Nosocomial cross-transmission of Pseudomonas aeruginosa between patients in a tertiary intensive care unit.

Background: Nosocomial infection caused by Pseudomonas aeruginosa (P. aeruginosa) is very common, despite the application of various preventive measures in intensive care units (ICUs) leading to increased morbidity, mortality, prolonged hospital stay, and increased treatment cost. Aim: The aim of the present study is to identify the source of P. aeruginosa infection in patients admitted to tertiary ICU. Materials and Methods: From 200 patients selected randomly, appropriate clinical specimens from different sites were collected and processed for the isolation and identification of the nosocomial pathogens. Surveillance samples from environmental sites and hands of nursing staff were also cultured. Results: P. aeruginosa was found to be the most common pathogen associated with nosocomial infections accounting for 23.3% of all bacterial isolates from different infection sites in the ICU. Serotyping of the clinical isolates and surveillance sample isolates from nurses' hands showed serotype E as the most common serotype. Other serotypes of P. aeruginosa were isolated from environmental cultures such as sinks, floors, walls, tap water, etc. Conclusion: Study revealed a high prevalence of P. aeruginosa infections in the ICU attributed to cross transmission from patient to patient via hands of the nursing staff. Strict enforcement of infection control protocols is essential to minimize the disease burden.

Clinical evaluation of atracurium on mother's hemodynamics and baby's wellbeing after caesarian section

Atracurium besylate is used mainly to produce skeletal muscle relaxation during surgery and to increase pulmonary compliance during assisted or controlled respiration [ventilation] after general anesthesia, also been used to facilitate endotracheal intubation. Fetal [Baby] wellbeing depends on placental blood flow which affected by systemic hypotension or hypertension, uterine blood flow rate which affected by maternal hemodynamic, uterine contraction and drugs that pass the placental blood barrier. Eighty pregnant women with full term pregnancy, normotensive, non diabetic or hypertensive [essential, pregnancy induced hypertension or eclampsia] and without any medical problems within normal placental sit and function undergoing Caesarean Section were included in this study. They had ASA grade I, their age ranged between 22-45 years old, their body weight was between 60-80 kilograms and received general anesthesia, half an hour to one hour after premedications [Primperan 10 mg IV, Randitine 100-150mg and 30 ml of 0.3-m sodium citrate [22], all patients had pre-oxygenation for 5 minutes and anesthesia induction was with intravenous sodium thiopentone [2.5%] 4mg/kg, scoline 1mg/kg, Atracurium 1-1.5mg/kg just after cndotracheal intubation and anesthesia was maintained by inhalational agent isoflurane 0.5%, Apgar score and baby's wellbeing were assessed in all the babies at the end of 1st and 5th minutes respectively. Resuscitation measures were also noted by pediatrician, data expressed as mean, standard deviation. A P-value<0.05 was considered statistically significant. After analysis of the collected data, there were no clinical significant decrease in maternal hemodynamic or babies wellbeing detected but statistically is highly significant as "t" test and P-value was 0.000, also baby's wellbeing was normal but Apgar Score and umbilical venous pH find a statistically significant-value 0.000. The administration of neuromuscular blocking agents [Atracurium] during Cesarean Section has no immediate or delayed adverse effects on the fetus, does not increases the likelihood of resuscitation the neonate. Indeed, the maternal hemodynamic changes in this study neither affects the placental blood flow and it's blood pressure auto-regulation range nor the babies wellbeing

Aeromonas caviae septicemia in immunocompetent gastrointestinal carriers

Aeromonas caviae strains have been isolated from blood and stool cultures of three immunocompetent patients, residents of Northern India, who presented with community acquired septicemia without any recent history of diarrhea. Cell culture infectivity test performed on Hep-2 cells have shown substantial degree of invasiveness in the isolated strains. This case unleashes a possibility of asymptomatic gastrointestinal carriage of such strains of A. caviae in a very large population of India, as several areas of India have very high rates of Aeromonas induced acute diarrhea/gastroenteritis (up to 13 percent). It needs to be appraised further in India as well as other countries having high rates of Aeromonas induced acute diarrhea/gastroenteritis.

Possible pharmacodynamic interactions between the CNS stimulant [Nikethamide] and analgesic drugs in experimental animals

Recently, there has been striking increase in research on drug combinations that enhance analgesia in clinical populations as well as in experimental animals. These studies involve combinations of drugs that have been viewed, as effective analgesics in their own right, such as opioids and nonsteroidal anti-inflammatory drugs, and drugs that have not traditionally been viewed as analgesics. The purpose of this study was to investigate the possible pharmacodynamic interactions between a CNS stimulant [nikethamide] and opioid [morphine] and non-opioid [paracetamol] drugs. Also, this study assessed the rationale of these interactions in terms of efficacy and safety by using different models of analgesic and behavioral tests. Albino mice and rates were used, as experimental animals. The analgesic effect of drugs and their combination was evaluated using [hot-plate] [54 °C], [tail clip] and [writhing] [acetic acid, 1%. i.p.] tests. The behavioral effects of the drugs and their combinations were also determined. Nikethamide significantly diminished the analgesic effect of morphine [1-10 mg/kg, i.p.] in all tests [antagonism] and enhanced the analgesic effect of paracetamol [50-400 mg/kg. i.p.] in all tests [additive]. Coadministration of nikethamide [100 mg/kg, i.p.] with morphine [2.71 mg/kg, ED[50]] significantly decreased locomotor activity and impaired the acquisition on conditioned avoidance responses but did not affect motor coordination to any significant extent. On the other hand, coadministration of nikethamide [100 mg/kg, i.p.] with paracetamol [117.94 mg/kg, i.p, ED[50]] significantly increased locomolor activity and improved the acquisition on conditioned avoidance responses but did not affect motor coordination to any significant extent. We can conclude that the systemic coadministration of nikethamide significantely antagonized the analgesic effect of morphine and such combination was accompanied by increased side effects. In contrast, nikethamide significantly enhanced, the analgesic effect of paracetamol in an additive fashion and this combination was not accompanied by increased side effects

Modulation of the antiepileptic activity of sodium valproate by lithium chloride against pentylene-tetrazole and strychnine-indced seizures in mice.

In this study, the influence of lithium chloride [LiCl] in a dose of 10 mg/kg on the anticonvulsant activity of sodium valproate [VAL] in doses of 200 or 600 mg/kg was valuated against both pentylenetetrazol [PTZ; 100 mg/kg] and strychnine [ST; 1 mg/kg]-induced seizures and mortality. The results revealed that the ip administration of VAL alone was effective against seizures and mortality induced by both PTZ and ST. Significant increases in the onset of seizures and the MST as well as the percent of mice protected from death were recorded. In contrast, the administration of LiCl alone significantly reduced the onset of seizures and offered no protection against death caused by the same convulsive agents, PTZ and ST. Compared with valproate- treated mice, combination of lithium chloride and valproate led to a reduction in the MST of mice and an increase in the percent of protection of animals treated with PTZ and an increase in the MST of mice as well as the percent of protection in the ST- treated group of mice. Also, the results revealed that the combined administration of LiCl and VAL into mice subjected to the test convulsive agents resulted in reduced serum and brain concentration of electrolytes in FTZ-treated animals. Also, significant lowering only in the brain Na+, K+ and Cd2+ contents was observed in mice treated with ST

Clinical down staging of cancer cervix with cytology.

A prospective study was carried out on 1500 patients attending the Gynaecology outpatient department of three referral hospitals in Dhaka City. These patients were selected on some selected clinical criteria to correlate several clinical markers (clinical down staging) with that of Pap's smear for early detection and secondary prevention of cancer cervix. Speculum examination and Pap's smear were done in all cases. Among 1500 women, 224 had abnormal Pap's smear. Histologic examination of specimens from these cases showed chronic cervicitis in 45 cases, dysplasia in 84 and squamous cell carcinoma in 95. Carcinoma was found in 130. Thus, there were 297 Pap's smear negative cases were biopsied on clinical ground. 225 cases of invasive carcinoma. From this study, it seems that clinical downstaging with cytology programme has to be started immediately throughout the country for diagnosis of carcinoma of the cervix in its preinvasive and potentially curable stage.

Bronchial carcinoma in Assiut University Hospital

The data of 106 patients [82 males and 24 females] with proved bronchogenic carcinoma were analysed. Seventy-three% of them were found inoperable after clinical and/or radiological examination. Another 7% were excluded from surgery after bronchoscopic examination. Twenty% were submitted to surgical treatment, while the rest once diagnosed were beyond the territory of the surgeon. Ten% were found to be resectable after thoracotomy. Delay, partly caused by the patient and the treating doctor and by the nature of the disease are behind the low operability and resectability rates here

Cytochemical study of aryl sulphatase and non-specific esterase in colon adenocarcinoma after 5-fluorouracil and OCNU treatment and their effects on the immune function

The localisation and enzymatic activity of aryl sulphatase and non-specific esterase in normal colon, colon adenocarcinoma, 5-fluorouracil and CCNU treated cells were studied respectively. Intracytoplasmic granular reactions were observed for all tissues. The enzymatic activity was found to be more intense in malignant cells of colon. The increased activities of these enzymes in treated cells might be considered as an index of the in creased fragility of lysosomes and degeneration of some tumour cells which acompanied by a decrease in T-Cells function

Hodgkin's disease: cytochemical studies of deoxyribonucleic acid [DNA] and glucose 6-phosphate dehydrogenase [C6PD] after cyclopho-sphamide [endoxan] treatment

Deoxyribonucleic acid [DNA] and glucose 6- phosphate dehydrcgenase [G6PD] enzyme were studied in human normal lymph node and Hodgk in's disease cells. It has been observed that DNA was present in chromatin materials, whereas [G6P D] was present as granules distributed uniformaly in the cytoplasm. Under the effect of endoxan, a decreased activity of DNA and G6PD has been noticed. This could be explained on the basis that alkylation of phosphate groups was the main point of attack on the DNA which result in the breakdown of the DNA molecule

Colon adenocarcinoma: cytochemical study of succinic and lactic dehydrogenases under the effect of 5-flurouracil and CCNU antitumour drugs

The localization and concentration of succinic dehydrogenase [SDH] and lactic dehydrogenase [LDH] in colon adenocarcinoma before and after the application of 5-Fluorouracil [5-Fu] and 1- [2-Chloroethyl] 3-CylohexanylM-Nitrosourea [CCNU] drugs were studied. It was found that there was a marked decrease in the concentration of lactic dehydrogenase [LDH] in the treated cells. On the contrary, the concentration of succinic dehydrogenase [SDH] was found to be increased