Introduction: Landscape of etiological profile and microbiological resistance of Spontaneous Bacterial Peritonitis (SBP) in Chronic Liver Disease (CLD) is continuously changing. Early antibiotic treatment of SBP is crucial but spread of Multidrug Resistant (MDR) organism makes its current management challenging. Our study provides fresh insight into its etiology and resistance profile to design better empiric regimen.
Objective: Study etiological profi le and resistance pattern of SBP in CLD Methods: This prospective observational study was conducted at Government Medical College, Srinagar from April 2018 to March 2019.
This document summarizes two recent studies on prognostic biomarkers for hepatocellular carcinoma (HCC). The first study found that high levels of C-reactive protein (CRP), an inflammatory marker, predicts poor long-term survival for patients with HCC undergoing nonsurgical treatments. The second study found that low levels of CD4+ cytotoxic T lymphocytes (CTLs), part of the immune system, predicts poor outcomes and high recurrence rates for HCC patients. Both inflammatory and immunological markers may provide prognostic information to supplement current clinical staging systems for HCC. However, more research is still needed to validate the prognostic value of these biomarkers.
Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Erwin Chiquete, MD, PhD
34. Chiquete E, Ochoa-Guzmán A, García-Lamas L, Anaya-Gómez F, Gutiérrez-Manjarrez JI, Sánchez-Orozco LV, Godínez-Gutiérrez SA, Maldonado M, Román S, Panduro A. Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Rev Med Inst Mex Seguro Soc. 2012;50(5):481-6. [PMID: 23282259]
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This study examined risk factors for fluconazole resistance in patients with Candida glabrata bloodstream infections (Cg-BSI). Among 144 patients with Cg-BSI, prior fluconazole use was not significantly associated with fluconazole resistance in primary analyses, but a borderline significant association was seen in secondary analyses limited to patients with highly resistant infections. Increased time at risk, or time from hospital admission to first positive blood culture, was found to be a significant independent risk factor for fluconazole resistance in both primary and secondary analyses.
This document provides guidelines for the diagnosis, treatment and prevention of Clostridium difficile infections (CDI). It summarizes key recommendations with evidence grading. For diagnosis, it recommends nucleic acid amplification tests over toxin enzyme immunoassays, and only testing diarrheal stool samples. It stratifies treatment based on disease severity into mild-moderate (treat with metronidazole), severe (vancomycin with/without metronidazole), and complicated (vancomycin orally and rectally with intravenous metronidazole). It also covers recurrent CDI treatment, managing CDI in patients with comorbidities, and infection control practices like contact precautions and environmental disinfection. The guidelines
1) Antibiotic de-escalation refers to narrowing or reducing the spectrum of antibiotics administered to critically ill patients once culture results are available.
2) Observational studies have found de-escalation therapy to be safely practiced in ICU patients and possibly associated with lower mortality and shorter hospital stays.
3) However, randomized trials have found possible higher risks of reinfection with de-escalation, without effects on mortality. Overall, de-escalation appears to be a well-tolerated strategy but is not widely adopted in practice.
This document summarizes the principles of tuberculosis treatment. It notes that while effective treatment has been available for 60 years, treatment takes at least 6 months. The standard treatment involves a 2-month induction phase with at least 3 drugs (isoniazid, rifampin, and pyrazinamide), followed by a 4-month consolidation phase with at least 2 drugs (isoniazid and rifampin). Challenges to treatment include bacterial populations with differing drug susceptibilities, sequestration of bacteria in tissues where drugs cannot reach, and factors influencing drug absorption and metabolism.
This study evaluated the performance of three pneumonia severity scores - CURB-65, CRB-65, and CURB-age - in predicting 30-day mortality in 559 adult inpatients with community-acquired pneumonia. The study found that CURB-age stratified patients into risk groups that were most closely associated with mortality outcomes. Specifically, CURB-age identified more low-risk patients who had lower mortality than CRB-65, and sorted more patients who died within 30 days into the high-risk group compared to the other scores. Analysis of receiver operating characteristics further indicated CURB-age had better ability to predict 30-day mortality compared to the other scores. The study concludes CURB-age may provide
This document summarizes two recent studies on prognostic biomarkers for hepatocellular carcinoma (HCC). The first study found that high levels of C-reactive protein (CRP), an inflammatory marker, predicts poor long-term survival for patients with HCC undergoing nonsurgical treatments. The second study found that low levels of CD4+ cytotoxic T lymphocytes (CTLs), part of the immune system, predicts poor outcomes and high recurrence rates for HCC patients. Both inflammatory and immunological markers may provide prognostic information to supplement current clinical staging systems for HCC. However, more research is still needed to validate the prognostic value of these biomarkers.
Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Erwin Chiquete, MD, PhD
34. Chiquete E, Ochoa-Guzmán A, García-Lamas L, Anaya-Gómez F, Gutiérrez-Manjarrez JI, Sánchez-Orozco LV, Godínez-Gutiérrez SA, Maldonado M, Román S, Panduro A. Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Rev Med Inst Mex Seguro Soc. 2012;50(5):481-6. [PMID: 23282259]
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This study examined risk factors for fluconazole resistance in patients with Candida glabrata bloodstream infections (Cg-BSI). Among 144 patients with Cg-BSI, prior fluconazole use was not significantly associated with fluconazole resistance in primary analyses, but a borderline significant association was seen in secondary analyses limited to patients with highly resistant infections. Increased time at risk, or time from hospital admission to first positive blood culture, was found to be a significant independent risk factor for fluconazole resistance in both primary and secondary analyses.
This document provides guidelines for the diagnosis, treatment and prevention of Clostridium difficile infections (CDI). It summarizes key recommendations with evidence grading. For diagnosis, it recommends nucleic acid amplification tests over toxin enzyme immunoassays, and only testing diarrheal stool samples. It stratifies treatment based on disease severity into mild-moderate (treat with metronidazole), severe (vancomycin with/without metronidazole), and complicated (vancomycin orally and rectally with intravenous metronidazole). It also covers recurrent CDI treatment, managing CDI in patients with comorbidities, and infection control practices like contact precautions and environmental disinfection. The guidelines
1) Antibiotic de-escalation refers to narrowing or reducing the spectrum of antibiotics administered to critically ill patients once culture results are available.
2) Observational studies have found de-escalation therapy to be safely practiced in ICU patients and possibly associated with lower mortality and shorter hospital stays.
3) However, randomized trials have found possible higher risks of reinfection with de-escalation, without effects on mortality. Overall, de-escalation appears to be a well-tolerated strategy but is not widely adopted in practice.
This document summarizes the principles of tuberculosis treatment. It notes that while effective treatment has been available for 60 years, treatment takes at least 6 months. The standard treatment involves a 2-month induction phase with at least 3 drugs (isoniazid, rifampin, and pyrazinamide), followed by a 4-month consolidation phase with at least 2 drugs (isoniazid and rifampin). Challenges to treatment include bacterial populations with differing drug susceptibilities, sequestration of bacteria in tissues where drugs cannot reach, and factors influencing drug absorption and metabolism.
This study evaluated the performance of three pneumonia severity scores - CURB-65, CRB-65, and CURB-age - in predicting 30-day mortality in 559 adult inpatients with community-acquired pneumonia. The study found that CURB-age stratified patients into risk groups that were most closely associated with mortality outcomes. Specifically, CURB-age identified more low-risk patients who had lower mortality than CRB-65, and sorted more patients who died within 30 days into the high-risk group compared to the other scores. Analysis of receiver operating characteristics further indicated CURB-age had better ability to predict 30-day mortality compared to the other scores. The study concludes CURB-age may provide
Articulo que intenta demostrar en un modelo linear mixto de efectos al azar, que las variables edad, sexo y estado nutricional de un paciente coinfectado VIH/TB influyen en la recuperación del CD4
This study examined the prevalence of hepatitis C virus (HCV) among indoor and outdoor patients at a tertiary care hospital in India over one year. Blood samples from 10,750 patients were tested for HCV antibodies. Overall, 3.74% of samples were positive. The positivity rate was higher in males (4.16%) than females (2.95%) and highest in the 11-20 age group (5.6%). Indoor samples had a higher positivity rate (7.8%) than outdoor samples (2.3%). Groups with especially high rates included patients on dialysis (13.1%), those in the thalassemia unit (12.8%), and patients in the gastroenterology surgery
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has been used as a treatment for infectious diseases for over a century. It involves transfusing plasma from patients who have recovered from an infection into patients who are currently ill with that same infection. Clinical trials are now investigating its use for COVID-19. While some early studies showed promising results, larger randomized controlled trials found no significant benefit of convalescent plasma for severe COVID-19. Further research is still needed to determine whether certain patient populations or plasma dosages may be more effective.
This study aimed to evaluate the efficacy of pegylated interferon alpha-2a in combination with ribavirin for the treatment of naive Egyptian patients with chronic hepatitis C virus (HCV) genotype 4. Fifty-three patients were treated for 72 weeks and followed up to assess sustained virological response. The study found that end of treatment response was achieved in 69.8% of patients, while sustained virological response was observed in 64.1% overall. However, patients with cirrhosis or high pre-treatment viral load had significantly lower response rates. The study concluded that pegylated interferon alpha-2a and ribavirin combination therapy is effective for HCV genotype 4, but outcomes are
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
case study- CCRT vs SCRT in unresectable locally advanced esophageal cancerAbhishek Pratap Singh
comparison of response, toxicity evaluation & one year survival in cases of unresectable locally advanced esophageal cancer, when using CCRT/SCRT as definitive treatment.
1) Pneumonia is a common infection seen in nephrology practice, especially in patients with nephrotic syndrome, chronic kidney disease, end-stage renal disease on dialysis, and renal transplant recipients.
2) Patients with nephrotic syndrome have increased risk of infections like pneumonia due to urinary losses of immunoglobulins and properdin factor B. One study found 36.6% of children with nephrotic syndrome developed major infections, with nearly 1/3 having pneumonia.
3) As chronic kidney disease progresses and reaches end-stage renal disease, risk of infections including pneumonia increases. Cardiovascular disease and infections are the main causes of death in end-stage
This study aimed to evaluate procalcitonin (PCT) as a marker for identifying bacteremia in febrile children with central lines presenting to the emergency department. The study found that PCT levels were significantly higher in bacteremic versus non-bacteremic patients, and that a cutoff of 0.3 ng/mL produced a sensitivity of 93% and specificity of 63% for detecting bacteremia. However, the study had limitations including potential confounding from underlying cancers. The discussion suggested further research with larger samples over time to expand understanding of PCT's utility in this population.
Development and validation of a novel diagnostic nomogram to differentiate be...Hidert Chusi Huamani
This study developed and validated two novel diagnostic nomograms to differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) using data from 310 patients across six hospitals in China. Eight variables were identified as valuable for establishing diagnostic models, including age, transverse ulcer, rectum involvement, skipped involvement of small bowel, target sign, comb sign, and interferon-gamma release assays or purified protein derivative test results. Two highly accurate nomograms were developed, with one showing 87.8% accuracy and the other showing 87.8% accuracy in differentiating CD from ITB. The nomograms provide a practical tool for clinicians to identify difficult cases of CD or ITB.
•Describe the role of antibiotic use in the development of resistance
•Review toxicity of commonly used antibiotics
•Understand the prevalence and clinical impact of carbapenem resistant enterobacteriaceae
•State the prognosis antimicrobial resistant Staph aureus infections
This study examined ventilator-associated pneumonia (VAP) in patients at a hospital in India over one year. A total of 86 patients who met the criteria for VAP were included. The most common pathogen isolated was Acinetobacter baumannii, found in 10 of 18 patients with monomicrobial infections. Polymicrobial infections were more common than monomicrobial, with the most frequent combination being Klebsiella pneumoniae and A. baumannii. Mortality was higher in patients with polymicrobial infections compared to monomicrobial. Most pathogens showed resistance to commonly used antibiotics. The study aims to identify local microbiological patterns and sensitivities to help guide empirical antibiotic therapy for VAP.
This article summarizes a study of 785 Tanzanian children living in an area with intense malaria transmission. The study found that iron deficiency (ID), as measured by ferritin levels in blood samples taken at routine visits, significantly decreased the odds of subsequent malaria parasitemia, severe malaria, and all-cause mortality in children. When samples from sick visits were also included, ID was associated with significantly lower prevalence of parasitemia, hyperparasitemia (very high parasite levels), and severe malaria at the time of sample collection. The results suggest that naturally occurring ID protects against severe malaria and death in young children, and that iron supplementation may increase malaria risk even in children with ID. Future studies are needed to determine
1) The document examines soluble epidermal growth factor receptor (sEGFR) levels in 308 advanced non-small cell lung cancer (NSCLC) patients and 109 healthy controls.
2) sEGFR levels were significantly lower in NSCLC patients compared to controls, however sEGFR alone was not a strong biomarker to distinguish patients from controls due to low sensitivity.
3) Lower sEGFR levels in patients correlated with poorer overall survival, suggesting sEGFR may be a useful prognostic biomarker in NSCLC. Further large-scale prospective studies are needed to validate its predictive value.
This document summarizes updates to the 2009 American Association for the Study of Liver Diseases (AASLD) Practice Guidelines for the management of chronic hepatitis B. Key changes include:
1) Tenofovir is now recommended as a first-line oral antiviral treatment based on its superior efficacy compared to adefovir in clinical trials. Adefovir is now recommended as a second-line treatment.
2) Entecavir is no longer recommended for patients co-infected with HBV and HIV due to data on its anti-HIV activity.
3) Screening recommendations were expanded to include persons born in intermediate endemic areas and those receiving cancer chemotherapy or long-term immunosuppression based on
1) The study aimed to use the PP65 antigenemia technique to diagnose active cytomegalovirus (CMV) infection in AIDS patients in Brazil and examine its occurrence in the region.
2) They found that 14 of 50 AIDS patients tested positive for PP65 antigenemia, indicating active CMV infection, while none of the 34 bone marrow transplant patients tested positive.
3) Having a CD4+ T-cell count below 100 cells/mm3 appeared to increase the risk of testing positive for PP65 antigenemia and active CMV infection, as more low CD4 count patients tested positive compared to higher CD4 count patients.
This document discusses new developments in the treatment of community-onset pneumonia. It notes that mortality from pneumonia has declined due to pneumococcal vaccines, timely administration of appropriate antibiotics, and avoiding overtreatment in low-risk patients. Viruses are now recognized as a common cause of adult pneumonia. Procalcitonin levels may help identify patients at low risk of deterioration who need only extremely short courses of antibiotics. While healthcare-associated pneumonia is associated with drug-resistant pathogens and worse outcomes, inappropriate antibiotics alone do not fully explain increased mortality.
The relationship between the molecular epidemiology of hepatitis c and the be...Alexander Decker
This study examined the molecular epidemiology and prevalence of hepatitis C virus (HCV) infection in Jordan. Researchers tested 1929 patients for HCV antibodies between 2010-2011. A total of 149 patients (9%) tested positive, with the infection being twice as common in males compared to females. The most common causes of infection were blood transfusion (68%), kidney dialysis (17%), addiction treatment centers (6%), and unknown causes (9%). HCV RNA detection and genotyping was performed on positive samples. The results suggest blood transfusion is a major route of HCV transmission in Jordan and screening of blood donors has helped reduce prevalence over time.
This study examined risk factors for HCV infection and severity of liver disease in 86 Mexican women reactive for anti-HCV antibodies. Surgery (80%) and blood transfusions before 1993 (58%) were main risk factors, with 52% having both. The most common reasons for surgery and transfusion were obstetric/gynecologic (74% and 68%). 64% were HCV RNA positive. Age and history of transfusion before 1993 predicted cirrhosis. Anti-HCV levels correlated with time since transfusion but not age. HBV co-infection rate was low (5%) and did not influence severity.
Cirrhosis increases the risk of bacterial infections which are a leading cause of death in patients with liver disease. Bacterial infections commonly seen in cirrhosis include spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, and bacteremia. The pathogenesis involves bacterial translocation from the gut and impaired immune defenses in cirrhosis. Clinical features can include fever, abdominal pain, renal failure, and hepatic decompensation. Diagnosis involves identifying signs of infection and testing ascitic fluid or other body fluids by cell count, cultures, and other tests. Antibiotic prophylaxis is recommended for gastrointestinal bleeding and recurrent SBP based on increased mortality from infection in these high risk groups.
Currently efficacy of therapy of patients with
MDR ТВ does not exceed 48.7% worldwide and in Russian
Federation. One of the reason is a frequent development of
adverse drug reactions during the use of combination of
antituberculosis drugs. Since 2013 after registration of
tioureidoiminomethylpyridinium perchlorate (Pecrhlozon®) in
Russian Federation, opportunities appeared for further study
of its efficacy and safety in treatment of tuberculosis with
multiple drug resistance (MDR). In the present study we
applied monitoring of adverse drug reactions during complex
therapy by Perchlozon in combination with five other drugs
with the use of international 5-grade scale. We used Common
Terminology Criteria for Adverse Events (version 3.0). In the
study only mild (grade 1) and moderate (grade 2) adverse drug
reactions were observed except single case when severe (grade
3) adverse drug reaction happened. Mild adverse reactions that
during receiving Perchlozon therapy in complex with other
drugs for MDR-TB did not require its cessation.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...eshaasini
This meta-analysis examined 27 studies to determine if serum thymidine kinase 1 concentration (STK1p) can provide benefit for risk assessment of gastric neoplasm progression to gastric carcinoma (GC) and for evaluating GC treatment effects. The studies included 1,909 GC patients, 1,229 gastric neoplasm patients, and 2,260 tumor-free individuals. The results showed that STK1p levels increased significantly from tumor-free to superficial gastritis to chronic gastritis to atrophic gastritis to gastric ulcer to GC. STK1p levels in 251 GC patients declined significantly by 66% one month after surgery compared to pre-surgery levels. This suggests that STK1p has
Articulo que intenta demostrar en un modelo linear mixto de efectos al azar, que las variables edad, sexo y estado nutricional de un paciente coinfectado VIH/TB influyen en la recuperación del CD4
This study examined the prevalence of hepatitis C virus (HCV) among indoor and outdoor patients at a tertiary care hospital in India over one year. Blood samples from 10,750 patients were tested for HCV antibodies. Overall, 3.74% of samples were positive. The positivity rate was higher in males (4.16%) than females (2.95%) and highest in the 11-20 age group (5.6%). Indoor samples had a higher positivity rate (7.8%) than outdoor samples (2.3%). Groups with especially high rates included patients on dialysis (13.1%), those in the thalassemia unit (12.8%), and patients in the gastroenterology surgery
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has been used as a treatment for infectious diseases for over a century. It involves transfusing plasma from patients who have recovered from an infection into patients who are currently ill with that same infection. Clinical trials are now investigating its use for COVID-19. While some early studies showed promising results, larger randomized controlled trials found no significant benefit of convalescent plasma for severe COVID-19. Further research is still needed to determine whether certain patient populations or plasma dosages may be more effective.
This study aimed to evaluate the efficacy of pegylated interferon alpha-2a in combination with ribavirin for the treatment of naive Egyptian patients with chronic hepatitis C virus (HCV) genotype 4. Fifty-three patients were treated for 72 weeks and followed up to assess sustained virological response. The study found that end of treatment response was achieved in 69.8% of patients, while sustained virological response was observed in 64.1% overall. However, patients with cirrhosis or high pre-treatment viral load had significantly lower response rates. The study concluded that pegylated interferon alpha-2a and ribavirin combination therapy is effective for HCV genotype 4, but outcomes are
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
case study- CCRT vs SCRT in unresectable locally advanced esophageal cancerAbhishek Pratap Singh
comparison of response, toxicity evaluation & one year survival in cases of unresectable locally advanced esophageal cancer, when using CCRT/SCRT as definitive treatment.
1) Pneumonia is a common infection seen in nephrology practice, especially in patients with nephrotic syndrome, chronic kidney disease, end-stage renal disease on dialysis, and renal transplant recipients.
2) Patients with nephrotic syndrome have increased risk of infections like pneumonia due to urinary losses of immunoglobulins and properdin factor B. One study found 36.6% of children with nephrotic syndrome developed major infections, with nearly 1/3 having pneumonia.
3) As chronic kidney disease progresses and reaches end-stage renal disease, risk of infections including pneumonia increases. Cardiovascular disease and infections are the main causes of death in end-stage
This study aimed to evaluate procalcitonin (PCT) as a marker for identifying bacteremia in febrile children with central lines presenting to the emergency department. The study found that PCT levels were significantly higher in bacteremic versus non-bacteremic patients, and that a cutoff of 0.3 ng/mL produced a sensitivity of 93% and specificity of 63% for detecting bacteremia. However, the study had limitations including potential confounding from underlying cancers. The discussion suggested further research with larger samples over time to expand understanding of PCT's utility in this population.
Development and validation of a novel diagnostic nomogram to differentiate be...Hidert Chusi Huamani
This study developed and validated two novel diagnostic nomograms to differentiate between intestinal tuberculosis (ITB) and Crohn's disease (CD) using data from 310 patients across six hospitals in China. Eight variables were identified as valuable for establishing diagnostic models, including age, transverse ulcer, rectum involvement, skipped involvement of small bowel, target sign, comb sign, and interferon-gamma release assays or purified protein derivative test results. Two highly accurate nomograms were developed, with one showing 87.8% accuracy and the other showing 87.8% accuracy in differentiating CD from ITB. The nomograms provide a practical tool for clinicians to identify difficult cases of CD or ITB.
•Describe the role of antibiotic use in the development of resistance
•Review toxicity of commonly used antibiotics
•Understand the prevalence and clinical impact of carbapenem resistant enterobacteriaceae
•State the prognosis antimicrobial resistant Staph aureus infections
This study examined ventilator-associated pneumonia (VAP) in patients at a hospital in India over one year. A total of 86 patients who met the criteria for VAP were included. The most common pathogen isolated was Acinetobacter baumannii, found in 10 of 18 patients with monomicrobial infections. Polymicrobial infections were more common than monomicrobial, with the most frequent combination being Klebsiella pneumoniae and A. baumannii. Mortality was higher in patients with polymicrobial infections compared to monomicrobial. Most pathogens showed resistance to commonly used antibiotics. The study aims to identify local microbiological patterns and sensitivities to help guide empirical antibiotic therapy for VAP.
This article summarizes a study of 785 Tanzanian children living in an area with intense malaria transmission. The study found that iron deficiency (ID), as measured by ferritin levels in blood samples taken at routine visits, significantly decreased the odds of subsequent malaria parasitemia, severe malaria, and all-cause mortality in children. When samples from sick visits were also included, ID was associated with significantly lower prevalence of parasitemia, hyperparasitemia (very high parasite levels), and severe malaria at the time of sample collection. The results suggest that naturally occurring ID protects against severe malaria and death in young children, and that iron supplementation may increase malaria risk even in children with ID. Future studies are needed to determine
1) The document examines soluble epidermal growth factor receptor (sEGFR) levels in 308 advanced non-small cell lung cancer (NSCLC) patients and 109 healthy controls.
2) sEGFR levels were significantly lower in NSCLC patients compared to controls, however sEGFR alone was not a strong biomarker to distinguish patients from controls due to low sensitivity.
3) Lower sEGFR levels in patients correlated with poorer overall survival, suggesting sEGFR may be a useful prognostic biomarker in NSCLC. Further large-scale prospective studies are needed to validate its predictive value.
This document summarizes updates to the 2009 American Association for the Study of Liver Diseases (AASLD) Practice Guidelines for the management of chronic hepatitis B. Key changes include:
1) Tenofovir is now recommended as a first-line oral antiviral treatment based on its superior efficacy compared to adefovir in clinical trials. Adefovir is now recommended as a second-line treatment.
2) Entecavir is no longer recommended for patients co-infected with HBV and HIV due to data on its anti-HIV activity.
3) Screening recommendations were expanded to include persons born in intermediate endemic areas and those receiving cancer chemotherapy or long-term immunosuppression based on
1) The study aimed to use the PP65 antigenemia technique to diagnose active cytomegalovirus (CMV) infection in AIDS patients in Brazil and examine its occurrence in the region.
2) They found that 14 of 50 AIDS patients tested positive for PP65 antigenemia, indicating active CMV infection, while none of the 34 bone marrow transplant patients tested positive.
3) Having a CD4+ T-cell count below 100 cells/mm3 appeared to increase the risk of testing positive for PP65 antigenemia and active CMV infection, as more low CD4 count patients tested positive compared to higher CD4 count patients.
This document discusses new developments in the treatment of community-onset pneumonia. It notes that mortality from pneumonia has declined due to pneumococcal vaccines, timely administration of appropriate antibiotics, and avoiding overtreatment in low-risk patients. Viruses are now recognized as a common cause of adult pneumonia. Procalcitonin levels may help identify patients at low risk of deterioration who need only extremely short courses of antibiotics. While healthcare-associated pneumonia is associated with drug-resistant pathogens and worse outcomes, inappropriate antibiotics alone do not fully explain increased mortality.
The relationship between the molecular epidemiology of hepatitis c and the be...Alexander Decker
This study examined the molecular epidemiology and prevalence of hepatitis C virus (HCV) infection in Jordan. Researchers tested 1929 patients for HCV antibodies between 2010-2011. A total of 149 patients (9%) tested positive, with the infection being twice as common in males compared to females. The most common causes of infection were blood transfusion (68%), kidney dialysis (17%), addiction treatment centers (6%), and unknown causes (9%). HCV RNA detection and genotyping was performed on positive samples. The results suggest blood transfusion is a major route of HCV transmission in Jordan and screening of blood donors has helped reduce prevalence over time.
This study examined risk factors for HCV infection and severity of liver disease in 86 Mexican women reactive for anti-HCV antibodies. Surgery (80%) and blood transfusions before 1993 (58%) were main risk factors, with 52% having both. The most common reasons for surgery and transfusion were obstetric/gynecologic (74% and 68%). 64% were HCV RNA positive. Age and history of transfusion before 1993 predicted cirrhosis. Anti-HCV levels correlated with time since transfusion but not age. HBV co-infection rate was low (5%) and did not influence severity.
Cirrhosis increases the risk of bacterial infections which are a leading cause of death in patients with liver disease. Bacterial infections commonly seen in cirrhosis include spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, and bacteremia. The pathogenesis involves bacterial translocation from the gut and impaired immune defenses in cirrhosis. Clinical features can include fever, abdominal pain, renal failure, and hepatic decompensation. Diagnosis involves identifying signs of infection and testing ascitic fluid or other body fluids by cell count, cultures, and other tests. Antibiotic prophylaxis is recommended for gastrointestinal bleeding and recurrent SBP based on increased mortality from infection in these high risk groups.
Currently efficacy of therapy of patients with
MDR ТВ does not exceed 48.7% worldwide and in Russian
Federation. One of the reason is a frequent development of
adverse drug reactions during the use of combination of
antituberculosis drugs. Since 2013 after registration of
tioureidoiminomethylpyridinium perchlorate (Pecrhlozon®) in
Russian Federation, opportunities appeared for further study
of its efficacy and safety in treatment of tuberculosis with
multiple drug resistance (MDR). In the present study we
applied monitoring of adverse drug reactions during complex
therapy by Perchlozon in combination with five other drugs
with the use of international 5-grade scale. We used Common
Terminology Criteria for Adverse Events (version 3.0). In the
study only mild (grade 1) and moderate (grade 2) adverse drug
reactions were observed except single case when severe (grade
3) adverse drug reaction happened. Mild adverse reactions that
during receiving Perchlozon therapy in complex with other
drugs for MDR-TB did not require its cessation.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...eshaasini
This meta-analysis examined 27 studies to determine if serum thymidine kinase 1 concentration (STK1p) can provide benefit for risk assessment of gastric neoplasm progression to gastric carcinoma (GC) and for evaluating GC treatment effects. The studies included 1,909 GC patients, 1,229 gastric neoplasm patients, and 2,260 tumor-free individuals. The results showed that STK1p levels increased significantly from tumor-free to superficial gastritis to chronic gastritis to atrophic gastritis to gastric ulcer to GC. STK1p levels in 251 GC patients declined significantly by 66% one month after surgery compared to pre-surgery levels. This suggests that STK1p has
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
This document summarizes a study evaluating the efficacy and safety of nivolumab compared to everolimus for treating advanced renal cell carcinoma (RCC) that has progressed after anti-angiogenic therapy (Checkmate 025). The study found that nivolumab provided a statistically significant improvement in overall survival compared to everolimus, with median survival of 25 months for nivolumab vs 19.6 months for everolimus. Nivolumab also had higher response and duration of response rates. While grade 3-4 adverse events were more common with nivolumab, fewer patients discontinued due to adverse reactions compared to everolimus. The study demonstrates the benefit of nivolumab immunotherapy for previously treated
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...daranisaha
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesion
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
We evaluated 112 consecutive Caucasian cirrhotic
patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2)
levels. Patients without confirmed HCC at baseline were further
followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as
histological confirmation of HCC was established in patients with
new lesions. During 5-year surveillance, 14 (16.6%) patients developed HCC
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...semualkaira
We evaluated 112 consecutive Caucasian cirrhotic
patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2)
levels. Patients without confirmed HCC at baseline were further
followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as
histological confirmation of HCC was established in patients with
new lesions. During 5-year surveillance, 14 (16.6%) patients developed HCC.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...JohnJulie1
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...NainaAnon
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...EditorSara
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions. Du
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...EditorSara
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions
This study evaluated the efficacy and safety of intravenous injection of Mycobacterium w (Mw) in treating gram-negative sepsis.
The study involved 30 patients over 18 years of age with gram-negative sepsis and single organ dysfunction. Patients received intravenous Mw injections in addition to standard care. Results showed significant improvements in vital signs, organ function markers, and sepsis severity scores from day 2 onward compared to baseline. No major adverse events occurred.
The study concluded that intravenous Mw appears to be a well-tolerated and effective adjuvant treatment for gram-negative sepsis when added to standard care, as demonstrated by improved clinical outcomes. However, larger randomized controlled trials are still needed to confirm these findings.
This document summarizes a journal presentation on the relationship between duration and life-stage of antibiotic use and the risk of cardiovascular events in women. The presentation found that longer durations of antibiotic use in middle adulthood were associated with an increased risk of cardiovascular disease later in life. Specifically, using antibiotics for 2 months or more between ages 40-59 was linked to higher risks. The risks may be due to effects of antibiotics on the microbiome and subsequent inflammation and weight gain. The conclusions were that cumulative antibiotic use during middle and older adulthood can increase cardiovascular risks for elderly women.
Similar to International Journal of Hepatology & Gastroenterology (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
Histololgy of Female Reproductive System.pptxAyeshaZaid1
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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2. International Journal of Hepatology & Gastroenterology
SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 010
ISSN: 2639-3778
INTRODUCTION
Spontaneous Bacterial Peritonitis (SBP) is an infection of the
previously sterile Ascitic Fluid (AF), without any apparent intra-
abdominal source of infection in patients of Chronic Liver Disease
(CLD) [1]. It was first described by Conn and Fessel in patients with
hepatic cirrhosis in 1906-1907 [2]. The prevalence of SBP varies
from 1.5-3.5% in out-patients and 10-30% in hospitalized patients
[3,4]. Factors associated with SBP include age, history of SBP [4],
gastrointestinal bleeding [4,5]. Severity of liver dysfunction scores
including the Child Turcotte Pugh (CTP) score or Model for End-
Stage Liver Disease (MELD) score, neutrophil count, low protein
concentration (< 1.5 g/ dL) in the ascitic fluid, and long term Proton
Pump Inhibitors (PPIs) use has been reported as a predictive factor
[6-11]for SBP. In hospital mortality for first episode of SBP is 10-50%
depending on various risk factors [12,13]. Recurrence rates are high,
more than 70% within one year [14,15].
In cirrhosis disturbance in microcirculation of intestinal mucosa,
results in a reduction of mucosal blood flow, intestinal bacterial
overgrowth, impaired mucosal integrity [16-18] and deficiencies in
local host immune defences are possible mechanisms for bacterial
translocation [19,20]. Catheters and other equipment used during
invasive procedures represent other possible sources of infection.
The gold standard for diagnosis of SBP consists of count ≥ 250
cells/ mm³ and/or a positive AF culture without any evidence of
intra-abdominal infectious source. Culture negative SBP (CN-SBP)
is defined as negative ascitic fluid culture with neutrophil count
of ≥ 250 cells/ mm³ in ascitic fluid [21]. Culture positive SBP (CP-
SBP) is seen in 35%-65% of SBP patients [22-26]. Enteric bacteria
are the most common etiological agent [17]. Frequency of Multi
Drug Resistance (MDR) bacteria in Hospital Acquired SBP (HA-
SBP) is 20%-35% [11,27] and 4%-16% in Community-Acquired
SBP (CA-SBP) [28]. Third-generation cephalosporins have been the
most frequently used antibiotics in the treatment of SBP since 1985
[29]. They were effective for CA-SBP in CLD, with resolution rates
of around 80% in past [30], but the development of resistance to
third-generation cephalosporins is of great concern. Resistance can
result in failure to respond to initial empirical therapy with a third-
generation cephalosporin in 33%-75% of cases [19,25]. Recent studies
indicate that third-generation cephalosporins are not appropriate for
the treatment of hospital acquired infections in patients with CLD
[31] because of effectiveness as low as 40% related to an increase in
the prevalence of MDR bacteria in nosocomial infections [9,26], that
is why SBP treatment recommendations distinguish between CA-
SBP and HA-SBP [9,32]. Moreover resistance to third-generation
cephalosporins occurred in 7.1% of CA-SBP, 21.1% of health care
associated SBP (HCA-SBP) and 40.9% of Hospital Acquired SBP
(HA-SBP) in recent past [33]. Some studies recommend combination
regimen of meropenem and daptomycin for the management of
HA-SBP [25,26], and some recommend cefoperazone/sulbactam or
piperacillin/tazobactam for the empirical treatment of SBP [34].
Overall paradigm of SBP is constantly changing with easy access
to hospitals and ever increasing use of antibiotics. Early antibiotic
treatment of SBP is crucial. With spread of MDR organisms its
current management is still challenging. There is a constant need
to evaluate this infection, by observing its behaviour, new strategies
aiming towards diagnostic improvement and management can
be sought. Our study provides fresh insight into its etiology and
resistance profile to design better empiric regimen.
OBJECTIVE
Study etiological profile and resistance pattern of SBP in CLD.
MATERIALS AND METHODS
Thisprospectiveobservationalstudywasconductedindepartment
of gastroenterology and hepatology, superspeciality hospital,
Shreenbagh, Srinagar. It is a twenty seven bedded department with
round the clock gastroenterology services.
All patients of cirrhosis and ascites with possibility of SBP more
than 10 years of age were recruited from out-patient Department
of Gastroenterology and Hepatology, and medical emergency
of government medical college; Srinagar over one year period.
A predesigned structured proforma was used to record patient’s
demographics, clinical presentation and laboratory results.
Abstract
Introduction: Landscape of etiological profile and microbiological resistance of Spontaneous Bacterial Peritonitis (SBP) in Chronic
Liver Disease (CLD) is continuously changing. Early antibiotic treatment of SBP is crucial but spread of Multidrug Resistant (MDR)
organism makes its current management challenging. Our study provides fresh insight into its etiology and resistance profile to design
better empiric regimen.
Objective: Study etiological profile and resistance pattern of SBP in CLD
Methods: This prospective observational study was conducted at Government Medical College, Srinagar from April 2018 to March
2019.
Results: Prevalence of SBP at our center was 38.09%. Eighty two patients were included in study. Mean age of cases was 59.09
± 12.90 years. Culture Positive SBP (CP-SBP) were 45 (54.87%), only 1 (2.22%) was fungal. Gram Negative Bacteria (GNB) were in
68.19% of bacterial cultures. Escheria coli was cultured in 25 (55.55%) bacterial cultures of which 12 (48%) were MDR and 1 Extended
Drug Resistance (XDR); Staphylococcus aureus in 13 (28.88%) of which 3 (23%) were MDR. Among CP-SBP, Community Acquired-SBP
(CA-SBP) were 26 (57.8%). Drug resistance in CA-SBP was high 34% and in hospital acquired SBP was 88%. Resistance to Quinolones
and third generation Cephalosporins was also high ranging from 60% to 70%.
Conclusion: In our study prevalence of SBP was 38.09%. Infections caused by GNB were 67% and antibiotic resistance approaching
60%. Resistance was highest to current first line therapy. We suggest upgrade in empirical therapy for SBP according to evolving profile
of organism and keeping in view risk factors for MDR and patient condition for better outcome.
Keywords: Spontaneous bacterial peritonitis; Community acquired; Hospital acquired; Hospital care associated; Multi drug resistant;
Culture
3. International Journal of Hepatology & Gastroenterology
SCIRES Literature - Volume 5 Issue 1 - www.scireslit.com Page - 011
ISSN: 2639-3778
Exclusions
Etiology of ascitis other than liver disease, recent antibiotics use
(within two weeks), suspected or conformed intra-abdominal source
of infection like surgery or trauma, children under 10 years of age and
those who did not consented to participate.
Paracentesis (only diagnostic tap) was performed bedside with
under mentioned protocol:
1. Performed using standard aseptic precaution for all study
participants.
2. Twenty milliliter syringes with 20 G (gauge) needle used
for ascitic fluid (AF) tap in left iliac fossa or midline below
umbilicus at bedside.
3. Total 20 milliliters AF was collected from each patient.
4. Ten ml for AF detailed biochemical and cytological report.
5. Ten ml of AF inoculated in blood culture bottles at the bed
side using aseptic technique and send for microbiology (for
aerobic and anaerobic culture).
6. Blood sample (10 ml) was collected at same time to perform
serum/plasma based blood work up as deemed necessary.
Severity of liver disease was assessed by:
Child Turcotte Pugh (CTP) score: Depending of sum of these
five variables patients are divided into three classes; A (score of 5-6),
B (score of 7-9) and C (score of 10-15). Class A has 1 year survival of
100% and 2 year survival of 90%. Class B has 1 year survival of 81%
and 2 year survival of 57%. Class C has 1 year survival of 45 % and 2
year survival of 35%.
Parameter 1 2 3
Encephalopathy None Stage 1-2 Stage 3-4
Ascitis None controlled Poor control
Serum Bilirubin (mg/dl) < 2 2-3 ≥ 3
Serum Albumin (gm/dl) > 3.5 3-3.5 < 3
Prothrombin time/ INR 0-4 / < 1.7 5-6 / 1.7-2.3 > 6 / > 2.3
Model of End-Stage Liver Disease (MELD) scores: Is calculated
by using formula:
MELD = 9.57 X LOGe
(creatinine) + 3.78 X LOGe
(total bilirubin)
+ 11.2 X LOGe
(INR) + 6.43
Originally was designed for post Transjugular intrahepatic
portosystemic shunt survival. It also predicts severity of liver disease
and cirrhosis related mortality (3 months). Mortality by MELD score
8% with score of 10-19, 24% with score of 20-29, 60% with score of
30-39, 81% with score of 40 and above. It is also used in allocation of
organs for transplant.
Infections diagnosed on admission or within 2 days after
admission were classified as Hospital Care Associated (HCA) in
patients with a prior contact with the healthcare environment
(hospitalization or short-term-admission for at least 2 days in the
previous 90 days, residence in a nursing home or a long-term care
facility or chronic hemodialysis). The infection was considered CA
when present at time of admission or developed within the first 2 days
after hospitalization with no history as mentioned above in HCA and
HA when the diagnosis was made thereafter [32,35].
MDR was defined as non-susceptibility to at least one agent in
3 or more antimicrobial categories. Extended Drug Resistant (XDR)
was defined as non-susceptibility to at least one agent in all but 2
or fewer antimicrobial categories and Pan Drug-Resistant (PDR) as
non-susceptibility to all currently available agents[36].
Data analysis
Statistical analysis was conducted using SPSS ver. 16.0 for
Windows (SPSS, Chicago, IL). Categorical variables were compared
using the chi-square or Fisher’s exact test where appropriate.
Continuousdatawerecomparedusingthet-testortheMann-Whitney
test, the Kruskal-Wallis test was used for multiple comparisons, when
appropriate. Quantitative variables with a normal distribution were
expressed as mean values ± standard deviation and those with a non-
normal distribution as median values (range). Significance level was
two-sided and set to less than 0.05.
Informed consent was obtained from all participants or their
attendants.
This study was cleared by institution’s review board.
RESULTS
Prevalence of SBP in CLD presenting at our center was 38.09%
(112/294). Eighty two patients were included in study. Mean age of
patients was 59.09 ± 12.90 years with minimum of 20 and maximum
of 89. Male were 47 (57.3%) and females were 35 (42.7%). Most
common clinical presentations were ascitis 100% and hepatic
encephalopathy 89%.
Majority of patients were CTP-C class i.e 73.2%. Other 15.9% and
11% were CTP-B class and CTP-A class respectively in our study.
Laboratory parameters are given in table 1. Ascitic fluid analysis
is given in table 2. Mean leukocytes and neutrophils in ascitic fluid
were 673 ± 340.11 and 517.95 ± 300.21 respectively. Mean SAAG was
1.30 ± 0.27.
Table 1: Laboratory parameters (blood) of patients with SBP on admission.
S.No. Parameter n = 82
1 Haemoglobin g/ dl 8.43 ± 2.42
2 Leukocyte count 14124.40 ± 3953.82
3 Platelets 118759.96 ± 65428.32
4 INR 1.86 ± 0.73
5 S. Bilirubin total 2.70 ± 2.53
6 S. Albumin 2.72 ± 0.62
7 S. Total Protiens 5.91 ± 0.79
8 S. Creatinine 1.34 ± 0.58
9 S. Glucose 135.30 ± 50.30
10 S. LDH 148.80 ± 32.31
11 S. Aspartate transaminase 85.37 ± 28.80
12 S. Alanine transaminase 73.39 ± 29.28
13 S. Alkaline phosphatase 119.86 ± 30.88
14 S. Sodium 132.70 ± 7.72
15 S. Potassium 3.52 ± 0.83
16 S. ESR 43.89 ± 18.99
17 S. CRP 13.11 ± 5.56
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In our study CA-SBP was present in 55 (67%), HCA-SBP in 29.3%
and HA-SBP in 3.7% respectively. We found CP-SBP in 54.87% and
CN-SBP in 45.13% cases. On comparing culture positivity with SBP
profile, 58% of CA-SBP, 67% of HCA-SBP and 100% of HA-SBP were
CP (p-value = 0.044).
We compared SBP profile with resistance pattern of pathogens. In
CA-SBP, Drug Sensitive (DS) were 18(69%), MDR were 7(27%) and
XDR were 1(4%). In HCA-SBP, DS were 4(25%), MDR were 8 (50%)
and XDR were 4(25%). In HA-SBP, DS were 1(33%) and MDR were
2(67%) as in table 3 & 4. (p -value = 0.03). Twelve cases have previous
history of SBP, and all were culture positive. Out of which 7(58%)
were MDR, 4 (33%) were XDR and 1 (8.3%) was drug sensitive as in
table 5 (p-value =0.00).
Among cases with CP-SBP; 44 (97.78%) were caused by bacteria
and 1 (2.22%) was fungal. In bacterial CP-SBP, GNB were 68.19% and
Gram Positive Bacteria (GPB) were 31.81%. We compared pathogen
profile with resistance pattern and found significant difference
among pathogens regarding resistance to antibiotics (p–value =0.00).
Escheriae coli (E. coli) was cultured in 25 (55.55%) of which 12 were
DS, 12 were MDR and 1 XDR; Staphylococcus aureus in 13 (28.88%)
of which 10 were DS and 3 were MDR; Klebsiella pneumoniae in 2
(4.44%), both were MDR; Pseudomonas aeruginosa in 2 (4.44%)
both were XDR; Acinetobacter baumanni 1 (2.22%) was XDR;
Micrococcus luteus in 1 (2.22%) was XDR and Candida albicans
in 1 (2.22%) was DS as in table 6 and figure 1. Highest antibiotic
resistance was seen with levofloxacin 71%, followed by ciprofloxacin
67.45%, cotrimoxazole 66% and ceftriaxone 64.52%. Reasonably
good sensitivity in range of 70% to 90% was found in Ceftaroline,
Piperacillin-tazobactam, Meropenem and Imipenem. Sensitivity
was highest with Colistin, Tigecycline Daptomycin, and Ceftaroline
approaching 100% as in figure 2.
Sixty six (80.49%) patient were treated successfully and
discharged. Sixteen cases of SBP died during hospital stay giving
mortality rate of 19.51%. Death rates as per CTP class were; 23.3% in
CTP-C and 15.4% in CTP-B. There were no deaths in CTP-A.
Out of 16 deaths, 14 (71.42%) were CTP- C class. 100% deaths
were recorded in patients with SBP because Acinetobacter baumani,
Klebsiella pneumonia, Pseudomonas aeruginosa and Micrococcus
lutes.
DISCUSSION
SBP is one of the infections in CLD with dynamic etiologic
profile demanding meticulous observation and updated management
strategy in view of ever changing antibiotic sensitivity profile to
improve outcome. We provide fresh insight into etiologic profile and
resistance pattern in this infection.
Prevalence of SBP in CLD with ascitis presenting at our center
was 38.09%. Mean age of cases was 59.09 ± 12.90 years. Most common
clinical presentations were ascitis 100% and hepatic encephalopathy
89%.
Harchand P et al. [37] studied 58 cases with SBP and found
prevalence of 51.3% (58/ 113). Mean age of cases was 49.72 ±10.3
years with males 86.7% and females 13.3%. Li YT et al. [27] studied
288 cases with SBP with mean age of 55 ± 12.6 years, males were
198 and females were 90. Friedrich K et al. [19] studied 311 cases
of 1st
time SBP with mean age of 57.8 ± 23.7 years, males were 70%
males and females were 30%. Li YT et al. [27] reported 68.9%% in
child C, 8.6% in child B, and 2.5% in child A class respectively in
their study. Similarly studies by Kawale JB in 2017 and Harchand P
in 2017 reported 56% and 87% majority of patients in CTP-C class
respectively[37,38].
Table 2: Laboratory parameters (ascitic fluid) of patients with SBP.
S. No. Parameter n = 82
1 Leukocytes 673 ± 340.11
2 Neutrophils 517.95 ± 300.21
3 Proteins 3.13 ± 0.76
4 Albumin 1.44 ± 0.50
5 Saag 1.30 ± 0.27
6 Glucose 107.98 ± 44.23
7 Lactate Dehydrogenase 62.36 ± 14.81
Table 3: SBP profile compared with ascitic fluid culture.
Ascitic Fluid Culture
Total
Negative Positive
SBP Profile
CA-SBP
29 26 55
78.4% 57.8% 67.07%
HA-SBP
0 3 3
0.0% 6.7% 3.65%
HCA-SBP
8 16 24
21.6% 35.6% 29.26%
Total
37 45 82
100.0% 100.0% 100%
p-value = 0.044
Table 4: SBP profile comparison with resistance profile
Resistance Profile
Total
DS MDR XDR
SBP
HCA
4 8 4 16
25.0% 50.0% 25.0% 100.0%
CA
18 7 1 26
69.2% 26.9% 3.8% 100.0%
HA
1 2 0 3
33.3% 66.7% 0.0% 100.0%
Total 23 17 5 45
p-value = 0.03
Table 5: Pathogen compared with resistance profile
Resistance Profile
Total
DS MDR XDR
Pathogen
Acinetobacter Baumanni
0 0 1 1
0.0% 0.0% 100.0% 100.0%
Candida Albicans
1 0 0 1
100.0% 0.0% 0.0% 100.0%
Escheria Coli
12 12 1 25
48.0% 48.0% 4.0% 100.0%
Klebsiella Pneumonia
0 2 0 2
0.0% 100.0% 0.0% 100.0%
Micrococcus Luteus
0 0 1 1
0.0% 0.0% 100.0% 100.0%
Pseudomonas Aeruginosa
0 0 2 2
0.0% 0.0% 100.0% 100.0%
Staphylococcus Aureus
10 3 0 13
76.9% 23.1% 0.0% 100.0%
Total
23 17 5 45
51.1% 37.8% 11.1% 100.0%
p-value = 0.003
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In our study CP-SBP was 54.87% and CN-SBP was 45.13%. Payal
H Purohit et al. [39], Harchand P et al. [37] and Ivan Gunjace et al.
[40] reported culture positivity of 43.6%, 38% and 15% respectively.
Friedrich K. [19] reported culture positive in 138 /311 (44.37). These
differences could be attributed to the evolution of pathogens, different
culture techniques and variable antibiotic use. Etiological profile of
SBP in CLD is changing world over. Among cases with CP-SBP; 44
(97.78%) were caused by bacteria and 1 (2.22%) was fungal (Table
6) (figure 1). Among bacterial CP-SBP, GNB were 68.19% and GPB
were 31.81%. Fiore M et al. [41] reported 0%-7.2% CP for fungus and
the most frequent isolate was Candida albicans. Harchand P et al. [37]
reported GNB isolates in 77.3% and GPB isolates in 22.7% of cases.
Ivan Gunjace et al. [40] reported GPB pathogens in 40% of patients.
Payal H Purohit et al. [39] studied 31 (43.6%) cases of CP-SBP, most
of them were GNB, mainly E. coli in 22 (70.9%) and GPB in 6 (19.3%)
cases. Friedrich K et al. [19] reported GPB in 47.8%, GNB in 44.9%
and fungal in 7.2% cultures. Li YT et al. [27] reported GPB in 27.8%,
GNB in 58.2% and fungal in 2.9% cultures. Most of studies report
predominance of gram negative organisms in ascitic fluid cultures,
however there studies showing trend towards increasing percentage
of infections caused by gram positive bacteria. Our study follows
same changing trend of increasing gram positive infections world
over with GPB cultures in 32% of cases.
Profile of organisms causing SBP in our study is shown in table
6 and figure 1 and their resistance profile in table 6 and figure 2. In
our study, E. coli was most common organism causing SBP i.e 25/
45 (55.55%) of which 12 were DS, 12 were MDR and 1 XDR. 52% of
E. coli in our study was either MDR or XDR; Harchand P et al. [37]
reported E. coli in 68.1% of cultures. Of 15 E. coli isolates, 13 (86.6%)
were MDR and 3 (20%) were XDR. Friedrich K et al. [19] reported
Enterobacter sp. in 41%. Li YT et al. [27] reported E. coli in 24.2% cases
and drug resistance around 40%. Payal H Purohit et al. [39] in study
of 31 culture-positive cases, E. coli was isolated from 17 (54.9%) cases.
Ivan Gunjace et al 2010 [40] found Escherichia coli in 13 (43.6%) of
cases and Li Sun et al. [42] in 53.1% (1st
period part of study)/39.8%
(2nd
period of study) of ascitic fluid cultures respectively.
We found Staphylococcus aureus in 13 (28.88%) of which 10 were
DS and 3 were MDR. Friedrich K et al. [19] reported staphylococcus
sp. in 13.8%. Li YT et al. [27] reported Staphylococcus aureus in
7.5% cases. Ivan Gunjace et al. [40] cultured staphylococcus species
in 4(24.9%) of cases. Li Sun et al. [42] reported staphylococcus
aureus in 4.7%/ 7.2% in 1st
/ 2nd
period of his study. Over all there
has been increasing frequency of gram positive infection as especially
staphylococcus sp. as evident above. Our study shows similar trend.
We found Klebsiella pneumoniae in 2 (4.44%) and both were
MDR, Harchand P et al. [357 in 4.05%, Friedrich K et al. [19] in
7.2%, Li YT et al. [247 in 18.9%. Payal H Purohit et al. [39] isolated
Klebsiella species from 5 (16.2%) cases. Li Sun et al. [42] reported
Klebsiella species in 10.9%/ 10.8% in 1st
/ 2nd
period of his study. We
found Pseudomonas aeruginosa in 2 (4.44%) cases, both were XDR,
Friedrich K et al. [19] in 0.7%, Li YT et al [27] in 2.9%.We found
Acinetobacter baumanni in 1 (2.22%) case, it was XDR, Li YT et al.
Table 6: Previous SBP compared with resistance profile
Profile Resistance
Total
DS MDR CN XDR
Previous SBP
NO
22 10 37 1 70
95.7% 58.8% 100.0% 20.0% 85.4%
YES
1 7 0 4 12
4.3% 41.2% 0.0% 80.0% 14.6%
Total
23 17 37 5 82
100.0% 100.0% 100.0% 100.0% 100.0%
p-value = 0.00
Figure 1: Etiological profile of SBP (n = 45).
Figure 2: Antibiotic sensitivity profile % (n = 45)
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[27] in 3.3%, Ivan Gunjace et al. [40] in 2 (12.5%). our study also have
more of these bacteria in HCA-SBP and HA-SBP (p value = 0.003).
We found Micrococcus luteus in 1 (2.22%) was XDR and Candida
albicans in 1 (2.22%) was DS. Li Sun et al. [42] found micrococcus
lutes in 1.2% of case.
Results of our study are in line with current trends world over with
gram negative enteric organisms most frequent isolates. Escheriae coli
being most common isolate from ascitic fluid cultures in SBP patients
in most of these studies. However regarding other pathogens literature
is heterogeneous regarding frequency and resistance pattern.
In our study overall 71.42%, 21.42% and 7.1% isolates of gram
positive bacteria were DS, MDR and XDR respectively whereas
40%, 46.6% and 13.40% isolates of gram negative bacteria were
DS, MDR and XDR respectively (Table 4 & 6) (Figure2). Highest
antibiotic resistance was seen with levofloxacin 71% followed by
ciprofloxacin 67.45%, co-trimaxozole 66% and ceftriaxone 64.52%
(Figure 2). Sensitivity was highest with Colistin, Daptomycin, and
Ceftaroline approaching 100% (figure 6). Friedrich K et al. [19] found
highest resistance to erythromycin 87%, ampicillin i.e 40% followed
by quinolones 58%, ceftriaxone 39%, vancomycin in 49% and
sensitivity was highest in Tigecycline i.e 95% followed by piperacillin/
tazobactam 89.9%, gentamicin 84.3% and meropenem 73.2%. He
concluded third generation cephalosporins have poor antibiotic
coverage of 60% and recommends against current guidelines of
third generation as first line empiric therapy. Harchand P et al. [37]
found Gram-negative isolates have high susceptibility to Colistin,
Tigecycline, amikacin, and Carbapenems, while low susceptibility
was seen toward Cephalosporins and Ampicillin. All the Gram-
positive isolates susceptible to Penicillin, Teicoplanin, Vancomycin,
Linezolid whereas showed less susceptibility to Aminoglycosides
(40%) and to Fluoroquinolones, Macrolides, and Tetracycline’s (20
% each). Among the culture-positive isolates, MDR and XDR were
seen more in E. coli isolates. Of 15 E. coli isolates, 13 (86.6%) were
MDR and 3 (20%) were XDR. Payal H Purohit et al. [39] reported
staphylococcus aureus resistance profile as; 20% in amoxicillin, 32%
in erythromycin and 60% in penicillin’s: E. coli resistance profile as;
30% in ciprofloxacin, 20% in tetracycline and 10 in Ofloxacin %.
Klebsiella species resistance profile reported as; 20% in ciprofloxacin,
30% in tetracycline: Pseudomonas species resistance profile as; 22%
in ampicillin, 33% in ciprofloxacin, 50% in tetracycline and 20% in
ofloxacin. In our study highest antibiotic resistance was seen with
levofloxacin 71% followed by ciprofloxacin 67.45%, co-trimaxozole
66% and ceftriaxone 64.52% because most of these antibiotic are
available in government hospital supply free of cost so are more
often used. Our study shows increasing trend of GP infections and
increasing MDR in gram GN infections, similarly world literature is
reporting increasing incidence infections by GPB and MDR bacteria
[30,34,43].
Sixtysix(80.49%)patientweretreatedsuccessfullyanddischarged.
Sixteen cases of SBP died during hospital stay giving mortality rate of
19.51%. Mortality was highest in CTP-C, out of 16 cases; 14 (87.5%)
belonged to CTP-C. There were no deaths in CTP-A. 100% deaths
were recorded in patients with SBP because Acinetobacter baumani,
Klebsiella pneumonia, Pseudomonas aeruginosa and Micrococcus
lutes. Mortality in patients with SBP reported in other studies was
44% and 26.60% by Juhi B. Kawale et al. [36] and Ivan Gunjace et al.
[40] respectively. Recent data reported that SBP mortality was 24.2%
at 1 month and 66.5% at 3 year [16].
CONCLUSION
SBP in CLD with ascitis presenting at our center was 38.09%.
Etiological profile of SBP in CLD is changing world over. In our
study most of infections were caused by GNB (67%) and prevalence
of antibiotic resistance is high approaching 60% (increasing trend).
E. coli was cultured in 25 (55.55%) of which 52% were MDR’s
and XDR’s; Klebsiella pneumoniae in 2 (4.44%), both were MDR;
Pseudomonas aeruginosa in 2 (4.44%) both were XDR; Acinetobacter
baumannii in 1 (2.22%) was XDR. High antibiotic resistance was seen
to commonly used antibiotic in SBP like quinolones, aminoglycosides
and third generation cephalosporins, approaching 60% to 70%. GPB
were present in 31.81% of cases (increasing trend), and resistance
was found in only 28.58% isolates. 50% of HCA- SBP was caused by
MDR’s and 25% by XDR’s respectively i.e total of 75% (increasing
trend).
We recommend all ascitic fluid culture to be screened for
presence of MDR, XDR and PDR strains to improve outcome. We
also suggest extended spectrum penicillin’s or Carbapenems plus
vancomycin or daptomycin therapy as Ist line for suspected cases of
SBP keeping in view increasing MDR pathogen infection, rising cases
of community acquired MDR SBP in our community with caveat that
local resistance pattern be taken into account.
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