The frequency of change in five-point scale score with a Bayesian penalised likelihood PET reconstruction algorithm on interim FDG PET-CT and its potential implications for therapy decisions in Hodgkin's lymphoma.

AIM: To assess the effect of a Bayesian penalised likelihood (BPL) reconstruction algorithm on the five-point scale (5-PS) score, response categorisation, and potential implications for therapy decisions after interim 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)-computed tomography (CT) (iPET-CT) to guide treatment in classical Hodgkin's lymphoma (HL). MATERIALS AND METHODS: The present study included new patients with HL undergoing iPET-CT from 2014-2019 after two cycles of doxorubicin (Adriamycin), bleomycin, vincristine, and dacarbazine (ABVD). Two reporters categorised response using the 5-PS and measured maximum standardised uptake values (SUVmax) of the most avid tumour residuum, mediastinal blood pool, and normal liver with ordered subset expected maximisation (OSEM) and BPL reconstructions. RESULTS: Eighty-one iPET-CT examinations were reviewed. Compared with OSEM, BPL increased the 5-PS score by a single score in 18/81 (22.2%) patients. The frequency of potential treatment intensification by changing a score of 3-4 was 13.6% (11/81) and represented 25% (11/44) of patients with a score of 3 on OSEM. All 11 patients remained in remission without a change in therapy (mean 63 months) except one who required second-line treatment for refractory disease. Median SUVmax of tumour residuum was significantly higher with BPL compared with OSEM (2.7 versus 2.4, p<<0.0001), whilst liver SUVmax was significantly lower for both reporters (up to 6.6%, p<0.0001). CONCLUSION: BPL PET reconstruction increased the 5-PS score on iPET-CT in 22% of HL patients and can potentially result in unnecessary treatment escalation in over half of these patients.

Dynamics of antibiotic resistance with special reference to Shiga toxin-producing Escherichia coli infections.

The discovery of antibiotics was paralleled by the evolution of antibiotic resistance which is probably the best example of contemporary evolution in action. The selection pressure, imposed by indiscriminate use of antibiotics, has changed the scale, mode and tempo of antibiotic resistance evolution. The presence of multidrug resistance, wide range of adaptability features and the infectivity make antibiotic resistance of Shiga toxin-producing Escherichia coli (STEC) more dangerous. The characterization, prevalence and the virulence factors of STEC have been profusely reported, whereas, the antibiotic resistance has been largely ignored because the antibiotic use in STEC infections is controversial. Thus, the current review has focussed on the source, evolution, persistence, mechanism, dissemination and control of antibiotic resistance viz-a-viz the STEC infections. The resistance development occurs by the inactivation of antibiotics, regulating the membrane permeability, modification of natural antibiotic targets or the use of efflux pumps against antibiotics. And, the dissemination of resistance genes occurs vertically by DNA replication and horizontally by conjugation, transduction and transformation. The prevention of development and dissemination of antibiotic resistance needs international public health bodies to rationalize the antibiotic use, prevent the flux of antibiotics into the environment, develop the rapid diagnostics tests, undertake proper surveillance of antibiotic resistance, promote the research on antibiotic resistance prevention, promote the research and development of novel alternative antibiotics, and encourage the widespread social awareness campaigns against the inappropriate antibiotic usage.

Safety of long-term treatment with Pegvisomant: analysis of Spanish patients included in global ACROSTUDY.

PURPOSE: To evaluate the long-term safety of Pegvisomant (PEG) in the Spanish cohort of ACROSTUDY. METHODS: As of July 2013, 199 Spanish patients were included in ACROSTUDY, a global non interventional safety PEG surveillance study. Patients were observed for safety, biochemical outcome and magnetic resonance imaging evaluations. RESULTS: PEG was administered during an average period of 6.7 ± 2.1 years and a mean daily dose of 15.5 ± 7.5 mg. 48.2% of patients received PEG monotherapy. 90.9% of patients had received other medical treatment before PEG start. 195 adverse events (AEs) were reported in 88 patients (44.2%), and serious AEs were described in 31 patients (15.6%). There were no cases of liver tests >10 ULN, or permanent liver damage. Tumor size changes were locally reported in 61 cases (33.5%), with increases observed in 11 patients (6%). In acromegalic patients with diabetes mellitus a decrease in fasting serum glucose value was reported, reaching statistical significance after 1 and 4 years of treatment (-24.6 and -25.9 mg/dl, p = 0.04). After 60 months, normal or lower limit of normal (LLN) IGF-I levels were found in 67.9% of patients. 85.5% of patients showed an IGF-I normal or

Can Bed-Side Grief Counseling Sessions Enhance Recovery in a Patient With Posttrauma Amputation? A Case Report.

Amputation is the surgical removal of all or part of a body part. It demands an adjustment in almost every sphere of a person's life in addition to physical disability. An amputee faces problems in almost every psychosocial sphere.1, 2 Along with physical pain in the stump, patients may experience phantom sensations.3-5 Patients may also grieve, feel depressed, and anxious3, 6, 4, 7 or have posttraumatic stress disorder symptoms.8, 9 They may be apprehensive about their future plans and inconclusive regarding life challenges. Grief is one of the most common reactions to amputation,10, 1, 7 but often gets neglected in intensive surgical units.1 Many times, grief reactions are not resolved, turning into complicated grief or prolonged grief, leading to conditions like depression, anxiety, or even suicide. This article is about an attempt to help a patient initiate the grieving process for healthy outcomes.

Irreversibility effects in peristaltic transport of hybrid nanomaterial in the presence of heat absorption.

The nano heat transport has gained much significance in recent era. The micro-level devices are enganged succssfully in diverse fields like electronics, biomedical, navel structures, manufacturing, transportation, and automotive industries in order to improve the heat transfer for cooling and heating. Owing to this fact, the current article illustrates the features of irreversibility and thermal jump in peristaltic transport of hybrid nanoliquid. Here, water is used as base liquid while nanoparticles include polystyrene and graphene oxide. The flow is carried out in a non-uniform channel where the walls of channel flexible nature. Additionally, magnetic field impacts on flow and Joule heating analysis are examined. The aspect featuring heat absorption is introduced. Nanoparticle's shapes effect is also incorporated in flow analysis. Under the consideration of small Rynold number and long wavelength, the relevent equations are reduced by implementing non-dimensional variables. Involved pertinent parameters influence the peristaltic flow characteristics are displayed graphically and discussed concisely. The result indicates that temperature curves are dominant for pure water as compared to P/water nanofluid and P-GO/water hybrid nanofluid. Moreover, the convergent channel shows least entropy effects and extreme effects are noted for divergent case whereas uniform channel stays behind the divergent one.

Surgical Management of Freiberg Disease by Dorsal Closing Wedge Osteotomy.

INTRODUCTION: The purpose of the study was to assess the efficacy of the dorsal closing wedge osteotomy for the treatment of Freiburg's infraction. MATERIAL AND METHODS: Twenty patients with Freiburg's infraction were admitted at our hospital over a period of six years. Patients with a normal plantar contour of the metatarsal head were included. All patients underwent a dorsal closing wedge osteotomy of the metatarsal. RESULTS: The mean Leeds Movement Performance Index (LMPI) score was 84 (range 70-86). The mean metatarsal shortening was 2mm. the passive flexion restriction was 16° and extension restriction was 10°. Also, a strong negative correlation was found between Smillie classification and American Orthopaedic Foot and Ankle Score (AOFAS) final score (r's = -0.85, P < .001). CONCLUSION: The dorsal closing wedge osteotomy is an efficient and reproducible method for the management of Freiburg's infraction.

Clinical Presentation, Management and In-Hospital Outcome of Healthcare Personnel With COVID-19 Disease.

Objective Healthcare personnel (HCP) are undoubtedly one of the major frontline fighters in the coronavirus disease 2019 (COVID-19) pandemic. Therefore, it comes as no surprise that many HCP have become infected by COVID-19 globally. The infection of HCP has received great attention in social media and is frequently reported from different parts of the world. However, there are few scientific reports addressing this aspect of the COVID-19 pandemic. The aim of this study was to evaluate the characteristics of clinical presentation, treatment, and outcome of COVID-19 infection among the HCP of our setting. Methods This cross-sectional study was performed in the National Heart Foundation Hospital & Research Institute of Bangladesh from April 29 to July 20, 2020. HCP employed in this hospital who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace were included in this study. The presence of COVID-19 disease was confirmed by real-time reverse transcriptase-polymerase chain reaction on nasopharyngeal samples. A total of 394 HCP were sampled and 139 had a positive corona test. Structured interviews were conducted to document symptoms for all HCP with confirmed COVID-19. Data analysis was performed in July 2020. Results Out of 1,409 HCP, 139 subjects tested positive for COVID-19. Among the HCP, infection rate was 9.86%. The mean age of the study population was 34.08±11.11 years (range: 20-69 yrs), of whom 82 (59%) were female. Most of this cohort were nurses (56 [40.3%]) and physicians (25 [18%]), and the remaining 58 (41.7%) were other staff. The mean duration of onset of symptoms to test was 2.89±2.07 days. The most common symptoms were fever (84.2%), fatigue (56.1%), cough (54%), body ache (39.6%), headache, and anosmia (38.8%). Most subjects had mild disease (125 [93%]), three (2.1%) of the HCP had moderate disease and one (0.7%) had severe disease. Ten of the HCP (7.2%) were asymptomatic. Most of them were treated either by ivermectin plus azithromycin or ivermectin plus doxycycline. Only 20 (14.4%) of the HCP were hospitalized, while others were treated either in home isolation (59.7%) or in institutional isolation (25.9%). Recovery was almost uneventful except one healthcare worker who died. Conclusion Most HCP had mild symptoms and a few of them were asymptomatic also. HCP with mild COVID-19 symptoms may be treated in home or institutional isolation. As they are a vulnerable group for infection, providing adequate protection to HCP is absolutely mandatory to safeguard them from this pandemic.

Inspirational people and care for the deprived: medical missionaries in Kashmir.

Lieutenant Robert Thorpe, a soldier in the British Army in India, visited Kashmir and witnessed the suffering and sorrows of the people there in the nineteenth century; his appeal to British soldiers raised enough funds for the Church Missionary Society to send medical missionaries to the Kashmir Valley. Thus began a process that would see the opening of a 150-bed British Mission Hospital in Srinagar and the start of a new wave of educational and healthcare reforms in the region. As the medical missionary work progressed so did the avenues of research, which led to pioneering work on skin cancer. The missionary doctors and nurses made a significant difference to the lives of the people of Kashmir and their pioneering work continues to live on.

Use of core biopsy in diagnosing cervical lymphadenopathy: a viable alternative to surgical excisional biopsy of lymph nodes?

OBJECTIVES Lymphoma often presents with a neck mass and while fine-needle aspiration cytology may be suggestive, tissue biopsy is required for reliable diagnosis and classification of a lymphoma that is sufficient to deliver the correct treatment for the patient. Traditionally, excisional biopsy of a lymph node has been the standard method of tissue sampling, providing ample tissue for assessment. However, this requires theatre time, and preceding fine-needle aspiration cytology, which may incur a delay. With careful use of tissue, coupled with advances in immunohistochemical and molecular investigative techniques, core biopsy provides a possible alternative to traditional fine-needle aspiration and excisional biopsy. In this study, we aimed to determine the efficacy of diagnosing neck masses. METHOD A retrospective analysis was performed of patients being investigated for a neck mass who were undergoing ultrasound-guided core biopsies of cervical lymph nodes over a 17-month period. The final histology report was scrutinised to assess whether adequate tissue was obtained to allow for full tissue diagnosis. RESULTS Over the 17-month period analysed, 70 patients with cervical lymphadenopathy underwent core biopsy. Of these, 63 (90%) were diagnostic for either lymphoma or other pathology and did not require further tissue sampling. Overall, 19 patients were diagnosed with lymphoma, of which only 1 required further biopsy due to inconclusive initial core biopsy. CONCLUSIONS Current guidelines for investigating lymphomas require that excisional biopsy be performed to obtain ample tissue to allow full nodal architecture assessment and ancillary investigation to reach an accurate histological classification. Within our head and neck multidisciplinary team, however, it is considered that results from core biopsies can be obtained in a more timely fashion and with histological accuracy equal to those of open biopsy. The results obtained demonstrate that core biopsy is an effective tool for investigation. We believe this should be the first-line investigation of choice, as it reduces the need for patients to undergo surgery, is more cost effective and offers a faster diagnosis.

Photosynthetic Nitrite Reduction as Influenced by the Internal Inorganic Carbon Pool in Air-Grown Cells of Synechococcus UTEX 625.

Photosynthetic reduction of NO2- was studied in air-grown cells of a cyanobacterium, Synechococcus UTEX 625. Addition of NO2- resulted in significant amounts of chlorophyll a fluorescence quenching both in the absence and presence of CO2, fixation inhibitors, glycolaldehyde or iodoacetamide. The degree of NO2- quenching was insensitive to the O2 concentration in the medium. Addition of 100 [mu]M inorganic carbon in the presence of glycolaldehyde and O2, leading to formation of the carbon pool within the cells, resulted in pronounced fluorescence quenching. Removal of O2 from the medium restored the fluorescence yield completely, and the subsequent addition of NO2- quenched 36% of the variable fluorescence. From the response to added 3-(3,4-dichlorophenyl)-1,1-dimethylurea, the quenching by NO2- appeared to be photochemical quenching, and nonphotochemical quenching did not seem to be present. The reduction of NO2- observed on its addition to inorganic carbon-depleted cells remained uninfluenced by O2 or glycolaldehyde. The internal inorganic carbon pool in the cells stimulated NO2- reduction, both in the presence and absence of O2, by 4.8-fold. An increase in NO2- reduction by 0.5-fold was also observed in the presence of O2 during simultaneous assimilation of carbon and nitrogen in inorganic carbon-depleted cells. Contrary to this, under anaerobiosis, NO2- reduction was suppressed when carbon and nitrogen assimilation occurred together.

Inorganic Carbon-Stimulated O2 Photoreduction Is Suppressed by NO2- Assimilation in Air-Grown Cells of Synechococcus UTEX 625.

The effect of NO2- assimilation on O2 exchange and CO2 fixation of the cyanobacterium, Synechococcus UTEX 625, was studied mass spectrometrically. Upon addition of 1 mM inorganic carbon to the medium, inorganic carbon pools developed and accelerated O2 photoreduction 5-fold when CO2 fixation was inhibited. During steady-state photosynthesis at saturating light, O2 uptake represented 32% of O2 evolution and balanced that portion of O2 evolution that could not be accounted for by CO2 fixation. Under these conditions, NO2- assimilation reduced O2 uptake by 59% but had no influence on CO2 fixation. NO2- assimilation decreased both CO2 fixation and O2 photoreduction at low light and and increased net O2 evolution at all light intensities. The increase in net O2 evolution observed during simultaneous assimilation of carbon and nitrogen over carbon alone was due to a suppression of O2 photoreduction by NO2- assimilation. When CO2 fixation was precluded, NO2- assimilation inhibited O2 photoreduction and stimulated O2 evolution. When the electron supply was limiting (low light), competition among O2, CO2, and NO2- for electrons could be observed, but when the electron supply was not limiting (saturating light), O2 photoreduction and/or NO2- reduction caused electron transport that was additive to that for maximum CO2 fixation.

Helicobacter pylori infection in a healthy population in Spain.

OBJECTIVE: To determine the seroprevalence of Helicobacter pylori infection in healthy individuals in Spain and its relationship with different epidemiological features. PATIENTS AND METHODS: The study was conducted on a large group of healthy individuals without ulcer disease antecedents or other gastrointestinal disease; moreover, information, was obtained on symptoms attributable to the gastrointestinal tract, smoking, alcohol consumption, non-steroidal anti-inflammatory drug (NSAID) use as well as the presence of peptic ulcer disease antecedents among first-degree relatives. The H. pylori infection status was ascertained by immunoglobulin G (IgG) antibody determination, using a quantitative enzyme-linked immunosorbent assay. RESULTS: Three hundred and eighty-one individuals (138 males and 243 females) were included in the study (mean age: 34.3 +/- 12.9 years; range: 5-77). Two hundred and two individuals (53%) were positive for H. pylori IgG antibodies. A consistent increase in H. pylori infection seroprevalence with increasing age was observed. No association was observed between H. pylori infection and consumption of alcohol, NSAID use or smoking. On the other hand, the presence of digestive symptoms and peptic ulcer disease antecedents among first-degree relatives were associated with a higher prevalence of infection in a given individual (P < 0.05). CONCLUSION: H. pylori infection seroprevalence in healthy individuals in Spain is similar to that in countries with high socio-economic standards and other Western countries. Digestive symptoms and previous antecedents of peptic ulcer disease in first-degree relatives were associated with a higher prevalence of Helicobacter pylori infection.

Usefulness of the combined IgG and IgA antibody determinations for serodiagnosis of Helicobacter pylori infection.

BACKGROUND: Serology is a good alternative, minimally invasive, diagnostic and screening test for Helicobacter pylori infection. Several immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) commercial kits have been evaluated. Information on IgA ELISAs is relatively poor, and on the combined use of IgG and IgA ELISAs very scarce. OBJECTIVE: We intended to evaluate the sensitivity, specificity and predictive values of two quantitative commercial IgG and IgA ELISAs (Helico-G and GAP, respectively) and more particularly the accuracy of their combined use. PATIENTS AND METHODS: Serum samples and gastric biopsy specimen culture findings from 400 patients were evaluated. RESULTS: The sensitivity, specificity, positive and negative predictive values of the IgG ELISA Helico-G test in detecting IgG antibodies to H. pylori were 97.2, 85.4, 98.3 and 77.8%, respectively, when compared with those of the reference method used. The corresponding findings for detection of IgA antibodies with the GAP test were 96.4, 80.5, 97.7 and 71.1%, respectively. When considering a patient infected with H. pylori when both tests were positive, the sensitivity, specificity, positive and negative predictive values were 94.1, 85.3, 98.2 and 62.5%, respectively. On the other hand, when at least one test was positive, the corresponding values were 99, 80, 97 and 94%, respectively. CONCLUSION: The IgG ELISA Helico-G and IgA ELISA GAP, taken separately, are good and reliable tests for the detection of antibodies to H. pylori. Furthermore, the combined use of both serological methods provided more useful information compared with single IgG and IgA determinations.

Semiquantitative culture of subcutaneous segment for conservative diagnosis of intravascular catheter-related infection.

BACKGROUND: Sensitivity and negative predictive values of combined surface cultures (skin and hub) are high in the presumptive diagnosis of catheter-related infection, but specificity and PPVs are poor. The purpose of the study was to evaluate the yield of the semiquantitative culture of the subcutaneous segment in the diagnosis of colonization of the catheter tip without removal of the catheter. METHODS: A prospective study was performed in 124 nontunneled central venous catheters that were removed because of suspected infection or the end of therapy. Catheter colonization was considered if >15 colony-forming units (CFU) in the roll procedure or > 1,000 CFU in the quantitative Cleri procedure were recovered from the tip cultures ("gold standard"). Before removing the catheter, a semiquantitative culture of skin surrounding the point of insertion, a semiquantitative culture of the subcutaneous segment (after removing the catheter only 2 cm), a semiquantitative cultures of the hub, and a pareated quantitative blood culture were performed. Receiver operating characteristic curves were calculated to estimate the cutoff points, and a culture was considered positive when CFUs were > or =15, > or =15, and > or =5 for skin, hub, and subcutaneous segment cultures, respectively. RESULTS: Catheter colonization was detected in 51 catheters. The mean duration of catheterization was 14 +/- 8 days, and the rates of incidence of tip colonization and bacteremia were 2.9 per 100 catheter days and 1.2 per 100 catheter days, respectively. Sensitivity of skin, subcutaneous, and hub cultures analyzed individually were < or =61%; however, specificity and positive predictive values (PPVs) of subcutaneous segment cultures were significantly higher than skin cultures (94% and 88.5% vs 71.6% (p = .001) and 62% (p = .014), respectively). Sensitivity of the combined skin and hub cultures and of the combined subcutaneous segment and hub cultures were similar: 86.2% and 84.3%, respectively; however, specificity and PPVs of this latter combination were significantly higher than former: 82% and 78.1% vs 59.7% (p = .008) and 61.9% (p = .07), respectively. The likelihood ratio of a positive test for the combined subcutaneous segment and hub culture was 4.68, and only 2.13 for the combined skin and hub culture. CONCLUSIONS: These results indicate that the combined subcutaneous segment and hub culture constitutes an easy, effective procedure for the conservative diagnosis of catheter colonization.

Abnormal lipids and the acquired immunodeficiency syndrome: is there a problem and what should we do about it?

Recent research has shown abnormal lipids in acquired immunodeficiency syndrome (AIDS). In human immunodeficiency virus (HIV) infection hypocholesterolaemia, hypertriglyceridaemia and also low high density lipoprotein (HDL)-cholesterol have all been described. In addition, increased dense low density lipoprotein (LDL) particles and also lipoprotein (a) have been observed in some patients. The use of the protease inhibitors has been associated with diabetes mellitus and also features of insulin resistance. This article looks at these lipid abnormalities in detail and discusses possible therapeutic options that may be available, in order to address them.

Effect of superficial scald suppression by diphenylamine application on volatile evolution by stored Cortland apple fruit.

Cortland apple fruit (Malus x domestica Borkh.) stored for 120-140 days in air at 0 degrees C were warmed to 22 degrees C and held for 8 days. A portion of the fruit was dipped in a solution of diphenylamine (DPA) at harvest to prevent scald development. Scald occurred only in those fruit not treated with DPA, and its development was accelerated after transfer to 22 degrees C. Ester production from apple fruit tended to increase from day 0 to day 6 of poststorage holding and declined thereafter in both treatments. However, ester production in scald-developing fruit was reduced by approximately 50%. The reduction in volatile production remained relatively constant during the rapid development of scald symptoms. Furthermore, the reduction in volatile production appeared to be independent of respiration and ethylene production. Production of esters derived from hexanol was most reduced in fruit developing scald, with hexyl 2-methylbutanoate production being reduced approximately 15-fold. Interestingly, the production of methyl butanoate was detected only in scalding fruit. alpha-Farnesene production in fruit developing scald was reduced 43% compared with DPA-treated fruit. In contrast, the primary volatile oxidation product of alpha-farnesene, 6-methyl-5-hepten-2-one (MHO), was present only in fruit developing scald. The data suggest that inhibition of ester production may occur as a result of the physiological changes associated with susceptibility to, rather than expression of, scald symptoms.

Relationship between ethylene response manipulation and volatile production in Jonagold variety apples.

The ripening of Jonagored Jonagold apple fruit (Malus x domestica Borkh.) during development was manipulated with preharvest applications of ReTain or a combination of ReTain plus Ethrel. The fruits, harvested preclimacteric at approximately the same stages of maturity, were stored in refrigerated air (RA) for 45 days or in controlled atmosphere (CA) for 180 days at 0 degrees C. Volatile evolution, ethylene production, and respiration of stored fruit were studied during poststorage holding at 22 degrees C. ReTain reduced volatile production by 19%, but application of Ethrel to ReTain-treated fruit increased production to control levels. The inhibition of volatile production by ReTain appears to be independent of respiration but may be related to the ethylene-producing capacity of the fruit. Although ReTain reduced flavor-related volatile esters, it did not affect levels of the compound responsible for the typical spicy flavor in Jonagored Jonagold fruit, 4-methoxy-2-propenylbenzene. The CA-stored fruit had a much reduced production of volatile compounds compared to RA-stored fruit, with more discernible effects in ReTain-treated fruit. Ethrel application to ReTain-treated fruit improved the volatile production intermediate between the ReTain alone and control in CA-stored fruit. The data collectively suggest that ReTain may have some promise for better scheduling of harvest of apples with no appreciable loss in RA-stored fruit quality. Reduction in production of alpha-farnesene by ReTain may also reduce the potential for scald development in CA-stored fruit.

[Prospective study of Staphylococcus aureus with reduced susceptibility to glycopeptides]. / Estudio prospectivo de Staphylococcus aureus con sensibilidad disminuida a los glucopéptidos.

The emergence of clinical methicillin-resistant Staphylococcus aureus with reduced susceptibility to glycopeptides has recently been documented. Heterogeneous levels of glycopeptides susceptibility have been demonstrated in these isolates. Prospectively, we investigated the presence of S. aureus isolates with reduced susceptibility to vancomycin in our hospital from October 1997 to January 1998. The vancomycin and teicoplanin susceptibility of 248 consecutively methicillin-susceptible and -resistant S. aureus isolates from clinical and surveillance specimens was studied by broth microdilution and agar dilution methods. In addition, 108 CFU/mI of overnight cultures were plated onto BHI-agar plates containing 6 and 10 microg/ml of vancomycin and were incubated for 48 hours at 35 degrees C. Under these conditions selected colonies were subcultured onto vancomycin plates and vancomycin susceptibility (E-test) was determined again. Vancomycin MIC(90) values by the agar dilution technique for methicillin-susceptible and -resistant isolates were 2 and 4 microg/ml, respectively No selected colonies were observed on 10 microg/ml vancomycin plates. In contrast, 12 isolates, including 8 (3.9%) methicillin-susceptible and 4 (9. 1%) methicillin-resistant isolates, showed subpopulations at a frequency rate of 10(-6)-10(-7) on 6 microg/ml vancomycin plates. Nevertheless, a significant increase in MIC values for vancomycin was not observed in these S. aureus subpopulations.

Malaria in inner London.

This retrospective analysis was performed to describe the malarial cases treated in an inner London hospital during a single year (1996). A total of 44 case records were available for review, 40 (90.9%) were due to Plasmodium falciparum. Thirty-seven patients were admitted to hospital, there were no deaths. Only two (4.5%) patients had taken adequate malarial prophylaxis. A total of 119 inpatient bed-days were utilized in the treatment of malaria in 1 year. In 75 (63%) of these bed-days, observation was the only reason for continued inpatient treatment. The commonest laboratory findings are mild elevation of serum bilirubin to a mean of 28 micromol/l, and a low platelet count to a mean of 124x10(12)/l. A bilirubin greater than 20 micromol/l was found in 72.9% of patients (95% CI; 58.7-87.3%). The platelet count was less than 150x10(12)/l in 77.3% of patients (95%, CI; 64.9-89.7%). We found that malaria is not uncommon in inner London. Whilst most cases are admitted few complications are usually seen. Many cases may well be able to be treated with a brief hospital admission, possibly to an accident and emergency observation ward.