Prevalence of methicillin-resistant Staphylococcus aureus among veterinarians: an international study.

Pig farmers and veterinarians in contact with livestock in The Netherlands have a higher risk of methicillin-resistant Staphylococcus aureus (MRSA) carriage than the general population. The objective of this study was to investigate whether this is also true for other professionals in contact with pigs in an international setting. A convenience sample of 272 participants at an international conference on pig health in Denmark was screened for MRSA carriage using combined nose/throat swabs and were asked to complete a questionnaire concerning animal contacts, exposure to known MRSA risk-factors, and the protective measures taken when entering pig farms. In total, 34 (12.5%) participants from nine countries carried MRSA. Thirty-one of these isolates were non-typeable by pulsed-field gel electrophoresis following SmaI digestion of chromosomal DNA. All of the non-typeable isolates belonged to spa types (t011, t034, t108, t571, t567 and t899) that correspond to multilocus sequence type 398. All of the above-mentioned spa types, with the exception of t899, have been isolated previously from either Dutch pigs, pig farmers and/or veterinarians. Protective measures, e.g., masks, gowns and gloves, did not protect against MRSA acquisition. Transmission of MRSA from pigs to staff tending to these animals appears to be an international problem, creating a new reservoir for community-acquired MRSA (CA-MRSA) in humans in Europe, and possibly worldwide. The rise of a new zoonotic source of MRSA could have a severe impact on the epidemiology of CA-MRSA, and may have consequences for the control of MRSA, especially in those countries that maintain a low prevalence by means of search-and-destroy policies.     

Dietary intake in a group of independent-living old people in Oslo.

Dietary intake (24-h recall), dietary supplementation practice and relative weight (BMI) were investigated in a random sample of 257 independent-living elderly persons above 75 years. The proportion of energy from fat was unfavorably high among women (41.7%), while diet nutrient density was similar for men and women. Mean intakes of vitamin D, thiamin and iron were below recommended levels. Use of a dietary supplement was more common among women (66%) than men (48%). Average daily energy intakes of 6.3 +/- 2.1 MJ in women and 7.3 +/- 2.2 MJ in men were just below the lower limit of the reference interval. Overweight was uncommon, while 14% of the women and 4% of the men had BMI below 18.5 kg/m2; 2% had a BMI below 16. We conclude that low energy intake is the major reason for potential malnutrition in this group of elderly persons; up to 10% may be at risk for energy deficiency, while 2% were chronic energy deficient.     

Clinical reasoning and decision-making in practice. A man with hip pain and fever

A 42-year-old man was admitted to the hospital because of pain in the left hip. On examination he was febrile at 38 degrees C and he walked with a limp. The chest, abdomen and extremities were normal. Laboratory tests showed an elevated ESR and CRP. The ANA test was positive. CT-scan of the abdomen revealed a mass in the psoas region and some dilatation of the left renal pelvis. Following the histological results of the first and second diagnostic percutaneous biopsies, the clinicians suspected idiopathic retroperitoneal fibrosis. They treated the patient with corticosteroids for a period of 4 weeks. After a short interval of improvement this treatment failed and a third biopsy was taken. Subsequently, the diagnosis of anaplastic large cell lymphoma (ALCL) was made. The patient was successfully treated with combination chemotherapy. Usually, in practice, clinical reasoning and decision-making is carried out in accordance with Bayes' theorem. But when the a priori probability of disease is unknown and the likelihood ratio of a diagnostic test unavailable, one has to combine the available 'evidence' with critical thinking, interdisciplinary communication, judgement, intuition and common sense.     

Variations in locoregional therapy in postmenopausal patients with early breast cancer treated in different countries

Background:

The Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial is an international randomized trial evaluating the efficacy and safety of exemestane, alone or following tamoxifen. The large number of patients already recruited offered the opportunity to explore locoregional treatment practices between countries.

Methods:

Patients were enrolled in Belgium, France, Germany, Greece, Ireland, Japan, the Netherlands, the UK and the USA. The core protocol had minor differences in eligibility criteria between countries, reflecting variations in national guidelines and practice regarding adjuvant endocrine therapy.

Results:

Between 2001 and 2006, 9779 patients of mean(s.d.) age 64(9) years were randomized. Some 58·4 per cent had T1 tumours (range between countries 36·8–75·9 per cent; P < 0·001) and 47·3 per cent were axillary node positive (range 25·9–84·6 per cent; P < 0·001). Independent factors for type of breast surgery were country, age, tumour status and calendar year of surgery. After breast‐conserving surgery, radiotherapy was given to 93·2 per cent of patients, 86·0 per cent in the USA and 100 per cent in France. Axillary lymph node dissection was performed in 82·0 (range 74·6–99·1) per cent.

Conclusion:

Despite international consensus guidelines, wide global variations were observed in treatment practices of early breast cancer. There should be further efforts to optimize locoregional treatment for breast cancer worldwide. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.     

Pharmacy course on women's and men's health

Objective. To design and implement an integrated course dedicated to women''s and men''s health.Design. A women''s and men''s health module that integrated the basic and clinical sciences was developed and implemented as part of the core undergraduate pharmacy curriculum. Instruction included classroom lectures, large- and small-group case discussion, self-directed learning assignments, and case-based simulations with standardized patients, all of which focused on conditions impacting women''s and men''s health.Assessment. Assessment of student learning included multiple-choice and written examinations using case vignettes when possible, evaluation of documentation of patient care process with standardized patient interactions, and group case assignments. Students appreciated the scope of topics, the active-learning opportunities, and use of simulated patients, as well as teaching by experts in the area.Conclusion. A mandatory course in women''s and men''s health was well received by students and ensured that these important issues were addressed in the undergraduate pharmacy curriculum.     

Acute sialoadenitis of the parotid gland

An 88-year-old diabetic women was hospitalized because of a pheripheral vascular disorder. During her hospitalization she developed a right-sided facial swelling which was not limited by anatomical structures in this area. Ultrasound and computertomographic scanning supported the clinical diagnosis acute sialoadenitis of the parotid gland. The swelling resolved shortly after starting antibiotic therapy.     

Deep corneal stromal opacities in long-term contact lens wear

In 32 patients with long-term contact lens wear (up to 19 years), deep whitish opacities directly adjacent to Descemet's membrane were seen in the central part of the cornea. These opacities were seen in soft hydroxyethylmethacrylate (HEMA) as well as in hard (polymethylmethacrylate, PMMA) contact lens wear. These conditions could reduce visual acuity. When contact lens wear was discontinued or when the HEMA or PMMA lenses were replaced by gas-permeable rigid lenses, the lesions gradually diminished and resolved completely in most patients. One possible cause of these opacities is an allergic reaction to thimerosal. Another possible cause is chronic anoxia of the corneal stroma and endothelium. Endothelial cell density was not abnormal, but there was a marked polymegethism of the endothelium as a sign of endothelial stress.     

Interstitial cells subjacent to the entorhinal region expressing somatostatin-28 immunoreactivity are susceptible to development of Alzheimer's disease-related cytoskeletal changes

Interstitial cells are isolated neurons located in the infracortical white matter that are known to express neuropeptides. Twenty-four cases selected for the absence, slight (Braak stages I-II), moderate (Braak stages III-IV), or serious degree (Braak stages V-VI) of cortical neurofibrillary pathology were studied for the presence of Alzheimer's disease-related abnormal tau in interstitial cells of the entorhinal region. AT8-immunoreactive white matter neurons were observed in all Braak stages of cortical neurofibrillary pathology. Both normal-appearing neurons and neurons with degenerative changes in the cellular processes were observed. Normal-appearing cells were predominantly found in stages I and II, whereas degenerative interstitial cells numerically increased from stage I onwards. The normal-appearing cells were medium-sized (10-25 micro m), with ovoid, fusiform, triangular or multipolar cell bodies, and showed an extensive dendritic field, which was oriented perpendicular to the direction of the perforant pathway. Since the morphology of the AT8-immunopositive normal-appearing cells was similar to that reported on somatostatinergic interstitial cells subjacent to the entorhinal region, double-labeling with AT8 and anti-somatostatin-28 (S309) was performed. All AT8-immunoreactive normal-appearing interstitial cells revealed co-staining with somatostatin-28 antiserum, whereas some of the AT8-immunopositive cells with degenerative processes reacted positively and others negatively with S309. In summary, a distinctive interstitial cell type characterized by extensive arborization oriented perpendicular to the course of the perforant pathway and showing somatostatin expression is susceptible to developing the Alzheimer's disease-related cytoskeletal changes. Progression in cytoskeleton change is accompanied by loss of somatostatin.     

Diagnostic criteria used in studies of reflex sympathetic dystrophy

OBJECTIVE: Assessment of the diagnostic criteria of reflex sympathetic dystrophy (RSD) and evaluation of the impact of the introduction of the diagnostic criteria of complex regional pain syndrome (CRPS) on the international application of diagnostic criteria of RSD. METHODS: Randomized controlled trials and clinical investigations, published between January 1980 and June 2000, were evaluated with regard to the applied diagnostic criteria of RSD. RESULTS: One hundred seven studies were identified. Thirty-four of these studies were excluded because of inadequate reporting of diagnostic criteria. The 73 included studies were not homogeneous with regard to the diagnostic criteria because they applied many different aspects of sensory and autonomic features. Only 12% of the studies considered the presence of motor features, mostly vaguely described, as mandatory for the diagnosis RSD. Although 10 of the 23 studies published since the introduction of CRPS have applied this term, only 3 used the exact criteria without additions or other modifications. CONCLUSION: Diagnostic criteria sets of RSD focus on many different aspects of sensory and autonomic features that generally are described vaguely. This has not changed since the introduction of the CPRS criteria. These findings question whether the current criteria adequately define RSD.