Urinary catheters: what type do men and their nurses prefer?

OBJECTIVES: Urinary catheters are used frequently, but the relative risks and benefits of different types of devices are not clear. We sought to determine the beliefs of both older male patients and nursing staff about the relative merits and problems of condom and indwelling catheters. DESIGN: Patient and nurse survey using convenience sampling. SETTING: A University-affiliated Veterans Affairs medical center. PARTICIPANTS: Men hospitalized on medical, rehabilitation and nursing home units using either an indwelling or a condom catheter were invited to participate as were all members of the nursing staff on these units. Of 116 eligible patients, 104 were interviewed (response rate = 90%). Of 107 eligible nursing staff members, 99 completed the questionnaires (response rate = 92%). INTERVENTION AND MEASUREMENTS: Consenting patients were interviewed personally about their urinary catheter. The nursing staff were asked to complete a self-administered questionnaire. RESULTS: Patients were mostly older and predominantly hospitalized on the medical service. Compared with those using an indwelling catheter, patients using a condom catheter were more likely to believe that their catheter was comfortable (86 vs 58%, P = .04) and less likely to believe it was painful (14 vs 48%, P = .008) or to restrict their activity (24 vs 61%, P = .002). The nursing staff had a mean of 13 years nursing experience, and the majority worked in the nursing home unit. Most of the nursing staff respondents believed that condom catheters were less painful and restrictive for patients and were easier to apply, but they also believed that they fell off and leaked more often and required more nursing time. CONCLUSIONS: Both patients and nursing staff prefer condom to indwelling catheters for patient comfort, but they recognize that dislodgment and leaking are major drawbacks of condom catheters. A more secure condom catheter would greatly improve the management of male incontinence.     

Platelet kinetics in patients with idiopathic thrombocytopenic purpura and moderate thrombocytopenia

We studied ten normal subjects and 20 patients with stable, untreated idiopathic thrombocytopenic purpura (ITP) and platelet counts in the range of 35,000 to 110,000/microL. The diagnosis was made by clinical criteria. Platelet-associated IgG was increased in all nine of the nine patients studied. Autologous platelets were labeled with chromium 51 and reinfused for measurement of mean cell life and platelet production rate. Mean cell life was calculated by two methods, weighted mean and multiple hit, with excellent agreement between the two. As expected, mean cell life was significantly reduced in ITP patients as compared to the normal subjects (2.9 days v. 8.0 days, P less than .001). However, mean platelet production rates in ITP patients and normal subjects, 3.5 and 3.8 X 10(9) platelets/k/d respectively, were not significantly different. Platelet production rate was above and below the normal range (2 to 5.6 X 10(9) platelets/k/d) in two and four patients, respectively. We conclude that the rate of platelet production is not increased in most patients with ITP who have platelet counts greater than 35,000/microL. We did find that platelet size was increased in eight of the 12 patients in whom it was measured, including two of the patients with low platelet production.     

Granulocyte colony-stimulating factor administration to healthy volunteers: analysis of the immediate activating effects on circulating neutrophils

In four healthy volunteers, we analyzed in detail the immediate in vivo effects on circulating neutrophils of subcutaneous administration of 300 micrograms of granulocyte colony-stimulating factor (G-CSF). Neutrophil activation was assessed by measurement of degranulation. Mobilization of secretory vesicles was shown by a decrease in leukocyte alkaline phosphatase content of the circulating neutrophils. Furthermore, shortly postinjection, Fc gamma RIII was found to be upregulated from an intracellular pool that we identified by immunoelectron microscopy as secretory vesicles. Intravascular release of specific granules was shown by increased plasma levels of lactoferrin and by upregulation of the expression of CD66b and CD11b on circulating neutrophils. Moreover, measurement of fourfold elevated plasma levels of elastase, bound to its physiologic inhibitor alpha 1- antitrypsin, indicated mobilization of azurophil granules. However, no expression of CD63, a marker of azurophil granules, was observed on circulating neutrophils. G-CSF--induced mobilization of secretory vesicles and specific granules could be mimicked in whole blood cultures in vitro, in contrast to release of azurophil granules. Therefore, we postulate that the most activated neutrophils leave the circulation, as observed shortly postinjection, and undergo subsequent stimulation in the endothelial microenvironment, resulting in mobilization of azurophil granules. Our data demonstrate that G-CSF should be regarded as a potent immediate activator of neutrophils in vivo.     

A current approach to diabetic foot infections

Foot infections are a common, complex, and serious problem in diabetic patients. Infections usually begin in foo ulcers, which are associated with neuropathy, vasculopathy, and various metabolic disturbances. These infections are potentially limb and sometimes life threatening. Etiologic agents are usually aerobic gram-positive cocci, but chronic or serious infections often contain gram-negative rods and anaerobes. Chronic infections can lead to contiguous bone infection. Diagnosing osteomyelitis may require imaging studies (especially magnetic resonance imaging) and occasionally bone biopsy. In addition to proper cleansing, debridement, and local wound care, diabetic foot infections require carefully selected antibiotic therapy. Serious infections necessitate hospitalization for initial parenteral broad-spectrum antibiotic therapy, but appropriately selected patients with mild infections can be treated as outpatients with oral (or even topical) agents. Initial antibiotic selection is usually empiric; modifications may be needed based on the results of properly obtained cultures and the clinical response. Therapy should be active against staphylococci and streptococci, with broader-spectrum agents indicated if polymicrobial infection is likely. Levels of most antibiotics, except fluoroquinolones, are often subtherapeutic in infected foot tissues. The duration of therapy ranges from a week (for mild soft tissue infections) to over 6 weeks (for osteomyelitis). No single antibiotic agent or combination has proven to be optimal. With appropriate local, surgical, and antimicrobial therapy, most diabetic foot infections can now be successfully treated.     

High-dose etoposide and cyclophosphamide without bone marrow transplantation for resistant hematologic malignancy

Seventy-five patients with resistant acute leukemia or lymphoma received high-dose cyclophosphamide and etoposide to explore the activity of this combination in resistant hematologic malignancies, and to determine the maximum doses of these drugs that can be combined without bone marrow transplantation. Etoposide was administered over 29 to 69 hours by continuous infusion corresponding to total doses of 1.8 g/m2 to 4.8 g/m2. Cyclophosphamide, 50 mg/kg/d, was administered on 3 or 4 consecutive days total 150 to 200 mg/kg ideal body weight). At all dose levels myelosuppression was severe but reversible. Mucosal toxicity was dose-limiting with the maximum tolerated dose level combining etoposide 4.2 g/m2 with cyclophosphamide 200 mg/kg. Continuous etoposide infusion produced stable plasma levels that were lower than would be achieved after administration by short intravenous infusion, and this could explain our ability to escalate etoposide above the previously reported maximum tolerated dose. There were 28 complete (35%) and 12 partial (16%) responses. Median duration of complete response (CR) was 3.5 months (range 1.1 to 20+). Seventeen of 40 patients (42%) with acute myelogenous leukemia (AML) achieved CR, including 6 of 20 (30%) with high-dose cytosine arabinoside resistance. We conclude that bone marrow transplantation is not required after maximum tolerated doses of etoposide and cyclophosphamide. This regimen is active in resistant hematologic neoplasms, and the occurrence of CR in patients with high-dose cytosine arabinoside-resistant AML indicates a lack of complete cross-resistance between these regimens.     

Expression of recombination activating genes 1 and 2 in peripheral B cells of patients with systemic lupus erythematosus

OBJECTIVE: To analyze immunoregulatory abnormalities in patients with systemic lupus erythematosus (SLE) by assessing the expression of messenger RNA (mRNA) for types 1 and 2 recombination activating genes (RAG) in the peripheral blood of patients with active SLE. METHODS: We examined B cell populations and also individual B cells from patients with SLE for the expression of RAG mRNA. RESULTS: Analysis of bulk mRNA indicated that RAG1 and RAG2 mRNA were found routinely in peripheral B cells of patients with active SLE, but not in healthy subjects. When assessed on a single-cell basis, there was a 3-fold increase in the frequency of RAG1- and RAG2-expressing B cells in SLE patients compared with healthy subjects. Notably, B cells expressing both RAG1 and RAG2 mRNA expressed only IgD mRNA, but not IgG mRNA. Fifty percent of RAG-expressing B cells also expressed VpreB mRNA, whereas all expressed CD154 mRNA. Phenotypic analysis indicated that RAG-expressing B cells were activated, mature B cells. CONCLUSION: These results indicate that RAG expression is up-regulated in peripheral IgD+ and VpreB+ B cells of patients with active SLE. These cells may contribute to the immunoregulatory abnormalities in patients with SLE.     

Factors affecting the clinical value of microscopy for acid-fast bacilli

In order to assess the clinical value of microscopy for acid-fast bacilli (AFB), the results of 3,207 clinical specimens submitted for mycobacterial smear and culture were analyzed. Mycobacteria grew from 176 (5.5%) of the specimens, 95 (54%) of which were Mycobacterium tuberculosis. Although the overall sensitivity of the smear was low (33%), 65% of respiratory specimens yielding M. tuberculosis had positive AFB smears. Furthermore, 96% of patients with pulmonary tuberculosis from whom more than one specimen was processed had at least a single positive AFB smear. Smear sensitivity correlated well with quantitative growth; 89% of specimens yielding greater than or equal to 50 colonies per slant were smear positive. Specificity of the AFB smear was high; 89% of smear-positive specimens had positive cultures. After the results from culture-negative patients known to have active tuberculosis were eliminated from the analysis, the specificity of a positive smear rose to 98.3%. When the results of all specimens from each patient were considered in toto, the AFB smear had a predictive value of greater than or equal to 96%.     

Unraveling the relationship between exposed surfaces and the photocatalytic activity of Ag3PO4: an in-depth theoretical investigation

Over the years, the possibility of using solar radiation in photocatalysis or photodegradation processes has attracted remarkable interest from scientists around the world. In such processes, due to its electronic properties, Ag₃PO₄ is one of the most important semiconductors. This work delves into the photocatalytic activity, stability, and reactivity of Ag₃PO₄ surfaces by comparing plane waves with projector augmented wave and localized Gaussian basis set simulations, at the atomic level. The results indicate that the (110) surface, in agreement with previous experimental reports, displays the most suitable characteristics for photocatalytic activity due to its high reactivity, i.e. the presence of a large amount of undercoordinated Ag cations and a high value work function. Beyond the innovative results, this work shows a good synergy between both kinds of DFT approaches.

Over the years, the possibility of using solar radiation in photocatalysis or photodegradation processes has attracted remarkable interest from scientists around the world.