Taking a Stand: On Teaching the Epidemiology of Sexually Transmitted Infections

Sexually transmitted infections affect over 15 million Americans per year. Teenagers and young adults are disproportionately affected by a sexually transmitted disease and the lack of protective resources to avoid exposure. Because many infections produce no immediate, visible, or indisposing outcomes, persons possessing an infection may be unaware of their infectious status, and, subsequently, may—quite unknowingly—pass the infectious agent on to others. The activity described in this paper demonstrates the epidemiological processes that contribute to infection. Participants learn how sexually transmitted infections (bacterial, viral, and ectoparasitic) can be transmitted within a sexual network from only one infected individual.     

Drugs of Abuse, Immune Modulation, and AIDS

Illicit drugs such as amphetamines, cocaine, marijuana, and opiates alter immune function and decrease host resistance to microbes in vitro and in experimental animal models. Effects on the immune system may be mediated indirectly as a result of drug interactions in the central nervous system (CNS) or directly through activation of cognate receptors on various immune cell types. For marijuana and opioids, seven-transmembranal G protein-coupled receptors have been identified in the CNS and in the immune system that may play a functionally relevant role in immune modulation. There is accumulating evidence that sigma₁ receptors play a comparable role in cocaine-mediated alteration of immune responses. A mode by which these exogenously introduced substances affects immunity and host resistance may be by perturbing the balance of Th₁ proinflammatory versus Th₂ anti-inflammatory cytokines and lipid bioeffectors. However, while illicit drugs have been documented to alter immune functions in vitro and in animal models, there is a paucity of controlled longitudinal epidemiological studies that definitively correlate immunosuppressive effects with increased incidence of infections or immune disorders in humans, including infection with the human immunodeficiency virus (HIV) or disease progression to AIDS.     

ICU昏迷患者下呼吸道感染危险因素与护理

目的研究昏迷患者下呼吸道感染危险因素，并采取相应的降低感染率的护理措施。方法采用前瞻性的临床研究，将1999年6月～2005年1月入住ICU的昏迷患者共104例，按有无人工气道分为两组，并排除原有慢性呼吸道疾病及已发生下呼吸道感染者，两组均实行定时翻身、肺部叩击等呼吸道护理。结果人工气道组感染率为85．07％，无人工气道组感染率为35．14％，两组资料经统计学分析，P〈0．05，差异有显著性。结论气管插管与气管切开等人工气道的建立，破坏了呼吸道的自然屏障，是下呼吸道感染的危险因素之一。维持人工气道的内环境平衡，使之符合生理的要求可降低感染的发生。     

Peritoneal dialysis catheter infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study

Peritonitis and catheter-related infections remain the two most-common causes of peritoneal dialysis (PD) treatment failure. To define the frequency and risks associated with exit site/tunnel infections (ESI/TI), as well as peritonitis, in pediatric patients on PD, we undertook a retrospective cohort study of patients initiated on PD in the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). We examined demographic data and PD catheter characteristics of 1,258 patients, aged <21 years, initiated on PD from 1992 to 1997. We examined the frequency and complications of ESI/TI occurring within 30 days, 6 months, and 1 year of follow-up. For peritonitis episodes, we examined patient risk factors for peritonitis. Almost 11% of patients had an ESI/TI at 30 days, 26% between 30 days and 6 months, and 30% between 6 months and 1 year of follow-up. There was no increased risk of ESI/TI associated with patient age, race, or catheter characteristics. Peritonitis occurred in dialysis patients at a rate of 1 episode per 13.2 patient months. Proportional hazards regression analysis demonstrated that black race, single-cuffed catheters, and upward pointing exit sites were independent risk factors for peritonitis in the pediatric PD population. Patients with ESI/TI had twice the risk of those without these infections of developing peritonitis or needing access revision, and an almost threefold increased risk of hospitalization for access complications/malfunction. ESI/TI occurs commonly in pediatric PD patients. These infections cause significant morbidity, through risk of peritonitis, access revision, and hospitalization for catheter complications. Further study of potentially modifiable risk factors for ESI/TI in pediatric end-stage renal disease patients is warranted. Received: 22 November 1999 / Revised: 7 June 2000 / Accepted: 9 June 2000     

新生儿下呼吸道超广谱β-内酰胺酶细菌感染的防治研究

目的 为探讨新生儿下呼吸道超广谱β－内酰妥酶（ESBLs）细菌感染的危险因素、病原菌、耐药情况及相应防治措施。方法 1998年1月－1999年12月对本院NICU中42例分别采集气道冲洗、机械通气治疗时的下呼吸道分泌物进行细菌学培养及药敏试验。分析了ESBLs细菌感染情况，总结出防治经验。结果 在下呼吸道分泌物培养42例中细菌培养阳性者23例，其中ESBLs阳性12例，占阳性结果的52％（12／23）。12例中曾应用第三代头孢菌素者9例（75％），机械通气10例（83％）。早产低体重儿8例（67％）。该12例中共检出21株细菌，其中肺炎克雷伯杆菌8株（38％），阴沟肠杆菌5株（24％），铜绿假单胞菌3株（14％），大肠埃希杆菌3株（14％），短黄杆菌1株（5％），嗜麦芽窄食单胞菌1株（5％），药敏试验显示，除部分对亚胺培南，环丙沙星、丁胺卡好、左旋氟沙星、替卡西林／棒酸、洛美沙星、哌拉西林敏感外，对其余抗生素均耐药。12例患儿中治愈10例，死亡1例，自动出院1例。结论 发生于新生儿下呼吸道的ESBLs细菌感染由多种因素引起。加强消毒隔离措施，严格遵守无菌操作规程和屏障护理，合理使用抗生素，提早免疫预防是控制产生ESBLs细菌浒的重要措施。     

Percutaneous umbilical blood sampling

In the present day, fetal blood is sampled from the umbilical vein via a needle guided by dynamic ultrasound from the maternal abdomen (percutaneous umbilical blood sampling, PUBS). PUBS has become important in the fields of fetal physiology, diagnosis and therapy. Indications for PUBS are fetal karyotyping, prenatal diagnosis of blood disorders and congenital infection, and evaluation of fetal hypoxemia. Although risk of fetal loss following PUBS depends on the indication for the procedure and the experience of the operator, the rate of fetal loss after PUBS is assumed to be around 1%. Recent advances in molecular and cytogenetic techniques have restricted the number of reasons for using PUBS. However, since this technique offers a considerable advantage in enabling access directly to the fetal circulation, PUBS is likely to be used more frequently for fetal therapy than for prenatal diagnosis in the future.     

Decompression for Bell’s palsy: why I don’t do it

All decompression surgery is based on the lack of understanding that Bell’s palsy is a viral demyelinating disease that is longitudinal – not perpendicular – to the facial canal and that surgery cannot possibly help a viral disease. These findings exclude the etiologic possibility of an “ischemic paralysis” and are in accord with our logically derived belief that treatment directed to relieve neural entrapment is a wasted effort. Received: 27 March 2001 / Accepted: 5 July 2001     

条件致病菌在骨伤科感染中的作用--附2947份细菌培养及药敏分析

为临床了解条件致病菌在骨伤科感染的作用及耐药情况。对住院治疗的 416 9例骨伤科患者的分泌物、脓液、抽出液进行了细菌培养、分离鉴定 ,并将得到的条件致病菌对常用抗生素的耐药情况进行统计总结。结果 2 947份有细菌生长 ,分离出细菌30 6 0株 ,其中条件致病菌 2 137株 ,占 6 9.84%,明显高于化脓性球菌和其他细菌的感染。在 2 137株条件致病菌中 ,以铜绿假单胞菌、变形杆菌、克雷伯氏菌属、肠杆菌属几种最为常见 ,通过对其药敏试验情况看 ,条件致病耐药性较强 ,以铜绿假单胞菌耐药性最强 ,在对常用 16种抗生素试验中耐药率 5 0 %以上有 11种 ,耐药率 90 %以上有 4种。认为条件致病菌在骨伤科感染中不但感染率高 ,且耐药性强 ,应引起临床的足够重视。     

Radiosurgery for Intracranial Arteriovenous Malformations in Children

Background: The objective of this retrospective study is to determine the value of radiosurgery in the management of arteriovenous malformations (AVM) in the pediatric age group. Methods: From January 1994 through January 1999, thirty-one children with arteriovenous malformations (AVMs) were treated with radiosurgery. All patients were treated on an outpatient basis at the same institution by the same team. The Leksell Gamma Knife unit was used. Workup included angiography, MRI, and MRA. Follow-up ranged from 7 months to 67 months, with a median of 33 months. Minimum doses of radiation, depending on the size of the lesion, ranged from 20 Gy to 25 Gy. Treatment volumes for all the vascular malformations ranged from 0.6 cc to 17 cc with a mean volume of 4.7 cc. The mean number of isocenters was 4.8. Results: Total obliteration of AVM nidus was obtained in 22 of 31 (71%) patients, while 9 patients had partial obliteration. Stabilization of the benign lesions was obtained in all the patients treated. None had rebleeding after the procedure and, as of this writing, no patient required retreatment. Conclusion: Radiosurgery is an effective noninvasive and safe therapeutic modality for the management of vascular malformations independent of location, size, or grade.     

Recognition of bladder instability on voiding cystourethrography in infants with urinary tract infection

PURPOSE: We evaluate voiding cystourethrography as a method for identifying bladder instability in infants. MATERIALS AND METHODS: Cystometry was combined with voiding cystourethrography in 79 male and 64 female infants with first time urinary tract infection. Bladder wall irregularity, elongation of bladder shape, and filling of the posterior urethra were transient radiological signs occurring during bladder filling and were considered to reflect bladder instability. A pediatric radiologist looked for these signs on all 480 films exposed during bladder filling. The results were correlated to simultaneous detrusor pressure recordings. The analysis was repeated independently by a urologist to evaluate the reliability of the radiological signs used. RESULTS: The sensitivity and specificity were both 90% in the evaluation of radiological signs of bladder instability. Filling of the posterior urethra was the least frequently reported radiological sign, which was seen at 53% of unstable contractions. However, when this sign was reported, instability was usually correctly detected (85%). Evaluation accuracy had improved with increasing numbers of noted signs per film. This accuracy had included 29%, 67% and 91% of unstable contractions that were correctly diagnosed when 1, 2 or 3 signs were noted, respectively. The number of noted signs was positively related to the strength of the unstable detrusor contraction. Urologist evaluations had similar results to the radiologist, although the sensitivity was somewhat lower (79% and 90%, respectively). CONCLUSIONS: Unstable detrusor contractions could be identified in infants by evaluation of radiological signs on voiding cystourethrography. Findings of bladder wall irregularity, elongation of bladder shape and filling of the posterior urethra indicated unstable detrusor contraction. The more such findings are observed, the stronger the indication.