Acinetobacter spp as Nosocomial Pathogen : Clinical Significance and Antimicrobial Sensitivity

Acinetobacter spp are ubiquitous aerobic Gram negative coccobacillus, that are now increasingly responsible for a large number of nosocomial infections. In our study, over a period of six months (Jan-Jun 2000) at a tertiary care hospital, 152 (12.9%) isolates of Acinetobacter spp were obtained from a total of 1175 isolates grown from all clinical specimens. Most of the isolates 126 (82.9%) were from hospitalised patients in the spinal cord injury centre, intensive care units and those on prior antibiotic therapy. Community acquired infections were also seen in 26 (17.1%) out patient department (OPD) cases. Isolates were from urine, respiratory exudates, blood and pus/burn wound swabs predominantly. They were resistant to commonly used antibiotics while being sensitive to amikacin, augmentin, piperacillin, netilmicin and cefotaxime. 69.2% isolates exhibited resistance to two or more antibiotics. Clinical co-relation must be under taken to exclude commensal contaminants, before considering it to be a pathogen and prescribing antibiotics to the patient.Key Words: Acinetobacter spp, Antibiotic resistance, Nosocomial infection     

High resolution mapping of reticulated water fluoride in Western Australia: opportunities to improve oral health

Background: Drinking water with an optimum fluoride concentration is a recognized effective method to reduce dental decay. Methods: In this study normal suppliers of drinking water in Western Australia provided map data regarding the distribution of their supplies and the locations of their test points. These data were collated into a single unified map of Western Australian water supplies and fluoride levels. It is clear that the effect of prevention in regionally isolated communities is significant as the cost of providing service is anywhere between 2 and 4 times higher than that in high density regions. Results: The current study found that although a very significant proportion of the population has access to water with fluoride concentrations that would be caries protective, most of these are large urban centre based. Conclusions: Those with high burdens of dental disease are mostly residential in rural and remote areas where water is either not fluoridated, nor regulated, or low in fluoride. However, it is acknowledged that water fluoridation, for many reasons, is not always feasible in rural and remote communities, and preventive efforts through alternative sources of fluoride (e.g. toothpaste) should be considered, even if less effective at community level.     

Female factor IX deficiency due to maternally inherited X‐inactivation

Esquilin JM, Takemoto CM, Green, NS. Female factor IX deficiency due to maternally inherited X‐inactivation. X‐chromosome inactivation is normally a random event that is regulated by the X chromosome itself. Rarely, females are affected by X‐linked disorders from extremely skewed X‐chromosome inactivation. Here, we report a family with hemophilia B with female expression through inherited X skewing that appears to be independent of either X chromosome. This finding suggests the possibility of a dominant autosomal contribution to inherited skewed X inactivation.     

The relationship between HLA-B27 positive peripheral arthritis and sacroiliitis

HLA typing for B27 antigen is a helpful diagnostic aid in the classification of peripheral arthritis patients (especially young patients) who are rheumatoid factor negative. We studied 109 patients with seronegative peripheral arthritis belonging to various clinical categories; 23% proved to be B27 positive in comparison to 7% of normal controls. In spite of a paucity of spinal manifestations there was a high prevalence of sacroiliitis (83%) in the B27 positive peripheral arthritis patients as opposed to only 21% in those without B27 antigen. HLA-B27 typing and radiographs of the sacroiliac joints are important differential tests.     

Local and regional anaesthesia in infants

Local or regional analgesia is the platform of multimodal analgesiafor all paediatric patients, whatever their age, undergoingsurgery or painful procedures, unless there is a specific contraindication.Local and regional analgesia provides dense intraoperative analgesiathat continues into the postoperative period. Lower amountsof volatile anaesthetic agents are needed and an opioid-sparingeffect is produced. For the pre-term neonate, some procedurescan be performed under spinal or epidural analgesia alone, whichmay improve outcome and reduce postoperative respiratory morbidity.Regional anaesthesia acts synergistically with non-steroidalanti-inflammatory drugs (NSAIDs) to produce good analgesia withminimum side-effects, so for most day-case surgery, opioidsmay be avoided completely. Single-dose techniques are most oftenemployed; however, pain control may be continued with repeatedapplication of topical local anaesthesia or repeated doses,or continuous infusions of local anaesthesia applied topically,near peripheral nerves or nerve plexuses or via the extraduralspace if required.     

Erythroid cell growth from normal and W/WV murine bone marrow on macrophage-coated membranes

Cellulose acetate membranes (CAM) placed in the peritoneal cavity of mice develop a macrophage layer capable of supporting in vivo hematopoietic colonies from intraperitoneally injected bone marrow cells. Modifications allowing for routine morphologic identification of colonies showed that both erythrocytic (E) and granulocytic (G) colonies occur with a consistent E:G ratio of 0.19 +/- 0.037. Stimulating recipients by bleeding or phenylhydrazine injection did not produce a significant change in the total number of colonies and a reduction in granulocytic colonies so that the E:G ratio significnatly increased. Hypertransfusion of donor animals had no effect on the number of erythroid colonies that grew on CAM of average recipients. The total colony-forming ability of bone marrow cells from genetically anemic W/WV mice was found not to differ from that of normal +/+ littermates; however, the E:G ratio of W/WV marrow in bled recipients was significantly lower (p less than 0.01) then that of +/+ marrow. These studies suggest that a CAM system supports an erythroid progenitor which is not affected by hypotransfusion of the donor animal, yet is dependent upon erythropoietin for colony formation, and that it is defective in the W/WV mouse.     

Controlled multicentre study of the influence of subcutaneous recombinant human erythropoietin on anaemia and transfusion dependency in patients with ovarian carcinoma treated with platinum-based chemotherapy

This randomised controlled multicentre trial evaluated the effectiveness of recombinant human erythropoietin (rhEPO) in preventing anaemia and reducing the need for blood or erythrocyte transfusion in 122 ovarian cancer patients receiving platinum-based chemotherapy. The patients were randomly allocated to receive rhEPO 150 U/kg or 300 U/kg subcutaneously, three times a week, or open control. Patients also received up to 6 cycles of carboplatin or cisplatin, alone or in combination with other cytotoxic agents. Intention-to-treat analysis showed that 39.4% of patients in the control group received at least one blood transfusion, compared with 9.2% of patients treated with rhEPO. Patients treated with rhEPO experienced a significantly longer time to first erythrocyte transfusion than the control group and were less likely to experience nadir haemoglobin levels <10 g/dl (P<0.001 and <0.05, respectively). A haemoglobin decrease <1 g/dl during the first chemotherapy cycle, as well as a low baseline serum erythropoietin concentration, predicted a low transfusion need in rhEPO-treated patients but not in controls. During the study, 103 patients suffered at least one adverse event, but no serious, and only nine non-serious adverse events were considered possibly related to rhEPO therapy. These results indicate that treatment with rhEPO prevents anaemia, it reduces the need for blood or rhEPO erythrocyte transfusion in patients with ovarian cancer receiving platinum-based chemotherapy, and it is well tolerated. A starting dose of 150 U/kg of rhEPO, three times a week, may be recommended.