Search

Objective: Contaminated blood cultures result in extended hospital stays and extended durations of antibiotic therapy. Rapid molecular-based blood culture testing can speed positive culture detection and improve clinical outcomes, particularly when combined with an antimicrobial stewardship program. We investigated the impact of a multiplex polymerase chain reaction (PCR) FilmArray Blood Culture Identification (BCID) system on clinical outcomes associated with contaminated blood cultures. Methods: We conducted a retrospective cohort study involving secondary data analysis at a single institution. In this before-and-after study, patients with contaminated blood cultures in the period before PCR BCID was implemented (ie, the pre-PCR period; n = 305) were compared to patients with contaminated blood cultures during the period after PCR BCID was implemented (ie, the post-PCR implementation period; n = 464). The primary exposure was PCR status and the main outcomes of the study were length of hospital stay and days of antibiotic therapy. Results: We did not detect a significant difference in adjusted mean length of hospital stay before (10.8 days; 95% confidence interval [CI], 9.8–11.9) and after (11.2 days; 95% CI, 10.2–12.3) the implementation of the rapid BCID panel in patients with contaminated blood cultures (P = .413). Likewise, adjusted mean days of antibiotic therapy between patients in pre-PCR group (5.1 days; 95% CI, 4.5–5.7) did not significantly differ from patients in post-PCR group (5.3 days; 95% CI, 4.8–5.9; P = .543). Conclusion: The introduction of a rapid PCR-based blood culture identification system did not improve clinical outcomes, such as length of hospital stay and duration of antibiotic therapy, in patients with contaminated blood cultures.

Mandibular distraction osteogenesis (MDO) and continuous positive airway pressure (CPAP) may each have a role in effectively treating tongue-based airway obstruction (TBAO) in Robin sequence (RS). This study describes longitudinal outcomes after treatment of TBAO with CPAP and/or MDO. Retrospective cohort study. Tertiary Pediatric Hospital. A total of 129 patients with RS treated with CPAP and/or MDO from 2009 to 2019 were reviewed. Subjects receiving baseline and at least one follow-up polysomnogram were included. 55 who underwent MDO ± CPAP and 9 who received CPAP-only treatment were included. Patient characteristics, feeding, and polysomnographic data were compared and generalized linear mixed modeling performed. Baseline obstructive apnea–hypopnea index (OAHI) was greater in the MDO-treated group (median x˜ = 33.7 [interquartile range: 26.5-54.5] than the CPAP-treated group (x˜ = 20.3[13.3-36.7], P ≤ .033). There was significant reduction in OAHI following treatment with CPAP and MDO modalities, P ≤ .001. SpO2 nadir after MDO was lower in syndromic (x˜ = 85.0[81.0-87.9] compared to nonsyndromic patients (x˜ = 88.4[86.8-90.5], P ≤ .005.) CPAP was utilized following MDO in 2/24 (8.3%) of nonsyndromic and 16/31 (51.6%) of syndromic subjects ( P ≤ .001,) for a median duration of 414 days. Three patients (5%) underwent tracheostomy, all had MDO. Nasogastric tube feeding at hospital discharge was more common following MDO (44, 80%) than CPAP-only (4, 44.4%, P ≤ .036), but did not differ at 6-month follow-up ( P ≥ .376). CPAP appears to effectively reduce obstructive apnea in patients with RS and moderate TBAO and be a useful adjunct in syndromic patients following MDO with improved but persistent obstruction.

Objective:To assess the clinical impact of contaminated blood cultures in hospitalized patients during a period when rapid diagnostic testing using a FilmArray Blood Culture Identification (BCID) panel was in use.Design:Retrospective cohort study.Setting:Single academic medical center.Participants:Patients who had blood culture(s) performed during an admission between June 2014 and December 2016.Methods:Length of hospital stay and days of antibiotic therapy were assessed in relation to blood-culture contamination using generalized linear models with univariable and multivariable analyses.Results:Among 11,474 patients who had blood cultures performed, the adjusted mean length of hospital stay for patients with contaminated blood-culture episodes (N = 464) was 12.3 days (95% confidence interval [CI], 11.4–13.2) compared to 11.5 days (95% CI, 11.0–11.9) for patients (N = 11,010) with negative blood-culture episodes (P = .032). The adjusted mean durations of antibiotic therapy for patients with contaminated and negative blood-culture episodes were 6.0 days (95% CI, 5.3–6.7) and 5.2 days (95% CI, 4.9–5.4), respectively (P = .011).Conclusions:Despite the use of molecular-based, rapid blood-culture identification, contamination of blood cultures continues to result in prolonged hospital stay and unnecessary antibiotic therapy in hospitalized patients.

Parental monitoring is important to help comprehending the conduct problems with children; it truly is widely recognized being a possibility element for the development regarding child as well as teenage conduct problems. Current study was directed to examine relationship between parental monitoring and conduct disorder among children. The sample of 100 children (50 boys and 50 girls) was select randomly and their mothers were approached from different schools of Multan. Disruptive Behavior Disorder Rating Scale (Malik, T.A, 2011) and Parental Monitoring Scale (Capaldi& Patterson, 1989) were used. Research finding showed that parental monitoring has significant effect on conduct disorder. Findings of research study depicted that a significant negative correlation between parental monitoring and conducts disorder. The finding depicted to socioeconomic status showed that children with high and low socioeconomic status have significant differences on the level of parental monitoring and conduct disorder. The findings pertaining to educational differences showed that educated and uneducated mother of children have significant differences on the level of parental monitoring and conduct disorder. The findings showed that mother’s work status has significant differences on the level of parental monitoring and conduct disorder among children and the findings pertaining that mother's age have significant differences on the level of parental monitoring and conduct disorder.

In 2009, a paper was published suggesting that watersheds provide a geospatial platform for establishing linkages between aquatic contaminants, the health of the environment, and human health. This article is a follow-up to that original article. From an environmental perspective, watersheds segregate landscapes into geospatial units that may be relevant to human health outcomes. From an epidemiologic perspective, the watershed concept places anthropogenic health data into a geospatial framework that has environmental relevance. Research discussed in this article includes information gathered from the literature, as well as recent data collected and analyzed by this research group. It is our contention that the use of watersheds to stratify geospatial information may be both environmentally and epidemiologically valuable.

To determine the frequency of gynaecological factors leading to chronic pelvic pain via diagnostic laparoscopy. To see the association of these factors with demographic variables of the patients.Fifty patients underwent the study over a period of 1.5 years from 1st January 2007 to 30th June 2008 at the Department of Gynaecology and Obstetrics, Jinnah Postgraduate Medical Centre, Karachi. All patients fulfilling inclusion criteria were admitted via Out Patient Department, underwent initial investigations and later Diagnostic Laparoscopy.Twenty nine patients were in 25-34 years age group and had parity between 1 to 5, and 56% of the patients belonged to poor socioeconomic and educational status. Pelvic Inflammatory disease was the most frequently found gynaecological etiology of Chronic Pelvic Pain (20% of patients) followed by endometriosis (14%) and Pelvic Congestion Syndrome (12%).Chronic Pelvic Pain is a common problem of women with multifactorial etiology. Laparoscopy was found be very effective in diagnosing the various gynaecological causes of the disorder.