Spinal infections increased since 1990’s due to aging populations, chronic debilitating diseases and higher number of immunocompromised hosts. Management of spinal infections is still challenging because symptoms are often non-specific which leads to delayed diagnosis. However local pain in the neck and back are the main common symptoms taking place in more than 90% patients. Only few of the patients experience fever and motion of the spine is limited due to localized pain and muscle spasm. One of the useful tools used for early diagnosis of spinal infection is the magnetic resonance imaging. And it is able to yield positive finding just after 3-5 days from the onset of disease
Laboratory Test and Imaging
Almost 90% of patients with spinal infection demonstrate an elevated erythrocyte sedimentation rate. It also showed local pain worsening, sepsis, fever, neurologic symptoms and new local pain following recent episode of sepsis. For the pathogens identified in cultured must have appropriate antibiotics for careful consideration of antimicrobial susceptibility and spinal tissue penetration. In radiographic finding almost 74% of patients shows narrowing of the disc space. By the time of 3-6 weeks from the onset of disease reveals destructive changes such as lytic lesions of endplate. In patients with M. tuberculosis infection shows bone destruction with bone atrophy.
Some indications for surgical treatment include neurologic deficit, spinal instability, progressive deformity, persistent infection and unbearable pain. However the gold standard in surgical treatment in most patients is an anterior radical debridement followed by bone grafting. On the other hand patients suspected to have spinal infection due to bacteria, identification of the causative agent is very important. Cultured must me initiated from blood and from locus of infection before administering antibiotic. The rate of pathogen obtained from the disc body varies from 41%-90% which is usually collected using biopsy.
Indeed, the posterior to anterior debridement and strut bone grafting are recently popular in spinal infection surgery. In which this method provides faster and more complete fusion and better bone correction. However in some cases recurrent infection occurs after spinal instrumentation.
Sources: Prepared by Joan Tura from Journal of Orthopaedic Science
Volume 23, Issue 1, January 2018, Pages 8-13
Daptomycin is a lipopeptide antibiotic used as treatment for systemic infections caused by gram-positive organisms. Its compound occurs naturally from soil. And its unique mechanism of action makes it useful in treating infections caused by multiple drug resistance bacteria. Daptomycin mode of action disrupts bacterial cell membrane and inserted into where it then aggregates. The aggregation alters the curvature of the membrane which then creates leaks of ions resulting to the bacterial cell death. However, data on the clinical outcomes with vascular graft infection patients treated with Daptomycin are limited. This study is the pioneer describing Daptomycin used in the treatment of vascular graft infections caused by gram-positive organisms.
Daptomycin on Vascular Graft Infections
It isa retrospective cohort study of patients diagnosed with VGI receiving Daptomycin during the period January 2010 to December 2012. A total of 1066 patients underwent surgery at tertiary level hospital and among of 72 developed surgical site infections. And 25 have vascular graft infection which then treated with Daptomycin. These patients had previously existing episode of acute renal failure with glycopeptides allergy. The average dose of Daptomycin is 6.1 mg/kg/day. Even though, the current guidelines of the Infectious Disease Society of America recommended 8-10mg/kg/day for complicated bacteremia and endocarditis.
Daptomycin is also associated with rifampicin into the biofilm created by gram-negative microorganisms. But all patients given with rifampicin in addition to Daptomycin showed remission of infection. Yet those who did not receive rifampicin only Daptomycin showed only 50% remission of infection. All the patients in this study did not develop muscle toxicity due to the administration of Daptomycin. Since muscle toxicity is mostly reported to be linked with Daptomycin. As well as other side effects such as pneumonia and eosinophilic were not observed.
However, it appears that treatment of VGI with Daptomycin alone has similar effects with other antibiotics but with fewer side effects. Indeed, the use of Daptomycin as an antibiotic treatment for VGI caused by gram-positive bacteria is effective and well tolerated. It may be also serves as an alternative treatment for vascular graft infections particularly in patients with peripheral arterial disease whom renal insufficiency is common.
Sources: Prepared by Joan Tura from International Journal of Infectious Diseases
Volume 68, March 2018, Pages 69-73
Carbon footprints in health care system attributes to the planetary threat of climate change. Major countries like USA and UK contributes about 10% and 4% total carbon footprints respectively. Each nation requires data on carbon emissions based on different economic sectors. Because climate change is an ultimate global health problem and information about the contributions of health care to the carbon footprints becomes more important. Australia has a small population yet has one of the highest carbon dioxide emissions per person in the world. Hospitals and pharmaceutical industries are accountable for the high carbon footprints linked with health care in Australia.
Carbon Dioxide Emission on Health Care System
Australia spend about AUS$161 billion on health care from year 2014-2015 that corresponds to 9.4% country’s gross domestic product. Health care has 7% of Australia’s entire carbon dioxide emissions whereas residential and other construction has 14% carbon dioxide emissions. And it signifies that health care is half on every single constructed building, pipeline, house, oil rig and rail road. Also health care is equal to the total carbon footprints of all activities including transport, electricity, food, entertainment and purchases. Hospitals comprise half of the total health care while pharmaceuticals contribute 20% more total carbon dioxide emissions. Medical services has 6% while general practitioners has 4% and direct used of fuel contributes 10% carbon dioxide emissions. Indirect productions due to purchases from economic sector shares almost 90% of the total.
The carbon footprints on economic sectors vary each year ensuing different carbon intensity. Based on statistics of Australia’s health care indicates that expenditure is rising and more money being spend. Notably there is linear association between carbon footprints emission and expenditures showing that high expenditures causes in high carbon dioxide productions. Indeed, health care system contributes carbon footprints that add-up to an increasingly climate change dilemma. Although it is apparent that strategies is needed to reduce harmful effects of carbon dioxide emissions and restoring Earth’s energy balance.
Hence, the study point out that health care significantly contributes to Australia’s total carbon footprints and recognizes major contributors. The role of public health and hospitals are crucial in carbon controlled health care system. Including all fields of medicine, medical associations and colleges will take part in reducing health care carbon footprints. Australian states implement programs to attain carbon neutral status by 2050 however, without baseline data carbon aspiration will be uncertain.
The Lancet Planetary Health Volume 2, Issue 1, January 2018, Pages e27-e35
The body is made up of millions of cells and cancer starts when one of them instigates to develop and proliferate too much resulting to make a growth called tumour. Over the decades cancer shows high incidence of death and different therapy technique develop including radiotherapy and chemotherapy. However, recent discovery about hyperthermia technique which does not use any chemicals or damaging radiation to eliminate cancer cell with minimum injury to the normal cells. Hyperthermia (also known as thermotherapy) is generally regarded as a mean body temperature higher than normal (Alexander, 2008). Research has shown that elevated body temperature can damage and kill cancerous cells with minimal injury to normal cells (van der Zee et al., 2000).
Hyperthermia causes tumor cell more susceptible to radiation and injure other cancer cells. The study focuses on the use of heat to treat cancer and it is generally applicable to any other forms of cancer therapy. Hyperthermia also intends to cure various types of cancer including lung, liver, brain, esophagus, breast, bladder and rectum. According to GLOBOCAN statistics analysis (2012) there are 14.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancers. There are different types of hyperthermia technique that are presently studied including local, regional and whole body hyperthermia. All of these technique show significant depression in tumor size combining with other therapy.
It is a technique that the heat applied only to the small fraction of the tumor tissue by using applicator emitting microwaves or antennas or radiowaves to locate the specific target area that can be heated in the surface with the contacting medium. There are different form of applicators used clinically such as waveguide applicators, horn spiral, compact applicator and current sheet. For local hyperthermia intra-tumoral temperature can be controlled by the applicators providing its specified location. On the other hand there are some side effects of local hyperthermia thus includes bleeding, pain to the target site, swelling, burns, blood clots and blistering as well as injuring the nerves and muscles roughly at the treated area.
In regional hyperthermia a body part such as organ, limbs and body cavity is heated using arrays of antennas with different applicators like sigma blade that is broadly used containing four pairs of dipole antennas. Endocavitary hyperthermia is useful for the tumors less than 5 cm in diameter and it is effective to administer along with brachy therapy. There are several antenna types used such as radiofrequency electrodes, ultrasounds transducers, microwave antennas, heat sources (hot water tubes, ferromagnetic seeds) and fibers. This technique is a bit painful since the positioning of the applicators is not more than 1.0-1.5 cm and the sensitivity to interference, positioning of the antennas and orientation is critical. The antennas inserted in the hollow organ that includes rectum, esophagus, cervix, urethra and vagina and on the outside of the body a counter electrodes applied to generate power deposition surface.
Whole Body Hyperthermia
The hyperthermia is administer to treat metastatic tumor that is already multiply throughout the body wherein a fixed state of 42 °C is uphold for 1 hour with tolerable adverse effects and with the help of general anesthesia the procedure would be possible. A person weigh about 70kg at 37 °C has a basal metabolic rate of 85 W which is double for 42 °C. The applicator used is sigma-Eyed applicator that consists of three shorter rings with four flat dipole antenna pairs. Side effects of whole body hyperthermia include vomiting, diarrhea and nausea. In rare cases it leads to the problem in blood vessels and some major organs.
Nowadays hyperthermia becomes a vital treatment modality in curing of cancer since it shows significant results supported by evidence. Hyperthermia is very important in addition to radiotherapy either with or without chemotherapy to treat advanced or high-risk tumors as well as to draw back the relapse of pre-irradiated area. Hyperthermia is the latest and become the fourth pillar to treat cancer along with surgery, radiotherapy and chemotherapy. Therefore it is looking forward to fight one common enemy wherein four weapons are better than three.