The presence of septic shock and MODS is associated with high mortality in the PICU of developing countries.

Staphylococcus lugdunensis has been increasingly recognized as a cause of serious infections, particularly prosthetic joint infections (PJIs). The aim of this study was to describe the clinical characteristics, treatments, and outcomes of S lugdunensis PJIs. This was a retrospective multicenter study of consecutive adult patients with S lugdunensis PJIs from January 2007 through December 2017; 28 patients met inclusion criteria. The knee was the most commonly affected joint (67.9%), followed by the hip (25%). Clinical and microbiologic characteristics, treatment modalities, and outcomes were evaluated. Thirteen (46.4%) patients had two-stage revision, 9 (32.1%) had debridement with or without revision, 5 (21.4%) had no surgical intervention, and 1 (3.6%) had one-stage revision. Twenty-four (85.7%) patients had monomicrobial infection with S lugdunensis , whereas 4 had polymicrobial. Two patients had concomitant bacteremia. All isolates, except 1, were susceptible to oxacillin. Three patients with no surgical intervention received oral antibiotics, 2 were not treated, and 1 was discharged to hospice. Relapse was observed in 2 of 13 (15%) patients who had two-stage revision, 4 of 9 (44%) who had debridement, and 6 of 6 (100%) who had no surgical intervention or one-stage revision regardless of antibiotic treatment regimen. There was a significant difference in cure rate for patients who underwent two-stage revision compared with other treatment modalities (85% vs 33%, P =.009). Appropriate management of S lugdunensis PJI includes both aggressive surgical treatment and a prolonged course of antibiotics and is associated with excellent clinical response. Regardless of route or duration of antibiotic therapy, relapse is high for patients not treated with two-stage revision. [ Orthopedics . 2020;43(6):345–350.]

Background & Objectives: Stroke is a leading cause of death and it causes significant long-term disabilities. It affects cognition and physical impairment in the patients. Cognitive impairments caused by stroke include loss of memory, disorientation, impaired attention, reasoning, and social perception. It may also lead to interaction deficit and inability to problem-solving, etc. The precise knowledge about the degree of cognitive impairment is essential to address the issue with appropriate measures. We aimed to develop a cognitive measurement scale for stroke patients. Methodology: The phenomenon was explored through in-depth interviews of 12 stroke survivors in different hospitals in Lahore, Pakistan. Seventeen items were generated. After factor analysis, 15 items were included in the scale and a pilot study was conducted on 15 participants. A sample of 106 patients was selected to administer the scale Cognitive Assessment Scale for Stroke Survivors (CASS) and Mini-Mental State Examination (MMSE) scale for concurrent validity. Results: The Principal Component Factor Analysis through Varimax rotation yielded three factors, e.g., ‘Social Cognition’, ‘Focus and Attention’, and ‘Orientation’. The results have shown significant values with good psychometric properties. The Cronbach’s Alpha value of the developed scale is 0.88 which indicates it as a highly reliable scale. Conclusion: This research reported that stroke survivors experience cognitive impairment after the stroke incidents. The developed scale to measure cognitive impairment after a stroke incident was proved to be valid and reliable, and can be used in medical practice. Abbreviations: CASS – Cognitive Assessment Scale for Stroke Survivors; MMSE – Mini-Mental State Examination. Citation: Qamar S, Iqbal MN, Rafiq M, Ismat Ullah Cheema IU, Masood K. Development and validation of ‘Cognitive Assessment Scale for Stroke Survivors’. Anaesth. pain intensive care 2022;26(4):663-668. DOI: 10.35975/apic.v26i4.2025

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BackgroundAlthough Staphylococcus lugdunensis is a coagulase-negative staphylococcus, it shares similar characteristics with S. aureus and is increasingly recognized as the cause of serious infections, including prosthetic joint infections (PJIs). The aim of this study was to determine the clinical characteristics and outcome of S. lugdunensis PJIs.MethodsThis was a retrospective multicenter study conducted from January 2007 through December 2017 involving consecutive adult patients with S. lugdunensis PJIs in northwest Ohio. Clinical and microbiologic characteristics, treatment modalities and outcome were evaluated.ResultsA total of 695 patients were evaluated and 29 (4%) patients met inclusion criteria (Table 1). All patients were Caucasian and 52% were female with a median age 68.8. Comorbidities included Diabetes Mellitus (34%), CAD (41%), CHF (20%), COPD (20%) and cancer (14%). The most common clinical presentations were pain (28/29, 97%), decreased range of motion (27/29, 93%) and joint swelling (21/29, 72%). Two patients had concomitant bacteremia. Knee was the most commonly affected joint (69%), followed by hip (24%). All isolates, except one, were susceptible to oxacillin. Thirteen (45%) patients had a two-stage revision, nine (31%) debridement with/without revision, six (21%) no surgical intervention and one (3%) a 1-stage revision. The majority of patients (71%) received ≥4 weeks of antibiotics (abx). Two patients with no surgical intervention and one with debridement received no abx. Another was discharged to hospice without intervention. Relapse was observed in two (15%) patients who had a 2-stage revision, four (44%) who had debridement, 6 (100%) who had no surgical intervention or 1-stage revision. Overall, there was a statistically significant difference in cure rates in patients who underwent 2-stage revision compared with other treatment modalities (P = 0.003) regardless of abx treatment regimen, including prolonged IV abx therapy. However, IV abx were superior to oral (P = 0.009).ConclusionAppropriate management of S. lugdunensis PJIs includes both aggressive surgical management with a prolonged course of abx with excellent clinical responses. Relapse is high in patients treated without two-stage revision irrespective of route or duration of abx therapy.Disclosures All authors: No reported disclosures.