Mercy General Hospital

Pseudomonas mendocina, a Gram-negative, aerobic bacillus, has rarely been implicated in human infections. This report details the first documented case of catheter-associated urinary tract infection (CAUTI) caused by P. mendocina in a COVID-19-positive patient. We present the case of a 70-year-old male with obstructive uropathy who presented with altered mental status eight days after testing positive for COVID-19. Urine cultures identified P. mendocina and Enterococcus faecalis. The antibiotic regimen was adjusted to cefepime and fosfomycin for coverage against P. mendocina and E. faecalis, respectively, resulting in the patient's improvement and discharge with an outpatient course of ciprofloxacin. However, the patient was readmitted 12 days later for recurrent symptoms and traumatic catheter removal, requiring nephrostomy tube placement. Follow-up revealed severe bladder and prostate abnormalities, confirming a complex interplay of factors contributing to his infection. P. mendocina is a rare opportunistic pathogen, often occurring in patients with pre-existing health conditions. This case is significant as the first CAUTI caused by P. mendocina and highlights potential links between COVID-19 and increased susceptibility to bacterial infections. The patient's comorbidities, particularly obstructive uropathy, and prolonged catheter use, were likely major factors in his infection. The role of COVID-19 in facilitating bacterial colonization remains speculative but warrants further investigation. This case report underscores the need for heightened clinical awareness and prompt intervention in patients with similar risk factors. The successful treatment regimen provides a valuable reference for managing such infections. Further research is needed to explore the interplay between viral and bacterial infections, particularly in the context of COVID-19.

Abstract BACKGROUNDPulsed field ablation (PFA) is a non-thermal ablative strategy that achieves cell death via electroporation. We investigated the preclinical safety and efficacy of PFA using two novel 8-French, 16-electrode spiral PFA/mapping catheters (CRC EP, Inc).METHODSBipolar PFA (>1.8 kV) was performed using 30 s, single-shot, QRS-gated applications. Ninety-four atrial structures were ablated in 23 swine, 1 canine, and 1 ovine, including right and left atria and atrial appendages, pulmonary veins, and superior and inferior (IVC) vena cavae. Additionally, we examined the impact of PFA on the phrenic nerve in 14 swine and on a deviated esophagus during ablation from inside the IVC in 5 swine.RESULTSAll applications were single-shot without repositioning the catheter. Minimal microbubbling was observed without significant skeletal muscle twitching/activation (mean acceleration: 0.05 m/s2). There was marked reduction in the post-versus pre-PFA atrial electrogram amplitude (0.17±0.21 mVvs. 1.18±1.08 mV; P<0.0001). Durable conduction block was demonstrated up to 3 months in all targeted tissues. Lesions were contiguous and transmural, measuring 25±9 mm x 21±7 mm without any thermal effects. Magnetic resonance, gross, and histologic examinations of the brain, rete mirabile and kidneys revealed no thromboembolism. No acute/long-term phrenic nerve dysfunction was encountered. Though within 2 hours of ablation, histologic examinations of the esophagus revealed acute PFA-related changes in the muscular layer, these completely resolved by 21±5 days.CONCLUSIONA novel, single-shot, spiral PFA system is capable of safely creating large, durable atrial lesions without significant adverse effects on the phrenic nerve or the esophagus.

IntroductionDuring radiofrequency ablation (RFA) using conventional RFA catheters (RFC), ~90% of the energy dissipates into the bloodstream/surrounding tissue. We hypothesized that a novel insulated‐tip ablation catheter (SMT) capable of blocking the radiofrequency path may focus most of the energy into the targeted tissue while utilizing reduced power and irrigation.MethodsThis study evaluated the outcomes of RFA using SMT versus an RFC in silico, ex vivo, and in vivo. Radiofrequency applications were delivered over porcine myocardium (ex vivo) and porcine thigh muscle preparations superfused with heparinized blood (in vivo). Altogether, 274 radiofrequency applications were delivered using SMT (4–15 W, 2 or 20 ml/min) and 74 applications using RFC (30 W, 30 ml/min).ResultsRFA using SMT proved capable of directing 66.8% of the radiofrequency energy into the targeted tissue. Accordingly, low power–low irrigation RFA using SMT (8–12 W, 2 ml/min) yielded lesion sizes comparable with RFC, whereas high power–high irrigation (15 W, 20 ml/min) RFA with SMT yielded lesions larger than RFC (p < .05). Although SMT was associated with greater impedance drops ex vivo and in vivo, ablation using RFC was associated with increased charring/steam pop/tissue cavitation (p < .05). Lastly, lesions created with SMT were more homogeneous than RFC (p < .001).ConclusionLow power–low irrigation (8–12 W, 2 ml/min) RFA using the novel SMT ablation catheter can create more uniform, but comparable‐sized lesions as RFC with reduced charring/steam pop/tissue cavitation. High power–high irrigation (15 W, 20 ml/min) RFA with SMT yields lesions larger than RFC.

Although it is not a very common condition, people who have suffered from neuro-damage or neuro-diseases are at risk for developing a condition known as Alien hand syndrome (AHS). Individuals who have this condition are unable to control the movement of their hands for certain brief intervals of time. In order to improve upon the treatment of individuals with AHS, it is important that signs and symptoms of the disease are identified as soon as possible. The purpose of this investigation is to catalog the data regarding the pre-existing conditions and the method of diagnosis for AHS. Within the review, it was revealed that stroke was the most common pre-existing condition for the disease. Therefore, physicians who have stroke patients within their care should carefully monitor their condition in case they do develop AHS. Additionally, it was found that using an MRI machine was the most common method of diagnosing a patient with AHS. This was most likely because MRI scans provide the most information about a patient’s brain functionality which can be used to deduce if an individual has AHS.

A cataract is the primary cause of preventable blindness and is characterized by a congenital, developmental, or acquired opacity of the human lens. Cataracts are predominantly treated through surgical procedures utilizing a combination of anesthetic agents such as proparacaine to reduce patient discomfort. Proparacaine is used to inhibit voltage-gated sodium channels on neuronal membranes to prevent signal propagation and pain signaling in the patient. Current clinical standards call for the utilization of 0.5% proparacaine when used for local anesthesia in cataract surgeries. In this review, the authors extracted the reported application site and concentrations of proparacaine in conjunction with various combination agents to accurately describe its usage in cataract surgery. It was found that most surgeons adhered to the standard concentrations of proparacaine and generally used tropicamide, an eye dilator, as a combination agent in cataract surgery. Additionally, surgeons preferred anesthetic application to the retrobulbar block. The authors find that although surgeons are following standard protocol, adjustments for lowering the standard dose of proparacaine could prove beneficial in preventing proparacaine toxicity. Furthermore, the authors find that more research can be conducted in the future examining other combination agents for use with proparacaine to improve patient outcomes.

Nocardia species are difficult to identify, saprophytic, aerobic actinomycetes that are associated with high mortality rates and primarily affect immunocompromised hosts. Recently, the number ofdiagnoses of Nocardia cyriacigeorgica has grown in the United States, yet complicated clinical diagnosis and costly identification methods presume an underestimation of its presence in patients. We describe a case of brain abscess secondary to a pulmonary infection in an elderly, diabetic, Afghani man with an extensive history of chewing tobacco use.

Abstract Importance: Abnormal left ventricular (LV) diastolic function, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). The association of diastolic function with duration of hospital stay after coronary artery bypass (CAB) is unknown. Objective: To determine if abnormal LV diastolic function (diastolic dysfunction) is associated with length of hospital stay after coronary artery bypass surgery (CAB). Design: Prospective observational studySetting: A single tertiary academic medical centerParticipants: Patients with normal systolic function undergoing isolated CAB from September 2017 through June 2018. Exposures: LV function during diastole, as assessed by intra-operative TEE prior to coronary revascularization. Main Outcomes and Measures: The primary outcome was duration of postoperative hospital stay. Secondary intermediate outcomes included common postoperative cardiac, respiratory, and renal complications. Results: The study included 176 participants (mean age 65.2 +/- 9.2 years, 73% male); 106 (60.2%) had LV diastolic dysfunction. Median time to hospital discharge was significantly longer for subjects with diastolic dysfunction (9.1/IQR 6.6-13.5 days) than those with normal LV diastolic function (6.5/IAR 5.3-9.7days) (P&lt; 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47-0.93) for subjects with diastole dysfunction, independent of potential confounders, including a baseline diagnosis of heart failure. There was a dose-response relation between severity of diastolic dysfunction and probability of discharge. LV diastolic dysfunction was also associated with postoperative cardio-respiratory complications; however, these complications did not fully account for the relation between LV diastolic dysfunction and prolonged length of hospital stay.Conclusions and Relevance: In patients with normal systolic function undergoing CAB, diastolic dysfunction is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications.