Clinical characteristics and prognosis of infections caused by OXA-48 carbapenemase-producing Enterobacteriaceae in patients treated with ceftazidime-avibactam

Background

Ceftazidime-avibactam has in vitro activity against Gram-negative bacilli that produce Class A, C and some D β-lactamases, and has been successfully used in the treatment of infections caused by cephalosporin and carbapenem-resistant Enterobacteriaceae. However, actual experience in the treatment of OXA-48 carbapenemase-producing Enterobacteriaceae (CPE) is limited.

Mental status assessment of insight and judgment

Although a traditional part of the mental status examination, assessment of insight and judgment has received scant attention from researchers and clinicians. This is unfortunate, because few abilities are more crucial to decisions about whether a patient can continue to live independently or what level of supervision is needed. The authors discuss current and evolving methods for the assessment of insight and judgment, and also address neuroanatomic substrates and theoretical conceptions of these functions.     

Lipids, lipoproteins, and coronary heart disease: Implications for antihypertensive therapy

There is now considerable evidence that treatment of abnormalities of lipids and lipoproteins reduces the incidence of coronary heart disease (CHD). Treatment of hypertension, another major cardiovascular risk factor, has not been shown to have the same impact on CHD. Possible explanations for this are that cardiovascular risk factors may occur in combination in an individual or that therapy for hypertension has adversely affected one or several of the other risk factors for CHD, thereby effuetting the benefit gained by lowering blood pressure.This article reviews the relationship between lipids, lipoproteins, and coronary heart disease, and the impact of cholesterol lowering on CHD. The evidence that antihypertensive drugs are associated with lipid and lipoprotein abnormalities is introduced by a critical appraisal of the several studies for such evidence. Implications for the treatment of the hypertensive patient are discussed.     

Diagnosis and successful management of calciphylaxis in a pancreas-kidney transplant patient

Nephrol Dial Transplant 2005 20: 1520–1521     

Blood pressure measurement by junior hospital doctors--a gap in medical education?

A questionnaire survey, combined with an observational study, evaluated the knowledge of doctors in training grades on the practical aspects of blood pressure measurement. Eighty (non-consultant) junior hospital doctors, graduates from 30 separate medical schools, participated in the study. The results show that 27 (33%) doctors acknowledged no formal education on how to measure blood pressure. This lack of precise theoretical knowledge was matched by an observed poor clinical technique in over one third of the study group. The precision and accuracy of blood pressure recording is fundamental to the clinical examination of patients, and crucial in their management in both hospital and community settings. The findings of this study support the urgent need for further training and assessment of blood pressure measurement at undergraduate, and postgraduate level.     

Isotope effect on electron transfer in reaction centers from Rhodopseudomonas sphaeroides

Previous ENDOR studies on reaction centers from Rhodopseudomonas sphaeroides have shown the presence of two hydrogen-bonded protons associated with the primary, ubiquinone, acceptor Q_A. These protons exchange with deuterons from solvent ²H₂O. The effect of this deuterium substitution on the charge-recombination kinetics (BChl)₂⁺Q_A^- → (BChl)₂Q_A has been studied with a sensitive kinetic difference technique. The electron-transfer rate was found to increase with deuterium exchange up to a maximum Δk/k of 5.7 ± 0.3%. The change in rate was found to have an exchange time of 2 hr, which matched the disappearance of the ENDOR lines due to the exchangeable protons. These results indicate that these protons play a role in the vibronic coupling associated with electron transfer. A simple model for the isotope effect on electron transfer predicts a maximum rate increase of 20%, which is consistent with the experimental results.     

Insulin for type 2 diabetes: choosing a second‐line insulin regimen

Guidance has been published on the choice of initial insulin regimen for patients with type 2 diabetes [NPH (isophane) insulin or a long‐acting insulin analogue] but not on how to choose a second regimen when glycaemic control becomes unsatisfactory. Aims: To develop pragmatic clinical guidance for choosing a second‐line insulin regimen tailored to the individual needs of patients with type 2 diabetes after failure of first‐line insulin therapy. Methods: Formulation of a consensus by expert panel based on published evidence and best clinical practice, taking into account patient preferences, lifestyle and functional capacity. Results: Six patient‐dependent factors relevant to the choice of second‐line insulin regimen and three alternative insulin regimens (twice‐daily premixed, basal‐plus and basal‐bolus) were identified. The panel recommended one or more insulin regimens compatible with each factor, emphasising the fundamental importance of a healthy lifestyle that includes exercise and weight reduction. These recommendations were incorporated into an algorithm to provide pragmatic guidance for clinicians. Conclusion: The three alternative insulin regimens offer different benefits and drawbacks and it is important to make the right choice to optimise outcomes for patients.