International Medical Publisher Journals (iMedPub)
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Usefulness of routine pairing of anaerobic with aerobic blood culture bottles and decision making on antimicrobial therapy
Get PDFObjectivesTo evaluate the growth concordance in paired aerobic/anaerobic sets, and the impact of the anaerobic growth on patients' antimicrobial management.MethodThis is a prospective multicenter study which was conducted in three hospitals, with total beds of 750 beds and 52 ICU beds. Prospectively, laboratory blood cultures logbooks were daily reviewed and patients from whom blood cultures were ordered were followed, their chart were reviewed. Entries on antimicrobial therapeutic changes were noted for all paired sets. Clinicians were blinded to the study, though they were informed about culture results via the usual work protocol in each hospital.ResultsCollected Blood culture sets totaled 2492; 172 single sets were excluded, and 1160 paired sets were analyzed. 1046 were concordant; 79 sets had bacterial growth and 967 sets had no bacterial growth. 114 sets were discordant; 97 in aerobic bottles, 13 in anaerobic, and 4 in both.The proportion of agreement for the concordant paired growth sets was 90.2%. The composite proportion of agreement for sets with any growth (N = 193, composite proportion of agreement = 56%, 95% C.I., 34% - 48%). Cohen kappa composite agreement, measured for the total analyzed paired-sets (N = 1160, K = .52, SE = .038. 95% C.I., .447 - .595). The odds of modifying antimicrobial regimen were for total and subgroups intent to treat odds, based on paired sets showed that one modification took place in one anaerobic growth set (N = 1160, Odds = 0.0008), the odds for all sets with any growth (N = 193, odds = .005), and based on any anaerobic sets (79 concordant, 13 anaerobic, and 4 discordant) with bacterial growth (N = 96: odds = 0.010).ConclusionThe study demonstrates that the proportion of agreement among paired sets were high, and needless to include anaerobic sets in routine blood culture collection. Also the decision-making of anti-infective treatment on patients based on anaerobic blood culture growth was not evident
Acute effects of resistance exercise on heart rate variability in cardiopathic patients: cross-sectional study
Get PDFBackground: Resistance exercise is used in clinical practice to improve muscle strength and resistance of patients with heart disease. However, it lacks studies regarding its acute effects on cardiac autonomic modulation. This cross-sectional study has aimed to evaluate the acute effects of resistance exercise on heart rate variability (HRV) in cardiopathic patients. Methods: We investigated 15 volunteers (63.8 ± 10.7 years old; 29.9 ± 4.32 Kg/m2), which were submitted to one maximal repetition (1RM) of knee extension and to the acute interventions with of 40% and 80% of 1RM, with minimal intervals of 48 hours. HRV was analyzed in the SDNN, RMSSD, Poincaré Plot, HF, LF, and LF/HF ratio indexes. We evaluated HRV in the periods of rest (10 min) and recovery (60 minutes, divided into 6 windows). Findings: No differences were observed between the immediate recovery and rest periods for all indexes. We observed increase in all indexes after 20 minutes of recovery. No differences were verified between the different protocols. Conclusion: a single acute session of resistance exercise in different intensities did not change the cardiac autonomic modulation
The Knowledge, Attitude and Practice of Exclusive Breastfeeding among Mothers in Two Semi-Urban Areas around a Baby Friendly Hospital Initiative (BFHI) designated hospital in Lagos State, Nigeria.
Get PDFBackground: The World health Organization (WHO) and UNICEF initiated intensive efforts to transform hospitals into breastfeeding support centers through the Baby Friendly Hospital Initiative. The study populations in this study were geographically located within the vicinity of a BFHI designated Hospital in Lagos, Nigeria. The aim of this study was to determine the knowledge, attitude and practice of exclusive breast feeding among mothers in two semi-urban areas around a BFHI designated hospital.Method: Four hundred self-administered questionnaires were distributed to mothers from two semi urban areas in Surulere Local Government Area of Lagos, Nigeria to ascertain their socio demographic data, knowledge, attitude and practice of exclusive breastfeeding. Approval for the study was granted by the Ethics Committee. The respondents were chosen by simple random sampling. The questions covered socio demographic data, knowledge, attitude and the practice of exclusive breastfeeding (EBF). Collected data was analyzed and investigated for statistical associations. Results: The knowledge, attitude and practice of exclusive breastfeeding amongst mothers in the semi urban area of Lagos, Nigeria is statistically significantly affected by their educational level and by their professional level. Those with a higher level of education were more likely to have a correct knowledge (P < 0.05). Religion, educational level, professional level and number of children were statistically significant for practicing EBF for at least three months (P < 0.05). The belief that colostrum is not good for the baby was statistically significant for educational level and profession (P < 0.05). The belief that sperm could get into the breast milk was statistically significant for age, religion, ethnic group, education, profession and the number of children (P < 0.05). Out of all the socio demographic variables examined, educational level of the mother and the mother’s professional level were the two variables that were most frequently statistically significant for knowledge, attitude and practice questions. Conclusion: The knowledge, attitude and practice of breast feeding are mostly affected by the education and the profession of the mother. Certain beliefs about breast milk and sperm were statistically significant across all the socio demographic data examined. Recommendations were made to increase health education targeted at correcting beliefs about colostrum and breast milk. Recommendation was also made for a reevaluation of BFHI.Keywords; Nigeria, Exclusive breastfeeding(EBF); Baby Friendly Hospital Initiative (BFHI); Knowledge; Attitude; Practice, Predictive Factors; Education; Socio demographic factors; Colostrum
Effects of modified Restricted Environmental Stimulation Therapy on relaxation, heart rate, blood pressure and flexibility
Get PDFBackground: Restricted Environmental Stimulation Therapy (REST) promotes physiological and behavioral changes that reduce the deleterious effects of stress. However, it requires expensive equipment and is accessible to a limited number of professionals and patients. We aimed to evaluate the physiological and behavioral effects of modified REST (mREST) in healthy young women. Method: Twenty-one healthy young women (20-25 yrs) participated. mREST consists of positioning the patient floating in the pool with 32oC for about 15 minutes, for twelve sessions, with blindfolded and wearing earplugs. The evaluation was performed before and after the intervention. The analysis of the state of relaxation was investigated by a questionnaire and the self-reports were categorized. Measures of heart rate and blood pressure were used as indicators of the cardiovascular response. Flexibility, measured by the finger-to-floor test, was used as an indicator of muscle relaxation. Results: Heart rate and blood pressure significantly decreased while flexibility and relaxation increased after the sessions (p<0.001 for all comparisons). Self-reports of relaxation were consistent with the blood pressure measures and indicated that the participants showed states of relaxation associated with the decrease of blood pressure and the increase of flexibility (p<0.001 for all comparisons). Conclusion: Healthy women undergoing mREST reported relaxation, with effects on muscular and cardiovascular systems. mREST is a simple, practical and affordable option for therapy in the aquatic environment
Extracorporeal Circulation in Cardiac Surgery Inflammatory response, controversies and Future Directions
Get PDFOne of the milestones in the history of the cardiac surgery is the development of extracorporeal circulation, which allowed hundreds of thousands of patients under successful open cardiac surgery. It´s objective is to maintain the vital organ´s perfusion, provide a bloodless field for surgery, and at the same time, give protection to the heart and lungs. Its principle is to bring most or all of the patient’s systemic blood, which normally returns to the right atrium, into an oxygenator in which oxygen is supplied to the blood and carbon dioxide is removed. The arterialized blood is filtered, heated and, pumped into the aorta and the systemic arterial system. But this continuous blood recirculation through nonendothelial surfaces of the perfusion system produces an inflammatory response. Despite all the advantages and strategies developed to try to make the most physiological condition during the extracorporeal circulation, there are still persistent controversies, which we are going to review, as well as the inflammatory response produced by the perfusion system, and it´s future directions
Dyspeptic syndrome and infection by Helicobacter pylori exhibit histopathologic correlation when observed in adolescents
Get PDFABSTRACT Objective: Chronic gastritis is a histological entity and is primarily associated with Helicobacter pylori infection. The main reason for controversy is the lack of correlation between dyspeptic symptoms and histopathologic changes. The purpose of this study was to compare histological findings with dyspeptic symptoms in adolescents. Methods: Adolescents aged 10 to 19 years old with dyspeptic symptoms were referred to upper endoscopy. A protocol was systematically submitted to all patients prior to endoscopy. Histopathologic examination was performed on biopsy specimens. H. pylori infection was detected by rapid urease test and histology. Results: A total of 162 consecutive outpatients with dyspeptic complaints and indication for endoscopy were entered in the database of this study. The mean age of the sample was 16 years old; There were 120 females (74%) and 42 males (26%). Helicobacter pylori were present in 123 patients (75.9%) with a Pearson’s coefficient of 0.7 (infection versus symptoms). The frequency of gastritis in the antrum and incisura angularis was significantly higher in subjects who had epigastric pain (p=0,004). Superficial gastritis was 2 times more frequent among subjects who had epigastric pain than those who do not presented (p=0,012). Severe gastritis was significantly more frequent among those who had epigastric pain (p=0,016). There was no correlation between gastritis and other dyspeptic symptoms. Conclusion: This study shows that there is a correlation between epigastric pain and superficial gastritis of greater intensity and infection by H. pylori. There is no correlation between epigastric pain and intestinal metaplasia in adolescents. Gastritis of the antrum and incisura angularis showed a correlation to regurgitation. Gastritis was not associated to other dyspeptic symptoms.Â
Comparing Intramedullary Nailing, External Fixation, and External Fixation followed by Intramedullary Nailing as management for open fractures of the tibial shaft: a Systematic Review
Get PDFBackground: The treatment of open fractures of the tibial shaft is often a dilemma since it requires particular caution and individual assistance for each case. Methods and Findings: Systematic review of the literature was conducted on the following databases: PubMed and VHL from 2000 to 2013 aiming to compare Intramedullary Nailing (IM Nailing), External Fixation (EF), and EF followed by IM Nailing in the treatment of open fractures of the tibial shaft. After analysis by inclusion criteria 24 articles met the eligibility criteria. The healing time was under 32 weeks, and the nonunion and defective healing rates were under 13.35% and 16.6%, respectively. The infection rate ranged from 3% to 53% for patients treated with EF as definitive management; from 0% to 22% for those treated with IM Nailing as definitive management; and from 0% to 16.7% for those who underwent EF followed by IM Nailing. Conclusion: The cases treated with EF as definitive management presented shorter healing time as for the analyzed samples. The nonunion cases with greater percentages were those of EF followed by IM Nailing. The studies using IM Nailing as definitive management presented more healing cases defective. Even though few studies analyze hospital stay, it was found to be shorter in the sample treated with EF as definitive management.Â
PMQR determinants among clinical isolates of ESBL and Amp C producing Serratia marcescens in Mansoura University Hospitals: A 6-year study
Get PDFBackground: Plasmid mediated quinolone resistant determinants (PMQR) are found to be of clinical relevance because it causes decreased quinolones sensitivity. Quinolones are valuable antibiotics against intrinsically resistant Serratia marcescens. Purpose: To determine the occurrence of PMQR determinants qnr, aac(6′)-Ib-cr and qep and their relation with extended-spectrum β-lactamase (ESBL) and / or Amp C- producing Serratia marcescens. Material and Method: One hundred and eleven Serratia marcescens were tested for resistance to five quinolones by disc diffusion method. Testing for qnr, aac(6′)-Ib-cr and qep was carried by multiplex PCR. Whereas ESBL and Amp C production were evaluated by double disc synergy test and cefoxitin Hodge test respectively. Results: Out of 111 Serratia marcescens , 51 (45.9%) were resistant to one or more of the used quinolones. Among Serratia marcescens isolates, 13 (11.7%) were ESBL producers while 5 (4.5%) were Amp C producers. Multiplex PCR confirmed the presence of PMQR determinant in 14 (12.6%) isolates of Serratia marcescens. Serratia marcescens positive  for qnr determinants were detected as qnrA and qnr B in 3 and 10 isolates respectively whereas one isolate co harbored aac(6')-Ib-cr and qnrA. Among 13 ESBL producers, 3 and 5 isolates were positive for qnrA and qnr B respectively (8/13, 61.5%). Whereas one isolate co- expressed aac(6')-Ib-cr  and qnrA was associated with Amp C production (1/5, 20%). Conclusion: This study indicated that PMQR play significant role in the occurrence and expansion of fluoroquinolone resistance in Serratia macrscens. Moreover they are closely associated with ESBL and Amp C producers. Â
Detection of Escherichia coli O157:H7 and O104:H4 in patients with diarrhea in Northern Lebanon and characterization of fecal E.coli producing ESBL and carbapenemase genes
Get PDFBackground. While most strains of Escherichia coli (E. coli) are harmless, some are causing intestinal infections of varying severity. Then Shiga toxin-producing E. coli (STEC)/ enterohemorrhagic E. coli strains can be associated with fatal clinical manifestations. Of these E. coli Serotypes O157: H7 and O104: H4 were responsible for worldwide epidemics causing thousands of intestinal infections and dozens of deaths.The aim of this research is to investigate the prevalence of E. coli O157: H7Â and O104: H4 in the diarrheal stools of 242 Lebanese patients.Materials and methods. This study includes 242 E. coli strains isolatedfrom fecal specimens of patients with diarrhea between February2013 and May 2014 in the microbiology department of Nini HospitalLaboratory in Tripoli - North Lebanon. All specimens were inoculatedon sorbitol MacConkey agar. Sorbitol negative strains were investigated for detection of stx1, stx2 and eae genes using real-time PCR. All carbapenem-resistant strains and ESBL producers were investigated by PCR for presence of KPC, IMI, NMC-A, EMS, GHG, VIM, NDM, IMP,OXA-48, blaTEM, blaCTX-M, blaSHV, blaOXA, blaGES and blaPER..Results. A total of 14 sorbitol negative strains were detected. The search for stx1, stx2 and eae genes showed the presence of a single positive strain for E. coli O157: H7. Out of 242 E.coli strains, 48 (19.8%) were ESBL-positive, 4 (1.6%) were resistant to ertapenem, and all were negative for stx2 genes, The blaCTX-M gene was the most frequentamong ESBL positive strains (85%), followed by the blaTEM gene (50%). One strain had the blaNDM-1 gene, another had the blaOXA-48 gene and 2 strains were probably resistant due to impermeability.Conclusion. The results of this study demonstrate rarely presence of enterohemorrhagic E. coli, but shows the frequent presence of multidrug resistant E.coli in the intestinal flra of North Lebanese patients. Therefore, it is important to search for MDR E.coli in the intestinal flra of patients who are going to be treated with major operations or those admitted to intensive care unit
Small-molecular tyrosine kinase inhibitors targeting vascular endothelial growth factor receptor-2 in the treatment of non-small cell lung cancer
No full textLung cancer is the leading cause of cancer-related death all around the world.Non-small cell lung cancer (NSCLC) accounts for almost 87% of all lung cancers. It has been well established that tumor angiogenesis is one of major mechanisms of tumor progression. Vascular endothelial growth factor receptor (VEGFR) signal pathway may be the dominant pathway involved in tumor angiogenesis, while the VEGFR-2 is now believed to the most important member of the VEGFR famil