Body image and psychological outcome after severe skin and soft tissue infection requiring intensive care.

BACKGROUND: Patients with severe skin and soft tissue infection (SSTI) requiring intensive care unit (ICU) stay are commonly treated with antibiotics, surgery and in some centers also with hyperbaric oxygen therapy. Long-term follow-up of body image and psychological outcome has not been described despite extensive surgery, potentially altered body image and subsequent psychological problems. The aim was to describe perceived body image and its relation to anxiety, depression and post-traumatic stress disorder (PTSD)-related symptoms in patients with severe SSTI 1 year after ICU stay. Specifically, we aimed to assess potential differences related to gender and anatomic site of infection. METHODS: Fifty patients treated for severe SSTI in the General ICU, Karolinska University Hospital 2008-2010 received the body image scale (BIS), impact of event scale (IES), and hospital anxiety and depression scale (HADS) 1 year after ICU discharge. RESULTS: Abdominoperineal SSTI was associated with more body image problems than other anatomic sites of infection in both men and women. Generally, women reported higher BIS scores than men (median 9.5 vs. 3.0 of total 30, P < 0.03) indicating more negative body image. A substantial number of patients reported scar dissatisfaction (63.9%), body dissatisfaction (51.1%) and body feeling less whole (51.0%). BIS scores correlated with HADS anxiety (r = 0.59, P < 0.01), depression (r = 0.60, P < 0.01) and IES (r = 0.61, P < 0.01) scores. CONCLUSION: One year after severe SSTI requiring intensive care, women and patients with abdominoperineal SSTI reported significantly more body image problems. Negative body image was associated with anxiety, depression and PTSD-related symptoms. Specific follow-up for SSTI patients is warranted.

Functional capacity and early radiographic osteoarthritis in middle-aged people with chronic knee pain.

BACKGROUND AND PURPOSE: In order to improve the physiotherapeutic treatment of patients with long-standing knee pain, it is important to identify osteoarthritis (OA) of the knee at an early stage. The aim of the present study was to test the value of single functional measurement variables with the focus on the lower extremities for the association to early radiographic signs of OA of the knee. The classification by Ahlbäck grade I (joint space narrowing) was used in a cohort of 204 individuals aged 35-54 years with long-standing knee pain. METHODS: The following five selected tests were employed: three tests of static and dynamic balance (Balance I-III); one test of muscle strength (one-leg-rising-test, OLR); and one test of walking ability (time for walking 300 m indoors). Odds ratios (ORs) were calculated with a 95% confidence interval. RESULTS AND CONCLUSIONS: Results revealed that the selected tests of functional capacity due to rather low sensitivity (0.15-0.81), specificity (0.21-0.86) and inconclusive odds ratios (0.78-1.62) are probably of limited value as assessment tools to find radiographic knee OA in a younger population with mild OA. However, it is also possible to conclude that in middle-aged individuals with chronic knee pain, the diagnosis of radiographic OA is not related to the functional capacity as measured in the present study.

An amplification technology for improving sensitivity when measuring components in biological samples.

A new technology for improving the sensitivity in measuring components in biological samples is described. The method is based on the use of spherical microbeads (detection beads) which contain a large amount of immobilized enzyme and a reagent with biospecific affinity for the component to be detected. These microbeads have been used in a 'sandwich reaction' for visualization of P-fimbriated Escherichia coli which has a known receptor structure (Gal(alpha 1-4)Gal(beta)). In the initial step the bacteria were enriched on a solid support (e.g., a plastic film or beads (greater than 150 microns)) to which the receptor structure had been covalently bound. In the next step detection beads coupled with enzyme and receptor structure were added and finally a chromogenic substrate for the enzyme was used for visualization. A sensitivity of 10(5) bacteria/ml was reached. The detection beads are of general utility and might be useful for the detection of lectins on other pathogens.

Receptor-specific agglutination tests for detection of bacteria that bind globoseries glycolipids.

Specific binding to the globoseries of glycolipid receptors explains the adherence of uropathogenic Escherichia coli to host cells. The minimal receptor disaccharide Gal alpha 1----4Gal beta [galactose alpha (1----4)galactose beta] is recognized by most attaching clinical isolates. However, wild-type isolates can express adhesins with several different receptor specificities. Bioassays do not permit separate analysis of each receptor specificity, since the target cells contain multiple potentially receptor-active molecules. In this study, bacterial adhesins were analyzed by using receptors immobilized into latex beads in one of two ways. In one way, di- and trisaccharides were covalently linked via a spacer arm to latex beads coupled with bovine serum albumin. In the other way, receptor-active glycolipids were coated onto the bovine serum albumin-latex beads. The latex beads were subsequently used for agglutination by using type strains with known receptor specificity. The composition was optimized regarding receptor structure and size of latex beads. Gal alpha 1----4Gal beta was as active as the trisaccharide derivative Gal alpha 1----4Gal beta 1----3glucose or Gal alpha 1----4Gal beta 1----3glucosamine. Among the natural glycolipids tested, globotetraosylceramide was the most active. Subsequently, the sensitivity and specificity of the Gal alpha 1----4Gal beta-latex and globotetraosylceramide-latex reagents were compared for 733 E. coli urinary isolates. Hemagglutination of human erythrocytes was used as the positive standard. No significant difference in the specificity or sensitivity of the latex reagents was found; the sensitivity ranged from 86%, when isolates agglutinating human erythrocytes of blood groups P1 and p were included, to 93%, when those isolates agglutinating erythrocytes of blood group p were excluded. These reagents provide tools for bacterial identification in patients with urinary tract infection.

Binding to galactose alpha 1----4galactose beta-containing receptors as potential diagnostic tool in urinary tract infection.

The diagnosis of urinary tract infection is based largely on quantitative urine cultures. The usefulness of qualitative information about the virulence of the infecting bacteria remains undefined. Ability to attach to human uroepithelial cells is one characteristic of the pyelonephritogenic clones, as well as a virulence factor per se. The identification of host cell receptors for attaching bacteria has permitted the construction of agglutination tests for simple detection of bacterial binding properties. In the present study, the reactivity with Gal alpha 1----4Gal beta-latex [galactose alpha (1----4)galactose beta-latex] and globotetraosylceramide-latex was analyzed for strains from patients with acute pyelonephritis (n = 135), acute cystitis (n = 121), and asymptomatic bacteriuria (n = 119) and from the fecal flora of healthy children (n = 120) and compared with agglutination of human blood group P1 and p, as well as guinea pig, erythrocytes. The reactivity by bioassay and the receptor-specific assays were significantly correlated. The frequency of positive reactions among the pyelonephritis isolates was 78.5% with the globotetraosylceramide-latex reagent, compared with 41% for the cystitis isolates, 25% for the asymptomatic bacteriuria isolates, and 13% for the fecal isolates. The combination of bioassays and receptor-specific assays increased the resolution of adhesins. Thus, adhesins reacting with human p erythrocytes frequently were coexpressed with Gal alpha 1----4Gal beta-specific adhesins. The receptor-specific assays provide a refined reagent to resolve bacterial binding specificities, as well as a potential tool for clinical diagnosis.