An audit of environmental health calls to a department of public health medicine

PURPOSE

To audit telephone calls concerning general issues in communicable disease control and environmental health to a department of public health medicine.

SETTING

A department of public health medicine in a district with a population of 190,000 during 1993.

METHOD

A retrospective audit of forms designed to record all calls concerning environmental health and communicable disease control. The intervention was a change in design of forms and education of doctors dealing with the calls. A re-audit was done after these changes had been implemented.

RESULTS

The number of recorded calls increased from 1.75 (1992) to 3.29 (mid-1993) per week. Signing of forms increased from 61% to 83% and dating from 6% to 72%. All forms filled in by registrars or senior registrars were reviewed by the Consultant in Communicable Disease Control (CCDC). Very few calls were considered to be inappropriate.

DISCUSSION

The increase in the number of calls was probably artefactual owing to better recording as a result of the audit. Improved recording will help in future training and audit, and be a medico-legal safeguard.

[Sarcoidosis as a cause of febrile++ syndrome of unknown origin. Retrospective study of 8 cases]

The authors report the results of a retrospective study of patients admitted to the Department of Infectious Diseases of Santa Maria Hospital with the diagnosis of sarcoidosis, from June 1982 to August 1991. Seven out of eight patients, were admitted due to fever of unknown origin. The results are discussed and the literature on sarcoidosis is also reviewed.

Use of technetium-HMPAO to demonstrate changes in cerebral blood flow reserve following carotid endarterectomy

Cerebral perfusion through stenosed internal carotid arteries is usually maintained by autoregulation. However, flow reserve may be reduced, suggesting hemodynamically significant stenosis, and such reduction should be improved by carotid endarterectomy. This concept was studied in 20 subjects with unilateral internal carotid artery stenosis (major stenosis greater than or equal to 70%, minor stenosis less than or equal to 50%). Thirteen had experienced recent transient ischemic attacks and seven had no definite focal symptoms. Subjects underwent Tc-HMPAO cerebral SPECT during acetazolamide dysautoregulation before and after internal carotid endarterectomy. Nine (45%) had perfusion defects that improved after surgery, suggesting surgery had improved cerebral flow reserve. Seven had defects that did not improve after surgery. Four had worsened or new defects after surgery, suggesting perioperative infarcts. The relatively large proportion of patients with improved cerebral blood flow reserve after surgery suggests that this technique may have a significant role to play in assessing which patients might benefit from carotid endarterectomy.

Cerebral perfusion defects, dysautoregulation and carotid stenosis

Single Photon Emission Computed Tomography (SPECT), imaging of cerebral blood flow was carried out in ten patients with haemodynamically significant carotid stenosis. Before and after carotid endarterectomy each patient was investigated by 3--dimensional SPECT brain scanning using technetium--hexamethyl propyleneamine oxine (99 mTcHMPAO, ceretec). Brain blood flow was normal before and after operation in 3 patients whose autoregulation was kept intact. Seven patients received acetazolamide to limit cerebral vascular reactivity and in four of these, preoperative perfusion defects were visible. After carotid endarterectomy the ipsilateral perfusion defects were abolished and it is concluded that carotid stenosis can reduce perfusion in the dysautoregulation brain and that carotid reconstruction can restore normal flow.

Activity of fosfomycin in the treatment of bacterial infections

30 patients with different infections were treated with fosfomycin: 13 had urinary infections, 14 had pneumonial infections, 2 had staphylococcus osteomyelitis and 1 had staphylococcus septicemia. The antibiotic was administered in doses ranging from 100 to 230 mg/kg/day, with periods of treatment that lasted from 5 to 58 days. The doses were administered every 6 h by the oral or intramuscular route. A total of 35 organisms were isolated: 7 E. coli, 7beta-hemolitic Streptococcus, 6 Proteus sp., 6 S. aureus, 6 S. viridans, 2 Klebsiella sp. and 1 negative coagulase S. aureus. All were sensitive to fosfomycin in vitro, as was revealed by the diffusion in discs method. The therapeutic results were good in 29 of the 30 cases (96.7%). There were no important side effects. A patient complained of a local pain in the area of the injection. The transaminases increased temporarily in 2 patients. One patient had a moderate eosinophilia while under treatment.