Мониторинг этиологической структуры возбудителей у пациентов с гнойными ранами

РАНЕВАЯ ИНФЕКЦИЯ /МИКРОБ /ЭТИОЛСТАФИЛОКОККИ /ПАТОГЕНSTAPHYLOCOCCUS /ПАТОГЕНЭНТЕРОБАКТЕРИИ /ПАТОГЕНENTEROBACTERIACEAE /ПАТОГЕНКОЛИФОРМНЫЕ БАЦИЛЛЫ /ПАТОГЕНПАРАКОЛОБАКТЕРИИ /ПАТОГЕНПСЕВДОМОНАДЫ /ПАТОГЕНГИДРОГЕНОМОНАДЫ /ПАТОГЕНХЛОРОБАКТЕРИИ /ПАТОГЕНКЛЕБСИЕЛЛЫ /ПАТОГЕНАКИНЕТОБАКТЕРИИ /ПАТОГЕНACINETOBACTER /ПАТОГЕНHERELLEA /ПАТОГЕНMIMA /ПАТОГЕНБАКТЕРИИ АНАЭРОБНЫЕ /ПАТОГЕНЦель исследования – изучить изменения в этиологической структуре возбудителей у пациентов с гнойными ранами. Материал и методы. На базе бактериологической лаборатории в 2006-2007 годах и в 2019-2020 годах обследованы бактериологическими методами 92 и 99 пациентов с гнойными ранами различных локализаций, соответственно. Пациенты проходили стационарное лечение в отделении гнойной хирургии УЗ "Витебская областная клиническая больница". Определение видовой принадлежности производилось в автоматическом режиме на биохимическом анализаторе АТВ Expression "bioMerieux" с использованием тест-систем: ID 32 STAPH – для стафилококков, ID 32 E – для энтеробактерий, ID 32 GN – для грамотрицательных палочек, rapid ID 32 A – для анаэробов и разработанных нами тест-систем "ИД-ЭНТЕР", "ИД-АНА" для энтеробактерий и анаэробных возбудителей, соответственно. Результаты. В результате проведенных исследований установлено, что на 13,96% (р<0,05) уменьшилась роль рода Staphylococcus, на 6,19% (р<0,05) Streptococcus pyogenes. На 12,25% (р<0,05) увеличилась доля Klebsiella pneumoniae, на 15,58% (р<0,05) – Acinetobacter baumannii. В микробном пейзаже начали появляться новые ассоциации: S.aureus + A.baumannii – 14,71% (р<0,05), представитель семейства Enterobacteriaceae + A.baumannii – 11,76% (р<0,05). Заключение. За 13 лет произошли существенные изменения в этиологической структуре экзогенных микроорганизмов у пациентов с гнойными ранами. На фоне снижения роли грамположительной флоры отмечается достоверное увеличение доли грамотрицательных проблемных возбудителей, таких как K.pneumoniae и A.baumannii. Полученные результаты необходимо учитывать при проведении антибиотикотерапии у пациентов с гнойными ранами.Objectives. To study changes in the etiological structure of pathogens in patients with purulent wounds. Material and methods. On the basis of the bacteriological laboratory, in 2006-2007 and in 2019-2020, 92 and 99 patients with purulent wounds of various locations, respectively, were examined by bacteriological methods. Patients underwent inpatient treatment at the department of purulent surgery at the Vitebsk Regional Clinical Hospital. Microflora was identified on an automated biochemical analyzer ATB Expression "bioMerieux" using test-systems: ID 32 STAPH – for staphylococci, ID 32 E – for enterobacteria, ID 32 GN – for gram-negative bacilli, rapid ID 32 A – for anaerobes and the "ID-ENTER", "ID-ANA" test-systems, developed by us for identification of enterobacteria and anaerobes, respectively. Results. As a result of the conducted investigations it has been found, that the role of the genus Staphylococcus decreased by 13.96% (p<0.05), and that of S.pyogenes decreased by 6.19% (p<0.05). The proportion of K.pneumoniae increased by 12.25% (p <0.05), and that of A.baumannii increased by 15.58% (p<0.05). New associations began to appear in the microbial landscape: S.aureus + A.baumannii – 14.71% (p<0.05), a representative of the family Enterobacteriaceae + A.baumannii – 11.76% (p<0.05). Conclusions. Over 13 years, significant changes have occurred in the etiological structure of exogenous microorganisms in patients with purulent wounds. Against the background of a decreasing role of gram-positive flora, a significant increase in the proportion of gram-negative problem pathogens, such as K.pneumoniae and A.baumannii, is observed. The obtained results must be taken into account, when providing antibiotic therapy in patients with purulent wounds

Changes in cognitive domains during three years in patients with Alzheimer's disease treated with donepezil

<p>Abstract</p> <p>Background</p> <p>The objective was to identify separate cognitive domains in the standard assessment tools (MMSE, ADAS-Cog) and analyze the process of decline within domains during three years in Alzheimer's disease (AD) patients with donepezil treatment.</p> <p>Method</p> <p>AD patients (n = 421) were recruited from a clinical multi-centre study program in Sweden. Patients were assessed every six months during three years. All patients received donepezil starting directly after study entry. After dropouts, 158 patients remained for analyses over three years. Data for the other patients were analysed until they dropped out (4 groups based on length in study).</p> <p>Results</p> <p>Factor analyses of all items suggested that there were three intercorrelated factors: a General, a Memory and a Spatial factor for which we constructed corresponding domains. Overall there was a cognitive improvement at six months followed by a linear drop over time for the three domains. Some group and domain differences were identified. Patients who remained longer in the study had better initial performance and a slower deterioration rate. The early dropouts showed no improvement at six months and many dropped out due to side effects. The other groups displayed a performance improvement at six months that was less pronounced in the Memory domain. Before dropping out, deterioration accelerated, particularly in the Spatial domain.</p> <p>Conclusion</p> <p>The course of illness in the three domains was heterogeneous among the patients. We were not able to identify any clinically relevant correlates of this heterogeneity. As an aid we constructed three algorithms corresponding to the cognitive domains, which can be used to characterize patients initially, identify rapid decliners and follow the course of the disease.</p

azithromycin prevents oxidative damage

Leaky lysosomes in lung transplant macrophages: azithromycin prevents oxidative damag

Icke-azeotropa blandningar i v\ue4rmepumpar - F\uf6rstudie f\uf6r fullskaleprojekt

In cooperation between STAL Refrigeration AB and the Department of Heat and Power Technology, Chalmers University of Technology, an experimental heat pump with a nonazeotropic mixture as working fluid is being prepared. This will be the first full scale plant in Sweden.This report contains the results from a pre-study to thefull scale project. The influence of a non-azeotropic mixture, as compared with a pure fluid on the design of the components in the heat pump, has been analyzed. This study has partly been done with a previously developed computer program, which has been improved. Some supplementary routines have been added to it, and the specific design of the prepared experimental planthas been inserted.The experimental heat pump which is to be used, has a countercurrent evaporator and a crosscurrent condenser. Since the best design for a non-azeotropic mixture is countercurrent, heat exchanger calculations have been done for this type of condenser. Comparisons indicate that a shell and tube heat exchanger with the non-azeotropic mixture on the shell side is highly interesting to investigate practically. The study of the internal heat exchanger shows that the dependence of COP on the degree of superheat before the compressor is slightly larger for a non-azeotropic mixture than for a pure fluid.During this project and also afterwards a dynamic debate onthe environmental effect of "CFCs" has been going on. Theuse of the mixture HCFC22/CFCl14, suggested in this report,will be forbidden in the future. However, it is stillinteresting to study it, since there are more and betterthermodynamic and physical data available for this mixturethan for other non-azeotropic mixtures. The experience andknowledge acquired in this project are possible to apply onother mixtures. Accurate calculations can be done for thesewhen more reliable data are available

Does quantitative lung SPECT detect lung abnormalities earlier than lung function tests? : Results of a pilot study

Background: Heterogeneous ventilation in lungs of allergic individuals, cigarette smokers, asthmatics and chronic obstructive pulmonary disease (COPD) patients has been demonstrated using imaging modalities such as PET, MR and SPECT. These individuals suffer from narrow and/or closed airways to various extents. By calculating regional heterogeneity in lung ventilation SPECT images as the coefficient of variation (CV) in small elements of the lung, heterogeneity maps and CV-frequency curves can be generated and used to quantitatively measure heterogeneity. This work explores the potential to use such measurements to detect mild ventilation heterogeneities in lung healthy subjects. Method: Fourteen healthy subjects without documented lung disease or respiratory symptoms, and two patients with documented airway disease, inhaled on average approximately 90 MBq 99mTc-Technegas immediately prior to the 20 min SPECT acquisition. Variation in activity uptake between subjects was compensated for in resulting CV values. The area under the compensated CV frequency curve (AUC), for CV values greater than a threshold value CVT, AUC(CV&gt; CVT), was used as the measure of ventilation heterogeneity. Results: Patients with lung function abnormalities, according to lung function tests, generated higher AUC(CV&gt;20%) values compared to healthy subjects (p=0.006). Strong linear correlations with the AUC(CV&gt;20%) values were found for age (p=0.006) and height (p=0.001). These demonstrated that ventilation heterogeneities increased with age and that they depend on lung size. Strong linear correlations were found for the lung function value related to indices of airway closure/air trapping, RV/TLC (p=0.009), and DLCOc (p=0.009), a value partly related to supposed ventilation/perfusion mismatch. These findings support the association between conventional lung function tests and the AUC(CV&gt;20%) value. Conclusions: Among the healthy subjects there is a group with increased AUC(CV&gt;20%) values, but with normal lung function tests, which implies that it might be possible to differentiate ventilation heterogeneities earlier in a disease process than by lung function tests.On the date of the defence date of the Ph.D. Thesis the status of this article was Manuscript.</p

Mucosal output of eotaxin in allergic rhinitis and its attenuation by topical glucocorticosteroid treatment

BACKGROUND: Eotaxin is a chemokine that attracts and activates eosinophils. The present study examines the occurrence of eotaxin in nasal mucosal surface liquids in patients with seasonal allergic rhinitis without allergen exposure and during repeat allergen challenge with and without topical glucocorticosteroid treatment. The number of subepithelial eosinophils and mucosal outputs of bulk plasma (alpha2-macroglobulin) and eosinophil cationic protein (ECP) are also examined. METHODS: Twelve patients underwent daily allergen challenges for 6 days. Separately, 14 patients, who were receiving budesonide and placebo in a parallel group design, also underwent allergen challenge for 6 days. Nasal biopsies were obtained before and 24 h after the allergen challenge series, and lavages were carried out before and 15 min after selected allergen challenges. RESULTS: At baseline nasal lavage fluid levels of eotaxin correlated to levels of alpha2-macroglobulin and ECP. After the first allergen challenge there was a correlation between nasal lavage fluid levels of eotaxin and ECP. Repeat allergen exposure increased the mucosal output of eotaxin (P <0.05) and ECP (P <0.01) as well as eosinophil numbers (P <0.01), but no correlation was found between increased eosinophil numbers and eotaxin. Budesonide reduced eotaxin levels during repeat allergen challenge (P <0.05). CONCLUSIONS: Repeat allergen exposure in allergic rhinitis is associated with increased mucosal output of eotaxin. Topical budesonide attenuates this effect, suggesting the possibility that inhibitory effects on mucosal eotaxin may contribute to anti-eosinophilic actions of topical glucocorticosteroids