January, 2005

Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostics:

  11096.  Bhand AA. Brain abscess--diagnosis and management. J Coll Physicians Surg Pak. 2004 Jul;14(7):407-10.

11097.  Burdette SD, Marinella MA. Pneumonia presenting as singultus. South Med J. 2004 Sep;97(9):915.

11098.  Butler KL, Best IM, Oster RA, Katon-Benitez I, Lynn Weaver W, Bumpers HL. Is bilateral protected specimen brush sampling necessary for the accurate diagnosis of ventilator-associated pneumonia? J Trauma. 2004 Aug;57(2):316-22.

11099.  Desai SR, Veeraraghavan S, Hansell DM, Nikolakopolou A, Goh NS, Nicholson AG, Colby TV, Denton CP, Black CM, du Bois RM, Wells AU. CT features of lung disease in patients with systemic sclerosis: comparison with idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia. Radiology. 2004 Aug;232(2):560-7.

11100.  Eloubeidi MA, Cohn M, Cerfolio RJ, Chhieng DC, Jhala N, Jhala D, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of foregut duplication cysts: the value of demonstrating detached ciliary tufts in cyst fluid. Cancer. 2004 Aug 25;102(4):253-8.

11101.  Feikin DR, Nelson CB, Watt JP, Mohsni E, Wenger JD, Levine OS. Rapid assessment tool for Haemophilus influenzae type b disease in developing countries. Emerg Infect Dis. 2004 Jul;10(7):1270-6.

11102.  Flori P, Bellete B, Durand F, Raberin H, Cazorla C, Hafid J, Lucht F, Sung RT.  Comparison between real-time PCR, conventional PCR and different staining techniques for diagnosing Pneumocystis jiroveci pneumonia from bronchoalveolar lavage specimens. J Med Microbiol. 2004 Jul;53(Pt 7):603-7.

11103.  Hopstaken RM, Witbraad T, van Engelshoven JM, Dinant GJ. Inter-observer variation in the interpretation of chest radiographs for pneumonia in community-acquired lower respiratory tract infections. Clin Radiol. 2004 Aug;59(8):743-52.

11104.  Kleinpell RM, Elpern EH. Community-acquired pneumonia: updates in assessment and management. Crit Care Nurs Q. 2004 Jul-Sep;27(3):231-40. Review.

11105.  Kyriacou DN, Stein AC, Yarnold PR, Courtney DM, Nelson RR, Noskin GA, Handler JA, Frerichs RR.   Clinical predictors of bioterrorism-related inhalational anthrax. Lancet. 2004 Jul 31;364(9432):449-52.

11106.  Leung DT, Tam FC, Ma CH, Chan PK, Cheung JL, Niu H, Tam JS, Lim PL. Antibody response of patients with severe acute respiratory syndrome (SARS) targets the viral nucleocapsid. J Infect Dis. 2004 Jul 15;190(2):379-86.

11107.  Liu CL, Lu YT, Peng MJ, Chen PJ, Lin RL, Wu CL, Kuo HT. Clinical and laboratory features of severe acute respiratory syndrome vis--vis onset of fever. Chest. 2004 Aug;126(2):509-17.

11108.  Losman JA, Cavanaugh K. Cases from the Osler Medical Service at Johns Hopkins University. Diagnosis: P. carinii pneumonia and primary pulmonary sporotrichosis. Am J Med. 2004 Sep 1;117(5):353-6.

11109.  Majewska E, Kasielski M, Luczynski R, Bartosz G, Bialasiewicz P, Nowak D. Elevated exhalation of hydrogen peroxide and thiobarbituric acid reactive substances in patients with community acquired pneumonia. Respir Med. 2004 Jul;98(7):669-76.

11110.  Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer. 2004 Jul;45(1):19-27.

11111.  Offidani M, Corvatta L, Malerba L, Marconi M, Bichisecchi E, Cecchini S, Manso E, Principi T, Gasparini S, Leoni P.  Risk assessment of patients with hematologic malignancies who develop fever accompanied by pulmonary infiltrates: a historical cohort study. Cancer. 2004 Aug 1;101(3):567-77.

11112.  Okamoto T, Gotoh M, Masuya D, Nakashima T, Liu D, Kameyama K, Ishikawa S, Yamamoto Y, Huang CL, Yokomise H. Clinical analysis of interstitial pneumonia after surgery for lung cancer. Jpn J Thorac Cardiovasc Surg. 2004 Jul;52(7):323-9.

11113.  Renoult E, Buteau C, Turgeon N, Moghrabi A, Duval M, Tapiero B. Is routine chest radiography necessary for the initial evaluation of fever in neutropenic children with cancer? Pediatr Blood Cancer. 2004 Sep;43(3):224-8.

11114.  Rosioreanu A, Brusca-Augello GT, Ahmed QA, Katz DS. CT visualization of silicone-related pneumonitis in a transsexual man. AJR Am J Roentgenol. 2004 Jul;183(1):248-9.

11115.  Tokar B, Ozkan R, Ilhan H. Tracheobronchial foreign bodies in children: importance of accurate history and plain chest radiography in delayed presentation. Clin Radiol. 2004 Jul;59(7):609-15.

11116.  Vincent JL. Ventilator-associated pneumonia. J Hosp Infect. 2004 Aug;57(4):272-80. Review.

11117.  von Lilienfeld-Toal M, Dietrich MP, Glasmacher A, Lehmann L, Breig P, Hahn C, Schmidt-Wolf IG, Marklein G, Schroeder S, Stuber F.  Markers of bacteremia in febrile neutropenic patients with hematological malignancies: procalcitonin and IL-6 are more reliable than C-reactive protein. Eur J Clin Microbiol Infect Dis. 2004 Jul;23(7):539-44.


11118.  Benson RA, Lowrey JA, Lamb JR, Howie SE. The Notch and Sonic hedgehog signalling pathways in immunity. Mol Immunol. 2004 Jul;41(6-7):715-25. Review.

11119.  Carter AB, Tephly LA, Venkataraman S, Oberley LW, Zhang Y, Buettner GR, Spitz DR, Hunninghake GW.  High levels of catalase and glutathione peroxidase activity dampen H2O2 signaling in human alveolar macrophages. Am J Respir Cell Mol Biol. 2004 Jul;31(1):43-53.

11120.  Masia M, Gutierrez F, Llorca B, Navarro JC, Mirete C, Padilla S, Hernandez I, Flores E.   Serum concentrations of lipopolysaccharide-binding protein as a biochemical marker to differentiate microbial etiology in patients with community-acquired pneumonia. Clin Chem. 2004 Sep;50(9):1661-4.

11121.  Meloni F, Caporali R, Marone Bianco A, Paschetto E, Morosini M, Fietta AM, Bobbio-Pallavicini F, Pozzi E, Montecucco C. Cytokine profile of bronchoalveolar lavage in systemic sclerosis with interstitial lung disease: comparison with usual interstitial pneumonia. Ann Rheum Dis. 2004 Jul;63(7):892-4.

11122.  Oberley RE, Ault KA, Neff TL, Khubchandani KR, Crouch EC, Snyder JM. Surfactant proteins A and D enhance the phagocytosis of Chlamydia into THP-1 cells. Am J Physiol Lung Cell Mol Physiol. 2004 Aug;287(2):L296-306.

11123.  Waters CM. Reactive oxygen species in mechanotransduction. Am J Physiol Lung Cell Mol Physiol. 2004 Sep;287(3):L484-5. Review.


11124.  Baddour LM, Yu VL, Klugman KP, Feldman C, Ortqvist A, Rello J, Morris AJ, Luna CM, Snydman DR, Ko WC, Chedid MB, Hui DS, Andremont A, Chiou CC; International Pneumococcal Study Group.  Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia. Am J Respir Crit Care Med. 2004 Aug 15;170(4):440-4.

11125.  Kozyrskyj AL, Dahl ME, Chateau DG, Mazowita GB, Klassen TP, Law BJ. Evidence-based prescribing of antibiotics for children: role of socioeconomic status and physician characteristics. CMAJ. 2004 Jul 20;171(2):139-45.

11126.  Vollman KM. The right position at the right time: mobility makes a difference. Intensive Crit Care Nurs. 2004 Aug;20(4):179-82. Review.



April, 2005

Some Selected Abstracts:


Kleckner M 3rd. Blending hospital economics with quality of care: a case study. Healthc Financ Manage. 2004 Dec;58(12):64-8, 70.

La Costa Group, LLC, Carlsbad, Calif., USA.

Many hospitals have attained substantial gains in cost control. Unfortunately, the impact of cost initiatives on quality of care and clinical outcomes is not clear. However, by looking at the patient management costs incurred relative to clinical outcomes as the patient progresses through diagnosis and treatment, healthcare organizations can evaluate a technology's economic value.


Hui DS, Wong KT, Antonio GE, Lee N, Wu A, Wong V, Lau W, Wu JC, Tam LS, Yu LM, Joynt GM, Chung SS, Ahuja AT, Sung JJ. Severe acute respiratory syndrome: correlation between clinical outcome and radiologic features. Radiology. 2004 Nov;233(2):579-85.

Department of Diagnostic Radiology and Organ Imaging, The Chinese Univ of Hong Kong, Prince of Wales Hosp, 30-32 Ngan Shing St, Shatin, Hong Kong SAR.

PURPOSE: To evaluate whether there is a correlation between the clinical outcomes and radiologic features of severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: The clinical, laboratory, and radiologic features of 138 patients with SARS were analyzed. Three radiologists in consensus retrospectively assessed the frontal chest radiographs obtained at presentation and during treatment (n = 2045) for the distribution (each lung was divided into upper, middle, and lower zones) and extent of lung parenchymal abnormality. Clinical end points included intensive care unit (ICU) admission and death. RESULTS: Thirty-six (26.1%) patients required ICU care, and eight (5.8%) died. The patients who required ICU care and/or died had more extensive consolidation on chest radiographs obtained initially (median percentage of consolidation, 3.30%, with interquartile range [IR] of 1.70%-8.78% vs 1.70% [IR, 0%-3.30%]; P < .001) and on day 7 after fever onset (median percentage of consolidation, 15.00% [IR, 6.48%-28.73%] vs 5.00% [IR, 2.50%-7.50%]; P < .001) than did surviving patients who did not require ICU care. Patients with involvement of more than one lung zone on initial and day 7 chest radiographs were more likely to require ICU care and/or die than were those with involvement of one or fewer zones (P < .001). Patients with bilateral pneumonic changes at presentation were more likely to have an adverse outcome than were those with unilateral pneumonia (P < .001). Involvement of more than one lung zone at baseline chest radiography was an independent predictor of ICU admission and/or death (odds ratio, 3.16; 95% confidence interval: 1.07, 9.32; P = .037) after adjustments for other significant factors (ie, patient age, and baseline neutrophil count and lactate dehydrogenase level). CONCLUSION: More extensive airspace disease at presentation is an independent predictor of adverse outcome in patients with SARS.


Bissinger R, Carlson C, Hulsey T, Eicher D. Secondary surfactant deficiency in neonates. J Perinatol. 2004 Oct;24(10):663-6.

College of Nursing, Medical University of South Carolina, SC 29445, USA.

Surfactant treatment has become the standard of care in premature infants with respiratory distress syndrome (RDS). Pulmonary hemorrhage, pulmonary edema, pneumonia, and atelectasis have been shown to liberate inflammatory mediators and plasma proteins, which damage type II pneumocytes and inactivate surfactant. These disease processes may, therefore, lead to a secondary surfactant inactivation or deficiency, which can be an unrecognized cause of respiratory decompensation after initial recovery from RDS in this vulnerable population. This is a descriptive report of three cases, which had acute respiratory decompensation between 1 and 3 weeks of age. All three infants demonstrated a response to secondary doses of surfactant. We submit that the diagnosis and treatment of secondary surfactant deficiency in the critically ill premature neonate warrants further study.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

11702.     Alvarez-Lerma F, Torres A. Severe community-acquired pneumonia. Curr Opin Crit Care. 2004 Oct;10(5):369-74. Review.

11703.    Astudillo L, Martin-Blondel G, Sans N, Dhaste G, Couret B, Arlet-Suau E. Solitary nodular form of bronchiolitis obliterans organizing pneumonia. Am J Med. 2004 Dec 1;117(11):887-8.

11704.      Bach JR. Don't forget the abdominal thrust.Chest. 2004 Oct;126(4):1388-9;

11705.      Bandi VD, Munnur U, Matthay MA. Acute lung injury and acute respiratory distress syndrome in pregnancy. Crit Care Clin. 2004 Oct;20(4):577-607. Review.

11706.        Bissinger R, Carlson C, Hulsey T, Eicher D. Secondary surfactant deficiency in neonates. J Perinatol. 2004 Oct;24(10):663-6.

11707.        Carver RT, Boysel LC, Marciniak CM, Nussbaum SB. Myotonic dystrophy presenting as new-onset hand weakness and recurrent pneumonia in a patient with paraplegia: a case report. Arch Phys Med Rehabil. 2004 Nov;85(11):1896-8.

11708.        Cetinkaya F, Gogremis A, Kutluk G. Comparison of two antibiotic regimens in the empirical treatment of severe childhood pneumonia. Indian J Pediatr. 2004 Nov;71(11):969-72.

11709.        Charles PG, Ananda-Rajah M, Johnson PD, Grayson ML. Are the Australian guidelines asking too much of the Pneumonia Severity Index (PSI)? Med J Aust. 2004 Nov 1;181(9):515;

11710.        Chen HL, Chiou SS, Hsiao HP, Ke GM, Lin YC, Lin KH, Jong YJ. Respiratory adenoviral infections in children: a study of hospitalized cases in southern Taiwan in 2001--2002. J Trop Pediatr. 2004 Oct;50(5):279-84.

11711.        Crowe JE Jr. Human metapneumovirus as a major cause of human respiratory tract disease. Pediatr Infect Dis J. 2004 Nov;23(11 Suppl):S215-21. Review.

11712.        Davies G, Wells AU, du Bois RM. Respiratory bronchiolitis associated with interstitial lung disease and desquamative interstitial pneumonia. Clin Chest Med. 2004 Dec;25(4):717-26, vi. Review.

11713.        Demetriades D, Constantinou C, Salim A, Velmahos G, Rhee P, Chan L. Liver cirrhosis in patients undergoing laparotomy for trauma: effect on outcomes. J Am Coll Surg. 2004 Oct;199(4):538-42.

11714.        Flaherty KR, Martinez FJ. Cigarette smoking in interstitial lung disease: concepts for the internist. Med Clin North Am. 2004 Nov;88(6):1643-53, xiii. Review.

11715.        Gea-Banacloche JC, Opal SM, Jorgensen J, Carcillo JA, Sepkowitz KA, Cordonnier C.  Sepsis associated with immunosuppressive medications: an evidence-based review. Crit Care Med. 2004 Nov;32(11 Suppl):S578-90. Review.

11716.        Gesell SB, Wolosin RJ. Inpatients' ratings of care in 5 common clinical conditions. Qual Manag Health Care. 2004 Oct-Dec;13(4):222-7.

11717.        Hui DS, Wong KT, Antonio GE, Lee N, Wu A, Wong V, Lau W, Wu JC, Tam LS, Yu LM, Joynt GM, Chung SS, Ahuja AT, Sung JJ. Severe acute respiratory syndrome: correlation between clinical outcome and radiologic features. Radiology. 2004 Nov;233(2):579-85.

11718.        Kaira K, Takise A, Goto T, Horie T, Mori M. Barium sulphate aspiration. Lancet. 2004 Dec 18;364(9452):2220.

11719.        Kleckner M 3rd. Blending hospital economics with quality of care: a case study. Healthc Financ Manage. 2004 Dec;58(12):64-8, 70.

11720.        Lim WS. Identifying failure of empirical treatment for pneumonia: vigilance and common sense. Thorax. 2004 Nov;59(11):918-9.

11721.        Marrie TJ, Beecroft MD, Herman-Gnjidic Z. Resolution of symptoms in patients with community-acquired pneumonia treated on an ambulatory basis. J Infect. 2004 Nov;49(4):302-9.

11722.        Narita M, Tanaka H. Two distinct patterns of pleural effusions caused by Mycoplasma pneumoniae infection. Pediatr Infect Dis J. 2004 Nov;23(11):1069;

11723.        Poon LL, Guan Y, Nicholls JM, Yuen KY, Peiris JS. The aetiology, origins, and diagnosis of severe acute respiratory syndrome. Lancet Infect Dis. 2004 Nov;4(11):663-71. Review.

11724.        van Saene HK, Ashworth M, Petros AJ, Sanchez M, de la Cal MA. Do not suction above the cuff. Crit Care Med. 2004 Oct;32(10):2160-2.

11725.        Williamson JP, Illing R, Gertler P, Braude S. Near-drowning treated with therapeutic hypothermia. Med J Aust. 2004 Nov 1;181(9):500-1.

11726.        Yiannakoulias N, Russell ML, Svenson LW, Schopflocher DP. Doctors, patients and influenza-like illness: clinicians or patients at risk? Public Health. 2004 Oct;118(7):527-31.


11727.     Reinert RR. Pneumococcal conjugate vaccines--a European perspective. Int J Med Microbiol. 2004 Oct;294(5):277-94. Review.

11728.     Remick DG. Do not get sick when you are sick: the impact of comorbid conditions. Crit Care Med. 2004 Oct;32(10):2147-8.


11729.     Fletcher MA, Fabre P, Debois H, Saliou P. Vaccines administered simultaneously: directions for new combination vaccines based on an historical review of the literature. Int J Infect Dis. 2004 Nov;8(6):328-38.


11730.     Barthwal MS, Deoskar RB, Rajan KE, Chatterjee RS. Intrapleural streptokinase in complicated parapneumonic effusions and empyema. Indian J Chest Dis Allied Sci. 2004 Oct-Dec;46(4):257-61.

11731.     Mouw DR, Langlois JP, Turner LF, Neher JO. Clinical inquiries. Are antibiotics effective in preventing pneumonia for nursing home patients? J Fam Pract. 2004 Dec;53(12):994-6. Review.

11732.    Peterson MW, Hornick DB. Community-acquired pneumonia guidelines: Peering back through the looking glass...clearly? Am J Med. 2004 Nov 15;117(10):799-800.



July, 2005

Some Selected Abstracts:


Shulman L, Ost D. Managing infection in the critical care unit: how can infection control make the ICU safe? Crit Care Clin. 2005 Jan;21(1):111-28, ix.

Division of Pulmonary and Critical Care Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA.

The goal of this article is to use ventilator-associated pneumonia (VAP) as a prototype for nosocomial infections to explore the issues of patient safety and infection control. To do this, we review disease-specific aspects of VAP, develop a brief working definition of patient safety, and then determine how the concepts of infection control fit into the broader context of patient safety.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

  1. Cammarota G, Certo M. Images in clinical medicine. Corkscrew esophagus. N Engl J Med. 2005 Feb 24;352(8):816.

  2. Chee CB, Da Costa JL, Sim CS. A female with dry cough, progressive dyspnoea and weight loss. Eur Respir J. 2005 Jan;25(1):206-9.

  3. Donnelly LF. Imaging in immunocompetent children who have pneumonia. Radiol Clin North Am. 2005 Mar;43(2):253-65. Review.

  4. Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005 Mar 1;142(5):352-8.

  5. Hanson CW 3rd, Thaler ER. Electronic nose prediction of a clinical pneumonia score: biosensors and microbes. Anesthesiology. 2005 Jan;102(1):63-8.

  6. La Scola B, Fournier PE, Gouin F, Motte A, Raoult D. Mycoplasma pneumoniae: a rarely diagnosed agent in ventilator-acquired pneumonia. J Hosp Infect. 2005 Jan;59(1):74-5.

  7. Mancini GJ, Mancini ML, Nelson HS Jr. Efficacy of laparoscopic appendectomy in appendicitis with peritonitis. Am Surg. 2005 Jan;71(1):1-4;

  8. Tobin MJ. Update in pulmonary diseases. Ann Intern Med. 2005 Feb 15;142(4):283-8. Review.

  9. Vachier I, Bonnans C, Chavis C, Farce M, Godard P, Bousquet J, Chanez P.  Severe asthma is associated with a loss of LX4, an endogenous anti-inflammatory compound. J Allergy Clin Immunol. 2005 Jan;115(1):55-60.

  10. Walsh SR, Parada NA. Images in clinical medicine. Uremic frost. N Engl J Med. 2005 Mar 31;352(13):e13.

  11. Williams S, MacDonald P, Hoyer JD, Barr RD, Athale UH. Methemoglobinemia in children with acute lymphoblastic leukemia (ALL) receiving dapsone for pneumocystis carinii pneumonia (PCP) prophylaxis: a correlation with cytochrome b5 reductase (Cb5R) enzyme levels. Pediatr Blood Cancer. 2005 Jan;44(1):55-62.

  12. Yella LK, Krishnan P, Gillego V. The air crescent sign: A clue to the etiology of chronic necrotizing pneumonia. Chest. 2005 Jan;127(1):395-7.

  1. Inaba H, Geiger TL, Lasater OE, Wang WC. A case of hemoglobin SC disease with cold agglutinin-induced hemolysis. Am J Hematol. 2005 Jan;78(1):37-40.

  2. MacDowell AL, Bacharier LB. Infectious triggers of asthma. Immunol Allergy Clin North Am. 2005 Feb;25(1):45-66. Review.

  3. Tenenbaum T, Heusch A, Henrich B, MacKenzie CR, Schmidt KG, Schroten H. Acute hemorrhagic pericarditis in a child with pneumonia due to Chlamydophila pneumoniae. J Clin Microbiol. 2005 Jan;43(1):520-2.

  1. Gessner BD, Sutanto A, Linehan M, Djelantik IG, Fletcher T, Gerudug IK, Ingerani, Mercer D, Moniaga V, Moulton LH, Moulton LH, Mulholland K, Nelson C, Soemohardjo S, Steinhoff M, Widjaya A, Stoeckel P, Maynard J, Arjoso S. Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet. 2005 Jan 1;365(9453):43-52.


  1. Andrade AL, Martelli CM. Globalisation of Hib vaccination--how far are we? Lancet. 2005 Jan 1;365(9453):5-7.

  2. Aubert G, Carricajo A, Vautrin AC, Guyomarc'h S, Fonsale N, Page D, Brunel P, Rusch P, Zeni F. Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit. J Hosp Infect. 2005 Feb;59(2):83-9.

  3. Booth CM, Stewart TE. Severe acute respiratory syndrome and critical care medicine: the Toronto experience. Crit Care Med. 2005 Jan;33(1 Suppl):S53-60.

  4. Brandt D. Acid suppression and pneumonia. Am J Nurs. 2005 Feb;105(2):21.

  5. Flores G. Preventing hospitalisations for children. Lancet. 2005 Jan 15;365(9455):201-2.

  6. Heffner JE. Multicenter trials of treatment for empyema--after all these years. N Engl J Med. 2005 Mar 3;352(9):926-8.

  7. Leone M. Endpoint: quality of life. Crit Care Med. 2005 Jan;33(1):267-8;

  8. Lincopan N, McCulloch JA, Reinert C, Cassettari VC, Gales AC, Mamizuka EM.  First isolation of metallo-beta-lactamase-producing multiresistant Klebsiella pneumoniae from a patient in Brazil. J Clin Microbiol. 2005 Jan;43(1):516-9.

  9. Madhi SA, Zar HJ, Saloojee H, Gray GE. Co-trimoxazole prophylaxis in African children with HIV-1. Lancet. 2005 Feb 26;365(9461):749-50;

  10. Shulman L, Ost D. Managing infection in the critical care unit: how can infection control make the ICU safe? Crit Care Clin. 2005 Jan;21(1):111-28, ix. Review.

  11. Timmermans S, Mauck A. The promises and pitfalls of evidence-based medicine. Health Aff (Millwood). 2005 Jan-Feb;24(1):18-28. 

  12. Veirum JE, Sodemann M, Biai S, Jakobsen M, Garly ML, Hedegaard K, Jensen H, Aaby P. Routine vaccinations associated with divergent effects on female and male mortality at the paediatric ward in Bissau, Guinea-Bissau. Vaccine. 2005 Jan 19;23(9):1197-204.

  13. Wattanawaitunechai C, Peacock SJ, Jitpratoom P. Tsunami in Thailand--disaster management in a district hospital. N Engl J Med. 2005 Mar 10;352(10):962-4.



October, 2005

Some Selected Abstracts:


Bang AT, Bang RA, Reddy MH, Baitule SB, Deshmukh MD, Paul VK, de C Marshal TF. Simple clinical criteria to identify sepsis or pneumonia in neonates in the community needing treatment or referral. Pediatr Infect Dis J. 2005 Apr;24(4):335-41.

Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli (Maharashtra), 442 605, India.

BACKGROUND: Sepsis, meningitis and pneumonia annually kill 1.1 million neonates in developing countries; most deaths occur at home. OBJECTIVES: To develop simple clinical criteria, enabling health workers in communities to identify neonates with potentially fatal sepsis; and to identify the danger signs alerting mothers to seek care. METHODS: In a field trial in 39 villages in Gadchiroli, India, trained health workers visited all neonates at home 8 times during the first 28 days of life, recording signs and outcome without interventions during 1995-1996 and with home-based management of sick neonates during 1996-1999. An independent neonatologist assigned the cause of death. We use the term "sepsis" to include sepsis, meningitis and pneumonia. We evaluated 31 signs as predictors of 43 sepsis deaths among 3567 neonates. We also evaluated mothers' observations as the danger signs to seek care. RESULTS: Simultaneous presence of any 2 of 7 signs (reduced or stopped sucking; weak or no cry; limbs becoming limp; vomiting or abdominal distension; baby cold to touch; severe chest indrawing; umbilical infection) predicted sepsis death with sensitivity 100%, specificity 92%, positive predictive value 27.2% and negative predictive value 100% in the nonintervention period. The criteria identified 10.6% of the neonates in the community as suspected sepsis, at a mean of 5.4 days before death. The criteria remained valid in the postintervention period. Any 1 of the 5 maternally observed danger signs (reduced sucking, drowsy or unconscious, baby cold to touch, fast breathing and chest indrawing) gave 100% sensitivity and identified 23.9% neonates for seeking care. CONCLUSION: These criteria identify neonates in the community who are at risk for dying of infection with excellent sensitivity, specificity and negative predictive value but a moderate positive predictive value. They can be used by health workers to select sick neonates for treatment or referral. One potentially fatal case would be treated per 4 presumptive cases treated.


Larson EL, Cimiotti J, Haas J, Parides M, Nesin M, Della-Latta P, Saiman L. Effect of antiseptic handwashing vs alcohol sanitizer on health care-associated infections in neonatal intensive care units. Arch Pediatr Adolesc Med. 2005 Apr;159(4):377-83  

School of Nursing, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University, 630 W 168th Street, New York, NY 10032, USA.

BACKGROUND: The Centers for Disease Control and Prevention, Atlanta, Ga, recommend use of waterless alcohol hand products in lieu of traditional handwashing for patient care, but there are few data demonstrating the impact of this recommendation on health care-associated infections. OBJECTIVE: To compare the effect of 2 hand hygiene regimens on infection rates and skin condition and microbial counts of nurses' hands in neonatal intensive care units. DESIGN, SETTING, AND PARTICIPANTS: Clinical trial using a crossover design in 2 neonatal intensive care units in Manhattan, NY, from March 1, 2001, to January 31, 2003, including 2932 neonatal hospital admissions (51 760 patient days) and 119 nurse participants. INTERVENTION: Two hand hygiene products were tested: a traditional antiseptic handwash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. RESULTS: After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with handwashing were 0.98 (95% confidence interval [CI], 0.77-1.25) for any infection, 0.99 (95% CI, 0.77-1.33) for bloodstream infections, 1.61 (95% CI, 0.57-5.54) for pneumonia, 1.78 (95% CI, 0.94-3.37) for skin and soft tissue infections, and 1.26 (95% CI, 0.42-3.76) for central nervous system infections. The skin condition of participating nurses was significantly improved during the alcohol phase (P = .02 and P = .049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses' hands (3.21 and 3.11 log(10) colony-forming units for handwashing and alcohol, respectively; P = .38). CONCLUSIONS: Infection rates and microbial counts on nurses' hands were equivalent during handwashing and alcohol phases, and nurses' skin condition was improved using alcohol. However, assessing the impact on infection rates of a single intervention is challenging because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.


Trad S, Ghosn J, Dormont D, Stankoff B, Bricaire F, Caumes E. Nuclear bilateral Bell's palsy and ageusia associated with Mycoplasma pneumoniae pulmonary infection. J Med Microbiol. 2005 Apr;54(Pt 4):417-9

Departement des Maladies Infectieuses et Tropicales, CHU Pitie-Salpetriere, 47-83 Boulevard de l'Hopital, 75013 Paris, France.

This case report describes a case of nuclear bilateral Bell's palsy and ageusia associated with Mycoplasma pneumoniae infection. Magnetic resonance imaging evidenced T2-weighted hyper-intense protuberantial lesions. Such topography leading to a nuclear palsy contrasts with previously reported infectious diplegia involving only peripheral facial nerves, and has not yet been described in the spectrum of M. pneumoniae post-infectious neurological manifestations.

Van Dissel JT, Numan SC, Van't Wout JW. Chills in 'early sepsis': good for you? J Intern Med. 2005 May;257(5):469-72 Erratum in: J Intern Med. 2005 Jul;258(1):92

Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.

We evaluated the predictive value of chills, bacteraemia and endotoxaemia for in-hospital mortality and survival at 5-10 years long-term follow-up in a prospective cohort of 'early sepsis' patients presenting with fever resulting from community-acquired pneumonia or pyelonephritis. Febrile patients with chills had bacteraemia more often (RR 3.1, 95% CI 1.8-5.4) than those without chills. Neither chills nor bacteraemia were significantly related to in-hospital mortality, but patients with endotoxaemia had a higher in-hospital mortality rate than those without endotoxaemia. Patients with chills had a significantly higher survival rate at long-term follow-up than those without chills on admission: the estimated risk of dying was 0.644 (95% CI 0.43-0.95, P = 0.029) for an individual with chills, compared to a person without chills, adjusting for the other factors [age cohort, underlying disease and the pro-inflammatory response in the blood, i.e. tumour necrosis factor-alpha (TNF-alpha) and blood leucocyte number, as scored on hospital admission] in the Cox proportional hazards model. Chills may characterize a patient subpopulation that upon pulmonary and urinary tract infection is able to raise a more rapid and/or efficient host response.


Valipour A, Kreuzer A, Koller H, Koessler W, Burghuber OC Bronchoscopy-guided topical hemostatic tamponade therapy for the management of life-threatening hemoptysis. Chest. 2005 Jun;127(6):2113-8.

Department of Respiratory and Critical Care Medicine and Ludwig-Boltzmann Institute for COPD, Otto-Wagner-Spital, Sanatoriumsstr. 2, 1140 Wien, Vienna, Austria.

STUDY OBJECTIVES: Massive hemoptysis is a life-threatening condition. Therapeutic strategies such as interventional angiography, surgery, and/or bronchoscopy have been applied in the clinical setting with variable results. We investigated the efficacy of bronchoscopy-guided topical hemostatic tamponade therapy (THT) using oxidized regenerated cellulose (ORC) mesh in the management of life-threatening hemoptysis. DESIGN: Seventy-six consecutive patients underwent emergency bronchoscopy for massive hemoptysis. Fifty-seven patients (75%) had persistent endobronchial bleeding despite bronchoscopic wedging technique, cold saline solution lavage, and instillation of regional vasoconstrictors. These patients subsequently underwent THT according to the same procedure. SETTING: Teaching hospital, bronchoscopy unit of a 300-bed tertiary pulmonary referral center. RESULTS: THT with ORC was successfully performed on 56 of 57 patients (98%) with an immediate arrest of hemoptysis. All patients successfully treated with THT remained free of hemoptysis for the first 48 h. None required intensive care support or immediate surgery. Mean procedure time (+/- SD) of THT was 11.5 +/- 4.2 min. Recurrence of hemoptysis that was characterized as being mild (< 30 mL) to moderate (30 to 100 mL) developed in six patients (10.5%) 3 to 6 days after THT. Post-obstructive pneumonia developed in five subjects (9%) after endoscopic THT. A subgroup of patients (n = 14) underwent bronchoscopic follow-up 4 weeks after discharge. The ORC mesh was absorbed in all of these patients without signs of foreign body reaction. CONCLUSIONS: Endobronchial THT using ORC is a safe and practicable technique in the management of life-threatening hemoptysis with a high success and a relatively low complication rate.

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