparent for topical antibiotics used to prevent infection among ICU patients.

Selective digestive decontamination, a seemingly effective regimen with individual benefit or a flawed concept with population harm?

Selective digestive decontamination (SDD) regimens, variously constituted with topical antibiotic prophylaxis (TAP) and protocolized parenteral antibiotic prophylaxis (PPAP), appear highly effective for preventing ICU-acquired infections but only within randomized concurrent control trials (RCCT’s). Confusingly, SDD is also a concept which, if true, implies population benefit. The SDD concept can finally be reified in humans using the broad accumulated evidence base, including studies of TAP and PPAP that used non-concurrent controls (NCC), as a natural experiment. However, this test implicates overall population harm with higher event rates associated with SDD use within the ICU context.