Summer outbreak of respiratory disease in an Australian prison due to an influenza A/Fujian/411/2002(H3N2)-like virus

An outbreak of influenza A occurred in a prison system in New South Wales, Australia in January 2003 during the southern hemisphere summer. This report documents only the third confirmed outbreak of influenza in a prison environment. The outbreak investigation included case ascertainment, state-wide surveillance, a case-control study and interventions to limit the outbreak such as infection control, quarantine, cohorting of cases, and the use of antiviral medication for prophylaxis. A total of 37 clinical cases were identified. Influenza A virus was detected in 11 of the 22 respiratory tract specimens collected. The virus was typed as an influenza A/Fujian/411/2002 (H3N2)-like virus. This strain subsequently became the predominant virus strain during the northern hemisphere winter and the following 2003 Australian southern hemisphere winter influenza season.     

Mortality after rib fracture: A population-based analysis

Background. In single-institution studies, age is a risk factor for mortality after rib fracture. Sample size has limited the assessment of other risk factors. We used a national database to analyze suspected risk factors contributing to mortality in patients sustaining rib fracture. Methods. The 1999 Nationwide Inpatient Sample was queried for all patients with rib fracture. Age, gender, number of rib fractures, ISS, comorbidities, pneumonia, and mortality were abstracted from the database. Comorbidities were scored according to Elixhauser. Multivariate analysis identified independent risk factors for mortality. Results. 23,426 patients were identified. Mean age was 59. Median number of ribs fractured was 3. Mean ISS was 11.1. The number of comorbidities ranged from 0 to 10 and 9% of patients had pneumonia. Overall mortality was 4%. Odds ratios for death are shown. Conclusions. In a model controlling for multiple known risk factors, age and injury severity are the most important predictors of mortality in patients with rib fractures. The effect of a single comorbidity is minimal; however, multiple comorbidities can increase the odds of mortality equivalent to advanced age or severe injury.

TABLE—ABSTRACT 39.

Risk factor	Odds ratio	95% Confidence interval
Age
< 55	1.0	—
55-64	1.9	1.4, 2.5
65-79	2.7	2.2, 3.3
>79	5.3	4.2, 6.6
Comorbidity score∗	1.14	1.1, 1.2
ISS
<9	1.0	—
9-15	1.4	1.2, 1.7
16-25	2.8	2.2, 3.6
>25	16.9	13.4, 21.3
Pneumonia	1.5	1.2, 1.9
Female gender	0.6	0.5, 0.7

∗

The odds ratio for comorbidity indicates the odds ratio/comorbidity; the reference is a comorbidity score of 0 (no comorbidities).

Full-size table

     

Synthesis and biological evaluation of novel membrane-permeant cyclic ADP-ribose mimics: N1-[(5''-O-phosphorylethoxy)methyl]-5'-O-phosphorylinosine 5',5''-cyclicpyrophosphate (cIDPRE) and 8-substituted derivatives

N1-[(5' '-O-Phosphorylethoxy)methyl]-5'-O-phosphorylinosine 5',5'-cyclicpyrophosphate (cIDPRE 2a) and the 8-substituted derivatives 8-bromo-, 8-azido-, 8-amino-, and 8-Cl-cIDPRE (2b-e) were synthesized from N1-[(5'-acetoxyethoxy)methyl]-2',3'-O-isopropylideneinosine (5) in good yields. The pharmacological activities of cIDPRE and the 8-substituted derivatives (2a-e) were analyzed in intact and permeabilized human Jurkat T-lymphocytes. The results indicate that cIDPRE permeates the plasma membrane, releases Ca2+ from an intracellular, cADPR-sensitive Ca2+ store, and subsequently initiates Ca2+ release-activated Ca2+ entry. The Ca(2+)-releasing activity of cIDPRE was confirmed directly in permeabilized cells. Using time-resolved confocal Ca2+ imaging at the single cell level, the development of global Ca2+ signals starting from local small Ca2+ signals evoked by cIDPRE was observed. 8-N3-cIDPRE 2c and 8-NH2-cIDPRE 2d were similarly effective in their agonistic activity as compared to cIDPRE 2a, showing almost indistinguishable concentration-response curves for 2a, 2c, and 2d and very similar kinetics of Ca2+ signaling. In contrast, the halogenated derivatives 8-Br- and 8-Cl-cIDPRE (2b and 2e) did not significantly elevate [Ca2+]i. Therefore, cIDPRE 2a, 8-N3-cIDPRE 2c, and 8-NH2-cIDPRE 2d are novel membrane permeant cADPR mimic and may provide important novel tools to study cADPR-mediated Ca2+ signaling in intact cells.     

Propofol withdrawal syndrome in an adult patient with thermal injury

A 48-year-old man with a history of ethanol abuse and bipolar disease fell asleep while smoking in an intoxicated state. The patient received a 30% total body surface area burn involving his face and upper torso that resulted in an inhalation injury. Several attempts at weaning from mechanical ventilation failed due to his extreme agitation, which was unresponsive to benzodiazepines, opiates, and antipsychotic agents. Propofol therapy was begun in combination with valproic acid, fluoxetine, and risperidone to assist in the treatment of his severe agitation associated with the bipolar disease, inhibiting ventilatory weaning. Repeated attempts to discontinue propofol were associated with withdrawal symptoms such as severe agitation, tremors, tachycardia, tachypnea, and hyperpyrexia. His symptoms resolved only after each time the propofol infusion was restarted. The patient received propofol for 95 days for management of his agitation before dying from refractory septic shock and multiple organ failure.     

Sex correction in testicular feminization syndrome

From 1993 to 2000 the authors observed 10 patients with testicular feminization. In spite of existent highly informative methods, early diagnosis of the genesis of abnormal sexual differentiation is not easy, it requires time. Treatment policy varied with the form of testicular feminization. In a complete form (6 patients), bilateral ventrofixation of the gonads (ovotestis) was made, in incomplete form (4 patients) male gonads were removed with subsequent replacement hormonotherapy. Correction of the external genitalia consisted in amputation of the hypertrophic clitoris with creation of the female-type external genitalia. It is emphasized that in incomplete testicular feminization surgical correction should be started before the appearance of secondary sexual characters to raise effectiveness of hormone treatment in formation of a female genotype.     

皮质类固醇治疗外伤性视神经病变的四天关键时期(英文)

目的:评估静脉注射甲基强的松龙(IVMP)对外伤性视神经病变患者的疗效。方法:回顾性分析2000-01至2007-06我院收治的16例外伤性视神经病变(TON)患者的临床资料。1g甲基强的松龙分3d静脉应用,然后口服泼尼松龙11d,并逐渐减量。记录从损伤开始到治疗开始的时间。视力变化是本研究结果的主要功能评价指标。在入院时,治疗后1,2,3d;1wk和1mo时,分别记录最佳矫正视力(BCVA)。结果:共有16例患者纳入本研究,平均年龄为30岁,其中男性14例、女性2例。引起TON的主要原因有摩托车事故(占69%),打架斗殴(占19%)和体育运动(占12%)。所有患者都表现有相对传入性瞳孔障碍。在损伤后4d内开始静脉注射甲基强的松龙,采用Snellen视力表检查视力,绝大部分(56%)患者视力提高超过3行或大于等于0.5(6/12)。在损伤后5d以上才开始用类固醇治疗,视力则没有任何进步。结论:治疗TON,静脉注射中等到大剂量甲基强的松龙仍将起到重要作用。静脉注射甲基强的松龙治疗TON可能存在伤后4d的关键时期,超过了这个时期,该治疗可能就毫无效果。但还需要有更多的研究来为我们提供有明显统计学意义的数据。