Comparative physiological study of the wild type and the small colony variant of Pseudomonas aeruginosa 20265 under controlled growth conditions.

Small-colony variants (SCVs) of Pseudomonas aeruginosa are often found in chronically infected airways of patients suffering from cystic fibrosis. These slow-growing morphological variants have been associated with persistent and antibiotic-resistant infections. Nevertheless, the behavior of SCVs under varied availability of O2 and iron, two key variables relevant to the lung environment of CF patients and pathogenicity of P. aeruginosa, has not been systematically studied so far. In this work, the effects of O2 and iron were comparatively studied for a CF P. aeruginosa wild type (WT) strain and its SCV phenotype in a real-time controlled cultivation system. Significant differences in the behavior of these strains were observed and quantified. In general, SCV exhibited a higher fitness than the WT toward aerobic conditions. Under iron rich condition, and despite less release of total extracellular proteins, absence of flagellin and lower siderophore production, the SCV cells grown at fully aerobic conditions showed a higher specific growth rate and a significantly higher cytotoxicity in comparison with the WT cells. The strains behaved also differently towards iron limitation. The phenomena of limited O2 transfer from the gas to the liquid phase and enhancement of formation of virulence factors under conditions of iron limitation were much more profound in the SCV culture than in the WT culture. These results have important implications for better understanding the pathogenicity of P. aeruginosa and its small-colony variants.

Frequency of intestinal parasitic infection among children in Hadhramout governorate (Yemen).

Six hundred children from urban and rural regions of Hadhramout governorate were examined targeted for the detection of intestinal parasites during the year 2009. The main infective parasites prevailed in children were Gardia lamblia (19.17%), Entamoeba histolytica (16.83%), Ascaris lumbricoides (15.83%), Trichuris trichiura (2.33%), Hymenolepis nana (2.33%), Taenia saginata (1.50%) and Schistosoma mansoni (0.67%). Besides, infections were accompanied by different symptoms as diarrhea (43.5%), abdominal pain (23.3%), abdominal distention (17.3%), constipation (9.1%), nausea and vomiting (8.02%) and fever (5.1%). The parasitosis reflected the hygienic problems and their influence on public health of Hadhramout.

Urinary tract infection among pregnant women in Al-Mukalla district, Yemen.

Urinary tract infection (UTI) is a common problem in pregnant woman. This study examined the frequency of UTI in 137 pregnant women attending Al Mukalla maternity hospital from January to June 2002. Urine samples were examined for UTI microscopically and by culture, and sensitivity tests were done for the organisms isolated using a range of antibiotics. Information on age, trimester, parity and number of pregnancies were also collected for each woman. This study showed that 30% of the women suffered from UTI; Escherichia coli was the most frequently isolated organism (41.5%), and it was highly susceptible to chloramphenicol, ciprofloxacin, ceftizoxime and amikacin. Of the variables examined, 53.7% of the infected women were in the age group 15-24 years, 48.8% were in their 3rd trimester and 75.6% had 1-3 children.

Urinary tract infection among pregnant women in Al-Mukalla district, Yemen

Urinary tract infection [UTI] is a common problem in pregnant woman. This study examined the frequency of UTI in 137 pregnant women attending Al Mukalla maternity hospital from January to June 2002. Urine samples were examined for UTI microscopically and by culture, and sensitivity tests were done for the organisms isolated using a range of antibiotics. Information on age, trimester, parity and number of pregnancies were also collected for each woman. This study showed that 30% of the women suffered from UTI; Escherichia coli was the most frequently isolated organism [41.5%], and it was highly susceptible to chloramphenicol, ciprofloxacin, ceftizoxime and amikacin. Of the variables examined, 53.7% of the infected women were in the age group 15-24 years, 48.8% were in their 3rd trimester and 75.6% had 1-3 children

Persistence of a clone of methicillin-resistant Staphylococcus aureus in a burns unit.

A total of 128 MRSA isolates from a burns unit in 1992 and 1997 was studied by resistotyping, plasmid analysis and pulsed-field gel electrophoresis (PFGE) of SmaI-digested chromosomal DNA to ascertain whether a clone of MRSA had persisted in the unit or whether different clones had been introduced at different times. All the MRSA isolates produced beta-lactamase and had high MICs to methicillin (>256 mg/L). All were resistant to tetracycline, kanamycin, cadmium acetate and mercuric chloride. Most were resistant to gentamicin, neomycin, erythromycin, chloramphenicol, trimethoprim, ciprofloxacin, propamidine isethionate and ethidium bromide, and were susceptible to minocycline, vancomycin and teicoplanin. None of the 1992 isolates was resistant to mupirocin, but 56% and 19% of the 1997 isolates expressed high- and low-level mupirocin resistance, respectively. Many of the 1997 isolates had acquired a 38-kb plasmid encoding high-level mupirocin resistance. The 1992 isolates had two main PFGE patterns; 82% of them belonged to PFGE pattern 1. The 1997 isolates had PFGE pattern 1, the same as the majority of the 1992 isolates. All MRSA isolates from both years carried the mecA gene in the same SmaI fragment. These findings demonstrated that a clone of MRSA that was prevalentin the burns unit in 1992 had persisted and became the predominant clone in 1997.

Plasmid profile and antibiotic resistance in coagulase-negative staphylococci isolated from polluted water.

Four different species of coagulase-negative staphylococci (CNS) were isolated from polluted waters in Fez, Morocco and found to be Staphylococcus simulans, Staph. lenticus, Staph. hyicus and Staph. xylosus. Eight isolates belonging to these four species were analysed for their plasmid content. Southern blot hybridizations were performed to define the resistance determinants of the plasmids harboured by these species. These determinants were found to be carried mainly by Class I staphylococcal plasmids (1-5 kb). A plasmid (4.3 kb) carrying a tetracycline resistance gene was present in five isolates from all identified species. Plasmids carrying a chloramphenicol resistance gene were more frequently encountered and found to be of different sizes. Plasmids carrying erythromycin, neomycin, and streptomycin resistance genes were less frequent and were the same size. The results indicate that the occurrence of multi-resistant CNS in polluted waters may constitute a reservoir for disseminating antibiotic-resistance into the community.

Peter's anomaly: diagnosis by ultrasound biomicroscopy.

Peter's anomaly is a congenital corneal disorder characterized by a central leukoma and adhesions at the periphery of the corneal opacity. A 35-year-old man presented for clinical evaluation of suspected sclerocornea. High-resolution ultrasound biomicroscopy revealed iridocorneal adhesions throughout the anterior segment, a shallow anterior chamber, and abnormal hyper-reflectivity along the posterior corneal surface. Through ultrasound biomicroscopy, characteristics of Peter's anomaly were recognized, and a diagnosis was established. This case illustrates how ultrasound biomicroscopy aids in the clinical differentiation between Peter's anomaly and other causes of congenital corneal opacification.

Ethical considerations in home care of the oncology patient.

OBJECTIVES: To examine the context of home care and the values of providers and patients that lead to potential ethical conflicts. To discuss a normative model of ethical decision making, and to suggest resources for resolving ethical issues. DATA SOURCES: Published articles pertaining to ethical issues and home health care. CONCLUSIONS: Home care is a viable and beneficial alternative to hospital care for a variety of patients, yet home care can result in unique value conflicts between patients and their families, and patients and home care providers. Loss of privacy and determining who is in charge are several unique areas to home care that can lead to ethical problems. Policies, guidelines, value statements, and ethics committees are excellent resources to assist in ethical decision-making. IMPLICATIONS FOR NURSING PRACTICE: A workable method or model to resolve ethical problems, and resources to assist in ethical decision-making can provide home care providers with guidelines to analyze an ethical problem and the support to choose and act on the best option.

Does the ileocolonic junction differentiate between solids and liquids?

Previous observations from our laboratory have suggested that colonic filling from the ileum is characterised by a series of bolus movements. The present experiments were designed to test the hypothesis that bolus transit of ileal contents into the colon would not distinguish between solids and liquids. After a manometric infusion assembly was positioned by mouth into the ileum of 13 healthy volunteers, a mixture of nutrients (75 kcal), incorporating a solid phase radiolabel (111In labeled resin pellets) and a liquid phase marker (99mTc-DTPA), was infused into the ileum. Transit of both labels from the ileum to colon was quantified scintigraphically and ileal motility was also recorded. When markers were infused into the proximal ileum, 100 cm proximal to the ileocolonic junction (six), there were clear cut examples of discriminant transit, when liquids moved more rapidly from the small to the large bowel than did solids. When isotopes were instilled into the distal ileum, less than 50 cm from the ileocolonic junction, no separate transit of the solid and liquid phases was observed. No specific motor pattern of the ileum was regularly associated with bolus filling of the colon. These results support the hypothesis that the distal ileum can discriminate between solids and liquids but that the ileocecal junction cannot.

Teamwork in home infusion therapy: the relationship between nursing and pharmacy.

To admit a client to a home infusion therapy program effectively and efficiently, all of the parties involved must take part in the planning process and decision making. The registered nurse and pharmacist are not the only players on the home healthcare team involved in planning for home infusion therapy, but their relationship is especially critical for a smooth transition to the home setting. Good communication between the nurse and pharmacist and a basic understanding of responsibilities are keys to successful coordination of care delivery. But communication can be challenging when the pharmacist and nurse do not work in the same physical location, which is often the case.

The emergence of the home care pharmacist.

As the fastest growing ambulatory care market in the United States, home care provides a challenging opportunity for pharmacists, but this opportunity has yet to be fully realized. This article will explore the potential for pharmacists in home care and barriers that have kept pharmacists from becoming full-fledged members of the home care team.

Developing an organizational ethos.

A code of ethics and an ethics committee are tools that can improve the quality of the ethical judgment calls that home care agencies and their hands-on providers face daily.

Ethical problems in home healthcare.

The introduction of sophisticated technology and the increased complexity of client care have caused a concomitant increase in ethical concerns in home care. In this pilot study, the author examined ethical problems from the perspectives of home care providers. The most common type of ethical problems cited were difficulties with payer regulations and the competence of coworkers.

Legal implications of withholding and withdrawing medical treatment.

It is important that home care providers be aware of recent developments in the law and public policy regarding terminal care decisions, as well as develop guidelines that both avoid legal and regulatory difficulties and ensure that the client is treated with dignity.

Whistleblowing in the OR: the ethical implications.

1. Whistleblowing highlights the positive social behavior that is intended to benefit others while concealing what is sometimes considered disloyal behavior. 2. Loyalty is one of the most important ethical values, but failure to recognize the limits of loyalty can lead to seriously unethical outcomes. 3. It is critical that the nurse contemplating whistleblowing exhaust all internal resources to resolve the wrongdoing before going outside the organization.