Incidence of hospital-acquired infections associated with caesarean section

A retrospective cohort study was conducted to determine the incidence of post-caesarean infections in a Canadian community teaching hospital using computer algorithms designed for the diagnosis of nosocomial infections. Inferential chart review was done on 1335 women delivered by lower-segment caesarean section (793 primary and 542 secondary) at the Calgary General Hospital between January 1985 and April 1988. The overall infection rates were 42·1 and 46·1% for women delivered by primary and secondary caesarean section, respectively. Incisional surgical wound infection accounted for the largest proportion of post-caesarean infections found. Women delivered by primary caesarean section had significantly higher rates of endometritis, deep surgical wound infection and bacteraemia than those delivered by secondary section. All types of post-caesarean infection, except asymptomatic bacteriuria, caused the duration of the post-partum hospital stay to be significantly increased.     

Nutritional Anemias

Prevention of nutritional deficiencies should be attained by the consumption of a good diet. Unfortunately, in the case of iron, this is not always possible, and it is advantageous to fortify food with iron. Milk-based formulas and cereals are the most commonly used iron-fortified products in infancy and early childhood. Bioavailability of iron from cereals is low and more clinical studies on the field are necessary to demonstrate the effectiveness of iron-fortified cereals in infants and children of developing countries. Infections and excessive blood loss in infancy related to the use of fresh, pasteurized or powdered cow milk result in much of the anemia we currently see in industrialized countries. Vitamin A deficiency interacts with iron metabolism and recent intervention studies have shown that anemia in Vitamin A deficient children can be successfully treated with oral supplements.     

A prospective radiologic and neurologic follow-up study of 61 HIV-1 -infected subjects: early beginning and slow progression of brain atrophy

The course of the organic brain disease caused by human immunodeficency virus (HIV-1) was evaluated in a follow-up study. The primary material included 200 consecutive HIV-1 infected persons. Sixty-one subjects, in whom other brain-affecting factors were excluded, consented to the follow-up. They underwent 278 radiologic examinations: computed tomography, magnetic resonance imaging, or a combination of both (mean 4.6 examinations/subject). Clinical neurologic status and, in 40 subjects, cognitive performance were repeatedly evaluated. Sixteen subjects were followed up until death and 11 of them were autopsied. Median follow-up time was 27 mo (range 2.5–66 mo). The most common radiologic finding was atrophy, found in 19 subjects at study entry and developing in 10 subjects during the study. Twenty-four subjects (39%) showed the development and/or progression of atrophy. Atrophic changes progressed most rapidly in acquired immunodeficiency syndrome (AIDS), but mild developing/progressive atrophy was found even in 33% of asymptomatic or neurologically intact subjects. Cognitive and radiologic worsening were simultaneous in 6/7 subjects with declining neuropsychologic test performance. Signal intensity changes including HIV-1 leukoencephalopathy appeared in AIDS patients with clear cognitive decline.     

Clinical evaluation of technetium-99m infecton for the localisation of bacterial infection

The aim of the study was to distinguish infection from inflammation in patients with suspected infection using technetium-99m Infecton. Ninety-nine patients (102 studies) referred for infection evaluation underwent imaging with 400 MBq^99mTc-Infecton at 1 and 4 h. Most patients had appropriate microbiological tests and about half (56) had radiolabelled white cell scans as well. No adverse effects were noted in any patient. The clinical efficacy of^99mTc-Infecton depended in part on whether imaging was undertaken during intibiotic therapy for infection or not. In consultation with the microbiologist, 5–14 days of appropriate and successful antibiotic therapy was considered adequate to classify some results as true-negatives. The figures for sensitivity and specificity of^99mTc-Infecton for active or unsuccessfully treated infection were 83% and 91% respectively. It is concluded that^99mTc-Infecton imaging contributed to the differential diagnosis of inflammation. It is being used as the first imaging modality when bacterial infection is suspected.     

Lessons to be learned from a complicated case of rhino-cerebral mucormycosis in a renal allograft recipient

Fungal infections still represent a serious complication after organ transplantation. Early diagnosis and aggressive treatment are crucial. Because of the many diagnostic problems involved, we present a case of mucormycosis--primarily affecting the paranasal sinuses with later intracranial extension--in a highly immunized recipient of a third renal transplant. Although fungal infection was suspected from various imaging techniques, only the detection of typical fungal hyphae in the infected tissue was diagnostic. Neither the blood tests and cerebrospinal fluid examinations performed nor cultures from maxillary sinus fluid were of any diagnostic help. Surgical debridement from a transnasal as well as an intracranial approach and systemic amphotericin B together with the discontinuation of immunosuppression after removal of the rejected graft were able to save the patient. This case stresses the importance of early diagnosis that can only be made from tissue biopsies and allows appropriate timely treatment.     

Respiratory tract infections due to different rhinovirus serotypes and the influence of maternal antibodies on the clinical expression of the disease in infants.

Rhinoviruses were isolated from nasopharyngeal secretions of 49 children hospitalized because of severe respiratory tract infection. The isolates were typed using 90 type-specific antisera. No obvious relation between certain serotypes and the severity of illness was found. Serum samples were drawn from all children simultaneously with the nasopharyngeal secretions and screened for the presence of type-specific neutralizing antibodies. Children aged 1 week to 6 months had higher neutralizing antibody titers and revealed a lower degree of morbidity than older children. The decline of neutralizing serum antibodies with increasing age was correlated with a higher incidence of severe disease in those aged 7-12 months. Nevertheless, also in this age group children with mild clinical courses of disease were observed despite a low concentration or an absence of neutralizing serum antibodies. This indicates that not only neutralizing serum antibodies, but other factors also influence the clinical expression of RHV-induced disease.     

Is it time to reconsider initial antibiotic treatment strategies for severe urinary tract infections in Europe?

Until recently, most reported cases of bacteraemia caused by multidrug-resistant strains of Enterobacteriacae producing an extended-spectrum beta-lactamase (ESBL) in Europe have been nosocomial in origin. However, increasing numbers of reports of community-acquired bacteraemia and urinary tract infection caused by ESBL-producing microorganisms suggest that the geographical origin of patients should be taken into account as a risk-factor for possible ESBL production. Early identification of patients at high-risk of infection with ESBL-producing microorganisms, based on their geographical origin and travel history, should help to optimise initial antibiotic treatment strategies for severe urinary tract infections in Europe.     

Disseminated histoplasmosis with oral manifestation

Histoplasmosis is a fungal disease that affects humans and is caused by Histoplasma capsulatum. The presentation of the infection may be acute, chronic, or disseminated. The disseminated form has extrapulmonary manifestations which may include oral manifestation a. A patient with AIDS sought treatment and he had disseminated histoplasmosis with oral manifestations. The purpose of this case report and literature review is to emphasize the role the dental team has in the diagnosis of disseminated disease when a patient presents with oral manifestations associated with the disease. This case report is clinically relevant because it is not uncommon for oral manifestations to be one of the first signs of systemic disease.