<Emphasis Type="Italic">Streptobacillus moniliformis</Emphasis> septic arthritis: a clinical entity distinct from rat-bite fever?

Background  

Streptobacillus moniliformis is a zoonotic agent associated with rodent contacts. Although it is more commonly reported to cause rat-bite fever with reactive arthritides, it can also lead to pyogenic infection of the joints.     

Dietary protein intake and bone mineral content in adolescents—The Copenhagen Cohort Study

Summary Data indicate that various protein sources may exhibit a differential effect on bone metabolism. We investigated associations of milk and meat protein intake with bone mineral content (BMC) in adolescents. Milk, but not meat, protein intake was positively associated with size-adjusted BMC. Milk-derived protein may be beneficial for bone mineralization. Introduction Milk and meat protein intake has been reported to exhibit a differential effect on serum insulin-like growth factor-I (IGF-I). IGF-I plays a key role in bone metabolism. Therefore, we investigated associations of different protein sources with BMC and bone area (BA) in adolescents. Methods This was a cross-sectional study of 17-year-old girls (n = 63) and boys (n = 46) participating in the second follow-up of The Copenhagen Cohort Study. We measured dietary intake (7-day food record), BMC and BA (dual-energy X-ray absorptiometry), serum markers for bone turnover and serum IGF-I (immunoassays). Results The mean total protein intake (∼1.2 g/kg) was modestly higher than that recommended. Total and milk (∼0.3 g/kg) protein intake, but not meat protein intake (∼0.4 g/kg), was positively associated with size-adjusted BMC (P ≤ 0.05). The positive association between milk protein intake and size-adjusted BMC remained significant after correction for energy, calcium, and physical activity (P ≤ 0.01) and did not seem to be mediated via current serum IGF-I. None of the analyzed protein sources was significantly associated with size-adjusted BA. Conclusions Our results suggest that some components of milk protein may promote bone mineralization. Further studies are needed to elucidate this phenomenon.     

Percutaneous endoscopic gastrostomy in children with cancer

We reviewed the clinical course of 32 children with cancer who received nutrition through a feeding tube placed percutaneously during gastroscopy (PEG). Their median age was 5.1 y (75%, range: 1.8-13.7 y, min: 3.5 mo) when the PEG was done 0.7-23 mo after diagnosis (median: 1.8 mo, 75%; range: 0.9-8 mo). Five of the children underwent bone marrow transplantation with the gastrostomy in place. There was a significant (p     

Treatment of recurrent neurocardiogenic syncope with cardiac inhibitors with ipratropium bromide

Pharmacological approaches for the treatment of cardioinhibitory vasovagal syncope are controversially discussed in the literature. In acute treatment of neurocardiogenic syncope, anticholinergics (atropine) are used effectively. Randomised and placebo-controlled clinical trials evaluating the preventive significance of anticholinergic agents in the therapy of cardioinhibitory vasovagal syncope are still missing.We report the case of an 18-year-old male patient with recurrent convulsive, cardioinhibitory neurocardiogenic syncope. Vasovagal syncope occurred predominantly as centrally induced syncope triggered by negative emotions such as fear or by seeing blood. Under resting conditions, the patient revealed increased parasympathetic tone with nocturnal bradycardia of 38 beats/min. In the course of head-up tilt table testing a cardioinhibitory syncope with an asystolic pause of 10 seconds occurred without any prodromes after 10 minutes of upright positioning. In order to inhibit parasympathetic tone, medication with ipratropiumbromide was initiated. Time-variant analysis of heart rate variability (autoregressive model) during head-up tilt table testing showed under the medication with ipratropiumbromide a vagal mediated cardioinhibition to 56 beats/min, but no further sinus arrest.Throughout clinical follow-up of 6 months the patient remained syncope-free under the medication. The usefulness of ipratropiumbromide in inhibiting vagal mediated cardioinhibition will be discussed referring to the case report and to studies evaluating anticholinergic agents in the treatment of neurocardiogenic syncope.     

Vulnerability in health care – reflections on encounters in every day practice

Vulnerability is a human condition and as such a constant human experience. However, patients and professional health care providers may be regarded as more vulnerable than people who do not suffer or witness suffering on a regular basis. Acquiring a deeper understanding of vulnerability would thus be of crucial importance for health care providers. This article takes as its point of departure Derek Sellman's and Havi Carel's discussion on vulnerability in this journal. Through different examples from the authors' research focusing on the interaction between health professionals and patients, existential, contextual, and relational dimensions of vulnerability are illuminated and discussed. Two main strategies in the professionals' interactions with patients are described. The strategy that aims at understanding the patients or families from the professional's own personal perspective oftentimes ends in excess attention to the professional's own reactions, thereby impairing the ability to help. The other strategy attempts to understand the patients or families from the patients' or families' own perspective. This latter strategy seems to make vulnerability bearable or even transform it into strength. Being sensitive to the vulnerability of the other may be a key to acting ethically.     

Lack of transmission of neutrophil and platelet antibodies by intravenous immunoglobulin in bone marrow transplant patients

BACKGROUND: Several studies have demonstrated that the administration of intravenous immunoglobulin (IVIG) may be followed by the transient appearance of positive red cell antibody screens, positive direct antiglobulin tests, and, occasionally, frank hemolysis. However, little information is available regarding the possibility that IVIG could transmit neutrophil and/or platelet antibodies. STUDY DESIGN AND METHODS: Serum samples were obtained both immediately before and immediately after the administration of 12 separate lots of commercially available IVIG to bone marrow transplant patients. RESULTS: None of the patients were shown by standard granulocyte immunofluorescence testing to have acquired neutrophil antibodies. Four of the 12 postinfusion sera were positive for platelet antibodies in standard platelet suspension immunofluorescence testing, but in all four instances the corresponding preinfusion serum was positive as well. CONCLUSION: The risk of acquiring neutrophil and/or platelet antibodies after the administration of commercially available IVIG appears to be low.