Evaluation the cases of neonatal sepsis and of antibiotic sensitivities in a neonatal intensive care unit

AMAÇ: Yenidoğan yoğun bakım ünitelerinde (YYBÜ) sepsis etkenleri ve antibiyotik duyarlılıkları zaman içinde ve kullanılan antibiyotiklere bağlı olarak değişir. Neonatal sepsise neden olan bakteriyel mikroorganizmaların ve antibiyotik duyarlılığının saptanması, ampirik antibiyotik tedavi rejimlerinin belirlenmesi ve uygun antibiyotik seçimi açısından önemlidir. GEREÇ veYÖNTEM: Ocak 2004-Haziran 2008 tarihleri arasında Adnan Menderes Üniversitesi Tıp Fakültesi YYBÜ'de izlenen 900 yenidoğan içerisinde sepsis tanısı alan 87 olgunun dosyaları incelendi. Kültür pozitif olan 45 olgunun klinik belirti ve bulguları, risk faktörleri, laboratuvar sonuçları, kültürde üreyen etkenler ve antibiyotik duyarlılıkları değerlendirildi. BULGULAR: Sepsis sıklıgı %9.6 bulundu. Kesin sepsis tanısı alan 45 olguda (%5), 49 kan kültürü üremesi oldu. Bunların %82'si prematüre ve%53'ü erkekti. Erken neonatal sepsiste Koagülaz Negatif Stafilokok (KNS) ve Staphylococcus aureus (S. aureus), geç neonatal sepsiste ise KNS'den sonra Candida spp. en sık üreyen mikroorganizmalardı. Mortalite oranı %13.3'tü. KNS'ler glikopeptidlere %100 duyarlı bulunurken, penisiline %96, metisiline %90 dirençliydi. S. aureus suslarının tamamı glikopeptidlere, metisiline, eritromisine ve klindamisine duyarlı bulunurken, penisiline direnç oranı %71.4 idi. Enterococcus spp. suslarında test edilen antibiyotiklere direnç saptanmadı. Enterobacter spp. susları 3. kusak sefalosporinlere ve karbapenemlere %100 duyarlı iken ampisilin-sulbaktama %100 dirençliydi. Acinetobacter spp. ve Pseudomonas spp. suslarının tamamı piperasiline dirençliydi. Klebsiella spp suslarının tamamı karbapenemlere, kinolonlara ve aminoglikozidlere duyarlı idi. Serratia spp., Escherichia coli ve Enterococcus spp. suslarında test edilen antibiyotiklere direnç saptanmadı. SONUÇ: Erken neonatal sepsiste Gram pozitif mikroorganizmaların ön plana geçmesi ve bu mikroorganizmalarda yüksek penisilin direnci görülmesi, ampirik antibiyotik uygulamalarının gözden geçirilmesi gerektiğini düşündürmektedir. Bununla birlikte S. aureus suslarında metisilin direncine rastlanmamıştır. Acinetobacter spp. ve Pseudomonas spp. suslarındaki yüksek piperasilin direnci önceki yıllarda bu antibiyotiğin sık kullanımına bağlandı.PURPOSE: Type and antibiotic sensitivity of pathogens leading sepsis in neonatal intensive care units (NICU) change over years. It is important to identify type and antibiotic sensitivity of pathogens leading sepsis for establishment of the local antibiotic policy. MATERIALS and METHODS: 87 cases with sepsis were investigated among 900 newborns followed in “Adnan Menderes University” NICU between January 2004-June 2008. Clinical symptoms and signs, risk factors, laboratory results, positive cultures and antibiotic sensitivity factors were evaluated in 45 cases with positive culture. RESULTS: Sepsis was found to have a 9.6% rate. 45 cases were diagnosed as definite sepsis with 49 positive blood cultures. 53% were males and 82% were premature. Most common pathogens were coagulase-negative staphylococci (CNS) and Staphylococcus aureus (S. aureus) in early neonatal sepsis, whereas CNS and the Candida in late neonatal sepsis. Mortality rate was 13.3%. Glycopeptide sensitivity of CNS was 100% , penicilline and meticilline resistance were 96% and 90% respectively. All S. aureus strains were sensitive to methicillin, clindamycine and eritromycine while penicillin resistance rate was 71.4%. No resistance was detected in Enterococcus spp. strains. Enterobacter spp. were 100% sensitive to 3. generation cephalosporins and carbapenems but resistant to ampicillin-sulbactam. Acinetobacter spp and Pseudomonas spp were resistant to piperaciline. All Klebsiella spp were sensitive to carbapenems, and aminoglycosides. No resistance was detected for the Serratia spp, Escherichia coli ve Enterococcus spp strains. CONCLUSION: Gram positive microorganisms as the leading etiologic agent in early neonatal sepsis, and their high penicillin resistance necessitated a revision in our ampiric antibiotic practices. However, no meticilline resistance was found in S. aureus species. High piperacilline resistance of Acinetobacter spp and Pseudomonas spp was associated with the recent frequent utilization of this agent

Atmospheric Pressure Mass Spectrometry of Single Viruses and Nanoparticles by Nanoelectromechanical Systems

Mass spectrometry of intact nanoparticles and viruses can serve as a potent characterization tool for material science and biophysics. Inaccessible by widespread commercial techniques, the mass of single nanoparticles and viruses (>10MDa) can be readily measured by NEMS (Nanoelectromechanical Systems) based Mass Spectrometry, where charged and isolated analyte particles are generated by Electrospray Ionization (ESI) in air and transported onto the NEMS resonator for capture and detection. However, the applicability of NEMS as a practical solution is hindered by their miniscule surface area, which results in poor limit-of-detection and low capture efficiency values. Another hindrance is the necessity to house the NEMS inside complex vacuum systems, which is required in part to focus analytes towards the miniscule detection surface of the NEMS. Here, we overcome both limitations by integrating an ion lens onto the NEMS chip. The ion lens is composed of a polymer layer, which charges up by receiving part of the ions incoming from the ESI tip and consequently starts to focus the analytes towards an open window aligned with the active area of the NEMS electrostatically. With this integrated system, we have detected the mass of gold and polystyrene nanoparticles under ambient conditions and with two orders-of-magnitude improvement in capture efficiency compared to the state-of-the-art. We then applied this technology to obtain the mass spectrum of SARS-CoV-2 and BoHV-1 virions. With the increase in analytical throughput, the simplicity of the overall setup and the operation capability under ambient conditions, the technique demonstrates that NEMS Mass Spectrometry can be deployed for mass detection of engineered nanoparticles and biological samples efficiently.Comment: 38 pages, 6 figure

A wideband high isolation CMOS T/R switch for x-band phased array radar systems

This paper presents an SPDT switch which is designed to operate at 8-12 GHz frequency range (X-Band), as a sub module of the front end circuit of a phased array radar. The switch distinguishes itself from its counterparts with its larger frequency range and higher isolation that is uniformly distributed over its bandwidth. It is fabricated using 0.25 mu m SiGe BiCMOS technology of IHP Microelectronics (Germany). As a new technique, shunt inductors are placed next to shunt transistors in order to improve trade-off between insertion loss and isolation. It has isolation higher than 30 dB in entire band, input referred 1dB compression point is 27.6 dBm, insertion loss is between 2.7-4.1 dB, input and output referred return losses are better than 11 dB in the frequency range of 8-12 Gliz

Management and Outcome of Cardiac and Endovascular Cystic Echinococcosis

Cardiac and vascular involvement are infrequent in classical cystic echinococcosis (CE), but when they occur they tend to present earlier and are associated with complications that may be life threatening. Cardiovascular CE usually requires complex surgery, so in low-income countries the outcome is frequently fatal. This case series describes the characteristics of cardiovascular CE in patients diagnosed and treated at a Tropical Medicine & Clinical Parasitology Center in Spain. A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995–2009) is reported. The main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. The clinical picture and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas. CE is a neglected disease and further studies are necessary in order to make more definite management recommendations for this rare and severe form of the disease. The authors propose a general approach based on cyst location: exclusively cardiac, endovascular or both

3D printed acoustically programmable soft microactuators

The concept of creating all-mechanical soft microrobotic systems has great potential to address outstanding challenges in biomedical applications, and introduce more sustainable and multifunctional products. To this end, magnetic fields and light have been extensively studied as potential energy sources. On the other hand, coupling the response of materials to pressure waves has been overlooked despite the abundant use of acoustics in nature and engineering solutions. Here, we show that programmed commands can be contained on 3D nanoprinted polymer systems with the introduction of selectively excited air bubbles and rationally designed compliant mechanisms. A repertoire of micromechanical systems is engineered using experimentally validated computational models that consider the effects of primary and secondary pressure fields on entrapped air bubbles and the surrounding fluid. Coupling the dynamics of bubble oscillators reveals rich acoustofluidic interactions that can be programmed in space and time. We prescribe kinematics by harnessing the forces generated through these interactions to deform structural elements, which can be remotely reconfigured on-demand with the incorporation of mechanical switches. These basic micromechanical systems will serve as the building blocks for the development of a novel class of untethered soft microrobots powered and controlled by acoustic signals.Comment: 6 Figures, 11 Supplementary Figures, 2 Supplementary Table

Nebivolol in preventing atrial fibrillation following coronary surgery in patients over 60 years of age

Objective: Postoperative atrial fibrillation is a common complication after cardiac surgery, with an incidence as high as 20-50%. Increased age is associated with a significant increase in postoperative atrial fibrillation risk. This common complication is associated with higher morbidity and mortality rates. The aim of this study was to assess the efficacy of nebivolol in preventing atrial fibrillation following coronary artery bypass surgery in patients over 60 years of age. Methods: In this prospective randomized study, 200 patients who were candidates for elective coronary artery bypass surgery were divided into two groups. The first group was administered with nebivolol and the second group was administered with metoprolol. Treatment was initiated four days prior to surgery, and patients were monitored for atrial fibrillation until discharge. Forty-one patients recieved 50 mg metoprolol succinate daily, which was initiated minimum 4 days before surgery. Results: Demographic data were similar in both groups. The incidence of postoperative atrial fibrillation in both groups was similar, with no significant difference being identified [n=20 (20%); n=18 (18%), P=0.718; respectively]. There were not any mortality at both groups during study. Inotropic agent requirement at ICU was similar for both groups [n=12 (12%), n=18 (18%), P=0.32]. Conclusion: We compared the effectiveness of nebivolol and metoprolol in decreasing the incidence of postoperative atrial fibrillation, and determined that nebivolol was as effective as metoprolol in preventing postoperative atrial fibrillation at patients. Nebivolol may be the drug of choice due to its effects, especially after elective coronary artery bypass surgery