Characterization of macrolide efflux pump mef subclasses detected in clinical isolates of Streptococcus pyogenes isolated between 1999 and 2005.

The macrolide efflux mechanism of resistance, mef, was characterized in community-acquired respiratory tract infections with Streptococcus pyogenes. Fifty-four (4.6%) M phenotype isolates were screen tested as negative for mef(A). Of these 54 isolates, 5 (0.4%), 27 (2.3%), and 1 (0.1%) were considered to be mef(I) positive, a novel mosaic variant of mef, or a novel subclass of mef, respectively. This study shows (i) the definitive presence of mef(E) in S. pyogenes and its global distribution, (ii) the presence of a mosaic variant of mef composed of mef(A) and mef(E), (iii) the previously undescribed presence of mef(I) in S. pyogenes, and (iv) the presence of a novel subclass of mef in S. pyogenes.

The cost of treatment for post-herpetic neuralgia in the UK.

Post-herpetic neuralgia (PHN) following acute shingles caused by the herpes simplex virus is a painful and often disabling condition. Treatment of the condition can involve a range of drug therapies. In addition, patients with continuing pain may make several visits to general practitioners and hospital outpatient departments. The costs of treatment for these patients may be substantial. The main objective of this study was to estimate the costs and consequences to the UK National Health Service (NHS) of the treatment of PHN following shingles, and the effect of the condition on patients' lives in terms of pain and time off usual activities such as work. The lifetime direct treatment costs of a cohort of people from onset of PHN to resolution of the disease or death were calculated. These costs were estimated from data on the type and quantity of health resources used, and the unit costs or prices of those resources. This study has shown that PHN can be a costly consequence of acute shingles. For patients attending a tertiary referral centre the lifetime cost was 770 British pounds sterling. For a 1-year incidence cohort of people with shingles in the UK, the lifetime costs of treating PHN are between 4.8 million British pounds sterling (incidence of 21 000 people) and 17.9 million British pounds sterling (incidence of 78 200 people). Efforts are needed to reduce the incidence or severity of PHN.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of complex regional pain syndrome in adults: a systematic review of randomized controlled trials published from June 2000 to February 2012.

Complex regional pain syndrome (CRPS) is a disabling pain condition with sensory, motor and autonomic manifestations. Uncertainty remains about how CRPS can be effectively managed. We conducted a systematic review of randomized controlled trials (RCTs) for treatment and prophylactic interventions for CRPS published during the period 2000-2012, building on previous work by another group reviewing the period 1966-2000. Bibliographic database searches identified 173 papers which were filtered by three reviewers. This process generated 29 trials suitable for further analysis, each of which was reviewed and scored by two independent reviewers for methodological quality using a 15-item checklist. A number of novel and potentially effective treatments were investigated. Analysing the results from both review periods in combination, there was a steep rise in the number of published RCTs per review decade. There is evidence for the efficacy of 10 treatments (3× strong--bisphosphonates, repetitive transcranial magnetic stimulation and graded motor imagery, 1× moderate and 6× limited evidence), and against the efficacy of 15 treatments (1× strong, 1× moderate and ×13 limited). The heterogeneity of trialled interventions and the pilot nature of many trials militate against drawing clear conclusions about the clinical usefulness of most interventions. This and the observed phenomenon of excellent responses in CRPS subgroups would support the case for a network- and multi-centre approach in the conduct of future clinical trials. Most published trials in CRPS are small with a short follow-up period, although several novel interventions investigated from 2000 to 2012 appear promising.

Painful diabetic neuropathy.

Chronic painful diabetic neuropathy causes symptoms that can last for many years and severely impair the quality of life of affected patients. This review describes the epidemiology, pathophysiology and treatment of chronic neuropathic pain. Particular emphasis is placed on a comprehensive review of the management of painful symptoms through a detailed review of the published literature using a variety of databases particularly Medline and EMBASE.