OBJECTIVE:Antimicrobial resistance (AMR) is a major challenge in complicated urinary tract infections (cUTIs), particularly among high-risk patients in resource-limited settings. METHODS:This retrospective study (January 2019-December 2023) analyses 622 urine culture-positive samples from cUTI patients at a rehabilitation centre to investigate pathogen distribution, AMR patterns, and associations with clinical outcomes using descriptive statistics and regression models. RESULTS:Escherichia coli (46%) was the predominant isolate, followed by Klebsiella pneumoniae (16%). Although Enterococcus faecalis and Pseudomonas aeruginosa were less common, their prevalence increased over time. High resistance rates to ciprofloxacin and ceftriaxone were observed in E. coli (69.5%, 74.7%) and K. pneumoniae (60.2%, 58.1%). Carbapenem resistance emerged in P. aeruginosa (51.4%) and K. pneumoniae (37.5%), with prior antibiotic exposure identified as a significant predictor (OR: 2.15; 95% CI:1.33-3.47; P = 0.002). In contrast, E. coli and E. faecalis retained high susceptibility to nitrofurantoin and fosfomycin. Multidrug-resistant (MDR) infections were independently associated with prolonged hospital stay (β = 1.889; P = 0.045). CONCLUSIONS:The high prevalence of resistance to first-line agents and emergence of carbapenem resistance underscore the urgent need for antimicrobial stewardship (AMS) interventions. The study suggests specific hospital-setting AMS should be prioritized the judicious use of agents such as nitrofurantoin and fosfomycin, which retain clinical effectiveness. Addressing MDR is crucial as it represents a key modifiable determinant of length of hospital stay in patients with cUTI.
BACKGROUND Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by the accumulation of surfactant within the alveoli. Its reported prevalence ranges from 3.7 to 40 cases per million. Because of its rarity and nonspecific clinical presentation, PAP is frequently misdiagnosed as more common respiratory conditions such as recurrent pneumonia. Accurate etiological classification is essential but can be challenging in routine clinical practice. CASE REPORT We report the case of a 79-year-old female non-smoker who presented with dyspnea and a history of unsuccessfully treated multiple pneumonia episodes. A computed tomography (CT) scan revealed a crazy paving pattern. Bronchoscopy showed the bronchoalveolar lavage fluid (BALF) had a milky appearance and became progressively opaque upon standing. The diagnosis of PAP was made based on a characteristic CT pattern and typical BALF analysis. Anti-granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies were negative, excluding autoimmune PAP. Extensive evaluation did not identify secondary causes such as hematologic disorders, immunodeficiency, chronic infection, or relevant environmental exposure. Genetic testing for hereditary PAP was not available; therefore, this subtype could not be definitively excluded. The patient subsequently underwent whole-lung lavage (WLL), leading to resolution of her symptoms and radiological features after 6 months of follow-up. CONCLUSIONS PAP can present with nonspecific respiratory symptoms and be misdiagnosed as recurrent pneumonia. Diagnosis relies on characteristic CT findings and BALF analysis, while determination of the PAP subtype requires systematic exclusion of autoimmune and secondary causes. This case highlights the diagnostic challenges of PAP classification in routine clinical practice.
Abstract Background: The Colour Blind Quality of Life Scale (CBQoL) is a questionnaire developed to assess the quality of life of individuals with congenital colour vision deficiency (CVD). This study aimed to translate the English version of the CBQoL into Vietnamese and evaluate the validity and reliability of the Vietnamese version (CBQoL-VN). Methods: A forward-backward translation method was performed to produce the Vietnamese text. Content validity was assessed by six experts in vision care. Reliability testing involved 30 participants with congenital CVD, while discriminant validity was evaluated by comparing this group against 30 participants with normal colour vision. Results: Following expert consensus, two items were removed and one transportation-related item was added. The content validation index (CVI) values of 1.0 for relevance, clarity, and understandability indicated excellent content validity. Internal consistency was high, with a Cronbach’s alpha of 0.95 for the full scale. Discriminant validity analysis showed that participants with congenital CVD scored significantly lower across all CBQoL-VN domains compared to those with normal colour vision. Conclusions: The modified CBQoL-VN is a valid and reliable instrument for assessing the quality of life of individuals with congenital CVD in the Vietnamese population.
OBJECTIVE:To evaluate the feasibility and clinical value of combined lateral spread response (LSR) and Zhong-Lee response (ZLR) monitoring during fully endoscopic microvascular decompression (E-MVD) for hemifacial spasm. METHODS:This case series included 18 consecutive patients with hemifacial spasm who underwent E-MVD with multimodal intraoperative neurophysiological monitoring from September 2024 to March 2026. Monitoring included LSR, ZLR, and brainstem auditory evoked potentials. LSR was recorded from four facial muscles at six predefined stages. ZLR was elicited by direct stimulation of the neurovascular conflict. Outcomes were assessed using the validated hemifacial spasm grading questionnaire. RESULTS:LSR was detected in 83% of patients and disappeared intraoperatively in 93% of those in whom it was detected, with early disappearance in 13%. ZLR was present in all patients before decompression and disappeared in all cases after decompression. ZLR was particularly useful when LSR was absent or disappeared early, and in identifying the true offending vessel in complex neurovascular conflicts. Immediate symptomatic resolution occurred in 78% of patients, and delayed resolution in 22%. The median clinical score improved from 13 (IQR 13-14) preoperatively to 0 (IQR 0-2) at discharge. Mean quality-of-life impairment decreased from 82% to less than 0.2% at 6 months (p < 0.001). CONCLUSIONS:E-MVD combined with LSR and ZLR monitoring was feasible and demonstrated favorable short-term clinical outcomes in this consecutive case series. The two monitoring modalities provided complementary intraoperative electrophysiological information, particularly in patients with absent or inconclusive LSR.
