Using mHealth strategies in a Diabetes Management Program to improve the quality of care in Argentina: Study design and baseline data

Aim

To evaluate the one-year post effect of the implementation of a diabetes program that includes mHealth interventions on the quality of diabetic care in public primary care centers.

Extracorporeal Shock Wave Lithotripsy for Obstructing Pancreatic Duct Calculi

Purpose

A review was done to determine the effectiveness of extracorporeal shock wave lithotripsy (ESWL^†) in the treatment of impacted pancreatic duct calculi.

Materials and Methods

A total of 19 patients, who were potential candidates for radical pancreatic surgery after unsuccessful endoscopic retrograde cholangiopancreatography, sphincterotomy and attempted stone extraction from the pancreatic ducts, underwent ESWL of the calculi. Followup ranged from 6 months to 6 years.

Results

Of the 19 patients 14 avoided a major operation and 6 have remained pain-free for the long term. Two patients died of causes not related to ESWL or endoscopic retrograde cholangiopancreatography. Five patients eventually underwent a Whipple or Puestow procedure for relief of symptoms or persistent obstruction. Complications were minimal.

Conclusions

ESWL is a valuable adjunct in patients with impacted pancreatic duct calculi unretrievable by primary endoscopic retrograde cholangiopancreatography.     

Rapid diagnosis of varicella-zoster virus infection with a monoclonal antibody based direct immunofluorescence technique

Diagnosis of varicella-zoster virus (VZV) infection in immunocompromised patients is difficult because of the frequent atypical appearance. Accurate and early diagnosis is important to allow rapid commencement of antiviral chemotherapy, with consequent improvement in antiviral efficacy. A monoclonal based direct immunofluorescence antibody technique (VZV IFA) was assessed in parallel with viral culture in 56 patients with suspected VZV infection. A subgroup of 17 patients from this group with classical dermatomal herpes zoster all had positive VZV IFA tests. Only 6 patients (35%) were positive on viral culture. None of the 15 patients with proven herpes simplex virus infection had a positive VZV IFA, nor did any patient with positive VZV viral culture have a negative VZV IFA. The VZV IFA test is a rapid and sensitive technique for detecting infection with VZV.     

Selective adherence as a determinant of the host tropisms of certain indigenous and pathogenic bacteria.

The relationship between the selective abilities of bacteria to adhere and their predilections for colonizing different mammalian hosts was investigated by using bacteria indigenous to the tongue dorsum of humans and rats as models. Streptococcus salivarius and S. sanguis averaged 22.6 and 2.8%, respectively, of the cultivable bacteria recovered from swab samples of the tonges of five humans, but these organisms were not indigenous on the tongues of rats (Charles River strain). S. faecalis and serum-requiring diphtheroids were consistently prominant on the tongues of rats, but they were not detected on the tongues of the humans examined. The ability of these organisms to adhere to the tongue surface of the hosts was compared by introducing mixtures of streptomycin-resistant strains into the mouths of human volunteers and rats. S. salivarius adhered in higher proportions to the dorsal tongue surface of humans than did strains of S. faecalis and the serum-requiring diphtheroid. S. sanguis also adhered to human tongues better than the serum-requiring diphtheroid. However, S. faecalis and the serum-requiring diphtheroid sorbed in higher proportions to the tongues of rats. In an in vivo assay, human strains of S. pyogenes and S. salivarius attached in higher numbers to buccal epithelial cells derived from humans than to those obtained from rats, whereas the reverse was observed with a serum-requiring diphtheroid derived from rats. Collectively, these studies show that bacteria sorb with a high degree of specificity to the tissues of different mammalian hosts, and the relative adherence of the organisms studied correlated with their natural host tropisms. The selective adherence of S. salvarius and S. faecalis was similar to the tongues of conventional and germ-free rats, suggesting that the presence of an indigenous bacterial flora did not significantly influence their attachment selectivity. Moreover, the ability of these organisms to colonize the tongues of gnotobiotic rats lacking an indigenous flora paralleled their adherence selectivity. Direct scanning microscopic observations indicated that the tongue dorsum of conventional rats is highly papillated but contains relatively sparse bacterial populations. Indigenous organisms colonized the bases of papillae on the anterior tip and lateral edges of the tongue as discrete microcolonies, but bacteria were rarely observed on other papillae. This localized and restricted pattern of colonization and the spatial distribution of the microcolonies of indigenous bacteria present also suggest that antagonistic interactions are unlikely to account for the bacterial tropisms observed for colonization of the tongues of rats.     

Microscopic observation drug susceptibility assay, a rapid, reliable diagnostic test for multidrug-resistant tuberculosis suitable for use in resource-poor settings

There is an urgent need for new tools to improve our ability to diagnose tuberculosis (TB) and multidrug-resistant TB (MDR-TB) in resource-poor settings. In a retrospective analysis undertaken in a region with a high incidence of TB, we evaluated the performance of the microscopic observation drug susceptibility assay (MODS), a novel assay developed in Perú which uses an inverted light microscope and culture in Middlebrook 7H9 broth to detect mycobacterial growth. MODS detected 94.0% of 1,908 positive sputum cultures, whereas Lowenstein-Jensen (LJ) culture detected only 86.9% (P < 0.001). The median time to culture positivity was 8 days (compared to 16 days for the same 208 samples by LJ culture; P < 0.001, Wilcoxon signed rank test). The results obtained by direct susceptibility testing using MODS demonstrated excellent concordance for isoniazid and rifampin and the detection of multidrug resistance with those obtained by indirect colorimetric methods: the microplate Alamar Blue assay (MABA) and the tetrazolium microplate assay (TEMA) (agreement, 95, 98, and 94%; kappa values, 0.8, 0.7, and 0.7, respectively). The concordance of the susceptibility testing results for ethambutol and streptomycin was poor. MODS is a novel assay which can detect the organisms responsible for TB and MDR-TB directly from sputum inexpensively, rapidly, and effectively. A comprehensive prospective evaluation of MODS is under way in Perú, and independent validation in nonresearch laboratories should be undertaken at the earliest opportunity.     

Comparative estimates of bacterial affinities and adsorption sites on hydroxyapatite surfaces

The adsorption of strains of prominent oral bacteria to hydroxyapatite (HA) surfaces was studied by use of an adsorption model based on the Langmuir adsorption isotherm; this permitted comparative estimates of the number of adsorption sites and the strength of the adsorption bonds on untreated and salivatreated HA surfaces for strain of Streptococcus mutans, S. salivarius, S. sanguis, S. mitis, Actinomyces viscosus, and A. naeslundii. The experimental data closely followed the adsorption model as judged by the high correlation coefficients obtained for all strains studied. Adsorption to untreated HA was similar for strains of the six species studied, suggesting that a common adsorption mechanism, possibly Ca²⁺ bridging, may exist for attachment to HA. More complex interactions appeared to be involved in bacterial adsorption to saliva-treated HA since adsorption of the strains tested at unsaturating cell concentrations varied more than 30-fold. This indicates that adsorbed salivary components on HA surfaces impart a higher order of specificity for subsequent bacterial adsorption. Fewer cells of strains of S. mutans, S. salivarius, and A. naeslundii adsorbed to saliva-treated HA than to untreated HA because adsorbed salivary components presented fewer adsorption sites. Substantially higher numbers of cells of strains of S. sanguis, S. mitis, and A. viscosus adsorbed to saliva-treated HA because the film of adsorbed salivary components increased the number of adsorption sites for these strains. The affinity constants for all but one strain studied were lower on saliva-treated HA than on untreated HA. The number of bacterial cells which adsorbed to saliva-treated HA more closely related to the number of available binding sites than to the strength of their adsorption bonds when tested at an initial concentration of 2 × 10⁷ organisms/ml. Although some differences were observed in the adsorption of strains of S. mutans representative of five serological groups, the numbers which attached to saliva-treated HA did not vary widely; this suggests that factors other than their ability to attach to a pellicle-covered HA surface may be responsible for their varying geographic distribution in human populations.     

Ability of Streptococcus mutans and a glucosyltransferase-defective mutant to colonize rodents and attach to hydroxyapatite surfaces

A mutant of Streptococcus mutans forming little or no cell-associated glucosyltransferase attached to the teeth of rats and to saliva-treated hydroxyapatite comparably to its parent.     

Male pseudohermaphroditism in sibs with the α-thalassemia/mental retardation (ATR-X) syndrome

Genital abnormalities have been noted in several patients with the X-linked form of α-thalassemia and mental retardation syndrome (ATR-X). The initial clinical report of the condition documented a phenotypic female with 46,XY karyotype. To this we now add 2 further siblings with abnormalities of the external genitalia, manifesting as male pseudohermaphroditism. © 1995 Wiley-Liss, Inc.     

Superantigen and endotoxin synergize in the induction of lethal shock

Endotoxin (lipopolysaccharide; LPS) and superantigens (exotoxins) have been identified as potent inducers of lethal shock. While endotoxin primarily interacts with CD 14 receptors on macrophages, superantigens like the staphylococcal enterotoxin B (SEB) preferentially activate T cells. Both cell types are triggered to release pro-inflammatory cytokines that in turn induce lethal shock. We analyzed whether endotoxin and superantigen interact during the induction phase of lethal shock. We report that LPS and SEB operate synergistically. Lethal doses of both inducers were reduced 100-fold when given in combination. The induced serum levels of tumor necrosis factor, interleukin-6, and interferon-γ (IFN-γ) were elevated and remained high for a prolonged period. Moreover, synergistic action of LPS and SEB induced lethal toxic shock even without presensitization of mice with D -galactosamine (D -GalN). Opposed to D -GalN-pretreated mice, mice injected with LPS and SEB showed less liver damage, but rather apoptosis of epithelial cells in the bowel. Cyclosporin A and treatment with anti-IFN-γ monoclonal antibody blocked the synergistic action of LPS and SEB, indicating that T cell-derived IFN-γ is the mediator of the observed synergism. Concomitant injection of LPS and SEB had no influence on SEB-induced T cell deletion and anergy induction. Since Gram-positive and Gram-negative bacteria can be recovered from septic blood samples, the synergistic action of endotoxin and superantigens might be relevant during lethal septicemia.