Refeeding syndrome is uncommon in alcoholics admitted to a hospital detoxification unit.

The refeeding syndrome is increasingly recognised. It is a serious change in electrolytes when nutrition is reintroduced to malnourished patients. Alcohol dependence is a risk factor for the refeeding syndrome. We report a prospective cohort study of 36 alcoholics hospitalised for withdrawal management. We found no evidence of refeeding syndrome in any patient after 3 days of hospitalisation, despite hypomagnesaemia, a risk factor for the refeeding syndrome being prevalent (44% of subjects). Low thiamine levels were infrequent affecting 3/29 (10%). We recommend that in alcoholics admitted for managed withdrawal, risk of refeeding syndrome appears to be low, and routine testing of repeat electrolytes appears unnecessary.

Comparative antimicrobial activities of aerosolized sodium hypochlorite, chlorine dioxide, and electrochemically activated solutions evaluated using a novel standardized assay.

The main aim of this study was to develop a standardized experimental assay to enable differential antimicrobial comparisons of test biocidal aerosols. This study represents the first chlorine-matched comparative assessment of the antimicrobial activities of aerosolized sodium hypochlorite, chlorine dioxide, and electrochemically activated solution (ECAS) to determine their relative abilities to decontaminate various surface-associated health care-relevant microbial challenges. Standard microbiological challenges were developed by surface-associating typed Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus subtilis spores, or a clinical methicillin-resistant S. aureus (MRSA) strain on stainless steel, polypropylene, or fabric. All test coupons were subjected to 20-min biocidal aerosols of chlorine-matched (100 ppm) sodium hypochlorite, chlorine dioxide, or ECAS within a standard aerosolization chamber using a commercial humidifier under defined conditions. Biocidal treatment type and material surface had a significant effect on the number of microorganisms recovered from various material surfaces following treatment exposure. Under the conditions of the assay, the order of antimicrobial efficacy of biocidal aerosol treatment was as follows: ECAS > chlorine dioxide > sodium hypochlorite. For all biocides, greater antimicrobial reductions were seen when treating stainless steel and fabric than when treating plastic-associated microorganisms. The experimental fogging system and assay protocol designed within this study were shown capable of differentiating the comparative efficacies of multiple chlorine-matched biocidal aerosols against a spectrum of target organisms on a range of test surface materials and would be appropriate for testing other biocidal aerosol treatments or material surfaces.

Electrochemically activated solutions: evidence for antimicrobial efficacy and applications in healthcare environments.

Due to the limitations associated with the use of existing biocidal agents, there is a need to explore new methods of disinfection to help maintain effective bioburden control, especially within the healthcare environment. The transformation of low mineral salt solutions into an activated metastable state, by electrochemical unipolar action, produces a solution containing a variety of oxidants, including hypochlorous acid, free chlorine and free radicals, known to possess antimicrobial properties. Electrochemically activated solutions (ECAS) have been shown to have broad-spectrum antimicrobial activity, and have the potential to be widely adopted within the healthcare environment due to low-cost raw material requirements and ease of production (either remotely or in situ). Numerous studies have found ECAS to be highly efficacious, as both a novel environmental decontaminant and a topical treatment agent (with low accompanying toxicity), but they are still not in widespread use, particularly within the healthcare environment. This review provides an overview of the scientific evidence for the mode of action, antimicrobial spectrum and potential healthcare-related applications of ECAS, providing an insight into these novel yet seldom utilised biocides.

Evaluation of the efficacy of electrochemically activated solutions against nosocomial pathogens and bacterial endospores.

AIMS: Electrochemically activated solutions (ECAS) are generated from halide salt solutions via specially designed electrolytic cells. The active solutions are known to possess high biocidal activity against a wide range of target microbial species, however, literature revealing the kill-kinetics of these solutions is limited. The aim of the study was to identify the kill-rate and extent of population kill for a range of target species (including endospores) using ECAS generated at the anode (anolyte). METHODS AND RESULTS: Standard suspensions of methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus atrophaeus spores and Clostridium difficile spores were treated with anolyte in a quantitative suspension assay. For vegetative cells, all concentrations of anolyte tested reduced the viable population to below the detection limit within 10 s. At a concentration of 99%, anolyte produced a log(10) reduction factor of greater than five in viable B. atrophaeus endospores within 90 s and reduced numbers of C. difficile endospores to below the experimental detection limit within 20 s at concentrations of 5% or greater. CONCLUSIONS: Anolyte was highly effective in killing test-bacteria and spores. The bactericidal efficacy was retained against vegetative cells at dilutions as low as 1% and against C. difficile spores as low as 5%. SIGNIFICANCE AND IMPACT OF STUDY: The results of this study demonstrate that ECAS are effective at lower concentrations and act more rapidly than previously reported. Potent bactericidal and sporicidal activity coupled with point-of-use generation, low production-costs and environmental compatibility suggest that acidic ECAS has the potential to be a useful addition to the current armoury of disinfectants.

Should ethanol be scheduled as a drug of high risk to public health?

Six criteria described in the New Zealand Misuse of Drugs Act and used by the Expert Advisory Committee on Drugs (EACD) for determining the risk of a drug to public health were examined in relation to ethanol, using gamma-hydroxybutyric acid (GHB) as a comparator drug. GHB is an ideal candidate for use as a comparator because it is a sedative substance very similar to ethanol and has been previously investigated by the EACD using these six criteria. GHB was subsequently classified as a Class B1 drug under the Misuse of Drugs Act, that is, as a prohibited drug of high risk to public health. The dangerousness level of ethanol was found to be at least similar to that of GHB in this analysis. This highlights a major discrepancy in public policy.

Surface engineering of artificial heart valve disks using nanostructured thin films deposited by chemical vapour deposition and sol-gel methods.

Pyrolytic carbon (PyC) is widely used in manufacturing commercial artificial heart valve disks (HVD). Although PyC is commonly used in HVD, it is not the best material for this application since its blood compatibility is not ideal for prolonged clinical use. As a result thrombosis often occurs and the patients are required to take anti-coagulation drugs on a regular basis in order to minimize the formation of thrombosis. However, anti-coagulation therapy gives rise to some detrimental side effects in patients. Therefore, it is extremely urgent that newer and more technically advanced materials with better surface and bulk properties are developed. In this paper, we report the mechanical properties of PyC-HVD, i.e. strength, wear resistance and coefficient of friction. The strength of the material was assessed using Brinell indentation tests. Furthermore, wear resistance and coefficient of friction values were obtained from pin-on-disk testing. The micro-structural properties of PyC were characterized using XRD, Raman spectroscopy and SEM analysis. Also in this paper we report the preparation of freestanding nanocrystalline diamond films (FSND) using the time-modulated chemical vapour deposition (TMCVD) process. Furthermore, the sol-gel technique was used to uniformly coat PyC-HVD with dense, nanocrystalline-titanium oxide (nc-TiO2) coatings. The as-grown nc-TiO2 coatings were characterized for microstructure using SEM and XRD analysis.

Blood pressure response to glucose potassium insulin therapy in patients with acute stroke with mild to moderate hyperglycaemia.

Insulin is neuroprotective in animal stroke models but its effects in acute stroke in humans are unknown. The Glucose Insulin in Stroke Trial (GIST-UK) is a randomised controlled trial investigating the benefits of maintaining euglycaemia in hyperglycaemic patients with acute stroke. Data are reported from a GIST-UK substudy which sought to determine the influence of glucose potassium insulin (GKI) infusion on blood pressure in acute stroke. All adult patients admitted to hospital with acute stroke with hyperglycaemia (plasma glucose 6.1-17 mmol/l) were potentially eligible. Randomised patients received either a GKI infusion (500 ml 10% glucose, 20 mmol potassium chloride, 16 units of insulin) or control therapy with 154 mmol/l (0.9%) saline at 100 ml/h for 24 hours. BM test strip glucose monitoring was performed 2 hourly, blood pressure monitoring 4 hourly, and plasma glucose sampling 8 hourly. Insulin concentration in the GKI infusate was altered according to test strip values to maintain test strip values between 4-7 mmol/l in the GKI group. Neurological impairment was determined using the European stroke scale (ESS). 145 patients were studied (73 GKI, 72 control). Mean systolic blood pressure was significantly lower during GKI infusion between 4 hours and 24 hours except at 8 hours. Median total ESS scores improved significantly between admission and day 7 in the GKI group (p<0.001) although there was no significant difference in total ESS score between groups at day 7. The significant reduction of systolic blood pressure in acute stroke associated with GKI therapy was not associated with neurological deterioration and may have been beneficial.

Follow up testing of hyperglycaemia during hospital admission: combined use of fasting plasma glucose and HbA1c.

AIM: To follow up patients without known diabetes, but with hyperglycaemia in hospital for diabetes at one year. METHODS: 159 patients with a random plasma glucose > or = 7.8 mmol/L recorded during hospital admission were sent a questionnaire and invited to have the following test one year following discharge: fasting plasma glucose, HbA1c and fasting lipid profile. Those with a fasting plasma glucose > or = 5.5 and < 7.0 mmol/L, and/or those with a HbA1c > or = 6.0%, were asked to have an oral glucose tolerance test. Those with a fasting plasma glucose > or = 7.0 mmol/L were defined as having diabetes. RESULTS: There were 88 full responses. Nineteen (21.6%) had diabetes and nine impaired glucose tolerance. Hb1Ac was > or = 6% in five subjects with a fasting plasma glucose < 5.5 mmol/L. Two had impaired glucose tolerance and one diabetes. If a random plasma glucose in-hospital of 10 mmol/L is used as a threshold for later testing, as suggested by previous studies, then 25% of those with an abnormal result would have been missed. CONCLUSIONS: A high proportion of those with hyperglycaemia in hospital have diabetes or impaired glucose tolerance at one year. Initial testing with fasting plasma glucose and HbA1c avoided oral glucose tolerance test in 76% of cases. Use of HbA1c detected otherwise missed diabetes and impaired glucose tolerance. A random plasma glucose of > or = 7.8 mmol/L in hospital targets patients who should be tested for impaired glucose tolerance or diabetes following discharge.

Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia: the Glucose Insulin in Stroke Trial (GIST).

BACKGROUND AND PURPOSE: Hyperglycemia following acute stroke is strongly associated with subsequent mortality and impaired neurological recovery, but it is unknown whether maintenance of euglycemia in the acute phase improves prognosis. Furthermore, the safety of such intervention is not established. METHODS: In an explanatory, randomized, controlled trial to test safety, 53 acute (within 24 hours of ictus) stroke patients with mild to moderate hyperglycemia (plasma glucose between 7.0 and 17.0 mmol/L) were randomized to receive either a 24-hour infusion of 0.9% (154 mmol/L) saline or a glucose potassium insulin (GKI) infusion at 100 mL/h. The GKI consisted of 16 U human soluble insulin and 20 mmol potassium chloride in 500 mL 10% glucose. Blood glucose was measured every 2 hours with Boehringer Mannheim Glycaemie test strips, pulse and blood pressure were measured every 4 hours, and plasma glucose samples were taken every 8 hours. Insulin concentration in the GKI was altered according to BM glucose values. RESULTS: There were no statistically significant differences between the 2 groups at baseline. Twenty-five patients received GKI, 1 of whom required intravenous glucose for symptomatic hypoglycemia. Plasma glucose levels were nonsignificantly lower in the GKI group throughout the infusion period. Four-week mortality in the GKI group was 7 (28%), compared with 8 (32%) in the control group. CONCLUSIONS: GKI infusions can be safely administered to acute stroke patients with mild to moderate hyperglycemia producing a physiological but attenuated glucose response to acute stroke, the effectiveness of which remains to be elucidated.

Development of a capillary electrophoretic separation of an N-(substituted)-glycine-peptoid combinatorial mixture.

Capillary electrophoresis was used for the separation of a combinatorially synthesized N-(substituted)-glycine (NSG) peptoid mixture. This mixture consisted of 24 trimeric compounds sharing a common backbone structure but differing in the side chain attached at the N-terminal residue. Standards of the individual components were unavailable so that development of the separation was based on the mixture. A variety of buffer additives were investigated to enhance the CE resolution of this diverse mixture. Ion-pairing agents, cyclodextrins and organic modifiers were all evaluated as buffer additives. The best separations were achieved using a combination of buffer additives, each serving a different purpose in the separation. Heptane sulphonic acid (HSA) was used to reduce hydrophobic intramolecular interactions. Methyl-beta-cyclodextrin was used to provide host-guest interactions in order to resolve the very hydrophobic components of the NSG-peptoid mixture. The optimized run buffer consisted of 250 mM sodium phosphate buffer, pH 2.0, with 25 mM HSA and 40 mg/ml BCD and resulted in the resolution of 21 peaks for the 24 peptoids in the combinatorial mixture.

Application of capillary electrophoresis to the separation of structurally diverse N-(substituted)-glycine-peptoid combinatorial mixtures.

The capillary electrophoresis (CE)-based separation of five N-(substituted)-glycine (NSG)-peptoid mixtures with a wide range of physical and chemical properties was studied. A CE separation, initially developed using a single representative peptoid mixture, with a background electrolyte (BGE) modified by the addition of both methyl-beta-cyclodextrin and heptane sulfonic acid was found to provide good separations of most of the combinatorial mixtures investigated. For those mixtures not separated well by this procedure, the use of SDS micelles in conjunction with methyl-beta-cyclodextrin resulted in dramatic improvements in the separation. While no single set of separation conditions proved sufficient for all of the NSG-peptoid combinatorial mixtures, the two methods were able to provide separation sufficient for characterization of a set of mixtures with a wide range of physical and chemical properties. The efficiency of the CE-based separation of the combinatorial mixtures studied was compared to a reversed-phase liquid chromatographic method using gradient elution.

Comparison of two commercial test kits for quantification of serum carbohydrate-deficient transferrin.

Serum levels of carbohydrate-deficient transferrin (CDT) were measured in subjects of two independent studies using two different commercial kits. The kits measure CDT either as a percentage of total transferrin (AXIS %CDT, AXIS Biochemicals AS, Norway), or as the absolute amount (CDTect, Pharmacia, Sweden). In a population of males (mean age 41 years) consisting of alcoholics, heavy, moderate and non-drinkers, a strong correlation was found between AXIS %CDT and CDTect results (r = 0.92, n = 58, P < 0.001). Sensitivity and specificity in detecting chronic alcoholic drinking of over 60 g/day were 78 and 94% for the AXIS assay, and 83 and 88% for the CDTect assay, respectively. In a population from a birth cohort study, consisting of 21-year-old males and females with less excessive alcohol consumption, the correlation between AXIS %CDT and CDTect CDT was weaker but still statistically significant (r = 0.46, n = 212, P < 0.001). In this population, with specificities > 83% in detecting alcohol consumption levels of > or = 6 drinks per week, the sensitivities were low with both CDT assays (< 43% for > or = 6 drinks per week, and < 44% for > or = 16 drinks per week). These results suggest that (a) both assays are equally effective in detecting chronic drinking over 60 g/day in older alcoholic males, and (b) both assays are similarly ineffective in detecting less excessive regular drinking in young males and females.

Vibration-resistant direct-phase-detecting optical interferometers.

Two dual-beam differential direct-phase-detecting optical interferometers for scanning moving surfaces are described. Two beams from these interferometers are focused ~42 mum apart on moving surfaces, and the difference in their reflected path lengths is measured to provide the surface roughness measurement. These interferometers are exceptionally insensitive to environmental vibrations and to surface physical and chemical factors. Applications discussed include the measurement of the surface roughness of a rotating cylinder and a moving web.

Hepatitis C prevalence and needle/syringe sharing behaviours in recent onset injecting drug users.

AIM: To investigate the prevalence of hepatitis C antibody (anti-HCV) in injecting drug users (IDU), particularly amongst those of recent onset beginning since the advent of the needle-exchange programme. Secondly this study sought information on needle-sharing practices. METHODS: The records of injecting drug users over 2 years from January 1992 were examined for anti-HCV results and needle-sharing reports on initial assessment at the Wellington drug dependency clinic. RESULTS: Amongst 110 injecting drug users 92 (84%) were tested for anti-HCV, and 71 (77%) were positive. There was a significant (p = 0.02) association between the reported duration of intravenous drug misuse and the proportion of injecting drug users who were positive for anti-HCV. Of those injecting drug users who had reported use of less than 4 years, since the introduction of the New Zealand needle exchange programme, 53% were positive for anti-HCV. Needle-sharing was frequently reported to have ever occurred in 74% of these patients at some time, and in 64% of those who reported use of less than 4 years. These differences were not significant. However, in the period before presenting 67% had not shared over the last 3 months and 57% had not shared over the previous 1 year, which are improvements on previous studies of needle-sharing, considered to be the most important mode of transmission for blood-borne viruses in injecting drug users. CONCLUSIONS: These results suggest considerable potential for HIV infection rates among injecting drug users in New Zealand to increase from the current low level. There needs to be continuing emphasis on public health programmes to eradicate needle-sharing, and to promote safe injecting techniques for injecting drug users.

The safety, tolerability and efficacy of transdermal nicotine (Nicotinell TTS) in initially hospitalised patients.

AIM: We studied a transdermal nicotine system with minimal behavioural intervention in hospitalised patients to assess patient acceptability, safety and efficacy. METHOD: In an open noncomparative study, 80 smoking patients (42 men and 38 women) were enrolled. They received 24-hour nicotine patches and simple support for 12 weeks and were followed for up to 26 weeks. Smoking was assessed by interview, expired air carbon monoxide and blood cotinine. RESULTS: Side effects included itch and local erythema (4), insomnia (7), abnormal taste (3). Two subjects withdrew from the study because of side effects. At 12 weeks 17 were nonsmokers. At 26 weeks 19 of 80 were nonsmokers and a further 14 had reduced their intake significantly. CONCLUSIONS: The nicotine skin patch proved to be safe and well tolerated. Efficacy was comparable to controlled trials of transdermal nicotine patches.