Biomedical subjects
Publications and source records attributed to A Quick.
Systemic embolic events are known complications of bacterial endocarditis. Embolization of prosthetic valves has previously been reported in the literature. We report a case of embolization of native aortic valve tissue to the popliteal artery as the presenting event in a patient with subacute bacterial endocarditis. To our knowledge, this rare complication has not been previously reported.
An 18-month prospective survey was performed to examine the effect of adding a fifth bed to four-bedded bays in three acute medical wards on colonization by methicillin-resistant Staphylococcus aureus (MRSA). Screening procedures were in accordance with the UK national guidelines. All patients newly colonized with MRSA were visited, and their bed location determined. Data from the five-bedded bays were compared with those from four-bedded bays in similar wards. Potential routes of transmission were investigated by observational surveys. The relative risk of colonization in five-bedded medium dependency bays was 3.15 compared with that of similar four-bedded bays (P < 0.005), and in five-bedded low dependency bays was 3.16 (P < 0.005). Increasing the number of beds in a fixed area heightens the risk of cross-infection with MRSA.
BACKGROUND: Clostridium difficile (CD) infection and methicillin-resistant Staphylococcus aureus (MRSA) colonization are increasingly common in elderly patients, are associated with cephalosporin or prolonged aminopenicillin courses and can be transmitted by direct contact. Management is by side-room isolation. Ward closure may be required to control outbreaks. METHODS: following prolonged bed closures due to CD and MRSA in an acute age-related geriatric service, an enhanced infection control policy was introduced-emphasis on handwashing, cephalosporin restriction, 7-day time limits on antibiotics and feedback of infection rates. The effect of this policy was evaluated by investigating 2,467 consecutive admissions in the 9 months before and after its introduction. RESULTS: CD infection fell from 36/1,075 admissions (3.35 per 100) to 27/1,392 (1.94 per 100; P < 0.05). MRSA incidence fell from 3.95 per 100 to 1.94 (P < 0.01) whilst that in the rest of the hospital continued to fluctuate. Cephalosporin use fell (and aminopenicillin and trimethoprim use rose) by a factor of three. Unoccupied bed days fell from 1,164 (12.6%) to 513 (5.1%) over the winter, an increase in bed availability of 4.95 a day. CONCLUSIONS: introduction of the policy was associated with significant reductions in CD infection and unoccupied bed-days and helped maintain a lower incidence of MRSA. It is not clear which elements of the policy most influenced outcome. A multi-centre study is needed to determine whether our findings are generally applicable.
The bacterial biodegradation of a secondary sulphonate, sulphosuccinate, has been shown to occur by direct desulphonation. A bacterium, designated Pseudomonas sp. BS1, was isolated from activated sewage sludge, for its capacity to grow on sulphosuccinate as the sole source of carbon and energy. Cultures grown on sulphosuccinate were able to convert this substrate to sulphite which was subsequently oxidized rapidly to sulphate. The sequence of desulphonation and carbon-chain catabolism of sulphosuccinate was determined from measurements of the kinetics of sulphite and 14CO2 release from specifically radiolabelled sulpho[1,4-14C]succinate and sulpho[2,3-14C]succinate, which were synthesized from the corresponding maleic anhydrides. When each radiolabelled compound was incubated separately with washed-cell suspensions of Pseudomonas BS1, sulphite was released before 14CO2, as shown by chemical assay and radiorespirometry, respectively. Differences in the kinetics and extent of 14CO2 release from the 1,4- and 2,3-labelled substrates were consistent with entry of the intact C4 chain into the citric acid cycle. When carrier oxaloacetate was added to incubation mixtures containing resting-cell suspensions and radiolabelled sulphosuccinate, a radiolabelled metabolite with the same HPLC retention time as oxaloacetate accumulated. No radioactive metabolites accumulated when carrier oxaloacetate was replaced with succinate, fumarate or malate. Collectively, the data indicated co-production of sulphite and oxaloacetate from sulphosuccinate, which is interpreted in terms of an oxidative desulphonation mechanism.
A 72-year-old woman was admitted to the hospital with "flash" pulmonary edema, preceded by chest pain, requiring intubation. Her medical history included coronary artery disease with previous myocardial infarctions, hypertension, and diabetes mellitus. A history of angioedema secondary to lisinopril therapy was elicited. Current medications did not include angiotensin-converting enzyme inhibitors or beta-blockers. She had no previous beta-blocking drug exposure. During the first day of hospitalization (while intubated), intravenous metoprolol was given, resulting in severe angioedema. The angioedema resolved after therapy with intravenous steroids and diphenhydramine hydrochloride.
In recent years, infection control in the operating department has focused on the concept of universal precautions. This allows protection for both patients and staff in relation to blood borne pathogens. Recent research, however, suggests that the introduction of universal precautions could lead to an increase in the transmission of other pathogens, for example, Methicillin Resistant Staphylococcus Aureus (MRSA). This article aims to provide a brief overview of the universal precautions, followed by an in-depth consideration of MRSA, its history, incidence, transmission, effect and implications for both patients and staff in the operating department.
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Consumerism is fashionable in the health service, but there is a danger that it will prove no more than window-dressing. Liz Winn and Allison Quick, who recently wrote a book on user-friendly services, addressed particularly to the managers of community health services, summarise their conclusions, pointing out the possibilities and pitfalls if consumerism is to be taken seriously.
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Venous plasma levels of lidocaine were determined in 8 patients presenting to the emergency department with acute distal radius fractures and who had had anesthesia with fracture hematoma block. The block was performed in an aseptic fashion via a dorsal approach with a dose of 2.2-2.4 mg/kg of lidocaine without epinephrine. Onset of anesthesia was in less than 5 min which reduced pain from manipulation of the fracture to modest levels. Plasma lidocaine levels determined by gas chromatography-mass spectrometry reflected rapid systemic absorption of lidocaine from the fracture hematoma. Maximum systemic concentrations were seen at 20-30 min and ranged from 100 to 1,100 ng/ml, well below the toxic threshold of 5,000 ng/ml.
The B12 absorption test (Schilling test) with intrinsic factor was used to examine ileal B12 absorption in 26 patients after allogeneic transplantation. The test was well tolerated and showed a profound fall in B12 absorption, which was maximal at two weeks after transplantation and recovered by eight weeks. The predominant influence on absorption at this stage was probably the conditioning schedule, and the presence of acute graft versus host disease (GVHD) was not associated with a further impairment of absorption. Six patients with chronic GVHD were studied. When compared with nine patients without GVHD there was a significant (p less than 0.005) reduction of B12 absorption. These findings suggest that the B12 absorption test may be a useful non-invasive method of studying bowel function after bone marrow transplantation.
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