Aetiology and resistance patterns of community-acquired pneumonia in León, Nicaragua

We conducted a prevalence study to gain greater insight into the aetiology, bacterial resistance and risk factors for community-acquired pneumonia (CAP) in the region of León, Nicaragua. During the period from July 2002 to January 2005, all consecutive patients with signs and symptoms suggestive of CAP were included in the study. Sputum samples, paired serum samples and urinary samples were collected for the detection of respiratory pathogens. The most frequently identified pathogens were Streptococcus pneumoniae (17%), followed by Staphylococcus aureus (5%), Chlamydia pneumoniae (5%) and Mycoplasma pneumoniae (4%). Pseudomonas aeruginosa was cultured from 5% of patients. No pathogens were identified in 55%. All tested S. pneumoniae were sensitive to erythromycin and penicillin. In contrast, resistance of S. aureus to penicillin and erythromycin was high.

Temporal evolution of polycyclic aromatic hydrocarbons (PAHs) in sludge from wastewater treatment plants: comparison between PAHs and heavy metals

This paper presents results on the presence and temporal variability of the 16 PAHs recommended by the EPA in primary, secondary and digested sewage sludge over a year. The sewage sludges originated from the Guadalete wastewater treatment plant (WWTP) site in Jerez de la Frontera (Cádiz, Spain). These organic pollutants have been extracted from the sewage sludge by microwave energy. High performance liquid chromatography coupled with diode array (HPLC-DAD) or fluorescence (HPLC-FL) detectors have been used. The results showed that total PAHs concentration varied between 1,945 ng g(-1) dry matter (DM) for primary sludges collected in March and 10,100 ng g(-1) DM for primary sludge collected in June. Generally, concentrations of PAHs were higher in compost and digested sludge than in fresh one. On the other hand, the highest concentration of PAHs were found on summer. This thing is associated to the traffic increase from inland zones to the coast (Jerez de la Frontera is very near to beaches). Finally, this paper present a comparative study of the American an European legislation concluding that the limits of concentrations established are not exceeded. In addition heavy metals were analysed. The origin of PAHs and heavy metals seems to be different.

[Acute myocardial infarction during tocolytic treatment with ritodrine]

Ritodrine, a beta2-adrenergic agonist with a selective effect on the uterine muscle, is prescribed to prevent premature labor and to treat a hypertonic uterus. At therapeutic doses ritodrine has chronotropic and peripheral vasodilator effects. At high doses it has been related to sporadic cases of subendocardial necrosis, pulmonary edema, and death in pregnancy. We report the case of a pregnant woman who had a non-Q wave acute myocardial infarction after administration of ritodrine.

[Comparison of 2 techniques for combined spinal-epidural analgesia for advanced labor in childbirth]

OBJECTIVES

To assess whether using a needle-locking device in combined spinal-epidural analgesia leads to better quality of pain relief for advanced stages of obstetric labor than can be achieved with conventional materials.

PATIENTS AND METHODS

A total of 230 women in advanced labor were randomized to 2 groups. In both groups the needle-through-needle technique was used. In group N we used a new technique with a Tuohy needle and a system for locking the spinal needle (27-gauge, pencil-point design). The conventional technique (group C) made use of the same Tuohy needle and spinal needle without the needle-locking device. The variables considered were patient characteristics, anesthesiologist, number of attempts and level of difficulty in carrying out the procedure, pain on a simple verbal visual analog scale before the procedure and 5 minutes later, latency, motor block, duration of spinal analgesia, complications, type of expulsion, and maternal satisfaction.

RESULTS

The 2 groups were similar with respect to all studied variables except duration of spinal analgesia (longer in group N, P<0.001); VAS after 5 minutes (lower in group N, P<0.010); latency (shorter in group N, P<0.001); lateralization (less in group N, P=0.034), and maternal satisfaction (greater in group N, P=0.037).

CONCLUSIONS

The use of devices specifically designed for administering combined spinal-epidural analgesia in advanced stages of labor provides faster pain relief, longer duration of analgesia, and greater maternal satisfaction without increasing the incidence of complications.

Fractionation of heavy metals in sludge from anaerobic wastewater stabilization ponds in southern Spain

The analysis of heavy metals is a very important task to assess the potential environmental and health risk associated with the sludge coming from wastewater treatment plants (WWTPs). However, it is necessary to apply sequential extraction techniques to obtain suitable information about their bioavailability or toxicity. In this paper, a sequential extraction scheme according to the Standard, Measurements and Testing Programme of the European Commission was applied to sludge samples collected from ten anaerobic wastewater stabilization ponds (WSPs) located in southern Spain. Al, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Ti and Zn were determined in the sludge extracts by inductively coupled plasma atomic emission spectrometry. In relation to current international legislation for the use of sludge for agricultural purposes, none of the metal concentrations exceeded maximum permitted levels. Overall, heavy metals were mainly associated with the two less-available fractions (34% oxidizable metal and 55% residual metal). Only Mn and Zn showed the highest share of the available (exchangeable and reducible) fractions (25-48%).

Mise en place de l'équipe d'intervention gériatrique et de l'évaluation gériatrique aux urgences de l'hôpital Henri-Mondor

BACKGROUND

The official French demographic previsions are a growing number of the older than 75 years elderly people. The Emergency services face this demographic evolution. We describe the establishment of the geriatric intervention group at the emergency of the Henri-Mondor university hospital at Creteil (France) and analyse the results of the geriatric assessment at the short unit care during the first four months.

METHODS

We analysed the results of the geriatric assessment of 206 patients during the first four months, by considering the final unit care. The geriatric assessment evaluates functional abilities, cognitive status and thymic function with elderly people validated tests and subjective assessment of nutrition status and the sensorial functions.

RESULTS

The statistical analysis of the geriatric assessment results was significant among the different hospitalized groups of patients, for the cognitive status, the nutritional risk and the walk and standing evaluation.

CONCLUSION

The results of the geriatric assessment at emergency showed cognitive impairment and gait abnormality in elderly patients were at risk of hospitalization.

Influence of cadmium on the performance of an activated SBR sludge treatment

High concentration of heavy metals is a toxic factor for most microorganisms. As a result, such metals give rise to severe disruption in wastewater treatment operations. It has been noticed, however, that biological systems may adapt to heavy metals when their concentration is limited. In fact, such systems can even produce some degree of metal elimination provided that an optimal exposure tempo is guaranteed. On the other hand, irreversible damage may occur when metal concentration is sufficiently high. It is the aim of the present study to report on the inhibiting effects due to Cadmium on the activated sludge treatment method. To that end, different Cd concentrations were tested (ranging from 0.25 to 14 mg l(-1)) in a Sequential Biological Reactor, using synthetic wastewater without recirculation. The feed water providing 325 mg l(-1) COD and 30 mg l(-1) NH4+ -N. The process was screened by checking elimination percentages for COD and ammonia, as well as the evolution of ciliate protozoa. In addition, research was carried out on Cd assimilation by the activated sludge system by means of measuring in the mixed liquor and in the effluent. Results showed a marked decrease in purification efficiency when Cd-concentration rose over 14 mg l(-1), in which case COD elimination dropped from 98% to 41% while ammonia elimination went down from 98% to 32%. The Sludge Biotic Index decreases to 0 at Cd concentrations above 10 mg l(-1).

Speciation as a screening tool for the determination of heavy metal surface water pollution in the Guadiamar river basin

The Guadiamar river basin has traditionally received pollutants from two main sources: in its northern section of mining origin, and in its southern section (next to Doñana National Park) from urban-industrial and agricultural sources. In April 1998, the spill of 6 million m3 of mining wastes (acidic waters and sludge) severely polluted the Guadiamar river basin with heavy metals, which caused serious damage to the local ecosystem. There is a direct association between the physicochemical speciation of an element and its toxicity, biological activity, bioavailability, solubility, etc. This work describes a distribution study of the metals Zn, Cd, Pb and Cu by speciation analysis of surface waters in eleven sampling points of the Guadiamar river basin. Four metal fractions were determined using anodic stripping voltammetry: labile metal forms, H+ exchangeable metal forms, strongly inert forms (associated with organic and inorganic matter in solution), and forms associated with suspended matter. Total concentrations in surface waters followed the trend Zn > Cu > Pb > Cd. The speciation study showed that Zn and Cd were present to a large extent in available forms (labile and H+ exchangeable), while Pb and Cu were found mostly in the less available forms (strongly inert). Moreover, the available forms were found in the northern section (mining pollution) and the strongly inert forms in the southern section (urban, industrial and agricultural pollution). These results can illustrate the potential value of speciation to discern between different sources of pollution.

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.

Micro-organism re-growth in wastewater disinfected by UV radiation and ozone: a micro-biological study

A series of disinfection experiments using UV radiation and ozone was performed on the secondary effluent from a wastewater treatment plant at a pilot plant scale. The microbial population in the inflowing wastewater and the treated outflow water were quantified for each of the treatment modules (fecal coliforms, fecal streptococci, Salmonella spp. (presence/absence), Clostridium Sulphite-reducers, Pseudomonas aeruginosa, Staphylococcus aureus, coliphages, nematodes, intestinal nematodes and pathogenic fungi). Treated water was stored in opaque tanks at a temperature between 20 and 22 degrees C, after which, a one-month study of the regrowth of the bacterial flora, nematodes and fungi was carried out. Clostridium Sulphite-reducers, pathogenic fungi and nematodes were the micro-organisms showing a greatest degree of resistence to UV- and Ozone-treatment. It was only concerning Clostridium and Pseudomonas abatement that significant elimination results were achieved with both technologies.

Tuberculosis screening among immigrants holding a hunger strike in churches

SETTING

In January 2001, approximately 600 immigrants held a sit-down and hunger strike in several churches in Barcelona to force the Spanish government to comply with demands to regulate their immigration status. Following the diagnosis of a case of smear-positive pulmonary tuberculosis (TB) in one of the immigrants, we performed a large contact investigation.

OBJECTIVES

To describe contact investigation procedures used in this setting and to evaluate contact investigation results.

METHODS

Demographic variables were collected, and tuberculin skin tests (TST) and chest radiograph examinations were performed. Odds ratios (OR) with 95% confidence intervals (CI) were calculated and logistic regression was used for multivariate analyses.

RESULTS

A total of 541 TSTs were performed. Of these, 86% were read and 40.5% yielded a positive reaction with an induration >14 mm. In a multivariate analysis, the risk of presenting a TST induration >14 mm was found to be three times higher among those aged >35 years compared to those <24 years (OR 3.40; 95%CI 1.76-6.59), and for immigrants from Bangladesh (OR 3.14; 95%CI 1.16-6.10) and Pakistan (OR 2.04; 95%CI 1.11-3.73) compared to those from India. A total of 314 chest radiographs examinations were performed and three additional cases of TB were identified, yielding a TB prevalence of 0.7%.

CONCLUSIONS

By focusing efforts and conducting targeted TB screening in this high-risk population, it was possible to complete the intervention in only 3 days. A high prevalence of TB infection and TB disease was found.

Huntington's disease-like 2 can present as chorea-acanthocytosis

Three patients from a previously described family with autosomal dominant chorea-acanthocytosis were found to have the CTG trinucleotide repeat expansion mutation of the junctophilin-3 gene associated with Huntington's disease-like 2 (HDL2). One of six previously identified patients with HDL2 had acanthocytosis on peripheral blood smear, suggesting that HDL2 should be considered in the differential of chorea-acanthocytosis.

Screening for carbohydrate-binding proteins in extracts of Uruguayan plants

The presence of carbohydrate-binding proteins, namely lectins, -galactosidases and amylases, was determined in aqueous extracts of plants collected in Uruguay. Twenty-six extracts were prepared from 15 Uruguayan plants belonging to 12 Phanerogam families. Among them, 18 extracts caused hemagglutination (HAG) that was inhibited by mono- and disaccharides in 13 cases, indicating the presence of lectins. The other 8 extracts did not cause any HAG with the four systems used to detect HAG activity (rabbit and mouse red cells, trypsin-treated rabbit and mouse red cells). For the extracts prepared from Solanum commersonii, HAG activity and HAG inhibition were similar for those prepared from tubers, leaves and fruits, with the chitocompounds being responsible for all the inhibitions. Purification of the S. commersonii tuber lectin was carried out by affinity chromatography on asialofetuin-Sepharose, and SDS-PAGE under reducing conditions gave a single band of Mr of approximately 80 kDa. The monomer N-acetylglucosamine did not inhibit HAG induced by the purified lectin, but chitobiose inhibited HAG at 24 mM and chitotriose inhibited it at 1 mM. -Galactosidase activity was detected in leaves and stems of Cayaponia martiana, and in seeds from Datura ferox. Only traces of amylase activity were detected in some of the extracts analyzed. The present screening increases knowledge about the occurrence of carbohydrate-binding proteins present in regional plants.

Effects of increasing dietary niacin on growth performance and meat quality in finishing pigs reared in two different environments

We conducted two experiments to determine the effects of added dietary niacin on growth performance and meat quality in finishing pigs. Pigs were blocked by weight and assigned to one of six dietary treatments in both experiments. Dietary treatments consisted of a corn-soybean meal-based control diet (no added niacin) or the control diet with 13, 28, 55, 110, or 550 mg/kg of added niacin. In Exp. 1, pigs were housed at the Kansas State University research from with two pigs per pen (six pens per treatment per sex). In Exp. 2, pigs were housed with 26 pigs per pen (four pens per treatment per sex) in a commercial research barn. In Exp. 1, 144 pigs (initially 51.2 kg) were fed diets in two phases (d 0 to 25 and 25 to 62) that were formulated to 1.00 and 0.75% lysine, respectively. In Exp. 2, 1,248 pigs (initially 35.9 kg) were fed diets in four phases (d 0 to 28, 29 to 56, 57 to 84, and 85 to 117), with corresponding total lysine concentrations of 1.25, 1.10, 0.90, and 0.65% lysine, respectively. Added fat (6.0%) was included in the first three phases. In Exp. 1, average daily feed intake tended (quadratic, P < 0.07) to increase then return to values similar to control pigs as dietary niacin increased. Longissimus muscle (LM) 24-h pH (longissimus of pigs fed added niacin) tended to increase (control vs niacin, P < 0.06) for pigs fed added niacin. In the commercial facility (Exp. 2), increasing added niacin improved gain:feed (quadratic, P < 0.01) and subjective color score, and ultimate pH (linear, P < 0.01). Added niacin also decreased (linear, P < 0.04) carcass shrink, L* values, and drip loss percentage. Results from these two studies show that 13 to 55 mg/kg added dietary niacin can be fed to pigs in a commercial environment to improve gain:feed. It also appears that pork quality, as measured by drip loss, pH, and color, may be improved by higher concentrations of added dietary niacin.