Nosocomial transmission clusters and risk factors in Moraxella catarrhalis

SUMMARYWe report an objective examination of nosocomial transmission events derived from long-term (10-year) data from a single medical centre. Cluster analysis, based on the temporal proximity of genetically identical isolates of the respiratory pathogen Moraxella catarrhalis, identified 40 transmission events involving 33 of the 52 genotypes represented by multiple isolates. There was no evidence of highly transmissible or outbreak-prone genotypes. Although most clusters were small (mean size 3.6 isolates) and of short duration (median duration 25 days), clustering accounted for 38.7% of all isolates. Significant risk factors for clustering were multi-bed wards, and winter and spring season, but bacterial antibiotic resistance, manifested as the ability to produce a beta-lactamase was not a risk factor. The use of cluster analysis to identify transmission events and its application to long-term data demonstrate an approach to pathogen transmission that should find wide application beyond hospital populations.     

Modeling the spread of infectious disease using genetic information within a marked branching process

Accurate assessment of disease dynamics requires a quantification of many unknown parameters governing disease transmission processes. While infection control strategies within hospital settings are stringent, some disease will be propagated due to human interactions (patient‐to‐patient or patient‐to‐caregiver‐to‐patient). In order to understand infectious transmission rates within the hospital, it is necessary to isolate the amount of disease that is endemic to the outside environment. While discerning the origins of disease is difficult when using ordinary spatio‐temporal data (locations and time of disease detection), genotypes that are common to pathogens, with common sources, aid in distinguishing nosocomial infections from independent arrivals of the disease. The purpose of this study was to demonstrate a Bayesian modeling procedure for identifying nosocomial infections, and quantify the rate of these transmissions. We will demonstrate our method using a 10‐year history of Morexella catarhallis. Results will show the degree to which pathogen‐specific, genotypic information impacts inferences about the nosocomial rate of infection. Published in 2009 by John Wiley & Sons, Ltd.     

Pretreatment lymphangiography in carcinoma of the uterine cervix

Pretreatment diagnosis of lymphatic involvement and evaluation of its extent are important in patients with carcinoma of the uterine cervix. From April 1973 to December 1974 all Stage I and II patients with histologically confirmed carcinoma of the cervix at Walter Reed Army Medical Center who were good operative risks underwent pretreatment lymphangiography. A total of 60 patients was studied. Clinical Stage I patients with negative nodes underwent Wertheim-Taussig hysterectomy. Stage II patients with negative lymphangiograms received radiation therapy. All patients with positive lymphangiograms underwent exploratory laparotomy providing histologic correlation and received appropriate postoperative radiotherapy.Histologic correlation with negative lymphangiograms was found in 94.1% of cases. All nodal metastases 1 cm or greater were identified radiologically, thus permitting a more rational selection of patients for surgical staging and enabling the precise direction of therapy.The results of this study suggest a definite role for lymphangiography as an adjunct in diagnosis and planning therapy in patients with carcinoma of the uterine cervix. It would appear especially useful in the selection of those patients who might benefit from removal of bulky metastases and extended field irradiation.     

Inflammatory response after neurosurgery

Investigation into the inflammatory response in the central nervous system (CNS) is a rapidly growing field, and a vast amount of information on this topic has accumulated over the past two decades. Inflammation is a particularly interesting issue in the (traditionally non-regenerating) CNS, owing to its dual role in worsening or improving regeneration and functional outcome in certain circumstances. This paper reviews the current literature on the interactions between the immune system and the CNS in physiological and pathological states. The first part will provide an overview of the cellular and molecular components of CNS inflammation, this being followed by a discussion of the concept of systemic immunodepression after neurotrauma and neurosurgery. Finally, the delicate balance of immune responses in the CNS, with an emphasis on the beneficial effects of inflammation and possible therapeutic options, will be discussed.     

Activation of adrenal preganglionic neurons during autonomic dysreflexia in the chronic spinal cord-injured rat

Autonomic dysreflexia (AD) occurs in a majority of high paraplegic and quadriplegic patients and is particularly characterized by a paroxysmal hypertension elicited by somatic or visceral stimuli. We have previously shown that plasma adrenaline and noradrenaline levels were significantly increased during episodes of AD in the 30-day spinal cord-injured (SCI) rats, suggesting the participation of adrenal catecholamines in the cardiovascular changes associated to AD. Thus, adrenal sympathetic preganglionic neurons (SPN) could be activated by visceral afferences leading to AD. The aim of this study was then to demonstrate whether visceral stimulation that induces AD activates adrenal SPN in chronic SCI rats. To this end, a retrograde tracer, the cholera toxin B subunit (CTB), was combined with the immunocytochemical detection of Fos protein after visceral stimulation. Chronic SCI rats received a CTB injection into the adrenal gland and, 3 days later, were stimulated by repetitive distension of the colon. Results showed that this stimulation elicited typical hypertensive episodes of AD and a significant increase in the number of double-labeled neurons (CTB/Fos immunoreactive neurons) in the thoracic spinal cord below the level of injury (T4 segment) when compared to the stimulated non-SCI rats. In conclusion, visceral stimulations in the chronic SCI rats activate adrenal SPN, which could induce release of catecholamines by the adrenal medulla. The present study brings new data on the spinal mechanisms of AD cardiovascular dysfunctions.     

Body composition of children in south-western Nigeria: validation of bio-electrical impedance analysis

Bio-electrical impedance analysis (BIA) is a non-invasive method of estimating body composition and has the potential to be useful in clinics and for nutrition and health-related research in Africa. We sought to validate BIA for use among a Yoruba population in south-western Nigeria and to use BIA to assess the body composition of a healthy cohort of children. Total body water (TBW) was measured in 92 individuals (53 adults and 39 children) using deuterium dilution; height, weight and resistance were measured by BIA. Multiple regression analysis was used to develop prediction equations for TBW among children only or among all participants. Independent covariates tested in the regression models included the impedance index (height(2)/resistance), weight, age and gender with TBW as the dependent variable. Depending on the model used, between 97% (root MSE=0.7 kg ) and 99% (root MSE=0.7 kg) of the variance observed in TBW could be explained by the impedance index, weight and/or gender; age, however, was not significant in any model. In a separate cohort of 69 children, 5-8 years old, anthropometrics were measured and TBW was estimated using the developed equations. Body composition data are presented by gender and age group. BIA was validated for use among Nigerian children and adults and provides a potentially important tool for research.     

Randomised controlled trial of the onset of analgesic efficacy of dexketoprofen and diclofenac in lower limb injury

Objective: To assess the time of onset and difference in analgesic efficacy of oral dexketoprofen compared with oral diclofenac in patients with acute lower limb injury.

Design: A prospective, double blind, randomised controlled trial.

Interventions: Patients who fitted the study criteria were given either 25 mg oral dexketoprofen trometamol or 50 mg sodium diclofenac immediately after triage; baseline and 15 minute pain scores were then recorded for one hour.

Results: 122 patients were studied (diclofenac = 57 and dexketoprofen = 65). There were no significant differences in age, sex, type of injury, or baseline pain scores between the two groups. The differences in group mean pain scores between diclofenac and dexketoprofen at 15, 30, 45, and 60 minutes were; 0.53 (95% confidence intervals -0.03 to 1.09), 0.70 (0.16 to 1.24), 0.89 (0.32 to 1.47), and 0.83 (0.21 to 1.45). Odds ratios for a decrease in pain score of at least 1 from baseline (on the 11 point scale) when given dexketoprofen rather than diclofenac at 15, 30, 45, and 60 minutes were; 2.66 (1.19 to 5.98), 3.52 (1.60 to 7.73), 4.48 (1.72 to 11.65), and 5.54 (1.90 to 16.15). Corresponding odds ratios for a decrease in pain score of 2 were; 6.88 (1.48 to 32.0), 3.79 (1.59 to 9.01), 5.19 (2.29 to 11.78), and 5.87 (2.68 to 12.88).

Conclusions: Dexketoprofen trometamol is an effective and rapidly acting analgesic for the treatment of acute musculoskeletal injuries.