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Background Early and accurate risk assessment is an important clinical demand in patients with infective endocarditis (IE). The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are independent predictors of prognosis in many infectious and cardiovascular diseases. Very limited studies have been conducted to evaluate the prognostic role of these markers in IE. Results We analyzed clinical, laboratory, and echocardiographic data and outcomes throughout the whole period of hospitalization for a total of 142 consecutive patients with definitive IE. The overall in-hospital mortality was 21%. Major complications defined as central nervous system embolization, fulminant sepsis, acute heart failure, acute renal failure, and major artery embolization occurred in 38 (27%), 34 (24%), 32 (22.5%), 40 (28%), and 90 (63.4%) patients, respectively. The NLR, total leucocyte count (TLC), neutrophil percentage, creatinine, and C-reactive protein (CRP) level obtained upon admission were significantly higher in the mortality group [p ≤ 0.001, p = 0.008, p = 0.001, p = 0.004, and p = 0.036, respectively]. A higher NLR was significantly associated with fulminant sepsis and major arterial embolization [p = 0.001 and p = 0.028, respectively]. The receiver operating characteristic (ROC) curve of the NLR for predicting in-hospital mortality showed that an NLR > 8.085 had a 60% sensitivity and an 84.8% specificity for an association with in-hospital mortality [area under the curve = 0.729, 95% confidence interval (CI) 0.616–0.841; p = 0.001]. The ROC curve of the NLR for predicting severe sepsis showed that an NLR > 5.035 had a 71.8% sensitivity and a 68.5% specificity for predicting severe sepsis [area under the curve 0.685, 95% CI 0.582–0.733; p = 0.001]. The PLR showed no significant association with in-hospital mortality or in-hospital complications. Conclusion A higher NLR, TLC, neutrophil percentage, creatinine level, and CRP level upon admission were associated with increased in-hospital mortality and morbidity in IE patients. Furthermore, a lower lymphocyte count/percentage and platelet count were strong indicators of in-hospital mortality among IE patients. Calculation of the NLR directly from a CBC upon admission may assist in early risk stratification of patients with IE.

Nebulized HSS may help preserving lung clearance mechanisms and therefore reduce VAP in premature infants. Multi center, double blinded, randomized, controlled, trial is needed to confirm safety and efficacy of such intervention.

Background and objectives Infection prevention and control is a set of practices, protocols, and procedures that are put in place to prevent infections that are associated with health care service provision settings. It is an element of quality of care and safety in health care service delivery; health worker occupational health and safety practices; medical waste management; and is also concerned with clinical and public health surveillance and action. Healthcare facilities are ideal settings for the transmission of infections to patients (who are more susceptible), healthcare workers, their families and communities. Healthcare associated infections lead to prolonged hospital stay, increased cost of care and death. Therefore, the objective of this study was to assess infection prevention and control practices in various types and levels of health facilities in Nyandarua County, Kenya. Methodology A cross-sectional descriptive study was conducted in 47 health facilities that were sampled from a total of 153, using cluster sampling technique. The facilities were drawn from public, private and faith based organizations distributed across 5 sub-counties of Nyandarua County, Kenya. Data collection method was purely quantitative using a structured questionnaire. Descriptive analysis was done using SPSS version 17. Results 42/47 of the facilities were observing safe injection practices. Only 8/ 26 of the public health facilities had all their workers immunized against hepatitis B despite procurement, supply and distribution of adequate vaccine doses for the entire health workforce. Poor medical waste management practices where 37/47, 15/47 and 28/47 were segregating waste, had colour coded bins and had functional incinerators respectively. Only 28/47of the sampled facilities were decontaminating patient reusable equipment/instruments appropriately. Electricity, gas, charcoal and firewood were fuels used for autoclaving. About 33/47 and 30/47 of the sampled facilities had running water and soap/hand disinfectant respectively. Conclusions The findings revealed several gaps in the implementation of the national IPC policy especially in healthcare worker occupational health and safety, reprocessing of patient reusable equipment/instruments, medical waste management and hand hygiene practices. These findings will assist the department of health in designing interventions for strengthening and improving IPC practices, to mobilize and allocate resources for IPC activities, improve infrastructure and supplies

A male child presented with left lacrimal gland and right submandibular masses that were diagnosed as high grade B-cell non-Hodgkin's Lymphoma. Immunodeficiency was suspected, mostly due to secondary to Epstein Barr virus infection. Chemotherapy was started and gradual regression was observed in the size of the lesions forming a central necrosis and facial wound. Cultures from this wound showed mixed gram negative growth of Pseudomonas aeruginosa, and Escherichia coli. Two days later, a follow up swab of the wound was taken and showed fungal growth of mixed Candida tropicalis and Cryptococcus laurentii which was treated with two antifungals (fluconazole and liposomal amphotericin B). After a second chemotherapy cycle, the facial necrotic lesion increased in size and the patient's general condition markedly deteriorated with multi-organ system failure secondary to septic shock by candidemia. Candida glabrata, which is non-Candida albicans fungus was the fungus that appeared in the patient's blood culture. Caspofungin was prescribed in addition to liposomal amphotericin B. two days later, the follow up blood culture revealed growth of methicillin resistant Staphylococcus aureus and the pulmonary condition of the patient then deteriorated gradually. Six days later, the patient developed multi-organ dysfunction syndrome secondary to sepsis. We conclude that we mixed fungal infection in not uncommon among immunocompromised patients, candidemia is fatal even if treated with the correct antifungals.

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