The clinical features and outcome of 2009 H1N1 influenza infection in allo-SCT patients: a British Society of Blood and Marrow Transplantation study.

The clinical course of 2009 H1N1 influenza in Allo-SCT patients is unknown. Data were collected in the UK from October 2009 to April 2010 on laboratory-confirmed cases of H1N1 influenza in Allo-SCT recipients. H1N1 infection was diagnosed in 60 patients, median age 42 years, at a median of 10 months post-SCT. Twenty-one patients (35%) developed pneumonia and nine (15%) required admission to intensive care units. Actuarial mortality was 7% at 28 days and 19% 4 months post-diagnosis of 2009 H1N1 influenza. Increasing age and pre-existing lung disease were risk factors for pneumonia (P=0.006 and 0.037, respectively); older age was a risk factor for death (P=0.012). Morbidity and mortality from 2009 H1N1 influenza in SCT patients exceeds that of immunocompetent patients, but parallels that in other critically ill hospitalised cohorts; the elderly and those with chronic pulmonary disease are at greatest risk.

Early hospital care of severe traumatic brain injury.

Head injury is one of the major causes of trauma-related morbidity and mortality in all age groups in the United Kingdom, and anaesthetists encounter this problem in many areas of their work. Despite a better understanding of the pathophysiological processes following traumatic brain injury and a wealth of research, there is currently no specific treatment. Outcome remains dependant on basic clinical care: management of the patient's airway with particular attention to preventing hypoxia; avoidance of the extremes of lung ventilation; and the maintenance of adequate cerebral perfusion, in an attempt to avoid exacerbating any secondary injury. Hypertonic fluids show promise in the management of patients with raised intracranial pressure. Computed tomography scanning has had a major impact on the early identification of lesions amenable to surgery, and recent guidelines have rationalised its use in those with less severe injuries. Within critical care, the importance of controlling blood glucose is becoming clearer, along with the potential beneficial effects of hyperoxia. The major improvement in outcome reflects the use of protocols to guide resuscitation, investigation and treatment and the role of specialist neurosciences centres in caring for these patients. Finally, certain groups are now recognised as being at greater risk, in particular the elderly, anticoagulated patient.

Investigation into the effect of detergents on disinfectant susceptibility of attached Escherichia coli and Listeria monocytogenes.

AIMS: Investigate the effect of detergent treatment on susceptibility of attached Escherichia coli and Listeria monocytogenes to subsequent disinfectant treatment. METHODS AND RESULTS: Plate counts show that E. coli attached to stainless steel surfaces became significantly more susceptible to benzalkonium chloride (BAC) after treatment with sodium alkyl sulfate (SAS) and fatty alcohol ethoxylate (FAE). No change in susceptibility was observed with Sodium dodecyl sulfate (SDS). L. monocytogenes became significantly less susceptible to BAC after treatment with SAS and SDS yet no change in susceptibility was observed with FAE. Flow cytometry using the fluoresceine propidium iodide revealed significant increases in cell membrane permeability of both organisms by SAS and FAE, although the effect was much greater in E. coli. No change was observed with SDS. Hydrophobic interaction chromatography showed that both organisms became less hydrophobic following treatment with SAS and SDS but FAE had no effect. CONCLUSIONS: In E. coli, detergents that increase susceptibility to BAC increase membrane permeability. In L. monocytogenes, detergents that reduce susceptibility to BAC lower cell surface hydrophobicity. SIGNIFICANCE AND IMPACT OF THE STUDY: Detergents can influence the sensitivity of pathogenic food borne micro-organisms to BAC.

Effectiveness of selected premilking teat-cleaning regimes in reducing teat microbial load on commercial dairy farms.

AIMS: To determine the effectiveness of premilking teat-cleaning regimes in reducing the teat microbial load and effect on milk quality. METHODS AND RESULTS: The effectiveness of several premilking teat-cleaning regimes in reducing teat microbial load was assessed using 40 cows on each of the four commercial UK dairy farms with herringbone parlours during two sampling periods. In the first experiment, all the treatments reduced teat total viable count (TVC), but there was no significant difference between the hypochlorite wash and dry wipe, iodine dip and dry and alcohol-medicated wipe or dry wipe alone. In the second experiment, the chlorine wash and dry wipe was significantly more effective in reducing teat TVC than a water wash and dry, chlorine dip and dry or a dry wipe. There was no relationship between cleaning regime and milk TVC, Enterobacteriaceae or Escherichia coli levels. CONCLUSIONS: All of the cleaning techniques studied reduced teat microbial load, however, the chlorine wash and dry was the most effective. SIGNIFICANCE AND IMPACT OF THE STUDY: The premilking teat-cleaning techniques studied reduced the teat microbial load and therefore reduced the potential for milk contamination; however, a wash including an effective disinfectant followed by a dry wipe was the most effective.

Transfer times for patients with extradural and subdural haematomas to neurosurgery in Greater Manchester.

Delay in transfer of patients with acute extradural (EDH) or subdural (SDH) haematoma to definitive neurosurgical evacuation has a detrimental effect on outcome. From July 2003 to December 2005 we undertook a prospective analysis of patients admitted to our unit for neurosurgical evacuation of their haematoma, who were transferred from non-neurosurgical hospitals. Data was collected for: 1) overall transfer time, 2) time taken from injury or deterioration to CT scan, 3) time from CT scan to arrival at our unit, and 4) time from arrival at our unit to surgery. Overall 81 patients were eligible, of which 39 had an EDH and 42 a SDH. The median transfer times for EDH and SDH were 5.25 hours and 6.0 hours respectively. This paper discusses the factors that may prolong delays in the transfer of patients between hospitals and the way in which our unit is trying to improve the local service for the population of Greater Manchester.

Brain stem death testing after thiopental use:A survey of UK neuro critical care practice.

A postal survey was conducted to determine how thiopental is used in UK neurosurgery critical care units. Thirty units were contacted and 26 replied. Thiopental is used in 23 units. The majority (60%) of these units govern the use of thiopental with protocols or guidelines and 74% use cerebral monitoring to guide dosage. When patients have had thiopental, 20 units delay brain stem testing, two will not perform tests and one unit incorporates cerebral angiography into their protocol. Twelve units use serum thiopental assays in their brain stem testing procedures, but there is wide variation in the interpretation of the results. We found inconsistency and confusion surrounding brain stem testing in this patient group, raising the possibility of misdiagnosis of brain stem death.

Deletion of chromosome 13 detected by conventional cytogenetics is a critical prognostic factor in myeloma.

In myeloma, the prognostic impact of different strategies used to detect chromosome 13 deletion (Delta13) remains controversial. To address this, we compared conventional cytogenetics and interphase fluorescence in situ hybridization (iFISH) in a large multicenter study (n=794). The ability to obtain abnormal metaphases was associated with a poor prognosis, which was worse if Delta13, p53 deletion or t(4;14) was present, but only Delta13 remained significant on multivariate analysis. Patients with Delta13, by either cytogenetics or iFISH, had a poor prognosis. However, when cases with Delta13 detectable by both cytogenetics and iFISH were separated from those detected by iFISH only, the poor prognosis of iFISH-detectable Delta13 disappeared; their outcome matched that of patients with no detectable Delta13 (P=0.115). Addition of ploidy status to iFISH-Delta13 did not affect the prognostic value of the test. Indeed both cytogenetics and iFISH Delta13 divided both hyperdiploidy and nonhyperdiploidy into two groups with similar prognoses, indicating that the poor prognosis of ploidy is entirely due to its association with Delta13. We conclude that Delta13 detected by metaphase analysis is a critical prognostic factor in myeloma. Absence of Delta13, even in those patients yielding only normal or no metaphases, is associated with a relatively good prognosis.

Differences between brain and rectal temperatures during routine critical care of patients with severe traumatic brain injury.

Theoretical models suggest that small differences only exist between brain and body temperature in health. Once the brain is injured, brain temperature is generally regarded to rise above body temperature. However, since reports of the magnitude of the temperature gradient between brain and body vary, it is still not clear whether conventional body temperature monitoring accurately predicts brain temperature at all times. In this prospective, descriptive study, 20 adults with severe primary brain trauma were studied during their stay in the neurointensive care unit. Brain temperature ranged from 33.4 to 39.9 degrees C. Comparisons between paired brain and rectal temperature measurements revealed no evidence of a systematic difference [mean difference -0.04 degrees C (range -0.13 to 0.05 degrees C, 95% CI), p = 0.39]. Contrary to popular belief, brain temperature did not exceed systemic temperature in this relatively homogeneous patient series. The mean values masked inconsistent and unpredictable individual brain-rectal temperature differences (range 1.8 to -2.9 degrees C) and reversal of the brain-body temperature gradient occurred in some patients. Brain temperature could not be predicted from body temperature at all times.

Age has a profound effect on the incidence and significance of chromosome abnormalities in myeloma.

A simple high throughput micro-fluorescence in situ hybridisation technique (FISH) was used to detect chromosome 13 deletions (delta13), immunoglobulin heavy chain (IgH) rearrangements, t(11;14)(q13;q32), t(4;14)(p16;q32), t(14;16)(q23;q32), p53 loss, and numerical changes of chromosomes 3, 6, 7, 9, 10, 11 and 17 in 228 cases of multiple myeloma (MM), including 33 asymptomatic/smouldering MM (SMM). The patients were not part of a clinical trial and were from 30 different hospitals. In all, 98.4% of cases were abnormal, with 43% having IgH rearrangements and 42% Delta13. The low incidence of IgH rearrangements was due to a decrease in this finding with age (P = 0.001) and the relatively high proportion of elderly patients in our study population (41% >70 years old). The incidence of specific IgH translocations was t(4;14) 11%, t(11;14) 16% and t(14;16) 3%. Univariate statistical testing showed delta13 (P = 0.002), and t(14;16) (P = 0.005) to be associated with shorter survival. This effect was exaggerated for patient's aged 70 years or under but no effect on survival was seen for those over 70 years. In younger patients t(4;14) (P = 0.044) and p53 deletion (P < 0.001) were also significant poor prognostic indicators. Multivariate analysis showed delta13 and t(14;16) to be independent prognostic variables when considered with age and clinical parameters.

Medium-induced inhibition of microbial adsorption to nickel and activated charcoal.

Equilibrium adsorption studies on Escherichia coli and Saccharomyces sp. revealed the capacity and affinity of these organisms for the surfaces of powdered charcoal and nickel. In simple salt solutions both organisms readily adsorbed to each solid with an affinity and maximum loading capacity individual to each cell-solid combination. In the presence of common growth media (lab-lemco, nutrient broth, peptone, and yeast extract, individually at a concentration of 1.3%), each medium substantially inhibited adsorption. Each medium contained a proteinaceous constituent as determined by ultraviolet (UV) analysis. The degree of inhibition was relative to medium concentration present during assay. Cell wall extracts from whole-yeast cells also effectively inhibited adsorption. Cells adsorbed in the presence of sodium chloride solutions were susceptible to subsequent desorption by nutrient broth.