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The structural, electronic, and magnetic properties of three spin configurations of L10-ordered FeM alloys (M = Ni, Pd, or Pt) were studied using the first-principles method. The calculations were carried out using Quantum ESPRESSO package within the framework of Density Functional Theory (DFT). The exchange-correlation functional potentials were studied using local density approximation (LDA) of Perdew-Zunger (PZ), the generalized gradient approximation (GGA) of Perdew-Burke-Ernzerhof (PBE), Perdew and Wang 91 (PW91), and Perdew-Burke-Ernzerhof revised for solids (PBEsol). We found that the PBE approximation has the most accurate results for lattice parameters compared to the experimental values. Furthermore, our results reveal that the most stable spin configuration for the considered alloys is the ferromagnetic configuration, where all spins are aligned perpendicular to the (001) plane. However, in FePd and FePt alloys, a small variation in the tetragonality ratio c/a (from 0.98 to 0.92) can transform them from ferromagnetic to antiferromagnetic state. In an antiferromagnetic state, a pseudogap is observed just below fermi energy for each alloy. Moreover, our calculations reveal large magnetocrystalline anisotropies for FePt alloy in the order of 3 meV/f.u. On the other hand, FePd and FeNi show relatively lower values in the range of 0.18-0.42 meV/f.u. Finally, Heisenberg exchange interactions are calculated from first-principles and Green's functions formalism.
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OBJECTIVES: To document the nociceptive innervation of the normal and osteoarthritic murine knee. METHODS: Knees were collected from naïve male C57BL/6 NaV1.8-tdTomato reporter mice aged 10, 26, and 52 weeks (n = 5/group). Destabilization of the medial meniscus (DMM) or sham surgeries (n = 5/group) were performed in the right knee of 10-week old male NaV1.8-tdTomato mice, and knees were harvested 16 weeks later. Twenty 20-µm frozen sections from a 400-µm mid-joint region were collected for confocal microscopy. Integrated density of the tdTomato signal was calculated using Image J by two independent observers blinded to the groups. Consecutive sections were stained with hematoxylin & eosin. C57BL/6-Pirt-GCaMP3 mice (n = 5/group) and protein gene product 9.5 (PGP9.5) immunostaining of C57BL/6 wild type (WT) mice (n = 5/group) were used to confirm innervation patterns. RESULTS: In naive 10-week old mice, nociceptive innervation was most dense in bone marrow cavities, lateral synovium and at the insertions of the cruciate ligaments. By age 26 weeks, unoperated knees showed a marked decline in nociceptors in the lateral synovium and cruciate ligament insertions. No further decline was observed by age 1 year. Sixteen weeks after DMM, the medial compartment of OA knees exhibited striking changes in NaV1.8+ innervation, including increased innervation of the medial synovium and meniscus, and nociceptors in subchondral bone channels. All results were confirmed through quantification, also in Pirt-GCaMP3 and PGP9.5-immunostained WT mice. CONCLUSIONS: Nociceptive innervation of the mouse knee markedly declines by age 26 weeks, before onset of spontaneous OA. Late-stage surgically induced OA is associated with striking plasticity of joint afferents in the medial compartment of the knee.
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Articulación de la Rodilla/inervación , Nocicepción/fisiología , Nociceptores/fisiología , Osteoartritis de la Rodilla/fisiopatología , Rango del Movimiento Articular/fisiología , Animales , Modelos Animales de Enfermedad , Masculino , Ratones , Ratones Endogámicos C57BLRESUMEN
AIM: This study critically appraised both quantitative and qualitative studies describing coping strategies utilized by nursing students when faced with stress. BACKGROUND: Stress in nursing students during clinical training is well documented in the nursing literature. The need to utilize positive-coping strategies is necessary to effectively deal with stress and its accompanying stressors. METHODS: An integrative review method was used in this review. PsycINFO, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and Scopus were the databases used in searching for relevant literature using the following search terms; 'coping', 'nursing students', clinical training', 'ways of coping' and 'clinical practice'. A total of 27 studies published from 2001 to 2016 were included in this review. FINDINGS: Findings demonstrated that nursing students utilized problem-focused coping strategies rather than emotion-focused coping strategies. Specific coping behaviours utilized included problem-solving behaviours, self-confident approaches and seeking of support from family and friends. CONCLUSION: The review contributes to the growing literature on coping strategies in nursing students and may have implications on nursing education and nursing policy. This review also demonstrated a scarcity of studies that links specific coping strategies to nursing school stressors and examines predictors of coping skills in nursing students. IMPLICATIONS FOR NURSING EDUCATION: Institutionalization of structured student orientation programme, implementation of well-planned mentoring programmes and establishment of support unit/centres may be helpful in supporting nursing students during their clinical placement. By developing empirically based interventions, nursing faculty can assist nursing students in strengthening their positive-coping skills to effectively deal with various stressors encountered.
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Adaptación Psicológica , Bachillerato en Enfermería/métodos , Autoimagen , Estrés Psicológico/psicología , Estudiantes de Enfermería/psicología , Competencia Clínica , Humanos , Investigación en Educación de Enfermería , Estudiantes de Enfermería/estadística & datos numéricosRESUMEN
AIM: This review explored peer-reviewed publications that measure nurses' preparedness for disaster response. BACKGROUND: The increasing frequency of disasters worldwide necessitates nurses to adequately prepare to respond to disasters to mitigate the negative consequences of the event on the affected population. Despite growing initiatives to prepare nurses for any disasters, evidence suggests they are under prepared for disaster response. METHODS: This is a systematic review of scientific articles conducted from 2006 to 2016 on nurses' preparedness for disasters. SCOPUS, MEDLINE, PubMed, CINAHL and PsychINFO were the primary databases utilized for search of literature. Keywords used in this review were as follows: 'emergency', 'disaster', 'disaster preparedness', 'disaster competencies', 'disaster nursing', 'disaster role' and 'nurse'. Seventeen (17) articles were selected for this review. FINDINGS: Factors that increase preparedness for disaster response include previous disaster response experience and disaster-related training. However, it is widely reported that nurses are insufficiently prepared and do not feel confident responding effectively to disasters. CONCLUSION: The findings of this review contribute to a growing body of knowledge regarding disaster preparedness in nurses and have implications for academia, hospital administration and nursing educators. The findings of this review provide evidence that could be used by nurse educators and nurse administrators to better prepare nurses for disaster response. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings from this review place an emphasis on hospitals to implement policies to address lack of preparedness among their employees. Furthermore, this review highlights the benefit of further research and provision of well-grounded disaster exercises that mimic actual events to enhance the preparedness of the nursing workforce.
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Actitud del Personal de Salud , Competencia Clínica , Planificación en Desastres/organización & administración , Servicios Médicos de Urgencia/organización & administración , Rol de la Enfermera/psicología , Atención de Enfermería/organización & administración , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Our molecular dynamics (MD) simulations have shown that nanodroplets containing water and nonane are nonspherical and strongly phase-separated. This "Russian doll" structure may be simply but realistically modeled as a spherical nonane lens that partially wets a spherical water droplet. We call this the lens-on-sphere model. Here, we present an analytical calculation of the particle form factor, P(q), needed to analyze the intensity curves for small-angle neutron and X-ray scattering by aerosol particles with this type of structure. For this model, the particle form factor must be evaluated by numerical integration. In addition, an exact formulation of the particle form factor is presented for cylindrically symmetric droplets with otherwise arbitrary position-dependent scattering length density. This result enables direct calculation of P(q) from numerical MD simulation data. Results using both formulations are compared, and excellent agreement is found between them. Analytical results are also presented for two limiting cases of the general result: the sphere-on-sphere model and the sphere-in-sphere (SIS) model, corresponding to contact angles of 180° and 0°, respectively. Finally, a generalization of the SIS model to ellipsoidal droplets is given.
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Excitotoxic stress is potentially an important component of disorders such as stroke and neurodegenerative diseases. Its toxic effects appear to be transduced through mechanisms that result in both acute and delayed forms of death. We examined here whether cyclin dependent kinases (CDKs), molecules normally associated with cell cycle control, may be involved in delayed excitotoxic death in two different excitotoxin models. We show that nuclear localized cyclin D1, an activator of Cdk4/6, is upregulated during kainic acid evoked death of CA3/CA1 neurons and that this upregulation is associated with increased phosphorylation of a critical CDK substrate, pRb. In addition, we find that the CDK inhibitor, flavopiridol blocks the delayed death of cultured cortical neurons evoked by 3-nitroproprionic acid, an inhibitor of the mitochondrial electron transport chain, treatment and that the NMDA antagonist, MK801 provides short term protection in this model. Full, long-term protection occurs when both flavopiridol and MK-801 are present. Taken together, these data support a role for cell cycle regulators in neuronal death evoked by excitotoxic stress and indicate a potential therapeutic target for treatment of excitotoxicity-related disorders.
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Ciclo Celular/fisiología , Quinasas Ciclina-Dependientes/metabolismo , Antagonistas de Aminoácidos Excitadores/farmacología , Degeneración Nerviosa/patología , Neuronas/fisiología , Animales , Ciclo Celular/efectos de los fármacos , Muerte Celular/efectos de los fármacos , Células Cultivadas , Corteza Cerebral/citología , Corteza Cerebral/patología , Ciclina D1/análisis , Maleato de Dizocilpina/farmacología , Transporte de Electrón/efectos de los fármacos , Embrión de Mamíferos , Flavonoides/farmacología , Hipocampo/citología , Hipocampo/patología , Ácido Kaínico/toxicidad , Ratones , Mitocondrias/metabolismo , Neuronas/citología , Neuronas/efectos de los fármacos , Neurotoxinas/farmacología , Neurotoxinas/toxicidad , Nitrocompuestos , Piperidinas/farmacología , Propionatos/farmacología , Ratas , Ratas Sprague-DawleyRESUMEN
This study argues that, in contrast to accepted excitotoxicity theory, O2/glucose deprivation damages neurons acutely by eliciting ischemic spreading depression (SD), a process not blocked by glutamate antagonists. In live rat hippocampal slices, the initiation, propagation, and resolution of SD can be imaged by monitoring wide-band changes in light transmittance (i.e., intrinsic optical signals). Oxygen/glucose deprivation for 10 minutes at 37.5 degrees C evokes a propagating wave of elevated light transmittance across the slice, representing the SD front. Within minutes, CA1 neurons in regions undergoing SD display irreversible damage in the form of field potential inactivation, swollen cell bodies, and extensively beaded dendrites, the latter revealed by single-cell injection of lucifer yellow. Importantly, glutamate receptor antagonists do not block SD induced by O2/glucose deprivation, nor do they prevent the resultant dendritic beading of CA1 neurons. However, CA1 neurons are spared if SD is suppressed by reducing the temperature to 35 degrees C during O2/glucose deprivation. This supports previous electrophysiologic evidence in vivo that SD during ischemia promotes acute neuronal damage and that glutamate antagonists are not protective of the metabolically stressed tissue. The authors propose that the inhibition of ischemic SD should be targeted as an important therapeutic strategy against stroke damage.
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Depresión de Propagación Cortical/fisiología , Glucosa/farmacología , Ácido Glutámico/farmacología , Oxígeno/farmacología , Células Piramidales/fisiología , 2-Amino-5-fosfonovalerato/farmacología , 6-Ciano 7-nitroquinoxalina 2,3-diona/farmacología , Animales , Isquemia Encefálica/fisiopatología , Depresión de Propagación Cortical/efectos de los fármacos , Potenciales Evocados/efectos de los fármacos , Potenciales Evocados/fisiología , Antagonistas de Aminoácidos Excitadores/farmacología , Hipocampo/citología , Hipocampo/fisiología , Técnicas In Vitro , Ácido Quinurénico/farmacología , Masculino , Neurotoxinas , Ratas , Ratas Sprague-Dawley , TemperaturaRESUMEN
Changes in how light is absorbed or scattered in biological tissue are termed intrinsic optical signals (IOSs). Imaging IOSs in the submerged brain slice preparation provides insight into brain activity if it involves significant water movement between intracellular and extracellular compartments. This includes responses to osmotic imbalance, excitotoxic glutamate agonists, and oxygen/glucose deprivation, the latter leading to spreading depression. There are several misconceptions regarding these signals. (1) IOSs are not generated by glial swelling alone. Although neuronal and glia sources cannot yet be directly imaged, several lines of evidence indicate that neurons contribute significantly to the changes in light transmittance. (2) Excitotoxic swelling and osmotic swelling are physiologically different, as are their associated IOSs. Hyposmotic swelling involves no detectable neuronal depolarization of cortical pyramidal neurons, only the passive drawing in of water from a dilute medium across the cell membrane. In contrast excitotoxic swelling involves sustained membrane depolarization associated with inordinate amounts of Na+ and Cl- entry followed by water. IOSs demonstrate substantial damage in the latter case. (3) Osmotic perturbations do not induce volume regulatory mechanisms as measured by IOSs. The osmotic responses measured by IOSs in brain slices are passive, without the compensatory mechanisms that are assumed to be active on a scale suggested by studies of cultured brain cells under excessive osmotic stress. (4) Spreading depression (SD) can cause neuronal damage. Innocuous during migraine aura, SD induces acute neuronal damage in brain slices that are metabolically compromised by oxygen/glucose deprivation, as demonstrated by IOSs. Neighboring tissue where SD does not spread remains relatively healthy as judged by a minimal reduction in light transmittance. IOSs show that the metabolic stress of SD combined with the compromise of energy resources leads to acute neuronal damage that is resistant to glutamate antagonists. (5) While hyperosmotic conditions reduce LT by causing cells to shrink, excitotoxic conditions reduce LT by causing dendritic beading. This conformational change increases light scattering even as the tissue continues to swell.
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Hipocampo/fisiología , Neuronas/fisiología , Células Piramidales/fisiología , Animales , Gráficos por Computador , Electrofisiología/métodos , Diseño de Equipo , Ácido Glutámico/farmacología , Hipocampo/citología , Hipocampo/efectos de los fármacos , Técnicas In Vitro , Luz , Masculino , Potenciales de la Membrana , Microscopía Fluorescente/instrumentación , Microscopía Fluorescente/métodos , Neuroglía/citología , Neuroglía/fisiología , Neuronas/citología , Células Piramidales/citología , Ratas , Ratas Sprague-Dawley , Dispersión de Radiación , Programas Informáticos , Espectrometría de Fluorescencia/instrumentación , Espectrometría de Fluorescencia/métodosRESUMEN
UNLABELLED: A clinical trial was conducted to determine whether dexamethasone as adjunctive therapy alters the outcome of bacterial meningitis in neonates. Fifty-two full-term neonates with bacterial meningitis were enrolled in a prospective study. Infants were alternately assigned to receive either dexamethasone or not. Twenty-seven received dexamethasone in addition to standard antibiotic treatment and 25 received antibiotics alone. Dexamethasone therapy was started 10-15 min before the first dose of antibiotics in a dose of 0.15 mg/kg per 6 h for 4 days. Baseline characteristics, clinical and laboratory features in the two groups were virtually similar. Both groups showed a similar clinical response and similar frequency of mortality and sequelae. Six (22%) babies in the treatment group died compared to 7 (28%) in the control group (P = 0.87). At follow up examinations up to the age of 2 years, 6 (30%) of dexamethasone recipients and 7 (39%) of the control group had mild or moderate/severe neurological sequelae. Audiological sequelae were seen in two neonates in the dexamethasone group compared to one in the control group. CONCLUSION: Adjunctive dexamethasone therapy does not improve the outcome of neonatal bacterial meningitis.
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Dexametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Antibacterianos , Dexametasona/efectos adversos , Quimioterapia Combinada/uso terapéutico , Estudios de Seguimiento , Glucocorticoides/efectos adversos , Humanos , Recién Nacido , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The objective of this study was to explore details of the clinical relationship between meconium-stained amniotic fluid (MSAF) in labour, abnormal fetal heart pattern and meconium aspiration (MA). This was a prospective study carried out in Princess Badeea Teaching hospital during a 6-month period from March to September 1997. During the study period 344 (8.5%) of the deliveries had MSAF (344 women). Continuous fetal heart monitoring was routinely used and 36 women with MSAF (10.5%) needed to be delivered by caesarean section because of fetal distress (diagnosed by abnormal fetal heart pattern) in early labour, compared with 0.95% in those with clear amniotic fluid (CAF), (P <0.00001). Many infants in the MSAF group had a low Apgar score and required ventilation at birth. Nineteen infants (5.5%) developed MA, three of whom (15.8%) died. We conclude that there is an association between MSAF, abnormal fetal heart pattern in labour and a low Apgar score and that it should be considered a high risk situation. MA a problem that occurs with particulate meconium was significantly related to abnormal fetal heart pattern and longer length of labour.
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During ischaemia neurons depolarize and release the neurotransmitter L-glutamate, which accumulates extracellularly and binds to postsynaptic receptors. This initiates a sequence of events thought to culminate in immediate and delayed neuronal death. However, there is growing evidence that during ischaemia the development of spreading depression (SD) can be an important determinant of the degree and extent of ischaemic damage. In contrast, SD without metabolic compromise (as occurs in migraine aura) causes no discernible damage to brain tissue. SD is a profound depolarization of neurons and glia that propagates like a wave across brain tissue. Brain cell swelling, an early event of both the excitotoxic process and of SD, can be assessed by imaging associated intrinsic optical signals (IOSs). We demonstrate here that IOS imaging clearly demarcates the ignition site and migration of SD across the submerged hippocampal slice of the rat. If SD is induced by elevating [K+]O, the tissue fully recovers, but in slices that are metabolically compromised at 37.5 degrees C by oxygen/glucose deprivation (OGD) or by ouabain exposure, cellular damage develops only where SD has propagated. Specifically, the evoked CA1 field potential is permanently lost, the cell bodies of involved neurons swell and their dendritic regions increase in opacity. In contrast to OGD, bath application of L-glutamate (6-10 mM) at 37.5 degrees C evokes a non-propagating LT increase in CA1 that reverses without obvious cellular damage. Moreover, application of 2-20 mM glutamate or various glutamate agonists fail to evoke SD in the submerged hippocampal slice. We propose that SD and OGD together (but not alone) constitute a 'one-two punch', causing acute neuronal death in the slice that is not replicated by elevated glutamate. These findings support the proposal that SD generation during stroke promotes and extends acute ischaemic damage.
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Isquemia Encefálica/fisiopatología , Depresión de Propagación Cortical , Glucosa/deficiencia , Hipocampo/fisiopatología , Animales , Isquemia Encefálica/metabolismo , Isquemia Encefálica/patología , Hipoxia de la Célula , Ácido Glutámico/farmacología , Hipocampo/metabolismo , Hipocampo/patología , Procesamiento de Imagen Asistido por Computador , Técnicas In Vitro , Masculino , Potenciales de la Membrana , Neuronas/patología , Ouabaína/farmacología , Ratas , Ratas Sprague-Dawley , TemperaturaRESUMEN
We retrospectively reviewed the perinatal outcome of twin pregnancies cohere the first baby was presenting by the breech. 21 were delivered vaginally and 37 abdominally. Differences in perinatal outcome, as measured by Apgar score and mortality, were not apparently different.
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Presentación de Nalgas , Cesárea , Parto Obstétrico , Resultado del Embarazo , Gemelos , Adulto , Femenino , Humanos , Mortalidad Infantil , Recién Nacido , Embarazo , Estudios RetrospectivosRESUMEN
To evaluate the safety of vaginal delivery for breech first twin we reviewed retrospectively and compared the perinatal outcome of breech first twin: 42 delivered vaginally and 87 delivered abdominally. Vaginal delivery was allowed under the same criteria for singleton breech presentation. Both groups had similar maternal and neonatal characteristics. Intergroup differences in perinatal outcome, as measured by Apgar score, and mortality cases, were not significant. Our results showed that vaginal delivery is a safe mode of delivery and this route is not associated with higher mortality and morbidity.
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We set out to compare the outcome of the second born twin with that of the first twin to determine if any differences could be improved. We reviewed retrospectively twin deliveries from 15 April 1994 to 14 April 1996. We excluded from analysis twins weighing < 500 g, where either twin had lethal malformation, and where either twin was dead before the onset of labour. After these exclusions 246 twin pairs remained in the study. We compared perinatal mortality, and 5 minutes Apgar scores for both twins. Perinatal mortality was similar for both twins as was the 5 minutes Apgar scores. Twins < 1500 g appear at special risk. The mode of delivery has no influence on the perinatal outcome of both twins. It is concluded that the second born twin may not be at increased risk of complications compared with the first born twin. Caesarean delivery will not improve this outcome.
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OBJECTIVE: To compare the outcome of the second-born twin with that of the first twin and to find out whether there were any differences and the reason for such differences, if any, and how to improve those differences. METHOD: We retrospectively reviewed twin deliveries from the 15th of April, 1994 to the 14th of April, 1996. Excluded were twins weighing < 500 gm, either twin with a lethal malformation, and either twin who died before the onset of labour. After this exclusion 246 twin pairs remained in the study. We compared perinatal mortality and 5-minute Apgar scores for both twins. RESULTS: Perinatal mortality was similar for both twins as well as 5-minute Apgar scores. The twins < 1500 gm appeared at special risk. The mode of delivery had no influence on the perinatal outcome of either twin. CONCLUSIONS: The second-born twin may not be at increased risk of complications compared with the first-born twin and caesarean delivery may not improve this outcome.
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Orden de Nacimiento , Parto Obstétrico , Gemelos , Puntaje de Apgar , Femenino , Humanos , Mortalidad Infantil , Recién Nacido , Presentación en Trabajo de Parto , Embarazo , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The safety of vaginal birth for singleton preterm breech has not often been addressed before. We retrospectively compared the perinatal outcome of two groups of preterm breech delivery. Sixty-six patients delivered vaginally and 32 delivered abdominally between 26 and 36 completed weeks. Vaginal delivery was allowed under the same protocol for singleton breech delivery at term. Both groups had similar maternal characteristics. Intergroup differences in early neonatal outcome, as measured by Apgar score, were not significant. Intrapartum and early neonatal deaths in vaginal and cesarean delivery were compared. There was no significant difference in intrapartum death and early neonatal mortality between those who delivered vaginally and those who delivered by cesarean section (16.6 vs. 15.6%). So even with optimum neonatal care facilities, cesarean section does not offer any advantage over vaginal delivery in a developing country. This study does not advocate the routine use of cesarean section for delivering preterm breech fetuses.
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Presentación de Nalgas , Cesárea , Parto Normal , Adulto , Femenino , Edad Gestacional , Humanos , Mortalidad Infantil , Recién Nacido , Jordania , Embarazo , Resultado del Embarazo , Estudios RetrospectivosRESUMEN
This is a retrospective study conducted at Princess Badee'a Teaching Hospital in North Jordan to compare neonatal loss and morbidity in term singleton breech infants delivered either vaginally or by caesarean section. In this study, all singleton term breech presentation at 37 completed weeks' gestation were reviewed. Three hundred and eight singleton term babies, presenting by the breech were studied. Intrapartum deaths, neonatal deaths and Apgar scores in vaginal and caesarean delivery were compared. After exclusion of infants with lethal congenital malformations and antenatal stillbirths, the incidence of intrapartum and neonatal deaths associated with vaginal births was 3.5% compared with 1.3% in infants born abdominally. The number of low Apgar scores were similar in both groups. We concluded that caesarean section for term singleton breech presentation is associated with good neonatal outcome and this may influence the decision of obstetricians about the mode of delivery.
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We analyzed the effect of two-photon absorption (TPA) on distributed Bragg reflectors and applied our results to the study of saturable Bragg reflectors in mode-locked Cr:LiSAF laser. We showed that in agreement with experimental results, TPA is greatly reduced compared to bulk materials. Hence, Bragg reflectors can be successfully used in a variety of low-loss laser components. c 1997 Optical Society of America.
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A two-and-a-half year prospective study of neonatal meningitis in the two main referral hospitals in Northern Jordan was carried out to determine the clinical spectrum and particular characteristics of meningitis in the newborn. The 53 cases studied represented an incidence of 1.1 per 1000 live births. The commonest bacterial pathogen isolated was Klebsiella species (40 per cent) followed by Enterobacter (19 per cent). The mortality rate and neurological sequelae among surviving children were 32 and 39 per cent, respectively, with higher rates among preterm/low birth weight and early onset meningitis groups. Of the presenting clinical features, there was a highly positive association between two risk factors and outcome. A bulging anterior fontanelle was the only significant predictor of mortality (P = 0.009) and altered sensorium was the only predictive of post-meningitis sequelae (P = 0.016). The need to recognize that Klebsiella species is an increasingly important pathogen; cefotaxime or ceftazidime plus ampicillin are the most appropriate antibiotics to be used initially, and continuous surveillance thereafter have been stressed.