Annual changes in the occurrence of antibiotic-resistant coliform bacteria and enterococci in municipal wastewater

Wastewater contains subinhibitory concentrations of different micropollutants such as antibiotics that create selective pressure on bacteria. This phenomenon is also caused by insufficient wastewater treatment technology leading to the development and spread of antibiotic-resistant bacteria and resistance genes into the environment. Therefore, this work focused on monitoring of antibiotic-resistant coliform bacteria and enterococci in influent and effluent wastewaters taken from the second biggest wastewater treatment plant (Petržalka) in the capital of Slovakia during 1 year. Antibiotic-resistant strains were isolated, identified, and characterized in terms of susceptibility and biofilm production. All of 27 antibiotic-resistant isolates were identified mainly as Morganella morganii, Citrobacter spp., and E. coli. Multidrug-resistance was detected in 58% of isolated strains. All tested isolates could form biofilm; two strains were very strong producers, and 74% formed biofilm by strong intensity. The flow rate of the influent wastewater had a more significant impact on the number of studied bacteria than the temperature. Graphical abstract.

[Serious sepsis treatment in intensive care departments in the Czech Republic - EPOSS Project pilot results]

INTRODUCTION

Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic.

METHODS

This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS).

RESULTS

394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%.

CONCLUSION

Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

[Ventilator-associated pneumonia]

Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring in a patient after intubation with an endotracheal tube or tracheostomy tube lasting for 48 hours or more. It is also one of the most common and fatal infections of patients in ICUs. The diagnostic process in VAP is still underestimated and precise criteria for diagnosis are inconsistent. Delayed diagnosis and subsequent delay in starting appropriate therapy are associated with worse outcomes in patients with VAP. Appropriate dose, adequate route of administration and reasonable length of antibiotic therapy together with de-escalation are the fundamental principles of therapy. Supportive care is also an integral part of the treatment. Implementing preventive procedures according to the local ICU standards is needed for reducing the incidence of VAP effectively.

[Contribution and selected risks of blood transfusion]

AIM

Overview of recent knowledge about risks and benefits of blood transfusion.

TYPE OF STUDY

Review article.

SETTING

Department of Anaesthesiology and Intensive Care, University Hospital, Ostrava.

METHODS

Summary of previously published data.

CONCLUSION

Transfusion of blood and blood products remains controversial in clinical practice. Neither indication and timing nor benefit of this procedure is clearly determined. Previously often reported complications as blood-group incompatibility and infection are less frequent now, and new transfusion's side effects as TRIM (transfusion-related immunomodulation) and TRALI (transfusion-related lung injury) are reported with growing evidence. This risk (often underestimated in the past) is discussed in the article, and compared with blood transfusion benefits. Either restrictive or more open approach to blood transfusion are supported as well as criticised by different groups of clinicians and "good clinical practice" definition remains open for the future.

[Pathogenesis of severe sepsis--from macrocirculation to mitochondria]

Severe sepsis is at present serious medical and social problem. In contrast to many other diseases its incidence shows an upward tendency and so does mortality due to sepsis. From the point of view of pathogenesis the cause of this complaint is a disturbed response to infection. The basis of this disruption is either a huge local inflammation that goes hand in hand with the penetration of proinflammatory cytokines into systemic circulation or an excessive proinflammatory systemic response. In the first instance the consequence is a systemic proinflammatory response accompanied by a disruption of macrocirculation, later also of microcirculation and finally mitochondrial failure. These mechanisms are responsible for the gradual failure of distant organs. In the second instance the consequence is a deactivation of systemic and local immunocompetent cells accompanied by the risk of uncontrolled proliferation of microorganisms. Affected are organs with a disturbed antimicrobial barrier, especially the lungs du ring mechanical ventilation, the bloodstream or the urinary system during catheterization. A large group of selectively acting preparations has been clinically tested in the management of this disorder, but only very few of these preparations were efficacious. We may postulate that the great diversity of the investigated population of patients was responsible for this lack of success.

[Hair whorl--a genetically bound phenomenon in testing of right-handedness and hemispheric dominance]

BACKGROUND

The importance of normal development of hemispheric dominance and its significance for the development of an individual is sufficiently known. The internationally not well known procedure according to Zlab (1) represents one of the most suitable examinations for right-handedness and laterality testing.

METHODS AND RESULTS

In our study we used one of the most popular questionnaires for phenotype testing of handedness- Edinburgh's Inventory (2). According to this questionnaire we have examined 65 children 10 years of age (+/- one year), and classified them into 3 groups: a) pure right-handed (n = 51), b) pure left-handed (n = 5) (all have fulfilled +90-100% resp. -90-100% of answers on corresponding ten questions) and c) a group of mixed laterality--ambidextrous (n = 9). The questionnaire we have accomplished by means of objective testing of hair whorl direction presupposed clockwise in right-handed and counter clockwise in lefthanded. Some of other tests we used turn to be more reliable than lid opening and using a broom (upper hand) by "dominant" hand used in Edinburg's Handedness Inventory. We have examined also hand, elbow, knee and leg joints excursibiliy (enlarged passivity and/or diminished muscle tonus) to define cerebellar dominance: right cerebellar hemisphere in right-handed and left cerebellar hemisphere in left-handed. In the group of pure right-handers we found clockwise hair whorl in 23 of 25 boys. In girls (probably due tu various hair combing) we found clockwise hair whorl only in 12 of 26 children.

CONCLUSIONS

Examination of the hair whorl direction seems to be enrichment for a quick clinical phenotype and genotype laterality testing.

[Traffic accidents from the view of neurologist]

Review article deals with traffic accidents in our country and the problems of their causes. In comparison with economically developed countries traffic accidents prevalence raised since 1990 till 1995 and with small decline in 2004 it remains on a high level of 140 deaths in traffic accidents for I million of inhabitants, which makes the Czech Republic one of the worst among the compared countries. In agreement with present views, the main course of accidents is the human error. Attention is given to traffic accidents prevalence of young men versus young women, and to the evaluation of psycho-physiologic functions in elderly drivers. Personal qualities are among the most important in the neglecting of traffic rules, in the aggressivity, non-tolerance and disrespect to the freedom of others. Besides the building of the more perfect infrastructure, it is necessary to improve the register of accident recidivist drivers and for accidents and repeated accidents to promote compulsory psycho-neurological examination. Similarly to preventive check outs for alcohol, it s necessary to introduce similar measures to cope with growing effects of drugs.

[Prion neuroinfections]

Prion neuroinfections represent an emergent problem namely after the epidemic brake out of the bovine spongiform encephalopathies, which culminated in 1993. Isolated cases can still emerge. The next case was the discovery of a new variant of Creutzfeldt-Jakob disease in the comparatively young persons with proved alimentary infection route--about 140 cases has been described. Physiological prions are glycoproteins, affixed to the rafts of cell membranes (namely in neurons) by glycosylphosphatidylinositol anchor. They act as signalling molecules and participate in the cooper metabolism. Despite the intensive study in many prestigious laboratories, the way how the pathogenic isoform of prions, given by the prevalence of beta-conformations in the polypeptide chain develops has not been proved yet. Pathogenic isoforms are formed intracellulary after the precedent endocytosis. Aggregations of abnormal prion molecules build up prion amyloid deposits in the form of fibrils or plaques. The loss of neurons brings about the neurological symptoms, which are not directly related to the amounts of amyloid deposits. Characteristic findings of spongiosis and the immunohistochemical evidence of protease-resistant prions belong to the only reliable tests. Reliable intravital test in the blood or urine is not yet available. All forms of human and animal transmissible spongiform encephalopathies develop only in genetically sensitive individuals. A brief overview of clinical forms and some biochemical and genetic aspects of the disease are given.

[Somatognosis, body schema and the phenomena of somatic and visceral phantoms and phantom pain]

The body scheme is a complex of memory patterns secured in the structures of the brain, where the parietal lobes play the most important role. Basic principles are given by the genetic programming of the structure and function along with the synthesis of information brought by means of sensory activity. The unitary perception of the body scheme is a dynamic image, enabling conscious and unconscious representation of our body, its parts, their functions, position, shape and/or movements. The recognition of the body scheme in humans is named somatognosia. Disorders of somatognosia include visceral and somatic phantom, phantom pain and other disorders related to the capability of communication by means of language: autotopoagnosia, hemiasomatognosia, pain asymboly, anosognosia of hemiplegia, anosognosia of blindness, deafness, neglect and other defects appearing at the neurologist's and psychiatrist's borderline of interest. Interest in the visceral phantom is usually much smaller than that in the phantom limb. The aim of this paper was to draw the to phantom phenomena in patients following rectum amputation and colostomy. A survey of contemporary knowledge about the body scheme and its disorders, cortical plasticity and the problem of cortical maladaptation are presented.

[Primary carcinoma of the duodenum]

The authors describe the case of a 70-year-old man with primary adenocarcinoma of the fourth segment of the duodenum. Due to the infrequency of the condition there was diagnostic and therapeutic uncertainty. After the endoscopic and bioptic diagnosis three months elapsed before an incorrectly indicated derivation operation and only after another month the tumour was resected. The exhausted patient developed postoperative pancreatitis with subsequent multiorgan failure to which he succumbed. The disease should be suspected even if the symptomatology is poor. The patient suffered only from nausea and anaemia. From the diagnostic aspect endoscopic examination is most useful for the oral segment of the duodenum and double contrast examination for the aboral one. The method of treatment is duodenopancreatectomy for the upper part and segmental resection for the distal part of the duodenum.

Apomorphine does not influence olfactory thresholds in Parkinson's disease

In order to verify the presumed dopaminergic basis of olfactory dysfunction in Parkinson's disease (PD), we studied olfactory functions in 12 PD patients (mean age 60.1 yrs, mean duration of PD 9.0 yrs, mean Hoehn and Yahr score 2.8) before and after apomorphine (APO) administration. Amylacetate (banana smell) in 12 sequential dilutions (in 50% steps) was used for the examination of olfactory thresholds. The testing showed no significant differences in any olfactory parameters before and after APO. Furthermore, when analysing the subgroup of 7 hyposmic PD patients, we also found no significant differences before and after APO. We therefore believe that olfactory dysfunction in PD is not dependent on dopamine deficiency.

[Present views on boxing--Henner's legacy]

Fifty years ago academician Henner formulated clearly the negative view of neurologists on boxing as practised in his time. It was his merit that a protective helmet was introduced, many of his demands concerning the regime after a KO and the importance of medical examinations were no yet adequately appreciated. At the opportunity of the 100th anniversary of Henner's birth and the fiftieth anniversary of the Clinic he founded in the premises of saint Catherine the author discusses contemporary views on boxing, the risk of repeated injuries for the development of encephalopathia pugilistica and their relationship to Alzheimer's disease. Contemporary boxing is a spectacle which is a continuation of historical fights of gladiators. If the main objective is to hurt the adversary, this activity does not deserve the name of "sport" Sport should promote and maintain physical and mental health which is not the case in professional boxing.

[Transient ischemic attacks (TIA) from the viewpoint of the clinical neurologist]

A transient ischaemic attack (TIA) is a cerebrovascular attack the clinical symptomatology of which is restored to normal within 24 hours. Minor haemorrhages, epilepsy, hypoglycaemia, migraine and even peripheral neuropathies can be mistaken for TIA. CT examination indicates in a considerable percentage of examined subjects encephalomalacia. The term TIA should be reserved for ischaemic attacks, where after regression of the clinical symptomatology within 24 hours no structural changes are found.

Morphology of regressive changes in the kidney following experimental ischaemia

Total or partial renal ischaemia was studied in rats and pigs in a series of experiments, after total devascularization (ligature of renal vessels and ureter); ligature of isolated renal artery; experimental embolization of renal artery by non-resorbable material; devascularization of a specific renal segment by deep, strangulating sutures. Morphological studies showed that the resulting necrotization is represented most frequently by coagulation necrosis, less frequently by colliquating necrosis. Occlusion of the renal artery by embolization or ligature leads only to partial necrotization or atrophy. Total devascularization of the renal hilus or total devascularization of a specific renal segment by strangulating sutures leads to total destruction of the devascularized (devitalized) tissues. Within 8-12 weeks, the whole organ changes into a small residue of connective tissue. The possibility of the use of the devascularization technique in the treatment of tumours is discussed.

[Actinomycoma of the abdominal cavity]

Six months of gastrointestinal embarrassment in a 31-year old male patient were coped with by transversostomy and subsequent anti-tumour drug and irradiation treatment. However, histology tests of a pseudotumour removed from the abdominal cavity proved the presence of actinomycosis (actinomycoma). Once adequate treatment had been started, the intraabdominal process began to recede thus permitting the transversostomy to be discontinued.

Prevention of postoperative thromboembolism by dextran 70 or low-dose heparin

The efficacy of intravenous infusion of dextran 70 or subcutaneous administration of low-dose heparin in preventing postoperative thromboembolic complications has been investigated in a prospective randomized trial. During part 1 of the study, 232 patients over the age of 40 years who were undergoing major gynecologic surgery underwent a complete test protocol. The 125I fibrinogen uptake test (FUT) was used for the diagnosis of deep vein thrombosis (DVT) in 117 patients in the dextran and 115 patients in the heparin group. Heparin was significantly more effective than dextran for reducing DVT (P less than .001). During part 2 of the study no FUT was done but the incidence of clinical and fatal pulmonary embolism (PE) and the number of complications were studied. Of 444 patients (parts 1 and 2) 1 fatal and 2 nonfatal pulmonary emboli were diagnosed. All the emboli occurred in the dextran group. The benefit: hazard ratio appeared to favor heparin for the prophylaxis of DVT.