Digital fetal scalp stimulation (dFSS) versus fetal blood sampling (FBS) to assess fetal wellbeing in labour-a multi-centre randomised controlled trial: Fetal Intrapartum Randomised Scalp Stimulation Trial (FIRSST NCT05306756).

BACKGROUND: Cardiotocography (CTG) is a screening test used to detect fetal hypoxia in labour. It has a high false positive rate resulting in many potentially unnecessary caesarean sections. Fetal blood sampling (FBS) is a second-line test of the acid-base status of the fetus. It is used to provide either reassurance that it is safe for labour to continue or objective evidence of compromise so that delivery can be expedited. Digital fetal scalp stimulation (dFSS) to elicit a fetal heart rate acceleration is an alternative less invasive second-line test of fetal wellbeing. This study aims to provide robust evidence on the role of these two second-line tests in assessing fetal wellbeing and potentially preventing operative delivery. METHODS: A multi-centre parallel group randomised controlled trial (RCT) is planned in four maternity centres in Ireland. The study aims to recruit 2500 nulliparous women with a term (≥37+0 weeks) singleton pregnancy who require a second-line test of fetal wellbeing in labour due to an abnormal CTG. Women will be allocated randomly to dFSS or FBS on a 1:1 ratio. The primary outcome is caesarean section. With 1250 women in each arm, the study will have 90% power to detect a difference of 5-6%, at a two-sided alpha significance level of 5%, assuming a caesarean section rate of at least 20% in the dFSS group. DISCUSSION: If the proposed study shows evidence that dFSS is a safe, reliable and effective alternative to FBS, this would have ground-breaking implications for labour management worldwide. It could potentially lead to a reduction in invasive procedures and emergency caesarean sections. TRIAL REGISTRATION: ClinicalTrials.gov NCT05306756. Registered on 31 March 2022. The trial commenced enrolment on 10 May 2022. Ethical committee approval has been granted by the Research Ethics Committee (REC) of each hospital: Dublin/CWIUH REC: 12.06.2019; Cork/UCC REC: 29.11.2019; Galway/NUIG REC: 06.09.2019; Limerick/UL REC: 30.09.2019.

Thirty-seven-year Population-based Study of Colorectal Cancer Rates in Renal Transplant Recipients in Ireland.

BACKGROUND: Renal transplantation is associated with an increased risk of neoplasia, including colorectal cancer (CRC). Advances in surgical techniques and immunosuppressive medications have resulted in increased survival rates of both patients and grafts, but the incidence of CRC in the Irish renal transplant population is currently unknown. The aim of this study is to review the incidence of CRC in the Irish renal transplant population and compare it to the general population. METHODS: A retrospective review of a prospectively maintained database of all renal transplant recipients in Ireland between January 1980 and July 2017 was performed. RESULTS: Thirty-three out of 4230 transplant recipients (men = 20, women = 13) developed CRC subsequent to transplantation and were eligible for inclusion in the series. The mean age at transplantation was 51.5 years, with patients developing CRC on average 10.9 years post-transplantation; 6.1% (n = 2/33) had stage IV disease at diagnosis. The majority of patients (87.8%) had a pathologic T stage of T3/T4 and 45.5% had involvement of locoregional lymph nodes (N1/N2); 42.4% also had a mucinous component at histopathologic assessment. The incidence of CRC was higher in the transplant population compared to the general population. CONCLUSION: This is the first population-based assessment of CRC development in the Irish renal transplant population. Our data suggest that Irish transplant recipients have an increased risk of being diagnosed with a more advanced tumor than the general population, with most being diagnosed almost a decade after transplantation. This highlights the need for increased awareness among patients and clinicians and the potential need for coordinated lifelong surveillance of this patient population to ensure early detection and treatment.

Supporting prescribing in Irish primary care: protocol for a non-randomised pilot study of a general practice pharmacist (GPP) intervention to optimise prescribing in primary care.

BACKGROUND: Prescribing for patients taking multiple medicines (i.e. polypharmacy) is challenging for general practitioners (GPs). Limited evidence suggests that the integration of pharmacists into the general practice team could improve the management of these patients. The aim of this study is to develop and test an intervention involving pharmacists, working within GP practices, to optimise prescribing in Ireland, which has a mixed public and private primary healthcare system. METHODS: This non-randomised pilot study will use a mixed-methods approach. Four general practices will be purposively sampled and recruited. A pharmacist will join the practice team for 6 months. They will participate in the management of repeat prescribing and undertake medication reviews (which will address high-risk prescribing and potentially inappropriate prescribing, deprescribing and cost-effective and generic prescribing) with adult patients. Pharmacists will also provide prescribing advice regarding the use of preferred drugs, undertake clinical audits, join practice team meetings and facilitate practice-based education. Throughout the 6-month intervention period, anonymised practice-level medication (e.g. medication changes) and cost data will be collected. A nested Patient Reported Outcome Measure (PROM) study will be undertaken during months 4 and 5 of the 6-month intervention period to explore the impact of the intervention in older adults (aged ≥ 65 years). For this, a sub-set of 50 patients aged ≥ 65 years with significant polypharmacy (≥ 10 repeat medicines) will be recruited from each practice and invited to a medication review with the pharmacist. PROMs and healthcare utilisation data will be collected using patient questionnaires, and a 6-week follow-up review conducted. Acceptability of the intervention will be explored using pre- and post-intervention semi-structured interviews with key stakeholders. Quantitative and qualitative data analysis will be undertaken and an economic evaluation conducted. DISCUSSION: This non-randomised pilot study will provide evidence regarding the feasibility and potential effectiveness of general practice-based pharmacists in Ireland and provide data on whether a randomised controlled trial of this intervention is indicated. It will also provide a deeper understanding as to how a pharmacist working as part of the general practice team will affect organisational processes and professional relationships in a mixed public and private primary healthcare system.

Transfusion-transmitted hepatitis B virus (HBV) infection from an individual-donation nucleic acid (ID-NAT) non-reactive donor.

Lookback was initiated upon notification of an acute HBV infection in a repeat Irish donor, 108 days post-donation. The donation screened non-reactive by individual-donation nucleic acid testing (ID-NAT) using the Procleix Ultrio Elite multiplex assay and again when the archived sample was retested, but the discriminatory assay for HBV was reactive. The immunocompromised recipient of the implicated red cell component was tested 110 days post-transfusion, revealing a HBV DNA viral load of 470 IU/ml. Genotype C2 sequences identical across two regions of the HBV genome were found in samples from the donor and recipient.

Risk factors for nonpurulent leg cellulitis: a systematic review and meta-analysis.

Nonpurulent cellulitis is an acute bacterial infection of the dermal and subdermal tissues that is not associated with purulent drainage, discharge or abscess. The objectives of this systematic review and meta-analysis were to identify and appraise all controlled observational studies that have examined risk factors for the development of nonpurulent cellulitis of the leg (NPLC). A systematic literature search of electronic databases and grey literature sources was performed in July 2015. The Newcastle-Ottawa Scale (NOS) was used to assess methodological quality of included studies. Of 3059 potentially eligible studies retrieved and screened, six case-control studies were included. An increased risk of developing NPLC was associated with previous cellulitis [odds ratio (OR) 40·3, 95% confidence interval (CI) 22·6-72·0], wound (OR 19·1, 95% CI 9·1-40·0), current leg ulcers (OR 13·7, 95% CI 7·9-23·6), lymphoedema/chronic leg oedema (OR 6·8, 95% CI 3·5-13·3), excoriating skin diseases (OR 4·4, 95% CI 2·7-7·1), tinea pedis (OR 3·2, 95% CI 1·9-5·3) and body mass index > 30 kg m-2 (OR 2·4, 95% CI 1·4-4·0). Diabetes, smoking and alcohol consumption were not associated with NPLC. Although diabetics may have been underrepresented in the included studies, local risk factors appear to play a more significant role in the development of NPLC than do systemic risk factors. Clinicians should consider the treatment of modifiable risk factors including leg oedema, wounds, ulcers, areas of skin breakdown and toe-web intertrigo while administering antibiotic treatment for NPLC.

Antimicrobial Resistance of Faecal Escherichia coli Isolates from Pig Farms with Different Durations of In-feed Antimicrobial Use.

Antimicrobial use and resistance in animal and food production are of concern to public health. The primary aims of this study were to determine the frequency of resistance to 12 antimicrobials in Escherichia coli isolates from 39 pig farms and to identify patterns of antimicrobial use on these farms. Further aims were to determine whether a categorization of farms based on the duration of in-feed antimicrobial use (long-term versus short-term) could predict the occurrence of resistance on these farms and to identify the usage of specific antimicrobial drugs associated with the occurrence of resistance. Escherichia coli were isolated from all production stages on these farms; susceptibility testing was carried out against a panel of antimicrobials. Antimicrobial prescribing data were collected, and farms were categorized as long term or short term based on these. Resistance frequencies and antimicrobial use were tabulated. Logistic regression models of resistance to each antimicrobial were constructed with stage of production, duration of antimicrobial use and the use of 5 antimicrobial classes included as explanatory variables in each model. The greatest frequencies of resistance were observed to tetracycline, trimethoprim/sulphamethoxazole and streptomycin with the highest levels of resistance observed in isolates from first-stage weaned pigs. Differences in the types of antimicrobial drugs used were noted between long-term and short-term use farms. Categorization of farms as long- or short-term use was sufficient to predict the likely occurrence of resistance to 3 antimicrobial classes and could provide an aid in the control of resistance in the food chain. Stage of production was a significant predictor variable in all models of resistance constructed and did not solely reflect antimicrobial use at each stage. Cross-selection and co-selection for resistance was evident in the models constructed, and the use of trimethoprim/sulphonamide drugs in particular was associated with the occurrence of resistance to other antimicrobials.

Antidepressant prescribing in Irish children: secular trends and international comparison in the context of a safety warning.

BACKGROUND: In 2003, the Irish Medicines Board (IMB) warned against the treatment of childhood depression with selective serotonin reuptake inhibitors (SSRIs) due to increased risk of suicide. This study examined the effect of this warning on the prevalence of anti-depressants in Irish children and compared age and gender trends and international comparisons of prescription rates. METHODS: A retrospective cohort study of the Irish Health Service Executive (HSE) pharmacy claims database for the General Medical Services (GMS) scheme for dispensed medication. Data were obtained for 2002-2011 for those aged ≤ 15 years. Prevalence of anti-depressants per 1000 eligible population, along with 95% confidence intervals, were calculated. A negative binomial regression analysis was used to investigate trends and compare rates across years, sex and age groups (0-4, 5-11, 12-15 years). International prescribing data were retrieved from the literature. RESULTS: The prevalence of anti-depressants decreased from 4.74/1000 population (95% CI: 4.47-5.01) in 2002 to 2.61/1000 population (95% CI: 2.43-2.80) in 2008. SSRI rates decreased from 2002 to 2008. Prescription rates for contra-indicated SSRIs paroxetine, sertraline and citralopram decreased significantly from 2002 to 2005, and, apart from paroxetine, only small fluctuations were seen from 2005 onwards. Fluoxetine was the most frequently prescribed anti-depressant and rates increased between 2002 and 2011. Anti-depressant rates were higher for younger boys and older girls. The Irish prevalence was lower than the US, similar to the U.K. and higher than Germany and Denmark. CONCLUSIONS: The direction and timing of these trends suggest that medical practitioners followed the IMB advice.

Benzodiazepine prescribing in children under 15 years of age receiving free medical care on the General Medical Services scheme in Ireland.

OBJECTIVE: To examine the prevalence and secular trends in benzodiazepine (BZD) prescribing in the Irish paediatric population. In addition, we examine coprescribing of antiepileptic, antipsychotic, antidepressant and psychostimulants in children receiving BZD drugs and compare BZD prescribing in Ireland to that in other European countries. SETTING: Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE)--Primary Care Reimbursement Services (PCRS). PARTICIPANTS: Children aged 0-15 years, on the HSE-PCRS database between January 2002 and December 2011, were included. PRIMARY AND SECONDARY OUTCOME MEASURES: Prescribing rates were reported over time (2002-2011) and duration (≤ or >90 days). Age (0-4, 5-11, 12-15) and gender trends were established. Rates of concomitant prescriptions for antiepileptic, antipsychotics, antidepressants and psychostimulants were reported. European prescribing data were retrieved from the literature. RESULTS: Rates decreased from 2002 (8.56/1000 GMS population: 95% CI 8.20 to 8.92) to 2011 (5.33/1000 GMS population: 95% CI 5.10 to 5.55). Of those children currently receiving a BZD prescription, 6% were prescribed BZD for >90 days. Rates were higher for boys in the 0-4 and 5-11 age ranges, whereas for girls they were higher in the 12-15 age groups. A substantial proportion of children receiving BZD drugs are also prescribed antiepileptic (27%), antidepressant (11%), antipsychotic (5%) and psychostimulant (2%) medicines. Prescribing rates follow a similar pattern to that in other European countries. CONCLUSIONS: While BZD prescribing trends have decreased in recent years, this study shows that a significant proportion of the GMS children population are being prescribed BZD in the long term. This study highlights the need for guidelines for BZD prescribing in children in terms of clinical indication and responsibility, coprescribing, dosage and duration of treatment.

Investigating a dilution effect between somatic cell count and milk yield and estimating milk production losses in Irish dairy cattle.

Increased somatic cell counts (SCC) are associated with reduced milk yield. Additionally, it has been hypothesized that as milk yield increases, SCC is diluted in cattle without an intramammary infection (IMI). If the hypothesis is correct, estimates of SCC from high-yielding cattle without an IMI are likely to be lower than those from low-yielding cattle without an IMI. The objectives of this paper were to investigate the presence of a potential dilution effect between SCC and milk yield, overall and by parity, and to estimate lactation milk production losses with increasing SCC in Irish dairy cattle. The data consisted of 100 randomly selected herds from all milk recording herds between 2008 and 2010. The data set comprised 8,229 cows, of which approximately 90% were Holstein or Holstein crossbred animals. Various adjustments were used to investigate the presence of a potential dilution effect between SCC and milk yield; additionally, lactation milk production losses with increasing SCC and parity were estimated. The data had an inherent hierarchical structure, with lactations nested within cows and cows within herds; thus, a linear mixed model with 2 random effects was used. We found no evidence of a dilution effect of SCC with increasing milk yield in Irish dairy cattle. Average milk production losses were estimated, and they increased with increasing SCC compared with the referent of ≤ 50,000 cells/mL. Additionally, for all SCC values for parities 1 to 3, this production loss increased significantly with increasing parity. Estimated milk losses for parities 4 and 5 did not differ, and differences between parities 3 and 4 were significant only for SCC values <300,000 cells/mL. The estimated milk loss with increasing SCC varies greatly across studies, with the results from the current study exceeding most previously published results (except for results from the UK). Several factors could explain these differences, including geographic factors such as milk yield and predominant mastitis pathogens. The dilution effect warrants further work, as does the effect of prior duration of increased SCC on milk yield and the potential for compensation of milk yield losses over a lactation.

Influences on antimicrobial prescribing behaviour of veterinary practitioners in cattle practice in Ireland.

Guidelines on prudent antimicrobial use in veterinary medicine have been developed to reduce inappropriate prescribing of antimicrobials. Such guidelines focus mainly on the clinical and pharmacological indications for prescribing. A questionnaire study of veterinary surgeons engaged in cattle practice was completed to determine if non-clinical issues influence the decision to prescribe antimicrobials, and to assess if pharmacological and non-pharmacological issues influence the choice of antimicrobial prescribed. Non-clinical issues, including issues related to professional stress, influenced the prescribing decision of the majority of respondents. However, the nature of the veterinarian-client relationship did not influence the prescribing behaviour of the majority of respondents. Pharmacological and non-pharmacological issues influenced the choice of antimicrobial prescribed. The veterinary surgeon's prior experience of a drug was considered 'often' or 'always' by 95.7 per cent of respondents when making this decision. The findings of this study have implications for the recognition and management of stress within the profession, and for the development of intervention strategies to reduce inappropriate antimicrobial prescribing.

Investigation of the persistence and transmission of MRSA CC 5 in pigs following intra-nasal inoculation.

MRSA CC5 spa type t002 appears to have a broad host range, has been isolated from animals and in-contact humans in Ireland and could potentially become established in pigs in Ireland. The aims of this study were to determine if MRSA CC5 spa type t002 could persist in the tissues of the porcine upper respiratory tract following intra-nasal inoculation; to determine the relative importance of environmental and animal sources of the bacterium in the transmission cycle and to determine the importance of the pharynx as a carriage site of Staphylococcus aureus and MRSA. Twelve pigs were inoculated intra-nasally with MRSA CC5 t002. After 1 or 6 days, the inoculated pigs were removed from the contaminated environment, were washed in an antiseptic solution and placed in a clean house with a group of naive pigs (in-contact group). Another group of naive pigs was placed in the contaminated environment to assess transmission from the environment (environmental group). Nasal swabs, environmental swabs and tissue samples from the upper respiratory tract were taken for MRSA culture. Infection rates were calculated for each group of exposed pigs. MRSA persisted in the pharyngeal tissues of 6 inoculated pigs for at least 30 days and higher counts of S. aureus were found in pharyngeal tissues than in other sites. In this study we were able to demonstrate the establishment of colonisation by MRSA CC5 spa type t002 in commercially sourced pigs already colonised by S. aureus; however, colonisation was sporadic despite the inoculation of large doses. Onward transmission via pig-to-pig contact or environmental contamination was possible and a significant difference was found between the proportion of pigs infected in the environmental group and the proportion infected in the in-contact group during the first 5 days. However, no significant difference was detected in overall infection rates between the 2 groups. The tissues of the pharynx were found to carry greater numbers of S. aureus than other tissues of the upper respiratory tract; therefore, pharyngeal carriage of MRSA and S. aureus in pigs may be more significant than previously thought.

Bovine tuberculosis and udder health in Irish dairy herds.

The association between bovine tuberculosis (TB) infection status based on results from the single intradermal comparative tuberculin test (SICTT) and milk production has been described in dairy cows in TB-infected herds in Ireland. The biological basis was uncertain, but could be related to increased TB susceptibility among lower producing dairy cows. In this study, the relationship between somatic cell count (as an objective measure of udder health) and SICTT reactivity (as a proxy for TB infection status) was investigated. Somatic cell counts of TB infected cows, both during and prior to the lactation of diagnosis of TB infection, were examined and compared to non-infected cows. All Irish dairy herds restricted from trading between June 2004 and May 2005 as a result of two or more TB reactors (test positive) to the SICTT were considered for study. Data were collected on 4340 cows from 419 herds. Previous lactation data for the cows were taken into consideration and all lactations on a cow were analysed together with the years of lactations. There was an inherent hierarchical structure in the data, with lactations nested within cows and cows within herds and so a linear mixed model with two random effects was used to describe the data. Milk production (305-day milk yield) was also included in the model as a fixed effect. The results of the study showed that for all lactations and years under investigation, somatic cell counts for SICTT reactor cows when compared to the non-reactor cows were not significantly different. In this study population, TB infection status was not associated with udder health.

[Polymorphous low-grade adenocarcinoma of the maxilla simulating an odontogenic cyst]. / Adénocarcinome polymorphe de bas grade du maxillaire simulant un kyste odontogénique.

INTRODUCTION: In 1990, the WHO classified Polymorphous Low Grade Adenocarcinoma as a low-grade malignant tumor of the minor salivary glands. This tumor often originates from the hard or soft palate minor salivary glands. We report the first case revealed as an infected maxillary odontogenic cyst around an impacted tooth. CASE REPORT: A 50-year-old female presented 20 months ago with a bulging, painful oral mass in the right superior vestibule. The diagnosis was infected odontogenic cyst associated with an impacted canine tooth. A course of oral antibiotics was given and cyst enucleation and tooth extraction were performed 6 days later. Ameloblastoma was suggested on macroscopic findings; nevertheless, the pathologic end diagnosis was Polymorphic Low-Grade Adenocarcinoma of minor salivary gland origin. After negative carcinological screening, wide surgical resection was performed. Postoperative external radiotherapy was applied to the operated area as well as to cervical lymph node areas. DISCUSSION: Most of the 565 published cases concern a palatine location. Even though wide surgical resection is sufficient, external radiotherapy may be used on a case-by-case basis.

Bovine tuberculosis and milk production in infected dairy herds in Ireland.

This study describes the relationship between bovine tuberculosis (TB) and milk yield in TB-infected dairy herds in Ireland. The study had two objectives: to determine whether cows detected as TB reactors (and thus subject to immediate slaughter) were likely to be the higher milk-producing cows, and to determine whether subclinical TB infection was associated with reduced milk production at or around the time of disclosure (detection). All Irish dairy herds restricted from trading between the 1(st) June 2004 and the 31(st) May 2005 as a result of two or more TB reactors by the Single Intradermal Comparative Tuberculin Test (SICTT) were considered for study. The data consisted of 419 herds. Data were collected on all TB reactors and a random sample of 5 non-reactor cows in these herds: a data set of 4340 cows (2342 TB reactors and 1998 non-reactors). Previous milk data for the cows were taken into consideration and thus all lactations on a cow were analysed together with the years of lactations. There was an inherent hierarchical structure in the data, with lactations nested within cows and cows within herds and thus a linear mixed model with two random effects was used to describe the data. The results of this study showed that for all lactations and years under investigation, milk yield was significantly lower for TB reactor cows, with differences ranging from 120kg (2003, lactation 3) to 573kg (2001, lactation 1), when compared to the non-reactor cows.

[Gingivoperiosteoplasty associated to bone graft: radiological evaluation]. / Gingivopériostoplasties associées à une greffe osseuse : évaluation radiologique.

INTRODUCTION: Gingivoperiosteoplasty associated to bone graft is part of a therapeutic strategy applied to the first 20 years of a patient's life. Management is pluridisciplinary. Most authors recommend a bone graft in mixed dentition at the end of premaxillary growth. Retroalveolar and panoramic radiography are the most often used to assess the bone height of the grafted site. We retrospectively studied the radiographies of 57 alveolar grafts in 44 patients. MATERIAL AND METHODS: Between 1999 and 2005, 44 patients underwent gingivoperiosteoplasty associated to bone graft. Thirteen underwent bilateral reconstruction. The surgical interventions were performed by the same surgeon. One year after surgery, the panoramic radiographies were analyzed by a single expert. The bone height compared to roots of adjacent teeth was classified in four grades. Grades 1 and 2 were considered as satisfactory or good and grades 3 and 4 not satisfactory and an indication for a new bone graft. In case of bilateral cleft, each side was analyzed independently. RESULTS: Grades 1 and 2 accounted for 84.2% of grafts. There was no statistical difference in alveolar bone height between patients presenting with agenesis of the lateral incisive. Eighty-one percent of patients grafted with mixed dentition (66% of the cases) had satisfactory results (35% of grade 1 and 46% of grade 2). Patients operated on after 15 years (n=15) had good results in 75% of the cases, 33% were bilateral cleft patients. There was no statistical difference between patients operated on early and those with delayed surgery. DISCUSSION: Radiological results for gingivoperiosteoplasty associated to bone graft are satisfactory. The procedure is easy, cheap, and reproducible. Evaluation with panoramic radiography is not as accurate as with the Denta Scan. CT scan is not used systematically to follow up alveolar cleft palate in children so as to limit irradiation. Volumetric tomography (cone beam) may be the best assessment.

[Tooth extraction and anticoagulants]. / Avulsions dentaires et anticoagulants.

INTRODUCTION: The purpose of this study was to show the possibility of extracting teeth without modifying the anticoagulant treatment (anti-platelet and anti-vitamin K agents). MATERIAL AND METHOD: Two hundred patients underwent dental extraction from May 2003 to July 2006 without modifying their anticoagulant treatment; only 137 of them were hospitalized. Most of the teeth were extracted under local anesthesia, and hemostatic pad were inserted in the sockets without suture. RESULTS: One thousand (and) sixteen extractions were performed with bleeding disorders in 4%, successfully resolved by using local hemostatics. DISCUSSION: Modifying an anticoagulant treatment is a thrombo-embolic complication risk factor. Performing tooth extraction according to our protocol decreases this risk and bleeding complications, thus proving the validity of our technique.

Listeria monocytogenes meningitis in an immunocompetent adult patient.

OBJECTIVE: To report an interesting case of meningitis caused by Listeria monocytogenes in an immunocompetent adult. PATIENT AND METHODS: A previously healthy 25-year-old man presented with typical clinical features of meningitis. Cerebrospinal fluid (CSF) was obtained on the day of admission for biochemical and microbiological investigations. In addition, blood was also taken for culture and hematological studies. Antibiotic susceptibility test was performed using the Etest method. Microscopic examination of the CSF showed pleocytosis, which was predominantly lymphocytic, while the biochemical investigation revealed raised concentrations of protein and lactic acid as well as decreased glucose concentration. A 24-hour culture yielded pure growth of gram-positive bacilli identified by standard methods as L. monocytogenes. It was susceptible to ampicillin and trimethoprim-sulfamethoxazole. The patient was treated with intravenous ampicillin combined with gentamicin and made a complete recovery. CONCLUSION: This presentation describes an unusual case of meningitis caused by L. monocytogenes in a previously healthy young adult with no risk factor. Only a few similar cases have been reported in the literature.

Essential Bacillus subtilis genes.

To estimate the minimal gene set required to sustain bacterial life in nutritious conditions, we carried out a systematic inactivation of Bacillus subtilis genes. Among approximately 4,100 genes of the organism, only 192 were shown to be indispensable by this or previous work. Another 79 genes were predicted to be essential. The vast majority of essential genes were categorized in relatively few domains of cell metabolism, with about half involved in information processing, one-fifth involved in the synthesis of cell envelope and the determination of cell shape and division, and one-tenth related to cell energetics. Only 4% of essential genes encode unknown functions. Most essential genes are present throughout a wide range of Bacteria, and almost 70% can also be found in Archaea and Eucarya. However, essential genes related to cell envelope, shape, division, and respiration tend to be lost from bacteria with small genomes. Unexpectedly, most genes involved in the Embden-Meyerhof-Parnas pathway are essential. Identification of unknown and unexpected essential genes opens research avenues to better understanding of processes that sustain bacterial life.

Relations between dietary restraint and patterns of alcohol use in young adult women.

The present study examined relations between dietary restraint and self-reported patterns of alcohol use, including separate assessment of quantity and frequency of alcohol consumption. One hundred seventy-six female university undergraduates completed the Restraint Scale (RS) and measures of their usual quantity and frequency of alcohol consumption over the past year. Quantity and frequency self-reports were scored separately and were also used to calculate 3 additional drinking variables: a composite weekly alcohol consumption score (drinks per week), a binge drinking categorical variable (where participants were classified as either binge drinkers or non-binge drinkers), and a yearly excessive drinking score (number of times in the past year that each participant consumed at least 4 alcoholic beverages per drinking occasion). RS scores were significantly positively correlated with scores on 4 of the 5 drinking behavior measures (i.e., quantity, drinks per week, binge drinking, and yearly excessive drinking, but not frequency). Thus, chronic dieting appears to be related to a relatively heavy drinking pattern that can be characterized as potentially risky, due to its established associations with adverse health and social consequences.

Family climates: family factors specific to disturbed eating and bulimia nervosa.

More than a decade of research has characterized the families of individuals with bulimia and bulimia anorexia (Anorexia Nervosa, Binge/Purging Type) as less expressive, less cohesive, and experiencing more conflicts than normal control families. This two-part study investigated variables believed more directly related to disturbed eating and bulimia as contributing to a "family climate for eating disorders." In Study 1. a nonclinical sample of 324 women who had just left home for college and a sample of 121 mothers evaluated their families. Principal-components analyses revealed the same factor structure for both students and mothers, with Family Body Satisfaction, Family Social Appearance Orientation, and Family Achievement Emphasis loading together, representing the hypothesized family climate for eating disorders: the remaining variables loaded with the more traditional family process variables (conflict, cohesion, expressiveness), representing a more general family dysfunction. As predicted, the family climate for eating disorders factor score was a more powerful predictor of disturbed eating. Study 2 extended these findings into a clin ical population, examining whether the family climate for eating disorders variables would distinguish individuals with bulimia from both depressed and healthy controls. Groups of eating-disordered patients (n = 40) and depressed (n = 17) and healthy (n = 27) controls completed family measures. The eating-disordered group scored significantly higher on family climate variables than control groups. Family process variables distinguished clinical groups (depressed and eating disordered) from healthy controls, but not from one another. Controlling for depression removed group differences on family process variables, but family climate variables continued to distinguish the eating-disordered group from both control groups. Indications for further research are discussed.