The principal pathways serving higher visual function comprise the dorsal stream and the ventral stream. The dorsal stream runs between the occipital lobes and the parietal lobes and subserves the ability to process the whole visual scene and carry out visually guided movement. The ventral stream runs between the occipital lobes and temporal lobe tissue and primarily subserves visual recognition and memory. These tissues are susceptible to dysfunction in children with brain damage. We report a series of 40 children in whom damage to the brain has led to a common symptom complex affecting vision. Lower visual field loss was frequently elicited. This was associated with impaired ability to make accurate visually guided movement (particularly of the lower limbs) accompanied by impaired simultaneous perception, and in some cases, with inaccurate saccades and in others, impaired perception of movement. These features are consistent with parietal/ dorsal stream dysfunction. Difficulty recognising faces and problems with route finding (which are ventral stream functions)were also present in a number of the children. These visual difficulties can be manifest in the presence of normal visual acuity. Recognition of these problems leads to understanding of the child's visual difficulties and facilitates adaptation of curriculum delivery at school.
Context: Antibiotic treatment duration for bloodstream infections (BSIs) is an area of controversy and uncertainty. Aims: Our objective was to assess antibiotic treatment duration practices for critically ill patients with BSIs in Kuwait. Subjects and Methods: A survey consisting of clinical scenarios followed by questions about recommended antibiotic treatment duration for each scenario was sent to Kuwaiti infectious diseases, critical care specialists, and anesthetists with critical care experience. Statistical Analysis Used: Descriptive analysis (medians and interquartile ranges) and Kruskal–Wallis test were used for statistical analysis. Results: The survey response rate was 68% (112/164). The median (interquartile range [IQR]) ranges for antibiotic duration recommendations were similar for each bacteremic syndrome: central line-associated BSIs, 10 days (7–14); pneumonia, 10 days (7–14); urinary tract infection, 10 days (7–14); intra-abdominal infection, 10 days (7–14); and skin and soft-tissue infection, 10 days (7–14). The median (IQR) antibiotic durations for the following bacteria were as follows: Staphylococcus aureus, 14 days (10–14); extended-spectrum beta-lactamase Escherichia coli, 10 days (7–14); multidrug-resistant (MDR) Pseudomonas aeruginosa, 14 days (10–14); MDR Acinetobacter baumannii, 14 days (10–14); vancomycin-resistant Enterococcus faecalis, 14 days (10–14); carbapenem-resistant Klebsiella pneumoniae, 14 days (10–14); and coagulase-negative Staphylococcus, 7 days (7–10). For all infectious syndromes and individual organisms, duration responses often followed discrete choices of 5, 7, 10, and 14 days. Prolonging antibiotic therapy for immunocompromised patients was favored among 70% of respondents. Conclusions: This survey demonstrates practice variation in treating BSIs and supports the need for adequately powered randomized controlled trials assessing optimal antibiotic duration for various bacteremic syndromes, pathogens, and resistance patterns.
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