Acta clinica Croatica
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Acta clinica Croatica · Sep 2020
Antibiotic Consumption in Hospitals and Resistance Rate of Klebsiella pneumoniae and Escherichia coli in Montenegro.
Inappropriate use of antibiotics leads to an increase in antibiotic resistance. Infections caused by antibiotic-resistant gram-negative bacteria are a serious threat to public health. This study aimed to compare data on inpatient antibiotic consumption with antimicrobial resistance (AMR) rate of Klebsiella pneumoniae and Escherichia coli invasive strains in Montenegro and provide targets for improving antibiotic use. ⋯ The highest resistance rates were recorded for Klebsiella pneumoniae to ceftriaxone, ceftazidime and gentamicin (93.59%, 90.79% and 89.87%, respectively), and Escherichia coli to aminopenicillins, ceftriaxone and ceftazidime (89.06%, 70.15% and 61.54%, respectively). High consumption of broad-spectrum antibiotics in Montenegro is accompanied by the high rate of resistance of Klebsiella pneumoniae and Escherichia coli to these agents. Antibiotic misuse demands the introduction of an antimicrobial stewardship program in Montenegrin hospitals.
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Acta clinica Croatica · Sep 2020
Case ReportsTRANS-ENDOSCOPIC TREATMENT OF CRANIOPHARYNGIOMA AND RECOVERY FROM BLINDNESS IN ADULT PATIENT - A CASE REPORT.
We report a case of trans-endoscopic transventricular approach to a large cystic craniopharyngioma. Surgery was performed three days after visual acuity on both eyes deteriorated to blindness. Magnetic resonance imaging before surgery revealed a large lesion in the suprasellar region that severely compressed the optic chiasm and displaced the third ventricle upward. ⋯ Postoperatively, visual acuity significantly improved on one eye. Our case shows that this minimally invasive technique is safe and effective and can be an alternative treatment for large cystic craniopharyngiomas. The reported case also shows that loss of vision can still be recovered even after the 72-hour period in adults.
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Acta clinica Croatica · Sep 2020
Case ReportsAtypical adult-onset subacute sclerosing panencephalitis.
Although subacute sclerosing panencephalitis is almost exclusively a childhood disease, it can occur in adults as well. We present an atypical case of adult-onset subacute sclerosing panencephalitis. The disease was characterized by prolonged insidious course followed by accelerated and aggressive phase, atypical EEG findings, and absence of myoclonic jerks. The diagnostic and treatment-related pitfalls are discussed.
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Acta clinica Croatica · Sep 2020
Case ReportsVancomycin-resistant Enterococcus faecium COLONIZATION and Clostridium difficile infection in a HEMATOLOGIC patient.
Vancomycin-resistant enterococci (VRE), especially Enterococcus faecium, have emerged as significant nosocomial pathogens and patients with impaired host defenses are at a particular risk of VRE infection. The most common occurrence is asymptomatic colonization of the gastrointestinal tract that can persist for a long time and serve as a reservoir for transmission of VRE to other patients. We present a case of a patient who was diagnosed with acute myelogenous leukemia and suffered from bone marrow aplasia following induction therapy. ⋯ This case also highlights the role of risk factors that could contribute to development of resistance, particularly CDI. Early detection of VRE colonization or infection is a crucial component in hospital program designed to prevent transmission of nosocomial infections. Surveillance cultures of such patients should be mandatory.
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Acta clinica Croatica · Sep 2020
Case ReportsCOMPLETE ATRIOVENTRICULAR BLOCK AND ASYSTOLE DURING EPILEPTIC SEIZURE: A CASE REPORT.
Cardiac arrhythmias during or after epileptic seizures are one of the possible pathomechanisms of sudden unexpected death in epilepsy. These arrhythmogenic epilepsies are most commonly associated with sinus tachycardia, but atrioventricular block and asystole can also be seen. Although a rare occurrence, these arrhythmias can lead to significant morbidity and mortality, but also can be potentially preventable with pacemaker implantation. Here we describe a patient with recurrent epileptic seizures, diagnosed with ictal third-degree atrioventricular block and asystole during seizure, which required a permanent cardiac pacemaker.