Kod zlatnog stafilokoka
Ponekad me nase novinari jako ljute...pogotovo kada pisu o stvarima o kojima neznaju i o kojima se niti ne raspitaju kod strucnjaka ili u strucnoj literaturi.
Naime, ovih dana udarna vijest na Dnevniku je kako su u Opcoj bolnici u Karlovcu kod dvoje pacijenata pronasli zlatni stafilokok tipa MRSA i kako su krivci neki zaposlenici kojima je isti pronadjen u nosnicama. Stanje pacijenata je stabilno, a klicnonse se tretiraju.
Zar je zbilja to toliko bitno da je mora biti udarna vijest na Dnevniku? Po tome bi moja bolnica i sve ostale bolnice ovdje trebala biti svaki dan na CNN-u. Jer nema dana kad u nasoj bolnici ne otkrijemo na desetke slucajeva infekcije MRSA-om.
Ako su vec odlucili staviti to u Dnevnik, onda su trebali malo poduciti gledatelje o cemu se tocno radi, koje opasnosti od MRSA vrebaju, kako se zastiti. I ne dizati nepotrebno paniku medju ljudima.
Zlatni stafilokok je sve prije nego zlatna bakterija. Zivi na kozi i otprilike 20-tak posto ljudi je naseljeno ovim bestijicama. Zlatni stafilokok uzrokuje cijeli niz infekcija koze, od obicnih cireva pa to upala pluca, srca, kostiju, meningitisa. Cesto je i smrtonona.
Zbog mutacija (bakterije traze nacina da prezivu i da nas unistu) jedan dio ovih bakterija je postao otporan na uobicajene antibiotike, pa su dobile naziv MRSA (meticilin rezistentni). Postoje dvije podvrste MRSA:
1.Community-Associated MRSA (CA-MRSA) - MRSA prisutna medju zdravim ljudima, posebice sportasima, zatvorenicima, vojnicima. Epidemija je zapocela 1990-tih.
2. Health Care-Associated MRSA (HA-MRSA) - MRSA u zdravstvenim ustanovama - koja uglavnom zahvace bolesne i nemocne. Otkrivena je 1961.
Istrazivanje provedeno od strane CDC (Centra za kontrolu bolesti SAD) koje je objavljeno u listopadu 2007 u JAMA, pokazalo je kako je 2005. godine zbog posljedica MRSA bilo u bolnicama oko 94,360 bolesnika od kojih je 18,650 umrlo. Zanimljivo je kako je od AIDS-a je te iste godine umrlo manje ljudi.
Kako se zastiti?
1. Pranjem ruku i koristenjem dezinfekcijskih sredstava (alkohol je dobar, ne samo za pice)
2. Testiranje svih pacijenata i osoblja na MRSA u bonicama
3. Dekolonizacija pozitivnih osoba (koristi se Bactroban 2% mast koja se stavlja u nosnice dva puta dnevno kroz sedam dana)
4. Izolacija pacijenta
5. Poboljsanje higijenskih uvjeta u zatvorima, vojarnama i sportskim klubovima
A cime se lijeci?
Iako je opasna i otporna, za MRSA postoje ljekovi. CA -MRSA se uspjesno lijeci sinersulom ili klindamicinom,
HA-MRSA se lijeci vankomicinom, linezolidom, quinupristin/dalfopristinom, daptomycinom i tigecyclinom.
MRSA je problem protiv kojeg se treba boriti, dobrog oruzja se ima i mjesta panici nema.
I naravno, uvijek je bolje sprijeciti nego lijeciti.
Dakle, sapun u ruke......
Ovo je visilo na zidu sale za sekcije u Zavodu za anatomiju na Salati u danima kad sam bio student. Jeli jos uvijek tako?
U bijeloj okrečenoj sobi stoje dva duga drvena stola.
Svakoga dana nove im goste dovezu mrtvačka kola.
Služavke umrle u bijedi ili sijede ispaćene pralje
Kojima ukočene ruke ne mogu prati dalje.
I koje uzevši im ruha ubonica amo šalje.
Bludnice koje pohotne ruke nikada više neće da dirnu
Što poslije sviju budnih, bludnih noći uđoše u jednu mirnu.
Il stigne ovamo kažnjenik kojeg je žandar prestao da vodi
Il napuhnuti utopljenik kojemu ime nesta u vodi
Il skitnjom izmučene skitnice vječito gonjene do mitnice
što prođoše kroz ovaj život bosi.
Svi oni amo jednom dođu zbiti u ljesove proste
I zauzmu svoje mjesto na stolu što vječno očekuje goste.
Žive su ih gonili i gnjeli, nožem su ih rasparali mrtve
Ti, što žrtve za života bjehu, ostadoše i poslije smrti žrtve.
Stanovahu na kraju grada u prljavom kvartu roblja
Počivat će na kraju groblja daleko od arkada.
I kao što je više nih imalo zajedničku sobu
Tako će i sad više njih noćivati u istom grobu.
The Prison Patient - by Dr. Klein, M.
Evo jedne zanimljive price o zatvorenicima, etickim dilemama i ....
Bennett drove to the state prison in the last moments before dawn. A second-year resident went to the prison at this promising hour every day of the year, and Bennett liked the drive. Long before other cars lit up the freeway with a dazzling headlight show, Bennett rolled his pickup truck down the entrance ramp and onto the empty night road. He kept his window down to touch and breathe the air. When he switched lanes, his turn signal blinked through the blue night like a satellite, and Bennett rocketed toward the great floodlit towers of the prison, glowing in the empty country.
Inside the prison, the lights were repellent, and the same air felt chilly and damp. Cheryl, the nurse, brought him a cup of coffee. Bennett fell into his chair in the little concrete office. He leaned back, legs spread wide like a high-school football coach, and flipped the list over. Only one name was on the roster.
"Only one today, hey," he said, still flipping at the corner of the list.
"Oh yes. Did you see who it is?" said Cheryl.
"Masterson? Oh boy." Bennett knew Masterson from other days. He came often. "Well, bring him in," he said, although the deputy had gone to retrieve the prisoner when he heard Bennett's heels coming down the hall.
"This is Masterson's last visit," Cheryl said. "He's going to court today. He's getting out." She was sure about this. In fact, Bennett trusted her to know more about these things than the law partners or the reporters because her mundane daily workload depended on the outcome. He was rarely surprised. Cheryl knew which prisoners went home from court.
There was a slam of the steel bolts in the doors. The deputy's voice rang through the office. "Stand along the left wall, Masterson. Atta boy. Siddown." The deputy appeared in the door, looking down at his slip of paper. He held it low on his abdomen and squinted at it over a spectacular jaw and chest. "I got your man," he said, and as he looked up, his flat top moved to a perfect horizontal. Cheryl nodded, and the deputy ducked into the next room for a cup of coffee.
"Mr. Masterson, come on in," Bennett said, waving his arm. He pressed his right hand into the chair between his legs and brought himself into a sitting position. Masterson, 62 years old, had suffered a heart attack about 6 months earlier. He came to see Bennett at the prison clinic almost every other day with an urgent concern. At first, Bennett had been spooked by Masterson, but the inmate was gentle with him, and respectful, and these qualities in someone so rough and different from himself stirred a kind of caring in Bennett's heart.
And Masterson needed Dr. Bennett. The heart attack 6 months ago haunted him incessantly as he plodded through the hours of windowless rooms and television, of foul language and urine, of farts and fights and humiliation.
He had been a car repairman before prison. Sometimes it seemed that he came to Bennett just to talk about cars, to get his mind off of his heart. No one had ever talked to Bennett about cars. He would describe a Monte Carlo engine, round and humming and shining, and compare it to a lady's smooth leg just where it flares into a buttock. He would shoot Bennett a sideways grin, then look down, ashamed. When Bennett glanced reflexively at the clock, Masterson would catch it and get to the point. He would ask Bennett about a mole on his belly, or a bump on his elbow, or a twinge that he had felt in his shoulder while watching "Baywatch." The inmate had a thousand nonexistent lesions, all imagined tangents from his heart. Bennett would listen to his lungs and listen to his belly, squeeze his lumpy shoulders and pat him on the back. When he reassured Masterson, when he said pointedly, "Your heart sounds fine, Mr. Masterson," the inmate would cry, big and jerky and trying to stop. After the deputy took him back to his cell, Bennett often sat quietly, impressed by his own unexpected power and by the transparency of Masterson's soul.
One day after the patient had left, Bennett overheard the deputy mutter, "Yeah, stay good and healthy so you can go ber some more little boys, Masterson." The grin on Bennett's face suddenly fell. His sympathy for the criminal seemed repulsive. Later, he stole a chance to review his patient's computer file and, when no one was looking, flipped the screen to the criminal record. Fifth-degree sexual assault. Sex with a minor. Distribution of child pornography. Sex with a 12-year-old boy. Statutory rape. The screen rolled over for a few seconds, blinking with the size of the list. Each name was a victim, each number was a sweaty boy lying in bed, still waking in a nocturnal panic. Bennett's mouth went dry when he recalled the reassuring touches he had given Masterson; on his back, his legs, his face.
Masterson appeared in the door. He wore neat prison scrubs stretched over his broad belly and, as always, he wore his brown work boots with years of engine oil smeared across their tongues. "Good morning, Dr. Bennett," he said. He scratched at a piece of fuzz caught in his graying beard. "Dr. Bennett, can I talk to you alone today?" he said, and threw a couple of abashed looks at Cheryl.
"Yeah, certainly, Mr. Masterson," Bennett said, and as he motioned for Cheryl to leave he rolled his eyes just a little for her, and she giggled. But he felt his mouth go dry again, and felt his pulse beating in his throat. "What's going on?"
"Dr. Bennett," the inmate said, "that medicine you gave me keeps me from getting hard-ons." His voice broke. "I haven't even got it up in the morning for 2 months. Is there something wrong with me? I can't get it up, Dr. Bennett, and it's been ever since I started that pill."
Bennett had started Masterson on a ß-blocker after the heart attack. He had forgotten to mention the possibility of impotence as a side effect. Back then, his patient's sex life hadn't occurred to him. "I don't want to take that pill any more, Dr. Bennett," he said, and his husky shoulders shook with real fear. "Am I sick? Am I going to die?" Masterson peeked up at him, shyly pulling up his shirt so Bennett could listen to his heart.
There was not even a pause. "Mr. Masterson, that pill is saving your life. You hear me? Listen to me." Bennett stood up and pulled his face close to the bearded, teary man. "Do you want another heart attack? Is that what you want? That pill is the only thing between you and the big one, see? Masterson, do you want to live to see tomorrow?" He was hissing at his patient and couldn't stop despite the petrified look in the man's eyes. Masterson nodded a tiny nod. "That pill is the only reason you are still alive today! That's the way it is, Masterson. You stick with that pill, every day. Hard-ons or no hard-ons," Bennett said, strling not to sneer, "you take that pill."
There was a long silence, and Bennett heard only his own heart surging in his ears. "Can you listen to my heart today, Dr. Bennett?" the patient whispered. For the first time, Bennett thought he smelled something forbidden on Masterson's breath. His nostrils recoiled.
"Your heart is fine." Bennett said quietly, turning away. "For now."
When Bennett stepped out onto the highway again, the light was lifting to a unifying gray. A crowd of headlights danced furiously past. He leaned a hairy hand on the bed of his pickup, hung his head, and waited for his knees to stop shaking. Up in the sky, the old towers of the prison revealed more cracks and dust with each onrushing minute of daylight.