Confronting multidrug-resistant Klebsiella meningitis after mid-clival Cerebrospinal Fluid leak repair: a therapeutic odyssey.

A man in his 40s with type 2 diabetes mellitus had persistent right-sided watery nasal discharge for 6 months following cerebrospinal fluid (CSF) leak repair at another hospital, prompting his visit to us due to recurring symptoms. Imaging revealed a CSF leak from the mid-clivus for which revision endoscopic CSF leak repair was done. Regrettably, he developed postoperative meningitis caused by multidrug-resistant (MDR) Klebsiella pneumoniaeManaging this complex case was a challenging task due to the pathogen's resistance to conventional drugs and the scarcity of scientific evidence. We initiated a culture-guided combination regimen with ceftazidime, avibactam, aztreonam and tigecycline. This decision stemmed from meticulous literature review and observed antibiotic synergy while testing for this organism.After 4 weeks of vigilant treatment, the patient's symptoms improved significantly, and CSF cultures were sterile. We present our approach to effectively confront and manage a challenging instance of postoperative MDR bacterial meningitis.

Assessment of Post-operative Complications in Patients Undergoing Thyroid Surgery in a Tertiary Care Hospital in Eastern India.

Background Thyroid surgeries, among the most common surgical procedures globally, present with varied complications. This study is aimed at identifying the complications and selected variables associated with thyroid surgery. Methods In this cross-sectional, retrospective, record-based study, a total of 107 patients who underwent thyroidectomies and satisfied the inclusion criteria, were recruited using convenience sampling technique. This study was conducted at a tertiary care hospital from January 2021 to December 2021. Data were collected from medical records using a researcher-created data extraction form after ethical approval from the institutional ethics committee. The data were analyzed using Epi Info software (Atlanta, GA: Centers for Disease Control and Prevention), with a p-value of <0.05 considered to be statistically significant. Results Of the 107 patients who underwent thyroidectomies, 92 (85.9%) reported one or more complications. Complications were most common (90.2% of patients) in the 25-34 years age group and among females (83.3%). The most common complications were dysphagia (30.84% of patients), voice change (21.50%), and respiratory obstruction (8.41%). Temporary hypocalcemia developed in 3.74% of these patients, while tracheal injury and hematoma were documented in 3.74% and 1.87%, respectively. Tobacco users (14.9%), alcohol users (16.8%), those eating a non-vegetarian diet (61.9%), and those eating saturated fats (13.0%) suffered more complications. Family history (p=0.03) was found to be significantly associated with complications. Conclusion The most common post-thyroidectomy complications in this group of patients were dysphagia and voice change, while hypocalcemia, tracheal injury, and hematoma were rare complications. Tobacco users and alcohol users reported more complications. Complications were more common in those with a family history of thyroid disease and those who were underweight.