ABSTRACT
Nosocomial pneumonia is one of the most frequent hospital-acquired infections. One of the types of nosocomial pneumonia is ventilator-associated pneumonia, which occurs in endotracheally intubated patients in intensive care units (ICU). Ventilator-associated pneumonia may be caused by multidrug-resistant pathogens, which increase the risk of complications due to the difficulty in treating them. Pneumonia is a respiratory disease that requires targeted antimicrobial treatment initiated as early as possible to have a good outcome. For the therapy to be as specific and started sooner, diagnostic methods have evolved rapidly, becoming quicker and simpler to perform. Polymerase chain reaction (PCR) is a rapid diagnostic technique with numerous advantages compared to classic plate culture-based techniques. Researchers continue to improve diagnostic methods; thus, the newest types of PCR can be performed at the bedside, in the ICU, so-called point of care testing-PCR (POC-PCR). The purpose of this review is to highlight the benefits and drawbacks of PCR-based techniques in managing nosocomial pneumonia.
ABSTRACT
Background: The true risk of infection after exposure to SARS-CoV-2 of healthcare workers (HCWs) in the workplace has not yet been established. This descriptive study analyzes the exposure characteristics of HCWs to SARS-CoV-2. Methods: In March 2020, at the beginning of the pandemic, a total of 58 HCWs in a regional hospital in Greece were exposed to three patients with symptomatic SARS-CoV-2 infection. These three index cases had taken part in an 8-day religious tour, during which 52 travelers spent 10 h every day in a tour bus. A study was made of the circumstances of the hospital exposure. Results: Of the 52 travelers in the bus, 48 contracted SARS-CoV2. None of the 58 HCW contacts developed symptoms related to COVID-19, although, 43% were exposed to a SARS-CoV-2 infected patient for more than 15 min, and 74% were within a distance of <1 m, and half of the contacts were not wearing a surgical mask. Additional information was that 63% of the contacts were exposed in a room sized more than 15 m2, and in more than 80% of cases, the window or the door to the room was open during their exposure. In about one-third of the exposure events, the HCW contacts were not wearing a mask and were at a distance of <1 m, and just under half of them were exposed for more than 15 min. One-fourth of the contacts underwent RT-PCR testing, and 11% IgG/IgM antibody testing for SARS-CoV-2, all of which were negative. All observed quarantine at home for 14 days. Conclusion: This observational study was made before the extent of the SARS-CoV-2 became apparent, and before routine preventive measures were observed by all HCWs. Comparing the conditions of exposure in the two different settings (bus vs. regional health facility), it is apparent that the duration of exposure and the small, enclosed nature of the bus are the distinguishing factors. In the healthcare setting, the elimination of both factors and the implementation of additional measures protected the exposed HCWs from contracting SARS-CoV-2 infection.
ABSTRACT
Datura stramonium (DS) is a widespread annual plant, containing atropine, hyoscyamine, and scopolamine, which can produce poisoning with a severe anticholinergic syndrome. Teenagers ingest the roots, seeds or the entire plant to obtain its hallucinogenic and euphoric effects. We presented the case of a 22 year old male who was admitted to the Emergency Room in a coma after consuming Datura stramonium, 2 hours earlier. The patient presented with fever, tachycardia with right bundle branch block, and urinary retention. Rapid sequence induction and intubation was performed immediately, with sedation and assisted-control mechanical ventilation, after being transferred to the Intensive Care Unit. The patient received activated charcoal, in repeated doses, external and internal cooling was applied, and an infusion of neostigmine was started. The biological assessment revealed rhabdomyolysis and prevention of renal failure was initiated. After a proper neurological evaluation, 36 hours after using Datura stramonium, the patient was extubated and transferred to the Psychiatric ward for further assessment and care.
ABSTRACT
Polytrauma still represents one of the leading causes of death in the first four decades of life. Septic complications represent the predominant causes of late death in polytrauma patients. Early diagnosis and treatment of infection is associated with an improved clinical outcome and reduced mortality. Several biomarkers have been evaluated for making early diagnosis of sepsis. Current evidence does not support the use of a single biomarker in diagnosing septic complications. Procalcitonin trend was found to be useful in early identification of post-traumatic sepsis.
