Multidrug-resistant surgical site infections in a humanitarian surgery project.

The epidemiology of surgical site infections (SSIs) in surgical programmes in sub-Saharan Africa is inadequately described. We reviewed deep and organ-space SSIs occurring within a trauma project that had a high-quality microbiology partnership and active follow-up. Included patients underwent orthopaedic surgery in Teme Hospital (Port Harcourt, Nigeria) for trauma and subsequently developed a SSI requiring debridement and microbiological sampling. Data were collected from structured chart reviews and programmatic databases for 103 patients with suspected SSI [79% male, median age 30 years, interquartile range (IQR) 24-37]. SSIs were commonly detected post-discharge with 58% presenting >28 days after surgery. The most common pathogens were: Staphylococcus aureus (34%), Pseudomonas aeruginosa (16%) and Enterobacter cloacae (11%). Thirty-three (32%) of infections were caused by a multidrug-resistant (MDR) pathogen, including 15 patients with methicillin-resistant S. aureus. Antibiotics were initiated empirically for 43% of patients and after culture and sensitivity report in 32%. The median number of additional surgeries performed in patients with SSI was 5 (IQR 2-6), one patient died (1%), and amputation was performed or recommended in three patients. Our findings suggest the need for active long-term monitoring of SSIs, particularly those associated with MDR organisms, resulting in increased costs for readmission surgery and treatment with late-generation antibiotics.

Overexpression of wild-type presenilin 2 or its familial Alzheimer's disease-associated mutant does not induce or increase susceptibility to apoptosis in different cell lines.

Programmed cell death, or apoptosis, has been implicated in Alzheimer's disease. Mutations in the presenilin (PS) genes, PS1 and PS2, are a major cause of early-onset familial Alzheimer's disease (FAD). Previous studies have suggested that the PS play a role in apoptosis. However, the mechanisms whereby presenilins affect apoptosis and the relationship of FAD-associated presenilin mutants to the apoptotic effect have not been elucidated. In the present study, in an attempt to further explore the effect of PS2 on apoptosis we examined whether overexpression of wild-type or mutant PS2 can directly induce apoptosis or increase cell susceptibility to apoptosis in various cell lines, such as N2a, CHO, and HEK 293T. Wild-type or mutant PS2 was transiently transfected into these cell lines and the viability of the transfected cells was evaluated by their morphology, DNA fragmentation and condensation, appearance of sub-G(1/0) cells, and caspase activation. We also examined the susceptibility of the PS2-transfected cells to apoptosis induced by the apoptotic inducers staurosporine and H(2)O(2). Our results showed that overexpression of either wild type or mutant PS2 in these cell lines did not directly induce apoptosis or increase the susceptibility to apoptosis induced by staurosporine or H(2)O(2). Taken together, these results suggest that overexpression of PS2 does not cause pro-apoptotic effects, at least not in the cellular systems and conditions employed in this study, and therefore it seems unlikely that apoptosis plays a prominent role in the neuropathological effects of PS2 in Alzheimer's disease.

[Intelligence and language performance of special education children at 7 and 9 years of age]. / Intelligenz und sprachliche Leistungen bei Sonderschulkindern mit 7 und 9 Jahren.

Prospective longitudinal data from children at a school for learning disabled were obtained. Intelligence and language scores were assessed at first grade and two years later. The results of two samples from Erlangen and München showed a high stability of the intelligence scores but less stability of the language scores. There were remarkable improvements in language comprehension. Expressive language had a constant lag compared with the test-standard of children of the same age; the articulation did improve as expected. The children from this special school still had problems with verbal short term memory.

[Follow-up of psychiatric disorders and specific developmental delay disorders in special education students]. / Verlauf psychiatrischer Störungen und umschriebener Entwicklungsrückstände bei Sonderschülern.

In a prospective longitudinal study 72 children who were attending a special school for children with learning disabilities in Erlangen were examined in 1990 and again in 1992/93. At the first examination the children's mean age was 7 years 1 month and at the second 8 years 10 months. The sample contained many more boys than girls. Reported here are the findings on the course of the psychiatric disorders and the specific developmental disorders of speech and language and motor function. There was a marked decrease in the prevalence of psychiatric disorders. Of the 17 children with a psychiatric disorder at follow-up, 13 (76%) also had a disorder at the start of the study and of the 23 with a psychiatric disorder at the start 13 (57%) still had a disorder at follow-up. Children with enuresis and those with disturbances of activity or attention had the best prognosis. The special school had a positive effect on conduct. The prevalence of specific developmental disorders also decreased over the two-year period. As expected, specific speech articulation disorders had the best prognosis. All other disorders had a poor prognosis. Increases in prevalence were mainly the result of different cutoff points for a given diagnosis at different ages. The high number of specific disorders of motor function at both time points is especially noteworthy.