No abstract

Pulmonary artery aneurysms (PAAs) are defined as having pulmonary artery diameter of greater than 40 mm. PAAs are rare and can occur in various pulmonary diseases. There are no clear-cut guidelines regarding the management of PAAs, and recommendations for management are made based on expert consensus opinion, case reports, and institutional experience. This series highlights three patients with pulmonary hypertension (PH) and PAA. The clinical course and diagnostic findings and the decision-making involved in the treatment are reviewed. An overview of three distinct management strategies including medical management, heart/lung transplant, and surgical aneurysm repair is presented.

ObjectivesThe objective of this study was to determine the awareness among healthcare professionals regarding stethoscopes as a source of nosocomial infections, their cleaning practices in this regard before or after examination, and to find out about the existence of any guidelines and accountability criteria issued by the hospitals in this regard.MethodologyA descriptive cross-sectional study of 243 healthcare professionals using non-probability convenience sampling was done to include consultants, residents, final-year medical students, and nursing staff and excluding medical students from pre-clinical years as well as doctors of those departments with infrequent use of a stethoscope. The study was conducted for a period of nine months at tertiary health care facilities of Rawalpindi and Islamabad. A self-administered structured questionnaire was used for data collection.ResultsParticipants from both genders included 54 participants (22.2%) from the final year, 48 (19.8%) house officers, 106 (43.6%) postgraduate trainees, nine (3.7%) specialists, and 26 (10.7%) nurses. A total of 210 (86.4%) were aware of stethoscopes as a source of nosocomial infections. Among participants, 23 (9.5%) cleaned their stethoscope per patient, 50 (20.6%) did it daily, 48 (19.8%) did it weekly, 41 (16.9%) did it monthly, 12 (4.9%) participants cleaned it six-monthly while 69 (28.4%) respondents had never cleaned their stethoscope. Almost 127 participants (52.3%) used alcohol wipes to clean their stethoscopes, 11 (4.5%) used a wet cloth, six (2.5%) used tissue paper. Sixty-one (24.9%) agreed that the hospital issued protocols for the decontamination of stethoscopes while 189 (77.8%) did not. A total of 241 (99.2%) believed that there were no accountability criteria set for the assessment of the cleanliness of stethoscopes in their hospitals.ConclusionA majority of the participants were aware of stethoscopes being a source of nosocomial infections and believed in cleaning stethoscopes regularly. However, a majority of the participants believed that their hospital did not issue any protocols for the decontamination of stethoscopes. Further research can expand our recommendations.

Drug use is a major challenge that negatively impacts many aspects of health. The issue of drug use is growing with every passing day. Efforts to mitigate its use are countered by even more people succumbing to the intravenous drug use due to their relatively easy availability and patients' poor insight into their medical condition. Infective endocarditis (IE) is a condition with high mortality and morbidity. It requires prolonged treatment with antibiotics, and, under some special circumstances, surgical management is also necessitated. Intravenous drug users who get valve replacement after index IE episode may continue to use drugs despite our utmost efforts to prevent it. They can subsequently develop prosthetic valve endocarditis (PVE), which is one of the indications for surgical valve replacement, hence requiring a redo surgery. However, their irregular behavior can create reservations while considering a repeat valvular surgery and delay the appropriate treatment. This can increase morbidity and mortality from PVE in intravenous drug users with otherwise no or few comorbidities.

Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.