Use of Time-Trend Analysis in the Design of Empirical Antimicrobial Treatment of Urinary Tract Infection

Selection of empirical treatment of hospitalized patients with urinary tract infection (UTI) is usually based on the results of urine culture as obtained from the local microbiology laboratory. In order to improve the precision and reliability of traditional methods, we analyzed temporal changes in the results of urine culture and antibiograms and stratified the results by inpatient department and the presence/absence of an indwelling catheter. The database consisted of urine cultures obtained during the first 3 months of each year over a 10-year period between 1991 and 2000. Only urine samples that grew a single organism at a concentration of >10⁵ cfu were included in the analysis. Trend statistical tools, readily available but thus far not used for microbiological analyses, were applied to assess the decay in activity of individual antibiotic agents over time and to calculate susceptibility rates of organisms in subsets of urine samples. Organisms, antimicrobial susceptibility rates and the degree of decay in antimicrobial susceptibility rates varied significantly according to the location of the patient in the hospital and the presence of an indwelling catheter. Stratified trend analysis is a useful tool that can be helpful in designing and adapting clinical guidelines for the selection of appropriate empirical antibiotic treatment for the individual patient with urinary tract infection. Electronic Publication     

Neuroblastoma: prognostic factors and survival. Experience in Hospital de Pediatria del Centro Medico Nacional del Siglo XXI and review of the literature

Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the literature. In Mexico it is less frequent, fallen to 8th place. Our objective was to analyze our experience and compare it with the one reported in other countries. We included all patients admitted to our hospital during the previous five years and who had not received any treatment. Patients with stages I, II, and IV received cyclophosphamide and epirrubicin. Patients with stages were III and IV received the same chemotherapy alternating with cisplatinum., ifosfamide and etoposide during 12 months as well as massive doses of 131-MIBG and surgical ablation of the remaining tumor when possible. We included 30 patients, 25 with initial presentation in the abdomen. Five were in early stages and 20 (70%) were advanced with an overall survival of 100% and 27% at 5 years respectively. When analyzed by age, 40% were 12 months of age and 60% older, with survival of 100% and 27% in the same period, respectively. According to histology there was 91% survival for differentiated and 23% for undifferentiated tumors. The chemotherapeutic regimen reported is effective but not better than that reported by other authors, in which some benefits are seen with use of transplant and immunotherapy. The most important prognostic factors are still considered to be age, stage and histology.     

Therapeutic efficacy of an E coli strain carrying an ovalbumin allergenic peptide as a fused protein to OMPC in a murine model of allergic airway inflammation

An Escherichia coli strain expressing the ovalbumin (OVA) 323-329 allergenic peptide on the bacterial surface was evaluated for its ability to reduce the lung inflammatory response in mice allergic to OVA. BALB/c mice were rendered allergic by means of two intraperitoneal injections of OVA suspended in alum 5 days apart, and one intratracheal boost 1 week later. The mice were then treated with two intranasal, 1 week apart, doses of 4x10(9) E. coli-UH302 transformed with plasmids pST13 or pST13-OVA(323-339), which bear the OmpC porin from Salmonella enterica serovar Typhi or the OmpC with the OVA allergenic 323-339 amino acid sequence inserted in the external loop 5. The allergic inflammatory reaction was evaluated on day 31, finding that mice treated with E. coli-UH302-pST13-OVA reduced four to seven times perivascular and peribronchial infiltrates, mucus production, goblet cell hyperplasia and eosinophils when compared with mice treated with E. coli-UH302-pST13 or saline solution. These results were consistent with a significant decrease of IL-5 mRNA and induction of IFN-gamma mRNA in cells from bronchio-alveolar lavages (BAL). Specific serum IgE anti-OVA was also reduced, although the decrease did not reach statistical significance. These results demonstrate that the bacterial live vector bearing an allergenic peptide successfully moderated two important components of allergy, pulmonary inflammation and mucus overproduction.     

Respiratory medications and the risk of cardiac arrhythmias

BACKGROUND: Medications used to treat respiratory diseases include beta-adrenoceptors, antimuscarinics, inhaled and oral corticosteroids, and theophyllines. Most of these drugs have been associated indirectly with cardiac rhythm disorders, but epidemiologic evidence is limited. METHODS: To evaluate the association between respiratory drugs and the occurrence of rhythm disorders among patients with asthma and those with chronic obstructive pulmonary disease, we conducted a case-control study nested in a population-based cohort of individuals 10-79 years of age and registered in the U.K. General Practice Research Database after 1 January 1994. The analysis included 710 confirmed cases and 5000 controls frequency-matched to cases by age (interval of 1 year) and sex. RESULTS: No increased risk of arrhythmias overall was found among users of inhaled steroids (relative risk = 1.0; 95% confidence interval = 0.8-1.3). Short-term use of theophylline was weakly associated with arrhythmia (1.8; 1.0-3.3). An increased risk was found among users of oral steroids, and the relative risk was greater at the beginning of therapy (2.6; 2.0-3.5). The risk of atrial fibrillation was increased, especially for short-term use of oral steroids (2.7; 1.9-3.8), and a weak association was seen for theophyllines, especially short-term use (1.8; 0.9-3.7). Supraventricular tachycardia was associated with long-term use of oral steroids (2.1; 0.8-5.7), long-term use of antimuscarinics (1.7; 0.7-4.1), and short-term use of theophylline (4.0; 0.9-18.1). Ventricular arrhythmias were associated with oral steroids (3.2; 0.8-13.3) and beta-adrenoceptors (7.1; 0.8-65.9). CONCLUSIONS: Oral steroids and theophylline were the therapeutic groups associated with risk of developing atrial fibrillation, especially with new courses of therapy. Results from this study also are consistent with certain suspected dysrhythmic effects of theophyllines, with supraventricular tachycardia associated with antimuscarinics, and with ventricular arrhythmias associated with beta-adrenoceptors.     

Evaluation of the effectiveness of the Pastormaster method for disinfection of legionella in a hospital water distribution system

The Pastormaster method consists of heating the water of hospital distribution systems at a specific point to a sufficient temperature for a minimum amount of time to eradicate legionella. The object of this study was to evaluate the effectiveness of the Pastormaster method for legionella disinfection in a hospital environment. A two-phase procedure was performed: hydraulic optimization of the water supply circuit, and implementation of the Pastormaster method. Water samples were taken at 10 representative points in the hospital hot-water system and cultured microbiologically. Other physical and chemical measurements were also determined. Implementation of the Pastormaster method and correction of the deficiencies identified during a hydraulic system audit confirmed the absence of legionella in the hospital water distribution system. The combination of implementation of the Pastormaster method and conduction of a hydraulic audit designed to identify and remedy any possible problems in water circulation is effective in minimizing the risk of legionella contamination in hospital water distribution systems.     

仙鹤草根芽中新二氢黄酮醇甙的结构研究

从仙鹤草根芽的苯提取物和丙酮提取物中分得三个化合物。通过理化性质,波谱数据(UV,IR,NMR,MS,GD,GC),化学降解和衍生物制备,两个已知化合物分别鉴定为软脂酸(Ⅷ)和胡萝卜甙(Ⅸ),一个新化合物确定为(2S,3S)-(一)-花旗松素-3-O-β-D-葡萄吡喃糖甙(Ⅹ)。     

The projections of the lateral geniculate nucleus of the squirrel monkey: studies of the interlaminar zones and the S layers

Anterograde and retrograde tracing techniques were used to reveal that axons arising from neurons within the interlaminar zones and the S layers of the lateral geniculate nucleus of the squirrel monkey terminate within the supragranular layers of area 17. Specifically, our data indicate that the axons of the neurons housed within the S layers end in a patchlike fashion in cortical layers IIIa and IIIb, while neurons in the interlaminar zones project primarily to layer I. Both pathways may convey W-cell information from the retina and the superior colliculus to the striate cortex.