Clonal diversity and zoonotic potential of MDR Escherichia coli isolated from poultry at different age intervals.

1. A pool of 480 E. coli isolates of poultry (broilers and ducks) representing different time intervals (0, 10, 20 and 30 days) was selected for ribotyping and used to determine polymorphism of 16-23S ribosomal RNA intergenic space. All the isolates were multidrug-resistant (MDR).2. Out of these, 10 isolates were tested for MultiLocus Sequence Typing (MLST) among which novel allelic combinations and therefore new sequence types were identified in seven isolates.3. This work showed the changes in E. coli strains structure at farm level and individual bird level in host species raised on organised farms with similar parental lineage and environmental housing. The statistical results showed that the structure of variation is very different by farm, supporting a strong effect of location, which confirms the temporal clustering.4. There were significant differences between E. coli strains in chickens and ducks, indicating host specificity of the E. coli strains.5. Some of the pathogenic E. coli strains found using MLST belonged to ST735, ST2796 and a pandemic clone ST752 of ST10 clonal complex. The results strongly suggested the clonal expansion and establishment of specific MDR clones that have zoonotic relevance.

Epidural failure rate using a standardised definition.

INTRODUCTION: There is no globally-accepted definition of epidural failure; this leads to wide differences in reported failure rates. A definition of epidural failure was standardised using a modified Delphi approach involving senior obstetric anaesthetists in the UK. Using this definition, epidural failures were calculated in our institution. METHODS: Following clinical governance approval, anonymised data from 1521 epidurals inserted between September 2010 and December 2011 were collected from our database. Details included pain relief 45 min from the start of the procedure, accidental dural puncture, epidural re-siting, maternal satisfaction, time of insertion and positioning for insertion. RESULTS: The overall failure rate was 23%. Individual failure rates for trainees were: Year 2, 26.8%; Year 3, 26.3%; Year 4, 21.4%; Year 5, 25%; Year 6, 18.5%; and Year 7, 13.5%. Epidural re-site rates for trainees were: Year 2, 6.5%; Year 3, 3.5%; Year 4, 4%; Year 5 and above, 1.5%. Cervical dilatation, time of day and position for insertion did not have a statistically significant association with the failure rate. However, the failure rate of the Year 2, Year 3, and Year 4 trainees was significantly higher when compared to that of Year 5 and above. The re-site rate was statistically higher for Year 2 and Year 4 trainees when compared to those of Year 5 and above. The accidental dural puncture rate was statistically higher among Year 3 trainees when compared to Year 5 and above. CONCLUSION: The study identified epidural failure rates using a standardised definition. This information could be used to guide training decisions and to support doctors during their training period.

A double blind comparison of the variability of block levels assessed using a hand help Neurotip or a Neuropen at elective caesarean section under spinal anaesthesia.

BACKGROUND: We previously noted that when two experienced anaesthetists assessed the level of spinal block to touch at caesarean section, one with a hand held device (Neurotip), and the other with a very similar spring loaded device (Neuropen), the median difference between the assessed levels of block was zero but there were some wide individual paired differences between the anaesthetists. We theorised that differences in the applied pressure of the stimulus may have contributed to this variation. We wished to investigate whether compared to the Neurotip, the Neuropen would reduce the variability of assessed block levels between anaesthetists of varying experience. METHODS: The levels of block to touch and sharp pinprick were assessed by paired anaesthetists using both the Neurotip and Neuropen. The anaesthetists were blind to each other's assessments. To ensure comparability of dermatome identification, the patient's torso was marked before surgery. RESULTS: In 44 cases, managed by 35 different pairs of anaesthetists, there was no statistically significant difference in the variability of differences in assessed levels of block between anaesthetists (P=0.23) whether the Neurotip or Neuropen or touch or sharp pinprick were used. The median dermatomal difference [upper quartile, lower quartile] was 0 [1, -1] for both instruments with both touch and sharp pinprick. CONCLUSION: Compared to the Neurotip, the Neuropen did not result in a reduction of the variability in the differences in spinal block levels when assessed by 35 different pairs of anaesthetists.

Fireworks injury: temporal bone penetration and a wooden intra-cranial foreign body.

We describe a case of a teenager sitting in a car, who was struck by a fireworks missile. The unusual presentation of a large wooden foreign body penetrating through the temporal bone and lodging in the brain is detailed. The management is discussed.

Parents in the anesthetic induction room: the preferences of parents in Kuwait.

OBJECTIVE: To ascertain whether the parents in Kuwait desire to be present during the induction of anesthesia in their children and to obtain the parents' views on factors associated with such presence. METHODS: The parents of 80 children scheduled for surgery under general anesthesia were given asked to complete a questionnaire. RESULTS: An overwhelming 88.75% of parents wished to he present in the anesthetic room during induction. CONCLUSIONS: Parents in Kuwait should he allowed to be present during the induction of anesthesia in their child. Protocols should be drafted accordingly and must include other child-friendly measures to reduce anxiety among parents and children in Kuwait.

Parents in the anesthetic induction room: the preferences of parents in Kuwait

To ascertain whether the parents in Kuwait desire to be present during the induction of anesthesia in their children and to obtain the parents' views on factors associated with such presence. The parents of 80 children scheduled for surgery under general anesthesia were given asked to complete a questionnaire. An overwhelming 88.75% of parents wished to he present in the anesthetic room during induction. Parents in Kuwait should he allowed to be present during the induction of anesthesia in their child. Protocols should be drafted accordingly and must include other child-friendly measures to reduce anxiety among parents and children in Kuwait