Nasal myiasis in an intensive care unit linked to hospital-wide mouse infestation

A large city hospital experienced an infestation of mice combated in part by broadcasting poisoned baits. Months later there was an invasion of flies into the hospital, and 2 comatose patients in an intensive care unit contracted nasal maggots. Adult flies were trapped and maggots removed from the nares of the second patient. These were identified as the green blowfly (Phaenicia sericata). Recent downsizing of hospital personnel had led to the unintended and unrecognized loss of housekeeping services in the canteen food storage areas. A mouse infestation of the hospital occurred, with the epicenter in the canteen area. This was initially addressed by scattering poisoned bait and using rodent glue boards. The result of such treatment was the presence of numerous mouse carcasses scattered throughout the building attracting the green blowfly. Adult gravid female flies trapped in the new intensive care unit (where mice were not present) laid eggs in the fetid nasal discharge of 2 comatose patients. Live trapping of mice and removal of carcasses led to an abatement of the fly infestation. The cause-and-effect nature of the mouse carcasses and flies was underscored a year later when an outbreak of P. sericata occurred in the operating department and was linked to the presence of mouse carcasses on glue boards not removed the previous fall. Hence, the disruption or loss of 1 vital link in hospital organization (in this case, housekeeping support) may lead to an unintended and bizarre outcome.     

Case-control study of vaccination history in relation to pertussis risk during an outbreak among school students

BACKGROUND: Between September and December 2003, an outbreak of pertussis occurred in Cass County, MO, mostly among adolescent school children. METHODS: We conducted a 1:2 matched case-control study among school children and used conditional logistic regression to evaluate risk factors for pertussis, including the total number of vaccine doses received, age at administration of each dose of vaccine and the type of vaccine (whole cell or acellular). RESULTS: Of all 127 pertussis cases reported in this outbreak, the majority were adolescents (10-19 years of age, 50%) and adults (20 years or older, 22%); only 10% were infants and children less than 5 years of age. Because the focus of our investigation was on school-aged children, we enrolled 237 students (79 cases and 158 controls) in our study. Students missing at least one dose of the vaccine had higher risk for pertussis than those who received all 5 doses (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.17-4.77). Early administration of the fifth dose of the vaccine at age 4 years was significantly associated with risk for pertussis compared with vaccination at age 5 years (adjusted OR, 2.45; 95% CI, 1.16-5.16). A short time interval (<36 months) between the fourth and fifth doses of the vaccine also tended to increase the risk for pertussis, although this association was not statistically significant. The type of vaccine was not a significant risk factor. CONCLUSION: Administering all 5 doses of pertussis vaccine and the fifth dose at age 5 years with at least 36 months between the fourth and fifth doses provided the best protection against pertussis among children and adolescents in this outbreak.     

THE EFFECT OF PROSTAGLANDIN E1 ON PULMONARYBLOOD FLOW AFTER RETROGRADE FLUSH ANDCOLD STORAGE OF LUNGS

ReSllm6 Objectif Nos studes Precedentes out montrd une panne fonCtion de la greffe pulmonaire traitde Prdalablementper perfusion forcde retrograde et un stockage d froid inns ~. L' etude Prdsente a pour but de determiner l' effet de ~ surlefiot mngUin du poumon trait4 Prdalablement per perfusion retrograde forcde et un stockage d froid. met~. 12poumons donneurs canins out ate trait4s per perfusion r4tFograde de solution UW. Chez 6 animaux du grouch A, 250ng furent injectes dans l' artrdre…     

Effect of coarse wheat bran fiber and exercise on plasma lipids and lipoproteins in moderately overweight men

The effects of the American Association of Cereal Chemists coarse wheat bran fiber and exercise were evaluated in 20 males, aged 24 to 35 yr, and at least 10% above ideal weight. Thirteen of the subjects participated in a 4 mile walk-jog run program 3 times weekly. In a cross-over design with diets switched midway through the experiment, both the exercising and sedentary groups consumed isocaloric amounts of either white bread or white bread containing wheat bran (0.5 g/kg body weight). Plasma total and lipoprotein cholesterol and triglycerides, body weights, and percentage body fats were determined at 0, 6, and 12 wk. No consistent effects were observed as a result of the wheat bran feeding on any of the parameters measured. Exercise training tended to decrease body weights and percentage body fats, and was associated with significantly increased (p less than 0.05) plasma high-density lipoprotein cholesterol levels and high-density lipoprotein cholesterol to low-density lipoprotein cholesterol ratios. After a rise in triglycerides at wk 6, a significant decline (p less than 0.05) back to base-line values was observed at wk 12 for the exercised subjects.     

Noncardiogenic pulmonary edema caused by decompression sickness: rapid resolution following hyperbaric therapy

Noncardiogenic pulmonary edema is a recognized but uncommon manifestation of type 2 decompression sickness. It typically occurs within 6 hours of a dive. Because the adult respiratory distress syndrome in this setting is believed to be due to microbubbles in the pulmonary vasculature, recompression in a hyperbaric chamber has been recommended as a form of therapy. A patient developed noncardiogenic pulmonary edema following a seawater dive to 75 feet. There was complete radiologic and clinical resolution within 5 hours of hyperbaric therapy.     

An update on transient ischemic attacks.

Each year in the United States 200,000-500,000 people have a transient ischemic attack (TIA). These episodes of brief neurologic deficits were thought to be fairly benign, but this view is changing. In 2002, a new definition for TIA was proposed, and a more intensive diagnostic workup recommended to look for a probable cause of the transient neurologic deficit. Implementation of prevention strategies is essential because the risk of a stroke following a TIA is approximately 30% within 5 years. These changes have important implications for nursing care and patient advocacy. In addition, patient and family education must be addressed by the entire healthcare team.