Detection of a highly prevalent and potentially virulent strain of Pseudomonas aeruginosa from nosocomial infections in a medical center

BACKGROUND: We correlated genotypes, virulence factors and antimicrobial susceptibility patterns of nosocomially identified Pseudomonas aeruginosa isolates from clinical specimens to those of environmental isolates encountered in the same units of a medical center. Antibiotic susceptibility testing, RAPD analysis and detection of enzymatic activities of extracellular virulence factors, were done on these isolates. RESULTS: Data showed that most of the clinical and environmental isolates were susceptible to tested antimicrobial agents. RAPD analysis determined the presence of 31 genotypes, with genotype 1 detected in 42% of the clinical isolates and 43% of the environmental isolates. Enzymatic activity testing showed that genotype 1 produced all virulence factors tested for. CONCLUSION: In conclusion, our data demonstrated the predominant prevalence of a potentially virulent P. aeruginosa genotype, circulating in a number of units of the medical center and emphasize the need to reinforce infection control measures

Fatal bilateral pneumothoraces complicating dyskeratosis congenita: a case report

<p>Abstract</p> <p>Introduction</p> <p>Dyskeratosis congenita is a rare genodermatosis, characterized by a triad of reticular skin pigmentation, nail dystrophy and leukoplakia of mucous membranes. It is also associated with a variety of non-cutaneous abnormalities such as bone marrow failure, malignancy and pulmonary complications. Among its wide range of clinical manifestations, fatal pneumothorax has rarely been reported.</p> <p>Case presentation</p> <p>We report the case of a 31-year-old Lebanese woman with dyskeratosis congenita who succumbed to devastating bilateral pneumothoraces.</p> <p>Conclusion</p> <p>Careful surveillance of patients with dyskeratosis congenita is required as incipient respiratory failure due to pneumothorax may be successfully treated if detected at an early stage.</p

Acute Onset of Psychosis in a Patient with a Left Temporal Lobe Arachnoid Cyst

Arachnoid cysts are considered a rare neurological tumor, few of which exhibit any symptomatology. A 38-year-old Haitian American female with no past psychiatric history presented with rapid onset of psychosis. Workup for medical etiology proved to be within normal limits, with the exception of a left temporal lobe arachnoid cyst. The purpose of this paper is to add to a number of existing case reports that suggest a relationship between such lesions and psychiatric illness

Case Report Acute Onset of Psychosis in a Patient with a Left Temporal Lobe Arachnoid Cyst

Arachnoid cysts are considered a rare neurological tumor, few of which exhibit any symptomatology. A 38-year-old Haitian American female with no past psychiatric history presented with rapid onset of psychosis. Workup for medical etiology proved to be within normal limits, with the exception of a left temporal lobe arachnoid cyst. The purpose of this paper is to add to a number of existing case reports that suggest a relationship between such lesions and psychiatric illness

Characterization of altered patterns of endothelial progenitor cells in sickle cell disease related pulmonary arterial hypertension

Endothelial dysfunction plays an important role in the pathogenesis of pulmonary arterial hypertension (PAH) in sickle cell disease (SCD). A variety of evidence suggests that circulating endothelial progenitor cells (EPCs) play an integral role in vascular repair. We hypothesized that SCD patients with PAH are deficient in EPCs, potentially contributing to endothelial dysfunction and disease progression. The number of circulating CD34+/CD14−/CD106+ EPCs was significantly lower in SCD patients with PAH than without PAH (P=0.025). CD34+/CD14−/CD106+ numbers significantly correlated with tricuspid regurgitation velocity (TRV, r=−0.44, P=0.033) 6-minute walk distance (6MWD, r= 0.72, P=0.001), mean pulmonary artery pressure (mPAP, r= −0.43, P=0.05), and pulmonary vascular resistance (PVR, r=−0.45, P=0.05). Other EPC subsets including CD31+/CD133+/CD146+ were similar between both groups. Numbers of EPCs did not correlate with age, sex, hemoglobin, WBC count, reticulocyte count, lactate dehydrogenase (LDH), iron/ferritin levels, and serum creatinine. These data indicate that subsets of EPC are lower in SCD patients with PAH than in those without PAH. Fewer EPCs in PAH patients may contribute to the pulmonary vascular pathology. Reduced number of EPCs in SCD patients with PAH might not only give potential insight into the pathophysiological mechanisms but also might be useful for identifying suitable therapeutic targets in these patients

Community- and healthcare-associated infections in critically ill patients: a multicenter cohort study

Objective: To compare the spectrum of infection, comorbidities, outcomes, and mortality of patients admitted to the intensive care unit (ICU) due to community-acquired or healthcare-associated severe sepsis. Methods: This prospective cohort study was conducted in three university medical centers in Lebanon from February 2005 to December 2006. Patients with severe sepsis were included and followed up until hospital discharge or death. Results: One hundred and twenty patients were included of whom 60% had community-acquired infections (CAI) and 40% had healthcare-associated infections (HAI). The most common infection in both groups was pneumonia. Hematologic malignancies were the only comorbidity more prevalent in HAI than in CAI (p = 0.047). Fungal infections and extended-spectrum beta-lactamase (ESBL) organisms were more frequent in HAI than in CAI (p = 0.04 and 0.029, respectively). APACHE and SOFA scores were high and did not differ between the two groups, nor did the proportion of septic shock, while mortality was significantly higher in the HAI patients than in the CAI patients (p = 0.004). On multivariate analysis for mortality, independent risk factors were the source of infection acquisition (p = 0.004), APACHE II score (p = 0.006), multidrug-resistant Pseudomonas infections (p = 0.043), and fungal infections (p = 0.006). Conclusions: Severe sepsis and septic shock had a high mortality rate, especially in the HAI group. Patients with risk factors for increased mortality should be monitored and aggressive treatment should be administered