Loracarbef versus penicillin VK in the treatment of streptococcal pharyngitis and tonsillitis in adults.

Loracarbef, a member of a unique class of beta-lactam compounds (carbacephems), has excellent chemical and beta-lactamase stability, as well as documented clinical effectiveness against a broad spectrum of bacteria. Ten-day treatment regimens of loracarbef (200-mg capsule BID or 15 mg/kg/day suspension) and penicillin VK (250-mg capsule QID or 20 mg/kg/day suspension) were compared in the treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis and tonsillitis. Adults (greater than or equal to 12 years of age) were administered loracarbef (n = 58) or penicillin (n = 58) in a double-blind, randomized, parallel study of clinical and bacteriologic response to treatment. Favorable clinical responses among qualified (evaluable) patients in the loracarbef-treated group (46/47; 97.9%) were similar to those for evaluable patients in the penicillin-treated group (43/43; 100%). Forty-one of 47 (87.2%) of the evaluable loracarbef-treated patients and 100% (43/43) of the evaluable penicillin-treated patients had negative posttherapy throat cultures for GABHS. Thirty-nine evaluable patients in each treatment group were assessed 28 to 35 days after completion of therapy: 2.6% of patients in each group experienced relapse of symptoms; and 7.7% of loracarbef-treated patients had positive cultures, compared to 12.8% of penicillin-treated patients. Two (1.9%) loracarbef-treated patients with rashes and one (0.9%) penicillin-treated patient with diarrhea withdrew from the study due to these adverse events. Diarrhea, the most frequently occurring adverse event during therapy in the loracarbef group, was reported by 8.6% of the loracarbef group and by 5.2% of the penicillin group. These data support the conclusion that loracarbef is comparable in safety and efficacy to penicillin VK for the treatment of streptococcal pharyngitis and tonsillitis in adults.     

Clinical experience using cultured epithelial autografts leads to an alternative methodology for transferring skin cells from the laboratory to the patient

We report a 10-year audit using cultured epithelial autografts (CEAs) for patients with extensive burns. Clinical take using CEAs averaged only 45% (as has been reported by others) but over half of all cells cultured for these patients had to be discarded owing to difficulties of timing the production of CEA sheets to the needs of the patients. CEAs could not be used until they had reached confluence and formed an integrated sheet, which took, on average, 12 days. However, once formed, they needed to be used within 2-3 days or they lost the ability to attach to wound beds. In response to this we developed a simpler carrier dressing methodology for transferring cultured subconfluent keratinocytes from the laboratory to the wound bed. This methodology offers an increase in speed of delivery but its major contribution is the greater flexibility in timing the transfer of cells from the laboratory to the changing needs of the patients.     

Nutrient intakes and foods selected by college students: comparisons among subgroups divided by energy intake

Food consumption patterns of college students, divided into subgroups of men (no. = 58), women with mean energy intakes greater than 1,200 kcal (no. = 192), and women consuming less than 1,200 kcal (no. = 53), were studied using 3-day food records. Patterns of nutrient intakes, eating frequency, and types of food eaten differed among subgroups. Women with less than 1,200 kcal had lower intakes of protein, carbohydrate, fat, calcium, iron, thiamin, riboflavin, and niacin; they ate less frequently; and they ate less meat and eggs, legumes, bread, cooked starchy vegetables, milk products, desserts, added fat, and added sugar than did men and women whose mean energy intakes exceeded 1,200 kcal. There were differences between the latter two groups for 10 nutrients and for intakes of fluid milk, meat and eggs, legumes, bread, cooked starchy vegetables, alcoholic beverages, and noncarbonated, sweetened beverages. Diets of men met the RDAs for all nutrients calculated, and diets of women whose intakes exceeded 1,200 kcal met all RDAs except that for iron. Group mean intakes of women with less than 1,200 kcal did not meet the RDAs for calcium, iron, thiamin, riboflavin, and niacin. However, the subgroup with intakes less than 1,200 kcal consumed food of greater nutrient density than did other college students.     

Ethics and society: Review of the organized support network for infertility patients in licensed units in the UK

In acknowledging that ‘counselling is generally recognizedas beneficial’, the Human Fertilization and EmbryologyAuthority (HFEA) Code of Practice requires that all infertilityunits provide counselling facilities to be available for patients.In this study, we intended to evaluate the support and counsellingservices made available by the licensed units in the UK. A questionnaireconsisting of 30 questions was designed and sent to every licensedtreatment unit in the UK. The data were coded on a nominal scaleand, using a data entry program, loaded onto a computer. Usingthe Statistical Package for the Social Sciences program, a non-parametricfrequency analysis was performed. Associations were examinedwith cross-tabulations and x² analysis. A total of 62 units(61.4%) responded to the questionnaire, from both the privateand National Health Service sectors. Of these, 95% have theirown counsellor, most of whom (84%) practised on the premises.One-third of these counsellors had a dual role, mainly as nurses,social workers or in administration; 98.6% were trained in counselling,with only 28% having either the Certificate or Diploma in Counselling.One-third (32.2%) of centres charged for counselling, with only13 units indicating their charges. The majority of centres (78.8%)do not actively follow-up patients after counselling and one-quarter(25.5%) did not have a specific counselling room. Over two-thirds(68.4%) of centres described their support network as adequate.The results of this survey suggest that, although the requirementsof the HFEA Code of Practice are being adhered to reasonablywell, overall patient uptake of counselling is low. The potentialbenefits of counselling are well documented, and therefore workersin this field need to place additional emphasis on the possibleadvantages of counselling in an effort to improve uptake.     

Screen‐detected colorectal cancers show improved cancer‐specific survival when compared with cancers diagnosed via the 2‐week suspected colorectal cancer referral guidelines

Aim Biennial screening for colorectal cancer using faecal occult blood testing has been shown to reduce the relative risk of mortality from colorectal cancer. The Norwich screening centre commenced screening in July 2006 and so far has diagnosed over 350 patients with colorectal cancer. We compared the stage at diagnosis and cancer‐specific mortality and survival in patients diagnosed through screening with a cohort of symptomatic patients with colorectal cancer within the same age range. Method A comparative analysis was undertaken of all screen‐detected colorectal cancer patients diagnosed between July 2006 and December 2010, with an age‐matched group of patients diagnosed in the Norfolk and Norwich Hospital through the 2‐week suspected colorectal cancer guidelines. Results Three hundred and fifty‐six cases of colorectal cancer were diagnosed through the screening programme, in patients with an age range of 60–79 years. In the same time period, 292 patients in the same age range were diagnosed with colorectal cancer through the 2‐week suspected colorectal cancer pathway. Sixteen patients in the screening group had evidence of metastatic disease at presentation compared with 62 in the symptomatic group (χ², P < 0.001). The proportion of T1/T2 and Dukes A cancers was significantly greater in the screening group (χ², P < 0.001). There were 21 colorectal cancer‐related deaths in the screening group compared with 66 in the symptomatic group. Survival analysis curves showed significantly better survival in the screening group (log‐rank analysis P < 0.001). Conclusion Screening for colorectal cancer identifies cancers at a significantly earlier stage than in symptomatic patients, with subsequent improvement in cancer‐specific survival.     

Incidence of vomiting in burns and implications for mass burn casualty management

When faced with large numbers of burn patients and limited resources such as in war or disaster, oral fluids may be used as an alternative to intravenous resuscitation. Vomiting during the first 48 h can limit the usefulness of this method; yet its incidence has not been documented. This study aimed to identify those patients at risk of vomiting following burn injury and who therefore might be suitable for oral resuscitation. A retrospective review of case notes from burn patients between 1990 and 2001 was undertaken. Burns requiring intravenous resuscitation (>10% total body surface area (TBSA) in children, >15% TBSA in adults) were included (n=110). Documentation of vomiting during the first 48 h following burn injury to an extent that prevented commencement of feeding was regarded as significant. Patients that vomited were significantly older (28.3 years compared with 18.5 years, P=0.03), and had sustained significantly larger burns (29.8% compared with 22.9%, P=0.047). Administration of opiates and anti-emetics was similar in both groups and not significant. Although the number of patients in this study excludes a logistic regression analysis, it would seem reasonable to attempt oral resuscitation in patients under 25 years of age and with burns up to 25% TBSA given limited resources.     

Treatment of burns and chronic wounds using a new cell transfer dressing for delivery of autologous keratinocytes

This study describes a new methodology for delivering cultured autologous keratinocytes to wounds on a sterile medical grade polymer coated with a chemically defined plasma polymerised functional surface containing 20% carboxylic acid (referred to as PPS). Seven patients (two acute major burns and five chronic non-healing wounds) were treated with applications of autologous keratinocytes delivered on a 6 cm diameter medical grade polymer disc whose surface was functionalised by PPS. For initial keratinocyte expansion a split-thickness skin biopsy was taken from each patient followed by keratinocyte isolation and expansion and, where required for repeated applications, freezing down of keratinocytes. After expansion, cells were cultured on the PPS for 2 days then the PPS with cells was inverted onto the patients wound bed to allow cell transfer to wound beds. For two burns patients transfer of cells from PPS onto donor sites was seen for both patients and it appeared to facilitate healing of grafted burns wounds. For five patients with intractable chronic wounds (with nine ulcers in total) repeated applications of cells resulted in complete healing in 5/9 ulcers with a major reduction in ulcer size for all other (4/9) ulcers. This reduction in ulcer size improved the wound conditions for two of these patients such that they were then considered suitable for conventional grafting and orthopaedic surgery respectively. In conclusion, PPS delivery of autologous cells is a promising approach for acute burns injuries and chronic wounds.This paper is dedicated to the memory of Mr Archibald Newman (Patient 3) who sadly died in January 2005.