Etiological factors causing lower respiratory tract infections isolated from hospitalized patients.

Lower respiratory tract infections (LRTI) account for 20-30 % of all hospital-acquired contagions. They are characterized by high mortality of hospitalized patients. The most serious form of LRTI is pneumonia, and the most common etiological factors in such cases are bacteria. The article gives the analysis of bacterial flora samples obtained from lower respiratory tract of hospitalized patients. In vitro susceptibility of pathogens to selected antibiotics has also been assessed. We carried out a retrospective analysis of 1,171 bacterial strains isolated from 1,171 patients treated in clinics of the Military Institute of Medicine in Warsaw, Poland. In most cases the samples were collected from an endotracheal or tracheostomic tube (71.5 %) and from bronchoalveolar lavage (21.7 %). The most commonly isolated pathogens included Acinetobacter baumannii (35.8 %), Staphylococcus aureus (27.6 %), Klebsiella pneumoniae (19.4 %), and Pseudomonas aeruginosa (16.2 %). Multidrug-resistant gram-negative bacteria exhibited 100 % susceptibility to colistin only. Klebsiella pneumoniae ESBL+ and Acinetobacter baumannii were most susceptible to carbapenems, while Pseudomonas aeruginosa strains to ceftazidime. Methicillin-resistant Staphylococcus aureus were 100 % susceptible to vancomycin, linezolid, and tigecycline. In conclusion, identifying the etiological factors causing infections of the lower respiratory tract and determining their drug-susceptibility is of key importance in empirical treatment.

Ethical issues in psychosocial interventions research involving controls.

Psychiatric research is of critical importance in improving the care of persons with mental illness. Yet it may also raise difficult ethical issues. This article explores those issues in the context of a particular kind of research: psychosocial intervention research with control groups. We discuss 4 broad categories of ethical issues: consent, confidentiality, boundary violations, and risk-benefit issues. We believe that, despite the potential difficulties, psychosocial intervention research is vital and can be accomplished in an ethical manner. Further discussion and research into these issues are warranted.

Confined placental mosaicism for trisomy 8 and intra-uterine growth retardation.

This report describes a case of apparent confined placental mosaicism for trisomy 8 in a pregnancy which produced a male infant with intra-uterine growth retardation. Postnatal cytogenetic and molecular studies were consistent with biparental disomy 8. Postnatally, the infant experienced a period of rapid catch-up growth and exhibited no clinical features of trisomy 8 mosaicism. His development was age appropriate.

The criminal responsibility of people with multiple personality disorder.

Because multiple personality disorder (MPD) is more frequently diagnosed today than in the past, it is likely that more multiples will plead insanity. The courts are in a state of disarray as to how best to respond to these pleas. This article considers multiples' responsibility on three interpretations of the status of their alters: that they are different people; that they are different personalities; or that they are parts of one complex, deeply divided personality. On all three theories multiples are nonresponsible. Nevertheless, three rare circumstances exist under which multiples should be found guilty. The article concludes by indicating the kinds of issues psychiatry might explore to further assist the law in its analysis of the criminal responsibility of multiples.

Human liver microsomal thiol methyltransferase: inhibition by arylalkylamines.

1. Thiol methyltransferase (TMT) is a microsomal enzyme catalyzing the S-methylation of aliphatic sulphydryl drugs and xenobiotics. Studies of the functional significance of S-methylation catalysed by TMT have been hampered by lack of a potent, relatively specific, non-toxic inhibitor of the enzyme. 2. Human hepatic microsomal TMT was inhibited by the arylalkylamine 2,3-dichloro-alpha-methylbenzylamine (DCMB), and by a series of arylalkylamines, as well as the arylamine, aniline. 3. Inhibition kinetic studies with DCMB, benzylamine, aniline, phenylethylamine and phenylethanolamine, five compounds with a wide range of IC50 values, showed 'mixed' inhibition of TMT with respect to the methyl acceptor substrate, 2-mercaptoethanol. Kis and Kii values were, respectively, 1.1 and 0.29 microM for DCMB, 160 microM each for benzylamine, 680 and 370 microM for aniline, 1640 and 1380 microM for phenylethylamine, and 2300 and 1400 microM for phenylethanolamine. Inhibition was at least partially reversible. 4. H.p.l.c. analyses were carried out with the products of enzyme reactions performed in the presence of aniline, benzylamine, and phenylethylamine to ascertain whether these compounds inhibited TMT by acting as methyl acceptors. Results showed that they did not act as methyl acceptor substrates.