Effects of nitric oxide synthase inhibition on ciliary blood flow, aqueous production and intraocular pressure.

A prior study found that inhibition of nitric oxide synthase with L-NAME causes a large, rapid decrease in IOP in anesthetized rabbits. In this follow-up study we sought to determine if this hypotensive effect was due to decreased aqueous production, possibly caused by ciliary vasoconstriction. Two protocols were performed in anesthetized rabbits. In the first protocol, mean arterial pressure (MAP) and IOP were measured by direct cannulation, and aqueous flow was measured by fluorophotometry, before and after L-NAME (5 mg kg(-1), i.v., n = 7). In the second protocol, ciliary blood flow was measured transclerally by laser Doppler flowmetry while MAP was varied mechanically over a wide range before and after L-NAME (5 mg kg(-1), i.v., n = 8). L-NAME caused a significant increase in MAP and decreases in IOP, ciliary blood flow and aqueous flow. L-NAME also caused a significant downward shift in the ciliary pressure-flow relation over the entire pressure range examined. The results indicate that L-NAME causes ciliary vasoconstriction and decreases aqueous production, suggesting that the L-NAME ocular hypotensive effect may be due in part to a blood flow-dependent decrease in aqueous production. However, assuming no uveoscleral outflow and constant episcleral venous pressure and outflow facility, the decrease in aqueous flow accounts for 66% of the drop in IOP, suggesting an additional effect of L-NAME on aqueous outflow.

Brucellosis among hospital employees in Saudi Arabia.

OBJECTIVE: To report experience with brucellosis among expatriate hospital employees in an area of the world where brucellosis is endemic. DESIGN: Review of cases from the viewpoints of direct supervisor and treating physician, including epidemiologic interviews and clinical follow-up. SETTING: Tertiary care hospital center in a developing country that increased from 125 beds to 450 beds during the period studied. PATIENTS: Employees with clinical findings suggesting brucellosis and in whom a positive blood culture or significantly elevated serologic test confirmed the diagnosis. RESULTS: Nine hospital employees from nonendemic areas developed brucellosis. Five were from England and four from North America. Seven were bacteriology technologists, one was a nurse, and one was an obstetrician. Each had an acute febrile illness with malaise, arthralgia, or headache. Brucella titers were > or = 1:1,280. Five were bacteremic with positive Brucella cultures. All responded to anti-Brucella therapy. Three patients had relapses, but there were no complications. CONCLUSIONS: Among Saudi patients, brucellosis is generally attributable to drinking infected milk or contacting infected animals. On the other hand, among expatriate hospital employees, the infection is likely due to processing Brucella cultures or dealing with infected body fluids. In 1988, the laboratory began stricter infection control measures. Since then, there has been only one case of brucellosis among the hospital employees.

Increasing compliance over five years in a hepatitis B infant immunization program in Saudi Arabia.

Immunization of babies born to hepatitis B carrier mothers at King Fahad National Guard Hospital began in July 1984. Thirteen months into the program, it was learned that 3.8% of the mothers were HBsAg positive, that less than half of the pregnant women came for any prenatal care, and that only 28% of the infants at risk completed the vaccination series. During the first five years (1984-88) of the program, there were 13,000 newborns, of whom 490 were born to hepatitis carrier mothers. The percentage of women who came for the least one prenatal visit increased from 46% in 1984 to 66% in 1987. Analysis showed that the percentage of return for the second vaccination increased from 49% in 1984 to 74% in 1988, and for the third vaccination from 21% in 1984 to 51% in 1988. Of 127 infants tested, 126 were HBsAg negative and one was borderline positive. Of 125 infants tested for anti-HBs, 87% showed seroconversion.

Comparative in vitro activities of ofloxacin, difloxacin, ciprofloxacin, and other selected antimicrobial agents against Brucella melitensis.

The in vitro activities of three quinolones (ofloxacin, difloxacin, and ciprofloxacin) were compared with those of trimethoprim-sulfamethoxazole, streptomycin, tetracycline, and rifampin against 47 Brucella melitensis strains. Ofloxacin was the most active of the test antimicrobial agents. It inhibited 90% of B. melitensis strains at a concentration of 0.02 micrograms/ml.

Brucellosis in Saudi Arabia.

This paper describes the history of brucellosis and the current public health picture in the Kingdom of Saudi Arabia. Health protection is made more difficult by several factors: (a) the local custom of drinking raw and warm milk of sheep, goats, and camels, (b) the animal reservoir of infection in the country complicated by importation of live animals both for sacrifice during Haj periods and to increase commercial flocks, and (c) by uncontrolled movements of humans and stock across political borders.

Analysis of 506 consecutive positive serologic tests for brucellosis in Saudi Arabia.

Brucellosis is common in the central region of Saudi Arabia. The major clue to the diagnosis is serologic testing. In 3 years, over 500 positive patients who had a titer of 1:160 or more were identified. Brucella species was the single organism most commonly recovered in all blood cultures, being found in 24% of patients with cultures positive for pathogenic bacteria. The expected greater number of Brucella cultures with high initial recorded titer was confirmed; 31% of the positive high-titer group had positive Brucella cultures. Conclusive correlation was uncommon below the 1:640 titer. The lower titers were less useful as indicators of active disease in this population, in which many people appear to have persistent low antibody levels.

Influence of country of origin on prevalence of hepatitis B markers among employees in a small suburban hospital.

Hepatitis risk in a small suburban hospital was evaluated by laboratory screening of all hospital employees for hepatitis immunologic markers. Excluding four U.S.-born subjects who had received hepatitis vaccination, the laboratory screening revealed 21% of those tested had some hepatitis B antigen or antibody. Positive markers were found in 46% of foreign-born compared to 10% of native-born (P less than 0.001). Foreign-born participants accounted for 68% of the positive marker cases while representing only 31% of the employee population. The country of origin appeared to have a statistically significant greater importance as a determinant of hepatitis B status than occupational area in this particular hospital setting.

The medical value of examining tissue from therapeutic abortions: an analysis of 13,477 cases.

In 1983 the United States Supreme Court ruled that therapeutic abortion tissue must be examined by a pathologist. A review of 13,477 specimens indicated that 98.7% had routine confirmation of the intrauterine pregnancy. Of the remainder, 60% had a deciduoid appearance, suggestive of but not diagnostic of pregnancy, 39% were not diagnostic of pregnancy, and 1% showed hydatidiform mole. In a subgroup of patients with non-routine reports, 28% had a problem warranting further care for ectopic pregnancy or trophoblastic disease or intrauterine retained placental tissue. It is concluded that a small percentage of patients receive benefit from this additional study because real or potential complications are identified early in the post-abortion period.