Thirty-one moderately or severely ill hospitalized patients with proved (25 patients) or suspected (six) bacterial infections were randomly allocated to receive imipenem/cilastatin (16) or cefotaxime (15). The median age, sex, duration of therapy, underlying disease, and types of infection were similar in both groups. Nineteen patients with pneumonia, eight with soft tissue infection, and four with acute pyelonephritis were included. The pathogens isolated included Escherichia coli (six), Streptococcus pneumoniae (five), Streptococcus pyogenes (five), Haemophilus species (four), Proteus species (three), Staphylococcus aureus (three), and Serratia marcescens (two). In the imipenem/cilastatin group, 13 patients were cured of their infections and three showed improvement. In the cefotaxime group, nine were cured, three showed improvement, and three showed no improvement. Nine patients treated with imipenem/cilastatin developed phlebitis, as compared with eight treated with cefotaxime. One patient treated with cefotaxime developed diarrhea. During therapy, potential pathogens were isolated from four patients in the imipenem/cilastatin group (Candida species [two] and Pseudomonas maltophilia [two]), as compared with eight in the cefotaxime group (enterococci [two], Pseudomonas aeruginosa [two], Candida species [two], Acinetobacter anitratus [one], and Pseudomonas fluorescens [one]). There were no recognized superinfections.

Adult↗

PubMedDate not supplied

Preservation of colonization resistance parameters during empiric therapy with aztreonam in the febrile neutropenic patient.

The role of the anaerobic intestinal flora in maintaining colonization resistance was examined in a study of empiric therapy in febrile neutropenic patients who received aztreonam plus tobramycin, aztreonam plus cloxacillin, or moxalactam plus tobramycin, regimens with differential effects on the anaerobic intestinal flora. Surveillance cultures showed that all regimens eradicated fecal carriage of enteric gram-negative bacilli but that fecal acquisition of fungi occurred in 4 (27%) of 15 aztreonam/tobramycin, 6 (43%) of 14 aztreonam/cloxacillin, and 13 (81%) of 16 moxalactam/tobramycin recipients. Fungi were acquired at 11 (22%) of 49 sites in aztreonam/tobramycin, 15 (31%) of 48 sites in aztreonam/cloxacillin, and 28 (54%) of 52 sites in moxalactam/tobramycin recipients. Aztreonam/tobramycin reduced fecal anaerobe counts by less than 1 log10; aztreonam/cloxacillin, by a mean of 2.5 log10; and moxalactam/tobramycin, by 5.1 log10 colony-forming units (cfu)/g of feces by day 10 +/- 3 of therapy. Elimination of the anaerobes was reflected by a reduction in concentrations of short-chain fatty acids (SCFAs) in fecal supernatants. Fecal specimens containing greater than or equal to 10(6) cfu of Bacteroides fragilis group organisms/g (dry weight) contained significantly higher concentrations of succinic, propionic, and isobutyric acids. Flat SCFA chromatograms were observed in 90% of fecal samples from which no anaerobes were recovered. Preservation of the anaerobic flora appears critical in the prevention of fungal acquisition in neutropenic patients.

Adolescent↗

PubMedDate not supplied

A double-blind clinical study comparing the safety and efficacy of Hexabrix and Renografin-76 in contrast enhanced computed body tomography.

Hexabrix, a new low osmolality, iodinated contrast medium and the ionic diatrizoate Renografin-76 were studied in a double-blind parallel group comparison to examine safety and efficacy in patients undergoing contrast assisted CT of the liver, spleen and kidney. No significant differences in pulse, respiration and blood pressure before and after injection were noted in the 100 patients studied. Heat sensation in the Hexabrix group was distinctly lower than in those receiving Renografin, but the two groups did not differ with respect to average scores for pain. There was no difference in adverse side effects. Clinical laboratory studies between the groups showed some differences which could not be attributed to the individual contrast agents. While scan quality of both agents was good to excellent, it should be noted that the dose of Hexabrix was not adjusted to compensate for the difference in iodine content (320 mg I/ml vs. 370 mg I/ml for Renografin-76).

Adult↗

PubMedDate not supplied

Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers.

The CANTAB battery was administered to a large group (n = 787) of elderly volunteers in the age range from 55 to 80 years. This battery, which is based on tests used to identify the neural substrates of learning and memory in non-human primates, has now been extensively used in the assessment of various forms of dementia and also validated on patients with neurosurgical lesions of the frontal and temporal lobes. The tests employed were pattern and spatial recognition, simultaneous and delayed matching to sample, learning of visuospatial paired associates, a matching to sample, reaction time task and a test of spatial working memory. The sample was banded into different IQ bands based on performance on 5 standard tests of intelligence. The MMSE was also administered to exclude cases of possible dementia (n = 16) in the normal sample. In general, performance declined with age and IQ, but these factors did not interact. A factor analysis (with varimax rotation) identified 4 factors with eigenvalues greater than 1, which accounted for over 60% of the variance. Factor 1 was equated with general learning and memory ability and loaded significantly with the Intelligence scores; factor 2 was related to speed of responding and loaded most heavily with Age. Comparisons were also made of performance on CANTAB of those subjects with dementing scores on the MMSE and the lowest 5th percentile of the population sample. The results are discussed in terms of the utility of the CANTAB battery for the assessment of dementia and of the implications for theories of changes in cognitive function during normal aging.

Aged↗

PubMedDate not supplied

Influence of dietary fats on blood coagulation and prostaglandin production in the common marmoset.

Common marmosets were fed a standard marmoset diet (REF) or diets supplemented with 12% (wt/wt) sunflower seed oil (SSO) or sheep fat (SF) for a period of 90 weeks. The values for coagulation indices, clotting time, and Russel viper venom time were consistent with decreased thrombotic tendency of platelets from animals on the SSO diet relative to the low fat, REF diet animals, while an increased tendency to thrombosis was observed with SF-fed marmosets. The SSO- and SF-supplemented marmosets showed a significantly reduced thromboxane (TXB2) generation from platelets aggregating to collagen (ASC) relative to the REF group, while at 50 micrograms/ml ASC this difference was maintained only by the SSO group. The SF diet-fed marmosets showed a reduced prostacyclin (measured as 6-keto-PGF1 alpha) generation from incubated aorta relative to the REF or SSO-fed groups, which were not different from each other. A reduced proportion of platelet phospholipid arachidonic acid (20:4, n-6) and increased alpha-tocopherol concentration was consistent with the decreased aggregability and thromboxane generation of platelets from SSO-fed marmosets relative to the REF and SF groups. The SF diet-fed marmosets, on the other hand, showed minimal change in arachidonic acid, alpha-tocopherol or platelet reactivity from the REF group. These differing responses to dietary fats are discussed in relation to the potential for the development of thrombosis and atherosclerosis.

Animals↗

PubMedDate not supplied

Health care in the upcoming 2000 election.

Health care will be one of the top issues in the year 2000 election, but voters' interest in health care is not as great as it was in 1992. There is no single unifying theme to the health care issue. Rather, there are multiple concerns: making Medicare financially sound, providing coverage for prescription medicines for seniors, covering the uninsured, and addressing patients' rights. Voters favor an incremental approach to expanding health insurance coverage rather than a major program. They express about equal levels of support for plans similar in concept to those proposed by presidential candidates Al Gore and George W. Bush.

Attitude to Health↗

PubMedDate not supplied

Insertion site dynamics and histology in a rabbit model after conventional or suspension rectus recession combined with ipsilateral antagonist resection.

We have used a rabbit model to study insertion movement, rotational forces, disinsertion forces, and histology of the surgically created insertion site after recession of the inferior rectus (IR) using a conventional (CONV) or suspension (SUS) technique combined with an ipsilateral superior rectus (SR) resection. During the 5-week observation period, the CONV and SUS recessed IR showed an initial posterior movement followed by an anterior movement while all resected SR had an initial posterior movement which remained stable. SR rotational forces increased and IR remained constant throughout the 5-week observation period. There were no rotation force differences between the SUS and CONV recession techniques. Disinsertion forces showed an initial large decrease in force followed by a gradual increase to preoperative levels by 3 postoperative weeks. Disinsertion force differences between the CONV and SUS recessions were observed for 5 weeks after surgery. Histologic analysis showed a delayed inflammatory response on the SUS recession compared to the CONV recession and at the middle of the insertion compared to the poles which was minimized by 3 weeks after surgery.

Animals↗

PubMedDate not supplied

Reversing blindness--one child at a time.

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Africa, Northern↗

PubMedDate not supplied

Relationship between serum inositol concentration and development of retinopathy of prematurity: a prospective study.

PURPOSE: To examine the relationship between the intake of sugar inositol, serum inositol levels, and ROP in three groups of low birthweight infants receiving feedings containing various concentrations of inositol. METHODS: Infants with a birthweight <1500 g, with severe lung disease, were eligible for the study when they began enteral feedings. Infant formulas contained three different inositol concentrations: 2500, 710, and 242 micromol/L. Serum inositol concentrations were averaged over specific time intervals. A logistic regression model was used to investigate the confounding effect of duration of mechanical ventilation and oxygen therapy, birthweight, Apgar score, and serum inositol concentration on development of ROP. RESULTS: Infants receiving high inositol formula and with higher serum inositol concentrations at birth and after 30 days had a statistically significant lower incidence of severe ROP than those receiving the lower inositol formula and with lower serum concentrations (P<.05). The effective serum inositol concentration (EC90) associated with lesser disease was >215 micromol/L. By logistic regression, the odds of developing severe ROP were greater among infants with low serum inositol concentration (odds ratio=4.7, 95% confidence interval 0.90-24.8, P=.017). CONCLUSION: Inositol supplementation may help prevent the most severe form of ROP.

Dietary Carbohydrates↗

PubMedDate not supplied

How much does the public know about health reform?

With federal action on major health reform set to take place in 1994, a recent survey of 1,200 adults found major gaps in Americans' understanding of what the problems are or how major legislative proposals would address them. While the public is primarily concerned about how health reform will affect them personally, their current lack of knowledge heightens the impact that political advertising, media coverage, and public education campaigns will have.

Advertising↗

PubMedDate not supplied

Breastfeeding outcomes of women following uncomplicated birth in Hamilton-Wentworth.

OBJECTIVE: To examine infant feeding practices up to 8 weeks postpartum in Hamilton-Wentworth. METHODS: A cross-sectional survey of 227 women using a pre-discharge, self-administered questionnaire, medical record review and follow-up telephone interview. RESULTS: Breastfeeding initiation rate was 85%. By 6-8 weeks postpartum, 30% of women had stopped breastfeeding; 55% had switched to formula within the first 14 days. Infants who did not receive supplementation in hospital were 2.49 times more likely than infants who received supplementation to breastfeed for at least 6 weeks. Although 54% of mothers who initiated breastfeeding reported receiving formula gift packs, no association was found. CONCLUSIONS: The breastfeeding initiation rate appears to have increased in Hamilton-Wentworth since 1995. However, this study reinforces the need to address early cessation and infant supplementation, and raises concern about violation of the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes through mailing of formula coupons.

Adult↗

PubMedDate not supplied

Nurse practitioners in accident and emergency.

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Emergency Service, Hospital↗

PubMedDate not supplied

Monosodium urate crystal-induced prostaglandin synthesis in the rat subcutaneous air pouch.

Monosodium urate crystal-induced inflammation was studied in an air pouch model of rat synovium. Phagocytosis of crystals by macrophage-like and fibroblast-like cells in the pouch lining was observed 30 minutes after crystal injection and preceded polymorphonuclear leukocyte accumulation. Levels of the prostaglandins PGE2 and 6-keto-PGF1 alpha, measured in serial pouch washouts, showed a clear temporal dissociation with leucocyte numbers, with peak levels of the prostanoids occurring before the maximum accumulation of leucocytes. Indomethacin abrogated prostaglandin synthesis completely without reducing leucocyte counts in pouch washouts. We propose that the pouch lining cells may be the primary source of the prostaglandins and these mediators do not have a significant role in leucocyte chemotaxis in this model.

6-Ketoprostaglandin F1 alpha↗