ABSTRACT
Background: nosocomial urinary tract infection [NUTI] is the most common infections in intensive care unit [ICU] with a considerably high mortality and morbidity rates. It is a cause of concern and major pool of resistant pathogens
Objective: this is a prospective study conducted to detect the frequency of NUTI, common microorganisms, the risk factors and mortality in neurological ICU [NICU] at Mansoura University Hospital
Patients and methods: the current study enrolled patients who were admitted to NICU for >/=48 hrs. From August 2009 to Sept 2010. Three hundred ninety-six patients [190 males and 206 females with median age 60 years] were enrolled in the present work NUTI were diagnosed according to the CDC definition for patients who had urinary catheters. The following risk factors, age, sex, length of stay, duration of catheterization, immuno-compromised and risk of mortality, were studied. As well, isolation, identification and antimicrobial susceptibility were performed. An Enterobacter cloacae outbreak of UTI was detected. Typing and tracing of the source of infection was confirmed using ERIC-PCR
Results: NUTI frequency rate was 20.5%. The NUTI rate were high among old age, female, prolonged hospitalization, catheterization and immunocompromised patients. The mortality rate among NUTI patients was not significantly high. E. coli was the most common isolate [27.3%] which had maximum sensitivity to amikacin followed by meropenem. ERIC showed the same banding patterns among isolates from the three patients and hands of a nurse who was considered as the source of the outbreak
Conclusion: prevention of NUTI clearly represents a real challenge that faces the health care field especially in ICUs. No doubt, effective interventions will be a critical step in the battle against antibiotic resistance and outbreak emergence in ICUs
ABSTRACT
Background: hospital acquired Klebsiella pneumoniae may produce Amp C Beta lactamases and/or extended spectrum Beta lactamases [ESBLs] as possible resistance mechanisms among others leading to therapeutic failures and global public health problem. Objectives: to investigate cephalosporin resistance mechanisms that may be referred to AmpC Beta lactamases production whether alone or among ESBLs
Methods: eighty two nosocomial Klebsiella pneumoniae isolates were included in the study. ESBLs production is diagnosed by positive double disk synergy test [DDST] and then PCR for bla CTX-M family was done. Both ESBLs and non ESBLs were tested for AmpC Beta lactamases production by resistance to cefoxitin and by positive three dimension enzyme test [I'DET]
Results: ESBLs were found in 76.7%, while non ESBLs were 23.3%. By PCR for bla CTX-M groups, 63.o4% and 36.7% were of CTX-M type and non CTX-M type respectively. Four cases [8. 7%] among ESBL producers were also AmpC Beta lactonases producers. While among non ESBLs, 5 cases [35. 7%] were harboring pure AmpC Beta lactamases and 9 cases [64.3%] were negative AmpC producers
Conclusion: resistance to beta lactam antimicrobial agents is quite frequent in Klebsiella pneumonia nosocomial isolates. Carbapenems is the first line of treatment followed by Piperacillin tazobactam
ABSTRACT
Multiple Sclerosis [MS] is a common demyelinating and inflammatory disease of the CNS with a presumed autoimmune etiology. IFN beta-1a and IFN beta-1b have a proven treatment effect on RRMS presumably through its regulatory properties on T-cell activation and cytokines production. Here we studied the clinical and MRI effects of these drugs in four groups of clinically and laboratory [Cerebrospinal fluid evaluation revealed elevation of immunoglobulin [IgG] synthesis rate and oligoclonal bands] definite RRMS patients for 18 months. In IFN beta-1a group [n = 25], the patients used IFN beta-la 30 micro g [6MU] intramuscular once a week, the other three groups of IFN beta-1a [n = 25] 22 micro g [6MU], IFN beta-la 44 micro g [n = 25] and IFN beta-1b 8MU [0.25 mg] [n = 25] were injected subcutaneously 3-time a week. In comparison with the pre-treatment values, reduction in the relapse rate was statistically significant in IFN beta-la 44 micro g, IFN beta-la 30 micro g and IFN beta-lb 8MU groups more than IFN beta-la 22 micro g [P < 0.001, 0.008, 0.001 and > 0.5 respectively], and the mean EDSS significantly reduced in the IFN beta-lb [P < 0.001], IFN beta-la intramuscular [P < 0.02] and 44 micro g IFN beta-la [P < 0.001], in contrast to 22 micro g IFN beta-la treated patients [P > 0.5]. Moreover, IFN beta-lb [P < 0.001] and 44ug IFN beta-la [P < 0.003] groups showed highly statistical significant reduction in MRI disease activity load [p < 0.05] in comparison with 22micro g IFN beta-1a [p < 0.5] and IFN beta-la intramuscular groups [p < 0.07]. The study confirmed also the effect of beta-IFNs on the short term physical disability scale [p < 0.01] while they have no significant effect on long term disability scale [p > 0.64]. Additionally, beta-IFNs groups showed no statistically significant severe drugs adverse effects [p > 0.8] while revealed significant effects of recovered side effects [p < 0.01]. The common adverse effects of lFN beta that were significantly found [p < 0.01], are flu-like symptoms, fatigue, chills and fever, injection site pain and local redness, headache, irregular menses and mild depression specially with IFN beta-la intramuscular. No difference in the clinical suspicions of binding antibodies development to beta-IFNs was found. On the whole, all groups showed significant reduction of relapse frequency and MRI load with different values [p < 0.01]. In summary, this study does make available meaningful and helpful clinical and radiological data to the clinician regarding the relative efficacy of each therapy in RRMS. First, the results of our study suggest that IFN beta-lb 8MU and IFN beta-1a 44 micro g may be more optimal choices than IFN beta-la 30 micro g Intramuscular and IFN beta-la 22 micro g at the currently available dose in treatment of RRMS patients. Secondly, the results do not differ from remarks made after 18 months of treatment in larger and more rigorously controlled studies. Thirdly, therapy does construct a difference and early treatment should be encouraged
Subject(s)
Humans , Male , Female , Interferon-alpha/pharmacology , Interferon-beta/pharmacology , Magnetic Resonance Imaging , Treatment OutcomeABSTRACT
Epilepsy surgery has a proven treatment effect on patients with medical intractable partial seizures, presumably through its resection of epileptogenic zone. This prospective and nonrandomized controlled study examines whether minimal invasive microneurosurgical interventional through frontolateral trans-sylvian approach for a high selective amygdalohippocampectomy would reduce the frequency of epilepsy and antiepileptic drugs [AEDS], for patients who have had long history of poor response on pharmacotherapy, via measuring over one year the clinical, activity of daily living and EEG outcomes. Our inclusion/ exclusion criteria for selected cases and according to the definition of ILAE are, intractable temporal lobe epilepsy [TLE] either right or left side origin, all patients had a history of treatment for more than 13 years by AEDS polytherapy and according to our inclusion criteria they should have at least 4 seizures a month. Selective amygdalohippocampectomy was done for 17 patients and all of them were followed up for one year. The study confirmed that selective amygdalohippo-campectomy reduces the seizures frequency and drugs doses in patients with mesial temporal lobe epilepsy [MTS]. However, amygdalohippocampectomy did not signify cessation of all AEDS, but all patients showed satisfactory seizure free outcome under monotherapy. There is also significant difference in epilepsy frequency postoperatively especially psychomotor component. The findings are important for the understanding of selective amygdalohippocampectomy role in the treatment of intractable TLE [MTS] with or without secondary generalization