Hospital acquired infections

Hospital acquired infections

Hospital-acquired infections are a major challenge to patient safety in the Indian hospitals and other hospitals across the world. It is estimated that in 2002, a total of 1.7 million hospital-acquired infections occurred (4.5 per 100 admissions), and almost 99,000 deaths resulted from or were associated with a hospital-acquired infection, making hospital-acquired infections the sixth leading cause of death in the United States; similar data have been reported from Europe.The estimated costs to the U.S. health care budget are $5 billion to $10 billion annually after spending similar amounts of money in the preventive measures in the developed nations. Approximately one third or more of hospital-acquired infections are preventable.We in India, should be very impressed by this fact that these are preventable to a large extent. On this World health day Apirl 2007, we are now asked to act to prevent the spread of resistant bacteria.

Complex structure of Heparin

Heparin can not be easily synthesized because of its complex structure! 

Recomparin is also expected to reduce dangerous side effects, such as uncontrolled bleeding, while providing the same benefits as naturally derived heparin.

“We proved we don’t really need that structure for the anticoagulant effect,” Liu said. “By eliminating the iduronic acid unit, we were able to reduce the structural complexity of the heparin molecule by approximately 50 percent.”

Customizable Heparin “Previously it was nearly impossible to change the nature of the heparin generated by the enzyme,” Liu says. “The degree of difficulty was ten-plus. Now it’s more like a two or three, which opens the door to the possibility of improving on the natural product.”There is also interest in heparin as a treatment for small-cell lung cancer, Liu says. Being able to produce customized versions of the heparin molecule using 2-O-sulfotransferase would allow researchers to emphasize the drug’s potential anti-cancer properties. Heparin-like structures have also shown potential as treatments for arthritis, asthma, and transplant rejection, among other conditions. In 2008, Liu and his colleagues developed a way to modify the enzyme heparan sulfate 2-O-sulfotransferase, which produces heparin in the human body in addition to other heparin-like molecules. By modifying 2-O-sulfotransferase, researchers will be able to create customized forms of synthetic heparin with different properties.

Autogenous Vein grafts

Saphenous vein grafts and their patency
Coronary artery bypass with vein grafts has been practiced for the past few decades and it has been an effective therapy for the ischemic heart disease. The long term results of bypass are compromised by the vein graft atherosclerosis and native artery atherosclerosis. In some studies it was found that 20% of the vein grafts are occluded in the first year after bypass. It was said that after 10 years only 60% of the vein grafts remain patent. Of the remaining patent grafts 50% would show a important stenosis in them. That means patients who have undergone CABG with vein grafts continue to be at risk of subsequent ischemic events as the time passes and therefore it becomes necessary to attend the risk factors more carefully with or without bypass. Though the arterial grafts gained the attention the saphenous vein remains the most commonly used conduit in many cardiac centers because of its ease of use and ready availability. Probably this holds good for the vein grafts in the leg bypass operations also.

Smoking and drug therapies

Smoking and Cytisine
Smoking is a common problem in peripheral vascular disease patients in India. Behavioural therapy programs are not popular in Indian medical practice. Most of the time it is the doctor who tells patients and at times threatens the patients explaining about the side effects of smoking. Rarely pharmacological intervention is asked by the patients. There is a fear that pharmaco-therapy is more expensive. Cytisine, a partial agonist that binds with high affinity to the α4β2 nicotinic acetylcholine receptor, is a low-cost treatment that may be effective in aiding smoking cessation.
The lower price of cytisine as compared with that of other pharmacotherapies for smoking cessation may make it an affordable treatment to advance smoking cessation globally. A randomized study is published in NEJM recently and that is supporting the role of cytisine in smoking cessation.
Pinjala R K
1st Oct 2011

Brown fat is better ?

Warfarin use is increasing - does that mean there is going to an increase in the intracranial bleeds in clinical practice?
In a recent study from Finland, it was shown there was increased use of warfarin to prevent thrombotic episodes ( atrial fibrillation) there was no corresponding increase in the intracranial bleeds.
Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage
Juha Huhtakangas, MD , A Longitudinal Population-Based Study
Results—The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008. Of a total of 982 patients with ICH, 182 (18.5%) had warfarin-related ICH. One-year survival rate after onset of stroke was 35.2% among warfarin users and 67.9% among nonusers. The annual incidence (P=0.062) and 28-day case fatality of warfarin-related ICHs (P=0.002) decreased during the observation period. Warfarin users were older (mean difference 6.6; 95% CI, 5.0 to 8.1; P<0.001) than nonusers. Admission international normalized ratio values above the therapeutic range (2.0 to 3.0) decreased through the observation period, suggesting improved control of anticoagulant therapy over time. Conclusions—The annual incidence and case fatality of warfarin-related ICHs decreased, although the proportion of warfarin users almost quadrupled in our population.

Heparin neutralization

Is there a better way to neutralize or remove the excess heparin from the patients?

In the new study, Krzysztof Szczubialka and colleagues point out doctors often want to remove heparin from the blood of patients undergoing surgery or other procedures immediately after completing the procedure. Leaving the heparin alone could lead to unwanted bleeding.

Doctors now eliminate heparin by giving patients protamine, a drug that stops heparin's anticoagulant effects. However, they are seeking a better drug because protamine carries a risk of serious side effects.The scientists describe development of a potential new approach that involves use of microscopic beads of a polymer made from modified chitosan, a material obtained from shellfish. In laboratory tests, the beads reduced concentrations of heparin to nearly zero within 10 minutes.

Coffee - is it safe in hypertensive patients who drink coffee?

In many Indian families early morning Coffee drinking is common and that happens even before taking the blood pressure medications.  There is a concern about the effect of coffee on blood pressure and cardiovascular risks. Coffee can increase the blood pressure which may be for transient period.

In the recent issue of American journal of clinical nutrition AE Mesas et al discussed about the implications of coffee intake in hypertensive patients. (The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis – Oct 2011 AJCN).

Non communicable diseases

Non-communicable diseases (NCDs)
Infectious diseases were given maximum attention in the past. All the Governments (health departments) in different countries focused on the prevention and treatment of infectious diseases and controlled their spread. Now they are realizing that the non-communicable disease related morbidity and mortality is increasing across the world. It was initially thought that this is a phenomenon only in the developed nations and urban societies. Some studies have shown that it is the poor nations who are going to see this change and its effects. Even the rural people are also going to be affected like the urban populations. This will be affecting the economic status of the people and countries.

Early intervention with rosuvastatin decreases the lipid components of the plaque in acute coronary syndrome: analysis using integrated backscatter IVUS (ELAN study). Blue becomes green after using the Rosuvastatin suggesting the reduction of lipid. (in IB -IVUS)

New Light On Detection of Bacterial Infection: Polymers Fluoresce in the Presence of Bacteria


Professor Sheila MacNeil, an expert in tissue engineering and wound healing, explained: "The polymers incorporate a fluorescent dye and are engineered to recognise and attach to bacteria, collapsing around them as they do so. This change in polymer shape generates a fluorescent signal that we´ve been able to detect using a hand-held UV lamp."

Imaging inflammatory Large Vessel Vasculitides (LVV)

Young lady (22 years) came to the vascular surgery clinic with low-grade fever, loss of weight, body pains, tenderness in the carotid triangle and weak radial pulsations in both the hands. There were no vascular risk factors or joint pains. Giant-cell arteritis (GCA) and Takayasu’s arteritis (TA) are the commonest large-vessel vasculitides (LVV) in such patients. Imaging studies are increasingly being used to diagnose and to monitor LVV. The aim of this presentation is to discuss a case and review the literature on imaging studies.

Imaging studies play a central role in diagnosing and monitoring the large vessel vasculitides (giant-cell and Takayasu’s arteritis). CT or MRI, TEE can examine the deep and central large vessels, while color Doppler ultrasound and MRI have been used with promising results to investigate the temporal arteries. Positron emission tomography is very sensitive in detecting large-vessel inflammation, although it does not delineate the vessel wall. Imaging procedures can also be used to monitor the disease course. However, imaging signs of inflammation may sometimes persist despite clinical remission and, conversely, seemingly unaffected vessels may develop alterations later on. The commonest angiographic findings in Takayasu’s disease are long, smooth vascular stenoses and sometimes occlusions and aneurysms. However, angiography cannot demonstrate early vasculitic lesions such as vessel wall alterations and is thus not useful for early diagnosis. 

Takayasu's disease

Multiple dilatations of aortic arch vessels and aortic dilatation. - Aortitis - Takayasu's disease

Is Obesity getting the proper attention? A noncommunicable disorder!