Paediatric antimicrobial stewardship programmes in the UK's regional children's hospitals.

A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. 'Audit and feedback' was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.

Biological evaluation of 3-hydroxybenzyl alcohol, an extrolite produced by Aspergillus nidulans strain KZR-132.

AIMS: The aim of the study was to purify and characterize a bioactive compound from Aspergillus nidulans strain KZR-132 and its biological evaluation. METHODS AND RESULTS: A bioactive extolite was purified from A. nidulans strain KZR-132, and its chemical structure was elucidated as 3-hydroxylbenzyl alcohol (3-HBA) based on 1 H and 13 C NMR, FT-IR and mass spectroscopic analysis. The antimicrobial efficacy of 3-HBA was established against Gram-positive, Gram-negative bacteria and different Candida strains. It also showed promising antibiofilm activity against various tested microbial strains. Reactive oxygen species induced by 3-HBA treatment on different Candida strains killed most of the cells and showed necrotic effect. It also exhibited dose-dependent antioxidant and anti-inflammatory activities. CONCLUSIONS: This bioactive extrolite produced by A. nidulans isolated from a niche habitat was demonstrated to possess significant biotechnological and pharmacological potential since it exhibited broad-spectrum antimicrobial and antibiofilm activities which are reported for the first time. SIGNIFICANCE AND IMPACT OF THE STUDY: The overall study demonstrates that 3-HBA produced by A. nidulansKZR-132 is a promising bioactive metabolite and possibly can function as a pharmacologically suitable broad-spectrum antimicrobial drug candidate against various dreaded human-related bacterial and fungal pathogens.

Medium term results of reverse total shoulder replacement in patients with rotator cuff arthropathy.

BACKGROUND: The Delta III total shoulder replacement is a reversed, semi-constrained prosthesis and is recommended for the management of rotator cuff arthropathy. METHODS: We performed a retrospective mid-term review of the Delta shoulder replacements performed during 2000-2005 with a minimum 18-month follow-up. We recorded the pre-operative and post-operative constant scores. RESULTS: The Constant's score improved from a pre-operative mean of 14.8 (95% CI +8.8 to +19.8) to a post-operative mean of 60.9 (95% CI +50 to +66.2) with a P valve of <0.0001. CONCLUSION: Delta III prosthesis restores the function in shoulder affected by severe pain and dysfunction due to rotator cuff arthropathy. Inferior scapular notching in the post-operative radiographs was better visualised in abduction views compared with standard anteroposterior radiographs. Long-term follow-up is required to predict the effect of scapular notching.

Voice and healing after vocal fold epithelium removal by CO2 laser vs. microlaryngeal stripping.

Controversy exists regarding voice recovery after the use of laser vs. microforceps techniques in the removal of benign vocal fold lesions. The purpose of this study is to compare recovery of voice and healing between groups of cats undergoing vocal fold epithelium removal by CO2 laser and those having vocal fold stripping. Fourteen adult female cats underwent standardized unilateral vocal fold injuries by CO2 laser ablation or stripping. After a 6-week recovery period, phonations were evoked by electrical stimulation of the midbrain periaqueductal gray area. Phonations were recorded for acoustic analysis. The larynges were harvested, fixed, and sectioned for histologic correlation. Acoustic analysis showed the mean signal-to-noise ratios in the laser group (19.72) to be significantly higher than those in the stripped group (13.51) (p = 0.04). The stripped group showed significantly greater amplitude perturbation (8.68% vs. 2.43%, p = 0.02). No between-group difference was found for period perturbation. Histologically, the laser group showed minimal Reinke's space scarring and near-normal epithelial regeneration, and the stripped group showed marked subepithelial scarring, often involving the vocalis muscle. These results demonstrate superior recovery of voice and healing in animals undergoing vocal fold epithelium removal with the CO2 laser. Inferior outcomes seen in the stripped group may be related to difficulty in preserving Reinke's space during epithelium removal.

The morbidity and mortality of splenectomy in childhood.

One hundred and eighty-two patients undergoing splenectomy in infancy and childhood were followed for periods of 2 to 15 years. Serious infections occurred in 11 patients (6%) with death in 6 (3.3%). In 10 patients the infection was sepsis, and in all but one patient the infection occurred within 2 years of splenectomy. Among children over 2 years of age the risk of infection was still appreciable except when the spleen was removed incidentally or for traumatic rupture. Splenectomy for thalassemia and portal hypertension resulted in an increased risk of serious infections when compared with removal of the spleen for hereditary spherocytosis, idiopathic thrombocytopenic purpura, trauma, or for technical reasons in the course of another operation. Post-splenectomy infections tended to follow a characteristic pattern. The infecting organism was predominantly pneumococcus, the course was fulminating and the mortality high.