Background: Hospital Associated infections (HAI) are very common in Intensive Care Units (ICU) and are usually associated with use of invasive devices in the patients. This study was conducted to determine the prevalence and etiological agents of HAI in a Surgical ICU in Kazakhstan, and to assess the impact of these infections on ICU stay and mortality. Objective: To assess the rate of device-associated infections and causative HAI etiological agents in an ICU at the National Research Center for Oncology and Transplantation (NRCOT) in Astana, Kazakhstan. Methods: This retrospective, observational study was conducted in a 12-bed ICU at the NRCOT, Astana, Kazakhstan. We enrolled all patients who were admitted to the ICU from January, 2014 through November 2015, aged 18 to 90 years of age who developed an HAI. Results: The most common type of HAI was surgical site infection (SSI), followed by ventilator-associated pneumonia (VAP), catheter-related blood stream infection (BSI) and catheter-associated urinary tract infection (UTI). The most common HAI was SSI with Pseudomonas aeruginosa as the most common etiological agent. The second most common HAI was VAP also with P. aeruginosa followed by BSI which was also associated with P. aeruginosa (in 2014) and Enterococcus faecalis, and Klebsiella pneumoniae (in 2015) as the most common etiological agents causing these infections. Conclusion: We found that HAI among our study population were predominantly caused by gram-negative pathogens, including P. aeruginosa, K. pneumoniae, and E. coli. To our knowledge, this is the only study that describes ICU-related HAI situation from a country within the Central Asian region. Many developing countries such as Kazakhstan lack surveillance systems which could effectively decrease incidence of HAIs and healthcare costs for their treatment. The epidemiological data on HAI in Kazakhstan currently is underrepresented and poorly reported in the literature. Based on this and previous studies, we propose that the most important interventions to prevent HAI at the NRCOT and similar Healthcare Institutions in Kazakhstan are active surveillance, regular infection control audits, rational and effective antibacterial therapy, and general hygiene measures.

Pseudomyxoma peritonei (PMP) is a rare clinical syndrome. It originates from neoplasms of the appendix and leads to the formation of peritoneal implants and the accumulation of mucinous ascites. PMP represents a spectrum of low to high-grade disease. Despite aggressive management, many PMP patients recur, leading to debilitating symptoms and few treatment options. Therefore, scientists have continued to look for ways to improve treatment and further understand disease pathogenesis. Microorganisms were previously hypothesized to play a role in PMP progression and development. Hence, antibacterial treatment was suggested by some authors, but the data were limited. In this paper, we review the current data on the role of bacteria in PMP, discuss the significance, and suggest possible solutions to the inherent challenges in these studies. Given the limitations of the discussed studies, we remain skeptical about introducing novel antibacterial treatment into clinical practice at this time; however, the available data are valuable and indicate that more research into the molecular mechanisms of PMP is needed.

BACKGROUND Spindle cell carcinomas and sarcomas are 2 uncommon primary spindle cell malignant tumors of the breast. Histopathology and immunohistochemistry for cell phenotypic markers can identify the type of tumor. This report is of a 45-year-old woman with a primary leiomyosarcoma of the breast, successfully treated by surgical excision. CASE REPORT A 45-year-old woman presented to our clinic in February 2018 with a 10.5-cm tumor in the right breast with lateral invasion of the pectoralis minor and pectoralis major. When the tumor first appeared in 2016, it was 5 cm in size and was diagnosed pathologically as a sarcoma. On immunohistochemical examination, the tumor cells were positive for smooth muscle actin, and vimentin with Ki 67 index of 15-20%. Previous treatment with 10 cycles of Gemcitabine was unsuccessful and showed rapid tumor growth up to 18 cm in May 2018. The patient underwent total right mastectomy with excision of the pectoralis minor muscle and partial excision of pectoral major muscle with axillary lymph node dissection. Pathological assessment revealed a necrotic mass 21.0×16.0×12.0 cm in size with invasion into the overlying breast skin and pectoralis major muscle with 2 out of 20 axillary lymph nodes with tumor growth. CONCLUSIONS This study has demonstrated the value of immunohistochemistry and histology in the diagnosis of primary spindle cell malignant breast cancers. To decrease the chance of recurrence and improve patient outcomes, primary leiomyosarcoma of the breast should be removed with a sufficient excision margin.