Detection, survival, and persistence of Staphylococcus capitis NRCS-A in neonatal units in England

BACKGROUND

The multidrug-resistant Staphylococcus capitis clone, NRCS-A, is increasingly associated with late-onset sepsis in low birthweight newborns in neonatal intensive care units (NICUs) in England and globally. Understanding where this bacterium survives and persists within the NICU environment is key to developing and implementing effective control measures.

AIM

To investigate the potential for S. capitis to colonize surfaces within NICUs.

METHODS

Surface swabs were collected from four NICUs with and without known NRCS-A colonizations/infections present at the time of sampling. Samples were cultured and S. capitis isolates analysed via whole-genome sequencing. Survival of NRCS-A on plastic surfaces was assessed over time and compared to that of non-NRCS-A isolates. The bactericidal activity of commonly used chemical disinfectants against S. capitis was assessed.

FINDINGS

Of 173 surfaces sampled, 40 (21.1%) harboured S. capitis with 30 isolates (75%) being NRCS-A. Whereas S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection. In the absence of cleaning, S. capitis was able to survive for three days with minimal losses in viability (<0.5 log10 reduction). Sodium troclosene and a QAC-based detergent/disinfectant reduced S. capitis to below detectable levels.

CONCLUSION

S. capitis NRCS-A can be readily recovered from the NICU environment, even in units with no recent reported clinical cases of S. capitis infection, highlighting a need for appropriate national guidance on cleaning within the neonatal care environment.

[Management Of Blader Exstrophy In Children At The CHU Gabriel Touré]

AIMS

To describe the clinical and evolutionary aspects of the primary closure of exstrophy at the CHU Gabriel Touré.

MATERIALS AND METHODS

This was a retrospective and prospective study carried out from January 2014 to December 2019 in all the children admitted and operated on for bladder exstrophy at the CHU Gabriel Touré.

RESULTS

We collected 35 cases of exstrophy, ie25 boys and 10 girls. The mean age at diagnosis was 4.8 months. The bladder plate was both normal and budded, ie 28.6% of cases. Plaque infection was found in 45.7%. A malformation was associated in 34.3% of cases. Primary plaque closure was achieved in all of our patients. Postoperative morbidity was 28.6% of cases and mortality 11.4% of cases.

CONCLUSION

Bladder exstrophy is a rare malformation of the urogenital sphere, its management is complex and its mortality is not null.

Hypofractionation in Hepatocellular Carcinoma - The Effect of Fractionation Size

The use of stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC) has increased over the years. Several prospective studies have demonstrated its safety and efficacy, and randomised trials are underway. The advancement in technology has enabled the transition from three-dimensional conformal radiotherapy to highly focused SBRT. Liver damage is the primary limiting toxicity with radiation, with the incidence of grade 3 varying from 0 to 30%. The reported radiotherapy fractionation schedule for HCC, and in practice use, ranges from one to 10 fractions, based on clinician preference and technology available, tumour location and tumour size. This review summarises the safety and efficacy of various SBRT fractionation schedules for HCC.

[Acute bursa of the child in pediatric surgery at the teaching hospital Gabriel Touré]

Acute bursa is a medico-surgical emergency because of its many etiologies threatening the functional prognosis of the testes and their appendages.

OBJECTIVES

Identify the causes of acute bursaries in the child and describe their clinical and therapeutic aspects.

MATERIALS AND METHOD

This was a retrospective descriptive study from January 1, 2010 to December 31, 2015 on all children aged 0 to 15 years received and treated for acute scholarship in the Pediatric Surgery department at the teaching hospital Gabriel Touré.

RESULTS

In 6 years, we registered 42 patients, ie a frequency of 1.4% of surgical emergencies. The mean age was 2.98 years (24 days-14 years). Prematurity represented 11.9% of cases. Painful scrotal tumefaction was the main reason for consultation (76.2%), The main aetiologies were HISE (90.5%), scrotal trauma (4.7%), orchi epididymitis (2.4%) and testicular torsion (2.4%). The treatment was surgical in 97.6% of cases. The course after 3 months was simple in 97.6% of cases.

CONCLUSION

Acute bursa in children is an uncommon condition, especially affecting infants. Strangulated inguino-scrotal hernia was the main aetiology. The diagnosis must be early and the treatment adequate in order to reduce morbidity and mortality.

A Risk Score Model for Locoregional Recurrence Following Upfront Surgery for Pancreatic Adenocarcinoma: Implications for Adjuvant Therapy

AIMS

The aims of the study were to identify predictors of locoregional failure (LRF) following surgery for pancreatic adenocarcinoma, develop a prediction risk score model of LRF and evaluate the impact of postoperative radiation therapy (PORT) on LRF.

MATERIALS AND METHODS

A retrospective review was conducted on patients with stages I-III pancreatic adenocarcinoma who underwent surgery at our institution (2005-2016). Univariable and then multivariable analyses were used to evaluate clinicopathological factors associated with LRF for patients who did not receive PORT. The risk score of LRF was calculated based on the sum of coefficients of the predictors of LRF. The model was applied to the entire cohort to evaluate the impact of PORT on the high- and low-risk groups for LRF.

RESULTS

In total, 467 patients were identified (median follow-up 22 months). Among patients who did not receive PORT (n = 440), predictors of LRF were pN+, involved or close ≤1 mm margin(s), moderately and poorly differentiated tumour grade and lymphovascular invasion. After adding patients who received PORT, the 2-year LRF in the high-risk group was 57% for patients who did not receive PORT (n = 242) and 32% among patients who received PORT (n = 22), with an absolute benefit to LRF of 25% (95% confidence interval 5-52%, P = 0.07). The 2-year overall survival for the high-versus the low-risk group was 36% versus 67% (P < 0.001).

CONCLUSION

This risk group classification could be used to identify pancreatic adenocarcinoma patients with higher risk of LRF who may benefit from PORT. However, validation and prospective evaluation are warranted.

Contribution of Protein Intake and Concurrent Exercise to Skeletal Muscle Quality with Aging

BACKGROUND

The use of magnetic resonance imaging (MRI) derived functional cross-sectional area (FCSA) and intramuscular adipose tissue (IMAT) to define skeletal muscle quality is of fundamental importance in order to understand aging and inactivity-related loss of muscle mass.

OBJECTIVES

This study examined factors associated with lower-extremity skeletal muscle quality in healthy, younger, and middle-aged adults.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Ninety-eight participants (53% female) were classified as younger (20-35 years, n=50) or middle-aged (50-65 years, n=48) as well as sedentary (≤1 day per week) or active (≥3 days per week) on self-reported concurrent exercise (aerobic and resistance).

MEASUREMENTS

All participants wore an accelerometer for seven days, recorded a three-day food diary, and participated in magnetic resonance imaging (MRI) of the lower limbs. Muscle cross-sectional area (CSA) was determined by tracing the knee extensors (KE) and plantar flexors, while muscle quality was established through the determination of FCSA and IMAT via color thresholding.

RESULTS

One-way analysis of variance and stepwise regression models were performed to predict FCSA and IMAT. KE-IMAT (cm2) was significantly higher among sedentary (3.74 ± 1.93) vs. active (1.85 ± 0.56) and middle-aged (3.14 ± 2.05) vs. younger (2.74 ± 1.25) (p < 0.05). Protein intake (g•kg•day-1) was significantly higher in active (1.63 ± 0.55) vs. sedentary (1.19 ± 0.40) (p < 0.05). Sex, age, concurrent exercise training status, and protein intake were significant predictors of KE FCSA (R2 = 0.71, p < 0.01), while concurrent exercise training status and light physical activity predicted 33% of the variance in KE IMAT (p < 0.01).

CONCLUSION

Concurrent exercise training, dietary protein intake, and light physical activity are significant determinants of skeletal muscle health and require further investigation to mitigate aging and inactivity-related loss of muscle quality.

Physicochemical characterisation of fluids and soft foods frequently mixed with oral drug formulations prior to administration to children

Oral drug administration to children poses specific pharmaceutical challenges that are often not seen to the same extent in adults, and whose occurrence may also be age dependent. When an age-appropriate dosage form is not available, manipulation of adult dosage forms (e.g., splitting and crushing of tablets or opening of capsules) has been reported as a means to facilitate administration to children. To enhance swallowability and/or mask an unpleasant taste of the dosage form to be administered, crushed/split tablets or the contents of capsules are often mixed with food or drinks or suspended in a vehicle prior to administration. However, it seems that the risks and benefits of an approach whereby the dosage form is modified prior to administration in this manner are everything but clear. The aim of the present study was to gain an overview of the physicochemical properties of a number of fluids, soft foods and suspension vehicles that are commonly reported to be mixed with oral medications before administration to children to improve patient acceptability. For this purpose, physicochemical parameters of 15 different fluids, soft foods and suspension vehicles were measured. These included pH, buffer capacity, osmolality, surface tension and viscosity. Results of the study clearly show the differences in physicochemical properties of the test candidates. It is thus obvious that the type of fluid/food mixed with a drug product before administration may have a significant impact on bioavailability of the drug administered. Therefore, a risk-based assessment of such practices considering API properties, formulation features and physicochemical properties of the fluids and foods intended to be co-administered with the dosage form, in conjunction with the anatomical and physiological maturity of the gastro-intestinal tract in the intended paediatric population, should be an essential part of paediatric oral formulation development.

Biphasic Effect of Basic Fibroblast Growth Factor on Anterior Pituitary Folliculostellate TtT/GF Cell Coupling, and Connexin 43 Expression and Phosphorylation

Basic fibroblast growth factor (bFGF) is a mitogenic and differentiating cytokine. In the anterior pituitary, folliculostellate (FS) cells constitute the major source of bFGF. bFGF affects endocrine cell proliferation and secretion in the anterior pituitary. In addition, bFGF increases its own expression by acting directly on FS cells. FS cell Cx43-mediated gap junction intercellular communication allows the establishment of an intrapituitary network for the transmission of information. In the present study, we assessed how bFGF regulates FS cell coupling. Time course studies were carried out on the FS cell line TtT/GF. Short-term bFGF treatment induced a transient cell uncoupling and the phosphorylation in Ser368 of membrane-bound Cx43 without modifying Cx43 levels. We demonstrated the involvement of the protein kinase C (PKC) isoform α in the phosphorylation of Cx43 in S368. Moreover, we showed that bFGF induced PKCα activation by stimulating its expression, phosphorylation and association with the plasma membrane. The long-term incubation with bFGF increased TtT/GF cell coupling, total Cx43 levels and Cx43 accumulation at the cell membrane of cytoplasmic projections. The Cx43 level increase was a result of the stimulation of Cx43 gene transcription as mediated by the extracellular-regulated kinase 1/2 signalling pathway. Taken together, the data show that bFGF modulates TtT/GF cell coupling by activating different pathways that lead to opposite effects on Cx43 phosphorylation and expression depending on the duration of the exposure of the cells to bFGF. A short-term bFGF exposure reduces cell-to-cell communication as a mean of desynchronising FS cells. By contrast, long-term exposure to bFGF enhances cell-to-cell communication and facilitates coordination among FS cells.

[HIV prevalence, associated risk factors and evolution among truck drivers from 2001 to 2007 in Guinea]

OBJECTIVE

The purpose of this study was to estimate correlation between HIV prevalence and behavior at risk for infection among truck drivers in Guinea and to report the trends of these indicators from 2001 to 2007.

METHODS

A total of 313 truck drivers in 2001 and 600 in 2007 were selected, interviewed and then tested for HIV infection. Data were analyzed with SAS Windows 9.2.

RESULTS

The prevalence HIV was 7.0% in 2001 and 5.3% in 2007 (p=0.30). Seroprevalence was positively correlated with monogamous marital status [prevalence ratio (PR)=10.00; p=0.02] in 2001, absence from home for longer than a month (PR=2.06; p=0.03), international hauls (PR=2.39; p=0.01), and alcohol consumption (RP=2.00; p=0.04) and negatively correlated with the ability to abstain in risk situations (PR=0.35; p=0.01) in 2007. Comparison of responses obtained in 2001 and 2007 showed a decrease in the number of casual sex partners (p<0.0001) and an increase in condom use (p<0.0001). Comparison also showed a decrease in the number of drivers who reported receiving counseling about HIV/AIDS from NGOs, state health care services and schools (p<0.0001).

CONCLUSION

These two surveys showed high HIV prevalence among Guinean truck drivers in both 2001 and 2007. Condom use increased between 2001 and 2007 but remained inadequate. The correlation between monogamous marriage observed in 2001 was not found in 2007 but other risk factors such as alcohol consumption, prolonged absence from home, and international hauls were observed. The ability to abstain from sex in risk situations was associated with lower seroprevalence. During the study period, a decrease was observed in the number of truck drivers who reported receiving HIV/AIDS counseling from NGOs, state health care services, or schools. Prevention activities against HIV/AIDS must be reinforced in this high-risk population.

Quality control limits for voriconazole disk susceptibility tests on Mueller-Hinton agar with glucose and methylene blue

An international collaborative study was performed in order to propose quality control limits for voriconazole disk diffusion tests on Mueller-Hinton agar with 2% glucose and 0.5 micro g of methylene blue per ml. The supplement may be added to the agar before autoclaving, or Mueller-Hinton agar plates may be flooded with a glucose-methylene blue solution. Replicate tests on both types of agar plates with 1- micro g voriconazole disks generated data to propose zone size limits for tests of Candida parapsilosis ATCC 22019 (28 to 37 mm), Candida albicans ATCC 90028 (31 to 42 mm), and Candida krusei ATCC 6258 (16 to 25 mm). Candida tropicalis ATCC 750 was not useful for this purpose.

Preparation of stock solutions of macrolide and ketolide compounds for antimicrobial susceptibility tests

Stock solutions of telithromycin, ABT-773, azithromycin, clarithromycin, erythromycin, roxithromycin and dirithromycin were each prepared with eight different combinations of solvents and diluents. Broth microdilution trays were then prepared and frozen at -60 degrees C. Standard quality control strains were evaluated periodically during a 12-week storage time. There were no significant changes in MICs with different solvents and diluents. It was concluded that the easiest approach was to dissolve each compound in water with a small volume (< 2.5 microL/mL) of glacial acetic acid added in a dropwise fashion, followed by further dilutions in deionised water.

Quality control limits for fluconazole disk susceptibility tests on Mueller-Hinton agar with glucose and methylene blue

An international collaborative study was performed in order to propose quality control limits for fluconazole disk diffusion susceptibility tests on Mueller-Hinton agar with 2% glucose and 0.5 micro g of methylene blue per ml. The supplements may be added before autoclaving the agar, or Mueller-Hinton agar plates may be flooded with a glucose-methylene blue solution. Replicate tests on both types of agar plates generated data to propose zone size limits for tests of Candida parapsilosis ATCC 22019 (22 to 33 mm), C. tropicalis ATCC 750 (26 to 37 mm), and C. albicans ATCC 90028 (28 to 39 mm). C. krusei ATCC 6258 was not useful for this purpose.

Nurses must now be the champions of older people

The National Service Framework (NSF) for Older People for the first time sets national standards of care for both health and social services (Department of Health (DoH), 2001). The aim of the NSF is to ensure that older people receive high quality, integrated health and social care and that they and their carers are always treated with respect, dignity and fairness. Some might argue that these are basic rights but, as Alan Milburn, the Secretary of State for Health, acknowledges, they are rights that older people are often denied.

Metastable Equilibrium Solubility Distribution of Carbonated Apatite as a Function of Solution Composition

Previous studies have shown that carbonated apatites (CAPs) exhibit the phenomenon of metastable equilibrium solubility (MES) in weak acid media. The purpose of the present investigation was to examine two questions: first, whether the MES concept is applicable to a broader range of solution conditions and, second, whether a driving force function associated with a surface complex having a constant stoichiometry governs the dissolution of CAP and, if so, what is this stoichiometry. CAP preparations with carbonate contents of 1.8-5.7 wt% (synthesized by hydrolysis of dicalcium phosphate anhydrate in solutions of varying bicarbonate levels or by direct precipitation from supersaturated calcium/phosphate/carbonate solutions) were studied as follows. MES distributions for each of the CAP preparations were determined by equilibrating the CAP under stirred conditions in a series of acetate buffers (0.10 M) containing various levels of calcium and phosphate in the pH range 4.5-6.5 and a solution calcium/phosphate ratio in the range 0.1-10. The amount dissolved in each instance was regarded as the fraction of the CAP possessing an MES value greater than that corresponding to the ion activity product (IAP) of the equilibrating solution. The solution IAPs were calculated from the solution compositions using plausible calcium phosphate stoichiometries, viz., dicalcium phosphate dihydrate, octacalcium phosphate, tricalcium phosphate, hydroxyapatite, carbonated apatite (based on the bulk composition of the particular CAP involved in the experiment), and tetracalcium phosphate. The fraction of CAP dissolved was plotted against the solution IAPs for each experimental set using each of the six assumed stoichiometries for the surface complex. The results demonstrated that the MES concept was applicable to all of the CAP preparations in media of various solution compositions and different pH levels. The most important new outcome of this study was that MES profiles for each of the CAP preparations in all of the experiments were found to be superimposable when solution IAPs were calculated using the hydroxyapatite stoichiometry, while such was not the case when other stoichiometries were used to calculate the solution IAPs. Copyright 1999 Academic Press.

Metastable equilibrium solubility behavior of bone mineral

Previous studies have shown that carbonated apatites with a range of carbonate contents and crystallinities exhibit the phenomenon of metastable equilibrium solubility (MES) distributions. The purpose of the present study was to investigate the solubility behavior of bone mineral using the concepts of MES and MES distributions and, together with crystallinity and chemical composition data, examine the similarity of bone mineral to carbonated apatite (CAP). Bone samples were harvested from 1-, 5-, and 8-month-old rats. The organic components of the bone samples were removed by hydrazine deproteination. Carbonated apatite was synthesized by the hydrolysis of dicalcium phosphate dihydrate (DCPD) in a NaHCO3-containing media at 50 degrees C. The MES distributions of bone mineral and CAP were determined by equilibrating predetermined amounts of CAP or bone mineral in a series of 0.1 M acetate buffers containing calculated levels of calcium and phosphate and maintained at essentially constant pHs of 5.0, 5.3, 5.7, and 6.5. From the compositions of the equilibrating buffer solutions, ion activity products based upon the stoichiometries of octacalcium phosphate, hydroxyapatite, and carbonated apatite were calculated in an attempt to determine the function governing the dissolution of CAP and bone mineral. The results of this study demonstrated that the MES distribution phenomenon appeared to hold for bone mineral and that the changes in crystallinity of bone mineral with age correlated well with changes in the MES values. A CAP sample was prepared that was found to be an excellent synthetic prototype closely mimicking the physicochemical behavior of bone mineral from an 8-month-old rat. Another finding of this study was that the ion activity product function based upon the hydroxyapatite stoichiometry well described the MES results obtained with both CAP and bone mineral. The interpretation that a surface complex with hydroxyapatite stoichiometry governs the solubility behavior of bone mineral is, therefore, consistent with the experimental data. Other calcium phosphate stoichiometries for the surface complex showed systematic variations in the MES profiles when the pH of the equilibrating solution was varied.