Enterobacter agglomerans, an uncommon cause of community-acquired bacterial infection in neonates.

Enterobacter agglomerans formerly termed Erwina herbicola but now called Pantonea agglomerans is a ubiquitous gram-negative bacterium that rarely causes mild and opportunistic infection in humans. Sources of infection are myriad causing both local and systemic disease across all systems of the body. Infection is often fulminant and fatal in neonates. We aim to report another facet of the infection as seen in our centre. Of the 248 neonates recruited into the study, 94 had bacteria isolated from their blood, eight (8.5%) of whom had E. agglomerans sepsis. Infection was acquired from the community though its source could not be determined. The clinical features were non-specific running a mild course. Toxic granulation, elevated immature polymorph count and procalcitonin level was found in 50% and 75% of the neonates. Isolate was sensitive to most tested antibiotics, showing 100% sensitivity to gentamicin and ciprofloxacin and the survival rate was excellent (87.5%).

Enterobacter agglomerans formerly Erwina herbicola but now called Pantonea agglomerans is a gram-negative organism that is found everywhere in our environment. It rarely causes a mild infection in humans, which is either local or generalized. Severe disease has been reported in babies and the elderly because of their low immunity and/or comorbid condition. The study aimed to report this rare condition in our neonatal unit. The study was conducted in the baby unit of Ahmadu Bello University Teaching Hospital in Zaria over 10 months. Any baby with symptoms/signs of infection was enrolled in the study and had their blood samples taken to look for the presence of infection. Of the 248 babies who were recruited, 94 had bacteria isolated from their blood out of whom 8 were due to E. agglomerans. All our babies came from the community as such source of infection could not be determined. Most had non-specific presentation fever, poor suck and jaundice and none had comorbidity or complicated procedures. The organism is generally sensitive to most antibiotics tested. All but one of the babies survived. Our study found E. agglomerans infection to be mild with a good prognosis.

Management of incidental discovery of microscopic squamous cell carcinoma in zones of osteoradionecrosis of the mandible.

OBJECTIVES: Osteoradionecrosis (ORN) of the mandible is a common complication of head and neck radiotherapy and often requires surgical treatment. Squamous cell carcinoma (SCC) can be exceptionally discovered within zones of ORN on histological examination of the operative specimen. The authors discuss the management of these lesions based on a short patient series. MATERIALS AND METHODS: This single-centre retrospective study was based on patients managed between 2012 and 2014 for ORN with incidental discovery of microscopic SCC. RESULTS: Five patients with incidental discovery of microscopic SCC in a zone of ORN of the mandible were included in this study. The mean time to onset of ORN after the end of radiotherapy for locally advanced SCC of the oral cavity or oropharynx was 42 months. Surgical treatment consisted of marginal or segmental mandibulectomy with free flap reconstruction. No recurrence was observed with a mean follow-up of 35 months [24-46]. CONCLUSION: The incidental discovery of microscopic SCC in a zone of ORN of the mandible is a rare event and has not been reported in the literature. Optimal management cannot be reliably defined due to the lack of data in the literature, but the present study supports careful histological examination of ORN specimens. Treatment must be as conservative as possible to avoid excessively invasive surgery.

Upper airway obstruction assessment: Peak inspiratory flow and clinical COPD Questionnaire.

OBJECTIVES: Spirometric evaluation of upper airway obstruction (UAO) is not commonly performed by Otolaryngologists. In addition, functional evaluation of UAO by flow-volume loops (FVL) is not available in all clinical settings. More recently, peak inspiratory flow (PIF) has proven to be a useful tool to monitor UAO at the patient's bedside. The aim of this work is to assess the role of PIF measured with a simple flow metre (In-Check method) as a standardised, simple, non-invasive tool in quantifying chronic and subacute UAO in a routine clinical practice. In addition, a Clinical COPD Questionnaire (CCQ), previously validated to assess the psychophysical status in patients with laryngotracheal stenosis, was utilised to evaluate respiratory function in UAO. DESIGN: Prospective cohort study. SETTINGS: University teaching hospital. PARTICIPANTS: Seventy 2 subjects, an UAO group of 26 patients and a control group of 46 healthy subjects. MAIN OUTCOME MEASURES: The ability of PIF values to discriminate between the UAO group and the control group was assessed using a ROC curve. A Spearman rank correlation was used to test the relationship between PIF measurements and the global CCQ score. Additionally, an analysis of CCQ at domain and items levels was performed. RESULTS: Peak inspiratory flow values were accurate, with an area under the ROC curve (AUC) of 0.98 (P < .05) for differentiating the control group from the UAO group. A threshold PIF value of 170 L/min was found for diagnosing UAO. An inconclusive negative trend was found (r = -.19; P = .35) between PIF values and CCQ global score. Concerning CCQ, the symptoms domain was the most affected by UAO, higher than mental domains (P < .001) as well as functional domains (P < .01). Exertional dyspnoea and cough were the items that obtained the highest disturbed scores. CONCLUSIONS: Peak inspiratory flow is a non-invasive, quantitative parameter to evaluate the severity of UAO. Testing can be easily performed in a routine clinical setting, with a non-expensive hand-held device, and could help medical follow-up programmes and prevent emergency situations. However, FVL may be necessary for further assessment of UAO diseases. The CCQ confirms that exertional dyspnoea is the main symptom of UAO, but cough remains a common symptom.

How to release neck dissections: Role of the triangle between the spinal accessory nerve and the internal jugular vein.

The neck dissection technique has been precisely defined. It allows resection of lymph node groups, comprising at least groups IIA, IIB, III and IV according to Robbins' classification for head and neck cancer. Neck dissection is classically performed in an upwards and forwards direction, but the technique can vary according to the site of lymph nodes. The authors describe the central role of dissection of the triangle between the spinal accessory nerve and the internal jugular vein at the beginning of neck dissection in order to facilitate group IIB dissection while avoiding traction on the spinal accessory nerve and to ensure early control of the internal jugular vein superiorly; release of the vein also facilitates subsequent dissection of the thyrolinguofacial trunk and identification of the hypoglossal nerve. This specific dissection and its role has not been previously described in the literature. This triangle constitutes the posterior part of group IIA, but is intimately related anatomically to group IIB dissection.

Relationship between documentation method and quality of chronic disease visit notes.

OBJECTIVE: To assses the relationship between methods of documenting visit notes and note quality for primary care providers (PCPs) and specialists, and to determine the factors that contribute to higher quality notes for two chronic diseases. METHODS: Retrospective chart review of visit notes at two academic medical centers. Two physicians rated the subjective quality of content areas of the note (vital signs, medications, lifestyle, labs, symptoms, assessment & plan), overall quality, and completed the 9 item Physician Documentation Quality Instrument (PDQI-9). We evaluated quality ratings in relation to the primary method of documentation (templates, free-form or dictation) for both PCPs and specialists. A one factor analysis of variance test was used to examine differences in mean quality scores among the methods. RESULTS: A total of 112 physicians, 71 primary care physicians (PCP) and 41 specialists, wrote 240 notes. For specialists, templated notes had the highest overall quality scores (p≤0.001) while for PCPs, there was no statistically significant difference in overall quality score. For PCPs, free form received higher quality ratings on vital signs (p = 0.01), labs (p = 0.002), and lifestyle (p = 0.002) than other methods; templated notes had a higher rating on medications (p≤0.001). For specialists, templated notes received higher ratings on vital signs, labs, lifestyle and medications (p = 0.001). DISCUSSION: There was no significant difference in subjective quality of visit notes written using free-form documentation, dictation or templates for PCPs. The subjective quality rating of templated notes was higher than that of dictated notes for specialists. CONCLUSION: As there is wide variation in physician documentation methods, and no significant difference in note quality between methods, recommending one approach for all physicians may not deliver optimal results.

Rock phosphate dissolution by specific yeast.

Phosphate solubilizing yeast (PSY) were isolated from rhizosphere, non-rhizosphere and fruits from Bhavnagar district. The potential of 25 yeasts were analyzed on the basis of phosphate solubilizing zone to growth on solid medium denoted as solubilization index (SI) which ranged from 1.10 to 1.50. Among 25 yeast isolates, 6 yeast belonging to genus Saccharomyces (2), Hansenula, Klockera, Rhodotorula and Debaryomyces exhibited highest SI (1.33-1.50) were further examined for in vitro tricalcium phosphate (TCP) and low grade rock phosphate (RP) solubilization. TCP proved superior to RP with all the yeasts. Within low grade RPs tested, except isolate Y5, all isolates showed maximum solubilization with Hirapur RP (HRP) ranging from 7.24 to 19.30 mg% P(2)O(5). Among six PSY screened, Debaryomyces hansenii showing maximal HRP solubilization was chosen for further physiological studies. Maximum HRP solubilization was expressed in following condition: pH optima 7.0, temperature optima 28°C and optimal period of incubation were 15 days. Acidic pH of the spent media was a constant feature in all the cases. No correlation could be established between final acidity produced by yeasts and the quantity of phosphate liberated.

Lymphoepithelioma-like carcinoma of the colon: report of a case with histologic, immunohistochemical, and molecular studies for Epstein-Barr virus.

We report a case of lymphoepithelioma-like carcinoma of the colon in a 62-year-old Hispanic male with multiple other tumors, including thyroid, breast, pharyngeal, and prostate carcinomas; a neurofibrosarcoma; and a meningioma. The association with Epstein-Barr virus infection and colonic lymphoepithelioma-like carcinoma was studied using immunohistochemical and polymerase chain reaction techniques.