Empirical antibiotic therapy for pneumonia in intensive care units: a multicentre, retrospective analysis of potentially pathogenic microorganisms identified by endotracheal aspirates cultures.

The purpose of this investigation was to explore the presumed relationship between the days of hospitalisation and microorganisms identified by endotracheal aspirate cultures in relation to adequate empirical treatment strategies of pneumonia in the intensive care unit (ICU). All potentially pathogenic microorganisms identified by (surveillance) cultures of endotracheal aspirates obtained in the ICUs of two Dutch teaching hospitals in 2007 and 2012 were retrospectively collected and analysed. Antibiotic susceptibilities to 11 antibiotics were calculated for several time points (days or weeks) after hospital admission and expressed per patient-day. In total, 4184 potentially pathogenic microorganisms identified in 782 patients were analysed. Prevalence of the classic early-onset pneumonia-causing microorganisms decreased from 55 % on the first four days to 34 % on days 4-6 after hospital admission (p < 0.0001). Susceptibility to amoxicillin/clavulanic acid was below 70 % on all days. Except for days 0 and 12, susceptibility to ceftriaxone was below 80 %. The overall susceptibility to piperacillin/tazobactam was 1518/1973 (77 %) in 2007 vs. 727/1008 (67 %) in 2012 (p < 0.0001). After day 8 of hospital admission, susceptibility to piperacillin/tazobactam therapy was below 80 % in 2012. After one week of hospital admission, susceptibilities to antibiotics were lower in the hospital that included that antibiotic in the local empirical treatment protocols as compared to the hospitals in which that antibiotic was not or infrequently included: 90/434 (21 %) vs. 117/398 (29 %); p = 0.004 for amoxicillin/clavulanic acid and 203/433 (47 %) vs. 253/398 (64 %); p < 0.001 for ceftriaxone. No cut-off in the number of days after hospital admission could be identified to distinguish early-onset from late-onset pneumonia. Consequently, the choice of empirical antibiotics should probably not be based on the time of onset.

Papillary serous carcinoma of the uterus: increased risk of subsequent or concurrent development of breast carcinoma.

OBJECTIVE: Some women with endometrial cancer may be at increased risk for developing breast cancer. The histologic type of endometrial cancer associated with synchronous or subsequent breast cancer has not been clearly established. Our purpose was to determine if a certain histologic type of endometrial cancer was associated with an increased risk of synchronous or subsequent breast cancer. METHODS: The University of Iowa Hospitals and Clinics tumor registry was queried to ascertain all patients with the diagnosis of uterine cancer from January 1, 1983, to December 31, 1994. Statistics were performed utilizing SPSS for Windows version 9.0 (SPSS Inc., Chicago, IL), including Student's t tests and chi(2) tests. RESULTS: Five hundred ninety-two patients had endometrial adenocarcinoma during the study period. Five hundred thirty-six women had endometrioid adenocarcinoma, 23 women had papillary serous carcinoma (UPSC), 21 women had adenosquamous carcinoma, 10 women had clear-cell carcinoma, and 1 woman each had mucinous or squamous carcinoma. Twelve patients had previously been diagnosed with breast carcinomas. Twenty-five patients were diagnosed with breast cancer either concurrently or subsequent to their diagnosis of endometrial cancer. Synchronous or subsequent breast cancers developed in 3.2% of patients with endometrioid carcinoma and in 25% of patients with UPSC (P < 0.001). CONCLUSION: Patients with UPSC have an increased risk of development of breast cancer as compared to patients with endometrioid adenocarcinoma of the uterus.

Development of a national injury prevention/safe community programme in Vietnam.

The aim of this study is to describe the initiation of a national programme on injury prevention/safe community (IP/SC). Market economy, Doi Moi, was introduced in Vietnam in 1986, and since then the injury pattern has been reported to have changed. The number of traffic injury deaths has increased three-fold from 1980 to 1996 and traffic injuries more than four-fold. Injuries are now the leading cause of mortality in hospitals. There are difficulties in obtaining a comprehensive picture of the injury pattern from official statistics and, in conjunction with the work initiated by the Ministry of Health, a number of local reporting systems have already been developed. Remarkable results have been achieved within the IP/SC in a very short time, based on 20 years of experience. An organizational construction system has been built from province to local community areas. Management is based on administrative and legislative documents. IP/SC implementation is considered the duty of the whole community, local authorities and people committees, and should be incorporated into local action plans. The programme is a significant contribution towards creating a safe environment in which everybody may live and work, allowing the stability for society to develop. Implementation of the programme in schools is a special characteristic. The programme will be developed in 800 schools with a large number of pupils (25% of the population). This model for safer schools is considerably concerned and is a good experience to disseminate. The recommendations are that more pilot models of IP/SC should be conducted in other localities and that the programme should be expanded to a national scale. Furthermore, co-operation between sectors and mass organizations should be encouraged and professional skills of key SC members at all levels should be raised.

Surgical Class III treatment: long-term stability and patient perceptions of treatment outcome.

To evaluate long-term changes after surgical correction of skeletal Class III deformity, postoperative cephalometric radiographs at 1 year and 2 or more years postsurgery were digitized for 92 patients who had received either a bilateral sagittal split osteotomy for mandibular setback, Le Fort I maxillary advancement, or a combination of the two procedures. Patients' perceptions of treatment were determined by four self-administered questionnaires: satisfaction, postsurgical perception of occlusion and function, problems with facial sensation, and postsurgical perceptions. From 1 year to longest follow-up, there were almost no mean changes in landmark positions for the maxillary advancement group and minimal mean changes in the mandibular setback and two-jaw groups. In all three groups, more than 90% of the patients showed no clinically significant long-term changes, which suggests that long-term changes are less likely after Class III than Class II treatment. At long-term recall, 89% of the patients expressed satisfaction with their treatment and would recommend it to others, 74% reported improved social interaction, and 63% said their appearance changed as they expected. The predominant problems reported were altered facial sensation for 67% of the patients and surprise at the length of recovery for 52%.

Isolation and characterization of a hemorrhagic proteinase from timber rattlesnake venom.

A protein isolated from timber rattlesnake (Crotalus horridus horridus) venom by ion-exchange and high-pressure liquid chromatography is hemorrhage inducing and lethal to mice (LD50 of 10 micrograms/g of body weight). It is a Ca2+- and Zn2+-containing proteinase and has the ability to hydrolyze hide powder azure. Atomic absorption spectroscopy shows 2.5 Ca2+ and 1 Zn2+ per protein monomer. The proteinase activity is destroyed by incubation with disulfide-reducing agents and by dialysis against ethylenediaminetetraacetate. Coincident with the loss of proteinase activity is a corresponding loss of lethal and hemorrhagic activities, suggesting that all three are related. Attempts to replace the metals and restore activity have been unsuccessful. Amino acid analysis and isoelectric focusing reveal that this component is an acidic protein (pI = 5.1) containing about 20 disulfide bonds and 507 residues. Reduction of one disulfide bond per molecule decreases proteinase activity by 50% while reduction of eight disulfide bonds decreases activity by 80%. Loss of hemorrhagic activity parallels the decrease in proteinase activity.