Intravenous sedation for handicapped dental patients: a clinical trial of midazolam and propofol.

A double blind, cross-over study to compare intravenous sedation using continuous infusions of midazolam and propofol was carried out in 18 handicapped patients, aged between 5 and 26 years. Using a syringe pump (Ohmeda 9000) midazolam was delivered at 0.4 mg/kg/h with a bolus dose of 0.02 mg/kg and propofol was infused at 4.0 mg/kg/h with a bolus dose of 0.2 mg/kg. Sequential analysis showed that induction and recovery times were shorter with propofol (P < 0.05 and P < 0.01 respectively) and more work was performed over unit time (P < 0.05), with 15.7 units of work being completed per hour on patients under propofol sedation compared to 11.0 units under midazolam. The quality of sedation was assessed as better in patients receiving propofol; eight cases were abandoned under midazolam infusion due to failure of induction, uncontrolled movement and/or emotional outbursts compared with none under propofol. All parents/patients preferred propofol sedation, because recovery was faster and smoother.

Nasal carriage of Staphylococcus aureus, including community-associated methicillin-resistant strains, in Queensland adults.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are emerging in southeast Queensland, Australia, but the incidence of carriage of CA-MRSA strains is unknown. The aim of this study was to assess the nasal carriage rate of S. aureus, including CA-MRSA strains, in the general adult population of southeast Queensland. 396 patients presenting to general practices in two Brisbane suburbs and 303 volunteers randomly selected from the electoral rolls in the same suburbs completed a medical questionnaire and had nasal swabs performed for S. aureus. All isolates of S. aureus underwent antibiotic susceptibility testing and single-nucleotide polymorphism (SNP) and binary typing, including determination of Panton-Valentine leukocidin (PVL). The nasal carriage rate of methicillin-susceptible S. aureus (MSSA) was 202/699 (28%), a rate similar to that found in other community-based nasal carriage studies. According to multivariate analysis, nasal carriage of S. aureus was associated with male sex, young adult age group and Caucasian ethnicity. Only two study isolates (one MSSA and one CA-MRSA) carried PVL. The nasal carriage rate of MRSA was low, at 5/699 (0.7%), and only two study participants (0.3%) had CA-MRSA strains. CA-MRSA is an emerging cause of infection in southeast Queensland, but as yet the incidence of carriage of CA-MRSA in the general community is low.

Life-threatening community-acquired methicillin-resistant Staphylococcus aureus infection in Australia.

Eight patients with invasive bacteremic community-acquired methicillin-resistant Staphylococcus aureus infection in southeast Queensland, Australia, are reported. One patient died of septic shock. Haematogenous seeding to lungs, bone, and other sites was common. All isolates carried the virulence factor Panton-Valentine leukocidin and were either the southwest Pacific clone or the newly described Queensland clone. Clinicians should consider community-acquired methicillin-resistant Staphylococcus aureus infection in any patient presenting to hospital with severe staphylococcal sepsis or pneumonia.

The impact of health care and nutritional education on an urban community in Zambia through the under five clinics.

A social survey was carried out on 60 surviving children who suffered from severe kwashiorkor, using 60 "normal" peers drawn from the same socio-economic area. The impact of local under five clinics in the area with regard to health education and health care was assessed and found to be inadequate, despite the large number of clinics available. The replacement of these under five clinics by "at risk" clinics for children of all ages within the framework of a community health centre was suggested.

ECG as a prognostic instrument in Kwashiorkor.

Serial ECG studies were carried out on 32 cases of severe kwashiorkor and two cases of marasmus. Single readings were also carried out on 10 controls. In those cases which had a bad prognosis, particularly those that died, there was a marked shift of the axis of the mean QRS vector of the limb leads to the right. Those that did not deteriorate showed no such shift, and those that deteriorated but eventually recovered, showed a shift to the left in the recovery phase. No such shift was noted in the two cases of marasmus. I suggest that this shift in mean QRS vector could be a useful and accurate prognostic guide.

Value of routine multiple blood tests in patients attending the general practitioner.

The paper describes the investigation of 296 patients selected at random from those attending the general practitioners' surgery and studied by means of multiple biochemical and haematological tests. The tests that would not normally have been requested led to a new diagnosis of clinical significance in 16.9% of patients, in most instances requiring an alteration of the patient's therapy. The effect of the profile tests on patient follow-up, referral of patients to hospital, and the need for subsequent investigations was studied by comparing the patients profiled with a control group of patients not having a blood profile. The place of such an investigation in general practice is considered.