Ralstonia mannitolilytica bacteremia in a maintenance hemodialysis patient

Ralstonia mannitolilytica is a nonfermentative, Gram-negative bacterium isolated infrequently from clinical samples. It is widelydistributed in nature, being a frequent contaminant in water supplies. It is increasingly identified as an opportunistic pathogen innosocomial infections, especially among immunosuppressed patients. It has also been implicated in common source nosocomialinfection outbreaks due to the addition of contaminated water to parenteral fluids and to medical equipment presumed to besterile. True bacteremia with the organism, however, cannot be ruled out, especially if it is isolated repeatedly from the samepatient within 3 successive days from blood cultures. A 22-year-old Ethiopian male presented to us in December 2015 with feverwith chills and rigor, vomiting, and headache. He was a known end-stage renal disease patient on thrice per week hemodialysisthrough a tunneled hemodialysis catheter for the past 1 year. He had an episode of catheter-related blood stream infection inOctober-November 2015 and was treated at a multispeciality hospital with parenteral antibiotics (piperacillin-tazobactam) for2 weeks (for growth of Pseudomonas aeruginosa in blood cultures) during the same admission phase. The tunneled catheter wasnot removed then and lock therapy was used and the patient improved gradually with antibiotics. During the current admission,three blood culture sets (aerobic and anaerobic), one set from the dialysis line and two from the peripheral lines were submittedto microbiology laboratory. Blood cultures (one bottle from each of the three sets) flagged positive. The blood culture sentfrom the hemodialysis line was the first to flag positive 12 h after it was loaded onto the BACTEC 9050 system. This wasfollowed by the aerobic and anaerobic bottles from the peripheral lines. The preliminary Gram-stain showed Gram-negativebacilli and the cultures grew Gram-negative organisms. The organism was identified as R. mannitolilytica by the Vitek 2C.Disc diffusion (CLSI, 2015) was done for the various antibiotics, and there was a 6 mm resistant zone for the following paneltested: Gentamicin, cotrimoxazole, aztreonam, amikacin, ceftriaxone, cefotaxime, cefepime, ceftazidime, and carbapenems; theorganism was intermediate to piperacillin-tazobactam (17 mm) and was sensitive to and cefoperazone-sulbactum (23 mm). In ourset up, this was the first case of R. mannitolilytica isolated as a significant pathogen in a case of true bacteremia. R. mannitolilyticacan thus cause true bacteremia as well in addition to just being an environmental contaminant. Early recognition of the infectionhelps in instituting appropriate antibiotic with complete resolution of the infection. In our case report, the prompt report ofmicrobiology department enabled us to treat the patient on time with appropriate antibiotic and also prevented the prematureremoval of the tunneled catheter. The problems caused by this bacterium occur rapidly and disease progression is fast; therefore,R. mannitolilytica infections should draw sufficient attention from clinical physicians and bacteriology workers to respond to theresulting severe consequences

Sleep Habits of Elementary and Middle School Children in South Texas

Background. Sleep difficulties, including insufficient sleep and inadequate sleep hygiene, have been prevalent among children. Sleep deprivation can lead to poor grades, sleepiness, and moodiness. We undertook this study to assess the prevalence of sleep abnormalities among elementary and middle school students in South Texas and how the groups compare with one another. Method. After approval from the appropriate school district for a sleep education program, a baseline survey was taken of elementary and middle school students, using the Children's Sleep Habit Questionnaire-Sleep Self-Report Form, which assessed the domains of bedtime resistance, sleep onset delay, sleep anxiety, sleep duration, night awakening, and daytime sleepiness. Results. The survey was completed by 499 elementary and 1008 middle school children. Trouble sleeping was reported by 43% in elementary school, compared with 29% of middle school children. Fifty percent of middle school children did not like sleeping, compared with 26% in elementary school. Bedtime resistance, sleep onset delay, and nighttime awakening were more common among elementary school students. Daytime sleepiness was more common among the middle school children when compared to elementary school children. Conclusions. Sleep abnormalities are present in elementary school children with changes in sleep habits into middle school

Designing an Optimal Cloud Migration Strategy

In this paper; we highlight the important aspects to be considered in designing an optimal cloud migration strategy. Cloud is today’s hype, it not only provides enterprises a means to reduce the carbon foot print and cost but also provides ease of use and networking across the globe. It helps enterprises maintain a common process ground for all their business needs. Day-by-Day we are seeing growth in enterprises switching to cloud. The methodology is defined as Cloud Migration. Despite of successful migration to cloud, many enterprises are suffering from security and other vulnerabilities in not only accessing but also maintaining their data in the cloud. We have taken this as our ground and we are trying to identify a secure way of migrating to cloud