Mucormycete infection or colonisation: experience of an Australian tertiary referral centre.

Mucormycosis is associated with significant morbidity and mortality. We reviewed patients with mucormycete isolated at Alfred Health, Australia. A retrospective review of 66 patients with mucormycete(s) identified, between 1 April 2008 and 30 June 2014. Baseline demographic, microbiological, radiological, treatment/outcome data were recorded. Site of isolation was sinopulmonary in 77% and skin/soft tissue in 21%. A total of 32% of cases were proven-IFD, 12% probable-IFD and 56% were defined as no-IFD (or colonisation). Rhizopus spp. was identified in 48%. Comparing probable/proven-IFD with no-IFD/colonisation, more patients were postallogeneic stem cell transplantation (28% vs. 0%, P < 0.01) and were receiving immunosuppressive therapy (59% vs. 24%, P < 0.01) including prednisolone >20 mg daily (24% vs. 5%, P = 0.04). A total of 93% of patients with proven/probable IFD received treatment while 30% of no-IFD/colonisation were treated. A total of 72% of patients with proven/probable IFD and 92% of those with colonisation had no further mucormycete isolated. Thirty day mortality was higher in the proven/probable-IFD cohort (24%) compared with no-IFD/colonisation (3%) (P = 0.02). Mucormycosis remains uncommon, with 56% of cases not associated with clinical infection. Immunosuppressive therapy remains strongly associated with mucormycosis. Mortality remains high in those with proven/probable IFD.

Reversible ligand binding reactions: Why do biochemistry students have trouble connecting the dots?

Adaptive chemical behavior is essential for an organism's function and survival, and it is no surprise that biological systems are capable of responding both rapidly and selectively to chemical changes in the environment. To elucidate an organism's biochemistry, its chemical reactions need to be characterized in ways that reflect the normal physiology in vivo. This is a challenging experimental problem because biological systems are inherently complex with myriads of interlinked chemical networks orchestrating processes that are mostly irreversible in nature. One successful approach for simplifying the study of biochemical reactions is to analyze them under controlled reversible equilibrium conditions in vitro that approximate the range of physiological conditions found in vivo. Because this approach has helped elucidate some of the chemical mysteries of complex biological systems, many topics presented in modern biochemistry courses are essentially rooted in the chemistry of reversible equilibrium reactions. Since most undergraduate biochemistry courses typically require students to complete year-long general and organic chemistry courses, biochemistry instructors may assume that entering students have sufficient understanding of basic reversible equilibrium chemistry to move forward into more advanced biochemical topics. However, this assumption is at odds with our experience in that many entering students seem confused by the conventions, language, symbolic formalism, and/or mathematical tools normally use to describe reversible equilibrium reactions. Part of the problem here may stem from how certain basic chemical concepts are taught (or are not taught) in their prerequisite chemistry courses. Here, we identify some conceptual barriers that many students seem to confront and we discuss instructional strategies designed to help students "connect the dots," so to speak, and better understand how dynamic biological processes can be analyzed in terms of reversible equilibrium chemistry.

Aortocaval fistula and contained rupture of an abdominal aortic aneurysm presenting with pelvic venous congestion.

This case report describes pelvic venous congestion without associated high-output cardiac failure as an unusual presentation of an aortocaval fistula as a complication of a contained rupture of an abdominal aortic aneurysm. Options for caval control and management of perioperative problems unique to this situation are discussed.

Legislative and humanitarian impetus for development of alcohol and other drug policy at an Australian university.

The rationale for comprehensive alcohol and other drug policy at a tertiary institution is presented here as a health promotion strategy for educating University policy makers. Particular emphasis is placed on a discussion of humanitarian issues, that is, the right to a healthy environment, and the potential for legal liability in an environment where alcohol is readily available and other drugs are present. There is little attention paid to drug use related legal issues in the University, but at the same time drawing the attention of policy makers to the organisation's vulnerability to lawsuits has been reported to be a motivating force for adoption of drug use policy. Universities do experience problems related to alcohol and other drug use by staff and students. Problem reduction, and better management of problems, are the major goals of policy in this area. Local initiatives, for example at the organisational level, make important contributions to the overall drug prevention efforts of the nation. Well-developed policy and procedures and effective implementation constitute an important structural health promotion strategy. Such policy would comply with the immediate requirements of Occupational Health, Safety and Welfare legislation and provide some protection against wrongful dismissal claims and negligence lawsuits, as well as providing long-term educative effects. Situations for which policies are needed, range widely due to the University's unique environment and complex roles.

Effects of continuous infusion of intravenous nitroglycerin on methemoglobin levels.

The effect of continuous infusion of intravenous nitroglycerin (NTG) on methemoglobin levels in 24 coronary care unit patients was studied. Fifteen patients were admitted with acute myocardial infarction, 5 patients with angina pectoris, 1 patient with congestive heart failure, 2 with chest pain of unknown origin and 1 with chest pain of musculoskeletal origin. Intravenous NTG therapy was initiated at a 5 micrograms/min dose and titrated at 5-micrograms increases until relief of symptoms or until the maximal dose tolerated by each patient. Successive methemoglobin levels were measured at baseline, at each 20 micrograms/min dose increase, at the maximal dose and immediately before weaning the patient from the maximal dose. Statistical analysis by the Student t test (paired samples, p less than 0.05) showed no significant difference between the mean methemoglobin levels at baseline and the mean methemoglobin levels drawn at 20, 40 and 60 micrograms, and before weaning from the maximal dose. No serious adverse effects associated with methemoglobinemia were encountered. It is concluded that intravenous NTG administration in a dose of 0.2 to 2.12 micrograms/min/kg body weight produces no significant methemoglobinemia.

Long-term neuropsychological deficits after traumatic head injury with comatosis.

Studied neuropsychological deficits in a population who had sustained traumatic head injuries of the concussive type. Experimental Ss were 48 adults who had been comatose and hospitalized during the 3-year period that preceded the study. Control Ss (N = 16) had been hospitalized due to other types of injuries and had not been comatose. Ss were recalled and administered the Halstead-Reitan Battery, Trail Making Test, WAIS, and various questionnaires. Significant differences between experimental and control Ss were found that indicated persistence of neuropsychological dysfunctions. Groups of Ss who had sustained long comas performed more poorly than those who had short comas, which indicated that duration of coma was an important factor.

Neurologic sequelae of Rocky Mountain spotted fever.

Forty-two children who had Rocky Mountain spotted fever were seen for neurologic and psychologic examination at follow-up. The presence of sequelae was more common in children with severely impaired states of consciousness. Behavioral disturbances and learning disabilities were the most common problems. Seizures, although a common occurrence during acute disease, did not occur as sequelae to Rocky Mountain spotted fever.

Social skills training with mildly retarded young adults.

Described a social skills assessment and training model for use with mildly retarded young adults (N = 20). The assessment procedure examined social behavior in three types of social situations (e.g., conversational situation, cooperative task and assertive situation) with both male and female respondents. Group behavioral social skills training was compared with a no treatment control condition using various dependent measures collected in the in-vivo social situations. Group behavioral social skills training was more effective than the control condition in increasing positive social behavior, attention to the transaction, and degree of empathy. It was also more effective than a control condition in decreasing negative social skill behavior. A situation effect also was observed, which suggests a need for more focus on particular social skills and a need to address issues of generalization. A comprehensive social skills assessment and training model is discussed.

Economic viability of the mental health worker.

Lower salary costs and effective provision of services to specific community groups are counted among the advantages of the use of mental health workers in community programs. In a cost-benefit analysis of the value of health manpower, salaries and service provision are only two of several factors, yet the circumstances of funding, training, and role diffusion that surround the use of the mental health worker have precluded true cost-benefit analysis. The authors believe that the mental health worker program of the Orange County, California, community mental health program is developed and stable encough that the initial steps of an economic analysis are possible. The data from the analysis show that, in the outpatient program, mental health workers constitute 37 per cent of the clinical staff and provide 41 per cent of the direct services, yet account for 26 per cent of the direct peronnel costs.

Self-destructive behavior patterns in male and female drug abusers.

One hundred and fourteen male and female drug abusers were interviewed regarding their histories of self-destructive behaviors. The data were analyzed to determine if, and identify what, differences existed between males and females with respect to types and extent of self-destructiveness. The analyzed data indicate that male and female drug abusers present very different self-destructive portraits. These portraits and their component parts are presented along with possible explanations for the differences. The paper also presents some of the differences between drug abusers and the general population with respect to self-destructiveness.

Effects of early neurological problems following head trauma on subsequent neuropsychological performance.

Early neurological indicants based on information from the hospital admission clinical examination were studied in a group of patients who had sustained accident-incurred traumatic head injuries. Patients who had been hospitalized during the 3-year period just preceding the study were recalled and a battery of neuropsychological tests was administered. Early neurological problems were found to have a detrimental effect on subsequent test performance. The results supported the use of these early indicants to make prognostic decisions.

Compulsive heroin use and interpersonal orientation.

This research attempt to clarify and quantify the ways in which heroin addicts deal with interpersonal relations. A sample of heroin addicts on a methadone maintenance program were given the Fundamental Interpersonal Relations Orientation-Behavior (FIRO-B) scale. An accidental sample consisted of 35, approximately one-half, of the clinic's population. A mean interpersonal orientation profile is established and interpreted. An analysis of variance was performed for each of the six FIRO-B scores. Patients needs based on FIRO-B scores are discussed with regard to the descriptions of addicts life-styles as described in the literature. The possible etiological basis for these interpersoanl orientations is also discussed. Several therapeutic approaches, as indicated by FIRO-B scores, are explored.

Drug abuse and suicide.

This paper examines the relationship between drug abuse and suicide. It attempts to assess the extent of suicidal thoughts or behaviors among a group of drug abusers. The research examines variables related to self-destructive or self-endangering behaviors, such as accidental overdoses, arrests for driving under the influence, and auto accidents in which the subject was the driver. These data were examined in relation to reports of suicidal thoughts and actual suicide attempts. The results indicate a suicide attempt rate at least 12 times greater than expected for the general population. The results also indicate significant correlations between suicidal thoughts and suicide attempts, suicidal thoughts and nonsuicidal overdoses, and arrests for driving under the influece of drugs or alcohol and nonsuicidal overdoses. The implications of these results along with the role of depression as discussed.