Hiatal hernia recurrence following magnetic sphincter augmentation and posterior cruroplasty: intermediate-term outcomes.

BACKGROUND: We have previously reported short-term outcomes after hiatal hernia repair (HHR) at the time of magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease (GERD). Here we report intermediate-term outcomes and hernia recurrence rate after concomitant MSA and HHR. METHODS: This is a retrospective cohort study of patients who underwent repair of a hiatal hernia 3 cm or larger at the time of MSA implantation between May 2009 and December 2015. The primary endpoint was hiatal hernia recurrence identified by routine postoperative videoesophagography or endoscopy. Recurrence was defined by a 2 cm or greater upward displacement of the stomach through the diaphragmatic esophageal hiatus. Secondary endpoints included cessation of proton-pump inhibitor (PPI), persistent dysphagia requiring intervention, and GERD health-related quality-of-life (HRQL) scores 1 year from surgery. RESULTS: During the study period, 47 of 53 (89%) patients underwent concomitant MSA with HHR and complied with surveillance. Hiatal hernias ranged from 3 to 7 cm (mean 4 ± 1). Mean clinical follow-up time was 19 months (range 1-39). GERD-HRQL score decreased from 20.3 to 3.1 (p < .001), 89% of patients remained off PPIs, and 97% of patients reported improvement or resolution of symptoms. Two recurrent hiatal hernias were identified on surveillance imaging for a recurrence rate of 4.3% at a mean 18 (± 10) months after initial operation. Persistent dysphagia occurred in 13% (6/47) over the first year, which resolved after a single balloon dilation in 67% (4/6). Two patients elected for device removal due to dilation-refractory dysphagia and persistent reflux symptoms. CONCLUSION: Concomitant magnetic sphincter augmentation and hiatal hernia repair in patients with gastroesophageal reflux disease and a moderate-sized hiatal hernia demonstrates durable subjective reflux control and an acceptable hiatal hernia recurrence rate at 1- to 2-year follow-up.

Increasing antibiotic resistance in Streptococcus pneumoniae colonizing children attending day-care centres in Singapore.

BACKGROUND AND OBJECTIVE: Streptococcus pneumoniae is an important cause of morbidity and mortality in both the paediatric and adult population. This study aimed to define pneumococcal colonization rates, and antibiotic resistance patterns across two periods a decade apart, and also assess the serotypes of colonizing strains in children in the era of early pneumococcal conjugate vaccine uptake in Singapore. METHODS: Two cross-sectional prevalence surveys were carried out in 1997 and 2007-2008 on children attending day-care centres across Singapore. Nasopharyngeal swabs were obtained and cultured for S. pneumoniae, and antibiotic susceptibility testing was performed. Serotyping was also done in the 2007-2008 survey. RESULTS: Three hundred and ninety-five children participated in the first survey in 1997, and 418 in the 2007-2008 survey. Pneumococcal colonization rates were 25.8 and 14.1%, respectively. There was a marked increase in antimicrobial non-susceptibility (penicillin 27.4% vs 69.5%; erythromycin 33.4% vs 78%; clindamycin 24.5% vs 45.8%, tetracycline 48% vs 67.8%), and multi-drug resistance (defined as non-susceptibility to three or more classes of antibiotics) increased from 33.3 to 74.6%. In the 2007-2008 survey, serotypes 6B (16.9%), 23F (11.9%) and 19F (10.2%) were most commonly observed. The projected coverage of the 7 and 13-valent conjugate pneumococcal vaccine for colonizing serotypes were 61.9 and 67%, respectively. CONCLUSIONS: S. pneumoniae antibiotic resistance has risen dramatically over the last 10 years in Singapore. Wider conjugate vaccine uptake and improved antibiotic stewardship should be made priorities. Surveillance of sentinel sites like day-care centres provides important data with respect to shifts in pneumococcal ecology.

Predominance of Candida tropicalis bloodstream infections in a Singapore teaching hospital.

An 18-month epidemiologic investigation of Candida bloodstream infections in a Singapore hospital identified 52 candidemic patients: 36% of whose infections were caused by C. tropicalis, 29% were due to C. albicans, 10% with C. parapsilosis and 21% involved C. glabrata. A predominant clonal C. tropicalis strain was demonstrated. No association with ICU stay, prior exposure to fluconazole/broad-spectrum antibiotics or increased mortality was found in this apparent shift towards non-C. albicans Candida species as the primary agents of candidemia.

NON-EQUIVALENCE FOR BEAN SEEDS OF CLOCKWISE AND COUNTERCLOCKWISE MAGNETIC MOTION: A NOVEL TERRESTRIAL ADAPTATION?

1. Three experiments on water-uptake in pinto beans, Phaseolus vulgaris, during their first four hours in water have all indicated that clockwise and counterclockwise rotating magnetic fields have statistically significantly different effects upon the rate of the process. 2. The results suggest that this difference is independent of time and place. Critically performed experiments at Evanston, Illinois and Woods Hole, Massachusetts, over more than a two-year span, all gave essentially the same results. 3. A clockwise rotating magnetic field abolished, for the beans, a correlation with concurrent control beans without magnet, while a counterclockwise rotating magnet failed to do so. 4. In a concurrent series involving rotating beans (1 rpm, clockwise and counterclockwise) and beans in fields of a weak rotating magnet (1 rpm, clockwise and counterclockwise), the effects of counterclockwise magnet and counterclockwise table rotations were of opposite character and highly significantly different from one another. Effects of clockwise magnet and clockwise table rotations differed significantly, in turn, from their opposite directions of rotations. 5. The results uniformly support the hypothesis that the different effects reported between clockwise and counterclockwise rotation of organisms result from their systematic, directional motions relative to the geomagnetic field. 6. It is postulated that this non-equivalence for organisms of clockwise and counterclockwise rotations of such extremely weak magnetic fields reflects a novel and fundamental adaptation of organisms to their rotating and sun-orbiting environments.

Rapid detection of Klebsiella pneumoniae from blood culture bottles by real-time PCR.

A LightCycler real-time PCR hybridization probe-based assay which detects a partial Klebsiella pneumoniae 16S rRNA gene was developed for the rapid identification of K. pneumoniae directly from growth-positive blood culture bottles (BACTEC 9240 system) within 2 h. No cross-reactivity was observed with 65 negative-control blood cultures that grew bacteria other than K. pneumoniae and 48 negative blood cultures from double-blind experiments, thus demonstrating 100% specificity when compared to results of conventional biochemical characterization. The assay also showed 100% sensitivity, as it correctly identified all 142 positive-control blood cultures and 4 from double-blind trials.