Superficial swab versus deep-tissue biopsy for the microbiological diagnosis of local infection in advanced-stage pressure ulcers of spinal-cord-injured patients: a prospective study.

OBJECTIVE: To assess the predictive value of superficial ulcer swab culture to make a microbiological diagnosis of deep wound infections in spinal cord injury (SCI) patients with advanced-stage pressure ulcers. METHODS: From July 2011 to February 2014, we performed a prospective, single-centre study on adult SCI patients undergoing scheduled surgical debridement and reconstruction for advanced-stage pressure ulcers, at Montecatone Rehabilitation Institute, a 150-bed hospital dedicated to SCI care. Three superficial ulcer swabs were preoperatively collected using the Levine technique, then sent for culture. In surgery, multiple bone and soft-tissue specimens were taken and sent for culture and histological examination. No antibiotics were administered before surgery. The results of swabs and intraoperative specimens were compared. RESULTS: In all, 116 patients were included, median age 49 years; a majority were males with post-traumatic paraplegia. According to intraoperative specimen cultures, the most common micro-organisms were Staphylococcus aureus, Proteus mirabilis, and Pseudomonas aeruginosa, found in 31, 27, and 16 cases, respectively. Concordance between superficial swabs and intraoperative specimen culture was found in only in 25 out of 116 cases (22%). The main reason for non-concordance was the yielding of different micro-organisms (41 out of 116); false negatives (swab negative/intraoperative positive) accounted for 31 out of 116 and false positives (swab positive/intraoperative negative) for 19 out of 116. When compared with intraoperative specimens, sensitivity and specificity of the swab culture were 80% and 54%, respectively. CONCLUSIONS: Our results confirm that in patients with advanced-stage pressure ulcers, the cultures of a superficial ulcer swab are not useful in either the diagnosis of a superinfection or the prediction of the role of involved micro-organisms.

Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study.

AIM: To date non-invasive (NIV) mechanical ventilation use is not recommended in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) and pH < 7.30 outside a 'protected environment'. We assessed NIV efficacy and feasibility in improving arterial blood gases (ABG) and in-hospital outcome in patients with ARF and severe respiratory acidosis (RA) admitted to an experienced rural medical ward. METHODS: This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio's District Hospital. Two hundred and seventy-two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria (pH < 7.35, PaCO2 > 45 mmHg). Patients were divided according to the severity of acidosis into: group A (pH < 7.26), group B (7.26 ≤ pH < 7.30) and group C (7.30 ≤ pH < 7.35). ABG were assessed at admission, at 2-6 h, 24 h, 48 h and at discharge. RESULTS: Group A included 55 patients (24 men, mean age: 80.8 ± 8.3 years), group B 31 (12 men, mean age: 80.3 ± 9.4 years) and group C 26 (15 men, mean age: 78.6 ± 9.9 years). ABG improved within the first hours in 92/112 (82%) patients, who were all successfully discharged. Eighteen percent (20/112) of the patients died during the hospital stay, no significant difference emerged in mortality rate (MR) within the groups (23%, 16% and 8%, for groups A, B and C, respectively) and between patients with or without pneumonia: 8/29 (27%) versus 12/83 (14%). On multivariable analysis, only age and Glasgow Coma Scale had an impact on the clinical outcome. CONCLUSION: In a non-'highly protected' environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.

EEG as a measure of developmental changes in the chicken brain.

Scalp-applied recording electrodes were used to monitor changes in basal EEG patterns in chickens during posthatch development. Frequency spectra produced by Fast Fourier Transform show a biphasic morphology in all chickens with one peak at about 6 Hz and another at 26 Hz. Changes in the lower frequency band show progressive development and provide a possible index of brain development. Both amplitude and dominant frequency of the spectra decrease between Weeks 3 and 8 posthatch, reaching adult levels between Weeks 5 and 7. These results suggest that modifications of basal EEG reflect the widespread functional changes in neuronal circuits occurring in chicken during the "synapse maturation" period between 3 and 8 weeks' posthatch.

FARMAGUIDA: a databank for the analysis of the Italian drug market and drug utilization in general practice.

FARMAGUIDA, a databank of drugs marketed in Italy (2,596 pharmaceutical substances corresponding to 10,448 products), permits analysis of the nature and value of the drugs prescribed. It contains coded pharmaceutical and administrative information, an original classification, as well as indicators of the therapeutic status of each drug. The FARMAGUIDA classification was built hierarchically according to a three-level pattern: the first level (42 categories) corresponds to major pharmacological groups; the second level (157 groups) gathers drugs having similar clinical indications and/or pharmacological actions; and the third level (246 subgroups) classifies drugs according to chemical structure and/or the mechanism of action. Drugs not falling into well-established pharmacotherapeutic criteria (e.g. neurotropics or liver protectants) are classified into separate subgroups. Two larger groupings were also formulated: THER (11 headings), a utilization-oriented arrangement in which each heading also contained the corresponding placebo-like drugs, and PHARM (14 headings), a rational pharmacological arrangement, in which all placebo-like drugs were relegated into a separate set. The following quality indicators were created: DOC, which defines five degrees of documentation of clinical efficacy according to major textbooks of pharmacology and therapeutics; CLASS, which groups DOC values for a more simple evaluation of prescription data; PREP, which distinguishes monocomponent preparations from fixed-dose combinations, and also provides coded information about the rationale for the combination; HOSP, which hallmarks drugs that should be reserved for in-patients, e.g. anti-pseudomonal antibiotics. The composition of the list of reimbursable drugs, the Italian National Formulary (NF; 5782 products in 1990) was analyzed according to the FARMAGUIDA classification and indicators.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug utilization in general practice: prescribing habits of National Formulary drugs by GPs of Emilia Romagna (Italy) in 1988 and 1989.

Two years of prescriptions for all the drugs included in the Italian National Formulary by 3,866 general practitioners, in a region of Northern Italy of almost 4 million inhabitants, were analysed to determine the pattern of drug use. The data (official code and proprietary name of the drug, number of packages prescribed, price of the drug, dispensing pharmacy, and date of dispensing) were collected monthly by retail pharmacies and were recorded and organized in database files. Quantitative and qualitative profiles of prescription patterns were studied for all the major therapeutic areas. Overall drug prescriptions averaged 600 DDD/1,000 inhabitants/day. Comparison of 1988 and 1989 data showed only a slight increase in total drug prescriptions, but greater changes were detected in certain drug groups, especially those recently marketed. Overprescription of well-documented drugs, such as H2-antagonists, ACE-inhibitors, calcium antagonists and the HMG-CoA-reductase inhibitors, in comparison to other countries was shown. There was frequent prescribing of drugs devoid of documentation of their clinical efficacy, which were mainly given for clinical conditions lacking a specific treatment, or as placebos for minor disorders. The data demonstrate the need for educational intervention to improve the quality of drug prescribing habits in primary health care in Italy.

Incidencia de Streptococcus mutans y alteración en la concentración de inmunoglobulinas séricas e IgAS en niños alérgicos con caries / Incidence of Streptococcus mutans and changes in the concentration of serum immunoglobulins and SIgA in allergic children with caries

Se investigó en niños alérgicos la incidencia de Streptococcus mutans en placa dental, la existencia de caries dentales y niveles modificados de Igs séricas de IgAS, la relación entre valores promedios de IgAS y a) dieta cariogánica, b) consumo de aguas con distintas concentraciones de fluoruros, c) diferentes hábitos de higiene bucal. Se realizó examen de las muestras obtenidas de placas dentales y caries por observación directa. Se hicieron cultivos en caldo tripticasa soya y agar sangre. Se llevaron a cabo las pruebas de catalasa, nitrato-reductasa y pruebas bioquímicas para identificar S. mutans. Las Igs séricas y las IgAS fueron medidas por la técnica de inmunodifusión radial. Se identificaron S. mutans en 25/45 muestras de niños alérgicos, en 3/16 no alérgicos, en 25/43 niños con caries y en 3/18 sin caries IgM alcanzó niveles más altos en los niños con caries. Los valores medios de IgA sérica fueron más en los alérgicos y aumentaron muy significantemente en los no alérgicos con caries. En los niños alérgicos se encontraron frecuentemente valores subnormales de IgAS. Dieta cariogénica, consumo de aguas fluoradas y hábito de higiene bucal no fueron factores incidentes en las concentraciones de IgAS. Los niños alérgicos manifestaron niveles disminuidos de IgA sérica y mostraron con mayor frecuencia S. mutans en placa dental. En estos niños estuvo disminuida la respuesta IgA clase específica a la invasión de microorganismos potencialmente cariógenos. Independientemente de que el niño fuera o no alérgico, la presencia de caries fue muchas veces acompañada de bajos niveles de IgAS. Los valores subnormales de IgAS pueden ser causa importante en el desarrollo de caries (AU)

Incidencia de Streptococcus mutans y alteración en la concentración de inmunoglobulinas séricas e IgAS en niños alérgicos con caries / Incidence of Streptococcus mutans and changes in the concentration of serum immunoglobulins and SIgA in allergic children with caries

Se investigó en niños alérgicos la incidencia de Streptococcus mutans en placa dental, la existencia de caries dentales y niveles modificados de Igs séricas de IgAS, la relación entre valores promedios de IgAS y a) dieta cariogánica, b) consumo de aguas con distintas concentraciones de fluoruros, c) diferentes hábitos de higiene bucal. Se realizó examen de las muestras obtenidas de placas dentales y caries por observación directa. Se hicieron cultivos en caldo tripticasa soya y agar sangre. Se llevaron a cabo las pruebas de catalasa, nitrato-reductasa y pruebas bioquímicas para identificar S. mutans. Las Igs séricas y las IgAS fueron medidas por la técnica de inmunodifusión radial. Se identificaron S. mutans en 25/45 muestras de niños alérgicos, en 3/16 no alérgicos, en 25/43 niños con caries y en 3/18 sin caries IgM alcanzó niveles más altos en los niños con caries. Los valores medios de IgA sérica fueron más en los alérgicos y aumentaron muy significantemente en los no alérgicos con caries. En los niños alérgicos se encontraron frecuentemente valores subnormales de IgAS. Dieta cariogénica, consumo de aguas fluoradas y hábito de higiene bucal no fueron factores incidentes en las concentraciones de IgAS. Los niños alérgicos manifestaron niveles disminuidos de IgA sérica y mostraron con mayor frecuencia S. mutans en placa dental. En estos niños estuvo disminuida la respuesta IgA clase específica a la invasión de microorganismos potencialmente cariógenos. Independientemente de que el niño fuera o no alérgico, la presencia de caries fue muchas veces acompañada de bajos niveles de IgAS. Los valores subnormales de IgAS pueden ser causa importante en el desarrollo de caries

[Incidence of Streptococcus mutans and changes in the concentration of serum immunoglobulins and SIgA in allergic children with caries]. / Incidencia de Streptococcus mutans y alteración en la concentración de inmunoglobulinas séricas e IgAS en niños alérgicos con caries.

The incidence of Streptococcus mutans in dental plaque and the relationship between dental caries and the levels of serum Igs and IgAS was investigated in allergic children. The relationship between IgAS mean levels and a) cariogenic diet, b) fluoride concentration in consumption water and c) different frequency in brush-washing was also studied. Direct examination of specimens obtained from either dental plaque or caries was performed. Cultures in tryptone soy agar and blood agar base were carried out. Catalase and nitrate reductase tests and biochemical tests for the identification of Streptococcus mutans were also done. Seric Igs and IgAS from saliva secretion were measured by radial immunodiffusion technique. Streptococcus mutans were found in 25/45 samples from allergic children, in 3/16 non allergic, in 25/43 children with caries and 3/18 children without caries. IgM reached higher levels in children with caries. Seric IgA average levels were lower in allergic children and were significantly increased in the non-allergic with caries. Most allergic children with caries showed very low IgAS values. Cariogenic diet, fluoride water ingestion and frequent brush-washing had no effect on IgAS concentration. Allergic children with caries showed low levels of seric IgA and Streptococcus mutans were frequently found in dental plaque. In these patients the specific class IgA response against the potentially cariogenic microorganisms was diminished. Allergic as well as non-allergic children with dental caries showed low IgAS levels suggesting that this may be an important factor in caries development.

Incidencia de Streptococcus mutans y alteración en la concentración de inmunoglobulinas séricas e IgAS en niños alérgicos con caries. / [Incidence of Streptococcus mutans and changes in the concentration of serum immunoglobulins and SIgA in allergic children with caries]

The incidence of Streptococcus mutans in dental plaque and the relationship between dental caries and the levels of serum Igs and IgAS was investigated in allergic children. The relationship between IgAS mean levels and a) cariogenic diet, b) fluoride concentration in consumption water and c) different frequency in brush-washing was also studied. Direct examination of specimens obtained from either dental plaque or caries was performed. Cultures in tryptone soy agar and blood agar base were carried out. Catalase and nitrate reductase tests and biochemical tests for the identification of Streptococcus mutans were also done. Seric Igs and IgAS from saliva secretion were measured by radial immunodiffusion technique. Streptococcus mutans were found in 25/45 samples from allergic children, in 3/16 non allergic, in 25/43 children with caries and 3/18 children without caries. IgM reached higher levels in children with caries. Seric IgA average levels were lower in allergic children and were significantly increased in the non-allergic with caries. Most allergic children with caries showed very low IgAS values. Cariogenic diet, fluoride water ingestion and frequent brush-washing had no effect on IgAS concentration. Allergic children with caries showed low levels of seric IgA and Streptococcus mutans were frequently found in dental plaque. In these patients the specific class IgA response against the potentially cariogenic microorganisms was diminished. Allergic as well as non-allergic children with dental caries showed low IgAS levels suggesting that this may be an important factor in caries development.