PspK of Streptococcus pneumoniae increases adherence to epithelial cells and enhances nasopharyngeal colonization.

Streptococcus pneumoniae (the pneumococcus) colonizes the human nasopharynx and can cause invasive disease aided by the pneumococcal capsule. Group II nontypeable S. pneumoniae (NTSp) lacks a polysaccharide capsule, and a subgroup of NTSp carriage isolates has been found to have a novel gene, pneumococcal surface protein K (pspK), which replaces the capsule locus. A recent rise in the number of NTSp isolates colonizing the human nasopharynx has been observed, but the colonization factors of NTSp have not been well studied. PspK has been shown to play a role in mouse colonization. We therefore examined PspK-mediated immune evasion along with adherence to host cells and colonization. PspK bound human secretory immunoglobulin A (sIgA) but not the complement regulator factor H and did not decrease C3b deposition on the pneumococcal surface. PspK increased binding of pneumococci to epithelial cells and enhanced pneumococcal colonization independently of the genetic background. Understanding how NTSp colonizes and survives within the nasopharynx is important due to the increase in NTSp carriage. Our data suggest that PspK may aid in the persistence of NTSp within the nasopharynx but is not involved in invasion.

Transdiaphragmatic intercostal hernia.

A 72-year-old man was seen with cough-induced rib fractures, a diaphragmatic tear, and an intercostal hernia containing abdominal contents. A review of the literature of this rare problem is presented, and techniques of repair are discussed.

Properties of the Beck Depression Inventory as a screening instrument for adolescent depression.

The utility of the Beck Depression Inventory (BDI) for identifying Major Depressive Episode was assessed with two samples of adolescents, 65 psychiatric hospital inpatients and 49 secondary school students. Diagnoses based on the Child Assessment Schedule served as criteria. With the school sample, a BDI screening score of 16 resulted in 100% sensitivity and 93.2% specificity. For the inpatient sample, a cutoff of 11 yielded a sensitivity of 81.5% and specificity of 52.6%. There was evidence of the BDI's convergent and discriminant validity for both samples. The results were consistent with the assertion that Major Depressive Episode is a sufficiently distinct diagnostic category in adolescence to be detected by a screening measure such as the BDI.

The importance of oral hygiene in nutritional support.

Disorders of the mouth can significantly impair the quality of life of the ill patient. For patients requiring nutritional support, especially those who are unable to take food via the oral route, good oral hygiene is of prime importance. This article, the third in a series on nutrition, suggests aims and objectives for mouthcare plus an assessment tool for recording the oral state of patients on admission. The role of saliva in oral health is explored along with the problems and alleviation of a dry mouth. The current range of oral hygiene products and their use are discussed. A sound scientific knowledge of the oral environment in nurse education is advocated; it is suggested that the dental team could help to provide this.