Alaa Mohamed Elalfy’s Post

𝗚𝗔𝗟𝗟𝗕𝗟𝗔𝗗𝗗𝗘𝗥 𝗗𝗜𝗦𝗘𝗔𝗦𝗘𝗦 1. Cholecystitis (Inflammation of the Gallbladder) 🔴 Causes: Bacterial infections, trauma, or blockages in the bile duct. 🔴 Symptoms: Vomiting, loss of appetite, jaundice (yellowing of skin and eyes), abdominal pain, fever. 🔴 Diagnosis: Ultrasound may reveal a thickened gallbladder wall, and blood tests may show elevated liver enzymes. 🔴 Treatment: Antibiotics to address infection, anti-inflammatories, and possibly surgery to remove the gallbladder (cholecystectomy). 2. Gallbladder Mucocele 🔵 Description: A condition where mucus accumulates in the gallbladder, causing the bile to become thick and obstructing bile flow. 🔵 Causes: The exact cause is unknown, but it is thought to be linked to certain endocrine disorders (e.g., hypothyroidism, Cushing's disease) 🔵 Symptoms: Vomiting, diarrhea, lethargy, jaundice, abdominal discomfort, or swelling. 🔵 Diagnosis: Ultrasound is key in diagnosing gallbladder mucocele, showing an abnormal "kiwi-like" pattern in the gallbladder. 🔵 Treatment: Surgery is often necessary to remove the gallbladder. Medical management includes using medications to dissolve the mucus or bile acids to promote flow, though this is less effective in advanced cases. 3. Gallstones (Cholelithiasis) 🟣 Description: The formation of stones in the gallbladder can block bile flow, causing inflammation and infection. 🟣 Causes: Imbalance in bile components, infections, or genetic factors. 🟣 Symptoms: Many pets may be asymptomatic, but when symptoms appear, they include vomiting, abdominal pain, jaundice, and lethargy. 🟣 Diagnosis: X-rays or ultrasound can detect gallstones. 🟣 Treatment: Treatment may range from medical dissolution of stones to surgical removal of the gallbladder. 4. Biliary Obstruction 🟠 Description: A blockage in the bile ducts prevents bile from entering the intestines, leading to bile backup and liver dysfunction. 🟠 Causes: Gallstones, tumors, inflammation, or trauma. 🟠 Symptoms: Severe jaundice, vomiting, dark urine, pale stools, and weight loss. 🟠 Diagnosis: Ultrasound is the most common diagnostic tool, and blood work can show high liver enzyme levels and bilirubin. 🟠 Treatment: Surgery is often needed to remove the obstruction, and sometimes the gallbladder itself. 5. Gallbladder Rupture 🟢 Description: A serious condition where the gallbladder tears and bile leaks into the abdomen, causing peritonitis. 🟢 Causes: Gallbladder mucocele, trauma, or severe infection can lead to rupture. 🟢 Symptoms: Sudden onset of severe abdominal pain, lethargy, vomiting, and jaundice. This is an emergency situation. 🟢 Diagnosis: Ultrasound or exploratory surgery can confirm the rupture. 🟢 Treatment: Emergency surgery to remove the gallbladder and clean the abdominal cavity is necessary. Pict credit https://lnkd.in/gUW5UuP8

JIM│ Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance #SepticCardiomyopathy #Multidrug-resistantPathogen #LeftVentricularFailure #RightVentricularDysfunction #Left/rightVentricularLongitudinalStrain #VentriculoarterialCoupling Link: https://buff.ly/3VgIevn Sepsis is a life-threatening organ dysfunction, and septic cardiomyopathy (SCM) may complicate the course of the disease. Infection with multidrug-resistant (MDR) pathogens has been linked with worse outcomes. This retrospective study aimed to evaluate SCM in patients with infections caused by different antimicrobial-resistant phenotypes included patients with sepsis/septic shock, hospitalized, and intubated in the intensive care unit (ICU). The patients were divided into two groups: a non-MDR-SCM and an MDR-SCM and the cardiac function was compared between the two groups. A total of 62 patients were included in the study. Twenty-six patients (41.9%) presented with left ventricular (LV) systolic dysfunction, and ≤35% right ventricular fractional area change (RVFAC) was present in 56.4%. Forty-four patients comprised the MDR-SCM and 18 the non-MDR-SCM group. LV systolic function was more severely impaired in the non-MDR-SCM group (left ventricular ejection fraction [LV EF], 35.8±4.9% vs. 45.6±2.4%, P=0.049, LV outflow tract velocity time integral [VTI], 10.1±1.4 cm vs. 15.3±0.74 cm, P=0.001, LV-Strain, -9.02±0.9% vs. -14.02±0.7%, P=0.001). The MDR-SCM group presented with more severe right ventricular (RV) dilatation (right ventricular end-diastolic area [RVEDA]/left ventricular end-diastolic area [LVEDA], 0.81±0.03 vs. 0.7±0.05, P=0.042) and worse RV systolic function (RVFAC, 32.3±1.9% vs. 39.6±2.7%, P=0.035; tricuspid annular plane systolic excursion [TAPSE], 15.9±0.9 mm vs. 18.1±0.9 mm, P=0.165; lateral tricuspid annulus systolic tissue Doppler velocity, 9.9±0.5 cm/s vs. 13.1±0.8 cm/s, P=0.002, RV-strain, -11.1±0.7% vs. -15.1±0.9%, P=0.002). SCM related to MDR infection presents with RV systolic dysfunction predominance, while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.

Pneumonia is defined as a lower respiratory tract infection with accompanying consolidation visible on chest x-ray. There are four main types of pneumonia: Community-acquired pneumonia (CAP) Hospital-acquired pneumonia (HAP) Aspiration pneumonia Immunocompromised pneumonia Aspiration Pneumonia Aspiration of the gastric contents into the pulmonary tissue will result in a chemical pneumonitis. However, this is not necessarily an infection, as only if any oropharyngeal bacteria are aspirated into the lung tissue as well will a lung infection result. Classically, any aspirated content will affect the right middle or lower lung lobes, due to the anatomy of the bronchi surgical patients, the main risk factors for an aspiration are: Reduced GCS (e.g. secondary to anaesthesia) Iatrogenic interventions (e.g. misplaced NG tube) Prolonged vomiting without NG tube insertion Underlying neurological disease Oesophageal strictures or fistula Post-abdominal surgery Much of the clinical features and investigations for an aspiration pneumonia will be the same as for HAP. Importantly, aspiration pneumonia should be suspected over a pneumonitis if there is evidence of an infective process developing. Management is mainly preventative, identifying the patients who are at an increased risk of aspirating and placing suitable precautions (e.g. NG tube feeding) in place until suitable. This will require involvement from both the nursing staff and the Speech and Language Therapists (SALT). Any pneumonitis only needs supportive measures, however an aspiration pneumonia will need antibiotic therapy, similar to that of HAP. Suction of any aspirated contents is rarely performed as has no real benefit to overall outcomes.

🔍 New Research Highlights Urgent Need for Enhanced Infection Prevention in Hip Replacements Our recent study published in the Journal of Bone and Joint Surgery reveals a concerning finding: Patients who develop a periprosthetic joint infection (PJI) following a total hip replacement face more than a five-fold increase in mortality risk within a decade. Conducted by #ICESOntario, Sunnybrook and the University of Toronto's Temerty Faculty of Medicine, this large-scale study analyzed data from over 175,000 patients and underscores the critical importance of both preventative and management strategies. Key insights from the study: 1. About 0.5% of patients developed PJI within a year of their hip replacement surgery. 2. The 10-year mortality rate for those with PJI was 11.4%, compared to 2.2% for those without. The study emphasizes the need for collaboration between arthroplasty surgeons and infectious disease experts to improve patient outcomes. With osteoarthritis affecting approximately 1 in 7 Canadians and the aging population increasing the demand for joint replacements, this research is vital for shaping future prevention strategies. It also highlights a crucial area for public health and clinical focus, urging us to enhance strategies to minimize infection risks and improve long-term patient care. 🔗https://lnkd.in/gS5RcAZv

What is the best dosing strategy for aminoglycosides, once-daily dosing or traditional divided daily dosing? While traditional aminoglycoside dosing involves giving a weight-based dose divided two to three times daily in patients with normal kidney function, once-daily dosing uses a higher weight-based dose given at extended intervals, every 24 hours for those with of normal kidney function, and longer for those with impaired kidney function. Situations where once-daily dosing is preferred: & Gram-negative bacterial infection especially for the treatment of MDR Enterobacterales and P. aeruginosa infections. (IDSA) & Neonates and children. & Cystic fibrosis. & Endocarditis due to Streptococcus species, Gentamicin (3 mg/kg/day as a single daily dose) is used for synergy. & Immunocompetent, non-pregnant adults and children >3 months of age with:  1- Complicated urinary tract infections 2- Intra-abdominal infections 3- Respiratory tract infections 4- Pelvic inflammatory disease 5- Soft-tissue infections 6- Bacteremia 7- Postpartum endometritis 8- Febrile neutropenia patients with malignancy Situations where traditional dosing is preferred: & Patients with renal impairment, CrCl <30 mL/min, requiring RRT, or unstable renal function. (If can’t be avoided). & Invasive enterococcal infections (such as endocarditis), with low doses of Gentamicin (1 mg/kg every eight hours).  & Prosthetic valve endocarditis due to Staphylococcus species, Gentamicin (1 mg/kg every eight hours). & Pregnant ladies (If can’t be avoided). & Patients who have augmented renal clearance (eg, some patients with burns, critical illness, trauma). However, once-daily dosing maybe used in ARC patients with caution. Advantages of once-daily dosing: 1- Ease of administration and concentration monitoring. 2- Reductions in administration and monitoring-related costs. 3- Advantage of two pharmacodynamic properties: the post-antibiotic effect and concentration-dependent killing. 4- Facilitation of the transition from inpatient to outpatient care. 5- Possibility of decreased nephrotoxicity (no clear evidence).

Our next Tox case, thanks to Dr. Mike Moss! Case Presentation A 2 year-old female presented to the ED with drooling, involuntary movements, nystagmus, and stridor. Though not witnessed, there was a suspected sting site on the left hand. Given the stridor and potential respiratory compromise, she was treated with 4 vials of Anascorp in addition to IV lorazepam. A chest x-ray showed some possible edema. She remained tachypneic and required high-flow oxygen at 20L. A fever occurred after infusion of the 4th vial of Anascorp, but no other allergic findings were reported. She continued to have increased respiratory secretions, though neuromuscular findings had resolved. Given ongoing respiratory symptoms and secretions, two additional vials of Anascorp were administered the morning after the envenomation. She continued to have stridor and bronchoconstriction despite multiple vials of antivenom and was intubated prior to transfer to a pediatric tertiary medical center. No edema was noted during laryngoscopy. A respiratory viral panel was positive for adenovirus, parainfluenza 3, and rhinovirus. The patient was extubated the following afternoon. Bark Scorpion Envenomation Though there are numerous scorpion species in Utah and throughout the United States, only the bark scorpion, Centruroides sculpturatus, is medically significant. It is only found in in northern Mexico, Arizona, and small portions of other states. The bark scorpion is only found in Washington County in Utah. The bark scorpion is not readily identified from other common scorpions without specialized knowledge or equipment. BThe venom acts on neuronal fast Na+ channels resulting in increased activation of skeletal muscles and sympathetic nerves. Children are more severely affected than adults, with severe envenomation occurring in 17% of young children vs 1% of adults (Curry 1983). A variety of different antivenoms have been developed and used historically, with the current product Anascorp FDA approved in the US in 2011. This antivenom is an F(ab’)2 equine derived product. The standard dose is 3 vials reconstituted in a total of 50 mL infused over 10 minutes. There is no age or weight adjustment as the dose is targeted to neutralize the amount of injected venom. Indications for antivenom are grade III or IV envenomation (see figure from Curry 1983). Not all grade III envenomations necessarily require antivenom if symptoms are limited to mild, intermittent extremity jerking.  Teaching Points ·         Bark scorpion envenomation may result in a syndrome of cranial nerve and neuromuscular activation with wandering eye movements, hypersalivation, laryngospasm, and jerking muscle movements ·         Pediatric patients are more severely affected than adults, but severe envenomation in all patients may be treated with a highly effective antivenom ·         Envenomation by other scorpions in the US only causes mild local pain without systemic symptoms

The Bone-Eating Disease: Understanding Osteomyelitis Osteomyelitis is a bacterial, fungal, or parasitic infection of the bone tissue. It is a serious condition that requires prompt medical attention to prevent long-term damage and complications. The causes of osteomyelitis can be direct, such as an open fracture, surgery, or injection, or indirect, such as the spread of infection from nearby tissue or through the bloodstream. Understanding the causes of osteomyelitis is crucial for effective prevention and treatment. Symptoms of osteomyelitis include severe pain and tenderness in the affected bone, swelling, redness, and warmth around the affected area, fever, chills, and fatigue, and drainage of pus or abscess formation. These symptoms can vary in severity and may develop rapidly or gradually. Diagnosis of osteomyelitis typically involves a physical examination, imaging tests such as X-rays, CT, or MRI scans, blood tests, and bone biopsy or aspiration. Early diagnosis is critical for effective treatment and prevention of complications. Treatment of osteomyelitis usually involves antibiotics or antifungal medications, surgical drainage or debridement, immobilization and rest, and pain management. In severe cases, hospitalization may be necessary to manage the infection and prevent complications. If left untreated, osteomyelitis can lead to chronic infection, bone damage or deformity, septic arthritis, and even sepsis or organ failure. Therefore, prevention is crucial, and can be achieved by practicing good hygiene and wound care, seeking medical attention for open fractures or wounds, and getting vaccinated against infections like pneumococcus and meningococcus. In conclusion, osteomyelitis is a serious bone infection that requires prompt medical attention. Early diagnosis and treatment can prevent long-term damage and complications, and awareness of the causes, symptoms, and treatment options is essential for effective management of this condition.

🔬💊 Unlocking the Power of Cephalosporins: Understanding the Generations As healthcare professionals, it's essential to stay informed about the latest advancements in medicine. Today, let's delve into the fascinating world of Cephalosporins, a class of antibiotics derived from the fungus Acremonium. What are Cephalosporins? Cephalosporins, structurally akin to penicillins, boast a broader spectrum of activity against bacteria. They are categorized into five generations, each with distinct characteristics and applications. Ist Generation: Think of Cephalexin and Cefadroxil—these workhorses are ideal for tackling skin infections, respiratory tract infections, urinary tract infections, and bone infections. II Generation: With Cefuroxime and Cefaclor leading the pack, this generation widens the spectrum of activity, combatting a broader range of bacteria, including some gram-negative organisms. They're go-to options for respiratory tract infections, urinary tract infections, and skin infections. III Generation: Enter Cefotaxime, Ceftriaxone, Ceftazidime, Cefdinir, and Cefixime. Enhanced activity against gram-negative bacteria makes them indispensable in treating serious infections like sepsis, meningitis, pneumonia, and urinary tract infections. IV Generation: Cefepime steps up with extended spectrum activity against both gram-positive and gram-negative bacteria, making it a frontline choice for febrile neutropenia, pneumonia, and complicated urinary tract infections. V Generation: Meet the heavyweights, Ceftaroline, and Ceftobiprole. With broad-spectrum activity against MRSA and other resistant strains, they're the go-to options for complicated skin and skin structure infections and certain types of pneumonia. The Mechanism of Action: Cephalosporins inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins, leading to bacterial cell lysis and death. Pharmacokinetics and Pharmacodynamics: Administered orally or intravenously, cephalosporins achieve therapeutic concentrations at infection sites, exhibiting concentration-dependent killing of bacteria. Understanding the nuances of each cephalosporin generation empowers healthcare professionals to make informed treatment decisions, ensuring optimal patient care. Let's continue our journey of learning and discovery in the ever-evolving field of medicine! 💡💼 #Cephalosporins #Antibiotics #Healthcare #Medicine #InfectiousDiseases #Pharmacology #Microbiology #DrugDiscovery #AntibioticResistance #MedicalResearch #PublicHealth #BacterialInfections #DrugDevelopment #HealthcareInnovation #ScienceCommunication

As a key player in the second stage of a two-stage revision for total joint arthroplasty, choosing the right bone cement is crucial. Since its introduction to the U.S. market in 2021, 𝐏𝐀𝐋𝐀𝐂𝐎𝐒® 𝐑+𝐆* 𝐚𝐧𝐝 𝐌𝐕+𝐆* 𝐩𝐫𝐨 – 𝐀𝐥𝐥-𝐢𝐧-𝐎𝐧𝐞 𝐅𝐢𝐱𝐚𝐭𝐢𝐨𝐧 𝐒𝐲𝐬𝐭𝐞𝐦™ has brought innovation into infection management. 🤔 Why an all-in-one mixing and application system pre-filled with antibiotic loaded bone cement, suitable for use with or without vacuum? ✅  It contains the aminoglycoside antibiotic 𝐠𝐞𝐧𝐭𝐚𝐦𝐢𝐜𝐢𝐧 to protect the cured bone cement and contiguous tissue against colonization by bacteria that are sensitive to gentamicin.¹ As a broad-spectrum antibiotic, gentamicin is also effective against 70% of the bacteria that cause PJI.² ✅  Enhanced safety features ✅  Integrated education ✅  Compared to systemic antibiotic prophylaxis alone, the combination of local and systemic administration of antibiotics achieves the best preventive results in arthroplasty.³⁻⁵ ✅  A vacuum cartridge mixing system optimizes the surface porosity, increasing cement resistance to crack growth.⁶⁻⁷   Have you used PALACOS® pro R+G* or MV+G* in your two-stage revision procedure yet? What do you believe are the benefits of an all-in-one fixation system?   Let us know your thoughts in the comments below! 💬 👇 Click here to learn more: https://lnkd.in/gEQe_hC2   *𝑃𝐴𝐿𝐴𝐶𝑂𝑆® 𝑅+𝐺 𝑝𝑟𝑜 𝑎𝑛𝑑 𝑀𝑉+𝐺 𝑝𝑟𝑜 𝑖𝑠 𝑖𝑛𝑑𝑖𝑐𝑎𝑡𝑒𝑑 𝑓𝑜𝑟 𝑢𝑠𝑒 𝑖𝑛 𝑡ℎ𝑒 𝑠𝑒𝑐𝑜𝑛𝑑 𝑠𝑡𝑎𝑔𝑒 𝑜𝑓 𝑎 𝑡𝑤𝑜-𝑠𝑡𝑎𝑔𝑒 𝑟𝑒𝑣𝑖𝑠𝑖𝑜𝑛 𝑓𝑜𝑟 𝑡𝑜𝑡𝑎𝑙 𝑗𝑜𝑖𝑛𝑡 𝑎𝑟𝑡ℎ𝑟𝑜𝑝𝑙𝑎𝑠𝑡𝑦 𝑎𝑓𝑡𝑒𝑟 𝑡ℎ𝑒 𝑖𝑛𝑖𝑡𝑖𝑎𝑙 𝑖𝑛𝑓𝑒𝑐𝑡𝑖𝑜𝑛 ℎ𝑎𝑠 𝑏𝑒𝑒𝑛 𝑐𝑙𝑒𝑎𝑟𝑒𝑑. #AntibioticsAugust #Infection #InfectionManagement #Orthopedics **𝑹𝒆𝒇𝒆𝒓𝒆𝒏𝒄𝒆𝒔 𝒄𝒂𝒏 𝒃𝒆 𝒇𝒐𝒖𝒏𝒅 𝒊𝒏 𝒕𝒉𝒆 𝒄𝒐𝒎𝒎𝒆𝒏𝒕𝒔.

🎥 We've got an exciting video featuring Dr. H. Erhan Güven! In this presentation, Dr. Güven takes us through 11 tough cases of diabetic foot attacks and necrotising fasciitis. He shows how DEBRICHEM® made a huge difference in these emergencies. From minor amputations to actually saving limbs, you’ll see impressive results. The patients, mostly around 58 years old and suffering from diabetes for about 15 years, faced serious infections. Thanks to DEBRICHEM®, we saw: ✅ No major amputations ✅ Successful angioplasty in 6 patients ✅ Fast granulation and healing ✅ Big drops in blood values indicating sepsis and infection Check out the video to see how DEBRICHEM® is changing the game in diabetic foot care. To further explore DEBRICHEM® and its applications, check out the following resources: 🚀 ✅ DEBRICHEM® Diabetic Foot: https://lnkd.in/dMq6F_SK ✅ Treating Wound Infections Without Antibiotics: https://lnkd.in/dE5rb9ph ✅ Developing a Clinical Pathway with DEBRICHEM®: https://lnkd.in/dgk697cP ✅ DEBRICHEM® in Home Care Setting: https://lnkd.in/dpuPqPrY ✅ Topical Use of DEBRICHEM® for the Treatment of Periungual Skin Lesions Post-Phenolization: A Case Series: https://lnkd.in/d58ruExm ✅ Pain Reception and Management During the Usage of DEBRICHEM®: https://lnkd.in/d5yzGmRe ✅ DEBRICHEM®: Biofilm Disruption Through Chemical Debridement: https://lnkd.in/dNXa_z2v ✅ DEBRICHEM® Wound Debridement: Integrating a Chemical Debridement Into a Clinical Pathway: https://lnkd.in/dedZqqNt ✅ A Parisian Case Series on DEBRICHEM® Use in the French Market: https://lnkd.in/djEQzUBD ✅ Using DEBRICHEM® for Specialized Wound Care Treatment in Primary Care: https://lnkd.in/dFjnByWV ✅ Efficacy of Chemical Debridement Agent on a Human Explant Model Infected by Biofilm: https://lnkd.in/d3xJexea Follow our LinkedIn page DEBx Medical to stay updated on our latest presentations and insights! #WoundCare #DiabeticFoot #DEBRICHEM #Healthcare #PatientCare