A rare agent of continuous ambulatory peritoneal dialysis peritonitis: Rhizobium Radiobacter.

Peritonitis is a common clinical problem in patients treated by continuous ambulatory peritoneal dialysis (CAPD). The most common microbiological factors causing peritonitis are Gram-positive (especially Staphylococcus spp.). Peritonitis with Rhizobium radiobacter (Agrobacterium radiobacter) is a rare infection in CAPD patients. Peritonitis due to R. radiobacter has been reported in our patient's dialysate culture who underwent CAPD for three years. We report the case of a 26-year-old female PD patient who had CAPD peritonitis due to R. radiobacter and successfully treated with intraperitoneal vancomycin and oral ciprofloxacin without relapses or removing the PD catheter.

The cut-off levels of procalcitonin and C-reactive protein and the kinetics of mean platelet volume in preterm neonates with sepsis.

BACKGROUND: Sepsis is a leading cause of morbidity and mortality among newborns. C-reactive protein (CRP) and procalcitonin (PCT) have some limitations in the diagnosis of preterm neonatal sepsis. In this study, the cut-offs of PCT and CRP, and the efficacy of mean platelet volume (MPV) were investigated. METHODS: We identified key demographic details and compared laboratory values between preterm infants with early onset and late onset neonatal sepsis (EONS/LONS) retrospectively. Blood samples were collected within the first few hours of the onset of clinical sepsis (CRP 1, PCT 1, MPV 1) and were repeated after 24 h (CRP 2, PCT 2, MPV 2). The optimal cut-offs for CRP, PCT and MPV were determined using receiver operating characteristic (ROC) analysis. Furthermore, pairwise comparisons of ROC curves were made to evaluate the performances of these tests. RESULTS: In EONS, the cut-off of CRP 1 was 2.6 mg/L, the sensitivity, specificity, PPV and NPV were 80.6, 83.0, 67.5 and 90.7%, respectively (p < 0.001). At a PCT 1 cut-off of 1.1 ng/mL, the sensitivity, specificity, PPV and NPV were 78.6, 81.2, 64.7 and 89.6%, respectively (p < 0.001). The sensitivity, specificity, PPV, and NPV of the CRP 1 cut-off of 3.6 mg/L for LONS were 78.3, 87.4, 74.8, and 89.4%, respectively. At a PCT 1 cut-off of 5.2 ng/mL, the sensitivity, specificity, PPV and NPV were 58.5, 95.5, 86.1, and 82.9% respectively. For proven sepsis, the cut-off of CRP 1 was 7.0 mg/L with a 76.5% sensitivity, 98.2% specificity, 94.9% PPV and 90.5% NPV (p < 0.001). At a PCT 1 cut-off of 1.36 ng/mL, the sensitivity, specificity, PPV and NPV were 90.8, 83.4, 70.6 and 94.4%, respectively (p < 0.001). In each subgroup, other than EONS, the performances of CRP 1 and PCT 1 measurements were found to be statistically higher than MPV 1. CRP 2 cut-off levels of LONS group and proven sepsis group were found to be lower than the initial values. CONCLUSIONS: Optimal cut-off levels of CRP 1 and PCT 1 may differ in preterm sepsis subgroups. The diagnostic performances of CRP 1 and PCT 1 didn't differ however, they were more efficacious than MPV.

Colistin vs. the combination of colistin and rifampicin for the treatment of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia.

The aim of this study was to compare the responses of colistin treatment alone vs. a combination of colistin and rifampicin in the treatment of ventilator-associated pneumonia (VAP) caused by a carbapenem-resistant A. baumannii strain. Forty-three patients were randomly assigned to one of two treatment groups. Although clinical (P = 0·654), laboratory (P = 0·645), radiological (P = 0·290) and microbiological (P = 0·597) response rates were better in the combination group, these differences were not significant. However, time to microbiological clearance (3·1 ± 0·5 days, P = 0·029) was significantly shorter in the combination group. The VAP-related mortality rates were 63·6% (14/22) and 38·1% (8/21) for the colistin and the combination groups (P = 0·171), respectively. Our results suggest that the combination of colistin with rifampicin may improve clinical and microbiological outcomes of VAP patients infected with A. baumannii.

Preauricular sinus, nephrolithiasis, infantine eczema and natal tooth: a new association.

Preauricular sinuses (ear pits) are common congenital abnormalities. The incidence of preauricular sinus is widely varied. Usually asymptomatic, they manifest as small hollows adjacent to the external ear near the anterior margin of the ascending limb of the helix, most frequently on the right side. Preauricular sinuses can be either inherited or sporadic. They may be bilateral, increasing the likelihood of being inherited, in 25-50% of cases. Preauricular sinuses are features of other conditions or syndromes in 3-10% of cases, primarily in association with deafness and branchio-oto-renal (BOR) syndrome. When other congenital anomalies coexist with these sinuses, auditory testing and renal ultrasound should be considered. A girl, who was three months and 20 days old, was presented because of the co-existence of a right infected preauricular sinus, nephrolithiasis, infantile eczema and a natal tooth.

Canal preparation with Hero 642 rotary Ni-Ti instruments compared with stainless steel hand K-file assessed using computed tomography.

AIM: To compare ex vivo root canal preparation with conventional stainless steel K-files and Hero 642 rotary Ni-Ti instruments. METHODOLOGY: Mesiobuccal canals of 20 maxillary first molars (with angles of curvature between 25 degrees and 35 degrees ) were used. After preparation with Hero 642 rotary instruments and stainless steel K-files, the amount of transportation that occurred was assessed using computed tomography. The teeth were scanned by computed tomography before instrumentation. One millimetre thick slices were prepared from the apical end point to the pulp chamber. The first two sections were 3 mm from the apical end of the root (apical level) and 3 mm below the orifice (coronal level). A further section (mid-root level) was recorded, dividing the distance between the sections of apical and coronal levels into two equal lengths. Ten teeth were instrumented using Hero 642 rotary instruments and another 10 teeth were instrumented using stainless steel K-files. Following the completion of the instrumentation, the teeth were again scanned and compared with the cross-sectional images taken prior to canal preparation. Amount of transportation and centreing ability was assessed. Student's t-test was used for statistical analysis. RESULTS: Less transportation occurred with Hero 642 rotary instruments than stainless steel K-files at the mid-root and coronal levels (mid-root: P < 0.05 and coronal: P < 0.001). Hero 642 rotary instruments had better centreing ability than K-files at all three levels (apical: P < 0.05, mid-root: P < 0.05 and coronal: P < 0.001). CONCLUSIONS: Hero 642 rotary instruments transported canals less, especially at the middle and coronal thirds of the root canals than stainless steel K-files. Hero 642 instruments had better centreing ability.