Aetiology of community-acquired urinary tract infection and antimicrobial susceptibility patterns of uropathogens isolated

INTRODUCTION

Antibiotic resistance among uropathogens causing urinary tract infection (UTI) is increasing worldwide. In most cases of UTI, family physicians can provide empirical treatment without the benefit of a pre-therapy urine culture. Knowledge of the aetiology and antimicrobial susceptibility patterns of uropathogens is important in order to determine the best empiric treatment option. This study aimed to determine the aetiology and antimicrobial susceptibility of uropathogens in culture-positive, community-acquired UTIs over a one-year period.

METHODS

This is a retrospective analysis of medical case records. All patients who were diagnosed and coded with UTI and had urine culture done were analysed. The prevalence of the UTI-causing organism and its antibiotic susceptibility was tabulated. Results were analysed with descriptive statistics. The chi-square and Fisher's exact tests were applied for categorical variables.

RESULTS

The commonest organism isolated for all age groups and gender was Escherichia coli (74.5 percent) and Klebsiella spp. (8.7 percent). Among the oral antibiotics widely used in primary care in Singapore, the Enterobacteriaceae family was most susceptible to amoxicillin/clavulanate. There was no significant difference in the susceptibility of common oral antibiotics when tested against the Enterobacteriaceae for both male and female patients and between patients older than 65 years and those 65 years and below.

CONCLUSION

Empirical treatment of community-acquired UTI with cotrimoxazole, ciprofloxacin, cephalothin and ampicillin is inadequate. Amoxicillin/clavulanate should be the drug of choice for empirical treatment instead.

Shifting of fluorescence peak in CdS nanoparticles by excitation wavelength change

CdS nanoparticles with different size are prepared by chemical bath deposition method. These particles show strong fluorescence at emission wavelength of 507 nm. It has been observed that this emission peak changes through a range of 147 nm, by varying the excitation wavelengths through 370-480 nm.The emission peak can thus be tuned by varying the excitation wavelengths. This peak emission wavelength shift is due to the selective excitation of vibronic levels in the surface state of the CdS nanoparticles.

Effect of aripiprazole versus haloperidol on PANSS Prosocial items in early-episode patients with schizophrenia

BACKGROUND AND AIM

Improving social functioning is critically important in early-episode schizophrenia, if patients are to achieve functional recovery. This post-hoc, pooled analysis of two studies compared the effect of aripiprazole versus haloperidol on social functioning in early-episode schizophrenia.

METHODS

Data were pooled from two 52 week, randomized (2:1), double-blind, multicenter studies involving 1294 patients with chronic schizophrenia who were in an acute psychotic episode and had a history of positive antipsychotic response during previous episodes. The early-episode group was defined as patients who are <or=40 years of age with <or=5 years' duration of illness. Social functioning was assessed by mean change from baseline on the PANSS Prosocial subscale (ANCOVA and LOCF), comprising six PANSS items, and the Modified Prosocial subscale, comprising four PANSS items. Measurements were taken at approximately monthly intervals for up to 1 year.

RESULTS

Aripiprazole (n=237) demonstrated significant improvement versus haloperidol (n=123) as early as Week 18 on both the Prosocial subscale (-4.75 versus -3.78, p<0.05) and on the Modified Prosocial subscale (-3.16 versus -2.28, p<0.05). Patients receiving aripiprazole continued to show similar significant improvement versus haloperidol at all remaining timepoints through Week 52 using the Modified Prosocial subscale, but less consistent improvement with the Prosocial subscale. Significant advantage for the aripiprazole-treated patients was observed at Weeks 46 and 52 (endpoint) with both subscales.

CONCLUSION

In patients with early-episode schizophrenia, aripiprazole demonstrates greater improvement than haloperidol on PANSS items related to social functioning. The cognitive and functional implications of these findings remain to be clarified in future studies.

Are portable bladder scanning and real-time ultrasound accurate measures of bladder volume in postnatal women?

Real-time ultrasound and portable bladder scanners are commonly used instead of catheterisation to determine bladder volumes in postnatal women but it is not known whether these are accurate. Change in bladder volumes measured by ultrasound and portable scanners were compared with actual voided volume (VV) in 100 postnatal women. The VV was on average 41 ml (CI 29 - 54 ml) higher than that measured by ultrasound, and 33 ml (CI 17 - 48 ml) higher than that measured by portable scanners. Portable scanner volumes were 9 ml (CI -8 - 26 ml) higher than those measured by ultrasound. Neither method is an accurate tool for detecting bladder volume in postnatal women.

Papillon-Lefevre syndrome: a case report

Papillon-Lefevre syndrome is a rare autosomal recessive genetic disorder. The clinical manifestations include palmer planter hyperkeratosis with precocious progressive periodontal disease that results in premature exfoliation of primary and permanent dentitions. Patients are often edentulous at an early age. This is a case report of prosthodontic rehabilitation of a 15-year-old girl with Papillon-Lefevre syndrome.

Dentinogenesis imperfecta: a case report

Dentinogenesis imperfecta is an autosomal dominant disorder of tooth development characterized by the presence of opalescent dentin, resulting in a dusky blue to brownish discoloration of the teeth. This condition is genetically and clinically heterogeneous; it may affect only the teeth or it may be associated with the osteogenesis imperfecta. Dentinogenesis imperfecta has been subdivided into three types: type I is associated with osteogenesis imperfecta; in type II there is no associated osteogenesis imperfecta; and when the condition is associated with the Brandywine triracial isolate and large pulp chambers it is classified as type III. This report describes a 16-year-old female patient who showed the characteristic dental features of dentinogenesis imperfecta type II. The etiology and prevalence of the disorder, and a comprehensive treatment plan, will be briefly reviewed.

Side illumination fluorescence emission characteristics from a dye doped polymer optical fiber under two-photon excitation

Two-photon excited (TPE) side illumination fluorescence studies in a Rh6G-RhB dye mixture doped polymer optical fiber (POF) and the effect of energy transfer on the attenuation coefficient is reported. The dye doped POF is pumped sideways using 800 nm, 70 fs laser pulses from a Ti:sapphire laser, and the TPE fluorescence emission is collected from the end of the fiber for different propagation distances. The fluorescence intensity of RhB doped POF is enhanced in the presence of Rh6G as a result of energy transfer from Rh6G to RhB. Because of the reabsorption and reemission process in dye molecules, an effective energy transfer is observed from the shorter wavelength part of the fluorescence spectrum to the longer wavelength part as the propagation distance is increased in dye doped POF. An energy transfer coefficient is found to be higher at shorter propagation distances compared to longer distances. A TPE fluorescence signal is used to characterize the optical attenuation coefficient in dye doped POF. The attenuation coefficient decreases at longer propagation distances due to the reabsorption and reemission process taking place within the dye doped fiber as the propagation distance is increased.

Endovascular stent graft treatment of leaking thoracic aortic tuberculous pseudoaneurysm

Mycobacterium tuberculosis infection is one of the leading causes of death from communicable diseases worldwide. However, the incidence of leaking thoracic aortic tuberculous pseudoaneurysms is rare as a complication. Conventional treatment of a leaking tuberculous pseudoaneurysm involves surgery with graft interposition or patch repair. With the emergence of stent graft treatment as a viable option for leaking pseudoaneurysms, we report a 63-year-old man who had his leaking toracic aortic tuberculous pseudoaneurysm treated with endovascular stent grafting.

Function and effect of bone morphogenetic protein-7 in kidney bone and the bone-vascular links in chronic kidney disease

In two independent and separate studies, we have shown that renal injury and chronic kidney disease (CKD) directly inhibit skeletal anabolism, and that stimulation of bone formation decreased the serum phosphate. In the first study, the serum Ca PO(4), parathyroid hormone (PTH), and calcitriol were maintained normal after renal ablation in mice, and even mild renal injury equivalent to stage 3 CKD decreased bone formation rates. More recently, these observations were rediscovered in low-density lipoprotein receptor null (LDLR-/-) mice fed high-fat/cholesterol diets, a model of the metabolic syndrome (hypertension, obesity, dyslipidemia and insulin resistance). We demonstrated that these mice have vascular calcification (VC) of both the intimal atherosclerotic type and medial calcification. We have also shown that VC is made worse by CKD and ameliorated by bone morphogenetic protein-7 (BMP-7). The finding that high-fat fed LDLR-/- animals with CKD had hyperphosphatemia which was prevented in BMP-7-treated animals lead us to examine the skeletons of these mice. It was found that significant reductions in bone formation rates were associated with high-fat feeding, and superimposing CKD resulted in the adynamic bone disorder (ABD), while VC was made worse. The effect of CKD to decrease skeletal anabolism (decreased bone formation rates and reduced number of bone modelling units) occurred despite secondary hyperparathyroidism. The BMP-7 treatment corrected the ABD and hyperphosphatemia, owing to BMP-7-driven stimulation of skeletal phosphate deposition reducing plasma phosphate and thereby removing a major stimulus to VC. A pathological link between abnormal bone mineralization and VC through the serum phosphorus was demonstrated by the partial effectiveness of directly reducing the serum phosphate by a phosphate binder that had no skeletal action. Thus, in the metabolic syndrome with CKD, a reduction in bone forming potential of osteogenic cells leads to the ABD producing hyperphosphatemia and VC, processes ameliorated by BMP-7, in part through increased bone formation and skeletal deposition of phosphate and in part through direct actions on vascular smooth muscle cells. We have demonstrated that the processes leading to vascular calcification begin with even mild levels of renal injury affecting the skeleton before demonstrable hyperphosphatemia and that they are preventable and treatable. Therefore, early intervention in the skeletal disorder associated with CKD is warranted and may affect mortality of the disease.

Hyperpyrexia and prolonged postoperative disorientation following methylene blue infusion during parathyroidectomy

A 65-year-old man underwent parathyroidectomy for hyperparathyroidism secondary to renal failure. Intra-operatively he received methylene blue infusion (7.5 mg.kg(-1), a total of 650 mg in 500 ml 0.9% sodium chloride) for visualisation of parathyroid glands. At the end of surgery, following extubation he developed agitation, intense shivering and hyperpyrexia, and his level of consciousness decreased to a Glasgow Coma score of 7. The differential diagnoses included methylene blue toxicity or malignant hyperpyrexia. His lungs were ventilated, and intravenous dantrolene was administered to control hyperpyrexia. Haemodialysis was started to remove the methylene blue dye. We review the literature on the pharmacological actions of methylene blue, and discuss the differential diagnosis and management of this patient.