The Interplay Between Reward-Relevant Life Events and Trait Reward Sensitivity in Neural Responses to Reward Cues

The reward-hypersensitivity model posits that trait reward hypersensitivity should elicit hyper/hypo-approach motivation following exposure to recent life events that activate (goal striving and goal attainment) or deactivate (goal failure) the reward system, respectively. To test these hypotheses, we had 87 young adults with high trait reward (HRew) sensitivity or moderate trait reward (MRew) sensitivity report frequency of life events via the Life Event Interview. Brain activation was assessed during the functional MRI monetary-incentive-delay task. Greater exposure to goal-striving events was associated with higher nucleus accumbens (NAc) reward anticipation among HRew participants and lower orbitofrontal cortex (OFC) reward anticipation among MRew participants. Greater exposure to goal-failure events was associated with higher NAc and OFC reward anticipation only among HRew participants. This study demonstrated different neural reward anticipation (but not outcome) following reward-relevant events for HRew individuals compared with MRew individuals. Trait reward sensitivity and reward-relevant life events may jointly modulate reward-related brain function, which has implications for understanding psychopathology.

Complicated COVID-19 pneumonia in an infant: A rare entity

In the era of the COVID-19 pandemic, children are spared from severe disease, accounting for 0.39–12.3%. According to a study in Wuhan China, only 2.7% of children are developed severe pneumonia. There are few cases reported with COVID-19 pneumonia in infants. We report the case of a 45-day-old infant who presented with respiratory distress with COVID-19 pneumonia required mechanical ventilation with an intercostal drainage tube for pyopneumothorax. The child was treated with intravenous antibiotics with supportive oxygen therapy. The fluid report of the pyopneumothorax was showing MRSA growth, so antibiotics were modified according to the sensitivity report. In this case report, COVID-19 pneumonia presented with complications in the form of pyopneumothorax with secondary bacterial infection and was successfully treated with a vigilant approach.

MRSA infection of masticatory spaces in a paediatric patient

Diagnosis of source of maxillofacial infection in paediatric patients can be challenging due to difficulty in eliciting a proper history and multiple potential sources of infection. Identification and removal of the nidus of infection with decompression and institution of antibiotic therapy as per the culture-sensitivity report form the mainstay treatment of the infection. Deviation from it may result in persistence or even progression of infection, resulting in significant morbidity and mortality. In the past decade, the incidence of community-acquired methicillin-resistant Staphylococcus aureus infection in the oral cavity has seen an upward trend. This has further led to an increase in complexity in the diagnosis of maxillofacial infections. In this case, the authors want to bring to light the challenges faced in managing a paediatric patient with persistent fascial space infection even after removal of the offending tooth, which signifies the importance of managing the infection by the time-tested protocol.

Comparison of empirical antibiotics used with microbiological sensitivity pattern among patients admitted with urinary tract infection

Background: Symptomatic Urinary tract infection (UTI) is among the most common infection described in hospital settings. Inappropriate use of antibiotics initiated before the laboratory results of urine culture contribute to increasing resistance to antibiotics in uropathogens. Awareness of the disease, knowledge of the spectrum of antibiotics and common complication of UTI will help to reduce morbidity and mortality. This study compares common empirical antibiotics used with their clinical outcomes and microbiological sensitivity pattern among patients admitted with UTI in a tertiary care hospital.Methods: It is a cross sectional study conducted in inpatients of Pushpagiri medical college, Thiruvalla from January 2017 – June 2018. Assuming that 50% of organisms will show sensitivity to empirical antibiotic therapy with a relative precision of 20% and alpha error of 5 %. Sample size is calculated as 100. Those patient satisfying the inclusion criteria was recruited into the study after obtaining informed consent till the sample size attained. Symptoms on the day of admission was assessed using the questionnaire for Clinical profile. Primary outcome was matching of empirical antibiotics with culture and sensitivity pattern. Secondary outcomes were Symptom resolution on third day with empirical antibiotics and profile organisms causing UTI.Results: Majority of the population belonged to 61-80 year of age (57%). The study population had 44 percent male and 56 females.72 percent of total population was diabetic. The most common antibiotic used to treat empirically was piperacillin –tazobactum accounting for 47.2 percent followed by ceftriaxone 45 percent. Others contributed less than 8 percent.75 percent of empirical antibiotics matched with culture and sensitivity report in the study population.The most common organisms found was Escherichia coli (61%) followed by Klebsiella pneumonia(15 %) The most common resistant organism was E Coli followed by Klebsiella pneumonia. Esbl resistance was encountered in 28 cases and carbepenamase resistance in 2 percent cases. 27 percent of diabetic patient had resistant organism infection in urine. Symptoms of urinary tract infections were better resolved when empirical antibiotics used had matched microbiological sensitivity pattern.Conclusions: After the age of 60 year UTI occurred almost equal in male and females There was only 75 percent agreement with empirical antibiotics and culture sensitivity report. Resistant organism were common in the diabetic population. Most common organism encountered in symptomatic UTI is E coli. Symptomatic resolution occurred in majority of cases where the empirical antibiotic was sensitive than compared to resistant case. Some of the resistant cases had symptomatic resolution possibly explained by the in vivo sensitivity. As the agreement with empirical antibiotics became low, hospital antibiotic policies must reviewed and changed according to resistance pattern and type of organism that is locally prevalent

A rare case on Rheumatic Heart Disease with Urosepsis and Septic shock

Rheumatic heart disease(RHD) is an inflammatory disease that mostly occurs in children of 5-15 years old. The major complications of RHD include arrhythmias, especially atrial fibrillation, stroke, infective endocarditis, cardiac failure, and also noted that problems increased in pregnancy. This is a rare case of RHD and urosepsis in a 67- year- old patient with a known history of cerebrovascular accident, pulmonary Arteriovenous(AV) malformation, acute renal failure, and hyponatremia presented to the emergency department with complaints of fever, severe breathlessness, and cough. The patient initially showed clinical manifestations of elevated inflammatory markers, neutrophilic leucocytosis, and hyponatremia, indicating septic shock. Our patient had been empirically treated with Piperacillin-Tazobactam because of the clinical features of urosepsis with septic shock. Based on Bronchoalveolar lavage(BAL) culture with non-fermenter Presumptive Acinetobacter and Klebsiella species and culture sensitivity report antibiotics were changed to Colistin and meropenem. The presence of carbapenem-resistant Klebsiella pneumoniae (CR Kp) entails stopping meropenem and adding tigecycline. Further creatinine clearance declined, and the drug Colistin was changed to Polymixin B. Meropenem was readministered based on the culture reports with scanty growth of multidrug-resistant Proteus mirabilis. Rational use of antibiotics along with the appropriate supportive measures is a meaningful measure in treating a rare and complicated condition of RHD with urosepsis.

Bacterial etiology of otitis media and their antibiogram among patients attending tertiary care hospital

<p class="abstract"><strong>Background:</strong> Otitis media is one of the common infection prevalent worldwide. Chronic ear infection in older children can cause hearing loss which leads difficulty in communication, learning and social adjustment. It can result to severe disability, death due to central nervous system disorder in developing countries. Hence, the present study aimed to determine the bacteriological profile and its antibiogram of ear infection.</p><p class="abstract"><strong>Methods:</strong> This study conducted in ENT department of MNR Medical College and Hospital during the period of October 2019 to January 2020. </p><p class="abstract"><strong>Results:</strong> A total of 120 patients were included in this study. Among the total, 70 were adult (58.3%), age group ranges between 20-55 years and 50 were children (41.6%). Bacterial isolates from ear swab included; <em>Staphylococcus aureus</em> 28, <em>Pseudomonas </em>19, <em>Klebsiella spp</em> 15, <em>Proteus spp</em> 10, <em>Escherichiae coli</em> 7, <em>Enterobacter spp</em> 4 and <em>Citrobacter spp</em> 2. Overall bacteria mostly sensitive to drugs like pipercillin tazobactum (85%), amikacin (90%) and gentamycin (90.2%). Other than these drugs ampicillin (90.1%), cefazolin (90%), cefuroxime (89.4%), ceftriaxone (81%), oxacillin (83.4%), penicillin (88.2%) showed highly resistant to bacterial isolates.</p><p class="abstract"><strong>Conclusions:</strong> Therefore, it is clear from this study that, most of the prescribed drugs were resistant to bacteria isolated from ear infection. Hence it is mandatory to include culture and sensitivity report to manage the cases of otitis media.</p>

Management of infections with Mycobacterium other than tuberculosis as a complication of surgical procedures

Background: Atypical Mycobacterium other than tuberculosis (MOTT) have emerged as significant human pathogens, causing post-surgical wound infections. The aim of this study is to assess the causative organisms of such infection and their treatment response.Methods: After matching the criteria, 28 cases, were taken for this prospective, single center, observational study. The diagnosis was confirmed by bacterial culture.Results: Among 28 patients, 16 were females (median age of 45.5 year). Patients had undergone laparoscopic cholecystectomy (n=13), laparoscopic appendicectomy (n=3), laparoscopic hernioplasty (n=2), open appendicectomy (n=2), open mesh hernioplasty (n=7), exploratory laparotomy (n=1). No major comorbidities or immunosuppression was identified. All patients were initially treated with repeated incision and drainage and started conventional antibiotics until culture and sensitivity report was available. All except one patient had culture confirmed MOTT infection. Combination antibiotics (clarithromycin, linezolid and ofloxacin) given for initial 3 months. 12 well responded within 3 months. 9 required additional few months to get complete cure. 4 patients cured after 6 months of treatment and 3 patients did not come for follow up.Conclusions: Delayed onset chronic wound infection by atypical mycobacteria is preventable. These organisms are not responsive to conventional antitubercular drugs but to specific drug regimens.

Effectiveness of Ciprofloxacin and Levofloxacin in treatment of Pseudomonas Aeruginosa infection

Background: Pseudomonas aeruginosa is the most troublesome and feared pathogen in medical field. It is the sixth mostcommon cause of hospital-acquired infections and the cause of ventilator-associated pneumonia. The most common multidrugresistantgram-negative pathogen in Ventilated Assisted Patient. In our study in 100 patients culture and sensitivity report only 46%were sensitive to oral treatment while 54% of the pseudomonas were resistant to ciprofloxacin and 34% sensitive and 66%resistant to levofloxacin.Objective: To find out resistance of pseudomonas to oral medication.Material and Methods: A cross-sectional study, conducted in Saidu Group of Teaching Hospital from January 2018 to July 2019. ).100 patient samples (tracheal aspirate, bronchial washing, sputum, pus, urine and blood) were cultured for pseudomonas and itssensitivity to oral medication ciprofloxacin and levofloxacin was recorded.Results: Sensitivity to 46% were samples was observed to oral treatment while 54% of the pseudomonas were resistant tociprofloxacin and 34% sensitive and 66% resistant to levofloxacin respectively.Conclusion: It was found that 54% pseudomonas were resistant to Ciprofloxacin and 66% resistant to levofloxacin. So we shouldalways consider for combination therapy.

Management of Infections with Mycobacterium Other Than Tuberculosis (MOTT) as a Complication of Surgical Procedures.

BACKGROUND:Atypical mycobacteria (MOTT) have emerged as significant human pathogens, causing post-surgical wound infections.The aim of this study is to assess the causative organisms of such infection and their treatment response.METHODS:After matching the criteria, 28 cases, were taken for this prospective, single center, observational study.The diagnosis was confirmed by bacterial culture. RESULTS:Among 28 patients, 16 were females (median age of 45.5 year). Patients had undergone laparoscopic cholecystectomy ( n=13 ), laparoscopic appendicectomy ( n=3), laparoscopic hernioplasty ( n=2 ), open appendicectomy ( n=2 ), open mesh hernioplasty ( n= 7 ), exploratory laparotomy (n=1 ). No major comorbidities or immunosuppression was identified. All patients were initially treated with repeated incision and drainage and started conventional antibiotics until culture and sensitivity report was available.All except one patient had culture confirmed MOTT infection. Combination antibiotics (clarithromycin, linezolid and ofloxacin ) given for initial 3 months. 12 well responded within 3 months. 9 required additional few months to get complete cure. 4 patients cured after 6 months of treatment and 3 patients did not come for follow up.CONCLUSIONS:Delayed onset chronic wound infection by Atypical mycobacteria is preventable.These organisms are not responsive to conventional antitubercular drugs but to specific drug regimens.

Gradenigo’s syndrome: a petrous apex lesion

<p class="abstract">Unsafe chronic suppurative otitis media (CSOM) requires early attention, otherwise leads to various extracranial and intracranial complications. Petrositis is one of the complications of temporal bone due to unsafe CSOM leading to inflammation or abscess in the petrous apex along with involvement cranial nerves V and VI nerve and leading to a trio of symptoms like ipsilateral otorrhea, deep facial pain and ipsilateral lateral rectus palsy, this clinical trio collectively called as Gradenigo’s syndrome. We have done retrospective study of 3 cases who were presented to our tertiary care centre ENT-OPD with symptoms suggestive of Gradenigo’s syndrome. Cases selected by simple random sampling. Cases with ear malignancy was excluded from study. Cases were followed up for 3 months and results were analysed. Petrositis if ignored can lead to rare but fatal complication of unsafe CSOM. Common in males in third decade and the ear swab suggestive of common organism was pseudomonas. Medical management given as per culture and sensitivity report of ear swab and then followed by definitive surgery of canal wall down tympano-mastoidectomy with petrous apex decompression.</p>