Importance of Vitamin D to Postmenopausal Women’s Health

Postmenopausal women have a significantly higher incidence and rate of breast cancer, cardiovascular disease, and osteoporosis compared with the general population. Current scientific evidence has shown that, in addition to calcium homeostasis, vitamin D has protective properties against breast neoplasms and cardiovascular risks and promotes bone health. Acknowledging these attributes of vitamin D will help not only to expand the understanding of pathophysiology of chronic conditions but also encourage primary care clinicians to provide vitamin D screening, supplementation, and education to prevent debilitating conditions in postmenopausal women.     

An Outbreak of Food‐borne Illness Due to Methomyl Contamination

Abstract

Background.?On December 26, 2002, 124 dinners took ill while eating lunch at a seafood restaurant in the town of Chiching in Kaohsiung municipality of Taiwan. Sixty‐nine people were sent to the emergency departments of the Municipal Chiching Hospital and Yuan's General Hospital. Methods.?We analyzed the clinical symptoms, detailed food history, and ingested amount of each food from 59 hospitalized adult patients and identified the source of the outbreak. Results.?The median latency period from beginning eating to first symptoms was 5 min. Twenty‐six symptoms and signs were recorded. The most commonly reported clinical effects were general weakness (84%), ataxia (82%), dizziness (82%), vomiting (80%), sweating (75%), floating sensation (71%), headache (69%), dyspnea (69%), and blurred vision (67%). Thirty‐one patients had residual symptoms 7 days after ingestion. Of the six residual symptoms reported, the most frequent ones were dizziness (40%), poor appetite and dry mouth (11%), and gastrointestinal disturbance (11%). The presence of residual symptoms correlated with the severity of the initial complaints (p < 0.01). Almost all patients ate cooked rice (93%) and leaf vegetable stir‐fried with crab claw (93%). The amount of each food eaten by the patients was not associated with the severity of symptoms (p > 0.05). High levels of methomyl in leaf vegetables of “leaf vegetables stir‐fried with crab claws” (380 ppm) and fried mussels (1113 ppm) were found by the Food Inspection Center at the Department of Health. The food history and chemical analysis of the poison indicated methomyl was the cause of this outbreak. Twenty‐four patients recovered completely within 7 days. Conclusion.?Food‐related methomyl intoxication produced a rapid onset of significant clinical toxicity in 124 individuals. Based on the analysis of 55 adult patients, the most common effects were gait ataxia, dizziness, generalized weakness, and vomiting.     

A Simple,Safe, and Efficient Way to Treat Severe Fluoride Poisoning—Oral Calcium or Magnesium

Purpose: To examine the efficacy and safety of administration of calcium and magnesium orally and intraperitoneally to treat severe sodium fluoride intoxication. Materials and Methods: Mice were initially gavaged a lethal dose of sodium fluoride (NaF) or water. Then, mice were treated with water or varying concentrations of calcium chloride (CaCl₂) or magnesium sulfate (MgSO₄) via intraperitoneal (IP) route or via oral route. Mice were monitored for 24h, and the time of death was recorded. Results: IP injections of large amounts of CaCl₂ or MgSO₄ were dangerous. All mice gavaged with water and then treated with oral CaCl₂ or MgSO₄ survived and displayed normal activity during the experiment. The survival rate of mice gavaged with a lethal dose of NaF and then treated with a high dose of oral CaCl₂ or MgSO₄ was significantly higher than those of using low dose. Conclusion: Oral administration of a high dose of CaCl₂ or MgSO₄ is a simple, safe, and effective adjunctive method for treating severe oral fluoride poisoning.     

Perihepatic,Pulmonary, and Renal Abscesses Due to Spilled Gallstones

Background

Spilled gallstones are common during laparoscopic cholecystectomy; however, they rarely lead to postoperative complications. Perihepatic abscesses develop in < 0.1% of patients with spilled gallstones and are typically contained within the peritoneal cavity.

Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Enterobacter cloacae: Role of Carbapenem Therapy

Enterobacter cloacae is an important nosocomial pathogen. However, few studies specifically dealing with the clinical characteristics and outcome of extended-spectrum β-lactamase (ESBL)-producing E. cloacae infections have been published. During an 8-year period in a medical center, of 610 E. cloacae bacteremic isolates, 138 (22.6%) with ESBL genes were designated the ESBL group, and 120 (19.6%) cefotaxime-nonsusceptible isolates without the ESBL phenotype and genes were designated the control group. Of the former group of isolates, 133 (96.3%) carried the bla_SHV-12 gene, 3 (2.1%) had bla_CTX-M3, and 2 (1.4%) had both the bla_SHV-12 and bla_CTX-M3 genes. After patients under the age of 18 years were excluded, there were 206 adults with E. cloacae bacteremia, and these consisted of 121 patients in the ESBL group and 85 in the control group. More episodes of hospital-onset and polymicrobial bacteremia, increased severity of illness, more cases of bacteremia onset in intensive care units (ICUs), and longer stays in the hospital and ICU after bacteremia onset were noted in the ESBL group. However, the crude and sepsis-related mortality rates in two groups were similar. Of the ESBL group, the in-hospital sepsis-related mortality rate of patients definitively treated by a carbapenem was lower than that of those treated by noncarbapenem β-lactams (5/53, or 9.4%, versus 13/44, or 29.5%; P = 0.01) though the difference was not significant in the hierarchical multivariate analysis (P = 0.46). Among 62 patients with follow-up blood cultures within 14 days of bacteremia onset, breakthrough bacteremia was more common in those treated by a noncarbapenem β-lactam agent than in those treated by a carbapenem (18/31, or 58.0%, versus 3/31, or 9.6%; P < 0.001). Thus, carbapenem therapy for ESBL-producing E. cloacae that cause bacteremia may provide therapeutic benefits.Enterobacter cloacae is an increasingly important nosocomial pathogen and causes a wide spectrum of infections involving the urinary tract, lower respiratory tract, skin and soft tissue, biliary tract, wounds, intravenous catheters, and the central nervous system (21). It is traditionally characterized by chromosomally encoded AmpC β-lactamases and obtains the ability to develop resistance upon exposure to broad-spectrum cephalosporins (10), but a growing number of E. cloacae strains with extended-spectrum β-lactamases (ESBLs) have been observed worldwide, including in Taiwan (1, 2, 23, 28).Based on previous reports concerning Taiwan, the prevalence of ESBL-producing E. cloacae was 15 to 28%, with the dominance of strain SHV-12 (1, 25, 27, 28). However, the impact of this resistance on mortality is still under debate (4, 9, 28), and few studies dealing specially with the clinical implications of ESBL-producing E. cloacae have been published. Moreover, carbapenem was considered a first choice for treatment of severe infections caused by ESBL-producing Enterobacteriaceae other than E. cloacae, such as Klebsiella pneumoniae and Escherichia coli (17). However, the role of carbapenem therapy in the clinical outcomes of patients with bacteremia caused by ESBL-producing E. cloacae remained unclear. The study was intended to characterize the clinical features and outcomes of patients with bacteremia due to ESBL-producing E. cloacae and to analyze the therapeutic effects of carbapenem therapy.     

The Unique Management of Cystic Fibrosis–Related Diabetes and the Importance of Glycemic Control

Cystic fibrosis (CF) is a rare autosomal recessive lung disease that decreases the ability of chloride channels to function properly, leading to complications such as salt loss and mucus accumulation in different organs. Mucus accumulation leads to lung infections and decreased pancreatic function, nutrition, and sperm production. Treatment developments have prolonged the median life expectancy, but, with increasing age, a condition known as CF-related diabetes (CFRD) is more likely to develop. CFRD is a distinct condition that is different from type 1 and type 2 diabetes in key ways, including its pathophysiology, diagnosis, and management. It is essential for nurse practitioners in the primary-care setting to recognize these differences, because CFRD is becoming more common in CF patients. Obtaining glycemic control and recognizing its importance in patients with CFRD is especially significant, because glycemic control is correlated with lung function. This review focuses on recognizing CFRD and the rationale behind treatment differences.     

Risks of leukapheresis and how to manage them—A non-systematic review

Leukapheresis is like any other preparative apheresis, except it isn’t: Leukapheresis typically takes much longer, larger blood volumes are processed and, consequently, larger ACD-A volumes are administered. Blood component donors and leukapheresis subjects are also quite different populations. Allogeneic donors tend to be younger and many are first-time donors, both of which are risk factors for adverse reactions during blood donation. Moreover, more than half of all leukapheresis collections are performed in patients. Here it is the age distribution, including patients at the extremes of age, as well as the underlying disease and co-morbidities which may expose them to higher, or different, risks compared to donors. Both groups thus have good reasons why adverse effects to leukapheresis might be more frequent, more severe, or even different in nature altogether. Compared to other preparative apheresis types like platelet or plasma apheresis, the risks of leukapheresis have been studied less extensively, as it is in comparison a relatively low-frequency intervention. Often leukapheresis remains a domain of hematologists who have a different sense of procedural safety than transfusionists. Furthermore, G-CSF mobilized “stem cell” aphereses by a wide margin outnumber unmobilized aphereses, so that the very strong signal from adverse reactions to G-CSF all but drowns out signals from the apheresis proper. This focused review assesses observations from leukapheresis as well as extrapolation of observations from other forms of preparative apheresis in an attempt to gauge the safety of leukapheresis and identify potential approaches to its further improvement. In short, the overall impression is one of a very satisfactory safety record of leukapheresis, with occasional issues with venous access or vasovagal problems, and frequent, but highly responsive and rarely limiting ACD-A toxicity.     

Complement and atherosclerosis—united to the point of no return?

Atherosclerosis is widely regarded as a chronic inflammatory disease that develops as a consequence of entrapment of oxidized low-density lipoprotein (LDL) in the arterial intima and its interaction with components of both innate and adaptive immunity. This article reviews the role of the complement system in the context of a different concept on atherogenesis. Arguments are forwarded in support of the contention that enzymatic and not oxidative modification of LDL is the prerequisite for transforming the lipoprotein into a moiety that is recognized by the innate immune system. In a departure from general wisdom, it is proposed that these processes are initially not pathological. To the contrary, they are physiological and meaningful because only thus can the stranded lipoprotein with its insoluble cargo, cholesterol, be removed from tissues. It is contended that histopathologically defined initial foam cell formation develops without inflammation and is reversible. Atherosclerosis as a disease evolves only when the cholesterol removal machinery is overloaded and it then represents a special type of immunopathological process primarily involving immune effectors of the innate rather than the adaptive immune system. This sets it apart from classical immunopathological reactions that are all based on dysfunctional adaptive immunity. But as with all other diseases of known origin, a defined molecular trigger, enzymatically modified-LDL (eLDL), exists whose intimal accumulation is required to initiate the pathologic process. And as with other diseases, the course of atherosclerosis will then be influenced by myriad genetic, endogenous, and environmental factors that by themselves, however, will not cause the disease. This simple concept is completely in line with general clinical experience and with the results of major clinical trials that have been conducted during the past decades.     

Impact of the MIC of Piperacillin-Tazobactam on the Outcome of Patients with Bacteremia Due to Extended-Spectrum-β-Lactamase-Producing Escherichia coli

We investigated the impact of the piperacillin-tazobactam MIC in the outcome of 39 bloodstream infections due to extended-spectrum-β-lactamase-producing Escherichia coli. All 11 patients with urinary tract infections survived, irrespective of the MIC. For other sources, 30-day mortality was lower for isolates with a MIC of ≤2 mg/liter than for isolates with a higher MIC (0% versus 41.1%; P = 0.02).     

Predictive Importance of Antenatal Depressive Rumination and Worrying for Maternal–Foetal Attachment and Maternal Well-Being

Rumination and worrying are relevant to the onset and maintenance of depression and anxiety. Yet, it is unclear, whether depressive rumination and worrying are predictive for depressive and anxious symptomatology during pregnancy. Likewise, the potential role of depressive rumination and worrying for maternal–foetal attachment has been rarely explored. In the present longitudinal study, N = 215 pregnant women were assessed within the first 4 months of pregnancy and again in the last 4 months of pregnancy. Using regression analysis, associations between worrying and depressive rumination on the one hand and maternal–foetal attachment, depression and anxiety on the other were studied—controlling for age, number of children, social support and baseline antenatal depressive and anxious symptoms. Baseline rumination was a significant predictor of impairments in maternal–foetal attachment in later pregnancy. Baseline worrying was a significant predictor of heightened depressive symptoms and anxiety. These effects were of modest magnitude. Nonetheless, our findings reveal that different types of perseverative thinking (i.e., rumination vs. worry) might have differential effects on maternal well-being and maternal–foetal attachment.