Disease cost in a surgical ward.

Data relating to the cost of caring for individual patients were collected for all patients in a general surgical ward over a six-month period. From this the cost per patient was calculated for various diseases and was found to be related to duration of stay. Postoperative morbidity was important in determining cost. A system that calculates cost by means of units based on the use of resources rather than by cash cost accounting is probably the most suitable for a clinician who has to monitor resources.     

Apoptosis in sepsis: a new target for therapeutic exploration.

The treatment of sepsis and septic shock remains a clinical conundrum, and recent prospective trials with biological response modifiers aimed at the inflammatory response have shown only modest clinical benefit. Recently, interest has shifted toward therapies aimed at reversing the accompanying periods of immune suppression. Studies in experimental animals and critically ill patients have demonstrated that increased apoptosis of lymphoid organs and some parenchymal tissues contributes to this immune suppression, anergy, and organ system dysfunction. During sepsis syndromes, lymphocyte apoptosis can be triggered by the absence of IL-2 or by the release of glucocorticoids, granzymes, or the so-called 'death' cytokines: tumor necrosis factor alpha or Fas ligand. Apoptosis proceeds via auto-activation of cytosolic and/or mitochondrial caspases, which can be influenced by the pro- and anti-apoptotic members of the Bcl-2 family. In experimental animals, not only can treatment with inhibitors of apoptosis prevent lymphoid cell apoptosis; it may also improve outcome. Although clinical trials with anti-apoptotic agents remain distant due in large part to technical difficulties associated with their administration and tissue targeting, inhibition of lymphocyte apoptosis represents an attractive therapeutic target for the septic patient.     

Zipf's law organizes a psychiatric ward.

We developed a simple mathematical model based on power law fitting for describing the interactions among patients from a psychiatric ward. First we defined a protocol in order to evaluate in a quantative way the state of the patient, measuring sociability/restlessness through a daily analysis of the behavior and attributing a grade for both parameters, per patient. The grades were checked by two different specialists and a table of incidence was constructed. This table generated power laws for the grades and their variations. We concluded that power laws, like Zipf's law, may be good to explain the data, showing a self-organizing process that indicates a strong interaction component determining the whole behavior. We would like to see more data being collected, in other centers and among normal populations, trying to quantify complex collective behavioral phenomena using self-organizing criticality laws.     

Respite care on a children's ward.

In March 1984 a short term respite care facility for handicapped children was opened in a children''s ward catering primarily for acute medical and surgical problems. The facility was based on a four bedded room designed so that if beds became short in the main ward it could revert immediately to the care of acutely sick children. Three nurses were appointed specifically to staff the facility, the nursing budget for the rest of the ward being reduced proportionately. Conversions were funded by charities and some of the conversion work done by volunteers. The main users were totally dependent children aged under 5 with severe mental and physical handicaps. Parents found the service invaluable, and in addition to planned admissions it was usually possible to accept a child at short notice--for example, when some domestic crisis occurred. Only very rarely was admission impossible because of the needs of acutely ill children. A short term respite care facility not only helps parents cope and may provide beneficial experience for a handicapped child but is also a useful training ground for medical students and junior staff.     

Fenotypical characteristic of coagulase negative staphylococci isolated from patients hospitalized on burn ward and surgical ward

The aim of the study was to analysis of the adhesion factors of coagulase-negative staphylococci (CNS) to intravenous catheter: ability to adhesion, slime production, hydrophobicity of surface of cells and susceptibility to antibiotics. The researches heve been done on CNS strains isolated from cardiosurgical patients. Slime production ability was evaluated using plate method according to Christensen and Congo Red Agar method. Adherence of bacterial strains to intravenous catheter (polytetrafluoroethylene) in vitro was determined using the method of Richards. Hydrophobicity of surface of cells was determined on the basis of agregattion in (NH4)2SO4 Susceptibility to antibiotics was determined using the disc-diffusion method. Out of the analyzed strains 19% were labeled as slime producing in the plate method and 14% in the Congo red Agar method. 43% of analyzed strains were found to have TTC reduction of 3+, 19% of 2+ and 28% of 1+. Among these 10% of the assesed strains did not reduce TTC.     

Staphylococcal footpad infection in mice.

Local footpad infection in mouse was investigated with 55 clinically isolated strains of Staphylococcus aureus. When 10(7) viable cells were inoculated into the footpad, local swelling and bacterial growth resulted after 24 hr. With a dose of 10(6) cells, moderate swelling was observed after a few hours but the reaction had almost disappeared after 24 hr. About 75% of the staphylococcal strains tested caused footpad edema in mice at doses of 10(7) cells. A statistical comparison of the virulence of the organisms on intravenous and intraperitoneal injection with that in inducing footpad swelling is also reported.     

A toll-like receptor 2 pathway regulates the Ppargc1a/b metabolic co-activators in mice with Staphylococcal aureus sepsis

Activation of the host antibacterial defenses by the toll-like receptors (TLR) also selectively activates energy-sensing and metabolic pathways, but the mechanisms are poorly understood. This includes the metabolic and mitochondrial biogenesis master co-activators, Ppargc1a (PGC-1α) and Ppargc1b (PGC-1β) in Staphylococcus aureus (S. aureus) sepsis. The expression of these genes in the liver is markedly attenuated inTLR2(-/-) mice and markedly accentuated in TLR4(-/-) mice compared with wild type (WT) mice. We sought to explain this difference by using specific TLR-pathway knockout mice to test the hypothesis that these co-activator genes are directly regulated through TLR2 signaling. By comparing their responses to S. aureus with WT mice, we found that MyD88-deficient and MAL-deficient mice expressed hepatic Ppargc1a and Ppargc1b normally, but that neither gene was activated in TRAM-deficient mice. Ppargc1a/b activation did not require NF-kβ, but did require an interferon response factor (IRF), because neither gene was activated in IRF-3/7 double-knockout mice in sepsis, but both were activated normally in Unc93b1-deficient (3d) mice. Nuclear IRF-7 levels in TLR2(-/-) and TLR4(-/-) mice decreased and increased respectively post-inoculation and IRF-7 DNA-binding at the Ppargc1a promoter was demonstrated by chromatin immunoprecipitation. Also, a TLR2-TLR4-TRAM native hepatic protein complex was detected by immunoprecipitation within 6 h of S. aureus inoculation that could support MyD88-independent signaling to Ppargc1a/b. Overall, these findings disclose a novel MyD88-independent pathway in S. aureus sepsis that links TLR2 and TLR4 signaling in innate immunity to Ppargc1a/b gene regulation in a critical metabolic organ, the liver, by means of TRAM, TRIF, and IRF-7.     

Staphylococcal enterotoxin A: a chromosomal gene product.

Physical and genetic analysis of the plasmid make-up of Staphylococcus aureus strains S6 and FRI-100 has shown that staphylococcal enterotoxin A is a chromosomal gene product.