Antibiogram and plasmid profiling of carbapenemase and extended spectrum Beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in Abeokuta,South western,Nigeria

Background

The increased reports of ESBL dissemination from various centres in south western, Nigeria and the recent emergence of carbapenem resistant bacteria prompted the conception of this study.

Objectives

To demonstrate the relationship between high molecular weight plasmids and the expression of antibiotic multi-resistance including ESBL and carbapenemase.

Methods

We investigated 97 isolates of selected organisms consisting of 67 E. coli and 30 Klebseilla spp for the presence of plasmids expressing ESBL including carbapenem-hydrolysing enzymes. Beta-lactamase was determined using acidometric method, while ESBL and carbapenemase activity was determined using the double-disk diffusion test as well as the Modified Hodge test (MHT). Plasmid profiles of ESBL and carbapenemase positive isolates were determined according to standard protocols.

Results

An ESBL prevalence rate of 21.6% and carbapenem- resistance rate of 9.3% was recorded. Antibiotic susceptibility profile of ESBL isolates showed 100.0% resistance against Amoxicillin, Cotrimoxazole and Erythromycin. Moderate susceptibility was recorded against the Quinolone class of antibiotics; Meropenem remained the most active antibiotic against ESBL isolates with 62.5% against E. coli and 60% against K. pneumoniae. The plasmid profiles of our study isolates ranged from 11.8kbp to 35.5kbp.

Conclusion

Due to the relationship between high molecular weight plasmids and multi-drug resistance, we hereby recommend regular molecular surveillance of this form in our study setting.     

TraumaNetzwerk DGU® und TraumaRegister DGU®

Background

The TraumaNetwork DGU® (TNW) connects hospitals with different capacities for the treatment of severely injured patients who work together as superregional (STC), regional (RTC) and local trauma centres (LTC). The standards of treatment and equipment are defined on the basis of current guidelines as published in the“White book of the Treatment of Severely Injured Patients”. An external audit process evaluates the organisation and structure of participating hospitals as well as the cooperation of the trauma centres within a regional TNW.

Results

In May 2013 a total of 618 hospitals were visited and assessed according to the White book and 39 fully certified regional TNWs covered around 85% of the area of Germany. Treatment quality in the certified TCs was analyzed on the basis of 25,249 severely injured patients in the TraumaRegister DGU® (2008–2011) and significant differences between the expected and observed mortality rates were found. These differences were most obvious in superregional and regional trauma centres.

Conclusion

The TraumaNetwork represents an innovative, cooperative project for successfully improving the treatment of severely injured patients.     

A Prospective,Randomized Comparison of Modified Pulmonary Vein Isolation Versus Conventional Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation

Modified Pulmonary Vein Isolation in AF Ablation. Introduction: Pulmonary vein isolation (PVI) is the primary ablation therapy in patients with atrial fibrillation (AF). We hypothesized that high dominant frequency (DF) sites (AF nests during sinus rhythm [SR]) adjacent to the PV ostia are associated with the atrial substrate that maintains AF, and PVI incorporating the high‐frequency AF nests may have a higher efficacy. Methods and Results: In a prospective and randomized comparison, 126 symptomatic paroxysmal AF patients that underwent PVI were enrolled. We compared the efficacy of a modified PVI (ablation line: 1.0–1.5 cm from the PV ostium with encircling the AF nests [spectral analysis with DF >70 Hz during SR, Group II]) versus the anatomy‐guided conventional PVI (Group I). In Group II, the DF value along the PV ostium was lower than 70 Hz after the PVI. The primary endpoint was the freedom from symptomatic atrial arrhythmias after a single procedure. We also followed the autonomic function by a time‐domain analysis of the heart rate variability. In both groups, AF nests were observed and electric isolation was successfully obtained in all patients. With a mean duration of 16 ± 6.1 months of follow‐up, Group II had a higher single procedure efficacy without drugs (78.7% vs 66.1%, log‐rank test: P = 0.02), and fewer repeat procedures (6.6% vs 23%; P = 0.04), as compared to Group I. Conclusion: PVI incorporating the high frequency AF nests adjacent to the PV ostia had a better single procedure efficacy. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1155–1162, November 2012)     

Exercise Reveals the Interrelation of Physical Fitness,Inflammatory Response,Psychopathology, and Autonomic Function in Patients With Schizophrenia

Maintaining and improving fitness are associated with a lower risk of premature death from cardiovascular disease. Patients with schizophrenia are known to exercise less and have poorer health behaviors than average. Physical fitness and physiological regulation during exercise tasks have not been investigated to date among patients with schizophrenia. We studied autonomic modulation in a stepwise exhaustion protocol in 23 patients with schizophrenia and in matched controls, using spirometry and lactate diagnostics. Parameters of physical capacity were determined at the aerobic, anaerobic, and vagal thresholds (VT), as well as for peak output. VT was correlated with psychopathology, as assessed by the Positive and Negative Syndrome Scale, with the inflammatory markers IL-1β, IL-6, and TNF-α and with peak output. The MANOVA for heart and breathing rates, as well as for vagal modulation and complexity behavior of heart rate, indicated a profound lack of vagal modulation at all intensity levels, even after the covariate carbon monoxide concentration was introduced as a measure of smoking behavior. Significantly decreased physical capacity was demonstrated at the aerobic, anaerobic, and VT in patients. After the exercise task, reduced vagal modulation in patients correlated negatively with positive symptoms and with levels of IL-6 and TNF-α. This study shows decreased physical capacity in patients with schizophrenia. Upcoming intervention studies need to take into account the autonomic imbalance, which might predispose patients to arrhythmias during exercise. Results of inflammatory parameters are suggestive of a reduced activity of the anti-inflammatory cholinergic pathway in patients, leading to a pro-inflammatory state.Key words: heart rate, physical exercise, respiration, schizophrenia, vagal threshold, cardiac death, inflammation, physical fitness     

Quality assurance of brachytherapy afterloaders using a multi-slit phantom

Brachytherapy is a very successful treatment option for many different tumors. Consequently the quality assurance (QA) of afterloaders is of special interest. For many quality checks verification films are essential. Because currently in many clinics the film development units are replaced by computed radiography systems, the question arises of how to perform QA for afterloaders without conventional radiography films. In this note the use of a new designed multi-slit phantom demonstrates the possibility of performing QA checks with high sensitivity computed radiography systems. Because the presented phantom allows a method for imaging the radiation source it might be useful in the development of further QA techniques.     

Körperliche Aktivität zur Stärkung kognitiver Ressourcen

Background

Nursing care insurance funds are supposed to deliver preventive services in nursing homes. The strengthening of cognitive resources is considered as one field of action.

Aim

The preventive effectiveness of physical activity on cognitive performance in nursing home residents shall be evaluated.

Methods

A systematic search was carried out in the databases MEDLINE, the Cochrane Library, EMBASE, CINAHL, PsycINFO and PEDro. Results were combined in random-effects meta-analyses.

Results

Taking into account 13 primary studies, it was shown that those participating in physical activity showed statistically significant greater cognitive performance compared to controls (SMD = 0.43, 95% CI 0.20–0.66, p = 00002). Subgroup analyses suggest that nursing home residents with different cognitive impairments might benefit from long-lasting physical activity interventions. Due to the high risk of bias in included studies, the results must be interpreted with caution.

Conclusion

Physical activity might be effective in the inpatient care setting. Further studies with longer intervention periods are required.

     

Correct,Fake and Absent Pre-Information Does Not Affect the Occurrence and Magnitude of the Bilateral Force Deficit

The present study examined whether different pre-information conditions could lead to a volitional modulation of the occurrence and magnitude of the bilateral force deficit (BFD) during isometric leg press. Twenty trained male adults (age: 24.5 ± 1.7 years; weight: 77.5 ± 7.1 kg; height: 1.81 ± 0.05 m) were examined on three days within a week. Isometric leg press was performed on a negatively inclined leg press slide. Each participant completed three maximal isometric strength test sessions with different pre-information conditions given in a graphical chart: no pre-information (NPI; first day), false pre-information (FPI; bilateral force > sum of unilateral forces; second or third day) and correct pre-information (CPI; bilateral force < sum of unilateral forces; second or third day) during bilateral, unilateral-left and unilateral-right leg-press. The sum of left- and right-sided force values were calculated for bilateral (F_BL = F_{BL_left} + F_{BL_right}) and unilateral (F_UL = F_{UL_left} + F_{UL_right}) analyses. Force data for NPI revealed: Mean (SD): F_{UL_NPI} = 3023 N (435) vs. F_{BL_NPI} = 2812 (453); FPI showed F_{UL_FPI} = 3013 N (459) vs. F_{BL_FPI} = 2843 (446) and the CPI revealed F_{UL_CPI} = 3035 (425) vs. F_{BL_CPI} = 2844 (385). The three (no, false, correct) x 2 (F_UL, F_BL) rANOVA revealed a high significant main effect of Force (F = 61.82, p < 0.001). No significant main effect of the factor Condition and no significant interaction between Force x Condition was observed. The BFD does not rely on the trueness of the given pre-information (no, false, correct). Cognition-based volitional influences on the BFD on supra-spinal level seem negligible.

Key points

• BFD is reliable occurring phenomenon
• Available theoretical knowledge does not affect the BFD
• Alternating sport should include alternating strength exercises

Key words: Bilateral force deficit, strength training, lower extremities, unilateral strength