In Vivo Effect of Carbon Dioxide Laser-Skin Resurfacing and Mechanical Abrasion on the Skin''s Microbial Flora in an Animal Model

BACKGROUND: Although beam-scanning carbon dioxide (CO2) lasers have provided a highly efficient tool for esthetic skin rejuvenation there has been no comprehensive animal studies looking into microbial skin changes following CO2 laser skin resurfacing. OBJECTIVE: To evaluate the in vivo effects of CO2 laser skin resurfacing in an experimental rat model in comparison with mechanical abrasion on the skin microbial flora. METHODS: Four separate cutaneous sections of the right dorsal surface of 10 Wistar rats were treated with a CO2 laser, operating at 18 W and delivering a radiant energy of 5.76 J/cm2, while mechanical abrasions of the skin were created on four sections of the left dorsal surface using a scalpel. Samples for culture and biopsies were obtained from the skin surfaces of the rats on day 1 of application of the CO2 laser or mechanical abrasion, as well as 10, 30, and 90 days after the procedure. The presence of four microorganisms (staphylococci, streptococci, diphtheroids, and yeasts) was evaluated as a microbe index for the skin flora, and colony counts were obtained using standard microbiological methods. RESULTS: Skin biopsy specimens, following CO2 laser treatment, initially showed epidermal and papillary dermal necrosis and later a re-epithelization of the epidermis as well as the generation of new collagen on the upper papillary dermis. The reduction in microbial counts on day 1 of the CO2 laser-inflicted wound was statistically significant for staphylococci and diphtheroids compared with the baseline counts (p=.004 and p<.001, respectively), and for staphylococci, diphtheroids, and yeasts compared with the scalpel-inflicted wound on the same day (p=0.029, p<.001, and p=.030, respectively). CONCLUSIONS: Skin resurfacing using CO2 lasers considerably reduces microbial counts of most microorganisms in comparison with either normal skin flora or a scalpel-inflicted wound. This might contribute to the positive clinical outcome of laser skin resurfacing.     

The increase in illegal private duty nurses in public Greek hospitals

fouka g., plakas s., papageorgiou d., mantzorou m., kalemikerakis i. & vardaki z. (2013) Journal of Nursing Management  21 , 633–637 The increase in illegal private duty nurses in public Greek hospitals Aim To consider key aspects of the increasing substitution of legal private duty nurses by an illegal immigrant health-care workforce. Background Inadequate nursing care infrastructure and an oversupply of illegal immigrants, coupled with the current economic climate, favours the growth of an unofficial economy in hospital care. Evaluation Information gathered from literature, governmental and ministerial records, the media and the press are evaluated. Key issues Increasing numbers of unauthorized immigrant health-care workers, facilitated by agencies, carry out undocumented private employment in hospitals for a considerably lower cost than their legal counterparts. Legal workers view their employment as being threatened and nurses have expressed concerns about quality of care and safety of patients, while at the same time health-care officials are unable to control this situation. Conclusions It is anticipated that unless an appropriate care infrastructure is developed, this situation will persist and even escalate. The effects on patient care and the economy of the country, in general, need to be evaluated. Implications for nursing management Managers ought to establish ways of improving the regulation and monitoring of illegal private duty nurses, in order to optimize the health, safety and wellbeing of patients.     

Successful Withdrawal from the Right Coronary Artery of an NIR Stent Dislodged from the Balloon Catheter

A 58-year-old patient who underwent right coronary arterial angioplasty with NIR stent placement is described. The stent was dislodged from the balloon catheter and a technique of stent entrapment with two guidewires was successfully performed to remove it from the coronary artery.     

Long‐Term Nonoutflow Septal Versus Apical Right Ventricular Pacing: Relation to Left Ventricular Dyssynchrony

Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long‐term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long‐term changes in LV volumes and EF. Methods: In thirty‐six patients with atrioventricular (AV) block, a dual‐chamber pacemaker was implanted. The ventricular electrode was placed either at the apex or at the lower septum, in a randomized sequence. Twenty‐four to 48 hours following implantation, we measured LV volumes, EF, and LV dyssynchrony (by tissue Doppler imaging), both with and without pacing. Patients were reassessed echocardiographically after 12 months. Results: Lower septal pacing induced a more synchronized pattern of LV contraction changes (P < 0.05). Following 12 months, differences were observed between groups regarding LV volumes and EF. EF increased within the septal group (from 52 ± 3.3% to 59 ± 3.0%, P < 0.05). A significant inverse relation was documented between changes in LV dyssynchrony and changes in EF (r =?0.64, P < 0.05). Conclusions: In patients with AV block, RV nonoutflow septal pacing represents an attractive alternative, since it preserves better and may even improve LV volumes and EF. Late changes in EF are associated with the changes in LV dyssynchrony imposed by pacing.     

SUPEROVULATION INDUCTION IN WOMEN SUPPRESSES LUTEINIZING HORMONE SECRETION AT THE PITUITARY LEVEL

In superovulated women the pituitary response to GnRH is markedly attenuated by an unspecified ovarian factor(s). To examine the site of attenuation, the response of the pituitary to GnRH was investigated in five normally ovulating women during the late follicular phase of 3 cycles, i.e. a spontaneous (control) cycle, a cycle treated with 'pure' FSH, and a cycle treated with a combination of 'pure' FSH and pulsatile GnRH, via a pump (15 micrograms/pulse). The oestradiol levels (mean +/- SEM) at the time of the GnRH challenge were respectively 646 +/- 35, 1692 +/- 282 and 5976 +/- 1129 pmol/l. The size of the leading follicle was similar in all groups. Serum LH levels during treatment with FSH decreased significantly, while during treatment with FSH plus GnRH they increased initially and then decreased progressively. The response of pituitary LH to GnRH was significantly attenuated during treatment with FSH and FSH plus GnRH, as compared to the spontaneous cycles, but was not abolished. The attenuation was significantly greater in the FSH plus GnRH cycles (94%) than in the FSH cycles (59%). We conclude that in superovulated cycles, the attenuation of the pituitary response to GnRH increases with the degree of ovarian hyperstimulation. It is suggested that the responsible unspecified ovarian factor(s) exerts its effects at least at the pituitary level.