RESUMEN
We report the first documented case of OXA-48-producing Klebsiella pneumoniae in Slovenia isolated from rectal surveillance cultures from a patient transferred from Libya. The patient was colonised with both ESBL-producing Escherichia coli and ESBL- and OXA-48-producing K. pneumoniae. Three further patients were colonised with ESBL-producing E. coli. This underscores the importance of an early warning system on European level and screening upon admission of patients transferred across borders and between healthcare systems.
Asunto(s)
Proteínas Bacterianas/biosíntesis , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/aislamiento & purificación , beta-Lactamasas/biosíntesis , Humanos , Libia/etnología , EsloveniaRESUMEN
AIM: The aim of this study was to determine whether an arm ergometry exercise test can successfully predict a clinician's decision for prosthetic fitting, and to define what other factors are also important predictors of a patient's ability to walk with a prosthesis. METHODS: The study included 63 patients who had undergone transfemoral amputation due to peripheral vascular disease and who had been admitted for primary inpatient rehabilitation. Participating patients went through standard admission procedures and performed an intermittent sub maximal arm ergometry exercise test in the first week after admission consisting of a two-minute exercise routine with a one-minute pause in-between by means of the Angio V2. The work loads started at 10 W and were increased by 10 W at each level. The cranking rate was 50 to 55 rpm. RESULTS: The patients reached an output level of 20 W on average. Those patients selected for fitting with a prosthesis achieved higher levels on the exercise stress test (26 versus 12 W, P<0.000). The results of the exercise stress test, the 6-minute walking test and the functional independence measures (FIM) at admission, as well as their age and gender, allowed for successful discrimination between patients who were fitted with a prosthesis and those who were not (P<0.000). The best discriminator was that of the results achieved on the exercise stress test. Using the five previously mentioned variables, 83.6% of the patients were successfully classified as to whether or not they were fitted for a prosthesis on the basis of our clinical decision. CONCLUSION: The exercise stress test is a good predictor of prosthetic fitting. It also anticipates the possibility of cardiovascular complications during rehabilitation programmes. Combined with the 6-minute walk, the FIM, and age, it may be an important criteria to consider in making the decision about the appropriateness of prosthetic fitting.
Asunto(s)
Amputados/rehabilitación , Miembros Artificiales , Prueba de Esfuerzo/métodos , Pierna/cirugía , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Enfermedades Cardiovasculares/diagnóstico , Distribución de Chi-Cuadrado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Vasculares Periféricas/cirugía , Ajuste de PrótesisRESUMEN
The main purpose of our study was to determine the parameters of the postocclusive reactive hyperemia test that could help and provide the clinician with information about the tissue oxygenation, the severity of the disease, and the results of the applied therapies. Near infrared spectroscopy (NIRS) proved to be a valid noninvasive trend monitor useful for investigating the physiology of oxygen transport to tissue. Important advantages of NIRS over transcutaneous oximetry (TcpO2) are: (a) a more dynamic nature of the NIRS signals which reflects more closely the actual response of the peripheral vasculature to the occlusive provocation; (b) larger sampling volume; and (c) the ability of assessing tissue oxygenation at deeper tissue levels. We demonstrated that the time parameters of reactive hyperemia, the rate of reactive hyperemia, and the maximal change during reactive hyperemia, all calculated from the oxyhemoglobin (HbO2) signal of the NIRS, clearly distinguish between healthy volunteers and patients with vascular disorder. The time parameters of reactive hyperemia were significantly longer (p<0.01), and the rate of reactive hyperemia (p=0.01) as well as the maximal change during reactive hyperemia (p=0.02) were significantly lower in patient group compared to healthy volunteers. These parameters were also in good correlation with the values of ankle brachial index (ABI) and the resting values of oxygen partial pressure (TcpO2). Values of the chosen parameters obtained from the HbO2 signal were further compared between groups of diabetic and nondiabetic patients with peripheral vascular disease. Although longer time parameters of reactive hyperemia and lower rates of hyperemic response were detected, the difference between both groups was not statistically significant.