Conocimiento en estudiantes de enfermería sobre sepsis quirúrgico / Knowledge in nursing students about surgical sepsis

Objetivo: Determinar el nivel de conocimiento de los estudiantes de enfermería de la Universidad Técnica de Ambato sobre sepsis quirúrgica. Material y método: La presente investigación tiene un diseño de desarrollo observacional, de tipo descriptivo, cohorte transversal, con un enfoque cuantitativo, ya que el nivel de cono-cimiento se verá representado mediante tablas y gráficos para des-cribir la problemática del periodo octubre 2023 febrero 2024. Re-sultados: Se evidencia un alto porcentaje de respuestas incorrectas por cada ítem por parte de los estudiantes. La categoría Nivel de Conocimiento sobre Definición de Sepsis, fue respondida de ma-nera incorrecta con un porcentaje del 83,9%, la categoría Nivel de Conocimiento sobre Diagnóstico de Sepsis obtuvo 51,7% y, por úl-timo, la Nivel de Conocimiento sobre Tratamiento de Sepsis con el 29,2%. Conclusiones: El nivel de conocimiento de los estudiantes sobre Sepsis Quirúrgica es malo, debido a que existe una subesti-mación de la gravedad de la sepsis como afección potencialmente mortal, lo que puede traer un impacto negativo en los pacientes[AU]

Objective: Determine the level of knowledge of nursing students at the Technical University of Ambato about surgical sepsis. Mate-rials and methods: This research has an observational, descriptive, transversal development design, with a quantitative approach since the level of knowledge will be represented through tables and gra-phs to describe the problems of the period October 2023-February 2024. Results: A high percentage of incorrect answers for each item by the students is evident. The category Level of Knowledge about Definition of Sepsis was answered incorrectly with a percentage of 83.9%, the category Level of Knowledge about Diagnosis of Sepsis obtained 51.7% and, finally, the category Level of Knowledge about Treatment of Sepsis. Sepsis with 29.2%. Conclusions: The level of knowledge of students about Surgical Sepsis is poor because there is an underestimation of the severity of sepsis as a potentially fatal condition, which can have a negative impact on patients[AU]

Objetivo: Determinar o nível de conhecimento dos estudantes de enfermagem da Universidade Técnica de Ambato sobre sepse ci-rúrgica. Material e método: Esta pesquisa possui desenho de coor-te observacional, descritivo, transversal, com abordagem quantita-tiva, uma vez que o nível de conhecimento será representado por meio de tabelas e gráficos para descrever o problema no período de outubro de 2023 a fevereiro de 2024. Resultados: Uma parada. É evidente o percentual de respostas incorretas para cada item por parte dos alunos. A categoria Nível de Conhecimento sobre Defi-nição de Sepse foi respondida incorretamente com percentual de 83,9%, a categoria Nível de Conhecimento sobre Diagnóstico de Sepse obteve 51,7% e por fim, a categoria Nível de Conhecimen-to sobre Tratamento de Sepse com 29,2%. Conclusões: O nível de conhecimento dos estudantes sobre a Sepse Cirúrgica é baixo, pois há uma subestimação da gravidade da sepse como uma condição potencialmente fatal, que pode ter um impacto negativo nos pa-cientes[AU]

Utilidad pronóstica de la procalcitonina, la proteína C reactiva, el índice PCR/PCT y el aclaramiento de ambas al ingreso a unidades de cuidados intensivos / Prognostic utility of procalcitonin, C-reactive protein, CRP/PCT index, and their clearance upon admission to intensive care units / Utilidade prognóstica da procalcitonina, proteína C reativa, índice PCR/PCT e clareamento de ambos na entrada em unidades de cuidados intensivos

Resumen El presente es un estudio retrospectivo, observacional, cuantitativo y descriptivo. Se evaluó la utilidad de la proteína C reactiva (PCR), la procalcitonina (PCT) y la relación PCR/PCT como marcadores de riesgo de sepsis, sumados al aclaramiento a las 72 h, como pronóstico de mortalidad y permanencia en unidades de cuidados intensivos (UCI). Se incluyeron 23 pacientes. Se clasificaron según qSOFA y se elaboraron curvas ROC. Se obtuvo un área bajo la curva de 0,79 para PCT. El valor umbral de PCT>0,88 ng/mL predice riesgo de sepsis con 77,78% de sensibilidad y 83,33% de especificidad. Utilizando PCR<31,23 mg/dL se obtuvo como parámetros destacados un 88,89% de sensibilidad y 83,33% de valor predictivo negativo, sin diferencias significativas (Mann-Whitney p<0,05) entre los grupos de sobrevivientes y óbitos y estadía prolongada vs. no prolongada. Se postula PCR como screening y PCT como marcador de riesgo de sepsis.

Abstract This is a retrospective, observational, quantitative and descriptive study. The utility of C reactive protein (CRP), procalcitonin (PCT) and the CRP/PCT ratio as sepsis risk markers was evaluated and these, added to clearance at 72 hours, as predictors of mortality and permanence in intensive care units (ICU). Twenty-three patients were included. They were classified according to qSOFA, and ROC curves were prepared, highlighting an area under the curve of 0.79 for PCT. The threshold value of PCT>0.88 ng/mL predicts the of sepsis with 77.78% sensitivity and 83.33% specificity. Using CRP>31.23 mg/dL, 88.89% sensitivity and 83.33% negative predictive value were obtained as outstanding parameters. No significant differences (Mann-Whitney p<0.05) were found between survivors and dead and prolonged vs. non-prolonged stay groups. CRP is postulated for screening and PCT as a sepsis risk marker.

Resumo Este é um estudo retrospectivo, observacional, quantitativo e descritivo. Foi avaliada a utilidade da proteína C reativa (PCR), da procalcitonina (PCT) e da relação PCR/PCT como marcadores de risco de sepse junto com o clareamento em 72 horas, como preditores de mortalidade e permanência em unidades de terapia intensiva (UTI). Vinte e três pacientes foram incluídos. Eles foram classificados de acordo com o qSOFA e foram elaboradas curvas ROC, destacando uma área sob a curva de 0,79 para PCT. O valor limite de PCT>0,88 ng/mL prediz o risco de sepse com sensibilidade de 77,78% e especificidade de 83,33%. Utilizando PCR>31,23 mg/dL, obtiveram-se como parâmetros em destaque 88,89% de sensibilidade e 83,33% de valor preditivo negativo. Não houve diferenças significativas (Mann-Whitney p<0,05) entre os grupos de sobreviventes e óbitos e permanência prolongada vs. não prolongada. A PCR é postulada como triagem e a PCT como marcador de risco de sepse.

Epidemiologia das queimaduras no estado de Minas Gerais. O que mudou em uma década? / Epidemiology of burns in the state of Minas Gerais. What has changed in a decade?

Introdução: De grande impacto na população, queimaduras exigem análise epidemiológica e planejamento constantes para prevenção, tratamento e reabilitação dos pacientes. Este trabalho objetiva comparar, após uma década, os indicadores do Centro de Tratamento de Queimados do Hospital João XXIII, em Belo Horizonte, MG, abordados no artigo "Epidemiologia das queimaduras no estado de Minas Gerais", publicado na Revista Brasileira de Cirurgia Plástica com dados de 2010, para validar as estratégias vigentes e as futuras. Método: Revisão dos prontuários dos pacientes acometidos por queimadura, internados no referido centro em 2020. Resultados: Foram internadas 473 vítimas de queimadura no período, 87,5% causadas por acidente, sendo 34,5% por líquidos quentes, 23,7% por álcool; 61,9% provenientes do interior do estado de Minas Gerais; 63,4% do sexo masculino. A idade média foi de 30 anos, a superfície corporal queimada média foi de 18,8% e o tempo médio de internação foi de 25 dias. Foram realizados 580 desbridamentos cirúrgicos e 473 enxertos cutâneos autólogos. Faleceram 7,4% dos pacientes, correspondentes a 29,5% dos internados no CTI adulto, com superfície corporal queimada média de 49,7%, e 10,5% dos internados no CTI pediátrico. A maior causa de óbitos foi devido à sepse, em 57,1% dos casos. A mortalidade diminuiu de 16,3% para 7,4% no período estudado. Conclusão: O perfil do paciente internado por queimadura mantevese em grande parte o mesmo após 10 anos. Houve aumento do número de atendimentos a vítimas de queimadura do interior do estado e queimaduras provocadas por líquidos quentes passaram a ser mais frequentes que por álcool. ''A busca da conformidade com o tratamento baseado na literatura mundial resultou em diminuição da mortalidade."

Introduction: With a major impact on the population, burns require epidemiological analysis and constant planning for the prevention, treatment, and rehabilitation of patients. This work aims to compare, after a decade, the indicators of the Burn Treatment Center at Hospital João XXIII, in Belo Horizonte, MG, covered in the article "Epidemiology of burns in the state of Minas Gerais", published in the Revista Brasileira de Cirurgia Plástica with data from 2010, to validate current and future strategies. Method: Review of the medical records of patients suffering from burns, admitted to the aforementioned center in 2020. Results: 473 burn victims were hospitalized during the period, 87.5% were caused by an accident, 34.5% due to hot liquids, 23.7% by alcohol; 61.9% from the interior of the state of Minas Gerais; and 63.4% were male. The average age was 30 years, the average burned body surface area was 18.8% and the average length of stay was 25 days. 580 surgical debridement and 473 autologous skin grafts were performed. 7.4% of patients died, corresponding to 29.5% of those admitted to the adult ICU, with an average burned body surface area of 49.7%, and 10.5% of those admitted to the pediatric ICU. The biggest cause of death was sepsis, in 57.1% of cases. Mortality decreased from 16.3% to 7.4% in the period studied. Conclusion: The profile of patients hospitalized for burns remained largely the same after 10 years. There was an increase in the number of visits to burn victims in the interior of the state and burns caused by hot liquids became more frequent than those caused by alcohol ''The search for compliance with treatment based on world literature resulted in reduction in mortality."

Diagnóstico molecular de bacteriemias: beneficios del empleo del panel de sepsis BCID2 de Filmarray en un hospital de tercer nivel / Molecular diagnosis of bacteriaemia: benefits of using the FilmArray® BCID2 sepsis panel in a third level hospital

Resumen Introducción : Los retrasos en el tratamiento anti microbiano adecuado de las bacteriemias prolongan la estadía hospitalaria, aumentan la mortalidad e in crementan los costos. Aún hoy en día se requiere un tiempo considerable para obtener la identificación y antibiograma de los microorganismos en los hemocul tivos positivos. El objetivo fue evaluar el impacto de la implementa ción del panel BCID2 de FilmArray® (FA) sobre el tiempo de inicio de tratamientos antimicrobianos adecuados y sobre los costos potenciales de los mismos. Métodos : Estudio observacional retrospectivo de los hemocultivos positivos de pacientes hospitalizados, procesados por FA y por metodología tradicional. Se evaluaron los cambios de antimicrobianos en base a los resultados del FA. Se calcularon los días de reducción de tratamiento antimicrobiano y el ahorro potencial en el uso de los mismos, teniendo en cuenta también los costos del FA. Resultados : Se analizaron 87 episodios de bacte riemia. En 42 (48.3%) de ellos se desescaló el trata miento a antimicrobianos de menor espectro, en 7 (8%) se escaló a antimicrobianos de mayor espectro, en 8 (9.2%) se cambió el antimicrobiano sin variar el espectro y en 30 (34.5%) no se realizaron cambios con los resultados del FA. Los cambios de antimicrobianos se realizaron en promedio 2.3 días más rápido que con los métodos convencionales. Se calculó un ahorro potencial de US$ 7408. Conclusión : La implementación del panel BCID2 de FilmArray ® permitió adecuar los tratamientos antimi crobianos más rápidamente acortando la duración de los tratamientos empíricos de amplio espectro, lo cual resultó costo-efectivo.

Abstract Introduction : Delay in initiating appropriate anti microbial therapy prolongs hospitalization, increases in-hospital mortality, and raises economic costs. Cur rently, the identification and susceptibility testing of bacteria in positive blood cultures require a considerable amount of time. The objective of this study was to assess the impact of the BCID2 FilmArray® (FA) panel on the timing of appropriate antimicrobial therapy and potential anti microbial costs. Methods : This is a retrospective observational study focused on positive blood cultures in hospitalized pa tients. FA processing was conducted concurrently with routine sample processing. Changes in antibiotic treat ments based on FA results were evaluated, and the re duction in antimicrobial therapy duration and associated cost savings were calculated. Results : Eighty-seven bacteremia episodes were ana lysed. In 42 (48%) of them antimicrobial therapy was de-escalated to narrower spectrum agents, while in 7 (8%) therapy was escalated to broader spectrum anti microbials. Additionally, in 8 (9%) antimicrobials were switched without changing spectrum and in 30 (34%) no changes were made based on FA results. Antimicrobial changes were made 2.3 days faster than with routine sample processing resulting in calculated potential sav ings of US$ 7408. Conclusion : The implementation of FA facilitated a faster administration of appropriate antimicrobial therapy, leading to a reduction in the duration of broad-spectrum empirical antimicrobial therapy and subse quent economic savings.

Evaluating the Safety of Retrograde Intrarenal Surgery (RIRS): Intra- and Early Postoperative Complications in Patients Enrolled in the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR)

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

Platelet count and its indices as diagnostic markers of neonatal sepsis: a cross-sectional study

Background: Neonatal sepsis is a critical condition posing a significant threat to newborns globally, particularly in developing countries. The non-specific symptoms and time-consuming traditional diagnostic methods highlight the need for rapid and reliable biomarkers. Recent studies suggest platelet count and indices such as mean platelet volume (MPV) and platelet distribution width (PDW) as potential indicators for early diagnosis of neonatal sepsis. This study aimed to assess the correlation between platelet count and its indices and neonatal sepsis.Methods: A hospital-based cross- sectional study was conducted at NICU of tertiary care hospital involving 80 neonates with suspected sepsis. Platelet count, PDW, and MPV were measured and correlated with neonatal sepsis. Statistical analyses were performed using SPSS software, with a significance set at p<0.05.Results: Of the 80 neonates studied, 22.5% exhibited thrombocytopenia. There was a noteworthy inverse relationship discovered between platelet count and sepsis, while MPV and PDW were higher. Gram-negative organisms were the most common cause of sepsis, out of which E. Coli (63.64%) was the most common.Conclusions: The study confirmed a significant association between platelet count and indices with neonatal sepsis. Platelet count, MPV, and PDW can serve as effective, rapid diagnostic markers, potentially improving early detection and outcomes in neonatal sepsis.

Study of serum ferritin as diagnostic and prognostic biomarker for severity of sepsis: a hospital-based study

Background: The objective of the study was to evaluate serum ferritin levels to define it as a diagnostic and prognostic biomarker for severity of sepsis.Methods: In this hospital-based descriptive type of observational study, conducted at the Department of Pediatrics, NIMS Medical College; 80 children of age group 6 months to 18 years with diagnosis of pediatric sepsis were included. Children were divided into grades of sepsis (sepsis, severe sepsis, septic shock, MODS). Progress of sepsis, severe sepsis, septic shock, and sepsis with MODS was followed with serum ferritin levels on day 1, day 3, day 7, or more than 7 days and one week post recovery.Results: Pneumonia was identified as the most common source of infection. The blood culture positivity rate was 32.5%. E. coli was the most common organism grown on blood culture. Median serum ferritin levels increased as sepsis severity worsened. A significant association was discovered between sepsis severity and CRP levels at the time of admission.Conclusions: There is a consistent pattern of Serum ferritin levels with increasing severity of pediatric sepsis. Routine use of serum ferritin levels in diagnosis and prognostication is both feasible and simple. CRP level correlate well with serum ferritin level for diagnosis of sepsis.

Empyema associated with Lemierre syndrome: case report and literature review

Postanginal septicemia, also called Lemierre syndrome, is a metastatic infection that can have multiple complications, including empyema. Therefore, the natural history of the disease begins with an infection of the oropharynx by microbiota from the digestive system, which causes a thrombophlebitis of the jugular vein with septic infiltrations, including into the lungs causing pneumonia, which in turn can generate parapneumonic effusions and/or empyemas. Furthermore, it is a syndrome that was thought to have been forgotten by the era of antibiotics, but with resistance to these antibiotics it has begun to re-emerge. Next, we will talk about a case of a 41-year-old man with no significant pathological history, who entered secondary to a peritonsillar abscess which turned into Lemierre syndrome with a treatment based on broad-spectrum antibiotics and then performed of lung decortication by thoracotomy. Empyema as a complication of Lemierre syndrome is rare and even more so in this post-antibiotic era, so health personnel should have a high clinical suspicion since adequate and timely treatment will help reduce the complications of this disease, as well as like his mortality.

Caracterização dos pacientes internados por infecção odontogênica em unidade hospitalar / Characterization of patients hospitalized for odontogenic infection in a hospital unit / Caracterización de pacientes hospitalizados por infección odontogénica en una unidad hospitalaria

Introdução: As infecções orais e maxilofaciais de origem odontogênica representam uma área relevante do conhecimento médico, pois podem evoluir para quadros de alta morbidade e mortalidade. Objetivo: Avaliar o perfil dos pacientes atendidos com diagnostico de infecção de origem odontogênica em um hospital público de Mato Groso do Sul. Métodos: Trata-se de um estudo retrospectiva do tipo observacional e transversal que consistiu na análise de 68 prontuários de pacientes com diagnostico de infecção odontogênica, no período de março de 2019 a fevereiro de 2022. Resultados e Conclusão: Os resultados apontam para uma incidência de infecção odontogênica em 39,70% para a população jovem entre 16 a 28 anos, com sintomas como edema em 82,35% dos casos, seguidos de trismo 51,47% e disfagia 17,64%, uma média de internação de 6,1 dias e necessidade de traqueostomia em 10,29% dos casos. Deste modo, o cirurgião dentista em frente a processos agudos de infecção odontogênica exerce a função primordial do reconhecimento dos sintomas e intervenção precoce evitando seu agravamento... (AU)

Introduction: Oral and maxillofacial infections of odontogenic origin represent a relevant area of medical knowledge, as they can evolve into cases of high morbidity and mortality. Objective: To evaluate the profile of patients treated with a diagnosis of infection of odontogenic origin in a public hospital in Mato Groso do Sul. Methods: This is a retrospective observational and cross-sectional study that consisted of analyzing 68 medical records of patients diagnosed with odontogenic infection, from March 2019 to February 2022. Results and Conclusion: The results point to an incidence of odontogenic infection in 39.70% for the young population between 16 and 28 years old, with symptoms such as edema in 82.35% of cases, followed by trismus 51.47% and dysphagia 17.64%, an average hospital stay of 6 ,1 days and need for tracheostomy in 10.29% of cases. In this way, the dental surgeon, faced with acute pro[1]cesses of odontogenic infection, plays the primary role of recognizing the symptoms and early intervention, preventing their aggravation... (AU)

Introducción: Las infecciones orales y maxilofaciales de origen odontogénico representan un área relevante del conocimiento médico, ya que pueden evolucionar hacia casos de alta morbilidad y mortalidad. Objetivo: Evaluar el perfil de los pacientes atendidos con diagnóstico de infección de origen odontogénico en un hospital público de Mato Groso do Sul. Métodos: Se trata de un estudio observacional retrospectivo y transversal que consistió en analizar 68 historias clínicas de pacientes con diagnóstico de infección odontogénica, desde marzo de 2019 hasta febrero de 2022. Resultados y Conclusión: Los resultados apuntan a una incidencia de infección odontogénica del 39,70%. para la población joven entre 16 y 28 años, con síntomas como edema en el 82,35% de los casos, seguido de trismo 51,47% y disfagia 17,64%, estancia hospitalaria promedio de 6,1 días y necesidad de traqueotomía en el 10,29% de los casos . De esta forma, el cirujano dentista, ante procesos agudos de infección odontogénica, realiza la función primordial de reconocer los síntomas e intervenir precozmente, evitando su agravamiento... (AU)

Streptococcus gallolyticus subspecies pasteurianus causing late onset neonatal sepsis and meningitis: a case report

Streptococcus gallolyticus is a gram-positive microbe rarely isolated from cases of neonatal sepsis. Prompt identification, management and monitoring is necessary in such cases due to potential complications like meningitis and endocarditis. We report a preterm baby referred to us on day 18 of life with fever, respiratory distress and lethargy with seizure. Blood culture revealed S. gallolyticus subspecies pasteurianus with meningitis on cerebrospinal fluid examination. He was treated with 21 days of injectable vancomycin and teicoplanin. Baby had no neurological sequelae or other end organ complications. To the best of our knowledge, this is the first case report from eastern India describing sepsis secondary to this rare organism.

Bacterial profiling, sensitivity and resistance pattern of neonatal sepsis in neonatal intensive care unit of tertiary care hospital

Background: This study aimed to identify the distribution of pathogens and their antimicrobial resistance patterns in the neonates admitted to the NICU of a tertiary care hospital in northern India.Methods: After obtaining written informed consent, neonates with confirmed or suspected cases of neonatal sepsis (n=167) aged 0-28 days were included. As soon as the baby arrived, all the clothes were removed and kept in a pre-heated warmer. Before administering I/V antibiotics, all the routine and culture samples were taken. The clinical data were collected and analysed using SPSS.Results: Most of the neonates were from lower middle class, out-born, LSCS, early preterm, and low birth weight (LBW). 167 neonates had culture-confirmed infections [blood culture positive (13.8%) and sepsis screen positive (86.2%)]. Gastric aspirate cytology was positive in 61.7% of patients. Maximum cytology-positive cases were seen in neonates with EOS. The most common risk factors were birth asphyxia. 142 individuals were discharged, with 72.5% diagnosed with EOS and 89% with LOS. There was a significant difference in gastric aspirate cytology when associated with expiry and discharge. Out of 167 neonates, 13.77% were culture-positive for neonatal sepsis. Out of 23 organisms, 82.6% were resistant, while, 17.4% were not. Staph aureus was the major causative organisms. Among the Gram Positive and Negative bacteria, the highest sensitivity was observed for imipenum. All gram-positive bacteria were resistant to cotrimazole, tobramycin, and erythromycin.Conclusions: Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.

Melioidosis: acute respiratory distress syndrome and sepsis

Melioidosis is a serious infection caused by the bacterium Burkholderia pseudomallei (B. pseudomallei) mostly found in endemic areas like Southeast Asia. Herein, we presented a case of melioidosis in a 32-year-old man who presented with respiratory distress, was a known case of type 2 diabetes not on any treatment presented to the emergency department (ED) with a history of pustules over skin, shortness of breath, and fever. He was initially misdiagnosed and treated as pulmonary tuberculosis in another hospital prior to his latest presentation. Melioidosis is a severe infection that can be misdiagnosed due to variable presentation and low awareness among healthcare workers of the disease. Diagnosis requires high clinical suspicion, especially in patients who are coming from endemic areas with appropriate risk factors such as diabetes mellitus. Treatment with appropriate antibiotics for a long duration, and outpatient follow-up is vital to reduce the risk of recurrence.

High diversity in the vaginal microbiome in women following preterm premature rupture of membranes and its effect on fetomaternal outcome

Background: Premature rupture of the membranes (PROM) complicates 3% of pregnancies and its associated with adverse perinatal outcome. Methods: This was a case control study conducted over a period of two years. Our aim was to evaluate the bacterial colonization of genital tract of antenatal patients who presented with preterm premature rupture of membranes and their maternal and neonatal complications. We studied 6023 patients during our study period among which 156 patients presented with preterm premature rupture of membranes. Results: PPROM was found more commonly among age 25-30 years (46.79%) with p<0.001. Out of 156 pregnant women with PPROM, only 16 patients (10.26%) developed clinical chorioamnionitis. We observed that 43.59% patients (n=68) with PPROM underwent LSCS which was significantly higher than control group (19.93%). Among them 81.41% (n=127) of the patients delivered within 24 hours of admission. Among 156 patients, 94 (59.12%) mothers had babies with birth weight ranging between 1.5-2.5 kg as compared to control group where 30.51% mothers had low birth weight babies. The difference was statistically significant. Approximately 18.24% babies developed respiratory distress syndrome requiring ICU care in study group as compared to 3.03% in control group and the difference was statistically significant. Conclusions: It is important to diagnose the PPROM early and manage the patient until delivery for better outcome. Timely intervention after proper analysis of risk and benefit of early termination helps in reducing adverse perinatal outcomes, reduced NICU admissions and unnecessary interventions for neonates.

A prospective study on evaluation of antibiotics usage in patients with sepsis at a tertiary care hospital

Background: Most developing countries are adopting antibiotic usage in sepsis. This study was conducted to evaluate the antibiotic usage in patients and to study medical adherence in high-risk patients. The study in particular aims to evaluate antibiotic usage in sepsis patients along with their related ADR’s. The study also aims to optimize the usage of antibiotics in high-risk patients at a tertiary care hospital. Methods: Study was prospective and observational review of patients record in the hospital. Clinical notes, medication chart and electronic data management system at the hospital were used to analyse usage of antibiotics. Culture and sensitivity reports were obtained from relevant departments. Observations were then compiled and documented. Results: Out of 40 cases collected 22 (55%) patients were male and 18 (45%) were female. Majority of the study population belongs to 71 years and above with 15 (37.5%) followed by age group of 41-60 years with 14 (35%). Most frequently prescribed antibiotics were found to be meropenem 16 (21.33%) and piperacillin tazobactam 14 (18.67%). The most resistant antibiotic was found to be cotrimazole in 35 (87.5%). ADRs were found in 35% of all cases. Conclusions: Prescribing patterns for antibiotics need to be optimized. Adherence to and update of the policy is also recommended. It was found that the adherence to hospital antibiotic policy is low.

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Significado biológico y utilidad clínica del lactato en la sepsis / Biological significance and clinical utility of lactate in sepsis

La sepsis es un problema global de salud y la progresión hacia el shock séptico se asocia con un incremento marcado de la morbimortalidad. En este escenario, el aumento del lactato plasmático demostró ser un indicador de gravedad y un predictor de mortalidad, y suele interpretarse casi exclusivamente como marcador de baja perfusión tisular. Sin embargo, últimamente se produjo un cambio de paradigma en la exégesis del metabolismo y propiedades biológicas del lactato. En efecto, la adaptación metabólica al estrés, aun con adecuado aporte de oxígeno, puede justificar la elevación del lactato circulante. Asimismo, otras consecuencias fisiopatológicas de la sepsis, como la disfunción mitocondrial, se asocian con el desarrollo de hiperlactatemia sin que necesariamente se acompañen de baja perfusión tisular. Interpretar el origen y la función del lactato puede resultar de suma utilidad clínica en la sepsis, especialmente cuando sus niveles circulantes fundamentan las medidas de reanimación.

Sepsis is a global health problem; progression to septic shock is associated with a marked increase in morbidity and mortality. In this setting, increased plasma lactate levels demonstrated to be an indicator of severity and a predictor of mortality, and are usually interpreted almost exclusively as a marker of low tissue perfusion. However, a recent paradigm shift has occurred in the exegesis of lactate metabolism and its biological properties. Indeed, metabolic adaptation to stress, even with an adequate oxygen supply, may account for high circulating lactate levels. Likewise, other pathophysiological consequences of sepsis, such as mitochondrial dysfunction, are associated with the development of hyperlactatemia, which is not necessarily accompanied by low tissue perfusion. Interpreting the origin and function of lactate may be of great clinical utility in sepsis, especially when circulating lactate levels are the basis for resuscitative measures.

Dengue en paciente de 32 días de vida. Reporte de un caso poco habitual / Dengue fever in a 32-day-old patient. A rare case report

El dengue es una enfermedad viral transmitida por la picadura del mosquito Aedes aegypti. El comportamiento del dengue en Argentina es epidémico; la mayoría de los casos se observan en los meses de mayor temperatura. Hasta la semana epidemiológica (SE) 20/2023, se registraron en Argentina 106 672 casos; se vieron afectadas 18 de las 24 provincias que conforman el país. Dentro de los principales grupos de riesgo, se incluyen los menores de 2 años. Reconocer los signos, síntomas e identificar los factores de riesgo es fundamental para el manejo de casos con mayor riesgo de gravedad. Presentamos el caso de una paciente de 32 días de vida que se internó por síndrome febril sin foco, con diagnósticos diferenciales de meningitis viral y sepsis, evolucionó con leucocitosis, plaquetopenia, hipoalbuminemia, asociado a exantema y edemas. Se llegó al diagnóstico de dengue por la clínica, epidemiologia e IgM positiva.

Dengue fever is a viral disease transmitted by the Aedes aegypti mosquitoes. In Argentina, dengue fever is an epidemic disease; most cases are reported during the hot months.Until epidemiological week (EW) 20/2023, 106 672 cases were reported across 18 of the 24 provinces of Argentina. Children younger than 2 years are among the main groups at risk. Recognizing signs and symptoms and identifying risk factors is fundamental for the management of cases at a higher risk of severity. Here we describe the case of a 32-day-old female patient who was hospitalized due to febrile syndrome without a source, who had a differential diagnosis of viral meningitis and sepsis and progressed to leukocytosis, thrombocytopenia, hypoalbuminemia in association with rash and edema. The diagnosis of dengue fever was established based on clinical, epidemiological, and positive IgM data.

Dopamine Dynamics in the Amygdala Influence Emotional Changes in the Early Stage of Systemic Inflammatory Response Syndrome in Rats / La Dinámica de la Dopamina en la Amígdala Influye en los Cambios Emocionales en la Etapa Temprana del Síndrome de Respuesta Inflamatoria Sistémica en Ratas

SUMMARY: Systemic inflammatory response syndrome (SIRS) is a potentially fatal reaction to various forms of tissue damage and infections that cause damage to various organs. Furthermore, the brain is damaged earlier than other organs, resulting in diffuse brain dysfunction. The central clinical symptom of SIRS is delirium and emotional changes are involved in disease development. Although the amygdala is known to play a major role, the mechanisms underlying emotional changes in the early stages of SIRS have not been elucidated. Therefore, changes to dopamine levels in the amygdala were observed using an in vivo model of lipopolysaccharide (LPS)- induced SIRS to clarify the biochemical mechanisms activated in the early stages of SIRS. Extracellular dopamine was collected from the amygdala of free moving rats via microdialysis and then analyzed by high-performance liquid chromatography. In addition, emotional changes were assessed with the open field and sucrose preference tests. In the LPS group, dopamine release in the amygdala increased remarkably immediately after LPS administration, peaking at 120 min. Thereafter, dopamine release temporarily decreased, but then significantly increased again after 180 min. The present results suggest that diffuse brain dysfunction in the early stages of SIRS may involve altered dopamine levels in the amygdala.

El síndrome de respuesta inflamatoria sistémica (SRIS) es una reacción potencialmente fatal a diversas formas de daño tisular e infecciones que causan injuria a varios órganos. Además, el cerebro se daña antes que otros órganos, lo que provoca una disfunción cerebral difusa. El síntoma clínico central del SIRS es el delirio y los cambios emocionales están involucrados en el desarrollo de la enfermedad. Aunque se sabe que la amígdala desempeña un papel importante, no se han dilucidado los mecanismos que subyacen a los cambios emocionales en las primeras etapas del SRIS. Por lo tanto, en el estudio se provocaron cambios en los niveles de dopamina en la amígdala utilizando un modelo in vivo de SRIS inducido por lipopolisacáridos (LPS) para dilucidar los mecanismos bioquímicos activados en las primeras etapas del SRIS. La dopamina extracelular se recogió de la amígdala de ratas en movimiento libre mediante microdiálisis y luego se analizó mediante cromatografía líquida de alta resolución. Además, se evaluaron los cambios emocionales con las pruebas de campo abierto y de preferencia de sacarosa. En el grupo de LPS, la liberación de dopamina en la amígdala aumentó de manera notable inmediatamente después de la administración de LPS, alcanzando un máximo a los 120 minutos. A partir de entonces, la liberación de dopamina disminuyó temporalmente, pero luego volvió a aumentar significativamente después de 180 min. Los resultadosactuales sugieren que la disfunción cerebral difusa en las primeras etapas del SIRS puede implicar niveles alterados de dopamina en la amígdala.

Bone and joint infection complicated with sepsis in neonates and infants under three months of age

Abstract Objective: Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. Methods: Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. Results: Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. Conclusion: Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.

A study of level of procalcitonin as marker of early onset sepsis in neonates

Background: Neonatal sepsis is one of the commonest causes of morbidity and mortality. It is one of the four leading causes of morbidity and mortality in India. The purpose of this study was to evaluate the levels of procalcitonin as a rapid diagnostic test, to identify those with infection as soon as possible, and to classify them into definitive, clinical, or no sepsis. The rise in Procalcitonin levels in the neonate with sepsis is very rapid. Hence, it can be used for the diagnosis of early onset neonatal sepsis. Objectives were to estimate the concentration of Procalcitonin for diagnosis of early onset neonatal sepsis and to compare the Procalcitonin levels amongst 3 categories of neonatal sepsis (definite, clinical and no sepsis).Methods: This is a hospital based analytical prospective study.Results: 104 babies with early onset sepsis were included in the study from the NICU in tertiary health care center. Procalcitonin is positive in 69 (66.35%) and negative in 35 (33.65%). Out of the total 69 neonates with Procalcitonin positive, 42 (60.8%) neonates are preterm and 27 (39.1%) are term neonates. Out of the total 35 neonates with Procalcitonin negative, 24 (68.5%) neonates are preterm and 11 (31.4%) are term neonates. There was no sepsis observed in 57 (54.8%) of cases, clinical sepsis was observed in 34 (32.6%) of cases and definite sepsis was observed in 13 (12.5%). The mean value of level of Procalcitonin in different categories of sepsis as determined from the data is 3.27 ng/ml in cases of No sepsis, 11.79 ng/ml in cases of clinical sepsis and 17.2 ng/ml in cases of definitive sepsis.Conclusions: Procalcitonin has good sensitivity and hence can detect most cases of neonatal sepsis and good negative predictive value. Procalcitonin contributes more significantly to the diagnosis of newborn septicemia when paired with additional testing and helps in identifying the categories of sepsis in neonates.