Is it time to reconsider initial antibiotic treatment strategies for severe urinary tract infections in Europe?

Until recently, most reported cases of bacteraemia caused by multidrug-resistant strains of Enterobacteriacae producing an extended-spectrum beta-lactamase (ESBL) in Europe have been nosocomial in origin. However, increasing numbers of reports of community-acquired bacteraemia and urinary tract infection caused by ESBL-producing microorganisms suggest that the geographical origin of patients should be taken into account as a risk-factor for possible ESBL production. Early identification of patients at high-risk of infection with ESBL-producing microorganisms, based on their geographical origin and travel history, should help to optimise initial antibiotic treatment strategies for severe urinary tract infections in Europe.     

Immune response to immunostimulatory complexes (ISCOMs) prepared from human immunodeficiency virus type 1 (HIV-1) or the HIV-1 external envelope glycoprotein (gp120)

In mice, immunostimulatory complexes (ISCOMs) prepared from HIV-1 B external envelope glycoprotein (gp120) induced 10-fold higher antibody titres than gp120 emulsified in depot adjuvant, as measured by enzyme-linked immunosorbent assay (ELISA). Rhesus monkeys immunized with gp120 ISCOMs produced precipitating and virus neutralizing antibody titres equivalent to those seen in HIV-infected chimpanzees and humans. After multiple immunizations with HIV-1 B gp120 ISCOMs, a rhesus monkey developed a neutralizing response to the HIV-1 isolates RF and MN, but not to the CC isolate. Antisera from ISCOM-immunized rhesus monkeys recognized gp120 on the membranes of HIV-1 B-infected H9 cells, indicating the preservation of epitope structure in the ISCOMs matrix.     

Malignant course of a benign anomaly: myocardial bridging

A 35-year-old man, with recent onset angina, developed recurrent episodes of syncope due to ventricular tachycardia. His coronary angiogram showed normal coronary arteries and myocardial bridging of the left anterior descending causing severe systolic milking effect. Extensive invasive and noninvasive investigations did not reveal cardiac pathology other than the myocardial bridging. Electrophysiologic studies, not previously reported in myocardial bridging, demonstrated inducible sustained ventricular tachycardia at a rate of 280 beats/min. The possible relationship between the arrhythmia and the myocardial bridge is suggested. Combined medical treatment with amiodarone and diltiazem proved to be an effective alternative to surgical myotomy of the bridge.     

Acute myocardial infarction: thrombotic complications of nephrotic syndrome

Thrombotic complications are common in patients with nephrotic syndrome. We report a case of acute inferior wall myocardial infarction in a nephrotic patient secondary to a thrombotic occlusion of the right coronary artery which was subsequently documented to be free from any significant atherosclerotic disease.     

OXYGEN FREE RADICAL IN HUMAN OSTEOARTHRITIS

The xanthine oxidase catalysed release of superoxide free radicals (O2-) from endogenous hypoxanthine was determined in homogenates of synovium obtained from three groups of patients, those undergoing primary or revision total hip replacement (THR) for osteoarthritis and those undergoing arthroscopy of the knee for semilunar disc injuries. The concentrations of hypoxanthine in homogenates obtained during THR were found to be significantly higher than those in the group with semilunar disc injuries. The results suggest that there is a greater predisposition to free radical release and tissue damage in osteoarthritis.     

Aging in Nigeria

Following the presentation of demographic data concerning the situation of the elderly in Nigeria, the government's policy with regard to the aged is described. One aim is to strengthen the traditional system of the extended family. Reference is made to the difficulties involved in gerontological research.