Airway fire due to diathermy during tracheostomy in an intensive care patient

We describe a case of airway fire in an 83-year-old, critically ill patient. The fire occurred during a surgical tracheostomy under general anaesthesia, following ignition of the tracheal tube by diathermy. After debridement of the burnt tissue and treatment with intravenous antibiotics and glucocorticoids, the patient's respiratory function worsened initially. The patient eventually recovered without long-term sequelae and was discharged from the intensive care unit. The circumstances of this and other similar incidents are reviewed, as are the suggested methods for preventing this frightening occurrence.

Food Safety Concerns in Pakistan: Monitoring of Antimicrobial-Resistant Bacteria and Residue Contamination in Commercially Available Fish and Poultry Meat Samples

Food safety is a critical issue in the 21st century due to antibiotic-resistant bacteria causing harmful foodborne diseases. This comprehensive study meticulously examined the presence of bacterial isolates, quinolone residue, and antimicrobial resistance genes in samples of broiler and fish meat. Forty samples were collected from various locations in the Faisalabad metropolis. The samples underwent culture on various types of agar, and the Vitek 2 compact system was used to confirm the isolates along with determining the minimum inhibitory concentration of antibiotics. Additionally, polymerase chain reaction was used to identify antimicrobial-resistant genes, and an enzyme-linked immunosorbent assay (ELISA) kit was employed to detect quinolone residue in each sample. Out of 40 fish samples, 66 polymicrobials were identified with Escherichia coli being the most prevalent (26.6%), followed by Klebsiella pneumoniae (16.6%) and Acinetobacter baumannii (15%). Furthermore, 70 polymicrobial were identified in the broiler samples, with 41.6% E. coli and 15% K. pneumoniae. In fish isolates, 14 (21%) qnr gene, 18 (27.2%) blaCTX-M, and 11 (16.6%) blaNDM-1, and in broiler samples, 19 (27.1%) qnr gene, 19 (27.1%) blaTEM and 22 (31.4%) blaCTX-M, and 5 (7.1%) blaNDM-1 were found. Eighteen (45%) broiler and 7 (17.5%) fish samples with more than 100 µg per kg (ppb) for quinolone residues. The study concluded that the increased prevalence of multidrug-resistant bacteria and quinolone residue poses a significant threat to consumer health.

Salmonella typhi and endocarditis: a systematic review of case reports

Introduction

Salmonella typhi, a gram-negative bacterium responsible for typhoid fever, can infect the inner lining or valves of the heart and cause endocarditis. This systematic review aimed to report cases of S. typhi-associated endocarditis and its clinical features.

Methods

This systematic review was reported as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist. Only case reports and case series of endocarditis caused by S. typhi, irrespective of age, gender, and demographics, were considered eligible for inclusion. To identify relevant studies, a literature search was conducted using relevant keywords on PubMed, Google Scholar, and the Cochrane Library from inception to 31 December 2023. After selecting the studies, the relevant data were extracted and pooled in terms of frequencies and percentages. A quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.

Results

This review included seven case reports, comprising 22.2% female and 77.8% male patients. The mean age of patients was 27.9 + 12.0 years. Regarding past medical history, 33.3% (3/9) of patients had a previous cardiac pathology. Fever remained the most common complaint, occurring in 88.9% of cases. Transthoracic and transesophageal echocardiography were used to diagnose all cases, with 33.3% identifying vegetation on the mitral, aortic, and tricuspid valves. Ceftriaxone, with or without gentamycin, remained the choice of antibiotic for 88.9% of cases, and all patients responded to the offered treatment.

Conclusion

S. typhi-associated endocarditis, though rare, presents unique challenges and requires timely diagnosis. This systematic review of seven cases highlights a predominantly male population affected, with a mean age in the third decade, suggesting a higher invasiveness than other causes. The findings from this study underscore the importance of early recognition and appropriate management, primarily with antibiotic therapy. Further research with larger cohorts is crucial to refine understanding and guide policymaking for this rare but life-threatening condition.