High incidence of multiresistant bacterial isolates from bloodstream infections in trauma emergency department and intensive care unit in Serbia

We investigated the incidence of bloodstream infections (BSIs) in trauma emergency department (ED) and intensive care unit (ICU), to assess ED- and ICU-related predictors of BSI and to describe the most common bacteria causing BSI and their antimicrobial resistance markers. A prospective study was conducted in two trauma ICUs of the ED of Clinical Center of Serbia. Overall, 62 BSIs were diagnosed in 406 patients, of which 13 were catheter-related BSI (3.0/1,000 CVC-days) and 30 BSIs of unknown origin, while 15% were attributed to ED CVC exposure. Lactate ≥2 mmol/L and SOFA score were independent ED-related predictors of BSI, while CVC in place for >7 days and mechanical ventilation >7 days were significant ICU-related predictors. The most common bacteria recovered were Acinetobacter spp., Klebsiella spp., and Pseudomonas aeruginosa. All Staphylococcus aureus and coagulase-negative staphylococci isolates were methicillin-resistant, whereas 66% of Enterococcus spp. were vancomycin-resistant. All isolates of Enterobacteriaceae were resistant to third-generation cephalosporins, whereas 87.5% of P. aeruginosa and 95.8% of Acinetobacter spp. isolates were resistant to carbapenems. ED BSI contributes substantially to overall ICU incidence of BSI. Lactate level and SOFA score can help to identify patients with higher risk of developing BSI. Better overall and CVC-specific control measures in patients with trauma are needed

Numeričko predviđanje strujnog polja pri pridodnoj ventilaciji stočarskih objekata

This paper deals with three dimensional flow fields of livestock buildings prediction by numerical simulations and computational fluid dynamics - CFD. Flow field investigation is based on analysis of all relevant parameters that influences on temperature and flow field inside and outside of object, taking in account local meteorological conditions and terrain configuration. Based on results it is possible to design improved models in early stages of architectural design or later, and improvement of object energy efficiency.U radu je dat metod predviđanja trodimenzionalnog strujnog polja u stočarskim objektima primenom numeričkih simulacija i kompjuterske dinamike fluida - CFD. Ispitivanje strujnog polja sprovodi se na osnovu analize svih relevantnih faktora koji utiču na strujnu sliku unutar i oko objekta uzimajući u obzir lokalne meteorološke podatke, merodavne prepreke strujanju iz pojedinih pravaca. Na osnovu dobijene strujne slike, moguće je definisanje unapređenih modela objekta u cilju unapređenja energetske efikasnosti objekta ili arhitektonskog korigovanja objekta u ranim fazama projektovanja

Numerička simulacija toplotnog opterećenja plastenika

The paper described the process of solving partial differential equations of heat conduction in the walls of the building envelope by numerical discretization in order to determine the precise unsteady temperature fields in the object. Numerical solution of complex equations of heat transfer is aimed at determining the thermal behavior of the object taking into account all the external parameters, stochastic variable in time, affecting the behavior of the object. Numerical simulation of the greenhouse is suitable for relatively simple geometry of the object and a small number of zones (rooms) inside the building. The procedure is explained in this paper is applied to the aid package for easier and faster calculation dataU radu je opisan postupak rešavanja parcijalnih diferencijalnih jednačina provođenja toplote u zidovima omotača objekta numeričkom diskretizacijom u cilju preciznog određivanja nestacionarnog temperaturskog polja u objektu. Numeričko rešavanje složenih jednačina prenosa toplote ima za cilj određivanje toplotnog ponašanja objekta uzimajući u obzir sve spoljne parametre, stohastički promenljive u vremenu, koji utiču na ponašanje objekta. Numerička simulacija plastenika pogodna je zbog relativno jednostavne geometrije objekta i manjeg broja zona (prostorija) unutar objekta. Postupak koji je objašnjen u radu primenjen je u pomoć programskog paketa radi lakšeg i bržeg računanja podataka

Energetska optimizacija sistema za korišćenje geotermalne energije za grejanje plastenika

Setting-up the right greenhouse environment is subject to complex requirements. Present conditions real time parameters are analyzed from the viewpoint of greenhouse heating and ventilation system demands in winter period. Insufficient amount of heat energy gained from geothermal source during the low outside air temperatures period and unused geothermal heat energy in periods when heating system is not required are discussed. Complex environmental parameters modeling necessary for greenhouse heating and ventilation yearly energy requirements is provided. Numerical simulations are performed to provide energy efficiency improving, effective geothermal source use, defining heat storage system and conceptual technical design. Finally, needs for further research and engineering development are outlined.Određivanje unutrašnjih parametara u plastenicima i staklenicima zahteva kompleksno razmatranje u cilju određivanja optimalnih sistema grejanja prostor au zimskom periodu i ventilacije u letnjem periodu. U cilju povećanja energetske efikasnosti objekta razmatrano je grejanje objekta energijom geotermalnog izvora, kao i modeliranje potrošnje geotermalne vode u uslovima nedovoljne količine pri izuzetno niskom temperaturama spoljašnjeg vazduha. Numeričke simulacije toplotnog opterećenja plastenika sprovedene su u cilju povećanja efektivne upotrebe izvora geotermalne energije i konceptualnih tehničkih rešenja. U radu je definisano termičko ponašanje objekta. Konačno, potreba za daljim istraživanjem i inženjerskim razvojem je naglašena

The effect of subchronic supplementation with folic acid on homocysteine induced seizures

Influence of folic acid on the CNS is still unclear. Folate has a neuroprotective effect, while on the other hand excess folate can exacerbate seizures in epileptics. The aim of the present study was to examine the effect of subchronic administration of folic acid on behavioural and electroencephalographic (EEG) characteristics of DL homocysteine thiolactone induced seizures in adult rats. The activity of Na+/K+-ATPase and Mg2+-ATPase in different brain regions was investigated. Adult male Wistar rats were divided into groups: 1. Controls (C, 0.9% NaCl); 2. DL homocysteine-thiolactone 8.0 mmol/kg (H); 3. Subchronic supplementation with folic acid 5 mg/kg for 7 days (F) and 4. Subchronic supplementation with F + single dose of H (FH). Seizure behaviour was assessed by incidence, latency, number and intensity of seizure episodes. Seizure severity was described by a descriptive scale with grades 0–4. For EEG recordings, three gold-plated recording electrodes were implanted into the skull. Subchronic supplementation with folic acid did not affect seizure incidence, median number of seizure episodes and severity in FH, comparison with H (p > 0.05). The majority of seizure episodes in all groups were of grade 2. There were no significant differences in lethal outcomes at 24 h upon H injection in the FH vs. H group. The activity of Na+/K+-ATPase and Mg2+-ATPase was significantly increased in almost all examined structures in the FH vs. H group. Subchronic folic acid administration did not exacerbate H induced seizures and completely recovered the activity of ATPases

early life weight patterns and risk of obesity at 5 years a population based cohort study

Abstract Childhood obesity is a major public health problem in industrialised countries. Recent studies suggest that obesity in adolescence is associated with characteristics present in early childhood. The aim of this study was to estimate the risk of overweight/obesity at age 5 yr based on BMI percentiles at age 3 and changes in percentiles from birth to 3 years of age. In this population-based study BMI data of 5173 children were collected at ages 3 and 5 yr and were linked to information relative to birth weight. The prevalence of obesity at 5 yr was 4.5%. The risk of obesity for children born large for gestational age was 8.4% while it was 13.8% for children overweight at 3 years and 49.8% for children who were obese at 3 yr, regardless of their previous weight trajectory (the prevalences were 50%, 50% and 53% for stable, moderate and strong increasing trajectory, respectively). BMI percentile at 3 years proved to be an efficient biomarker for sustained obesity at age 5 yr. In practice, if one targeted early preventive interventions to only 15% of the population (3-year-olds affected by overweight/obesity) one can address 80% of children who would be affected by obesity at age 5 yr

Differences in MRSA prevalence and resistance patterns in a tertiary center before and after joining an international program for surveillance of antimicrobial resistance

Methicillin-resistant Staphylococcus aureus (MRSA) emerged as one of the most important causes of hospital-acquired bloodstream infections (BSIs), especially the multidrug resistant clones. The aim of the present study was to compare prevalence and resistance patterns of MRSA bacteremia in the major tertiary-care academic and referral center in Serbia before and after implementing an active antimicrobial resistance (AMR) surveillance. Laboratory-based before-after study was conducted during a two-year period (January 2012 to December 2013) in Clinical Centre of Serbia. Isolation and identification of bacterial strains were done following standard microbiological procedures. During the AMR surveillance, nearly twice more bloodstream samples were collected compared to the year without surveillance (1,528 vs. 855). In total, 43 isolates of MRSA were identified. MRSA was significantly more prevalent during the AMR surveillance compared to the previous year [14 (66.7%) to 29 (76.3%); P = 0.046]. During the AMR surveillance, MRSA more frequently originated from medical departments compared to intensive care unit, surgical department, and internal medicine (P = 0.027) indicating increasing MRSA infections in patients with less severe clinical condition and no apparent risk factors. Higher prevalence of MRSA and its lower susceptibility to erythromycin were revealed by implementation of active AMR surveillance, which may reflect more thoughtful collection of bloodstream samples from patients with suspected BSI

Imaging-based indices combining disease severity and time from disease onset to predict COVID-19 mortality: A cohort study

Background: COVID-19 prognostic factors include age, sex, comorbidities, laboratory and imaging findings, and time from symptom onset to seeking care. Purpose: The study aim was to evaluate indices combining disease severity measures and time from disease onset to predict mortality of COVID-19 patients admitted to the emergency department (ED). Materials and methods: All consecutive COVID-19 patients who underwent both computed tomography (CT) and chest X-ray (CXR) at ED presentation between 27/02/2020 and 13/03/2020 were included. CT visual score of disease extension and CXR Radiographic Assessment of Lung Edema (RALE) score were collected. The CT- and CXR-based scores, C-reactive protein (CRP), and oxygen saturation levels (sO2) were separately combined with time from symptom onset to ED presentation to obtain severity/time indices. Multivariable regression age- and sex-adjusted models without and with severity/time indices were compared. For CXR-RALE, the models were tested in a validation cohort. Results: Of the 308 included patients, 55 (17.9%) died. In multivariable logistic age- and sex-adjusted models for death at 30 days, severity/time indices showed good discrimination ability, higher for imaging than for laboratory measures (AUCCT = 0.92, AUCCXR = 0.90, AUCCRP = 0.88, AUCsO2 = 0.88). AUCCXR was lower in the validation cohort (0.79). The models including severity/time indices performed slightly better than models including measures of disease severity not combined with time and those including the Charlson Comorbidity Index, except for CRP-based models. Conclusion: Time from symptom onset to ED admission is a strong prognostic factor and provides added value to the interpretation of imaging and laboratory findings at ED presentation

Validation of a new fully automated software for 2D digital mammographic breast density evaluation in predicting breast cancer risk.

We compared accuracy for breast cancer (BC) risk stratification of a new fully automated system (DenSeeMammo-DSM) for breast density (BD) assessment to a non-inferiority threshold based on radiologists' visual assessment. Pooled analysis was performed on 14,267 2D mammograms collected from women aged 48-55 years who underwent BC screening within three studies: RETomo, Florence study and PROCAS. BD was expressed through clinical Breast Imaging Reporting and Data System (BI-RADS) density classification. Women in BI-RADS D category had a 2.6 (95% CI 1.5-4.4) and a 3.6 (95% CI 1.4-9.3) times higher risk of incident and interval cancer, respectively, than women in the two lowest BD categories. The ability of DSM to predict risk of incident cancer was non-inferior to radiologists' visual assessment as both point estimate and lower bound of 95% CI (AUC 0.589; 95% CI 0.580-0.597) were above the predefined visual assessment threshold (AUC 0.571). AUC for interval (AUC 0.631; 95% CI 0.623-0.639) cancers was even higher. BD assessed with new fully automated method is positively associated with BC risk and is not inferior to radiologists' visual assessment. It is an even stronger marker of interval cancer, confirming an appreciable masking effect of BD that reduces mammography sensitivity

Mowat-Wilson syndrome : growth charts

Background Mowat-Wilson syndrome (MWS; OMIM #235730) is a genetic condition caused by heterozygous mutations or deletions of theZEB2gene. It is characterized by moderate-severe intellectual disability, epilepsy, Hirschsprung disease and multiple organ malformations of which congenital heart defects and urogenital anomalies are the most frequent ones. To date, a clear description of the physical development of MWS patients does not exist. The aim of this study is to provide up-to-date growth charts specific for infants and children with MWS. Charts for males and females aged from 0 to 16 years were generated using a total of 2865 measurements from 99 MWS patients of different ancestries. All data were collected through extensive collaborations with the Italian MWS association (AIMW) and the MWS Foundation. The GAMLSS package for the R statistical computing software was used to model the growth charts. Height, weight, body mass index (BMI) and head circumference were compared to those from standard international growth charts for healthy children. Results In newborns, weight and length were distributed as in the general population, while head circumference was slightly smaller, with an average below the 30th centile. Up to the age of 7 years, weight and height distribution was shifted to slightly lower values than in the general population; after that, the difference increased further, with 50% of the affected children below the 5th centile of the general population. BMI distribution was similar to that of non-affected children until the age of 7 years, at which point values in MWS children increased with a less steep slope, particularly in males. Microcephaly was sometimes present at birth, but in most cases it developed gradually during infancy; many children had a small head circumference, between the 3rd and the 10th centile, rather than being truly microcephalic (at least 2 SD below the mean). Most patients were of slender build. Conclusions These charts contribute to the understanding of the natural history of MWS and should assist pediatricians and other caregivers in providing optimal care to MWS individuals who show problems related to physical growth. This is the first study on growth in patients with MWS.Peer reviewe