[Evaluation of the activity and effects of combinations of various antibacterial agents against methicillin-resistant Staphylococcus aureus in vitro].

MICs of various antibacterial agents against methicillin-resistant Staphylococcus aureus (MRSA) were measured. Furthermore, we evaluated the effects of combinations of antibacterial agents against MRSA in vitro. In 24 cases out of 37, in which MRSA was isolated from inpatients, other microorganisms, such as Candida spp., Entrococcus spp., and Pseudomonas aeruginosa, were simultaneously isolated. From the results of minimum inhibitory concentrations (MICs), obtained from micro broth-dilution method, of various antibacterial agents against MRSA, range of MICs of arbekacin (ABK), vancomycin (VCM) and teicoplanin (TEIC) were < or = 0.25-4.0, 0.5-1.0 and 0.25-4.0 micrograms/ml respectively, and no strains of MRSA showed resistance to ABK, VCM and TEIC, so that we concluded that these three antibacterial agents were effective for MRSA infection. On the in vitro study of combination-effect of antibacterial agents, significant synergistic effects were achieved in the combination of VCM and flomoxef (FMOX) (Synergism rate was 97.3%) or VCM and imipenem (IPM) (Synergism rate was 97.2%). From the results that the fractional inhibitory concentration index in the combination of VCM with IPM was smaller than that with FMOX and that P. aeruginosa or Enterococcus spp. were simultaneously isolated in high frequency in the MRSA-isolated cases, we thought that the combination of VCM with IPM is more useful, because IPM is effective against P. aeruginosa but FMOX is not.

[Estimation of antibacterial activity of various antibiotics against Pseudomonas aeruginosa by score method].

Antibacterial activity of various antibiotics against Pseudomonas aeruginosa isolated from each hospitals depends on the variety or amount of antibiotics used in each hospital. The antibiotic, which is effective to P. aeruginosa in a certain hospital is not always effective to that in other hospital. The excellent antibiotics in antibacterial activity have low MIC and hard to progress in resistance, and such antibiotics may be effective against P. aeruginosa isolated from any hospitals. Therefore we thought that the antibiotic, which was progress to resistance, would show a great difference in MIC among hospitals, and we investigated MIC and difference of MIC of various antibiotics against P. aeruginosa isolated from six hospitals. Furthermore, we converted the data of MICs and difference of MIC among six hospitals into the score, and tried to estimate antibacterial activity of various antibiotics by using those scores. From the results of analysis in this report, we think the antibiotics actually surpass in antibacterial activity may be imipenem, cefozopran, cefsulodin and amikacin. New analytical method proposed in this report will become one of potential methods to estimate antibacterial activity of antibiotics against bacteria isolated from inpatient with bacterial infections.

[Reliability of disc-diffusion susceptibility testing for arbekacin, vancomycin and teicoplanin against methicillin-resistant Staphylococcus aureus].

We investigated the differences in judgments among four disc-diffusion methods on susceptibility testing of arbekacin (ABK), vancomycin (VCM) and teicoplanin (TEIC) against 37 strains of methicillin-resistant Staphylococcus aureus (MRSA). These results were compared with minimum inhibitory concentrations (MICs) obtained from micro broth-dilution method. A marked difference was noted in the judgment of susceptibility to TEIC in Tri-disc method, that is 2 strains (5.4%) fell into sensitive (+3) 34 strains (91.9%) into moderately sensitive (+2) and 1 strain (2.7%) into moderately resistant (+), while in Sensi-disc method all strains fell into sensitive (S). According to the MICs, no strain of the MRSA tested revealed resistance to ABK, VCM and TEIC. Consequently, these three antimicrobial agents were thought to be effective on MRSA infections. From these results, we concluded that Tri-disc method for glycopeptide against MRSA, especially for TEIC, is not recommendable as a disc-diffusion method in susceptibility testing.

[Evaluation of antibacterial activities of various antibiotics against glucose non-fermentative gram-negative rods other than Pseudomonas aeruginosa].

MICs of piperacillin, sulbactam/cefoperazone, minocycline (MINO), gentamicin, amikacin, flomoxef, ceftazidime, cefozopran, cefsulodin and imipenem were determined, against 189 clinical isolated strains of glucose non-fermentative Gram-negative Rods (NFGNR; Acinetobacter baumannii (44), Alcaligenes faecalis (5), Alcaligenes xylosoxidans (25), Burkholderia cepacia (12), Chryseobacterium indologenes (23), Chryseobacterium meningosepticum (9), Pseudomonas fluorescens (8), Pseudomonas putida (12), Stenotrophomonas maltophilia (51). Most species of these NFGNR show resistance to many antibiotics tested. Among the antibiotics used in this study, the only antibiotic effective against all species of NFGNR tested is MINO. The spectrums of antibacterial activities of various antibiotics determined by MICs may be useful in preliminary test for identification of these NFGNR.

[In vitro antibacterial activities of carbapenems and other antibiotics against Pseudomonas aeruginosa determined using low-amino-acid agar].

MICs of imipenem (IPM), panipenem (PAPM), cefozopran (CZOP), cefpirome (CPR), gentamicin (GM), tobramycin (TOB) and amikacin (AMK) against Pseudomonas aeruginosa were determined using Mueller-Hinton agar and low-amino-acid agar. On Mueller-Hinton agar, the antibacterial activity of TOB was superlative, followed in order by GM, CZOP, IPM, AMK, PAPM and CPR, whereas on low-amino-acid agar, the order changed to IPM, PAPM, TOB, CZOP, GM, AMK and CPR. The largest decrease of MICs was seen with PAPM on low-amino-acid agar, and the antibacterial activity of PAPM was not stronger than that of IPM. The growth of P. aeruginosa on the low-amino-acid agar were significantly weaker than that on Mueller-Hinton agar, hence the evaluation of appearance colonies was difficult and misjudgement may result. Based on the above observations, we believe further investigations are needed before the application of low-amino-acid agar becomes routine.

[Annual number of Pseudomonas aeruginosa isolated inpatients, and antibacterial activity of various antibiotics against P. aeruginosa isolated from clinical specimens of inpatients].

In recent years, isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) has decreased, while the rate of Pseudomonas aeruginosa has increased. This phenomenon may be a result of regulation of use of antibiotics which belongs to the third cephems and extensive preventive measures against hospital acquired infections due to MRSA. Based on our investigation in which we determined MICs of various antibiotics against P. aeruginosa strains isolated from inpatients, the antibacterial activities of cefclidin (CFCL) was superior to those of other antibiotics. The antibacterial activity of CFCL against P. aeruginosa tested was similar to or stronger than that of tobramycin.

Origin of the foveal granular pattern in entoptic viewing.

PURPOSE: To investigate the controversial origin of the foveal granular pattern at the center of the entoptic Purkinje vessel shadows. Both phenomena may be vividly elicited by oscillating a focused spot of light across the scleral surface of the eye in a circumferential direction. METHODS: The site and pattern of oscillation of the light spot were varied and were correlated with the appearance of the foveal granular pattern. Movement of the granular pattern relative to a foveal afterimage was also observed. RESULTS: Oscillation of the light in a meridional direction abolishes the granular pattern. Oscillating illumination through the central pupil can elicit Purkinje vessel shadows but not the characteristic foveal granular pattern. With transscleral illumination, the granular pattern oscillates with an "against" motion with respect to the motion of the Purkinje vessel shadows and with a "with" motion with respect to apparent motion of an afterimage serving as a fixed anatomic reference, and it is displaced from the center of the foveal avascular zone in the visual direction away from the source of illumination. CONCLUSIONS: These observations strongly suggest that the foveal granular pattern is a random moire pattern produced by spatial aliasing as the striated light pattern cast by the parafoveal nerve fiber elements sweeps over the photoreceptors in the form of a faint, high-spatial-frequency, irregular grating. An anatomic section of the fovea reveals the necessary geometry for production of such striated patterns, and the Nyquist frequency for the foveal photoreceptor mosaic supports the spatial aliasing effect. Also, a grating moving over a stationary random dot background demonstrates the origin of the "against" motion that is characteristic of the foveal granular pattern.

Cardiovascular fitness in children with asthma correlates with psychologic functioning of the child.

Abnormalities in fitness in asthmatic children are assumed to derive from illness severity. We studied 90 children with moderately severe to severe but stable asthma for (1) fitness levels using bicycle ergometry, (2) measures of asthma severity, (3) clinician's impression of child (Child Global Assessment Scale), and (4) mother's rating of child's behavior (Child Behavior Checklist). Fitness values ranged from 15% to 120% of normal values for age, sex, and body surface area: 48% were abnormal (less than 2 SD below mean) and 5% were borderline (1 to 2 SD below mean). Associations between levels of fitness and medical and psychologic criteria were tested using regression analyses. Of the 11 medical variables used to define the severity of asthma, recent exacerbation of disease, forced expiratory volume in 1 second, and specific airway conductance together accounted for 8.1% of the variability in the workload ratios (ie, R2 = 0.081). The importance of the psychologic factors in determining the variability in the workload ratios was tested after the importance of the medical variables had been considered: Child Global Assessment Scale accounted for a significant amount of variability, improving the R2 to 0.180 (an increase to 0.100, P = .003). These data suggest that, within the spectrum of disease presented by the patients in this study, adjustment to the disease is at least as important as severity of disease in determining fitness.

Determinants of school performance in children with chronic asthma.

We have documented performance on standardized academic achievement tests for reading and mathematics in 99 children with moderately severe to severe chronic asthma. Academic performance and intelligence test scores indicated that, overall, the academic capabilities of the children with asthma were average to above average. A stepwise regression analysis was used to examine relationships between the dependent variables of reading and mathematics and the independent variables of socioeconomic status, school attendance, medical factors relating to asthma, age, and emotional and behavioral problems of the children. Factors that were associated significantly with low performance scores were low socioeconomic status, older age, history of continuous oral steroid use (prednisone or methyl prednisolone taken at least every other day for the year prior to evaluation), and presence of emotional and behavioral problems. School absenteeism, use of medical resources, oral steroid dosage, other medications used to treat asthma, and pulmonary functions were not associated with academic performance. Investigation of poor classroom performance of a child with chronic asthma should include investigation of the roles of socioeconomic status, oral steroid therapy, and emotional and behavioral problems.

Outcome of long-term hospitalization for asthma in children.

Children whose asthma continues to be poorly controlled with outpatient management are often referred to a long-term hospital program for care. Although these programs have been in existence since the 1950s, there has been no systematic study of their effectiveness. The purpose of the present study was to determine outcome in 103 children discharged consecutively after a long-term hospitalization. These children had both severe asthma and significant psychologic problems. Eighty-three of the 103 children had required continuous or frequent intermittent steroids for asthma control. In the year before admission, they had been hospitalized for asthma a mean of 2.6 times for 11.8 days and had had 4.6 visits to emergency rooms and 6.6 visits to physician offices for acute wheezing. Use of medical resources for asthma decreased significantly in the year after long-term hospitalization compared to the year before hospitalization (hospitalization: -34%, p less than 0.0001; hospital days: -39%, p less than 0.0002; emergency room visits: -46%, p less than 0.00001; physician office visits for acute asthma, -42%; p less than 0.00001; and a composite score giving increasing weight to more intensive and costly care: -30%, p less than 0.0001). Long-term hospitalization for children with asthma not responsive to outpatient management is associated with improvement in their use of medical resources.

Determination of fitness in children with asthma. Use of standardized tests for functional endurance, body fat composition, flexibility, and abdominal strength.

Children with asthma frequently have exercise-induced disease that can limit their participation in both organized sports and vigorous free play. We measured fitness in a group of children with moderately severe to severe asthma with an instrument that is used widely and is available to clinicians for assessment of the physical capability of their patients. Abnormalities in physical fitness were present primarily in the area of endurance, with performance in the nine-minute run frequently found to be low. Increased skin-fold thickness was also present more frequently than in the normal population. Abdominal strength and flexibility were normal. Abnormalities in fitness were not well explained by measures indicating the presence of poorly controlled disease. All children with significant asthma probably should be tested to document the level of fitness so that appropriate intervention can be initiated.

A teaching attachment for retinoscopy.

A teaching attachment for a conventional streak retinoscope allows a second observer to view the retinoscopic reflex during retinoscopy. The device weighs 200 grams and is attached to the retinoscope by a semi-flexible, rotatable linkage. A beam splitter, one-power telescope, and erecting mirror form a displaced aerial image of the retinoscope peephole for the observer. With identical retinoscopic reflexes observed through the actual peephole and its aerial image, the device can be used to teach basic retinoscopy techniques to new refractionists, or to demonstrate subtle reflexes to more experienced observers.

Psychomotor adaptation in children with severe chronic asthma.

Acute effects of steroid medications or hypoxic-induced brain damage have been hypothesized to cause neuropsychologic impairment in children with severe asthma. The present investigation included neuromotor, cognitive, psychosocial, and medical evaluations of 67 hospitalized asthmatic children from 9 to 14 years of age, at risk for motor dysfunction. Mean scores from the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were similar to test norm means and were not indicative of neuromotor impairment. Scores of the BOTMP correlated significantly (P less than .01) with measures of child and family psychosocial adaptation but not with measures of cognitive ability, steroid dose at admission, or severity of asthma. Thirteen children had battery composite scores more than 1 SD below age means but did not demonstrate decreased IQ or increased steroid use, respiratory failure, seizures, or abnormal neurologic signs compared with the other 55 children. These results indicate that most severely asthmatic children, including many with histories of hypoxia and high-dose steroid use, do not demonstrate psychomotor impairments indicative of brain damage. It is concluded that neuromotor development in asthmatic children is associated with psychologic characteristics that influence adaptation to illness and activity level.

Normalization of cardiopulmonary endurance in severely asthmatic children after bicycle ergometry therapy.

Sixty-five children with severe asthma were tested on a bicycle ergometer to determine their cardiopulmonary endurance and to determine whether they could achieve normal levels of endurance after a physical rehabilitation program. Workloads on entry into the study ranged from 12% to 222% (median 70%) of predicted. Abnormalities in cardiopulmonary endurance did not correlate with historical features commonly used to define severe asthma or degree of airways obstruction. Forty (58%) patients required further bicycle ergometry training two to five times per week: 32 had scores less than 2 SD below the mean, and eight had scores between 1 and 2 SD below the mean. No adverse side effects were encountered during either testing or training. Of the children with scores less than 2 SD below the mean, 84% achieved normal workloads within 2 to 17 weeks of hospitalization. Rates of improvement were similar in the 27 children who subsequently passed and the five children who did not pass, suggesting that duration of program participation was the most important variable in determining success. Thus severely asthmatic children with abnormal fitness levels can achieve normal cardiopulmonary fitness after training on the bicycle ergometer.

Visual-evoked potentials elicited by laser speckle patterns. Studies on the characteristics and assessment of visual function in patients with ocular media opacities.

Visual-evoked potentials (VEPs) were recorded using a laser speckle pattern. Stimulation with a speckle pattern was elicited either by pattern appearance-disappearance or by pattern shift. The VEPs obtained by this method were similar in properties to the previous pattern VEPs that were obtained either by pattern appearance-disappearance or by pattern reversal. Patients in whom dense and diffuse ocular media opacity defied measurement by the interferometric visual acuity method were studied to test if the speckle pattern generated by diffusion from lens opacity itself could act as a stimulus for obtaining VEPs. It is concluded that the present method enables one to obtain a reliable VEP and to assess the visual function of the retino-cortical system, even in patients with mature cataracts.

Symptoms and experiences in chronic bronchitis and emphysema.

A heterogeneous group of 146 patients with chronic bronchitis and emphysema were asked to rate the frequency with which 89 symptoms and experiences occurred during their breathing difficulties. Normative values and the reported frequency of occurrence for the 11 symptom categories are presented. As expected, symptoms of dyspnea were the most frequently reported during breathing difficulties. In decreasing order, symptoms of dyspnea were followed by symptoms of fatigue, sleep disturbance, congestion, irritability, anxiety, decathexis, helplessness-hopelessness, poor memory, alienation. Separation of the patients into subgroups revealed that women reported more anxiety and helplessness-hopelessness than men. Younger patients reported more irritability and anxiety than older patients. Patients with mixed disease reported more dyspnea than those with chronic bronchitis or emphysema, although patients with emphysema reported more loss of interest in life than patients with chronic bronchitis. Self-ratings of functional incapacitation were clearly related to the symptom reports. Relationships among the symptom categories were discussed, as was the potential usefulness of symptom patterns in exploring coping styles in respiratory disease.