Notification of infectious diseases by junior doctors in accident and emergency departments.

OBJECTIVE: To assess the knowledge about notifiable infectious diseases by accident and emergency (A&E) senior house officers. METHODS: A telephone questionnaire of senior house officers was carried out over a one week period at the end of their six month attachment in A&E departments in Northern Ireland. RESULTS: 81 (91%) of the senior house officers participated in the study; 23 (29%) realised that the doctor diagnosing the notifiable disease had a statutory duty to notify that disease; nine (11%) were aware there were three statutory lists in the United Kingdom. Knowledge about which infectious diseases require notification varied from 79/81 (98%) for meningococcal disease to 15/91 (19%) for methicillin resistant S aureus. Seventy nine (98%) of the doctors thought that a poster displayed in the A&E department would be helpful. There was no significant difference between duration of qualification and performance on the questionnaire (p = 0.2). CONCLUSIONS: Despite varying experience, junior doctors in A&E do not know which infectious diseases are notifiable by statute. They felt that it would be helpful to have a poster in the A&E department listing the notifiable diseases of that region. To encourage accurate reporting, interregional variation between the statutory lists should be abolished and replaced by one nationally agreed list.

Adult Arnold-Chiari malformation: a postpartum case presentation.

Adult Arnold-Chiari malformation, also known as Chiari malformation type I, typically occurs in women during early adulthood and can be a cause of unexplained headaches, as well as associated syringomyelocele. In this unique case report, a 32-year-old, postpartum woman with posturally induced headache from Chiari malformation type I had symptoms occur for the first time during pregnancy. Magnetic resonance imaging of the brain confirmed the diagnosis and is the neuroimaging study of choice in such cases. Neurosurgical decompression, when performed early, is highly successful in symptomatic individuals.

Motor neuron-astrocyte interactions and levels of Cu,Zn superoxide dismutase in sporadic amyotrophic lateral sclerosis.

Copper, zinc superoxide dismutase (SOD1) is involved in neutralizing free radicals within cells, and mutant forms of the enzyme have recently been shown to occur in about 20% of familial cases of amyotrophic lateral sclerosis (ALS). To explore the mechanism of SOD1 involvement in ALS, we have analyzed SOD1 in sporadic ALS using activity assays and immunocyto-chemistry. Analyses of SOD1 activity in washed erythrocytes revealed no difference between 13 ALS cases and 4 controls. Spinal cord sections from 6 ALS cases, 1 primary lateral sclerosis (PLS) case, and 1 control case were stained using three different antibodies to SOD1. Since astrocytes are closely associated with motor neurons, antibodies to glial fibrillary acidic protein (GFAP) and vimentin were used as independent monitors of astrocytes. The principal findings from localizations are: (1) normal motor neurons do not have higher levels of SOD1 than other neurons, (2) there was no detectable difference in SOD1 levels in motor neurons of ALS cases and controls, (3) ALS spinal cord displayed a reduction or absence of SOD1-reactive astrocytes compared to the control and PLS cases, and (4) examination of GFAP-stained sections and morphometry showed that the normal close association between astrocytic processes and motor neuron somata was decreased in the ALS and PLS cases. These results indicate the disease mechanism in sporadic ALS may involve alterations in spinal cord astrocytes.

Low-risk mothers. Oral intake and emesis in labor.

This study examined the pattern of oral intake and its impact on emesis and other complications in low-risk gravidas during labor. It is common clinical practice to restrict oral intake in most institutions. The historical bases for this restrictive practice are explored. Findings from this study indicate that when given a choice, all 106 women chose a variety of types and amounts of oral intake throughout all stages of labor. Over 80% of women who ate or drank during labor had no emesis. Of the 20 who did have any emesis, 40% (eight) vomited more than once. None of the women who vomited experienced poor outcomes. These data suggest that women who choose oral intake during labor are at relatively low risk for complications related to this intake. Based on a comprehensive review of the literature and these study results, practitioners should allow as much choice as is consistent with empirical knowledge and safe practice.