透明角膜切口白内障术后分枝杆菌性伤口溃疡

1例81岁女性，右眼透明角膜切口白内障术后3周出现了伤口的浸润。局部滴用氧氟沙星和激素类药物后出现卫星病灶。在手术切口附近可以看到结晶样的角膜浸润（图1）。抗酸染色显示为阳性杆菌，培养出分枝杆菌（图2），按其药物敏感性由大到小依次是：克拉霉素，环丙沙星，妥布霉素和阿米卡星。在局部滴用阿米卡星硫酸盐和口服克拉霉素后溃疡仍有进展。确诊后6周，由于严重的玻璃体炎症采取了平坦部玻璃体切除术。     

Evidence for high seroprevalence of Taenia solium cysticercosis in individuals from three rural communities in Venezuela

A serological study was undertaken in 1998 to evaluate levels of Taenia solium cysticercosis in 3 rural Venezuelan communities. Infection with viable metacestodes was diagnosed with a trapping enzyme-linked immunosorbent assay (ELISA) that detects a secreted product of viable parasites. Anti-metacestode antibodies were assayed by ELISA using T. solium vesicular fluid as antigen. A total of 1254 sera was collected from 3 communities (Canoabo, Sanare, and Rio Tocuyo) where previous studies had suggested the presence of T. solium. Our results demonstrate an unusually high seroprevalence of cysticercosis, indicating an attendant risk of transmitting the disease to other areas. The seroprevalence of infection with viable cysts, as indicated by detection of circulating parasite antigen, was 9.1% in Canoabo, 6.1% in Sanare, and 5.7% in Rio Tocuyo. The corresponding frequency of antibodies to T. solium cyst antigens was 36.5% in Canoabo, 36.5% in Sanare, and 4% in Rio Tocuyo. As these communities are probably representative of many others in Venezuela, T. solium cysticercosis may be a significant public health problem and more work is certainly indicated. An important finding was that local knowledge of the disease and its transmission do not necessarily guarantee diminished disease prevalence, indicating a lack of appropriate vigilance towards disease control.     

Executive functioning in adults and children with developmental dyslexia

The performance of developmentally dyslexic children and adults was studied upon a range of tasks that involved executive functioning. Both adult and child samples of dyslexics were found to under-perform on the group-embedded figures test. This test required the identification of constituent parts from within complex visual arrays, with good performance necessitating the inhibition of the processing of the surrounding context. A general deficit on visual-spatial tasks was eliminated as an explanation as dyslexics performed normally upon a range of other non-verbal assessments. The dyslexics consistently demonstrated a deficit in digit span tasks, a decrement that was increased with distractors, again suggesting difficulties in inhibiting the processing of the surrounding context. A deficit was also identified upon a verbal fluency task without a deficit in vocabulary level. Additionally, a specific deficit in the recollection of the temporal order of the presentation of items was in evidence, without a deficit in the recognition of the items themselves. The findings taken as a whole suggest that dyslexic individuals show deficiencies in executive functions relating to inhibition of distractors and to sequencing of events, a set of tasks associated with left prefrontal cortex functioning in the acquired neuropsychology literature.     

Evaluation of a critical care simulation series for undergraduate nursing students

Simulation is increasingly being used to prepare and supplement clinical practice in critical care areas for undergraduate Bachelor of Nursing (BN) students, with some success. However, the effects of multiple, medium-high fidelity simulations for this purpose have not been previously assessed. The purpose of this study was to assess self-reported confidence and competence using scenario-based simulations. A pre-test post-test design was used to evaluate a series of simulations conducted over a semester. There were twenty seven scenarios, incorporating programmed mannequins, moulage and actors. The scenarios were embedded in a team-based process involving preparation and video-recordings used for debriefing. Third year BN students reported their confidence and competence before and after the simulation series and made comments on their perception of the experience. Multiple scenario simulations are effective in improving BN students' confidence and competence related to critical care practice and are an enjoyable experience for students.     

COPD: Focus on Prevention: Recommendations of the National Lung Health Education Program

The purpose of this article is to provide the nurse in primary care with an overview of the National Lung Health Education Program guidelines. We outline the components of the guidelines for spirometry testing in persons at risk for chronic obstructive pulmonary disease. The role of spirometry testing in identifying those persons for whom smoking cessation is crucial is emphasized. (Heart Lung^® 2000;29:446-9.)     

Trends in contact lens-related corneal ulcers

PURPOSE: To analyze the frequency of contact lens-related corneal ulcers and its relationship to the type of contact lens and care. METHODS: Charts of 376 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from July 1, 1999 to December 31, 2002 were retrospectively reviewed. All patients with contact lens-related corneal ulcers were identified, and information regarding cultures, lens type, usage, and cleaning was obtained. RESULTS: Of the 376 cases, 113 (30%) were related to contact lens use. The contact lens history was recorded in 83 of 113 cases (73%). The soft daily wear frequent replacement lens was the most common lens type associated with corneal ulcers (n = 36/83, 43%). Corneal cultures were performed in 71 of 113 cases (63%) and were positive in 51 of 71 cases (72%). The most common microorganism involved was Pseudomonas aeruginosa (n = 17/51, 33%). The frequency of contact lens-related corneal ulcers from 1999-2002 (n = 113/376, 30%) was significantly greater than that from years 1996-1999 (n = 37/299, 12%) at our institution (P < 0.05). CONCLUSION: There was a significant increase in the number of contact lens-related corneal ulcers between 1999 and 2002 compared with previous years (P < 0.05). The contact lens type most frequently associated with corneal ulcers was the soft daily-wear frequent-replacement contact lens (43%). Contact lens-related corneal ulcers continue to be a serious problem despite a shift in the market to the use of frequent-replacement daily-wear contact lenses and advances in contact lens technology.