Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience.

This study aimed to assess the potential impact of implementing an electronic alert system (EAS) for systemic inflammatory syndrome (SIRS) and sepsis in pediatric patients mortality. This retrospective study had a pre and post design. We enrolled patients aged ≤ 14 years who were diagnosed with sepsis/severe sepsis upon admission to the pediatric intensive care unit (PICU) of our tertiary hospital from January 2014 to December 2018. We implemented an EAS for the patients with SIRS/sepsis. The patients who met the inclusion criteria pre-EAS implementation comprised the control group, and the group post-EAS implementation was the experimental group. Mortality was the primary outcome, while length of stay (LOS) and mechanical ventilation in the first hour were the secondary outcomes. Of the 308 enrolled patients, 147 were in the pre-EAS group and 161 in the post-EAS group. In terms of mortality, 44 patients in the pre-EAS group and 28 in the post-EAS group died (p 0.011). The average LOS in the PICU was 7.9 days for the pre-EAS group and 6.8 days for the post-EAS group (p 0.442). Considering the EAS initiation time as the "zero time", early recognition of SIRS and sepsis via the EAS led to faster treatment interventions in post-EAS group, which included fluid boluses with median (25th, 75th percentile) time of 107 (37, 218) min vs. 30 (11,112) min, p < 0.001) and time to initiate antimicrobial therapy median (25th, 75th percentile) of 170.5 (66,320) min vs. 131 (53,279) min, p 0.042). The difference in mechanical ventilation in the first hour of admission was not significant between the groups (25.17% vs. 24.22%, p 0.895). The implementation of the EAS resulted in a statistically significant reduction in the mortality rate among the patients admitted to the PICU in our study. An EAS can play an important role in saving lives and subsequent reduction in healthcare costs. Further enhancement of systematic screening is therefore highly recommended to improve the prognosis of pediatric SIRS and sepsis. The implementation of the EAS, warrants further validation in multicenter or national studies.

A Rare Case of Metastatic Glioblastoma Diagnosed by Endobronchial Ultrasound-Transbronchial Needle Aspiration.

Glioblastoma is a common primary brain tumor that has a high mortality rate. Reports of intrathoracic metastases are uncommon, with the most commonly reported site for metastases are the lung and pleura. However, involvement of the mediastinum is not well documented, and few reports of confirmed mediastinal metastases diagnosed by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) exist. Herein, we report a rare case of metastatic glioblastoma to the thorax. A lady in her 40s has been previously diagnosed with intracranial glioblastoma with multiple incidences of disease recurrence despite treatment with chemoradiotherapy, adjuvant chemotherapy, and repeated surgical resections. She presented with dyspnea and pleural effusion, for which radiological imaging revealed lung, pleural, and mediastinal lesions. Further diagnostic workup with EBUS and pleural fluid sampling confirmed metastatic disease to both sites. The pleural fluid showed highly atypical cells positive for GFAP, and EBUS-TBNA immunostains were GFAP, S100, and synaptophysin positive, giving an overall picture consistent with metastatic glioblastoma. The patient was referred for palliative care, and unfortunately, she passed away after several months.

Glomerulonephritis disease pattern at Saudi tertiary care center.

OBJECTIVE: To assess changes in the pattern of glomerular diseases to help guide optimal allocation of resources, to focus future reasearch, and improve outcomes. Methods: A retrospective chart review was conducted on kidney biopsies taken between 2007 and 2016 at a single tertiary care center in Saudi Arabia (King Fahad Medical City, Riyadh) to evaluate the prevalence and pattern of glomerulonephritis (GN). Results: The most common primary GN in 102 biopsies from adult patients with a mean age of 28.9 ± 13.6 years and 40.2% female, was focal and segmental glomerulosclerosis (35.3%). Among 64 patients with systemic lupus erythematosus associated nephritis, of whom most (82.8%) were female, lupus nephritis (LN) 4 (46.9%), and (LN) 3 (32.8%) were the most common lupus nephritis classes. Conclusion: Establishing prospective GN registries from which robust diagnosis, treatment, and outcomes data can be acquired is warranted; however, registry development and maintenance are often precluded by resource limitations. Accordingly, retrospective analysis of administrative data will continue to provide important complementary information on GN epidemiology.