Cervical Artery Dissection (CAD)

Occurs as a result of the interplay among risk factors, minor trauma, anatomic &

congenital abnormalities, & genetic predisposition.

Diagnosis can be challenging both clinically & radiologically.

In those with acute ischemic stroke attributable to CAD, acute treatment

strategies such as thrombolysis & mechanical thrombectomy are reasonable in

otherwise eligible patients.

AHA suggest that the antithrombotic therapy choice be individualized &

continued for at least 3 to 6 months.

Risk of recurrent dissection is low, & preventive measures may be considered

early after the diagnosis & continued in high-risk patients. 

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Perioperative Antithrombotic Management:

The recommended pre-operative workup for patients taking anticoagulants involves

 stratifying both thromboembolic & bleeding risk, determining appropriate timing for

 medication interruption, & deciding whether bridging therapy is needed. The

 specific approach depends on the type of anticoagulant, renal function, and

 procedure-related bleeding risk.

• Direct Oral Anticoagulants (DOACs)

1. For apixaban, rivaroxaban, and Edoxaban, the American College of Chest Physicians recommends stopping these agents 1-2 days before low-to-moderate bleeding risk procedures and 2 days before high bleeding risk procedures.

• For dabigatran, interruption timing depends on renal function. 

1. With normal renal function (CrCl ≥50 mL/min), stop 1-2 days before low-risk procedures and 2 days before high-risk procedures. 
2. With impaired renal function (CrCl <50 mL/min), extend interruption to 3-4 days before high-risk procedures due to predominantly renal clearance.

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Urinary Tract Infections (UTI)

• Women have a lifetime risk of 53% of experiencing UTI. 
• Men prior to age 50, have lifetime risk is 14%.
• Risk of experiencing a UTI increase with age in both sexes.

Classification:

• Uncomplicated UTI

Infection confined to the bladder in afebrile women or men.

• Complicated UTI: 

Infection beyond the bladder in women or men. 

• Pyelonephritis 
• Febrile or bacteremic UTI 
• Catheter-associated (CAUTI)
• Prostatitis.

Catheter- Associated UTI (CA-UTI)

• CAUTIs are one of the most common healthcare-associated infection (HAI).
• 75% of UTIs developed in hospitals are associated with a urinary catheter.
• 15-25% of hospitalized pts receive urinary catheters during their hospital stay.
• CAUTIs are associated with increased morbidity, mortality, healthcare costs & LOS.
• They are preventable.

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Invasive Fungal Infection (IFI

 

Invasive fungal infections are severe infections in which fungal pathogens invade normally sterile body sites. They predominantly affect immunocompromised patients, including those with neutropenia, hematologic malignancies, solid organ or stem cell transplants, and prolonged corticosteroid or broad-spectrum antibiotic use.

Common Pathogens

• Candida species (most frequent cause of bloodstream infections)
• 
  
• Aspergillus species (primarily pulmonary infections)
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• Cryptococcus species (commonly CNS involvement)
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• Emerging molds and rare fungi in high-risk populations

Risk Factors

• Immunosuppression (neutropenia, chemotherapy, transplant)
• 
  
• Indwelling catheters or prosthetic devices
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• Prolonged ICU stay and broad-spectrum antibiotic exposure

Clinical Presentation

• Symptoms vary by site of infection and may include fever, organ dysfunction, respiratory distress, or neurological deficits

Diagnosis

• Culture and microscopy from sterile sites
• 
  
• Antigen/antibody testing (e.g., β-D-glucan, galactomannan, cryptococcal antigen)
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• Imaging studies (CT, MRI) for organ involvement
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• Histopathology when feasible

Management Principles

• Early initiation of targeted antifungal therapy
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• Source control, including removal of infected catheters or drainage of abscesses
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• Selection of therapy guided by species identification and antifungal susceptibility
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• Multidisciplinary approach with infectious diseases consultation

Prognosis

• Dependent on timely diagnosis, host immunity, and pathogen virulence
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• Delays in treatment significantly increase morbidity and mortality

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