Central Military Hospital Research Articles

Editorial introductions.

Editorial introductions.

Analysis of a patient group with head and facial injuries in scooter accidents treated at the Central Military Hospital in Prague from 2010 to 2022

Analysis of a patient group with head and facial injuries in scooter accidents treated at the Central Military Hospital in Prague from 2010 to 2022

Assessment of bowel movement dysfunction following laparoscopic low anterior resection for rectal cancer: a single-center study from Vietnam.

Postoperative bowel movement dysfunction is a challenging problem greatly affecting patients' quality of life after low anterior resection. We aimed to evaluate the bowel movement function of patients undergoing laparoscopic low anterior resection for rectal cancer. This retrospective study recruited 82 rectal cancer patients undergoing laparoscopic low anterior resection from July 2018 to July 2020 at 108 Military Central Hospital, Hanoi, Vietnam. The patients' mean age was 62.3±11.6 (28-84) years, 54 (65.9%) were males, and 28 (34.1%) were females. Bowel movement function changed significantly after one year: the average score for low anterior resection syndrome (LARS) after three months, six months, and one year was 17.6, 14.0, and 10.6, respectively. The rate of patients with major LARS decreased from 26.8% after three months to 14.6% after one year. The Wexner score also decreased from 5.9 after three months to 3.4 after one year. The rate of patients with normal bowel movement increased from 28.0% after three months to 46.3% after one year. The rate of patients with complete fecal incontinence decreased from 11.0% after three months to 7.3% after one year. Preoperative chemoradiotherapy (p=0.017), tumor location (p=0.02), method of anastomosis (p=0.01), and anastomosis location (p=0.000) were risk factors associated with major LARS after surgery. Bowel movement dysfunction in rectal cancer patients undergoing laparoscopic low anterior resection is a common and persistent problem after surgery. However, bowel function gradually recovers over time. Therefore, patients should be monitored and supported for a better quality of life.

Epidemiology of hospitalized patients with COVID-19 in a tertiary care hospital.

COVID-19, caused by the betacoronavirus SARS-CoV-2, has overwhelmed the world's health systems. To describe the epidemiological characteristics of patients treated in a tertiary care hospital. A retrospective cohort study of patients diagnosed with or suspected of having COVID-19 from March 23 to July 31, 2020 was conducted. 4,401 patients were hospitalized at Central Military Hospital, out of which 35 % were beneficiaries, 26 % civilians, 28 % active military personnel, and only 11 %, retired military personnel. Male gender predominated, both in hospitalized patients and in those who died, as well as the O+ group and absence of comorbidities; among the observed comorbidities, the main ones were overweight and diabetes. Hospitalized patients' median age was 49 years, while median age of those who died was 62 years; women older than 51 years had a higher risk of dying. Adjusted case fatality rate was 18.5 %; 50 % died within the first six days. In this study, the epidemiological characteristics and main comorbidities in Mexican patients with SARS-CoV-2 infection were identified.

"Nearly off-track lesions" or a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track does not seem to be accurate in predicting recurrence after an arthroscopic Bankart repair in a military population: a case-control study.

On-track lesions with a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track (nearly off-track) may predispose recurrence after arthroscopic Bankart repair (ABR) in the general population. The aim of this study was to determine if a shorter distance between the medial edge of the Hill-Sachs lesion and the medial edge of the glenoid track could accurately predict recurrence after an ABR in a high-demand military population. It was hypothesized that a shorter distance would not accurately predict recurrence. A retrospective monocenter case-control study was performed at the Dutch Central Military Hospital. Patients with an on-track Hill-Sachs lesion who underwent a primary ABR between 2014 and 2019 with a minimal follow-up of 2 years and a preoperative magnetic resonance imaging (MRI) assessment received a questionnaire. The primary outcome was recurrence, defined as a complete dislocation or subluxation. Glenoid bone loss was assessed using a linear-based method on MRI. The distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track was defined as the distance to dislocation (DTD). A receiver operating characteristic curve was created to determine the predictive value of the DTD for recurrence. Logistic regression was used to determine preoperative risk factors that predispose recurrence. Covariates were selected based on univariable analysis and included gender, body mass index, age at surgery and first dislocation, laterality, smoking habits, overhead shoulder activity during work, preoperative dislocations, sports type and level, bony or labral lesions on MRI, and DTD. In total, 80 patients with an average follow-up of 4.8±1.9 years completed the questionnaire and were included in the analyses. Seventeen patients (21%) experienced recurrence at the final follow-up. No difference in DTD was observed among patients who experienced recurrence (9 ± 4 mm) compared with patients who did not (9 ± 5 mm; P=.81). The receiver operating characteristic curve demonstrated no predictive power of DTD for recurrence (area under the curve=0.49). Smoking at the time of surgery (odds ratio: 3.9; confidence interval: 1.2-12.7; P=.02) and overhead shoulder movement during work (odds ratio: 9.3; confidence interval: 1.1-78.0; P=.04) were associated with recurrence according to the logistic regression analysis. A shorter DTD demonstrated no accuracy in predicting recurrence in a military population. Smoking at the time of surgery and overhead shoulder activity during work were associated with recurrence; however, these analyses were underpowered to draw valid conclusions.

Value of Some Scoring Systems for the Prognosis of Rebleeding and In-Hospital Mortality in Liver Cirrhosis with Acute Variceal Bleeding

Background: Upper gastrointestinal (GI) hemorrhage, caused by acute esophageal variceal bleeding, is a common complication and a leading cause of death in patients with cirrhosis. Therefore, predicting the risk in order to employ an active management to prevent rebleeding and death is crucial. Currently, there are many prognostic scoring systems that have been proposed, but research is needed to find a valid score which can be applied in clinical practice in each country and population. Aims: To compare the value of ALBI (Albumin-Bilirubin), PALBI (Platelet Albumin-Bilirubin), AIMS65, model for end-stage liver disease (MELD), and Child–Pugh scores (CPS) approaches in predicting early rebleeding and in-hospital mortality of acute variceal bleeding in patients with cirrhosis. Subjects and methods: We performed a cross-sectional descriptive study on cirrhotic patients with acute variceal bleeding who were being treated at the Department of Gastroenterology, Intensive care unit—Military Hospital 103 and the Institute for Treatment of Digestive Diseases—108 Military Central Hospital from September 2020 to May 2022. We calculated ALBI, PALBI, AIMS65, MELD, Child–Pugh values and compared them with the rates of early rebleeding and in-hospital mortality. Then, determined and compared the prognostic value through an analysis of the area under the curve (AUC). Results: 222 patients with acute esophageal variceal bleeding were eligible for inclusion in the study. The rates of rebleeding and in-hospital mortality were 9.0% and 6.8%, respectively. Regarding the prognosis of early rebleeding, the ALBI and PALBI scores have good prognostic value (AUROC 0.74; 95% CI: 0.63–0.85 and AUROC 0.7; 95% CI: 0.59–0.81; p = 0.004, respectively), while the Child–Pugh, MELD, AIMS65 scores have little prognostic value, with AUROC < 0.70. Regarding prognosis of in-hospital mortality: the ALBI, PALBI, MELD and AIMS65 all have good value in predicting in-hospital mortality, with AUROC of 0.81 (95% CI: 0.68–0.93, respectively; p < 0.001); 0.8 (95% CI: 0.69–0.91; p <0.001); 0.83 (95% CI: 0.72–0.93; p < 0.001); and 0.82 (95% CI: 0.76–0.87, p < 0.001), respectively. While Child–Pugh score only has medium prognostic value, with AUROC 0.79 (95% CI: 0.66–0.92; p < 0.05). However, there was no significant difference between these prognostic scoring systems. Conclusion: the ALBI, PALBI, MELD and AIMS65 scores all had similar good value in predicting in-hospital mortality, but with early rebleeding prognosis, only ALBI and PALBI had good value. CPS does not show prognostic value like other scores, both in predicting early rebleeding and in-hospital mortality.

The computed tomography characteristics of lumbar facet joints in spondylosis patients

Objective: To demonstrate the computed tomography (CT) features of lumbar facet joints in spondylosis patients. Subject and method: It was a cross-sectional and descriptive study including 42 spondylosis patients (416 lumbar facet joints) who took consultation in 108 Military Central Hospital, from December 2021 to July 2022. The subjects were recruited as the correspondence between Gomez Vega 2019 clinical criteria and CT scan. The examined index included: Joint shapes which were C-shaped, straight shape, J-shaped; joint angles regarding sagittal line; joint tropisms. Osteoarthritis characteristics of lumbar facet joints based on Pathria classification with 4 grades. Data were analyzed by SPSS, comparisons of two means were performed by T-test. Statistical significance was defined by p<0.05. Result: Average age of patients was 63.79 ± 2.24 years old, female/male ratio was 4.25. 2/42 (4.76%) patients had sacralization of L5. The proportions of joint shapes (C, straight and J) were 86.76%, 13.24%, 0% respectively. The angle of joints increased in respect of descending levels, from 31.14 ± 8.78o (L12) to 45.61 ± 11.20o (L5S1). The average of articular tropisms in each level were ranged from 5.47 ± 4.09o to 7.58 ± 7.22o. The percentages of Pathria classification (grade 0, 1, 2, 3) were 2.40%, 59.62%, 11.06%, 26.92%, respectively. Pathria 3 dominantly distributed at L45 level (Left 47.62% and right 42.86%). Subchondral sclerosis and hypertrophy contributed to the highest rate of degenerative characteristics (99.03% and 92.51% respectively). Conclusion: C-shaped joint was the most popular. Large tropism might be a consequence of prolonged osteoarthritis. Subchondral sclerosis and hypertrophy presented at almost facet joints. Pathria grade 3 was the most popular at L45 level which had higher percentage of severe osteoarthritis features.

STUDY ON THE PRESENCE OF OIPA AND DUPA GENES OF HELICOBACTER PYLORI IN GASTRIC CANCER PATIENTS

Objectives: To determine the percentage of Helicobacter pylori (H. pylori) carrying the outer inflammatory protein A (oipA), duodenal ulcer promotion (dupA) genes, and their relationship with endoscopic imaging, histopathology, and the risk of gastric cancer (GC). Subjects and methods: A cross-sectional study on 89 GC patients, compared with 90 patients with chronic gastritis (CG) with H. pylori infection, diagnosis based on histopathological results at Military Hospital 103 and Central Military Hospital 108 from August 2019 to May 2022. Determination of oipA, dupA genes of H. pylori by realtime-PCR technique on biopsy tissue samples of the gastric mucosa. Results: The percentage of H. pylori carrying the oipA and dupA genes was 30.2% and 10.1%, respectively. The relationship between bacterial infection harboring these 2 genes and endoscopic images and histopathology of GC has not been recorded. There was no difference in the prevalence of H. pylori carrying the oipA and dupA genes infection between the GC and CG groups (p > 0.05). Conclusion: The infection of H. pylori with oipA and dupA genes positive may not increase GC risk in Vietnamese.

Evaluation of the left ventricular torsion and twist in patients with chronic heart failure using three dimensional speckle tracking echocardiography

Objective: To evaluate the left ventricular torsion deformation in patients with chronic heart failure using 3D speckle tracking echocardiography. Subject and method: From January 2018 to October 2020, a prospective, cross-sectional study with controls was conducted on 110 chronic heart failure patients and 50 healthy people who were treated as inpatients at the Department of Cardiology, 108 Military Central Hospital. Result: The mean age of the group of patients with heart failure was 65.82 ± 11.77, with men accounting for 66.36%, while the mean age of the control group was 65.16 ± 10.24, with men accounting for 68%. The heart failure group's left ventricular torsion parameters were all lower than the control group's: Peak-AR (4.56 ± 2.960 versus 10.41 ± 3.060; p<0.001), Peak-BR (-4.04 ± 2,250 vs -8.97 ± 2.750; p<0.001), Peak-Twist (7.94 ± 4.280 vs 18.99 ± 4.280; p<0.001), and Torsion (1.01 ± 0.560 vs 2.42 ± 0.600; p<0.001) and decreased in both the preserved EF group and the control group: Peak-AR (6.63 ± 2.49 vs 10.41 ± 3.06, p<0.05), Peak-BR (-5.02 ± 3,040 vs -8.97 ± 2.750; p<0.05), Peak-Twist (10.96 ± 4,740 vs 18.99 ± 4,280, p<0.05), Torsion (1.46 ± 0.600 vs 2.42 ± 0.600, p<0.05). The absolute value of left ventricular torsion parameters gradually decreased from heart failure with EF 50% to heart failure with a slight decrease in ejection fraction to heart failure with EF 40%. From the group of heart failure with grade I diastolic dysfunction to the group of heart failure with grade III diastolic dysfunction, the absolute value of the parameters of left ventricular torsion decreased statistically significantly. Apical rotation and left ventricular torsion have a moderate relationship with EF, left ventricular longitudinal strain as measured by 2D speckle tracking echocardiography. On 2D speckle tracking echocardiography, the angle of rotation should be weakly correlated with EF and left ventricular longitudinal strain drived from 2D speckle tracking echocardiography (2D–GLPS). Conclusion: Torsional deformation parameters of the left ventricle were lower in heart failure patients compared to controls, and they changed earlier in the group with preserved ejection fraction. Torsion deformation parameters, despite being the last variable parameter, are still quite sensitive in detecting left ventricular dysfunction.

Clinical characteristics, brain computerized tomography scan and surgical outcome in elderly patients with chronic subdural hematoma

Objective: To determine clinical characteristics, computer tomography brain imaging, and surgical outcome for elderly patients with chronic subdural hematoma (CSDH). Subject and method: A cross-sectional, descriptive, and retrospective study was conducted on 74 elderly patients diagnosed with CSDH and operated at 108 Military Central Hospital from June 2020 to June 2021. Result: Mean age was 75.2 years; male/female ratio was 3.93/1, the most common cause was traumatic brain injury (49%). The common presenting symptoms of CSDH were altered mental state (70.9%) and headache (68.9%), followed by cognitive impairment (54.1%), hemiparesis (21.6%), hematoma maximal thickness and midline shift were associated with a higher rate of hemiparesis in CSDH patients (p<0.05); The percentage of patients with GCS score ≥ 13 was 90.5%. The portion of unilateral on the brain CT was 78.4%. The most common densities of CSDH obtained from CT imaging was isodense (accounting for 54.0%); followed by hypodense (20.3%), high-density (17.6%), and mixed-density (8.1%); The most common complication of burr hole technique was pneumocephalus (accounting for 8.1%); recurrence of CSDH (5.4%). The Glasgow outcome scale (GOS) 4-5 was 89.7% within 3 months. Conclusion: Chronic subdural hematoma was one of the most common diseases in neurosurgery. The burr hole drainage technique was safe and effective.

Results of risk stratification and accessory pathway ablation in patients with asymptomatic Wolf-Parkinson-White pattern at 108 Military Central Hospital

Objective: To evaluate the electrophysiological characteristics, risk stratification and ablation outcomes in patients with asymptomatic Wolf-Parkinson-White pattern at 108 Military Central Hospital. Subject and method: A retrospective observational study on 45 asymptomatic Wolf-Parkinson-White patients underwent electrophysiology study and ablation by radiofrequency energy at Department of Cardiology, 108 Military Central Hospital, from December 2018 to December 2021. All patients were evaluated by electrophysiology study to stratify the risks. Indications of ablation was according to European Society of Cardiology guideline. Result: The average age of patients was 34.8 ± 15.1 years old. Majority of patients were men with the rate of 82.2%. The proportion of patients at high clinical risk was 31.1%. In electrophysiology study, the mean accessory pathway effective refractory period (APERP) was 215.5 ± 60.1 (in which 73.3% patients had APERP ≤ 240ms). Among patients with having spontaneous/ induced atrial fibrillation (22.2%), the mean shortest pre-excited R-R interval in atrial fibrillation (SPERRI) was 232 ± 81.2ms (80% of patients had SPERRI ≤ 250ms). The rate of patients with inducible atrioventricular reentrant tachycardia was 22.2%. There were 43 patients (95.55%) having indication for ablation (4.44% due to high-risk occupation and 91.11% due to high risk by electrophysiological study). The locations of accessory pathways included: 53.4% from left side (the most common region was anterior wall of mitral valve with 18.6%) and 46.6% from right side (14% from posterolateral wall of tricuspid valve). The mean number of attempt ablations before success was 3.1 times. The rate of successful ablation was 97.6%. There were no complications in our study sample. Conclusion: Among 45 patients with asymptomatic Wolf-Parkinson-White pattern, there were 95.55% patients having indication for ablation (4.44% due to high-risk occupation and 91.11% due to high risk by electrophysiological study). The locations of accessory pathways included: 53.4% from left side (18.6% from anterior wall of mitral valve) and 46.6% from right side (14% from posterolateral wall of tricuspid valve). The rate of successful ablation was 97.6%.

Predictive factors for triple-negative breast carcinoma

Objective: To determine the clinicopathologic factors and Ki67 expression predicting triple-negative breast cancer (TNBC). Subject and method: A descriptive study on 169 patients with breast cancer at the 108 Military Central Hospital from October 2015 to September 2020. The status of estrogen receptor (ER), progesteron receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki67 expression were examined by immunochemistry. Result: The mean age of the patients was 53.8 ± 12.2 years. The rate of tumor size larger than 2cm was 54.4% (92/169). The percentage of cases with tumor grade 2 was highest at 64.5% (109/169). The rate of axillary lymph node metastasis was 37.9%. TNBC accounted for 16.6%. The statistically significant correlation was observed between TNBC and location, tumor size, histological grade and Ki67 ≥ 14%. Conclusion: Our study suggested that the right side, histological grade 3 and Ki67 ≥ 14% were independent predictive factor of TNBC.

Incidence and risk factors for urinary tract infection in the first year after kidney transplantation at 108 Military Central Hospital, Vietnam

Objective: To determine the incidence of urinary tract infections in kidney transplant patients in our hospital, to identify the microbial pathogens, risk factors for urinary tract infection. Subject and method: Primary kidney transplant patients at 108 Military Central Hospital with full follow-up records in the first year were included in the study. Age, sex, cause of kidney failure, pre-transplantation treatment measures, post-transplantation immunosuppressive regimen were collected. Patient was followed and midstream urine was cultured monthly. Result: There were 94 kidney transplant patients included in our study. Seventy patients (74.5%) were male and 24 (25.5%) were female. One hundred and two episodes of urinary tract infections in 37 patients (39.4%) were reported. Sex (female) (p=0.003; 95% CI: 1.716-14.021), urologic complications (p=0.006, 95% CI: 0.001-0.320) were found as risk factors for UTI in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated pathogens. UTI had no negative impact on short-term graft survival. Conclusion: The results of our study showed a high incidence of UTI in kidney transplant recipients. Infection control methods should be used regularly during post-transplant therapy.

Survey on clinical and subclinical characteristics of first diagnosed prostate cancer at 108 Military Central Hospital

Objective: To describe several clinical and subclinical characteristics of patients with first diagnosed prostate cancer at 108 Military Central Hospital. Subject and method: A retrospective study was performed on 312 patients with first diagnosed prostate cancer in Department of Urology, 108 Military Central Hospital, from January 1st, 2016, to December 31st, 2020. Main research criteria: age, symptoms of urinary disorders, total PSA, signs of bone metastases, and Gleason score. Result: Mean age was 73.9-year-old, frequent clinical symptoms were urinary hesitancy 51% and acute urinary retention 32.4%; mean prostate volume was 61.1ml; the rate of carcinoma was 99.6%; most of cases had high PSA (³ 20ng/ml) and very high (³ 100ng/ml); 63.7% of cases had signs of bone metastases at the time of diagnosis. Conclusion: Prostate cancer is mainly late diagnosed; the rate of adenocarcinoma accounted for 99.6%.

Antibiotic susceptibility of Pseudomonas aeruginosa isolated at 108 Military Central Hospital from 01/2020 to 06/2022

Objective: To determine antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated at the 108 Military Central Hospital from January 2020 to June 2022. Subject and method: A total of 784 Pseudomonas aeruginosa strains were isolated from patient specimens from different departments. Bacteria identification and antibiotic susceptibility test were performed using the Vitek MS system and the Vitek-2 Compact system, respectively. Multidrug-resistant and/or carbapenem-resistant Pseudomonas aeruginosa (MDR/CPR P. aeruginosa) strains were determined. Colistin susceptibility test was done using cation-modified Muller-Hinton broth diffusion method (CBDE, colistin broth disk elution). Result: Pseudomonas aeruginosa was highly resisting to fluoroquinolones (62.8%), and aminoglycosides (53.4%). The proportion of MDR/CPR P. aeruginosa was 54.3% (426/784), of which the highest proportion was found in the Department of Infectious Diseases (65.52%), ICU (64.39%) and the Internal Respiratory Department (45.69%). Carbapenem-resistant Pseudomonas aeruginosa was highly prevalent in urine specimens (65.38%) and respiratory specimens (56.76%). Of 258 MDR/CPR P. aeruginosa isolates, 11.2% isolates were resistant to colistin, 26.6% and 33.3% of these remained susceptible to amikacin and piperacillin/tazobactam, respectively. Conclusion: The prevalence of antibiotic resistante Pseudomonas aeruginosa remains high, including resistance to carbapenem and colistin. Antibiotic regimen should include amikacin or piperacillin/tazobactam in combination with other antibiotics. The study suggested the routine application of diagnostic tools for the rapid detection of resistant strains.

Treatment outcomes of neoadjuvant chemotherapy with dose-dense AC-T regimen for patients with stage II, III breast cancer

Objective: To evaluate the treatment outcomes of neoadjuvant chemotherapy with dose-dense AC-T (dd AC-T) regimen on stage II, III breast cancer (BC) patients, and to assess several clinical and subclinical factors associated with treatment response in these patients. Subject and method: This was a cross-sectional, prospective study with longitudinal follow-up, no control group. The study was conducted on 44 stage II, III BC patients receiving NAC with dd AC-T regimen at Department of General Oncology, Institute of Oncology, 108 Military Central Hospital from June 2018 to August 2022. Result: After receiving NAC, CEA, CA15-3 mean concentrations and tumor size decreased statistically (p<0.05). Regarding clinical response according to RECIST ver 1.1 criteria, the overall response rate (ORR) was 97.7%, in which the complete response (CR) rate accounted for 36.4%. All patients underwent surgery after receiving NAC. The rate of pathological complete response (pCR) was 31.8%. Several factors associated with treatment response include: Tumor size, skin involvement status, TNM stage, histopathology grade (p<0.05). Patients achieving clinical CR had a higher rate of pCR than the other group (p<0.001). Conclusion: NAC with ddAC-T regimen in treatment for stage II, III BC patients resulted in high clinical and pathological response. As a result, this is a good NAC option for these patients. Several factors associated with response include: Tumor size, skin involvement status, TNM stage, histology grade. Patients achieving clinical CR had a higher rate of pCR than the other group.

Clinical features, laboratory characteristics and treatment outcomes of liver abscess at the Institute of Clinical Infectious Diseases - 108 Military Central Hospital

Objective: To describe clinical features and laboratory characteristics, treatment outcomes of liver abscess treated at Institute of Clinical Infectious Diseases. Subject and method: This is a retrospective descriptive study on 65 patients with liver abscess, treated at the Institute of Clinical Infectious Diseases - 108 Military Central Hospital, from January 2018 to June 2022. Result: The majority of patients were male (85%), from 41 to 70 years of age, had diabetes (44.62%). Clinical symptoms were prolonged fever: (92.31%); chills (75.38%), right upper quadrant pain (83.08%), jaundice (21.54%). Inflammatory marker: leukocytosis 75.4%; elevated procalcitonin (68.75% PCT > 10ng/ml). Liver function test: Elevated liver enzyme 83.1%, increased bilirubin 52.3%, prolong prothrombin time 47.7%; decreased albumin (63.1%) and thrombocytopenia 21%. About 94% liver abscess were single foci, located in the right liver lobe (81.54%), large size > 5cm accounted for 75.35% with mixed features on ultrasound (84.62%). Among 41 strains of bacteria isolated, Klebsiella pneumoniae (87.8%); E. coli (9.75%) and Streptococcus sp. (2.45%). Mortality rate: 1.54%. In total: 83.07% patients underwent invasive procedure (Aspiration: 50.77% and Percutaneous drainages: 32.3%). Mean duration in hospital (days): 14.77 ± 6.37 with mean deferverescent time was: 4.45 ± 2.36 (days). Conclusion: The clinical features of LA still remain typical with prolonged fever, chills and right upper quadrant pain. Patients with an advanced ages and diabetes mellitus as an underly condition appear LA. The sub-clinical characteristic were an increased inflammatory marker and abnormal liver function tests. On ultrasound, majority of patients had one abscesses > 5cm on the right liver lobe. Treatment with broad spectrum antibiotics and minimal invasive procedures including aspiration and percutaneous drainage showed good response.

Central Venous Catheter–Associated Infection: An Experience of a High Complexity Hospital

Abstract Background Central line–associated bloodstream infections (CLABSIs) are among the pathologies that increase mortality and morbidity in hospitalized patients with some type of device. Objective The aim of this study was to describe the clinical, microbiological, therapeutic characteristics, and economic costs associated with CLABSI. Methodology This study is a retrospective cohort study in subjects hospitalized at the Central Military Hospital of Bogotá, Colombia, describing the clinical, microbiological, and therapeutic characteristics in patients undergoing the insertion of a central venous catheter (CVC) and comparing them between subjects who did or did not develop infection. Central line–associated bloodstream infections were defined based on the criteria of the Infectious Diseases Society of America, a significant P < 0.05 was considered. Results A total of 821 patients were evaluated, of which 75 had a diagnosis of CLABSI, reaching a frequency of 9.1%. Patients with CVC infection were 12 years younger on average compared with the control group (55 vs 67 years; P = 0.001), 85.3% of the population with CVC-associated infection were men compared with 62.0% (P = 0.023) of the group without CLABSI. The CVC anatomical insertion sites with the highest proportion in both study groups were at the jugular and right subclavian levels (P = 0.001). The overall mortality of the study population was 24.6%, reaching 32% in the population with CLABSI compared with 23.9% in the control group (P = 0.254). Patients with CLABSI present higher associated costs during hospitalization (P = 0.013) and total costs (P = 0.028). Conclusions The younger population, the male sex, and the anatomical insertion of the CVC at the jugular and right subclavian levels presented a higher proportion of CLABSI. The costs associated with hospitalization and total costs were higher in the group of patients with CLABSI.

Covid a karbapeném-rezistentná Klebsiella pneumoniae v nemocničnom prostredí

The COVID-19 pandemic era brought about new medical challenges, which, together with nosocomial bacterial infections, resulted in an enormous burden for the healthcare system. One of the most alarming nosocomial threats was carbapenem-resistant Klebsiella pneumoniae (CRKP). Monitoring CRKP incidence and antimicrobial resistance globally and locally is vitally important. In a retrospective study, the incidence of CRKP in the pre-COVID-19 period (2017–2019) and the COVID-19 pandemic (2020–2022) was investigated in the central Military Hospital in Ružomberok, Slovak Republic. The relative incidence of CRKP significantly increased during the COVID-19 period—by 4.8 times, from 0.18 to 0.76%. At the same time, 47% of CRKP-positive patients also had COVID-19. Twenty-six KPC and sixty-nine NDM-producing isolates were identified. CRKPs isolated in the year 2022 were submitted to whole genome sequencing, and their susceptibility was tested to cefiderocol, ceftazidime–avibactam, imipenem–relebactam and meropenem–vaborbactam, with excellent results. KPC-producing isolates were also highly susceptible to colistin (92%). The NDM isolates revealed lower susceptibility rates, including only 57% colistin susceptibility. St-307 prevailed in KPC and St-11 in NDM isolates. Despite the excellent activity of new antimicrobials, rational antibiotic policy must be thoroughly followed, supported by complementary treatments and strict anti-epidemic precautions.

Features of the organization of surgical care for patients with a new coronavirus infection at a branch of the central military hospital

Features of the organization of surgical care for patients with a new coronavirus infection at a branch of the central military hospital