Antibiotic therapy for Klebsiella pneumoniae bacteremia: Implications of production of extended-spectrum beta-lactamases

The prevalence of extended-spectrum beta-lactamase (ESBL) production by Klebsiella pneumonia approaches 50% in some countries, with particularly high rates in eastern Europe and Latin America. No randomized trials have ever been performed on treatment of bacteremia due to ESBL-producing organisms; existing data comes only from retrospective, single-institution studies. In a prospective study of 455 consecutive episodes of Klebsiella pneumoniae bacteremia in 12 hospitals in 7 countries, 85 episodes were due to an ESBL-producing organism. Failure to use an antibiotic active against ESBL-producing K. pneumoniae was associated with extremely high mortality. Use of a carbapenem ( primarily imipenem) was associated with a significantly lower 14-day mortality than was use of other antibiotics active in vitro. Multivariate analysis including other predictors of mortality showed that use of a carbapenem during the 5-day period after onset of bacteremia due to an ESBL-producing organism was independently associated with lower mortality. Antibiotic choice is particularly important in seriously ill patients with infections due to ESBL-producing K. pneumoniae.

Upper Devonian biostratigraphy of the Iberian Pyrite Belt, southwest Spain Part One: Miospores

The Iberian Pyrite Belt (IPB), which forms part of the Variscan orogenic massif, is renowned for the magnitude and extent of its massive sulfide mineralization. The stratigraphic record of the IPB consists of Upper Palaeozoic sedimentary and igneous rocks. In ascending order, these comprise the thick Phyllite-Quartzite Group attributed to the Middle and Upper Devonian and characterized by shales and quartzites with conglomeratic and carbonate intercalations towards the top; the appreciably thinner Volcano-Sedimentary Complex, a heterogeneous uppermost Devonian-Mississippian unit embodying diverse volcanic, subvolcanic, and sedimentary rocks that host the massive sulfide deposits; and the shaly and sandy, turbiditic Culm Group (Carboniferous). This entire succession was folded and faulted during the Asturian phase of the Variscan Orogeny that gave rise to a thin-skinned type structure. The present study constitutes a detailed blostratigraphic investigation of palynologically productive samples representative of the Phyllite-Quartzite Group and the basal (anoxic) portion of the Volcano-Sedimentary Complex. These were collected from surface and mine exposures variously located in the Spanish part of the IPB; out of 282 samples processed, 117 proved to be productive palynologically. The aim of this project is to provide comprehensive palynostratigraphic data applicable to precise dating and correlation of the IPB's stratigraphic succession (i.e., of the two sampled lithostratigraphic units), which has hitherto been investigated biostratigraphically on a relatively localized basis. The results are incorporated in two successive parts. The first of these, i. e., the present paper, focuses on the systematic analysis of the terrestrial (miospore) component of the palynological assemblages. The second part, devoted to the marine, organic-walled microphytoplankton (acritarchs and prasinophytes), will evaluate the stratigraphic significance of the IPB palynofloras and their application to elucidating the geological history of the region. In the systematic-descriptive section, which occupies the bulk of this paper, 55 species of trilete miospores are described and are allocated among 34 genera, two of which (Cristicavatispora and Epigruspora) are newly instituted herein. The majority of the species are either positively identifiable or closely affiliable with previously named species. The nine newly established species are as follows: Camptozonotriletes confertus, Indotriradites diversispinosus, Cristicavatispora dispersa (type species), Epigruspora regularis (type species), Ancyrospora? implicata, Endosporites tuberosus, Rugospora explicata, Spelaeotriletes plicatus, and Teichertospora iberica.

Vladimir Janda, MD, DSc - Tribute to a master of rehabilitation

The purpose of this presentation is to pay tribute to the life's work of Professor Vladimir Janda, a key figure in the 20th Century rehabilitation movement. An accomplished neurologist, he founded the rehabilitation department at Charles University Hospital in Prague, Czechoslovakia. He was one of the seminal members of the Prague school of manual medicine and rehabilitation that expanded its influence throughout Central and Eastern Europe. His observations regarding muscle imbalances, faulty posture and gait, and their association with chronic pain syndromes, etiologically, diagnostically, and therapeutically, influenced the rehabilitation world. The authors comprise a multinational, multiprofessional group representative of rehabilitation specialists around the world who would like to pay tribute and give a final word of thanks to this innovative educator, clinician, and author.

The provenance and technology of Near Eastern glass: Oxygen isotopes by laser fluorination as a complement to strontium

The ability to make rapid measurements on small samples using laser fluorination enhances the potential of oxygen isotopes in the investigation of early inorganic materials and technologies. delta O-18 and Sr-87/Sr-86 values are presented for glass from two primary production sites, four secondary production sites and a consumer site in the Near East, dating from Late Antiquity to the medieval period. delta O-18 is in general slightly less effective than Sr-87/Sr-86 in discriminating between sources, as the spread of measured values from a single source is somewhat broader relative to the available range. However, while Sr-87/Sr-86 is derived predominantly from either the lime-bearing fraction of the glass-making sand or the plant ash used as a source of alkali, delta O-18 derives mainly from the silica. Thus the two measurements can provide complementary information. A comparison of delta O-18 for late Roman - Islamic glasses made on the coast of Syria-Palestine with those of previously analysed glasses from Roman Europe suggests that the European glasses are relatively enriched in O-18. This appears to contradict the view that most Roman glass was made using Levantine sand and possible interpretations are discussed.