Infliximab rescue therapy in a patient with acute severe ulcerative colitis and coronavirus disease 2019 followed by Escherichia coli 0157:H7 infection: a case report

The management of patients with acute severe ulcerative colitis and SARS-CoV-2 presents a clinical challenge. We report on the first case of a patient with acute severe ulcerative colitis and mild coronavirus disease 2019 (COVID19) who received rescue infliximab therapy, followed by a relapse caused by enterohemorrhagic Escherichia coli 0157:H7. The treatment challenges we faced were biologic therapy administration during active COVID-19, about which little was known at the time, and how to treat EHEC due to the risk of hemolytic uremic syndrome. Acute severe ulcerative colitis was treated with rescue infliximab therapy, and enteric infection with an antibiotic, both with satisfactory clinical response. The decision to induce biologic therapy for inflammatory bowel disease relapse in SARS-CoV-2-positive patients should be made on a caseto-case basis and should be driven by the dominant disease. Our patient tested positive for SARS-CoV-2, but actually had mild disease. At the same time, she had acute severe ulcerative colitis, so we started anti-tumor necrosis factor therapy despite serological tests and the recommendation to delay biological therapy administration for two-weeks. Second, due to severity of the first flare, COVID-19, and the patient’s general condition, we opted for an antibiotic treatment of Escherichia coli 0157:H7 while monitoring the parameters of potential hemolytic uremic syndrome developmen

Anemija kronične bolesti: bolest ili adaptivni mehanizam

The anemia of chronic disease (ACD) is the most prevalent anemia after iron deficiency anemia. It is associated with infectious, inflammatory and neoplastic disease. ACD is a medical condition caused by the release of cytokines which mediate inflammatory and immune response (tumor necrosis factor, interleukins 1 and 6, and interferon). Abnormal iron metabolism with iron trapping in reticuloendothelial cells is primarily the cause of this condition, making iron unavailable for erythropoiesis although iron tissue reserves are elevated. Disorder in erythropoietin secretion and shortening of red cell life span also play a role in the pathogenesis of ACD. The main therapy is treatment of the underlying disorder and red cell transfusions in severe anemia. In more severe (protracted) anemias that lead to impaired quality of life and have an impact on the mortality and survival rate, erythropoiesis stimulating agents are used. Recently, new possibilities are being evaluated in terms of therapy for ACD in defined conditions, such as chelating agents, as well as hepcidin antagonist and other erythropoiesis stimulating agents.Anemija kronične bolesti je iza sideropenične anemije najraširenija vrsta anemije. Pojavljuje se uz infekcije, upale i zloćudne bolesti. Nastaje kao posljedica lučenja upalnih citokina koji posreduju u upalnom i imunom odgovoru (faktor nekroze tumora, inteleukin-1 i interferoni). Glavni poremećaj se sastoji u poremećenom metabolizmu željeza koje ostaje zarobljeno u stanicama retikuloendotelnog sustava i nije na raspolaganju eritropoezi iako ga u tkivnim rezervama ima u suvišku. Također je poremećeno lučenje eritropoetina i skraćen je poluživot eritrocita. Liječenje se sastoji u terapiji osnovne bolesti, transfuzijama eritrocita kod teže anemije, a kod dugotrajnih anemija koje ugrožavaju kavalitetu života i imaju utjecaj na ukupnu smrtnost i možda preživljenje terapija se po određenim definiranim uvjetima može provoditi tvarima koje stimuliraju eritropoezu. U novije vrijeme se razmatraju i druge mogućnosti liječenja poput kelirajućih tvari

VASCULAR VIBRATION INJURY AND PAGET-SHROETTER SYNDROME

Sindrom Paget-Schroetter je relativno rijetko medicinsko stanje koje označava primarnu trombozu aksilarne vene odnosno vene supklavije na kostoklavikularnom spoju. Vibracijska ozljeda rijedak je etiološki čimbenik u nastanku ovog kliničkog entiteta. Prikazujemo slučaj 28-godišnjeg muškarca koji se prezentirao s akutno nastalim edemom lijeve ruke nakon cjelodnevnog rada s pneumatskom bušilicom. Vaskularnim ultrazvukom dokazan je tromb u lijevoj aksilarnoj veni te u veni supklaviji, te je započeta terapija niskomolekularnim heparinom.Paget-Schroetter syndrome is a relatively uncommon condition related to primary thrombosis of the axillary/subclavian vein at the costoclavicular junction. Vibration injury is an unusual cause of this syndrome. We report on a 28-year-old man who presented with acute onset left arm swelling after whole-day work with a pneumatic drill. Duplex ultrasound confirmed the presence of a thrombus in his left axillary and subclavian vein, which was treated with low molecular weight heparin, eventually switched to oral anticoagulation

The impact of interventions to improve adherence to preventive measures on the incidence of nosocomial infections in ICUs

Half of all life-threating nosocomial infections occur in intensive care units (ICUs) and, despite the advances in intensive care, the incidence of nosocomial infections is still high. About one third of nosocomial infections are considered preventable. Awareness of risk factors, adherence to preventive measures and collaboration of all members participating in preventive programmes can lead to reduction of the incidence of nosocomial infections and thus can produce a positive impact on reducing morbidity, mortality and healthcare costs. A retrospective surveillance study was performed in a 14-bed medical ICU to identify device-related infections before and after the preventive interventions. Ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) were obtained and compared before and after the interventions. In the year before the interventions, device-related nosocomial infections were diagnosed in 7.9% out of 737 hospitalised patients in the ICU, and in the year after the interventions they were diagnosed in 5.1% out of 684 hospitalised patients. Before the interventions, the infection rates were distributed as follows: 7.5 CLABSI/1000 catheter days, 28.4 VAP/1000 ventilator days, 6.5 CAUTI/1000 catheterisation days. After the interventions, the rates were distributed as follows: 2.5 CLABSI/1000 catheter days, 26.5 VAP/1000 ventilator days and 4.1 CAUTI/1000 catheterisation days. The implementation of effective preventive measures and maintaining strict surveillance is the basis of limiting the risk of nosocomial infections. Since hospital nosocomial infection rate is considered an indicator of quality and safety of care, all infection control activities are focused to decrease rate of nosocomial infections

Prijelomi dijafize humerusa: liječenje antegradnim usidrenim endomedularnim čavlom s primjenom neutralizacijskih vijaka kroz frakturnu pukotinu

The aim of this study was to compare union time between two different nail designs for the treatment of humeral shaft fracture, i.e. antegrade interlocking intramedullary nail with and without additional interlocking neutralization screws. The retrospective study included 51 patients treated with antegrade humeral intramedullary nailing between January 2015 and December 2017. The inclusion criteria of the study were proximal and middle third humeral shaft fractures. Fifty-one patients met the inclusion criteria; 23 patients were treated with antegrade intramedullary nail with additional interlocking neutralization screws through fracture site (group A) and 28 patients were treated with antegrade intramedullary nail without additional interlocking neutralization screws (group B). Medical documentation and radiographic images taken preoperatively and postoperatively were reviewed. Radiological union was defined as cortical bridging of at least three of four cortices in two-plane radiographs, with disappearance of the fracture gap. There were no significant differences in union time between the groups (p>0.05). To our knowledge, this is the first report of antegrade interlocking humeral nailing with additional interlocking neutralization screws through fracture site. Hypothetical advantages of fracture gap reduction by additional interlocking neutralization screws to promote union were not confirmed by this first clinical trial.Cilj ovoga istraživanja bio je usporediti vrijeme cijeljenja prijeloma dijafize humerusa pri liječenju s dva različita dizajna intramedularnog čavla: antegradni ukotvljeni intramedularni čavao s dodatnim ukotvljenim neutralizacijskim vijcima i bez njih. Retrospektivna studija obuhvatila je 51 bolesnika liječenog antegradnim humeralnim intramedularnim čavlima između siječnja 2015. i prosinca 2017. godine. Kriteriji uključenja u studiju bili su prijelomi proksimalne i srednje trećine dijafize humerusa. Pedeset i jedan bolesnik je ispunio kriterije uključenja: 23 bolesnika su liječena antegradnim intramedularnim čavlom s dodatnim ukotvljenim neutralizacijskim vijcima kroz mjesto prijeloma (skupina A), a 28 bolesnika je liječeno antegradnim intramedularnim čavlom bez dodatnih ukotvljenih neutralizacijskih vijaka (skupina B). Analizirana je medicinska dokumentacija i radiološke slike učinjene prije i poslije operacije. Radiološko cijeljenje prijeloma definirano je kao kortikalno premošćivanje najmanje tri od četiri korteksa u dvoprofilnim radiografima, s nestankom frakturne pukotine. Nije bilo značajne razlike u vremenu cijeljenja prijeloma između skupina (p>0,05). Prema našim spoznajama, ovo je prva studija o liječenju prijeloma humerusa antegradnim intramedularnim čavlom s dodatnim ukotvljenim neutralizacijskim vijcima kroz mjesto prijeloma. Hipotetsku prednost redukcije prijelomne pukotine s dodatnim ukotvljenim neutralizacijskim vijcima u svrhu poticanja cijeljenja nije potvrdila ova prva klinička studija