ESBLs: A Clear and Present Danger?

Extended spectrum β-lactamases (ESBLs) are enzymes produced by a variety of Gram negative bacteria which confer an increased resistance to commonly used antibiotics. They are a worrying global public health issue as infections caused by such enzyme-producing organisms are associated with a higher morbidity and mortality and greater fiscal burden. Coupled with increasing prevalence rates worldwide and an ever diminishing supply in the antibiotic armamentarium, these enzymes represent a clear and present danger to public health. This article aims to give an overview of the current situation regarding ESBLs, with a focus on the epidemiology and management of such infections

Best practice standards for the delivery of NHS infection services in the United Kingdom

Infection expertise in the NHS has historically been provided predominantly by hospital-based medical microbiologists responsible for provision of diagnostic services and advice to front-line clinicians. While most hospitals had consultant-led microbiology departments, infectious iiseases departments were based in a small number of specialist centres. The demand for infection expertise is growing in the NHS, driven by advances in medical care, increasing awareness of the impact of antibiotic resistant and healthcare associated infections and threats from emerging infectious diseases. At the same time diagnostic services are being reorganised into pathology networks. The Combined Infection Training (CIT) is delivering a consultant workforce with expertise both in laboratory diagnostic practice and delivery of direct patient care. These changes create challenges for delivery of high quality infection expertise equitably across the NHS. They also offer an opportunity to shape infection services to meet clinical and laboratory demands.To date there has not been an attempt to bring together a single set of best practice guidelines for the requirements of an infection service. This document sets out seven standards. These are written to be practical and flexible according to the diverse ways in which infection expertise may be required across the NHS. It has been prepared by the Clinical Services Committee of the British Infection Association drawing on published evidence and guidance where they exist and on the group’s extensive experience of delivering infection services in hospitals across the NHS. It was then refined with input from the RCP Joint Specialist committee (JSC) and the RCPath Specialist Advisory Committee (SAC) and through consultation with the RCPath membership. It has been endorsed by the Royal College of Pathologists and the Royal College of Physicians. It will be reviewed annually by the CSC and updated as additional evidence becomes available

Outcomes of Unstable Subaxial Cervical Spine Fractures Managed by Posteroanterior Stabilization and Fusion

Study Design Retrospective study. Purpose To evaluate clinical and radiological outcomes of unstable subaxial cervical spine injuries managed by both posterior tension band column stabilization and anterior decompression, stabilization, and fusion. Overview of Literature Unstable subaxial cervical spine injuries often involve disruption of the anterior column and posterior tension band osteoligamentous complex. Such injuries need immediate surgical intervention. Different methods of reduction and surgical approaches have been published in the literature, with lack of consensus on a uniform or standardized method. Controversy still exists regarding stabilization of unstable cervical fractures by anterior or posterior approach alone or combined approaches. Methods We retrospectively evaluated 24 patients with post-traumatic unstable subaxial cervical spine injuries with their preoperative clinical details, X-ray, computed tomography, and magnetic resonance imaging of the cervical spine for fracture classification based on the mechanism of injury with status of disc herniation and posterior tension band disruption. All patients were managed by immediate reduction, posterior and anterior stabilization, and fusion in a single session of anesthesia. Data of all patients were analyzed with respect to pre- and postoperative neurological status based on American Spinal Injury Association grading, Visual Analog Scale score, the observation of bony fusion, and implant failure at 1, 3, 6, and 12 months. Data were analyzed using paired t-test. Results All patients had solid fusion at the desired level with considerable neurological improvement at the 1-year follow-up. Conclusions In unstable cervical injuries, stabilization of disrupted posterior tension band increases the stability of anterior plating and fusion. This method of immediate reduction and circumferential stabilization is rapid, safe, and effective and has a low rate of complications

Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System

OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system

A comprehensive study on maxillofacial trauma conducted in Yamunanagar, India

BACKGROUND: The Department of Oral and Maxillofacial Surgery, D.A.V [C] Dental College and Hospital, Yamuna Nagar, Haryana, India conducted a study on patients with maxillofacial fractures in a time span of seven years (2003-2010). The purpose of this study was to evaluate their aetiology, incidence, patterns and different modalities employed for management. METHODS: In this study, 740 patients with 1054 fractures were evaluated clinically and radiographically, based on which closed reduction and open reduction was undertaken. Review of patient records included: Age, sex, time, mechanism and etiology of injury, history of bleeding, unconsciousness and prior first aid, type of vehicle and use of preventive measures, type of fracture and treatment modalities. RESULTS: Road traffic accidents accounted for highest number of fractures predominantly occurring in the age group of 21-30 years (38.3%)1,2. Males incurred more fractures with a male female ratio of 4.2: 1.Mandible was the most commonly fractured bone with parasymphysis being the commonest affected site.76.66% patients had associated head injury and 15.68 % had history of unconsciousness. Open reduction and internal fixation was the preferred modality for mandible whereas the mid face fractures were treated more often by closed methods. CONCLUSIONS: Injuries occurred more commonly in 20 – 40 age range with road traffic accident being the major etiological factor. Majority of the patients were driving two wheelers and most were under the effect of alcohol. Most of the injuries occurred during night and road traffic accidents (71.89%) were found to be the major etiological factor. Out of 532 road traffic accidents, 490 patients (66.2%) were on two wheelers, among whom 49(10%) were wearing helmet. In the mandible, fractures occurred most commonly in the parasymphyseal region (224, 30.2%), and out of the 314 fractures of the middle third showed, 155 (49.4%) ZMC. OPG was the most commonly advised Xray. With regard to treatment modalities, 36.8% of all the mandibular fractures (740) were treated by closed reduction, 62.6% were treated using open reduction and 0.5% was under observation only

A prospective study of comparison between open trendelenburg operation, radiofrequency ablation, EVLA, and glue technique for the management of varicose veins

Background: Varicose veins are a subset of Chronic Venous disorders, including spider, reticular, varicose, and leg oedema. In our country, varicose veins are common surgical problems most commonly seen in low socio-economic groups and associated with certain occupation(s). Varicose veins have been known to affect the quality of life (QoL) leading to changes in occupation. Surgical treatment methods such as Saphenofemoral Junction (SFJ) Ligation and Great Saphenous Vein (GSV) stripping with spinal or general anaesthesia, Radio Frequency Ablation (RFA), Endovascular Laser Ablation (EVLA) and GLUE Technique within the operating room are considered in patients who remain refractory to conservative management and continue being symptomatic. Aim & Objectives: The study aimed to compare the outcome and associated post-operative complications, including Deep Venous Thrombosis, Pulmonary Embolism or Paresthesia, and Ecchymosis, with various modalities in the management of varicose veins. Material and Methods: The study was performed at a tertiary care centre which included 200 patients over a period of one year and was evaluated in the basis of VCSS & VDS scores. Results: We observed that all treatment protocols demonstrated results which improved the general physical condition of patients with the least number of complications. Treatment for varicose veins encompasses open surgeries and Endovenous techniques (EVLA and RFA), which show comparative results in clinical improvement, complications and postoperative hospital stay. Both VCSS and VDS are sensitive tools for measuring clinical outcomes of treatments of venous disease. However, the choice of appropriate tool is dependent upon the type of treatment, the Surgeon 's personal experience, availability of resources, durations of hospital admission and cost of treatment

Gaining an Understanding of Pneumocystosis in Wales

Pneumocystis pneumonia (PcP) is a serious complication of many significant immunocompromising conditions. Prior incidence estimates in Wales are based on PcP’s presentation in the HIV and transplant populations. The objectives were to describe the incidence of PcP in Wales using laboratory reporting measures and assess the impact of underlying immunosuppression cause on mortality. All positive PCR results for PcP between 2015 and 2018 were identified. The total number of unique positives with clinical and radiological correlation was 159 patients, a mean of 39.75 annually. The healthcare records of these patients were reviewed. The mortality at one month was 35.2% and 49.1% at one year. HIV remains the commonest cause of immunosuppression but has lower mortality than non-HIV conditions (12% vs. 59% at one year, p p = 0.149), highlighting the negative impact of PcP. An incidence of PcP in Wales of 1.23–1.26 cases per 100,000 has been identified, 32–35% greater than the upper limit previously estimated. There is high mortality in non-HIV patients regardless of immunosuppression cause. A heightened awareness of PcP in these groups will hasten diagnosis and potentially improve mortality