Ertapenem (MK-0826), a new carbapenem: comparative in vitro activity against clinically significant anaerobes

Ertapenem, a new long acting beta-lactam with broad-spectrum antimicrobial coverage, was tested in vitro to compare its activity against 556 clinical isolates of anaerobes to other established agents using a broth microdilution method as recommended by the NCCLS. Against all anaerobes ertapenem inhibited 99.1% of isolates at 4 microg/mL, had a mode MIC of 0.12 microg/mL, and showed activity comparable to imipenem, meropenem, trovafloxacin, piperacillin-tazobactam, and metronidazole. Five of the B. fragilis group (4 B. fragilis, 1 B. vulgatus) isolates tested showed reduced susceptibility (>or=8 microg/mL; <1%) to ertapenem while all isolates of Prevotella, Porphyromonas, Fusobacterium, and Peptostreptococcus were susceptible. Only piperacillin-tazobactam had susceptible MIC's for all test isolates followed by metronidazole and the carbapenems exhibiting low resistance rates (<1%).     

Care of the dying: is pain control compromised or enhanced by continuation of the fentanyl transdermal patch in the dying phase?

The introduction of fentanyl transdermal patches has led to concern and confusion regarding the management of pain control in the dying phase. Data were collected retrospectively from 94 dying patients. Two groups were identified-patients treated with fentanyl transdermal patch who remained on the patch in the dying phase and patients on oral morphine who converted to a 24-hour subcutaneous infusion of diamorphine via a syringe driver in the dying phase. Both the fentanyl group and the diamorphine group had good pain control in the last 48 hours of life. During the last 48 hours of life, the proportion of patients with controlled pain was statistically significant in favor of the fentanyl group in 2 of the 12 observations undertaken, in particular whether the fentanyl transdermal patch should be continued or discontinued. Patients in the fentanyl group received fewer "as required" opioid doses compared to patients in the diamorphine group, although the difference was statistically significant only for the last day of life. This study showed that pain control was not compromised in the dying phase with continued use of the fentanyl patch.     

Hook of the hamate fractures in competitive golfers: results of treatment by excision of the fractured hook of the hamate

Seven competitive golfers presented with isolated fractures of the hook of the hamate. All patients were treated with excision of the fractured hook of the hamate, with complete resolution of pain. All patients returned to their previous level of play. It is reasonable to deduce, with this group of patients, that this fracture pattern represents an overuse or repetitive motion injury. Regardless of etiology, prompt diagnosis and treatment of this injury with excision of the fractured hook of the hamate bone allows competitive golfers to return to their previous level of competition.     

Absorption,tissue distribution and elimination of 4-[(3)h]-epigallocatechin gallate in beagle dogs

Polyphenols found in tea are potent antioxidants and have inhibitory activity against tumorigenicity. The purpose of the described study was to assess the absorption, tissue distribution, and elimination of epigallocatechin gallate (EGCG), the principal catechin found in green tea, in a nonrodent species. 4-[(3)H]-EGCG was administered to beagle dogs by intravenous (IV) and oral routes. Following IV administration of 25 mg/kg, radioactivity in the bloodstream resided predominantly in the plasma. Distribution occurred during the first hour, and the plasma levels of total radioactivity declined with a mean half-life of approximately 7 hours. The apparent volume of distribution (0.65 l/kg) indicated wide distribution, and the total body clearance (1.01 ml/min-kg) was low. A subsequent single oral dose (250 mg/kg) was rapidly absorbed, with peak plasma levels at about 1 hour after administration, followed by elimination with a mean half-life of 8.61 hours. The mean area under the curve (AUC) for total radioactivity was approximately 20% of the value following IV administration (corrected for dose administered). Excretion of radioactivity in the feces predominated over urinary excretion following both IV and oral administration of [(3)H]-EGCG. Tissue distribution was determined 1 hour after an IV dose (25 mg/kg) administered after 27 days of oral treatment with EGCG (250 mg/kg/day) to mimic chronic consumption of tea. Radioactivity was distributed to a variety of epithelial tissues; the highest concentrations were observed in the liver and gastrointestinal tract tissues. Repeat dose oral administration of EGCG resulted in significantly lower blood radioactivity compared to the concentration following a single dose. These results are generally in accord with previous studies in rodents and indicate that, after oral administration, EGCG (as parent compound and metabolites) is widely distributed to tissues where it can exert a chemopreventive effect.     

From attitude formation to behavioral response in organ donation: using marketing to increase consent rates

This article presents a theoretical analysis of attitude formation and the relationship to stated behavioral intentions as it relates to the decision to donate organs. This analysis reveals the presence of three distinct paths to behavior of potential donors, groups differing in their involvement with organ donation. Promotional objectives and campaign strategies designed to influence attitudes and behaviors should differ according to the behavioral path in operation and the involvement of the audience. Mass media campaigns are likely to reach high involvement groups only. Therefore, personal selling, underutilized in previous donation campaigns, should be brought into the donation strategy to appeal to low involvement groups. By recognizing differences in audience involvement and implementing different strategies, overall donation rates could substantially increase.     

Medial meniscus interposition in proximal tibial epiphyseal fracture: a case report and review of the literature

Proximal tibial fractures are rare in children, and most are treated conservatively. We report a case of a minimally displaced proximal tibial epiphyseal injury (Salter-Harris type III) in an 11-year-old child. We initially thought to treat this fracture conservatively, but the presence of massive haemarthrosis and considerable pain made us choose arthroscopy under general anaesthetic. During examination under anesthesia no instability could be detected, but the knee was locked in 5 degrees of flexion. On screening the fracture was not reducible anatomically. At arthroscopy the medial meniscus was not visualised as it was displaced into the fracture site. A small medial arthrotomy showed the meniscus trapped in the fracture site without any avulsion in the anterior or posterior horns. The fracture easily reduced once the meniscus was levered out. The importance of this injury is the fact that it could have been easily missed and would have led to serious functional deficit of the knee joint. We present radiographs and intra-operative pictures of this interesting injury.     

Perpetrators of spousal homicide: a review

It has been argued that individuals who engage in spouse abuse increase their violence toward their partners, which can culminate in the death of either the assaulter or the victim. The aim of this review is to identify risk factors that determine whether an abusive relationship will end in eventual death. An extensive search revealed 22 empirical research studies on risk factors for spousal homicide. The circumstances of spousal homicide are described and salient risk factors are highlighted. In the United Kingdom, 37% of all women were murdered by their current or former intimate partner compared to 6% of men. The most common cause of an intimate partner's death in England and Wales was being attacked with a sharp implement or being strangled. By contrast, the most common cause in the United States for spousal homicide was being shot. Nine major risk factors are found that may help predict the probability of a partner homicide and prevent future victims.     

Searching PubMed/MEDLINE, Ingenta, and the Music Therapy World Journal Index for articles published in the Journal of Music Therapy

The purpose of this study was to carry out a comparison between references to articles published in the Journal of Music Therapy before December 2002 identified through searching PubMed/MEDLINE, the Ingenta database and those actually published in the journal. To carry out this comparison we have created a new database, called the Music Therapy World Journal Index, which includes complete indexes of selected music therapy journals. All articles published in the Journal of Music Therapy since its commencement in 1964 are referenced in this database. We found a large number of articles that are not identified by searching PubMed/MEDLINE. There is an under-representation of both the amount of articles published in this journal and in the range of areas for clinical application and research in music therapy. The Ingenta database is comprehensive but limited in its coverage of the early years. To carry out a comprehensive research of the literature, it is necessary to consult an expert database, such as the Music Therapy World Journal Index, that guarantees an unequivocal level of completeness.