Intracerebral haemorrhage in a young adult: consider amphetamine abuse

We present the case of a young female who suffered a massive intracerebral bleed following the ingestion of a small quantity of amphetamine (speed). Physicians should be aware that amphetamine abuse can lead to cerebrovascular events in young adults.     

Reduced speed of sound in tibial bone of haemodialysed patients: association with serum PTH level

BACKGROUND: In end-stage renal disease, average bone mineral density has been reported to be normal or only modestly reduced, more so in the cortical bone. The purpose of the present study was to explore the potential use of quantitative ultrasound, a method reflecting both quantitative and qualitative properties of bone, in assessing bone status in patients on maintenance haemodialysis. METHODS: We studied 71 patients (age 17-81 years, time on dialysis 0-18 years). The speed of sound waves (tSOS; m/s) propagating along the cortical bone has been determined at the tibial shaft. tSOS results were expressed as Z scores, i.e. units of standard deviations from age- and sex-matched normal mean values, and correlated with relevant clinical and biochemical variables. RESULTS: SOS Z score averaged -2. 0 (range -6.8 to 0.6; P<0.001) and was negative in 93% of the patients. Significant inverse correlations were found between SOS Z score and both time on dialysis (r=-0.52; P<0.0001) and serum PTH (r=-0.39; P=0.0002). Markedly reduced SOS Z score, below -2, was found in 80% of the patients whose PTH levels exceeded 34 pmol/l (five times the upper normal limit), compared with 43% of the patients whose PTH levels were below 34 pmol/l(P=0.04). Compared to patients without bone pain (n=51), subjects with bone pain (n=20) had somewhat lower SOS Z scores -2.5+/-2.0 versus -1.8+/-1.4; P=0. 08), but this could be accounted for by longer time on dialysis. CONCLUSIONS: tSOS is substantially reduced in the majority of haemodialysed patients and is related to time on dialysis and serum PTH level. The clinical value of this novel method needs further exploration.     

Actinoplanic acids A and B as novel inhibitors of farnesyl-protein transferase

Actinoplanic acids A and B are macrocyclic polycarboxylic acids that are potent reversible inhibitors of farnesyl-protein transferase. Actinoplanic acids A and B were isolated from Actinoplanes sp. MA 7066 while actinoplanic acid B was isolated from both MA 7066 and Streptomyces sp. MA 7099. Actinoplanic acids A and B are competitive with respect to farnesyl diphosphate and are selective inhibitors of farnesyl-protein transferase because they do not inhibit geranylgeranyl-protein transferase type 1 or squalene synthase. MA 7066 is believed to be a novel species of actinomycetes while MA 7099 is believed to be a novel strain of Streptomyces violaceusniger on the basis of morphological, biochemical and chemotaxonomic characteristics as well as its production of actinoplanic acids.     

Improvement of some pharmaceutical properties of drugs by cyclodextrin complexation. 4. Chlorpromazine hydrochloride

This study is a retrospective review of admissions, discharge records and blood culture results of neonates admitted to the Neonatal Intensive Care Unit of Korle Bu Teaching Hospital in Accra, from the first of January 1991 to the 31st of December 1992. During this two year period there were 443 positive blood cultures. Ninety percent of the blood cultures were from babies born in Korle Bu Teaching Hospital, thus making the incidence of neonatal bacteraemia 22.2 per 1000 live births. The overall mortality rate was 37.2%. Gram negative bacteria accounted for 70.9% and Gram positive bacteria for 29.1% of all neonatal bacteraemia. The most common isolates were Enterobacter species 29.6%; Streptococcus faecalis 14.4%; Staphylococcus aureus 10.8%; Acinetobacter species 9.5%; Klebsiella species 9% and Escherichia coli 8.8%. It is concluded that the incidence of neonatal bacterial sepsis is high in our hospital and is associated with a very high mortality rate. There is thus an urgent need to institute appropriate preventive and therapeutic measures.     

Accidental hypothermia: incidence, risk factors and clinical course of patients admitted to hospital

This study was initiated to identify the incidence, risk factors and outcome predictors of patients admitted to hospital in the Netherlands because of accidental hypothermia. Information about these patients was available for study through the National Health Care Data Bank. Between 1987 and 1990, 612 accidental hypothermic patients were admitted: 185 hypothermic patients also suffered from submersion (HYPSUBS), but this was not the case in the remaining 427 patients (HYPNOTSUBS). Patients in the HYPNOTSUBS group were older (average age 55.2 years versus 38.9 years; p < 0.001), remained longer in hospital (average 20.8 days versus 9.2 days; p < 0.001) and had a higher death rate than those in the HYPSUBS group (16.9% versus 5.9%; p < 0.001). In HYPNOTSUBS, increasing age correlated with increases in the length of hospital stay and death rate. This relationship was not found in HYPSUBS. Trauma was the major associated problem in both groups; these patients had the highest death rate (22.8% versus 16.7%; not significant). Death occurred within 2 days in 54% of HYPNOTSUBS non-survivors and 73% of HYPSUB non-survivors. HYPNOTSUBS admitted to university hospitals showed a lower death rate (5.9%) compared with HYPNOTSUBS admitted to non-university hospitals with less than 400 beds (13.4%) or more than 400 beds (21.7%). In contrast, the death rate in HYPSUB was higher in university hospitals (14.3%) than in non-university hospitals with less than 400 beds (5.2%) or more than 400 beds (3.6%). We observed that the incidence of accidental hypothermia is low at 1.1 per 100,000 inhabitants per year. We concluded that HYPNOTSUBS and HYPSUB are different groups of patients with respect to demographic data, risk factors and prognostic factors. Old age is an important unfavourable prognostic factor in HYPNOTSUB but not in HYPSUB. Hypothermia with trauma is an unfavourable combination in both groups. Almost half of the HYPNOTSUBS non-survivors died after more than 2 days. Because body temperature will have returned to normal by then, this must be the result of late complications. Most HYPSUB non-survivors died during the first 2 days, probably as a direct result of the submersion injury.     

Antithrombin III and trauma patients: factors that determine low levels

Using capillary videomicroscopy of the nail fold, the frequency of cold-induced vasospasm and capillary hemodynamic parameters were studied after application of cold in 50 patients with primary fibromyalgia, 50 patients with chronic low back pain, and 50 healthy controls. Cold-induced vasospasm was detected in 38% of the patients with fibromyalgia. In this group it was significantly more frequent than in the patients with chronic low back pain (20%, p < 0.05) and healthy subjects (8%, p < 0.001). In the fibromyalgia group, the magnitude of vasospasm as measured by the capillary blood flow deceleration after cold application correlated negatively with the pain intensity as measured by pain score (r = -0.3839, p < 0.01). No differences in clinical appearance were found between patients with and without cold-induced vasospasm in both the fibromyalgia and low back pain group.     

Prevention of infective endocarditis in the pediatric congenital heart population

In 1997, the American Heart Association updated recommendations for the prevention of sub-acute bacterial endocarditis (SBE) or infective endocarditis (IE) occurring in the pediatric population with congenital heart disease (Dajani, et al., 1997). Although uncommon, endocarditis remains an important cause of morbidity and mortality in children with cardiovascular disease, which constitutes the primary population at risk. Through comprehensive discharge planning and teaching, the advanced practice nurse (APN) and the pediatric cardiovascular nurse may contribute significantly toward preventing IE in this population. Nursing's role and responsibility is to convey the appropriate information to patients, families, and the staff who care for children with heart disease.