Prehospital use of intraosseous infusion by paramedics.

Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a training program in IO placement. Patients enrolled were less than five years of age and in cardiac arrest. During a 10-month period, paramedics attempted 12 IO placements, of which 10 (85%) were successful, nine on the first attempt. Although no patients achieved long-term survival, three were initially resuscitated from arrest. Paramedics can be trained in IO placement, and IO infusion can be used in prehospital pediatric care. Training methods, limitations, and implications for future use are discussed.

Serum and cerebrospinal fluid proteins in tuberculous meningitis.

Serum and CSF protein electrophoresis was performed on cellulose acetate in 8 controls and 30 cases of tuberculous meningitis before treatment and during a hospitalization period of 5 months. The analysis of the CSF electrophoretic pattern showed that abnormalities in the prealbumin, beta and gamma fractions may still exist as late as 5 months after initiation of treatment. An increase in alpha 2 and decrease in the albumin fractions in the serum also persisted. Treatment for 20 weeks improved the clinical condition of the patients and resulted in a significant improvement in the CSF prealbumin and alpha 1 fractions. These findings indicate that changes in these fractions may be considered a good prognostic aid.

Penetration of amoxicillin into cerebrospinal fluid.

The penetration of amoxicillin into cerebrospinal fluid (CFS) in the presence of meningeal inflammation was evaluated in patients with tuberculous meningitis. Serum and CSF concentrations of amoxicillin were measured at 2 h in nine patients who received a 1-g oral dose and at 1.5 and 4 h in ten patients who received a 2-g intravenous injection of sodium amoxicillin. After the oral dose, CSF concentrations ranged from 0.1 to 1.5 mug/ml. After the intravenous injection, CSF concentrations ranged from 2.9 to 40.0 mug/ml at 1.5 h and from 2.6 to 27.0 mug/ml at 4 h. These data on penetration suggest that parenterally administered sodium amoxicillin may be of value in the therapy of acute bacterial meningitis.

Acute bacterial meningitis in Cairo, Arab Republic of Egypt, 1 January 1971 through 31 December 1975.

Between 1 January 1971 and 31 December 1975, 1,333 patients with acute bacterial meningitis were admitted to the meningitis ward of the Abbassia Fever Hospital. These cases are tabulated by distribution of diagnosis, seasonal distribution, age and sex distribution, and age-specific case fatality ratio. Results are compared with those of other large series of cases reported from other parts of the world. The annual incidence of acute bacterial meningitis in Egypt varies widely. Recent data show this to be due to variations in the incidence of group A meningococcal meningitis. The study includes the declining phase of an epidemic of that disease and confirms a previously reported finding that the case fatality ratio in group A meningococcal meningitis varies inversely with the annual number of cases.

Treatment of giardiasis with tinidazole.

Fifty-five patients, 51 males and 4 females heavily infected with Giardia lamblia were treated with a single 2 g dose of tinidazole (four tablets); 53 were cured. Of 20 other infected patients kept under the same conditions and given four placebo tablets, 18 continued to pass cysts or trophozoites in the stools during the whole 3- to 4-wk follow-up period in hospital. There were no side effects attributed to the drug.

Rapid diagnosis of lymphocytic meningitis by frequency-pulsed electron capture gas-liquid chromatography: differentiation of tuberculous, cryptococcal, and viral meningitis.

Cerebrospinal fluid specimens from patients with tuberculous (17 cases), cryptococcal (15 cases), and viral (14 cases) meningitis were analyzed by frequency-pulsed electron capture gas-liquid chromatography and mass spectrometry. Compounds that disappeared after therapy were found to be present in each of these specimens and were not detected in controls. They occurred in repetitive patterns such that these three types of meningitis could be rapidly distinguished. The compound associated with tuberculous meningitis has been tentatively identified. These finding have implications for rapid diagnosis, pathophysiological studies, and possible new therapeutic approaches.

Hepatic amebiasis: diagnostic counterimmunoelectrophoresis and metronidazole (flagyl) therapy.

In an ongoing study of obscure fevers in Cairo, Egypt which is presently in its 6th year, 12 cases of hepatic amebiasis have been diagnosed. Three were diagnosed during the period 1971-1974. With the introduction of amebic serologic techniques, particularly counterimmunoelectrophoresis, nine additional cases have been diagnosed in 1975-1976. Of 9 patients treated with metronidazole 6 were rapidly cured, 2 had a recurrence of fever necessitating surgical drainage of the abscess, and 1 died suddenly on the 3rd day of therapy.

Comparative single/dose treatment of hookworm and roundworm infections with levamisole, pyrantel and bephenium*.

One-hundred and forty-five farmers aged 7-45 years who were infected with Ancylostoma duodenale and/or ascaris were treated with a single dose of levamisole, pyrantel, or bephenium. The percentage cure rates were ascaris 100 per cent ahd hookworm 93 per cent for levamisole; ascaris 90 per cent and hookworm 78 per cent for pyrantel; and ascaris 73 per cent and hookworm 81 per cent for bephenium. The 3 drugs were well tolerated. The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or The Egyptian Ministry of Healty.

Renal biopsy in Schistosoma-Salmonella associated nephrotic syndrome.

Percutaneous needle biopsy of the kidney on eight nephrotic patients with Schistosoma mansoni and chronic Salmonella paratyphi A infection showed diffuse proliferative glomerular change in all biopsies. Capillary basement membrane was normal. Diffuse granular deposits were detected in the glomerular mesangial cells by direct staining with fluorescein labelled anti-IgG anti-IgM. No fluorescence was obtained with rabbit anti-Salmonella paratyphi A. After treatment with ampicillin and niridazole, a reduction of cellular proliferation and mesangial matrix expansion was observed. Simultaneously following treatment there occurred a dramatic clinical improvement with cessation of proteinuria and a return of plasma protein levels and serum complement (C3) to normal values.

The value of epicillin and ampicillin in the treatment of meningococcal and pneumococcal meningitis.

96 patients with meningitis due to Neisseria meningitidis and Diplococcus pneumoniae were treated with epicillin or ampicillin according to a predesigned randomization chart. Results indicate that epicillin and ampicillin are effective single drugs in the treatment of meningococcal and pneumococcal meningitis. No adverse reactions were noted with either drug and they were comparable in their efficacy.

The value of ethambutol in the treatment of tuberculous meningitis.

This is a prospective treatment study of 86 patients with tuberculous meningitis admitted to the Abbassia Fever Hospital Cairo, Egypt. The causative organism was cultured from the cerebro spinal fluidin 47 patients, was identified by Zeihl Nelson stain in five and in the remaining 34 patients the diagnosis was based on the clinical course and changes in the CSF chemistry and cell count. The data indicate that ethambutol can be used as a companion drug to INH and streptomycin in the treatment of the disease and that the mortality is directly dependent on the state of consciousness upon initiation of therapy.

Treatment of chronic enteric fever with amoxicillin.

Twelve patients with proven Salmonella typhi or Salmonella paratyphi A bacteriuria and recurrent bacteremia associated with schistosomiasis were treated for four weeks with amoxicillin (250 mg four times daily). Seven of the 12 patients were seriously ill and febrile before treatment. They showed a dramatic response, and, within three to six days of initiation of amoxicillin therapy, they were afebrile and much improved clinically. Amoxicillin was rapidly and highly concentrated in the urine of all patients; peak levels of 115-2,700 mug/ml were obtained within 2-4 hr of the first dose. Concentration of the drug in serum was also rapid and in all but two patients exceeded the minimal inhibitory concentration of the organism within 4 hr of the first dose. Within one week after treatment started, all urine and blood specimens obtained from the patients became negative for Salmonella and remained so throughout the four-week follow-up period, during which the patients were hospitalized.

Nephrotic syndrome in Schistosomiasis mansoni complicated by chronic salmonellosis.

Thirteen patients with concomitant chronic salmonellosis and schistosomiasis and with the nephrotic syndrome were studied. Of the seven patients' sera examined, all had markedly low complement C3 and near normal C4 levels. This indirectly suggests an active role of Salmonella endotoxin in the etiology of the nephrosis.