Invasive fungal consecutive infections in a patient with acute myeloid leukaemia.

A woman with AML who became febrile and neutropenic after chemotherapy. At the first, Aspergillus was isolated from a sinus biopsy. After 4 weeks, while she was taking voriconazole, another episode of fever combined with dry coughs was detected. Fungal culture and histopathology of sinus biopsy revealed mucormycosis.

Bacterial etiology and antibiotic resistance pattern of pediatric bloodstream infections: A multicenter based study in Tehran, Iran.

BACKGROUND: Due to the diverse nature of bloodstream infections etiology and to the antibiotic resistance patterns in periodic intervals, rational and accurate use of antibiotics requires an understanding of common causative agents of septicemia and their susceptibility patterns. The present study aimed to determine the bacterial etiology of the neonate and pediatric septicemia, and their antibiotic resistance pattern in Tehran, North of Iran. MATERIAL AND METHODS: This retrospective cross-sectional study was conducted along two years, from October 2014 to November 2016 among children with suspected bloodstream infection. Blood specimens were collected aseptically in BACTECTM blood bottles, and standard microbiological methods were applied for the isolation and identification of the bacteria. Antimicrobial susceptibility tests were performed using the disk diffusion method according to Clinical and Laboratory Standards Institute recommendations. RESULTS: Overall, 433 (21.1%) blood cultures showed a significant bacterial growth. Gram-negative bacteria with a proportion of 55.4% were the predominant isolates. The most frequently isolated Gram-negative bacteria were Pseudomonas spp. (26.8%), followed by Klebsiella spp. (8.8%), and Acinetobacter spp. (7.9%). Ciprofloxacin, amikacin, and piperacillin/tazobactam had the highest antibacterial effect on non-fermenting Gram-negative bacilli. Regarding the recovered Enterobacteriaceae, aminoglycosides and carbapenems showed a promising effect for tested isolates. The prevalence of methicillin-resistant S. aureus and coagulase-negative staphylococci were 52.6%, and 78.6%, respectively. The rate of vancomycin-resistant enterococci was estimated 68.8%. Meanwhile, the overall prevalence of multiple-drug resistant isolates was 83.4. CONCLUSION: Regarding results, Multiple Drug Resistant isolates had a significant role in the occurrence of bloodstream infections. Hopefully, several locally available antibiotics still have promising effects on these isolates.

Ventilator-associated pneumonia in a teaching hospital in Tehran and use of the Iranian Nosocomial Infections Surveillance Software.

Ventilator-associated pneumonia is the most common health-care-associated infection in the intensive care unit (ICU) and computer-assisted diagnosis and surveillance is called for. The frequency of ventilator-associated pneumonia was assessed prospectively during a 6-month period in the ICUs of a teaching hospital in Tehran, Islamic Republic of Iran. To determine the accuracy of the Iranian Nosocomial Infections Surveillance (INIS) system, patient data were input to the software and compared with physicians' judgement. The frequency of ventilator-associated pneumonia was 21.6%, or 9.96 episodes per 1000 ventilator days. The duration of admission to the ICU, duration of mechanical ventilator and number of re-intubations were significantly higher in patients who developed pneumonia. The INIS system identified 100% of cases, with no false-positive or false-negative results. Compared with developed countries, the frequency of ventilator-associated pneumonia was high in our ICUs, and INIS software was accurate in diagnosing nosocomial infection.

Internal kinematics of the tongue in relation to muscle activity and jaw movement in the pig.

To explore the coordinative characteristics of tongue deformation, muscle activity and jaw movement during feeding, six ultrasonic crystals were implanted into the tongue body of ten 12-week-old Yucatan minipigs 1 week before the recording. These crystals formed a wedge-shaped configuration to allow recording dimensional changes in lengths, anterior and posterior widths and posterior thicknesses of the tongue body during feeding. Wire electromyographic activities (EMG) of superior and inferior longitudinalis, verticalis/transversus, genioglossus, styloglossus, masseter and digastricus and jaw movements were recorded simultaneously. Signals from these three sources were synchronized for real-time analyses. The results indicate: (i) dimensional changes were stereotypical in relation to each cycle of all three feeding behaviours; (ii) during chewing, expansion of tongue widths mainly occurred in the occlusal phase of jaw movement and was less coupled with the activity of tongue muscles, but the expansions of length and thickness were seen in the opening and closing phases and were better coupled with the activity of tongue muscles (P < 0.05); (iii) ingestion was characterized by the two-phased jaw opening, early expansion of anterior width prior to the occlusal phase and strong associations between tongue deformation and muscle activity; (iv) during drinking, the duration of the opening and closing phases was significantly prolonged (P < 0.01), the durations of tongue widening and lengthening were significantly shortened (P < 0.05) and anterior widening was predominant in the opening rather than in the closing or occlusal phases as compared with chewing and ingestion; and (v) the intrinsic tongue muscles did not show more or stronger correlations with the tongue deformation than did the extrinsic tongue muscles. These results suggest that (i) regional widening, lengthening and thickening of the tongue body occurs sequentially in relation to jaw movement phases, but the initiation of tongue dimensional expansions does not correspond with the activation of tongue muscles simultaneously; (ii) there is a better coupling between tongue deformations and tongue muscle activations in the sagittal (lengthening and thickening) than the transverse (widening) planes; and (iii) the patterns and ranges of tongue deformation and their relations to muscle activity and jaw movement are task-specific and the expansion magnitudes of tongue deformation does not have closer correlations with the amount of EMG activity in the intrinsic than the extrinsic tongue or jaw muscles.

Insulin adsorbance to polyvinylchloride (PVC) surfaces of fluid container and infusion-set.

INTRODUCTION: In total parenteral nutrition (TPN) solution, adsorbance of insulin to polyvinylchloride (PVC) surfaces of fluid containers and infusion-sets, decrease the amount of insulin that reaches the patients. OBJECTIVE: To clarify the biding sites of insulin and to propose a solution to overcome this problem. METHODS AND MATERIALS: To each of four 1000ml. PVC bottles of 5 percent dextrose solution, 300 microunit of insulin per each milliliter of dextrose solution were added. Each bottle was then connected to an infusion-set and the system made to run at an infusion rate of 100ml. per hour. One milliliter samples were then collected from both the PVC bottles and infusion-sets-terminal, separately, immediately at the starting point (time zero) and 15, 30, 45 and 60 minutes thereafter. The concentrations of insulin were checked using insulin kits. RESULTS: At the starting point (time zero) the mean of insulin concentrations among four PVC bottles was 213.79 microunit per each milliliter of 5 percent dextrose solution. No significant fluctuation was noted in the concentration of insulin in the PVC bottles through 60th minute period. However the concentration of insulin at infusion-set- terminal decreased significantly at the end of the same hour (p. value = 0.004). CONCLUSION: Our results demonstrate that the adsorbance of insulin takes place at the surfaces of infusion sets. It follows therefore that increase in the primary dosage of insulin added to PVC infusion solutions and the selection of a suitable infusion set (polyethylene) seem to be beneficial for overcoming this problem.

Granular myringitis: is it a surgical problem?

OBJECTIVE: An attempt to settle the controversies associated with granular myringitis (GM) including incidence, etiology, pathology, presentation, relation to chronic otitis media, and treatment. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center and private otology practice. PATIENTS: 94 patients presenting with GM over 28 years. INTERVENTION: Diagnosis by otoscopy, audiometry, radiology, and bacteriology; long-term follow-up (6 months to 12 years); assessment of treatment results. MAIN OUTCOME MEASURES: The pathologic states of the affected tympanic membranes were studied in both active and quiescent stages. The results of conservative versus surgical management were evaluated. RESULTS: The disease presents with chronic painless otorrhea, normal hearing and mastoid pneumatization, and granular areas, which may be patchy, diffuse, or segmental. The latter is the most frequent and is most commonly posterosuperior. The infecting organism is Pseudomonas aeruginosa. The pathologic process affects all drum layers and can cause a perforation. The most important predisposing factor is disturbed epithelial migration, which may be exaggerated by eustachian tube dysfunction. Of 26 cases treated conservatively, none healed without recurrence. Of 48 cases treated surgically, there were 2 recurrences. CONCLUSIONS: Pathologically, the disease affects all drum layers. It presents with an active stage, which may be misdiagnosed as chronic otitis media or cholesteatoma, and a quiescent stage when it may be overlooked. Although distinct from chronic otitis media, it can cause a perforation. The disease responds readily to medical treatment, but recurrence is common. Radical surgery offers a curative measure in refractory cases.

Long-term fate of Plastipore in the middle ear.

Four Plastipore prostheses, removed at revision surgery 7-10 years after implantation, have been examined. The gross appearance of the prostheses was preserved. The prostheses were surrounded by a fibrous tissue capsule and showed fibrous tissue ingrowth localized in peripheral zones. Foreign-body giant cells and macrophages were detected in small numbers. Histologic evidence of breakdown of the prostheses, in the form of microdisintegration of the walls of micropores, was detected on a small scale. Compared to the massive foreign-body reactions reported in short-term studies, the tissue reaction apparently subsides with time and becomes insignificant. Strict criteria for insertion should be regarded.

The fibrous annulus in myringoplasty.

Graft cholesteatoma is a serious complication of tympanic membrane grafting. It is due to burying keratinizing epithelium under the graft. Its occurrence in the anterior angle has been attributed to the presence of epithelial rests within the annulus in this area, and consequently is considered inevitable with overlay technique. In the present study we propose that this complication is due to inadequate surgical technique rather than due to factors inherent in underlying pathology or in the technique itself.

Autograft ossiculoplasty in cholesteatoma.

Although using autogenous ossicles in reconstruction offers stable hearing results with good tendency for healing and minimal extrusion, their use in cholesteatomatous ears has been criticized for the possibility of progressive osteitis, bone resorption and cholesteatoma recurrence. In the present study we have been investigating a way which affords safe re-implantation of such ossicles. Treatment by burring followed by autoclaving seems to offer an implant that is safe both bacteriologically and pathologically. We have found no evidence that cholesteatoma could develop from such treated ossicles.

Options in ossiculoplasty.

To achieve good results in ossicular reconstruction residual and recurrent disease must be eliminated. The surgeon must assess the anatomic, physiologic and pathologic situation and consider the available options. Staging is mandatory in many cases. Indication, surgical technique, hearing results and causes of failure are presented in a retrospective study of 138 consecutive operations.

Emergency repair of traumatic drum tears.

Tympanic membrane tears have been found in about 20% of casualties in modern combat (war of October 1973). Repair of the tears that do not seem to have the optimal chances for spontaneous healing should be undertaken during the first few days of trauma. This prompts healing, prevents complications, and obviates the need for future intervention.