de-escalation protocol for febrile neutropenia cases and its impact on carbapenem resistance: a retrospective, quasi-experimental single-center study

Our objective was to evaluate the impact of using an imipenem de-escalation protocol for empiric febrile neutropenia on the development of carbapenem resistance. A pre-post intervention design was used. The intervention was adopting the imipenem de-escalation approach, which began on January 1, 2012. A retrospective chart review of cases of febrile neutropenia bacteremia was performed one year before and one year after the intervention. We compared the development of carbapenem resistance between the two study periods. Seventy-five episodes of febrile neutropenia bacteremia were included in the study. They had similar demographics, clinical features and outcomes. There were 78 and 12 pathogens in the primary and follow-up blood cultures, respectively. Approximately 61% and 66% of the primary and follow-up blood cultures, respectively, were gram-negative bacteria with similar carbapenem resistance profiles in the two study periods. In our study population, 57% of the gram-negative bacteria were ESBL pathogens. The resistance of the gram-negative bacteria to piperacillin/tazobactam [72% versus 53%, p = 0.161], imipenem [16% versus 11%, p = 0.684], and meropenem [8% versus 16%, p = 0.638] did not significantly change after our policy change. In conclusion, the use of the carbapenem de-escalation approach for febrile neutropenia in our institution was not associated with an increase in carbepenem resistance. Future prospective multi-center studies are recommended to further confirm the current findings

Compensatory renal hypertrophy following unilateral nephrectomy in albino rats

This study was carried out on 72 albino rats [36 experimental and 36 control] following UNX and so we know the rate and extent of compensatory renal hypertrophy [CRH] of the remaining kidney. The mean absolute change in mass due to hypertrophy in the experimental kidney KW [compensatory] following unilateral nephrectomy after 10, 20, 30, 40, 50 and 60 days was 0.384 +/- 0.003, 0.674 +/- 0.005, 0.768 +/- 0.004, 0.926 +/- 0.006, 0.940 +/- 0.005 and 0.932 +/- 0.007 gm respectively. The mean relative change in mass due to hypertrophy in the experimental kidney,%KW[compensatory following unilateral nephrectomy after 10, 20, 30, 40, 50 and 60 days was 46.36 +/- 0.84, 77.66 +/- 1.16, 91.43 +/- 0.96, 105.71 +/- 0.77, 110.15 +/- 0.77 and 112.08 +/- 1.89 respectively. It was concluded that there was rapid compensatory increase in the renal mass of the experimental kidney within first 10 days, the mean relative compensatory increase in the renal mass of the experimental kidney was 46.36 +/- 0.84% than the control. From the 11th day to the 40th day there was a steady compensatory increase at a slower rate [59.35% in 30 days] until the mean relative compensatory increase in the renal mass of the experimental kidney had reached 105.71 +/- 0.77% of the control value

Endoscopic management of ureteric calculi

A study involving 60 patients with ureteric calculi was conducted at the Department of Urology, Lahore General Hospital, from January 1991 to December 1993. The purpose of this study was to evaluate the efficacy and complications of uretero-renoscopy for ureteric calculi. This procedure was performed for fragmentation or removal of stone with the help of auxiliary instruments where possible. The study group predominantly consisted of male patients more than 14 years of age having ureteric calculi larger than 5 mm in diameter. The overall success rate of fragmentation, removal or push/bang of ureteric Galculi was 66.7 percent. In 15 patients although ureteric orifice was negotiated, the calculi could not be accessed either due to failure of visualization [n=8] or due to oedema and narrowing of lumen [n=7]. In five patients [25 percent] we failed to negotiate ureteric lumen due to narrow ureteric orifice. Perforation of ureter [n=1] and mucosal injury [n=1] occurred during the procedure. Fever in postoperative period occurred in three patients

Management of ureteric stones [a study of 200 cases]

A series of 200 consecutive patients with radiopaque ureteric stones seen at the Urology Department, Postgraduate Medical Institute, Lahore is presented. The age of the patients was between 15-72 years, with a male to female ratio of 3:1. Renal pain was the chief presenting symptom and duration varied between 1 day and 8 years. Majority of the ureteric stones were impacted in the pelvic part of the ureter. The size of the stone varied between 0.3-1.5cm along the transverse diameter. One seventy two patients [86%] were managed conservatively with a success rate of 73%. Twenty six patients [13%] underwent ureteroscopic stone removal with a success rate of 74%. open surgery was performed only in two patients [1%].We conclude that the size of the stone in majority of the patients is such, that they are amenable to conservative or endoscopic procedures. open surgery has less role to play as primary form of treatment in the management of ureteric stone