Multidrug resistant Proteus mirabilis and Escherichia coli causing fulminant necrotising fasciitis: a case report

Abstract Background Necrotizing fasciitis is a rare soft tissue infection characterized by rapid progressive necrosis with relative sparing of underlying muscles. This case is reported to highlight the emergence of multidrug resistant microbes in recent days which limits the use of empiric antibiotic therapy and necessitates early cultures and sensitivity enabling targeted antibiotic therapy. Factors that lead to antimicrobial resistance especially in sub-Saharan Africa have also been discussed. Case presentation We report the case of a 52-year-old black man who was referred to our centre for the management of cellulitis and suppurating ulcers of the right leg which had progressed to a wet gangrene. Following physical examination and work-up, a diagnosis of fulminant necrotizing fasciitis of the right leg caused by multidrug resistant Proteus mirabilis and Escherichia coli was made. Despite the broad-spectrum empiric antibiotic therapy and aggressive multiple surgical debridement, necrosis progressed leading to an above-knee amputation. Conclusion Necrotizing fasciitis is a surgical emergency that requires prompt diagnosis and aggressive surgical debridement in order to reduce morbidity and mortality. The emergence of multidrug resistant organisms in recent days have limited the use of empiric antibiotic therapy, necessitating early culture and sensitivity and the use of susceptibility-guided antibiotic therapy. Timely action to control the use of antibiotics in sub-Saharan Africa will reduce multidrug resistance and delay the arrival of post-antibiotics era

Prevalence and association of iron deficiency with anemia among patients with heart failure in the USA: NHANES 2017-2018

Background: Heart failure (HF) is a major debilitating disease. HF patients with iron deficiency(ID) have poorer outcomes and treatment significantly improves outcomes. We set out to update the national prevalence of ID in the USA and its association with anemia using data from NHANES 2017-2018. Methods: Diagnosis of HF was self-reported. ID was defined as serum ferritin levels \u3c100 ng/mL or a ferritin level between 100 and 299 ng/mL with transferrin saturation \u3c20%. Anemia was defined as a hemoglobin level of \u3c13 g/dl and \u3c12 g/dl for men and women, respectively. Differences in prevalence of ID across various groups were assessed using Chi-squared test for categorical variables and equality of means for continuous variables with p-values \u3c0.05 considered statistically significant. Results: A total of 187 persons ≥20 years, corresponding to a 5.57million had HF. The prevalence of ID was 48.17% (95% CI 36.84-59.69) and the prevalence of anemia was 12.08%(95% CI 8.16-17.53). Diabetics (61.03%) were more likely to have ID compared to nondiabetics (35.38%), p 0.022. The prevalence of ID was similar in persons with anemia (47.45%) and persons without anemia (48.27%), p-value 0.983. The prevalence of ID has been constant for at least the past 20 years, making ID in HF an underdiagnose and/or undertreated condition among patients with HF and should be addressed. Conclusions: One in every two persons with HF has ID. Also, prevalence of ID was similar in patients with anemia and without anemia. Anemia should not be considered a prerequisite for screening for ID in patients with HF

Prevalence and control rates of hypertension in the USA: 2017-2018

Background: Recent review of hypertension guidelines requires fresh updates of prevalence and control rates. Though retrospective analysis provided burden estimates, control rates were grossly misleading. We set out to update the prevalence and control rates of hypertension in the USA using contemporary NHANES data. Methods: Persons with mean systolic blood pressure (mSBP) ≥130 mmHg or mean diastolic blood pressure (mDBP) ≥80 mmHg or self-reported current use of antihypertensive medications were classified as hypertensives. Hypertensives on medications with mSBP \u3c130 mmHg and mDBP \u3c80 mmHg were classified as having well-controlled hypertension. Subgroup comparisons of hypertension prevalence were computed using Chi-square test. Predictors of hypertension and well-controlled BP were assessed using multivariable logistic regressions. Two tailed p-values \u3c0.05 were considered statistically significant. Results: The prevalence of hypertension in the USA in 2017-2018 was 49.64% (95% CI 46.67-52.61) corresponding to 115(95% CI 104-128) million persons. NH Blacks: 58.53% (95% CI 55.39-61.60); Men: 54.46% (95% CI 51.01-57.87); older persons and obese individuals: 61.03% (95% CI 57.31-64.63) as well as persons with diabetes and CKD, comparatively. The overall rate of well-controlled hypertension was 39.64% (95% CI 36.20-42.81). Persons with at least a college degree: OR 2.20(95% CI 1.02-5.04, p=0.049) and persons with incomes ≥3 times the poverty threshold; OR 1.88(95% CI 1.1.8-2.99, p=0.011) had higher rates of well-controlled hypertension when compared to lowest categories. Conclusion: One in every two persons ≥20 years in the USA has hypertension with only 39.64% on medications having well-controlled hypertension. Significant discrepancies exist in the burden and control rates in different subpopulation categories. Targeted interventions could help improve the prevalence and hypertension control rates in the USA

10-Year trend in the prevalence and predictors of depression among patients with heart failure in the USA from 2007-2016

BACKGROUND: Heart failure (HF) constitutes a major public health problem in the USA with self-management playing a key role in treatment. Depressed patients often have poor insights which correlates with increased rates of adverse events such as emergency room visits, admissions and readmissions, length of hospital stay and mortality. AIM: To determine the prevalence, trends, and predictors of depression among community-based patients with HF in the USA, and its association with self-perceived health status. METHODS: Using the 2007 through 2016 NHANES data, we identified patients with HF aged 20-80 years with completed PHQ-9 depression screening questionnaire. PHQ-9 scores ≥10 were considered diagnostic for depression. The Chi square test was used for comparison of prevalence of depression between subgroups with p \u3c 0.05 considered statistically significant. RESULTS: The prevalence of depression among community-based patients with HF was 17.3% and remained stable from 2007 through 2016. Female participants, persons CONCLUSION: Over 1 in 6 community-based patients with HF suffers from depression with women, individual