Medical information about diabetes--how to keep up to date.

Diabet. Med. 27, 1335-1340 (2010) ABSTRACT: There is a vast amount of new medical information published on diabetes each year; the number of systematic reviews on diabetes is also increasing rapidly. It is therefore difficult for clinicians keep up to date with the new evidence. It is suggested that reading the full National Institute for Clinical Excellence (NICE) guidelines on diabetes will bring you up to date with information as at the date of the evidence cut-off, which is usually approximately 1 year before publication. Also regularly visiting 'NHS Evidence--diabetes', an online resource that offers a foraging service, surveying the literature and alerting clinicians to all the new important and useful information, enables the busy clinician to manage information overload and help keep up to date.

Dissipation of quantum turbulence in the zero temperature limit.

Turbulence, produced by an impulsive spin down from angular velocity Omega to rest of a cube-shaped container, is investigated in superfluid 4He at temperatures 0.08 K-1.6 K. The density of quantized vortex lines L is measured by scattering negative ions. Homogeneous turbulence develops after time t approximately 20/Omega and decays as L proportional, t-3/2. The corresponding energy flux =nu'(kappaL)2 proportional, t-3 is characteristic of quasiclassical turbulence at high Re with a saturated energy-containing length. The effective kinematic viscosity in T=0 limit is nu'=0.003kappa, where kappa=10(-3) cm2 s(-1) is the circulation quantum.

Surveillance for influenza--United States, 1994-95, 1995-96, and 1996-97 seasons.

PROBLEM/CONDITION: Influenza epidemics occur nearly every year during the winter months and are responsible for substantial morbidity and mortality in the United States, including an average of approximately 114,000 hospitalizations and 20,000 deaths per year. REPORTING PERIOD: This report summarizes U.S. influenza surveillance data from October 1994 through May 1997, from both active and passive surveillance systems. DESCRIPTION OF SYSTEM: During the period covered, CDC received weekly reports from October through May from a) state and territorial epidemiologists on estimates of local influenza activity, b) approximately 140 sentinel physicians on their total number of patient visits and the number of cases of influenza-like illness (ILI), and c) approximately 70 World Health Organization (WHO) collaborating laboratories in the United States on weekly influenza virus isolations. WHO collaborating laboratories also submitted influenza isolates to CDC for antigenic analysis. Throughout the year, vital statistics offices in 121 cities reported deaths related to pneumonia and influenza (P&I) weekly, providing a measure of the impact of influenza on mortality. RESULTS: During the 1994-95 influenza season, 25 state epidemiologists reported regional or widespread activity at the peak of the season. Cases of ILI reported by sentinel physicians exceeded baseline levels for 4 weeks, peaking at 5%. Influenza A(H3N2) was the most frequently isolated influenza virus type/subtype. The longest period of sustained excess mortality was 5 consecutive weeks, when the percentage of deaths attributed to P&I exceeded the epidemic threshold, peaking at 7.6%. During the 1995-96 season, 33 state epidemiologists reported regional or widespread activity at the peak of the season. ILI cases exceeded baseline levels for 5 weeks, peaking at 7%. Influenza A(H1N1) viruses predominated, although influenza A(H3N2) and influenza B viruses also were identified throughout the United States. P&I mortality exceeded the epidemic threshold for 6 consecutive weeks, peaking at 8.2%. The 1996-97 season was the most severe of the three seasons summarized in this report. Thirty-nine state epidemiologists reported regional or widespread activity at the peak of the season. ILI reports exceeded baseline levels for 5 consecutive weeks, peaking at 7%. The proportion of respiratory specimens positive for influenza peaked at 34%, with influenza A(H3N2) viruses predominating. Influenza B viruses were identified throughout the United States, but only one influenza A(H1N1) virus isolate was reported overall. The proportion of deaths attributed to P&I exceeded the epidemic threshold for 10 consecutive weeks, peaking at 9.1%. INTERPRETATION: Influenza A(H1N1), A(H3N2), and B viruses circulated during 1994-1997. Local surveillance data are important because of geographic and temporal differences in the circulation of influenza types/subtypes. PUBLIC HEALTH ACTIONS: CDC conducts active national surveillance annually from October through May for influenza to detect the emergence and spread of influenza virus variants and monitor the impact of influenza-related morbidity and mortality. Surveillance data are provided weekly throughout the influenza season to public health officials, WHO, and health-care providers and can be used to guide prevention and control activities, vaccine strain selection, and patient care.

Nonimmunoselected intrastrain genetic variation detected in pairs of high-yielding influenza A (H3N2) vaccine and parental viruses.

Seven influenza A (H3N2) high-yielding vaccine candidate strains were examined. Antigenic analysis revealed that 5 of the strains could be distinguished antigenically from their corresponding wild type parent viruses. Comparative sequence data for the HA1 domains of the HA (hemagglutinin) genes for these 5 high-yielding viruses and the corresponding wild type parents demonstrated one to three amino acid substitutions within each virus pair, with at least one amino acid change being located in a previously defined antigenic site. Comparison of the HA sequences of the 2 antigenically indistinguishable virus pairs revealed no amino acid differences in 1 and one amino acid change in the other. Examination of 1 additional wild type virus, A/Guangdong/39/89, and its three high-yielding derivatives obtained either by serial egg passage or by reassortment revealed an additive effect of the HA and M genes in creating the high-yielding phenotype.

Comparison of 10 influenza A (H1N1 and H3N2) haemagglutinin sequences obtained directly from clinical specimens to those of MDCK cell- and egg-grown viruses.

PCR was used to amplify and sequence the complete HA1 region of the haemagglutinin (HA)-encoding genes of 10 clinical isolates of influenza virus of the H1N1 or H3N2 subtypes. These sequences were compared to those obtained from viruses isolated from the same specimens after passage in eggs and MDCK cells. Amino acid substitutions in the egg-derived HA sequences were found in nine out of the 10 specimens analysed, whereas seven out of eight of the MDCK-derived HA sequences were identical to those in the corresponding original specimens. Changes in the H1 HA occurred at residues 77a, 196 (also found in the corresponding HA from the MDCK isolate), 225, 226 and 227; changes in the H3 HA occurred at residues 137, 156, 186, 248 and 276. In addition, we have shown that an amino acid change at residue 145 in the HA of the H3 subtype that was previously demonstrated to be egg-selected is now present in circulating strains.

Inactivation and stability of viral diagnostic reagents treated by gamma radiation.

The objective of this study was to apply the pertinent findings from gamma inactivation of virus infectivity to the production of high quality diagnostic reagents. A Gammacell 220 (Atomic Energy of Canada, Ltd., Ottawa, Canada) was used to subject 38 viruses grown in either susceptible tissue cultures or embryonated chicken eggs to various doses of gamma radiation from a cobalt-60 source. The radiation required to reduce viral infectivity was 0.42 to 3.7 megarads (Mrad). The effect of gamma treatment on the antigenic reactivity of reagents for the complement fixation (CF), hemagglutination (HA) and neuraminadase assays was determined. Influenza antigens inactivated with 1.7 Mrad displayed comparable potency, sensitivity, specificity and stability to those inactivated by standard procedures with beta-propiolactone (BPL). Significant inactivation of influenza N1 and B neuraminidase occurred with greater than 2.4 Mrad radiation at temperatures above 4 degrees C. All 38 viruses were inactivated, and CF or HA antigens were prepared successfully. Antigenic potency remained stable with all antigens for 3 years and with 83% after 5 years storage. Influenza HA antigens evaluated after 9 years of storage demonstrated 86% stability. Gamma radiation is safer than chemical inactivation procedures and is reliable and effective replacement for BPL in preparing diagnostic reagents.

Another chance: a non-seatbelt related fracture of the lumbar spine.

A previously undescribed upper lumbar spine fracture configuration is reviewed in three patients. These flexion/distraction injuries were not associated with seatbelt use. The anterior vertebral body underwent significant compression. The distraction component created a horizontal fracture through the pedicles and lamina, with avulsion of the spinous process of the adjacent cephalad vertebra.

Effect of gentamicin on growth of viral, chlamydial, and rickettsial agents in mice and embryonated eggs.

Gentamicin, at concentrations up to 500 mug/ml, showed no effect on the replication, yield, or infectivity of seven viruses or on the agents of psittacosis and meningopneumonitis when grown in mice or embryonated eggs. At the 500 mug/ml level, lymphogranuloma venereum cultures had a slight reduction in infectivity. Rickettsia akari demonstrated susceptibility at the 5 mug/ml level, whereas R. rickettsii, R. mooseri, and R. canada grown in embryonated eggs were susceptible in varying degrees to gentamicin at or above the 50 mug/ml concentration.

Quantitative and qualitative microbiological profiles of the Apollo 10 and 11 spacecraft.

Microbiological profiles were determined for surfaces of the command module, lunar module (ascent and descent stages), instrument unit, Saturn S-4B stage, and the spacecraft lunar module adapter of the Apollo 10 and 11 spacecraft. Average levels of contamination of the command module were 2.1 x 10(4) and 2.7 x 10(4) microorganisms per ft(2) for Apollo 10 and 11, respectively. With the exception of the exterior surfaces of the ascent stage of the lunar module and the interior surfaces of the command module, average levels of microbial contamination on all components of the Apollo 11 were found to be lower than those observed on Apollo 10. For each Apollo mission, approximately 2,000 colonies were picked from a variety of media and identified. The results showed that approximately 95% of all isolates were those considered indigenous to humans; the remaining were associated with soil and dust in the environment. However, the ratio of these two general groups varied depending on the degrees of personnel density and environmental control associated with each module.

Comparative Hemolytic Activity of Vibrio parahaemolyticus and Related Vibrios.

The hemolytic activities of 91 strains of Vibrio parahaemolyticus isolated from human diarrheal stools, sea fish, and sea water; 21 suspected V. parahaemolyticus cultures isolated from wound infections; 14 nonpathogenic marine vibrios; and 21 V. parahaemolyticus isolated from moribund blue crabs Callinectes sapidus were compared. Potentially pathogenic V. parahaemolyticus strains could be differentiated from the related nonpathogenic marine vibrios, because the former hemolyzed hamster, sheep, and human blood, whereas the latter were nonhemolytic. In addition, V. parahaemolyticus isolated from tissue infections could be differentiated from those of the first group isolated from sea fish or human stools, because the former exhibited primarily an alpha-hemolytic reaction on chicken blood; the latter exhibited mostly beta. It is suggested that V. parahaemolyticus isolated from blue crabs may be differentiated from the first group on the basis of their hemolysis of human blood. A useful schema of the differential hemolytic reactions, exhibited by V. parahaemolyticus, tissue infection vibrios, and nonpathogens on hamster, sheep, chicken, goose, and human blood is given. The patterns of hemolytic activity of these groups on special human blood-agar plates (Kanagawa hemolysis) resembled that seen on ordinary human blood-agar.

Immunochemistry of a formamide-extracted antigen from Clostridium perfringens cell walls.

The type-specific antigen of a strain of Clostridium perfringens involved in food poisoning was isolated from the cell wall by the use of hot formamide. The antigen appears to consist of polysaccharide or mucopeptide. The formamide extract was shown to be heterogeneous by gel filtration on Sephadex G-200. The serologically active fraction contained about 25% of the amount of protein present in the original formamide extract. Hexosamine, acetyl groups, and carbohydrate also were detected. The formamide extract showed a high degree of serological activity. The serological activity was increased twofold on Sephadex gel filtration.

Morphological, cultural, biochemical, and serological comparison of Japanese strains of Vibrio parahemolyticus with related cultures isolated in the United States.

Morphological, cultural, biochemical, and serological characteristics of 79 strains of Vibrio parahemolyticus isolated from patients suffering from gastroenteric disease in Japan were compared with 17 suspected V. parahemolyticus cultures isolated from wound infections and 14 nonpathogenic vibrios isolated from an estuarine environment in the United States. These groups were differentiated on the basis of several key reactions which included: the range of growth temperature and salt tolerance; the production of catalase and acetoin; the hydrolysis of starch; the fermentation and utilization as single carbon source of sucrose, cellobiose, and arabinose; and the ability to swarm on 1% agar. The separation of the groups on the basis of cultural and biochemical analyses was confirmed by means of slide agglutinations with specific anti-K antisera. The results of this study strongly suggest that the wound infection isolates are V. parahemolyticus species which are easily distinguished from the nonpathogenic estuarine vibrios.

Examination of market foods for coliform organisms.

Food specimens (490) in nine categories were examined for total aerobic plate count and numbers and types of coliform organisms, including the enteropathogenic Escherichia coli (EEC). The total counts were compared with various suggested standards, and a limit of 100,000/g appeared to be a realistic goal, except for certain food types with a high level of natural flora. Plate counts in VRB were compared to counts obtained by isolation by enrichment in LST Broth, and the latter method produced a higher percentage of isolations. The presence of E. coli was determined by use of EC Medium incubated at 44.5 +/- 0.1 C. Only 40.4% of the positive EC tubes, however, contained E. coli. It appeared that a limit of 10 coliform organisms per g as a suggested standard could be met with several types of foods. Isolation of EEC was obtained only three times, or in 0.6% of the specimens.

Enterotoxin B: serological assay in cultures by passive hemagglutination.

Bis-diazotized benzidine hemagglutination with Formalinized sheep erythrocytes was adapted to the rapid and specific detection of enterotoxin B in staphylococcal culture fluids. There was complete agreement between hemagglutination inhibition (HI) and gel diffusion in detecting 8 enterotoxin B-positive cultures from a total of 68 staphylococcal cultures tested. The sensitivity of HI equals or exceeds that of gel diffusion. Also, results can be obtained in several hours, even with extremely low concentrations of enterotoxin, whereas it may require 24 hr to 1 week to obtain comparable results with gel diffusion. Problems associated with the presence of potent hemagglutinins for sheep erythrocytes in several staphylococcal culture fluids are discussed.

Examination of Feces from Food Handlers for Salmonellae, Shigellae, Enteropathogenic Escherichia coli, and Clostridium perfringens.

Duplicate fecal specimens from food handlers were collected in Louisiana. One set of specimens was examined immediately for salmonellae and shigellae by the Central Laboratory of the Louisiana State Board of Health in New Orleans; the other set was shipped to the Food Microbiology Unit at the Robert A. Taft Sanitary Engineering Center in Cincinnati, Ohio, where it was examined for enteropathogenic Escherichia coli (EEC) and Clostridium perfringens. A total of 219 specimens were examined by both laboratories. None yielded salmonellae or shigellae; 171 (78.1%) yielded C. perfringens; 175 (79.9%) yielded E. coli; and 14 (6.4%) yielded EEC. The 14 isolates of EEC were distributed among eight serotypes; one specimen yielded two serotypes. Multiple isolations of C. perfringens strains (two to four) were made from 64 (37.4%) of the specimens, and a total of 244 strains were isolated and studied for identifying characteristics. Of the total, only 87 (35.5%) could be identified serologically by a battery of 67 antisera; only 4 (1.6%) possessed the characteristics of the English "food-poisoning type." The hemolytic activity on agar containing horse, ox, or sheep blood showed that 140 (57.1%) were "hemolytic," 81 (33.1%) were "nonhemolytic," and 23 (9.8%) gave varied results. Only 12 (4.9%) of the strains produced spores that resisted boiling for 30 min or more.