Unusual appearance of Stenotrophomonas maltophilia in entubated patients hospitalized in Clinic for anestesiology, reanimation and intensive care) - KARIL Skopje

Stenotrophomonas maltophilia-associated infection is increasingly recognized as an nosocomial infection which occurs, in immunosuppressed individuals but not exclusively. Many strains of the bacterium manifest resistance to multiple antibiotics. It is considered an environmental bacterium, although little is known of the epidemiology of S. maltophilia, its sources and reservoirs. Even less is known of pathogenic mechanisms and virulence factors and this, reflects over difficulties in distinguishing colonization from true infection, which has fostered the view that the bacterium is essentially non-pathogenic.This study is generaly case report of unusual isolation of originated from medical devices (endotracheal tubes) used to support immunosuppressed surgical patients in KARIL and attempt to distinguish colonization from infection. During our continious monitoring procedure in KARIL, we have isolated 9 multi-drug resistant strains of Stenotrophomonas maltophilia (100% resistance to cefixime, ceftriaxone, cefuroxime, cefotaxime, coamoxiclav,imipenem). Automatic VITEK technique has been used for identification as well as for antibiotik susceptibility testing, to confirm traditional microbiological tecniques (morphology of colonies on blood agar plates and positive oxidase test,diskdifussion method and E-test).All patients suffered from traumatic haemoragical shock syndrome. Clinical significance has been confirmed in 2 cases with clinical signs for lower respiratory infection (high body temperatute 38.5oC, and Ro confirmation). These patients have been treated with clindamycin and ceftriaxone with recovering period in 4 days. Keywords:Stenotrophomonas maltophilia, ICU, clinical significance, endotracheal tub

Preemptive analgesic effects of midazolam and diclofenac in rat model

The aim of the present study was to investigate the preemptive analgesic effects of intraperitoneally administrated midazolam and diclofenac, before acute and inflammatory induced pain in rat model. One hundred twenty-eight (n=8 in each group) male Sprague Dawley rats were included in the study. Paw movements in response to thermal stimulation or paw flinching in response to formalin injection were compared after midazolam (0.1, 1, 5 and 10 mg/kg) and diclofenac (10 mg/kg), intraperitoneal administration. Saline was used as a control. Preemptive analgesic effect was significant in both tests when diclofenac and midazolam was administrated before the pain stimuli (p<0.01 and p<0.001). Intraperitoneal injection of midazolam in doses 5 and 10 mg/kg, increase the response time in hot plate test and decrease the number of flinches in formalin test (p<0.01 vs. p<0.001). ED50 of midazolam (with diclofenac) in hot plate test was 2.02 mg/kg (CI95% =-3.47-5.03 mg); and, 0.9 mg/kg (CI95% =-0.87-4.09 mg) in phase I and 0.7 mg/kg (CI95% = 0.48-6.63 mg) in phase II, in formalin test. Intraperitoneally administered midazolam and diclofenac had preemptive analgesic effects on acute thermal, and inflammatory induced pain in rats

SODIUMNITROPRUSSIDE AS A HYPOTENSIVE AGENT DURING GENERAL ANAESTHESIA AND PLASMA LEVEL OF NO

The study included 30 patients who received general anaesthesia due to chronically inflammatory disease of the middle ear.The aim of the study was determination of plasma level of NO if we use sodium nitroprusside (SNP) as a hypotensive agent and the correlation between plasma level of NO and mean arterial pressure (MAP).Material: 30 patients were divided in two groups: 15 patients received general anaesthesia with continuous intravenous infusion of sodium nitroprusside as a hypotensive agent and 15 patients received general anaesthesia without hypotensive agent.The level of MAP during hypotensive anaesthesia was between 60 and 70 mmHg (8-9kPa).Method: enzymatic method according to Conrad.The results have shown that general anaesthesia with continuous intavenous infusion of SNP produces higher plasma level of NO than plasma level of NO in patients who received general anaesthesia without hypotensive agent. The type of correlation between NO and MAP is negative, which means that if the level of MAP decreases, the level of NO increases