Emphysematous pyelonephritis (EPN) is a rare form of renal suppuration. It is associated with a high mortality in the absence of rapid and effective treatment. Nephrectomy is suggested as the reference treatment associated to medical treatment. However, medical treatment exclusive is a conservative therapeutic option which is effective and successful in some cases. Many clinical and radiological criteria must be analyzed and gathered; we describe three cases of EPN treated successfully with medical treatment alone in two cases and associated to nephrectomy in one case.

Background and Objectives: Appropriate empiric antibiotic therapy in patients with severe community-acquired pneumonia (CAP) is crucial in terms of outcome. International guidelines suggest combination therapy (CT) for CAP patients admitted to Intensive Care Units (ICU). However, that type of combination of antibiotics is not clear. This study aims to determine the empiric antibiotic treatment of severe CAP in two periods. Our hypothesis was that macrolide use has decreased in the recent years. Materials and Methods: We compared in two prospective similarly designed cohort studies (1) CAP in ICU (2000-2002) and (2) H1N1 SEMICYUC (2009-2011) of critically ill patients with CAP: (a) Rate of CT and (b) use of macrolide or quinolones in each period. Demographic, severity of illness and clinical data were recorded. Chi-square test (categorical variables) and Student's t-test (continuous variables) were used. Results are shown as median, standard deviation, odds ratio, and 95% confidence interval. P < 0.05 was considered. Results: We included 1059 patients, 529 (49.9%) in the first period and 530 (50.1%) in the second period. The severity of illness and mortality rate was not different between periods. In overall, 866 (81.7%) received CT and this therapy was more frequent in the second period (85.3% vs. 78.3%, P < 0.003). A significant reduction in macrolide use in the second period was observed (26% vs. 55%; P < 0.01) even in patients with shock. Conclusions: Despite published evidence, CT use with quinolones has increased in the last years in Spanish ICUs.

Background and Objectives: Antitubercular drugs just like other drugs used in clinical practice are not free from ADRs(Adverse drug reactions).The added problem is that combination of drugs are used for prolonged periods of time. Moreover the ADRs to drugs used is one of the major reasons for patient default, hence leading to emergence of resistant organisms. Identification of the ADR profile of drugs in a hospital setup can be useful for the prevention, early detection and management of ADRs. 1) We aim to study the demographic profile of patients receiving Antitubercular therapy. 2) To identify the pattern and incidence of ADRs in the intensive phase Antitubercular therapy following DOTS strategy. Materials and Methods: A descriptive longitudinal study conducted for twelve months at tertiary care hospital in Eastern India. All the adult T.B. patients attending the outpatient department from January 2015 till December 2015 were included as per the study criteria and were monitored for ADRs. The data were evaluated for patient demography, type of DOTS treatment, type of ADRs and Organ site/system affected. ADRs were then subjected to severity assessment as per Hartwig scale.Statistical analysis was done using statistical software Graf Pad Prism version 4.03 for Windows. Results: Out of 296 patients, majority were males (59.79%), belonged to the age group of 20-30years(53.37%). Out of 296 patients 196 patients developed 312 detected ADRS mostly reported in the 5th week of DOTS therapy. In 11(5.61%) cases drugs were withdrawn, 21(10.71%) cases drugs were reduced and remaining 164 (83.67%) cases drugs were continued in original dose. Among them 164 cases received symptomatic treatment. The most common organ system involved was G.I.T. The most common type of ADR was nausea and vomiting (23.07%). On evaluation of severity assessment showed that most of the patients ADRs were of mild level-1(79.39%). Conclusion: Regular ADR monitoring is required to reduce morbidity and development of multiple drug resistance among patients with ADRs and also to improve patient compliance.

Exacerbations are significant events in the course of bronchiectasis. Exacerbations are associated with accelerated lung function decline and deterioration in quality of life (QoL). Prevention of exacerbations is therefore one of the key objectives of management of bronchiectasis. A few treatments have been proven to reduce the risk of exacerbations, but these include the treatment of underlying causes of bronchiectasis and the use of prophylactic antibiotic therapies (macrolides and inhaled antibiotics). Nonantibiotic therapies, such as airway clearance and pulmonary rehabilitation, also play an important role in the prevention of exacerbations. Acute exacerbations are treated with antibiotics directed against the known bronchiectasis pathogens and guided by previous sputum culture results. This emphasizes the importance of screening sputum cultures in stable patients. Assessment of severity is used to determine whether patients should be treated at home or in hospital. Supportive therapy for exacerbations should include airway clearance alongside oxygen, hydration, and treatment of bronchospasm as required. Bronchiectasis is a rapidly developing field and new therapies, both for the prevention of exacerbations and the treatment of acute exacerbations, are currently being developed.

There is a higher prevalence of community-acquired pneumonia (CAP) worldwide. The stratification of the severity and prognosis of CAP is a vital feature as it is one of the most common causes of mortality among other infectious diseases in the developed countries. The mortality rate of patients with CAP depends on the severity of the disease, treatment failure along with the requirement of hospitalization and/or Intensive Care Unit (ICU) management which is quite cost-effective. To improve the outcomes in the management of CAP, there has recently been a significant attention paid to focus on the use and implication of evidence-based scoring systems and biological markers to justify hospital admission in either acute medical settings or ICU, also to classify the disease severity which will help in predicting the mortality rate. We have reviewed the significance of established and newly developed clinical scores, biological markers, and cytokines whether used alone or in conjunction with the clinical severity scores to assess the severity of the disease, prediction of early or late treatment failure, justify the acute in-hospital or ICU admission, and for the identification of short- and long-term mortality. In conclusion, the incorporation of the biological markers in the prognostic scales of the clinical scoring systems may improve the mortality prediction value of patients with CAP requiring acute hospitalization or ICU care and further studies at a larger scale are needed to corroborate the additive value of biological markers.

The recent upsurge of Zika virus infection has alarmed public health officials because of its possible association with thousands of suspected cases of microcephaly, thereby sparking a public health emergency. This mosquito-borne arboviral disease majorly remains asymptomatic. Unavailability of specific prophylaxis or vaccines or treatment necessitates the need to advocate preventive personal measures to get protected from these daytime bitters. Prevention and control measures should be aimed at reducing the vector density and minimizing the vector-patient contact.