How reliable are cultures of specimens from superficial swabs compared with those of deep tissue in patients with diabetic foot ulcers?

PurposeTo assess the reliability of cultures of superficial swabs (SS) by comparing them with cultures of concomitantly obtained deep tissue (DT) specimens in patients with diabetic foot ulcers.MethodsWe reviewed clinical and microbiological data from patients with diabetes who presented during a two-year period to our hyperbaric medicine center with a foot ulcer. We identified patients who had at least one concomitantly collected SS and DT pair of specimens sent for culture.ResultsA total of 89 culture pairs were available from 54 eligible patients, 33 (61.1%) of whom were hospitalized. Wounds were infected in 47 (87.0%) of the patients and 28 (51.9%) patients had received antibiotic therapy within the previous month. Overall, 65 (73%) of the SS and DT pairs had identical culture results, but in 11 (16.9%) cases the cultures were sterile; thus, only 54 (69.2%) of the 78 culture-positive pairs had identical results. Compared with DT, SS cultures yielded ≥ 1 extra organism in 10 (11.2%) cases, missed at least one organism in 8 (9.0%), and were completely different in 6 (6.7%). When compared to DT culture results, SS cultures had a positive predictive value of 84.4%, negative predictive value of 44.0%, and overall accuracy of 73.0%.ConclusionsIn patients with diabetic foot ulcers, results of specimens for culture taken by SS did not correlate well with those obtained by DT. This suggests that SS specimens may be less reliable for guiding antimicrobial therapy than DT specimens.     

Is There a Relationship between Vitamin B12 and Stress Urinary Incontinence?

Objective: Pelvic floor, which includes collagen, elastin, and smooth muscle, is very important in preventing urinary incontinence (UI). Studies suggest that vitamin B12 is involved in collagen synthesis. In the present study we aimed to determine the association of vitamin B12 deficiency with stress UI in a sample of Turkish women. Methods: Forty‐two women with stress UI or mixed UI who met the inclusion criteria from a group of 541 women with stress UI or mixed UI, were included in the study. The study group was compared with a control group of 20 healthy women without UI who matched to the study group's demographic data and met the inclusion criteria. Demographic data as well as duration of symptoms and vitamin B12 levels were analyzed and compared. Results: The mean ages of the study and the control groups were 50.04 ± 4.6 and 49.02 ± 5.1 years, respectively. Vitamin B12 level was 300.95 ± 142.9 pg/mL in the study group, whereas in the control group it was 598.98 ± 120.3 pg/mL (P < 0.001). In the study group, 66.6% of the patients with stress UI had vitamin B12 levels less than 300 pg/mL. When the duration of symptoms and vitamin B12 levels were compared, women with vitamin B12 levels less than 200 pg/mL had symptoms for a longer duration (P < 0.01). Conclusion: One of the main etiologic factors for stress UI is a defect in pelvic floor support. Vitamin B12 is lower in women with stress UI. Analysis of vitamin B12 levels should also be considered in the evaluation of women with stress UI.     

Posterior reversible encephalopathy syndrome in children: report of three cases

Purpose

Posterior reversible encephalopathy syndrome (PRES) is a condition characterized by varying degrees of headache, nausea, vomiting, visual disturbances, focal neurologic deficit, and seizures due to severe systemic hypertension. The knowledge of secondary hypertension in children is most commonly due to renal abnormalities, suggesting that the leading cause of PRES in childhood is renal diseases.

Methods

Three pediatric patients who developed PRES due to various underlying renal diseases were reviewed.

Results

The etiology of hypertension of our patients was all renal problems including atrophic kidney, hydronephrosis secondary to reflux nephropathia, nephrotic syndrome, and acute poststreptococcal glomerulonephritis. While two of them had typical of the parieto-occipital and frontoparietal involvement, the other had brain stem involvement. All of the patients were recovered by the control of high blood pressure.

Conclusion

Primary involvement of the brain stem is rare in children. PRES should be taken into account, especially in children with renal disease in the appropriate clinical settings.     

Similarities and differences in cervical and thoracolumbar multisegmental motor responses and the combined use for testing spinal circuitries

Abstract

Study design

Experimental study.

Objective

To determine similarities and differences of C7 and T11–12 multisegmental motor responses (MMR) studies for the upper limbs (UL) and lower limbs (LL).

Settings

Neuroscience Lab, TWU (School of Physical Therapy, TX, USA).

Methods

C7 and T11–12 percutaneous electrical stimulations were applied while recording muscle action potentials from ULs and LLs.

Results

The procedure of cervical MMR (CMMR) was easier in application than thoracolumbar MMR (TMMR), requiring less current intensities but cause more “jolts” in the trapezius/shoulder complex, due to close proximity of the stimulation electrodes. CMMR evoked large amplitude motor responses in the millivolts range in (UL) muscles, but smaller amplitude signal in (LL) muscles (in microvolts). TMMR evoked large amplitude motor responses in both UL and LL (in millivolts). The MMR amplitude was generally larger in the UL as compared to the LL, in the distal limb muscles more than in the proximal limb muscles. CMMR and TMMR for the UL were comparable in amplitude, latencies and action potential shapes. Signal latencies were longer for distal limb muscles as compared to proximal limb muscles and were slightly longer for LL as compared to UL muscles. MMR signals were either biphasic or triphasic in shape.

Conclusion

CMMR and TMMR have similarities and differences in the methods and recording signal that must be considered during its clinical applications. Comparing the signal of the UL muscles with CMMR and TMMR could be a useful test for the integrity of the ascending and descending spinal pathways in patients with spinal cord injuries and diseases.     

The Effect of Taurine on the Relationship Between NO,ADMA and Homocysteine in Endotoxin-Mediated Inflammation in HUVEC Cultures

The aim of our study was to investigate the effect of taurine on the relationship between nitric oxide (NO), asymmetric dimethylarginine (ADMA) and homocysteine (Hcy) in endotoxin-induced human umblical vein endothelial cell (HUVEC) cultures. For this reason, four groups were formed (n?=?12). Control group consists of HUVEC cultures without any treatment. Lipopolysaccharide (LPS) and LPS?+?taurine groups were treated with 10 μg/mL endotoxin, 5 μg/mL taurine and endotoxin?+?taurine (same doses), respectively. Nitrite/nitrate (NOx), ADMA and Hcy levels were measured. There was a significant increase of NOx, ADMA and Hcy in endotoxemia (p?p?ADMA levels to the control level both in taurine and taurine?+?LPS group compared to LPS. Hcy levels increased significantly compared to taurine group (p?ADMA–NO relationship whereas no beneficial effect was observed in Hcy levels (p?相似文献   

Association of OSR‐1 With Vascular Dysfunction and Hypertension in Polycystic Kidney Disease

Autosomal‐dominant polycystic kidney disease (ADPKD) is associated with oxidative stress and hypertension development before renal function decline and cardiovascular disease development. Oxidative stress‐responsive kinase‐1 (OSR‐1) participates in the signaling regulating Na⁺ transport during oxidative stress and also plays a role in the regulation of cell volume and blood pressure. Therefore, we aimed to investigate the potential role of OSR‐1 in ADPKD patients. Eighty ADPKD patients, 80 healthy controls, and 80 non‐ADPKD patients with hypertension were enrolled in this cross‐sectional study. Twenty‐four‐hour ambulatory blood pressure monitoring was conducted in all participants. Blood samples were taken after 12‐h fasting for the measurement of biochemical parameters and OSR‐1 gene expression. Vascular dysfunction was assessed using ischemia‐induced forearm flow‐mediated vasodilation (FMD). Briefly, of the 80 ADPKD patients, 41(51%) were male, and 53(66%) of them were hypertensive. The mean age of the 80 controls was 35.3 ± 12.6 years, and 37(46%) of them were male. The mean age of the 80 non‐ADPKD patients with hypertension was 44.6 ± 11.9 years, and 38(47.5) of them were male. There were significant differences in serum OSR‐1 gene expression between the ADPKD patients and the control subjects. Serum OSR‐1 gene expression was also significantly increased in hypertensive ADPKD patients in comparison with both normotensive ADPKD counterparts and non‐ADPKD hypertensive subjects. Serum OSR‐1 gene expression was increased in patients with ADPKD than healthy subjects. Low estimated glomerular filtration rate (eGFR), OSR‐1 gene expression, total kidney volume (TKV), and high‐density lipoprotein (HDL) were also independently associated with hypertension in ADPKD patients.