Outbreaks of Infections Associated With Drug Diversion by US Health Care Personnel

ObjectiveTo summarize available information about outbreaks of infections stemming from drug diversion in US health care settings and describe recommended protocols and public health actions.Patients and MethodsWe reviewed records at the Centers for Disease Control and Prevention related to outbreaks of infections from drug diversion by health care personnel in US health care settings from January 1, 2000, through December 31, 2013. Searches of the medical literature published during the same period were also conducted using PubMed. Information compiled included health care setting(s), infection type(s), specialty of the implicated health care professional, implicated medication(s), mechanism(s) of diversion, number of infected patients, number of patients with potential exposure to blood-borne pathogens, and resolution of the investigation.ResultsWe identified 6 outbreaks over a 10-year period beginning in 2004; all occurred in hospital settings. Implicated health care professionals included 3 technicians and 3 nurses, one of whom was a nurse anesthetist. The mechanism by which infections were spread was tampering with injectable controlled substances. Two outbreaks involved tampering with opioids administered via patient-controlled analgesia pumps and resulted in gram-negative bacteremia in 34 patients. The remaining 4 outbreaks involved tampering with syringes or vials containing fentanyl; hepatitis C virus infection was transmitted to 84 patients. In each of these outbreaks, the implicated health care professional was infected with hepatitis C virus and served as the source; nearly 30,000 patients were potentially exposed to blood-borne pathogens and targeted for notification advising testing.ConclusionThese outbreaks revealed gaps in prevention, detection, and response to drug diversion in US health care facilities. Drug diversion is best prevented by health care facilities having strong narcotics security measures and active monitoring systems. Appropriate response includes assessment of harm to patients, consultation with public health officials when tampering with injectable medication is suspected, and prompt reporting to enforcement agencies.     

What Clinicians Should Know About the 2014 Ebola Outbreak

The ongoing Ebola outbreak that began in Guinea in February 2014 has spread to Liberia, Sierra Leone, Nigeria, Senegal, Spain, and the United States and has become the largest Ebola outbreak in recorded history. It is important for frontline medical providers to understand key aspects of Ebola virus disease (EVD) to quickly recognize an imported case, provide appropriate medical care, and prevent transmission. Furthermore, an understanding of the clinical presentation, clinical course, transmission, and prevention of EVD can help reduce anxiety about the disease and allow health care providers to calmly and confidently provide medical care to patients suspected of having EVD.     

CDC关于导管相关感染预防的最新观点

近年来,随着各类动、静脉导管在临床的广泛应用,导管相关感染也逐渐增多,而治疗该种感染特别是导管相关血流感染(CRBSIs)的费用也相当惊人。2002年8月,美国CDC发布了新的静脉导管相关     

胶质瘤治疗的靶分子CDC2 RNA干扰的体外实验研究

目的 探讨抑制细胞周期依赖性激酶CDC2基因对人脑胶质瘤细胞生长的影响,并为其作为胶质瘤发生发展相关基因在胶质瘤治疗方面的应用价值提供实验依据.方法 利用本实验室基因重组构建的CDC2 shRNA逆转录病毒表达质粒对体外培养的人脑胶质瘤细胞进行转染.倒置显微镜观察细胞形态和数量变化;RT-PCR及荧光实时定量PCR检测CDC2 mRNA表达;Western blot检测CDC2蛋白表达;流式细胞仪检测细胞周期和凋亡的变化;透射电子显微镜观察细胞超微结构.结果 人脑胶质瘤细胞系U251在转染针对CDC2的shRNA逆转录病毒表达质粒48h后,贴壁生长的细胞逐渐漂浮,细胞生长受到抑制,CDC2 mRNA下调均达98%以上,蛋白表达下调达92%以上,同时出现了明显的细胞G2/M期阻滞,细胞凋亡由0.57%上升到13.01%,并且超微结构受损明显.结论 CDC2 shRNA逆转录病毒表达质粒介导的RNA干扰能有效的抑制U251细胞的增殖,CDC2可作为胶质瘤基因治疗靶分子作进一步研究.     

Effect of High Concentrations of Bile Acids on Cultured Hepatocytes

High concentrations of bile acids have been reported as injurious to hepatocytes. We report the influence of various combinations of bile acids on the liver-specific function of cultured rat hepatocytes. Using 4 bile acids (glycocholate [GC], taurocholate [TC], glycohenodeoxycholate [GCDC], and taurochenodeoxycholate [TCDC]), we obtained 6 bile-acid mixtures, each containing equal amounts of 2 bile acids (total bile acids [TBA], 2 m M ). Changes in gluconeogenesis, ureagenesis, DNA contents, medium alanine aminotransferase, and morphologies were compared among the paired bile acid compositions by measuring the C/CDC ratio ([GC + TC]/[GCDC + TCDC]) of each. In terms of their relative impairments of ureagenesis from greatest to least, the acids were GCDC, TCDC, and GC, which was almost the same as TC. When the C/CDC ratio was 0, the values of all parameters measured deteriorated. When the C/CDC ratio was 1 in the presence of 1 m M GCDC, only the rate of ureagenesis was diminished. When the C/CDC ratio was infinite, no hepatocellular injury was observed. GCDC and TCDC, together or separately, showed significant hepatocellular injury when the TBA concentration was 2 m M .     

Biomarkers in assessing residential insecticide exposures during pregnancy and effects on fetal growth

The Columbia Center for Children's Environmental Health is using a combination of environmental and biologic measures to evaluate the effects of prenatal insecticide exposures among urban minorities in New York City. Of the 571 women enrolled, 85% report using some form of pest control during pregnancy and 46% report using exterminators, can sprays, and/or pest bombs. Chlorpyrifos, diazinon, and propoxur were detected in 99.7-100% of 48-h personal air samples collected from the mothers during pregnancy (n = 394) and in 39-70% of blood samples collected from the mothers (n = 326) and/or newborns (n = 341) at delivery. Maternal and newborn blood levels are similar and highly correlated (r = 0.4-08, P < 0.001). Levels of insecticides in blood samples and/or personal air samples decreased significantly following the 2000-2001 U.S. Environmental Protection Agency's regulatory actions to phase out residential use of chlorpyrifos and diazinon. Among infants born prior to 1/1/01, birth weight decreased by 67.3 g (95% confidence interval (CI) -116.6 to -17.8, P = 0.008) and birth length decreased by 0.43 centimeters (95% CI, -0.73 to -0.14, P = 0.004) for each unit increase in log-transformed cord plasma chlorpyrifos levels. Combined measures of (ln)cord plasma chlorpyrifos and diazinon (adjusted for relative potency) were also inversely associated with birth weight and length (P 0.8). Results support recent regulatory action to phase out residential uses of these insecticides.     

Diagnosis of chronic disseminated candidosis from liver biopsies by a novel PCR in patients with haematological malignancies

Hepatic Candida infection (HCI; known as chronic disseminated candidosis or CDC) is a distinct form of disseminated Candida infection with predominant involvement of the liver. Diagnosis of HCI is usually made on clinical suspicion together with multiple lesions in liver on ultrasound (US), CT and/or MRI scan. Fungal elements may not always be visible in liver tissue and mycological culture is frequently negative, making the evidence for proven fungal disease difficult. We studied a novel commercially available low-cost and density-array (LCD) chip technique for a molecular diagnosis of HCI. This is a two-step procedure with PCR amplification after DNA extraction followed by hybridization on a small chip provided by the manufacturer (Fungi 2.1, Chipron GmbH). The analysis of DNA from 45 fungal control strains showed an excellent specificity and sensitivity. The DNA from 11 liver biopsies of patients with haematological malignancies suffering from CDC was analysed on the LCD chip and overall 11 fungal pathogens could be detected in eight liver biopsies, supporting the clinical diagnosis of HCI/CDC. Analysis of liver biopsies from controls was negative for fungal DNA in all samples studied. In conclusion, the novel LCD chip technique examined in our study was able to detect fungal pathogens in liver biopsies from patients with haematological malignancies and suspected HCI/CDC but was negative in control biopsies.     

The challenge of informed consent for increased risk living donation and transplantation

The Organ Procurement and Transplantation Network (OPTN) mandates that organ recipients provide "specific informed consent" before accepting organs that the OPTN defines as "increased risk". However, the OPTN does not provide specific guidelines for what information should be disclosed to potential recipients. Such vagueness opens the door to inadequate informed consent. This paper examines the ethical dimensions of informed consent when the prospective living donor has self-reported behaviors associated with increased risk for infection transmission. Donor privacy is a primary ethical concern that conflicts with recipients' informed consent for use of increased risk organs. We propose that both the increased risk status and the specific behavior be disclosed to the recipient. Because the actual risk posed is linked to the type of risk behavior, disclosure is therefore needed to make an informed decision. The donor's risk behavior is material to recipients' decision making because it may impact the donor-recipient relationship. This relationship is the foundation of the donation and acceptance transaction, and thus comprises a critical feature of the recipient's informed consent. Optimizing a recipient's informed consent is essential to protecting patient safety and autonomy.     

运城疾病控制中心工作人员应对方式与心理健康的关系

目的探讨运城市疾病控制中心(CDC)工作者应对方式的特点,了解其与心理健康的关系。方法采用整群抽样法抽取73名运城市CDC工作人员,并采用症状自评量表(SCL-90)和简易应对方式问卷(SCSQ)对其进行调查。结果运城CDC工作者的心理健康状况与全国常模的差别不具有统计学意义(P0.05);不同专业的工作人员心理健康状况差别具有统计学意义(P0.05),且非医学专业者总体状况欠佳;运城CDC工作人员心理健康的多因素回归分析发现,消极应对方式、专业和是否经常与艾滋病人沟通等因素均有正性影响。结论运城CDC工作者应对方式与心理健康关系密切;减少采用消极应对方式和改善医患沟通模式是维护其心理健康的重要举措。