Microbiology of otitis media in Indigenous Australian children: review.

OBJECTIVES: To review research addressing the polymicrobial aetiology of otitis media in Indigenous Australian children in order to identify research gaps and inform best practice in effective prevention strategies and therapeutic interventions. METHODS: Literature review. RESULTS: Studies of aspirated middle-ear fluid represented a minor component of the literature reviewed. Most studies relied upon specimens from middle-ear discharge or the nasopharynx. Culture-based middle-ear discharge studies have found that non-typeable Haemophilus influenzae and Streptococcus pneumoniae predominate, with Moraxella catarrhalis, Staphylococcus aureus and Streptococcus pyogenes isolated in a lower proportion of samples. Alloiococcus otitidis was detected in a number of studies; however, its role in otitis media pathogenesis remains controversial. Nasopharyngeal colonisation is a risk factor for otitis media in Indigenous infants, and bacterial load of otopathogens in the nasopharynx can predict the ear state of Indigenous children. CONCLUSION: Most studies have used culture-based methods and specimens from middle-ear discharge or the nasopharynx. Findings from these studies are consistent with international literature, but reliance on culture may incorrectly characterise the microbiology of this condition. Advances in genomic technologies are now providing microbiologists with the ability to analyse the entire mixed bacterial communities ('microbiomes') of samples obtained from Indigenous children with otitis media.

Providing acupuncture in a breast cancer and fatigue trial: The therapists' experience.

OBJECTIVE: To explore the experiences of therapists providing acupuncture in a trial context, to women with fatigue, following breast cancer treatment. METHODS: The focus groups were nested within a multi-site randomised control trial. Therapists (n = 15) involved in the trial were invited to participate in one of the focus groups, which took place in the north and south of England. The treatment protocol imposed constraints on dialogue to essential procedural conversation and stipulated needling times of 20 min. RESULTS: All 15 therapists (100%) participated. Whilst they reported learning more about fatigue and cancer, adhering to the trial protocol limited the holistic nature of their practice. Seeing improvements, despite the protocol, made some therapists question their practice, in terms of needling times and limiting dialogue. CONCLUSIONS: The study provided information about the therapists' perspective of working within a trial. This could have implications for providing acupuncture treatments more cost effectively and timely within clinical practice.

Efficacy of low-dose intratympanic dexamethasone as a salvage treatment for idiopathic sudden sensorineural hearing loss: the Modbury Hospital experience.

OBJECTIVE: To evaluate the efficacy of low-dose intratympanic dexamethasone therapy in patients with idiopathic sudden sensorineural hearing loss whose hearing in the affected ear had failed to improve following a course of oral steroid therapy. METHODS: A prospective pilot study was undertaken of eight patients with idiopathic sudden sensorineural hearing loss whose hearing had failed to improve after a course of prednisolone. These patients subsequently received 8 mg intratympanic dexamethasone therapy, delivered via a ventilation tube on a weekly basis for 1 month. Clinical outcome was assessed weekly with pure tone audiography. RESULTS: At the end of the 1-month treatment period, no significant hearing improvement was observed on pure tone audiography in any of the patients (i.e. improvements were all less than 10 dB). CONCLUSION: The response to 8 mg of intratympanic dexamethasone used as a salvage therapy for idiopathic sudden sensorineural hearing loss was inadequate. A higher dosage of intratympanic dexamethasone might be required to achieve better outcomes.

A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture.

BACKGROUND: Maintenance acupuncture is advocated by clinicians after successful clinic-based acupuncture. We aimed to assess the effectiveness of maintenance acupuncture in the management of cancer-related fatigue (CRF); treatment delivered by therapists or self-acupuncture/self-needling was compared with no maintenance treatment. METHODS: Breast cancer patients who participated in a randomized trial of acupuncture for CRF management (reported elsewhere) were re-randomized to receive an additional four acupuncturist-delivered weekly sessions; four self-administered weekly acupuncture sessions (self-needling); or no acupuncture. Primary outcome was general fatigue (Multidimensional Fatigue Inventory). Mood, quality of life and safety were also assessed. RESULTS: In total, 197 patients were re-randomized, with 65 to therapist-delivered sessions, 67 to self-acupuncture/self-needling and 65 to no further acupuncture. Primary outcome scores were equivalent between the therapist-delivered acupuncture and self-acupuncture (P > 0.05). A non-significant trend in improving fatigue was observed at the end of 4 weeks in the combined acupuncture arms (P = 0.07). There was no impact on mood or quality of life of the further acupuncture sessions at 18 weeks beyond the improvement observed in initial trial. CONCLUSION: Self-acupuncture is an acceptable, feasible and safe maintenance treatment for patients with CRF. However, overall, maintenance acupuncture did not yield important improvements beyond those observed after an initial clinic-based course of acupuncture. TRIAL REGISTRATION NUMBER: NCT00957112.

Adaptive immune responses in Staphylococcus aureus biofilm-associated chronic rhinosinusitis.

BACKGROUND: The etiopathogenesis of chronic rhinosinusitis (CRS) is currently an area of intense debate. Recently, biofilms have been proposed as a potential environmental trigger in this disease. In particular, Staphylococcus aureus biofilms appear to be a predictor of severe disease recalcitrant to current treatment paradigms. However, direct causal links between biofilms and host immune activation are currently lacking. This study aimed to document both the adaptive immune responses that characterize S. aureus biofilm-associated CRS and the relative contributions of staphylococcal superantigens and S. aureus biofilms in the inflammatory make-up of this disease. METHODS: A total of 53 disease subjects and 15 controls were recruited. Sinonasal mucosa was collected for the determination of S. aureus and Haemophilus influenzae biofilms and presence of total and superantigen-specific IgE and for the measurement of cytokines that characterize the T-helper pathways. RESULTS: Staphylococcus aureus biofilms and superantigens are significantly associated in CRS patients, suggesting the biofilm may be a nidus for superantigen-eluting bacteria. The presence of S. aureus biofilms is associated with eosinophilic inflammation, across the spectrum of CRS, on the back of a T-helper(2) skewing of the host's adaptive immune response (elevated Eosinophilic Cationic Protein and IL-5). This can be distinguished from the superantigenic effect resulting in the induction of IgE. CONCLUSION: This study provides novel evidence of a link between S. aureus biofilms and skewing of the T-cell response toward the T-helper(2) pathway that is independent of superantigen activities. Further research is required to confirm the cause-effect relationship of this association.

Differential Ca(2+) sensitivity of skeletal and cardiac muscle ryanodine receptors in the presence of calmodulin.

Calmodulin (CaM) activates the skeletal muscle ryanodine receptor Ca(2+) release channel (RyR1) in the presence of nanomolar Ca(2+) concentrations. However, the role of CaM activation in the mechanisms that control Ca(2+) release from the sarcoplasmic reticulum (SR) in skeletal muscle and in the heart remains unclear. In media that contained 100 nM Ca(2+), the rate of (45)Ca(2+) release from porcine skeletal muscle SR vesicles was increased approximately threefold in the presence of CaM (1 microM). In contrast, cardiac SR vesicle (45)Ca(2+) release was unaffected by CaM, suggesting that CaM activated the skeletal RyR1 but not the cardiac RyR2 channel isoform. The activation of RyR1 by CaM was associated with an approximately sixfold increase in the Ca(2+) sensitivity of [(3)H]ryanodine binding to skeletal muscle SR, whereas the Ca(2+) sensitivity of cardiac SR [(3)H]ryanodine binding was similar in the absence and presence of CaM. Cross-linking experiments identified both RyR1 and RyR2 as predominant CaM binding proteins in skeletal and cardiac SR, respectively, and [(35)S]CaM binding determinations further indicated comparable CaM binding to the two isoforms in the presence of micromolar Ca(2+). In nanomolar Ca(2+), however, the affinity and stoichiometry of RyR2 [(35)S]CaM binding was reduced compared with that of RyR1. Together, our results indicate that CaM activates RyR1 by increasing the Ca(2+) sensitivity of the channel, and further suggest differences in CaM's functional interactions with the RyR1 and RyR2 isoforms that may potentially contribute to differences in the Ca(2+) dependence of channel activation in skeletal and cardiac muscle.

Blood transfusion as a major risk factor for HTLV-I infection among hospitalized children in Gabon (Equatorial Africa).

To study the risk factors for HTLV-I infection of African infants living in a high seroprevalence area, a survey was conducted among hospitalized children and their mothers in Franceville, southern Gabon. A total of 610 children (6 months to 14 years old) from 555 families and 434 mothers participated in the study. HTLV-I seroprevalence was 7.1% in the mothers and 2.8% in the children. No increase by age was observed in the children. Significantly more children with sickle cell anemia (11 of 57, or 19.2%) were infected than others (1%) (Fisher's exact test p < 0.001). Of the 13 seropositive infants (C+) whose mothers were tested, six (43%) had a seropositive mother (M+) [p < 0.001, prevalence ratio (PR) 10.12, 95% CI 3.40-30.35, attributable risk (AR) 0.55]. Risk factors for nonmaternally acquired HTLV-I infection were previous blood transfusion (Fisher's exact test p < 0.001, PR 15.74, CI 5.20-47.60, AR 0.71) and hospital admission. In a hospitalized pediatric population in Gabon mother-to-child transmission and blood transfusion (because of sickle cell disease) were equally implicated in HTLV-I infection. Control of HTLV-I infection in children in Africa requires prevention of both vertical and transfusion-associated transmission, which may be exceedingly difficult in developing countries.

Occupational asthma and IgE sensitization in a pharmaceutical company processing psyllium.

We assessed the prevalence of occupational asthma and IgE sensitization to psyllium in a pharmaceutical company producing psyllium hydrophilic mucilloid, which is used as a laxative. Workers were intermittently exposed, approximately 5 times/yr, for periods of less than 10 days. Of the 140 employees, 130 (93%) were studied before a processing period via a questionnaire spirometry (n = 125), blood sampling (n = 118), and skin prick tests (n = 120) with 7 common inhaled allergens as well as plantain and psyllium. Thirty-nine workers had a history suggestive of occupational asthma. Twenty-three of 120 (19%) showed a skin wheal diameter greater than or equal to 3 mm to psyllium and 31 of 118 (26%) had increased specific IgE antibodies; 39 (32%) workers had at least 1 of these 2 features. Subjects with a questionnaire suggestive of asthma or occupational asthma were further investigated by serial monitoring of peak expiratory flow rates and PC20 methacholine before and during the psyllium processing period. All workers had spirometry repeated during the processing period. Twenty-one subjects who had a PC20 less than or equal to 16 mg/ml (n = 10) and/or decreased their PC20 by a greater than or equal to 3.2-fold difference (n = 4) and/or changed their FEV1 by greater than or equal to 10% (n = 13) during the processing period were referred for inhalation challenges to psyllium in the laboratory. Five of the 18 workers for whom these tests were feasible gave an immediate bronchoconstrictive reaction.(ABSTRACT TRUNCATED AT 250 WORDS)