Practice parameters for evaluating new fever in critically ill adult patients. Task Force of the American College of Critical Care Medicine of the Society of Critical Care Medicine in collaboration with the Infectious Disease Society of America

OBJECTIVE: To develop practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice. PARTICIPANTS: A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened from the membership of the Society of Critical Care Medicine, and the Infectious Disease Society of America. EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times in person and twice monthly by teleconference over a 1-yr period of time to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the experts' opinions. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. CONCLUSIONS: The panel concluded that, because fever can have many infectious and noninfectious etiologies, a new fever in a patient in the ICU should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests. A cost-conscious approach to obtaining cultures and imaging studies should be undertaken if it is indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether or not infection is present, so additional testing can be avoided and therapeutic options can be made.     

A new PCR-primer for specific amplification of human DNA fragments selected on the basis of computer analysis of the nucleotide sequences of MER1 dispersed repeats in man

A HPLC method with coulometric detection has been established to carry out the separation of the three nitrofuran derivatives, nitrofurantoin, furazolidone and furaltadone. A Nova-Pak C18 column (150 x 3.9 mm) and a Coulochem II detector from ESA have been used. After obtaining the hydrodynamic curves of the three compounds in the porous graphite electrode a potential of -600 mV was selected as the working potential. The influence of other variables such as mobile phase composition and flow-rate were studied. The mobile phase considered as an optimum was acetonitrile-0.1 M aqueous solution of sodium perchlorate (28:72), with 0.5% glacial acetic acid. The oxygen of the mobile phase was removed with a vacuum system on-line and a nitrogen stream was used to remove the oxygen of the samples. The calibration graphs and the detection limits were established. The method proposed was used, with good results, for the determination of the three compounds in milk.     

The hospital nurse's role in managed care

This article describes the staff nurse's role in managed care and can be used by nurse managers in the education process. An obstetric case study demonstrates the potential of increasing patient-care quality while reducing health care cost.     

The emergence of silent myocardial ischemia as the manifestation of the nitrate withdrawal syndrome in patients with ischemic heart disease

A patient is described, who was examined 1 year after surgery for mandibular cyst diagnosed as radicular near the !5 tooth and for plasty of the secondary osseous cavity with hydroxyapatite granulate. X-Ray examination revealed a cystic cavity near the roots of teeth !234. Histologic examination of tissue fragments and the remainder of hydroxyapatite granulate, obtained by cystectomy, helped diagnose a primordial cyst. Intensive bone regeneration was observed at the site of hydroxyapatite granule accumulation and fusion of the new bone with the granules to form a solid osseogranular complex. The authors recommend hydroxyapatite ceramic granules for surgical treatment of minor and medium bone defects and for corrective bone plasty.     

Changes in the prevalence of residual pockets and tooth loss in treated periodontal patients during a supportive maintenance care program

Bleeding on probing and the presence of deep periodontal pockets are considered to be the best site-specific indicators for periodontal disease progression during the maintenance phase of periodontal therapy. A major emphasis of supportive periodontal care (SPC) programs, therefore, has been the control of bleeding pockets. This investigation retrospectively evaluated the changes in the prevalence of bleeding on probing, periodontal pockets, bleeding periodontal pockets and the prevalence of tooth loss in a random sample of 273 periodontal patients participating in a supportive maintenance care program at a University Clinic. During an observation period of 67+/-46 months (range 5 months to 23 years), the overall incidence of all causes of tooth mortality was 0.23+/-0.49 teeth per patient per year of observation. 56% of subjects, however, did not experience any tooth loss, while less than 10% of patients lost more than 3 teeth. Thus, participation in the SPC program was effective in preventing tooth loss in the majority of patients. During the SPC period, however, a significant increase in the prevalence of periodontal pockets, and of bleeding on probing positive periodontal pockets, in particular, was observed. At completion of active periodontal therapy, 56.4% of patients were free from bleeding pockets. This decreased to a mere 13.6% at the latest SPC evaluation. The observed increases in the number of bleeding pockets was significantly associated with: longer times since completion of active periodontal therapy, more advanced periodontal diagnosis, higher %s of bleeding sites in the dentition, cigarette smoking, lack of inclusion of periodontal surgery in the active treatment phase, tooth loss, and the response to the active phase of periodontal treatment. The data presented in the paper indicate that the observed increase in the prevalence of bleeding pockets and tooth loss was not homogeneously distributed in the studied SPC population. Rather, high risk groups of individuals could be identified. It is suggested that better knowledge of risk indicators may lead to improved and more efficient risk management efforts during periodontal maintenance care.     

Detection of telomerase activity in Chinese hamster V79 cells and its inhibition by 7-deaza-deoxy guanosine triphosphate and (TTAGGG)4 in vitro

To investigate the nature of telomerase activity and its inhibition in Chinese hamster V79 cells, we have detected telomerase activity in Chinese hamster cells using Telomeric Repeat Amplification Protocol (TRAP) assay. We have further studied inhibition characteristics of this enzyme in vitro by nucleotide analogue 7-deaza-2'-deoxy guanosine triphosphate (7-deaza-dGTP) and oligonucleotide (TTAGGG)4. Both the inhibitors inhibited the telomerase activity in a dose dependent manner. To attain 50% inhibition of the telomerase activity, we needed about 4.5 microM of 7-deaza-dGTP. Similarly, preincubation at 37 degreesC of the cell extract with 1.25 x 10(-3) microgram oligonucleotide (TTAGGG)4 showed 50% inhibition of the control value. Inhibition of telomerase activity by 7-deaza-dGTP could be due to the incorporation of the modified nucleotide in the telomeric repeat and thus altering the further binding/extension by the enzyme. (TTAGGG)4 could have possibly interacted with RNA component of telomerase and inhibited its activity.     

Reactive oxygen species activity and lipid peroxidation in Helicobacter pylori associated gastritis: relation to gastric mucosal ascorbic acid concentrations and effect of H pylori eradication

BACKGROUND: Helicobacter pylori is an independent risk factor for gastric cancer, and this association may be due to the bacterium causing reactive oxygen species mediated damage to DNA in the gastric epithelium. High dietary ascorbic acid intake may protect against gastric cancer by scavenging reactive oxygen species. AIMS: To assess reactive oxygen species activity and damage in gastric mucosa in relation to gastric pathology and mucosal ascorbic acid level, and to determine the effect of H pylori eradication on these parameters. PATIENTS: Gastric biopsy specimens were obtained for analysis from 161 patients undergoing endoscopy for dyspepsia. METHODS: Reactive oxygen species activity and damage was assessed by luminol enhanced chemiluminescence and malondialdehyde equivalent estimation respectively. Ascorbic acid concentrations were measured using HPLC. RESULTS: Chemiluminescence and malondialdehyde levels in gastric mucosa were higher in patients with H pylori gastritis than in those with normal histology. Successful eradication of the bacterium led to decreases in both parameters four weeks after treatment was completed. Gastric mucosal ascorbic acid and total vitamin C concentrations were not related to mucosal histology, but correlated weakly with reactive oxygen species activity (chemiluminescence and malodialdehyde levels). CONCLUSIONS: Data suggest that reactive oxygen species play a pathological role in H pylori gastritis, but mucosal ascorbic acid is not depleted in this condition.     

Composition and dynamics of articular cartilage: structure, function, and maintaining healthy state

Functional magnetic resonance imaging (fMRI) based on blood oxygen level-dependent (BOLD) contrast has become an increasingly popular technique for mapping the brain. The relationship between BOLD-fMRI imaging and imaging of blood flow activation with positron emission tomography (PET) remains unclear. Moreover, BOLD imaging strategies and analysis procedures vary widely across laboratories. To examine the relationship between these different methods, we compared brain activation maps of a word-stem completion task obtained both using PET and using fMRI across two separate institutions (Washington University and Massachusetts General Hospital) with different acquisitions (gradient-refocused echo and asymmetric spin echo) and different analysis techniques. Overall, activation maps were highly similar across both fMRI methods and PET. A set of activated brain areas, in consistent locations in Talairach atlas space, were identified across all three studies, including visual striate and extrastriate, left prefrontal, supplementary motor area (SMA), and right cerebellar areas. Decreases in activation were also consistently observed in medial parietal, posterior insular, and medial inferior frontal areas. Some differences were noted that may be related to the silent performance of the task with fMRI. The largely consistent results suggest that comparisons can be made appropriately across imaging modalities and laboratory methods. A further implication of the consistencies, which extended to both increases and decreases in signal, is that the underlying brain physiology leading to BOLD contrast may be more similar to blood flow than originally appreciated.