A variety of respiratory viruses found in symptomatic travellers returning from countries with ongoing spread of the new influenza A(H1N1)v virus strain.

Clinical specimens from 79 symptomatic individuals with a recent history of travel to countries with verified transmission of influenza A(H1N1)v (North America) were tested with a multiple real-time PCR targeting a broad range of agents that may cause acute respiratory infection. This analysis revealed that besides four cases of influenza A(H1N1)v, other respiratory viruses were diagnosed in almost 60% of the samples. These observations are a reminder that many different viral transmissions occur simultaneously in countries with ongoing spread of influenza A(H1N1)v. The findings demonstrate that the definition of suspected cases by clinical and epidemiological criteria has only a poor capacity for discriminating influenza A(H1N1)v from other viral infections.

Nausea and vomiting in patients undergoing radiofrequency catheter ablation.

BACKGROUND: Radiofrequency catheter ablation is a technique for curing cardiac arrhythmias by destroying tissue that is a critical part of the targeted electrical circuit. Nausea and vomiting have been observed after use of this technique, but no study to date has examined these complications. OBJECTIVES: To determine the incidence of nausea and vomiting after radiofrequency catheter ablation, determine factors related to nausea and vomiting, and evaluate the antiemetic efficacy of promethazine given during the procedure. METHODS: Medical records for 369 cases of radiofrequency catheter ablation performed in a 4-year period at a university medical center were reviewed. RESULTS: Nausea after the procedure was documented in 22% of cases. Logistic regression analysis based on variables significant in bivariate analysis revealed that younger age, female sex, and longer procedure duration were significantly and independently related to nausea. Vomiting after the procedure occurred in 13% of cases. Logistic regression revealed that younger age and longer procedure duration were significantly and independently related to vomiting. Further analysis showed that patients who received larger doses of promethazine relative to the dose of fentanyl had a significantly lower incidence of vomiting. CONCLUSIONS: Nausea and vomiting occurred in a considerable number of cases. Female sex, younger age, and longer procedure duration increased the risk of nausea, whereas only age and procedure duration were associated with vomiting. This study may guide clinicians to use a prophylactic antiemetic in patients undergoing radiofrequency catheter ablation, especially patients at increased risk for nausea and vomiting.

A telephone reassurance program for elderly home care clients after discharge.

Telephone reassurance programs (TRP) was developed to address the ongoing needs of chronically ill clients after home care discharge. Graduate students from Yale University School of Nursing worked with the Regional Visiting Nurse Agency of Connecticut, Inc., to develop this interesting program that could be replicated by home health agencies. Project objectives, a TRP protocol, program tools, potential benefits, and implications for agencies are presented.

Validating a clinical workload measurement instrument for documenting pharmaceutical care.

The purpose of this study was to develop and validate a workload documentation instrument to manually record clinically oriented pharmaceutical care activities. Previous research documents clinical workload by pharmacists; however, the tools employed have not been tested for validity. Reported information is difficult to interpret since individuals are unlikely to categorize activities in a consistent manner. PharmaTrend was used as a template for defining activity and problem categories that corresponded to various clinical activities performed by our clinical, faculty, and staff pharmacists. Because the institution was not completely computerized, the actual documentation tool was portable and manual. Testing of the original instrument was accomplished using a survey consisting of written scenarios. Two phases of testing were required to achieve an overall 80 percent accuracy rate. At least 60 percent of available pharmacists participated in both phases and completed 90 percent or more of the surveys. The investigators concluded that an instrument to record clinically oriented pharmaceutical care activities had been developed, tested, and validated.

Transdermal fentanyl disposition in elderly subjects.

The pharmacokinetic characteristics of a 20-cm2 fentanyl 24-hour transdermal patch were compared between 10 healthy elderly subjects 67-87 years and 6 young subjects 19-27 years. All 10 elderly subjects required patch removal prior to 24 h due to adverse effects versus none of the young subjects. The mean patch duration (PD) in elderly subjects was 11.7 +/- 4.9 h, yielding a mean area under the curve from 0 to 60 h (AUC0-60) of 20.4 +/- 10.3 ng h/ml versus a mean AUC0-60 of 21.0 +/- 10.4 ng h/ml in young subjects. Correcting AUC0-60 for PD (AUC0-60/PD) gave a mean value of 2.05 +/- 1.10 ng/ml for elderly subjects, which was significantly greater than the AUC0-60/PD of 0.88 +/- 0.44 ng/ml in young subjects (p = 0.034, Student's t test). The higher serum concentrations reflect increased absorption and/or decreased clearance in the elderly.

Haemorrhagic fever with renal syndrome: evaluation of ELISA for detection of Puumala-virus-specific IgG and IgM.

IgM and IgG ELISA to Puumala virus were evaluated using sera from patients with haemorrhagic fever with renal syndrome (HFRS) from different geographical regions: Sweden, Denmark, Norway, Belgium and the European USSR. IgM ELISA proved useful in the diagnosis of HFRS in patients from all the regions mentioned above. Specific IgM could be detected as early as day 1 post onset of disease, and patients remained IgM-positive for several months. Specific IgG ELISA antibodies were also frequently detected in acute sera, and acute-convalescent serum pairs often failed to show a significant titre rise or increase in optical density (OD) values. This limits the use of IgG ELISA in patient diagnosis. Sera collected 2 years after infection revealed higher IgG ELISA OD readings than convalescent sera, and very high values were still detectable 10 to 20 years postinfection. IgG ELISA is therefore useful for the testing of immunity and in seroepidemiological studies. Acute and convalescent sera from HFRS patients in Korea and the Asian USSR showed no or only very weak reactivity in the Puumala virus IgG and IgM ELISA. These results are consistent with the "one-way" crossing described earlier.

Cadmium concentration in human kidney biopsies.

This study reports the cadmium concentration and histopathology of kidney tissue from 29 patients with clinical findings that motivated a diagnostic percutaneous kidney biopsy and/or a history of possible exposure to cadmium. Cadmium was found in all specimens examined including those from controls. In the patients, the mean cadmium concentration was 12.9 (0.6-45.0) micrograms cadmium per g wet kidney tissue. The highest concentrations (30-45 micrograms/g) were found in three patients with morphological and clinical findings of tubulo-interstitial damage. Patients with signs of tubulo-interstitial disease had higher mean cadmium concentrations than those with glomerular changes, and patients with normal blood pressure had higher concentrations than those with diastolic hypertension. In a control group of 22 autopsies, the mean cadmium concentration was 8.7 (2.9-22.4) micrograms/g. The mean difference between the right and the left kidney was 2.3 (0.9-9.6) micrograms/g. Laboratory findings in patients with cadmium nephropathy were nonspecific. Thus, in patients with interstitial nephritis and cadmium exposure, a biopsy for the analysis of kidney cadmium concentration may be motivated. The combination of morphological and clinical findings of interstitial nephritis and a high concentration of cadmium in biopsied kidney tissue indicates cadmium nephropathy.

Nephropathia epidemica: incidence of clinical cases and antibody prevalence in an endemic area of Sweden.

The incidence of nephropathia epidemica (NE) was compared with the NE antibody prevalence in normal population in a highly endemic area of Sweden (Västerbotten county). The antibody prevalence rate in the oldest age groups were found to be 14 and 20 times higher than the accumulated life-risk of being hospitalized with NE for men and women respectively. Whether the infection in persons not admitted to hospital is subclinical, atypical or clinically fulminant, remains to be determined.

Isolation and propagation of nephropathia epidemica virus in bank voles.

Three strains of nephropathia epidemica (NE) virus were isolated from lung tissues of bank voles (Clethrionomys glareolus) and a grey-sided vole (C. rufocanus) trapped in Västerbotten county, Sweden. Two of these isolates were serially passaged in seronegative laboratory-bred bank voles. Experimentally infected animals developed a subclinical infection characterized by virus persistence, particularly in lung tissue. Attempts to infect other species of colonized rodents with NE virus and to isolate NE virus from acute phase patient blood were unsuccessful. The serial propagation of NE virus in colonized bank voles provides opportunities to study experimental infection in its reservoir rodent host.

Mobile lidar system for environmental probing.

A fully mobile remote-sensing system based on the lidar principle is described. With this system, atmospheric probing using Mie scattering, differential absorption, or Raman techniques can be performed yielding information on atmospheric pollutants or general atmospheric parameters. The system incorporates a powerful Nd:YAG laser pumping a dye laser and is equipped with a fixed Newtonian telescope used in conjunction with a flat steering mirror. The lidar signals are electrically recorded using a fast-transient digitizer and are processed by a minicomputer, which also controls the laser, the chosen measuring direction, and the output media. Examples of measurements on atmospheric NO(2) and SO(2) are given.

Lidar system applied in atmospheric pollution monitoring.

A lidar system, incorporating tunable dye lasers and a 25-cm diam Newtonian telescope, has been constructed and applied in atmospheric pollution monitoring. The system, which is fully controlled by a specially designed microcomputer, has been used in several field tests, where stack effluents as well as the ambient air have been monitored. Results from particle, NO(2), and SO(2) measurements are discussed.