Protecting Yourself Against MRSA and Other Staph Infections

Methicillin-resistant Staphylococcus Aureus (also known as MRSA) is a type of staph infection that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently in hospitals and other healthcare facilities but could also occur within the community.

In the community most Staph or MRSA infections are skin infections that may appear as pustules or boils which often are red, swollen, painful or have pus or other drainage. These skin infections commonly occur at sites of visible skin trauma such as cuts and abrasions and areas of the body covered by hair (back of neck, groin, buttock, armpit, beard area of men). MRSA is usually transmitted by direct skin-to-skin contact or contact with shared items or surfaces that have come into contact with someone else's infection (towels, used bandages, etc.)

MRSA skin infections can occur anywhere. Some settings have factors that make it easier for MRSA to be transmitted. These factors, referred to as the 5 C's, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness. Locations where the 5 C's are common include schools, dormitories, military barracks, households, correctional facilities, and daycare centers. In addition to being resistant to antibiotics and most traditional forms of medicine, MRSA is especially concerning, given the fact that it can be fatal if entered into the blood stream.

The recent outbreaks of these types of antibiotic-resistant infections have communities across the country extremely concerned. However, there is a viable solution that is cost-effective and safe. Even though antibiotics and other prescription medications are not effective against MRSA, there is a special type of honey that is being used in health care products that is capable of destroying MRSA and other forms of bacteria. It's called 'Manuka Honey' and it's being used as a main ingredient in some health care products. "Unlike antibiotics, Manuka Honey destroys bacteria by drawing water out of the microorganisms by osmosis," says Frank Buonanotte, CEO of Honeymark International, manufacturer of health care products containing Manuka Honey. "Bacteria have the ability to mutate and become resistant to elements that can destroy it. However, bacteria cannot survive without water and that's what makes Manuka Honey different than more traditional forms of medicine."

Manuka Honey is a special type of honey that is indigenous to New Zealand that has been found to have no negative side effects. It's also an all-natural, organic ingredient. Manuka Honey has other factors that assist in the healing process of wounds by generating new skin growth and increasing blood circulation. Wound care products made with Manuka Honey have also been known to prevent scaring, relieve pain and remove any malodor associated with the wound.

Source:www.theopenpress.com

The New Hygiene Hypothesis

Bengt Björkstén has a gold mine of feces in his freezer. Over the past 11 years, the Swedish pediatrician and immunologist has been carefully collecting fecal samples from a cohort of children living in Sweden and neighboring Estonia. The samples harbor a wealth of information on the children's microbial inhabitants, which have been shown to play a vital role in immune function. Björkstén hopes that new technologies that allow scientists to analyze microbes more precisely than ever before will reveal why allergy rates in Sweden and other wealthy nations, including the United States, have risen dramatically over the past 50 years, while rates in historically poorer nations, such as Estonia, have not.

His findings could provide a new twist on the hygiene hypothesis, which suggests that rising allergy rates are linked to our more antiseptic, modern lifestyle. If scientists can find the elusive x factor that either protects against allergies or increases risk for them, they may be able to recreate it, perhaps by dosing mothers or babies with healthy bacteria, known as probiotics. "We're on the verge of a revolution in understanding the human microbiome," says Björkstén. "The key to understanding these diseases may be in the gut, rather than in the environment."

A host of explanations have been put forth to account for rising rates of allergy and asthma, including reduced rates of breast feeding, parents who smoke, and worsening pollution. But as most of these factors have been ruled out--poorer cities with high levels of pollution often have lower allergy levels, for example--an alternative explanation has taken the lead. Scientists suggest that now that many of the most harmful bugs in our environment have been eradicated with modern sanitation and medicine, our immune systems turn their attack on usually harmless molecules, such as those in cat dander or dust mites.

Support for the hygiene hypothesis comes from studies showing that pre- and postnatal exposure to pets, farms, and older siblings protects against allergies. But as scientists are beginning to better understand the beneficial bacteria that live within us--and the role that it plays in immune development--a new twist on the hygiene hypothesis is emerging. It may be that these environmental factors impact the microbes that colonize newborn babies, which in turn affect immune development and risk for allergy. "The first microbes we put in our GI tract can settle there," says Josef Neu, a physician and scientist at the University of Florida, in Gainesville. "Are there long-term effects to microbiome manipulation? We need to use new techniques to look at this much more broadly."

It's here that Björkstén's frozen treasure trove will come in handy. For more than a decade, the pediatrician has been collecting fecal samples--bacteria in stool are a measure of the microbial inhabitants of our gut--as well as extensive medical records and allergen-test results. Because living conditions in Estonia are similar to those in Sweden 40 years ago, the Estonian children provide a snapshot of the past. Comparing the two populations is starting to reveal how our gut ecology is changing over time and how those changes impact disease. "These are incredibly precious moments to understand microbial evolution in humans," says Jeff Gordon, a scientist and gastroenterologist at Washington University in St. Louis.

Initial studies of the children's gut microbes using traditional microbiology approaches have yielded tantalizing clues into their role in allergy: the number and diversity of microbes inhabiting a baby's gut soon after birth seem to predict his likelihood of later developing allergic disease. In addition, babies born in urban environments have fewer microbes and fewer diverse microbial communities than those born and raised on farms. The same is true for babies born in Sweden versus those born in Estonia.

Björkstén, who named the pattern the "immunologically mediated syndrome of affluence," now aims to analyze the samples using metagenomics, which assesses microbial populations without having to grow them in the lab--a major impediment to the research until very recently. (See "The Next Human Genome Project: Our Microbes.") This approach will generate a much more extensive microbial profile and allow scientists to look for specific patterns linked to allergy. If they can pinpoint the precise factors that lead the immune system awry and boost risk for immune disorders, the researchers may be able to prevent them. "No one wants to go back to a poor state of hygiene with maternal sepsis in the maternity ward," says Björkstén. "So we need to solve this another way."

Source:www.technologyreview.com

Ailing scribe seeks remedy for Gott aches

I hope you can help me. I have this splitting headache, a persistent ringing in my right ear and a crick in my neck where I cradle my phone. And the tips of my fingers are kind of sore. I'm not sure what happened.

As I look back, I think the symptoms started a couple weeks ago. Because a few of your recent columns gave some readers pause (references to bloody orifices, shower masturbation and ejaculation), we decided to try out a new purveyor of medical advice. I didn't presume that children are regular readers of your work, but lots of kids are in that neighborhood each day, poring over their favorite comic strips. That made me uncomfortable.

Our fill-in physician, the good Dr. Donohue, appears in many papers across the country. But he just didn't fit in here. Readers said he was "antiseptic," "stale" and "humorless." And he had a scary photo. They missed your homey, learned advice and familiar face.

So, as the phone rang and the e-mails arrived, my aches grew more pronounced. I was reminded of some good advice I received years and years ago when my right arm was bothering me.

"It only hurts when I throw," I told the doc. He sized me up and delivered a foolproof remedy: "Well, then don't throw."

Perhaps it's a stretch, but I saw a parallel there. So I cleared the way for your return to our comics pages. You are back in your old space. But the pain still lingers because the phone calls and e-mails from readers heralding your return have been heavy and, at times, heated. Rarely do we see such volume of reader feedback on a topic. Some examples:

"Please provide one example of good-taste boundaries being stretched, then get off your high horse."

"Can't we retain a little bit of humor and folk-medicine cures in this day and age without offending some PC sensibilities? Sadly, I'm inclined to believe that you don't believe that we can."

"I am a member of a coffee group of eight over-60-year-olds. We each have a stable of doctors, but all rely on Dr. Gott. None of us ever saw anything in his column that we considered inappropriate, but our standards aren't real high either. We were all lost without Dr. Gott."

"Gott is much better than dry and lame Dr. Donohue."

"Hard to believe that anyone could be offended by this wise and witty man so many of us trust."

"Stretching good-taste boundaries? Boy we sure missed that part. Sure they weren't referring to Doonesbury?"

"Your disclaimer at the end of the article smacks of censorship. Perhaps if open and frank answers were given to patients by health care providers instead of being glossed over by additional testing and/or referrals to someone else down the line, our costly medical industry may learn how to curtail itself. I am tired of a press in America not telling it like it is instead pushing its editorial policy as "news" that it wants us to hear. We have enough do-gooders in this country attempting to sanitize our thoughts and actions without the Billings Gazette adding their two cents worth, thank you."

"I am a faithful reader of your paper, and am appalled that you would considering editing a medical column that covers all aspects of life. If editing is to be done - it needs to be in the home and not by someone at the paper who is going to decide what I can and cannot read. Shame on you."

I should say, Dr. Gott, I do appreciate this candid feedback from some of our most loyal and longtime readers. And because their health questions should take precedence over my job-related injuries, please don't feel the need to respond right away. I think once the dust settles and I get some rest, I'll be fine. There's a lot to be said for leaving well enough alone.

Comics capers
The reader's mention of Doonesbury above gives me an opening to update you on changes to our Sunday comics. We've put on hold for now our plan to revamp the Sunday comics section in January. We're still talking with the company that prints our comics in Reno about possible changes before we stride out and begin printing our own four-page section in Billings.

In the meantime, we've tallied more than 2,500 votes on your favorite and least-favorite strips. The big winners? Pickles and Zits. Both now appear in the weekday paper and you want to see them on Sunday in a big way. On the other end of the tally, you had little love for Get Fuzzy, Uncle Art's Funland, Cathy and Prince Valiant.

Source:www.billingsgazette.net

Pick of the paperbacks

Toby Clements, Sameer Rahim, Simon Baker, Lucy Davies, Roland Hancock, Nicholas Bagnall and Katie Owen review the latest paperbacks

Bad Medicine by David Wootton

"Before 1865 all medicine was bad medicine, that is to say, it did far more harm than good."
David Wootton traces an uneven but genuine line of progress from the Hippocratic tradition (all that blood letting and balancing of humours) to Lister's first antiseptic surgery in 1865 and the use of antibiotics in 1942 - the point at which visiting the doctor became worthwhile.

Wootton's history is lively and iconoclastic: Lind did not discover that lemons prevented scurvy - sailors had already done so - and since he didn't work out the science behind the cure, he "deserves to be left in obscurity". Fleming was lucky with his penicillin mould and did not think through his discoveries.

Sometimes Wootton forgets that what seems obvious now was not necessarily so in the past; and he is unfair on the Hippocratic doctors who helped people, often in valuable ways, according to the limits of their knowledge. This book is provocative and well written; it leaves you wanting to find out more. SR

A Game for Hooligans by Huw Richards

In the past 20 years, rugby union has charged infield from the margins of society, so that its stars are household names and as many as 2.25 million people went to watch the 2007 Rugby World Cup finals in France. Huw Richards's book claims to be the first history of the game, from the Roman game of harpastum to Webb Ellis picking up the ball (or not) and on to the recent world cups. It helps to know a little about rugby before you read it, but it is full of incident, detail and gossip, even if it is not much of a celebration: nothing comes close to the 1970s, when the Welsh were the team to beat. TC

The Glass Books of the Dream Eaters by G W Dahlquist

A quest by Miss Temple, a spirited, 19th-century heroine, to find out why her fiancé broke off their engagement, sets in motion the Byzantine (and bizarre) plot of this adventure story. She follows him to a party at a gothic mansion, and there uncovers a sect performing mind-control experiments.

Multiple narratives, a lot of sex and some magical glass books later, we have a conclusion - or rather we don't, since there's a sequel planned and nothing is resolved. The setting is vague and the characterisation thin, but as a pastiche of a yarn it is good fun. SB

Alliance by Jonathan Fenby

This book analyses the relationship between the leading figures of the Alliance, Churchill, Roosevelt and Stalin, showing how their fraught relationship "won one war and started another".

Jonathan Fenby has an instinct for drama, and gives the reader a sense of what it was like at the negotiations. What comes through most clearly is the expediency of the Alliance; despite Churchill's public praising of Stalin, necessity was everything: as he said, if Hitler had invaded hell he would have found it in himself to "make a favourable reference to the Devil in the House of Commons". SB

Lorenzo Da Ponte by Rodney Bolt

By the time he was 40, Lorenzo Da Ponte had been a poet, priest, lover and libertine; a friend of Casanova and librettist for three of Mozart's operas: Don Giovanni, The Marriage of Figaro and Così fan tutte. He contributed elegant, witty and hugely singable verse, as well as plots and characters capable of carrying and embodying the sparkle of Mozart's music.

But one needn't be an opera buff to enjoy this evocative biography. Its ne'er-dally approach and fluid prose are a winning formula and it captures an extraordinary character and a vibrant era. LD

When a Crocodile Eats the Sun by Peter Godwin

During the day, the Godwins sit on white garden furniture and drink weak tea. At night, they barricade themselves in their house, hoping they won't be attacked.

Peter Godwin's affectionate portrait of his parents living as part of a thinning racial minority in Zimbabwe is a powerful and detailed account of the farm invasions.

He relates the history of white settlement in southern Africa and the rise of the black African resistance movements in Rhodesia, combining this with personal explorations of exile and belonging, written with the eye of a journalist and the emotions of a son. LD

Non-Violence: the History of a Dangerous Idea by Mark Kurlansky

If history is written by the winners of its wars, this compelling little book shouldn't exist. Spanning two thousand years, from the birth of Christianity to the first Iraq war, via both world wars and the creation of America, the author draws a direct line between the first Roman legionaries who refused to fight to the soldiers who despair at their role in modern warmongering.

Despite making a strong case for today's leaders to lay down their arms, this work is that rarest of things - a powerful and moving study of a worthy ideal that doesn't preach. RH

Trickster Travels by Natalie Zemon Davis

Hasan al-Wazzan, Moroccan scholar, prolific author and important diplomat, was captured by pirates in 1518 and sent to Rome, where he met Pope Leo X and converted to Christianity, though Natalie Davis seems to doubt his sincerity here; his new name was Leo. He then travelled all over North Africa and wrote about what he saw, straddling two worlds, and was an expert on Islamic law. Yet his life remains shadowy. This book puts more flesh on an extraordinary man. NB

Villages of Vision by Gillian Darley

Gillian Darley writes not only of those ideal communities whose inhabitants came together because they thought alike, as did C. R. Ashbee's aesthetes in Chipping Camden, but more often of estates whose architecture and layout were meant to shape for the better the lives of those who settled there, such as the garden cities. This book first appeared 30 years ago, and though some communities have died, Darley is certain, she says in a new introduction, 'that there will be more.' NB

William Winstanley by Alison Barnes

The 17th-century East Anglian poet and farmer Winstanley did as much as anyone by his writings to restore the old Christmas customs after their enforced neglect under Cromwell, so that jollity returned, roast turkey, carols and all. There are many splendid illustrations both of the time and later. And the well-researched text brings to life his generosity and particularly his popularity with children, to say nothing of his reputation as 'the finest storyteller in the land'. NB

Blowing Up Russia by Alexander Litvinenko

The former KGB man Alexander Litvinenko was poisoned in London in 2006. His Blowing Up Russia, first published in 2002 but naturally banned in Russia, had made the now-familiar claim that the terrorist bombs of 1999 were the work not of Chechnya but of Russia herself, giving her a reason for her war against that country. Many pages are devoted to details of the failed bombing in Ryazan. His co-author Yuri Feltshtinsky now expands the original and writes a frightening revised foreword. NB

On Chesil Beach by Ian McEwan

A wedding night in 1962 is the subject of Ian McEwan's novella, in which, as in Atonement, he exquisitely delineates sexual tension and precisely skewers uptight Englishness. At the start of 'that famous decade', Florence and Edward do not have the vocabulary to discuss their anxieties. The result of their first-night nerves is disaster: a moment that changes the course of their lives. It is an extremely slight book, but the elegance of the prose, catching every nuance of the situation, makes it compelling. KO

The Book Thief by Markus Zusak

'I know what happens and so do you.' Thus Death, the narrator of this powerful Holocaust novel, addresses the reader as he tells an all too familiar story of persecution and suffering in a small German town. An orphaned girl,

a Jewish man hidden in her foster-parents' basement, parades of Jews passing through town on their way to Dachau, bombs falling - Death is kept extremely busy as the war progresses. Markus Zusak's style is both punchy and highly emotive. KO

Source:www.telegraph.co.uk

Health Precautions for Haj Advised

As Haj approaches, pilgrims and people living in and around Makkah are getting ready to protect themselves from diseases that could be contagious during this annual season. Hospitals and health care centers are equipped with vaccinations, mostly ACWY meningococcal vaccines that must be taken 10 days prior to Haj.

“All patients must consult their family physicians before going to Haj, especially old people or those with chronic medical conditions,” said Dr. Muntazar Bashir, a consultant family physician and chairman of family medicine at King Faisal Specialist Hospital & Research Center.

Other recommended vaccines are those against Hepatitis A and B; infectious diseases of the digestive system; typhoid and diphtheria; and the common flu. It is important that pilgrims do not allow people to sneeze, cough or have physical contact (shaking hands) with people that have respiratory diseases. An antiseptic cream is useful in these cases. These diseases are common during Haj and they vary from viral infections like cold and flu to bacterial infections like pneumonia and tuberculosis.

Traveling to Makkah in advance of the Haj is sensible especially for people who are not used to the climate in Makkah.

“They must be aware that heart produces sweat and that up to five liters of water and 20g of salt may be lost per day,” he said. Food poisoning is also common during Haj. Some people tend to buy food from peddlers and small cafeterias that may not implement safety measures.

“I advise pilgrims to eat only thoroughly cooked food and drink bottled water and also eat only fruit with peels, like oranges and bananas, to avoid germs,” he said. As men have to have their heads shaved or hair trimmed to remove their “Ihram,” they have to be careful not to reuse the same blade after others, as risks of transmitting HIV and Hepatitis B and C are possible. Many pilgrims come from regions where such infections are endemic so pilgrims must insist that their barbers use new blades.

Patients of chronic diseases, such as high blood pressure, diabetes and asthma must take sufficient supplies of their usual drugs and have the generic names of the drugs with them if they need to refill their prescriptions. “It is recommended that these pilgrims take a letter documenting medical problems and drugs they take. That will allow rapid assessment should an illness occur,” said Dr. Bashir.

As for diabetic pilgrims, insulin must be refrigerated. Those patients need careful monitoring and insulin may be temporarily needed in patients with Type 2 diabetes. “Although problems of hyperglycaemia can occur, the second of these is more common as a result of increased physical activity. Food intake may have to be increased before exertion,” Bashir.

Some women delay menstruation in order to be able to perform Haj. Some women who have a regular menstrual cycle have it every year in the time of Haj. It is healthy to take a combined contraceptive pills or daily progesterone. Pilgrims could expect symptoms of weakness, light headaches and muscle cramps that will respond to a combination of rest, cooling and fluid and salt replacement.

Source:www.arabnews.com

Scientists examine health in honey

The health benefits of honey are the focus of discussions taking place today at an international symposium bringing together scientists to examine the potential of the natural sweetener.
Taking place in Sacramento, California, the event is designed to review new science and traditional medicine that supports the role of honey in human health.

While honey has been used for thousands of years to treat wounds and ailments, scientists have only recently begun to explain the precise effects of the natural sweetener's antiseptic and antibacterial qualities on human health.

According to the Committee for the Promotion of Honey and Human Health, the non-profit group that has organized the symposium, some of the benefits to be discussed include honey's potential to improve chemotherapy-induced neutropenia, wound healing, restorative sleep, cough suppression and cognitive function.

"It seems that the role of honey as a functional food useful for the management and treatment of many human conditions is just beginning to gain momentum in the US," according to Dr Ron Fessenden, co-chairman of the committee.

"It has been the goal of the Committee for the Promotion of Honey and Health to highlight some of this exciting research. We trust that this symposium will stimulate further research that may advance the role for honey in health, from weight management to risk reduction for neurodegenerative conditions, including Alzheimer 's disease and Parkinsonism."

Today's presentations include the US Department of Agriculture's David Baer, who will discuss experimental evidence suggesting that honey consumption compared to some other sweeteners may improve blood sugar control and insulin sensitivity.

In a related presentation, Dr GBKS Prasad, from the Department of Biochemistry, Jiwaji University in India, will share findings from a recent trial that revealed that honey may not produce the elevations in blood sugar seen with glucose in people who suffer from mild diabetes - or a difficulty in metabolizing glucose.

Nicola Starkey from Waikato University in Hamilton, New Zealond will present findings from an animal study that suggest the use of honey instead of sugar as a sweetener can result in less weight gain.

"Given the rise of the functional food category for an increasingly health conscious population, food companies may want to take note and experiment more with using honey as the sweetener of choice for food products," she will say.

In addition to the research to be presented at the symposium, attendees will also discuss future directions for further research into the benefits of honey. These include the prevention of chemotherapy-induced neutropenia, and improved cognitive function for mental performance and memory.

Other recent scientific reports linking honey to health include research suggesting that taking honey in combination with calcium supplements could help boost bone strength.

Furthermore, Spanish scientists have found that bees that feed on honeydew produce honey with double the amount of antioxidants.

Research such as this has helped boost honey consumption around the world, with sales increasing 14 per cent between 2004 and 2006, according to market analysts Mintel.

In international terms China is currently by far the largest honey-producing nation in the world, with around a 40 per cent slice of the market, while the next biggest producers are the US, Argentina and Ukraine.

According to the American Honey Producers Association, China and Argentina have been adversely affecting America's domestic honey industry with cheap imports, although there is a counter argument that both China and Argentina have been helping to counterbalance falling production in the US.

Source:www.foodnavigator-usa.com

No supplies in hospital

If you seek medical attention in the emergency room of the government-run Mandaue City Hospital, be ready to buy your own plaster, syringes, and cotton balls.

The facility has “dwindling-to-zero” hospital supplies, said hospital chief Dr. Dominga Obenza yesterday because their operating budget for the 3rd and 4th quarters worth P5.379 million was not yet released by City Hall.

The hospital chief said the problem would become more crucial once they cater to emergencies during the holiday season when firecracker blast victims walk in.

“Maybe patients will have to buy their own Betadine,” Obenza said.

Mandaue Mayor Jonas Cortes said he would ask his staff for the speedy procurement of supplies because Supplemental Budget No.5, containing the hospital budget, was already approved early this month. But whether the hospital budget was among the items carried is still being debated by the executive and legislative department.

“The doctors are available, the medical attention you need will be given but when it comes to logistical support, it will be prescribed to the patient mostly,” said Obenza. She was referring to basic items such as plasters, syringes, and antiseptic like Betadine.

Although the hospital has enough medicine and drugs such as antibiotics, Obenza said non-drug supplies at the hospital are no longer available.

Of the P5.3 million hospital budget, P2.5 million is earmarked for “medical, dental and laboratory supplies expenses”. The balance is for personal services like salaries and benefits (P443,000) and maintenance and other operating expenses like food supplies, utilities, and services for laundry, janitors and security.

As of Tuesday, Obenza said the 41-bed Mandaue City Hospital is fully occupied in its wards, two private rooms, and four semi-private rooms.

At the emergency room, patients have to buy their own items or settle for unused supplies left by other patients, she said.

Most of the patients buy their own medicines, according to the hospital chief, depending on the availability of the prescribed drugs.

“Until we get a new budget, we will (also) be prescribing our patients to buy supplies,” she added. “We will not drive away emergency patients even if our hospital is full. Until the patient is stable, that is when we ask them to transfer to another hospital because we can no longer accommodate them.”

“As much as we want to purchase the supplies, we cannot even if the budget is approved or not because of the time element,” Obenza said.

Mayor Cortes criticized the system of budgeting in the hospital which is done quarterly instead of a yearly plan. “This (quarterly budgeting) will be something we will change for next year. I have asked the hospital to prepare a budget that is good for one year.”

“I have been saying this since day one that I will prioritize basic services such as hospital services, so I will change the system next year,” Cortes said.

The opposition-led City Council said SB No. 5 did not have an approved budget for hospital supplies after the mayor had vetoed the version approved by the legislature.

The mayor prepared a total of P62 million for SB 5 in November but the Council approved only P48 million in December. The Council slashed several items in the budget but the mayor overturned it through a line veto.

Vice Mayor Carlo Fortuna said he believed the mayor “killed” some items in the hospital's budget after he vetoed the slashed SB No.5 version of the City Council.

Source:globalnation.inquirer.net

Herbal Remedies and Thyme

Thyme is a very popular and well known culinary herb. It is a very decorative plant while it is growing and is also very easy to grow as well but be prepared because bees just love Thyme. Many people use Thyme in stews, salads, meats, soups, and vegetables. Thyme is a very common household herb and is a member of the mint family. The plant is very aromatic and comes in many varieties. Thyme is a frequently used herb in many fish dishes. Oddly enough as much as honey bees love to suck the nectar from the Thyme plant is as much as other insects loathe it. Some people have been known to make a mist spray of Thyme and water and use it as a bug repellent.

Various forms of Thyme are available year round but many people prefer to grow their own. Nothing beats the smell and taste of fresh Thyme as long as you know to pick it just as the flowers appear. Once fresh Thyme is harvested it should be stored in either a plastic bag in the crisper or stood straight up in a glass of water on the shelf in the refrigerator for easy access.

The bad news, fresh Thyme does not have a very long shelf life, you will be lucky if it last a week. If you have selected fresh Thyme and decide to dry it then simply hang it upside down in a warm and dry atmosphere for about a week to ten days. Then you can crumble it into a powdery form and stored in a sealed dark container for no more than six months. You want to eliminate the stems as they have a tendency to have a woody taste to them.

Thyme has some medicinal purposes as well as an antiseptic, an expectorant, and deodorant properties as well. When combined with fatty meats Thyme has been known to aid in digestion too, especially with lamb, pork, and duck. Herbal medicine has used Thyme for various things such as extracts, teas, compresses, for baths, and for gargles. More modern medicine has chimed in and verified that Thyme just might strengthen the immune system.

Distilled Thyme oils have been used for the commercial use of antiseptics, toothpaste, mouthwash, gargle, hair conditioner, dandruff shampoo, potpourri, and insect repellant. It is also used in the production of certain expectorants that are prescribed for whooping cough and bronchitis. Thyme has also been used in part as an aphrodisiac and in aromatherapy oils as well.

If by some chance you are in the middle of cooking recipes that calls for Thyme and you find that you are out do not fret, it is said that you can use a pinch of oregano as a substitute if you have to. Thyme is very often used when cooking European cuisine but is essential for the correct preparation of French foods as it has that faint lemony taste to it. It has also been said that Thyme is one of the only herbs that a cook can not over season with because the flavor is so mild. Thyme is a primary spice that everyone should have stocked in their pantry.

Source:www.americanchronicle.com

What pilots can teach doctors

Last month our board applauded the first-ever public release in Canada of standardized mortality rates for hospitals. "Publication of the hospital standardized mortality ratios (HSMRs)," we wrote, "will provoke change faster than any number of dreary meetings in doughnut-dusted boardrooms. Administrators working from the top down will find it easier to push front-line staff to get behind new evidence-based programs. And better yet, caregivers who already know where and why problems exist will have more power to command the attention of their superiors, their health ministers and the public." We added that the changes needed to reduce hospital mortality are often pretty simple. At this point in the history of medicine, it's easier to save lives by cutting back on medical errors and hospital infections than it is to discover the next big heroic intervention.

Just ask Johns Hopkins hospital specialist Dr. Peter Pronovost, who is the subject of a glowing profile in a recent New Yorker by the ever-compelling surgeon/journalist Atul Gawande. Dr. Pronovost (note the good solid Canadian surname!) has become an international crusader for the humblest of frontline care tools imaginable: the checklist. In 2001, he made an outrageously simple experiment--he wrote down the things a doctor is supposed to do before inserting an intravascular line into a patient.

Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary... The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

This and a handful of other short intensive-care checklists have been shown to save lives by the dozens--or indeed thousands, if introduced to large regions or nations. Doctors in places where the technique has been tried initially grumble about "paperwork" and resist the idea that a checklist can be useful in a chaotic hospital environment, but eventually they come to realize that it's precisely the chaos that necessitates a checklist. The next great wave in medicine is likely to consist of purely functional measures like this that constitute an overdue retrenching--getting bureaucratized hospitals to implement, in evidence-based ways, what's already known about patient care. Gawande's piece is long but, as usual, rewards the attention.


Source:network.nationalpost.com

Hospital counselors fill spiritual need at Stanford

Judith Dover lay dying in Stanford University Hospital, her liver rapidly failing. The 59-year-old Aptos woman's skin and eyes were a deep yellow, and she was openly hemorrhaging.

She had days, or more likely, hours to live.

Dr. Bruce Feldstein, a chaplain in the hospital's Spiritual Care Service, had been a steady presence during her weeks in the hospital, waiting and hoping for a donor liver.

With none available, Feldstein realized he probably was witnessing her final hours, as he stood by to offer comfort.

A growing number of hospitals provide more than medical expertise. They provide an in-house team of chaplains to calm and support patients and their families.

Christians, Jews, Muslims, Buddhists, Hindus, Sikhs and simply those in need of human support find counselors to buoy their spirits, help them cope with fear or confusion at why they, of all people, fell so ill.

Stanford retains five in-house spiritual counselors and more than 200 volunteer chaplains.

Feldstein is Jewish, but chaplains often counsel those outside of their faith. "We discover that when we get to the bedside, we leave our spiritual ZIP codes behind," he said.

Demand never ceases for the chaplains' services, but they say it's particularly valued during the holidays, when patients remain sequestered inside antiseptic hospital rooms and the world outside celebrates beloved rituals with friends and family.
season of the year, which is supposed to be light, celebration and joy, with the pathos" of a hospital stay, said C. George Fitzgerald, director of Stanford University Hospital's Spiritual Care Service.

Medicine and spirituality have been intertwined for millenniums, Fitzgerald pointed out. "Monasteries were the original hospitals," he said.

But the rise of scientific method in medicine changed that, according to the Web site of the Association for Clinical Pastoral Education, which trains clergy to work within clinical settings. "The advent of science created a chasm between the two," the Web site states.

Yet over the past decades, clergy sought to reunite medical with spiritual practice, first by training ministers to counsel those with serious medical afflictions. "Ministers were good at giving sermons," said Fitzgerald. "They weren't good at dealing with pain."

And in the modern world of health care, that specialized training has become even more important, Fitzgerald said. "They don't get freaked out by the high-tech nature of hospitals."

Then, in the 1990s, a surging interest in the connection between the physical, the psychological and the spiritual accelerated the adoption of in-house spiritual support programs, Fitzgerald added.

"This is coming back," he said. Stanford's program began in the 1960s, and Feldstein said many hospitals don't provide services as extensive.

That day early this month when Dover lay dying, Feldstein said he offered to light a candle during Hanukkah for the Jewish woman. When he asked how he should dedicate the candle, Dover's answer in the midst of her suffering stunned him. "She said 'If only we could all get along a little bit better in the world.' "

"It was such a selfless statement," Feldstein said.

Then, he said, a miracle occurred. Shortly after that conversation, a nurse walked into Dover's room with an announcement: A donor liver was suddenly available. The staff rushed Dover into the operating room, and she emerged 10 hours later with a newly-transplanted liver.

Feldstein remains a regular presence by Dover's bedside, providing spiritual sustenance while medical staff attends to the woman, who's gradually recovering. On Thursday, he elicited a wide smile from Dover as he began singing a Jewish song. She then faintly joined in the song.

Feldstein worked as an emergency-room physician before changing careers to join the hospital-based chaplaincy.

And he deeply believes in the connection between spirituality and healing, citing studies to support his conviction.

"This is my medicine now," said Feldstein. "I stand in the world of spirituality and science."

Source:www.mercurynews.com

Preoperative Decolonization of Methicillin-resistant Staphylococcus aureus

Screening should be considered for patients who are at high risk of being MRSA carriers and for those who are undergoing high-risk procedures such as prosthetic implantion.

Staphylococcus aureus penicillin resistance was first identified in 1944, and by the 1950s the first studies began to suggest a relationship between nasal carriage of S aureus and surgical site infections.1 In fact, patients with Staphylococcus in their anterior nares are 2 to 9 times more likely to develop surgical site infections than non-carriers,2,3 and for the first time in 1999, the Centers for Disease Control and Prevention (CDC) listed preoperative nasal carriage of S aureus as a risk factor for surgical site infection.4 Even infections from elective procedures may be catastrophic, leading to further surgery, loss of the prosthesis, disability, and risk of mortality.5 No general consensus exists concerning the optimal preoperative decolonization and/or prophylaxis of patients who are colonized with antibiotic resistance pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). A recent investigation conducted by the Association for Professionals in Infection and Epidemiology (APIC) showed that 46 out of every 1000 patients were either infected or colonized with MRSA. This rate is between 8 and 11 times greater than the previous MRSA estimates.7 While MRSA infection rates in certain institutions and countries vary, the increasing acknowledgement of community-acquired MRSA and current antibiotic-prescribing trends make MRSA and potentially vancomycin-resistant S aureus a growing concern for the orthopedist.

Staphylococcus aureus is ubiquitous. It can easily be recovered from human skin and mucous membranes. Methicillin-resistant is a variant of S aureus that is resistant to all beta-lactam antibiotics (including penicillins and cephalosporins); by definition, MRSA must be resistant to methicillin, oxacillin, or nafcillin. The bacteria may also be resistant to aminoglycosides, erythromycin, quinolones and others. Studies involving dialysis patients, long-term care patients, and postoperative patients in the surgical intensive care unit report that patients colonized with MRSA were at increased risk for the development of S aureus infections when compared to methicillin-susceptible S aureus carriers.8-10

Advanced age, prolonged hospitalization, invasive procedures, and prior antibiotic therapy have all been listed as risk factors for the development of postoperative infection.11 With the additional risk of MRSA colonization, surgical site infection becomes a dangerous and expensive possibility, especially for prosthetic implants that may require subsequent removal.

While S aureus located in the anterior nares has mostly been studied, colonization may occur in the axilla, a chronic wound or decubitus ulcer surface, perineum, around a gastrostomy and tracheostomy site, or sputum. Most studies have shown that between 25% to 30% of the general population carry methicillin-susceptible S aureus in their anterior nares. The prevalence of MRSA colonization is not well documented1 although a Welsh study reported MRSA colonization rates to be as high as 5.3% on orthopedic and surgical wards.12
Screening

Current guidelines recommend screening for S aureus colonization in only a limited patient population. Risk factors for community-based MRSA colonization that may warrant pre-surgical screening include: recent hospitalization within the past 24 months, current prolonged hospitalization, advanced age, outpatient visit within the past 12 months, nursing home admission within the past 12 months, antibiotic exposure within the past 12 months, severity of underlying disease, intravenous drug use, a history of invasive procedures, and close contact with a person who has any of the above risk factors.13,14

While current protocols for preoperative antibiotic prophylaxis, infection control policies, improved antisepsis, better surgical techniques, and postoperative wound care have improved surgical site infection outcomes, the continued overuse and misuse of antibiotics have kept postoperative infections an important issue for surgeons.

The focus of surgical site infections is on those patients with infections in the following situations: lengthy preoperative hospitalizations that may have an increased risk of acquiring resistant nosocomial organisms; trauma and elective surgeries affected by community-acquired resistant organisms; and active infections or colonization distant from the surgical site that have increased the incidence of surgical site infection.15 In such instances, an appropriate decolonization regimen may be used to reduce or prevent the prevalence of surgical site infection.

Table: Selected Preoperative Methicillin-Resistant Staphylococcus aureus Decolonization Regimens
Decolonization

The decolonization of MRSA in carriers has proven to be difficult. During the past 60 years, >40 different decolonization regimens have been tested (some are described in the Table), including the use of systemic antimicrobials, normal bacterial flora augmentation, antiseptic washes, and topical antimicrobials.11,16-18 Because of their limited ability to penetrate the nasal epithelium, resistance of the organism, side effects of the medications, and the quickness of recolonization of the nares, oral antimicrobials have had limited success.

Rifampin (Rifadin; Sanofi Aventis, Bridgewater, New Jersey) suppresses RNA synthesis in susceptible bacteria.19 While this mechanism of action is shared with other antibiotics, many studies have shown that rifampin is the most active agent for S aureus eradication.20 This can be partially explained by the fact that the nose is the most important site for carriage and rifampin has better nasal penetration than most other antibiotics.21 However, antimicrobial resistance may occur during and even after treatment with rifampin alone in a significant amount of patients; therefore, using other antibiotics (oral or topical) in combinations may decrease the probability of resistance.

Tetracyclines inhibit protein synthesis and are bacteriostatic. This class of antibiotics has good activity against MRSA, desirable pharmacokinetic properties, easy dosing schedules and few side effects.22 Studies have shown that no statistically significant difference exists in the eradication of MRSA carriage between rifampin monotherapy and combinations of rifampin with other antimicrobial agents, including tetracyclines.20 However, using combination therapy with a tetracycline may decrease the likelihood of developing resistance to rifampin.

Trimethoprim/sulfamethoxazole (Septra; GlaxoSmithKline, Philadelphia, Pennsylvania and Bactrim; Roche, Nutley, New Jersey) has excellent bactericidal activity against susceptible MRSA.23 Both trimethoprim and sulfamethoxazole interfere with bacterial folic acid synthesis. Previous data suggest that trimethoprim/sulfamethoxazole may decrease the number of MRSA-colonized patients, but may not permanently eradicate the MRSA carrier state.24 Trimethoprim/sulfamethoxazole typically is reserved for susceptible staphylococcal infections, including community-acquired MRSA.

Ciprofloxacin (Cipro; Bayer Pharmaceuticals, Wayne, New Jersey) is bactericidal and its mode of action depends on blocking bacterial DNA replication. It has been used in the past because it is able to achieve high concentrations in the sweat and may persist in the axilla and nostril for several weeks.25 Most isolates of methicillin-susceptible S aureus are susceptible to ciprofloxacin, however its use has fallen out of favor because of the selection of MRSA, which is almost entirely resistant to the fluoroquinolones.26

Local agents as treatment options seem to be the most promising because of their ease in application, ability to deliver high drug amounts to the affected area, and effectiveness over long periods of time.1,2,27,28 Of these topical intranasal applications, mupirocin ointment (Bactroban Nasal, GlaxoSmithKline) has proven to be the most effective.29

Mupirocin has a unique mechanism of action in which it blocks protein synthesis in bacteria. Because this mechanism of action is not shared with any other antibiotic, mupirocin has few problems of antibiotic cross-resistance. Mupirocin demonstrated the ability to eliminate 97% of S aureus nasal carriage in health care workers within 24 hours of application.30

A prospective, randomized, placebo-controlled clinical trial reported in the New England Journal of Medicine in 2002 showed that the use of intranasal mupirocin in patients who had S aureus in their anterior nares did not significantly reduce the rate of surgical site infection from Staphylococcus but significantly decreased the rate of other nosocomial S aureus infections.31 Conversely, a meta-analysis from 2005 concluded that preoperative intranasal mupirocin appears to decrease the incidence of surgical site infection when used as prophylaxis in nongeneral surgery, including orthopedic surgery.32

The current recommended regimen includes the application of 2% mupirocin calcium ointment to the anterior nares 2 to 3 times a day for 5 days. A follow-up nasal swab culture performed >1 weeks after decolonization therapy is useful since nasal colonization will not be successfully eradicated in all patients. Those with wounds, ulcers, or tracheostomy sites colonized by MRSA are not as likely to respond to this 5-day topical intranasal therapy.33

Another potential therapeutic agent is retapamulin (Altabax; GlaxoSmithKline), a new, novel pleuromutilin antibacterial developed for topical use. However, retapamulin lacks data confirming its application in the decolonization of MRSA.

Chlorhexidine (Hibiclens; GC America, Alsip, Illinois) strongly adsorbs to bacterial membranes, causing leakage of small molecules and precipitation of cytoplasmic proteins. Chlorhexidine is thus bactericidal on contact and has the advantage of producing a residual antibacterial effect.34 In fact, the decreasing prevalence of nasal carriage of MRSA that has been observed from patients in the intensive care unit35 may be attributed to treatment with mupirocin nasal ointment and chlorhexidine baths.

Povidone-iodine (Betadine; Purdue Pharma, Stamford, Connecticut) acts by destroying microbial protein and DNA. The mechanism of action of iodine is diverse, which may explain why bacterial resistance has not been apparent. Results suggest that povidone-iodine may be a possible alternative to mupirocin for the elimination of nasal carriage of S aureus and may have a role in the prevention of colonization and infection caused by MRSA, including mupirocin-resistant strains.32

Bacitracin (Baciguent; Johnson & Johnson, New Brunswick, New Jersey) interferes with the bacterial cell wall synthesis.36 In one investigation, bacitracin ointment was ineffective in eliminating S aureus from the anterior nares and had a post-treatment carrier rate equal to the control rate.37 Because of its lack of efficacy, bacitracin should no longer be considered for MRSA decolonization.

The decolonization of MRSA from those orthopedic patients with decubitus ulcers or other chronic wounds is more difficult, and the actual benefit of eradication of the carrier state is controversial. Low and even high-level mupirocin-resistant strains of MRSA have been associated with decolonization protocols exceeding a 10-day course.38-40 Furthermore, intranasal application of mupirocin has limited effectiveness in eradicating colonization even with prolonged regimens in patients who carry the organism at multiple body sites.17

Because decolonization has virtually always been used in combination with other control measures, its efficacy has been difficult to determine. Furthermore, even with existing infection control standards, the outcomes are debated. However, a recent open-label, randomized controlled trial reported in Clinical Infectious Diseases showed treatment with topical mupirocin, chlorhexidine gluconate washes, oral rifampin, and doxycycline for 7 days was safe and effective in eradicating MRSA colonization in hospitalized patients for at least 3 months.41 This is the first study demonstrating a decolonization regimen that has long-term eradication of MRSA.
Cost

In addition to ensuring product efficacy, clinicians should consider the overarching financial impact of MRSA infections and decolonization/treatment options. The cost-effectiveness of using intranasal mupirocin has been evaluated in multiple studies.

A study in 1996 estimated that >$16,000 would be saved per surgical site infection prevented when intranasal mupirocin ointment was used prior to surgery.42 Other studies not involving surgical patients value the savings to Medicare of $784,000 to $1.117 million per 1000 hemodialysis patients annually if mupirocin prophylaxis were implemented.43 The estimated savings per patient screened or treated in conjunction with nonemergent surgery requiring postoperative hospitalization44 was $102 and $88 respectively.
Recommendations

Although the goal of decolonization is the elimination of the MRSA carrier state to decrease the morbidity associated with subsequent S aureus infections and potential antibiotic toxicities, its value in the general orthopedic patient remains contested. The answer is more obvious if the patient is immunosuppressed and colonized or has had a history of repeated infections caused by the MRSA strain with which they are colonized.

Considerable benefit exists with the use of mupirocin in reducing nasal colonization and subsequent systemic infections with S aureus. Instead of committing each patient to the decolonization protocol, the orthopedist should assess each unique situation based on clinical and laboratory evidence to avoid the expense of the decolonization protocol as well as the excess use of mupirocin and the ensuing development of resistance.

While debate exists in the literature regarding the benefits of routine decolonization protocols in preventing surgical site infection and postoperative nosocomial infections, screening should be considered for patients who are at high risk of being MRSA carriers and for those who are undergoing high-risk procedures such as prosthetic implantation.10

Currently, many orthopedic procedures are unscheduled and the time required for the incubation of cultures before decolonization with mupirocin is started makes such a protocol impractical. The development of rapid diagnostics to more rapidly identify S aureus is needed before the surgeon will see maximum benefits with mupirocin prophylaxis or a decolonization regimen. However, the patient who is undergoing an elective surgery and has at least one risk factor for colonization should be considered for mupirocin therapy alone or in combination with an effective oral antimicrobial.


Source:www.orthosupersite.com

Cattle Health: Living Without 7% Iodine

Treating the navel cord stump of newborn calves, foals, lambs, kids, and piglets has been done for many years. This practice has been recommended for the prevention of infections of the navel stump and generalized infections of the body that gain access through the navel such as joint infections. Perhaps the most often recommended antiseptic for use on the navel stump has been 7% tincture of iodine or "strong iodine tincture." If you have attempted to buy this product for the upcoming calving season, you may have found that it is either unavailable or more difficult to obtain. The reason is that, in July, the Department of Justice published the final rules that make iodine tinctures and solutions greater than 2.2% subject to regulatory control by the Drug Enforcement Administration (DEA). This came about because iodine crystals are being used in the illegal production of methamphetamine, and they can be fairly easily extracted from iodine tinctures and solutions. In fact, some unscrupulous feed storeowners have been guilty of supplying iodine, iodine crystals, and other supplies to methamphetamine producers. (An interesting overview of this problem can be found at http://149.101.1.32/ndic/pubs1/1467/1467p.pdf published by the Department of Justice in 2002). The final regulatory announcement concerning 7% iodine tincture can be found at: http://www.deadiversion.usdoj.gov/fed_regs/rules/2007/fr0702.htm and Dianne Shoemaker, Extension Dairy Specialist, has written a nice overview of the problem and current situation at: http://dairy.osu.edu/bdnews/v009iss03.htm#ChangesinIodine .



Some veterinarians are still supplying their clients with 7% iodine tincture. It can be obtained by veterinarians who are registered with the DEA and subject to the record keeping requirements for purchase and sale of these products. However, some veterinarians and other suppliers have chosen not to sell it because of the additional recordkeeping and storage requirements. Veterinarians and Extension professionals are being asked for alternatives to 7% iodine.



There are no antiseptics actually labeled for treating the navel stump to this author's knowledge. Although the practice has been recommended for decades, and our experience seems to suggest it is useful, published research data concerning the value of treating the navel cord in newborn farm animals, with any compound, is very, very scarce. Several years ago, researchers at the College of Veterinary Medicine, University of California, evaluated 7% iodine and chlorhexidine for treating the navel in newborn foals. Their conclusion was that chlorhexidine was more effective than the iodine and that iodine could injure the sensitive skin around the foal's navel. As a result of this work, many equine veterinarians recommend chlorhexidine solutions to their clients, but other veterinarians have continued to recommend iodine tincture. In the past few years, chlorhexidine solutions have been used in some settings to treat the navel stump in newborn human infants to prevent bacterial colonization and invasion. Recent work suggests that this technique may be especially useful in developing and impoverished countries where babies may be born at home and in rather unsanitary surroundings. However, a review of the available literature on treatment of infant navels with chlorhexidine suggests that most protocols call for treating the navel daily for up to seven of the first ten days of the baby's life, and that although such treatment appears to reduce infections and death in infants, more research is needed to determine the ideal concentration of chlorhexidine and frequency of treatment. (see refs 1 and 2 below)



So where does this leave us? If you want to use 7% iodine, you will need to contact your veterinarian or animal health product supplier to see if they can provide it for you. For now at least, the 2% iodine tincture is still available, and its sale is not regulated. There are no published studies comparing the effectiveness of the two on navel cord stumps, but it may be effective, especially if more than one application is used. Be aware that the "tamed" iodine products used for teat dips, application to wounds, and for skin cleansing prior to surgery are not the same as tinctures (iodine crystals in alcoholic solution), and they do not "dry" the tissue like the tinctures. There is a similar lack of information about their effectiveness on navel stumps, but they certainly are effective as skin disinfectants and are not irritating. Chlorhexidine can be acquired from your veterinarian and some animal health suppliers. The research in foals was done with a 0.5% chlorhexidine (one-half percent) solution, and various concentrations up to 4% have been used on infant navels. It is safe and not irritating to skin, but dilutions should be prepared with distilled water, not tap water, and common soaps will inactivate it. No matter what disinfectant you and your veterinarian decide to use, it should be applied soon after birth.



We should not lose sight of the fact that disinfection of the navel stump is not likely to completely compensate for animals being born in unsanitary conditions. Most disinfectants fail in the presence of heavy organic matter contamination (read dirt and manure); and the bacteria that produce diseases, such as abscessed navels, joint infections, and possibly brain and respiratory infections, when they gain access to the body through the navel stump tend to build up to very high levels in crowded and unsanitary conditions. These high levels can overwhelm natural body defenses and the benefits of an antiseptic on the navel. Animals born outside in clean, dry, sunny pastures have a low risk of developing navel and other infections in the first few weeks of life. Clean, dry, well-bedded maternity pens are also less risky for newborns.

source:www.cattlenetwork.com