Persistence of location-specific microbial signatures on boats during voyages

Objects collect microorganisms from their surroundings and develop a microbial "fingerprint" that may be useful for determining an object's past location (provenance). It may be possible to use ubiquitous microorganisms for forensics or as environmental sensors. Here, we use microbial communities in the Chesapeake Bay region to demonstrate the use of natural microorganisms as biological sensors to determine the past location of boats. The microbiomes of two boats and of the open water were sampled as these vessels traveled from the Port of Baltimore to the Port of Norfolk, and back to Baltimore. 16S rRNA sequencing was performed to identify microorganisms. Differential abundance and machine learning analyses were utilized to identify microbial signatures and predicted probabilities which were used to determine the vessel's previous location. The work presented here provides a better understanding of how microbes in aquatic systems can be leveraged as utility for object biosensors.

Acupuncture Audit in Rheumatology

Clinically, audit is the systematic, critical analysis of the quality of medical care. In order to indulge in audit it is necessary initially to identify an area of concern and define standards in that area. If there are none generally accepted in the field to be audited then they must be derived from a statement of the ideal situation, tempered with the expectation of current practice.

The advantages of audit are that it encourages education by discussion, can identify the means of improving clinical efficiency and, most importantly, it aims to improve the quality of medical care. Audit is a pointless exercise unless it results in beneficial change. The circle should be completed by monitoring the audit after a suitable interval to assess the extent of any change in practice and to see if there has indeed been an acceptable improvement in quality.

An audit of acupuncture practice in the rheumatology department of the Wycombe Health District resulted in better standardisation of acupuncture usage within the clinics and, by highlighting the degree of patient benefit from this treatment, a more enthusiastic acceptance of the technique by new members of the department. Improved care for patients was seen in the introduction of a check list of contraindications to acupuncture, better provision of information leaflets and explanation of side effects, and more detailed assessment of outcome with better communication with GPs.

Following this positive experience of audit, it is seen as an essential tool in the delivery of modern medical care, despite the time, commitment and hard work that successful audit demands.

Tiaprofenic acid in the treatment of rheumatoid arthritis

Tiaprofenic acid is a new non-steroidal anti-inflammatory agent. Two studies of its use in treating rheumatoid arthritis are reported here. In the first, tiaprofenic acid was compared with phenylbutazone in a double-blind cross-over study of 10 weeks' duration. Both drugs were significantly better than placebo and equal in efficacy with each other. The second study was a long-term open trial of tiaprofenic acid in 20 patients. The drug has been well tolerated over periods of up to three years and its effects in reducing the symptoms and signs of rheumatoid arthritis have been maintained. Side-effects were very few in both studies. Gastro-intestinal symptoms were the most frequently reported. One patient developed melaena three years after starting the drug.

Penicillamine in the treatment of rheumatoid arthritis

Between 1973 and 1979, 203 patients with classical or definite rheumatoid arthritis were treated with chloroquine phosphate, gold, or penicillamine. Of 132 receiving penicillamine, 76 received it as the sole treatment. Forty of 50 withdrawals from penicillamine were side effect-related, although 4 of these 50 subsequently resumed therapy. Nineteen showed no response to penicillamine. Eight-six remained on the drug in early 1980. Penicillamine compares favourably with gold with regard to clinical response, number of side effects, and withdrawal rate of the patients on penicillamine.

Hematologic toxicity from penicillamine in rheumatoid arthritis

The occurrence of thrombocytopenia and leukopenia in association with penicillamine treatment has been described, as have been isolated cases of polycythemia. Thrombocytopenia, which can occur in 8% of rheumatoid arthritis patients treated with penicillamine, is usually readily reversible on drug withdrawal or after lowering the dosage. Leukopenia and bone marrow aplasia are rare in penicillamine treatment and can occur precipitously. Frequently monitoring of all penicillamine recipients is essential to prevent such potentially fatal side effects.

Antirheumatic activity of fenclofenac

This study has set out to establish whether fenclofenac has an antirheumatic effect in addition to its anti-inflammatory and analgesic activity. The results show that during the course of a 6-month study the drug improved clinical parameters, including the articular index, early morning stiffness, ring sizes, and grip strength, and produced changes in laboratory measurements such as the levels of C-reactive protein, IgG, and rheumatoid factor.

Epithelial deposition of gold in the cornea in patients receiving systemic therapy

Epithelial gold deposits were demonstrated biomicroscopically in 13 of 15 patients receiving gold therapy for rheumatoid arthritis. Only one of six further patients who had received gold therapy in the past showed such deposits. Deposits appeared with a cumulative dose of sodium thiomalate exceeding 100 mg. The earliest appearance was after seven months of therapy and deposits were visible in one subject as long as nine months after therapy had stopped. The density of deposit does not appear to increase over the whole of the dose range, possibly as a result of the effect of epithelial turnover. No symptoms attributable to the deposit were encountered in any patient.