Antimicrobial Resistance in Enterobacterales Bacilli Isolated from Bloodstream Infection in Surgical Patients of Polish Hospitals.

BACKGROUND AND AIMS: Bloodstream infections (BSIs) are one of the most frequently observed hospital-acquired infections (HAIs). We sought to describe the epidemiology and drug resistance secondary Enterobacterales BSIs in surgical patients and check for any correlation with the type of hospital ward. MATERIALS AND METHODS: This multicenter (13 hospitals in southern Poland) laboratory-based retrospective study evaluated adults diagnosed with BSI secondary to surgical site infection (SSI) hospitalized in 2015-2018; 121 Enterobacterales strains were collected. The drug resistance was tested according to the EUCAST recommendations. Tests confirming the presence of extended-spectrum ß-lactamases (ESBLs) and bla resistance genes were carried out. The occurrence of possible clonal epidemics among K. pneumoniae strains was examined. RESULTS: The prevalence of Enterobacterales in secondary BSI was 12.1%; the most common strains were E. coli (n = 74, 61.2%) and Klebsiella spp. (n = 33, 27.2%). High resistance involved ampicillin and ampicillin/sulbactam (92, 8-100%), fluoroquinolones (48-73%), and most cephalosporins (29-50%). Carbapenems were the antimicrobials with the susceptibility at 98%. The prevalence of ESBL strains was 37.2% (n = 45). All the ESBL strains had bla CTX-M gene, 26.7% had the bla SHV gene, and 24.4% had bla TEM gene. The diversity of Klebsiella strains was relatively high. Only 4 strains belonged to one clone. CONCLUSIONS: What is particularly worrying is the high prevalence of Enterobacterales in BSI, as well as the high resistance to antimicrobial agents often used in the empirical therapy. To improve the effectiveness of empirical treatment in surgical departments, we need to know the epidemiology of both surgical site infection and BSI, secondary to SSI. We were surprised to note high heterogeneity among K. pneumoniae strains, which was different from our previous experience.

Revision of 116 orthognathic surgery patients operated on with the high-oblique sagittal osteotomy (HOSO): a retrospective case series (PROCESS-compliant article).

BACKGROUND: The high-oblique sagittal osteotomy (HOSO) is an alternative to a bilateral sagittal split osteotomy (BSSO). Due to its novelty, there are no long-term studies which have focused on describing the incidence and type of complications encountered in the post-operative follow-up. The aim of this retrospective study is to analyze patients operated on with this surgical technique and the post-operative complications encountered. PATIENT AND METHODS: The electronic medical records of all patients treated with orthognathic surgery at the Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany, between the years 2009 and 2016 were retrospectively reviewed. RESULTS: A total of 116 patients fulfilled the inclusion criteria. The cases operated on with the standard osteosynthesis (X, Y, and straight) showed a complication rate of 36.37% (n = 4/11). The cases operated on with the HOSO-dedicated plates (HOSO-DP) showed, in total, a complication rate of 6.67% (n = 7/105). The most common post-operative complication resulting from both fixation methods was a reduction in mouth opening and TMJ pain for 4.3%. During the first years of performing the surgery (2009-211), a variety of standard plates had material failure causing non-union or pseudarthrosis. No cases of material failure were observed in the cases operated on with the HOSO-DP. The statistical results showed a highly significant dependence of a reduction in OP-time over the years, when the HOSO was performed without additional procedures (R2 > 0.83, P < 0.0015). CONCLUSION: The rate of complications in the HOSO were shown to be comparable to the rate of complications from the BSSO reported in the literature. Moreover, the use of the ramus dedicated plate appears to provide enough stability to the bone segments, making the surgery safer. CLINICAL RELEVANCE: The HOSO needs to be considered by surgeons as an alternative to BSSO. Once the use of the HOSO-DP was established, the rate of complications and the operation time reduced considerably.

Factors affecting atmospheric radon concentration, human health.

We studied the influence of terrain, geology and weather condition on radon concentration in the atmosphere and occurrence of radon density currents. The survey was carried out in Kowary (SW Poland) and in the spoil tip formed during uranium mining. The measurements of radon concentration were performed using SSNTD LR-115. The measurements of uranium thorium and potassium content in soil were carried out using gamma ray spectrometer Exploranium RS-230. We noticed that terrain and stability of weather condition had significant impact on atmospheric radon concentration. The seasonal variations of radon concentrations in Kowary differ from those usually registered in temperate climate. Based on our analyses, the increase of radon concentration in winter and spring was caused by inversion occurring in that area during these seasons. The observed seasonal variations of radon concentrations in the spoil tip were consistent with those characteristic for temperate climate (the highest radon concentration registered in spring and summer and the lowest in winter and autumn). The spoil tip is located above 900m a.s.l. and is not cover by grass or trees. These circumstances promoted radon exhalation. The air movement above the spoil tip area is intensive, even in winter time. The average atmospheric radon concentration in the spoil tip was 318Bqm-3. The performed research did not reveal occurrence of radon density currents and flow of radon from the spoil tip to lower lying areas in Kowary. We noticed interdependence of atmospheric radon concentration measured at the height of 1.5 above the ground and uranium content in soil and no correlation between thorium content and radon concentration. The lung cancer in residents of Kowary which is more common than in Poland can be associated with increased concentrations of radon. The average radon concentration in the atmosphere in Kowary was 79Bq m-3.

Parenteral nutrition in patients with inborn errors of metabolism - a therapeutic problem.

BACKGROUND: Parenteral nutrition is now a standard part of supportive treatment in pediatric departments. We describe four cases in which parenteral nutrition was extremely difficult due to coincidence with inborn errors of metabolism. The first two cases was fatty acid beta-oxidation disorders associated with necrotizing enterocolitis and congenital heart disease. Thus, limitations of intravenous lipid intake made it difficult to maintain a good nutritional status. The third case was phenylketonuria associated with a facial region tumour (rhabdomyosarcoma), in which parenteral nutrition was complicated because of a high phenylalanine content in the amino acid formulas for parenteral nutrition. The fourth patient was a child with late-diagnosed tyrosinemia type 1, complicated with encephalopathy - during intensive care treatment the patient needed nutritional support, including parenteral nutrition - we observed amino acid formula problems similar to those in the phenylketonuria patient. Parenteral nutrition in children with inborn errors of metabolism is a rare, but very important therapeutic problem. Total parenteral nutrition formulas are not prepared for this group of diseases.

Safety of a non-adjuvanted therapeutic vaccine for the treatment of feline dermatophytosis.

The safety of a non-adjuvanted inactivated fungal vaccine for the treatment of dermatophytosis in cats was investigated in two studies: a controlled laboratory study, and a placebo-controlled double-blind field study with a cross-over design in Europe. In the laboratory study, two groups of 10 cats each were administered an intramuscular twofold overdose, followed by five single 1 ml doses, of either vaccine or control product at 14-day intervals. In the field study, cats were treated with three intramuscular injections of 1 ml vaccine administered at 14-day intervals, as recommended by the manufacturer. A total of 89 cats were enrolled in the field study and divided into two groups to receive either vaccine or placebo for the first three treatments, followed by the opposite product for the final three treatments. The cats enrolled in the two studies were 12 weeks of age or older, as recommended by the manufacturer. All the cats were monitored closely for possible injection site reactions, systemic reactions (including changes in rectal body temperature) and adverse events. The results from both studies showed no significant differences between the vaccinated cats and the control or placebo-treated cats with regard to local or systemic reactions. A few mild to moderate local reactions were noted, but these were evenly distributed between the vaccinated and placebo-treated cats and resolved within a few days. No severe or serious adverse events related to the vaccinations were observed.

In vitro anti-HIV activity of five selected South African medicinal plant extracts.

AIM OF THE STUDY: Five South African medicinal plants, Bulbine alooides (L.) Willd. (Asphodelaceae), Crinummacowani Baker (Amaryllidaceae), Hypoxis sobolifera var. sobolifera (Jacq.) Nel (Hypoxidaceae), Leonotisleonurus (L.) R.Br. (Lamiaceae) and Tulbaghiaviolacea Harv (Liliaceae) used for the treatment of various ailments, including infectious diseases, were screened for activity against human immunodeficiency virus (HIV). MATERIALS AND METHODS: Aqueous and ethanol extracts were tested for inhibitory activity in HIV-1 infected CEM.NK(R)-CCR5 cells, and against HIV-1 reverse transcriptase (RT) and HIV-1 protease (PR). RESULTS: In CEM.NK(R)-CCR5 cells, ethanol extracts of Leonotisleonurus inhibited HIV-1 significantly (33% reduction in HIV-1 p24, P<0.05). HIV-1 RT inhibition (> or =50%) was shown for extracts of Bulbine alooides (aqueous and ethanol), Hypoxis sobolifera (aqueous and ethanol) and Leonotisleonurus (aqueous), but inhibitory activity was lost upon dereplication for removal of non-specific tannins/polysaccharides. HIV-1 PR inhibition was observed for extracts of Hypoxis sobolifera (aqueous), Bulbine alooides (aqueous and ethanol) and Leonotisleonurus (ethanol). Only ethanolic extracts of Bulbine alooides and Leonotisleonurus retained HIV-1 PR inhibition after dereplication with IC50 of 94 microg/ml and 120 microg/ml, respectively. CONCLUSION: The dereplicated ethanolic extracts of Leonotisleonurus and Bulbine alooides showed the greatest anti-HIV potential in this study through inhibition of HIV-1 PR.

Reversible cerebral hyperperfusion syndrome after stenting of the carotid artery - two case reports.

Hyperperfusion syndrome can complicate carotid revascularization, be it endarterectomy or carotid artery stenting (CAS). Although extensive effort has been devoted to reducing the incidence of ischemic stroke complicating CAS, little is known about the incidence, etiology, and prevention strategies for hyperperfusion following CAS. We report two cases (female patients 72 and 81 years) presenting severe internal carotid stenosis (> 90%), who underwent presurgical and therapeutic intervention with CAS. Both patients developed hyperperfusion symptoms at 2 hours and at 30 minutes, respectively, following stenting, in both cases unilateral hyperperfusion was CCT confirmed. Case 1 was presenting with acute edema of the right hemisphere, case 2 with distended focal edema (left fronto-temporoparietally). Hyperperfusion syndrome and neurological symptoms retroceded in both cases (conservative therapy) and both patients returned to full activity (case 2 within 48 hours).

[The role of infusion fluids and blood derived preparations during the perioperative period]. / Miejsce plynów infuzyjnych i krwiopochodnych w okresie okolooperacyjnym.

The treatment with infusion fluids in perioperative period is a basic therapeutic method. Depending on clinical situation, the doctor has various fluids available, both blood-replacing, and blood-derived. The number of crystaloid and colloidal fluids used has been systematically growing in two last decades. Ever more importance, beside the 0.9% NaCl solution and Ringer's solution used, is gaining 7.5% NaCl solution and hydroxyethyl starch solutions. The production of hydroxyethyl starch solutions in Poland has created an alternative to the use of dextran and gelatin solutions. The change towards treatment with blood components has caused the change of the strategy of therapeutic management of patients used as yet. For compensation of oxygen demand during blood loss, erythrocyte concentrate is commonly used. Such management requires blood-clotting factor monitoring. Hypofibrinogenaemia develops earlier than deficiencies of the remaining blood-clotting factors and later than thrombocytopenia. The use of fresh frozen plasma (FFP) is the first step in the treatment of pathological bleeding in surgically treated patients. The occurrence of thrombocytopenia shows great individual variability. Thrombocyte concentrate transfusion should be performed after laboratory determination of thrombocyte count.

[Results of the activity of Jose Carreras Memorial Cord Blood Bank in Warsaw]. / Podsumowanie dzialalnosci Banku Krwi Pepowinowej im. Jose Carrerasa w Warszawie.

Following the first successful cord blood transplantation in 1988, several hundreds of patients were treated using same protocol. The main limitation of the wide use of cord blood as a source of haematopoietic cells is the number of available units of this tissue. To make possible selection of HLA-matched cells for individual patient, several thousands of cord blood samples must be collected and stored in liquid nitrogen. The network of cooperating cord blood banks with join accessible database is necessary. In this paper the activity of Jose Carreras memorial Cord Blood Bank established in Warsaw was described. Since the middle of January the collection of cord blood units for clinical purposes was started. During first three months 80 samples of cord blood was collected. Collections were obtained from normal full-term deliveries after the third stage of labour. For the banking the collection over 60 ml or contain over 4 x 10(8) of mononuclear cells were qualified. Whole blood samples and plasma samples obtained following volume reduction were used for HLA and bacteriology tests. After volume reduction the number of nucleated cells (WBC), mononuclear cells (MNC) and hematopoietic cells (CD34+) were evaluated. After processing the cord blood samples were frozen using control freezer and were stored in liquid nitrogen storage tanks. According to results of cord blood transplantation hundred percent of banked samples are suitable for recipients weighing 10 kg and only 7 percent for these weighing 50 kg.

[Comparison of the selected methods of cord processing for transplantation purposes]. / Porównanie wybranych metod preparatyki krwi pepowinowej przeznaczonej dla celów transplantacyjnych.

Human umbilical cord blood (UCB) has been successfully used as a source of allogeneic hematopoietic cells for transplantation. Banking of the UCB requires its volume reduction to decrease storage space, costs and volume of infused DMSO. In order to select an optimal method for volume reduction we compared several methods of cord blood processing, namely buffy coat centrifugation, red cell lysis, hydroxyethyl starch (HES)-, methylcellulose- and gelatin-sedimentations. The viability of cells and the recoveries of total white blood cells, mononuclear cells and CD34+ cells was evaluated. We also compared the efficacy of red cells depletion from the original UCB sample. Buffy coat centrifugation, red cell lysis, HES, gelatin or methylcellulose resulted in high mononuclear cell recoveries, whereas high hematopoietic cell recovery was observed only after HES sedimentation and buffy coat processing. The HES sedimentation procedure compared to buffy coat processing is more time and labor consuming and resulted in higher red blood cell and platelets depletion. Both methods can be recommended as a method at choice for the umbilical cord blood processing before banking.

[Subcutaneous immunoglobulin infusion in antibody deficiency substitution of a patient sensitized to intravenous immunoglobulins. Case report]. / Podskórne infuzje immunoglobulin w substytucji niedoboru przeciwcial u chorej uczulonej na immunoglobuliny dozylne. Opis przypadku.

Patients with severe form of common variable immunodeficiency require chronic immunoglobulin substitution. However, intravenous Ig administration may not be possible in some of them because of serious anaphylactoid reactions. It has been suggested that such patients may tolerate well Ig administration by subcutaneous infusion. A case is described (originally with IgG level of 53 mg/dl) who reacted with anaphylactic shock to intravenous immunoglobulin and now for more than 7 months at 1-2 week intervals receives immunoglobulin by subcutaneous infusion without any adverse reactions and maintaining IgG level above 400 mg/dl. In contrast to the period proceeding immunoglobulin substitution, the patient remains free of bacterial infection during last 7 months.

[Class II HLA antigens in patients with multiple sclerosis from Warsaw and Gdansk regions]. / Antygeny HLA II klasy u chorych na stwardnienie rozsiane z regionu Warszawy i Gdanska.

An investigation of class II histocompatibility antigens was carried out in patients with definite diagnosis of multiple sclerosis (MS) according to Poser's criteria. There were 42 patients from Warsaw and 98 patients from Gdansk. Histocompatibility antigens were assayed with microlymphocytotoxicity test. 6 antigens on locus DR and 1 antigen on locus DQ were evaluated. The antigen frequencies were compared in the two groups using the chi-square test. The antigen HLA-DQw1 occurred significantly more frequently in MS patients compared to healthy control group. Antigens HLA-DR2 and DR3 occurred more frequently in patients from Gdansk than Warsaw region.

[Treatment of myocardial infarction by primary PTCA within 12 to 24 hours after onset of pain]. / Myokardinfarkt-Therapie mit primärer PTCA innerhalb von 12 bis 24 Stunden nach Schmerzbeginn.

BACKGROUND AND OBJECTIVE: The time elapsed until effective infarct vessel perfusion has been identified as an essential determinant of survival after acute myocardial infarction (MI). Significant mortality rate reduction has not been demonstrated for patients who received thrombolytic treatment more than 12 to 24 hours after MI. For this reason such patients have so far largely been denied reperfusion treatment and have thus been excluded from any potential benefit of an reopened infarct vessel. It was the aim of this study to assess the applicability and safety of achieving reperfusion by percutaneous transluminal coronary angioplasty (PTCA) without prior thrombolysis (primary PTCA) within 12 (> 12) to 24 (< or = 24) hours after onset of pain, taking into account early and late results in selected consecutive patients. PATIENTS AND METHODS: The data were analysed retrospectively of 35 patients (29 men, 6 women; mean age 60 [49-78] years) who had been admitted and treated by primary PTCA for MI more than 12-24 hours after onset of pain, with persisting ECG changes and (or) continuing chest pain. Reperfusion rates, acute haemodynamic parameters, acute cardiac and noncardiac complications, 30-day mortality rate, 3-month angiographic results and late mortality rate were obtained after an average of 23 (4-36) months. RESULTS: Complete infarct vessel reperfusion was achieved in 30 patients (85.7%), the infarct vessel remaining occluded in five. The early measurement of mean left ventricular ejection fraction was 53% (8-76%). A small, conservatively managed pericardial effusion occurred in one patient due to coronary artery penetration. Three patients who were in cardiogenic shock on admission died (8.6% 30-day mortality rate). Nine cases of restenosis and two of re-occlusion of the infarct vessel were documented in 24 patients who were investigated invasively 3 months after the primary PTCA. One patient had sustained a nonfatal MI. During the follow-up period one patient died of a noncardiac cause. INTERPRETATION: In this selected group of patients who received treatment more than 12 to 24 hours after MI primary PTCA achieved a high rate of reperfusion, while early and late complications were rare. Using individualized criteria of patient selection, primary PTCA can accomplish recanalization. The question of prognostic advantage can only be answered by results in a larger and randomized cohort of patients.

[Humoral response in hepatitis C infections: types of anti-HCV and reactivity evaluated using BLOT-index]. / Odpowiedz humoralna w zakazeniach wirusem C zapalenia watroby; rodzaje anty-HCV i typy reaktywnosci oceniane wskaznikiem BLOT-indeks.

In this paper an attempt has been made at quantitative evaluation of reactivity of various types anti-HCV using proposed BLOT-index. We based our research on 20 patients diagnosed with hepatitis-C (clinical, biochemical, serological and enzymatical criteria--repeatedly positive results of second generation screening tests EIA ABBOTT HCV and UBI HCV Monoelisa Organon Teknika) who were anti-HCV determined at the beginning the acute phase and after 3 and 6 months. Multiantigen tests were used veryfying LIATEK-HCV 2 and LIATEK-HCV 3 Organon Teknika. Value of BLOT-index was algebraic sum of "pluses" for particular anti-HCV. Three models of dynamics of BLOT-index were observed: increase, plateau and decrease. Statistically significant differences between values of BLOT-index were shown at the beginning of the acute phase of hepatitis-C and after 6 months. There were no differences observed between convalescents and patients who developed chronic hepatitis-C (test t-Student's and f-Fisher's). Reactivity of anti-HCV, evaluated using BLOT-index, shown increasing trend, which is a dominant pattern, however quantitative and qualitative changes do not occur more frequently than every 6 months. The LIATEK-HCV 3 gives fewer undetermined reactions and detects anti-HCV earlier than a former generation of this test.

High serum levels of allergen specific IgG-4 (asIgG-4) for common food allergens in healthy blood donors.

High serum levels of asIgG-4 against common food allergens are found in many patients with symptoms suggesting food allergy. The same patients are frequently negative for allergen specific IgE (asIgE) against the same allergens. These data were frequently interpreted as suggestive of a role of asIgG-4 in food allergy. In order to evaluate this hypothesis we tested serum levels of asIgG-4 against food allergens in young blood donors without any signs or history of food allergy. Fifty young healthy male donors were evaluated. The serum levels of IgE, and asIgE and IgG-4 against 14 common food allergens were determined. The studies were carried out using commercially available 3M Diagnostics Systems kits. AsIgG-4 against food allergens were found in sera of 92% blood donors, and in 62% of these healthy persons the levels of asIgG-4 were higher than 10.0 micrograms/ml. In a small proportion of patients, high serum levels of IgE and asIgE against the same food and/or inhalant allergens were found. Common occurrence of asIgG-4 against food allergens in healthy persons (without any symptoms which could suggest allergy or food intolerance) argues against the possible participation of these antibodies in the pathogenesis of food allergy. It is possible that their occurrence is the result of immunization against food antigens (allergens). It remains to be resolved whether the presence of these antibodies represents an epiphenomenon or may have some other biological role.

[Glucose-6-phosphate dehydrogenase deficiency in erythrocytes observed in two cases]. / Niedobór dehydrogenazy glukozo-6-fosforanu krwinek czerwonych w swietle obserwowanych dwóch przypadków.

In two male patients the deficiency of G-6-PD in erythrocytes became manifested in 27th year of age with severe hemolytic crisis. In the first case hemolysis appeared after three days of heavy alcohol drinking. There was no evident relation between alcohol and hemolysis. In the second patient (an Iraqi Student) suffering from diabetes since adolescence, hemolysis was provoked by respiratory tract infection, antiinflammatory drugs and concomitant ketosis. Pneumonia, renal insufficiency and acute pancreatitis complicated the course of illness. The patient required a consecutive erythrocyte concentrate transfusions. Aplastic crisis was treated with folic acid.