OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.

Cyclodestructive techniques have been a treatment option for refractory glaucoma since its first use in the 1930s. Over the past nine decades, cyclodestruction has advanced from the initial cyclodiathermy to micropulse transscleral cyclophotocoagulation (MP-TSCPC) which is the current treatment available. Complications associated with cyclodestruction including pain, hyphema, vision loss, hypotony and phthisis have led ophthalmologists to shy away from these techniques when other glaucoma treatment options are available. Recent studies have shown encouraging clinical results with fewer complications following cyclophotocoagulation, contributing greatly to the current increase in the use of cyclophotocoagulation as primary treatment for glaucoma. We performed our literature search on Google Scholar Database, Pubmed, Web of Sciences and Cochrane Library databases published prior to September 2017 using keywords relevant to cyclodestruction, cyclophotocoagulation and treatment of refractory glaucoma.

Community-acquired pneumonia (CAP) exhibits mortality rates, between 20% and 50% in severe cases. Biomarkers are useful tools for searching for antibiotic therapy modifications and for CAP diagnosis, prognosis and follow-up treatment. This non-systematic state-of-the-art review presents the biological and clinical features of biomarkers in CAP patients, including procalcitonin, C-reactive protein, copeptin, pro-ANP (atrial natriuretic peptide), adrenomedullin, cortisol and D-dimers.

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Précis: A modification to the surgical technique of Ahmed glaucoma valve (AGV) implantation without plate sutures or surgical glue products has a similar safety and efficacy profile than the standard procedure, in the short and mid-term follow-up. Purpose: The purpose of this study was to assess the safety and efficacy of a modified AGV implantation technique without plate sutures. Methods: A retrospective case-control study including patients seen in the Glaucoma service of an academic institution. Patients that underwent a modified AGV implantation without plate sutures were included as cases and patients that underwent standard AGV implantation, as controls. Success was defined as intraocular pressure (IOP) reduction >20%, IOP >5 and <21 without the need for additional surgical intervention, and maintenance of light perception. Results: A total of 170 eyes were included. Mean (range) follow-up was 11.2±7.39 (3 to 24) months. There was no statistically significant difference in visual acuity and IOP between the groups during the postoperative period. In a univariate analysis, there was a larger decrease in IOP for the no plate suture group at the 6 months (−15.6±11.6 vs. −11.5±10.5, P=0.04) and 1 year (−16.4±10.4 vs. −11.1±10.4, P=0.02) visits. There was also a larger decrease in number of medications in the no plate suture group in the 3 months (−1.65±1.5 vs. −1.13±1.22, P=0.02), 6 months (−1.55±1.44 vs. −0.98±1.3, P=0.01) and 1 year (−1.70±1.5 vs. −1.04±1.2, P=0.04) visits. However, those differences were not confirmed by a multivariable model after adjusting for glaucoma type and number of previous glaucoma surgeries. No differences in the trajectory of the survival curves were noted between groups (P=0.36). Conclusion: The comparison of short and mid-term outcomes of patients undergoing AGV implantation using both techniques showed similar outcomes and success rates.