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The deadly influenza of 1918-1919 is believed to have been caused by the swine influenza virus (SIV) or a related virus. This disease affects swine and turkeys, and is a common cause of respiratory disease among these animals during the winter. Since the isolation of SIV from a human subject in 1974, at least 11 other outbreaks of the infection have been noted. The fear of another pandemic led to the massive swine flu vaccination effort by the federal government in 1976 and 1977. In a recent case in October 1988, a pregnant woman and her husband attended an agricultural fair. A few days later, both became ill. The woman was put on a mechanical ventilator; a healthy baby was born, but the woman died of respiratory arrest. The SIV virus of the type seen in ill swine in Wisconsin was detected. Through interviews conducted later it was determined that 40 to 60 percent of swine exhibitors had influenza-like illness (ILI) during the fair. The dead woman had been infected either directly from the pigs, or by transmission from the pigs to her husband, and then to her. Existing regulations for agricultural fairs in Wisconsin bar infected animals from being exhibited. However, SIV infection is transmitted rapidly, and swine who become ill after arrival may already spread the infection to other swine. It may be necessary to close pig barns to the public as soon as infection is detected. Priority should be given to the development of a SIV vaccine for swine; one already exists for turkeys. This would not only benefit the farmers, who lose money on sick swine, but all humans who come in contact with the pigs. (Consumer Summary produced by Reliance Medical Information, Inc.)

The article focuses on Ventriculoperitoneal (VP) Shunt Infections and its causes. It is suggested to intake prophylactic antibiotic to prevent those infections. Intravenous antimicrobial treatment regimens are mentioned for ventriculoperitoneal shunt infections along with causative pathogens. VP shunts are managed by removal of infected shunt and replacing it by temporary external ventricular drains (EVD). [ABSTRACT FROM AUTHOR]

Introduction: Limited data suggest mild hypernatremia may be related to lower intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The practice at the study center has been to use hypertonic saline (HTS) to generate a targeted serum sodium of 145 to 155 mEq/l in patients with TBI. The purpose of this study was to determine the relationship between serum sodium values and ICP, and to evaluate the acute effect of HTS on ICP. Methods: A retrospective review of patients who were admitted to the trauma ICU for TBI, had an ICP monitor placed, and received at least one dose of HTS between January 2006 and March 2011 was performed. Data were collected for up to 120 hours after ICP monitor placement. The primary outcome was the relationship between serum sodium and maximum ICP. Secondary outcomes were the relationship between serum sodium and the mean number of daily interventions for ICP control, and the acute effect of HTS on ICP during the 6 hours after each dose. Linear regression was used to analyze the primary outcome. Analysis of variance on ranks and repeated measures analysis of variance were used to evaluate the number of interventions and the acute effect of HTS on ICP, respectively. Results: Eighty-one patients were enrolled with mean ± standard deviation age of 36 ± 15 years and median Glasgow Coma Scale score of 7 (interquartile range, 4 to 7). A total of 1,230 serum sodium values (range, 118 to174 mEq/l) and 7,483 ICP values (range, 0 to 159 mmHg) were collected. There was no correlation between serum sodium and maximum ICP (R2 = 0.0052). The overall mean ± standard deviation number of interventions for elevated ICP per day was 4.2 ± 2.9, 2.9 ± 2.0, and 2.6 ± 2.3 for patients with a mean serum sodium of < 145, 145 to 155, and > 155 mEq/l, respectively (P <0.001). Regarding the acute effect of HTS on ICP, there was no statistical difference in mean ICP compared with baseline during hours 1 through 6 following HTS doses (baseline, 13.7 ± 8.4 mmHg; hour 1, 13.6 ± 8.3 mmHg; hour 2, 13.5 ± 8.8 mmHg; hour 3, 13.3 ± 8.7 mmHg; hour 4, 13.4 ± 8.7 mmHg; hour 5, 13.4 ± 8.3 mmHg; hour 6, 13.5 ± 8.3 mmHg; P = 0.84). Conclusions: Serum sodium concentrations did not correlate with ICP values. These results warrant further evaluation and possible reassessment of sodium goals for ICP management in patients with TBI. [ABSTRACT FROM AUTHOR]

Ventilator-associated pneumonia (VAP) is the most common infectious complication in the intensive care unit. It can increase duration of mechanical ventilation, length of stay, costs, and mortality. Improvements in the administration of empirical antibiotic therapy have potential to reduce the complications of VAP. This review will discuss the current data addressing empirical antibiotic therapy and the effect on mortality in patients with VAP. It will also address factors that could improve the administration of empirical antibiotics and directions for future research.