Intensive Unit Research Articles

Frequency of positive antenatal scans in neonates with congenital diaphragmatic hernia admitted in NICU of tertiary care hospital.

Objective: To determine the frequency of positive prenatal scans in newborns with CDH admitted to a tertiary care hospital, we designed the current study. Study Design: Cross-sectional study. Setting: Neonatal Care Intensive Unit of NICH. Period: March to October 2024. Methods: Neonates admitted with confirmed diagnosis of CDH were included in this study. Neonates born with multiple gestation (like twin or triplet) were excluded from this study. Gestational age at diagnosis, baby age and gender, birth weight and laterality of CDH were noted and documented in a pre-designed proforma. Results: Total 40 patients were included into the study. Mean gestational age was 37.5±2.8 weeks. Majority patients were males (56%). Mean birth weight was 25.3 ± 1.6 grams. Out of 40 patients, 22.5% patients were prenatally identified to have CDH. None of the patients’ features were significantly different among those who were prenatally and post-natally diagnosed for CDH. Conclusion: The present study found that prenatal diagnosis rate of CDH in our settings is low. We should focus on advanced techniques and improving our skills for increasing prenatal diagnosis rate which will be help for parental counselling and planning the management for safe neonatal outcomes.

Nurses' Knowledge, Attitude and Practice in Nutrition Management of Hospitalised Adults: A Mixed-Methods Study.

To examine nurses' knowledge, attitude and practice regarding nutrition management in hospitalised adults and explore their views on it. A mixed-method approach combining cross-sectional and descriptive qualitative methods. 379 enrolled/registered nurses working in acute or intensive units of a tertiary hospital were recruited between 24th August 2023 and 3rd December 2023. Participants completed a questionnaire on their sociodemographic profile, knowledge, attitude and practice (KAP) regarding nutrition management. Data analysis was conducted using R software, reporting levels of KAP and its associations with sociodemographic factors. Mann-Whitney U and Kruskal-Wallis tests were used for non-normally distributed knowledge and practice scores (reported as median and interquartile range). Two-sample t-tests and ANOVA were used for normally distributed attitude scores (reported as mean and standard deviation). 21 of the participants from the quantitative study were either purposively sampled or snowballed from the quantitative study to undergo semi-structured interviews (physically or virtually face-to-face), which were transcribed verbatim and analysed using content analysis. The mean scores on KAP were 61.6, 19.4 and 22.8, respectively. Knowledge varied significantly by educational level (p < 0.001), while attitudes also differed based on education (p = 0.001) and years of employment (p = 0.019). Practice scores showed differences based on subspeciality (p = 0.032), nursing rank (p < 0.001) and years of employment (p = 0.004). Findings identified barriers to effective nutrition management, including prioritisation issues, varying professional roles, limited autonomy and resource shortages. It also emphasises nurses' roles in nutrition management and strategies such as nurses' autonomy and family members involvement to improve nutrition management. Sociodemographic factors significantly influence nurses' KAP in nutrition management, revealing knowledge deficits, low prioritisation and time constraints. Tailored education and training, increased autonomy, resource expansion and greater family involvement can enhance nurses' KAP in nutrition management.

Point prevalence survey of antibiotics in a pediatric tertiary hospital in the Republic of Panama.

To conduct a point prevalence survey (PPS) of antibiotic use in the main pediatric tertiary-level hospital in Panama City to establish antibiotic prevalence and identify key areas for addressing antimicrobial resistance. This point prevalence survey (PPS) conducted in a tertiary-level hospital in Panama followed the Pan American Health Organization's adaptation of the methodology proposed by the World Health Organization for PPSs on antibiotic use. Information obtained included patients' demographic characteristics, antimicrobial prescriptions, indication for antimicrobial use, and prescription's adherence to guidelines. Of 298 patients surveyed from August to September 2023, 176 (59.0%) were treated with antibiotics. The pediatric ward (86.3%) and the neonatal intensive unit (80.0%) had the highest prevalence of antibiotic use. Hospital-acquired infections accounted for 32.6% of antibiotic prescriptions, with piperacillin/tazobactam (29.4%), meropenem (15.3%), amikacin (15.3%), and ampicillin/sulbactam (10.2%) being the most prescribed. Treatment for community-acquired infections represented 55.9% of antibiotic prescriptions, with ampicillin (24.6%), gentamicin (22.6%), and ampicillin/sulbactam (14.0%) being the most frequently used. Of the prescriptions considered in the analysis, 61.0% adhered to hospital guidelines. This PPS observed a high prevalence of antibiotic use. The findings suggest it is necessary to assess the need for ampicillin, gentamicin, and piperacillin-tazobactam use in patients admitted to pediatric critical care units, with special emphasis on children with pneumonia and sepsis diagnosis, the most common pathologies for which an antimicrobial was prescribed.

Forearm Bio-Medical Signal Processing

This research utilizes low-dimensional surface EMG and EEG data, obtained from the human arm using ECG electrodes, to analyze forearm muscle signals through a novel approach. Both EMG and EEG signals are employed side by side: EEG captures brain activity, particularly in the beta (13-30 Hz) and alpha (8-12 Hz) frequency ranges, while EMG focuses on muscle activity in the 20 Hz to 200 Hz range. Beta waves are associated with motor planning and voluntary movements, while alpha waves decrease during movement execution, indicating disengagement from a resting state. Event-related desynchronization (ERD) of alpha and beta waves is vital in understanding motor tasks, including forearm movements. Although EEG alone showed a poor response in tracking movement execution, EMG provided better performance, with higher frequencies reflecting more intense muscle contractions and motor unit activation. The combination of EEG and EMG improves the analysis of event-related potentials (ERPs) in timing tasks, enabling precise monitoring of both brain and muscle activity. However, coordinating both signals can be complex and often relies on user experience. Extensive experimentation confirms that using this dual approach is feasible and effective in replicating natural arm movements. The findings highlight important advancements in applying signal processing techniques to muscle activity analysis, providing new insights into the control of muscles and enhancing accessibility to modern assistive technologies.

IDENTIFICATION OF THE FEATURES OF THE INFLUENCE OF HETEROGENEOUS-VELOCITY GROUND LAYERS ON LARGE-EARTHQUAKE EFFECTS IN THE MONGOLIAN-SIBERIAN REGION

The southern part of Eastern Siberia and the northern part of Mongolia were quantitatively assessed in terms of the influence of the upper-crustal heterogeneous-velocity ground layers on a single reasonable initial signal. Seismically, the territory is estimated at 7–9 intensity units; geomorphologically, it appears as a system of intermountain depressions and mountain structures; geologically, the area is a part of the Baikal rift zone system as its southwestern and southern fragments are incorporated therein.The work is aimed at developing methods for studying and predicting seismic effects of large earthquakes in the Mongolian-Baikal region. The implementation of the task is associated with the need of assigning calculated accelerograms, modeling seismic ground motion, and carrying out theoretical calculations for the region under study. Using the data from 2020-2022 relatively large earthquakes recorded simultaneously in Irkutsk and Ulaanbaatar, I category grounds were assigned a single initial signal with regard to potential source zones of near and distant large earthquakes in the region. Computational models of seismic ground motions were developed based on recently obtained seismic survey and seismometric measurement data. The authors also took into account the available general dataset on the change in seismic wave velocities with depth for the most common types of loose unsaturated grounds to a few hundred meters and for the bedrock to the probable depth of earthquake occurrence. The constructed models are characterized by layer thickness, change in longitudinal and transverse wave velocities with depth, volumetric mass, and attenuation decrement.The results of theoretical calculations for the features of the influence of heterogenous-velocity ground layers on the amplitude and frequency composition of the assigned initial signals are presented as the parameters of seismic effects (maximum accelerations, predominant ground motions frequencies and their corresponding amplitude level, resonant frequencies and accompanying ground motions amplification values) for seismic probability models developed based on the calculated accelerograms, spectra, and frequency characteristics.

Evaluación del bienestar animal en vacas lecheras de una unidad de producción de la Comarca Lagunera, México

The aim of this study was to evaluate the animal welfare status of dairy cows in an intensive production unit, using the Welfare Quality protocol. A total of 315 lactating and dry cows were evaluated, based on four principles: adequate feeding, housing, health and behavior. To achieve this, animal-based, management-based and housing-based measures were recorded. As indicated in the protocol, most of them contain a three-point scale ranging from zero to two, 0: welfare is good, 1: there is some compromise in welfare and 2: welfare is insufficient and unacceptable. The critical variables found for cow welfare were: absence of thirst; cleanliness of quarters (46.62%), udder (13.42%) and flanks (38.34%); time to lie down (5.24 s); dystocia (24%), eye discharge (6.27%) and diarrhea (100%). It is concluded that the production unit has important areas of opportunity to improve the animal welfare of its cows, according to the standards proposed by the Welfare Quality protocol.

Natural history of HPV16-E6 serology among cancer-free men in a multicenter longitudinal cohort study.

Human papillomavirus (HPV)16-E6 seropositivity accurately predicts oropharyngeal squamous cell carcinoma (OPSCC) risk decades before diagnosis; but the biomarker's translational potential is unknown. To inform considerations for OPSCC screening, we described HPV16-E6 seroprevalence, predictors, and kinetics among cancer-free men. In a cohort study in Brazil, Mexico, and United States, we calculated HPV16-E6 seropositivity [median fluorescence intensity (MFI) units > 1,000], measured by multiplex serology, in cancer-free men. HPV16-E6 seropositivity predictors were assessed using logistic regression, adjusting for country, age, sexual orientation, and lifetime number of partners. Among HPV16-E6 seropositive men, we retrieved all available retrospective serum samples and described temporal HPV16-E6 antibody patterns. Of 3,997 men, 14 had HPV16-E6 antibodies detected [seroprevalence = 0.35%; 95% confidence interval (95%CI)=0.19%-0.59%] (median MFI = 2,407; interquartile range = 1,325-5,986). Older age was associated with increased odds of HPV16-E6 seropositivity (50-84 years vs 18-29 years odds ratio = 16.61; 95%CI = 2.20-417.03). Serum from 11 of the 14 seropositive men retested positive; six men had MFI > 5,000, of whom two had MFI > 10,000. Seven men had ≥3 years follow-up; all were persistently seropositive for 3 years. One man was seropositive for nine years but seroreverted at his exit visit. Oral HPV16-DNA (prevalence = 1.13%) was associated with HPV16-E6 seropositivity (odds ratio = 16.87; 95%CI = 3.35-69.55). However, oral HPV16-DNA positivity was not persistent over follow-up, even when HPV16-E6 antibodies were persistently detected. HPV16-E6 seropositivity is rare but generally stable once detected; thus, HPV16-E6 antibodies may be an informative biomarker of HPV-driven OPSCC. Few men seroreverted following HPV16-E6 seropositivity but remained close to the seropositivity cut-off; thus, cancer risk among these men is less clear.

Microbial landscape in the neonatal care intensive unit

Improvement of the clinical outcomes of newborns with hospital-acquired infections requires microbiological monitoring to ensure timely initiation of appropriate empirical therapy. In our study we investigated the patterns of pathogens responsible for hospital-acquired infections in neonatal intensive care units and assessed the levels of antibiotic resistance among these pathogens. The study included 4,891 samples from newborns. Gram — positive microflora was found in 55.9% of the samples and gram-negative — in 44.1%. The antibiotic resistance profile revealed high resistance to penicillin-based antibiotics among staphylococci. Gram-negative microorganisms remained sensitive to most antibacterial drugs.

Title: Is Celiac Trunk Revascularization Necessary After High-Flow Pancreaticoduodenal Arterial Arcades Aneurysm Retrograde Embolization?

Background and Objective: High-flow pancreaticoduodenal artery (PDA) aneurysms secondary to celiac trunk occlusion or stenosis have a high risk of rupture. Embolization offers a less invasive alternative to surgery. We evaluated the effectiveness and safety of retrograde embolization via the superior mesenteric artery of high-flow PDA aneurysms without celiac trunk revascularization. Methods: This retrospective bicentric study included patients who underwent embolization of high-flow PDA aneurysms due to significant celiac trunk stenosis or occlusion. All patients underwent pre-interventional dynamic contrast-enhanced computed tomography. Retrograde embolization was performed using microcoils and/or liquid agents without celiac trunk revascularization. Follow up involved clinical and radiological assessment at one month. Technical and clinical success were evaluated, and complications were categorized as minor or major. Results: Twenty-three patients (mean age 65 ± 14 years; 52% male) were included. Emergency embolization was required in 12 patients (52%). The technical success rate was 100%. Patients were monitored for a median of 16 months. Clinical success was 87%. No hemorrhagic recurrences were observed. Minor complications occurred in two cases. One major complication involved splenic infarction due to glue migration, requiring splenectomy and intensive unit care admission. Conclusions: Retrograde embolization of high-flow PDA aneurysms is effective and safe without needing celiac trunk revascularization.

A Data-Loader Tunable Knob to Shorten GPU Idleness for Distributed Deep Learning

Deep Neural Networks (DNNs) have been applied as an effective machine learning algorithm to tackle problems in different domains. However, the endeavor to train sophisticated DNN models can stretch from days into weeks, presenting substantial obstacles in the realm of research focused on large-scale DNN architectures. Distributed Deep Learning (DDL) contributes to accelerating DNN training by distributing training workloads across multiple computation accelerators, for example, graphics processing units (GPUs). Despite the considerable amount of research directed toward enhancing DDL training, the influence of data loading on GPU utilization and overall training efficacy remains relatively overlooked. It is non-trivial to optimize data-loading in DDL applications that need intensive central processing unit (CPU) and input/output (I/O) resources to process enormous training data. When multiple DDL applications are deployed on a system (e.g., Cloud and High-Performance Computing (HPC) system), the lack of a practical and efficient technique for data-loader allocation incurs GPU idleness and degrades the training throughput. Therefore, our work first focuses on investigating the impact of data-loading on the global training throughput. We then propose a throughput prediction model to predict the maximum throughput for an individual DDL training application. By leveraging the predicted results, A-Dloader is designed to dynamically allocate CPU and I/O resources to concurrently running DDL applications and use the data-loader allocation as a knob to reduce GPU idle intervals and thus improve the overall training throughput. We implement and evaluate A-Dloader in a DDL framework for a series of DDL applications arriving and completing across the runtime. Our experimental results show that A-Dloader can achieve a 28.9% throughput improvement and a 10% makespan improvement compared with allocating resources evenly across applications.

Incidence of and Risk Factors for Central Venous Catheter Thrombosis: Results from a Single-Center Pediatric Intensive Care Unit.

Central Venous Catheter (CVC) is a necessary and important tool in managing acutely ill children and those needing complex care. CVC enables infusing venous medication, fluids, blood products, chemotherapy, total parental nutrition, and painless withdrawal of blood for laboratory testing when needed. To identify the incidence and risk factors for Central Venous Catheter-Related Thrombosis (CVC-RT) among patients admitted to the Pediatric Intensive Unit. This was a prospective, observational, single-center study that was conducted over 17 months from September 2019 to January 2021 at King Abdulaziz Medical City, Jeddah. Prospective observational study. King Abdulaziz Medical City, a tertiary care center in the western region of Saudi Arabia. Pediatric patients aged 1 to 168 months who were admitted to the PICU and required central line insertion (whether inserted centrally or peripherally) for more than 48 hours were included. Screening for thrombosis was performed within day 4-7 post-line insertion and again on the 14th day. A total of 255 patients were enrolled over 17 months. The incidence rate of CVC-RT was 5.4%. The type of CVC was significantly different between the two groups; in the no thrombosis group, 59.2% had a central line while in the CVC-RT groups, 51.9% had a PIC line (p = 0.027). In a multivariate regression analysis including patients' clinical profile, high D-dimer as baseline and low platelets were both significant risk factors for CVC-RT [adjusted OR = 3.22, CI (1.25-8.28), p = 0.015 and adjusted OR = 7.38, CI (2.18-25.02), p = 0.001], respectively. The current study found that PIC line was associated with an increased risk of CVC-RT, which is congruent with the literature. As children with CVC can have multiple risk factors for developing CVC-RT, it is important to conduct further large prospective studies to identify such factors and decrease the incidence of CVC-RT.

Efficacy of a Communication Toolkit to Optimize Palliative Care Communication in the Surgical Intensive Unit

Efficacy of a Communication Toolkit to Optimize Palliative Care Communication in the Surgical Intensive Unit

A customizable and low-cost 3D-printed transwell device coupled with 3D cell culture for permeability assay

The permeability-based assay is commonly used to assess intestinal barrier function, and it relies on using a transwell insert as an essential compartment. The device consists of a semipermeable membrane that is attached at the bottom of the insert and splits the system into the apical and basolateral compartments. However, commercial inserts are standardized with different pore sizes based on the application and offer only a flat plane of two-dimensional cell culture. Herein, we present a simple, low-cost 3D-printed transwell device and a robust method to functionalize the inserts for paper-based 3D cell culture. This 3D-printed device was fabricated from a polylactic acid (PLA) filament, and a paper membrane used to support HT-29 cells for intestinal permeability assessment. A device showed good biocompatibility when culturing HT-29 cells for 48 and 72 h with 97 % and 98 % cell viability, respectively. Together with fluorescence images, cells were attached directly to the microfiber networks of a Matrigel-functionalized paper, indicating that the functionalized paper is biocompatible and bioactive. Furthermore, in a more appropriate culture microenvironment, SEM analyses revealed cellular features differentiating into mucus-secreting cells, evidenced by the formation of microvilli on the cell surface, which was further confirmed by immunofluorescence staining of villin-1. To demonstrate the usability of the 3D-printed transwell device, intestinal permeability was assessed using both chemical and biological stimulation treatments. The permeability results employing FITC-dextran validated the association between a different level of relative fluorescence intensity unit (RFU) and the orange color of live cells by CellTrackerTM. As a result, this 3D-printed transwell device provides a straightforward and cost-effective method for manufacturing a device for customization in many laboratory settings, making it a feasible alternative to marketed transwell devices that do not allow for customization.

Implementing an Antimicrobial Stewardship Program and Complete Screening in an Intensive Care Unit in Relation to the Overall Clinical Outcome of Patients.

The high prevalence of resistant microorganisms indicates a multidisciplinary approach, which will ensure efficiency and balance between resistance therapy of choice and the implementation of an antimicrobial stewardship (AMS) program in intensive unit care (ICU). The objectives are based on the assessment of AMS in a cardiac surgical intensive care unit (CICU), by determination with the reduction of: inotropic support, length of antibiotic treatment, and need for renal replacement therapy (RRT). The research is a retrospective, group comparative, analytical cross-sectional study, in the period from 2020-2023, within the Cardiosurgery department, at Acibadem Sistina. 1277 patients participated in the research, divided into two groups: group 1 (2020-2021) and group 2 (2022-2023). Primary endpoints investigated: inotropic support, need for RRT and length of antibiotic treatment. Secondary endpoints investigated: optimization of antibiotic therapeutic regimen and clinical outcome assessment of patients (survival). The inotropic support during 24, 48 and 72 h was statistically significantly lower in group 2. A statistically significant shorter length of time for antibiotic treatment was determined in patients in group 2 (p=0.000), as well as a lower value of the need for RRT. A statistically significant difference in time to event (fatal outcome) was determined between the two groups (p=0.000). A significant difference (p=0.000) was determined in the prescription and optimization of the therapeutic regimen. Integrating AMS, initial comprehensive microbiological screening and application of biomarkers in the CICU, established appropriately, will result in improved overall clinical outcome for patients.

Identifying high-risk central lines in critically ill children: a novel nurse-driven screening and mitigation intervention to reduce CLABSI

BackgroundDespite strong adherence to central line associated bloodstream infection (CLABSI) infection prevention bundles, the CLABSI rate in our academic pediatric intensive care unit (PICU) and pediatric cardiac intensive unit (PCICU) remained high. MethodsWe developed a novel screening tool that stratified patients' risk for CLABSI and considered risk-mitigation strategies. ResultsOf 1583 screenings, 30% were classified as high-risk, 27% as moderate-risk, and 43% as low-risk. With accurate screening, the tool was 100% sensitive to patients who developed CLABSI, with a negative predictive value of 100% for low-risk screens. The CLABSI rate declined from 1.83 per 1000 catheter-days to 0.98 and 1.02 in 2021 and 2022, respectively, with unprecedented consecutive months CLABSI free. Device utilization was stable across both units, declining by 22% in the PICU and rising in the PCICU with increased cardiac surgeries. Clinicians expressed increased awareness of patient CLABSI risk factors and mitigation strategies in surveys. DiscussionsThis novel screening tool effectively identified high-risk patients to target resources and promoted improvements in CLABSI-prevention processes in the PICU and PCICU. ConclusionsA novel nurse-driven CLABSI risk factor screening tool identified and focused resources on patients at high-risk for CLABSI, and increased awareness and proactive risk mitigation by clinicians.

A regional multicentre prospective survey addressing sport-related myocardial infarction: clinical characteristics of 155 patients and one year follow-up

Abstract Background Exercise is a keystone of cardiovascular prevention; however, it is also a powerful trigger of acute cardiovascular events including sudden cardiac arrest and acute myocardial infarction. Contemporary studies addressing these sport-related myocardial infarction (SR-MI) are scarce. Aim To describe clinical characteristics and follow-up of SR-MI. Methods We conducted a regional multicentric prospective survey addressing patients admitted for a SR-MI in 2 intensive coronary units. SR-MI was defined as MI onset occurring during sport or within the 1st hour of recovery. A one-year follow-up was performed by phone call. Results From April 1st 2018 to February 23th 2023, 155 SRMI were included, of whom 13 (8.4%) were female, median age was 61-y. (IQR 54-66). Cycling was the most frequent sport (32.5%) followed by fitness and hiking (12.6% each) then jogging (11.3%) (Figure). Most were ST elevation MI (68.8%). The main risk factors were dyslipidaemia (33.8%), hypertension (27.3%) and tobacco smoking (24.5%). No cardiovascular risk factor other than age was identified in 38 patients (25.7%). Prodromal symptoms were reported by 66 subjects (42.6%). SR-MI occurred mostly during exercise (60.6%). Out of hospital cardiac arrest (OHCA) occurred in 20 (12.6%) patients, more commonly among patients with prior coronary artery disease (CAD) (p = 0.02) and tobacco smoking (p=0.047). A significant single vessel disease was observed in 67 patients (43.2%); revascularization was performed by stenting in 134 patients (86.5%) and surgery in 11 (7.1%). In-hospital death occurred in 4 patients and was associated to OHCA (p=0.007). Among the survivors at time of discharge (151 patients), 141 were eligible to follow-up, none one lost: one patient died suddenly at home, one suffered from a recurrent MI, one experienced a cardioversion from his implantable cardioverter defibrillator (ICD) and an ICD was implanted in 4 others. A cardiovascular rehabilitation was performed in 101 patients (65.2%); from the 30 smokers at the time of SRMI, 26 declared smoking cessation. Conclusions Among patients admitted for a SR-MI, most were male. Prodromal symptoms were common but neglected. OHCA occurred in 1 patient out of 8 and was associated with history of CAD, tobacco smoking and in-hospital death. Such findings highlight the need for mass education to prevention including recognition of prodromal symptoms and management of cardiac arrest. In this exercising population, rehabilitation rate was high and quitting tobacco was commonly achieved.Table

Topical Losartan Dosage Response and Corneal Toxicity at Higher Concentrations.

The purpose of this study was to evaluate the efficacy and safety of higher dosages of topical losartan in an alkali-burn fibrosis model in rabbits. In total, 18 rabbits had standardized alkali burns that trigger stromal fibrosis. Six eyes per group were treated with topical losartan (0.8 mg/mL, 8 mg/mL, or 40 mg/mL) 6 times per day. Slit-lamp photographs were obtained, and multiplex immunohistochemistry was performed for myofibroblast marker alpha-smooth muscle actin (α-SMA), mesenchymal cell marker vimentin, and basement membrane marker laminin alpha-5. Topical losartan at 40 mg/mL 6 times per day produced severe discomfort and ocular surface toxicity in all rabbits, and treatment was discontinued at nine days in this group. Topical losartan at 8 mg/mL 6 times per day caused less rabbit discomfort on application, but there were persistent epithelial defects and marked stromal opacity in 5 of 6 eyes after 1 month of treatment. Topical losartan 0.8 mg/mL was well tolerated by rabbits, and corneal opacity was markedly reduced at 1 month in 5 of 6 corneas compared with corneas in the 8 mg/mL and 40 mg/mL losartan groups. A persistent epithelial defect with opacity was noted in 1 cornea in the 0.8 mg/mL losartan group. Both total SMA-positive stromal cells per section (14.5 ± 2.8 vs. 3.5 ± 0.7, P = 0.04) and total stromal vimentin intensity units (310 ± 64 vs. 132 ± 35, P = 0.02) were significantly greater after 1 month of treatment in corneas treated with 8 mg/mL than corneas treated with 0.8 mg/mL of topical losartan. Topical losartan dosages over 0.8 mg/mL should be used cautiously in patient eyes. In eyes with a current epithelial defect, it is recommended that 0.2 mg/mL losartan 6 times per day be used until the epithelium closes.

Genomic insights into qnrVC1 gene located on an IncP6 plasmid carried by multidrug resistant Pseudomonas aeruginosa from clinical asinine isolates

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen, causing significant global health threat due to its antimicrobial resistance. Among equines, P. aeruginosa can cause infections, particularly in the reproductive tract, leading to reproductive failure. Multidrug-resistant (MDR) P. aeruginosa has been a major concern in animal husbandry, including the donkey industry. The study aims to elucidate the phylogenetic relationship of P. aeruginosa strains isolated from donkeys with endometritis farmed in a large intensive unit in Hebei Province, China. Genes coding for multiple antimicrobial resistances were predicted by whole genomic sequencing. Multilocus sequence typing (MLST) revealed that all strains belonged to the same sequence type (ST1058). An IncP6 plasmid encoding the qnrVC1 gene, associated with quinolone resistance, was identified. Comparative genomic analysis illustrated the characteristics of the strains and genetic context of qnrVC1. This study is the first to report that these MDR P. aeruginosa asinine strains exhibited high levels of antimicrobial and metal resistance conferred by a qnrVC1-carrying plasmid. Additionally, P. aeruginosa strains with integrated mega-plasmids were identified. From a One Health perspective, the study underlined the significance of monitoring antimicrobial resistance genes in food animals, including donkeys.

Generalized tetanus complicated with Takotsubo-cardiomyopathy in a septuagenarian following a laceration injury with soil contamination – a case report

BackgroundTetanus is a clinical rarity due to the successful globally adopted childhood vaccination programme. The rising elderly population in the United Kingdom creates a subset of individuals whom are prone to develop Tetanus as they preceded this vaccination drive.Case summaryA 76 year old Caucasian lady presented with a soil contaminated laceration injury on her knee following a fall. Though she received urgent assessment and wound care, the relevance of the injury in the backdrop of her age was not appreciated and her tetanus post exposure prophylaxis was overlooked. She readmitted seeking further management 1 week later with an infected wound with Trismus and clinical features favoring Generalized tetanus. During her stay she developed Takotsubo-cardiomyopathy with congestive cardiac failure and required prolonged care in the intensive unit with mechanical ventilation and rehabilitation before being discharged home.ConclusionFirst contact physicians should have a greater appreciation of the types of injuries and at-risk individuals who are more prone to develop tetanus upon exposure to ensure early and appropriate identification. There should be greater situational awareness with regard to the elderly in view of their heightened risk of development of tetanus specially those born before the vaccination drive. Knowledge regarding post exposure prophylaxis measures for tetanus should be regularly updated using local guidance to ensure awareness, so as to despite its rarity Tetanus remains an adequately appreciated disease.

Gastrointestinal Stromal Tumor of the Duodenum in a 13-Year-Old Girl: A Rare Case Report

Introduction: One of the main causes of death for kids and teenagers is a tumor which exceeds 200.000 in all of the world. One of the tumors is Gastro Intestinal Stromal Tumor (GIST). GIST is a mesenchymal gastrointestinal tumor with a focus on the Interstitial Cells of Cajal (ICC). Not more than 100 cases of pediatric GIST and less than 5% of childhood tumors are seen in the Gastrointestinal (GI) Tract. Due to their rarity, the current literature consists only of reviews of small case series, less than a third of all cases reported in the literature. Case Description: A thirteen-year-old girl presented to the emergency room with nausea, dizziness, and syncope a day before. She had the same complaint 2 months before and was diagnosed with iron deficiency anemia but it got worse when she came to emergency in the next two months. She got some tests and found a tubulovillous adenoma suspected as GIST in duodenal. This girl was unable to survive in the intensive unit after the surgical resection due to the massive bleeding in her stomach. Conclusion: We reported a rare case of Gastrointestinal Stromal Tumor (GIST) of the duodenum found in a girl.