Conversion of treatment from cefoxitin to ampicillin/sulbactam: experience in a university teaching hospital

A 12-month trial, conducted in a 650-bed university teaching hospital, evaluated the conversion from cefoxitin to ampicillin/sulbactam. This report discusses the methodology used to evaluate the feasibility of the change and the challenges encountered during the trial period. The effect of cost and overall therapeutic outcome were other aspects of the evaluation. Results indicate that a conversion from cefoxitin to ampicillin/sulbactam is not only feasible but is also a realistic approach to achieving high-quality, cost-effective care.     

Infection of sabA-positive H. pylori does not induce anti-Lewis X antibody in host

BACKGROUND/AIMS: H. pylori uses the sialic acid-binding adhesin (SabA) to recognize Lewis X (LeX) antigen of gastric epithelial cells. SabA is associated with nonopsonic activation of human neutrophils. The aims of this study were to examine the association of bacterial sabA status to the presence of anti-LeX antibody in host and the grade of gastritis. METHODOLOGY: 44 H. pylori strains cultured from gastric biopsies were examined by PCR for presence of 23SrRNA, cagA, and sabA. Serum samples were obtained from all the patients to measure the level of anti-LeX antibody. Histological grade of gastritis was graded according to the updated Sydney System. RESULTS: 23SrRNA gene and the cagA gene were seen in all the samples while 21 strains were sabA positive. The mean titer of anti-LeX antibody was 0.09 and 0.18 in patients infected with sabA-positive and -negative strain, respectively (NS). The grade of inflammatory infiltration was not significantly different between groups in both the corpus and the antral mucosa. CONCLUSIONS: Possession of the sabA gene by infected H. pylori strain might not associate with the presence of anti-LeX antibody in the host. Possession of sabA gene by infected H. pylori might not associate with severity of gastric mucosal inflammation.     

Factor analysis of lifestyle-related factors in 12,525 urban Japanese subjects

This study describes the clustering patterns of several lifestyle-related factors in urban Japanese subjects. The effect of aging on these patterns was also investigated. Data of 8 factors that included body mass index (BMI), blood pressure (BP), fasting plasma glucose (FPG), serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLc), gamma-glutamyl-transferase (GGT), and cigarette smoking were analyzed for 12,525 individuals (4,591 men and 7,934 women) aged either 40, 50, or 60 years. Factor analysis showed eight factors clustered into 3 unrelated groups. BMI and BP were excluded in subjects aged 60 years. Our data showed that the effect of obesity on the prevalence of type 2 diabetes mellitus was age dependent. In spite of the established inverse relationship between TG and HDLc, we found that TG had an association with GGT. These results indicated that aging may have a major influence on the expression of multiple risk factors. The influence of BMI on the lifestyle-related factors appeared to be mostly expressed in younger people, while these factors appeared to be independent of BMI at age 60.     

Magnetoencephalographic localization of multiple seizure foci for surgical treatment of intractable frontal lobe epilepsy: confirmation with intra-operative electrocorticography

A successfully treated case of intractable FLE, of which preoperative magnetoencephalography (MEG) provided multiple spike localization and intraoperative corticogram (ECoG) confirmed the resection area. A 22-year-old male patient, with a history of subdural abscess at the age of 14 years, had suffered frequent simple (SPSs) and complex partial seizures (CPSs) and falling attacks since the age of 16 years. Although he underwent corpus callosotomy at the age of 17 years, additional surgical treatment was considered because of intractable and more frequent SPSs and CPSs. Magnetic resonance (MR) imaging demonstrated diffuse lesions in the right frontal lobe. Although, both interictal and ictal electroencephalography (EEG) failed to show focal epileptogenic localization, interictal MEG localized several clusters over the multiple anatomical lesions in the right prefrontal and frontal opercular regions. The patient underwent right fronto-temporal craniotomy, and anterior frontal lobectomy, followed by lesionectomy of the premotor area based on the intraoperative ECoG findings. The ECoG localized frequent spike discharges over the right prefrontal, frontal operculum and premotor cortices, which showed good correspondence with the MEG findings. MEG can be a useful noninvasive method for presurgical evaluation of intractable FLE.