Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis

<p>Abstract</p> <p>Background</p> <p>Super-infection in adult bacterial meningitis (ABM) is a condition wherein the cerebrospinal fluid (CSF) grows new pathogen(s) during the therapeutic course of meningitis. It is an uncommon but clinically important condition rarely examined in literature.</p> <p>Methods</p> <p>Twenty-seven episodes of super-infection states in 21 ABM patients collected in a 9.5-year study period (January 2001 to June 2010) were evaluated. The clinical characteristics, implicated pathogens, results of antimicrobial susceptibility tests, and therapeutic outcomes were analyzed.</p> <p>Results</p> <p>Twenty-one patients (13 men, 8 women) aged 25-73 years (median, 45 years) had post-neurosurgical state as the preceding event and nosocomial infection. The post-neurosurgical states included spontaneous intracranial hemorrhage (ICH) with craniectomy or craniotomy with extra-ventricular drainage (EVD) or ventriculo-peritoneal shunt (VPS) in 10 patients, traumatic ICH with craniectomy or craniotomy with EVD or VPS in 6 patients, hydrocephalus s/p VPS in 2 patients, and one patient each with cerebral infarct s/p craniectomy with EVD, meningeal metastasis s/p Omaya implant, and head injury. All 21 patients had EVD and/or VP shunt and/or Omaya implant during the whole course of ABM. Recurrent fever was the most common presentation and the implicated bacterial pathogens were protean, many of which were antibiotic resistant. Most patients required adjustment of antibiotics after the pathogens were identified but even with antimicrobial therapy, 33.3% (7/21) died. Morbidity was also high among survivors.</p> <p>Conclusions</p> <p>Super-infection in ABM is usually seen in patients with preceding neurosurgical event, especially insertion of an external drainage device. Repeat CSF culture is mandatory for diagnostic confirmation because most of the implicated bacterial strains are non-susceptible to common antibiotics used. Unusual pathogens like anaerobic bacteria and fungi may also appear. Despite antimicrobial therapy, prognosis remains poor.</p

La estimulación psicomotriz en relación al desarrollo integral del niño con Síndrome de Down

Tesis (Profesor de Educación Física para la Enseñanza Básica, Licenciado en Educación)Una psicomotricidad óptimamente desarrollada nos permite, conocer el mundo e integrarnos a él como personas adaptadas, sensibles y capaces de responder a estímulos, tanto físicos como sociales. En el niño con síndrome de down esta necesidad de adaptación e integración al mundo se hace mas extrema ya que debido a sus características naturales derivadas de su afección es aislado de todo contexto social. Es por ello que una estimulación psicomotriz planificada y sistemática ejecutada por un especialista dentro de la educación formal se hace indispensable, no solo por una cuestión motora, si no por una cuestión de calidad de vida y desarrollo integral entendiendo este como desarrollo del lenguaje, habilidades matemáticas, buena postura, respiración entre otras destrezas que van a convertirse en basamentos y herramientas claves para su adaptación al mundo dentro de un contexto social y posterior inserción en el mundo laboral, con lo cual dejan de ser una carga social y pasan a ser entes productivos