奥美拉唑与脑卒中相关性肺炎的关系研究

目的探讨无法进食经鼻饲的急性脑卒中患者给予奥美拉唑后胃液pH值、胃腔细菌定植情况以及对应激性消化道溃疡、卒中相关性肺炎（SAP）的影响。方法90例患者依据奥美拉唑应用时间随机分为三组,每8小时抽取胃液,测pH值及潜血试验。留取胃液、深部痰行细菌培养。结果三组胃液pH值、各组SAP发生率差异有统计学意义：三组应激性溃疡的发生率差异无统计学意义。90例患者中31例发生胃腔细菌定植,三组差异有统计学意义。胃腔细菌定植患者pH值与无细菌定植患者胃液pH值差异有统计学意义;发生胃腔细菌定植细菌主要为革兰阴性杆菌;17例SAP患者痰细菌培养主要为革兰阴性杆菌。17例SAP患者pH值与非SAP患者胃液pH值差异有统计学意义;急性脑卒中鼻饲患者,应用奥美拉唑时间延长,胃液pH增加,胃腔细菌定植增多,SAP发生率增加,应激性溃疡发生率下降。结论对于急性脑卒中患者应选择应用奥美拉唑时间,需监测胃液pH值,使胃液pH值保持适当范围。     

Consecutive outbreaks of Vibrio cholerae O139 and V. cholerae O1 cholera in a fishing village near Karachi, Pakistan

In July 2002 and June 2003, cholera outbreaks were detected by a diarrhoea surveillance system in a village outside Karachi, Pakistan. Specimens were culture confirmed. The first outbreak was caused by Vibrio cholerae O139 (n = 30) and the second outbreak by V. cholerae O1 (n = 39). Demographic and clinical features of patients were recorded and case-control studies were conducted following each outbreak. Clinical information was obtained for 29 of the 30 patients in the first outbreak, and 2 of the patients in the second outbreak were either out of the area or lost to follow-up, leaving 29 and 37 cases in the analysis for the first and second outbreak, respectively. Eighteen (49%) of the 37 V. cholerae O1 patients were under 2 years of age compared with 6 (21%) of the 29 V. cholerae O139 patients (P = 0.02). Vibrio cholerae O139-infected patients were more likely to be febrile (16/29) than those infected with V. cholerae O1 (2/37; P<0.001). A household contact with cholera was a risk factor in both outbreaks; water source was a risk factor in the first outbreak only. Geographically, cases were clustered during the first outbreak but not during the second. Person-to-person contact and water reservoirs appear to be the main transmission routes for cholera in this setting.     

Ketamine–propofol versus ketamine fentanyl for anesthesia in pediatric patients undergoing cardiac catheterization: A prospective randomized study

ObjectiveThe aim of the study was to assess, compare the safety and efficacy of continuous IV administration of a combination of ketamine–propofol versus ketamine fentanyl for anesthesia in children undergoing cardiac catheterization procedures with RT to Lt Shunt.MethodsThirty-six children aged from 1 to 8 years, with RT to Lt Shunt scheduled for Cardiac catheterization in Mansoura Children Hospital were included in this study. Patients in group KP (n = 18) received ketamine (1 mg/kg) and propofol (2 mg/kg) as induction agents followed by combination of ketamine (25 μg/kg/min) and propofol (25 μg/kg/min) for maintenance of anesthesia. On other hand, patients in group KF (n = 18) received ketamine (1 mg/kg) and fentanyl (1 μg/kg) as induction agents followed by combination of ketamine (25 μg/kg/min) and fentanyl (0.75 μg/kg/min) for maintenance of anesthesia. Hemodynamic, oxygenation, recovery variables and side effects were recorded.ResultsThere were no statistical significant differences with age, sex, duration of anesthesia. There were statistical significant decreases in mean arterial blood pressure (MAP), systemic vascular resistance (SVR), pulmonary to systemic vascular resistance ratio in KP group. Additionally, Sao₂ and Pao₂ after anesthesia in KF group were statistically significant higher than the other group. Also there was significant prolongation of time to full recovery in KF group compared with KP group.ConclusionWe concluded that a combination of ketamine–fentanyl is safer and more efficacious than ketamine–propofol for pediatric cardiac catheterization although it was associated with prolonged recovery time.     

Visual impairments in people with severe and profound multiple disabilities: an inventory of visual functioning

Background The prevalence of visual impairments in people with severe and profound multiple disabilities (SPMD) is the subject of considerable debate and is difficult to assess. Methods In a typical Dutch care organization, all clients with SPMD (n = 76) participated in the study and specific instruments adapted to these clients (requiring a minimum of cooperation) were used to measure visual acuity, the visual field, binocular vision, contrast sensitivity, refractive errors and visual functioning behaviour. Results We found an unexpected 92% of clients with SPMD to have visual impairments. Previously, only 30% were known to have visual problems. None of the persons observed had normal visual acuity. Subnormal visual acuity was the best result. The severity of the visual impairment was related to the severity of the intellectual disability. In addition to the problem of acuity, impairments in the visual field, impaired contrast sensibility and impaired binocular functioning were found, as well as impaired visual attention, fixation and following. In 22% of the _clients observed, refractive errors were found and glasses were advised. Conclusions Consequences for caregiving and for modifications of the environment were discussed.     

A study in male and female 5-HT transporter knockout rats: An animal model for anxiety and depression disorders

Human studies have shown that a reduction of 5-HT transporter (SERT) increases the vulnerability for anxiety and depression. Moreover, women are more vulnerable to develop depression and anxiety disorders than men. For that reason we hypothesized that homozygous 5-HT transporter knockout rat (SERT^−/−) models, especially female, are valuable and reliable animal models for humans with an increased vulnerability for anxiety- and depression-related disorders. As rats are extensively used in neuroscience research, we used the unique 5-HT transporter knockout rat, that was recently generated using N-ethyl-N-nitrosurea (ENU) -driven mutagenesis, to test this hypothesis. Behavioral testing revealed that male and female SERT^−/− rats spent less time in the center of the open field and spent less time on the open arm of the elevated plus maze compared with wild-type 5-HT transporter knockout rats (SERT^+/+). In the novelty suppressed feeding test, only male SERT^−/− rats showed a higher latency before starting to eat in a bright novel arena compared with SERT^+/+ controls. Both male and female SERT^−/− rats showed a higher escape latency from their home cage than SERT^+/+ littermates. Moreover, SERT^−/− rats were less mobile in the forced swim test, and sucrose consumption was reduced in SERT^−/− rats relative to SERT^+/+ rats. Both effects were sex-independent. Neurochemically, basal extracellular 5-HT levels were elevated to a similar extent in male and female SERT^−/− rats, which was not influenced by the selective 5-HT reuptake inhibitor citalopram. 5-HT immunostaining revealed no difference between SERT^+/+ and SERT^−/− rats in the dorsal raphe nuclei, in both males and females. These findings demonstrate that SERT^−/− rats show anxiety and depression-related behavior, independent of sex. Genetic inactivation of the SERT has apparently such a great impact on behavior, that hardly any differences are found between male and female rats. This knockout rat model may provide a valuable model to study anxiety- and depression-related disorders in male and female rats.     

Prevalence of Salmonella in finishing swine raised in different production systems in North Carolina,USA.

We compared the prevalence of salmonella in faecal samples from finishing pigs and in feed samples from swine herds in North Carolina, USA. Farms were either finishing sites using all-in/all-out management of buildings in multiple-site systems (14 farms) or farrow-to-finish systems using continuous flow management of finishing barns (15 farms). The two groups of herds differed with respect to several management variables. Salmonella were isolated from 565 of 2288 (24.6%) faecal samples and from at least 1 faecal sample on 24 of 29 (83%) farms. Predominant serotypes were S. derby, S. typhimurium (including copenhagen), S. heidelberg, S. worthington and S. mbandaka. Fewer farrow-to-finish farms were detected as positive compared with all-in/all-out farms. Prevalence was lower for pigs raised on slotted floors compared with all other floor types, and was highest for pigs raised on dirt lots. Modern methods of raising pigs in multiple-site production systems, using all-in/all-out management of finishing pigs, appear to have no benefit in reducing the prevalence of salmonella compared with conventional farrow-to-finish systems.     

Private demand for cholera vaccines in Beira, Mozambique

In the summer of 2005, we interviewed 996 randomly selected respondents in Beira, Mozambique concerning their willingness and ability to pay for cholera vaccine for themselves and for other household members. Respondents were told that two doses of the vaccine would be required 2 weeks apart, and that the cholera vaccine would offer excellent protection against infection for the first year following vaccination, and some protection during the second and third year after a person is vaccinated. This research was carried out in order to learn more about private demand for vaccines in a cholera-endemic area. We asked two types of valuation questions: (1) a discrete-price offer for a vaccine that could be purchased for household members and (2) a payment card designed to assess uncertainty in the respondent's demand for a vaccine for self-protection. We estimate average household willingness to pay (WTP) for cholera vaccines in Beira to be 2005 US$ 8.45. This estimate of household WTP represents the perceived private economic benefits to a household--six persons on average--of giving all members free cholera vaccines.     

Safety and immunogenicity of a reformulated Vietnamese bivalent killed, whole-cell, oral cholera vaccine in adults

Vietnam currently produces an orally administered, bivalent (O1 and O139) killed whole-cell vaccine and is the only country in the world with endemic cholera to use an oral cholera vaccine in public health practice. In order to allow international use, the vaccine had to be reformulated to meet World Health Organization (WHO) requirements. We performed a randomized, placebo controlled, safety and immunogenicity studies of this reformulated vaccine among Vietnamese adults. One hundred and forty-four subjects received the two-dose regimen and 143 had two blood samples obtained for analysis. We found that this reformulated oral killed whole-cell cholera vaccine was safe, well tolerated and highly immunogenic.