Fear of progression in chronic illnesses other than cancer: a systematic review and meta-analysis of a transdiagnostic construct.

Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has rarely been studied outside of the cancer context. This review aimed to: (1) meta-synthesise qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e., seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.

Mycobacterium tuberculosis DNA in tissues affected by sarcoidosis.

BACKGROUND: Although some studies have reported the presence of Mycobacterium tuberculosis (MTb) DNA in tissues affected by sarcoidosis, the data are conflicting. The aim of this study was to collect prospectively tissue from patients with sarcoidosis in whom tuberculosis had been excluded, and to use polymerase chain reaction (PCR) to search for DNA sequences specific for MTb. METHODS: Fresh tissue samples (node or lung biopsy) taken from 23 patients with newly diagnosed sarcoidosis, 10 with other respiratory disease, and four patients with culture positive tuberculosis were analysed using PCR to amplify a 123 bp fragment of IS6110, the insertion element present in MTb, and nested PCR to further amplify an 85 bp sequence within the 123 bp product. DNA was also extracted from formalin fixed tissue from eight additional patients with sarcoidosis. RESULTS: MTb DNA was not detected in any of the tissue samples from patients with sarcoidosis or other respiratory disease but was found in all four patients with tuberculosis. CONCLUSIONS: This study has shown the absence of MTb DNA in lymph node and lung biopsy samples from patients with sarcoidosis. MTb is therefore unlikely to be a factor in the pathogenesis of this disease.

Adaptation of methicillin-resistant Staphylococcus aureus during antibiotic therapy.

Colonization of a patient by methicillin-resistant Staphylococcus aureus (MRSA) of a single phage-type for over four years is described. During this period we observed the appearance and disappearance of resistance to erythromycin, clindamycin, gentamicin, kanamycin, tobramycin, neomycin and mupirocin. We also saw stepwise increases in methicillin resistance and reversible changes in physical appearance and the colonizer pathogen role. Correlation of clinical observations, details of antibiotic therapy and laboratory studies demonstrated that adaptation of MRSA during antibiotic therapy favoured MRSA establishment and predominance.

Cephalosporin susceptibility of methicillin-resistant, coagulase-negative staphylococci.

Coagulase-negative staphylococci were tested for susceptibility to methicillin, cephradine, ceftriaxone, cephalothin, and cefamandole by standard broth microdilution. Most of the 26 methicillin-resistant isolates were susceptible to cephalothin and cefamandole, but very few were susceptible to ceftriaxone, and none was susceptible to cephradine. The proportion of bacterial cells that grew in the presence of 128 micrograms of methicillin per ml was calculated for each methicillin-resistant isolate. Those with every cell or 1 in 10 cells resistant to 128 micrograms of methicillin per ml included the isolates that were most resistant to the cephalosporins and highly resistant to methicillin. Those with 1 cell resistant in 10(5) or 10(6) cells were the isolates most susceptible to the cephalosporins, and their methicillin MICs were lower. When cells resistant to 128 micrograms of methicillin per ml were used as inocula for broth microdilution tests, resistance to cephradine remained the same, but resistance to ceftriaxone, cephalothin, and cefamandole increased significantly. Cefamandole was the only cephalosporin which retained antibacterial activity against some methicillin-resistant isolates (12 of 26). Cephradine, ceftriaxone, cephalothin, and cefamandole resistance appeared to be expressed by the same cells that expressed methicillin resistance. In this way, cross resistance was demonstrated between methicillin and the cephalosporins.

Comparison of a beta-lactamase induction test with a test that detects low-frequency resistance to cefotaxime.

A paper strip test that detects cefotaxime-resistant variants of gram-negative bacilli was described and compared with a beta-lactamase induction test. Both tests demonstrated a potential for resistance that is not indicated by standard agar dilution and agar diffusion tests.

Comparison of coagulase, deoxyribonuclease (DNase), and heat-stable nuclease tests for identification of Staphylococcus aureus.

One thousand and thirty-five clinical isolates of the genus staphylococcus were used to compare the coagulase test with the deoxyribonuclease (DNase) and heat-stable nuclease tests as methods for identifying Staphylococcus aureus. Conflicting results were obtained with 65 isolates when the coagulase test was compared with the DNase test but with only one isolate when the coagulase test was compared with the heat-stable nuclease test. The heat-stable nuclease test produced reliable results after four hours' incubation and was considered a satisfactory substitute for the coagulase test in the clinical laboratory.