Bleach and LISS: a potential hazard

Investigation into the corrosion of a copper alloy inlet port of a vacuum aspirator revealed an exothermic reaction between copper, glycine--the primary constituent of low-ionic-strength-saline (LISS)--and the widely used disinfectant sodium hypochlorite (common bleach). The apparatus had been used for several years to aspirate LISS-wash supernatants during the preparation of LISS-suspended red cells for antibody detection tests. A small blue-rimmed hole had formed through the side of the inlet port of the equipment, which had been rinsed with bleach during periodic cleansing. Our observations indicate a need for caution when using bleach to decontaminate waste or spills containing glycine. Contact of such materials with base metal parts of laboratory apparatus should be avoided, especially when copper is involved.     

Car seat heaters: a potential hazard for burns

Car seat heaters have gained popularity in America and worldwide. They offer comfort by heating the sitting surface to a soothing temperature. Several cases of heating-element malfunction resulted in burn injuries and have triggered recalls of thousands of cars by the manufacturers. We present a case of a 48-year-old patient with long-standing paraplegia who sustained third-degree burns on his buttock during the initial drive of a new car with seat heaters. Car seat heaters can cause severe burns. Patients with decreased sensation or immobility are at increased risk and should not use car seat heaters. This case illustrates the need for design modifications and consumer education regarding the risks associated with car seat heaters.     

Gel wheelchair cushions: a potential cold weather hazard

Paraplegia and quadriplegia with concomitant impairment of cutaneous sensation predisposes to secondary skin damage, most commonly due to pressure or heat. Cold exposure, however, can also damage the skin. This report describes a 19-year-old man with myelodysplasia and L3 incomplete paraplegia who sustained extensive freeze burns of the buttocks from sitting on a gel wheelchair cushion that had been left outside in freezing weather. When he initially presented for medical care, the lesions were described by his physician as ischial pressure sores. On careful further questioning, prompted because of the unusual margins of the lesions, the true etiology was determined. The medical and surgical management of this patient's cold thermal injury, the thermomechanical properties of gel wheelchair cushions, and the literature pertaining to cold injury in the population with impaired spinal cord function are discussed.     

Laribacter hongkongensis: a potential cause of infectious diarrhea

In this study, we describe the isolation of Laribacter hongkongensis, a recently described genus and species of bacterium, in pure culture on charcoal cefoperazone deoxycholate agar from the stool of six patients with diarrhea. Three patients were residents of Hong Kong, and three of Switzerland. In none of the stool samples obtained from these six patients was Salmonella, Shigella, enterohemorrhagic Escherichia coli, Vibrio, Aeromonas, Plesiomonas, or Campylobacter recovered. Rotavirus antigen detection, electron microscopic examination for viruses, and microscopic examinations for ova and cysts were all negative for the stool samples obtained from the three patients in Hong Kong. Enterotoxigenic E. coli was recovered from one of the patients in Hong Kong. Unlike L. hongkongensis type strain HKU1, all the six strains were motile with bipolar flagellae. Sequencing of the 16S ribosomal RNA genes of the six strains showed that they all had sequences with only 0-2 base differences to that of the type strain. Pulsed field gel electrophoresis of the SpeI digested genomic DNA of the six isolates and that of the type strain revealed that the seven isolates were genotypically unrelated strains. More extensive epidemiologic studies should be carried out to ascertain the causative association between L. hongkongensis and diarrhea and to define the reservoir and modes of transmission of L. hongkongensis.     

Sample-to-result molecular infectious disease assays: clinical implications,limitations and potential

Molecular infectious disease diagnostic tests have undergone major advances in the past decade and will continue to rapidly evolve. Assays have become extraordinarily simple to perform, eliminating the need for pre-analytic sample preparation and post-amplification analysis. This allows these tests to be performed in settings without sophisticated expertise in molecular biology, including locations with limited resources. Additionally, the sensitivity and specificity of these assays is superb and many offer extremely fast turn-around times. These tests have major impacts on patient care, but also have some limitations.     

Emerging infectious disease agents and their potential threat to transfusion safety

BACKGROUND: Emerging infections have been identified as a continuing threat to human health. Many such infections are known to be transmissible by blood transfusion, while others have properties indicating this potential. There has been no comprehensive review of such infectious agents and their threat to transfusion recipient safety to date.
STUDY DESIGN AND METHODS: The members of AABB's Transfusion Transmitted Diseases Committee reviewed a large number of information sources in order to identify infectious agents with actual or potential risk of transfusion transmission now or in the future in the US or Canada; with few exceptions, these agents do not have available interventions to reduce the risk of such transmission. Using a group discussion and writing process, key characteristics of each agent were identified, researched, recorded and documented in standardized format. A group process was used to prioritize each agent on the basis of scientific/epidemiologic data and a subjective assessment of public perception and/or concern expressed by regulatory agencies.
RESULTS: Sixty-eight infectious agents were identified and are described in detail in a single Supplement to TRANSFUSION . Key information will also be provided in web-based form and updated as necessary. The highest priorities were assigned to Babesia species, Dengue virus, and vCJD.
CONCLUSION: The information is expected to support the needs of clinicians and transfusion medicine experts in the recognition and management of emerging infections among blood donors and blood recipients.     

Hyperbaric oxygen: applications in infectious disease

This article reviews the applications of hyperbaric oxygen (HBO) as an adjunctive treatment of certain infectious processes. Infections for which HBO has been studied and is recommended by the Undersea and Hyperbaric Medicine Society include necrotizing fasciitis, gas gangrene, chronic refractory osteomyelitis (including malignant otitis externa), mucormycosis, intracranial abscesses, and diabetic foot ulcers that have concomitant infections. In all of these processes, HBO is used adjunctively along with antimicrobial agents and aggressive surgical debridement. This article describes the details of each infection and the research that supports the use of HBO.     

Increasing whole blood oxygen affinity during rapid exchange transfusion: a potential hazard

Whole blood cell separators are being used to achieve partial exchange transfusions in patients with hemoglobin S. The rate and extent of the alteration of whole blood oxygen affinity, incurred by this procedure, has been determined in a patient with Hb S/C disease. The implications in terms of oxygen delivery to the tissues are described for this patient and also for patients with the more severe disease associated with Hb S/S. It is concluded that whole blood cell separators should be used with an awareness of the possible detrimental effects of acute increases of whole blood oxygen affinity in these patients.     

Progress in the treatment of a neglected infectious disease: visceral leishmaniasis

Visceral leishmaniasis (kala-azar) is a disseminated intracellular protozoal infection. Most cases (90%) occur in the rural regions of five countries: India, Sudan, Nepal, Bangladesh and Brazil. As with other infectious diseases embedded in high-level poverty, developing and/or delivering new treatments for visceral leishmaniasis had been painfully slow or nonexistent. However, despite persistent unresolved obstacles (e.g., drug affordability), renewed interest in visceral leishmaniasis and numerous successful treatment trials have combined to turn a therapeutic corner in the past 5 years, yielding new alternatives to conventional pentavalent antimony. Advances include the use of low-cost generic pentavalent antimony, rediscovery of amphotericin B, short-course regimens via lipid formulations of amphotericin B, retesting injectible paromyomycin and, of clear-cut importance, identifying miltefosine (Impavido, Zentaris) as the first effective oral therapy for this neglected disease.     

Progress in the treatment of a neglected infectious disease: visceral leishmaniasis

Visceral leishmaniasis (kala-azar) is a disseminated intracellular protozoal infection. Most cases (90%) occur in the rural regions of five countries: India, Sudan, Nepal, Bangladesh and Brazil. As with other infectious diseases embedded in high-level poverty, developing and/or delivering new treatments for visceral leishmaniasis had been painfully slow or nonexistent. However, despite persistent unresolved obstacles (e.g., drug affordability), renewed interest in visceral leishmaniasis and numerous successful treatment trials have combined to turn a therapeutic corner in the past 5 years, yielding new alternatives to conventional pentavalent antimony. Advances include the use of low-cost generic pentavalent antimony, rediscovery of amphotericin B, short-course regimens via lipid formulations of amphotericin B, retesting injectible paromyomycin and, of clear-cut importance, identifying miltefosine (Impavido^®, Zentaris) as the first effective oral therapy for this neglected disease.     

Prostacyclin in liver disease: a potential therapeutic option

Complex molecular and cellular mechanisms are involved in the initiation and progression of hepatic fibrosis. Recent studies have shown that hepatic stellate cells, endothelin, cytokines and prostacyclin play crucial roles in this pathology. Prostacyclin exerts vasorelaxant, antioxidant and antifibrotic properties that prevent the development of fibrosis and cirrhosis in liver diseases. In this editorial, the authors discuss some of the molecular and cellular mechanisms involved in the initiation and progression of liver fibrosis and the role played by prostacyclin in counteracting it. At the moment, however, only limited information is available from clinical studies demonstrating the effectiveness of prostacyclin in liver diseases and this makes it difficult to draw any conclusions; further efforts are necessary to verify whether prostacyclin, alone or in combination with other drugs, may be a valid therapeutic option in liver diseases.     

Prostacyclin in liver disease: a potential therapeutic option

Complex molecular and cellular mechanisms are involved in the initiation and progression of hepatic fibrosis. Recent studies have shown that hepatic stellate cells, endothelin, cytokines and prostacyclin play crucial roles in this pathology. Prostacyclin exerts vasorelaxant, antioxidant and antifibrotic properties that prevent the development of fibrosis and cirrhosis in liver diseases. In this editorial, the authors discuss some of the molecular and cellular mechanisms involved in the initiation and progression of liver fibrosis and the role played by prostacyclin in counteracting it. At the moment, however, only limited information is available from clinical studies demonstrating the effectiveness of prostacyclin in liver diseases and this makes it difficult to draw any conclusions; further efforts are necessary to verify whether prostacyclin, alone or in combination with other drugs, may be a valid therapeutic option in liver diseases.     

PCR-electrospray ionization mass spectrometry: the potential to change infectious disease diagnostics in clinical and public health laboratories

During the past 20 years, microbial detection methods that are genetically based, such as real-time PCR and peptide nucleic acid fluorescent hybridization, coexisted with traditional microbiological methods and were typically based on the identification of individual genetic targets. For these methods to be successful, a potential cause of infection must be suspected. More recently, multiplex PCR and multiplex RT-PCR were used to enable more broad-range testing based on panels of suspected pathogens. PCR-electrospray ionization mass spectrometry (PCR-ESI/MS) has emerged as a technology that is capable of identifying nearly all known human pathogens either from microbial isolates or directly from clinical specimens. Assay primers are strategically designed to target one or more of the broad pathogen categories: bacterial, mycobacterial, fungal, or viral. With broad-range amplification followed by detection of mixed amplicons, the method can identify genetic evidence of known and unknown pathogens. This unique approach supports a higher form of inquiry, asking the following question: What is the genetic evidence of known or unknown pathogens in the patient sample? This approach has advantages over traditional assays that commonly target the presence or absence of one or more pathogens with known genetic composition. This review considers the breadth of the published literature and explores the possibilities, advantages, and limitations for implementation of PCR-ESI/MS in diagnostic laboratories.     

Delayed-impact infectious disease after a natural disaster

Most recent studies of natural disasters have shown little increase in post-disaster infectious disease. The result has been a de-emphasis of the disease control portion of many disaster relief programs. This study demonstrates a significant increase in four out of the five diseases studied following two hurricanes in the Dominican Republic, with the major impact of the increases coming several months after the disaster. Posited reasons for the increase in infectious diseases are: (a) overcrowding of makeshift refugee centers with insufficient sanitary facilities, and (b) flood-caused water transmission of pathogens.     

Accidental hypothermia: A potential life-threatening hazard of automobile platform lifts

The wheelchair/scooter of a patient with a relapsing-remitting form of multiple sclerosis was immobilized after inadvertent slippage of the rear wheels of his scooter off an automobile platform lift during travel. While waiting 45 min for the rescue squad, he developed mild hypothermia that responded to passive external rewarming techniques. This potentially life-threatening injury could have been prevented by using a platform lift equipped with full inboard and outboard roll-stop barriers on the platform.     

持续静脉-静脉血液滤过治疗重症急性胰腺炎的护理

目的总结24例重症急性胰腺炎(SAP)患者行持续静脉-静脉血液滤过(CVVH)的护理体会。方法对24例SAP患者在行CVVH过程中的心理变化、生命体征、血滤机参数及治疗并发症进行观察及护理。结果在治疗过程中监测血液生化指标和尿量,均能平稳清除多余水分和毒素,维持水、电解质和酸碱平衡,为SAP的救治提供了有效的支持。结论CVVH治疗SAP的重点是做好患者的心理护理,严密观察生命体征,注意监测血滤机参数,加强管路护理,预防CVVH的并发症等。