Reduced survival of adult Culex pipiens infected with Rift Valley fever virus

The effect of Rift Valley fever (RVF) viral infection on the survival of female Culex pipiens was examined. In 3 experiments in which mosquitoes ingested RVF virus, there was a 44% decrease in survival to days 14-16 for transmitting vs. nontransmitting mosquitoes, and a 48% decrease in survival for individuals with disseminated vs. nondisseminated infections. These results were corroborated by other experiments in which survival of mosquitoes intrathoracically inoculated with RVF virus was compared with that of those inoculated with diluent. In both the per os and inoculation tests, uninfected mosquitoes survived significantly longer than infected mosquitoes. Even though mosquitoes with disseminated infections had a lower survival rate than did uninfected mosquitoes, dissemination and transmission rates were similar at days 7 and 14-18 after the infectious bloodmeal. This suggests that nondisseminated individuals were developing disseminated infections and becoming capable of transmitting virus between days 7 and 14-18 at approximately the same rate older transmitters were dying. The decreased survival associated with RVF viral infection should be considered in predictive models of this disease.     

Obesity is Associated with Worse Outcomes Among Abdominal Trauma Patients Undergoing Laparotomy: A Propensity-Matched Nationwide Cohort Study

Introduction

Obesity is associated with increased morbidity and mortality in abdominal trauma patients. The characteristics of abdominal trauma patients with poor outcomes related to obesity require evaluation. We hypothesize that obesity is related to increased mortality and length of stay (LOS) among abdominal trauma patients undergoing laparotomies.

Methods

Abdominal trauma patients were identified from the National Trauma Data Bank between 2013 and 2015. Patients who received laparotomies were analyzed using propensity score matching (PSM) to evaluate the mortality rate and LOS between obese and non-obese patients. Patients without laparotomies were analyzed as a control group using PSM cohort analysis.

Results

A total of 33,798 abdominal trauma patients were evaluated, 10,987 of them received laparotomies. Of these patients, the proportion of obesity in deceased patients was significantly higher when compared to the survivors (33.1% vs. 26.2%, p < 0.001). Elevation of one kg/m² of body mass index independently resulted in 2.5% increased odds of mortality. After a well-balanced PSM, obese patients undergoing laparotomies had significantly higher mortality rates [3.7% vs. 2.4%, standardized difference (SD) = 0.241], longer hospital LOS (11.1 vs. 9.6 days, SD = 0.135), and longer intensive care unit LOS (3.5 vs. 2.3 days, SD = 0.171) than non-obese patients undergoing laparotomies.

Conclusions

Obesity is associated with increased mortality in abdominal trauma patients who received laparotomies versus those who did not. Obesity requires a careful evaluation of alternatives to laparotomy in injured patients.

     

Elevation of blood lead levels in emergency department patients with extra-articular retained missiles

BACKGROUND: Patients who survive gunshot wounds often have retained missiles. Unlike intra-articular retained missiles, extra-articular retained missiles (EARMs) are not routinely removed. Cases of lead toxicity from EARMs have been described. This study seeks to determine whether blood lead levels are elevated in emergency department patients with EARMs compared with matched controls, whether clinical symptoms of lead toxicity are more prevalent in patients with EARMs than in controls, and whether longer missile retention times or recent hypermetabolic conditions are associated with higher blood lead levels. METHODS: One hundred twenty adults with EARMs and 120 age- and gender-matched controls with no history of gunshot wound were prospectively enrolled on presentation to a large urban emergency department. Whole blood lead (WBL), zinc protoporphyrin, and hemoglobin levels were obtained. Patients completed a questionnaire regarding time since gunshot injury; symptoms of lead toxicity; and occurrence within 30 days of any surgery, alcohol abuse, illicit drug abuse, diabetic ketoacidosis, hyperthyroidism, infection, fracture, pregnancy, or lactation. RESULTS: Five EARM patients (4%) and no control patients (0%) had WBL greater than our threshold for medical follow-up (20 microg/dL). Mean WBL was 6.71 microg/dL (95% confidence interval [CI], 5.68-7.74 microg/dL) in EARM patients and 3.16 mug/dL (95% CI, 2.79-3.53 microg/dL) in controls. This difference was statistically significant when analyzed by matched pairs t test (p = 0.0001). There was no difference in the number of symptoms associated with lead toxicity that were noted by EARM patients versus controls (p = 0.377). Longer duration of missile retention was not associated with higher blood lead levels (r = 0.125, p = 0.172). Of the five hypermetabolic conditions analyzed, only fractures were associated with elevated blood lead levels (9.95 microg/dL [95% CI, 5.77-14.13 microg/dL] in EARM patients with fractures vs. 6.23 microg/dL [95% CI, 5.23-7.23 microg/dL] in EARM patients without fractures). CONCLUSION: Patients with EARMs have significantly elevated blood lead levels compared with matched controls. The occurrence of a bony fracture within the past 30 days is associated with a higher lead level. In 96% of patients with EARMs, elevated lead levels were not clinically significant and did not change patient management.     

Electrical remodeling in a patient with biventricular pacemaker

Electrical remodelling in a patient with biventricular pacemaker - a case report. A case of a 70-year-old patient with dilated cardiomyopathy is presented. The patient underwent biventricular pacemaker implantation and improved markedly. Indications for resynchronisation therapy are discussed.     

Postinfarct VSD management using 3D computer printing assisted percutaneous closure

Postinfarct VSD (PIVSD) carries a grim prognosis. The mainstay of management has been surgical repair. The advent of septal occluder devices has offered an attractive alternative to surgical repair. Most PIVSD have serpiginous tracts with necrotic tissue, which makes assessing the defect challenging. 3D computer printing has become useful in preprocedure planning of complex surgical procedures in multiple subspecialties.     

护理人员对输液过程中药液丢失问题的认识及其相关因素研究

为探讨减少药液丢失的操作方法，了解护理人员对输液过程中药液丢失问题的认识，用直接观察和采访调查相结合的方法，对李地区182名护理人员于输液过程中药液丢失问题的认识进行了解和分析。并采用随机抽样的方法，按不同职称随机抽取80名护理人员，并分为两组，每组进行100例次静脉输液。对照组采用常规静脉输液操作。研究组采用两次溶解抽吸药液、不全插入输出针头、过滤器水平位排气、提高输液瓶增加管内压的方法进行输液。比较两组静脉输液中药液丢失量。结果：研究组药液丢失量为用药量的2．69％，对照组为11．67％，两组药液丢失量差异有统计学意义（P＜0．05）。提示：临床静脉输液过程中药液丢失问题较严重，改进后的静脉输液方法，可有效地减少药液丢失量。     

Visual outcome and complications after cataract extraction in Saudi Arabia.

Cataract is the leading cause of blindness in Saudi Arabia. The author studied 1383 patients who had undergone cataract extraction (total of 1520 procedures) from October 1985 to March 1986 at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. All patients were observed for at least two months. Of 1520 eyes 555 (37%) achieved a visual acuity of 20/40 or better, 309 (20%) a visual acuity of 20/50-20/60 after surgery, and 656 (43%) eyes a visual acuity of 20/70 or less. The number of eyes that had intraoperative complications was 176 (12%). The number of eyes that had postoperative complications was 539 (35%). Some eyes had more than one complication. The main factors responsible for failure to achieve visual acuity of 20/40 or better were: (1) error of refraction in 492 (32%) eyes; (2) pre-existing corneal scarring and opacity in 211 (14%) eyes; (3) climatic droplet keratopathy in 134 (9%); and (4) presumed visual loss due to glaucoma in 134 (9%) eyes.     

Biventricular pacing demonstrates similar effects in elderly and younger patients with advanced heart failure in the mid-term follow-up

BACKGROUND: Biventricular (BIV) pacing has been shown to improve haemodynamics and functional status of patients (pts) with advanced chronic heart failure (CHF). No study has determined the effects of BIV in relation to the age of pts. AIM: To compare the clinical outcome in two groups of pts: > or =65 years (yrs) and <65 yrs referred for BIV pacing in our centre with at least 6 months of follow-up. METHODS: Among 15 pts > or =65 yrs and 16 pts <65 yrs successfully implanted with a BIV pacemaker, 12 and 15 pts, respectively, completed 6-month follow-up. Evaluation included change of NYHA class, 6-minute walking distance (6-minWD), drug therapy, QRS duration and echocardiographic parameters. The need for hospitalisation due to the worsening of CHF symptoms, assessed 6 months before and 6 months after BIV pacing, was compared. During long-term follow-up survival and complications related to this therapy were analysed. RESULTS: In both groups after 6 months of BIV pacing clinical improvement was observed, as demonstrated by the reduction in NYHA class (p <0.005), average duration of hospitalisation due to CHF (p <0.05) and diuretics doses (p <0.05). The comparison of changes in these parameters between the two groups, as well as of changes in 6-minWD and echocardiographic parameters, did not show significant difference. BIV pacing enabled an increase in the dosage of beta-blockers (in 50% pts > or =65 yrs and 60% pts <65 yrs), as well as of ACEI or ARB (25% and 40% pts, respectively). Survival was 80% in 15 pts > or =65 yrs during 16+/-15 months of follow-up and 81% in 16 pts v65 yrs during 22+/-14 months. All complications occurred in the 30-day post-operative period with similar frequency in both groups, also when LV lead-related complications were compared. CONCLUSIONS: In the mid-term follow-up BIV pacing demonstrates similar improvement in clinical status and exercise tolerance in elderly pts > or =65 yrs, as compared with pts <65 yrs. In both groups BIV pacing reduced the need for hospitalisation due to worsening of CHF symptoms, and enabled beneficial changes in the pharmacological treatment. Elderly patients are not at risk of more frequent complications associated with BIV pacing.