Prevalence of beta lactamase producing species of pseudomonas and acinetobacter in pediatric burn patients.

Burn wound infection is a major cause of morbidity and mortality in burn victims. Pseudomonas and Acinetobacter species are among the most common organisms complicating burn wounds. Presence of extended spectrum ß-lactamase (ESBL) and metallo-ß-lactamase (MBL) genes plays an important role in spreading ß-lactam resistant strains of these organisms and is a serious condition in the treatment of the affected patients. As a result, we aimed to determine the prevalence of SHV, TEM, PER and VIM ß-lactamases in Pseudomonas and Acinetobacter species isolates from burn wound swabs of children with burn injury. In this descriptive observational study, 107 Pseudomonas and Acinetobacter isolates collected from burn patients were subjected to PCR assay. Using PCR method and DNA sequencing, the existence of SHV-, TEM-, PER- and VIM-type ß-lactamase encoding genes were determined. Out of the 107 Pseudomonas and Acinetobacter isolates, 66 (77.6%) were ESBL positive, 26.2% were positive for SHV gene, 37.4% were positive for TEM gene, 14% were positive for PER gene and 15.9% of them harbored VIM gene. More than half of the Pseudomonas and Acinetobacter strains in our pediatric burn unit harbor ß-lactamase encoding genes that make them resistant to a wide range of ß-lactam antibiotics. Consequently, it is suggested to choose an appropriate antibiotic regimen based on the antibiogram pattern of the strains.

Les infections cutanées sont une cause majeure de morbidité et de mortalité chez les brûlés. Pseudomonas et Acinetobacter sont parmi les micro-organismes les plus communs chez les brûlés. La présence des gènes codant les ß-lactamases à spectre étendu (BLSE) et métallo-ß-lactamases (MBL) joue un rôle important dans la dissémination des souches résistantes et obère le traitement des patients infectés. Nous avons étudié la prévalence des gènes encodant pour des enzymes des groupes SHV, TEM, PER et VIM dans des isolats de Pseudomonas et Acinetobacter chez les brûlés pédiatriques, grâce à des techniques de PCR. Dans cette étude observationnelle descriptive, 107 isolats de Pseudomonas et Acinetobacter, obtenus chez des patients brûlés ont été étudiés. Plus des 3/4 des souches de Pseudomonas et Acinetobacter expriment une BLSE (26.2% SHV; 37.4% TEM; 14% PER; 15.9% VIM), ce qui les rend résistants à de nombreuses ß-lactamines. Il est donc suggéré de choisir un traitement antibiotique approprié, basé sur l'antibiogramme des souches infectantes.

Inflammatory pseudotumour of the temporomandibular joint.

Head and neck inflammatory pseudotumors (IPs) are rare, idiopathic, non-neoplastic lesions that most commonly affect the orbit, but may involve other areas such as the larynx, oropharynx, paranasal sinuses, and meninges. We report the case of a 55-year-old man who presented with progressive left-sided hearing loss, aural fullness, and otalgia. Computed tomography and magnetic resonance imaging (MRI) detected a soft-tissue mass in the left temporomandibular joint (TMJ). Histopathologic examination showed overlying squamous epithelium with hyperkeratosis, parakeratosis, subepithelial fibrosis, and chronic inflammatory infiltrate, which were consistent with an IP. Radiologic images and MRI indicated an ill-defined soft tissue involving the roof and posterior aspect of the TMJ, extending into the anterior external auditory canal. Our case was treated with a 2-week course of high dose prednisone (1 mg/kg) and a 2-week taper with resolution of symptoms. Two years after treatment, the patient shows no evidence of recurrence on MRI.

Role of spirometry in detection of nasal obstruction.

BACKGROUND: A subjective feeling of nasal airflow obstruction is a common symptom. An objective method for quantitative measurement of nasal airflow has long been desired. Rhinomanometry and acoustic rhinometry have been developed for anatomical and physiological evaluation of nasal obstruction. This study was designed to determine the usefulness of a portable spirometer in assessing upper airway obstruction. METHODS: One hundred and ninety-six patients were assessed with nasal inspiratory spirometry to determine nasal airflow. All patients also underwent paranasal sinus computed tomography to determine anatomical abnormalities. Spirometry was performed on each nostril separately. RESULTS: Sensitivity and specificity levels were high. This portable and easy to use device may be useful in respiratory assessment. Correlation between anatomical obstructions and subjects' complaints was statistically significant (p < 0.001), but no definite correlation between septal deviation severity and spirometric values was found. CONCLUSION: Portable spirometry is an objective and useful method of evaluating nasal obstruction, but needs more investigation to establish a standardised test.