Prevalence of integrons in multidrug-resistant Escherichia coli isolates from waters and vegetables in Nsukka and Enugu, Southeast Nigeria.

Irrigation of fresh produce with poorly treated wastewater or contaminated freshwater sources can lead to produce contamination and foodborne illnesses, as well as the dissemination of antimicrobial resistance determinants. In this study, we assessed the presence of integrons in multidrug-resistant Escherichia coli isolated from the University of Nigeria, Nsukka Wastewater Treatment Plant effluent, tap water, vegetables from irrigated gardens and vegetables sold in selected markets from Nsukka and Enugu cities. E. coli was isolated following standard laboratory procedure and confirmed through beta-glucuronidase (uidA)-targeted polymerase chain reaction (PCR). The antibiotic resistance of the isolates was determined using Bauer-Kirby disk diffusion assay, and multiplex PCR was used to determine the presence of class 1 and 2 integrons. Our result revealed a total of 188 E. coli isolates from WWTP effluent (n = 41), tap water (n = 10) and vegetables from greenhouse (n = 46), farms (n = 55) and market (n = 36). Multidrug resistance was detected in all the isolates, ranging from three-drug resistance in a single isolate to 7-drug resistance patterns in two different isolates. Of the total isolates, class 1 integrons were abundantly detected in 175 (93.1%) and class 2 in 5 (2.7%). All the class 2 integrons were found in isolates that were positive for class 1. The abundance of multidrug-resistant E. coli harbouring class 1 integrons in the effluent and vegetable samples is a potential public health risk. Therefore, the appropriate measures for the safe use of poorly treated wastewater for vegetable farm irrigation are required to be put in place to reduce the microbial load of the discharged effluent. Also, education of farmers and the community on the dangers of wastewater effluent-grown plants and proper methods for cleaning harvested vegetable is recommended.

Geoelectrical resistivity data sets for subsurface characterisation and aquifer delineation in Iyesi, southwestern Nigeria.

This article consists of geoelectrical resistivity data sets for thirty (30) vertical electrical sounding (VES) and four (4) traverses of 2D electrical resistivity imaging (ERI) collected within Iyesi, Ota, southwestern Nigeria for about five (5) weeks between December, 2016 and January, 2017 using an ABEM Terrameter (SAS1000/4000). The observed apparent resistivity data sets for the VES were processed using WinResist to obtain geoelectric layer parameters while those of the 2D ERI were processed with RES2DINV to obtain 2D inverse model resistivity images. The geoelectric parameters for the VES and the inverse models for the 2D ERI were integrated to characterise the subsurface and delineate the underlying aquifer units.

Complications of methylene blue dye in breast surgery: case reports and review of the literature.

INTRODUCTION: Methylene blue dye has been used worldwide successfully with few complications in breast surgery. We present two different complications involving methylene blue: 1) skin and parenchymal necrosis when dye was injected in a subdermal fashion and 2) Mycoplasma infection caused by contaminated methylene blue in breast reduction surgery. METHODS: We present two cases seen at the University of Arizona during 2008 and referred to a breast surgeon for management. We evaluated and managed complications of methylene blue dye injected by 2 referring surgeons for different indications. A review of the literature was performed. RESULTS: The first case is a 67 year old female diagnosed with infiltrating ductal carcinoma of the left breast for which she was treated by her initial surgeon with left segmental mastectomy and sentinel node biopsy. The operating surgeon injected methylene blue in a subareolar subdermal fashion (distant from the primary tumor); unfortunately the patient suffered skin and breast necrosis requiring multiple surgical debridements and finally achieving delayed primary closure. The second case is a 45 year old female with infiltrating lobular carcinoma with a history of Mycoplasma infection secondary to methylene blue injected for breast reduction surgery. She required multiple debridements and had granulomas masquerading as cancer on MRI that confounded her extent of disease. CONCLUSIONS: The use of methylene blue dye in breast surgery is not without risk. In both cases methylene blue was responsible for complications requiring surgical debridement for local wound problems. In each case severe necrosis and infection were present. Methylene blue may cause not only significant morbidity, but may also produce cosmetically unsatisfactory results.

[Breast calcifications. The usefulness of a standardized system for the description and assessment of the mammographic findings to improve the positive predictive value]. / Calcificazioni mammarie. Utilità di un sistema standardizzato di descrizione e valutazione dei reperti mammografici ai fini del miglioramento del valore predittivo positivo.

PURPOSE: To investigate the usefulness of a standardized reporting and data system in improving the positive predictive value of mammography in breast calcifications. MATERIALS AND METHODS: Using the Breast Imaging Reporting and Data System lexicon developed by the American College of Radiology, we defined 5 descriptive categories of breast calcifications and classified diagnostic suspicion of malignancy on a 3-grade scale (low, intermediate and high). Two radiologists reviewed 117 mammographic studies selected from those of the patients submitted to surgical biopsy for mammographically detected calcifications from January 1993 to December 1997, and classified them according to the above criteria. The positive predictive value was calculated for all examinations and for the stratified groups. RESULTS: Thirty-five of 36 cases classified as low-grade suspicion at mammography were benign at histology, while the extant one was a microinvasive lobular carcinoma in situ. Of 44 cases of intermediate-grade suspicion, 21 were benign while 23 were malignant lesions. All the 37 cases graded as highly suspicious were actually carcinomas. The positive predictive value was 0.52 for the whole series, 0.02 in the low suspicion group, 0.52 in the intermediate suspicion group and finally 1.0 in the high suspicion group. If the low suspicion cases had not undergone surgical biopsy, the positive predictive value would have been 0.74, with a single false-negative. DISCUSSION AND CONCLUSION: Defining a standardized system for assessing and describing breast calcifications helps improve the diagnostic accuracy of mammography in clinical practice.

[Collagen diseases and the involvement of the mouth in childhood]. / Collagenopatie ed interessamento del cavo orale in età pediatrica.

In the review, the authors describe the lesions of the oral cavity, which are present in lupus erythematosus, scleroderma, dermatomyositis. They underline the importance of their knowledge for the dentist and for the pediatrician, because the last recognition can influence prognosis negatively.

Quality assurance: a process for continuous improvement.

As E.S. Woodlard Jr., Chairman of Du Pont states, "Continuous improvement is vitally important in today's environment. The world is full of savvy, agile competitors who know quality makes a difference." Dentists are part of the health care industry and compete for their patients' discretionary dollars. Careful attention to the development of an integrated RM/QA program for their dental offices is one means of ethical marketing for patient satisfaction. Lessons from the competitive hospitals in the United States and current practices of successful service industries should form part of the framework of the QA component of a practice. A marketing plan is good sense in today's turbulent economic environment and ethical marketing will make the risky "selling" of dental treatment unnecessary.

Risk management: the clinician's defense against liability.

As Stock and LeFroy conclude, a RM program lends structure and direction to management. Consistent delivery of high-quality service requires that hundreds of individuals perform numerous roles with a value-added service orientation. Jan Carlzon, the Director of Scandinavian Airlines and the person responsible for its remarkable turnaround, has the proper perspective: "We don't seek to be one thousand percent better at any one thing. We seek to be one percent better at one thousand things." Risk management is one factor in the development of a service-oriented health care culture that leads to sustained profitability through a stable patient base. The development of a RM program for a private dental office will lay the groundwork for a higher goal; a demonstrable, verifiable quality of care throughout the practice.

Renal biopsy in patients with acute renal failure and prolonged bleeding time: a preliminary report.

A significant percentage of acute renal failure patients may benefit from a diagnostic renal biopsy, but this procedure carries an unacceptable risk of hemorrhagic complications. We have previously shown that red cell transfusions and 1-deamino-8-D-arginine vasopressin (DDAVP) are effective in managing uremic bleeding. We now report the results of giving washed red cell transfusions or DDAVP to 9 patients with uremia due to acute renal failure to improve hemostasis and allow a diagnostic renal biopsy. All patients admitted to the study had prolonged bleeding time (BT), ie, more than 10 minutes, and our procedure shortened BT in all cases, though in two patients BT after the therapeutic procedure was still longer than normal. In these two, biopsy was not performed. The seven patients whose BT became normal underwent percutaneous biopsy. Only minor clinical complications were registered. Computerized tomography (CT) revealed an incidence of perirenal hematomas comparable to that usually reported in patients with normal or slightly depressed renal function who undergo renal biopsy. Our findings indicate that red cell transfusions or DDAVP can temporarily restore hemostasis, allowing a diagnostic percutaneous biopsy in patients with acute renal failure.