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Vibrio gastroenteritis in the US Gulf of Mexico region: the role of raw oysters.

We examined clinical and epidemiological features of 575 laboratory-confirmed cases of vibrio gastroenteritis in Alabama, Florida, Louisiana, and Texas from 1988 to 1997 (the US Gulf of Mexico Regional Vibrio Surveillance System). Illnesses occurred year round, with peaks in spring and autumn. Illnesses lasted a median of 7 days and included fever in half of patients and bloody stools in 25% of patients with relevant information. Seventy-two percent of patients reported no underlying illnesses. In the week before onset, 236 (53%) of 445 patients for whom data were available ate raw oysters, generally at a restaurant or bar. Educational efforts should address the risk of vibrio gastroenteritis for raw oyster consumers, including healthy individuals. Further studies should examine environmental conditions affecting vibrio counts on seafood and processing technologies to enhance the safety of raw oysters.

Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting.

The influence of infection-control practices on bloodstream infection (BSI) risk was examined in a home health care setting in which three needleless devices were used consecutively. A case-control study and a retrospective cohort study were conducted. Risk factors for BSI included lower education level, younger age, having a central venous catheter (CVC) with multiple ports, or having a tunneled CVC. Among patients with a tunneled CVC, those at greatest risk had been allowed to shower rather than bathe and to get their exit site wet (P<.01). A high proportion (49%) of isolates were hydrophilic gram-negative bacteria, suggesting water sources of infection. In the cohort study, the BSI rate decreased as the frequency of changing the needleless device end cap increased from once weekly up to every 2 days, suggesting that the mechanism for BSI may involve contamination from the end cap. These findings may help to develop infection-control measures specific to home health care.

Vibrio vulnificus infection reporting on death certificates: the invisible impact of an often fatal infection.

This study assessed accuracy of (a) recording Vibrio vulnificus infection on death certificates and (b) International Classification of Disease (ICD)-9 codes for V. vulnificus. Patients with microbiologically confirmed V. vulnificus infection were identified as part of co-ordinated surveillance in four USA Gulf Coast states between 1989 and 1993. Of 60 deaths, 51 death certificates were reviewed and V. vulnificus was recorded as the immediate cause of death on 11 (22%). There was no ICD-9 code for V. vulnificus infection, thus no patients had an ICD-9 code indicating V. vulnificus infection. Of 23 certificates where V. vulnificus was recorded on the death certificate, only 5 (22%) were coded for Gram-negative, septicaemia. This study highlights the importance of teaching physicians how to provide epidemiologically meaningful data on death certificates and the need for accurate ICD mortality codes.

Infant sleep position instruction and parental practice: comparison of a private pediatric office and an inner-city clinic.

OBJECTIVE: To determine infant sleep instructions that hospital personnel in our community were giving to parents and actual positions practiced after the April 15, 1992 American Academy of Pediatrics recommendation for nonprone positioning. DESIGN: Survey of mothers of infants

Reproducibility of echocardiography. A study evaluating the variability of serial echocardiographic measurements.

In this study, serial reproducibility was determined on standard M-mode (M-mode) and two dimensional guided M-mode (2-D M-mode) records for ten normal volunteers and 20 patients. Overall intraobserver variability in the normal group was 518 +/- 1.8 percent (M-mode) and 3.1 +/- 0.8 percent (2-D M-mode), and in the patient group 3.1 +/- 0.6 percent (M-mode) and 4.7 +/- 0.7 percent (2-D M-mode) (P = NS). Variability on serial examination, however, was twofold to threefold greater. In the normal group, reproducibility varied by 10.8 +/- 1.6 percent (M-mode) and 9.4 +/- 1.2 percent (2-D M-mode), while in the patient group, it was 8.7 +/- 0.9 percent (M-mode) and 9.4 +/- 0.7 percent (2-D M-mode). The lowest serial variability achieved was for the diastolic LV dimension on serial M-mode examination (4 percent); the largest variability pertained to measurement of the interventricular septum (14 percent). Other structures had intermediate variation in reproducibility. This study emphasizes that establishing performance variability for an echocardiographic laboratory is an important part of the interpretation of serial records.

Long-range atmospheric transport of soil dust from Asia to the tropical north pacific: temporal variability.

The concentration of airborne soil dust at Enewetak Atoll(11 degrees N, 162 degrees E) in April 1979 was 2.3 micrograms per cubic meter but decreased steadily to 0.02 microgram per cubic meter over the next 5 months. The spring dust is probably derived from China; its deposition rate ( approximately 0.3 millimeter per 1000 years) suggests that it may be a significant contributor to the deep-sea sediments of the North Pacific.

Echocardiographic features of an unruptured aneurysm of the right sinus of Valsalva.

A 2-cm aneurysm of the right sinus of Valsalva was documented in a patient with a prosthetic aortic valve. The M-mode findings differed from prior reports and mimicked those of aortic root dissection or a catheter placed in the right ventricular outflow tract. Two-dimensional echocardiograms readily distinguished the aneurysm of the right sinus of Valsalva from the alternative possibilities.

Enrichment of heavy metals and organic compounds in the surface microlayer of Narragansett Bay, Rhode Island.

Concentrations of lead, iron, nickel, copper, fatty acids, hydrocarbons, and chlorinated hydrocarbons are enriched from 1.5 to 50 times in the top 100 to 150 micrometers of Narragansett Bay water relative to the bulk water 20 centimeters below the surface. Trace metal enrichment was observed in the particulate and organic fractions but not in the inorganic fraction. If these substances are concentrated in films only a few molecular layers thick on the water surface, the actual enrichment factor in the films may be well over 10(4), resulting in extremely high localized pollutant concentrations in the surface microlayer.

Chemotherapeutic activity of bluensomycin.

Bluensomycin inhibited various species of proteus in vitro at low concentrations. A lethal proteus infection in mice was cured by bluensomycin.

Chemotherapeutic activity of 5-fluorocytosine against a lethal Candida albicans infection in mice.

Numerous strains of Candida were inhibited by low concentrations of 5-fluorocytosine in vitro. Marked increase in life span occurred in C. albicans-infected mice treated with 5-fluorocytosine.