Lactobacillus rhamnosus bacteremia in a kidney transplant recipient.

Lactobacillus rhamnosus is a rare clinical pathogen. A case of bacteremia caused by L. rhamnosus in a kidney transplant recipient is described. Once considered only as a contaminant or a low-virulence organism, L. rhamnosus might be an opportunistic pathogen in immunocompromised patients. To our knowledge, this is the first report of primary bloodstream infection caused by L. rhamnosus in a kidney transplant recipient.

Comparison of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia and tracheobronchitis caused by Pseudomonas aeruginosa or Acinetobacter baumannii.

PURPOSE: This study was designed to compare the efficacy of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT) by Pseudomonas aeruginosa or Acinetobacter baumannii. METHODS: A prospective cohort study was performed. Patients >18 years of age with the diagnosis of VAP or VAT who received appropriate therapy for >48 h were analyzed. The primary outcome was 30-day mortality. Clinical covariates were assessed and compared between the groups. RESULTS: A total of 67 episodes were analyzed: 45 (67 %) treated with polymyxin B and 22 (33 %) with comparators. The crude 30-day mortality was 53 % (24 of 45) in the polymyxin B group and 27 % (6 of 22) in the comparator group (P = 0.08). Multivariable analysis using Cox regression models indicated that polymyxin B treatment was independently associated with increased mortality. CONCLUSIONS: Polymyxin B treatment in the currently recommended dosage may be inferior to other drugs in the treatment of VAP and VAT caused by organisms tested as susceptible in vitro to this agent.

Effect of ventilation on systemic blood flow evaluated by echodopplercardiography.

Systemic blood flow (Q) was measured by echodopplercardiography in 5 normal young adult males during apnea, eupnea and tachypnea. Measurements were made in a recumbent posture at 3-min intervals. Tachypnea was attained by doubling the respiratory frequency at eupnea at a constant tidal volume. An open glottis was maintained during apnea at the resting respiratory level. The Q values were positively correlated with the respiratory frequency, decreasing from eupnea to apnea and increasing from eupnea to tachypnea (P < 0.05). These data demonstrate that echodopplercardiography, a better qualified tool for this purpose, confirms the positive and progressive effects of ventilation on systemic blood flow, as suggested by previous studies based on diverse technical approaches.

Effect of ventilation on systemic blood flow evaluated by echodopplercardiography

Systemic blood flow (Q) was measured by echodopplercardiography in 5 normal young adult males during apnea, eupnea and tachypnea. Measurements were made in a recumbent posture at 3-min intervals. Tachypnea was attained by doubling the respiratory frequency at eupnea at a constant tidal volume. An open glottis was maintained during apnea at the resting respiratory level. The Q values were positively correlated with the respiratory frequency, decreasing from eupnea to apnea and increasing from eupnea to tachypnea (P<0.05). These data demonstrate that echodopplercardiography, a better qualified tool for this purpose, confirms the positive and progressive effects of ventilation on systemic blood flow, as suggested by previous studies based on diverse technical approaches.

Chronic bronchitis and the type of cigarette smoked.

BACKGROUND: Smoking is a well known primary risk factor for chronic bronchitis. However, little is known about the relationship between different types of cigarettes smoked and chronic bronchitis. OBJECTIVE: To determine the association between chronic bronchitis and the type of cigarette smoked. METHODS: A cross-sectional prevalence study was conducted in an urban area (Pelotas) of Southern Brazil. A total of 1053 subjects aged > or = 40 years were interviewed about respiratory symptoms and some risk factors for chronic bronchitis. RESULTS: After adjustment for confounding factors, the number of daily cigarettes smoked was strongly associated with the risk of chronic bronchitis (odds ratio [OR] = 8.10, 95% CI: 4.46-14.71 for smokers of > or = 20 cigarettes per day compared to non-smokers). Among smokers, maize leaf cigarettes showed the highest risk (OR = 5.43 compared to non-smokers, 95% CI: 2.65-11.13) and filter cigarettes the lowest (OR = 2.19, 95% CI: 1.19-4.03). CONCLUSIONS: In addition to the number of cigarettes smoked, the use of maize leaf cigarettes was shown to have an important independent association with chronic bronchitis.

Prevalence and risk factors for chronic bronchitis in Pelotas, RS, Brazil: a population-based study.

BACKGROUND: Chronic bronchitis causes high morbidity and mortality throughout the world. It is basically a preventable disease. However, few population based studies of chronic bronchitis have been carried out in less developed countries. METHODS: A population based cross sectional survey was conducted to determine the prevalence of chronic bronchitis and associated risk factors in an urban area (Pelotas) of southern Brazil. 1053 subjects aged 40 years and over (90.3% of eligible subjects) were interviewed using the ATS-DLD-78 questionnaire. RESULTS: Of the subjects interviewed 12.7% were classified as having chronic bronchitis. In univariate analyses a significant increase in the relative odds of chronic bronchitis was seen in men (OR = 2.17, 95% CI 1.50 to 3.13), low family income (OR = 2.60, 95% CI 1.47 to 4.47 for lowest quartile), low schooling (OR = 4.65, 95% CI 2.36 to 9.18 for those with no schooling), smoking habits (OR = 6.92, 95% CI 4.22 to 11.36 for smokers of 20 or more cigarettes per day), high occupational exposure to dust (OR = 2.48, 95% CI 1.56 to 3.94), inadequate housing (OR = 2.09, 95% CI 1.22 to 3.58), high level of indoor air pollution (OR = 1.86, 95% CI 1.16 to 2.99), and reported childhood respiratory illnesses (OR = 2.08, 95% CI 1.25 to 3.49). Multiple logistic regression resulted in the identification of the following independent risk factors: family income (OR = 1.99, 95% CI 1.04 to 3.81 for subjects in the lowest quartile compared with those in the highest quartile), schooling (OR = 5.60, 95% CI 2.52 to 12.45 for subjects with no schooling compared with those with nine or more years), smoking (OR = 8.10, 95% CI 4.46 to 14.71 for smokers of 20 or more cigarettes per day compared with non-smokers), and history of major respiratory illnesses in childhood (OR = 2.16, 95% CI 1.20 to 3.85). CONCLUSIONS: Low family income, poor schooling, smoking, and childhood respiratory illnesses were significantly associated with chronic bronchitis.