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Das, B.C.; Khan, A.S.; Elahi, N.E.; Uddin, M.S.; Debnath, B.C.; Khan, Z.R. |
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Title |
Morbidity and Mortality after Pancreatoduodenectomy: A Five Year Experience in Bangabandhu Sheikh Mujib Medical University |
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Journal Article |
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Year |
2017 |
Publication |
Mymensingh Medical Journal : MMJ |
Abbreviated Journal |
Mymensingh Med J |
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26 |
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1 |
Pages |
145-153 |
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Abstract |
Mortality and morbidity was assessed after adoption of a systematic care for patient with pancreatoduodenectomy starting from patient selection and preparation, operative technique, and postoperative care. In this prospective study seventy patients who underwent pancreatoduodenectomy for periampullary carcinoma with curative intent between January 2010 and December 2014 were carefully analyzed prospectively. Patients were selected those who had ampullary carcinoma, lower bile duct carcinoma and small size carcinoma head of pancreas without local invasion and distant metastasis, and the patient who did not have any major disabling comorbid diseases. All patients were assessed uniformly before surgery and deficiency were corrected up to normal level before operation. Pancreatoduodenectomy and standard lymphadenectomy was performed meticulously with minimum blood loss. The pancreatojejunal reconstruction was performed using duct-to-mucosa method mostly. A nasojejunal feeding tube was placed in most patients for starting postoperative early oral feeding. Broad spectrum antibiotics and the epidural analgesia were mostly prescribed for good control infection and pain. Proper nutrition was maintained in calculative way through central venous line and nasojejunal feeding tube in the early postoperative period. General care, early mobilization and chest physiotherapy were given routinely in each patient. Seventy-seven percent (n=54) patients did not have any postoperative complications and they were discharged from hospital within 12-14 postoperative days. The morbidity occurred in 16 patients (23%) and most common complication was wound infection (18%, n=9). The rest complications were pancreatojejunal anastomotic leakage – 2, hepaticojejunal anastomosis leakage – 1, melaena – 1, intra-abdominal abscess – 1, intra-abdominal hemorrhage – 1, and renal dysfunction – 1. The mortality rate was 5.7% (n=4), causes of death were massive myocardial infarction; 1, failure of reversal from anesthesia; 1, massive intraabdominal bleeding; 1 and CV catheter related severe sepsis; 1. Review of recent published literature revealed that mortality and morbidity our series is better than low volume center and almost similar with high volume center of pancreatoduodenectomy surgery. Our systematic management policy of careful patient selection, planned approach in the form of proper work up, meticulous conduction of the procedure, appropriate postoperative care provides an acceptable morbidity and mortality after pancreatoduodenectomy. |
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Dr Bidhan C Das, Associate Professor, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail: dbidhan@yahoo.com |
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1022-4742 |
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PMID:28260769 |
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99757 |
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Zapotoczna, M.; Forde, E.; Hogan, S.; Humphreys, H.; O'Gara, J.P.; Fitzgerald-Hughes, D.; Devocelle, M.; O'Neill, E. |
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Title |
Eradication of Staphylococcus aureus Biofilm Infections Using Synthetic Antimicrobial Peptides |
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Journal Article |
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Year |
2017 |
Publication |
The Journal of Infectious Diseases |
Abbreviated Journal |
J Infect Dis |
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Volume |
215 |
Issue |
6 |
Pages |
975-983 |
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Keywords |
Animals; Anti-Bacterial Agents/*pharmacology; Biofilms/*drug effects; Catheter-Related Infections/*drug therapy; Cytokines/blood; Disease Models, Animal; Humans; Methicillin-Resistant Staphylococcus aureus/*drug effects; Microbial Sensitivity Tests; Peptides/*pharmacology; Peptides, Cyclic/pharmacology; Rats; Rats, Sprague-Dawley; Staphylococcal Infections/*drug therapy; Vancomycin/administration & dosage; *Staphylococcus aureus; *antimicrobial peptides (AMPs); *biofilm; *catheter lock solution (CLS) |
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Here, we demonstrate that antimicrobial peptides (AMPs) are an effective antibiofilm treatment when applied as catheter lock solutions (CLSs) against S. aureus biofilm infections. The activity of synthetic AMPs (Bac8c, HB43, P18, Omiganan, WMR, Ranalexin, and Polyphemusin) was measured against early and mature biofilms produced by methicillin-resistant S. aureus and methicillin-susceptible S. aureus isolates from patients with device-related infections grown under in vivo-relevant biofilm conditions. The cytotoxic and hemolytic activities of the AMPs against human cells and their immunomodulatory potential in human blood were also characterized. The D-Bac8c2,5Leu variant emerged as the most effective AMP during in vitro studies and was also highly effective in eradicating S. aureus biofilm infection when used in a CLS rat central venous catheter infection model. These data support the potential use of D-Bac8c2,5Leu, alone or in combination with other AMPs, in the treatment of S. aureus intravenous catheter infections. |
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Department of Microbiology, School of Natural Sciences, National University of Ireland, Galway, Ireland |
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0022-1899 |
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PMID:28453851 |
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99511 |
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Yu, W.-L.; Lee, M.-F.; Chen, C.-C.; Tang, H.-J.; Ho, C.-H.; Chuang, Y.-C. |
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Title |
Impacts of Hypervirulence Determinants on Clinical Features and Outcomes of Bacteremia Caused by Extended-Spectrum beta-Lactamase-Producing Klebsiella pneumoniae |
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Journal Article |
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2017 |
Publication |
Microbial Drug Resistance (Larchmont, N.Y.) |
Abbreviated Journal |
Microb Drug Resist |
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23 |
Issue |
3 |
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376-383 |
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Aged; Anti-Bacterial Agents/therapeutic use; Bacteremia/drug therapy/*microbiology; Bacterial Proteins/genetics; Cross Infection/drug therapy/microbiology; Female; Hospital Mortality; Humans; Klebsiella Infections/drug therapy/*microbiology; Klebsiella pneumoniae/*genetics; Male; Middle Aged; Serogroup; Urinary Tract Infections/drug therapy/microbiology; Virulence Factors/*genetics; beta-Lactamases/*genetics; Esbl; Klebsiella pneumoniae; hypermucoviscosity; hypervirulence; rmpA; virulence |
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We investigated the implications of hypervirulence determinants on clinical features of 48 adult patients with bacteremia caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Isolates in the hypervirulence group included any of the following virulence determinants: K1/K2 capsule serotypes, hypermucoviscosity phenotype, rmpA gene, or rmpA2 gene. Nonhypervirulence group isolates were negative for all of the above virulence factors. In this study, all isolates used were non-K1/K2 strains. Statistically significant differences were observed in clinical features of patients between the two groups. The hypervirulent isolates (n = 19), including 11 isolates with the hypermucoviscosity phenotype, 15 with the rmpA gene, and 16 with the rmpA2 gene, were more commonly recovered from diabetic patients and mainly manifested as secondary bacteremia (such as pneumonia, urinary tract infections, or other localized infections). The nonhypervirulent isolates (n = 29) were more commonly recovered from patients after prolonged hospital stays (>30 days) and mostly manifested as primary bacteremia. The overall in-hospital mortality was 56.3%. Hazard ratio (HR) analysis revealed the following positive predictors for mortality: nosocomial infection, stay in an intensive care unit, no removal of the central venous catheter, Charlson comorbidity score, and APACHE II score (>==15). The negative predictors were initial appropriate antibiotic therapy (HR 0.42) and urinary tract infection (HR 0.19). Charlson score was an independent confounder based on multivariate analysis (HR 1.43, 95% confidence interval 1.04-1.99). In conclusion, hypervirulence determinants played a role in causing secondary infections in diabetic patients; however, the presence of morbidity cofactors could themselves influence mortality, despite the absence of hypervirulence determinants. |
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6 Department of Internal Medicine, Chi Mei Medical Center-Liou Ying , Tainan City, Taiwan |
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1076-6294 |
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PMID:27380450 |
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99505 |
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Shibata, W.; Sohara, M.; Wu, R.; Kobayashi, K.; Yagi, S.; Yaguchi, K.; Iizuka, Y.; Iwasa, M.; Nakahata, H.; Yamaguchi, T.; Matsumoto, H.; Okada, M.; Taniguchi, K.; Hayashi, A.; Inazawa, S.; Inagaki, N.; Sasaki, T.; Koh, R.; Kinoshita, H.; Nishio, M.; Ogashiwa, T.; Ookawara, A.; Miyajima, E.; Oba, M.; Ohge, H.; Maeda, S.; Kimura, H.; Kunisaki, R. |
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Incidence and Outcomes of Central Venous Catheter-related Blood Stream Infection in Patients with Inflammatory Bowel Disease in Routine Clinical Practice Setting |
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Journal Article |
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2017 |
Publication |
Inflammatory Bowel Diseases |
Abbreviated Journal |
Inflamm Bowel Dis |
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23 |
Issue |
11 |
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2042-2047 |
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BACKGROUND: Patients with inflammatory bowel disease (IBD) occasionally require central venous catheter (CVC) placement to support a therapeutic plan. Given that CVC can predispose patients to infection, this investigation was undertaken to assess the incidence, risk factors, and outcomes of CVC-related blood stream infection (CRBSI) in patients with IBD during routine clinical practice. METHODS: Data were compiled using retrospective chart reviews of 1367 patients treated at our IBD center between 2007 and 2012 during routine clinical practice. Among the 1367 patients, 314 who had received CVC placements were included. Patients with positive blood culture were considered as “definite” CRBSI, whereas “possible” CRBSI was defined as patients in whom fever alleviated within 48 hours post-CVC without any other infection. Patients' demographic variables including age, body mass index, serum albumin, duration of CVC placement, use of antibiotics, medications for IBD, and perioperative status between CRBSI and non-CRBSI subgroups were compared by applying a multivariate Poisson logistic regression model. RESULTS: Among the 314 patients with CVC placement, there were 83 CRBSI cases (26.4%). The average time to the onset of CRBSI was 22.5 days (range 4-105 days). The jugular vein access was found to be the most serious risk of CRBSI (risk ratio 2.041 versus subclavian vein). All patients with CRBSI fully recovered. CONCLUSIONS: In this investigation, regardless of the patients' demographic features including immunosuppressive therapy, up to 30% of febrile IBD patients with CVC showed CRBSI. It is believed that CVC placement per se is a risk of CRBSI in patients with IBD. |
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*Inflammatory Bowel Disease Center, Yokohama City University Medical Centre, Yokohama, Japan;daggerDivision of Gastroenterology, Department of Medicine, Yokohama City University, Yokohama, Japan;double daggerSchool of Medicine, Yokohama City University, Yokohama, Japan; section signDepartment of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Centre, Yokohama, Japan; ||Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan; and paragraph signDepartment of Infectious Diseases, Hiroshima University Hospital, Japan |
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1078-0998 |
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PMID:29045261 |
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Serial |
99359 |
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Saleh, H.M.; Tawfik, M.M.; Abouellail, H. |
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Prospective, randomized study of long-term hemodialysis catheter removal versus guidewire exchange to treat catheter-related bloodstream infection |
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Randomized Controlled Trial |
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2017 |
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Journal of Vascular Surgery |
Abbreviated Journal |
J Vasc Surg |
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66 |
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5 |
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1427-1431.e1 |
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Aged; Anti-Bacterial Agents/therapeutic use; Catheter-Related Infections/blood/diagnosis/microbiology/*therapy; Catheterization, Central Venous/*adverse effects/*instrumentation; Catheters, Indwelling/*adverse effects; Central Venous Catheters/*adverse effects; *Device Removal/adverse effects; Disease-Free Survival; Egypt; Equipment Design; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Prospective Studies; Renal Dialysis; Risk Factors; Time Factors; Treatment Outcome |
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BACKGROUND: Long-term (tunneled cuffed) hemodialysis catheters are frequently used vascular access in renal failure patients. Catheter-related bloodstream infection (CRBSI) is a common complication of long-term hemodialysis catheters, with severe morbidities and high risk of mortality. Management of CRBSI by systemic antibiotics while keeping the catheter in place is not effective. Among the different modalities of CRBSI management are catheter removal (CR) and guidewire exchange (GE) of the catheter. The aim of this study was to compare the clinical outcome of CRBSI treated with two different strategies: GE vs CR with new catheter insertion 3 to 7 days later. METHODS: This prospective randomized study analyzed the outcomes of all cases of long-term hemodialysis CRBSI during a 5-year period. The catheter infection-free survival time was analyzed in the two groups of patients (GE group, 339 patients; CR group, 339 patients). Three weeks of systemic antibiotic therapy was used according to culture in both groups. The catheter infection-free survival was analyzed using Kaplan-Meier analysis. RESULTS: No statistically significant difference was found in catheter infection-free survival time for GE and CR groups (P = .69), which is not affected by age, sex, presence of diabetes mellitus, or type of causative organism. CONCLUSIONS: Our study did not demonstrate a difference in the clinical outcome of CRBSI treated with GE or CR with new catheter insertion 3 to 7 days later. However, guidewire catheter exchange saves veins for future access, reduces the cost and number of procedures, and avoids complications of new venipuncture. |
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Department of Nephrology, Ain Shams University, El Demerdash Hospital, Cairo, Egypt |
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0741-5214 |
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PMID:28822660 |
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99317 |
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