Evaluation of the IRIS 939 UDx flow microscope as a screening system for urinary tract infection

AIMS

To evaluate the IRIS flow microscope for the examination of urine specimens and to compare its performance with that of manual methods; in addition, to assess its usefulness as a screening system for the detection of significant bacteriuria in a routine clinical laboratory.

METHODS

The IRIS system was compared with manual quantitative microscopy for the detection of formed elements and with a variety of culture methods to detect urinary tract infection.

RESULTS

The IRIS had a higher sensitivity for the detection of clinically significant formed elements than did manual methods, and using a combination of bacterial and white cell counts produced a sensitivity and specificity of 94.9% and 54.4%, respectively, for predicting positive significant growth, with a 98.5% predictive value for a negative result. Approximately 50% of specimens could be reported as negative on the day of receipt using the screening algorithm.

CONCLUSIONS

The sensitivity and specificity of the IRIS is equivalent to that of other automated screening systems and would remove the need for manual microscopy for most specimens. The system was easy to operate and is a useful addition to the methods currently available for the examination of urine specimens.

Malaria prophylaxis for long-term travellers

These guidelines are designed to assist healthcare workers who are advising long-term travellers on malaria prophylaxis, defined for the purpose of this document as those travelling for longer than 6 months. The document focuses on long-term use of antimalarials for adults, but also identifies specific issues for women and children. However, data on the long-term use of antimalarials is limited for all travellers and few data are available on the incidence of malaria in travellers overseas or, indeed, deaths overseas from malaria. Whilst all available evidence is taken into account, the advice provided also reflects experienced professional opinion. This document has been written on behalf of the Health Protection Agency's Advisory Committee on Malaria Prevention for UK Travellers, and is designed to act as a supplement to the 'Guidelines for malaria prevention in travellers from the United Kingdom for 2003'. The latter document contains a more complete description of antimalarials and additional preventive measures, together with recommendations for malaria chemoprophylaxis for individuals countries. Decisions on the terms under which different drugs are licensed for use are the responsibility of the Committee on Safety of Medicines. This paper should also, therefore, be used in conjunction with Summary of Product Characteristics (data sheets).

Cognitive effects of olanzapine and clozapine treatment in chronic schizophrenia

RATIONALE

Schizophrenia patients are known to manifest widespread, multifaceted cognitive deficits. There is now an increasing emphasis on the critical importance of cognitive deficits for the functional outcome in schizophrenia. Typical antipsychotics, although effective in reducing positive symptoms of the illness, have not shown much effect on cognitive functions. Atypical antipsychotics have shown promise of improving some cognitive functions.

OBJECTIVES

This naturalistic study aimed to determine whether olanzapine and clozapine improve cognitive functioning in a sample of 48 patients with chronic schizophrenia who had either failed to show sufficient clinical improvements or suffered from distressing side effects with conventional antipsychotics and were switched to either olanzapine or clozapine for clinical reasons and, if so, whether the two drugs produce similar or different cognitive effects.

METHODS

All patients completed a comprehensive battery of neuropsychological tests designed to index executive functioning, verbal learning, verbal and visual and memory, attention, working memory, and psychomotor speed at: (i) baseline, (ii) after 6 weeks and (iii) after 6 months of treatment with olanzapine or clozapine.

RESULTS

From the initial 48 patients who remained on olanzapine ( n=16) or clozapine ( n=14) for the entire duration with continuous participation, 30 provided data for this study. There were improvements over time (i.e. from baseline through 6 weeks to 6 months) in both treatment groups on verbal fluency, verbal learning and verbal and visual memory measures.

CONCLUSIONS

The findings indicate similar beneficial effects of olanzapine and clozapine on verbal learning and memory measures in patients showing a favourable clinical response to these drugs.

Characterization of mesenchymal stem cells isolated from murine bone marrow by negative selection

Mesenchymal stem cells (MSCs) are typically enriched from bone marrow via isolation of the plastic adherent, fibroblastoid cell fraction. However, plastic adherent cultures elaborated from murine bone marrow are an admixture of fibroblastoid and hematopoietic cell types. Here we report a reliable method based on immunodepletion to fractionate fibroblastoid cells from hematopoietic cells within plastic adherent murine marrow cultures. The immunodepleted cells expressed the antigens Sca-1, CD29, CD44, CD81, CD106, and the stem cell marker nucleostemin (NST) but not CD11b, CD31, CD34, CD45, CD48, CD90, CD117, CD135, or the transcription factor Oct-4. They were also capable of differentiating into adipocytes, chondrocytes, and osteoblasts in vitro as well as osteoblasts/osteocytes in vivo. Therefore, immunodepletion yields a cell population devoid of hematopoietic and endothelial cells that is phenotypically and functionally equivalent to MSCs. The immunodepleted cells exhibited a population doubling time of approximately 5-7 days in culture. Poor growth was due to the dramatic down regulation of many genes involved in cell proliferation and cell cycle progression as a result of immunodepletion. Exposure of immunodepleted cells to fibroblast growth factor 2 (FGF2) but not insulin-like growth factor (IGF), murine stem cell factor, or leukemia inhibitory factor (LIF) significantly increased their growth rate. Moreover, 82% of the transcripts down regulated by immunodepletion remain unaltered in the presence of FGF2. Exposure to the later also reversibly inhibited the ability of the immunodepleted cells to differentiate into adipocytes, chondrocytes, and osteoblasts in vitro. Therefore, FGF2 appears to function as a mitogen and self-maintenance factor for murine MSCs enriched from bone marrow by negative selection.

Physician and family assisted suicide: results from a study of public attitudes in Britain

Legalisation of assisted suicide presents a dilemma for society. This arises because of a lack of consensus regarding the precedence to be accorded freedom of choice versus the inviolability of human life. Several factors including improvements in medical technology, population ageing and changing perceptions about quality of life serve to make a re-examination of attitudes to this issue appropriate at this time. Within this context, data from the 1983, 1984, 1989 and 1994 British Social Attitudes Surveys (BSAS) were examined. These demonstrate a slight increase in support for physician-assisted suicide (PAS) from around 75% to around 84% over the 11-year period in Britain. A much lower level of support (54%) was recorded in relation to family-assisted suicide (FAS). A logistic regression analysis of data from the 1994 survey was undertaken to establish the relationship between attitudes toward legalisation of PAS and FAS and the characteristics of the respondent. Strength of religious affiliation was found to be a significant determinant of opposition to legalisation of both. Religious denomination was found to be marginally significant in relation to PAS but not FAS. Members of the Church of England, non-Christian faiths and those of no faith were found to be marginally more likely to support legalisation of PAS, than Roman Catholics or those of other Christian faiths. Education, income, sex, marital status, long-standing illness and age were not found to be significant predictors of attitude. In relation to FAS age was also found to be significant predictor of opposition. Findings here suggest that if Britain continues to become a more secularised society, support for legalisation of PAS (and FAS) is likely to increase. As health care costs continue to grow and the ability to extend life (even where the quality of that life may be poor) increases, pressure for legalisation of PAS may increase.

Oral weekly ibandronate prevents bone loss in postmenopausal women

OBJECTIVES

To investigate the efficacy, safety, and dose-response of once-weekly oral ibandronate in the prevention of postmenopausal bone loss.

DESIGN

This was a multi-centre, placebo-controlled, double-blind, randomized, 24-month phase II/III dose-finding study.

SETTING

Primary care units in 14 osteoporosis centres.

SUBJECTS

A total of 630 women were stratified into four strata according to time since menopause (TSM, 1-3 vs. >3 years) and baseline bone mineral density (BMD; normal: T-score > or =1 vs. osteopenic: -2.5 < or = T-score < or = 1) of the lumbar spine.

INTERVENTIONS

Within each stratum women were further randomized to receive once-weekly ibandronate (5, 10, or 20 mg week-1) or placebo for 24 months.

MAIN OUTCOME MEASURES

Efficacy parameters were the relative changes from baseline in spine (L1-4) and hip BMD, and biochemical markers of bone turnover (serum and urinary C-telopeptide of collagen type I (CTx), osteocalcin, and alkaline phosphatase) measured by dual energy X-ray absorptiometry and enzyme immunoassays, respectively.

RESULTS

Once-weekly therapy with ibandronate induced dose-dependent increases in spine and hip BMD. At month 24, differences between the relative changes in spine and hip BMD induced by 20 mg ibandronate and placebo was 4.0 and 2.7%, respectively. Similar or more pronounced differences were seen in osteopenic women of TSM 1-3 years (5.3 and 3.5%) and of TSM >3 years (3.5 and 2.9%), respectively. A dose-dependent suppression of all biochemical markers of bone turnover was observed with significant decreases in the 20 mg dose groups of all strata at month 24. The overall safety results indicated that once-weekly oral ibandronate was well-tolerated at all three doses.

CONCLUSION

Once-weekly oral therapy with 20 mg ibandronate provides an effective and safe therapy for the prevention of postmenopausal bone loss.

Computer-assisted instruction: guiding learning through a key features approach in a community-based medical course

Computer assisted instruction (CAI) offers a valuable adjunct to the difficulties encountered in teaching medical students in a community-based course in rural Australia. The paper outlines the educational planning processes behind the project and provide an outline of the modular solution to the task. Preliminary results show that this approach is feasible and acceptable to guide students' learning.

Treatment of hemorrhagic radiation proctitis with 4 percent formalin

PURPOSE

The purpose of this study was to review our results in patients undergoing treatment with 4 percent formalin for radiation-induced injury to the rectum.

METHODS

A retrospective review of office charts was performed, identifying all patients undergoing formalin treatment. Patient gender, initial malignancy, prior treatments, response to treatment with formalin, complications, and length of follow-up were reviewed. All patients had flexible endoscopy to assess for proximal sources of bleeding. The indication for treatment was a symptomatic patient with endoscopic evidence of radiation injury. A cotton pledget was used for direct application of 4 percent formalin to the affected area via a rigid proctoscope or anoscope. The treatment was repeated if blanching did not occur or if bleeding continued. Patients were followed up at three-week to four-week intervals and treatment was repeated based on the above indications. Treatments were continued until cessation of bleeding occurred or, when treatment failed, operative treatment was required.

RESULTS

Thirty-six patients were identified. Three were lost to follow-up. Symptoms included bleeding in all but one patient, who presented with an ulcer. There were 33 (26 male) patients. Seventeen (51.5 percent) patients had prior treatment. The number of formalin treatments ranged from 1 to 13, with a mean of 3.4. The follow-up ranged from 1 to 60 months, with a mean of 18 months. Twenty-nine (88 percent) patients had improvement or cessation of symptoms. Four (12 percent) patients failed treatment. Two patients were noted to have full-thickness ulcers and both failed formalin treatment. No complications were noted related to formalin treatment.

CONCLUSION

We conclude that formalin therapy is a safe and effective form of treatment that can be performed in the office with minimal discomfort and no complications. It can be performed multiple times until results are achieved. Formalin therapy may be useful as a first-line treatment for chronic radiation proctitis, however, a prospective controlled trial comparing modalities is required to prove this to be true.

Longitudinal study of symptoms and cognitive function in chronic schizophrenia

There is conflicting evidence of a relationship between changes in symptoms and cognitive functioning in schizophrenia. This study investigated longitudinal changes in psychopathology and cognitive functioning in chronic schizophrenia utilising three different dimensional models of symptomatology. Sixty-two patients diagnosed with DSM-IV schizophrenia or schizoaffective disorder were examined on two occasions over a period of 6 months for symptom improvement, measured by Positive and Negative Syndrome Scale (PANSS) [Kay et al., Schizophr. Bull. 13 (1987) 261]. Participants also completed a comprehensive battery of neuropsychological tasks designed to assess attention, verbal and non-verbal memory, psychomotor processing and executive/frontal functioning on both occasions. Twenty-five control subjects were assessed for comparison purposes. Severity of negative symptoms predicted poor neuropsychological performance on IQ, verbal fluency and memory measures at occasion one. However, using regression analyses, significant improvements in symptom ratings over time using two-, three- or five-dimensional models did not predict improvements in any aspect of cognitive functioning measured, except motor speed. The results do not suggest a causal relationship between the course of symptoms and neuropsychological functioning in chronic schizophrenia.

A test battery of child development for examining functional vision (ABCDEFV)

A battery of 22 tests is described, intended to give an integrated assessment of children's functional visual capacities between birth and four years of age. As well as sensory visual measures such as acuity, visual fields and stereopsis, the battery is intended to tap a range of perceptual, motor, spatial and cognitive aspects of visual function. Tests have been drawn from practice in ophthalmology and orthoptics, vision research, paediatric neurology, and developmental psychology to give an overall view of children's visual competences for guidance in diagnosis, further investigation, management and rehabilitation of children with developmental disorders. 'Core vision tests' require no motoric capacities beyond saccadic eye movements or linguistic skills and so assess basic visual capacities in children of any age. 'Additional tests' have age-specific requirements and are designed to pinpoint specific deficits in the perceptual, visuo-motor and spatio-cognitive domains. Normative data are reported on nine age groups between 0-6 weeks and 31-36 months, each including 32-43 typically developing children. Pass/fail criteria for each test are defined. These data allow the selection of a subset of tests for each age group which are passed by at least 85% of normally developing children, and so are appropriate for defining normal development. The normalized battery has been applied to a range of at-risk and clinical groups. Aspects of children's visual performance are discussed in relation to neurobiological models of visual development.

Metallothionein in bovine spongiform encephalopathy

An increase in metallothionein I and II (MT I/II) mRNA concentrations has been reported in the central nervous system of scrapie-infected rodents. In this study we compared cattle with bovine spongiform encephalopathy (BSE), cattle affected by neurological disease other than BSE, and clinically healthy cattle in respect of MT I/II immunoreactivity in brainstem medullary tissue. Marked astrocytic MT I/II immunolabelling was seen in all BSE-affected animals, in contrast to clinically healthy cases, in which no such labelling was detected. In BSE, MT I/II immunoreactive astrocytes were confined specifically to areas of vacuolation or abnormal prion protein (PrP(BSE)) deposition, or both. MT I/II immunolabelling was also seen in a small number of animals with a neurological disease other than BSE. These findings complement previous studies by demonstrating increased levels of MT I/II in transmissible spongiform encephalopathy (TSE)-infected brain tissue, indicating that MT I/II may play some as yet unidentified role in the response to TSE infection.

Caring for the chronically ill: a clinic for final-year medical students

In 2000 the Diabetes Centre and the Medical Oncology Department of St Vincent's Hospital, Sydney established a joint clinic for the teaching of final-year medical students. The clinic was established amid concerns that hospitals are increasingly focused on acute care and have few resources available for teaching about chronic conditions. The clinic aimed to improve both patient care and learning opportunities by engaging students in useful activities with chronically ill patients. The students met with their patients regularly to monitor progress, adjust medication (under supervision) and arrange support services. The students and staff from both units met once a week in a coordination meeting where cases were reviewed and learning issues discussed. Students had informal interactions with medical and allied health staff at other times. Overall the clinic provided a rich learning environment for students with a focus on the development of the integrated skills required in the care of chronically ill people, rather than on the specific medical disciplines involved.

Extracranial fasciitis in childhood: a sheep in wolf's clothing

Soft tissue tumours in children are rare, and the differentiation between pseudosarcomatous tumours and sarcomas is difficult. Rapidly-enlarging masses within the head and neck region in infants require rapid diagnosis and prompt definitive treatment to lessen psychological burden on the parents and the surgical team. We present a case of a 17-month-old girl who had a large, rapidly-enlarging soft tissue mass within the maxilla which was excised. The diagnosis of childhood extracranial fasciitis was confirmed histopathologically. We emphasise the importance of conservative excision once the diagnosis has been confirmed.