Ceftolozane/tazobactam in the treatment of osteomyelitis and skin and soft-tissue infections due to extensively drug-resistant Pseudomonas aeruginosa: clinical and microbiological outcomes

Infections due to multidrug-resistant bacteria (MDR) are currently a clinical challenge, mainly in elderly patients. The antimicrobial spectrum, safety and efficacy of ceftolozane/tazobactam (C/T) make it an attractive option for the treatment of MDR bacterial infections beyond the indications approved to date. Here we report our experience with C/T in four cases of osteomyelitis and three cases of skin and soft-tissue infections due to extensively-drug-resistant Pseudomonas aeruginosa.

A soft X-ray beamline for transmission X-ray microscopy at ALBA

The MISTRAL beamline is one of the seven phase-I beamlines at the ALBA synchrotron light source (Barcelona, Spain) that will be opened to users at the end of 2010. MISTRAL will be devoted to cryotomography in the water window and multi-keV spectral regions for biological applications. The optics design consists of a plane-grating monochromator that has been implemented using variable-line-spacing gratings to fulfil the requirements of X-ray microscopy using a reflective condenser. For instance, a fixed-focus condition independent of the included angle, constant magnification as well as coma and spherical aberration corrections are achieved with this system. The reported design is of wider use.

Indoor radon in a Spanish region with different gamma exposure levels

In the beginning of 1990s within the framework of a national radon survey of more than 1500 points, radon measurements were performed in more than 100 houses located in Galicia region, in the Northwest area of Spain. The houses were randomly selected only bearing in mind general geological aspects of the region. Subsequently, a nationwide project called MARNA dealt with external gamma radiation measurements in order to draw a Spanish natural radiation map. The comparison in Galicia between these estimations and the indoor radon levels previously obtained showed good agreement. With the purpose of getting a confirmation of this relationship and also of creating a radon map of the zone, a new set of measurements were carried out in 2005. A total of 300 external gamma radiation measurements were carried out as well as 300 measurements of 226Ra, 232Th and 40K content in soil. Concerning radon, 300 1-m-depth radon measurements in soil were performed, and indoor radon concentration was determined in a total of 600 dwellings. Radon content in soil gave more accurate indoor radon predictions than external gamma radiation or 226Ra concentration in soil.

[Intradialysis hemolysis secondary to hypophosphatemia]

We report a 76-year-old man, stable on a thrice-weekly hemodialysis program over a period of 3 years, who developed acute intradialysis hemolysis secondary to hypophosphatemia, an unusual cause of hemolysis. During the dialysis session we monitored the starting point, the severity and duration of intradialysis hemolysis. Severe hyphosphatemia is a rare cause of intradialysis hemolysis. It is important to think of his possibility to make an adequate diagnosis and treatment. The patient was treated with a phosphorus-enriched acid concentrate, bicarbonate-buffered dialysate, with biochemical and clinical improvement.

Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death

OBJECTIVE

The persistence of cerebral blood flow (CBF) in patients with whole brain death (BD) diagnosis is an unusual phenomenon. We describe patients with whole BD diagnosed despite persistence of intracranial blood flow on transcranial Doppler sonography (TDS).

MATERIALS AND METHODS

From January 2001 to December 2002, we reviewed the records of 11 patients. Etiology of BD was craniocephalic trauma in 2 cases, schemic cerebrovascular accident (CVA) in 4 cases, Hemorrhagic CVA in 3 cases, subaracnoid hemorrhage in 1 case, and acute hydrocephalus in 1 case. Six patients had a cerebral decompressive mechanism. In all patients, TDS was used to confirm BD after clinical diagnosis. Additionally, all patients underwent an electroencephalogram (EEG). In 3 patients cerebral angiography (CA) and in 2 others radionuclide angiography (RA) with Tc99m HMPAO were done.

RESULTS

All TDS studies showed persistent telediastolic positive flow in at least 1 artery. Because the TDS did not confirm the clinical diagnosis of BD, EEG tests were performed showing silence of bioelectrical activity. Those cases showed CA or RA results with a complete absence of CBF.

CONCLUSION

The TDS technique directly evaluates the intracranial but not the intracerebral circulation. For this reason, during the BD diagnosis for patients with previous decompressive techniques, it was possible to find persistence of intracranial telediastolic flow using TDS. In those cases, it is advisable to use other tests to confirm the clinical diagnosis of BD.

Washing machine associated 50 Hz detected as ventricular fibrillation by an implanted cardioverter defibrillator

This case report describes a patient with an automatic ICD who suffered a defibrillation shock without warning symptoms. An electrical interference can be observed in the stored EGM of the episode. The patient explained that the moment he felt the shock he was touching a washing machine. After correct grounding of this machine the patient did not suffer more inappropriate shocks.

[Comparison of ropivacaine and bupivacaine for epidural analgesia during labor]

OBJECTIVES

To compare the analgesic efficacy and level of motor block using two local anesthetics, ropivacaine and bupivacaine, during labor.

MATERIAL AND METHODS

Sixty nulliparous women were enrolled during labor after full-term pregnancies. They were randomly assigned to receive epidural analgesia with ropivacaine (group R) or bupivacaine (group B). Group R patients received 10 ml of 0.18% ropivacaine with 5 microgram/ml of fentanyl followed by continuous epidural infusion of 0.1% ropivacaine with 2 microgram/ml of fentanyl at a rate of 10 ml/h. Group B patients received 10 ml of 0.15% bupivacaine with 5 microgram/ml of fentanyl followed by continuous epidural perfusion of 0.0625% bupivacaine with 2 microgram/ml of fentanyl at the same rate. Pain intensity was assessed on a visual analog scale, motor blockade on a Bromage scale, and level of sensory block at different moments. We also recorded total doses of local anesthetic employed during continuous epidural infusion, manner of final delivery, Apgar score, degree of maternal satisfaction and side effects.

RESULTS

The demographic and delivery characteristics were similar in both groups. We found no statistically significant differences between the two groups for level of motor blockade, which was nil for 29 patients (96.66%) in group R and 28 patients (93.33%) in group B. No differences in degree of pain or level of sensory block (T8-T10 in both groups) were observed. The total doses of local anesthetic used were similar at 23.7 +/- 11.6 mg in group R and 16.5 +/- 7.3 mg in group B (non-significant difference). Nor did we find differences in manner of delivery, neonatal Apgar scores, degree of maternal satisfaction or side effects.

CONCLUSION

Ropivacaine and bupivacaine are equally effective for epidural analgesia during labor at the doses used and they do not cause a relevant level of motor blockade.

[The use of oral amiodarone as a chronic treatment in a patient with prior fulminant hepatitis due to intravenous amiodarone]

Acute hepatitis for intravenous amiodarone is an uncommon problem with scarce appearances in medical literature. Sometimes, it has postulated that the vehicle of the intravenous preparation and not the active principle is the possible cause of this complication. We report a patient with fulminating hepatitis and severe encephalopathy following the administration of intravenous amiodarone. We present also the clinical evolution of the patient after reintroduction of oral amiodarone. In the end, we make a review of the associated literature with our case.

[Impact of anesthetic technic (general anesthesia versus intradural anesthesia) on the immune status]

OBJECTIVE

To study changes in the immune system appearing after general and regional (intradural anesthesia).

PATIENTS AND METHODS

Fifty patients scheduled for elective surgery to repair inguinal hernias were studied. The patients were randomly assigned to 2 groups: group A patients received general anesthesia and group B patients received intradural anesthesia. Blood was extracted 5 times to determine levels of lymphocytes, activated T cells and B lymphocytes, and T-suppressant activity: t0 (before surgery), t1 (1 h), t2 (4 h), t3 (24 h) y t4 (7 days).

RESULTS

The patients in group A showed slight increases in T lymphocytes, activated T lymphocytes and B lymphocytes, whereas T-suppressant activity decreased significantly. All lymphoid population decreased in group B. Baseline levels had recovered in both groups by 7 days after surgery.

CONCLUSION

Anesthetic procedures have an effect on immune responses but the impact is only temporary.

Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol

OBJECTIVE

To assess autonomic and peripheral nervous system function in patients with chronic alcoholism.

DESIGN

A cross-sectional study.

PATIENTS

A consecutive sample of 107 alcoholic patients and 61 controls.

MAIN OUTCOME MEASURE

For autonomic assessment, heart rate variations during deep breathing and Valsalva maneuver and on standing were measured. Blood pressure response to standing up and to sustained handgrip were also evaluated. For assessment of the peripheral nervous system, an electrophysiologic examination was performed.

RESULTS

Alcoholic patients exhibited reduced heart rate variability compared with controls (P < .01, on all parasympathetic tests), whereas no differences in the mean values of the blood pressure responses between both groups were found. Twenty-six patients (24.3%) had criteria of autonomic neuropathy, and 34 (32%) had electrophysiologic criteria of peripheral neuropathy. None of the controls exhibited criteria of autonomic neuropathy, and only one had criteria of peripheral neuropathy. The estimated total lifetime dose of alcohol correlated inversely with the parasympathetic indexes (r = -.48 to -.51; P < .001 on all parasympathetic tests) and the sensory potential amplitudes of upper and lower limbs (r = -.43; P < .001, both limbs). Finally, a significant correlation between autonomic and peripheral neuropathies was observed (P = .01). By contrast, these lesions were not related to age, nutritional status, or other alcohol-related diseases.

CONCLUSIONS

Autonomic and peripheral neuropathies are common among hospitalized alcoholic patients. Alcohol appears to be toxic to autonomic and peripheral nerves in a dose-dependent manner.