Extensively drug-resistant Acinetobacter baumannii in a Lebanese intensive care unit: risk factors for acquisition and determination of a colonization score.

BACKGROUND: Acinetobacter baumannii (AB) has emerged as an important nosocomial pathogen causing worldwide hospital outbreaks. It has become a prototype of extensively drug-resistant (XDR) organisms. AIM: To identify risk factors for acquisition of XDR-AB and to develop a colonization risk score in intensive care unit (ICU) patients in a Lebanese tertiary care centre where XDR-AB causes intermittent outbreaks. METHODS: This retrospective study included 257 patients with baseline negative screening cultures for XDR-AB admitted to a seven-bed ICU from July 2012 to July 2013. Patients' demographic data and clinical characteristics were collected from the hospital's electronic medical records. Univariate analysis of potential risk factors was performed followed by multivariate analysis to determine parameters to be included in the colonization risk score. FINDINGS: The rate of XDR-AB acquisition was 15.6%. Multivariate analysis identified urinary catheter placement >6 days (odds ratio: 16.98; 95% confidence interval: 3.96-49.56; P<0.0001), ICU contact pressure for >4 days (2.38; 1.48-3.57; P=0.001), presence of gastrostomy tube (5.44; 1.43-20.68; P=0.013), and previous use of carbapenems or piperacillin-tazobactam (4.20; 1.65-11.81; P=0.002) as parameters to be included in the colonization score. The risk of XDR-AB acquisition was 0, 5.6%, 17.2%, 56.8%, and 80% in the presence of a score of 0, 1, 2, 3, and 4 respectively. A score of 4 indicates high probability of XDR-AB acquisition, suggesting that patient isolation is required; zero indicates a low probability of XDR-AB acquisition. CONCLUSION: Risk factors could be used to develop a score to decide which patients need isolation to limit the spread of XDR-AB.

Exploring dysmenorrhoea and menstrual experiences among Lebanese female adolescents.

Data on menstrual experiences and their impact on quality of life among women in developing countries are scant. The aim of this study was to assess the prevalence of dysmenorrhoea among adolescent girls in Sidon city and suburbs, Lebanon, and to explore its possible relationship with menstrual experience. In a cross-sectional design, 389 post-menarcheal schoolgirls aged 13-19 years were selected using a cluster random sampling method. Of these 161 (41.4%) were regularly or sometimes absent from school due to menstrual problems and 289 (74.3%) experienced dysmenorrhoea. Nevertheless only 7.3% of the girls had consulted a physician about dysmenorrhoea. Three-quarters of these young women (75.2%) had scores indicating negative menstrual experience based on the Menstrual Experience and Behavior Questionnaire. Significant predictors of dysmenorrhoea were negative menstrual experience, younger age of girl, longer duration of bleeding and longer cycle length. Better reproductive health educational programmes focusing on menstruation are needed for female adolescents.

Exploring dysmenorrhoea and menstrual experiences among Lebanese female adolescents

Data on menstrual experiences and their impact on quality of life among women in developing countries are scant. The aim of this study was to assess the prevalence of dysmenorrhoea among adolescent girls in Sidon city and suburbs, Lebanon, and to explore its possible relationship with menstrual experience. In a cross-sectional design, 389 post-menarcheal schoolgirls aged 13-19 years were selected using a cluster random sampling method. Of these 161 [41.4%] were regularly or sometimes absent from school due to menstrual problems and 289 [74.3%] experienced dysmenorrhoea. Nevertheless only 7.3% of the girls had consulted a physician about dysmenorrhoea. Three-quarters of these young women [75.2%] had scores indicating negative menstrual experience based on the Menstrual Experience and Behavior Questionnaire. Significant predictors of dysmenorrhoea were negative menstrual experience, younger age of girl, longer duration of bleeding and longer cycle length. Better reproductive health educational programmes focusing on menstruation are needed for female adolescents

Exploring dysmenorrhoea and menstrual experiences among Lebanese female adolescents

Data on menstrual experiences and their impact on quality of life among women in developing countries are scant. The aim of this study was to assess the prevalence of dysmenorrhoea among adolescent girls in Sidon city and suburbs, Lebanon, and to explore its possible relationship with menstrual experience. In a cross-sectional design, 389 post-menarcheal schoolgirls aged 13-19 years were selected using a cluster random sampling method. Of these 161 [41.4%] were regularly or sometimes absent from school due to menstrual problems and 289 [74.3%] experienced dysmenorrhoea. Nevertheless only 7.3% of the girls had consulted a physician about dysmenorrhoea. Three-quarters of these young women [75.2%] had scores indicating negative menstrual experience based on the Menstrual Experience and Behavior Questionnaire. Significant predictors of dysmenorrhoea were negative menstrual experience, younger age of girl, longer duration of bleeding and longer cycle length. Better reproductive health educational programmes focusing on menstruation are needed for female adolescents

A comparison of pudendal block vs dorsal penile nerve block for circumcision in children: a randomised controlled trial.

We compared the analgesic and anaesthetic efficacy of pudendal nerve block with that of dorsal penile nerve block in male patients aged 3-5 years of age, undergoing elective circumcision. Thirty patients had a nerve stimulator-guided pudendal nerve block with two separate injection points 1.5-2 cm from the centre of the anus, and thirty patients received a dorsal penile nerve block. The same total anaesthetic volume of 0.3 ml.kg(-1) was used in both groups. The pudendal nerve group showed significantly lower postoperative pain scores than the dorsal group (SD) (p < 0.05), and significantly fewer patients consumed analgesics in the pudendal group than the dorsal group: 0 vs 5 (17%) at 0 and 6 h, respectively. This study demonstrates the effectiveness of pudendal nerve block in comparison to the dorsal nerve block, with improved postoperative outcomes in children undergoing circumcision.

A comparison of nerve stimulator guided paravertebral block and ilio-inguinal nerve block for analgesia after inguinal herniorrhaphy in children.

The aim of this study was to compare the efficacy of nerve stimulator guided paravertebral block with ilio-inguinal nerve block in children undergoing inguinal herniorrhaphy. Eighty children were randomly allocated to receive either paravertebral block or ilio-inguinal nerve block. Each block was evaluated in terms of intra-operative haemodynamic stability, postoperative pain scores at rest, on movement and during activity, requirement for supplemental analgesia and parental satisfaction. Haemodynamic stability was maintained significantly better during sac traction in the paravertebral block group (p < 0.005). Pain scores and analgesic consumption were significantly lower in the paravertebral block group during the postoperative follow-up period (p < 0.05). Parental satisfaction (93%vs 69%) and surgeon satisfaction (93%vs 64%) were significantly higher in the paravertebral block group (p < 0.05). Paravertebral blockade improved and prolonged postoperative analgesia, and was associated with greater parental and surgeon satisfaction when compared to ilio-inguinal nerve block.

Repetitive paravertebral nerve block using a catheter technique for pain relief in post-herpetic neuralgia.

We described in this report a case of post-herpetic neuralgia refractory to medical therapy that was successfully treated with repetitive injections of local aesthetic mixture (bupivacaine 0.5% 19 ml and clonidine 150 microg ml(-1) 1 ml) every 48 h for 3 weeks using a paravertebral catheter inserted at T2-T3 level.

Comparison and evaluation of a disease activity index for use in patients with rheumatoid arthritis.

An algorithm (Stoke index) has been designed to give a global measure of disease activity in rheumatoid arthritis. This algorithm has been created as an easy to use flow diagram based on two objective laboratory measures (C-reactive protein and erythrocyte sedimentation rate), one subjective and two semi-objective clinical measures (morning stiffness, synovitis score and Ritchie articular index). Results of six clinical markers and seven laboratory markers of disease activity on a cohort of 371 rheumatoid patients have been used to evaluate the algorithm and compare it with a previously described index of disease activity (Mallya-Mace index). Principal component analysis validates its ability to measure disease activity. Sensitivity is described by the distribution of patients between the two index scores. Change in index score by patients over a 6-month period indicates reversibility. The Stoke index demonstrates greater sensitivity and reversibility than the Mallya-Mace index. These findings indicate that the algorithm described provides a useful index of global disease activity for use in the assessment of rheumatoid arthritis.

Pharmacological effects of deltamethrin on the central nervous system.

Pharmacological exploration of the central nervous system carried out by means of a series of tests confirms the affinity of 3-(2,2-dibromovinyl)-2,2-dimethylcyclopropanecarboxylic acid alpha-cyano-3-phenoxybenzyl ester (delta-methrin) for the nervous system and reveals the following activities of deltamethrin: Deltamethrin has no neuroleptic or sedative action. It inhibits motility, sense of balance and inquisitiveness of treated animals. It potentiates chloral-induced hypnotic action but not that of pentobarbital. Not only does it have no antagonistic action on convulsivant agents: electric shock, pentetrazol, strychnine, but it stimulates their toxicity and prolongs the convulsive seizures. The fact that deltamethrin acts on different convulsivant agents (i.e. pentetrazol and strychnine) with various sites of action suggests that its activity is located in both the cortical and the medullary centres. Deltamethrin reveals the latent toxicity of tryptamine used in the non-toxic dose range; this predicts that deltamethrin might have an IMAO (inhibitor of monoamine oxidase) activity. Experiments carried out under the conditions adopted showed that deltamethrin acts on various sites.