Combined interventions are effective in MRSA control.

BACKGROUND: A large healthcare-associated epidemic mainly caused by one methicillin-resistant Staphylococcus aureus (MRSA) strain broke out in Pirkanmaa County, Finland, in 2001. This study describes the impact of infection control and screening practices on the epidemic. METHODS: The number of hospital-acquired (HA)-MRSA findings obtained from clinical and screening samples during the epidemic was calculated. Strains were typed by pulsed-field electrophoresis (PFGE) or spa typing. Strain type distribution was studied in relation to sample type, year of the epidemic and site of transmission. Several infection control interventions were launched stepwise and screening protocols were expanded. RESULTS: A total of 4118 cases were identified during 2001-2014, of which 3527 were classified as HA. One strain (spa t067) dominated in the epidemic. HA-MRSA cases decreased constantly from the year 2011. The number of new HA-MRSA cases was 57% less in the year 2014 (n = 171) as compared with the year 2011 (n = 399). The proportion of the epidemic strain declined significantly over the years. Screening samples comprised 71% (2439/3527) and clinical samples 29% (1034/3527) of HA-MRSA findings. The number of HA-MRSA cases found from clinical samples started to decrease when screening was expanded. An increase in hand-rub consumption was associated with a decrease in transmissions in Tampere University Hospital (TAUH). CONCLUSION: Implementation of universal screening together with several other interventions is effective in containing an MRSA epidemic. The proportion of other than Pirkanmaa epidemic (PE)-MRSA strain findings increased throughout the period, indicating the changing epidemiology of MRSA.

A severe case of Puumala hantavirus infection successfully treated with bradykinin receptor antagonist icatibant.

A patient with severe capillary leakage syndrome caused by a Puumala hantavirus infection was treated with a single dose of icatibant, a bradykinin receptor antagonist, with a dramatic positive response. We suggest that this drug should be tested in a larger number of patients with severe hantavirus infection.

Methicillin-resistant Staphylococcus aureus epidemic restricted to one health district in Finland: a population-based descriptive study in Pirkanmaa, Finland, years 2001-2011.

BACKGROUND: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) has been low in the Scandinavian countries, including Finland. METHODS: We report a population-based, prospective survey of an exceptionally large ongoing MRSA epidemic in a Finnish health district (HD), Pirkanmaa HD, during 2001-2011 caused by 1 strain, spa t067 (FIN-16). RESULTS: The first FIN-16 case in the HD was identified in 2000. Ten years later, 2447 carriers had been found in 95 different institutions. MRSA in carriers was mostly health care-associated (98%). The epidemic emerged in long-term care facilities and gradually spread to acute hospitals. The majority of carriers were elderly people (median age 78 y). Fifty-two percent of new carriers had an infection with MRSA at the time of detection. CONCLUSIONS: The incidence of MRSA in Pirkanmaa HD is substantially higher than the incidence for all of Finland. Temporary projects to control MRSA have not proved sufficient to contain this large epidemic.

Calcium channel antagonists and inhibition of human sphincter of Oddi contractions.

OBJECTIVE: Nifedipine has been used in the treatment of sphincter of Oddi dyskinesia, a biliary disease characterized by upper abdominal pains and increased pressure in the sphincter. The effects of other calcium channel antagonists on sphincter of Oddi have not been elucidated. MATERIAL AND METHODS: We compared the effects of three calcium blockers with differing smooth muscle selectivity (verapamil, nifedipine and felodipine) on human sphincter of Oddi contractions. Transverse sections of the sphincter obtained from five patients undergoing Whipple resection were studied in an organ bath chamber in vitro. RESULTS: All three calcium blockers significantly (>50%) inhibited the acetylcholine-induced and KCl-induced sphincter contractions in a dose-dependent manner. Both nifedipine and felodipine were more potent than verapamil in inhibiting the acetylcholine-induced contractions, whereas only nifedipine, but not felodipine, reduced the KCl-elicited contractions more than verapamil. CONCLUSIONS: The smooth muscle selective calcium channel antagonists are potent inhibitors of human sphincter of Oddi contractions. Although nifedipine is, to date, the only agent studied in clinical settings, other dihydropyridines are also likely to be useful in sphincter of Oddi dyskinesia.

Long-term physical exercise and atrial natriuretic peptide in obese Zucker rats.

Endurance training increases natriuretic peptide synthesis in the hypertrophied myocardium of spontaneously hypertensive rats. We examined the effects of 22-week-long treadmill exercise on plasma and tissue atrial natriuretic peptide in Zucker rats, a model of genetic obesity and moderate hypertension without clear cardiac hypertrophy. The blood pressures of the animals were measured by the tail-cuff method, and plasma and tissue samples for the peptide determinations were taken at the end of the study. The training increased heart weight to body weight ratio, while atrial natriuretic peptide contents in the right and left atrium, ventricular tissue, and plasma did not change. The exercise prevented the elevation of blood pressure, which was observed in non-exercised obese Zucker rats, and also reduced blood pressure in the lean rats. In conclusion, these results suggest that in the absence of preceding myocardial hypertrophy, the long-term exercise-induced workload is not deleterious to the heart in experimental obesity, since no changes in plasma and tissue atrial natriuretic peptide were detected.