Onset of tuberculosis disease: new converters in long-term care settings.

Elders living in communal settings, such as nursing homes or other types of long-term care facilities have a tuberculosis (TB) incidence rate of 39.2 per 1,000, nearly four times the rate of TB in the general population. This fact mandates routine screening, reporting, and strict follow-up of TB in long-term care facilities as well as recognizing and addressing barriers to worker and resident protection. As healthcare in this country evolves from acute care facilities to alternative ambulatory care settings, the focus for infection control personnel is to develop effective TB control plans appropriate to the care setting using current clinical guidelines set forth by the Centers for Disease Control and Prevention (CDC) or other agencies, the main goal of which is to reduce the number of infections and exposures to this disease. As the incidence of TB continues in long-term care settings, away from acute care facilities, public health officials, administrators, and infection control personnel need to develop TB control plans, risk assessment procedures, and appropriate follow-up on positive converters among the workers and the residents. The case study presented herein is a good example of an individual being offered a screening test for an infectious airborne disease and positive test results being disregarded.

Prevalence of abnormal adrenocortical function in human immunodeficiency virus infection by low-dose cosyntropin test.

Recent evidence suggests that 10 microg cosyntropin test has higher sensitivity for detecting hypothalamus-hypophysis-adrenal axis (HHA-A) dysfunction. Our objective was to determine prevalence of glucocorticoid insufficiency with the 10 microg cosyntropin test and the level of the HHA-A defect. One hundred and four HIV-infected patients underwent the 10 microg cosyntropin test. In abnormal and borderline respondents, insulin-induced hypoglycaemia test and human corticotropin releasing hormone test were used to confirm and localize the level of the HHA-A defect. Thirty-two patients with HIV infection and 72 with AIDS were identified. Prevalence of glucocorticoid insufficiency by the 10 microg cosyntropin test was 21.2%. By clinical categories, the frequency in AIDS and HIV infection patients was 26.4% and 9.4%, respectively. Confirmed glucocorticoid insufficiency by insulin-induced hypoglycaemia test was found in 16 out of 19 cases. Twelve cases had primary glucocorticoid insufficiency, 7 had secondary glucocorticoid insufficiency and 3 were false positive. In conclusion, adrenocortical dysfunction occurs in approximately 20% of the cases with HIV disease. Clinical findings commonly occurring in HIV disease as well as adrenocortical insufficiency are not reliable indicators for performing adrenocortical laboratory assessment. Our results suggest screening all AIDS patients with the 10 microg cosyntropin test.

Nosocomial infection among immunosuppressed patients in the intensive care unit.

Advances in technology and development of multidrug-resistant antibiotics have increased the number of immunosuppressed patients in need of crisis care and the incidence of nosocomial infection in the nation's hospitals. Nosocomial infections are proving particularly difficult to prevent in intensive care units (ICUs), where special care must be taken to avoid transmission of any infection. The authors present an overview of this problem in the ICU, outlining basic measures to be taken in preventing nosocomial infections and ensuring the safety of the patients.

Antimicrobial activity of flavonoids in medicinal plants from Tafí del Valle (Tucumán, Argentina).

Preliminary studies of flavonoids have been realised in five native species from Tafí del Valle (Tucumán, Argentina) used in popular medicine. Most of compounds detected were flavonoids mono and dihydroxylated in B ring. Screening for antimicrobial activity against Gram positive and Gram negative microorganisms has been realised with Lippia turbinata, Satureja parvifolia, Sambucus peruviana, Verbena officinalis and Chenopodium graveolens. The total extracts of flavonoids of each plant were tested and four species studied showed antimicrobial activity.

Hematopoietic stem cell allografts using a non-myeloablative conditioning regimen can be safely performed on an outpatient basis: report of four cases.

Using a non-myeloablative, immunosuppressive, fludarabine-based conditioning regimen, we performed allogeneic peripheral blood stem cell transplants totally on an outpatient basis in four patients (two with chronic myelogenous leukemia, one with acute myelogenous leukemia and one with thalassemia major). The median granulocyte recovery time to 0.5 x 109/l was 10 days and the lowest absolute neutrophil count was 0.064 x 109/l; only one patient developed thrombocytopenia below 20 x 109/l. No patient required red blood cell transfusions and one was given a single prophylactic platelet transfusion. All patients are alive at 210-390 (median 285) days and have definite evidence of chimerism; one developed biopsy-proven GVHD on day 50, with a limited cutaneous rash. The procedure is less costly than its counterpart using myeloablative conditioning regimens and may represent another approach in the management of patients requiring an allogeneic stem cell transplant. Bone Marrow Transplantation (2000) 25, 131-133.

A high-sensitivity test in the assessment of adrenocortical insufficiency: 10 microg vs 250 microg cosyntropin dose assessment of adrenocortical insufficiency.

The short cosyntropin (synthetic ACTH) test is recognized as the best screening manoeuvre in the assessment of adrenocortical insufficiency. Recent data, however, suggest that i.v. administration of 250 microg cosyntropin could be a pharmacological rather than a physiological stimulus, losing sensitivity for detecting adrenocortical failure. Our objective was to compare 10 vs 250 microg cosyntropin in order to find differences in serum cortisol peaks in healthy individuals, the adrenocortical response in a variety of hypothalamic-pituitary-adrenal axis disorders and the highest sensitivity and specificity serum cortisol cut-off point values. The subjects were 83 healthy people and 37 patients, the latter having Addison's disease (11), pituitary adenomas (7), Sheehan's syndrome (9) and recent use of glucocorticoid therapy (10). Forty-six healthy subjects and all patients underwent low- and standard-dose cosyntropin testing. In addition, 37 controls underwent the low-dose test. On comparing low- and standard-dose cosyntropin testing in healthy subjects there were no statistical differences in baseline and peaks of serum cortisol. In the group of patients, 2 out of 11 cases of Addison's disease showed normal cortisol criterion values during the standard test but abnormal during the low-dose test. In our group of patients and controls, the statistical analysis displayed a better sensitivity of the low-dose vs standard-dose ACTH test at 30 and 60 min. In conclusion, these results suggest that the use of 10 microg rather than 250 microg cosyntropin i.v. in the assessment of suspicious adrenocortical dysfunction gives better results.

Effects of relaxation on anxiety in primary caregivers of chronically ill children.

PURPOSE: To evaluate the effects of self-applied breathing and guided imagery relaxation techniques, separately and in combination, and a reinforcement tool on primary caregivers (PCGs) coping with anxiety when caring for a chronically ill child. METHOD: Twenty PCGs, aged 25-57, of chronically ill children were randomly assigned to an experimental or control group. The State Anxiety Scale of the State-Trait Anxiety Inventory (Form Y) was used to measure state anxiety across three test administrations. FINDINGS: While there were no statistically significant changes in state anxiety, behavioral evaluations indicated that PCGs used both the self-applied relaxation techniques and the reinforcement tool more than twice daily. CONCLUSIONS: Relaxation techniques may be useful for those people caring for chronically ill children.

GM1 ganglioside treatment of spontaneously hypertensive stroke prone rats.

Many reports indicate that GM1 ganglioside is effective in reducing CNS ischemic injury in animal models. These models employ invasive surgery to induce ischemic damage in otherwise healthy animals. The purpose of this study was to determine if the beneficial effects of GM1 could be generalized to Spontaneously Hypertensive Rats-Stroke Prone (SHRSP). The SHRSP strain develops a pathology similar to those observed in patients with stroke. The SHRSP have "risk" factors that include hypertension, fibrinoid necrosis, and sensitivity to diet. Female SHRSP were randomly assigned to GM1- or saline-treatment conditions. Rats were fed a stroke-inducing diet. Daily body weights, weekly blood pressure, time of stroke onset, and age at death were recorded. Spontaneous activity and performance on a tail-hang test were assessed thrice weekly. The results indicate that GM1 treatment did not delay the time of stroke onset or death. GM1 did reduce hyperactivity in the initial stages of the ischemic pathology, but did not prevent the marked decline in behavioral activity observed at later time points. There were no differences in weight loss, performance on the tail-hang test, or number of CNS injury-related symptoms observed. These findings suggest that GM1 was not as effective in decreasing mortality, weight loss, or behavioral deficits in SHRSP as previously reported using other animal models of ischemia. Distinguishing between those animal models in which GM1 is more and less effective may be useful in determining under which clinical situations GM1 is likely to be most suitable.