bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Application of Evaluation Indices for Hospital Infection Surveillance and Control Programs in the Republic of Korea
Authors: Oh Hyang Soon , Cheong Hae Won , Yi Seung Eun , Kim Ho , Choe Kang Won , Cho Sung Il
Published: March 2007

Objective.

To develop new evaluation indices of infection control and to use them to evaluate Korean infection surveillance and control programs (ISCPs).

Design.

We performed a questionnaire-based survey to 164 acute care general hospitals throughout the Republic of Korea that had more than 300 beds. Study methods were based completely on those of the Study on the Efficacy of Nosocomial Infection Control (SENIC). Four SENIC indices (hospital epidemiologist index, infection control nurse index, surveillance index, and control index) and 4 newly developed indices (healthcare worker index, quality improvement index, resource index, and hand hygiene facilities index) were used to evaluate Korean ISCPs. Data were collected by questionnaire from June 17 to October 11, 2003.

Setting.

One hundred sixty-four general hospitals with more than 300 beds in the Republic of Korea.

Results.

Personnel from 85 general hospitals responded to the study questionnaire. The reliability and validity of the evaluation indices were statistically significant (P<.05). The 8 evaluation indices were categorized into 2 factor groups: personnel factors (hospital epidemiologist index and infection control nurse index) and activity factors (the remaining 6 indices). Korean ISCPs showed a major weakness in surveillance. The scores for the newly developed evaluation indices were better than those for the SENIC evaluation indices. However, most Korean hospitals were estimated to have had only slight reductions in nosocomial infection rates. The evaluation indices were influenced significantly by the number of beds in the hospital, whether the hospital was located in the Seoul-Gyonggi region, the presence of full-time infection control nurses at the hospital, the education level of the infection control nurses, and the nurses' experience in infection control (P<.05).

Conclusions.

The reliability and validity of the SENIC evaluation indices and the newly developed evaluation indices were satisfactory in evaluating Korean ISCPs. However, surveillance should be improved to increase the efficacy of Korean ISCPs.
Prevalence of Hospital-Acquired Infections During Successive Surveillance Surveys Conducted at a University Hospital in The Netherlands
Authors: Hopmans T. E. M. , Blok H. E. M. , Troelstra A. , Bonten M. J. M.
Published: March 2007

Objective.

To monitor hospital-wide trends in the prevalence of hospital-acquired infections (HAIs) in order to identify areas where the risk of infection is increasing.

Methods.

Successive surveillance surveys were conducted twice yearly, from November 2001 until May 2004, to determine the prevalence of HAIs at 2 Dutch hospitals, using Centers for Disease Control and Prevention criteria.

Results.

In all, 340 HAIs were observed in 295 (11.1%) of 2,661 patients surveyed. The overall prevalence per survey varied from 10.2% to 15.6%, with no significant differences between successive surveys. In the surgical department, the prevalence of HAIs increased from 10.8 cases per 100 surgeries in November 2001 to 20.4 cases per 100 surgeries in May 2002. Further analysis revealed a high prevalence of surgical site infection among patients who had an orthopedic procedure performed. In the neurology-neurosurgery department, the prevalence increased from 13.0 cases per 100 patients in May 2002 to 26.6 cases per 100 patients in May 2003 and involved several types of infection. Further analysis retrieved exceptionally high incidences of infections associated with cerebrospinal fluid drainage. Specific infection control interventions were developed and implemented in both departments. The total cost of the surveys was estimated to be €9,100 per year.

Conclusion.

Successive performance of surveillance surveys is a simple and cheap method to monitor the prevalence of infection throughout the hospital and appeared instrumental in identifying 2 departments with increased infection rates.
Quality of Data Reported to a Smaller-Hospital Pilot Surveillance Program
Authors: Bennett Noleen J. , Bull Ann L. , Dunt David R. , Richards Michael J. , Russo Philip L. , Spelman Denis W.
Published: March 2007

This data quality study assessed the accuracy of data collected as part of a pilot smaller-hospital surveillance program for methicillin-resistant Staphylococcus aureus (MRSA) infection and bloodstream infection (BSI). For reported MRSA infection, estimated values were as follows: sensitivity, 40%; specificity, 99.9%; and positive predictive value, 33.3%. For reported BSI, estimated values were as follows: sensitivity, 42.9%; specificity, 99.8%; and positive predictive value, 37.5%.
Risk Adjustment for Surgical Site Infection After Median Sternotomy in Children
Authors: Kagen Jessica , Bilker Warren B. , Lautenbach Ebbing , Bell Louis M. , Coffin Susan E. , John Keith H. St. , Teszner Eva , Dominguez Troy , Gaynor J. William , Shah Samir S.
Published: March 2007

Objective.

To determine whether the National Nosocomial Infections Surveillance (NNIS) System risk index adequately stratified a population of pediatric patients undergoing cardiac surgery according to the risk of developing surgical site infection (SSI).

Design.

A retrospective, case-control study.

Setting.

An urban tertiary care children's hospital.

Patients.

Patients who had a median sternotomy performed between January 1,1995, and December 31, 2003, were eligible for inclusion in the study. For all case patients, medical records were reviewed to verify that all patients met the case definition for SSI. Control subjects were chosen randomly from among all patients who underwent median sternotomy during the study period who did not develop SSI.

Results.

Thirty-eight patients with SSI and 172 patients without SSI were included. One hundred six patients (50%) were male. The median patient age was 4 months. The sensitivity of the NNIS risk index with cutoff scores of 0 to 1 and 2 to 3 was 20%. The distribution of patients with SSI for an NNIS risk index score of 0 was 0%; for a score of 1, 80%; for a score of 2, 20%; and for a score of 3, 0%. The distribution of patients without SSI for a scores of 0 was 4%; for a score of 1, 87%; for a score of 2, 9%; and for a score of 3, 0%. The area under the receiver-operating characteristic curve (AUC) of the original NNIS risk index was 0.57. The modified risk indices did not perform significantly better, with an AUC range of 0.58 to 0.73.

Conclusions.

The NNIS risk index did not adequately stratify pediatric patients undergoing median sternotomy according to their risk of developing an SSI. Various modifications to the risk index yielded only slightly higher AUC values.
Use of Cellular Telephones and Transmission of Pathogens by Medical Staff in New York and Israel
Authors: Goldblatt Joseph Gil , Krief Iris , Klonsky Tal , Haller Daniel , Milloul Victor , Sixsmith Diane M. , Srugo Isaac , Potasman Israel
Published: March 2007

Hands and instruments used by healthcare workers may serve as vectors for the nosocomial transmission of microorganisms. The use of cellular telephones by medical personnel and the associated nosocomial transmission of pathogens have not been thoroughly examined. Findings from our study show that cellular telephones are commonly used by hospital personnel, even during patient contact. One-fifth of the cellular telephones examined in this study were found to harbor pathogenic microorganisms, showing that these devices may serve as vectors for transmission to patients.
Predicting Clostridium difficile Toxin in Hospitalized Patients With Antibiotic-Associated Diarrhea
Authors: Peled Nir , Pitlik Silvio , Samra Zmira , Kazakov Arkadi , Bloch Yoram , Bishara Jihad
Published: March 2007

Objective.

Clostridium difficile infection is implicated in 20%-30% of cases of antibiotic-associated diarrhea. Studying hospitalized patients who received antibiotic therapy and developed diarrhea, our objective was to compare the clinical characteristics of patients who developed C. difficile–associated diarrhea (CDAD) with those of patients with a negative result of a stool assay for C. difficile toxin.

Methods.

A prospective study was done with a cohort of 217 hospitalized patients who had received antibiotics and developed diarrhea. Patients with CDAD were defined as patients who had diarrhea and a positive result for C. difficile toxin A/B by an enzyme immunoassay of stool. The variables that yielded a significant difference on univariate analysis between patients with a positive assay result and patients with a negative assay result were entered into a logistic regression model for prediction of C. difficile toxin.

Setting.

A 900-bed tertiary care medical center.

Results.

Of 217 patients, 52 (24%) had a positive result of assay for C. difficile toxin A/B in their stool. The logistic regression model included impaired functional capacity, watery diarrhea, use of a proton pump inhibitor, use of a histamine receptor blocker, leukocytosis, and hypoalbuminemia. The area under the receiver operating characteristic curve for the model as a predictor of a positive result for the stool toxin assay was 0.896 (95% confidence interval, 0.661-1.000; P<.001), with 95% specificity and 68% sensitivity.

Conclusions.

Our results may help clinicians to predict the risk of CDAD in hospitalized patients with antibiotic-associated diarrhea, to guide careful, specific empirical therapy, and to direct early attention to infection control issues.
Evaluation of susceptibility of Trichophyton mentagrophytes and Trichophyton rubrum clinical isolates to antifungal drugs using a modified CLSI microdilution method (M38-A)
Authors: Barros Maria Elisabete da Silva , Santos Daniel de Assis , Hamdan Júnia Soares
Published: March 2007

Onychomycosis is a common adult human mycosis, and dermatophytes of the Trichophyton genera are the most common causative agent. Many antimycotic agents are safe and highly effective for the treatment of dermatophytosis, and are available for clinical practice. Successful treatment depends on the ability of antifungal drugs to eradicate the fungal isolates. The aim of this work was to determine the MICs of four antifungal drugs (fluconazole, itraconazole, terbinafine and griseofulvin) recognized for ungual dermatophytosis treatment caused by Trichophyton species, especially Trichophyton
mentagrophytes and Trichophyton
rubrum. MICs were determined using a broth microdilution method in accordance with Clinical and Laboratory Standards Institute approved standard M38-A with some modifications, such as an incubation temperature of 28 °C, an incubation time of 7 days and inocula constituted of only microconidia. The results showed that the activities of terbinafine and itraconazole were significantly higher (MICs of <0.007–0.031 and 0.015–0.25 μg ml−1, respectively) than other tested agents. All isolates had reduced susceptibility to fluconazole (1–64 μg ml−1). The MIC of griseofulvin varied among strains (MICs of 0.062–1 μg ml−1). The parameters adopted to perform susceptibility testing of T. rubrum and T. mentagrophytes to antifungal agents appeared to be suitable and reliable, and could contribute to the possible development of a standard protocol.
Detection of a neonatal human rotavirus strain with VP4 and NSP4 genes of porcine origin
Authors: Mascarenhas Joana D'Arc P. , Leite José Paulo G. , Lima Jackson C. , Heinemann Marcos B. , Oliveira Darleise S. , Araújo Irene T. , Soares Luana S. , Gusmão Rosa Helena P. , Gabbay Yvone B. , Linhares Alexandre C.
Published: March 2007

A human rotavirus strain (NB-150) was detected in stool samples from a neonate hospitalized for mild/moderate community-acquired diarrhoea. This baby lived in the outskirts of Belém, Brazil, under poor sanitation conditions. The NB-150 strain displayed a typical long electrophoretic pattern with 11 gene segments. It had two VP7 alleles, G1 and G4, and belonged to VP6 subgroup II. A close relatedness with human rotaviruses was shown for VP7 alleles: G1 (96.9–100 % similarity at the amino acid level) and G4 (97.1–100 % similarity at the amino acid level). As for VP6, 95.1–97.5 % similarity at the amino acid level was noted. VP8* and NSP4 genes showed a close relatedness with those of porcine rotavirus strains, as follows: VP8* (95.0 % similarity at the amino acid level) and NSP4 (93.7–96.0 % similarity at the amino acid level). This is believed to be the first report in Brazil of a rotavirus infection involving a strain with G1 and G4 alleles, with VP8* and NSP4 genes of porcine origin. These findings strongly suggest the occurrence of interspecies transmission.
Identification of Gram-negative bacilli directly from positive blood culture vials
Authors: Ng Siew Yong , Kwang Lee Ling , Tan Thean Yen
Published: March 2007

The provision of rapid results from positive blood cultures is important for the clinical management of septicaemia. This study tested the accuracy of direct inoculation of biochemical tests from positive blood culture vials for the identification of members of theEnterobacteriaceaeandAcinetobacterspecies. A hundred and eighty-one samples were included in the study, with 25 % subsequently excluded as a result of mixed colonial growth. The study method successfully identified 133 (98 %) isolates from 136 vials to genus level and was technically simple to perform, requiring an additional 3 min for the processing of each positive vial. The results of this study demonstrate that a direct inoculation method provides acceptable genus identification of Gram-negative bacilli in positive blood culture vials, with a potential saving of 24 h compared with traditional methods.
Clinical and microbiological features of nocardiosis 1997–2003
Authors: Muñoz J. , Mirelis B. , Aragón L. M. , Gutiérrez N. , Sánchez F. , Español M. , Esparcia O. , Gurguí M. , Domingo P. , Coll P.
Published: March 2007

Nocardiosis has been believed to be caused by the members of the Nocardia asteroides complex and the Nocardia brasiliensis species. However, recent advances in genotypic identification have shown that the genus exhibits considerable taxonomic complexity and the phenotypic markers used in the past for its identification can be ambiguous. The aim of this study was to assess the species distribution of Nocardia isolates and to determine whether there are differences in pathogenicity or antimicrobial susceptibility between the different species identified. Nocardia isolates obtained over a 7 year period were retrospectively reviewed. The isolates were identified genotypically, their antibiotic susceptibility was tested and the clinical data of the 27 patients were retrieved. Eight different Nocardia species were identified: Nocardia farcinica (n=9), Nocardia abscessus (n=6), Nocardia cyriacigeorgica (n=6), Nocardia otitidiscaviarum (n=2), Nocardia nova (n=1), N. nova complex (n=1), Nocardia carnea (n=1) and Nocardia transvalensis complex (n=1). All species were susceptible to co-trimoxazole but different patterns of susceptibility to other agents were observed. All patients had active comorbidities at the time of infection. A total of 19 patients were immunosuppressed, due to human immunodeficiency virus infection, chronic corticosteroid therapy, immunosupressive therapy or haematological malignancies. Six patients displayed a Charlson comorbidity index score above 4. Global mortality was 50 % while attributable mortality was 34.6 %. Patients infected with N. farcinica – the most resistant species – had the highest Charlson index score and the highest mortality rate. Accurate identification of the species and susceptibility testing of Nocardia isolates may play an important role in diagnosis and treatment.
Clinical and microbiological investigations of typhoid fever in an infectious disease hospital in Kuwait
Authors: Dimitrov Tsonyo , Udo Eded E. , Albaksami Ossama , Al-Shehab Shehab , Kilani Abdal , Shehab Medhat , Al-Nakkas Aref
Published: March 2007

A retrospective analysis of 135 typhoid cases was conducted to review the clinical, epidemiological and microbiological characteristics of enteric fever cases diagnosed and treated at the Infectious Diseases Hospital, Kuwait, from 2002 to 2005. Diagnosis of patients was based on clinical features, serology and blood culture. The susceptibility testing of the isolates to ampicillin, chloramphenicol, trimethoprim–sulfamethoxazole, ceftriaxone, ciprofloxacin and nalidixic acid was performed by the disc diffusion method, and MICs of ceftriaxone and ciprofloxacin were determined by Etest. Of 135 typhoid fever patients, 108 (88 %) were treated with ceftriaxone and 27 (20 %) were treated with ciprofloxacin. The mean time for fever defervescence with ciprofloxacin therapy was 8 days and 6.3 days for those treated with ceftriaxone. Of the 135 Salmonella enterica serotypes Typhi and Paratyphi A isolated from patients, 50 (37 %) were multidrug resistant (MDR) and 94 (69.6 %) isolates of both serotypes were nalidixic acid resistant (NAR). Between 90 and 100 % of MDR and NAR strains had decreased susceptibility to ciprofloxacin (0.125–1 μg ml−1). Low-level resistance to ciprofloxacin (MIC 0.125−1 μg ml−1) was also detected in 13.8 and 33.3 % of nalidixic acid-susceptible isolates of S. Typhi and S. Paratyphi A, respectively. All isolates were susceptible to ceftriaxone. Two relapses occurred in the ciprofloxacin-treated group. MDR strains and strains resistant to ciprofloxacin and ceftriaxone are a major threat in the developing world. A situation is fast approaching where the emergence of highly resistant Salmonella isolates is quite likely. Proper steps must be taken to avoid a pandemic spread of MDR S. Typhi strains.
Molecular identification of Exiguobacterium acetylicum as the aetiological agent of bacteraemia
Authors: Keynan Yoav , Weber Gabriel , Sprecher Hannah
Published: March 2007

A case of catheter-related bacteraemia caused by Exiguobacterium acetylicum is reported in an elderly patient. The availability of sequence-based methods facilitated rapid identification and expanded the spectrum of diseases attributed to coryneform bacteria and specifically to the genus Exiguobacterium.
A Helicobacter hepaticus catalase mutant is hypersensitive to oxidative stress and suffers increased DNA damage
Authors: Hong Yang , Wang Ge , Maier Robert J.
Published: March 2007

Catalase (KatA) is known to play an important role in oxidative stress resistance in many bacterial species and a homologue exists in Helicobacter hepaticus, a member of the enterohepatic Helicobacter species. Here, a katA mutant was constructed by insertional mutagenesis and its oxidative stress phenotype was investigated. Catalase activity was readily detected [196 units (mg protein crude cell extract)−1] in the wild-type, whereas the mutant strain was deficient in, but not devoid of, activity. In contrast, Helicobacter pylori katA strains lack detectable catalase activity and wild-type H. pylori generally contains higher specific activity than H. hepaticus. Wild-type H. hepaticus cells tolerated 6 % O2 for growth, whilst the katA mutant could not survive at this oxygen level. Even at the optimal O2 level, the growth of the H. hepaticus katA strain was severely inhibited, which is also in contrast to H. pylori katA strains. Wild-type H. hepaticus cells withstood exposure to 100 mM H2O2 but the katA mutant cells were killed by the same treatment. Wild-type cells suffered no significant DNA damage by H2O2 treatment (100 mM for 6 min), whilst the same treatment resulted in severe DNA fragmentation in the katA mutant. Thus H. hepaticus KatA plays an important role as an antioxidant protein.
Vaccine efficacy of an attenuated but persistent Mycobacterium tuberculosis cysH mutant
Authors: Senaratne Ryan H. , Mougous Joseph D. , Reader J. Rachel , Williams Spencer J. , Zhang Tianjiao , Bertozzi Carolyn R. , Riley Lee W.
Published: March 2007

The emergence of drug-resistant Mycobacterium tuberculosis strains and the widespread occurrence of AIDS demand newer and more efficient control of tuberculosis. The protective efficacy of the current Mycobacterium bovis bacille Calmette–Guérin (BCG) vaccine is highly variable. Therefore, development of an effective new vaccine has gained momentum in recent years. Recently, several M. tuberculosis mutants were tested as potential vaccine candidates in the mouse model of tuberculosis. However, only some of these mutants were able to generate protection equivalent to that of BCG in mice. This study reports the vaccine potential of an attenuated 5′-adenosine phosphosulfate reductase mutant (ΔcysH) of M. tuberculosis. Immunization of mice with either BCG or ΔcysH followed by infection with the virulent M. tuberculosis Erdman strain demonstrated that ΔcysH can generate protection equivalent to that of the BCG vaccine.
Toll-like receptor 2-mediated dendritic cell activation by a Porphyromonas gingivalis synthetic lipopeptide
Authors: Asai Yasuyuki , Makimura Yutaka , Ogawa Tomohiko
Published: March 2007

A PG1828 gene-encoded triacylated lipoprotein was previously isolated from aPorphyromonas gingivalislipopolysaccharide preparation as a Toll-like receptor (TLR) 2 agonist and its lipopeptide derivatives were synthesized based on the chemical structure. In the present study, granulocyte–macrophage colony stimulating factor-differentiated bone marrow-derived dendritic cells (BMDDCs) were stimulated separately with theP. gingivalissynthetic lipopeptideN-palmitoyl-S-[2-pentadecanoyloxy, 3-palmitoyloxy-(2R)-propyl]-l-Cys-Asn-Ser-Gln-Ala-Lys (PGTP2-RL) and its glyceryl stereoisomer (PGTP2-SL). Only PGTP2-RL activated BMDDCs from wild-type mice to secrete tumour necrosis factor-α, interleukin (IL)-6, IL-10 and IL-12p40, whilst PGTP2-RL-induced cytokine production was eliminated in TLR2 knockout (−/−) BMDDCs. BMDDCs from wild-type mice but not TLR2−/−mice responded to PGTP2-RL as well as Pam3CSK4by increasing the expression of maturation markers, including CD80 (B7-1), CD86 (B7-2), CD40, CD275 (B7RP-1/inducible T-cell co-stimulatory ligand) and major histocompatibility complex class II. Taken together, these results indicate that the fatty acid residue at the glycerol position in theP. gingivalislipopeptide plays a pivotal role in TLR2-mediated dendritic cell activation.
Multiplex PCR assay for identification of Corynebacterium pseudotuberculosis from pure cultures and for rapid detection of this pathogen in clinical samples
Authors: Pacheco Luis G. C. , Pena Roberta R. , Castro Thiago L. P. , Dorella Fernanda A. , Bahia Robson C. , Carminati Renato , Frota Marcílio N. L. , Oliveira Sérgio C. , Meyer Roberto , Alves Francisco S. F. , Miyoshi Anderson , Azevedo Vasco
Published: March 2007

Corynebacterium pseudotuberculosisis the aetiological agent of caseous lymphadenitis (CLA), a debilitating disease of sheep and goats. Accurate diagnosis of CLA primarily relies on microbiological examination, followed by biochemical identification of isolates. In an effort to facilitateC. pseudotuberculosisdetection, a multiplex PCR (mPCR) assay was developed targeting three genes of this bacterium: the 16S rRNA gene,rpoBandpld. This method allowed efficient identification of 40 isolates of this bacterium that had been identified previously by biochemical testing. Analysis of taxonomically related species did not generate theC. pseudotuberculosismPCR amplification profile, thereby demonstrating the assay's specificity. As little as 1 pg ofC. pseudotuberculosisgenomic DNA was detected by this mPCR assay, demonstrating the sensitivity of the method. The detection limit in clinical samples was estimated to be 103 c.f.u.C. pseudotuberculosiscould be detected directly in pus samples from infected sheep and goats (n=56) with a high diagnostic sensitivity (94.6 %). The developed assay significantly improves rapidC. pseudotuberculosisdetection and could supersede bacteriological culture for microbiological and epidemiological diagnosis of CLA.
Identification of species of Abiotrophia, Enterococcus, Granulicatella and Streptococcus by sequence analysis of the ribosomal 16S–23S intergenic spacer region
Authors: Tung Sheng Kai , Teng Lee Jene , Vaneechoutte Mario , Chen Hung Mo , Chang Tsung Chain
Published: March 2007

The feasibility of sequence analysis of the ribosomal 16S–23S intergenic spacer region (ITS) was evaluated for identification of 24 species ofStreptococcus, one species ofAbiotrophia, 18 species ofEnterococcusand three species ofGranulicatella. As GenBank currently lacks ITS sequence entries for many species of these four genera, the ITS sequences of 38 type strains were first sequenced and submitted to GenBank to facilitate species identification of these genera. Subsequently, the ITS sequences of 217 strains (84 reference strains and 133 clinical isolates) were determined and species identification was made byblastsearch for homologous sequences in public databases. Species other thanStreptococcuscontained multiple ITS fragments and only the shortest fragment was analysed. A total of 25 isolates (11.5 %) produced discrepant identification by ITS sequencing. The 25 discordant strains were analysed further by sequencing of the 16S rRNA gene for species clarification, and 21 were found to be identified correctly by ITS sequence analysis. The correct identification rate by ITS sequencing was 98.2 % (213/217). Several closely related enterococcal and streptococcal species/subspecies contained specific ITS signature sequences that were useful for differentiating these bacteria. In conclusion, ITS sequencing provides a useful approach towards identifying this group of pathogens on a molecular platform alongside 16S rRNA gene sequencing.
Phylogeny of Macroptilium (Leguminosae): morphological, biochemical and molecular evidence
Authors: Espert Shirley M. , Drewes Susana I. , Burghardt Alicia D.
Published: March 2007

Macroptilium (Benth.) Urban (Phaseoleae, Papilionoideae, Leguminosae) is an American genus of legumes, belonging to subtribe Phaseolinae along with other economically important genera, such as Vigna Savi and Phaseolus L. (the common bean genus). Cladistic analyses based on morphological, biochemical (storage seed proteins) and molecular (nuclear and plastid DNA sequences) data were performed on the 18 species currently ascribed to the genus, exploring several character weighting strategies. Equal weights, implied weighting and different transversion/transition costs were applied. The three data sets were first analyzed with separate partitions, and then combined into a single matrix. This study is the first one to analyze all the species of the genus from a cladistic point of view. In all the most parsimonious trees obtained, Macroptilium is monophyletic with excellent support values. Two monophyletic clades are recovered in almost all the analyses. Both are compound by nine species, and they constitute two sections of Macroptilium. Several interspecific relationships inside the genus are discussed.

© The Willi Hennig Society 2007.
Temporary epicardial pacing after cardiac surgery: a practical review
Authors: Reade M. C.
Published: March 2007

The first part of this two‐part review discussed the indications for various types of epicardial pacing systems and an overview of the routine care of a pacemaker‐dependent patient. Dual chamber temporary pulse generators now feature many of the refinements developed initially for use in permanent pacemakers. Few of these are utilised in the immediate postoperative period, often solely due to lack of familiarity with all but basic functions. The second part of the review deals with the selection of pacing modes. Troubleshooting real and apparent pacemaker malfunctions, including manual adjustment of parameters such as the AV interval, post atrial refractory period and upper rate limit, to avoid over‐ and undersensing, cross‐talk and pacemaker‐mediated tachycardia will also be addressed.
Risk factors associated with bleeding during and after percutaneous dilational tracheostomy*
Authors: Beiderlinden M. , Eikermann M. , Lehmann N. , Adamzik M. , Peters J.
Published: March 2007

We evaluated the effect of pre‐operative coagulation status on the incidence of acute and chronic bleeding in 415 consecutive patients undergoing percutaneous dilational tracheostomy. The incidence of acute bleeding was independent of the coagulation variables tested. The risk of chronic bleeding was higher with an activated partial thromboplastin time above 50 s (OR 3.7 (95% CI 1.1–12.7); NNT 18.4 (95% CI 9.0–∞); p = 0.04), a platelet count below 50 × 109 l−1(OR 5.0 (95% CI 1.4–17.2); NNT 12.3 (95% CI 6.2–833.3); p = 0.01) and in the presence of two or more abnormal coagulation variables (OR 9.5 (95% CI 2.3–34.7); NNT 6.2 (95% CI 3.2–68); p = 0.002). Low‐dose heparin treatment did not significantly increase the risk of chronic bleeding.
Internal jugular vein compression to assess the correct placement of an epidural catheter in postpartum women*
Authors: Chilvers J. , Geoghegan J. , Moore P. , Shah J.
Published: March 2007

We investigated whether the increase in epidural pressure produced by jugular compression could be used as a test for correct placement of epidural catheters in 20 postpartum women who had good epidural analgesia during labour. We measured the epidural pressure by using the epidural catheter as a manometer, and measured the rise in the meniscus in response to jugular vein compression whilst the epidural catheter was still in the epidural space. The catheter was then withdrawn until the tip lay just outside the epidural space and the response to jugular vein compression reassessed. In all subjects, jugular vein compression produced a rise in the meniscus only whilst the catheter tip lay in the epidural space. Jugular compression is a useful test for confirming the correct placement of the epidural catheter.
Avoidance of phrenic nerve paresis during continuous supraclavicular regional anaesthesia*
Authors: Cornish P. B. , Leaper C. J. , Nelson G. , Anstis F. , McQuillan C. , Stienstra R.
Published: March 2007

This study sought to determine whether it is possible reliably to avoid phrenic nerve block using the bent needle technique for continuous supraclavicular brachial plexus anaesthesia. In a prospective study, 100 patients undergoing a variety of upper extremity surgical procedures were studied. Ultrasound examinations of the patients' diaphragms were performed after insertion of an anaesthetic block, and were repeated a day later with the analgesic block working. Three phrenic nerve blocks were detected in different patients. Factors were identified in all three cases that we think contributed to the phrenic nerve blocks. We think it is possible to provide continuous supraclavicular regional anaesthesia and analgesia for a wide range of upper extremity operations without phrenic nerve blockade.
Postoperative analgesia requirements at home after inguinal hernia repair: effects of wound infiltration on postoperative pain*
Authors: Ausems M. E. , Hulsewé K. W. , Hooymans P. M. , Hoofwijk A. G.
Published: March 2007

The aim of this study was to evaluate our postoperative pain protocol after ambulatory herniorrhaphy and to determine how infiltration with local anaesthetics would add to our management of postoperative pain. Two groups of 60 patients, scheduled for herniorrhaphy, received wound infiltration with 20 ml levobupivacaine 0.5% or saline 0.9%. Postoperatively, the patients regulated their own analgesic consumption and registered VAS scores, use of analgesics and side‐effects in a diary for 5 days. The median time to first analgesic, the pain visual analogue scale scores, number of patients using no analgesic and the use of analgesic medication were significantly lower in the levobupivacaine group in the first 24 h, but not thereafter. Most patients used acetaminophen in the first 5 days after surgery and occasionally diclofenac. Only a minority used tramadol. Our multimodal pain protocol achieved reasonable results at rest, but a considerable number of patients experienced moderate to severe pain with movement.
Major complications of epidural analgesia after surgery: results of a six‐year survey
Authors: Christie I. W , McCabe S.
Published: March 2007

We performed a retrospective case note review to identify the major complications of epidural analgesia occurring after surgery at our hospital. By cross‐referencing the radiology, microbiology and patient information management system databases, we identified patients who had undergone either spinal magnetic resonance imaging or a lumbar puncture within 60 days of surgery in the period from January 2000 to December 2005. Review of these case notes identified six cases of epidural abscess, three of meningitis and three of epidural haematoma. Symptoms of epidural abscess or meningitis developed a median of 5 days after epidural catheter removal. Methicillin‐resistant Staphylococcus aureus was the predominant pathogen. Epidural haematoma symptoms developed while the epidural catheter was in place. These symptoms were initially attributed to the epidural infusion. Diagnostic delays contributed to adverse neurological outcome in three patients. This study suggests that leg weakness is a critical monitor of spinal cord health. A national database is needed to establish a more accurate estimate of the incidence of major complications and to identify relevant risk factors.
Tracheal intubation via the Classic™ and Proseal™ laryngeal mask airways: a manikin study using the Aintree Intubating Catheter
Authors: Blair E. J. , Mihai R. , Cook T. M.
Published: March 2007

Fibreoptic‐assisted tracheal intubation with an Aintree Intubating Catheter via a dedicated airway is sometimes recommended when conventional tracheal intubation fails. This study compares the use of the Classic™ and Proseal™ laryngeal mask airways (LMA) for this purpose in a manikin. Twenty‐five anaesthetists of all grades performed two intubations with each device. The overall success rate was 95%. The procedure took < 90 s in all cases and < 60 s in 88% of patients. The speed of intubation increased from the first to fourth attempt and between the first and second attempt with each device (p < 0.001). Allowing for the learning effects observed with each device, there was no statistically significant difference found when comparing speed of intubation with the two devices (p > 0.05). There was no significant difference between the devices with regard to ease of advancement of the fibrescope or the view of the vocal cords with the Aintree Intubating Catheter. Four failures occurred with the LMA Classic and one with the LMA Proseal. Subjective comments favoured the LMA Proseal (p < 0.05), although the clinical importance of these comments is difficult to determine. This study has shown that, in a manikin, fibreoptic guided intubation via an LMA Proseal is at least as easy and reliable as through an LMA Classic. In view of the potential advantages of the LMA Proseal for airway rescue and management of the difficult airway, this study suggests a clinical evaluation of the use of the combination of an LMA Proseal and an Aintree Intubating Catheter in patients is justified.
Peri‐operative management of an adult patient with type 2N von Willebrand's disease scheduled for coronary artery bypass graft
Authors: Gerling V. , Lahpor J. R. , Buhre W.
Published: March 2007

We describe a patient with type 2N von Willebrand's disease scheduled for elective coronary artery bypass graft for severe three‐vessel coronary artery disease with involvement of the left main stem. He was given a pre‐operative bolus of 3000 IU factor VIII/Willebrand factor concentrate (∼ 40 IU.kg−1), followed by a continuous infusion of 3 IU.h−1 (228 IU.h−1) before undergoing coronary surgery with full heparinisation and cardiopulmonary bypass. There were no intra‐operative bleeding complications and only one unit of packed red blood cells was required postoperatively. Thromboprophylaxis with low‐molecular weight heparin and aspirin was given and the infusion of factor VIII/von Willebrand factor concentrate continued for 2 days. As a result of haematological monitoring, heparin therapy was changed from prophylactic to therapeutic on day 5–6 and stopped on day 7.
Portal venous gas – case report and review of the literature
Authors: Mohammed A. H. , Mohammed A. H. , Khot U. P. , Thomas D.
Published: March 2007

A 74‐year‐old man with chronic renal failure was admitted to the renal unit with non‐specific symptoms and positive blood cultures. He later deteriorated and was admitted to the Intensive Care Unit with septic shock, respiratory failure and deranged liver function. Initial improvement was followed by abdominal distension and discomfort. Portal venous gas (PVG) and thrombosis were diagnosed on computed tomography. A conservative line of management was adopted. Improvement was soon followed by deterioration with septic shock. Extensive portal venous gas and free intra‐abdominal gas were now evident on repeat computed tomography. The patient was too unwell to withstand surgery and a decision was made not to escalate therapy. He died on day 16. Portal venous gas is not a disease; it is a diagnostic clue in patients who may be harbouring an intra‐abdominal catastrophe. Successful management of these cases requires early identification of the underlying pathology and can range from simple observation to extensive surgical intervention.
Plasticity of predation behaviour as a putative driving force for parasite life‐cycle dynamics: the case of urban foxes andEchinococcus multilocularistapeworm
Authors: HEGGLIN D. , BONTADINA F. , CONTESSE P. , GLOOR S. , DEPLAZES P.
Published: March 2007

Parasite transmission frequently depends on an intermediate host species being subject to predation by a definitive host. We hypothesized that the population dynamics of this type of parasite would be affected by plasticity of the predation behaviour of the final host.

The zoonotic tapewormEchinococcus multilocularisLeuckart is transmitted to foxes (Vulpes vulpesL.) by predation on infected rodents. One possible mechanism underlying the significant decrease in the prevalence ofE. multilocularisin red foxes observed towards the centre of Zurich (Switzerland) is that the relative abundance of intermediate hosts varies between different urbanized habitats.

The water vole,Arvicola terrestris schermanL., which is the major intermediate host, was less abundant in urban compared with peri‐urban areas, due to both a reduced availability of suitable habitats and lower numbers within those habitats. Stomach content analyses indicated that foxes in urban areas consumed more anthropogenic food but preyed less frequently on rodents – and those rodents taken belonged to species less susceptible toE. multilocularisinfection.

We conclude that the functional response of final hosts to changes in supply of intermediate hosts and alternative food sources can significantly affect the transmission dynamic of dixenous parasites, such as this zoonotic tapeworm.
The effect of the renewal of calcium hydroxide paste on the apexification and periapical healing of teeth with incomplete root formation
Authors: Felippe M. C. S. , Felippe W. T. , Marques M. M. , Antoniazzi J. H.
Published: March 2007

Aim  To evaluate the influence of renewing calcium hydroxide paste on apexification and periapical healing of teeth in dogs with incomplete root formation and previously contaminated canals.

Methodology  Forty premolars from four 6‐month‐old dogs were used. After access to the root canals and complete removal of the pulp, the canal systems remained exposed to the oral environment for 2 weeks. Canal preparation was then carried out using Hedströem files, under irrigation with 1% sodium hypochlorite, 1 mm short of the radiographic apex. After drying, the canals of one premolar in each dog were left empty (group 4‐control), and those of the other nine teeth in each animal were filled with a calcium hydroxide‐propylene glycol paste. All teeth were restored with reinforced zinc oxide cement (IRM) or IRM and amalgam (group 4). The paste was renewed and the teeth restored again 1 week later. Then, the nine teeth in each animal were divided into three experimental groups: group 1 – paste not changed; group 2 – paste renewed every 4 weeks for 5 months; and group 3 – paste renewed after 3 months had elapsed. The teeth were restored with IRM and amalgam (groups 1 and 3) or IRM (group 2). The animals were killed 5 months later, and blocks of the teeth and surrounding tissues were submitted to histological processing. The sections were studied to evaluate six parameters: apical calcified tissue barrier, inflammatory reaction, bone and root resorption, paste extrusion and microorganisms. Results of experimental groups were analysed by Kruskal–Wallis nonparametric tests and by the test of proportions. The critical value of statistical significance was 5%.

Results  Significant differences (P < 0.05) were found in relation to the presence of bone resorption and paste in the periradicular area, the formation of a calcified tissue barrier at the apex, and the intensity of the apical inflammatory reaction. Bone resorption was more evident in group 1 (medicament not changed), and the presence of paste in the periodontal tissues was more common in groups 2 and 3. Renewal of the paste reduced the intensity of the inflammatory reaction (groups 2 and 3), but the formation of apical calcified tissue was more noticeable in the teeth where the paste had not been renewed.

Conclusions  Replacement of calcium hydroxide paste was not necessary for apexification to occur, however, it did reduce significantly the intensity of the inflammatory process. Monthly renewal of calcium hydroxide paste reduced significantly the occurrence of apexification.
Continued root formation of a pulpless permanent incisor following root canal treatment: a case report
Authors: Safi L. , Ravanshad S.
Published: March 2007

Aim  To present a case of a pulpless permanent incisor that continued root formation following root canal treatment.

Summary  A healthy 8‐year‐old girl with a history of dental trauma resulting in a coronal fracture involving enamel, dentine and pulp was referred by her general dental practitioner for treatment and evaluation of tooth 21. The tooth had a necrotic pulp and periapical rarefaction was evident radiographically. The canal was prepared, dressed with Ca(OH)2 and then filled with a rolled gutta percha cone and Roth's root canal sealer.

A radiograph exposed eight years post‐treatment, showed evidence of continued apical formation.

Key learning points

Teeth with necrotic pulps and periapical rarefaction may show evidence of continued apical formation after root canal treatment.

Hertwig's epithelial root sheath may be more resistant than expected to trauma and infection.
Methods of experimental induction of periapical inflammation. Microbiological and radiographic evaluation
Authors: Tanomaru‐Filho M. , Poliseli‐Neto A. , Leonardo M. R. , Silva L. A. B. , Tanomaru J. M. G. , Ito I. Y.
Published: March 2007

Aim  To evaluate the influence of coronal filling and apical perforation on the induction of periapical inflammation.

Methodology  Fifty‐eight root canals in the teeth of dogs were divided into four groups. Groups I and II: root canals were exposed for 180 days; groups III and IV: root canals were exposed for 7 days and then the access cavity filled for 53 days. The root apices of groups I and III were perforated after the coronal opening, whilst those of groups II and IV remained intact. Standard radiographs were taken before and after the experimental periods. Digital images of the radiographs were created and then analysed by three examiners. After induction of periapical inflammation, the root canal contents were collected using paper points. Microbiologic evaluation of the type of microorganism was carried out by culture in different growth media. The radiographic and microbiologic data were statistically analysed using anova at a 5% significance level.

Results  There were a greater total number of microorganisms in groups I and II (P < 0.05). The number of anaerobes was greater than the number of aerobes (P < 0.05). The size of the periapical radiolucencies were not significantly different between the experimental groups.

Conclusions  The different methods analysed induced similar areas of periapical radiolucency in dogs with predominantly anaerobic bacteria. However, the time required for induction was less when the method with coronal filling was used.
Short‐term antibacterial activity of root canal sealers towards Enterococcus faecalis
Authors: Kayaoglu G. , Erten H. , Alaçam T. , Ørstavik D.
Published: March 2007

Aim  To investigate the antimicrobial activity of root canal sealers on Enterococcus faecalis, either allowing or avoiding direct contact between sealers and bacteria.

Methodology  Filter paper discs were immersed in standardized E. faecalis suspensions and exposed to freshly mixed sealers (MCS, AH Plus, Grossman's sealer, Sealapex, Apexit) in teflon wells for 30 min, with or without a filter membrane placed between filter paper discs and sealers (membrane‐restricted contact test and direct contact test, respectively). After exposure, the filter paper discs were transferred to vials containing phosphate‐buffered saline (PBS) and glass beads, and vigorously vortexed. PBS with resuspended bacterial cells was serially diluted and 25 μL droplets were seeded on TSA plates. The plates were incubated in air at 37 °C for 24 h and colony‐forming units were counted. Using α = 0.05 as level for statistical significance, the data obtained were analysed using Student's t‐test.

Results  In the direct contact test, MCS and AH Plus killed the bacteria to a level below the detection limit. They were followed in decreasing order of efficacy by Grossman's sealer, Sealapex and Apexit. In the membrane‐restricted contact test, the sealers ranked: MCS, AH Plus, Grossman's sealer, Apexit and Sealapex, in descending order of antibacterial potency. MCS, AH Plus and Grossman's sealer significantly reduced the number of viable bacteria in both tests. Sealapex and Apexit were not statistically different from control.

Conclusions  MCS, AH Plus and Grossman's sealer were effective in reducing the number of cultivable cells of E. faecalis. Calcium hydroxide‐based sealers, Sealapex and Apexit were ineffective in this short‐term experiment.
Mental health triage in the ER: a qualitative study
Authors: Coristine Ron W. , Hartford Kathleen , Vingilis Evelyn , White Dawn
Published: March 2007

Rationale, aims and objectives  The London Health Sciences Centre found that its emergency room (ER) mental health services were affected by people presenting with problems that did not require psychiatric intervention. Consequently, a second triage using a crisis worker (CW) was introduced in the ER to identify those persons with mental illness (PMI) who presented for social stressors related to housing, finances and legal issues. A qualitative, process evaluation study was conducted to capture experiences and perceptions of the new triage and CW.

Method  Qualitative input was obtained from a broad range of stakeholders in three waves of data‐gathering over a 25‐month period. This method allowed corroboration of findings from informants with varying interests and backgrounds. The data were collected through interviews, focus groups and surveys. The NUD‐ist Qualitative Data Analysis Software Program was used to conduct content analyses.

Results  Many PMI seeking ER mental health services are presenting with problems related to social stressors and being referred by the second triage to the CW. The introduction of the second triage CW has had a positive effect on ER functioning, the workload of ER staff and the experience of persons presenting at ER.

Conclusions  A defined triage process coupled with the use of psychiatric nursing staff may be applicable to ERs within general hospital settings to improve ER functioning, focus support for PMI and further integrate ERs within the community mental health model.