Aspergillosis Prophylaxis and Treatment for Pediatric HSCT Patients: Environmental and Pharmacologic Options

Hematopoietic stem cell transplant (HSCT) recipients are at increased risk of viral, bacterial, fungal, and parasitic infections both pretransplant and post-transplant. One of the most dangerous infections that can be acquired during this time is aspergillosis. Several drugs are available for prophylaxis, though no particular regimen has been proven to be superior; although the CDC has clear recommendations regarding prophylaxis for many other infections (such as cytomegalovirus, herpes simplex, toxoplasmosis, and Candida) for HSCT patients, there are none for aspergillosis. Researchers have varying opinions as to which drugs are best for prophylaxis. In this article, pharmacologic and environmental options for prophylaxis are discussed as well as antifungals currently in use, and recommendations on how nurses can help keep their patients safe from this infection are given.     

Pathomechanism and Management of Stroke in COVID-19: Review of Immunopathogenesis,Coagulopathy, Endothelial Dysfunction,and Downregulation of ACE2

Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.     

Pathophysiology of overheating in a piglet model: Findings compared with sudden infant death syndrome

Objective : To examine the nature of hyperthermia-induced pathophysiological changes in an animal model including effects on lung compliance.
Methodology : Piglets were randomly assigned to heated or non-heated groups. Heated animals were warmed to 4°C above normal body temperature while sedated and breathing spontaneously. Cardiorespiratory variables were recorded serially and haematological assessments and blood cultures taken at 0 and 6 h. After 6 h the animals were killed and a limited postmortem was performed. Control animals had all procedures without heating.
Results : Heated piglets developed tachycardia, hypotension and a metabolic acidosis in addition to tachypnoea, hypocapnic alkalosis and a neutrophil leucocytosis. Rectal temperature after death fell at the same rate in both groups. Lung histology revealed an excess of lung haemorrhage and alveolar oedema in the heated group. No significant group differences in dynamic lung compliance were demonstrated.
Conclusions : The pathological changes that occur during hyperthermia are non-specific but not incompatible with those found in sudden infant death syndrome. There was no confirmation of the thesis that hyperthermia causes death by altering lung compliance.     

Catecholamines and opioid peptides increase in plasma in humans during possession trances.

Naturally induced possession trances have been observed in healthy people of many societies. The neurophysiological basis of this phenomenon remains unknown, however, because of the difficulty in accessing subjects in trances due to their sacred context. In the present study, we measured the plasma levels of several neuroactive substances from subjects exhibiting or lacking possession trance characteristics during Balinese dedicatory dramas under natural conditions. The trance group exhibited significant increases in plasma concentrations of noradrenaline, dopamine and beta-endorphin, compared with controls who performed the same actions as the trance group. The present finding suggests that catecholamines and opioid peptides are involved in possession trances.     

Priorities and realities: addressing the rich-poor gaps in health status and service access in Indonesia

Introduction  

Over the past four decades, the Indonesian health care system has greatly expanded and the health of Indonesian people has improved although the rich-poor gap in health status and service access remains an issue. The government has been trying to address these gaps and intensify efforts to improve the health of the poor following the economic crisis in 1998.     

Level and determinants of incentives for village midwives in Indonesia

Since the early 1990s Indonesia has attempted to increase thelevel of skilled attendance at birth by placing rural midwivesin every village in an effort to reduce persistently high levelsof maternal mortality. Yet evidence suggests that there remainsinsufficient incentive to ensure an equal distribution acrossareas while the poor in all areas continue to access skilledattendance much less than those in richer groups. We reporton a survey that was conducted as part of a complex evaluationof the rural midwife programme in Banten Province, to betterunderstand the effect of financial incentives on the distributionof midwives and use of services. Midwives obtain almost two-thirdsof their income from private clinical practice. Private incomeis strongly associated with competence and experience. Multivariateanalysis suggests that midwives are well able to earn a substantialprivate income even in remoter areas. Yet the study also founda high level of unwillingness to move posts to a more remotearea for a variety of non-financial reasons. The results suggestthat the access to skilled attendance of those unable to affordfees may be impaired by the dependence on fee income, a resultsupported by companion household studies. In addition, ensuringthat staff live and work in remoter areas is only likely tobe financially sustainable if midwives can be attracted to livein these areas early in their careers. Finally, the overallstrategy of basing skilled attendance mainly on village servicesthroughout the country may need to be re-visited, with alternativemodels offered in areas where it continues to be impracticaleven with a change in the incentive framework.     

Sexual behavior among injection drug users in 3 indonesian cities carries a high potential for HIV spread to noninjectors

OBJECTIVE: To establish the prevalence of injecting practices that carry a risk of HIV infection among injection drug users (IDUs) in Indonesia and to examine the risk of sexual transmission of HIV from IDUs to noninjecting populations. DESIGN: A first round of behavioral surveillance among community-recruited male IDUs in 3 cities. METHODS: In late 2002, IDU gathering places were mapped in 3 cities, and 650 IDUs were recruited using multiple wave sampling originating from sites systematically selected for diversity. Trained interviewers, mostly former IDUs, administered a questionnaire focusing on injecting practices, sexual behavior, and HIV-related knowledge. RESULTS: Almost all IDUs knew that HIV is transmissible through shared needles, but 85% of injectors reported using a syringe previously used by another IDU in the previous week. Over two thirds of IDUs were sexually active, 48% reported multiple partners, and 40% had bought sex from a female sex worker in the preceding 12 months. Consistent condom use was reported by 10%. CONCLUSIONS: The potential for the sexual spread of HIV from IDUs to noninjectors is extremely high in Indonesia. Interventions are urgently needed to reduce high levels of needle sharing, but a focus on needle cleaning and increasing condom use among IDUs is also essential.     

A potential danger of bedclothes covering the face

Investigations of infants dying unexpectedly have reported up to 28% being found completely under bedding. No detailed physiological studies looking at the possibilities of asphyxia in this situation are available. The aim was to determine the potential for asphyxia under different types and thicknesses of bedding. A mechanical model of a 3-month-old infant's respiratory system was used. Bedding was positioned over the head in a supine position, and inspired carbon dioxide recorded. With a fixed respiratory rate and tidal volume, carbon dioxide accumulation increased with increasing layers of blankets. Up to 8.3% inspired carbon dioxide was recorded with more than four layers of blankets. A cotton sheet between the face and blankets reduced the accumulation by half. An infant found dead under bedding may have been exposed to an asphyxial stress. Suffocation from rebreathing trapped, expired gases can be a cause of death in this situation.