Abstract: Community-acquired pneumonia (CAP) is a common and often serious disease with substantial morbidity and mortality worldwide. The 2004 World Health Organization Global Burden of Disease Study estimated that lower respiratory tract infections (LRTIs), which include CAP, were responsible for 429.2 million episodes of illness worldwide and were the leading cause of disease burden measured in terms of disability-adjusted life years (DALYs) among all age groups, accounting for 94.5 million DALYs. In adults aged over 59 years, 1.6 million deaths annually are attributed to CAP. LRTIs accounted for 4% of overall deaths in developed regions of the world, compared with the Middle East/North Africa (MENA) region, where overall mortality due to LRTIs has been reported to be as high as 10%. The burden of CAP is of even greater concern for aging adults when considering that the number of persons aged over 60 years globally is projected to triple, from 759 million in 2010 to 2 billion by 2050. Streptococcus pneumoniae is the most common pathogen implicated in adult CAP in this region and there is a high level of resistance to penicillin. Increasing resistance to commonly used antibiotics to treat pneumococcal diseases suggests that preventive strategies, including adult vaccination against pneumococcal disease, will be important in the future. The adoption of the recommended Gulf Cooperation Council CAP Working Group guidelines as a standard of care in the MENA region, the development of a regional database to track guideline utilization and clinical outcomes and the strengthening of co-ordinated surveillance through the Eastern Mediterranean Region Surveillance Network will enhance public health efforts to reduce the burden of CAP in adult patients in the MENA region. Future discussions are required to facilitate the implementation of these concepts throughout the region.

Abstract: INTRODUCTION: Left ventricular aneurysms are a frequent sequela of transmural myocardial infarction. The vast majority is true aneurysms and false are rare (12).
CASE PRESENTATIONS: A 53-year-old women presented by recurrent left-sided, sharp chest pain for two months. Her medical history and examination were insignificant. Chest X-ray was unremarkable.
Computed tomography (CT) showed a 3.5-cm diameter pseudoaneurysm emanating from the lateral aspect of the left ventricle.
Magnetic resonance imaging (MRI) defined a 5x3-cm oval pseudoaneurysm extending from the anterolateral wall of the left ventricle. A jet phenomenon is noted at the site of communication between the cavity of the left ventricle.Cardiac Cineangiography confirmed the presence of a pseudoaneurysmal cavity connected to the left ventricle.
DISCUSSION: A pseudoaneurysm is the consequence of rupture of the cardiac wall within extra-cardiac hematoma; its lumen communicates with the ventricle. In CT, the presence of a typical neck is not always diagnostic of a pseudoaneurysm, and sometimes the neck is not clearly demarcated. A keystone in diagnostic imaging with angiography, echocardiography, and radionuclide studies is the visualization of a “typical neck”(12).
CONCLUSIONS: The use of combined diagnostic radiology techniques (CT and MRI) and Cardiac cineangiography help in the diagnosis of ventricular pseudoaneurysm.

Abstract: STUDY OBJECTIVE: To evaluate the relationship between the adequacy of antimicrobial treatment for bloodstream infections and clinical outcomes among patients requiring ICU admission. DESIGN: Prospective cohort study. SETTING: A medical ICU (19 beds) and a surgical ICU (18 beds) from a university-affiliated urban teaching hospital. PATIENTS: Between July 1997 and July 1999, 492 patients were prospectively evaluated. INTERVENTION: Prospective patient surveillance and data collection. RESULTS: One hundred forty-seven patients (29.9%) received inadequate antimicrobial treatment for their bloodstream infections. The hospital mortality rate of patients with a bloodstream infection receiving inadequate antimicrobial treatment (61.9%) was statistically greater than the hospital mortality rate of patients with a bloodstream infection who received adequate antimicrobial treatment (28.4%; relative risk, 2. 18; 95% confidence interval [CI], 1.77 to 2.69; p < 0.001). Multiple logistic regression analysis identified the administration of inadequate antimicrobial treatment as an independent determinant of hospital mortality (adjusted odds ratio [AOR], 6.86; 95% CI, 5.09 to 9.24; p < 0.001). The most commonly identified bloodstream pathogens and their associated rates of inadequate antimicrobial treatment included vancomycin-resistant enterococci (n = 17; 100%), Candida species (n = 41; 95.1%), oxacillin-resistant Staphylococcus aureus (n = 46; 32.6%), coagulase-negative staphylococci (n = 96; 21.9%), and Pseudomonas aeruginosa (n = 22; 10.0%). A statistically significant relationship was found between the rates of inadequate antimicrobial treatment for individual microorganisms and their associated rates of hospital mortality (Spearman correlation coefficient = 0.8287; p = 0.006). Multiple logistic regression analysis also demonstrated that a bloodstream infection attributed to Candida species (AOR, 51.86; 95% CI, 24.57 to 109.49; p < 0.001), prior administration of antibiotics during the same hospitalization (AOR, 2.08; 95% CI, 1.58 to 2.74; p = 0.008), decreasing serum albumin concentrations (1-g/dL decrements) (AOR, 1.37; 95% CI, 1.21 to 1.56; p = 0.014), and increasing central catheter duration (1-day increments) (AOR, 1.03; 95% CI, 1.02 to 1.04; p = 0.008) were independently associated with the administration of inadequate antimicrobial treatment. CONCLUSIONS: The administration of inadequate antimicrobial treatment to critically ill patients with bloodstream infections is associated with a greater hospital mortality compared with adequate antimicrobial treatment of bloodstream infections. These data suggest that clinical efforts should be aimed at reducing the administration of inadequate antimicrobial treatment to hospitalized patients with bloodstream infections, especially individuals infected with antibiotic-resistant bacteria and Candida species.