Predictive value of systemic immune-inflammation index for cerebral reperfusion and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment

OBJECTIVE

The systemic immune inflammation (SII) index has been an excellent prognostic indicator in patients with acute ischemic stroke (AIS). In this study, we assessed the utility of the SII in predicting the prognosis and reperfusion status of patients with AIS who underwent endovascular treatment (EVT).

PATIENTS AND METHODS

123 consecutive AIS patients were enrolled in our study. The receiver-operating characteristics (ROC) curve was used to determine the cut-off value of SII for predicting unsuccessful cerebral reperfusion. Multivariate logistic regression analysis analyzed the association between SII and unsuccessful reperfusion rate after EVT.

RESULTS

The median value of SII was significantly higher in patients with unsuccessful reperfusion compared to patients with successful reperfusion [2,029 (1,217-2,771) vs. 1,172 (680-2,145) respectively, p=0.003)]. A ROC curve analysis showed that the best cut-off value of SII for predicting unsuccessful reperfusion status was 1,690, with sensitivity and specificity of 71% and 69%, respectively. The area under the curve (AUC) was 0.673 (95% CI; 0.552-0.793). Multivariate analysis demonstrated that SII ≥ 1,690 value was an independent predictor of unsuccessful cerebral reperfusion and unfavorable clinical outcome after EVT (Hazard ratio - H.R.=3.713, 95% CI: 1.281-10.76, p=0.016, HR=2.28, 95% CI: 1.06-4.88, p=0.035, respectively).

CONCLUSIONS

We suggested that SII is a potential indicator to predict the unsuccessful cerebral reperfusion and unfavorable clinical outcome for patients with AIS undergoing EVT.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC)

PURPOSE

To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey.

METHODS

CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program.

RESULTS

During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate.

CONCLUSIONS

This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.

A prospective, multi-center study: factors related to the management of diabetic foot infections

The Turkish Association of Clinical Microbiology and Infectious Diseases, Diabetic Foot Infections Working Group conducted a prospective study to determine the factors affecting the outcomes of diabetic foot infections. A total of 96 patients were enrolled in the study. Microbiological assessment was performed in 86 patients. A total of 115 causative bacteria were isolated from 71 patients. The most frequently isolated bacterial species was Pseudomonas aeruginosa (n = 21, 18.3%). Among cases with bacterial growth, 37 patients (43%) were infected with 38 (33%) antibiotic-resistant bacteria. The mean (±SD) antibiotics cost was 2,220.42 (±994.59) USD in cases infected with resistant bacteria, while it was 1,206.60 (±1,160.6) USD in patients infected with susceptible bacteria (p < 0.001). According to the logistic regression analysis, the risk factors related to the growth of resistant bacteria were previous amputation (p = 0.018, OR = 7.229) and antibiotics administration within the last 30 days (p = 0.032, OR = 3.796); that related to the development of osteomyelitis was wound size >4.5 cm(2) (p = 0.041, OR = 2.8); and that related to the failure of the treatment was the growth of resistant bacteria (p = 0.016, OR = 5.333). Diabetic foot osteomyelitis is usually a chronic infection and requires surgical therapy. Amputation is the accepted form of treatment for osteomyelitis. Limited limb-saving surgery and prolonged antibiotic therapy directed toward the definitive causative bacteria are most appropriate. This may decrease limb loss through amputations. As a result the infections caused by resistant bacteria may lead to a high cost of antibiotherapy, prolonged hospitalization duration, and failure of the treatment.

Electrical properties of a novel 1,3-bis-(p-iminobenzoic acid) indane Langmuir-Blodgett films containing ZnS nanoparticles

ZnS nanoparticles have been formed in a newly synthesized 1,3-bis-(p-iminobenzoic acid) indane (IBI) by exposing Zn2+ doped multilayered Langmuir-Blodgett (LB) film to H2S gas after the growth. The formation of ZnS nanoparticles in the LB film structure was verified by measuring UV-Visible absorption spectra. DC electrical measurements were carried out for thin films of IBI prepared in a metal/LB films/metal sandwich structure with and without ZnS nanoparticles. It was observed that ZnS nanoparticles in the LB films cause a blue-shift in the absorption spectra as well as a decrease in both capacitance and conductivity values. By analysing I-V curves and assuming a Schottky conduction mechanism the barrier height was found to be about 1.13 eV and 1.21 eV for IBI LB films without and with ZnS nanoparticles, respectively. It is thought that the presence of ZnS nanoparticles influences the barrier height at the metal-organic film interface and causes a change in electrical conduction properties of LB films.

A rare case of HSV-2 encephalitis

Herpes simplex viruses (HSV), and especially HSV-1, are the most common cause of acute, sporadic viral encephalitis. HSV-2 is an uncommon cause of encephalitis. We report a rare case of HSV-2 encephalitis that was free of genital lesions. In terms of the patient's case history, she had a Cesarean section four months before, herpes labialis 30 days before, varicella zoster 20 days before. We discuss the possibility that postpartum stress may be one of the factors in this case.

Characterization of a novel 1,3-bis(p-iminobenzoic acid)indane Langmuir-Blodgett film for organic vapor sensing

In the present paper we report about the Langmuir-Blodgett thin film characterization and organic vapor sensing properties of a novel 1,3-bis(p-iminobenzoic acid)indane (IBI) containing polar carboxylic acid groups. LB film properties of IBI material is characterized by UV-visible spectroscopy, atomic force microscopy, and quartz crystal microbalance. Our results show that high-quality and uniform LB films can be prepared with the transfer ratio of over 0.95. Organic vapor sensing properties are studied using quartz crystal microbalance measurement system. IBI film is found to be significantly more sensitive to benzene and the response of LB sample is fast, large, and reversible. The sensitivity of detection of toluene, ethyl alcohol, and isopropyl alcohol is much smaller than that of benzene. This newly synthesized IBI is a suitable molecule for the fabrication of an LB film and can be regarded as a promising sensing material in the development of a room temperature gas sensor for benzene vapor applications.

Human fascioliasis

Fasciola hepatica, a zoonotic liver fluke, can also cause disease in humans. Common symptoms are epigastric pain, upper abdominal pain and malaise. Fever and arthralgia are common in acute fascioliasis. Eosinophilia is the predominant laboratory finding, especially in patients with the acute form of the disease. Diagnosis and treatment is not easy, as physicians rarely encounter this disease, and effective drugs are not available in many countries. Human fascioliasis may be underestimated. Patients with eosinophilia and abdominal pain should be evaluated for F. hepatica infestation by parasitological, radiological and serological tests.

Coincidental acute myeloblastic leukemia in a patient with renal angiosarcoma

A case of acute myeloblastic leukemia diagnosed 7 months after radical nephrectomy for renal angiosarcoma is presented. Chemotherapy or radiotherapy was not performed following nephrectomy and ethiologic factor remains unknown.

Cervical pregnancy: can age and parity be predisposing factors?

A fifty-year old woman, gravida 17, para 17, presented with profuse vaginal bleeding following curettage in another hospital. At emergency laparotomy total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed because of intractable hemorrhage. Histopathologic examination revealed endocervical placentation and adenomyosis uteri. The case is presented due to its rarity and possible predisposing factors are discussed.