What metaanalyses teach people professionals along with cons

The selection of therapeutic agent to be used for the treatment of multidrug-resistant bacteria is a major concern. Polymyxin B use has been commenced in Turkey, although its clinical breakpoint is not listed in the EUCAST. This study aimed to determine the correlation between the MIC values of polymyxin B and colistin. A total of 505 isolates, including 122 isolates of Escherichia coli and 383 isolates of Klebsiella pneumoniae were included in the present study. All the isolates were assessed for colistin and polymyxin B using the broth microdilution method. The categorical agreement in the E. coli isolates was 98.4%, and the rate of very major error was 33.3%. The categorical agreement in the K. pneumoniae isolates was 99.5%, the rate of major error was 0.36%, and the rate of very major error was 0.98%. In the evaluation of the essential agreement, 1.6% error in E. coli and 2.3% error in K. pneumoniae were observed. It was concluded that polymyxin B should never be used in the treatment of the isolates reported as colistin-resistant, and if the MIC values are above 4 mg/L in E. coli and K. pneumoniae. Our results indicate importance of reporting both polymyxin B and colistin susceptibility results of clinical isolates.Összefoglaló. A felszínpótló, fém a fémen csípőízületi protézisek reneszánszukat élték a 2000-es években. Elsősorban fiatal, aktív betegek esetében javasolták használni a remélt elméleti előnyök, mint a combfej csontállományának megőrzése, a csípőízület biomechanikájának fenntartása, a luxatio kockázatának csökkentése, a polietilén törmelékek és kopástermékek hiánya miatt. Bemutatunk egy beteget, akinél 19 éves korában kétszeri vesetranszplantációt követő, hosszan tartó szteroidkezelés következtében kialakult kétoldali combfejnekrózis miatt került sor felszínpótló, fém a fémen csípőprotézis beültetésére. A harmadik posztoperatív évtől mindkét csípőt érintő, fokozatosan súlyosbodó fájdalom, pszichés tünetek, valamint ismételt veseelégtelenség alakult ki. A tünetek hátterében kifejezetten magas Co-Cr szérumszintet, a csípőízület környezetében pszeudotumor-kialakulást, kiterjedt acetabularis cystákat, a combnyakak jelentős elvékonyodását találtuk, mely jobb oldalon periprotetikus combnyaktörést okozott. A revízieplacement prostheses were replaced with cementless ceramic-ceramic total prostheses. Following the revisions, local and psychiatric symptoms resolved, and serum Co-Cr levels normalized, allowing a third kidney transplant to be performed. The rapid improvement of our patient after prosthesis revisions serves as indirect evidence for the negative role of Co-Cr ions in both local and systemic tissue reactions, including damage to the transplanted kidney. Our case report shows that the use of metal on metal prostheses after organ transplantation should be avoided and simply setting up an indication for hip prosthesis and use the most modern type of prosthesis is inadequate. Depth analysis of the patient's ancillary conditions, medications, co-morbidities are required to select the most appropriate prosthesis type, which is an unavoidable responsibility of orthopedic surgeons. Orv Hetil. 2021; 162(20) 800-805.Összefoglaló. Bevezetés Általánosságban elmondható, hogy a fekvőbeteg-ellátást nyújtó egészségügyi intézmények intenzív terápiás osztályain (ITO) jelennek meg a legsúlyosabb kórképekkel és a legmagasabb halálozási aránnyal bíró esetek, rendszerint megkésve. Eltérően az ITO-tól, más betegellátó osztályokon előfordulhat, hogy nem észlelik megfelelően és időben a betegek olyan állapotváltozásait, melyek előre jelzik például a szívleállást vagy a keringési rendszer várható összeomlását. Ennek kiküszöbölésére jelenthet megoldást az úgynevezett gyors reagálású rendszer (RRS), melynek segítségével csökkenthető a kórházon belüli mortalitás. Célkitűzés A Somogy Megyei Kaposi Mór Oktató Kórház a teljes intézményre kiterjedően a 2016. évtől alkalmazza az RRS-t. A jelen tanulmány célja a kórházi mortalitás csökkentésével kapcsolatos első eredmények bemutatása. learn more Módszer Vizsgálatunkban az ITO-ra került betegek adatbázisán alapuló kereszttáblás, illetve nemparametrikus statisztikai módszereket alkalmaztuk. Eredmények A stat5e-14) with using RRS or without it. Among those admitted via RRS, more severe patients with respiration insufficiency and septic conditions were represented in higher rate, while the number of the admitted ones after resuscitation has decreased.
Hospital mortality rate of 2.983% without using RRS decreased into 2.932% in the period of using RRS, though we observed remarkable differences in data of non-ICU in-patient departments. Mortality has reduced in 19 in-patient departments out of 21, after implementing RRS.
To sum it up, we identified that RRS implemented on the basis of international references has increased the efficiency of healthcare and owing to it, institution-level mortality has successfully decreased. Orv Hetil. 2021; 162(20) 782-789.
To sum it up, we identified that RRS implemented on the basis of international references has increased the efficiency of healthcare and owing to it, institution-level mortality has successfully decreased. Orv Hetil. 2021; 162(20) 782-789.The aim of this study is to present our knowledge about pachychoroid diseases using case reports, literature review and our own clinical experiences. A summary flow chart of treatment options for the subgroups was prepared, too. Pachychoroid diseases include the following central serous chorioretinopathy (CSCR), pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV), peripapillary pachychoroid syndrome (PPS), focal choroidal excavation (FCE). A common feature of pachychoroid diseases is the quantitative or qualitative abnormality of the choroidea, which is often associated with subretinal fluid accumulation. The disease group does not currently have a standard treatment protocol; some of the multiple treatments prove to be more effective, however, there are significant differences between the subgroups. We summarize which subgroup benefits from eplerenone tablet therapy, micropulse laser therapy, verteporfin photodynamic therapy or intravitreal anti-VEGF injection therapy. Orv Hetil. 2020; 162(20) 770-781.Összefoglaló. Bevezetés Bevezetés A citológiai alapú méhnyakrákszűrés átmeneti kategóriáinak optimális menedzselése a humán papillomavírus (HPV) szűrése és tipizálása ellenére jelenleg is kihívás. Vizsgálatunk célja a modern cervixspektroszkópiának (multimodális hiperspektroszkópia - MHS), egy azonnali eredményt nyújtó, digitális technológiára épülő módszernek a vizsgálata volt a citológiai alapú méhnyakszűrés találati biztonságának javítására. Betegek és módszer Vizsgálatainkat 208, 18 és 75 év közötti nőbeteg bevonásával végeztük, akiknél már indikálásra került valamely, a méhnyakon végzendő műtét, citológiai eredményük rendelkezésre állt (a HPV-tesztet, amennyiben nem történt meg, elvégeztük), valamint valamennyi betegnél elvégeztük a műtét előtt az MHS-vizsgálatot. A szövettani mintavétel 166 betegnél történt meg. Eredmények A citológiai vizsgálatot (az összes betegre tekintve) magas álpozitív arány jellemezte (69,28%), amely megfigyelések mindenképpen utalnak az újabb komponens alkalmazásának igényére a ause of its outstanding false negative rate it is a great aid and should be considered in the triage of such patients. Orv Hetil. 2021; 162(20) 790-799.New vaccine introduction accompanied by social mobilization activities could contribute to improved routine immunization timeliness. This study assesses the impact of Kenya's introduction of pneumococcal conjugate vaccine (PCV) on the timeliness of routine childhood vaccination in two informal, urban settlements in Nairobi. Data collected from 2007 to 2015 as part of a demographic surveillance system were used to estimate annual vaccination delays of ≥ 4 weeks among children aged 12-23 months in the period before and after the introduction of PCV in Kenya. Binomial segmented regression models using generalized estimating equations examined the association between vaccine introduction and timeliness of routine immunization. Over half of all children vaccinated in the two urban areas received one or more doses ≥ 4 weeks after the recommended age. The timeliness of routine immunization showed slight improvements or nonsignificant changes during the years following PCV introduction compared with the preceding years (adjusted prevalence ratio [aPR] 0.67, 95% CI 0.45-0.99 for Bacille Calmette-Guerin receipt; aPR 0.59, 95% CI 0.41-0.83 for third dose Pentavalent receipt; aPR 1.19, 95% CI 0.99-1.42 for measles). However, as of 2015, delayed vaccination remained prevalent in children, particularly among the poorest residing in the settlements. Many sub-Saharan African countries have introduced new life-saving vaccines into their routine childhood immunization schedule. Additional evidence regarding the positive or neutral influence of new vaccine introduction on the performance of delivery systems provides further justification to sustain the inclusion of these more costly vaccines in the immunization schedule.Rhinosporidiosis is a chronic mucosal infection caused by Rhinosporidium seeberi, an aquatic protistan parasite. It presents as nasal or ocular polypoidal or vascularized masses. It is endemic in tropical and subtropical areas, especially in South Asia; R. seeberi´s endemicity in the Americas is often overlooked. The objective of this study was to describe the demographic and clinical characteristics of patients with rhinosporidiosis in the Americas, its management, and patient outcomes. This study is a systematic review of cases of human rhinosporidiosis in the Americas reported in the literature from 1896 to February 28, 2019. This review screened 1,994 reports, of which 115 were eligible for further analysis. The selected reports described 286 cases of human rhinosporidiosis between 1896 and 2019. Cases were diagnosed in Brazil (32.2%), Colombia (24.4%), Paraguay (12.6%), and the United States (11.9%). The majority of the cases (91%) occurred in geographic areas with altitudes less then 1,000 m above sea level and in areas with median temperatures ≥ 25°C (67.3%). Most of the patients presented nasal (65%) and ocular involvement (35%). Surgical treatment was provided for 99.6% of patients, but 19.8% of them recurred. This review describes the under-recognized geographic distribution and clinical presentation of rhinosporidiosis in the Americas and highlights clinical differences to cases in Asia, specifically in reference to a higher prevalence of ocular disease and higher relapse rates.Invasive Salmonella infection is a common cause of acute febrile illness (AFI) among children in sub-Saharan Africa; however, diagnosing Salmonella bacteremia is challenging in settings without blood culture. The Uganda AFI surveillance system includes blood culture-based surveillance for etiologies of bloodstream infection (BSIs) in hospitalized febrile children in Uganda. We analyzed demographic, clinical, blood culture, and antimicrobial resistance data from hospitalized children at six sentinel AFI sites from July 2016 to January 2019. A total of 47,261 children were hospitalized. Median age was 2 years (interquartile range, 1-4) and 26,695 (57%) were male. Of 7,203 blood cultures, 242 (3%) yielded bacterial pathogens including Salmonella (N = 67, 28%), Staphylococcus aureus (N = 40, 17%), Escherichia spp. (N = 25, 10%), Enterococcus spp. (N = 18, 7%), and Klebsiella pneumoniae (N = 17, 7%). Children with BSIs had longer median length of hospitalization (5 days versus 4 days), and a higher case-fatality ratio (13% versus 2%) than children without BSI (all P less then 0.