Effect of hospitalization on the antibiotic resistance of fecal Enterococcus faecalis of surgical patients over time

The prevalence of antibiotic resistant Enterococcus faecalis was determined in fecal samples of 263 patients admitted to the surgical wards of three university-affiliated hospitals on admission, at discharge, and at 1 and 6 months after discharge. A slight increase in the prevalence of antibiotic resistance of E. faecalis was found at discharge for the antibiotics tested compared to those on admission, vancomycin excepted. At 6 months after discharge, the prevalence of resistance for amoxicillin (0%), ciprofloxacin (3%), erythromycin (47%), and oxytetracycline (60%) decreased to the level on admission (respectively 0%, 8%, 45%, and 64%). Gentamicin resistance was the same at discharge (10%) as 1 month later (12%), but decreased 6 months after discharge (8%) to the level on admission (7%). In conclusion, hospitalization resulted in the study population in a slight increase in the prevalence of resistant fecal E. faecalis isolates at discharge, which decreased again (slowly) to the level on admission 6 months after discharge. Thus, the influence of hospitalization on the prevalence of antibiotic resistance in the extramural situation disappears between 1 and 6 months after discharge in this population.     

MILITANCY TRAUMA : MAXILLOFACIAL INJURY,ANAESTHESIA AND CRITICAL CARE

Eighty four out of 2151 militancy trauma patients sustained severe maxillofacial injury from Jan 1990 to March 1993. The resuscitation, stabilisation and intensive care of these patients was based on management priorities of primary resuscitation, care of airway, management of haemodynamics, oxygenation and monitoring. Anaesthesia was administered in a situation when the airway was likely to be compromised and the patients were critically sick. Initial ventilation and oxygenation was the most difficult and could be achieved with satisfactory seal around the face mask by applying water-soaked guaze pieces around the mouth and nose to “fill-in” the defects. Tracheal intubation could be accomplished with intravenous sedation by an experienced anaesthesiologist. Dental occlusion and wiring necessiated the placement of nasotracheal tube for 48-72 hours after surgery.KEY WORDS: Trauma, Maxillofacial injury, Trauma anesthesia, Anaesthesia and critical care     

DEATH AS A STIMULUS TO IMPROVING THE AFRICAN ENVIRONMENT FOR MORE HEALTHFUL LIVING

In D. Leviton's (1991) conception of horrendous death , a poorly managed environment can contribute to widespread mortality, and the deaths so caused can further create an environment for subsequent death. The African environment in particular is characterized by a number of "deathogenic" factors that must be understood and confronted by health educators committed to minimizing or eliminating the impact of horrendous death on the African continent. In this comment, the author argues that attention to characteristic but preventable forms of death in the African context can lead to greater public advocacy among African health educators, contributing to the physical and psychological wellbeing of the populations they serve.     

Comparison of relative and actual chest compression depths during cardiac arrest in children, adolescents, and young adults

Aim

Cardiopulmonary resuscitation (CPR) guidelines recommend specific chest compression (CC) target depths for children. We quantitatively describe relative anterior–posterior diameter (APD) depth, actual depth, and force of CCs during real CPR events in children.

Methods

CC depth and force were recorded during real CPR events in children ≥8 years using FDA-approved CC sensor. Patient chest APD was measured at conclusion of each CPR event. CC data was stratified and analyzed according to age (pre-puberty, 8–14 years; post-puberty, 15+ years). Relative (% APD) and actual CC depth, corrected for mattress deflection, were assessed and compared with American Heart Association (AHA) 2005 and 2010 pediatric CPR guidelines.

Results

35 events in 32 subjects included 16,158 CCs for data analysis: 16 pre-puberty (CCs = 7484, age 11.9 ± 2 years, APD 164.6 ± 25.1 mm); 19 post-puberty (CCs = 8674, age 18.0 ± 2.7 years, APD 196.5 ± 30.4 mm). After correction for mattress deflection, 92% of CC delivered to pre-puberty were <1/3 relative APD and 60% of CC were <38 mm actual depth. Mean actual CC depth (36.2 ± 9.6 mm vs. 36.8 ± 9.9 mm, p = 0.64), mean relative APD (22.5% ± 7.0% vs. 19.5 ± 6.7%, p = 0.13), and mean CC force (30.7 ± 7.6 kg vs. 33.6 ± 9.4 kg, p = 0.07) were not significantly less in pre-puberty vs. post-puberty.

Conclusions

During in-hospital cardiac arrest of children ≥8 years, CCs delivered by resuscitation teams were frequently <1/3 relative APD and <38 mm actual depth after mattress deflection correction, below pediatric and adult target guidelines. Mean CC actual depth and force were not significantly different in pre-puberty and post-puberty. Additional investigation to determine depth of CCs to optimize hemodynamics and outcomes is needed to inform future CPR guidelines.     

Long-term elution of monomers from resin-based dental composites

Objective

To bridge the gap between the current alarming literature on resin-based dental materials and the limited clinical observations, more precise knowledge on the actual quantity of released compounds should be acquired. The objective of this study was to quantify the long-term elution of various compounds from resin-based dental composites during one year.

The cross‐modal aspect of mouse visual cortex plasticity induced by monocular enucleation is age dependent

Monocular enucleation (ME) drastically affects the contralateral visual cortex, where plasticity phenomena drive specific adaptations to compensate for the unilateral loss of vision. In adult mice, complete reactivation of deprived visual cortex involves an early visually driven recovery followed by multimodal plasticity 3 to 7 weeks post ME (Van Brussel et al. [ 2011 ] Cereb. Cortex 21:2133–2146). Here, we specifically investigated the age dependence of the onset and the exact timing of both ME‐induced reactivation processes by comparing cortical activity patterns of mice enucleated at postnatal day (P) 45, 90, or 120. A swifter open‐eye potentiated reactivation characterized the binocular visual cortex of P45 mice. Nevertheless, even after 7 weeks, the reactivation remained incomplete, especially in the monocular cortex medial to V1. In comparison with P45, emergent cross‐modal participation was demonstrated in P90 animals, although robust reactivation similar to enucleated adults (P120) was not achieved yet. Concomitantly, at 7 weeks post ME, somatosensory and auditory cortex shifted from a hypoactive state in P45 to hyperactivity in P120. Thus, we provide evidence for a presensitive period in which gradual recruitment of cross‐modal recovery upon long‐term ME coincides with the transition from adolescence to adulthood in mice. J. Comp. Neurol. 522:950–970, 2014. © 2013 Wiley Periodicals, Inc.