Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey

We explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases-International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (similar to 5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%-90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs' implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted. (C) 2022 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences

The correlation of insulin resistance with serum tumor necrosis factor-alpha levels in patients with rheumatoid arthritis

The aim of this study was to assess the acute insulin response and insulin sensitivity in patients with rheumatoid arthritis. We also examined the correlation of serum tumor necrosis factor-alpha (TNF-alpha) levels with insulin resistance and impaired acute insulin response

Recurrent Gastrointestinal Bleeding, Intraabdominal Abscesses and Synchronous Candidemia and Meningitis Due to Leflunomide Therapy: Case Report

Leflunomide is a tumor necrosis factor-alpha (TNF-alpha) blocking agent which is commonly used in the management of rheumatoid arthritis (RA). We report a suspected case of leflunomide-induced recurrent gastrointestinal bleeding, intraabdominal abscesses with synchronous candidemia and then meningitis. A 63-year-old man was admitted to our Emergency Department with fever, mental confusion, and urinary incontinence. He had been used anticoagulants for ten years because of atrial fibrillation and leflunomide for two years because of RA. A history of two gastrointestinal bleeding attacks, intraabdominal abscess and candidemia during the leflunomide therapy had been documented. We diagnosed meningitis together with intraabdominal abscess, gastrointestinal bleeding, and candidemia in the third hospitalization of the patient. Leflunomide was discontinued, and the patient was treated with antimicrobials (antifungal and antibacterial) and surgical procedures consisting of drainage and resection of the intrabdominal abscess. Symptoms and signs of the patient were improved and he was discharged on the 25th day of hospitalization. There was no recurrence in following six months period. Leflunomide should be started after very strict evaluations to indicated patient. These evaluations should be focused on primarily tendency to bleeding especially in oral anticoagulant users and possible infectious complications of community acquired or nosocomial originated

Comparison of ketamine-propofol and remifentanil in terms of hemodynamic variables and patient satisfaction during monitored anaesthesia care

  BACKGROUND: This study aimed to compare remifentanil and ketamine-propofol in terms of hemodynamic response, duration of recovery and patient satisfaction in operative hysteroscopy cases who underwent monitored anaesthesia care in combination with paracervical block. METHODS: Monitored anaesthesia care was used in 60 ASA I-II female patients. The patients were divided into two groups as remifentanil (Group R) and ketamine-propofol (Group K-P). The hemodynamic effects of remifentanil and ketamine-propofol, and duration of recovery were recorded and compared. The patient satisfaction was also recorded and the two groups were compared. RESULTS: Age, body mass, ASA status, duration of anaesthesia and type of surgery were found to be similar between groups. The time of the Aldrete score reaching ≥ 9 was found to be shorter in Group R when compared with Group KP (Group R: 4.1 ± 1.9 min, Group K-P: 6.1 ± 2.6 min) (P < 0.05). The incidence of postoperative nausea and vomiting was found to be significantly higher in the remifentanil group (P ≤ 0.05). When the groups were compared in terms of patient satisfaction, in both groups this was found to be similar. CONCLUSION: Sedation with remifentanil combined with a paracervical block during monitored anaesthesia care provides early recovery with effective sedation and analgesia in hysteroscopy procedures.  BACKGROUND: This study aimed to compare remifentanil and ketamine-propofol in terms of hemodynamic response, duration of recovery and patient satisfaction in operative hysteroscopy cases who underwent monitored anaesthesia care in combination with paracervical block. METHODS: Monitored anaesthesia care was used in 60 ASA I-II female patients. The patients were divided into two groups as remifentanil (Group R) and ketamine-propofol (Group K-P). The hemodynamic effects of remifentanil and ketamine-propofol, and duration of recovery were recorded and compared. The patient satisfaction was also recorded and the two groups were compared. RESULTS: Age, body mass, ASA status, duration of anaesthesia and type of surgery were found to be similar between groups. The time of the Aldrete score reaching ≥ 9 was found to be shorter in Group R when compared with Group KP (Group R: 4.1 ± 1.9 min, Group K-P: 6.1 ± 2.6 min) (P < 0.05). The incidence of postoperative nausea and vomiting was found to be significantly higher in the remifentanil group (P ≤ 0.05). When the groups were compared in terms of patient satisfaction, in both groups this was found to be similar. CONCLUSION: Sedation with remifentanil combined with a paracervical block during monitored anaesthesia care provides early recovery with effective sedation and analgesia in hysteroscopy procedures

Obstetric outcomes and prognostic factors of lupus pregnancies

To determine maternal and fetal outcomes in pregnancies with Systemic Lupus Erythematosus (SLE), and to evaluate the prognostic factors that may affect obstetrical outcomes

Diagnosis and outcome of pregnancies with prenatally diagnosed fetal dextrocardia

Objective: To evaluate the incidence, associated cardiac and extracardiac malformations and clinical outcome of fetuses with dextrocardia

Splenic complications in malaria: report of two cases from Turkey

Malaria is still a major health problem in Turkey, where Plasmodium vivax malaria is endemic. Spontaneous rupture of the spleen is an important and life-threatening complication and occurs in up to an estimated 2% of cases. Hence the small number of case reports suggests under-reporting or underdiagnosis. Review articles have reported only 18 malaria cases with spontaneous splenic rupture in the English language literature since 1960. Two cases of P. vivax malaria with splenic complications are reported here. One of them showed signs and symptoms of acute abdominal pain, then splenic rupture occurred

Scimitar syndrome and pregnancy, complicated with severe preeclampsia

Scimitar syndrome (pulmonary venolobar syndrome) is a rare anomaly of venous return to the heart, most commonly consisting of partial or total anomalous pulmonary venous return from the right lung. This is the report of a case of a 29-year-old woman at 31 weeks of gestation of pregnancy who was previously diagnosed with scimitar syndrome. MR angiography and PET-CT results which were obtained before pregnancy demonstrated vascular malformation in the inferior part of the right lung. No specific treatment was planned throughout the pregnancy due to the absence of any symptoms. The patient's first physical examination was unremarkable except mild hypertension. In her follow-up, severe preeclampsia was developed and the patient had undergone a cesarean section of a live birth at 34 weeks and 2 days of gestation. This is the first case of scimitar syndrome with pregnancy in which the cardiac status of the patient deteriorated coincidentally due to the development of another manifestation such as severe preeclampsia besides the syndrome itself