Aventura Hospital and Medical Center

BackgroundImipenem/relebactam (I/R) demonstrates potent in vitro activity against multidrug-resistant (MDR) Pseudomonas aeruginosa. The objective of this study was to evaluate the effectiveness of I/R for treatment of MDR P. aeruginosa infections across the U.S.Table 1.Detailed inclusion and exclusion criteria for patients receiving I/R1 Pneumonia was defined as the presence of a new or progressive infiltrate with at least one of the following: purulent tracheal secretions, worsening cough or dyspnea, PaO2/FiO2 < 200 with PEEP ≥5 cm H2O, fever (≥38°C) or hypothermia (≤35°C), leukocytosis (≥10,000 white blood cells per µL), or tachypnea (respiratory rate >30 beats per minute).2 MDR was defined as non-susceptibility to at least one agent in three or more antibiotic classes.Table 2.Patient demographics, underlying diseases, severity of illness, and treatment characteristics of patients treated with I/R for pneumonia or bacteremia.*Other immunocompromising conditions included bone-marrow transplant, chronic steroid use, neutropenia, and AIDS.Abbreviations: IQR = interquartile rangeMethodsThis was a retrospective, multicenter, observational study of I/R for MDR P. aeruginosa pneumonia and bacteremia. Patients were included if they received I/R for >48h initiated within 7 days of the index MDR P. aeruginosa culture (Table 1). Clinical success was defined as survival, resolution of signs and symptoms of infection, completion of the intended treatment course, and the absence of a recurrent infection due to MDR P. aeruginosa. I/R susceptibility was determined by site-level microbiology labs; non-susceptibility was defined by the Clinical and Laboratory Standards Institute (CLSI) criteria.Table 3.Real-world characteristics of I/R use in pneumonia and bloodstream infections.1 I/R treatment was discontinued in one patient with acute interstitial nephritisTable 4.Clinical outcomes of patients treated with I/R for MDR P. aeruginosa pneumonia or bacteremia1 Non-susceptibility was defined as a categorical change from susceptible to non-susceptible as defined by CLSI interpretive criteria. Among the 16 cases meeting this criteria, non-susceptibility was identified by gradient strip testing and broth microdilution in 25% and 75%, respectively. The median I/R MICs for isolates categorized as susceptible and non-susceptible were 2 and 8 mg/L, respectively.Results64 patients from 10 centers were included (Table 2); patients from 6 additional centers were screened and did not meet inclusion criteria. The overall cohort was critically-ill; 80%, 75%, and 48% were in the intensive care unit, receiving mechanical ventilation, and on vasopressors, respectively. The median (interquartile range; IQR) SOFA score was 7 (5 – 12). 53% received treatment with another new β-lactam for MDR P. aeruginosa infections prior to I/R. The median time to I/R initiation was 67 hours. I/R treatment was primarily prescribed based on susceptibility results in 75% of patients, including resistance to other novel β-lactam agents (Table 3). 63% of patients completed the intended I/R treatment course as planned. At day 7 and 30, 80% and 55% met criteria for clinical success, respectively (Table 4). The overall 30- and 90-day mortality rates were 17% and 30%, respectively. Recurrent infections were documented in 38% of patients within 90 days.ConclusionIn this critically-ill patient population we found that I/R was often used following treatment with other novel β-lactams. Clinical outcomes were generally comparable to those previously reported in similar real-world studies for other novel β-lactam agents suggesting that I/R plays a role in treatment of MDR P. aeruginosa infections, particularly when other agents are not available or test resistant.Disclosuresjason M. Pogue, PharmD, Entasis: Advisor/Consultant|Entasis: Grant/Research Support|GlaxoSmithKline: Advisor/Consultant|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support Alexander J. Lepak, MD, FIDSA, BioMerieux: Grant/Research Support William R. Miller, M.D., Merck: Grant/Research Support|UpToDate: Royalties, topic author Jeffrey C. Pearson, PharmD, InflaRx Pharmaceuticals, Inc.: Advisor/Consultant Emre Yucel, PhD, Merck & Co., Ltd: Stocks/Bonds (Public Company)

This article examines the nature and functioning of trust signals in digital branding, focusing on visual identity and social proof. The relevance of the study is driven by increasing consumer dependence on online platforms, where a brand’s ability to establish credibility quickly is a decisive competitive advantage. The methodology is based on comparative analysis, structural modeling, and case studies of educational platforms. The author analyzes how design, logos, and social signals (reviews, endorsements) influence users. A three-tier architecture of trust is formulated, comprising visual, social, and institutional signals. Using Coursera as a case study, the article demonstrates the transformation of a brand into a trusted infrastructure. A framework for evaluating the effectiveness of trust signals is proposed, taking into account cultural contexts and ethical challenges. The results emphasize that digital trust is a function of alignment between visual coherence, social validation, and institutional integrity.

Herpes simplex encephalitis is most commonly caused by herpes simplex virus type 1 (HSV-1) and is believed to result from retrograde transport along the trigeminal and olfactory nerves into the central nervous system. This case report presents a 73-year-old female who arrived at the emergency department following the acute onset of confusion before an elective outpatient procedure. Her initial physical examination and diagnostic workup were unremarkable. By day six of hospitalization, the patient became progressively obtunded, with significant clinical deterioration marked by a Glasgow Coma Scale score of 5 and recurrent episodes of high-grade fever. Magnetic resonance imaging revealed inflammation and hyperintensities in the right frontotemporal lobes, highly suggestive of HSV encephalitis, and cerebrospinal fluid analysis confirmed HSV-1 infection. This case report discusses the rapid clinical progression of HSV-1 encephalitis, highlights potential complications, and reviews the acute management of a patient with a poor prognosis.

We present the case of a 68-year-old male with a history of hypertension, prostate cancer, and glioblastoma, who presented for inferior vena cava (IVC) filter placement due to a deep venous thrombosis (DVT) with elevated thromboembolic risk and a contraindication to anticoagulation secondary to fall risk from ataxia. Pre-procedural imaging revealed a rare double IVC variant with a mega cava configuration above the confluence - a condition that can complicate vascular interventions and increase thromboembolic events. The anatomical variation made a single IVC filter infeasible due to size constraints and instead prompted the use of dual IVC filters, one in each IVC, to ensure protection against pulmonary embolism. A double IVC occurs when there is persistence of the bilateral supracardinal veins during embryogenesis. In cases of mega cava (diameter >28 mm), conventional IVC filters are ineffective. This case involved the placement of two filters to optimize protection against pulmonary embolism due to the large IVC diameter, with the option of a Bird's Nest filter as an alternative approach. Dual filters were chosen, as they effectively covered both venous channels while offering retrievability, compared to the Bird's Nest filter, which is permanent and may pose a higher risk of complications, including migration or IVC perforation. This case adds to the current knowledge base by demonstrating that dual IVC filter placement is an effective strategy for managing patients with a double IVC and mega cava when single filter placement is not possible. This case highlights the importance of recognizing and managing unique anatomical variations in IVC filter placement. Endovascular surgery requires a strategic approach, utilizing pre-procedural imaging to plan the next steps and optimize thromboembolic protection.

Olives, a staple of Mediterranean culture, hold significant historical, spiritual, and cultural importance, particularly in Islamic traditions. This review explores the use of olives and their derivatives in complementary and alternative medicine, focusing on dermatological applications. A systematic literature review using EMBASE and PubMed databases, adhering to PRISMA guidelines, identified 44 articles for inclusion. Olive oil demonstrated effectiveness in reducing erythema, scaling, and pain associated with radiation and contact dermatitis, and in managing symptoms of atopic dermatitis and psoriasis through modulation of inflammatory pathways. It also promoted wound healing, benefiting patients with pressure ulcers, chronic wounds, and burns. Additionally, the Mediterranean diet, rich in olives, was linked to reduced inflammation in conditions like cystic acne and hidradenitis suppurativa. These dermatological benefits are attributed to the antioxidant and anti-inflammatory properties of olive's phenolic compounds. This review highlights olives’ potential in dermatology as a natural, affordable treatment option, encouraging further research into their therapeutic applications.

The emergence of immunotherapies has revolutionized cancer treatment by leveraging the immune system to target malignancies, offering new hope where traditional therapies often fall short. Within this context, hyperthermia (HT) has re-emerged as a promising adjunctive treatment, capable of enhancing the effectiveness of radiotherapy, chemotherapy, and immunotherapy. HT influences both the innate and adaptive immune systems, enhancing the activity of immune cells such as neutrophils, NK cells, and dendritic cells, while also modulating the tumor microenvironment (TME) to promote immunogenic cell death (ICD) and reduce immunosuppressive conditions. These effects contribute to the transformation of immunologically "cold" tumors into "hot" tumors, making them more susceptible to immune-mediated destruction. Furthermore, HT can amplify the efficacy of immune checkpoint inhibitors (ICIs) by improving immune cell infiltration, inducing damage-associated molecular pattern (DAMP) release, and enhancing antigen presentation. Preclinical and clinical studies support the combination of HT with ICIs, demonstrating improved outcomes in otherwise resistant tumors. However, the full therapeutic potential of the different technologies allowing to apply HT remains to be fully understood, and further research is needed to optimize treatment protocols, explore the differential impacts of local versus whole-body hyperthermia, and identify biomarkers for patient stratification. This review underscores the multifaceted role of HT in immunity and its potential to significantly enhance the efficacy of immunotherapy.

EUS-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stents (LAMS) has excellent technical and short-term clinical success for acute cholecystitis (AC). The goals of this study were to determine the long-term clinical outcomes and adverse events (AEs) of EUS-GBD with LAMS. A multicenter, retrospective study was conducted at 18 US tertiary care institutions. Inclusion criteria: any AC patient with attempted EUS-GBD with LAMS and minimum 30-day post-procedure follow-up. Long-term clinical success was defined as absence of recurrent acute cholecystitis (RAC) > 30 days and long-term AE was defined as occurring > 30 days from the index procedure. A total of 109 patients were included. Technical success was achieved in 108 of 109 (99.1%) and initial clinical success in 106 of 109 (97.2%). Long-term clinical success was achieved in 98 of 109 (89.9%) over a median follow-up of 140 days (range 30-1188). On multivariable analysis (MVA), acalculous cholecystitis (odds ratio [OR] 15.93, 95% confidence interval [CI] 1.22-208.52, P = 0.04) and the occurrence of a LAMS-specific AE (OR 63.60, 95% CI 5.08-799.29, P <0.01) were associated with RAC. AEs occurred in 38 of 109 patients (34.9%) at any time, and in 10 of 109 (9.17%) > 30 days from the index procedure. Most long-term AEs (7 of 109; 6.42%) were LAMS-specific. No technical or clinical factors were associated with occurrence of AEs. LAMS were removed in 24 of 109 patients (22%). There was no difference in RAC or AEs whether LAMS was removed or not. EUS-GBD with LAMS has a high rate of long-term clinical success and modest AE rates in patients with AC and is a reasonable destination therapy for high-risk surgical candidates.