The effects of general anaesthesia on memory recall following day-case knee arthroscopy

Declaration: The authors would like to declare that this study has not been published or being reviewed by other journals. Retention of new information may be impaired during recovery from general anaesthesia. Patients are likely to be anxious if they cannot recall information conveyed at the surgeons’ postoperative visit. Previous studies have shown evidence of short-term memory impairment after GA. Patients undergoing day case knee arthroscopy under general anaesthesia were told five random words and three diagnostic findings from their operation, by the surgeon prior to discharge. The patients were telephoned the following day to test their recall of words and diagnostic findings, with a maximum possible score of eight. 96 patients were available for the telephone follow-up. The patients were grouped according to the interval between the end of anaesthesia and the time the information was given to them. For knee arthroscopy day cases it appears that, allowing as much time as possible after anaesthesia, at least two hours if possible, before reviewing a patient in the recovery area will likely enhance his/her later recall of the clinical information, potentially setting patient expectations at the appropriate level and improving compliance with postoperative rehabilitation. For the surgeons’ post-operative visit to be valuable to the patient, it should take place at least two hours following cessation of anaesthesia. It is advisable to endorse verbal communication with written information (AU)

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Correction of dorsally-malunited extra-articular distal radial fractures using volar locked plates without bone grafting.

Malunion is the most common complication of the distal radius with many modalities of treatment available for such a problem. The use of bone grafting after an osteotomy is still recommended by most authors. We hypothesised that bone grafting is not required; fixing the corrected construct with a volar locked plate helps maintain the alignment, while metaphyseal defect fills by itself. Prospectively, we performed the procedure on 30 malunited dorsally-angulated radii using fixed angle volar locked plates without bone grafting. At the final follow-up, 22 wrists were available. Radiological evidence of union, correction of the deformity, clinical and functional improvement was achieved in all cases. Without the use of bone grafting, corrective open wedge osteotomy fixed by a volar locked plate provides a high rate of union and satisfactory functional outcomes.

Comparison of two multiple-locus variable-number tandem-repeat analysis methods for molecular strain typing of human Brucella melitensis isolates from the Middle East.

Brucella species are highly monomorphic, with minimal genetic variation among species, hindering the development of reliable subtyping tools for epidemiologic and phylogenetic analyses. Our objective was to compare two distinct multiple-locus variable-number tandem-repeat analysis (MLVA) subtyping methods on a collection of 101 Brucella melitensis isolates from sporadic human cases of brucellosis in Egypt (n = 83), Qatar (n = 17), and Libya (n = 1). A gel-based MLVA technique, MLVA-15(IGM), was compared to an automated capillary electrophoresis-based method, MLVA-15(NAU), with each MLVA scheme examining a unique set of variable-number tandem repeats. Both the MLVA(IGM) and MLVA(NAU) methods were highly discriminatory, resolving 99 and 101 distinct genotypes, respectively, and were able to largely separate genotypes from Egypt and Qatar. The MLVA-15(NAU) scheme presented higher strain-to-strain diversity in our test population than that observed with the MLVA-15(IGM) assay. Both schemes were able to genetically correlate some strains originating from the same hospital or region within a country. In addition to comparing the genotyping abilities of these two schemes, we also compared the usability, limitations, and advantages of the two MLVA systems and their applications in the epidemiological genotyping of human B. melitensis strains.

Factors affecting platelet yield and their impact on the platelet increment of patients receiving single donor PLT transfusion.

The aim of this study was to analyze the impact of various donor and machine parameters on PLT yield in 127 PLT apheresis procedures, to optimize PLT yield achieving clinical and economic advantages. One hundred and twenty-seven apheresis procedures were analyzed. Age, gender, volume processed, Hb, and PLT precounts were included as donor predicting variables. AC infusion rate, processing time, and plasma volume collected with PLTs were assessed as machine parameters. We evaluated the post-transfusion effectiveness in 23 patients with thrombocytopenia, studying the effect of PLT dose, ABO group, and PLT storage time. Females gave higher yields, compared to males, P<0.01. PLT yield correlated positively with PLT precount (r=0.512), and TBV (r=0.404), and negatively with donor preapheresis Hb (r=-0.306). Processing time and AC infusion rate had a positive impact on PLT yield. Post-apheresis decrease in PLT count was 53.6+/-26.3x10(11). Donors with Hb>or=12 g/dl, donated safely. Most of the complications were citrate related (13.4% of all procedures). PLT increments in transfused patients correlated positively with the number of units transfused (r=0.41), and negatively with PLT storage days (r=-0.342). PLT increments in patients receiving ABO-compatible PLTs were 75% higher, compared to the increments in patients receiving incompatible PLTs. PLT count and volume processed were the main predictors of PLT yield. Increasing the processing time, the AC infusion rate, or the volume of plasma obtained with PLTs can increase PLT yields. High PLT dose, short storage time, as well as ABO compatibility should be considered during PLT transfusion.

Isolation of Exophiala dermatitidis from endotracheal aspirate of a cancer patient.

Exophiala (Wangiella) dermatitidis is a melanised (darkly pigmented) yeast-like organism that has been reported from the environment and wild animals. The organism is a frequent coloniser of lungs of patients with cystic fibrosis and causes occasional disseminated phaeohyphomycosis and fungaemia. Exophiala dermatitidis is distributed worldwide, but cerebral cases are restricted to East Asia. We report a case of 54-year-old Qatari female patient with a known history of cancer, suffering from pulmonary disorder. Culture of endotracheal aspirate revealed the growth of E. dermatitidis concomitant with Candida krusei. The final diagnosis of E. dermatitidis and attribution to genotype B was achieved by sequencing the rDNA internal transcribed spacer (ITS) region. The present case concerns a pulmonary colonisation by E. dermatitidis, similar to that commonly seen in cystic fibrosis patients. For the detection of E. dermatitidis in clinical specimens culturing techniques are required. The patient finally expired with persistent cancer and C. krusei fungaemia. Review of literature and listing of E. dermatitidis cases published after 1992 show a sharp increase in clinical cases during the 1990s.

Microbiological identification in cystic fibrosis patients with CFTR I1234V mutation.

Recurrent and chronic bacterial pulmonary infection is the major cause of morbidity and mortality in cystic fibrosis (CF). Over 6 months, 72 sputa or oropharyngeal samples were examined from 36 Arab Bedouin CF patients attending Hamad General Hospital, Doha, Qatar. More than 100 pathogens were isolated, mostly Haemophilus influenzae, Staphylococcus aureus and Pseudomonas aeruginosa. Unusual pathogens included Stenotrophomonas maltophilia, Acaligenes xylosoxidans and Mycobacterium abscessus. It is concluded that microbiological biodiversity in the lower airways of CF patients continues to be underestimated and that CF patients harbouring mucoid strains of P. aeruginosa are at a higher risk of acquiring more unusual organisms and probably have a worse prognosis.

Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit.

Between January and June 2002, an outbreak of multidrug-resistant Acinetobacter baumannii occurred in a trauma intensive care unit (TICU) at the Hamad Medical Corporation, Qatar. The outbreak involved 21 patients whose infection/colonization was hospital acquired. All the strains were resistant to all tested antibiotics except amikacin. An A. baumannii strain with a similar antibiogram was isolated from the environment, equipment and hands of healthcare workers (HCWs). The technique of open suctioning probably resulted in aerosilization and contamination of the immediate patient environment. This allowed the hands of HCWs to be contaminated with the outbreak strain, with subsequent transmission to other patients and their environment. Lack of proper hand hygiene between patients and equipment contact facilitated this transmission. A review of hand hygiene practices, extensive environmental cleaning, a closed suctioning system, education and review of other infection-control practices, contributed to the termination of the outbreak.

Coronary events in Khartoum, Sudan.

The aim of the study was to determine coronary events in a defined Sudanese population. All coronary events occurring in Khartoum, the capital of Sudan, were registered during the calendar year 1989. The cold pursuit method of identifying coronary events by surveillance of routinely collected data was adopted. A total of 517 cases representing coronary events in 1989 was recorded and submitted to the WHO MONICA diagnostic and classification protocol. The annual (1989) coronary event rate for men and women was 112/100,000, with a total mortality rate of 36/100,000 (men, 52/100,000; women, 18/100,000). Event rates for men and women were 162/100,000 and 64/100,000 and fatality rates were 33 and 30%, respectively. The highest event rate 364/100,000, occurring in men 45-64 years of age compared to 120/100,000 in women of the same age group. The study establishes a baseline for coronary event rates, mortality, and case fatality rates. It also defines coronary heart disease in Khartoum and provides means for comparison with other countries. We recommend that the disease receive more health attention, and efforts to define the precipitating risk factors should be undertaken. Health education and preventive measures to curb the disease are needed.

An outbreak of gentamicin-resistant Klebsiella pneumoniae in a neonatal ward.

Gentamicin-resistant Klebsiella pneumoniae (GRKP) was isolated from nineteen patients in the neonatal ward of Sultan Qaboos University Hospital (SQUH) in Oman. Thirteen cases were infected and six were colonized. Two infected patients died due to septicaemia, eight cases occurred within SQUH and eleven cases were imported from other hospitals. Sixteen isolates were of the same serotype (K25), three were non typeable. Referred patients from peripheral hospitals were the source of the organism and hand carriage the probable vehicle of transmission. The first strain of gentamicin-sensitive Kleb. pneumoniae was isolated five months after combating the outbreak.

The Widal test in a normal healthy population in the Sudan.

The Widal test was performed in 114 normal individuals from the Gezira area in Sudan. Salmonella typhi O agglutinins were found at a titre of 1.320 in 12 (10.5%) of them. Salmonella paratyphi A agglutinins were found at 1.160 in 5 (4.3%) and Salmonella paratyphi B "O" agglutinins were found in 6 (5.3%) at a titre of 1.160. None of these individuals had a history of typhoid fever or vaccination with TAB vaccine. The following points emerged: (i) normal healthy people in the Sudan have high antibody titres of Salmonella typhi; (ii) the Widal test in the Sudan should be interpreted against this background; (iii) previous diagnostic titre of 1.160 for S. typhi results in high false positive results; (iv) a titre above 1.320 is suggested as diagnostic for S. typhi; 1.160 for both S. partyphi B and S. paratyphi A.