Detection of rotavirus in paediatric oncology patients with diarrhoea: the impact of rotavirus vaccine.

Seven years' data were reviewed to examine stool-testing for rotavirus in patents treated in a regional paediatric oncology unit before and after the introduction of UK-wide rotavirus immunization in July 2013. The prevalence of rotavirus positivity has diminished since the introduction of rotavirus immunization, with 21 of 416 positive samples between 2010 and 2012, but only one positive test out of 122 samples in 2015 and 2016. Based on these results, there seems to be little use for routine rotavirus-testing in children and young people with cancer presenting with diarrhoea.

MRSA surveillance in a UK district hospital: measuring clinical isolates with MRSA is more useful than measuring MRSA bacteraemias.

The introduction of mandatory surveillance of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias and targets in England has led to reductions in most hospitals. However, reductions were difficult to demonstrate at Peterborough & Stamford Hospitals NHS Foundation Trust as MRSA bacteraemia was already an uncommon event. The authors questioned the efficacy of monitoring bacteraemias in a low-prevalence hospital, and this study sought to determine the accuracy of measuring bacteraemias compared with all clinical isolates (excluding bacteraemias; e.g. wound, sputa, urine) to assess the effectiveness of interventions. Over the six-year study period, a significant reduction was seen in MRSA in clinical specimens and new MRSA carriers identified by screening, whereas the MRSA bacteraemia rate remained at low levels. The measurement of clinical isolates may be more useful for assessment of the effectiveness of interventions now that MRSA bacteraemia rates have fallen to low levels almost universally across the UK.

Low concentrations of vancomycin stimulate biofilm formation in some clinical isolates of Staphylococcus epidermidis.

AIMS: To examine the response of Staphylococcus epidermidis isolates from prosthetic orthopaedic infections to vancomycin concentrations below the minimum inhibitory concentration. METHODS: Staphylococcal biofilms were grown in 96-well flat-bottomed cell culture plates under a variety of culture conditions and stained using an ammonium crystal violet solution. Optical density (450 nm wavelength) was recorded to estimate the biofilm density for each strain. Population analysis and time-kill studies were also performed on selected isolates. RESULTS: A range of responses were observed, including increased biofilm density at drug concentrations approaching the minimum inhibitory concentration. This increased density was associated with the presence of a more resistant population identified on population analysis but without an apparent effect on the time-kill curves. CONCLUSIONS: The ability of some strains to show increased biofilm density could be a factor in the failure of vancomycin therapy reported in some cases. The demonstration that low concentrations of vancomycin may increase the density of newly forming S epidermidis biofilms may indicate an area of potential concern in the use of vancomycin in orthopaedic implants and intravascular catheter locks, and may partially account for some cases of treatment failure.

Value of CT-guided biopsy in the diagnosis of septic discitis.

AIM: To determine the role of CT-guided biopsy in the management of cases of infective discitis. METHODS: Data were examined from a retrospective case series of CT-guided biopsies for the 5-year period ending June 2006. RESULTS: 98 CT-guided biopsies were performed in the study period on 103 patients. Malignancy was diagnosed in 49 episodes. Discitis and paravertebral abscess accounted for 27 cases. Culture was positive in nine of 25 (36%) samples received by the microbiology laboratory. Staphylococcus aureus (four cases) and Mycobacterium tuberculosis (three cases) were the most frequent organisms isolated, followed by group G streptococci and coagulase-negative staphylococci (one case each). Blood cultures were diagnostic in a further nine patients. The main reason for a negative culture was prior antimicrobial therapy. The biopsy changed management in 9/25 (36%) of cases. There were no reported adverse events. CONCLUSION: Septic discitis is a serious condition with a wide variety of infective causes. CT-guided biopsy is a useful tool when the diagnosis of infectious spinal infection is considered in terms of commencing and targeting therapy, and it is a safe and well-tolerated procedure.

New methods in combinatorial chemistry-robotics and parallel synthesis.

Technological advances in the automation of parallel synthesis are following the model set by the semiconductor industry: miniaturization, increasing speed, lower costs. Recent work includes preparation of high-density reaction blocks, development of ink-jet dispensing to polypropylene sheets and synthesis inside customized microchips.

Medication compliance in elderly people: influencing variables and interventions.

This paper describes a study in which 70 elderly patients were assessed for risk factors in their medication regimen. They were separated into three study groups, including two levels of teaching intervention focused on the home medication administration system, and a control group. The intervention utilizing a follow-up telephone call demonstrated a significant change in risk-related behaviours such as verbalization of the regimen, congruence between instructions and usage of medications, and taking of medicines not currently prescribed or over-the-counter.

[Bronchiolitis obliterans with cryptogenetic-like organizing pneumonia. Demonstration of gastro-esophageal reflux in 5 cases]. / Bronchiolite oblitérante avec pneumonie en voie d'organisation en apparence cryptogénétique. Mise en évidence d'un reflux gastro-oesophagien dans 5 cas.

Gastro-oesophageal reflux was demonstrated in 5 cases of bronchiolitis obliterans with apparently cryptogenetic organizing pneumonia. In addition, one patient had hiatus hernia and another, oesophageal diverticulum. In 4 patients, after failure of prolonged antibiotic therapy, medical or surgical treatment of the gastro-oesophageal reflux resulted in regression of the clinical and radiological signs of pulmonary lesions. The cure thus obtained persisted throughout a follow-up period of 2 months to 8 years. Gastro-oesophageal reflux therefore could be one of the causes of apparently cryptogenetic bronchiolitis obliterans with organizing pneumonia, and all patients with this respiratory disease should be investigated for gastro-oesophageal reflux.

Kinetics of dissolution of calcium oxalate calculi with calcium-chelating irrigating solutions.

Dissolution of calcium oxalate urinary calculi was studied in vitro. Rate constants were calculated by measuring the concentration of calcium in solution during dissolution. Various irrigating agents, including ethylenediaminetetraacetic acid (EDTA) and other calcium-chelating substances, were tested at different concentrations and pH values. EDTA was the most effective agent in dissolving calcium oxalate calculi. When EDTA was used, the rate of dissolution depended on both concentration and pH. At a pH of 7.5 or 10.0, the rate of dissolution increased progressively with the EDTA concentration. At each concentration tested, dissolution was faster at a pH of 10.0 than at a pH of 7.5. Calculated rate constants were extrapolated to determine whether in vivo irrigation with EDTA solutions is clinically practical. Even at an EDTA concentration of 0.03 M at a pH of 7.5, a two mm. calculus could be dissolved within 48 hr. Although dissolution of calcium oxalate calculi is not a practical first-line treatment, it might be a useful adjunct to percutaneous stone removal or extracorporeal shock wave lithotripsy.

Predisposing factors and prevention of renal calculi.

Over the last few years there have been marked advances in both the surgical and medical treatment of urinary stone disease. At present, we have expectations of decreasing the incidence of stone recurrence in a vast majority of patients with medical therapy alone. While there are still many patients who will continue to develop new stones, decreasing their rate of new stone formation will lessen the need for surgical intervention.

Effect of gastric distension on human pancreatic secretion.

The effect of gastric distension on pancreatic secretion of bicarbonate and trypsin was studied in 10 individuals in the basal state or during stimulation with low and high doses of secretin or secretin plus cholecystokinin (CCK). Gastric distension augmented the pancreatic response to secretin but had no consistent effect on the pancreatic response to combination of secretin and CCK. We conclude that gastropancratic reflexes do not have much functional significance in man.

Very long-term treatment of peptic ulcer with cimetidine.

In an open trial, 96 patients with endoscopically proven peptic ulcers were randomly allocated to treatment with cimetidine (1 g/day) for periods of 3, 6, 9, or 12 months. After their courses of treatment, the patients were followed up for at least 6 months. In 92% the ulcers had healed after treatment for 1 month, and in a further 5% the ulcers healed during the next 2 months. Ulcers recurred during treatment in 24% of patients and within 6 months of withdrawal of treatment in a further 43%. In nearly a third of patients the recurrences were asymptomatic and were discovered only through routine endoscopic studies. Continuous treatment with full doses of cimetidine for a year seems to prevent relapse of the majority of ulcers which have healed during treatment; but it does not cure the ulcer disease, since relapse generally occurs quite rapidly when treatment is discontinued.

Gastric secretion of acid in patients with pancreatic disease.

In view of the destruction of pancreatic extract, used in the treatment of pancreatic insufficiency, by gastric juice, we measured the gastric secretory response to pentagastrin in patients with pancreatic disease. The patients with chronic pancreatitis and steatorrhoea secreted as much acid as patients with duodenal ulcer, emphasising the need for therapeutic gastric secretory inhibition to supplement treatment of pancreatic insufficiency with pancreatic extract.

Effects of cimetidine and poldine on nocturnal gastric secretion in duodenal ulcer.

Cimetidine inhibited nocturnal secretion of acid but only slightly inhibited the nocturnal secretion of pepsin in patients with duodenal ulcer. Administration of cimetidine (200 or 400 mg), together with an anticholinergic drug (poldine), augmented the inhibition of the nocturnal secretion of acid and of pepsin. The combination of an H2-receptor-blocking drug with an anticholinergic drug will have therapeutic application in the management of duodenal ulceration.