AIDS breakthrough as vaccine cuts infections for first time

AIDS breakthrough as vaccine cuts infections for first time

BANGKOK (AFP) - – An experimental AIDS vaccine has for the first time cut the risk of infection in humans in what scientists Thursday called a "breakthrough" in the quarter-century fight against the epidemic.

The vaccine reduced the chance of being infected by a third, researchers announced after the world's largest trial of 16,000 volunteers, carried out by the US Army and Thailand's Ministry of Public Health.

The surprising result comes after years of fruitless attempts by the medical world to find an HIV vaccine, including one trial jab that apparently boosted infection rates.

"It is the first demonstration that a vaccine against HIV can protect against infection," Colonel Jerome Kim of the US military HIV research programme told a news conference in Bangkok via video link.

"This is a very important scientific advance and gives us hope that a globally effective vaccine may be possible in the future," he said.

Thai Public Health Minister Witthaya Kaewparadai said the "outcome of this study is a scientific breakthrough."

The vaccine was a combination of two older drugs that had not reduced infection on their own and the researchers said they were now studying why the two apparently worked together.

The study combined the canarypox vaccine ALVAC, manufactured by Sanofi-Aventis of France, and AIDSVAX, originally made by VaxGen Inc and now licensed to the non-profit Global Solutions for Infectious Diseases.

Researchers said the latest vaccine showed a 31.2 percent efficacy in reducing the risk of HIV infection.

"The outcome represents a breakthrough in HIV vaccine development because for the first time ever there is evidence that HIV vaccine has preventative efficacy," said the research team in a statement.

The vaccine was tested on volunteers -- all HIV negative men and women aged from 18 to 30 -- at average risk of infection in two Thai provinces near Bangkok starting in October 2003.

Half received the vaccine and the rest were given a placebo. Out of the placebo recipients 74 of 8,198 became infected compared with 51 of 8,197 who got the vaccine.

The World Health Organization and the Joint UN Programme on HIV/AIDS congratulated the researchers for the "encouraging" results.

"The study results, representing a significant scientific advance, are the first demonstration that a vaccine can prevent HIV infection in a general adult population and are of great importance," they said in a statement. Experts' reactions

The UN said it may not be possible to get licensing permission for the drug at the moment based on the results, and that further studies were needed to determine if the vaccine has the same effect in other parts of the world.

AIDS first came to public notice in 1981 and has since killed at least 25 million people worldwide, and 33 million others are living with AIDS or the HIV virus.

Swift progress in identifying the virus that caused AIDS unleashed early optimism that a vaccine would quickly emerge. HIV destroys immune cells and exposes the body to opportunistic disease.

But out of the 50 candidates that have been evaluated among humans, only two vaccines have made it through all three phases of trials, and both were flops. About 30 vaccines remain in the pipeline.

Scientists were in 2007 forced to abandon two advanced clinical trials of a vaccine by pharmaceutical company Merck after it appeared to actually heighten the risk of AIDS infection.

Sanofi Pasteur, the vaccines division of Sanofi-Aventis, said the results of the latest test, although "modest", were the first concrete demonstration that a vaccine "could one day become a reality."

The Global HIV Vaccine Enterprise, an alliance of researchers, policymakers, donors and advocates that includes the Bill and Melinda Gates Foundation, said it was a "historic day in the 26-year quest to develop an AIDS vaccine."

The International AIDS Vaccine Initiative (IAVI), an organization that promotes the search for a vaccine, said the trial results were "very exciting and a significant scientific achievement."

The head of the US agency tasked with controlling the spread of infectious disease said it was an important breakthrough.

"These new findings represent an important step forward in HIV vaccine research," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the US National Institutes of Health, which provided major funding and logistical support for the study.

But a top AIDS scientist, France's Jean-Francois Delfraissy, warned that the results were "good news but the effect remains modest".

Source: Yahoo! News

Bad habits take a decade off life: study

Middle-aged male smokers with high cholesterol and blood pressure
die, on average, a decade sooner than peers without any of these
heart disease risk factors, according to a study.

PARIS (AFP) - Middle-aged male smokers with high cholesterol and blood pressure die, on average, a decade sooner than peers without any of these heart disease risk factors, according to a study published on Friday.

Many studies have shown that not smoking, eating healthily and exercising cut heart disease rates.

But few have tackled the problem from the other end: to what extent is life expectancy shortened by having these heart disease risk factors?

To find out, researchers from Oxford University sifted through data from 19,000 male civil servants who were examined in the late 1960s when they were 40 to 69 years old.

Participants provided detailed information about their medical history, lifestyle and smoking habits, and doctors recorded their weight, blood pressure, lung function, cholesterol and blood sugar levels.

More than 7,000 of the surviving participants were re-evaluated in 1997, 28 years after the initial examination.

The study, published in the British Medical Journal (BMJ), found that the men who faced a triple risk threat at the outset were two-to-three times more likely to have died of a heart-related problem than men free of all three risk factors.

On average, their lives were shortened by a decade, the study found.

The percentage of people who have fatal strokes or heart attacks has declined by about a quarter in many rich countries over the last decade.

But the prevalence of known risk factors has not dropped as quickly.

In the United States, for example, uncontrolled hypertension has fallen since 1999 by only 16 percent, high blood cholesterol by 19 percent, and tobacco use by just over 15 percent, says the American Heart Association.

Other sources of risk have remained constant or even increased: people exercise no more than 10 years ago, while rates of obesity have climbed sharply, especially among children.

Source: Yahoo! News

Parkinson’s Disease

Definition

• Is a progressive neurologic disease affecting the brain centers responsible for control and regulation of movement.
• A deficiency of dopamine due to degenerative changes in the substantia nigra produces tremor, bradykinesia, rigidity, and autonomic dysfunction.
• The cause is not known.
• Complications of Parkinson’s disease include dementia, aspiration, and injury from falls.
• The incidence of Parkinson’s disease increases with age; approximately 1% of the population older than age 60 has this disorder.

Assessment

1. Characteristic resting tremor of the extremities (may be worse on one side), and possibly affecting the head and neck.
2. Bradykinesia (slowness of movement).
3. Muscle rigidity in performing all movements, as well as rest.
4. Verbal fluency may be impaired.
5. Signs of autonomic dysfunction (sleeplessness, salivation, sweating, orthostatic hypotension).
6. Depression, dementia.
7. Masklike facies.
8. Poor balance, gait disturbances, speech problems.

Diagnostic Evaluation

1. Diagnosis is based on observation of clinical symptoms and consideration of patient’s age and history, confirmed by favorable response to levodopa therapy.
2. CT scanning and MRI may be performed to rule out other disorder.

Pharmacologic Interventions

1. Various drugs can be used, often in combination to prolong effectiveness because tolerance develops.

• Anticholinergics to reduce activation of cholinergic pathways, which are thought to be overactive in dopamine deficiency.
• Amantadine, which may improve dopamine release in the brain.
• Levodopa, a dopamine precursor, combined with carbidopa, a decarboxylase inhibitor, to inhibit destruction of L-dopa in the bloodstream, making more available to the brain.
• Bromocriptine, a dopaminergic agonist that activates dopamine receptors in the brain.
• Monoamine oxidase inhibitors as adjunct to levodopa therapy.
• Catecholamine-O-methyltransferase (COMT) inhibitors, as adjunct therapy in combination with levodopa therapy; COMT is an enzyme that eliminates dopamine from the brain.

Surgical Interventions

1. Medical pallidotomy to improve dyskinesia, rigidity, and tremor.
2. Chronic deep brain stimulation through electrodes implanted into the thalamus or globus pallidus to decrease tremor.
3. Brain tissue transplants through the use of stem cells and genetically engineered animal cells are a promising area of research.

Nursing Intervention

1. Monitor drug treatment to note adverse reactions and allow for dosage adjustments. Monitor for liver function changes and anemia during drug therapy.
2. Monitor the patient’s nutritional intake and check weight regularly.
3. Monitor the patient’s ability to perform activities of daily living.
4. To improve mobility, encourage the patient to participate in daily exercise, such as walking, riding stationary bike, swimming, or gardening.
5. Advise the patient to perform stretching and postural exercises as outlined by a physical therapist.
6. Teach the patient walking techniques to offset parkinsonian shuffling gait and tendency to lean forward.
7. Encourage the patient to take warm baths and massage muscles to help relax muscles.
8. Instruct the patient to rest often to avoid fatigue and frustration.
9. To improve the patient’s nutritional status, teach the patient to think through the sequence of swallowing.
10. Urge the patient to make a conscious effort to control accumulation of saliva (drooling) by holding head upright and swallowing periodically. Be alert for aspiration hazard.
11. Have the patient use secure, stabilized dishes and eating utensils.
12. Suggest the patient eat smaller meals and additional snacks.
13. To prevent constipation, encourage patient to consume foods containing moderate fiber content (whole grains, fruits, and vegetables), and to increase his or her water intake.
14. Obtained a raised toilet seat to help the patient sit and stand.
15. Teach the patient facial exercises and breathing methods to obtain appropriate pronunciation, volume, and intonation.
16. Teach the patient about the medication regimen and adverse reaction.

Source:
www.nursingcrib.com

Inserting A Nasogastric Tube

1. Check physician’s order for insertion of nasogastric tube.
2. Explain procedure to patient.
3. Gather equipment.
4. If nasogastric tube is rubber, place it in a basin with ice for 5 to 10 minutes or place a plastic tube in a basin of warm water if needed.
5. Assess patient’s abdomen.
6. Perform hand hygiene. Don disposable gloves .
7. Assist patient to high Fowler’s position or to 45 degrees if unable to maintain upright position and drape his or her chest with bath towel or disposable pad. Have emesis basin and tissues handy.
8. Check nares for patency by asking patient to occlude one nostril and breathe normally through the other. Select nostril through which air passes more easily.
   
9. Measure distance to insert the tube by placing tip of tube at patient’s nostril and extending to tip of earlobe and then to tip of xiphoid process. Mark tube with a piece of tape.
10. Lubricate tip of tube (at least 1-2 inches) with water-soluble lubricant. Apply topical analgesic to nostril and oropharynx or ask patient to hold ice chips in his or her mouth for several minutes (according to physician’s preference).
11. After having the patient lift his or her head, insert tube into nostril while directing tube downward and backward. Patient may gag when tube reaches the pharynx.
12. Instruct patient to touch his or her chin to chest. Encourage him or her to swallow ever if no fluids are permitted. Advance tube in a downward-and-backward direction when patient swallows. Stop when patient breathes. Provide tissues for tearing or watering eyes. If gagging and coughing persist, check placement of tube with a tongue blade and flashlight. Keep advancing tube until tape marking is reached. Do not use force. Rotate tube if it meets resistance.
13. Discontinue procedure and remove tube if there are signs of distress, such as gasping, coughing, cyanosis, and inability to speak or hum.
14. Determine that tube is in patient’s stomach. Hold tube in place to keep it from withdrawing while placement is checked.

1. 1. Attach syringe to end of tube and aspirate a small amount of stomach contents.
   2. Measure pH of paper or a meter.
   3. Visualize aspirated contents, checking for color and consistency.
   4. Obtain radiograph of placement of tube (as ordered by physician).
   
   
2. Apply tincture of benzion to tip of nose and allow to dry. Secure tube with tape to patient’s nose. Be careful not to pull tube too tightly against nose.

1. 1. Cut a 4-inch piece of tape and split bottom 2 inches or use packaged nose tape nasogastric tubes.
   2. Place unsplit end over bridge of patient’s nose.
   3. Warp split ends under tubing and up and over onto nose.
2. Attach tube to suction or clamp tube and cap it according to physician’s orders.
3. Secure tube to patient’s gown by using a rubber band or tape and a safety pin. If double-lumen tube is used, secure vent above stomach level. Attach at shoulder level.
4. Assist or provide patient with oral hygiene at regular intervals.
5. Perform hand hygiene. Remove all equipment and make patient comfortable.
6. Record the insertion skill, type, and size of tube and measure tube from tip of nose to end of tube. Also document description of gastric contents, which nares used, and patient’s response.

Nasogastric Tube Insertion Video

Source:

www.nursingcrib.com

Sutures (O.R. Technique)

Definition:

• a suture is a piece of thread-like material used to stitch or approximate tissues, and hold the wound together until healing takes place.
• any strand of material used to ligate bleeders or used to approximate tissue.
• any materials used to sew, sick or hold tissue together until healing process occurs.

Purpose of Suture:

• to hold a wound together in good apposition until such time as the natural healing process is sufficiently well established to make the support from the suture material unnecessary and redundant.

Ligature or Tie – refers to a suture material that is tied around a blood vessel to occlude the lumen.

Two types of ligature or tie:

1. Free tie – is a stand of material that is handed or given the surgeon or assistant to ligate a vessel. This stand is not threaded on a needle.
2. Stick tie or suture ligature – the suture material is threaded either on a needle holder or on a right angle clamp before occluding a deep or large vessel.

Atraumatic Suture – a suture material prepared or manufactured with a needle attached to it. It is referred to as an eyeless needle or atraloc-swage on needle.

Strand – suture material prepared or manufactured without a needle attached to it.

Continuous Suture – a suturing technique wherein a surgeon start suturing at one point and ends at the other point without cutting the suture material. This may be referred to as a running stitch and also used to close the peritoneum and vessels because it provide a leakproof suture line.

Interrupted Suture – the suture is taken, tied and out separately. This technique is time consuming.

Subcuticular Suture – a continuous suture is placed beneath epithelial layer of skin in short lateral stitches. It leaves a minimal scar formation.

Buried Suture – a suture placed under the skin, buried either continuous or interrupted suture.

Burse String or Inverting Stitch – a continuous suture is used as a draw string method to invert the loose ends or edges of tissue and tied the close the lumen. (for example, stamp of the appendix.)

Traction Suture – is used to hold tissue out of the way during the operation.

Classification of Suture Material:

1. Absorbable Suture. An absorbable suture is made from material that can be absorbed (digested) by body cells and fluids. Rate of absorption depends on various factors, including type of body tissue, nutritional status of the patient, and the presence of infection. Absorbable suture is available prepackaged and pre-sterilized in various sizes graded by diameter and length. Sizes range from number 12-0, which is the finest, to number 5, which is the heaviest. The length ranges from 12 to 60 inches.

a. Plain gut. Plain indicates a surgical gut material that has not been treated to lengthen its absorption time in the tissue. This suture is absorbed more rapidly than treated suture.

b. Chromic gut. Chromic surgical gut has been treated with chromic oxide so that it will delay its rate of digestion or absorption.

c. Synthetic Absorbable Sutures

i. Polyglactin 910 (Vicryl).

ii. Polyglycolic Acid (Dexon).

iii. Polydioxanone (PDS).

2. Non-absorbable Suture. This suture material is not absorbed during the healing process. Non-absorbable suture becomes encapsulated (enclosed in a capsule) with tissue and remains in the body until it is removed or cast off. Silk, nylon, cotton, linen, polypropylene, and corrosion-resisting steel wire are examples of non-absorbable sutures. Sutures used for skin closure are usually removed before healing is complete.

Suture Sizes:

• Sutures are sized by the USP (United States Pharmacopoeia) scale
• The available sizes and diameters are:
• 6-0 = 0.07 mm
• 5-0 = 0.10 mm
• 4-0 = 0.15 mm
• 3-0 = 0.20 mm
• 2-0 = 0.30 mm
• 0 = 0.35 mm
• 1 = 0.40 mm
• 2 = 0.5 mm

Suture characteristics:

• Suture materials vary in their physical characteristics
• Monofilament sutures (e.g. polypropylene) are smooth
• The slide well in tissues but if handles inappropriately they can fracture
• Multifilament sutures (e.g. polyglactin) are braided
• They have a greater surface area
• They are easier to handle and knot well
• Some suture materials have a ‘memory’ (e.g. polypropylene)
• Return to former shape when tension is removed

Catgut

• Made from the submucosa of sheep gastrointestinal tract
• Broken down within about a week
• Chromic acid delays hydrolysis
• Even so it is destroyed before many wounds have healed

Silk

• Strong and handles well but induces strong tissue reaction
• Capillarity encourages infection causing suture sinuses and abscesses

Vicryl

• Tensile strength
• 65% @ 14 days
• 40% @ 21 days
• 10% @ 35 days
• Absorption complete by 70 days

Polydioxone

• Tensile strength
• 70% @ 14 days
• 50% @ 28 days
• 14% @ 56 days
• Absorption complete by 180 days

Specifications for Suture Materials:

1. It must be sterile
2. It must be uniform in tensile strength by size and material.
3. It must be hypoallergenic and less tissue reactive.
4. It must be safe on each type of tissue.
5. It must be secure and tight when knotted.
6. It must be appose and maintain the tied tissues together until it fully heal.

Source:
http://www.surgical-tutor.org.uk
http://www.wikipedia.org
Operating Room Technique Instructional Manual - 2nd Ed.

How to Perform a Self-Breast Examination

Breast Self Examination (BSE) is a method of finding abnormalities of the breast, for early detection of breast cancer. The method involves the woman herself looking at and feeling each breast for possible lumps, distortions or swelling.

BSE was once promoted heavily as a means of finding cancer at a more curable stage, but randomized controlled studies found that it was not effective in preventing death, and actually caused harm through needless biopsies and surgery.

1. The self-exam is performed by standing in front of a mirror with the torso exposed to view.
2. The woman looks in the mirror for visual signs of dimpling, swelling, or redness on or near the breasts. This is usually repeated in several positions, such as while having hands on the hips, and then again with arms held overhead.
3. The woman then palpates her breasts with the pads of her fingers to feel for lumps (either superficial or deeper in tissue) or soreness. To be effective, this process needs to cover the entire breast, including the “axillary tail” of each breast that extends toward the axilla (armpit). This is usually done once while standing in front of the mirror and again while lying down.
4. Some guidelines suggest mentally dividing the breast into four quadrants and checking each quadrant separately. Finally, women that are not breastfeeding gently squeeze each nipple to check for any discharge.

The 7 P’s of Breast Self Examination (BSE)

1. Position: Inspect breasts visually and palpate in the mirror with arms at various positions. Then perform the examination lying down, first with a pillow under one shoulder, then with a pillow under the other shoulder, and finally lying flat.
2. Perimeter: Examine the entire breast, including the nipple, the axillary tail that extends into the armpit, and nearby lymph nodes.
3. Palpation: Palpate with the pads of the fingers, without lifting the fingers as they move across the breast.
4. Pressure: First palpate with light pressure, then palpate with moderate pressure, and finally palpate with firm pressure.
5. Pattern: There are several examination patterns, and each woman should use the one which is most comfortable for her. The vertical strip pattern involves moving the fingers up and down over the breast. The pie-wedge pattern starts at the nipple and moves outward. The circular pattern involves moving the fingers in concentric circles from the nipple outward. Don’t forget to palpate into the axilla.
6. Practice: Practice the breast self-exam and become familiar with the feel of the breast tissue, so you can recognize changes. A health care practitioner can provide feedback on your method.
7. Plan: Know what to do if you suspect a change in your breast tissue. Know your family history of breast cancer. Have mammography done as often as your health care provider recommends.

For pre-menopausal women, BSE is best done at the same stage of their period every month to minimize changes due to the menstrual cycle. The recommended time is just after the end of the last period when the breasts are least likely to be swollen and tender. Older, menopausal women should do BSE once a month, perhaps on the first or last day of every month.

Learn more about Breast Cancer

Source:

wikipedia.org

http://www.stevens-tech.edu/

Therapeutic Diet

A. Clear Liquids

1. Purpose—to provide hydration to a post-op patient

2. Foods Allowed—tea, coffee, fat-free broth, bouillon, fruit ices, popsicles, gelatin, soda

3. Foods Not Allowed—milk products, fruit juices with pulp

B. Full Liquid

1. Purpose—after a post-op patient tolerates clear liquids, this is often ordered.

2. Foods Allowed—all foods that are liquid or are liquid at room temperature

3. Foods Not Allowed—nuts, beans, solid food

C. Soft Diet

1. Purpose—for post-op patients after full liquid or for patients with infections or GI problems

2. Foods Allowed—all foods that are soft, tender, minced, stewed, or creamed

3. Foods Not Allowed—coarse or whole grain breads, meats, sharp cheeses, dried fruits and nuts

D. Bland Diet

1. Purpose—to eliminate irritating foods to allow the stomach lining to heal (ulcer patients)

2. Foods Allowed—milk, custards, white bread, cooked cereals, creamed or pureed soups, baked or broiled potatoes

3. Foods Not Allowed—strongly flavored and highly seasoned foods, coffee, tea, citrus fruits, raw fruits and vegetables, whole grains, very hot or cold beverages

E. Low-Residue Diet

1. Purpose—to reduce fiber for patients with Crohn’s disease, colon or rectal surgery, esophagitis, diarrhea.

2. Foods Allowed—clear fluids, sugar, salt, meats, fats, eggs, some milk, refined cereals and white breads, peeled white potatoes

3. Foods Not Allowed—cheeses, fried foods, highly seasoned foods, and high fiber foods.

F. High-Fiber Diet

1. Purpose—to provide bulk in the stool and bring water into the colon for patients with constipation or diverticulitis

2. Foods Allowed—raw fruits and vegetables, whole grains

3. Foods Not Allowed—minimize low fiber foods

G. Sodium Restricted

1. Purpose—for patients with kidney, cardiovascular disease or hypertension to control the retention of sodium and water and thus lower blood pressure

2. Foods Allowed—natural foods without salt, milk, and meat in limited quantities

3. Foods Not Allowed—canned prepared foods, table salt, most prepared seasonings not labeled low sodium

H. Gluten-Free Diet

1. Purpose—eliminates gluten, a protein found in wheat products. These are used for patients with malabsorption syndromes such as celiac disease.

2. Foods Allowed—rice, corn, soy flour, fruits, vegetables, meat, eggs, milk

3. Foods Not Allowed—all wheat, rye, barley, oats: many prepared foods such as creamed sauces or breaded foods (may contain thickeners and fillers)

I. Lactose-Free Diet

1. Purpose—to reduce or eliminate foods with lactose, for patients who cannot metabolize it

2. Foods Allowed—most meats, fruits and vegetables, cereals and grains

3. Foods Not Allowed—foods containing lactose, such as milk, cheese and ice cream

J. Low-Cholesterol

1. Purpose—to reduce the intake of cholesterol in order to lower blood cholesterol levels

2. Foods Allowed—fruits, vegetables, lean meats and fish, poultry without skin, skim milk

3. Foods Not Allowed—organ meats, egg yolks, shrimp, beef, lamb, pork

K. Low-Purine Diet

1. Purpose—to reduce the amount of purine, which is a precursor of uric acid, in the diet. It is used with patients who have gout or uric acid kidney stones.

2. Foods Allowed—most vegetables (except cauliflower), spinach, asparagus, peas, fruit juices, cereals, eggs, cottage cheese

3. Foods Not Allowed—organ meats, fish, poultry, lentils, dried peas, nuts beans, oatmeal, whole wheat.

Source: www.nursingcrib.com