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Objetivo: Determinar el nivel de conocimiento de los estudiantes de enfermería de la Universidad Técnica de Ambato sobre sepsis quirúrgica. Material y método: La presente investigación tiene un diseño de desarrollo observacional, de tipo descriptivo, cohorte transversal, con un enfoque cuantitativo, ya que el nivel de cono-cimiento se verá representado mediante tablas y gráficos para des-cribir la problemática del periodo octubre 2023 febrero 2024. Re-sultados: Se evidencia un alto porcentaje de respuestas incorrectas por cada ítem por parte de los estudiantes. La categoría Nivel de Conocimiento sobre Definición de Sepsis, fue respondida de ma-nera incorrecta con un porcentaje del 83,9%, la categoría Nivel de Conocimiento sobre Diagnóstico de Sepsis obtuvo 51,7% y, por úl-timo, la Nivel de Conocimiento sobre Tratamiento de Sepsis con el 29,2%. Conclusiones: El nivel de conocimiento de los estudiantes sobre Sepsis Quirúrgica es malo, debido a que existe una subesti-mación de la gravedad de la sepsis como afección potencialmente mortal, lo que puede traer un impacto negativo en los pacientes[AU]

Objective: Determine the level of knowledge of nursing students at the Technical University of Ambato about surgical sepsis. Mate-rials and methods: This research has an observational, descriptive, transversal development design, with a quantitative approach since the level of knowledge will be represented through tables and gra-phs to describe the problems of the period October 2023-February 2024. Results: A high percentage of incorrect answers for each item by the students is evident. The category Level of Knowledge about Definition of Sepsis was answered incorrectly with a percentage of 83.9%, the category Level of Knowledge about Diagnosis of Sepsis obtained 51.7% and, finally, the category Level of Knowledge about Treatment of Sepsis. Sepsis with 29.2%. Conclusions: The level of knowledge of students about Surgical Sepsis is poor because there is an underestimation of the severity of sepsis as a potentially fatal condition, which can have a negative impact on patients[AU]

Objetivo: Determinar o nível de conhecimento dos estudantes de enfermagem da Universidade Técnica de Ambato sobre sepse ci-rúrgica. Material e método: Esta pesquisa possui desenho de coor-te observacional, descritivo, transversal, com abordagem quantita-tiva, uma vez que o nível de conhecimento será representado por meio de tabelas e gráficos para descrever o problema no período de outubro de 2023 a fevereiro de 2024. Resultados: Uma parada. É evidente o percentual de respostas incorretas para cada item por parte dos alunos. A categoria Nível de Conhecimento sobre Defi-nição de Sepse foi respondida incorretamente com percentual de 83,9%, a categoria Nível de Conhecimento sobre Diagnóstico de Sepse obteve 51,7% e por fim, a categoria Nível de Conhecimen-to sobre Tratamento de Sepse com 29,2%. Conclusões: O nível de conhecimento dos estudantes sobre a Sepse Cirúrgica é baixo, pois há uma subestimação da gravidade da sepse como uma condição potencialmente fatal, que pode ter um impacto negativo nos pa-cientes[AU]

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Abstract Objective To assess the outcome of patients with cancer-related sepsis requiring continuous renal replacement therapy (CRRT) in a single-center pediatric intensive care unit (PICU). Method Children with sepsis who necessitate CRRT from January 2017 to December 2021 were enrolled. The patients with leukemia/lymphoma or solid tumors were defined as underlying cancer. Multivariate logistic regression analysis was performed to identify the death risk factors in patients with cancer-related sepsis. Results A total of 146 patients were qualified for inclusion. Forty-six (31.5%) patients with cancer-related sepsis and 100 (68.5%) non-cancer-related sepsis. The overall PICU mortality was 28.1% (41/146), and mortality was significantly higher in cancer-related sepsis patients compared with non-cancer patients (41.3% vs. 22.0%, p = 0.016). Need mechanical ventilation, p-SOFA, acute liver failure, higher fluid overload at CRRT initiation, hypoalbuminemia, and high inotropic support were associated with PICU mortality in cancer-related sepsis patients. Moreover, levels of IL-6, total bilirubin, creatinine, blood urea nitrogen, and international normalized ratio were significantly higher in non-survivors than survivors. In multivariate logistic regression analysis, pediatric sequential organ failure assessment (p-SOFA) score (OR:1.805 [95%CI: 1.047-3.113]) and serum albumin level (OR: 0.758 [95%CI: 0.581 -0.988]) were death risk factors in cancer-related sepsis receiving CRRT, and the AUC of combined index of p-SOFA and albumin was 0.852 (95% CI: 0.730-0.974). Conclusion The overall PICU mortality is high in cancer-related sepsis necessitating CRRT. Higher p-SOFA and lower albumin were independent risk factors for PICU mortality.

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INTRODUCTION. There is an important number of reports in Latin America, but there is a lack of data on acute promyelocytic leukemia (APL) in Ecuador., this is the main reason to carry out this study in the country, a disease that in recent decades has shown a significant improvement in survival. OBJECTIVES. To evaluate the overall survival (OS) and event-free survival (EFS), and also the demography, and the most relevant clinical and laboratorial findings. METHODS. We retrospectively reviewed the medical records of 48 patients with APL, diagnosed between January 2012 and December 2019. We collected the most relevant demographic, clinical and laboratorial characteristics, as well as data related to 30-day mortality, and 5 year­OS (overall survival) and EFS (event-free survival). RESULTS. Among the forty-eight (48) patients with acute promyelocytic leukemia, 44 patients received treatment, the mean number of days for the start of all trans retinoic acid (ATRA) and/or arsenic trioxide (ATO) was of 2.5 days from the moment of the diagnosis. 60.4% of patients were classified as low risk and 39.5% as high risk, according to the national comprehensive cancer network (NCCN). The early death rate was 31.2%, the main cause of which was sepsis, multidrug resistant (MDR) bacterias were isolated in 83% of the patients who took blood cultures and died of early sepsis. after a median follow-up of 35 months only one patient relapsed. the five-year OS and EFS was 51.2%; In the multivariate analysis, only age was identified as an adverse prognostic factor. DISCUSSION. Compared to prospective trials with ATRA-based regimens, we found an inferior OS, mainly because of a high-rate early death. if we compare our findings with other real-world reports, we will also show inferior results probably explained by the high rate of early death due to infection by MDR batteries, in addition to the early deaths caused by hemorrhages. CONCLUSION. The low rate of OS shown in this study, could be improved based on changes to optimize the ac-cess of the patients to an early diagnosis and treatment and the reduction of the unacceptably high rates of multidrug resistance bacterial infections in our setting.

INTRODUCCION. Existe un número importante de reportes en Latinoamérica, pero se carece de datos sobre la leucemia promielocítica aguda (LPA) en Ecuador, ésta es la principal razón para realizar este estudio en el país, enfermedad que en las últimas décadas ha mostrado una importante mejoría en la sobrevida. OBJETIVOS. Evaluar la sobrevida global (SG) y la sobrevida libre de eventos (SLE), así como la demografía y los hallazgos clínicos y laboratoriales más relevantes. MÉTODOS. Se revisaron retrospectivamente las historias clínicas de 48 pacientes con LPA, diagnosticados entre enero de 2012 y diciembre de 2019. Se recogieron las características demográficas, clínicas y datos de laboratorio más relevantes, así como datos relacionados con la mortalidad a 30 días, y a 5 años-OS (supervivencia global) y EFS (supervivencia libre de eventos). RESULTADOS. De los cuarenta y ocho (48) pacientes con leucemia promielocítica aguda, 44 pacientes recibieron tratamiento, la media de días para el inicio de ácido transretinoico total (ATRA) y/o trióxido de arsénico (ATO) fue de 2,5 días desde el momento del diagnóstico. El 60,4% de los pacientes fueron clasificados como de bajo riesgo y el 39,5% de alto riesgo, según la red nacional integral del cáncer (NCCN). La tasa de mortalidad precoz fue del 31,2%, cuya causa principal fue la sepsis, aislándose bacterias multirresistentes (MDR) en el 83% de los pacientes que se sometieron a hemocultivos y fallecieron por sepsis precoz. Tras una mediana de seguimiento de 35 meses, sólo un paciente sufrió una recaída, la SG y la SSC a cinco años fue del 51,2%; en el análisis multivariante, sólo la edad se identificó como factor pronóstico adverso. DISCUSIÓN. En comparación con los ensayos prospectivos con regímenes basados en ATRA, encontramos una SG inferior, principalmente debido a una alta tasa de muerte temprana. Si comparamos nuestros hallazgos con otros informes del mundo real, también mostraremos resultados inferiores probablemente explicados por la alta tasa de muerte temprana debida a infección por baterías MDR, además de las muertes tempranas causadas por hemorragias. CONCLUSIONES. La baja tasa de SG mostrada en este estudio, podría mejorarse en base a cambios para optimizar el acceso de los pacientes a un diagnóstico y tratamiento precoz y la reducción de las inaceptablemente altas tasas de infecciones bacterianas multirresistentes en nuestro medio.

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La sepsis neonatal temprana es un desafío de salud pública en Ecuador, con altas tasas de morbilidad-mortalidad. El diagnóstico precoz es crucial, pero los métodos actuales tienen limita-ciones. El índice neutrófilo linfocito se presenta como un biomarcador prometedor para detec-ción y manejo de la sepsis neonatal temprana. Este estudio busca establecer su punto de corte y evaluar su eficacia en el Hospital de Especialidades Carlos Andrade Marín. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo y descriptivo en este hospital, recopilando datos clínicos neonatales de enero de 2017 a diciembre de 2021. Se incluyeron expedientes de pacientes con sospecha de sepsis neonatal temprana nacidos desde la semana 26, excluyendo historias clínicas incompletas o con sepsis tardía. Se analizaron variables como edad, sexo y biomarcadores, utilizando el software SPSS versión 27. El estudio fue aprobado por el Comité de Ética de Investigación en Seres Humanos del Hospital de Especialidades Carlos Andrade Marín. RESULTADOS: Se analizaron 102 expedientes de recién nacidos con sepsis neonatal en 5 años. La mayoría eran neonatos muy prematuros y nacidos por cesárea. Con punto de cor-te de 0.86 para el índice neutrófilo linfocito, con una sensibilidad del 98.1% y especificidad del 85.4%. DISCUSIÓN: No se encontró una relación significativa entre el sexo y la sepsis. Aunque el índice neutrófilo linfocito mostró alta sensibilidad y especificidad, su baja área bajo la curva indica que no es un marcador fiable para diagnosticar de sepsis neonatal. CONCLUSIÓN: Se requieren estudios adicionales con muestras más grandes y otros marcadores biológicos para mejorar la capacidad diagnóstica de la sepsis neonatal.

Early neonatal sepsis is a public health challenge in Ecuador, with high morbidity and mortality rates. Early diagnosis is crucial, but current methods have limitations. The neutrophil-lympho-cyte ratio, emerges as a promising biomarker for the detection and management of early neo-natal sepsis. This study aims to establish its cutoff point and evaluate its efficacy at the Carlos Andrade Marín Specialty Hospital. MATERIALS AND METHODS: A retrospective and descrip-tive study was conducted at this hospital, collecting neonatal clinical data from January 2017 to December 2021. Records of patients with suspected early neonatal sepsis born from week 26 were included, excluding incomplete medical records or those with late-onset sepsis. Variables such as age, sex, and biomarkers were analyzed using SPSS version 27 software. The study was approved by the hospital's ethics committee. RESULTS: A total of 102 medical records of newborns with neonatal sepsis over 5 years were analyzed. Most were very premature and born by cesarean section. A cutoff point of 0.86 for the neutrophil-lymphocyte ratio was determined, with a sensitivity of 98.1% and a specificity of 85.4%. DISCUSSION: No significant relationship was found between sex and sepsis. Although the neutrophil-lymphocyte ratio showed high sen-sitivity and specificity, its low area under the curve indicates that it is not a reliable marker for diagnosing neonatal sepsis. CONCLUSION: Additional studies with larger samples and other biological markers are needed to improve the diagnostic capacity for neonatal sepsis.

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Background: The co-occurrence of acute respiratory distress syndrome (ARDS) and sepsis presents a critical challenge in critical care medicine. ARDS involves diffuse alveolar damage, leading to severe hypoxemia, while sepsis entails a dysregulated host response to infection, resulting in systemic inflammation and organ dysfunction. This study aims to provide a comprehensive understanding of the contributing factors to ARDS and sepsis co-presentation, highlighting its significance in clinical scenarios, often leading to severe respiratory compromise and increased mortality risk. The findings offer original insights into potential biomarkers and therapeutic strategies that could inform future research and clinical practices. Methods: This systematic review adheres to PRISMA 2020 guidelines. Inclusion criteria cover studies on ARDS and sepsis co-presentation (2014–2024), diverse designs, human participants, and English articles. Electronic searches (PubMed, Embase, Cochrane Library) utilized MeSH terms and free-text. Manual searches ensured comprehensive exploration. Two reviewers screened titles/abstracts and conducted full-text eligibility assessments. Data extraction involved a narrative synthesis, focusing on study outcomes, strengths, and limitations. Results were organized into tables for clarity. Results: Of 1624 studies, 343 duplicates were removed. 1281 studies underwent title/abstract screening, with 149 assessed for eligibility. 138 studies were excluded, yielding 11 included studies. These studies, involving 4086 patients, utilized diverse methodologies. Mortality risk, molecular phenotypes, immune responses, potential biomarkers, and fluid management strategies were identified. Limitations included study heterogeneity and biases. Conclusion: This systematic review provides nuanced insights into ARDS and sepsis co-presentation. The originality of this review lies in its identification of novel biomarkers and therapeutic avenues, which may contribute to refining clinical approaches and informing future research. Despite valuable findings, limitations exist in study methodologies and challenges in establishing causality. The review underscores the need for ongoing updates and emphasizes the importance of prospective, multicenter studies with standardized methodologies for robust evidence and improved clinical practices.

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Background: Thorough documentation of morbidity and mortality is crucial for understanding health trends in very low birth weight (VLBW) neonates. Morbidity and mortality in VLBW neonates represent significant health issues, making it essential to identify associated risk factors. The perinatal and neonatal periods are critical in highlighting the health conditions of at-risk populations. This study aims to examine intricate patterns of morbidity and mortality among VLBW neonates. Methods: VLBW neonates admitted to the Neonatal Intensive Care Unit, BKL Walawalkar Hospital, from November 2022 to May 2024 were examined. We collected comprehensive maternal information, such as age, birth locality, gestational age, and various risk factors. The study focused on demographic profiles, clinical variables, and outcomes. Results: Out of 203 VLBW neonates, 31% were appropriate for gestational age, 66% were small, and 6.4% were restricted Intrauterine growth. Common morbidities were respiratory distress syndrome (39.9%) followed by sepsis (25.6%). The majority of VLBW neonates were born of normal vaginal delivery (44.8%) with gestational age between 28-32 weeks (54.7%). A significant statistical association between gestational age and mortality outcomes was found(p-value=0.005) Conclusion: Respiratory distress syndrome is the leading cause of morbidity and mortality in VLBW neonates. It is crucial to utilize surfactant therapy effectively and ensure timely transportation for neonates. To address these issues, it is essential to improve prenatal care, guarantee skilled attendance during childbirth, conduct regular screenings, implement infection control measures, and educate parents.

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Background: One of the cases of accidental injuries is burns. Globally, every year estimated 180,000 mortalities occur due to burns, and most of the deaths are seen in the lower or poor socioeconomic class of developing countries. Due to predominantly poor and low socioeconomic status, overpopulation, poor education, and unreachability to advanced burn care in certain parts of the country - the incidence, complications, and deaths have continued to rise in developing countries. About 75% of the deaths associated with burn injuries are related to wound infection, especially in developing countries. The present study was undertaken to study the microflora of burn wounds as well as drug utilization in the management of burn patients in a tertiary care teaching hospital. Aims and objectives: Assessment of antimicrobial susceptibility and resistant pattern and drug utilization in burns patients. Materials and Methods: This observational cross-sectional descriptive study was performed on 130 hospitalized burn patients over 12 months (from November 2020 to November 2021). All burn patients who were admitted in the hospital and received at least 1 day of treatment were included in the study. All required information, including demographic data, prescribed medication, microbial culture sensitivity report, and treatment outcome were recorded in the case record form. Descriptive statistics using Microsoft Excel version 2019. Results: Of a total of 130 burn patients, 52% were females. The most common type of burn was flame in 69% of patients. The mean length of hospital stay was 9 days and it ranged from 1 to 40 days. Culture from burns wound revealed Pseudomonas aeruginosa (47.6%) as the most common organism isolated followed by Klebsiella pneumoniae (45.2%), Acinetobacter baumannii (14.2%), Proteus mirabilis (14.2%), Staphylococcus aureus (9.5%), and Escherichia coli (4.7%). Among the isolated microorganisms, most of them showed sensitivity to beta-lactam, aminoglycoside, and tetracyclines. Sulphonamide was dominant among the topically applied antibiotics, whereas cephalosporins were dominant among the systemically administered antibiotics. The average number of drugs per-prescription ranges from 6.5 to 8.5. Conclusion: The present study results are helpful in understanding the pattern of burns wound sepsis, the dominant bacterial organism, the antimicrobial susceptibility/resistance, and the drug utilization pattern in burns patients.

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Introdução: De grande impacto na população, queimaduras exigem análise epidemiológica e planejamento constantes para prevenção, tratamento e reabilitação dos pacientes. Este trabalho objetiva comparar, após uma década, os indicadores do Centro de Tratamento de Queimados do Hospital João XXIII, em Belo Horizonte, MG, abordados no artigo "Epidemiologia das queimaduras no estado de Minas Gerais", publicado na Revista Brasileira de Cirurgia Plástica com dados de 2010, para validar as estratégias vigentes e as futuras. Método: Revisão dos prontuários dos pacientes acometidos por queimadura, internados no referido centro em 2020. Resultados: Foram internadas 473 vítimas de queimadura no período, 87,5% causadas por acidente, sendo 34,5% por líquidos quentes, 23,7% por álcool; 61,9% provenientes do interior do estado de Minas Gerais; 63,4% do sexo masculino. A idade média foi de 30 anos, a superfície corporal queimada média foi de 18,8% e o tempo médio de internação foi de 25 dias. Foram realizados 580 desbridamentos cirúrgicos e 473 enxertos cutâneos autólogos. Faleceram 7,4% dos pacientes, correspondentes a 29,5% dos internados no CTI adulto, com superfície corporal queimada média de 49,7%, e 10,5% dos internados no CTI pediátrico. A maior causa de óbitos foi devido à sepse, em 57,1% dos casos. A mortalidade diminuiu de 16,3% para 7,4% no período estudado. Conclusão: O perfil do paciente internado por queimadura mantevese em grande parte o mesmo após 10 anos. Houve aumento do número de atendimentos a vítimas de queimadura do interior do estado e queimaduras provocadas por líquidos quentes passaram a ser mais frequentes que por álcool. ''A busca da conformidade com o tratamento baseado na literatura mundial resultou em diminuição da mortalidade."

Introduction: With a major impact on the population, burns require epidemiological analysis and constant planning for the prevention, treatment, and rehabilitation of patients. This work aims to compare, after a decade, the indicators of the Burn Treatment Center at Hospital João XXIII, in Belo Horizonte, MG, covered in the article "Epidemiology of burns in the state of Minas Gerais", published in the Revista Brasileira de Cirurgia Plástica with data from 2010, to validate current and future strategies. Method: Review of the medical records of patients suffering from burns, admitted to the aforementioned center in 2020. Results: 473 burn victims were hospitalized during the period, 87.5% were caused by an accident, 34.5% due to hot liquids, 23.7% by alcohol; 61.9% from the interior of the state of Minas Gerais; and 63.4% were male. The average age was 30 years, the average burned body surface area was 18.8% and the average length of stay was 25 days. 580 surgical debridement and 473 autologous skin grafts were performed. 7.4% of patients died, corresponding to 29.5% of those admitted to the adult ICU, with an average burned body surface area of 49.7%, and 10.5% of those admitted to the pediatric ICU. The biggest cause of death was sepsis, in 57.1% of cases. Mortality decreased from 16.3% to 7.4% in the period studied. Conclusion: The profile of patients hospitalized for burns remained largely the same after 10 years. There was an increase in the number of visits to burn victims in the interior of the state and burns caused by hot liquids became more frequent than those caused by alcohol ''The search for compliance with treatment based on world literature resulted in reduction in mortality."

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Resumen El presente es un estudio retrospectivo, observacional, cuantitativo y descriptivo. Se evaluó la utilidad de la proteína C reactiva (PCR), la procalcitonina (PCT) y la relación PCR/PCT como marcadores de riesgo de sepsis, sumados al aclaramiento a las 72 h, como pronóstico de mortalidad y permanencia en unidades de cuidados intensivos (UCI). Se incluyeron 23 pacientes. Se clasificaron según qSOFA y se elaboraron curvas ROC. Se obtuvo un área bajo la curva de 0,79 para PCT. El valor umbral de PCT>0,88 ng/mL predice riesgo de sepsis con 77,78% de sensibilidad y 83,33% de especificidad. Utilizando PCR<31,23 mg/dL se obtuvo como parámetros destacados un 88,89% de sensibilidad y 83,33% de valor predictivo negativo, sin diferencias significativas (Mann-Whitney p<0,05) entre los grupos de sobrevivientes y óbitos y estadía prolongada vs. no prolongada. Se postula PCR como screening y PCT como marcador de riesgo de sepsis.

Abstract This is a retrospective, observational, quantitative and descriptive study. The utility of C reactive protein (CRP), procalcitonin (PCT) and the CRP/PCT ratio as sepsis risk markers was evaluated and these, added to clearance at 72 hours, as predictors of mortality and permanence in intensive care units (ICU). Twenty-three patients were included. They were classified according to qSOFA, and ROC curves were prepared, highlighting an area under the curve of 0.79 for PCT. The threshold value of PCT>0.88 ng/mL predicts the of sepsis with 77.78% sensitivity and 83.33% specificity. Using CRP>31.23 mg/dL, 88.89% sensitivity and 83.33% negative predictive value were obtained as outstanding parameters. No significant differences (Mann-Whitney p<0.05) were found between survivors and dead and prolonged vs. non-prolonged stay groups. CRP is postulated for screening and PCT as a sepsis risk marker.

Resumo Este é um estudo retrospectivo, observacional, quantitativo e descritivo. Foi avaliada a utilidade da proteína C reativa (PCR), da procalcitonina (PCT) e da relação PCR/PCT como marcadores de risco de sepse junto com o clareamento em 72 horas, como preditores de mortalidade e permanência em unidades de terapia intensiva (UTI). Vinte e três pacientes foram incluídos. Eles foram classificados de acordo com o qSOFA e foram elaboradas curvas ROC, destacando uma área sob a curva de 0,79 para PCT. O valor limite de PCT>0,88 ng/mL prediz o risco de sepse com sensibilidade de 77,78% e especificidade de 83,33%. Utilizando PCR>31,23 mg/dL, obtiveram-se como parâmetros em destaque 88,89% de sensibilidade e 83,33% de valor preditivo negativo. Não houve diferenças significativas (Mann-Whitney p<0,05) entre os grupos de sobreviventes e óbitos e permanência prolongada vs. não prolongada. A PCR é postulada como triagem e a PCT como marcador de risco de sepse.

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despite great advances in neonatal care, deaths in this age period remain high throughout the world, highlighting prematurity and neonatal sepsis as the main causes. This study aimed to assess the incidence of early neonatal sepsis and associated maternal and neonatal risk factors in premature infants admitted to Neonatal Intensive Care Units in a city in the countryside of Bahia. Methods: a non-concurrent cohort study including 268 preterm infants admitted on the day of birth between January 2016 and December 2017 and followed during the neonatal period. The incidence of early neonatal sepsis and its risk factors were calculated. Poisson regression with robust variance was used for multivariate analysis, obtaining estimates of Relative Risk (RR) and respective 95% Confidence Intervals (CI). Statistical significance was considered when p-value ≤ 0.05. Results: incidence of early sepsis was 38% (102), of which 12.3% (33) had sepsis treated by the clinic and 25.7% (69) also presented at least one laboratory alteration. The diagnosis of presumed early sepsis was identified in 63.4% (170); no sepsis was confirmed with culture; and sepsis was ruled out in 25.5% (68) of premature infants. The following were positively associated with the outcome: being born by vaginal delivery (RR: 1.53; 95%CI: 1.19-1.97), gestational age less than 32 weeks (RR: 1.86; 95%CI: 1.35-2.57), less than 28 weeks (RR: 2.16; 95%CI: 1.59-2.94) and 5-minute Apgar score less than 7 (RR: 1.45; 95%CI: 1.14-1.83). Conclusion: there was a high incidence of early sepsis compared with international and national research. The results suggest the need for strategies to prevent prematurity and improve care during childbirth.(AU)

apesar dos grandes avanços na assistência neonatal, os óbitos nesse período etário continuam elevados em todo o mundo, destacando-se a prematuridade e a sepse neonatal como as principais causas. Este estudo objetivou avaliar a incidência de sepse neonatal precoce e os fatores de risco materno e neonatal associados de prematuros internados nas Unidades de Terapia Intensiva Neonatais em uma cidade no interior da Bahia. Métodos: estudo de coorte não concorrente, incluindo 268 prematuros internados no dia do nascimento, entre janeiro de 2016 e dezembro de 2017, acompanhados no período neonatal. Foram calculados a incidência de sepse neonatal precoce e seus fatores de risco. Utilizou-se, para análise multivariada, a regressão de Poisson com variância robusta, obtendo-se estimativas do Risco Relativo (RR) e dos respectivos Intervalos de Confiança (IC) de 95%. Considerou-se significância estatística quando valor de p ≤ 0,05. Resultados: incidência da sepse precoce foi 38% (102), sendo que 12,3% (33) tiveram sepse tratada pela clínica e 25,7% (69) apresentaram, também, pelo menos uma alteração laboratorial. O diagnóstico de sepse precoce presumida foi identificado em 63,4% (170); nenhuma sepse foi confirmada com cultura; e a sepse foi afastada em 25,5% (68) dos prematuros. Associaram-se positivamente ao desfecho nascer de parto vaginal (RR: 1,53; IC95%: 1,19-1,97), idade gestacional menor que 32 semanas (RR: 1,86; IC95%: 1,35-2,57), menor que 28 semanas (RR: 2,16; IC95%: 1,59-2,94) e Apgar 5º minuto menor que 7 (RR: 1,45; IC95%:1,14-1,83). Conclusão: houve elevada incidência de sepse precoce, comparada com as pesquisas internacionais e nacionais. Os resultados sugerem necessidade de estratégias para a prevenção da prematuridade e melhoria da assistência durante o parto.(AU)

a pesar de los grandes avances en la atención neonatal, las muertes en este período de edad siguen siendo elevadas en todo el mundo, destacando la prematuridad y la sepsis neonatal como principales causas. Este estudio tuvo como objetivo evaluar la incidencia de sepsis neonatal temprana y factores de riesgo maternos y neonatales asociados en bebés prematuros ingresados en Unidades de Cuidados Intensivos Neonatales en una ciudad del interior de Bahía. Métodos: estudio de cohorte no concurrente, que incluyó 268 prematuros hospitalizados el día del nacimiento, entre enero de 2016 y diciembre de 2017, seguidos en el período neonatal. Se calculó la incidencia de sepsis neonatal temprana y sus factores de riesgo. Para el análisis multivariado se utilizó la regresión de Poisson con varianza robusta, obteniendo estimaciones del Riesgo Relativo (RR) y los respectivos Intervalos de Confianza (IC) del 95%. Se consideró significación estadística cuando el valor de p ≤ 0,05. Resultados: La incidencia de sepsis temprana fue del 38 % (102), el 12,3 % (33) recibió tratamiento de sepsis en la clínica y el 25,7 % (69) también tuvo al menos una anomalía de laboratorio. El diagnóstico de presunta sepsis temprana se identificó en el 63,4% (170); no se confirmó sepsis con cultivo; y se descartó sepsis en el 25,5% (68) de los bebés prematuros. Se asociaron positivamente con el resultado de nacer por vía vaginal (RR: 1,53; IC95%: 1,19-1,97), edad gestacional menor de 32 semanas (RR: 1,86; IC95%: 1,35-2,57), menos de 28 semanas (RR: 2,16; IC95%: 1,59-2,94) y Apgar al quinto minuto inferior a 7 (RR: 1,45; IC95%: 1,14-1,83). Conclusión: hubo una alta incidencia de sepsis temprana, en comparación con la investigación nacional e internacional. Los resultados sugieren la necesidad de estrategias para prevenir la prematuridad y mejorar la atención durante el parto.(AU)

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Background: Neonatal sepsis is a critical health issue worldwide, with high morbidity and mortality rates, especially in developing countries. Effective management of neonatal sepsis includes timely administration of appropriate antibiotics based on antimicrobial susceptibility patterns. Aims and Objectives: This cross-sectional study aimed to investigate the choice of empiric and definitive antibiotics in neonatal septicemia, assess bacterial susceptibility patterns, and correlation with clinical outcomes, and highlight the importance of antimicrobial stewardship. Materials and Methods: The study was conducted at a tertiary care center and enrolled neonates diagnosed with septicemia over 2 months. Blood cultures were obtained, and antibiotics were initiated empirically based on local guidelines. Definitive antibiotics were started after culture sensitivity reports and compared with empiric treatment for clinical outcomes and bacteriological profiles were analyzed with appropriate statistical methods. Results: In this study, Piperacillin-Tazobactam and Amikacin were used as empiric treatment in all cases. Meropenem showed high sensitivity in definitive treatment post-culture. No significant difference between empiric and definitive treatment groups was observed in clinical outcomes. Conclusion: This study found no significant difference in clinical outcomes between empiric and definitive antibiotic regimens for neonatal sepsis. However, high meropenem susceptibility suggests the potential for more targeted therapy. Regularly updating local antibiogram, data remain crucial to optimize empiric treatment and combat resistance in this vulnerable population.

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ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology.

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Resumen La perforación estercoral es una ruptura del colon asociada a impactación fecal, rara y letal, con menos de 200 casos reportados globalmente. Predomina en la población geriátrica y se manifiesta principalmente con estreñimiento crónico. El objetivo del artículo es presentar el caso de una mujer adulta intermedia con antecedentes de estreñimiento crónico y enfermedad diverticular, que ingresó a urgencias con una semana de dolor abdominal generalizado, y evolucionó a abdomen en tabla, alteración en la conciencia y taquipnea. Se sospechó sepsis abdominal por lo que se llevó a una laparotomía de emergencia. Esta reveló pelviperitonitis fecal originada por fecaloma sigmoideo con perforación estercoral de 12 cm, manejada con sigmoidectomía, antibioticoterapia de amplio espectro y lavado peritoneal. La paciente evolucionó favorablemente y fue dada de alta. Este desafiante caso, desde el punto de vista quirúrgico y diagnóstico, destaca la complejidad de una patología poco común en un grupo etario atípico.

Abstract Stercoral perforation is a rupture of the colon associated with fecal impaction, rare and lethal, with fewer than 200 cases reported globally. It predominates in the geriatric population and primarily manifests with chronic constipation. The objective of the article is to present the case of a mid-adult woman with a history of chronic constipation and diverticular disease, who was admitted to the emergency room with a one-week history of generalized abdominal pain, progressing to a rigid abdomen, altered consciousness, and tachypnea. Abdominal sepsis was suspected, leading to an emergency laparotomy. This revealed fecal pelvic peritonitis originating from a sigmoid fecaloma with a 12 cm stercoral perforation, managed with sigmoidectomy, broad-spectrum antibiotic therapy, and peritoneal lavage. The patient had a favorable outcome and was discharged. This surgically and diagnostically challenging case highlights the complexity of an uncommon pathology in an atypical age group.

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Resumen Introducción : Los retrasos en el tratamiento anti microbiano adecuado de las bacteriemias prolongan la estadía hospitalaria, aumentan la mortalidad e in crementan los costos. Aún hoy en día se requiere un tiempo considerable para obtener la identificación y antibiograma de los microorganismos en los hemocul tivos positivos. El objetivo fue evaluar el impacto de la implementa ción del panel BCID2 de FilmArray® (FA) sobre el tiempo de inicio de tratamientos antimicrobianos adecuados y sobre los costos potenciales de los mismos. Métodos : Estudio observacional retrospectivo de los hemocultivos positivos de pacientes hospitalizados, procesados por FA y por metodología tradicional. Se evaluaron los cambios de antimicrobianos en base a los resultados del FA. Se calcularon los días de reducción de tratamiento antimicrobiano y el ahorro potencial en el uso de los mismos, teniendo en cuenta también los costos del FA. Resultados : Se analizaron 87 episodios de bacte riemia. En 42 (48.3%) de ellos se desescaló el trata miento a antimicrobianos de menor espectro, en 7 (8%) se escaló a antimicrobianos de mayor espectro, en 8 (9.2%) se cambió el antimicrobiano sin variar el espectro y en 30 (34.5%) no se realizaron cambios con los resultados del FA. Los cambios de antimicrobianos se realizaron en promedio 2.3 días más rápido que con los métodos convencionales. Se calculó un ahorro potencial de US$ 7408. Conclusión : La implementación del panel BCID2 de FilmArray ® permitió adecuar los tratamientos antimi crobianos más rápidamente acortando la duración de los tratamientos empíricos de amplio espectro, lo cual resultó costo-efectivo.

Abstract Introduction : Delay in initiating appropriate anti microbial therapy prolongs hospitalization, increases in-hospital mortality, and raises economic costs. Cur rently, the identification and susceptibility testing of bacteria in positive blood cultures require a considerable amount of time. The objective of this study was to assess the impact of the BCID2 FilmArray® (FA) panel on the timing of appropriate antimicrobial therapy and potential anti microbial costs. Methods : This is a retrospective observational study focused on positive blood cultures in hospitalized pa tients. FA processing was conducted concurrently with routine sample processing. Changes in antibiotic treat ments based on FA results were evaluated, and the re duction in antimicrobial therapy duration and associated cost savings were calculated. Results : Eighty-seven bacteremia episodes were ana lysed. In 42 (48%) of them antimicrobial therapy was de-escalated to narrower spectrum agents, while in 7 (8%) therapy was escalated to broader spectrum anti microbials. Additionally, in 8 (9%) antimicrobials were switched without changing spectrum and in 30 (34%) no changes were made based on FA results. Antimicrobial changes were made 2.3 days faster than with routine sample processing resulting in calculated potential sav ings of US$ 7408. Conclusion : The implementation of FA facilitated a faster administration of appropriate antimicrobial therapy, leading to a reduction in the duration of broad-spectrum empirical antimicrobial therapy and subse quent economic savings.

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Background: Neonatal sepsis is a critical condition posing a significant threat to newborns globally, particularly in developing countries. The non-specific symptoms and time-consuming traditional diagnostic methods highlight the need for rapid and reliable biomarkers. Recent studies suggest platelet count and indices such as mean platelet volume (MPV) and platelet distribution width (PDW) as potential indicators for early diagnosis of neonatal sepsis. This study aimed to assess the correlation between platelet count and its indices and neonatal sepsis.Methods: A hospital-based cross- sectional study was conducted at NICU of tertiary care hospital involving 80 neonates with suspected sepsis. Platelet count, PDW, and MPV were measured and correlated with neonatal sepsis. Statistical analyses were performed using SPSS software, with a significance set at p<0.05.Results: Of the 80 neonates studied, 22.5% exhibited thrombocytopenia. There was a noteworthy inverse relationship discovered between platelet count and sepsis, while MPV and PDW were higher. Gram-negative organisms were the most common cause of sepsis, out of which E. Coli (63.64%) was the most common.Conclusions: The study confirmed a significant association between platelet count and indices with neonatal sepsis. Platelet count, MPV, and PDW can serve as effective, rapid diagnostic markers, potentially improving early detection and outcomes in neonatal sepsis.

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Background: The objective of the study was to evaluate serum ferritin levels to define it as a diagnostic and prognostic biomarker for severity of sepsis.Methods: In this hospital-based descriptive type of observational study, conducted at the Department of Pediatrics, NIMS Medical College; 80 children of age group 6 months to 18 years with diagnosis of pediatric sepsis were included. Children were divided into grades of sepsis (sepsis, severe sepsis, septic shock, MODS). Progress of sepsis, severe sepsis, septic shock, and sepsis with MODS was followed with serum ferritin levels on day 1, day 3, day 7, or more than 7 days and one week post recovery.Results: Pneumonia was identified as the most common source of infection. The blood culture positivity rate was 32.5%. E. coli was the most common organism grown on blood culture. Median serum ferritin levels increased as sepsis severity worsened. A significant association was discovered between sepsis severity and CRP levels at the time of admission.Conclusions: There is a consistent pattern of Serum ferritin levels with increasing severity of pediatric sepsis. Routine use of serum ferritin levels in diagnosis and prognostication is both feasible and simple. CRP level correlate well with serum ferritin level for diagnosis of sepsis.

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Complete loss of lateral femoral condyle of the femur following sepsis of the knee region in infancy is a well-recognized entity. The etiopathogenesis of the sequelae is poorly understood with synovial plicae and post-septic growth disturbance postulated as possible causes. Two illustrative cases are presented to elucidate the clinical effects of condylar loss in the pediatric age group.There is a typical pattern of unicondylar damage, loss of adjacent metaphysis, and metaphyseal spur in involved cases. Abnormal loading of the knee, ligament laxity, and the presence of a physeal bar contribute additionally to deformity. The deformity progression can be as rapid as 2.8 degrees per month. The lesion is most often treated by balancing the knee mechanics using osteotomies and growth modulations. The lesion progresses downhill due to the absence of lateral support of the knee joint configuration. The anatomical region supplied by the superior lateral genicular vessels closely matches with the lateral unicondylar femoral loss seen post-sepsis. A vascular etiology is therefore hypothesized for the lesion.

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Clinical sepsis (CS) poses a formidable challenge globally, impacting patient care and healthcare systems at large. The microbial etiology of sepsis is identied through bacteriology testing of clinical specimens. Positive culture-based targeted antimicrobial treatment improves outcomes of CS. To assess culturing practices and identify prevalent organisms associated with CS in the Country of Georgia we conducted a study of ICU patients. Eight ICUs across the country participated in the study, and 396 patients were randomly selected from the list of patients hospitalized in 2017 with PPS methodology. To identify CS episodes based on clinical parameters we used the case denition of the Surviving Sepsis Campaign. Demographic, medical and laboratory data were obtained with a structured questionnaire from the medical records. Overall 184 clinical sepsis episodes were identied in 161 (41%) patients of 396 sampled. A minimum of one clinical specimen was cultured during 72 (39%) CS episodes, and at least one positive culture was received in 56 (78%) of cultured episodes. Out of 207 clinical specimens tested 99 positive cultures were received. About half of positive cultures were gram-negative, 35% - gram-positives organisms and 10% were fungi. From 99 positive cultures, 36 were identied at the genus level and an antimicrobial susceptibility test was performed for 21 organisms. Respiratory tract specimens were most frequently tested samples (40%), followed by blood and urine specimens, respectively 25% and 23%. Out of 52 blood specimens from 45 patients 5 were culture-positive (positivity rate: 9.6%). The study showed suboptimal culturing practices in ICUs. Awareness campaigns for physicians on early recognition of CS will improve culturing practices and eventually improve CS management in ICUs.

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Background, Aims, and Objectives: Patients admitted to intensive care units are at a higher risk of experiencing medical errors and have an increased likelihood of developing septicemia. Due to the high mortality associated with sepsis, doctors are more frequently sued for negligence. Patients alleging medical negligence in India can seek compensation through the National Consumer Dispute Redressal Commission (NCDRC). This study aims to analyze NCDRC cases where patients suffering from septicemia filed for negligence. In medical negligence cases filed by patients suffering from Septicemia, the objective is to find out the court’s outcome/verdict, the pattern of monetary compensation involved in the case, the legal standard of accepted care in the management of septicemia, and ways in which doctors can protect themselves from negligence claims, etc. Materials and Methods: This is a record review study in which judgments were obtained from www. scconline.com. The final analysis included cases where patients were diagnosed with sepsis based on medical records or postmortem reports. Qualitative data is presented as percentages, while quantitative data is expressed as a median with an interquartile range. Fisher’s exact test was used to compare qualitative variables. Results: A total of 34 judgments met the inclusion criteria, with the court ruling in favor of doctors in only eight cases. Surgical intervention (11 cases, 32.3%) was the most common cause of sepsis, followed by abdominal infection (14.7%). The outcome of the cases was not influenced by whether the doctor or patient initiated the lawsuit (Fisher exact probability = 0.49). Conclusion: The NCDRC found doctors negligent in most cases where patients with septicemia sued. Eventful surgery was identified as the most common cause of sepsis. The study suggests that doctors can protect themselves by promptly diagnosing post-surgical injuries to intra-abdominal organs and preventing the spread of local infections.

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Postanginal septicemia, also called Lemierre syndrome, is a metastatic infection that can have multiple complications, including empyema. Therefore, the natural history of the disease begins with an infection of the oropharynx by microbiota from the digestive system, which causes a thrombophlebitis of the jugular vein with septic infiltrations, including into the lungs causing pneumonia, which in turn can generate parapneumonic effusions and/or empyemas. Furthermore, it is a syndrome that was thought to have been forgotten by the era of antibiotics, but with resistance to these antibiotics it has begun to re-emerge. Next, we will talk about a case of a 41-year-old man with no significant pathological history, who entered secondary to a peritonsillar abscess which turned into Lemierre syndrome with a treatment based on broad-spectrum antibiotics and then performed of lung decortication by thoracotomy. Empyema as a complication of Lemierre syndrome is rare and even more so in this post-antibiotic era, so health personnel should have a high clinical suspicion since adequate and timely treatment will help reduce the complications of this disease, as well as like his mortality.