Broad-spectrum Intravenous Antibiotics Research Articles

CLINICAL COMPLICATIONS OF MALIGNANT OTITIS EXTERNA AND SURGICAL TREATMENT

For clinical complications of malignant otitis externa and its surgical treatment, the introduction addresses a rare and serious condition, characterized by necrotizing infection of the external auditory canal, often associated with comorbidities such as decompensated diabetes mellitus. This condition requires rapid intervention due to the potential for spread to adjacent structures such as the skull and skull base, resulting in serious complications such as facial paralysis, osteomyelitis, and meningitis. Management includes broad-spectrum intravenous antibiotic therapy and, in many cases, surgical intervention to debride necrotic tissue and control infection. Objective: to synthesize recent evidence on the effectiveness of surgical treatments in malignant otitis externa, highlighting clinical outcomes and associated mortality. Methodology: it was structured according to the PRISMA checklist, using PubMed, Scielo and Web of Science databases to search for articles published in the last 10 years. Descriptors included "malignant otitis externa", "surgical treatment", "complications", "mortality" and "intervention". Inclusion criteria were clinical studies and systematic reviews that addressed surgical treatment and clinical outcomes. Exclusion criteria were studies focusing exclusively on non-surgical treatments, isolated case reports and studies with fewer than 10 participants. Results: highlighted the effectiveness of early surgical debridement in reducing mortality and serious neurological complications. The analysis revealed that adjuvant antibiotic therapy and intensive surveillance are crucial for successful management. Conclusion: the importance of a multidisciplinary approach and timely surgical intervention is emphasized to improve outcomes in patients with malignant otitis externa, highlighting the need for further studies to elucidate ideal therapeutic protocols and prevention strategies

Salvaging Vision: A Study of Non-Traumatic Optic Neuropathies

Background and Objectives: Various ear, nose, and throat (ENT) conditions can result in vision loss. The purpose of this study is to identify the etiologies, presentations, and radiological findings associated with impaired vision in the context of ENT. Additionally, this article discusses management protocols, including optic nerve decompression and orbital decompression.Methods: In a retrospective study, we examined the period from 2016 to 2022 at a tertiary care hospital in Mumbai, India. The analysis included 11 patients who presented with progressive diminution of vision. All patients received a regimen of broad-spectrum intravenous antibiotics and high-dose intravenous steroids. This was followed by either endoscopic optic nerve decompression or orbital decompression. Subsequent improvements in vision were documented, and any complications were evaluated.Results: A total of 11 patients were treated with medical management followed by successful surgery, with 10 patients demonstrating significant vision improvement.Conclusion: Identifying the etiology of vision loss and managing the condition can present challenges for otorhinolaryngologists. A thorough grasp of the underlying pathophysiology, combined with active surveillance of clinical and radiological indicators, can enable these clinicians to achieve effective and rewarding outcomes.

Evaluating bentonite clay’s potential in protecting intestinal flora and alleviating pseudomembranous colitis following antibiotic usage

As the most commonly used drugs, antibiotics have several adverse effects. When intravenous broad-spectrum antibiotics are administered for infections outside the gut, they are also released into the gut, upsetting the natural balance of flora and potentially causing opportunistic infections there. Pseudomembranous colitis induced by the excessive growth of Clostridioides difficile following antibiotic administration and disruption of the normal gut flora is a main consequence of antibiotic therapy. Unfortunately, effective strategies to mitigate the damage caused by antibiotics to the microbiota remain elusive, with limited information available on the subject. Several studies have examined the effects of enzymatic inactivation of specific antibiotics, but non-enzymatic inactivation of antibiotics has been explored to a lesser extent, resulting in the introduction of only a restricted number of products. We believe that bentonite clay, an underutilized substance that exhibits promising features for counteracting the unfavorable effects of antibiotics has a high potential to circumvent the side effects of antibiotics. It is a cost-effective and safe and has garnered significant attention in the medical history, predominantly for its superior adsorption properties. Given the diverse characteristics of bentonite clay, capacity to protect the natural flora, antibacterial and anti-inflammatory traits, and its contribution to wound healing, it is plausible to assume that bentonite clay exhibits significant potential in mitigating the detrimental consequences of antibiotic on the natural gut microbiota and following pseudomembranous colitis. Further research is necessary to unravel the full extent of its therapeutic effects in combating this condition.

Successfully managed alcoholic ketoacidosis with sepsis leading to multiple organ dysfunction syndrome: a case report

We present the case of a 28-year-old male with a history of alcohol dependency and smoking, who presented with chest pain, shortness of breath, and altered sensorium. He exhibited severe metabolic acidosis, hypoglycemia, low platelet count, and acute kidney injury. Alcoholic ketoacidosis was suspected due to ketonuria, metabolic acidosis, and ketonemia, compounded by electrolyte abnormalities and radiographic findings of pneumonia. Prompt intervention included intravenous fluids, electrolyte correction, thiamine supplementation, broad-spectrum antibiotics, and diuretics. Thiamine played a pivotal role in the patient’s recovery, with significant improvement in consciousness observed within a day. After six days, the patient was discharged in stable condition, with normal renal and hepatic function at follow-up. This case emphasizes the need for early recognition and comprehensive management in alcoholic ketoacidosis, highlighting thiamine’s crucial role in treatment success.

Subcutaneous Washout Procedure (SWOP) for Treating Severe Complications of an Aesthetic Gluteal Augmentation with a Copolyamide Filler

Apart from surgical procedures for breast and buttock augmentation, copolyamide fillers can be locally injected for an increase in volume. This method is especially popular in Asia. A 39-year-old female patient had received a buttock augmentation by injection of a copolyamide filler. She presented with multiple abscesses six years after the augmentation. She had developed multiple fistulas and the filler had migrated down to the thigh muscles. In the presented case, the patient experienced multiple complications such as abscess formation, filler migration and chronic infection, with a significant time delay. Complete removal of the filler is only possible by removing surrounding tissue as well. Surgical treatment with repeated debridements and administration of an intravenous broad-spectrum antibiotic are the current standard of care. In contrast, the SWOP technique presented here appears to be less invasive and less likely for local recurrence. A breast or buttock augmentation with copolyamide fillers is associated with a high risk of abscess and fistula formation leading to a permanent disfigurement of the patient.

Diagnosis of Empyema as a Complication of Liver Abscess in Peripheral Area

Right pleural empyema is one of the rare complications in liver abscess. This condition is life-threatening as it causes breathing difficulties and requires immediate life-saving. This case report aims to diagnose and manage empyema in a male patient with a liver abscess in a limited diagnostic setting. Methods: According to medical records, a 44-year-old man came to the emergency room (ER) of Umbu Rara Meha General Hospital with complaints of shortness of breath that had been getting worse for two months, accompanied by a cough with phlegm for one week, fever, and weight loss. The patient also complained of pain in the right upper abdomen for the last four months. History of pulmonary tuberculosis, diabetes mellitus, or hypertension was denied. The patient is not a smoker. On physical examination, there was an increase in the frequency of breathing and a decrease in the vesicular sounds on the right side. Right thorax X-ray examination revealed massive right pleural effusion without pulmonary infiltrates. Abdominal ultrasound showed a liver abscess. Emergency pleural puncture was performed in the ER, and 1600 cc of purulent pleural fluid was removed, followed by Water Sealed Draignase (WSD) installation. The patient was given intravenous broad-spectrum antibiotics and treated for 12 days. Conclusion: Empyema can be a rare but life-threatening complication of liver abscess. Medical action must be taken immediately in the ER to save the patient. Delaying pus drainage can increase morbidity and mortality rates.

Predicting persistent fever in patients with cancer using machine learning.

e13552 Background: Sepsis is the leading cause of hospital readmission and death in the developed world. Cancer patients are at high risk due to their underlying disease and therapies. Meanwhile, antimicrobial resistance increases steadily, warranting a more careful administration of antibiotics. Predicting fever persistence 48 hours after initiation of antibiotics could help reduce antibiotic escalation and chest CT scans in patients where fever is predicted to subside within the next 24 hours. Methods: All cancer patients of the University Hospital Essen (UHE) between 1/1/2020-7/1/2023, receiving broad-spectrum i.v. antibiotics, and having persistent fever after 48 hours of first administration were extracted from UHE’s Fast Health Interoperability Resources clinical database. Vital signs, clinically important covariates, as well as lag features of vital signs and laboratory values were included. The binary target to predict was prevalence of body temperature ≥38 °C after 48-72 hours. Gradient boosting machines, a deep learning neural network, logistic regression (LR), random forest (RF) and a voting ensemble classifier were implemented. Hyperparameter tuning and model validation was performed through five-fold stratified cross validation (80/20% train/test split). Results: Analyzing 2.9 million patient records of UHE we obtained approx. 27,000 hospitalized adults with cancer. Restriction to hematology/oncology wards and intravenous broad-spectrum antibiotics resulted in 1,267 cancer patients. Of these, 264 patients had persistent fever after 48 hours, of which 111 patients had solid cancers, 66 lymphomas, and 87 other hematologic malignancies. 72 hours after antibiotic therapy 160 patients (60.2%) had persistent fever. Based on the area under the precision-recall curve (AUPRC) of 81.7%, the voting classifier model had the highest predictive performance. The model shows a sensitivity of 85%, a specificity of 63%, a Negative Predictive Value (NPV) of 75% and a Positive Predictive Value (PPV) of 73% on a cross-validated test set (Table). Conclusions: Machine learning-based algorithms can predict fever evolution and assist in clinical decision-making, potentially contributing to better patient care by preventing unnecessary antibiotics escalations and CT scans. Based on current model performance, 25% of chest CT scans could be obsolete as patients will not have persistent fever after 48 hours. Additional results will be presented at the meeting. [Table: see text]

A REPERTOIRE OF ACUTE DACRYOCYSTITIS

Background: Clinical features of acute dacryocystitis comprise of three stages- stage of cellulitis, lacrimal abscess and fistula formation. Infective odontogenic focus is one of the known etiologies for acute dacryocystitis. Pre-septal cellulitis is the most common presentation associated with epiphora. Tenacious inflammation of sac or distal nasolacrimal duct obstruction can result in a lacrimal abscess. Unattended abscess may consequently form a fistula. Acute dacryocystitis rarely can get complicated to cause orbital cellulitis overstriding the anatomic barriers. Case Presentation: Case1: A 72/F complained of toothache since a week, followed by diffuse swelling below lower eyelid, pain and discharge near medial canthus. The case was diagnosed as acute dacryocystitis with pre-septal cellulitis due to apical abscess of right maxillary molar which was visualised on orthopantomogram. Case2: A 36/M presented with mild pre-septal cellulitis and lacrimal abscess. Case3: A 79/M presented with diminution of vision, pain and inability to move the right eye. He had history of watering for8 years. He was diagnosed to have orbital cellulitis with fistula secondary to acute on chronic dacryocystitis. Discussion: Case 1: Symptoms resolved spontaneously with emergency access opening of right first maxillary molar and systemic intravenous broad-spectrum antibiotics. She further underwent dacryocystectomy with fistulectomy. Case 2: Lacrimal abscess was managed with incision and drainage followed by dacryocystorhinostomy. Case 3: Orbital cellulitis was managed with broad-spectrum intravenous antibiotics. Dacryocystectomy with fistulectomy was performed after the eye was quiet. Conclusion: Presentation of dacryocystitis can have variable causes hence proper history and addressing underlying cause at the earliest can help in early resolution. Aggressive management of complications can help in steady subsidence without progression.

Serial neutrophils count as a stratifying tool for early follicular tonsilitis remission

Background/Aim: This study examines the correlation between sequential serum neutrophil levels and the overall improvement status or reduction rate of intravenous antibiotic administration. This study seeks to identify a cost-effective and easily accessible biomarker that can accurately predict the need for hospitalisation in patients with acute tonsillitis who are receiving intravenous broad-spectrum antibiotics. The goal is to determine the patients' suitability for early discontinuation of intravenous antibiotics and discharge. Methods: This study was conducted at the King Hussein Medical Centre in Jordan, focusing on patients with severe acute tonsillitis who did not respond to oral antibiotics. Data was collected from the electronic medical record system (Hakeem) from January 2018 to May 2021. The study classified serial serum neutrophil measurements during the first week of hospital admission into four categories. The levels were compared between the non-penicillin Cohort (Group I) and penicillin Cohort (Group II) using an Independent-T Test. The outcomes of interest included a drop in neutrophil counts exceeding 50%, a decrease in the use of intravenous antibiotics in favor of oral antibiotics, and early eligibility for discharge. The study also examined serial neutrophil counts over the tested days and compared to the outcomes of positive and negative states using receiver operating curve analyses. The optimal cutoff operating point for each ROC curve was determined by selecting the highest Youden's index of each prognosticator day level. The analysis of all results was conducted using SPSS version 20 with a significance level set at p-value <0.05. Results: This study analyzed 1638 adult and elderly patients admitted to KHMC, RMS, Amman, Jordan between January 2018 and May 2021. The average age was 51.88±16.22 years, with patients dependent on intravenous penicillin being slightly older. The distribution of males and females was significant, with males making up 2.55 times the number of females. The odds ratio for positive outcomes was 4.12, with a high rate of poor outcomes in 1318 out of all eligible patients. A total of 994 (60.7%) medical patients were treated with intravenous administration, while 644 (39.3%) surgical patients were scheduled for a tonsillectomy procedure. The risk estimate for patients admitted from medical wards compared to surgical wards was an odds ratio of 0.562. The study also provided sensitivity analysis for the four tested serial neutrophil prognosticators at different day levels. Conclusion: The study supports the use of Somatic Nucleated Cell (SNC) as a reliable measure for evaluating EFR in cases of catarrhal acute tonsillitis. The maximum SNC count in Group one was 11,269 cells per cubic millimeter. Acute streptococcal infection often exhibits an ESR higher than 40, but this may be concealed by other complications. The SNC test has advantages like simplicity, quickness, and cost-effectiveness, but lacks specificity. Monitoring SNC and EFR fluctuations can initiate treatment cessation, preventing relapse and severe complications during recovery.

Mucosal emphysematous head and neck infections: Scoping review and a case of emphysematous tonsillitis.

This scoping review seeks to understand the existing research in otolaryngological mucosal emphysematous infections and to elucidate gaps in knowledge in the field. We also present a case of bilateral necrotizing tonsillitis in an immunocompromised patient with the first reported imaging findings of emphysematous abscess of the tonsils. PubMed, Embase, Web of Science. We conducted our review according to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. Patient presentation, management, and outcomes were summarized. We also describe the case of a patient with aplastic anemia found to have emphysematous tonsillitis, managed with intubation, broad spectrum intravenous antibiotics and bilateral tonsillectomy. We identified seven case reports or series, involving nine total patients, who presented with emphysematous epiglottitis, supraglottitis, or tonsillitis. The hallmark imaging characteristic was submucosal "gas bubble" on computed tomography. Presenting symptoms included dysphagia, odynophagia, dysphonia, cough, and fever. Both immunocompetent and immunocompromised patients were affected. All patients were treated with broad spectrum antibiotics, and most with steroids. Patients at risk of airway compromise also underwent intubation and surgical drainage or debridement of the emphysematous infection. Emphysematous pharyngeal infections are rare but potentially life-threatening infections that can progress rapidly, resulting in airway compromise and sepsis in both immunocompetent and immunocompromised individuals. We highlight the importance of swift intervention, with intubation and surgical intervention often required for severe cases. More research is needed on common pathogens and patient risk factors to guide future medical and surgical management.

The impact of levofloxacin prophylaxis on empiric intravenous antibiotic use in pediatric hematopoietic stem cell transplant recipients.

Levofloxacin prophylaxis during periods of neutropenia in pediatric hematopoietic stem cell transplant (HSCT) may reduce the number of febrile episodes and use of empiric intravenous antibiotics (EIA); however, the literature is conflicting. This retrospective review compared EIA use before and after implementation of levofloxacin prophylaxis at a children's hospital. Levofloxacin prophylaxis was associated with reduced use of certain EIA; however, did not reduce the number of positive blood cultures or clinical deteriorations. Therefore, levofloxacin prophylaxis may have implications for the stewardship of broad-spectrum intravenous antibiotics used in pediatric HSCT.

Prehospital management of sepsis with IV antibiotics: a UK literature review

Background: Sepsis mortality rates increase if prompt treatment is not administered. The Sepsis Six care bundle advocates the early administration of broad-spectrum intravenous antibiotics to reduce mortality and morbidity but this is not routinely practised nationally in UK prehospital settings, although UK ambulance services regularly attend septic patients. Aims: A literature review was conducted to investigate knowledge around paramedics' ability to recognise and treat prehospital sepsis with intravenous antibiotics in the UK and the impact of this on patient outcomes. Methods: A search was conducted and the three eligible studies included underwent a structured critical appraisal and thematic analysis. Findings: Three themes emerged: diagnostic accuracy; administration of prehospital antibiotics; and impact on patient outcomes. Conclusion: There is a significant gap in evidence in this field in the UK, and it was difficult to make generalised recommendations from the studies. Paramedics have the potential to be highly accurate in the recognition of sepsis and administer intravenous antibiotics when following a protocol. No major studies measure patient outcomes following prehospital intravenous antibiotics administration by paramedics in the UK and large empirical studies should be conducted to assess the effectiveness of this.

Giant Parotid Abscess With Significant Skin Necrosis: A Case Report.

Poor blood glucose control is a common predisposing factor for parotid abscesses; however, extensive skin necrosis secondary to parotid abscesses has rarely been reported. In this article, we present the case of a 70-year-old man with poor glycemic control admitted to our hospital with swelling, congestion, and pain in the right parotid region that had gradually increased over 15 days prior to presentation. Based on the clinical, imaging, and laboratory findings, the patient was diagnosed with a giant parotid abscess with extensive skin necrosis caused by Klebsiella pneumoniae. The abscess responded poorly to long-term treatment with intravenous broad-spectrum antibiotics, and the patient underwent daily Bacillus exchange with blood glucose level management and electrolyte monitoring via routine blood tests. At the 3 month follow-up, complete resolution of the right parotid gland abscess and skin rupture was observed.

Pneumocystis jirovecii pneumonia: a case report

Introduction and importancePneumocystis jirovecii (PJP) pneumonia is a serious life-threatening condition in immunocompromised individuals and is often associated with human immunodeficiency virus (HIV) + patients. We describe a case of PJP pneumonia which provided a diagnostic challenge in a patient who presented with no known risk factors leading to a delay in initiation of appropriate antibiotic therapy.Case presentationA 71-year-old previously healthy white/Caucasian male presented with subacute hypoxic respiratory failure due to multifocal pneumonia with diffuse bilateral ground glass opacities with consolidations despite prior treatment with antibiotics and steroids. He was admitted and started on intravenous broad-spectrum antibiotics but continued to deteriorate, eventually requiring intubation and transfer to the ICU. Bronchoscopy revealed PJP and treatment was initiated, but the patient developed refractory shock and multiorgan failure, and ultimately died. It was later discovered that he was HIV-1 positive.Clinical discussionPJP, as a potential cause of his presentation, was not considered given that our patient lacked any overt risk factors for PJP pneumonia. He continued to worsen despite broad spectrum antibiotic therapy and hence bronchoscopy was pursued. His clinical profile, in hindsight, was suspicious for PJP pneumonia and early PJP-directed antibiotic therapy may have prevented a fatal outcome, as in this case. There was an element of cognitive bias across multiple providers which may have contributed to the delay in treatment despite his rapid clinical decline while on conventional pneumonia treatment protocol. His diagnosis was later evident when his BAL-DFA grew PJP in addition to his low levels of CD4 and CD8 cells. He was found to be HIV-1 positive five days after his death; there was a delay in this diagnosis since all positive HIV tests from the hospital are reported as ‘pending’ until the presumptive positive sample goes to the Connecticut Department of Public Health State laboratory for the confirmatory test. PJP-targeted therapies were initiated later in our patient’s hospital course when the infection had progressed to refractory septic shock with multiorgan failure and eventual death.ConclusionPJP pneumonia is a fatal disease if not recognized early in the course of illness, and the patient usually undergoes multiple antibiotic regimens before they are diagnosed and receive appropriate clinical care. The gold standard of diagnostic testing for PJP is by obtaining bronchial washings through a flexible bronchoscopy and the turnaround time for such results may take a few days to result. A significant proportion of patients may not have any overt risk factors of immunosuppression and early empiric treatment for PJP may be clinically appropriate as the delay in diagnosis may be associated with significant morbidity and mortality risk.

Management of <i>Kotha Roga</i> (Necrotizing Fasciitis) by Modified <i>Ksharapichu</i> (Wound Packing): A Case Report

The present case report was a 25-year-old male patient with severe pain at the right index finger, fever, oedema, and discharge, not having any history of surgery, hypertension, diabetes, or any systemic disorder was diagnosed with kotha roga (necrotizing fasciitis). Presently available treatment for this is broad-spectrum intravenous antibiotics, appropriate hydration support, and meticulous surgical debridement with regular wound packing. But because of contaminated wounds and poor prognosis, herbal therapies have a possibility to cure kotha as they are readily available, and inexpensive. In this case, a kshara formulation i.e., modified ksharpichu was chosen as an atrial medication to be applied locally after everyday cleaning and dressing. It was observed that ksharpichu acted as a debriding agent and healing as well. The case was followed up for 30 days. This study employed pretty simple criteria to gain preliminary observations on the effectiveness of this Kshara taila on kotha roga.

Culture-negative endocarditis with multifocal spread and flail mitral valve leaflet: a case report

Introduction: Blood culture-negative infective endocarditis is the condition in which a causative organism cannot be identified after inoculation of at least three samples using standard blood-culture systems for 7 days. It has a low reported incidence of about 2.5–31%. Causes may be infectious or non-infectious; use of prior antibiotic therapy is usually the leading factor. Case presentation: The authors present a case of true culture-negative endocarditis involving the mitral valve, with multiple foci of spread including brain, spleen, liver, and Intervertebral disc, which remained persistent despite treatment with intravenous broad-spectrum antibiotics on an inpatient and outpatient basis but eventually improved after upgrading alternative broad-spectrum antibiotic for an extended duration. The patient had complications in the form of a flail mitral valve with persistent mitral regurgitation, requiring mitra-clip placement. Discussion: Positive blood culture is one of the major diagnostic criteria to establish infective endocarditis. Patients may have persistent negative cultures due to previous antibiotic use, the presence of fastidious organisms, or the use of inappropriate techniques or media. Involvement of a multidisciplinary team, use of multimodal investigations, and appropriate antibiotic stewardship are crucial. Extended duration of treatment and upgrading antibiotics can be helpful next steps in highly suspicious cases. With multifocal spread as in our case, it further becomes challenging to control and treat the infection as it is frequently connected with higher morbidity and mortality. Conclusion: Blood culture-negative endocarditis is an entity that can present with early complications. It is diagnostically and therapeutically challenging to treat such patients. Multimodal approaches for early diagnosis and appropriate treatment are crucial owing to its high morbidity and mortality.

Odontogenic orbital cellulitis: literature review

Introduction: Odontogenic origin is a rare cause (1.3–5%) of cases of orbital cellulitis, but it can lead to very important morbidity such as blindness or thrombosis of the cavernous sinus. It is therefore important to know how to recognize it. Methods: A literature review was performed. The parameters analyzed included age, sex, ethnicity, clinical presentation, imaging to determine orbital involvement, etiology, microbiology, treatment (medical and/or surgical), and final outcome of each case. Chandler's classification was used to classify the different types of cellulitis. Results: Thirty-five cases of odontogenic orbital cellulitis have been described in literature from 1980 to 2022. In 42.9% of cases, the cellulitis corresponded to an intra-orbital abscess (Chandler stage IV). Thrombosis of the cavernous sinus (stage V) was detected in 5.7% of cases. Periorbital edema (100%), ocular or facial pain (82.9%) and limitation of eye movements (82.9%) were the three most common ophthalmological signs. The anamnesis revealed an element pointing to a dental origin in 97.1% of the cases, the two most frequent being a dental avulsion (20%) or an endodontic treatment (14.3%), in days or weeks preceding the onset of symptoms. Imaging was performed on admission in 94.3% of cases. Regarding the most frequently encountered germs, commensal streptococcus of the oral cavity or anaerobic bacteria were found in 25.7% of cases, and coagulase-negative staphylococcus in 22.9% of cases. In 94.3% of cases, broad-spectrum intravenous antibiotic therapy was initiated as soon as the diagnosis was made. The common feature was the use of metronidazole in 51.4% of cases, combined with a third-generation cephalosporin (11.4%) or amoxicillin-clavulanic acid (8.6%). Orbital drainage was necessary in 71.4% of cases to allow resolution of symptoms, associated with drainage of the maxillary sinus in 45.7% of cases. Finally, the treatment allowed a recovery without sequelae in 80% of cases. Discussion: In case of suspected orbital cellulitis, imaging is crucial to confirm the diagnosis, the type of cellulitis and plan the appropriate surgical treatment. The first step of treatment will be the quick start of a broad spectrum intravenous antibiotic therapy, targeting aerobic and anaerobic bacteria. However, it seems imperative to associate a surgical treatment consisting in a first step of an oral drainage and an elimination of the oral infectious source, as well as an orbital drainage whose approach will have been determined by the imaging. Conclusion: Orbital cellulitis is a rare complication of oral cavity infections, but it must be recognized and treated in time to avoid serious morbidity. An early medical and surgical treatment will usually allow good results and a healing process without sequelae.

Case of Ray Fungus Presenting with Abdominal Distension

Actinomycosis is a rare infection caused by filamentous, non acid fast staining and gram positive bacteria. The diagnosis is rarely made preoperatively, and only histopathological examination can confirm it, as the condition presents with varied clinical manifestations, often resembling a malignant lesion on radiographic images. Hereby, the authors present a case of a 67-year-old female, who was admitted for evaluation of an abdominal mass. Radiologically, the mass resembled a desmoplastic fibroma, and clinically, it was suspected to be the same. The mass was excised and sent for histopathological examination. Grossly, two specimens were received. The first consisted of adherent bowel loops, including the ileum, appendix, caecum and descending colon, with the mass arising from mesentery involving the bowel, measuring 11.5x9.5x6 cm. The second specimen was a partial cystectomy specimen, with the abdominal wall mass infiltrating the bladder anteroposteriorly, measuring 11x10x8 cm. Microscopic examination revealed extensive areas of inflammation with actinomycotic organisms exhibiting the Splendore-Hoeppli phenomenon, along with numerous multinucleated giant cells and acute on chronic inflammatory infiltrate. Surrounding areas showed dense collagen bundles. The prognosis after complete surgical resection is good, along with the administration of broad spectrum intravenous antibiotics.

An Innovative Therapy by Changing the Gut Microbiome for the Dual Post-Operative Complications of the Recurrent Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in the Residual Type II First Branchial Cyst and Facial Nerve Palsy

A very unusual, interesting, and challenging case of a 24-year-old female who was born with three openings in the neck. The patient had chronic abdominal gaseous distention, recurrent abdominal pain, and constipation since early infancy. The patient presented in emergency with acute painful red, hot, and tender swelling in the left upper cervical area. Laboratory studies showed high inflammatory markers and a provisional diagnosis of abscess with a sinus was made. The patient underwent an emergency incision and drainage. Sinus recurred and a sinogram showed it to be a residual cyst in the left submandibular salivary gland. The total cyst excision was attempted with resultant recurrence and grade IV facial nerve palsy. Post-operatively recurrent infections caused by Methicillin-resistant Staphylococcus aureus (MRSA) required several courses of oral and intravenous broad-spectrum antibiotics with several hospital admissions with no resolution in sight. Subsequent ultrasound and magnetic resonance imaging showed a residual infected cyst, cutaneous sinus, and a fistula opening in the left ear canal. A diagnosis of branchial cyst type II of the first brachial cleft remnant with a fistula was established with bilateral branchial fistulas of the second branchial remnants and the associated colorectal hypoganglionosis based on radiological studies. The patient refused any further operative interventions. Therefore, the option of conservative treatment of hypoganglionosis with holobiotics consisting of prebiotics, probiotics and postbiotics, laxatives, dietary changes, lifestyle modifications, and dietary supplements started. All antibiotics were stopped. These therapies resulted in the resolution of residual first branchial remnants and recurrent MRSA infections with the improvement in the facial nerve palsy from grade IV to grade III-IV together with an excellent cosmetic and functional result. The patient is doing well at follow-ups being infection-free for 18 months and repeat contrast-enhanced computed tomogram (CECT) has shown complete resolution of the residual cyst, sinus, and fistula with fibrosis.

Comparison of Miniperc and Standard Percutaneous Nephrolithotomy in the Treatment of Renal Stone: An Open Level Parallel Arm Randomized Control Trial

Background: Treatment of renal stone is very crucial for the outcomes of the patients. Objective: The purpose of the present study was to compare the Miniperc and standard percutaneous nephrolithotomy in the Treatment of Renal Stone. Methodology: This randomized control trial was conducted in the Department of Urology at National Institute of Kidney Diseases and Urology, Dhaka and some private hospitals in Dhaka city of Bangladesh from July 2016 to November 2017 for a period of one and half year. Patients from 18 to 65 years of age with renal calculi ( 2cm) were selected on the basis of plain X-ray and ultra-sonogram of KUB region, from Urology outpatient Department (OPD) in National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and some private hospitals in Dhaka city. Patients were selected in every alternate sequence (odd numbers for Miniperc in Intervention group and even numbers for Standard PCNL, control group). All patients underwent PCNL of both the procedures under general anesthesia and received intravenous broad spectrum antibiotics. Results: A total number of 60 patients were selected for study of which 30 patients were underwent miniperc and 30 patients were undergoing standard PCNL. The mean age of miniperc group and PCNL group were 34.43±11.09 and 36.70 ± 12.27 years respectively. An overall stone clearance rates was 93.33 (28) in intervention group and 6.67 % (2) was not cleared. Among the control group an overall stone clearance rates were 96.67% (29) and 3.33% (1) was not cleared. Stone clearance rates were not significant. The mean operative time (min) of intervention group was 97.47±15.03 and the mean operative time (min) of control was 86.37±17.73 Operative time was significant between the groups (p<0.05). Conclusion: In conclusion the rate of clearance of intervention group is not statistically significant. Journal of Current and Advance Medical Research, January 2023;10(1):19-24