Background Urinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended‐spectrum beta‐lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae. Objectives To determine the global prevalence of ESBL‐producing (ESBL‐P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females. Data sources A systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted. Study selection and data extraction Studies that reported the frequency of ESBL‐P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed. Synthesis In order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta‐analysis was performed using the random‐effects model. Results Twenty‐three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL‐P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2 = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40). Conclusions The prevalence of ESBL‐P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.
This study is about an infrequent first presentation of Aortic Dissection (AD), and it is primary Ventricular Fibrillation (VF). We present a 64-year-old woman with a history of hypertension who came with sudden retrosternal chest pain, dizziness, nausea, and vomiting. The patient suffered a cardiac arrest a few seconds after admission. Cardiopulmonary resuscitation (CPR) was done for her. An electrocardiogram (ECG) showed ST elevation that demonstrated acute anterior MI (Myocardial Infarction). Trans-thoracic echocardiography (echo) CT angiography demonstrated decreased left ventricular ejection fraction with normal LV size (LVEF=25%) and type A Stanford and type I DeBakey aortic dissection flap from root up to distal of abdominal Aorta. This is while the patient's first presentation was VF, and she had anterior MI, which is unusual for aortic dissection. Therefore, we must consider AD in patients with VF. We have to consider AD in anterior MI patients because of the contraindication of medication.
Prinzmetal angina is one of the causes of acute coronary syndromes, the exact etiology of which is still unknown. Here we introduce a 27-year-old man with no history of cardiovascular disease, with a history of hospitalization due to acute pericarditis in the previous month, who was discharged with a good response to ibuprofen treatment but had clinical and electrocardiographically recurrence of pericarditis with compressive retrosternal chest pain and electrocardiogram (ECG) changes in favor of acute infero-postero-right ventricular (RV) myocardial infarction (MI). Treatment with vasodilator improved compressive retrosternal chest pain and reversed acute myocardial infarction changes completely and left pleuritic chest pain and pericarditis changes in the ECG. Due to the typical chest pain, he was admitted to the emergency room; ECG revealed generalized ST-segment elevation with acute pericarditis pattern again. Acute infero-posterior and right ventricular acute myocardial infarction pattern was also evident. After treatment with nitroglycerin in the Critical Cardiac Unit (CCU), all ECG ischemic changes returned to baseline, and pericarditis remained in all leads. The patient was discharged with non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, and a good general condition.
This study is about an infrequent first presentation of Aortic Dissection (AD), and it is primary Ventricular Fibrillation (VF). We present a 64-year-old woman with a history of hypertension who came with sudden retrosternal chest pain, dizziness, nausea, and vomiting. The patient suffered a cardiac arrest a few seconds after admission. Cardiopulmonary resuscitation (CPR) was done for her. An electrocardiogram (ECG) showed ST elevation that demonstrated acute anterior MI (Myocardial Infarction). Trans-thoracic echocardiography (echo) CT angiography demonstrated decreased left ventricular ejection fraction with normal LV size (LVEF=25%) and type A Stanford and type I DeBakey aortic dissection flap from root up to distal of abdominal Aorta. This is while the patient's first presentation was VF, and she had anterior MI, which is unusual for aortic dissection. Therefore, we must consider AD in patients with VF. We have to consider AD in anterior MI patients because of the contraindication of medication.
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