The International Infections in Pregnancy Study: group B streptococcal colonization in pregnant women

Background: Heavy colonization with group B streptococcus (GBS) has been associated with increased risk of preterm birth and neonatal sepsis; the burden of neonatal GBS disease varies geographically. To determine whether variation in heavy colonization and GBS serotypes could contribute to geographic differences in disease burden, we assessed the prevalence of heavy colonization and the distribution of serotypes in asymptomatic pregnant women in multiple countries.

Methods: Cervical, lower vaginal and urine samples were collected from women attending seven prenatal clinics in six countries. Light colonization was defined as GBS isolation from Lim broth only; heavy colonization was isolation from urine or sheep blood agar plates. Isolates were serotyped using capillary precipitation.

Results: GBS was present in 11.3% of 1308 participants (range 7.1–21.7%); 5.0% were heavily colonized (0.4–18.8%) and 6.4% were lightly colonized (2.9–8.0%). Serotypes III and V were most common (both 17.2%). Serotypes VII and VIII were found in one study center.

Conclusions: The prevalence of heavy colonization and GBS serotypes varied significantly among our study centers. Whether this variation could in part explain geographic differences in neonatal morbidity and mortality is a hypothesis that needs further study.     

Preventing hospital admissions by reviewing medication (PHARM) in primary care: design of the cluster randomised,controlled, multi-centre PHARM-study

Background  

Medication can be effective but can also be harmful and even cause hospital admissions. Medication review or pharmacotherapy review has often been proposed as a solution to prevent these admissions and to improve the effectiveness and safety of pharmacotherapy. However, most published randomised controlled trials on pharmacotherapy reviews showed no or little effect on morbidity and mortality. Therefore we designed the PHARM (Preventing Hospital Admissions by Reviewing Medication)-study with the objective to study the effect of the total pharmaceutical care process on medication related hospital admissions and on adverse drug events, survival and quality of life.     

Diagnostic imaging and radiation exposure in inflammatory bowel disease

Diagnostic imaging plays a key role in the diagnosis and management of inflammatory bowel disease(IBD). However due to the relapsing nature of IBD, there is growing concern that IBD patients may be exposed to potentially harmful cumulative levels of ionising radiation in their lifetime, increasing malignant potential in a population already at risk. In this review we explore the proportion of IBD patients exposed to high cumulative radiation doses, the risk factors associated with higher radiation exposures, and we compare conventional diagnostic imaging with newer radiation-free imaging techniques used in the evaluation of patients with IBD. While computed tomography(CT) performs well as an imaging modality for IBD, the effective radiation dose is considerably higher than other abdominal imaging modalities. It is increasingly recognised that CT imaging remains responsible for the majority of diagnostic medical radiation to which IBD patients are exposed. Magnetic resonance imaging(MRI) and small intestine contrast enhanced ultrasonography(SICUS) have now emerged as suitable radiation-free alternatives to CT imaging, with comparable diagnostic accuracy. The routine use of MRI and SICUS for the clinical evaluation of patients with known or suspected small bowel Crohn’s disease is to be encouraged wherever possible. More provision is needed for out-of-hours radiation-free imaging modalities to reduce the need for CT.     

Giant cell tumour of the tendon sheath of the hand: A pictorial essay

Giant cell tumour of the tendon sheath is a soft tissue mass found occasionally in the hand. Its diagnosis can be readily made preoperatively if the characteristic MRI features are appreciated. This pictorial essay demonstrates and describes the imaging findings correlated with histopathological findings in a group of patients with proven giant cell tumour of the tendon sheath.     

Magnetic resonance imaging of cervical ligamentous anatomy and traumatic ligamentous injuries

Cervical spine trauma accounts for majority of spinal injuries, and approximately one‐third involve the craniocervical junction (CCJ). Due to its high sensitivity, magnetic resonance imaging (MRI) has become the standard tool for imaging suspected ligamentous injuries in an unstable spine and in patients with neurological deficits having a normal CT. The ligamentous anatomy of the CCJ is complex, and thorough knowledge is a prerequisite for accurate interpretation of the MRI findings. This pictorial essay aims to familiarise radiologists with the ligamentous anatomy, mechanisms of injury and MRI appearances of injuries in the cervical spine, with emphasis on the CCJ.     

Ectopic Pancreas in the Stomach Presenting as an Inflammatory Abdominal Mass

A case of 29-yr-old woman with an ectopic pancreas in the stomach, presenting as an inflammatory mass, is presented. Physical examination revealed a tender mass in the upper abdomen. Laboratory data showed leukocytosis and an increase of ESR and CRP. A computed tomographic (CT) scan demonstrated a solid mass adjacent to the gastric antrum. Endoscopy disclosed a submucosal mass at the antrum. With a diagnosis of inflammatory mass lying near the gastric antrum, laparotomy was done. A mass 3 cm in diameter was found at the gastric antrum, and partial gastrectomy was performed. Surgical specimen showed a submucosal mass with a central umbilication. Histological examination revealed an ectopic pancreas with an abscess formation. The white cell count, ESR, and CRP returned to normal within 1 wk after surgery. From a review of the English and Japanese literature, we believe that ours is the first report of an ectopic pancreas, presenting as an inflammatory abdominal mass.     

Tobacco, cocoa, coffee, and ragweed: cross-reacting allergens that activate factor-XII-dependent pathways

A glycoprotein antigen has been isolated from cured tobacco leaves (TGP- L) Nicotiana tabacum) and from cigarette smoke condensate (TGP-CSC) to which approximately one-third of human volunteers, smokers and non- smokers, exhibit immediate cutaneous hypersensitivity. TGP-L and TGP- CSC contain polyphenol haptens that activate the factor XII (Hageman factor) dependent pathways of coagulation, fibrinolysis, and kinin generation in normal human plasma. The purpose of this communication is to describe the isolation antigens from cocoa powder (Theobroma cacao), ground coffee (Coffea arabica), and ragweed (Ambrosia eliator) pollen that are immunologically cross-reactive with TGP-L and TGP-CSC, contain similar polyphenol haptens, and are capable of activating factor-XII- dependent pathways in normal human plasma.     

A polymerase chain reaction study of the stability of Ig heavy-chain and T-cell receptor delta gene rearrangements between presentation and relapse of childhood B-lineage acute lymphoblastic leukemia

Ig heavy-chain (IgH) and partial V delta 2-D delta 3 T-cell receptor (TCR) gene rearrangements were investigated, by polymerase chain reaction (PCR) amplification and sequence analysis, in 52 patients at presentation and first relapse and in 14 at both first and second relapse of B-lineage acute lymphoblastic leukemia. In combination, these techniques amplified one or more clonal markers at presentation in 90% of patients (IgH-PCR, 75%; V delta 2-D delta 3-PCR, 46%; both, 33%). Changes in the pattern of amplification between presentation and first relapse were seen in 31% of patients positive by IgH-PCR at presentation and in 25% of those positive by TCR delta-PCR. Only 3 patients showed complete change in their rearrangements, which is suggestive of relapse with a new clone. Furthermore, despite the high reported rates of oligoclonality and clonal evolution at the IgH locus, the results presented show that false-negative minimal residual disease (MRD) detection can be avoided by designing D-N-J probes to all presentation rearrangements. Using a PCR approach for both gene markers, false-negative testing because of clonal evolution would have only occurred in 3 (8%) of the IgH-positive patients, in contrast to 5 (21%) of V delta 2-D delta 3-positive patients. Combining these two systems increases the proportion of patients open to study to 90%, allows comparative studies of the sensitive of the two methods, and reduces the rate of false-negative assessment of MRD caused by clonal evolution to less than 10%. We conclude that large prospective PCR studies of MRD detection should examine gene rearrangements at multiple loci to maximize their applicability and to minimize false-negative relapse prediction.