Evaluation and Prediction of Post-stroke Cerebral Edema Based on Neuroimaging

Cerebral edema is a common complication of acute ischemic stroke that leads to poorer functional outcomes and substantially increases the mortality rate. Given that its negative effects can be reduced by more intensive monitoring and evidence-based interventions, the early identification of patients with a high risk of severe edema is crucial. Neuroimaging is essential for the assessment and prediction of edema. Simple markers, such as midline shift and hypodensity volume on computed tomography, have been used to evaluate edema in clinical trials; however, advanced techniques can be applied to examine the underlying mechanisms. In this study, we aimed to review current imaging tools in the assessment and prediction of cerebral edema to provide guidance for using these methods in clinical practice.

Aiming for Zero: Reducing Transmission of Coronavirus Disease 2019 in the D.C. Department of Corrections

Background Washington, District of Columbia lowered severe acute respiratory syndrome coronavirus 2 transmission in its large jail while community incidence was still high Methods Coordinated clinical and operational interventions brought new cases to near zero. Results Aggressive infection control and underlying jail architecture can promote correctional coronavirus disease 2019 management. Conclusions More intensive monitoring could help confirm that in-house transmission is truly zero.

Admission criteria in critically ill COVID-19 patients: A physiology-based approach

Introduction The COVID-19 pandemic required careful management of intensive care unit (ICU) admissions, to reduce ICU overload while facing limitations in resources. We implemented a standardized, physiology-based, ICU admission criteria and analyzed the mortality rate of patients refused from the ICU. Materials and methods In this retrospective observational study, COVID-19 patients proposed for ICU admission were consecutively analyzed; Do-Not-Resuscitate patients were excluded. Patients presenting an oxygen peripheral saturation (SpO2) lower than 85% and/or dyspnea and/or mental confusion resulted eligible for ICU admission; patients not presenting these criteria remained in the ward with an intensive monitoring protocol. Primary outcome was both groups’ survival rate. Secondary outcome was a sub analysis correlating SpO2 cutoff with ICU admission. Results From March 2020 to January 2021, 1623 patients were admitted to our Center; 208 DNR patients were excluded; 97 patients were evaluated. The ICU-admitted group (n = 63) mortality rate resulted 15.9% at 28 days and 27% at 40 days; the ICU-refused group (n = 34) mortality rate resulted 0% at both intervals (p < 0.001). With a SpO2 cut-off of 85%, a significant correlation was found (p = 0.009), but with a 92% a cut-off there was no correlation with ICU admission (p = 0.26). A similar correlation was also found with dyspnea (p = 0.0002). Conclusion In COVID-19 patients, standardized ICU admission criteria appeared to safely reduce ICU overload. In the absence of dyspnea and/or confusion, a SpO2 cutoff up to 85% for ICU admission was not burdened by negative outcomes. In a pandemic context, the SpO2 cutoff of 92%, as a threshold for ICU admission, needs critical re-evaluation.

3. Stopping Hospital Infections with Environmental Services (SHINE): A Cluster-Randomized Trial of Intensive Monitoring Methods for Terminal Room Cleaning on Rates of Multidrug-Resistant Organisms (MDROs) in the Intensive Care Unit (ICU)

Background MDROs frequently contaminate hospital environments. We performed a multicenter cluster-randomized, crossover trial of two methods for intensive monitoring of terminal cleaning effectiveness at reducing infection and colonization with MDROs within ICUs. Methods Six medical and surgical ICUs at three medical centers received both intensive monitoring interventions sequentially, in a randomized order. The intervention included surveying a minimum of 10 surfaces each in 5 rooms weekly, after terminal cleaning, with adenosine triphosphate (ATP) monitoring or an ultraviolet fluorescent marker (UV/F). Results were delivered to environmental services (EVS) staff in real-time, with failing surfaces recleaned. The primary study outcome was the monthly rate of infection or colonization with MDROs, including methicillin-resistant Staphylococcus aureus, Clostridioides difficile, vancomycin-resistant Enterococcus, and multidrug-resistant gram-negative bacilli (MDR-GNB), assessed during a 12-month baseline comparison period and sequential 6-month intervention periods, separated by a 2-month washout. Outcomes during each intervention period were compared to the combined baseline period plus the alternative intervention period using mixed-effects Poisson regression, with study hospital as a random effect. Results The primary outcome rate varied by hospital and ICU (Figure 1). The ATP method was associated with a relative reduction in the incidence rate of infection or colonization with MDROs (incidence rate ratio (IRR) 0.887, 95% confidence-interval (CI) 0.811–0.969, P=0.008) (Table 1), infection with MDROs (IRR 0.924, 95% CI 0.855–0.998, P=0.04), and infection or colonization limited to multidrug-resistant MDR-GNB (IRR 0.856, 95% CI 0.825–0.887, P&lt; 0.001). The UV/F intervention was not associated with a statistically significant impact on these outcomes. Room turn-around time was increased by a median of one minute with the ATP intervention and 4.5 minutes with the UV/F intervention compared to baseline. Conclusion Intensive monitoring of ICU terminal room cleaning with an ATP modality is associated with a relative reduction of infection and colonization with MDROs with a negligible impact on TAT. Disclosures Hilary Babcock, MD, MPH, FIDSA, FSHEA (nothing to disclose), David K. Warren, MD, MPH, Homburg & Partner (consultant), Ebbing Lautenbach, MD, MPH, MSCE (nothing to disclose), Jennifer Han, MD, MSCE, GlaxoSmithKline (employee, shareholder).

Anaphylaxis to tocilizumab in patients with rheumatic disease

Background: Anaphylaxis to tocilizumab has been reported anecdotally. Therefore, we evaluated the incidence of anaphylaxis in patients starting tocilizumab. Materials & methods: This retrospective study included patients with rheumatic disease who were administered tocilizumab from 2013 to 2020. The incidence of anaphylaxis was examined during the first 6 months. Results: During follow-up, four of 171 patients developed anaphylaxis within the third course of infusions. The incidence of anaphylaxis to tocilizumab was higher in patients with adult-onset Still’s disease (AOSD) than in those with other rheumatic disease (21.4% in AOSD vs 0.7% in rheumatoid arthritis vs 0% in Takayasu arteritis). Conclusions: When we consider tocilizumab treatment, especially in AOSD, we should keep in mind that intensive monitoring for anaphylaxis is necessary.

Marine mammal strandings in the northern Palk Bay from 2009 to 2020

Globally, the marine mammal population has been under threat due to various human activities. Data on stranding of these animals that are important for effective conservation planning and management, however, are not available in most of the developing countries. This paper presents observations on marine mammal strandings in northern Palk Bay, the southeastern coast of India over the last decade. In total, 21 stranding events consisting of 23 marine mammals were observed from 2009 to 2020. These stranded mammals include a Humpback Dolphin, a Blue Whale, two Finless Porpoises, and 19 Dugongs. The evident reason for the death of the dugongs and the porpoise being fishing activities, regulations on fishing practices, and intensive monitoring of the existing dugong population and their habitats are necessary. This study recommends for establishment of conservation reserve, and setting up district-level marine mammal rescue and release units in Nagapattinam, Tiruvarur, Thanjavur, Pudukkottai, and Ramanathapuram districts, comprising fishers and line departments. These units need to be sufficiently equipped in terms of equipment and infrastructure, and periodical technical training and workshops on marine mammal rescue and release procedures to quickly respond and handle marine mammal strandings in the area.

An Intensive Monitoring of Adverse Drug Reactions in Indoor Patients of Paediatric Department at Tertiary Care Teaching Hospital in Gujarat, India.

they differ from adults in pharmacokinetic and pharmacodynamics responses. ADRs reported in adults do not predict those in children. Thus, this study aimed to intensively monitor ADRs occurred in inpatients of paediatric department of tertiary care teaching hospital to assess the same in terms of incidence, causality, severity and preventability. A prospective observational single centre study was done in the paediatric department of SSG hospital, Vadodara over duration of 8 months. The ADRs were actively monitored and collected reports were analysed for ADR pattern, demographic profile, causality, severity, and preventability. A total of 66 ADRs were documented during the period of 8 months. Among these 53.03% ADRs occurred below the age of 1 year, 89.13% ADRs occurred due to antibiotics, 56.06% ADRs are of Diarrhoea and vomiting and 80.43% ADRs developed after receiving drug intravenously. As per WHO-UMC criteria, 46.96 % ADRs were of probable while 51.51% ADRs were of possible causality while as per Naranjo scale 60.61% ADRs were of probable and 39.39% ADRs were of possible category. As per severity scale 69.70% reactions were mild and 30.30 % reactions were moderate. Probably preventable ADRs were about 57.58%. ADRs occurred more among infants and antibiotics were more commonly implicated. Most of the reactions were of mild severity and were probably preventable. Certain Precautionary measures can lead to significant prevention of ADRs in paediatric patients.