Aim
We aimed at assessing the frequency of Community‐acquired Methicillin‐resistant Staphylococcus aureus (CA‐MRSA) infections, identifying its risk factors and evaluating resistance patterns of ...Staphylococcus aureus to various antibiotics in order to recommend the optimal empirical treatment for suspected Staphylococcus aureus infections.
Methods
We reviewed the medical records of children who were treated at Shaare Zedek medical centre, located in Jerusalem, Israel, over the years 2008–2019 and had a positive culture for Staphylococcus aureus. Patients with CA‐MRSA infections were compared with Methicillin‐susceptible Staphylococcus aureus (CA‐MSSA) infections.
Results
In this study, 620 paediatric patients were included. The number of children in the CA‐MRSA study group was 124, while the MSSA control group consisted of 496 children. Risk factors for CA‐MRSA infections included young age (1–5 years), female sex, Arab ethnicity and residence in East Jerusalem. The incidence of CA‐MRSA increased over the past decade, with an average of 11.2%. An increase in MSSA resistance to clindamycin was noted while Trimethoprim‐Sulphamethoxazole resistance remained low.
Conclusion
The incidence of CA‐MRSA in Jerusalem was rising, along with changes in resistance patterns of both MSSA and MRSA to various antibiotic agents. In order to optimise empirical treatment for suspected staphylococcal infection, continued monitoring of CA‐MRSA prevalence and resistance rates is essential.
Background
The presentation of the patient with acute cholangitis (AC) ranges from mild illness to life‐threatening shock. Therefore, prompt diagnosis and treatment are critical. Abdominal ultrasound ...(US) is the imaging of choice to locate bile duct dilatation. Other modalities include abdominal computed tomography (CT) or endoscopic retrograde cholangiopancreatography (ERCP).
Objectives
To determine whether sonographic common bile duct dilatation in emergency department (ED) patients with AC predicts outcomes including sepsis, hospital length of stay (LOS), admission to the intensive care unit (ICU), time to ERCP, and mortality.
Methods
Electronic medical records of all patients hospitalized in a tertiary care medical center between July 2012–February 2021 with a discharge diagnosis of cholangitis were assessed. Patients were dichotomously classified as CBD dilated or CBD non‐dilated based on ultrasound. Dilation was defined as CBD larger than 6 mm in patients younger than 60 or larger than 6 mm + 1 mm per decade in patients over 60.
Results
The study included 271 patients‐ 172 with CBD dilation versus 99 without. Mean LOS was 9.92 days for those with a dilated CBD versus 13.4 days without. The mean time to ERCP was 4.26 days for those with a dilated CBD versus 6.56 days without. Sepsis, mortality, and ICU admission were scarce and there was no statistically significant difference between the cohorts.
Conclusion
Patients with a dilated CBD per the abdominal US performed during the patient's ED stay, underwent ERCP earlier, and were hospitalized fewer days than patients without CBD dilation.
Acute cholangitis ranges from mild illness to life‐threatening shock. Abdominal ultrasound is the imaging of choice to locate bile duct dilatation. This study shows that patients with a dilated CBD per abdominal US performed during ED stay underwent ERCP earlier and were hospitalized fewer days than patients without CBD dilation.
Objective Twin pregnancies are a risk factor for preeclampsia with a reported incidence of 2-3 times higher than singleton pregnancies. Soluble fms-like tyrosine kinase 1 (sFlt1), which is a ...circulating antiangiogenic molecule of placental origin, plays a central role in preeclampsia by antagonizing placental growth factor (PlGF) and vascular endothelial growth factor signaling in the maternal vasculature. Increased sFlt1 and the ratio sFlt1/free PlGF have been shown to antedate clinical signs in preeclampsia. Although the cause of the upregulated sFlt1 in preeclampsia still is not understood clearly, placental ischemia with accompanying hypoxia is thought to play an important role. We therefore hypothesized that the higher risk of preeclampsia in twin pregnancies results from high sFlt1 (or sFlt1/PlGF) and that the sFlt1 upregulation was due to either relative placental hypoxia and/or increased placental mass. Study Design Maternal serum samples and placentas from third-trimester twin and singleton pregnancies without preeclampsia were used. Serum samples were analyzed for levels of sFlt1 and free PlGF by enzyme-linked immunosorbent assay and reported as means (in nanograms per milliliter and picograms per milliliter, respectively). Placentas were weighed and examined for content of sFlt1 and PlGF messenger RNA (mRNA) by quantitative polymerase chain reaction and hypoxia inducible factor-1α (HIF-1α) protein by Western blot. Results Soluble Flt1 concentrations in twin pregnancy maternal serum were 2.2 times higher than those that were measured in singleton pregnancy maternal serum samples (30.98 ± 9.78 ng/mL vs 14.14 ± 9.35 ng/mL, respectively; P = .001). Free PlGF concentrations were not significantly different between twin and singleton maternal serum samples, but the mean sFlt1/PlGF ratio of twin pregnancy maternal serum samples was 2.2 times higher than the equivalent ratio in singleton pregnancy samples (197.58 ± 126.86 ng/mL vs 89.91 ± 70.63 ng/mL, respectively; P = .029). Quantitative polymerase chain reaction for sFlt1 and PlGF mRNA revealed no significant differences between the 2 study groups. Western blot analysis of placental samples for HIF-1α revealed a mean ratio HIF-1α/actin of 0.53 vs 0.87, for the twins vs singletons placental samples respectively (twins showed lower HIF-1α, not higher). The mean weights of twin and singleton placentas were 1246 vs 716 g, respectively ( P < .001). Importantly, the placental weights correlated very well with the circulating sFlt1 levels ( R2 = .75). Conclusion In twin pregnancies, circulating sFlt1 levels and sFlt1/PlGF ratios were twice as high as those in singleton pregnancies. The increased serum sFlt1 levels in twin pregnancies were not accompanied by any changes in the levels of sFlt1 mRNA and HIF-1α protein in the twin placentas but were correlated with increased placental weight. These findings suggest that the increased risk of preeclampsia in twin pregnancies may be due to increased placental mass that leads to increased circulating levels of sFlt1.
Purpose
To review s presented at five consecutive meetings of the European College of Veterinary Ophthalmologists (ECVO), and identify characteristics that affect the probability of their publication ...in peer‐reviewed journals.
Methods
An online search was conducted for peer‐reviewed publications (PRPs) stemming from s from five ECVO meetings (2008–2012). Time to publication and journal were noted. Effects of ocular tissue/discipline, species, type of presentation and study, funding acknowledgment and affiliation, professional qualifications, and nationality of the first and last authors on probability of publication were analyzed.
Results
Of presented s, 29% (87/299) were published as PRPs in Veterinary Ophthalmology (n = 50), other veterinary journals (n = 22), and nonveterinary journals (n = 15). During the 5 years studied, there was no significant difference between the impact factor of Veterinary Ophthalmology and the 25 other journals in which PRPs were published (P = 0.369). Median time to PRP acceptance or publication was 468 days. Independent variables most significant in determining the probability of PRP were oral presentation (P = 0.002), resident authorship (P < 0.0001), and species (P = 0.002), with food animal s having the highest odds ratio. Ocular tissue/discipline (P = 0.13) and type of study (P = 0.33) did not affect publication probability. Funding acknowledgment (P = 0.02), author nationality (P = 0.02), and academic affiliation (P = 0.04) were also significant factors.
Conclusions
Publication rate of ECVO s is lower, but time to publication is similar, compared with most biomedical meetings.
This study has retrospectively reviewed the medical records of 140 dogs sustaining road traffic accident (RTA), and has examined the population characteristics, medical history, injury type, physical ...examination, emergency laboratory tests and radiography findings, the animal trauma triage (ATT) score, the length of hospitalisation, the complications and the outcome. The survival rate was 83.2 per cent. Younger dogs sustained more frequently lung contusions and limb fractures, while larger dogs more frequently suffered limb fractures, and smaller dogs and older ones sustained more frequently pelvic fractures and sacroiliac luxation (P<0.05 for all). Dogs sustaining orthopaedic injuries required longer hospitalisation (P<0.001). The survival rates of non-ambulatory dogs (P<0.001) and those with neurological abnormalities (P<0.001), abnormal body temperature (P=0.001), hyperglycaemia (P=0.026) or hypoproteinaemia (P=0.04) at presentation were lower compared with those in which these were absent. The number of injured body systems was significantly (P<0.001) and positively associated with death. Dogs surviving RTA to presentation to the hospital have a good prognosis for survival to discharge. Older age, and high ATT score, abnormal body temperature, neurological deficits, hyperglycaemia and hypoproteinaemia at presentation, and occurrence of multiorgan trauma are negative prognostic indicators in such dogs.
The impact of inadequate empirical antibiotic treatment on patient outcomes and hospitalization duration for non-life-threatening infections in children remains poorly understood. We aimed to assess ...the effects of inadequate empirical antibiotic treatment on these factors in pediatric patients.
The medical records of children admitted for infectious diseases with bacteria isolated from sterile sites between 2018 and 2020 were retrospectively reviewed. Patients who received adequate empirical treatment were compared with those who received inadequate treatment in terms of demographic, clinical, and laboratory variables.
Forty-eight patients who received inadequate empirical antimicrobial treatment were compared to 143 patients who received adequate empirical treatment. Inadequate empirical antimicrobial treatment did not significantly affect the length of hospital stay or the incidence of complications in non-critically ill children with bacterial infections. Younger age and underlying renal abnormalities were identified as risk factors for inadequate antimicrobial treatment, while associated bacteremia was more common in the adequate antimicrobial treatment group.
inadequate antibiotic treatment did not affect the outcomes of non-critically ill children with bacterial infectious diseases. Therefore, routine empirical broad-spectrum treatment may not be necessary for these cases, as it can lead to additional costs and contribute to antibiotic resistance. Larger prospective studies are needed to confirm these findings.
Melanoma is widely treated with programmed cell death‐1 (PD‐1) inhibitors. As part of their anti‐tumor immunity effect, they increase the susceptibility to cutaneous immune‐related adverse events ...(cIRAE) among other autoimmune effects. To characterize the manifestations of cIRAE in melanoma patients treated with PD‐1 inhibitors, and evaluate the correlation with tumor response. A retrospective study of 95 metastatic malignant melanoma patients treated with PD‐1 inhibitors at the Hadassah Medical Center during 2013–2016. The most common cIRAE was pruritus reported by 39 (41%) patients. All other cIRAE were noted in 34 patients (35.8%), of which the most common cutaneous manifestation was vitiligo, demonstrated in 17 patients (17.9%) followed by various rashes (7.4%, including erythema multiforme, oral lichen planus, photosensitive rash, insect bite‐like reaction, and urticaria), psoriasiform rash (3.2%), bullous pemphigoid (3.2%), and eczema (1%). Interestingly, higher response rates to immunotherapy were demonstrated in patients who developed pruritus (85%) and cIRAE (88%), with lower mortality rates in the cIRAE group (38.2%) versus the non‐cIRAE group (70.5%, p = 0.002). cIRAE are common among malignant melanoma patients treated with PD‐1 inhibitors and may be a marker for favorable prognosis.
Objective
To describe indwelling cephalic or saphenous vein catheter use for intravenous regional limb perfusion (ID‐IV‐RLP) to treat horses with synovial injury (contamination/infection) of the ...distal aspect of the limb.
Study Design
Retrospective case series.
Animals
Horses (n = 44; 45 limbs) treated with proximal ID‐IV‐RLP.
Methods
Horses had ID‐IV‐RLP using a cephalic (21 limbs) or saphenous (24 limbs) vein. Amikacin was the most frequently used antibiotic. Number of perfusions ranged from 3 to 21 (median 7). A cast was applied to 14 injured limbs (1 tube cast, 1 full‐limb cast, 2 foot casts, and 10 half‐limb casts).
Results
Synovial sepsis of the distal portion of 87% of limbs (39) resolved, and 61% of horses returned to soundness. Catheter‐related complications occurred in 27% of the limbs but were not significantly associated with outcome. Presence of osteomyelitis was significantly associated with a poor outcome.
Conclusions
ID‐IV‐RLP using the cephalic or saphenous vein is an alternative to traditional RLP. An indwelling catheter provided prolonged venous access and facilitated successive perfusions.
Background Hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) are cohorted under contact precautions, including in the days between rehospitalization and surveillance culture ...results. This study investigates duration of CRE carriage to define populations requiring precautions upon readmission. Methods Patients with CRE-positive culture during 2009-2010 were followed up by rectal swab cultures taken retrospectively and prospectively for the study or as part of clinical follow-up. Results One hundred thirty-seven patients met the inclusion criteria, with follow-up cultures obtained from 97. Mean time to CRE negativity was 387 days (95% confidence interval: 312-463). Seventy-eight percent of patients (64/82) had positive culture at 3 months, 65% (38/58) at 6 months, and 39% (12/30) at 1 year. Duration of carriage was affected by repeat hospitalization ( P = .001) and clinical, as opposed to surveillance, culture ( P = .002). Conclusion CRE carriers from a previous hospitalization have a lower probability of CRE carriage upon readmission if the index specimen was a surveillance culture and 1 year passed without further hospitalization. Multiple hospitalizations and CRE disease extend duration of carriage. This study better defines patients requiring cohorting and isolation, thus limiting spread of CRE and allowing for improved allocation of infection control measures.
Sperm quality in lymphoma patients may be reduced even prior to initiation of chemotherapy. The objective of this study was to examine the relationship between lymphoma prognostic factors and sperm ...quality prior to chemotherapy. A retrospective cohort study was conducted in a Hadassah Medical Center sperm bank and the Hematology department. The cohort included 101 Hodgkin's and 90 non‐Hodgkin's lymphoma patients that underwent sperm cryopreservation before chemotherapy between 1998 and 2015. Known lymphoma prognostic factors were compared between patients with normal and impaired sperm parameters. The Prognostic Score Ratio (PSR), an index representing the number of negative lymphoma prognostic measures that found in a lymphoma patient, was additionally calculated and compared between the groups. Among the prognostic factors of lymphoma, the following factors were found to be associated with impaired sperm parameters—low albumin (p < 0.001) and haemoglobin (p < 0.001) levels, B symptoms (p = 0.021) and PSR (p < 0.001). Logistic regression showed significant association of albumin and haemoglobin with reduced sperm quality (OR = 2.7 and OR = 13.5, p < 0.05; respectively). To conclude, low albumin and haemoglobin levels are related to reduced sperm quality. The linkage between these prognostic factors and sperm quality may be related to a general inflammatory status.
