Chronic blepharitis and dry eyes.
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Adolescent↗
Biomedical subjects
J M Dougherty
Publications and source records attributed to J M Dougherty.
Cerebrospinal fluid cultures and analysis.
Prompt and accurate diagnosis of acute central nervous system infections is of vital importance to the emergency physician. With the advent of modern antimicrobial therapy, the nearly uniformly fatal outcome of untreated bacterial meningitis can be reduced substantially. Proper test selection is crucial in arriving at a correct and timely diagnosis. A variety of tests are currently available for evaluation of the patient with an acute central nervous system infection. We review the current state of the art in central nervous system testing. Cost considerations and an algorithm for efficient selection of appropriate tests are presented.
Acridine Orange↗
Bacterial aspects of chronic blepharitis.
Patients with all forms of chronic blepharitis were thoroughly evaluated. These patients were found to have evidence for a primary bacterial component in the disease process only in the clinical staphylococcal and mixed seborrheic/staphylococcal forms of chronic blepharitis. Evidence was found for a shared common pathway for Staphylococcus aureus, coagulase negative staphylococci, and Propionibacterium acnes to contribute to the disease process. These organisms were found to produce lypolytic exoenzymes including fatty wax esterase, cholesteryl esterase, and triglyceride lipase. Statistically significantly larger numbers of coagulase negative staphylococci were found to produce these enzymes in patients with the various forms of seborrheic blepharitis and meibomian keratoconjunctivitis. Additionally, abnormalities in the free fatty acid component of the meibomian secretions were found in these patients supporting the hypothesis that lypolytic exoenzymes produced by bacteria might alter the meibomian secretion. Even though a primary pathogen is identifiable only in staphylococcal and mixed seborrheic/staphylococcal blepharitis, several different bacteria may contribute to the expression of disease in all other forms of chronic blepharitis.
Blepharitis↗
Cerebral spinal fluid.
The advent of very sensitive and rapid agglutination tests has been a major advance in facilitating the rapid diagnosis of bacterial meningitis (Table 3). Future investigations will focus on the use of monoclonal antibodies that have been found to be more sensitive and specific than polyclonal antiserums. Modifications of enzyme immunoassays of bacterial antigens to improve speed and technical reliability are in progress. The day may come with the present advances in technology that within 1 hour of receiving a CSF specimen, both the identity and antimicrobial sensitivity of the invading pathogen will be known to the physician. In addition, through quantitation of bacterial antigen, a reliable prognosis as to the outcome of the treated meningitis will also be possible. Finally, the continued refinement of reliable antiserums to group B Neisseria meningitidis, as well as other bacteria responsible for meningitis, particularly in the immunocompromised host will occur.
Adult↗
Analysis of the free fatty acid component of meibomian secretions in chronic blepharitis.
Meibomian secretions were collected from 43 patients with chronic blepharitis and 8 normal controls. Patients were divided into six clinically distinct groups of chronic blepharitis. Individual secretions were weighed and separated into specific lipid classes by thin-layer chromatography. The free fatty acid (FFA) fraction was recovered, methylated, and analyzed by gas-liquid chromatography. Quantitation was achieved through the use of an internal standard, and qualitative analyses were aided by the use of commercial external standards. Carbon numbers were expressed in terms of their equivalent chain lengths (E.C.L.). For statistical comparisons, specific acid weights were expressed as nanograms per milligram of secretion. Data from individual subjects were tabulated by group and analyzed by a nonparametric analysis of variance. The FFA portion made up from 0.21% to 1.3% of the total meibomian secretion. Acids ranged in length from 12 to 29 carbon atoms. Iso-branched and anteisobranched carbon chains made up approximately 33% of the FFA fraction. E.C.L.'s corresponding to C16:0, C18:0, and C18:1 together made up a major portion of the total FFA fraction (mean = 49%). When compared to normals, a significantly decreased amount of C12:0 was seen in the mixed seborrheic/staphylococcal group and the meibomian seborrhea group. A significantly decreased amount of anteiso-branched C15:0 was seen in the mixed seborrheic/staphylococcal group. Significantly decreased amounts of anteiso-branched C23:0 were seen in all of the seborrheic blepharitides. A significantly increased amount of isobranched C22:0 was seen in the meibomian keratoconjunctivitis group. No significant differences were seen in the staphylococcal group.
Blepharitis↗
Bacterial lipases and chronic blepharitis.
Eyelids and conjunctivae of 36 normal individuals and 60 patients from six clinical groups of chronic blepharitis were cultured for aerobic and anaerobic bacteria. The most common species isolated were coagulase-negative staphylococci (C-NS) and Propionibacterium acnes. All strains of these species, and all Staphylococcus aureus strains isolated were tested for the ability to break down triglycerides, cholesterol esters, and fatty waxes. Each strain was incubated independently with appropriate substrates in nutrient media. Each medium was then extracted and assayed for the presence of substrate hydrolysis products by thin-layer chromatography. The percentage of strains capable of hydrolyzing a particular substrate was determined for each individual. S. aureus was a consistent and strong lipase producer, able to hydrolyze all three substrates. P. acnes was able to hydrolyze triolein and behenyl oleate but not cholesteryl oleate. No differences were observed among groups for P. acnes or S. aureus. C-NS showed a high degree of strain variability. Eighty-three percent of C-NS strains could hydrolyze triolein, 82% behenyl oleate, and 40% cholesteryl oleate. Significant group differences were seen in the percentage of lipase positive C-NS strains isolated per individual. Patients in the mixed staphylococcal/seborrheic, meibomian seborrheic, secondary meibomitis, and the meibomian keratoconjunctivitis (MKC) groups harbored significantly more C-NS strains capable of hydrolyzing cholesteryl oleate than did normal individuals. Patients in the meibomian seborrheic, secondary meibomitis, and MKC groups harbored significantly more C-NS strains capable of hydrolyzing behenyl oleate than did normals. No group differences were seen among groups with triolein hydrolyzing C-NS strains.
Blepharitis↗
Blepharitis associated with acne rosacea and seborrheic dermatitis.
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Adult↗
Tear lysozyme measurements in chronic blepharitis.
Tear lysozyme concentrations were measured on 47 patients with chronic blepharitis and 22 normal control patients. The patients consisted of 26 individuals with various types of chronic blepharitis alone and 21 individuals with chronic blepharitis and clinically-diagnosed keratoconjunctivitis sicca (KCS). The mean lysozyme concentration of blepharitis patients without KCS (4070 micrograms/ml) was not significantly different from normals (3760 micrograms/ml). However, mean lysozyme concentration of the blepharitis patients with KCS (2530 micrograms/ml) was significantly lower than normals or blepharitis patients without KCS (p less than 0.01). It was concluded that tear lysozyme deficiency does not play a significant role in the etiology of chronic blepharitis. However, a large percentage of patients with chronic blepharitis were found to have KCS.
Adolescent↗
Comparative bacteriology of chronic blepharitis.
One hundred and fifteen patients with chronic blepharitis were compared with 47 normal controls. Six clinically distinct groups of blepharitis were observed: staphylococcal; seborrhoeic, alone, with associated staphylococcal superinfection, meibomian seborrhoea, or secondary inflammation of the meibomian glands; and meibomian keratoconjunctivitis (MKC). Staphylococcus aureus was isolated in appreciable frequency from the staphylococcal and the mixed staphylococcal/seborrhoeic groups in contrast to the normal and non-staphylococcal groups. Coagulase-negative Staphylococcus spp., Propionibacterium acnes, and cornyneform bacteria were the most commonly isolated bacteria from the lid for all groups. Cultures of material expressed from the meibomian glands yielded similar organisms but in reduced frequency. Testing of antibiotic susceptibility revealed Staph aureus to be usually sensitive to most commonly used ophthalmic antimicrobials except sulphonamides.
Anti-Bacterial Agents↗
Classification of chronic blepharitis.
Since last thoroughly evaluated over three decades ago, the clinical spectrum of chronic blepharitis has changed. The relative prevalence of Staphylococcus aureus alone or in combination with seborrheic blepharitis has decreased. The relative prevalence has increased of seborrheic blepharitis with or without associated excess meibomian secretions (meibomian seborrhea) or inflammation (meibomitis). Primary meibomitis appears not to be a primarily infectious entity but to represent a facet of generalized sebaceous gland dysfunction and to be found in association with seborrheic dermatitis or acne rosacea. The keratoconjunctivitis found in association with primary meibomitis may be contributed to by the production of bacterial lypolytic exoenzymes that split neutral lipids, resulting in an increased level of free fatty acids in the tears. A frequent finding of keratoconjunctivitis sicca in this patient population, especially the S. aureus group (50%), is of note. Of particular importance is that these entities be recognized as chronic diseases requiring control and ones for which there is no "cure."
Adolescent↗
In-field extremity amputation: prevalence and protocols in emergency medical services.
OBJECTIVE: To determine current experience, attitudes, and training concerning the performance of in-field extremity amputations in North America. DESIGN: Cross-sectional, epidemiological survey. PARTICIPANTS: Emergency medical services (EMS) directors from the 200 largest metropolitan areas in North America and attendees at the 1992 Mid-Year National Association of EMS Physicians Meeting. INTERVENTIONS: The survey consisted of five questions focusing on demographic and operational data, the frequency of occurrence of the performance of in-field amputations, personnel responsible for performing the procedure, existing written protocols for the procedure, and the scope of training provided. RESULTS: A total of 143 surveys was completed. Eighteen respondents (13%) reported a total of 26 in-field extremity amputations in the past five years. The most common cause for the injuries requiring amputations was motor-vehicle accidents. In the majority of cases (53.2%), trauma surgeons were responsible for performing the amputation, followed by emergency physicians (36.4%). Of respondents, 96% stated that there was no training available through their EMS agencies related to the performance of in-field extremity amputations. Only two EMS systems had an existing protocol regarding in-field amputations. CONCLUSIONS: The results suggest a need for established protocols to make the procedure easily accessible when needed, especially in large metropolitan EMS systems. This information should be emphasized during EMS training and reinforced through continuing education.
Accidents, Occupational↗
Core temperature monitoring of firefighters during hazardous materials training sessions.
OBJECTIVE: To determine core temperature (Tc) elevations in hazardous materials (HazMat) technicians wearing level-A fully encapsulated, chemically resistive suits (FECRSs) during training scenarios. DESIGN: Cross-sectional, observational feasibility study with Institutional Review Board approval. SETTING: HazMat training scenarios held during the summer of 1994. Weather conditions included both rainy and sunny days, with a mean ambient temperature of 75.8 degrees F (24.3 degrees C) (range 69-83 degrees F [20.6-28.3 degrees C). PARTICIPANTS: Nine male firefighters participating in training scenarios in the Midwestern United States. INTERVENTIONS: Each volunteer swallowed a capsule containing a Tc sensor developed by the National Aeronautics and Space Administration. The capsule continuously monitored Tc and stored data in an ambulatory recorder worn under the level-A FECRS during training. RESULTS: Mean age of the volunteers was 34 years, mean weight was 92.6 kg, and average baseline Tc was 36.7 degrees C (97.1 degrees F) (range 35.3-38.2 degrees C [95.5-100 degrees F]). Time in the FECRS averaged 25.4 minutes (range 14-35 minutes). All subjects demonstrated increased Tc while in the suit; the mean Tc increase was 0.8 degree C (1.4 degrees F) (range 0.2-1.3 degrees C [0.4-2.3 degrees F]). The Tc continued to increase during wet decontamination procedures and after suit removal. Mean heat storage values (delta Tcx LBMx 3.47 kJ) were calculated, and found to be moderately elevated to 3.6 kJ/kg (range 2.1-4.6 kJ/kg). CONCLUSION: These observations support the validity and significance of implementing prophylactic measures for firefighters using protective clothing. Simple protective measures include enforced time limitations, hydration, and efforts to minimize heat buildup by avoiding both direct sunlight and unnecessary time encapsulated in the suit.
Adult↗
Negative pressure devices in pediatric practice.
Pediatric nurses are seeing a renewed interest in the use of negative pressure ventilators in the hospital and home setting. Although body ventilators are a novelty to many nurses, they also present several challenges for safe and supportive care.
Child↗
Developing a competency-based curriculum for tracheostomy and ventilator care.
Advances in technology and medical practice have enabled children with special health needs, such as tracheostomy and ventilator care, to be discharged to their families while continuing to require specialized care. Yet, corresponding increases in the availability and competence of home care providers have not kept pace with this trend. The authors set a goal to design, develop, implement, validate, and disseminate a competency-based curriculum to prepare adults to care for these children in the home and community. This article is Part 1 of a two-part series.
Adult↗
Part 2: using a competency-based curriculum to train experienced nurses in ventilator care.
As pediatric nurses, we are caring for increasing numbers of children with special health needs such as tracheostomy and ventilator care. These children are being discharged to their families requiring specialized care, including in-home skilled nursing services. In Part I of this two-part series, the authors described the development of a training curriculum for nurses caring for ventilator-assisted children at home. The next step was to validate that the curriculum was effective, feasible, and replicable. Part 2 describes the initial validation efforts with hospital and home care nurses.
Child↗