Acute insufficiency of the gastrointestinal tract (GIT) in patients with severe gunshot injuries is an important link of pathogenesis of the polyorganic insufficiency syndrome. The character of the wound, the numerical score objective assessment of the injury severity and severity of the patient's state are considered to be criteria of early diagnosis of a risk of the development of acute insufficiency of GIT. The specific feature of "general" intensive therapy of acute insufficiency of GIT in severe gunshot traumas is the necessary application of regional anesthesia, sympatholytics, anticholinesterase agents and H2-blockers. Intensive "enteral" therapy of acute insufficiency of GIT in severe gunshot wounds includes the measures resulting in improvement of microcirculation, tissue respiration in organs of GIT, decompression of the stomach, local defense of mucosa, detoxication and early enteral balanced nutrition. The described method of treatment of wounded to the stomach used at specialized medical institutions resulted in 6.2 less lethality among this category of patients.
Oral rabies vaccination of wildlife has effectively reduced the incidence of rabies in wildlife and has led to the elimination of rabies in large areas of Europe. The safety of oral rabies vaccines has been assessed in both target (red fox and raccoon dog) and several non-target species.
Since 2011, the competent authority in Finland has received a few reports of dogs experiencing adverse reactions that have been assumed to be caused by the consumption of baits containing oral rabies vaccine. The dogs usually exhibited gastrointestinal symptoms (vomiting, inappetence, constipation or diarrhoea) or behavioral symptoms (restlessness, listlessness and unwillingness to continue hunting).
Nevertheless, these adverse reactions are transient and non-life threatening. Even though the adverse reactions are unpleasant to individual dogs and their owners, the benefits of oral rabies vaccination clearly outweigh the risks.
Human C1q deficiency is associated with systemic lupus erythematosus (SLE) and increased susceptibility to severe bacterial infections. These patients require extensive medical therapy and some develop treatment-resistant disease. Because C1q is produced by monocytes, it has been speculated that allogeneic hematopoietic stem cell transplantation (allo-HSCT) may cure this disorder.
We have so far treated 5 patients with C1q deficiency. In 3 cases, SLE symptoms remained relatively mild after the start of medical therapy, but 2 patients developed treatment-resistant SLE, and we decided to pursue treatment with allo-HSCT. For this purpose, we chose a conditioning regimen composed of treosulfan (14 g/m) and fludarabine (30 mg/m) started on day -6 and given for 3 and 5 consecutive days, respectively. Thymoglobulin was given at a cumulative dose of 8 mg/kg, and graft-versus-host disease prophylaxis was composed of cyclosporine and methotrexate.
A 9-year-old boy and a 12-year-old girl with refractory SLE restored C1q production after allo-HSCT. This resulted in normal functional properties of the classical complement pathway followed by reduced severity of SLE symptoms. The boy developed posttransplant lymphoproliferative disease, which resolved after treatment with rituximab and donor lymphocyte infusion. Unfortunately, donor lymphocyte infusion induced severe cortisone-resistant gastrointestinal graft-versus-host disease, and the patient died from multiple organ failure 4 months after transplantation. The girl is doing well 33 months after transplantation, and clinically, all signs of SLE have resolved.
Allo-HSCT can cure SLE in human C1q deficiency and should be considered early in subjects resistant to medical therapy.
Children with neurological impairments are prone to develop serious infection due to anaerobic bacteria. They often are predisposed to develop infections caused by their own indigenous bacterial flora caused by impairments of their mechanical and immunological defenses, the change in their oral flora due to poor hygiene, and the delay in recognition of acute infection. The most common anaerobic infections are decubitus ulcers, gastrectomy site wound infections, pulmonary infections (aspiration pneumonia, lung abscesses, and tracheitis), and chronic suppurative otitis media. The unique microbiology of each of the infections and their medical and surgical management were discussed in this review.
In Canada in late 1987 there was an outbreak of an acute illness characterized by gastrointestinal symptoms and unusual neurologic abnormalities among persons who had eaten cultivated mussels. Health departments in Canada solicited reports of this newly recognized illness. A case was defined as the occurrence of gastrointestinal symptoms within 24 hours or of neurologic symptoms within 48 hours of the ingestion of mussels. From the more than 250 reports received, 107 patients met the case definition. The most common symptoms were vomiting (in 76 percent of the patients), abdominal cramps (50 percent), diarrhea (42 percent), headache, often described as incapacitating (43 percent), and loss of short-term memory (25 percent). Nineteen patients were hospitalized, of whom 12 required intensive care because of seizures, coma, profuse respiratory secretions, or unstable blood pressure. Male sex and increasing age were associated independently with the risks of hospitalization and memory loss. Three patients died. Mussels associated with this illness were traced to cultivation beds in three river estuaries on the eastern coast of Prince Edward Island. Domoic acid, which can act as an excitatory neurotransmitter, was identified in mussels left uneaten by the patients and in mussels sampled from these estuaries. The source of the domoic acid appears to have been a form of marine vegetation, Nitzschia pungens, also identified in these waters in late 1987. The contaminated mussels from Prince Edward Island were removed from the market, and no new cases have occurred since December 1987. We conclude that the cause of this outbreak of a novel and severe intoxication was the ingestion of mussels contaminated by domoic acid, a potent excitatory neurotransmitter.
Comment In: N Engl J Med. 1990 Dec 6;323(23):1631-32073268
The aim of this study was to investigate admittance rates and doctors workload during Christmas. In addition, we examined if admittance data supports the common notions that overeating during Christmas results in increased rate of admittances for abdominal problems and that there is an increase in admittance of the elderly at the end of Christmas (i.e. "granny dumping").
A retrospective study analyzing data from the database of the hospital units of Sydvestjysk Sygehus was performed. Data covered admittance in the months spanning from November through January in 1994-2010. Data from Christmas was compared with data from adjacent months.
During Christmas more patients with abdominal complaints were admitted to the hospital (p
Quantitative microbial risk assessments (QMRAs) often lack data on water quality leading to great uncertainty in the QMRA because of the many assumptions. The quantity of waste water contamination was estimated and included in a QMRA on an extreme rain event leading to combined sewer overflow (CSO) to bathing water where an ironman competition later took place. Two dynamic models, (1) a drainage model and (2) a 3D hydrodynamic model, estimated the dilution of waste water from source to recipient. The drainage model estimated that 2.6% of waste water was left in the system before CSO and the hydrodynamic model estimated that 4.8% of the recipient bathing water came from the CSO, so on average there was 0.13% of waste water in the bathing water during the ironman competition. The total estimated incidence rate from a conservative estimate of the pathogenic load of five reference pathogens was 42%, comparable to 55% in an epidemiological study of the case. The combination of applying dynamic models and exposure data led to an improved QMRA that included an estimate of the dilution factor. This approach has not been described previously.