Cryptococcus gattii infections in China: extent of the problem?

Approximately 70 species are accepted in the genus Cryptococcus;1 however,only two species,Cryptococcus neoformans (C.neoformans,serotypes A,AD and D) and C.gattii (serotypes B and C) are responsible for almost all human cryptococcal infections,2,3 and resulted in over 1 million new cases of cryptococcosis in the world each year with over 600 000casualties.4 It is generally assumed that cryptococcal infections are acquired by inhalation of fungal spores,desiccated cells,or poorly encapsulated yeasts from environmental niches,such as decayed wood debris of certain tree species or bird droppings.5 Epidemiological surveys have shown that C neoformans caused about 80％ of cryptococcosis cases globally each year,particularly in immunocompromised persons,such as human immunodeficiency virus (HIV)-infected people and acquired immunodeficiency syndrome (AIDS) patients,2,3 while C.gattii primarily infects apparently immunocompetent hosts,and is mainly responsible for the remaining cases of cryptococcosis.6,7     

A 30 year perspective of the quality of evidence published in 25 clinical journals: Signs of change?

Methods

The quality of clinical studies published in five different specialties, over three decades was evaluated. Computerised search of the Medline database was undertaken to evaluate the articles published in 25 clinical journals in 1983, 1993, and 2003 from five different specialties (medicine, surgery, paediatrics, anaesthesia, and psychiatry). The number of randomised controlled trials (RCTs), meta‐analyses, and other clinical trials (non‐RCT) were noted.

Results

From the 27 030 articles evaluated, there were 2283 (8.4%) RCTs, 166 (0.6%) meta‐analyses, and 4153 (15.4%) other clinical trials. For the proportion of RCTs, the rank order of the specialties was; anaesthesia (503; 18%), psychiatry (294; 9.6%), medicine (899; 8.1%), paediatrics (326; 6.4%), and surgery (261; 5.3%) (p<0.001). For the proportion of meta‐analysis, the rank order of the specialties was; psychiatry (36; 1.2%), medicine (105; 0.9%), paediatrics (15; 0.3%), anaesthesia (6; 0.2%), and surgery (4; 0.1%) (p<0.001). Overall, from 1983 to 2003, there were increases in the proportion of RCTs (449, 5.9% to 1027, 9.6%), meta‐analysis (0, 0% to 127, 1.2%), and other clinical trials (897, 12% to 1983, 19%) (p<0.001). This trend was apparent in each clinical specialty (p<0.001).

Conclusions

Over the three decades evaluated, clinical trials, notably RCTs and meta‐analysis form only a small proportion of articles published in prominent journals from five clinical specialties. This is notwithstanding the modest increases in the proportions of RCTs and meta‐analysis over the same period.     

What's new in the treatment of cerebrovascular disease?: an endovascular perspective

Surgical therapy currently allows for the correction of many pathologic conditions affecting the vasculature of the central nervous system. Recent advances in technology have given the cerebrovascular specialist further options in the minimally invasive sphere. Endovascular techniques, complimentary to surgery in some conditions, are poised to replace conventional open surgery in others. A review of current interventional radiological procedures for the treatment and prevention of ischemic and hemorrhagic stroke are herewith presented.     

Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections?

Objective

Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation.

Methods

We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well.

Results

A total of 157 patients were enrolled to a stent (ST) and 153 patients to a no-stent (NST) group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65). Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%).

Conclusion

Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.     

A New Concept in the Control of Iron Deficiency:Community-based Preventive Supplementation of At-Risk Groups by the Weekly Intake of Iron Supplements

INTRODUCTIONIrondeficiencyisasystemicconditionthataffectsover2ooenzymefunctions,oxygentransportandutilizationatthecellularlevel,andaltersenergyutilization,hormonalregulation,musclefunctionandphysicalproductivity,infection-defensemechanisms,intestinalfunctionandabsorption,pregnancyoutcome,andgrowthanddevelopment(Dallman,l986;Enwonwu,l989).Inthiscontext,nervoussystemdevelopmentandfunctionappeartobepermanentIydamagedfromearlyID,resultinginimpairedcognition,diminishedlearningcapacityandatten…     

Implementation of an obstetric cell salvage service in a tertiary women’s hospital

INTRODUCTION

Intraoperative cell salvage (ICS) is an important aspect of patient blood management programmes. An ICS service was introduced at KK Women’s and Children’s Hospital, Singapore, from 2 May 2011 to 30 April 2013 to aid in the management of massive obstetric haemorrhage.

METHODS

With support from the Ministry of Health’s Healthcare Quality Improvement and Innovation Fund, a workgroup comprising obstetricians, anaesthetists and nursing staff was formed to develop training requirements, clinical guidelines and protocols for implementing ICS using the Haemonetics Cell Saver 5. Pregnant women with an anticipated blood loss of > 1,000 mL during Caesarean delivery, a baseline haemoglobin level of < 10 g/dL, rare blood types and who had refused donor blood were recruited to the service after obtaining informed consent.

RESULTS

A total of 11 women were recruited to the ICS service; the primary indications were placenta praevia and placenta accreta. Median blood loss in these 11 patients was 1,500 (range 400–3,000) mL. In four patients, adequate autologous blood was collected to initiate processing and salvaged, processed blood was successfully reinfused (mean 381.3 [range 223.0–700.0] mL). Median blood loss among these four patients was 2,000 (range 2,000–3,000) mL. No adverse event occurred following autologous transfusion. Mean immediate postoperative haemoglobin level was 8.0 (range 7.1–9.4) g/dL.

CONCLUSION

The implementation of an obstetric ICS service in our institution was successful. Future studies should seek to address the cost-effectiveness of ICS in reducing allogeneic blood utilisation.     

Does informed consent influence therapeutic outcome? A clinical trial of the hypnotic activity of placebo in patients admitted to hospital

To examine whether written informed consent might influence the results of clinical trials the effect of placebo when given with or without informed consent to patients suffering from insomnia was studied. The study was a single blind observer blinded trial, and patients were paired according to sex, age, and hospital environment. Randomisation assigned the first patient of each pair to the control group (without informed consent) or the group to give informed consent. Of the 56 patients, 26 refused to give informed consent, and the age and sex distribution of these differed significantly (p less than 0.02) from the 30 pairs of patients ultimately enrolled into the study. In this "biased" sample, the hypnotic activity of placebo was significantly higher in the control group (p less than 0.05). It is concluded that the informed consent procedure biases the results of clinical trials and might affect their general applicability.     

Urogenital infections in women: can probiotics help?

Urogenital infections not caused by sexual transmission, namely yeast vaginitis, bacterial vaginosis, and urinary tract infection remain a major medical problem in terms of the number of women afflicted each year. Although antimicrobial therapy is generally effective at eradicating these infections, there is still a high incidence of recurrence. The patient's quality of life is affected and many women become frustrated by the cycle of repeated antimicrobial agents whose effectiveness is diminishing due to increasing development of microbial resistance. There is good clinical evidence to show that the intestinal and urogenital microbial flora have a central role in maintaining both the health and wellbeing of humans. Furthermore, the use of "good bacteria" to replace or augment bacterial populations is gradually achieving scientific acceptance. This application is termed probiotics: "live micro-organisms which when administered in adequate amounts confer a health benefit on the host". The role of the intestinal, vaginal, and urethral flora and probiotics in urogenital health will be the focus of this review.