Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit.

During an outbreak of infections caused by methicillin-resistant (MR) Staphylococcus aureus in our burn unit, we conducted an extensive 10-week study to define the environmental epidemiology of the organism. The inanimate environment in patient rooms and adjacent areas was examined by using volumetric air samplers and Rodac plates. Airborne and surface level contamination with MR S. aureus was quantitated, and overall, MR S. aureus comprised 16, 31, and 40% of all bacterial growth from air, elevated surfaces, and floor surfaces, respectively. Mean air, elevated surface, and floor surface MR S. aureus contamination in rooms of MR S. aureus-infected burn patients were 1.9 MR S. aureus per ft3 (ca. 0.028 m3), 20 MR S. aureus per Rodac plate and 48 MR S. aureus per Rodac plate, respectively. Peak patient room environmental contamination levels were 6.9 MR S. aureus per ft3 of air, 70 MR S. aureus per Rodac plate per elevated surface and 138 MR S. aureus per Rodac plate per floor surface. Environmental contamination levels in the adjacent work areas were considerably lower than in infected patient rooms. There was ample opportunity for contamination of personnel through the inanimate environment in this unit

Efeito do sexo e da gestação sobre os níveis séricos de frutosamina de indivíduos normais

A frutosamina é um índice do controle metabólico no diabete mélito, refletindo as variações da glicemia nas últimas 2-3 semanas. Representa um conjunto de proteínas glicosadas, cuja fração principal é a albumina. Com o objetivo de es tabelecer os valotes normais da frutosamina em homens, mulheres e gestantes, os níveis séricos de frutosamina forilm medidos em 42 indivíduos normais (homens, n=21, idades 24-81 anos; mulheres, n=21, idades 22-71 anos) e 36 gestantes (idades 18-38 anos, idade gestacional 17-37 semanas). A frutosamina foi medida pelo método colorimétTico em um analisador automático COBAS MIRA-ROCHE. Os valores de frutosamina (média ± desvio padrão) observados em homens (2,99 ± 0.32 mmoljl) foram maiores do que nas mulheres (2,70 ± 0.26 mmol/1). Os valores nom1ais nas gestantes foram menores (2.40 ± 0.22 mmoljl) do que nas mulheres não-grávidas e a correção di! frutosamina de acordo com os túveis de albumina sérica não modificaram os resultados. Os dados apresentados indicam que devem ser considemdos o sexo ea presença ou não de gravidez pam se definir os limites normais dos valores de frutosamina sérica.Serum fructosamine is an index of metabolic control in diabetes mellitus, reflecting the glucose variations during the last 2-3 weeks. It represents a group of glycated proteins, in which the main fraction is albumin. The aim of this study was to determine the normal values in men, women and pregnants. Serum fructosamine was measured in 42healthy subjects (men n=21, aged 24-81 years; women n=21, aged 22-71years) and 36 normal pregnants (aged 18-38 years; gestacional age 17-37weeks). The fructosamine was determined by colorimetric method in an auto-analyser COBAS MIRA-ROCHE. The normal values (mean ± standard deviation) observed in men (2,99 ± 0,32 mmol/L)was higher than women (2,70 ± 0.26 mmol/L). The normal values in pregnants (2.40 ± 0.22mmol/L) were lower than non-pregnant women and the values were not dependent on serum albumin concentration. This data indicated the sex and pregnancy should be taken in account in order to establish the normal range of serum fructosamine

Infrared thermography to evaluate the training horse thermoregulation

Heat-regulation mechanisms, such as changes in peripheral blood flow, are activated by thermal stress to maintain body homeostasis. The infrared thermography enables to identify changes in blood flow and it has been valuable for recognizing stress in animals. This research aimed to evaluate the use of infrared thermography in the training horse thermoregulation. An Anglo-Arab horse was studied and exercised once a day. Infrared thermography images of horse´s armpit, croup, breast and groin and physiological parameters were taken before and after exercise and 0, 5 and 10 minutes after shower for eight days. The air temperature, relative humidity and air velocity were also registered. There were no differences between the surface temperature of croup and breast and the treatments, implying low participation in thermoregulation. However, the armpit and groin temperature increased after the exercise and decreased after shower, suggesting that vasomotor mechanisms were activated to heat exchange. Similar results were found for physiological parameters which show organism thermal responses for heat loss. It was concluded that infrared thermography allowed accuracy in determining the horse body surface temperature and it was possible to infer on thermoregulation.O estresse térmico em equinos aciona mecanismos termorregulatórios, como mudanças no fluxo sanguíneo periférico, para a manutenção da homeostase corporal. A termografia infravermelha permite detectar estas alterações, sendo uma ferramenta útil para avaliar o estresse em animais. Assim, o objetivo deste estudo foi avaliar o uso da termografia infravermelha na termorregulação de equino em condição de treinamento. Foi utilizado um cavalo anglo-árabe, exercitado uma vez ao dia. Foram captadas imagens termográficas da axila, garupa, peito e virilha do cavalo e registrados os parâmetros fisiológicos antes e após exercício e 0; 5 e 10 minutos após o banho, durante 8 dias. A temperatura, a umidade relativa e a velocidade do ar foram monitoradas. A temperatura de superfície da garupa e do peito não diferiu entre os tratamentos, indicando baixa participação destas partes na termorregulação. Em contrapartida, a temperatura superficial da axila e da virilha aumentou após o exercício e diminuiu após o banho, sugerindo evidência dos mecanismos vasomotores para a troca térmica do cavalo. Comportamento semelhante foi observado para as variáveis fisiológicas, o que demonstra tentativas orgânicas do organismo para sair das condições de estresse térmico. Concluiu-se que a termografia infravermelha permitiu determinar com precisão a temperatura de superfície corporal do cavalo, sendo possível inferir sobre a termorregulação.233

End-stage heart failure in congenitally corrected transposition of the great arteries:a multicentre study

BACKGROUND AND AIMS: For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear. METHODS: This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained. The composite primary outcome was mechanical circulatory support, heart transplantation, or death. RESULTS: From 558 patients (48% female, age at first visit 36 ± 14.2 years, median follow-up 8.7 years), the event rate of the primary outcome was 15.4 per 1000 person-years (11 mechanical circulatory support implantations, 12 transplantations, and 52 deaths). Patients experiencing the primary outcome were older and more likely to have a history of atrial arrhythmia. The primary outcome was highest in those with both moderate/severe right ventricular (RV) dysfunction and tricuspid regurgitation (n = 110, 31 events) and uncommon in those with mild/less RV dysfunction and tricuspid regurgitation (n = 181, 13 events, P &lt; .001). Outcomes were not different based on anatomic complexity and history of tricuspid valve surgery or of subpulmonic obstruction. New CHF admission or ventricular arrhythmia was associated with the primary outcome. Individuals who underwent childhood surgery had more adverse outcomes than age- and sex-matched controls. Multivariable Cox regression analysis identified older age, prior CHF admission, and severe RV dysfunction as independent predictors for the primary outcome. CONCLUSIONS: Patients with ccTGA have variable deterioration to end-stage heart failure or death over time, commonly between their fifth and sixth decades. Predictors include arrhythmic and CHF events and severe RV dysfunction but not anatomy or need for tricuspid valve surgery.</p

Genetic regulation of glycogen biosynthesis in Escherichia coli : In vivo effects of the catabolite repression and stringent response systems in glg gene expression

The synthesis of two of the Escherichia coli glycogen biosynthetic enzymes, ADPglucose pyrophosphorylase ( glg C) and glycogen synthase ( glg A) was activated by the addition of 5 m M cyclic AMP (cAMP) to maxicells; synthesis of glycogen branching enzyme ( glg B) was unaffected. β -Galactosidase activity expressed from a gene fusion, φ(glg C- lac Z), was approximately five-fold higher in a cya + versus an isogenic cya − strain of E. coli . Addition of cAMP restored β -galactosidase in the cya − strain. The expression of φ(glg C‘−’ lac Z) encoded β -galactosidase activity in a series of spo T mutants exhibited an apparent exponential relationship to intracellular guanosine 5′-diphosphate 3′-diphosphate (ppGpp) levels. These results provide evidence for the control of glycogen biosynthesis in vivo by cAMP and ppGpp at the level of gene expression, and identify a region of DNA required for the control. The φ(glg C‘−’ lac Z) encoded β -galactosidase activity was also elevated three-to five-fold in strain AC70R1, which contains a transacting mutation ( glg Q) that affects the levels of the glycogen biosynthetic enzymes and glg C transcripts.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41337/1/284_2005_Article_BF02091831.pd

A Multicenter, Long-Term Study on Arrhythmias in Children with Ebstein Anomaly

To assess the prevalence, history, and treatment of arrhythmias, in particular preexcitation and Wolff–Parkinson–White (WPW) syndrome, in patients with Ebstein anomaly (EA) during childhood and adolescence, we performed a multicenter retrospective study of all consecutive live-born patients with EA, diagnosed, and followed by pediatric cardiologists between 1980 and 2005 in The Netherlands. During a follow-up after EA diagnosis of 13 years 3 months (range: 6 days to 28 years 2 months), 16 (17%) of the 93 pediatric EA patients exhibited rhythm disturbances. Nine patients showed arrhythmic events starting as of the neonatal period. Supraventricular tachycardia was noted in 11 patients. One patient died in the neonatal period due to intractable supraventricular tachycardia resulting in heart failure and one patient died at 5 weeks of age most probably due to an arrhythmic event. The 14 surviving patients all show preexcitation, albeit 4 of them intermittently, and all have a right-sided accessory pathway location. Nine patients underwent catheter ablation of an accessory pathway. Only four patients are currently on antiarrhythmic drugs. The 17% prevalence of rhythm disturbances in pediatric EA patients, most commonly supraventricular arrhythmias, is significantly lower than in adult EA patients. Life-threatening rhythm disturbances are not frequent early in life. Symptomatic patients are well treated with radiofrequency catheter ablation