Multidrug resistance and diversity of resistance profiles in carbapenem-resistant Gram-negative bacilli throughout a wastewater treatment plant in Colombia.

OBJECTIVES: Carbapenem-resistant Gram-negative bacilli (CRGNB) have been reported in different wastewater treatment plants (WWTPs) throughout the world; however, few studies have described the antimicrobial resistance profile in different CRGNB throughout WWTPs, information that would identify points of selection of resistant bacteria. The objective of this work was to characterize the resistance profile of CRGNB harbouring blaKPC-2 from a Colombian WWTP. METHODS: Six samples were taken from four points of a WWTP. CRGNB were selected in chromID® CARBA and identified by 16S rRNA. Carbapenemases were determined by polymerase chain reaction (PCR), and susceptibility was assessed using VITEK2. RESULTS: One hundred and forty-two CRGNB harbouring blaKPC-2 were detected: 41% corresponded to Aeromonas spp. (n = 58) and 59% to Enterobacteriaceae. To establish the resistance profile, 50% of the isolates were selected proportionally by family and sampling point (26 Aeromonadaceae and 45 Enterobacteriaceae). All Enterobacteriaceae showed resistance to carbapenems and penicillins + inhibitors, high percentages of resistance to ceftriaxone (88.9%), and ciprofloxacin (44.4%), and low resistance to other antibiotics (>30%). In Aeromonadaceae, 76.9% were resistant to ceftriaxone, 58% to carbapenems, and 65.4% to ciprofloxacin. Twenty-one resistance profiles were observed, the most common of which were resistant to penicillins + inhibitor, cephalosporins (third to fourth generation), and carbapenems (19%). The percentage of multidrug resistance was 91% and was similar at all points of the WWTP. CONCLUSIONS: The high frequency of multidrug resistance and great diversity of resistance profiles observed throughout the WWTP is of concern, and shows the role of WWTP as a reservoir and dissemination source of antimicrobial resistance to water sources.

Strong water-mediated friction asymmetry and surface dynamics of zwitterionic solids at ambient conditions: L-alanine as a case study.

Water molecules strongly interact with freshly cleaved (011) surfaces of L-alanine single crystals at low relative humidity (below 10%) promoting diffusion of L-alanine molecules. Species mobility is enhanced above ~40% leading to the formation of two-dimensional islands with long-range order through Ostwald ripening. Scanning force microscopy experiments reveal that both, islands and terraces, are identical in nature (composition and crystallographic structure) but a relevant friction asymmetry appearing upon water-surface interaction evidences that orientation dependent properties exist between them at the molecular level. We interpret this observation as due to water incorporation in the topmost surface crystal structure. Eventually, for high humidity values, surface dissolution and roughening occur.

[Cholestasis associated with prolonged parenteral nutrition in neonates: the role of urso-deoxycholic acid]. / Colestasis asociada a la nutrición parenteral prolongada en el período neonatal: posible eficacia del ácido ursodesoxicólico.

INTRODUCTION: The morbidity associated with prematurity occasionally leads to the use of prolonged parenteral nutrition, with the subsequent development of cholestasis being one of its complications. PATIENTS AND METHODS: This is a two year retrospective study which compared biochemical markers of liver damage and cholestasis in premature babies who received or did not receive urso-deoxycholic acid for parenteral nutrition associated cholestasis. RESULTS: Of a total of 24 recruited patients 17 received urso-deoxycholic acid and 7 did not. In the treated group significant decreases (P<0.05) in gamma-glutamyltranspeptidase and conjugated bilirubin were found after four and five weeks of treatment, respectively. Moreover, a significant correlation (P<0.01) between conjugated bilirubin and duration of total parenteral nutrition was established. CONCLUSIONS: Patients who were promptly treated with urso-deoxycholic acid showed a more rapid decrease in biochemical markers of cholestasis, but not of cytotoxicity in the hepatobiliary complications secondary to prolonged parenteral nutrition. However, the present study has limitations derived from its design and therefore it would be desirable launch a randomized trial with sufficient power to evaluate the benefits derived from prophylactic or therapeutic use of urso-deoxycholic acid in the hepatobiliary conditions associated with the prolonged use of parenteral nutrition in the premature infants.

Diagnosis of paediatric anaplastic large-cell lymphoma: a historical perspective from a single institution.

INTRODUCTION: Anaplastic large-cell lymphoma (ALCL) is an infrequent childhood malignancy whose diagnosis and treatment have largely evolved since its initial description in 1985. PATIENTS AND METHODS: We retrospectively reviewed our experience in the field, and report here a single institution experience focusing on diagnostic and therapeutic milestones achieved as novel tools have been developed. This is a series of 9 children diagnosed from 1987 to 2007. RESULTS: Our first patient was diagnosed shortly alter this entity was described based on morphology and Ki-1 positivity, while the diagnostic work-up for the last two children included accurate molecular diagnosis for ALK-NPM rearrangement. Despite a wide variety of multimodal therapies used over time, only one patient died of toxicity during progression and another child relapsed and survived alter an autograft. After 156 months of median follow-up (range 4-245), 8 out of 9 children are alive, free of disease. CONCLUSIONS: Our series exemplifies the long journey travelled from the definition of a new entity only 20 years ago to the molecular characterization not only with diagnostic but also therapeutic purposes. Besides this, significant efforts are being made to recruit all European patients into a multinational collaborative trial in order to start drawing major evidence-based conclusions.

Granular cell tumors: Review of the parameters determining possible malignancy.

The granular cell tumor (GCT) is normally benign in behavior, but occasionally surprises us with local aggressiveness, and in 2% of cases with distant dissemination. Diagnosis of proven malignancy can only be confirmed by the presence of metastasis. We revised the parameters which give rise to a GCT being considered to have malignant behavior in the absence of metastasis, basing our account on a clinical case.

Radioactivity as a significant energy source in prebiotic synthesis.

Radioactivity in the continental crust (due mainly to the isotopes 238U, 235U, 232Th and 40K), as a energy source for chemical evolution in the early Archean (between 3.5 and approximately 4 Ga bp), is reviewed. The most important radioactive source in the continental crust is due to the production and accumulation of radioactive gases within the crust voids (porosity). The study of such mechanism has allowed us to reach a deeper understanding about the nature of the radioactive source and to describe its behavior, particularly with regard to prebiotic chemical evolution. An effective total energy of 3 x 10(18) Ja-1 has been obtained for a depth of 1 km, 4 Ga ago. If a depth of 30 km is taken, the obtained value is almost equal to the UV solar energy radiation (lambda < 150 nm). Within the voids the radioactive source of the continental crust played a relevant role in prebiotic synthesis. In uranium deposits of the same age, the role of radioactivity must have been even more relevant in favoring chemical evolution.

Implementing a nonlatex surgical glove study in the OR.

Sterile surgical gloves are used to protect patients and health care workers (HCWs) from infection during surgery and to shield HCWs from exposure to bloodborne pathogens. Based on increased reports of latex allergy, many HCWs now use nonlatex surgical gloves as a substitute for natural rubber gloves. Little is known, however, about the performance of nonlatex gloves in surgery. This article describes a study that currently is being performed to test the barrier performance of nonlatex surgical gloves after they have been used in surgery and to determine HCW satisfaction. To date, 12,703 latex and nonlatex gloves from all surgical services have been collected and tested for barrier quality. This article describes the project and challenges encountered by the collaborative team of perioperative staff members and nurse researchers as they collect data.

Physician beliefs about victims of spouse abuse and about the physician role.

Our purpose was to measure the beliefs of physicians about victims of spouse abuse and to examine factors related to holding positive (e.g., supportive) and negative beliefs about providing services to victims of domestic violence. This was a total site sample of 150 physicians (76 responded; RR 51%), surveyed at one time, practicing in a large general hospital and the surrounding urban/periurban area. Four specialities are represented: emergency medicine, family practice, obstetrics-gynecology, and psychiatry. Three aspects of beliefs are measured: beliefs toward physician role in assisting victims of spouse abuse, beliefs about victims of spouse abuse, and beliefs about resources available to physicians to assist victims of spouse abuse. Almost all (97%) physicians believe it is part of their role to assist victims of domestic violence. Almost one third (30%) hold victim-blaming attitudes toward victims of spouse abuse, and the majority (70%) do not believe that they have the resources available to them to assist victims of domestic violence. Being female, younger, practicing obstetrics-gynecology, and having fewer years in practice are all significantly related to holding supportive (positive) beliefs. The majority of negative beliefs held are about resource availability. Hence, training programs may need to be developed locally for physicians and tailored to individual community characteristics. Training programs should also emphasize the importance of understanding the victims of spouse abuse and of not blaming the victims for the violence.

Prenatal factors and birth outcomes in the public health service: a rural/urban comparison.

To determine whether predictors of birth outcomes differ for women in rural versus urban areas, data were obtained from the health records of women who received prenatal care through the Public Health Departments of a rural (N = 364) and urban (N = 415) setting. The rural group was more apt to be single, less educated, African-American, and have a lower income than the urban group. Rural women also had a higher incidence of low birth weight infants, which may be related to poor nutrition and low weight gain during pregnancy. Urban women had more maternal and neonatal complications, which may be related to a higher incidence of drug use and smoking. Membership in a rural or urban population did not predict low birth weight. Race, weeks gestation at first prenatal visit, number of total visits, and adequacy of diet and weight gain were significant predictors of birth weight. Neonatal complications were higher in the urban group and best predicted by poor diet, alcohol intake, and race. Both rural and urban women received inadequate prenatal care, as indicated by late entry into care and total number of visits. Alternative models of care which explore strategies to individualize care, while providing comprehensive care, should be investigated.

[Knowledge and use of contraceptive methods on the Atlantic coast of Colombia]. / Conocimiento y uso de metodos anticonceptivos en la Costa Atlantica Colombiana.

PIP: The Atlantic region contains 20% of Colombia's population, including 1.4 million women aged 15-49. 2/3 of the population is urban. Despite an increase in contraceptive usage from 39% in 1978 to 52% in 1986, the region still has the lowest prevalence of any of Colombia's major regions. PROFAMILIA has planned campaigns to increase contraceptive usage in the Atlantic region and to encourage the use of temporary methods for birth spacing. The 1st survey of the Atlantic Coast was conducted in 1988 to obtain information on contraceptive use and attitudes as the basis for a campaign to promote use of Microgynon 21 oral contraceptives (OCs) and Tahiti condoms. 59% of women in union were using a method at the time of the survey. In urban and rural areas respectively, 17.9% and 12.2% used pills, 25.8% and 23.8% used female sterilization, 4.9% and 2.8% used IUDs, and 2.5% and 2.8% used injectables. Only .9% and 1.1% used vaginal methods, and .6% and .2% used condoms. No men in rural areas and .2% in urban areas chose vasectomy. 91% of OC users reported taking a pill each day, but some users took one only when they had sexual relations or 1 each week. 70% of users waited an incorrect number of days before starting a new cycle. Over half responded correctly that if they forgot a pill they should take another immediately and follow the regular cycle. Over half of current pill users had thought of changing methods, with over half of those considering sterilization, 28% the IUD, and 12% injectables. 38% of OC users thinking of changing methods would do so because of side effects and 36% because they were tired of taking a pill each day. All users of vaginal methods reported using them correctly. Condoms are usually purchased by men, who prefer to buy them at the drug store. All urban condom users reported having considered changing methods, 3/4 to female sterilization and 1.4 to an IUD. 65% of sterilized women reported undergoing the operation because they wanted no more children, 28% on the recommendation of a physician, and 4% because of economic problems. Over 95% of sterilized women reported satisfaction with the operation.^ieng

Assessment of radiological emissions from Spanish coal power plants: radioactive releases and associated risks.

The radioactivity of coals and ashes from Spanish coal power plants (CPP) was evaluated. This radioactivity is due mainly to 40K and the U and Th series. The samples were measured in secular equilibrium using a NaI(T1) detector. The annual average airborne releases were also evaluated. An atmospheric dispersion model was developed to predict the annual average concentration of radionuclides in air. The risks from inhalation were calculated and compared with those from nuclear power plants (NPP) and natural radioactivity.

The universal Rn wave. An approach.

A large set of hourly Rn atmospheric concentration data collected during 1976, 1978, 1979 and 1980 has been obtained. These data follow a log-normal distribution law. The Fourier analysis of the mean daily course of Rn by month (Rn wave) shows that to accurately represent such a wave two terms are sufficient. Assuming that with a great deal of data the influence of the meteorological variables is very low, the two terms have been interpreted taking into account only the atmospheric stability, which depends on the solar flux. By applying the same treatment to Rn concentration data from other sites it was found that: (a) the phase of the first harmonic is a constant, independent of the site; (b) the phase of the second harmonic is a linear function of the hourly difference between sunrise and sunset; (c) the amplitude of the first harmonic is a linear function of the solar flux; and (d) no reliable correlation was found for the amplitude of the second harmonic, for which reason a mean value was taken. The error obtained in the prediction of the Rn wave was tolerable.

Manual de criterios de seleccion de personal auxiliar de enfermeria para la Unidad Regional de Girardot / Manual of selection criteria of nursing auxiliaries for Unidad Regional de Girardot

Teniendo un cuenta que la seleccion de auxiliares de enfermeria en los hospitales locales de la Regional de Girardot es una actividad de la enfermera durante el ano de servicio social obligatorio se hizo este manual con el proposito de suministrar parametros objetivos para la realizacion de esta importante tarea administrativa. Para tal efecto se describen los principios de la seleccion del personal: a) colocacion (identificacion de las cualidades del candidato para desempenar un rol) b) orientacion (asesoria personal u ocupacional a las personas (rechazadas) c) etica (responsabilidad en la toma de desiciones del aceptar o rechazar un candidato. Las tecnicas de seleccin del candidato: vacantes, solicitud, fuentes de reclutamiento, entrevista, pruebas de trabajo y requisitos laborales.