Urgent aortic valve replacement in severe aortic stenosis with severe left ventricular dysfunction and severe pulmonary hypertension: a perioperative multidisciplinary management approach

Severe aortic stenosis [AS] with reduced left ventricular systolic function and pulmonary artery hypertension [PH] is associated with poor outcome if remained untreated We report a case report of a 62 years old male patient weighing 69 kg had progressive dyspnea for 5 years and was diagnosed cardiac patient, and was scheduled for an urgent aortic valve replacement. He had severely reduced left ventricular [LV] function and severe pulmonary hypertension. The patient was put on bypass with special emphasis on myocardial protection. Tissue valve was placed and patient was successfully put off cardiopulmonary bypass on high inotrope score, which was tapered after some time. The patient was shifted to CICU after chest closure and was extubated on fast track mode. The patient was followed up for three months showing improvement in symptoms and LV function The objective of reporting the case is to highlight the role of multidisciplinary integrated approach in the perioperative period for best patient outcome

Frequency and treatment of methicillin resistant staphylococcus aureus in obstetric and gynaecological sepsis

To perform culture and sensitivity for pathogens causing puerperal and postoperative wound sepsis and determine the frequency of Methicillin Resistant Staphylococcus aureus [MRSA] in such infections. Observational study. Obstetrics and Gynaecology Ward, Jinnah Postgraduate Medical Centre, Karachi, from December 2008 to May 2010. All patients presenting with puerperal sepsis or postoperative wound infection were enrolled. Pus was collected for culture and sensitivity using standard technique. Two samples were taken from each patient; one before starting the treatment and one at the end of treatment. Ames transport medium was used. Empirical treatment with triple regimen [Ampicillin, Metronidazole and Gentamicin] was started immediately to cover Gram positive as well as negative bacteria in addition to anaerobic infection. After receiving the sensitivity report, antimicrobial agent were changed accordingly. Samples from ward and theater staff and environment were also taken to look for possible mode of transmission. Data was recorded on a proforma. Discrete variables are expressed as percentages. Staphylococcus aureus was the most frequent organism isolated in 34% cases. Methicillin sensitive Staphylococcus aureus was seen in 20% cases and methicillin resistant Staphylococcus aureus was seen in 14.6%. Out of these 14.6% MRSA, [17] 77% was associated with puerperal sepsis and rest [5] 23% was associated with post-operative wound infection. It showed best sensitivity to vancomycin. Staphylococcus aureus and E.coli were common agent of postoperative infections and puerperal sepsis