Fever after subarachnoid hemorrhage: risk factors and impact on outcome.

OBJECTIVE: To identify risk factors for refractory fever after subarachnoid hemorrhage (SAH), and to determine the impact of temperature elevation on outcome. METHODS: We studied a consecutive cohort of 353 patients with SAH with a maximum daily temperature (T(max)) recorded on at least 7 days between SAH days 0 and 10. Fever (>38.3 degrees C) was routinely treated with acetaminophen and conventional water-circulating cooling blankets. We calculated daily T(max) above 37.0 degrees C, and defined extreme T(max) as daily excess above 38.3 degrees C. Global outcome at 90 days was evaluated with the modified Rankin Scale (mRS), instrumental activities of daily living (IADLs) with the Lawton scale, and cognitive functioning with the Telephone Interview of Cognitive Status. Mixed-effects models were used to identify predictors of T(max), and logistic regression models to evaluate the impact of T(max) on outcome. RESULTS: Average daily T(max) was 1.15 degrees C (range 0.04 to 2.74 degrees C). The strongest predictors of fever were poor Hunt-Hess grade and intraventricular hemorrhage (IVH) (both p < 0.001). After controlling for baseline outcome predictors, daily T(max) was associated with an increased risk of death or severe disability (mRS > or = 4, adjusted OR 3.0 per degrees C, 95% CI 1.6 to 5.8), loss of independence in IADLs (OR 2.6, 95% CI 1.2 to 5.6), and cognitive impairment (OR 2.5, 95% CI 1.2 to 5.1, all p < or = 0.02). These associations were even stronger when extreme T(max) was analyzed. CONCLUSION: Treatment-refractory fever during the first 10 days after subarachnoid hemorrhage (SAH) is predicted by poor clinical grade and intraventricular hemorrhage, and is associated with increased mortality and more functional disability and cognitive impairment among survivors. Clinical trials are needed to evaluate the impact of prophylactic fever control on outcome after SAH.

Clinical adaptation of a high-performance liquid chromatographic method for the assay of pyridoxal 5'-phosphate in human plasma.

Vitamin B6, measured as pyridoxal 5'-phosphate (PLP), is a co-enzyme in the transsulfuration pathway of homocysteine metabolism. Since depletion of PLP has been suggested as an independent risk factor for coronary artery disease, PLP is frequently measured to guide patient care. By a change and utilization of an Aquasil C18 column and the addition of an acetonitrile clean-up gradient to the potassium phosphate, with sodium perchlorate and bisulfite buffer between samples we report the modification of a previously described method for analysis of PLP. The result is a more practical, efficient, reliable and robust method for daily clinical use. We also determined and report that it is critical to protect freshly prepared standard PLP samples from light exposure during assay preparation.

Communicating in end-of-life care.

In pediatric cases communication is a key element of care--more so than for any other type of care because parents and other family members are as involved as the child is. Thus, learning effective communication skills is essential for successful care. End-of-life settings make the need for quality communication even more important. Providers can learn skills from this article to apply to any pediatric care situation.

The cat-1 gene of Caenorhabditis elegans encodes a vesicular monoamine transporter required for specific monoamine-dependent behaviors.

We have identified the Caenorhabditis elegans homolog of the mammalian vesicular monoamine transporters (VMATs); it is 47% identical to human VMAT1 and 49% identical to human VMAT2. C. elegans VMAT is associated with synaptic vesicles in approximately 25 neurons, including all of the cells reported to contain dopamine and serotonin, plus a few others. When C. elegans VMAT is expressed in mammalian cells, it has serotonin and dopamine transport activity; norepinephrine, tyramine, octopamine, and histamine also have high affinity for the transporter. The pharmacological profile of C. elegans VMAT is closer to mammalian VMAT2 than VMAT1. The C. elegans VMAT gene is cat-1; cat-1 knock-outs are totally deficient for VMAT immunostaining and for dopamine-mediated sensory behaviors, yet they are viable and grow relatively well. The cat-1 mutant phenotypes can be rescued by C. elegans VMAT constructs and also (at least partially) by human VMAT1 or VMAT2 transgenes. It therefore appears that the function of amine neurotransmitters can be completely dependent on their loading into synaptic vesicles.

Simian immunodeficiency virus burden in tissues and cellular compartments during clinical latency and AIDS.

In the course of human immunodeficiency virus infection or of the related simian immunodeficiency virus (SIV), progression to AIDS is associated with high virus burdens in blood. How virus burden in the bloodstream is related to virus burden in tissue reservoirs was addressed in an animal model of rhesus macaques infected with SIV. In situ hybridization and quantitative image analysis were used to quantitate virus burden. Animals who developed AIDS had high levels of virus production and storage in lymphoid tissue reservoirs and evidence of productive infection of macrophages in the nervous system. With the quantitative approach described, it should be possible to design and assess the impact of treatment and shed light on the outstanding issues in pathogenesis.

Death in custody due to a colopericardial fistula.

Death while in custody is a sensitive issue as it has the potential to cause legal ramifications and political fall-out, to embarrass the law enforcement community, and to incite the general population. Studies of deaths while in custody show that natural deaths are much more common than both suicides and homicides combined. Studies also indicate that natural deaths cluster in the older population, while suicides, on the other hand, occur predominantly in the younger population. We present a summary and discussion of a death in custody that is unique in several aspects. Contrary to the norm, death in this 18-year-old male inmate was natural. It was due to a rare complication (colopericardial fistula) of a surgical procedure (colonic interposition) performed roughly 16 years previously. We believe that our case represents the third example of a colopericardial fistula and the first to occur following corrective surgery for esophageal atresia.

HLA-DR expression in macaque neuroendothelial cells in vitro and during SIV encephalitis.

HLA-DR expression in neuroendothelial cells (NEC) was studied during the course of SIV encephalitis in rhesus monkeys. HLA-DR determinants were detected on NEC in monkeys with SIV encephalitis, but not in control animals. In situ hybridization with an SIV probe indicated that HLA-DR expression was not a consequence of SIV replication within NEC. Cultured rhesus NEC stimulated with gamma interferon expressed HLA-DR to a higher degree than cultured brain fibroblasts or astrocytes. These data support the contention that NEC participate in retrovirus-induced inflammation and autoimmunity within the central nervous system.

Self-care and menopause: critical review of research.

Existing literature on self-care as it relates to menopause is examined to determine whether the knowledge base in this area reflects important tenets in women's health. One such tenet is that understanding the lived experience of women is critical in developing effective health care interventions. Few investigators acknowledge the lived experience of women in their studies of self-care and menopause.

Peroxidase-labeled primary antibody method for detection of pestivirus contamination in cell cultures.

Contaminating bovine viral diarrhea (BVD) virus in cell cultures and in fetal bovine serum (FBS) is a well recognized problem. This study describes a direct peroxidase (DP) labeled primary antibody method for detection of pestivirus antigens in cell culture that is simple and reliable. Using this method, most bovine and porcine cell cultures, a cat lung, four mosquito and two monkey cell cultures were found contaminated with BVD virus. The rodent and human cell cultures tested were negative by this method for BVD virus.

In vitro antimicrobial activity of benzoquinolinediones.

The in vitro antibacterial and anti-fungal activity of benz[g]isoquinoline-5,10-dione (1), benzo[g]quinoline-5, 10-dione (2), benzo[g]quinoline-5,6-dione (3), and anthraquinone (4) was determined using the agar well-diffusion assay. The minimum inhibitory concentrations (MIC's) of each of the active compounds (1-3) was determined using the two-fold serial dilution technique. Of the four compounds tested, benz[g]isoquinoline-5,10-dione exhibited the best overall activity against both bacteria and fungi. Particularly noteworthy was its significant antifungal activity which was comparable to the activity of the standard antifungal antibiotic amphotericin B.