1188 Management of Prosthetic Joint Infections and Fracture Related Infections at A District General Hospital

Aim The aim of our study was to determine if there was cohesion in management of orthopaedic infections between the surgical and microbiology team to ensure optimal patient outcome in accordance with BOA standards for management of Orthopaedic infections. Surgical sampling intraoperatively of orthopaedic infections was evaluated. Method We retrospectively reviewed 19 patients that had suspected PJI or fracture related infections between July 2019 to December 2019 at a District General Hospital. Patient information was collated from patient notes, fusion, bone infection database and MDT notes. Analyses were performed using R (R Foundation for Statistical computing, Vienna, Austria). Results 19/19 patients had a preoperative antibiotic plan prior to index surgery. 0% of discharge summaries contained information for patients or primary care staff regarding management of a suspected orthopaedic infection. 100% of patients who were septic were reviewed by a consultant within 24hours of admission. 72% of patients that had operative intervention had 5 microbiology + 2 histology samples. 0% of patients had surgical recording of process of sampling. All patients were discussed at the newly formed Bone infection MDT with a microbiology consultant, radiologist, and allied health professionals. Conclusions For optimal management of orthopaedic infections an MDT approach is vital. Early microbiological input and appropriate surgical sampling and debridement are key to providing a diagnosis of deep infection. The newly created PJI pathway will aid future management of orthopaedic infections and standardise care.

Osteomyelitis in Children from Rural Population of Uttar Pradesh

Occurrence of Staphylococcus aureus in children with osteomyelitis. This study was conducted at K. M. M. C. & Hospital, Mathura (UP). A total of 60 patients with osteomyelitis contributed to this study from October 2017 to October 2019. Patients with known immunodeficiency syndromes were excluded. Specimen collections were meticulously performed to avoid contamination which was accomplished by needle aspiration or surgical sampling. Staphylococcus aureus was recovered in more than half of the cases of osteomyelitis in both infants and children. Amikacin, Clindamycin and Cefazolin were effective in such cases. The distal end of the femur and upper-end tibia were the most common sites of infection where boys were more infected than girls. The haematogenous route was the main cause of the transmission of osteomyelitis in children. Principally Staphylococcus aureus causes the majority of cases of osteomyelitis in children followed by H. influenza, Group B Streptococcus, P. aeruginosa, E. coli and Serratia marcescens.

Stomach Content Analysis of Tilapia Fish (Oreochromis mossambicus) in Talaga Lake Waters Donggala Regency

Tilapia fish (Oreochromis mossambicus) is a type of freshwater consumption fish, flat body shape with grey, brown or black colour. The purpose of this study was to describe the types of food found in the stomach of tilapia fish (Oreochromis mossambicus) in Talaga Lake, Donggala Regency. This research was conducted in April 2019. The method used in this study was a volumetric occurrence frequency method by a surgical sampling of fish to extract the stomach and analyze it. Based on the results of the analysis of the stomach contents of the Mujair fish (Oreochromis mossambicus), two groups of feed were obtained, namely Vegetable food (Fitoplaknton) in the form of Navicula placentula, Schroederia segitera, Schoroederia anchora, Zignemopsis circumcaniratum, Anabaena sp, Oscillatoria princeps, Spirogyra protifica, Bacillaria sp, Nitzschia aetinastroides, Oedogonium sp, Coelastrum chodati, and animal feed (Zooplankton) in the form of Tubipex sp, Brachionus havanaensis, Cyclops sp, Carcinus sp, Arcella sp, Acetes sp.

Malpractice and Patient Safety Concerns

Objectives “Assurance behaviors,” a type of defensive medicine, involve physicians’ utilization of additional patient services to avoid adverse legal outcomes. We aim to compare the use of clinical behaviors (such as ordering additional tests, services, and consultations) due to malpractice concerns with the same behaviors due to patient safety concerns. Methods A national sample of dermatopathologists (n = 160) completed an online survey. Results Participants reported using one or more of five clinical behaviors due to concerns about medical malpractice (95%) and patient safety (99%). Self-reported use of clinical behaviors due to malpractice concerns and patient safety concerns was compared, including ordering additional immunohistochemistry/molecular tests (71% vs 90%, respectively, P < .0001), recommending additional surgical sampling (78% vs 91%, P < .0001), requesting additional slides (81% vs 95%, P < .0001), obtaining second reviews (78% vs 91%, P < .0001), and adding caveats into reports regarding lesion difficulty (85% vs 89%, P > .05). Conclusions Dermatopathologists use many clinical behaviors both as assurance behaviors and due to patient safety concerns, with a higher proportion reporting patient safety concerns as a motivation for specific behaviors.

18F-Fluciclovine PET to distinguish treatment-related effects from disease progression in recurrent glioblastoma: PET fusion with MRI guides neurosurgical sampling

Differentiation of true tumor progression from treatment-related effects remains a major unmet need in caring for patients with glioblastoma. Here, we report how the intraoperative combination of MRI with18F-fluciclovine PET guided surgical sampling in 2 patients with recurrent glioblastoma.18F-Fluciclovine PET is FDA approved for use in prostate cancer and carries an orphan drug designation in glioma. To investigate its utility in recurrent glioblastoma, we fused PET and MRI images using 2 different surgical navigation systems and performed targeted stereotactic biopsies from the areas of high (“hot”) and low (“cold”) radiotracer uptake. Concordant histopathologic and imaging findings suggest that a combined18F-fluciclovine PET-MRI–guided approach can guide neurosurgical resection of viable recurrent glioblastoma in the background of treatment-related effects, which can otherwise look similar on MRI.