Fatal meningoencephalitis due to Bacillus anthracis

Abstract: We report the first case of fatal anthrax meningoencephalitis in Hong Kong over the past 60 years. A 13 year-old boy presented with right lower quadrant pain, diarrhoea and progressive headache. Lumbar puncture yielded gram positive bacilli initially thought to be Bacillus cereus, a contaminant. He was treated with ampicillin and cefotaxime, but died 3 days after hospitalization. The organism isolated from blood and cerebrospinal fluid was later identified as Bacillus anthracis.     

Escherichia coli tetracycline efflux determinants in relation to tetracycline residues in chicken

ObjectiveTo screen for Escherichia coli (E. coli) resistant to tetracycline, followed by identification of tet efflux genes by polymerase chain reaction (PCR). In addition, detection of tetracycline residues in chicken livers and kidneys were conducted using high performance liquid chromatography-tandem quadrupole mass spectrometry (HPLC-MS-MS).MethodsStrains of E. coli were isolated from samples of chicken colon and screened for tetracycline resistance. Tetracycline genes conferring resistance (Tc^r) were detected by polymerase chain reaction (PCR). Most of the isolates were resistant to tetracycline (97.9%).ResultsPCR analysis indicated that Tc^r E. coli R-plasmids contained tet(A), tet(B) and a combination of both efflux genes. None of the isolates contained other efflux tet genes tet (C, D, E and Y). High performance liquid chromatography-tandem quadrupole mass spectrometry (HPLC-MS-MS), a sensitive technique, was used to detect residues of chlortetracycline (CTC), oxytetracycline (OTC), doxycycline (DC) in chicken livers and kidneys. The samples containing tetracycline residues were at 0.13-0.65 pg/μL levels.ConclusionsTetracycline and other antibiotics are commonly used in the poultry and meat production industry for prevention of microbial infections. Multiple antibiotic resistant bacteria in Oman have increased to alarming levels, threatening public health, domestic and may have adverse effect on environment.     

Hypolipidemic activity of a hydroalcoholic extract of Cyperus scariosus Linn. root in guinea pigs fed with a high cholesterol diet

Lipid-lowering and antioxidant activities of a hydroalcoholic extract of Cyperus scariosus Linn. root（HCS） were evaluated in guinea pigs fed with a high cholesterol diet. Serum lipid profile（total cholesterol, triglycerides, LDL-C, VLDL-C, and HDL-C）, atherogenic indices and serum enzymes（ALT, AST, ALP, LDH, and CK-MB） were performed in each group at 0 days and at the end of 60 days. Histological study of liver and kidney was done in groups 1, 2, 5, 6 and 7. The total phenolic and flavonoid content in HCS and its antioxidant activity were evaluated by the DPPH assay. Both doses of HCS decreased serum lipid profile and atherogenic indices（P 〈 0.05）. HCS has lipid lowering, immunosuppressive and antioxidant properties, and mays have value in atherosclerosis prevention. The higher dose of HCS also reduced serum AST, ALP, and LDH levels and rosuvastatin increased AST and ALP levels（P 〈 0.05）. Histology of the liver showed decreased lipid accumulation and improvement in hepatocytes in HCStreated animals. The antioxidant activity of HCS may be responsible for its lipid lowering and cytoprotective action. HCS had significant lipid lowering and antioxidant activity, which; may be due to the phenolic compounds. HCS may be a safe and cost effective alternative to current statin therapy for patients with dyslipidaemia.     

High-dose etoposide and cyclophosphamide without bone marrow transplantation for resistant hematologic malignancy

Seventy-five patients with resistant acute leukemia or lymphoma received high-dose cyclophosphamide and etoposide to explore the activity of this combination in resistant hematologic malignancies, and to determine the maximum doses of these drugs that can be combined without bone marrow transplantation. Etoposide was administered over 29 to 69 hours by continuous infusion corresponding to total doses of 1.8 g/m2 to 4.8 g/m2. Cyclophosphamide, 50 mg/kg/d, was administered on 3 or 4 consecutive days total 150 to 200 mg/kg ideal body weight). At all dose levels myelosuppression was severe but reversible. Mucosal toxicity was dose-limiting with the maximum tolerated dose level combining etoposide 4.2 g/m2 with cyclophosphamide 200 mg/kg. Continuous etoposide infusion produced stable plasma levels that were lower than would be achieved after administration by short intravenous infusion, and this could explain our ability to escalate etoposide above the previously reported maximum tolerated dose. There were 28 complete (35%) and 12 partial (16%) responses. Median duration of complete response (CR) was 3.5 months (range 1.1 to 20+). Seventeen of 40 patients (42%) with acute myelogenous leukemia (AML) achieved CR, including 6 of 20 (30%) with high-dose cytosine arabinoside resistance. We conclude that bone marrow transplantation is not required after maximum tolerated doses of etoposide and cyclophosphamide. This regimen is active in resistant hematologic neoplasms, and the occurrence of CR in patients with high-dose cytosine arabinoside-resistant AML indicates a lack of complete cross-resistance between these regimens.     

A phase II study of continuous infusion recombinant human granulocyte- macrophage colony-stimulating factor as an adjunct to autologous bone marrow transplantation for patients with non-Hodgkin's lymphoma in first remission

Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) clearly hastens myeloid recovery in patients with relapsed hematologic malignancies undergoing autologous bone marrow transplantation (ABMT). In efforts to further improve neutrophil engraftment and shorten hospital stay in ABMT patients, rhGM-CSF was administered by a potentially more potent route (continuous infusion) to non-Hodgkin's lymphoma (NHL) patients with better BM reserve (first remission). Time to myeloid engraftment was compared with that of NHL patients treated in first remission at our institution on a similar ABMT protocol but without growth factor support (controls). Median neutrophil engraftment (absolute neutrophil count, 500 cells/microL) in first remission patients treated with rhGM-CSF was 14 days, compared with 22 days in controls (P = .0001). Hospital stays were also significantly reduced for rhGM-CSF patients (P = .0003). Platelet engraftment did not differ between the two groups. Persistent fever and generalized serositis were the primary toxicities. rhGM-CSF, delivered by this route, was efficacious but more toxic than 2-hour rhGM-CSF infusions previously reported by other investigators. Future alterations in both dose and schedule may retain comparable efficacy yet diminish toxicity.     

The Use and Intended Outcomes of Presence: A Focus Group Study

PURPOSE

To explore and understand the use and intended outcomes of presence from the perspective of and as experienced by nurses.

METHODS

Twenty‐seven nurses participated in one of four focus groups. Data were analyzed using Giorgi's phenomenological method.

FINDINGS

Four themes emerged: (1) therapeutic communication; (2) nurse well‐being; (3) dimensions of presence; and (4) intention to improve client outcomes.

CONCLUSIONS

Presence was described as a multidimensional intervention that required therapeutic communication and nurse well‐being with the intention of improving client outcomes. Study findings provide evidence of the significance of presence in the face of human interaction that is shifting to virtual, impersonal communication.