Gaylene Bouska Altman

Increased symptoms in female IBS patients with dysmenorrhea and PMS

Women with irritable bowel syndrome often report premenstrual distress syndrome and dysmenorrhea. A descriptive, four-group comparison design was used to compare the symptoms and psychological distress levels of women with irritable bowel syndrome (age 18–45 years) with and without dysmenorrhea and premenstrual distress syndrome. Data from three studies on women with irritable bowel syndrome (n = 226) collected between 1995 and 2004 were combined. Of these, 38 had self-reported irritable bowel syndrome with dysmenorrhea and premenstrual distress syndrome, 59 had irritable bowel syndrome with premenstrual distress syndrome, 15 had irritable bowel syndrome and dysmenorrhea, and the remaining 114 had irritable bowel syndrome only. Participants completed the Symptom Checklist-90 Revised and a symptom diary. Pain symptoms and computed scales of anxiety, depression, anger, and cognitive difficulties were compared during the luteal phase, menses phase, and for the change from luteal to menses phases. Premenstrual distress syndrome and dysmenorrhea had a strong impact on uterine cramping at menses, and a weaker effect on other pain symptoms at both luteal and menses phases. Premenstrual distress syndrome was associated with higher depression, anger, and cognitive problems at both luteal and menses phases; however, it was not associated with a greater increase from luteal to menses phases for any symptoms other than uterine cramping. The multiple symptoms reported by women with both irritable bowel syndrome and premenstrual distress syndrome suggest that this group may be particularly challenging to treat and may require a multicomponent (e.g., education, diet, relaxation, cognitive restructuring) approach.

RANTES Production by Cultured Primate Endometrial Epithelial Cells

PROBLEM: RANTES (regulated upon activation, normal T cell expressed and secreted), is a chemokine with monocyte, macrophage, T lymphocyte, and eosinophil attractant and activating activities. This mediator has been detected in the peritoneal fluid of patients with endometriosis and in cultures of stromal cells from human endometrial and endometriotic tissue. To determine if endometrial epithelial cells were also a potential source of this mediator, primate endometrial epithelial cells were cultured in vitro and the constitutive and stimulated production of RANTES in these cultures was measured.

Release of RANTES from nasal and bronchial epithelial cells

RANTES is a chemokine with eosinophil attractant and activating activities. This study was undertaken to determine whether primary cultures of human nasal and primate bronchial epithelial cells produce RANTES and the effect of various cytokines and dexamethasone on the release of this chemokine. Nasal epithelial cells from 32 patients (HNE) and bronchial epithelial cells from 17 Macaca nemestrina monkeys (PBE) were cultured in vitro for 24 to 72 h with LPS, TNF-α, IL-1β, IFN-γ and TNF-α combined with IFN-γ and/or dexamethasone at 10 to 1000 µg/ml. Culture supernatants were assayed for RANTES by ELISA. RANTES synthesis was measured by immunoprecipitation. HNE and PBE released modest constitutive amounts of RANTES (350 to 1000 pg/ml) which did not increase with time in culture. Release of RANTES was stimulated by all activators except LPS in a time-dependent manner, with the greatest synthesis induced by the combined addition of TNF-α and IFN-γ. The combination of these activators also increased RANTES synthesis as determined by immunoprecipitation. Dexamethasone at 100 and 1000 µg/ml produced significant inhibition of stimulated RANTES release. These data indicate that normal nasal and bronchial epithelial cells release RANTES which is upregulated by various cytokines and inhibited by dexamethasone. The enhanced release is due to stimulation of both synthesis and secretion. Production of RANTES by epithelial cells could contribute to the inflammation that characterizes the respiratory tract in asthma and rhinitis and downregulation of RANTES by glucocorticoids may be one mechanism of the therapeutic effect of these agents.

Tularemia. A pathogen in nature and a biological weapon.

Tularemia as a potential biological weapon is of great concern because F. tularensis is a hardy organism that can be spread with a small inoculum. In addition, tularemia can be contracted through nature, predominately in rural areas. This disease can be spread by a wide variety of animals and can range from skin lesions to multi-organ involvement. The severity varies with amount of inocula, the virulence of the bacterium, and the port of entry. Exposure to aerosolized forms of F. tularensis, the major concern with bioterroism, can rapidly lead to respiratory failure and death. Untreated, other forms of tularemia can spread through the blood stream to other organs, leading to sepsis and death. Early recognition and treatment is tantamount to treatment and prevention of morbidity and mortality. Occupational health nurses are on the front line and must be assertive in identifying risk factors associated with exposure. Furthermore, education of the general population about exposure through nature can potentially decrease the incidence of tularemia. Occupational health nurses, as one of the largest health specialties in the workplace, may be the first contact for the exposed individual. Tularemia is treatable with knowledge of prevention, astute assessment, prompt identification, and treatment. Combined, they are powerful nursing tools in achieving optimal outcomes.

Implementation of nursing audit

The purpose of the article is to outline steps in initiating a patient care review program for nurse practitioners. This article is not directed toward individual peer evaluation, but instead toward the evaluation of the patients status.