Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity initially described in 1996. PRES frequently develops in patients with preeclampsia and eclampsia. There is not much literature on risk factors causing PRES in pregnant patients with eclampsia. This study aimed to determine the incidence of PRES in eclampsia, its association with pregnancy, risk factors, and maternal and perinatal outcomes. Patients and methods: All patients who were admitted with eclampsia and developed PRES in an intensive care unit of a tertiary medical facility between 1997 and 2017 were included in the study. Patients’ demographics, pregnancy and gestational data, treatment mode, and outcomes were retrospectively obtained from their medical charts/files. Data were entered using SPSS program version 23. Chi-square test was used to compare the variables, and a p value of < 0.05 was considered statistically significant. Results: A total of 151 patients were admitted during the study period, and 25 developed PRES. The diagnosis was common in patients older than 25 years. Eclampsia patients who developed PRES were without any pregnancy-associated comorbidities (p < 0.08). At the time of diagnosis, their gestational age was more than 36 weeks, which was significant (p < 0.04). Incidence was significantly higher in patients presenting with eclampsia and had recurrent seizures (p < 0.01 and 0.002, respectively). Its incidence was significantly higher in postpartum eclampsia patients (p < 0.01). It was also significantly higher in patients who had cesarean section and hypertension treated with labetalol (p < 0.001 and 0.02, respectively). Overall, the maternal mortality rate of eclampsia patients complicated with PRES was 4% in our population. Conclusion: Of eclampsia patients, 16% developed PRES, which is on the lower side than the reviewed literature (10%–90%). Eclampsia on presentation, recurrent seizures, postpartum eclampsia, cesarean delivery, and labetalol use were associated with increased risk of PRES development.
Introduction Acute adult supraglottitis (AAS) is one of the upper airway infections that can potentially cause upper airway obstruction and, if not treated promptly, can be life-threatening. The widespread use of vaccines against Hemophilus influenzae has decreased the incidence of epiglottitis in children, whereas the incidence of AAS is on the rise. We aim to highlight the presentation, diagnosis, and management in AAS with our study. Patients and Methods A retrospective analysis was performed on all patients admitted to a tertiary health care facility surgical intensive care unit (SICU) where AAS was identified and the demographic data, duration of symptoms, imaging studies, management, and complications were recorded. In these patients, the diagnosis of AAS was confirmed by nasopharyngeal endoscopy. Data was entered in the IBM Statistical Package for Social Sciences (SPSS), version 23 (IBM SPSS Statistics, Armonk, NY), and groups were compared using student t-test and chi-square test. P values of ≤ 0.05 were considered statistically significant. Results A total of 118 patients were admitted to the SICU. The male: female ratio was 3.9: 1. Major risk factors were smoking and drinking cold liquids. The common presenting symptom was sore throat (89.8%). The thumb sign was positive in 65% of the patients. Common bacteria were the Streptococcus species (11.9%). Ceftriaxone was the most commonly prescribed inpatient antibiotic. All patients received steroids as adjuvant therapy. Adrenaline nebulization was used in 66% of the cases. Forty-six percent of patients required endotracheal intubation. In 10.2% of patients, intubation was not possible and in 12.7% of patients, a tracheostomy was done. Ludwig’s angina was the most frequent complication. Patients presenting with dysphagia and fever had a significantly higher incidence of Ludwig’s angina (P ≤ 0.02 and 0.005, respectively). AAS patients complicating into Ludwig’s angina (severe cellulitis of submandibular, submental, and sublingual spaces) had a significantly longer duration of symptoms, a higher incidence of streptococcal infection, airway interventions, and prolonged stay in an intensive care unit (p ≤ 0.05). Conclusion Male gender, smoking, and drinking cold liquids were the risk factors associated with AAS, and thumb sign on lateral neck soft tissue x-ray was suggestive of it. AAS caused by Streptococcus species was a relatively serious condition, leading to complications like Ludwig’s angina.
Background: Urinary tract infections caused by bacteria are the most prevalent type of hospital-acquired infection. They are also responsible for the greatest number of patient fatalities, lengths of hospital stays, and overall costs associated with medical care. Even though Escherichia coli is the bacteria that is found the most frequently, several studies have found different levels of prevalence for it. The current dilemma with antibiotic resistance is being caused, in large part, by the inappropriate and excessive use of antibiotics. Methodology: Laboratory records were searched in order to obtain information regarding the organisms that were isolated from urine samples as well as the pattern of antibiotic susceptibility. The urine samples that were obtained were processed according to the normal procedures, and a Kirby-Bauer Disk Diffusion test was used to determine the antibiotic susceptibility of the bacteria. Results: E. coli was found to be the most frequent causative agent of UTI (40.6%) followed by candida spp. (28%), Enterococcus spp (10.6%), Klebsiella spp (9.8%), Staphylococcus aures (1.58%) and Acinatobacter spp (1.97%). E. coli showed variable antimicrobial resistance to various antibiotics such as AMP (95.6%) followed by CRO (91.5%), CAZ (86.5%), CTX (82.09%), and MXF (80.8%) while most sensitive antibiotic was fosfomycin (93.2%) followed by sulzone (83.5%), imepinem (78.1%) and amikacin (77.1%). Keywords: Pathogens, susceptibility pattern, urinary tract infection
This paper describes our internship experiences with Newton Neighbors, a mutual aid group based in the greater Boston area. Throughout our time with Newton Neighbors, we have gained in experience in community and public health work. This involved completing tasks such as conducting a community needs assessment, distributing health information, and evaluating the impact of the mutual aid work. We have reflected on our experience and learned a variety of lessons such as community mobilizing efforts are able to support public health efforts, increasing accessibility to public health information is essential, diversity in privilege exists in wealthy communities, and diverse women role models in leadership are significant for inspiring and leading young female public health professionals.
Background: Acinetobacter has gained significant importance in the medical literature due to the steady development of drug resistance since1980s. Aim: To investigate various patterns and susceptibility trends of the Acinetobacter bacteria isolated from the patients of Intensive Care Units in Holy Family Hospital, Rawalpindi. Methods: It was a cross sectional study carried out at Holy Family Hospital, Rawalpindi from January-July 2019 including case data from intensive care units of medical, surgical, burn and pediatric departments. Acinetobacter isolates were cultured from intensive care units. Antibiotic susceptibility testing was performed using disc diffusion method. Atotal 204 cases of Acinetobacter infection were isolated, of these 102 isolates were from intensive care unit. Majority of the cases were males (56.9%). Results: Our results validate that intensive care units are the main source of overall hospital acquired infections such as Acinetobacter baumanni as half of our cases were isolated in ICUs compared to half in all other general departments. Acinetobacterwas the most common bacterial pathogen 141 (69.1%) isolated in this study followed by klebsiella spp. 32 (15.7%) and e-coli 15 (7.4%). Acinobacter was found to be pan-resistant in more than 80% of the cases. Campylobacter showed frequent resistance to the drug TZP (85%) followed by CAZ (67.6%), SCF (66.2%) and CRO (60.3%). Conclusion: Pan-resistance to Acinetobacter can be associated to the misuse of antibiotics and environmental contamination of hospital equipment and hence it can be implied that these factors play a major role in the outbreaks of Acinetobacter spp. Keywords: Pan-resistance, Acinetobacter, Intensive Care Unit, Hospital Acquired Infections
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