Verapamil Increases the Bactericidal Activity of Bedaquiline against Mycobacterium tuberculosis in a Mouse Model

Bedaquiline is a newly approved drug for the treatment of multidrug-resistant tuberculosis, but there are concerns about its safety in humans. We found that the coadministration of verapamil with subinhibitory doses of bedaquiline gave the same bactericidal effect in mice as did the full human bioequivalent bedaquiline dosing. Adding verapamil to bedaquiline monotherapy also protected against the development of resistant mutants in vivo. The adjunctive use of verapamil may permit use of lower doses of bedaquiline to be used and thereby reduce its dose-related toxicities in tuberculosis patients.     

Physiology: evacuation, pelvic floor and continence mechanisms

Faecal continence is defined by the ability to perceive, retain and evacuate bowel contents at socially convenient times. This is reliant upon normal function of the main involved organs (i.e. rectum, pelvic floor and anal sphincters) together with their associated sensorineural pathways. Incontinence may occur as a result of dysfunction in any one of these systems or due to factors such as systemic disease, emotion, bowel motility and stool consistency. The act of defaecation is a conscious process that involves interplay between motor and sensory elements, initiated by higher cortical function.Incontinence and evacuatory dysfunction are investigated using specialized tests that assess sphincter function and structure (anorectal manometry, endoanal ultrasound), anorectal and pelvic floor function (defaecating proctography, nerve conduction studies) and luminal integrity and colonic function (transit studies and endoscopy).     

Efflux Inhibition with Verapamil Potentiates Bedaquiline in Mycobacterium tuberculosis

Drug efflux is an important resistance mechanism in Mycobacterium tuberculosis. We found that verapamil, an efflux inhibitor, profoundly decreases the MIC of bedaquiline and clofazimine to M. tuberculosis by 8- to 16-fold. This exquisite susceptibility was noted among drug-susceptible and drug-resistant clinical isolates. Thus, efflux inhibition is an important sensitizer of bedaquiline and clofazimine, and efflux may emerge as a resistance mechanism to these drugs.     

A novel and accurate technique of photographic wound measurement

Context:

Wound measurement is an important aspect of wound management. Though there are many techniques to measure wounds, most of them are either cumbersome or too expensive.

Aims:

To introduce a simple and accurate technique by which wounds can be accurately measured.

Settings and Design:

This is a comparative study of 10 patients whose wounds were measured by three techniques, i.e. ruler, graph and our technique.

Materials and Methods:

The graph method was taken as the control measurement. The extent of deviation in wound measurements with our method was compared with the standard technique. The statistical analysis used was ANOVA.

Results:

The ruler method was highly inaccurate and overestimated the wound size by nearly 50%. Our technique remained consistent and accurate with the percentage of over or underestimation being 2-4% in comparison with the graph method.

Conclusions:

This technique is simple and accurate and is an inexpensive and non-invasive method to accurately measure wounds.KEY WORDS: Digital planimetry, photography, wound measurement

You can’t manage what you can’t measureW. Edwards Deming

     

International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases

BackgroundLaparoscopic sleeve gastrectomy (LSG) is an emerging surgical approach, but 1 that has seen a surge in popularity because of its perceived technical simplicity, feasibility, and good outcomes. An international expert panel was convened in Coral Gables, Florida on March 25 and 26, 2011, with the purpose of providing best practice guidelines through consensus regarding the performance of LSG. The panel comprised 24 centers and represented 11 countries, spanning all major regions of the world and all 6 populated continents, with a collective experience of >12,000 cases. It was thought prudent to hold an expert consensus meeting of some of the surgeons across the globe who have performed the largest volume of cases to discuss and provide consensus on the indications, contraindications, and procedural aspects of LSG. The panel undertook this consensus effort to help the surgical community improve the efficacy, lower the complication rates, and move toward adoption of standardized techniques and measures. The meeting took place at on-site meeting facilities, Biltmore Hotel, Coral Gables, Florida.MethodsExpert panelists were invited to participate according to their publications, knowledge and experience, and identification as surgeons who had performed >500 cases. The topics for consensus encompassed patient selection, contraindications, surgical technique, and the prevention and management of complications. The responses were calculated and defined as achieving consensus (≥70% agreement) or no consensus (<70% agreement).ResultsFull consensus was obtained for the essential aspects of the indications and contraindications, surgical technique, management, and prevention of complications. Consensus was achieved for 69 key questions.ConclusionThe present consensus report represents the best practice guidelines for the performance of LSG, with recommendations in the 3 aforementioned areas. This report and its findings support a first effort toward the standardization of techniques and adoption of working recommendations formulated according to expert experience.