Typical CIDP, distal variant CIDP, and anti-MAG antibody neuropathy: An ultra-high frequency ultrasound comparison of nerve structure.

To date, little is known about the usefulness of ultra-high frequency ultrasound (UHF-US, 50-70 MHz) in clinical practice for the diagnosis of dysimmune neuropathies. We present a prospective study aimed at comparing UHF-US alterations of nerves and fascicles in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), distal CIDP (d-CIDP) and anti-MAG neuropathy and their relationships with clinical and electrodiagnostic (EDX) features. 28 patients were included (twelve CIDP, 6 d-CIDP and 10 anti-MAG) and ten healthy controls. Each patient underwent neurological examination, EDX and UHF-US study of median and ulnar nerves bilaterally. UHF-US was reliable in differentiating immune neuropathies from controls when using mean and/or segmental nerve and/or fascicle cross-sectional area (CSA); furthermore, fascicle ratio (fascicle/nerve CSA) was a reliable factor for differentiating d-CIDP from other types of polyneuropathies. The fascicle CSA appears to be more increased in CIDP and its variant than in anti-MAG neuropathy. UHF-US offers information beyond simple nerve CSA and allows for a better characterization of the different forms of dysimmune neuropathies.

[Bacterial multiresistance emergence in South-Western Romania]. / Emergenta multirezistentei bacteriene în partea de Sud-Vest a României.

INTRODUCTION: European Centre for Diseases Control (ECDC), involved in the surveillance of nosocomial infections (NI) and resistance to antimicrobials (AMR) in Europe, estimates 4 million IN/year, among whom 37,000 deceased, out of which half are determined by multiresistant germs (MDR). A phenomenon encountered more and more often is that of pan-resistance of germs, without the option for an optimal antibiotherapy. The allarming increase of AMR is a phenomenon which our country also faces in the present. MATERIAL, METHOD, RESULTS: Resistance rate registered in Intensive Care Units in Timisoara during 2005-2007 (when we participated in the Helics European network) situates us among the last places among the European countries that participated--with 50-60% MRSA strains, 24% E. coli BLSE strains, 62,7% K. pneumoniae BLSE strains, 34% P. aeruginosa BLSE. Furthermore, data registered in ambulatory in the South-West part of Romania during 2006-2007 (processed by the greatest private laboratory in the region) are not more optimistic--26% MRSA strains, 4,25% E. coli BLSE, 12,49% K. pneumoniae BLSE, 8,69% P. aeruginosa BLSE. CONCLUSIONS: As the management of MDR produced infections requires huge costs, a better antibiotic policy in the Romanian hospitals and ambulatory is compulsive, being more efficient to spend for control than for the treatment of these infections.

The establishment of resistance phenotypes for bacteria isolated from outpatients in urine cultures.

From 1911 outpatients, who addressed a Timisoara private clinical laboratory, from January to December 2005, we collected 1,889 urine cultures, 431 being positive. Bacteria identification was generally done using morphological, cultural, biochemical characters and pathogenicity tests. Sensitivity testing to antimicrobial medical drugs was done by using the classical diffusion Kirby-Bauer method and the automatic analyzer Osiris, also. The main bacteria involved in the etiology of these infections were represented by Enterobacteriaceae, head of the list being Escherichia coli (81.21%), followed by Klebsiella pneumoniae (8.35%) and Proteus mirabilis (3.02%). We also isolated Gram positive cocci (in a much smaller proportion), mainly represented by Enterococcus faecalis (1.16%), Staphylococcus aureus (0.93%), Streptococcus agalactiae, and also Gram negative non-fermentative bacilli, such as Pseudomonas aeruginosa (0.93%) or Acinetobacter baumanii (0.23%). As soon as we performed the sensitivity tests, we divided them in resistance phenotypes: Most of the Enterobacteriaceae were integrated in the wild phenotype, followed by the penicillinase producing phenotype. An E. coli strain (0.29%) and 3 Klebsiella pneumoniae strains (8.33%) were integrated in the large spectrum, multidrug resistant, beta-lactamase producing phenotype, also associated with resistance to fluoroquinolones and aminoglycosides; Non-fermentative bacilli did not present special resistance problems, the four Pseudomonas aeruginosa strains were integrated in the wild phenotype (secreting induced chromosomal cephalosporinase). As for Staphylococcus aureus it was identified a strain having fluoroquinolone resistance, two strains secreting penicillinase and having a K (Nm) phenotype and a strain secreting penicillinase only. Antibiotic resistance represents a major concern for patients, physicians, healthcare managers, and policymakers. The use of antibiotics is closely linked with the development of acquired antibiotic resistance.