An occurrence of sepsis during inpatient fecal disimpaction.

Functional constipation is a common pediatric problem that is often treated through well-established algorithms. Fecal disimpaction is the initial therapeutic step, and severe cases require hospitalization for intensive therapies. We describe a significant unexpected complication of this common clinical situation. An 8-year-old boy with suspected chronic functional constipation was hospitalized for disimpaction by continuous nasogastric administration of polyethylene glycol electrolyte (PEG-E) solution. On the sixth day of disimpaction, the patient abruptly developed fever, tachycardia, and tachypnea. Evaluation included blood culture, which grew Escherichia coli, and treatment with a course of appropriate antibiotics was provided. The safety of PEG-E solutions has been shown in studies of children with constipation, which made this patient's illness surprising. Several potential etiologies of his infection were considered, including bacterial translocation (BT). BT is defined as the passage of live microbes and microbial products from the gastrointestinal tract to extraintestinal sites, such as the bloodstream. It has been shown to occur in a variety of clinical conditions but is of unclear clinical significance. In this case, physical damage to the intestinal mucosa was thought to contribute to the potential occurrence of BT, and prolonged disimpaction was considered as a risk factor. E coli sepsis in a child undergoing inpatient nasogastric fecal disimpaction with PEG-E represents a clinical problem never before reported in the literature and should increase clinicians' indices of suspicion for uncommon complications of common procedures.

Epidemiology of severe injuries among United States high school athletes: 2005-2007.

BACKGROUND: Over 7 million students participate in high school athletics annually. Despite numerous health benefits, high school athletes are at risk for injury. HYPOTHESIS: Severe injury rates and patterns differ by gender and type of exposure. Study Design Descriptive epidemiology study. METHODS: Sports-related injury data were collected during the 2005-2007 academic years from 100 nationally representative United States high schools via RIO (Reporting Information Online). Severe injury was defined as any injury that resulted in the loss of more than 21 days of sports participation. RESULTS: Participating certified athletic trainers (ATCs) reported 1378 severe injuries during 3 550 141 athlete-exposures (0.39 severe injuries per 1000 athletic exposures). Football had the highest severe injury rate (0.69), followed by wrestling (0.52), girls' basketball (0.34), and girls' soccer (0.33). The rate in all boys' sports (0.45) was higher than all girls' sports (0.26) (rate ratio [RR], 1.74; 95% confidence interval [CI], 1.54-1.98; P < .001). However, among directly comparable sports (soccer, basketball, and baseball/softball), girls sustained a higher severe injury rate (0.29) than boys (0.23) (RR, 1.28; 95% CI, 1.08-1.52; P = .006). More specifically, girls' basketball had a higher rate (0.34) than boys' basketball (0.24) (RR, 1.43; 95% CI, 1.10-1.86; P = .009). Differences between boys' and girls' soccer and baseball/softball were not statistically significant. The severe injury rate was greater in competition (0.79) than practice (0.24) (RR, 3.30; 95% CI, 2.97-3.67; P < .001). Nationally, high school athletes sustained an estimated 446 715 severe injuries from 2005-2007. The most commonly injured body sites were the knee (29.0%), ankle (12.3%), and shoulder (10.9%). The most common diagnoses were fractures (36.0%), complete ligament sprains (15.3%), and incomplete ligament sprains (14.3%). Of severe sports injuries, 0.3% resulted in medical disqualification for the athletes' career, and an additional 56.8% resulted in medical disqualification for the entire season. One in 4 (28.3%) severe injuries required surgery, with over half (53.9%) being knee surgeries. CONCLUSION: Severe injury rates and patterns varied by sport, gender, and type of exposure. Because severe injuries negatively affect athletes' health and often place an increased burden on the health care system, future research should focus on developing interventions to decrease the incidence and severity of sports-related injuries.

Assay of the activity of malonyl-coenzyme A decarboxylase by gas chromatography-mass spectrometry.

We developed a gas chromatography-mass spectrometry (GC-MS) assay to measure the activity of malonyl-coenzyme A (CoA) decarboxylase (MCD) in crude tissue homogenates. Liver extracts are incubated with [U-(13)C(3)]malonyl-CoA to form [U-(13)C(2)]acetyl-CoA by the action of MCD. The reaction mixture contains 2 mM ADP to prevent the hydrolysis of [1,2-(13)C(2)]acetyl-CoA by acetyl-CoA hydrolase present in the extracts. Newly formed [U-(13)C(2)]acetyl-CoA and internal standard of [(2)H(3),1-(13)C]acetyl-CoA are analyzed as thiophenol derivatives by GC-MS. This assay was applied to a study of the kinetics of MCD in rat liver. Using the Lineweaver-Burke plot of MCD kinetics, K(m) of 202microM and V(max) of 3.3micromol min(-1) (g liver)(-1) were calculated. The liver MCD activities (micromol min(-1) g(-1)+/-SD) in three groups of rats with different nutritional statuses-fed, 1-day fasted, and 2-day fasted-were 1.80+/-0.41, 2.59+/-0.37 (P<0.05), and 3.07+/-0.70 (P<0.05), respectively. We report a practical, nonradioactive, sensitive assay of MCD in crude tissue extract.