Educational case: Pseudomonas and acinetobacter sepsis due to thermal injury

Background: Multi drug resistant (MDR) Pseudomonas and Acinetobacter species are defined as resistant to at least three classes of antibiotics. Most studies have demonstrated that MDR gram negative infections convey increased mortality and morbidity. Case: An 11-year âold girl was admitted to pediatric burns unit with burn injury of approximately 68 total body surface area (TBSA). Discussion: Role of systemic antibiotics is adjunctive and never replaces surgical debridement, use of topical agents, nutritional support, increasing in immune system function and grafting. Evidence in the published literature suggests that combination therapy with Meropenem and Colistin are effective for burned patients with MDR gram negative sepsis. © 2013, Kowsar Corp

Prevalence of beta lactamase producing species of pseudomonas and acinetobacter in pediatric burn patients Prevalence de pseudomonas et acinetobacter secreteurs de blse et metallo-beta lactamases chez les brules pediatriques

Burn wound infection is a major cause of morbidity and mortality in burn victims. Pseudomonas and Acinetobacter species are among the most common organisms complicating burn wounds. Presence of extended spectrum β-lactamase (ESBL) and metallo-β-lactamase (MBL) genes plays an important role in spreading β-lactam resistant strains of these organisms and is a serious condition in the treatment of the affected patients. As a result, we aimed to determine the prevalence of SHV, TEM, PER and VIM β-lactamases in Pseudomonas and Acinetobacter species isolates from burn wound swabs of children with burn injury. In this descriptive observational study, 107 Pseudomonas and Acinetobacter isolates collected from burn patients were subjected to PCR assay. Using PCR method and DNA sequencing, the existence of SHV-, TEM-, PER- and VIM-type β-lactamase encoding genes were determined. Out of the 107 Pseudomonas and Acinetobacter isolates, 66 (77.6) were ESBL positive, 26.2 were positive for SHV gene, 37.4 were positive for TEM gene, 14 were positive for PER gene and 15.9 of them harbored VIM gene. More than half of the Pseudomonas and Acinetobacter strains in our pediatric burn unit harbor β-lactamase encoding genes that make them resistant to a wide range of β-lactam antibiotics. Consequently, it is suggested to choose an appropriate antibiotic regimen based on the antibiogram pattern of the strains. © 2015, Mediterranean Club for Burns and Fire Disasters. All rights reserved

The effects of probiotics, prebiotics and synbiotics on the reduction of IBD complications, a periodic review during 2009–2020

Aims: To perform a systematic review on randomized controlled trials to examine the efficacy of probiotics, prebiotics and synbiotics in the treatment of IBD. Methods and Results: PubMed, Web of science, Scopus and Google Scholar were systematically searched from January 2009 to January 2020 using the following keywords: ‘Inflammatory Bowel Disease’, ‘Probiotics’ and ‘Clinical trial’. The statistical analysis was performed using SPSS software version 24.0. A total of 1832 articles were found during the initial search and 21 clinical trials were eligible. Studies comparing the effects of probiotics and placebo among patients with active ulcerative colitis (UC) showed a significant difference in clinical outcomes. Moreover, probiotics improved the overall induction of remission rates among patients with Crohn’s disease (CD). Probiotics significantly decreased the IL-1β, TNF-α and IL-8 levels. Also, the need for systemic steroids, hospitalization, surgery, as well as histological score and disease activity index significantly decreased in patients who used probiotic or pro-/synbiotics. Conclusions: The use of probiotics, as food supplements, can induce anti-inflammatory reactions, balance the intestinal homeostasis and induce remission in IBD. The efficacy of probiotics on remission induction is more reported in UC rather than CD. Larger well-designed clinical trials are needed to further determine whether probiotics are of clear benefits for remission in IBD. © 2020 The Society for Applied Microbiolog

Autologous cricoid cartilage as a graft for airway reconstruction in an emergent technique - A case report

Introduction: Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents. Case Report: This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right&left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen. Conclusion: It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations

The association of emotional intelligence with sport injuries and receiving penalty cards among Iranian professional soccer players

Background: High emotional intelligence (EI) seems to be preventive for unconventional sports behavior within competitions leading prevention of sport injuries and also minimization of giving penalty cards. Objectives: The present study aimed to examine this relationship among Iranian Premier League footballers. Methods: This study was performed on Iranian professional soccer players participating in Premier League in 2014-2015 season. To assess emotional intelligence among athletes, the Schutte Self-Report Emotional Intelligence test (SSEIT) was employed. Sport-related injuries were recorded by the physician of each team. Also, the reports of the number of yellow and red cards for each athlete as well as for all teams in two phases (middle and end of each season) was recorded by the Football League Organization were reviewed and recorded. The chi-square test and t-test were used for comparing the variables. The Pearson�s correlation test and the multivariable regression model were also used for discovering association and relationship, respectively. P values of 0.05 or less were considered statistically significant. Results: Among different subscales of EI, only regulation of emotions was significantly different between injured and non-injured athletes (P = 0.04). Lower ability to regulate emotions was associated with higher risk for sport injuries (OR = 0.88, 95 CI: 0.79-0.98, P = 0.02). None of the subscales of EI was related to receiving yellow card, but utilizing emotions was adversely related to receiving red card. The association between utilizing emotions and receiving red card changed to insignificant after using the multivariable regression modeling. Conclusions: By regulating emotions, sport-related injuries can be preventable in soccer players. However, EI may not be helpful in reducing sport fines. © 2019, Author(s)

Serum 25-hydroxyvitamin D levels in pediatric burn patients

Background: Previous studies have implicated the important and active role of vitamin D in the immune system. Objectives: The aim of this study was to evaluate serum levels of 25-hydroxyvitamin D in children with burn injuries. Materials and Methods: In this cross-sectional study, 118 patients with various degrees of burn injuries were enrolled. A checklist consisting of demographic data, total body surface area (TBSA) affected by burn, degree of burn, serum level of 25(OH)D, total protein, albumin, electrolytes, and parathyroid hormone was recorded for each patient. Results: Sixty-eight (57.6) males and 50 (42.4) females with a mean age of 4.04 years (SD = 3.04) were evaluated. The mean level of 25(OH)D was 14.58 ng/mL (SD = 6.94). Levels of 25(OH)D in four (3.39) cases were higher than 30 ng/mL, while 95 (81.35) cases had levels lower than 20 ng/mL, and 19 (16.10) cases had levels of 21 - 30 ng/mL. The level of 25(OH)D was below recommended levels in 96.61 of cases, while 81.34 had vitamin D deficiency and 16.1 had insufficiency. We found a significant correlation between vitamin 25(OH)D and total protein, albumin, and total and ionized calcium (P < 0.001). There was also a significant negative correlation between 25(OH)D and TBSA affected by burn (P = 0.001). Conclusions: The levels of 25(OH)D in children suffering from severe burns were low. Supplementation might be useful in patients with very low levels of serum vitamin D. Copyright © 2016, Trauma Monthly

The effects of probiotics, prebiotics and synbiotics on the reduction of IBD complications, a periodic review during 2009�2020

Aims: To perform a systematic review on randomized controlled trials to examine the efficacy of probiotics, prebiotics and synbiotics in the treatment of IBD. Methods and Results: PubMed, Web of science, Scopus and Google Scholar were systematically searched from January 2009 to January 2020 using the following keywords: �Inflammatory Bowel Disease�, �Probiotics� and �Clinical trial�. The statistical analysis was performed using SPSS software version 24.0. A total of 1832 articles were found during the initial search and 21 clinical trials were eligible. Studies comparing the effects of probiotics and placebo among patients with active ulcerative colitis (UC) showed a significant difference in clinical outcomes. Moreover, probiotics improved the overall induction of remission rates among patients with Crohn�s disease (CD). Probiotics significantly decreased the IL-1β, TNF-α and IL-8 levels. Also, the need for systemic steroids, hospitalization, surgery, as well as histological score and disease activity index significantly decreased in patients who used probiotic or pro-/synbiotics. Conclusions: The use of probiotics, as food supplements, can induce anti-inflammatory reactions, balance the intestinal homeostasis and induce remission in IBD. The efficacy of probiotics on remission induction is more reported in UC rather than CD. Larger well-designed clinical trials are needed to further determine whether probiotics are of clear benefits for remission in IBD. © 2020 The Society for Applied Microbiolog

Exact results in modeling planetary atmospheres--I. Gray atmospheres

An exact model is proposed for a gray, isotropically scattering planetary atmosphere in radiative equilibrium. The slab is illuminated on one side by a collimated beam and is bounded on the other side by an emitting and partially reflecting ground. We provide expressions for the incident and reflected fluxes on both boundary surfaces, as well as the temperature of the ground and the temperature distribution in the atmosphere, assuming the latter to be in local thermodynamic equilibrium. Tables and curves of the temperature distribution are included for various values of the optical thickness. Finally, semi-infinite atmospheres illuminated from the outside or by sources at infinity will be dealt with.Comment: 29 pages, 1 figure, Journal of Quantitative Spectroscopy and Radiative Transfer (www.elsevier.com/locate/jqsrt), accepted 11 September 200

Comparison of antimicrobial sensitivity to older and newer quinolones versus piperacillin-tazobactam, cefepime and meropenem in febrile patients with cancer in two referral pediatric centers in Tehran, Iran

Background: Infection in pediatric cancer patients has become a concerning problem due to increasing antimicrobial resistance. The goal of this study was to determine the antimicrobial resistance patterns of blood isolates from pediatric oncology patients in Iran to determine if there was significant resistance to quinolones. Methods: Children with cancer who were admitted with or developed fever during admission to Aliasghar Children's Hospital or Mahak Hospitals July 2009 through June 2011 were eligible for enrollment. Two blood cultures were obtained. Antimicrobial sensitivity test was performed for ciprofloxacin, moxifloxacin, gatifloxacin, meropenem, cefepime, and piperacillin-tazobactam on isolates from children who were bacteremic. Results: Blood cultures were positive for 38 episodes in 169 enrolled children but 9 episodes were excluded as blood cultures were thought to be contaminated, yielding a bacteremia rate of 29/160 (18). The mean age of children and the stage of malignancy did not differ between those with and without bacteremia. Meropenem was the most likely antibiotic to cover isolates (97) with cefepime having the lowest coverage rate (21). Quinolone coverage ranged from 63 to 76. Conclusion. Quinolones may not be suitable for use as empiric therapy in febrile pediatric oncology patients in Iran

Nonlinear mode coupling in rotating stars and the r-mode instability in neutron stars

We develop the formalism required to study the nonlinear interaction of modes in rotating Newtonian stars in the weakly nonlinear regime. The formalism simplifies and extends previous treatments. At linear order, we elucidate and extend slightly a formalism due to Schutz, show how to decompose a general motion of a rotating star into a sum over modes, and obtain uncoupled equations of motion for the mode amplitudes under the influence of an external force. Nonlinear effects are added perturbatively via three-mode couplings. We describe a new, efficient way to compute the coupling coefficients, to zeroth order in the stellar rotation rate, using spin-weighted spherical harmonics. We apply this formalism to derive some properties of the coupling coefficients relevant to the nonlinear interactions of unstable r-modes in neutron stars, postponing numerical integrations of the coupled equations of motion to a later paper. From an astrophysical viewpoint, the most interesting result of this paper is that many couplings of r-modes to other rotational modes (modes with zero frequencies in the non-rotating limit) are small: either they vanish altogether because of various selection rules, or they vanish to lowest order in the angular velocity. In zero-buoyancy stars, the coupling of three r-modes is forbidden entirely and the coupling of two r-modes to one hybrid rotational mode vanishes to zeroth order in rotation frequency. In incompressible stars, the coupling of any three rotational modes vanishes to zeroth order in rotation frequency.Comment: 62 pages, no figures. Corrected error in computation of coupling coefficients, added new selection rule and an appendix on energy and angular momentum of mode