Confusion,Urea, Respiratory Rate and Shock Index or Adjusted Shock Index (CURSI or CURASI) criteria predict mortality in community-acquired pneumonia

BackgroundCommunity-acquired pneumonia (CAP) is common and associated with a significant mortality. Shock index, heart rate divided by systolic blood pressure, has been shown to be associated with outcome in sepsis.ObjectiveTo examine the usefulness of two new criteria CURSI (confusion, urea, respiratory rate and shock index), and CURASI where shock index is replaced by temperature adjusted shock index in mortality assessment of CAP.MethodsA prospective study was conducted in Norfolk and Suffolk, UK. We explored the usefulness of CURSI and CURASI which we derived and performed mapping exercise using a different cohort. In this study we compared these new indices with the CURB-65 criteria in correctly predicting mortality in CAP.ResultsA total of 190 patients were included (males = 53%). The age range was 18–101 years (median = 76 years). There were a total of 54 deaths during a six-week follow-up. All died within 30-days. Sixty-five (34%) had severe pneumonia by CURB-65. Using CURSI and CURASI, 71(37%) and 69(36%) had severe pneumonia, respectively. The sensitivity, specificity, positive and negative predictive values in predicting death during six-week follow-up were comparable among three indices examined. The Receiver Operating Characteristic curve values (95%CI) for the criteria were 0.67(0.60–0.75) for CURB-65, 0.67(0.59–0.74) for CURSI and 0.66(0.58–0.74) for CURASI (p > 0.05). There were strong agreements between these three indices (Kappa values ≥0.75 for all). Repeating analyses in those who were aged 65 years and over (n = 135) did not alter the results.ConclusionsBoth CURSI and CURASI are similarly useful to CURB-65 in predicting deaths associated with CAP including older patients.     

Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam

Background  

Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated with antibiotics.     

Highly increased numbers of leukocytes in inflamed gingiva from patients with HIV infection.

BACKGROUND: HIV infection increases susceptibility for marginal periodontitis, with horizontal and rapid loss of periodontal soft tissues and alveolar bone. OBJECTIVES: To examine whether numbers, distribution and some properties of mast cells, neutrophils and macrophages are normal in chronically inflamed gingiva of HIV-positive patients. METHODS: Gingival biopsies were stained for mast cell tryptase and chymase, neutrophil elastase, CD68, human transforming growth factor beta(1), HLA-DR, Fc gamma RI, Fc gamma RII and Fc gamma RIII and calprotectin. RESULTS: Patients at all stages of HIV infection showed radically increased numbers of mast cells and neutrophils throughout the connective tissue, and of macrophages below the oral gingival epithelium (P < 0.05). CONCLUSION: HIV infection is associated with increased numbers of mast cells, macrophages and neutrophils in the chronic periodontal lesion. This may predispose for tissue destruction through the release of inflammatory mediators and effector molecules. The unusually heavy cell infiltrate throughout the gingival connective tissue may contribute to the diverging pattern of periodontal tissue loss in HIV-positive patients.     

Selected Nonpharmacological Therapies for Chronic Pain: The Therapeutic Use of the Placebo Effect

Chronic pain is a common problem requiring a multidisciplinary approach. Nursing can offer diverse therapies complementary to the medical-surgical approach. Guidelines for practice and challenges for research are outlined for selected nonpharmacological chronic pain therapies. This article discusses the placebo effect, which is common to all therapies. Placebos can therapeutically empower patients to stimulate their psychophysiologic self-regulation abilities. Effects, theories, ethics, and therapeutic methods of stimulating the placebo effect are explored.     

Clinical and histological features of inoculation site skin lesions in cynomolgus monkeys experimentally infected with Orientia tsutsugamushi

Cynomolgus monkeys, as animal models of scrub typhus, are typically infected with Orientia tsutsugamushi by intradermal inoculation. However, the clinical and histological features at the O. tsutsugamushi inoculation sites, akin to "eschars" at chigger inoculation sites in humans, have not been fully characterized. We intradermally inoculated one medial thigh of six cynomolgus monkeys with semi-purified O. tsutsugamushi (Karp). Within 7 days, two animals developed scrub typhus-like eschars and four had dusky plaques, accompanied by inguinal lymphadenopathy. Biopsies of eschars and an enlarged regional lymph node resembled human disease and stained positively for O. tsutsugamushi by Giemsa, anti-Karp fluorescent antibody, or streptavidin alkaline phosphatase. O. tsutsugamushi-specific IgM and IgG antibody levels measured in both of two monkeys rose steadily after infection. This pilot study shows that cynomolgus intradermally inoculated with O. tsutsugamushi replicate the localized cutaneous pathogenesis of human scrub typhus infections, strengthening the value of this animal model.