Low rate of carriage of macrolide-resistant group B streptococci in pregnant women in The Netherlands

OBJECTIVES: To describe prevalence of phenotypic and genotypic macrolide-resistance among GBS isolates in pregnant women and explore the possibility of clonal spread of resistant GBS isolates in a multicultural population. STUDY DESIGN: Antimicrobial resistance patterns of 107 GBS isolates obtained from asymptomatic pregnant women were determined using E-tests. Macrolide resistance genes mef(A), erm(TR) and erm(B) were determined with PCR and a subset of 39 isolates, including the 8 isolates harbouring macrolide resistance genes, was subjected to RAPD analysis to detect clonal spreading. RESULTS: Resistance to erythromycin and clindamycin was found in 8% and 7%, respectively. Macrolide resistance genes mef(A), erm(TR) and erm(B) were found in 1, 2 and 5 isolates, respectively; only five of these eight isolates exhibited both genotypic as well as phenotypic resistance. One genotype occured in 36% of the subset. CONCLUSIONS: Earlier reports on prevalence of phenotypic resistance were confirmed. Among the susceptible isolates one clonal type of GBS was clearly predominant; one of the resistant isolates shared its genotype. When such clonal types acquire resistance traits in the future, GBS disease may become harder to control.     

The incidence and factors of inappropriate rapid antigen test usage for group A streptococcus

IntroductionAlthough rapid antigen tests (RADTs) for group A streptococcus (GAS) can help diagnose group A streptococcal pharyngitis, little is known about the inappropriate use of these RADTs.MethodsThis retrospective observational study compared the appropriate vs. inappropriate use of RADTs in patients who had a RADT between January 2019 and August 2022. RADTs for patients with a low Centor score of 0–1 point were deemed inappropriate.ResultsOf the 1015 patients, 380 (37.4%) had inappropriate RADTs. Patients with asthma were associated with an increased risk of inappropriate testing. In contrast, during the coronavirus 2019 pandemic, outpatients and residents were associated with a reduced risk of inappropriate testing. Consequent to the inappropriate use of RADTs, 162 (16.0%) patients received potentially inappropriate antibiotics.ConclusionsOur results suggest that diagnostic stewardship for pharyngitis, including education for healthcare workers, is needed to reduce inappropriate test ordering and prevent unnecessary care.     

De la psychiatrie intégrative à la constellation épistémique

ObjectiveFor three years, my colleagues and I have been leading a seminar on the epistemology of psychiatry. Based on this shared experience, in addition to our own personal experiences (as clinicians, philosophers, etc.), we tackle the question of openness in psychiatry. What does psychiatry open up to ? What idea of progress are we pursuing ?MethodWe have, during these years of work, been lucky enough to be able to grasp a common thread that links the very diverse contributions that have been presented in our seminar, both in terms of the history of our discipline, as well as psychoanalysis, the philosophy of science, anthropology, experiential knowledge.ResultWe note that psychiatry exists in its complete and satisfactory definition only in the debate that we have facilitated with those who have something to say about it from a place that could be judged external: historian, psychoanalyst, anthropologist, philosopher..DiscussionIf a theoretical corpus believes itself sufficient to speak about the psychic thing, it is wrong; however, if we veer into integrative psychiatry we move away differently, but irremediably, from the scientific truth of our object.ConclusionWe therefore explain a new way of describing the practice of psychiatry: inspired by institutional psychotherapy, which proposes to bring together the transferences of each of the participants in care while respecting subjective integrity, we posit that it is possible to bring together an epistemic constellation for each of our caregiving efforts, bringing together the knowledges necessary for this without distorting them or causing them to lose their radicality.     

广元市育龄妇女及婴幼儿TORCH感染情况调查

目的：了解四川省广元市部分育龄妇女及婴幼儿TORCH感染情况，为优生优育提供相关信息。方法：选取2020年12月—2022年1月在广元市中心医院进行体检或产前筛查的育龄妇女（20～42岁）及婴幼儿为研究对象，排除其中患基础疾病者，共纳入育龄妇女1 147名、婴幼儿164名，采用化学发光检测系统测定其血清中弓形虫（TOX）、风疹病毒（RV）、巨细胞病毒（CMV）、单纯疱疹病毒I型（HSV I）和单纯疱疹病毒II型（HSV II）特异性抗体IgG和IgM。结果：1 147名育龄妇女TORCH-IgG抗体阳性率分别为：CMV-IgG 95.90%,RV-IgG 85.00%,HSV I-IgG 23.89%,HSV II-IgG12.29%,Tox-IgG 6.45%。TORCH-IgM抗体阳性率分别为：CMV-IgM 1.74%,HSV II-IgM 1.13%,RV-IgM 0.52%,Tox-IgM0.44%, HSV I-IgM 0.08%。婴幼儿TORCH-IgG抗体阳性率分别为：CMV-IgG 83.53%, RV-IgG 70.12%, HSV I-IgG82.93%,HSV ...     

Association of HLA class II DR/DQ alleles in children and adolescents with rheumatic heart disease from a tertiary care centre in North India

IntroductionRheumatic fever and RHD constitutes an important public health problem in India. The relatively low attack rate of RF, the high concordance rate for RF in monozygotic twins (19%) compared to dizygotic twins (2.5%), and the high familial incidence of RF suggest the involvement of host genetic factors in susceptibility to RF with consequential progression to RHD.ObjectiveTo study the association of HLA CLASS II DR/DQ alleles in children and adolescents with RHD from a tertiary care center in North India.Methods30 RHD patients and 30 age and sex-matched controls were included in our study and blood samples for HLA typing were processed through LAB Type™ reverse SSO DNA typing method. The assignment of the HLA typing was based on a comparison with already published HLA gene sequences.ResultsThe mean age of RHD patients and matched control groups were 12.97 ± 2.95 and 11.93 ± 3.23, respectively. In the cases and control group, males accounted for 63.3% and 50% of the patients respectively. A significant difference was found between the cases and controls for HLA DR1 15 (p-value 0.002), HLA DR1 B4 (p-value 0.045), HLA DR1 B5 (p-value 0.017), and HLA DQB11 02 (p-value 0.005).ConclusionOur study suggests that HLA class II haplotypes may provide insight into the molecular mechanism of RHD and be a useful tool in predicting the clinical outcome in RF patients, thereby affording new means of intervention or vaccine design. Larger studies are needed to address this in our population.