New guidelines for cardiac risk assessment prior to non‐cardiac surgery

To cite this article:
Int J Dent Hygiene
DOI: 10.1111/j.1601‐5037.2009.00427.x
Pickett FA. New guidelines for cardiac risk assessment prior to non‐cardiac surgery. Abstract: The European Society of Cardiology (ESC) has established guidelines to determine the risk for non‐cardiac procedures, such as oral procedures, when individuals have experienced severe cardiac disease, including myocardial infarction. This is the first time the ESC has developed consensus guidelines to assist practitioners in managing care for cardiac patients receiving medical or dental procedures. Factors for risk assessment are described and management for oral care is discussed.     

Estimation of undernutrition and mean calorie intake in Africa: methodology, findings and implications

Background

Agricultural science can address a population's vitamin, amino acid and mineral malnutrition through biofortification - agronomy, plant breeding and biotechnology to develop crops with high nutrient contents. Biofortified crop varieties should be grown in areas with populations at risk of nutrient deficiency and in areas where the same crop is already grown and consumed. Information on the population at risk of nutrient deficiency is rarely available for sub-national administrative units, such as provinces, districts, and municipalities. Nor is this type of information commonly analyzed with data on agricultural production. This project developed a method to identify populations at risk of nutrient deficiency in zones with high crop production, places where biofortification interventions could be targeted.

Results

Nutrient deficiency risk data were combined with crop production and socioeconomic data to assess the suitability of establishing an intervention. Our analysis developed maps of candidate sites for biofortification interventions for nine countries in Latin America and the Caribbean. Results for Colombia, Nicaragua, and Bolivia are presented in this paper. Interventions in northern Colombia appear promising for all crops, while sites for bean biofortification are widely scattered throughout the country. The most promising sites in Nicaragua are found in the center-north region. Candidate sites for biofortification in Bolivia are found in the central part of the country, in the Andes Mountains. The availability and resolution of data limits the analysis. Some areas show opportunities for biofortification of several crops, taking advantage of their spatial coincidence. Results from this analysis should be confirmed by experts or through field visits.

Conclusion

This study demonstrates a method for identifying candidate sites for biofortification interventions. The method evaluates populations at risk of nutrient deficiencies for sub-national administrative regions, and provides a reasonable alternative to more costly, information-intensive approaches.     

"Upstream markers" provide for early identification of patients at high risk for myocardial necrosis and adverse outcomes

BACKGROUND: For patients presenting with acute coronary syndrome (ACS) to the emergency department, early identification of those that are at high risk for subsequent myocardial necrosis or adverse outcomes would allow earlier or more aggressive treatment. We determined if a panel of biomarkers can be used to identify high risk patients. METHODS: A cohort (84 females/132 males) from our 1996 ACS study population that had EDTA specimens stored (-70 degrees C) was selected and the earliest available specimen was analyzed for 11 biomarkers (IL-6, IL-8, MCP-1, VEGF, L-selectin, P-selectin, E-selectin, ICAM-1, VCAM-1, NT-proBNP, cTnT). These data were linked to the existing cTnI and health outcome databases for this population. ROC curve analysis for myocardial necrosis (i.e., peak cTnI >0.04 microg/l) identified 3 candidate biomarkers. These 3 biomarkers were applied together to generate a panel test (2 of the 3 biomarkers increased for a positive result) and assessed for its ability to identify patients at risk for myocardial necrosis and the combined endpoint of death, myocardial infarction (MI) and heart failure (HF). RESULTS: The panel test (IL-6, NT-proBNP, E-selectin) alone detected 60% (95% CI: 49-69; false positive rate: 26%) of subjects that would be classified with myocardial necrosis. Kaplan-Meier and Cox proportional analyses indicated that patients positive by the biomarker panel (including those with cTnI < or =0.04 microg/l) had significantly worse outcomes (death/MI/HF) as compared to those negative by both cTnI and the panel test. CONCLUSION: A biomarker panel analyzed early after pain onset can identify individuals at risk for both myocardial necrosis and the combined endpoint of death/MI/HF. Additional prospective studies are required to assess this panel for both early MI detection and to further refine which health outcomes (death, MI, HF) are associated with positive panel results.     

我省长学制医学教育的回顾与思考

我省七年制医学教育开办了近20年,为社会培养了一批深受欢迎、质量较好和具有较高综合素质的高层次医学人才。建立与我省经济发展水平相适应的以五年制为主体、重点发展八年制的医学教育学制体系,是我省高等医学教育发展的必然趋势。     

Extracting variant and invariant information from faces: the neural substrates of gaze detection and sex categorization

Guided by influential models of face processing, efforts have been expended to uncover the neural substrates subserving the many facets of face perception. Extending this work, the present study used functional brain imaging (fMRI) to explore the relationship between the operations supporting the explicit extraction of sex and gaze-related information from faces. The brain imaging data showed the right superior temporal sulcus to be preferentially involved during assessments of gaze direction and a region of the left fusiform gyrus to be involved during sex categorization. These results provide support for the distributed face-processing model advanced by Haxby and colleagues (2000).     

Impact of rapid molecular screening for meticillin-resistant Staphylococcus aureus in surgical wards

Background:

This study aimed to establish the feasibility and cost‐effectiveness of rapid molecular screening for hospital‐acquired meticillin‐resistant Staphylococcus aureus (MRSA) in surgical patients within a teaching hospital.

Methods:

In 2006, nasal swabs were obtained before surgery from all patients undergoing elective and emergency procedures, and screened for MRSA using a rapid molecular technique. MRSA‐positive patients were started on suppression therapy of mupirocin nasal ointment (2 per cent) and undiluted chlorhexidine gluconate bodywash.

Results:

A total of 18 810 samples were processed, of which 850 (4·5 per cent) were MRSA positive. In comparison to the annual mean for the preceding 6 years, MRSA bacteraemia fell by 38·5 per cent (P < 0·001), and MRSA wound isolates fell by 12·7 per cent (P = 0·031). The reduction in MRSA bacteraemia and wound infection was equivalent to a saving of 3·78 beds per year (£276 220), compared with the annual mean for the preceding 6 years. The cost of screening was £302 500, making a net loss of £26 280. Compared with 2005, however, there was a net saving of £545 486.

Conclusion:

Rapid MRSA screening of all surgical admissions resulted in a significant reduction in staphylococcal bacteraemia during the screening period, although a causal link cannot be established. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

A simultaneous outbreak on a neonatal unit of two strains of multiply antibiotic resistant Klebsiella pneumoniae controllable only by ward closure.

Two aminoglycoside-resistant strains of Klebsiella pneumoniae caused an outbreak on the neonatal unit at St Thomas' Hospital. One, which affected 18 patients, was capsular type K18 and resistant to newer cephalosporins by the production of the extended-spectrum beta-lactamase SHV-2; the other, which colonized four patients, was capsular non-typeable and did not produce extended-spectrum beta-lactamase. Both strains were probably brought into the unit by carrier patients; the probable carrier of the non-typeable strain was transferred from another hospital but was negative on a single admission screen; the probable carrier of the K18 strain was not screened on admission because he had been born at St Thomas', but his mother had been transferred from another hospital. Despite intensive efforts to control the outbreak by standard methods of hand washing, screening, patient isolation and environmental cleaning, a total of 22 neonates on the unit eventually became colonized or infected. One of three patients with bacteraemia died. A small proportion of samples of expressed breast milk, electronic thermometers and oxygen saturation probes were contaminated by the K18 strain and may have contributed to some of the cross-infection, but this did not explain the extent of the outbreak. The outbreak was controlled only by opening a temporary ward for colonized neonates and another for newly born babies, which allowed the closure and cleaning of the main neonatal unit. Multiply antibiotic resistant klebsiellas may be highly epidemic and cause serious, difficult-to-control outbreaks on neonatal units. All patients, regardless of their admission history, should be screened on admission for carriage of multiply resistant enterobacteria by a sensitive method, and units should have plans for temporary ward closure should outbreaks occur.     

Parentage analysis by endonuclease shattering of hypervariable DNA

Single-locus DNA probes for tandem repeat sequences are now used in conjunction with particular endonucleases to characterize heritable restriction fragment lengths in parentage tests. Southern blots of this type, however, demonstrate only two attributes of an allele: its length and the presence of nucleotide sequences that are complementary to the probe. Not all restriction fragments of the same apparent length that react with the same probe are identical. Differences between comigrating fragments can be detected by the selection of a restriction enzyme that recognizes sites in a subset of the repeat sequences, and the information content of these loci is therefore increased. This report describes a paternity case in which two brothers appeared, after DNA phenotyping using Hinf I, to be the father. A second phenotyping using Hae III excluded one of the brothers.     

Improved recovery of antibiotic-stressed microorganisms on inclusion of saponin in aerobic blood culture media

The recovery rates and times to detection of microorganisms isolated from two similar blood culture media, one containing saponin, were compared. A total of 2117 blood cultures were analysed in a prototype automated blood culture system. Significantly more gram-positive organisms (P<0.05) and gram-negative organisms (P<0.05), includingEnterobacterlaceae (P<0.05) were recovered from the lytic medium. Average time to detection in the lytic medium was 15.8 h, compared to 22.7 h in the other medium (P<0.001). The improved recovery of microorganisms was most pronounced in blood samples obtained from patients being treated with antibiotics at the time of venesection. In vitro experiments on antibiotic affected bacteria confirmed the protective effect of saponin.