Colistin inhalation monotherapy for ventilator-associated pneumonia of Acinetobacter baumannii in prematurity.

BACKGROUND: Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii is increasing. It has a high mortality rate but experience in using inhaled colistin as monotherapy for VAP in children, especially pre-term infants, is limited. This study presents experiences using aerosolized colistin as monotherapy for VAP due to A. baumannii infection in pre-term infants. METHODS: Eight pre-term infants (gestational age 25-36 weeks) admitted to the neonatal intensive care unit (NICU) of Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2006 to December 2010 who received inhaled colistin as monotherapy for VAP due to A. baumannii infection were retrospectively evaluated. Of the isolated microorganisms, five were multi-drug resistant strains of A. baumannii (MDR-AB) but all were sensitive to colistin. All patients received inhaled colistin at a dose of 1,000,000 IU (33.4 mg) twice daily for an average of 9.1 days (range, 4-22 days). RESULTS: All pre-term infants were cured, with A. baumannii eradicated from airway secretions. There were no clinical or laboratory adverse events related to colistin use. CONCLUSIONS: Aerosolized colistin may be used as monotherapy for VAP due to A. baumannii infection in pre-term infants. A larger controlled study is warranted to corroborate the findings.

Usefulness of desaturation index for the assessment of obstructive sleep apnea syndrome in children.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) can result in learning, behavioral, and even growth problems in children. Overnight polysomnography (PSG) is the gold standard for the diagnosis of OSAS, but this diagnostic technique is time consuming and inconvenient. It is well documented that patients with OSAS experience oxygen desaturation during sleep. The purpose of this study was to determine if the level of oxygen desaturation can be used to predict OSAS in children. METHODS: This retrospective study included 148 children aged from 3 to 12 years; all were snorers and were suspected of having OSAS. Objective PSG parameters, nocturnal pulse oximeter data and subjective modified Epworth Sleepiness Scale (ESS) scores were assessed. Mild, moderate, and severe OSAS was classified as apnea-hypopnea index (AHI)≥1 and <5, AHI≥5 and <10, and AHI≥10, respectively. RESULTS: Of the 148 children, 130 (87.8%) were diagnosed with OSAS. There was no correlation between the AHI and the modified ESS score (r = -0.048, p = 0.563). The desaturation index (DI) had the highest correlation with AHI (r = 0.886, p < 0.001). Using the DI cut-off values of 2.05 to predict OSAS in children had good positive predictive value of 98.1%. The optimal DI cut-off values for predicting the occurrence of mild, moderate, and severe OSAS were 2.05 (sensitivity: 77.7%; specificity: 88.9%), 3.50 (sensitivity: 83.8%; specificity: 86.5%) and 4.15 (sensitivity: 89.1%; specificity: 86.0%), respectively. CONCLUSIONS: These findings suggest that DI, as determined using a nocturnal pulse oximeter, may be a good tool for predicting both the presence and the severity of OSAS in children.

Effect of the interaction between light and touch stimuli on inducing curling seminal roots in rice seedlings.

Root development is sensitive to environmental stimuli. We have recently reported that the light signal could promote the helical growth of seminal roots and drive the wavy root morphology in rice (Oryza sativa L.) young seedlings. The light-stimulated wavy roots were mostly performed in indica-type rice varieties (e.g. Taichung Native 1; TCN1) but not in japonica rice (e.g. Tainung 67; TNG67). Here, we demonstrated that the light-driven circumutation trajectory of TCN1 seminal roots could be changed if the seedling roots were grown in the medium containing high concentration of Phytagel. The data showed the root morphology would be modulated from wavy to curling when the Phytagel concentration was increased to 2%. However, the touch-stimulated curling root phenotype could not be performed in dark. In addition, the touch-induced curling roots were not appeared in the TNG67 rice cultivar. Although touch stimuli could not induce wavy/curling root phenotype in dark, it could modify the light-promoted helical growth to conduct curling roots in TCN1 rice seedlings. Thus, it was suggested that there is a crosstalk mechanism between touching-induced root curling and light-stimulated root waving.

Unusual clinical course in pediatric Tolosa-Hunt syndrome.

We report on a 7-year-old immunocompetent boy initially presenting with right-sided frontal cephalalgia, painful ophthalmoplegia, and ptosis for 1 month. Initial cerebrospinal fluid analysis produced normal results. Magnetic resonance imaging revealed an inflammatory pseudotumor of the right cavernous sinus after intravenous gadolinium administration, indicating a rare idiopathic inflammatory disorder of the cavernous sinus, i.e., Tolosa-Hunt syndrome. Ptosis and cephalalgia resolved after steroid treatment, although right-sided ophthalmoplegia remained. Breakthrough headache, associated with signs of meningeal irritation, developed 6 weeks later. Follow-up contrast-enhanced computed tomography revealed no enhancing cavernous soft tissue mass. A further lumbar puncture disclosed central nervous system infection with Staphylococcus saprophyticus. After 6 weeks of vancomycin, the headache resolved completely, and neuroimaging produced normal results. A diagnosis of Tolosa-Hunt syndrome should be rendered cautiously, because the etiology may involve a rare but not "idiopathic" infection. Moreover, if clinical signs are not fully responsive to steroid treatment, the underlying problems should receive careful investigation.