Infections in neurosurgical patients admitted to the intensive care unit at the University Hospital of the West Indies

Patients admitted to the Intensive Care Unit (ICU) are at risk of developing life-threatening nosocomial infections, especially with organisms resistant to commonly used antibiotics. Neurosurgical patients are particularly vulnerable because of the serious nature of their illness, the frequency of associated trauma and the presence of invasive devices. Of 120 neurosurgical patients admitted to the ICU of the University Hospital of the West Indies (UHWI) between September 1995 and December 1999, the records of 73 patients were available for analysis. All had prophylactic antibiotics. Twenty-one of these 73 patients (28.8) developed 22 infections after a mean of five days in the ICU: nine with chest infection, seven with urinary tract infection, four with central nervous system (CNS) infection and one each with wound and skin infection. This is an incidence of 11.6/1000 patient-days. The responsible organisms included Pseudomonas (7/21), Acinetobacter (3/21), E. coli 2/21, Enterobacter (2/21), and Klebsiella (2/21), and one each with Staphylococcus aureus, methicillin resistant Staphylococcus aureus, coagulase negative Staphylococcus, group D Streptococcus and bacteroides (1/21). Infection was significantly related to length of hospital stay, length of ICU stay, duration of intubation, duration of ventilation and the presence of diabetes mellitus. All patients who had surgery after ICU admission developed infection, seven with chest infection, two with urinary tract infection, two with CNS and one with skin infection. The three patients who were admitted with intracranial infections all developed other infections. Infected patients had a significantly longer hospital stay. Five patients died, none directly attributable to infection, while 55 (75.5) made a good recovery. The problem of ICU infection may be expected to escalate with the increased use of intensive care, increasingly more complex surgical procedures and the growing problem of antibiotic resistance. Since infection is related to the length of ICU stay, earlier discharge of neurosurgical patients to an appropriately staffed high dependency unit is likely to result in reduction of the infection rate. Reinforcement of infection control strategies within the ICU may be expected to further minimize the infection rate

Did exclusive breast-feeding and early discharge lead to excessive bilirubin levels in newborns in Antigua and Barbuda?

Hyperbilirubinaemia is a common neonatal problem worldwide and is the leading cause of admission to the Special Care Nursery in Antigua and Barbuda. In 1990, the Innocenti Declaration in support of breast-feeding led to the adoption of the Baby-Friendly Hospital Initiative in many countries of the Caribbean, including Antigua and Barbuda. Comparing 1989 to the years 1992 to 1994, the Special Care Nursery at Holberton Hospital experienced a 40 increase in newborns admitted with hyperbilirubinaemia (peak total bilirubin > 12 mg/dl or 205 mumol/l). A retrospective review of Special Care Nursery and Maternity Ward records was undertaken to determine the incidence and aetiology of hyperbilirubinaemia from 1992 to 1994. There were 3721 infants born in Antigua and Barbuda in those years, 98 of Afro-Caribbean or mixed ancestry. The overall incidence of peak total bilirubin over 12 mg/dl (205 mumol/l) was 12.5 (466/3721), not inconsistent with the reported incidence of 8 to 20 in other countries. However, the incidence of higher levels of hyperbilirubinaemia in Antigua and Barbuda exceeded those reported for other countries. In Antigua and Barbuda, total bilirubin of 15 mg/dl (255 mumol/l) or higher was found in 263 of 3721 infants (7.1) compared to 5.9 in India and 2 of breast-fed infants in the United States of America (USA). Total bilirubin of 20 mg/dl (340 mumol/l) or higher was seen in 91 of 3721 infants (2.5) exceeding reported prevalence in the USA for both African-American and Caucasian infants (1) and equal to the reported prevalence in Asian infants (2). The possible aetiologies of hyperbilirubinaemia in neonates with total bilirubin 18 mg/dl (306 mumol/l) or higher in our patients were investigated. Medical records of 134 of 156 (86) infants having this level of hyperbilirubinaemia were available for review. The possible reason for hyperbilirubinaemia was ABO incompatibility in 4/134 (3), Rh incompatibility in 1/134 (1), prematurity in 12/134 (9) and sepsis neonatorum in 21/134 (16). The hyperbilirubinaemia was idiopathic in 96/134 (71) infants. Newborns in Antigua and Barbuda were discharged 3.7 days after their mothers' admission, with 50 discharged prior to 48 hours of age. Early discharge in developed countries has led to increased readmissions for hyperbilirubinaemia. Following the appointment of a dietitian to supervise breast-feeding, admissions for hyperbilirubinaemia fell by 50 by 1998. These data suggest that exclusive br

Terapia con alendronato como prevencion de la perdida de resistencia osea por defectos metastasicos en un modelo animal / Therapy with alendronate as prevention of the loss bony resistance by metastasic defects in an animal model

Las metastasis son los tumores óseos malignos más frecuentes. La incidencia de metastasis varía dependiendo del tipo de tumor primario y puede llegar a ser mayor de 85 en cáncer de seno o 64 en carcinoma bronquial. Los cuerpos vertebrales y la metafisis de los huesos largos son las localizaciones anatómicas más frecuentes. Las células tumorales hacen su siembra en la médula ósea de éstos a través del torrente sanguineo y crecen dentro de la cavidad medular extendiendose posteriormente hacia canales de havers y volkman.