Hematology, plasma biochemistry, and tissue enzyme activities of invasive red lionfish captured off North Carolina, USA.

The red lionfish Pterois volitans is important not only in the aquarium trade but also as an invasive species in the western Atlantic. Introduced to waters off the southeastern coast of the United States, red lionfish have rapidly spread along much of the East Coast and throughout Bermuda, the Bahamas, and much of the Caribbean. Hematology and plasma biochemistry were evaluated in red lionfish captured from the offshore waters of North Carolina to establish baseline parameters for individual and population health assessment. Blood smears were evaluated for total and differential white blood cell counts, and routine clinical biochemical profiles were performed on plasma samples. To improve the interpretive value of routine plasma biochemistry profiles, tissue enzyme activities (alkaline phosphatase [ALP], alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyl transferase [GGT], lactate dehydrogenase [LD], and creatine kinase [CK]) were analyzed from liver, kidney, skeletal muscle, gastrointestinal tract, and heart tissues from five fish. The hematological and plasma biochemical values were similar to those of other marine teleosts except that the estimated white blood cell counts were much lower than those routinely found in many species. The tissue enzyme activity findings suggest that plasma LD, CK, and AST offer clinical relevance in the assessment of red lionfish.

Student awareness of research findings.

One problem faced by all faculty who teach research to undergraduate students is how to make the topic of utilization of research both interesting and practical. The author describes an approach that elicited students' active participation in replicating an earlier study by indicating their awareness of research-validated practices. Involvement of the students in an actual study seems a positive way to introduce the topic of utilization and has been used with success in one program over the past 4 years.

Combining the role of the nurse practitioner and the community health nurse. An educational model for implementing community-based primary health care.

With increasing health care costs, public health agencies and other institutions have a critical need for master's-prepared nurses who can provide health care for common health problems of individuals and families but also assess, plan, intervene, and evaluate the needs of communities. This article describes the development of a nursing master's degree program to meet that need which combines the traditional roles of the nurse practitioner and the community health nurse. The program is based on the global concept of primary health care as defined by the World Health Organization, which includes more emphasis on economic, political, environmental, and social factors.

Battered and pregnant: a prevalence study.

We interviewed 290 pregnant women randomly selected from public and private prenatal clinics, 80 per cent of whom were at least five months pregnant (ages 18-43, 42 per cent Latino, 22 per cent Black). Twenty-four women reported physical battering during this pregnancy (44 reported physical battering before the current pregnancy). Eight of the 24 pregnant women had sought medical treatment for injuries sustained; none reported having been assessed by prenatal care providers for abuse.

Acquired immune deficiency syndrome in homosexual men with Hodgkin's disease. Three case reports.

Fatal opportunistic infections developed in three homosexual men with Hodgkin's disease. Widely disseminated Kaposi's sarcoma developed in one, and another had persistent lymphadenopathy with a biopsy specimen showing benign follicular hyperplasia two years before the diagnosis of Hodgkin's disease. Physicians are alerted to the possible association of Hodgkin's disease and the acquired immune deficiency syndrome (AIDS). They are cautioned to consider the diagnosis of Hodgkin's disease in homosexual men with lymphadenopathy and warned of the risk of serious infections in homosexual men receiving therapy for Hodgkin's disease.

Antimicrobial synergism in the therapy of gram-negative rod bacteremia.

To determine if antimicrobial synergism might affect the results of treatment of gram-negative rod infections, 444 bacteremias from 1972 through 1974 were studied. On these, 173 were treated with two antibiotics to which the infecting organisms were sensitive. Clinical responses were observed in 80% of 83 cases where antibiotic activity was synergistic, as defined by a minimum inhibitory concentration (MIC) of each antibiotic in combination being one-fourth or less than the MICs of individual drugs. This response rate was significantly better than the 64% response seen in patients treated with nonsynergistic combinations (p less than 0.05). Synergism correlated with significantly better clinical responses in those patients with "rapidly fatal" and "ultimately fatal" underlying disease (p less than 0.005), neutropenia (p less than 0.001), shock (p less than 0.01) and Pseudomonas aeruginosa infections (p less than 0.05). These results suggest that the use of antibiotic combinations to treat patients with gram-negative rod bacteremia who have the poorest prognosis is clinically justified and the improved results may be related to the synergistic activity of antimicrobial agents.

[Vegetations of the mitral valve and the mitral prosthesis in patients with subacute bacterial endocarditis. Echocardiographic diagnosis]. / Vegetaciones de la válvula mitral y de la prótesis mitral en un paciente con endocarditis bacteriana subaguda. Diagnóstico ecocardiográfico.

In a patient with SBE in three differents ocassions in a period approximately of 9 months, the mitral valve was replaced on two occasions. The echocardiogram detected vegetations on two ocassions. The diagnosis of vegetation at the level of the mitral valve, was done for the first time in our hospital by this method. During the last admission, the echocardiogram suggested a vegetation at the level of the artificial mitral valve, projecting into the left atrium with the systole. This was confirmed by surgery.

Gram-negative rod bacteremia: microbiologic, immunologic, and therapeutic considerations.

During the last 2 decades, Gram-negative rod bacteremia has become the leading infectious disease problem in American hospitals. With improvements in conventional microbiologic techniques, bacteremic infection can be diagnosed reliably within 3 days using only three sets of cultures. Clinical management still requires aggressive, presumptive use of antimicrobials in patients with the most adverse host factors. In the latter group, the use of combinations of antibiotics that interact synergistically in vitro has improved clinical results. In bacteremia due to anaerobes, particularly Bacteroides species, drainage of infected sites is probably more important than specific drug therapy. Various host defects have been associated with Gram-negative bacteremia; the most common in the nonleukopenic patient is impaired opsonization. The evidence that endotoxins are involved in the pathophysiology of Gram-negative bacillemia is inferential. Nevertheless, both clinical and experimental evidence suggest that active or passive immunization with endotoxin components or antigens similar to Gram-negative polysaccharides may be protective.

Simultaneous antibiotic levels in "breakthrough" gram-negative rod bacteremia.

Of 237 cases of gram-negative rod bacteremia observed at the UCLA Medical Center during a 12 month period, 52 (22 per cent) occurred while the patient was receiving antibiotics which inhibited the infecting organism by disc diffusion tests. One half of the plasma samples available from 42 such patients with "breakthrough" bacteremia had subinhibitory circulating antibiotic levels when cultures were positive. Sepsis documented within 72 hours of initiation of therapy was usually due to antibiotic-sensitive Esch. coli and was associated with inadequate antibiotic levels; the patient was usually treated with a penicillin or cephalosporin. The source of bacteremia was most frequently the urinary tract or the biliary tree. In contrast, sepsis occurring more than 72 hours after the administration of antibiotics was frequently caused by multiple antibiotic-resistant Esch. coli in patients treated with gentamicin in adequate dosage and was associated with leukopenia or undrained purulent collections. Therapy ultimately failed in 20 cases (48 per cent): in early "breakthrough" bacteremia, failure was associated with subinhibitory antibiotic levels, and in late "breakthrough" bacteremias with inadequate drainage or impaired host defenses.

Long-term follow-up of aortic valve replacement with the fresh aortic homograft.

The long-term results of aortic valve replacement with the fresh aortic homograft, performed in 114 patients at Stanford University Medical Center from 1967 to 1971, were evaluated. There were 10 operative deaths (8.8 per cent), only 3 (5 per cent) in the period from 1968 to 1971. There were 6 late deaths in the first year (5.8 per cent) and 8 in later years (1.5 per cent per year); 12 late deaths were due to cardiac causes, 6 of them to valve dysfunction. The homograft was replaced later with a prosthetic valve or heterograft in 22 patients (3.2 per cent per year): for regurgitation in 20 and for calcific stenosis in only one. Infective endocarditis occurred in 5 cases, accounting for one operative death, 2 late deaths, and 2 reoperations with survival. Systemic thromboembolism occurred in 6 patients, 3 with mitral valve disease, one with atrial fibrillation, and one with infective endocarditis; none was a proved instance of embolism from bland thrombus on the aortic homograft valve. Of 53 patients followed for 5 years or more with the homograft intact, 47 have minimal or no disability, despite aortic diastolic murmurs in many. We conclude that long-term results are good in the majority of patients, with aortic regurgitation requiring reoperation being the leading complication. These results may serve as a basis for comparison of more recently introduced methods of aortic valve replacement.