Dynamics of antibiotic resistance with special reference to Shiga toxin-producing Escherichia coli infections.

The discovery of antibiotics was paralleled by the evolution of antibiotic resistance which is probably the best example of contemporary evolution in action. The selection pressure, imposed by indiscriminate use of antibiotics, has changed the scale, mode and tempo of antibiotic resistance evolution. The presence of multidrug resistance, wide range of adaptability features and the infectivity make antibiotic resistance of Shiga toxin-producing Escherichia coli (STEC) more dangerous. The characterization, prevalence and the virulence factors of STEC have been profusely reported, whereas, the antibiotic resistance has been largely ignored because the antibiotic use in STEC infections is controversial. Thus, the current review has focussed on the source, evolution, persistence, mechanism, dissemination and control of antibiotic resistance viz-a-viz the STEC infections. The resistance development occurs by the inactivation of antibiotics, regulating the membrane permeability, modification of natural antibiotic targets or the use of efflux pumps against antibiotics. And, the dissemination of resistance genes occurs vertically by DNA replication and horizontally by conjugation, transduction and transformation. The prevention of development and dissemination of antibiotic resistance needs international public health bodies to rationalize the antibiotic use, prevent the flux of antibiotics into the environment, develop the rapid diagnostics tests, undertake proper surveillance of antibiotic resistance, promote the research on antibiotic resistance prevention, promote the research and development of novel alternative antibiotics, and encourage the widespread social awareness campaigns against the inappropriate antibiotic usage.

Irreversibility effects in peristaltic transport of hybrid nanomaterial in the presence of heat absorption.

The nano heat transport has gained much significance in recent era. The micro-level devices are enganged succssfully in diverse fields like electronics, biomedical, navel structures, manufacturing, transportation, and automotive industries in order to improve the heat transfer for cooling and heating. Owing to this fact, the current article illustrates the features of irreversibility and thermal jump in peristaltic transport of hybrid nanoliquid. Here, water is used as base liquid while nanoparticles include polystyrene and graphene oxide. The flow is carried out in a non-uniform channel where the walls of channel flexible nature. Additionally, magnetic field impacts on flow and Joule heating analysis are examined. The aspect featuring heat absorption is introduced. Nanoparticle's shapes effect is also incorporated in flow analysis. Under the consideration of small Rynold number and long wavelength, the relevent equations are reduced by implementing non-dimensional variables. Involved pertinent parameters influence the peristaltic flow characteristics are displayed graphically and discussed concisely. The result indicates that temperature curves are dominant for pure water as compared to P/water nanofluid and P-GO/water hybrid nanofluid. Moreover, the convergent channel shows least entropy effects and extreme effects are noted for divergent case whereas uniform channel stays behind the divergent one.

Surgical Management of Freiberg Disease by Dorsal Closing Wedge Osteotomy.

INTRODUCTION: The purpose of the study was to assess the efficacy of the dorsal closing wedge osteotomy for the treatment of Freiburg's infraction. MATERIAL AND METHODS: Twenty patients with Freiburg's infraction were admitted at our hospital over a period of six years. Patients with a normal plantar contour of the metatarsal head were included. All patients underwent a dorsal closing wedge osteotomy of the metatarsal. RESULTS: The mean Leeds Movement Performance Index (LMPI) score was 84 (range 70-86). The mean metatarsal shortening was 2mm. the passive flexion restriction was 16° and extension restriction was 10°. Also, a strong negative correlation was found between Smillie classification and American Orthopaedic Foot and Ankle Score (AOFAS) final score (r's = -0.85, P < .001). CONCLUSION: The dorsal closing wedge osteotomy is an efficient and reproducible method for the management of Freiburg's infraction.

Inspirational people and care for the deprived: medical missionaries in Kashmir.

Lieutenant Robert Thorpe, a soldier in the British Army in India, visited Kashmir and witnessed the suffering and sorrows of the people there in the nineteenth century; his appeal to British soldiers raised enough funds for the Church Missionary Society to send medical missionaries to the Kashmir Valley. Thus began a process that would see the opening of a 150-bed British Mission Hospital in Srinagar and the start of a new wave of educational and healthcare reforms in the region. As the medical missionary work progressed so did the avenues of research, which led to pioneering work on skin cancer. The missionary doctors and nurses made a significant difference to the lives of the people of Kashmir and their pioneering work continues to live on.

Photosynthetic Nitrite Reduction as Influenced by the Internal Inorganic Carbon Pool in Air-Grown Cells of Synechococcus UTEX 625.

Photosynthetic reduction of NO2- was studied in air-grown cells of a cyanobacterium, Synechococcus UTEX 625. Addition of NO2- resulted in significant amounts of chlorophyll a fluorescence quenching both in the absence and presence of CO2, fixation inhibitors, glycolaldehyde or iodoacetamide. The degree of NO2- quenching was insensitive to the O2 concentration in the medium. Addition of 100 [mu]M inorganic carbon in the presence of glycolaldehyde and O2, leading to formation of the carbon pool within the cells, resulted in pronounced fluorescence quenching. Removal of O2 from the medium restored the fluorescence yield completely, and the subsequent addition of NO2- quenched 36% of the variable fluorescence. From the response to added 3-(3,4-dichlorophenyl)-1,1-dimethylurea, the quenching by NO2- appeared to be photochemical quenching, and nonphotochemical quenching did not seem to be present. The reduction of NO2- observed on its addition to inorganic carbon-depleted cells remained uninfluenced by O2 or glycolaldehyde. The internal inorganic carbon pool in the cells stimulated NO2- reduction, both in the presence and absence of O2, by 4.8-fold. An increase in NO2- reduction by 0.5-fold was also observed in the presence of O2 during simultaneous assimilation of carbon and nitrogen in inorganic carbon-depleted cells. Contrary to this, under anaerobiosis, NO2- reduction was suppressed when carbon and nitrogen assimilation occurred together.

Inorganic Carbon-Stimulated O2 Photoreduction Is Suppressed by NO2- Assimilation in Air-Grown Cells of Synechococcus UTEX 625.

The effect of NO2- assimilation on O2 exchange and CO2 fixation of the cyanobacterium, Synechococcus UTEX 625, was studied mass spectrometrically. Upon addition of 1 mM inorganic carbon to the medium, inorganic carbon pools developed and accelerated O2 photoreduction 5-fold when CO2 fixation was inhibited. During steady-state photosynthesis at saturating light, O2 uptake represented 32% of O2 evolution and balanced that portion of O2 evolution that could not be accounted for by CO2 fixation. Under these conditions, NO2- assimilation reduced O2 uptake by 59% but had no influence on CO2 fixation. NO2- assimilation decreased both CO2 fixation and O2 photoreduction at low light and and increased net O2 evolution at all light intensities. The increase in net O2 evolution observed during simultaneous assimilation of carbon and nitrogen over carbon alone was due to a suppression of O2 photoreduction by NO2- assimilation. When CO2 fixation was precluded, NO2- assimilation inhibited O2 photoreduction and stimulated O2 evolution. When the electron supply was limiting (low light), competition among O2, CO2, and NO2- for electrons could be observed, but when the electron supply was not limiting (saturating light), O2 photoreduction and/or NO2- reduction caused electron transport that was additive to that for maximum CO2 fixation.

Effect of superficial scald suppression by diphenylamine application on volatile evolution by stored Cortland apple fruit.

Cortland apple fruit (Malus x domestica Borkh.) stored for 120-140 days in air at 0 degrees C were warmed to 22 degrees C and held for 8 days. A portion of the fruit was dipped in a solution of diphenylamine (DPA) at harvest to prevent scald development. Scald occurred only in those fruit not treated with DPA, and its development was accelerated after transfer to 22 degrees C. Ester production from apple fruit tended to increase from day 0 to day 6 of poststorage holding and declined thereafter in both treatments. However, ester production in scald-developing fruit was reduced by approximately 50%. The reduction in volatile production remained relatively constant during the rapid development of scald symptoms. Furthermore, the reduction in volatile production appeared to be independent of respiration and ethylene production. Production of esters derived from hexanol was most reduced in fruit developing scald, with hexyl 2-methylbutanoate production being reduced approximately 15-fold. Interestingly, the production of methyl butanoate was detected only in scalding fruit. alpha-Farnesene production in fruit developing scald was reduced 43% compared with DPA-treated fruit. In contrast, the primary volatile oxidation product of alpha-farnesene, 6-methyl-5-hepten-2-one (MHO), was present only in fruit developing scald. The data suggest that inhibition of ester production may occur as a result of the physiological changes associated with susceptibility to, rather than expression of, scald symptoms.

Relationship between ethylene response manipulation and volatile production in Jonagold variety apples.

The ripening of Jonagored Jonagold apple fruit (Malus x domestica Borkh.) during development was manipulated with preharvest applications of ReTain or a combination of ReTain plus Ethrel. The fruits, harvested preclimacteric at approximately the same stages of maturity, were stored in refrigerated air (RA) for 45 days or in controlled atmosphere (CA) for 180 days at 0 degrees C. Volatile evolution, ethylene production, and respiration of stored fruit were studied during poststorage holding at 22 degrees C. ReTain reduced volatile production by 19%, but application of Ethrel to ReTain-treated fruit increased production to control levels. The inhibition of volatile production by ReTain appears to be independent of respiration but may be related to the ethylene-producing capacity of the fruit. Although ReTain reduced flavor-related volatile esters, it did not affect levels of the compound responsible for the typical spicy flavor in Jonagored Jonagold fruit, 4-methoxy-2-propenylbenzene. The CA-stored fruit had a much reduced production of volatile compounds compared to RA-stored fruit, with more discernible effects in ReTain-treated fruit. Ethrel application to ReTain-treated fruit improved the volatile production intermediate between the ReTain alone and control in CA-stored fruit. The data collectively suggest that ReTain may have some promise for better scheduling of harvest of apples with no appreciable loss in RA-stored fruit quality. Reduction in production of alpha-farnesene by ReTain may also reduce the potential for scald development in CA-stored fruit.

Partial synovectomy in the treatment of tuberculosis of the knee.

Fifty synovectomies of the knee joint for tuberculous synovitis performed during a six-year period with complete postoperative follow-up were studied to assess the value of such procedures and the conclusions drawn are reported here. In order to obtain good results, synovectomy should be performed during the early phase of disease, when the knee remains swollen and warm, even after antitubercular therapy, or when the range of movement does not show signs of returning. Exploration of such joints in children shows that the cartilage is wholly or partly covered by pannus. Removal of this pannus allows better nutrition of the cartilage and thus greatly reduces the number of children eventually requiring arthrodesis. Even in adults, when the disease is mainly synovial with pannus formation over the articular cartilages but without serious damage to the bony articular surface, partial synovectomy, or more precisely, joint clearance gives encouraging results and arthrodesis may only need to be performed in patients with severe forms of the disease, often involving the bony articular surfaces.

Cyclopic malformation in infants of diabetic mothers.

Two cases of cyclopic malformations are described among 450 infants of diabetic mothers during a period of four years. Both died within 30 min. of birth. Both belonged to unrelated Libyan families with absent consanguinity and family history. No chromosomal defect was found in either. A possible etiological association with uncontrolled maternal diabetes is discussed.

Perinatal outcome at Benghazi and implications for perinatal care in developing countries.

PIP: Using 1984 perinatal mortality rates as indicators of the level of maternal and newborn health care service quality and efficiency, Libya's high perinatal loss is compared to perinatal losses of 9 other developing countries. Timely antenatal care is identified as the essential component needed to reduce perinatal loss. Libyan perinatal, still birth, and early neonatal death rates were 26.3, 11.4, and 14.9/100, respectively. Perinatal death rates of other countries in the study ranged from 18.8 to 100/thousand. The major causes of still births in Libya included antepartum hemorrhage, cord accidents, maternal diabetes mellitus, and fetal malformations. The effect of timely obstetric care in reducing still birth rates (SBR) is evidenced by comparing SBRs of 16.8 to 63.8 in pregnant women receiving or not receiving minimal antenatal care at a peripheral health center, respectively. The clinical causes of early neonatal death were major congenital malformation (24.9%), hyaline membrane disease and aspiration syndrome (26.1%), birth asphyxia and injury (17.9%), very low birth weight (17.2%), and sepsis/meningitis (13.1%). High general fertility rates of developing countries leads to increased proportions of women under 20 and over 35 years of age bearing children. These women are prone to bearing offspring comparatively more vulnerable to early neonatal death. Consanguineous marriages leading to congenital malformation, and lack of maternal immunization with tetanus toxoid are also cited as factors contributing to high perinatal mortality. In closing, the authors call for future community-based studies, and recognize socioeconomic level as a main determinant in obtaining obstetric care.^ieng

Mechanical ventilation in newborn infants.

A 20-month experience of mechanical ventilation (MV) in the newborn infants (birth weight greater than or equal to 1500 g) from a developing country is described. A total of 41 neonates (4.1% of total admissions to the Neonatal Intensive Care Unit) were treated with MV. The mode of MV was intermittent positive pressure ventilation and continuous positive airway pressure via nasotracheal intubation. The mean birth weight and gestational age were 2544 g and 36.2 weeks, respectively. The mean age at the start of MV was 141 h and the mean duration was 54 h. The indications for MV were respiratory distress syndrome (18), aspiration pneumonia (8), non-aspiration pneumonia (6), apnoea (8) and tetanus neonatorum (1). The complications encountered during MV were sepsis (26.8%), pulmonary haemorrhage (21.9%), congestive heart failure (17.1%), pneumothorax (14.6%) and intraventricular haemorrhage (7.3%). Post-extubation atelectasis was observed in 29.6% of cases. The overall survival rate was 43.9%. The risk factors for a poor outcome were birth weight less than 2000 g, prematurity and late referrals to the Neonatal Intensive Care Unit.

Brucellosis in pediatric patients: A review of 114 cases from Asir region.

Over a period of four years. 114 children (> 28 days to

Easily identifiable congenital malformations in children: Survey of incidence and pattern in 32,332 live born neonates.

Over a period of two years, 32,332 live-born infants were screened for the presence of identifiable congenital malformations. Congenital anomalies were present in 2.38% of all infants; major and minor malformations were present in 79% and 21% of the cases, respectively. Anomalies in general and chromosomal anomalies in particular were more common in multiparous women of advanced age. Anatomical organs most frequently affected were musculoskeletal and cardiovascular systems; talipes, chromosomal anomalies and congenital cardiac defects being the most common. The incidence of congenital anomalies in infants of diabetic mothers was 13.8% compared with 3% in the non-diabetic population (P=<0.01); multiple anomalies were present in 50% of the cases. Of a total of 770 infants born with malformations, 58 died during the early neonatal period with a mortality rate of 7.5% compared with an overall early neonatal death rate of 11.8/1000 live births.