Oral streptogramins in the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections

OBJECTIVES

Chronic methicillin-resistant Staphylococcus aureus (MRSA) infections in debilitated patients are difficult to treat. We studied the clinical efficacy and safety of an oral streptogramin, pristinamycin, for these patients.

PATIENTS AND METHODS

Patients were admitted consecutively to receive pristinamycin, usually with doxycycline, for 7-21 days. Fifty-six patients (average age 75 years) from hospital and community were treated for skin, soft tissue, chest and other infections.

RESULTS

The overall clinical response rate was 39 of 53 patients (74%; 95% CI: 60%, 85%) cured or substantially improved, from 53 of 56 (95%) patients clinically and 49 of 56 (87.5%) patients bacteriologically evaluable. Toxic effects comprised gastrointestinal disturbances in eight patients (14%) and one (2%) possible skin rash.

CONCLUSION

This study suggests that oral streptogramins may be useful in the management of debilitated patients with MRSA infections.

A capture-recapture model to estimate prevalence of children born in Scotland with developmental eye defects

BACKGROUND

Microphthalmia, anophthalmia and coloboma (MAC) are closely related structural developmental eye defects that have caused public concern in the UK following media reports of apparent clusters of cases. An extensive search was carried out to identify potential cases, and diagnoses were confirmed by ophthalmological review. Despite this effort, it was recognised that some cases would remain unidentified. Capture-recapture methods could improve the accuracy of the study's birth prevalence estimate.

METHODS

A register of all children born with the developmental eye defects of MAC in Scotland (1981-96) was compiled. This identified 188 cases from eight national ascertainment sources. The methods described by Hook and Regal were used to determine possible estimates for each source. A log-linear method of capture-recapture was used to fit a model to the number of children identified by the different combinations of the eight national sources, and the individual sources were included in the model as main effects.

RESULTS

Maximum-likelihood estimates were calculated for tables of captured/not captured by one source versus any other source. The estimated number of unobserved cases for the most complete source, the register of congenital anomalies for Scotland, and the seven others combined is 78 (95% CI 53-115). Estimates calculated from two different log-linear models of the numbers of cases unobserved by all sources were 61 (95% CI 43-86) and 175 (95% CI 106-287). An external check with an independent congenital-anomalies register in one region, which is known to have high completeness, gave an estimate of 120. The study found a birth prevalence of MAC in Scotland of 1.9/10000, based on total live births during the study period. The capture-recapture analysis suggests that the true birth prevalence lies between 2.4/10 000 and 3.5/10000.

DISCUSSION

Our experience shows that, even with multiple sources of ascertainment and considerable resources directed at case identification, a considerable level of under-ascertainment of congenital eye-anomalies still results, and suggests that the use of capture-recapture analysis would be a useful addition to congenital anomalies registers for needs assessment, disease-burden estimates and health-service planning.

Gingivitis and toothbrushes: potential roles in viridans streptococcal bacteraemia

We report a case of Streptococcus oralis bacteraemia in a paediatric neutropenic patient with acute myeloid leukaemia whose predominant form of oral compromise was severe gingivitis, rather than mucositis. By phenotypic and genotypic analyses, the strain of S. oralis from blood culture was indistinguishable from an isolate from his mouth, suggesting that gingivitis may have provided a portal of entry for viridans streptococci into the bloodstream. To improve the patient's oral and dental hygiene and reduce gingivitis, conventional disposable foam toothettes were substituted with a new soft toothbrush for use as part of the oral care protocol. As there are no guidelines regarding the frequency of replacement of toothbrushes used by immunocompromised patients, the brush was swabbed regularly and culture performed to detect microbial colonization. Viridans streptococci were cultured from the toothbrush after 2 weeks of use. Phenotypic, followed by genotypic analyses, demonstrated that a strain of S. oralis from the toothbrush was indistinguishable from the strain previously isolated from blood culture and mouth. Soft toothbrushes may be useful tools for maintaining oral hygiene in immunocompromised individuals. However the results of this study indicate that regular replacement is warranted, as the toothbrush itself may become colonized with the organisms responsible for bacteraemia.

The BIMDA shuttle flight mission: a low cost microgravity payload

This paper presents the design, operation and experiment protocol of the Bioserve sponsored flights of the ITA Materials Dispersion Apparatus Payload (BIMDA) flown on the Space Shuttle on STS-37. The BIMDA payload represents a joint effort between ITA (Instrumentation Technology Associates, Inc.) and Bioserve Space Technologies, a NASA Center for the Commercial Development of Space, to investigate the methods and commercial potential of biomedical and fluid science applications in the microgravity environment of space. The BIMDA payload, flown in a Refrigerator/Incubator Module (R/IM) in the Orbiter middeck, consists of three different devices designed to mix fluids in space; four Materials Dispersion Apparatus (MDA) Minilabs developed by ITA, six Cell Syringes, and six Bioprocessing Modules both developed by NASA JSC and Bioserve. The BIMDA design and operation reflect user needs for late access prior to launch (<24 h) and early access after landing (<2 h). The environment for the payload is temperature controlled by the R/IM. The astronaut crew operates the payload and documents its operation. The temperature of the payload is recorded automatically during flight. The flight of the BIMDA payload is the first of two development flights of the MDA on the Space Shuttle. Future commercial flights of ITA's Materials Dispersion Apparatus on the Shuttle will be sponsored by NASA's Office of Commercial Programs and will take place over the next three years. Experiments for the BIMDA payload include research into the following areas: protein crystal growth, thin film membrane casting, collagen formation, fibrin clot formation, seed germination, enzymatic catalysis, zeolite crystallization, studies of mixing effects of lymphocyte functions, and solute diffusion and transport.

National study of microphthalmia, anophthalmia, and coloboma (MAC) in Scotland: investigation of genetic aetiology

We report an epidemiological and genetic study attempting complete ascertainment of subjects with microphthalmia, anophthalmia, and coloboma (MAC) born in Scotland during a 16 year period beginning on 1 January 1981. A total of 198 cases were confirmed giving a minimum live birth prevalence of 19 per 100 000. One hundred and twenty-two MAC cases (61.6%) from 115 different families were clinically examined and detailed pregnancy, medical, and family histories obtained. A simple, rational, and apparently robust classification of the eye phenotype was developed based on the presence or absence of a defect in closure of the optic (choroidal) fissure. A total of 85/122 (69.7%) of cases had optic fissure closure defects (OFCD), 12/122 (9.8%) had non-OFCD, and 25/122 (20.5%) had defects that were unclassifiable owing to the severity of the corneal or anterior chamber abnormality. Segregation analysis assuming single and multiple incomplete ascertainment, respectively, returned a sib recurrence risk of 6% and 10% in the whole group and 8.1% and 13.3% in the OFCD subgroup. Significant recurrence risks were found in both unilateral and bilateral disease. In four families, one parent had an OFCD, two of which were new diagnoses in asymptomatic subjects. All recurrences in first degree relatives occurred in the OFCD group with a single first cousin recurrence seen in the non-OFCD group. A total of 84/122 of the MAC cases were screened for mutations in the coding regions of PAX6, CHX10, and SIX3. No pathogenic mutations were identified in the OFCD cases. A single PAX6 homeodomain missense mutation was identified in a subject with partial aniridia that had been initially misclassified as coloboma.

2-Aryl indole NK(1) antagonists: optimisation of the amide substituent

The in vivo properties of a series of 2-arylindole NK(1) antagonists have been improved, by modification of the amide substituent. The 1-(2-methoxyphenyl)piperazine amide was identified as a major area of metabolism in the lead compound 1. Replacement of this amine moiety by a 4-benzyl-4-hydroxypiperidine resulted in a compound 18 with reduced clearance and improved central duration of action.

Determination of the collisionally activated dissociation of a substituted indole by orthogonal acceleration quadrupole time-of-flight mass spectrometry

The use of orthogonal acceleration quadrupole time-of-flight (Q-TOF) mass spectrometry to determine the collisionally activated dissociation (CAD) of a test compound 1-(3-[5-[1,2,4-triazol-4-yl]-1H-indol-3-yl]propyl)-4-(2-[3-fluorophenyl]ethyl)piperazine is described. At unit-mass resolution the identity of many ions is ambiguous because of the complexity of the resulting product ion spectrum. Using the high resolution capabilities of the Q-TOF instrument, exact masses for each fragment were determined. These data were used to infer molecular formulas for each fragment through software interpretation and, by further applying chemical intuition, the majority of ions were fully assigned. Additionally, by utilizing in-source fragmentation at high cone voltage, analyses of second-generation products allowed derivation of a consistent sequential fragmentation pathway. This study clearly demonstrates the power of Q-TOF mass spectrometry to elucidate complex product ion spectra.

2-Aryl indole NK1 receptor antagonists: optimisation of indole substitution

The synthesis and biological evaluation of a series of 2-aryl indoles with high affinity for the human neurokinin-1 (hNK1) receptor are reported, concentrating on optimisation of the indole substitution.

What do we need for robust, quantitative health impact assessment?

Health impact assessment (HIA) aims to make the health consequences of decisions explicit. Decision-makers need to know that the conclusions of HIA are robust. Quantified estimates of potential health impacts may be more influential but there are a number of concerns. First, not everything that can be quantified is important. Second, not everything that is being quantified at present should be, if this cannot be done robustly. Finally, not everything that is important can be quantified: rigorous qualitative HIA will still be needed for a thorough assessment. This paper presents the first published attempt to provide practical guidance on what is required to perform robust, quantitative HIA. Initial steps include profiling the affected populations, obtaining evidence for postulated impacts, and determining how differences in subgroups' exposures and susceptibilities affect impacts. Using epidemiological evidence for HIA is different from carrying out a new study. Key steps in quantifying impacts are mapping the causal pathway, selecting appropriate outcome measures and selecting or developing a statistical model. Evidence from different sources is needed. For many health impacts, evidence of an effect may be scarce and estimates of the size and nature of the relationship may be inadequate. Assumptions and uncertainties must therefore be explicit. Modelled data can sometimes be tested against empirical data but sensitivity analyses are crucial. When scientific problems occur, discontinuing the study is not an option, as HIA is usually intended to inform real decisions. Both qualitative and quantitative elements of HIA must be performed robustly to be of value.

Bacteriostatic activity of human lactoferrin against Staphylococcus aureus is a function of its iron-binding properties and is not influenced by antibiotic resistance

The in vitro antistaphylococcal activity of lactoferrin and the antibiotic resistance of clinical Staphylococcus aureus isolates obtained from three different sites of infection were examined. Antibiotic, but not lactoferrin resistance correlated with selective antibiotic pressure, and nosocomial and most community isolates were antibiotic resistant, whereas only a third of each group was resistant to lactoferrin. The antimicrobial activity of lactoferrin, both in defined medium and in normal human plasma serum, was dependent upon its ferrochelating properties. Therapeutic approaches based on the use of ferrochelating agents such as lactoferrin combined with antimicrobial drugs may help to counteract the reduced efficacy of current antibiotics.

Health effects of housing improvement: systematic review of intervention studies

OBJECTIVE

To review the evidence on the effects of interventions to improve housing on health.

DESIGN

Systematic review of experimental and non-experimental housing intervention studies that measured quantitative health outcomes.

DATA SOURCES

Studies dating from 1887, in any language or format, identified from clinical, social science, and grey literature databases, personal collections, expert consultation, and reference lists.

MAIN OUTCOME MEASURES

Socioeconomic change and health, illness, and social measures.

RESULTS

18 completed primary intervention studies were identified. 11 studies were prospective, of which six had control groups. Three of the seven retrospective studies used a control group. The interventions included rehousing, refurbishment, and energy efficiency measures. Many studies showed health gains after the intervention, but the small study populations and lack of controlling for confounders limit the generalisability of these findings.

CONCLUSIONS

The lack of evidence linking housing and health may be attributable to pragmatic difficulties with housing studies as well as the political climate in the United Kingdom. A holistic approach is needed that recognises the multifactorial and complex nature of poor housing and deprivation. Large scale studies that investigate the wider social context of housing interventions are required.

Quantitative determination of L-775,606, a selective 5-hydroxytryptamine 1D agonist, in rat plasma using automated sample preparation and detection by liquid chromatography-tandem mass spectrometry

L-775,606 is under investigation as a selective 5-hydroxytryptamine 1D agonist for the treatment of migraine. A reliable and sensitive method for the analysis of L-775,606 in plasma was required in order to support preclinical evaluation of this compound. A semi-automated sample preparation method using the Beckman Biomek 2000 workstation to perform all liquid handling tasks has been established. The sample analysis was performed using HPLC-MS-MS with a cycle time of 3.5 min per sample. Intra- and inter-day assay accuracy and precision are excellent with a calibration range of 1-2000 ng/ml and a reproducible limit of quantification of 1 ng/ml.

Progressive peripheral agraphia

We describe RW, a patient who presented with writing difficulty that deteriorated over time. While her graphemes were typically legible, her writing was extremely slow, and her letters were written in an inconsistent and heterogeneous manner (e.g. each "a" in the word "banana" was produced in a different way). Her mental imagery of letters was impoverished, and she also produced allographic errors in her writing. She had some spelling errors as well, but many of these were due to omissions, perseverations, and motor operations. A positron emission tomography scan demonstrated superior parietal occipital and superior frontal defects that were more evident on the left than the right. Our observations are consistent with the hypothesis that RW has a deficit retrieving physical letter forms as manifested by her heterogeneous and slow production of letter forms. This disruption of grapheme retrieval is associated with interruption of a superior frontal-parietal system in the left hemisphere.

The NASA astrobiology program

The new discipline of astrobiology addresses fundamental questions about life in the universe: "Where did we come from?" "Are we alone in the universe?" "What is our future beyond the Earth?" Developing capabilities in biotechnology, informatics, and space exploration provide new tools to address these old questions. The U.S. National Aeronautics and Space Administration (NASA) has encouraged this new discipline by organizing workshops and technical meetings, establishing a NASA Astrobiology Institute, providing research funds to individual investigators, ensuring that astrobiology goals are incorporated in NASA flight missions, and initiating a program of public outreach and education. Much of the initial effort by NASA and the research community was focused on determining the technical content of astrobiology. This paper discusses the initial answer to the question "What is astrobiology?" as described in the NASA Astrobiology Roadmap.

Semi-inclusive lambda and K(S) production in p-Au collisions at 17.5 GeV/c

The first detailed measurements of the centrality dependence of strangeness production in p-A collisions are presented. Lambda and K(S) dn/dy distributions from 17.5 GeV/ c p-Au collisions are shown as a function of "grey" track multiplicity and the estimated number of collisions, nu, made by the proton. The nu dependence of the Lambda yield deviates from a scaling of p-p data by the number of participants, increasing faster than this scaling for nu</=5 and saturating for larger nu. A slower growth in K(S) multiplicity with nu is observed, consistent with a weaker nu dependence of K&Kmacr; production than YK production.

Beyond the exchange--the future of B2B

Using the Internet to facilitate business-to-business commerce promises many benefits, such as dramatic cost reductions and greater access to buyers and sellers. Yet little is known about how B2B e-commerce will evolve. The authors argue that changes in the financial services industry over the past two decades provide important clues. Exchanges, they say, are not the primary source of value in information-intensive markets; value tends to accumulate among a diverse group of specialists that focus on such tasks as packaging, standard setting, arbitrage, and information management. Because scale and liquidity are vitally important to efficient trading, today's exchanges will consolidate into a relatively small set of mega-exchanges. Originators will handle the origination and aggregation of complex transactions before sending them on to mega-exchanges for execution. E-speculators, seeking to capitalize on an abundance of market information, will tend to concentrate where relatively standardized products can be transferred easily among a large group of buyers. In many markets, a handful of independent solution providers with well-known brand names and solid reputations will thrive alongside mega-exchanges. Sell-side asset exchanges will create the networks and provide the tools to allow suppliers to trade orders among themselves, sometimes after initial transactions with customers are made on the mega-exchanges. For many companies, traditional skills in such areas as product development, manufacturing, and marketing may become relatively less important, while the ability to understand and capitalize on market dynamics may become considerably more important.

Determination of the in vitro metabolism of (+)- and (-)-epibatidine

The oxidative in vitro metabolism of epibatidine was investigated using liver microsomes from rat, dog, rhesus monkey and human. Analysis was performed using liquid chromatography-mass spectrometry (LC-MS) using both achiral and chiral stationary phases. Comparison of the metabolism of the (+)- and (-)-enantiomers revealed species differences in the extent of metabolism, with rhesus monkey>dog>rat=human. Furthermore, differences in the routes of metabolism for epibatidine enantiomers were also observed, with mass spectra consistent with hydroxylation of the azabicycle for (-)-epibatidine and with the formation of diastereomeric N-oxides for (+)-epibatidine being obtained. For chiral LC-MS, a volatile ion-pair reagent of heptafluorobutyric acid was used in place of pentanesulphonic acid with no deterioration in chiral selectivity. Analysis of the same samples by chiral LC-MS revealed no evidence for metabolic chiral interconversion and chiral analysis from a metabolic time course of racemic material revealed enantiomers to be metabolised to approximately the same extent. Such findings may be important particularly should epibatidine be investigated in non-rodent species.