Trends in bacterial resistance in a tertiary university hospital over one decade

The objective of this study was to investigate bacterial resistance trends, infection sites and the relationship between resistance and admittance to the intensive care unit (ICU). A total of 53,316 bacteria identified between 1999 and 2008 were evaluated. Multidrug resistance was characterized when gram-negative bacilli (GNB) presented resistance to two or more classes of antibiotics. Gram-positive cocci (CPC) were assessed for resistance to penicillin, oxacillin and vancomycin. GNB were the most common (66.1%) isolate. There was a 3.7-fold overall increase in multidrug resistant GNB over the study period; Acinetobacter baumanii and Staphylococcus aureus were the most prevalent. Highest increases were recorded for Klebsiella pneumoniae (14.6-fold) and enterococci (73-fold). The resistance rates for GNB and GPC were 36% and 51.7%, respectively. Most multidrug resistant GNB and GPC were recovered from ICU patients (p-value < 0.001). Vancomycin-resistant enterococci were isolated during this decade with an increase of 18.7% by 2008. These data confirm the worldwide trend in multidrug bacterial resistance.     

Clinical implementation of the hysteroscopic morcellator for removal of intrauterine myomas and polyps. A retrospective descriptive study

The aim of this study is to report our experience with a novel technique, the hysteroscopic morcellator (HM), for removal of intrauterine myomas and polyps. We performed a retrospective study on 315 women undergoing operative hysteroscopy with the HM in our university-affiliated teaching hospital. We collected data on installation and operating times, fluid deficit, peri- and postoperative complications. In 37 patients undergoing myomectomy with the HM, mean installation time was 8.7 min, mean operating time, 18.2 min, and median fluid deficit, 440 mL. Three out of 37 HM procedures were converted to resectoscopy, related to a type 2 myoma. In 278 patients, mean installation and operating times for polypectomy with the HM were 7.3 min and 6.6 min, respectively. All procedures were uneventful. Implementation of the HM for removal of type 0 and 1 myomas ≤3 cm, and removal of polyps appears safe and effective.     

Premature acute myocardial infarction in a child with nephrotic syndrome

We report a case of acute myocardial infarction in a nephrotic child. A 7-year-old boy with a 4-year history of steroid-unresponsive nephrotic syndrome due to mesangial proliferation disease presented with acute vomiting and chest pain. An electrocardiogram showed ST elevation and pathological Q waves in leads consistent with anterior and septal myocardial infarction. Subsequent cardiac catheterization showed no evidence of atherosclerotic coronary artery disease, and thrombotic occlusion of the anterior descending coronary artery was the likely cause of the event. Myocardial scintigraphy showed extensive myocardial damage. The child had no long history of extreme hypercholesterolemia or hypertriglyceridemia. The case suggests that children with long-lasting nephrotic syndrome may be at increased risk for ischemic cardiovascular events, due to hyperlipidemia as well as a hypercoagulability state. The literature is reviewed regarding the relationship between nephrotic syndrome and the incidence of ischemic heart disease. Received: 2 May 2001 / Revised: 31 October 2001 / Accepted: 18 November 2001     

Protein kinase C modulators enhance angiotensin II desensitization of guinea pig ileum via maxi-K+ channels

We investigated the role of protein kinase C in the desensitization of the angiotensin II-induced contraction of guinea pig ileum. In contrast to their antagonistic effects on enzymatic activity, both activator and blockers accelerated the dissipation of the 10(-7) M angiotensin II isometric contractile response. These agents indirectly activated maxi-K+ channels in cell-attached membrane patches from freshly dispersed myocytes bathed in high-K+ solution and clamped at -40 mV. In parallel with the contractile responses, fura 2-loaded myocytes bathed in Tyrode solution showed additive increases in [Ca2+]i in response to both angiotensin II and phorbol dibutyrate (PDB). The PDB-promoted increase of the rate of angiotensin II desensitization was completely abolished by pretreatment of the tissue strips with 93 nM iberiotoxin or 8 mM KCl. Thus, we conclude that protein kinase C modulators promote faster angiotensin II desensitization by recruiting maxi-K+ channels and inducing membrane repolarization rather than by affecting the protein kinase C activity.     

Group intervention with a focus on emotional care: report of an experience

Attention to emotional health should be given at any circumstances of human beings development. It is especially necessary when an individual is ill and feels fragile, afraid, uncomfortable and anxious due to hospitalization. In this paper, we present an experience in which group work was used as a strategy of assistance to patients in the hospital, aiming at the implementation of an emotional assistance plan. The trajectory of the group, as well as the characteristics of the work done and its peculiarities are shown in this study. Results indicate that group work is a valuable tool for planning emotional care to these patients. However, it requires specific preparation and knowledge of group dynamics on the part of nursing professionals, so that the "healing" potential of group work can be better used.     

Carotenoids,mostly the xanthophylls,exchange between plasma lipoproteins

Carotenoids are exclusively transported by lipoproteins; in vitro studies suggest that they might protect these particles against oxidation. Little is known about the factors that govern the distribution of these micronutrients among lipoproteins. The objective of this study was to assess whether carotenoids are exchanged between lipoproteins and what factors, if any, were involved. In the first experiment, different groups of trout were fed for five days with either a carotenoid-free diet or with diets containing 80 mg pure carotenoid per kilogram of feed. Lipoproteins were separated by ultracentrifugation and carotenoid-rich, high-density lipoproteins (HDL) were incubated for two hours at 37 degrees C with carotenoid-free, very low-density lipoproteins (VLDL), and vice versa. After incubation, lipoproteins were re-separated and carotenoids were quantified to measure the transfer. The same experiments were done in the presence of cholesteryl ester transfer protein (CETP) and lecithin cholesterol acyltransferase (LCAT) inhibitors. In a second experiment, the exchange was measured between human VLDL and HDL. In trout, incubation of carotenoid-rich HDL with carotenoid-free VLDL resulted in the appearance of carotenoids in VLDL, and inversely. The higher the hydrophobicity of a carotenoid, the lower its proportion in HDL after incubation. CETP and LCAT inhibitors significantly increased the proportion of carotenoids in HDL after incubation. Results obtained with human lipoproteins showed that the xanthophyll lutein transferred between lipoproteins, but could not show any carotenes (alpha-carotene, beta-carotene, and lycopene) transfer. We conclude that carotenoids, chiefly the xanthophylls, exchange between lipoproteins. The transfer depends on plasma factor(s) sensitive to CETP and/or LCAT inhibitors.     

Scarff-Bloom-Richardson (SBR) grading: a pleiotropic marker of chemosensitivity in invasive ductal breast carcinomas treated by neoadjuvant chemotherapy

The Scarff-Bloom-Richardson (SBR) grade, an important prognostic factor in breast cancer, was also associated with cell proliferation, a consistent indicator of response to chemotherapy. The determination of an association between SBR grade and responsiveness would be clinically useful. We explored the influence of SBR grade on response to neoadjuvant chemotherapy in patients with invasive ductal breast carcinoma. The present study centered on 431 patients registered onto one of four prospective phase II trials. SBR grading was performed according to the Elston method on needle core biopsies prospectively collected prior to treatment from 290 patients and on residual tumour at surgery from 171 patients. The post-operative grades were then compared with those obtained at diagnosis. Univariate and multivariate analysis were used to evaluate the significance of SBR grade on response to neoadjuvant chemotherapy. Both statistical analysis revealed that SBR grade III tumours responded better to neoadjuvant treatment than SBR grade I (p<10(-6)). None of the other patient and tumour characteristics tested correlated with response. Moreover, tumour responsiveness was significantly related to changes of the SBR grade (p=7 x 10(-3)). As a conclusion, we showed that SBR grade is a strong predictive factor of response to induction chemotherapy in breast cancer, independently of the type of regimen used. The association between evolution of the histological grade following chemotherapy and response to treatment may prove valuable for clinicians as they make their decision regarding patient therapy.