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Etiology of Diabetic Foot Infection in Patients with Poorly Controlled Diabetes

Summary

The aim of the study was to define the spectrum and susceptibility of microorganisms, isolated from diabetic foot ulcers in patients with poorly controlled diabetes, treated at the clinic of surgery, and compare microbial findings of specimens collected superficially and from deep tissues. The study included 19 patients with type 1 and 2 diabetes with clinical signs of infection. All patients were with poorly controlled diabetes and staged from 3rd to 5th grade according to the Wagner diabetic foot scale. Swab samples from non-debrided wounds and biopsy samples from deep tissues were collected from each patient. Specimens were inoculated on media for isolation of aerobic and anaerobic bacteria. Identification and susceptibility testing of the isolated oiganisms were performed by conventional methods, and VITEK 2 and mini API Systems (bioMerieux, France). A total of 88 bacterial isolates were cultured, comprising 56 clinical strains. Gram positive bacteria were the most common isolated organisms (53.57%), followed by Gram negative bacteria (26.78%) and anaerobic bacteria (19.64%). Staphylococcus aureus was the most common organism detected (10 strains), followed by Enterococcus spp. (7 strains), Escherichia coli (7 strains), Bacteroides spp. (6 strains) and various other organisms of low incidence. Polymicrobial infection was detected in 17 (89.47%) of the patients. In most of the cases infections were caused by 3 bacterial species. Mixed aerobic/anaerobic infections were detected in 9 (47.3%) patients. In 15 (78.94%) patients, there was a coincidence of bacterial findings from superficial and deep tissue samples. The strains isolated were susceptible to commonly used antimicrobials for treatment of diabetic foot infection. The predominant part of the diabetic foot infections were polymicrobial, caused by association between two or three microbial species. In half of the cases the infection was mixed. There was a good correlation between microbial findings from superficial swabs and deep tissue specimens when they were delivered to the microbiology laboratory immediately after collection.

Open access
Late Prosthetic Vascular Graft Infections after Reconstructions on Aortoiliac Segment: An Eleven Years Experience

Summary

The purpose of the study was to evaluate the frequency and etiology of late prosthetic vascular graft infections after reconstructions on aortoiliac segment. From 2001 to 2011,545 primary reconstructions were performed on 545 consecutive patients. We had 18 cases of late intracavitary graft infections in 14 of them. A total of 58 clinical specimens collected from patients before, during and after reoperation were analyzed. Pathogens were isolated using conventional methods for aerobic and anaerobic bacteria. The isolates were identified down to species level by conventional biochemical methods, VITEK 2 and mini API Systems (bioMereux, France). During an 11-year period after prosthetic grafting of the abdominal aorta and aortoiliac segment the incidence of late (more than 4 months after implantation) infection was 3.11%. The mean interval between the initial operation and development of infection was 39.2 months (range 4 to 84). Positive microbial cultures were found in 46 clinical specimens. A total of 66 microbial isolates were cultured, comprising 27 clinical strains. Gram-positive bacteria were predominant - 15 (55.55%) strains, followed by Gram-negative bacteria - 9 (3 3.33%), Candida albicans - 2 (7.4%) and Bacteroides fragilis - 1 (3.7%). In 7 cases, the infection was monobacterial, caused predominantly by Staphylococcus species. In the rest of the cases, the infections were polymicrobial, caused by association between two microbial species. Mortality rate was 35.71% (5 cases) - in 4 of them the infection was caused by association between two species of Gram-negative bacteria or between Gram-negative bacteria and Candida albicans. The incidence of late intracavitary vascular graft infection was low. The average period for development of this complication was about 3 years after reconstruction. Among the causative agents, Gram-positive microorganisms had a predominant role but infections caused by Gram-negative bacteria, especially when they were in association, had a worse outcome.

Open access
Multidrug Resistance Among Enterococci at a Tertiary Care Hospital in Northern Bulgaria

Summary

Multidrug-resistant (MDR) enterococci are a growing threat. The aim of this study was to determine the species distribution and prevalence of multidrug resistance among 100 enterococcal strains, isolated from patients treated in the University Hospital in Pleven, Bulgaria. Susceptibility to 11 antimicrobial agents was determined, using the disc diffusion method according to the performance standards of Clinical Laboratory Standards Institute (CLS1), 2012. All isolates were screened for high-level aminoglycoside resistance and resistance to vancomycin according to the recommendations of CLS1, 2012. For strains with reduced susceptibility to vancomycin, minimal inhibitory concentrations (MIC) of glycopeptides were determined by Etest (Liofilchem, Italy) and by Vitek 2 automated system. Our results demonstrated decreased susceptibility of enterococci to almost all intensively used anti-enterococcal drugs. Resistance to both penicillins (ampicillin and penicillin) among E.faecium strains was significantly higher (83-87%) than among E.faecalis isolates (4-27%). HLGR was detected in 70% of E.faecium and 38% of E.faecalis isolates. All HLGR strains were foundtobemultiple-drug resistant. Of particular note was the emergence of concomitant resistance to 6 antimicrobials in almost 50% of E.faecium isolates. Despite the wide dissemination of MDR E.faecium strains penicillins in our hospital, acquired resistance to vancomycin was not found.

Open access
The Place of Penetrating Keratoplasty in Corneal Diseases

Summary

The aim of the study was to analyze the results from penetrating keratoplasties (PK) in patients with different comeal diseases. The retrospective study included 124 patients (130 eyes) who underwent penetrating keratoplasty at the Eye Clinic, Pleven, between 1990 and 2011. The patients were divided into four groups, according to the main indication for keratoplasty: 1 - bullous keratopathy - pseudophakic and aphakic bullous keratopathy (PBK and ABK); 2 - degeneration and dystrophy (including keratoconus); 3 - keratitis, scar, trauma; 4 - repeat keratoplasty. The main indications for penetrating keratoplasty included regraft - 27%, PBK - 22.62%, ABK - 11.9% and keratoconus - 10.71%, though the leading cause had been different at different periods of time. By the time of suture removal (8-9 months on the average) in the group of patients with bullous keratopathy, the percentages of clear grafts were as follows: 55.88% in the group of patients with bullous keratopathy, 97.44% in the group with comeal degeneration and dystrophies, and 60% in the group with keratitis, corneal scar and trauma. In patients with regrafts, For the whole period of the study, grafts failed in 61.54% of patients with one regraft, and in 50% of the cases with second and third regrafts. Penetrating keratoplasty proved a valuable method of treatment for a number of comeal diseases. The prognosis and outcome, however, depended on the pathology responsible for comeal blindness.

Open access
Three-Dimensional Reconstruction of Arterial-Lymphatic Vascular Complex (Vessel Within the Vessel) in Breast Tissue

Summary

The phenomenon “vessels within vessels” was initially described by Merchant S et al. as arteries found free-floating inside the lumen of veins. We have described another version of the “vessels within vessels”complex, composed of arteries found inside the lumen of lymphatic vessels. The purpose of the present study was to describe the structure of the lympho-arterial vascular complex in a breast tissue specimen from a male subject using three- dimensional tissue reconstruction. A histological specimen from a 64 year-old male subject diagnosed with gynecomastia was used. The tissue sample was sectioned in a multi-step manner. An overall of approximately 150pm thick tissue material was sampled. Immunostaining with anti-CD34 antibody and anti-podoplanin antibody was performed. Three-dimensional reconstruction of the vessel within the vessel structure was performed with “Reconstruct” software When the reconstruction of the breast parenchyma was revealed as a 3D image, it became apparent that the arterial vessel was situated inside the lymphatic vessel and could be followed along the entire length of the vascular segment studied. We have proved that these vascular complexes are not artificial phenomenon and do exist. The function of the vascular complexes is still uncertain, and is probably related to lymph propulsions in the initial collector vessels.

Open access
Ultrastructural Study of the Synaptic Glomeruli in the Rat’s Cochlear Nucleus

Summary

The granule cell domain of the cochlear nuclear complex contains interneurons, which are the targets for nonprimary auditory inputs from the superior olivary complex, inferior colliculus, auditory cortex, cuneate and trigeminal nuclei of the somatosensory system. The cellular targets of the non-primary projections are unknown due to a lack of information regarding postsynaptic profiles in the granule cell areas. In the present paper, we examined the synaptic relationships between a heterogeneous class of large synaptic terminals, called mossy fibers and their targets within subdivisions of the granule cell domain. During the late stage of postnatal development, we observed heterogenous groups of complex synaptic glomeruli. Using electron microscopy, we provide evidence for ultrastructural features of dendrites that receive input from the mossy fibers. The distinct synaptic relations between mossy fibers and dendrites of microneurons further imply fundamentally separate roles in processing of acoustic signals.

Open access