Key predictors and burden of meticillin-resistant Staphylococcus aureus infection in comparison with meticillin-susceptible S. aureus infection in an Australian hospital setting.

BACKGROUND: Staphylococcus aureus is associated with significant mortality and increased burden on the healthcare system. Relatively few reliable estimates are available regarding the impact of meticillin-resistant S. aureus (MRSA) infection compared with meticillin-susceptible S. aureus (MSSA) infection. AIMS: To compare patients with MRSA infection and MSSA infection to identify differences in inpatient mortality, length of stay and costs of hospital services, and identify predictors of MRSA as a cause of S. aureus infection. METHODS: An analytical, retrospective, longitudinal study using non-identifiable linked data on adults admitted to hospitals of a health district in Australia with a diagnosis of S. aureus infection over a 10-year period. The main outcome measure was 30-day inpatient mortality. Secondary endpoints included total overnight stays, all-cause inpatient mortality, and hospitalization costs within 1 year of index admission. FINDINGS: Inpatient mortality at 30, 100 and 365 days was estimated to be significantly greater for patients with MRSA infection. The mean additional cost of MRSA infection when controlling for additional factors was $5988 and 4 nights of additional hospital stay per patient within 1 year of index admission. Key predictors of MRSA infection were: date of index admission; higher comorbidity score; greater socio-economic disadvantage; admission to hospital other than via the emergency department; older age; and prior admission to hospital within 28 days of index admission. CONCLUSIONS: MRSA infection is associated with increased inpatient mortality, costs and hospital length of stay compared with MSSA infection. Efforts are required to alleviate the additional burden of MRSA infection on patients and healthcare systems.

Hipotiroidismo primario posradioterapia en pacientes con cáncer de cabeza y cuello / Primary hypothyroidism after radiotherapy in patients with head and neck cancer

Introducción: El tratamiento con radioterapia en el cáncer de cabeza y cuello es una causa de hipotiroidismo. Nos proponemos estudiar el desarrollo de hipofunción tiroidea en estos pacientes. Pacientes y métodos: Se realizó un análisis retrospectivo de 194 pacientes tratados con radioterapia por cáncer de cabeza y cuello. Se determinó la tirotropina (TSH) y la tiroxina (T4) libre a los 3, los 6 y los 12 meses después de la radioterapia y anualmente durante el seguimiento. El hipotiroidismo se clasificó como subclínico (aumento de la TSH y la T4 libre normal) y clínico (aumento de la TSH y disminución de la T4 libre). Se analizó la relación del hipotiroidismo con edad, sexo, estirpe histológica del tumor, dosis de radiación y el uso de quimioterapia. Resultados: Con una media de seguimiento de 4,2 años, 56 pacientes presentaron elevación de la TSH (39 pacientes subclínico y 17 clínico). El tiempo medio para el diagnóstico fue de 3,0 ± 1,8 años (subclínico 2,6 ± 1,5 años, clínico 4 ± 1,9 años; p < 0,05). El 80% de los pacientes fueron diagnosticados entre el segundo y el sexto año desde la radioterapia. La edad, la histología del tumor, la dosis de radiación y el uso de quimioterapia no modificaron la probabilidad de desarrollar hipotiroidismo. El sexo demostró un valor predictor (un 66,6 frente a un 25,8% en mujeres y varones, respectivamente; p < 0,05). Conclusiones: La tasa de incidencia de hipotiroidismo después de radioterapia en pacientes con cáncer de cabeza y cuello es elevada. Es importante determinar la TSH durante un largo período de tiempo después de la radioterapia (AU)

Introduction: Radiotherapy in the treatment of cancer of the head and neck can cause hypothyroidism. Our aim was to study the development of thyroid hypofunction in these patients. Patients and methods: We performed a retrospective analysis of 194 patients who underwent radiotherapy for head and neck cancer. Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were determined at 3, 6 and 12 months after radiotherapy and then annually during follow-up. Hypothyroidism was classified as subclinical (SHT) (an increase of TSG and normal FT4 levels) and clinical (CHT) (an increase of TSH and a decrease of FT4). The association between hypothyroidism and age, sex, histological type of the tumor, radiation dose and use of chemotherapy was analyzed. Results: With a mean follow-up of 4.2 years, 56 patients showed elevated TSH levels (SHT in 39 patients and CHT in 17). The mean time to diagnosis was 3.0 ± 1.8 years (SHT 2.6 ± 1.5 years, CHT 4 ± 1.9 years; p < 0.05). Eighty percent of the patients were diagnosed between the second and the sixth year after radiotherapy. Age, histological type, radiation dose and use of chemotherapy did not affect the probability of developing hypothyroidism. Sex had a predictive value (66.6% in women versus 25.8% in men; p < 0.05). Conclusions: The incidence rate of hypothyroidism after radiotherapy in patients with cancer of the head and neck is high. Prolonged follow-up of TSH levels should be performed in these patients after radiotherapy (AU)

Identification of a novel DRB1-allele (DRB1*0106) by sequence-based typing.

We report herein the identification of a new DRB1 allele using sequence-based typing. The new allele, DRB1*0106, was detected during routine HLA typing of a patient undergoing bone marrow transplantation. DRB1*0106 is identical to DRB1*0101 except for two codons, 71 (AGG-->GCG) and 86 (GGT-->GTG), changing the encoded arginine to alanine and glycine to valine. Both sequences were confirmed by polymerase chain reaction with sequence-specific primers (PCR-SSP). The polymorphism at codon 71 has not been, until now, identified in DRB1*01 alleles, although it is present in all the DRB1*15 alleles as well as DRB1*1309 and DRB1*1424.

Fine needle aspiration of the spleen at the Yaounde Central Hospital

The aim of the study was to find out if the fine needle aspiration (FNA) of the spleen is feasible in our milieu. The technic was used in 5 patients with splenomegaly and without a precise disgnosis; at the Yaounde Central Hospital. The aspirated sample was submitted to a cytological examination that showed lymphomatous lymphoblastic cells in 3 patients and normal lymphoid cells in 2. Fine needle aspiration of the spleen is feasible in our milieu under certain conditions. Hemorrage which is its main complication was not observed in our study of 5 patients

Nursing process: help or hindrance?

Many standard nursing texts effectively treat 'the nursing process' and 'nursing' as one and the same, yet there have been few attempts to critically analyse the concept and its implications. This paper seeks to do both.