Life-threating complication of parapharyngeal abscess and mediastinitis in a 10-year-old otherwise healthy girl following elective tonsillectomy - first reported paediatric case.

BACKGROUND: Parapharyngeal abscess and mediastinitis are rare but very severe post-operative complications following an elective tonsillectomy. Parapharyngeal abscess as a complication to tonsilectomy is very seldom described in the literature and no cases in the paediatric population have been described.Case reportThis paper presents, to our knowledge, the first case of life-threatening parapharyngeal abscess and mediastinitis following elective adenotonsillectomy in an otherwise healthy, fully vaccinated 10-year-old girl. CONCLUSION: Diagnosing parapharyngeal abscess and mediastinitis can be challenging, but should be suspected and ruled out in cases of post-operative odynophagia, fever, and/or neck swelling and thoracic pain. Diagnosis is made based on magnetic resonance imaging and computed tomography findings. Prompt broad-spectrum intravenous antibiotic treatment and surgical drainage should be initiated. Other severe complications such as meningitis should also be considered.

Efficacy and safety of switching from sitagliptin to liraglutide in subjects with type 2 diabetes (LIRA-SWITCH): a randomized, double-blind, double-dummy, active-controlled 26-week trial.

AIMS: To confirm superiority on glycaemic control by switching from sitagliptin to liraglutide 1.8 mg/d versus continued sitagliptin. MATERIALS AND METHODS: A randomized, multicentre, double-blind, double-dummy, active-controlled trial across 86 office- or hospital-based sites in North America, Europe and Asia. Subjects with type 2 diabetes who had inadequate glycaemic control (glycated haemoglobin [HbA1c] 7.5-9.5% on sitagliptin (100 mg/d) and metformin (≥1500 mg daily) for ≥90 days were randomized to either switch to liraglutide (n = 203) or continue sitagliptin (n = 204), both with metformin. The primary endpoint was change in HbA1c from baseline to week 26. Change in body weight was a confirmatory secondary endpoint. RESULTS: Greater reduction in mean HbA1c was achieved with liraglutide than with continued sitagliptin [-1.14% vs. -0.54%; estimated mean treatment difference (ETD): -0.61% (95% CI -0.82 to -0.40; p < 0.0001)], confirming superiority of switching to liraglutide. Body weight was reduced more with liraglutide [-3.31 kg vs. -1.64 kg; ETD: -1.67 kg (95% CI -2.34 to -0.99; p < 0.0001)]. Nausea was more common with liraglutide [44 subjects (21.8%)] than with continued sitagliptin [16 (7.8%)]. Three subjects (1.5%) taking sitagliptin reported a confirmed hypoglycaemic episode. CONCLUSIONS: Subjects insufficiently controlled with sitagliptin who switch to liraglutide can obtain clinically relevant reductions in glycaemia and body weight, without compromising safety. A switch from sitagliptin to liraglutide provides an option for improved management of type 2 diabetes while still allowing patients to remain on dual therapy.

Efficacy and safety of liraglutide compared to sulphonylurea during Ramadan in patients with type 2 diabetes (LIRA-Ramadan): a randomized trial.

AIMS: Compare effects of liraglutide 1.8 mg and sulphonylurea, both combined with metformin, on glycaemic control in patients with type 2 diabetes (T2D) fasting during Ramadan. MATERIALS AND METHODS: In this up to 33-week, open-label, active-controlled, parallel-group trial, adults [glycated haemoglobin (HbA1c) 7%-10% (53-86 mmol/mol); body mass index ≥20 kg/m(2) ; intent to fast] were randomized (1:1) ≥10 weeks before Ramadan to either switch to once-daily liraglutide (final dose 1.8 mg) or continue pre-trial sulphonylurea at maximum tolerated dose, both with metformin. PRIMARY ENDPOINT: change in fructosamine, a validated marker of short-term glycaemic control, during Ramadan. RESULTS: Similar reductions in fructosamine levels were observed for both groups during Ramadan [liraglutide (-12.8 µmol/L); sulphonylurea (-16.4 µmol/L); estimated treatment difference (ETD) 3.51 µmol/L (95% CI: -5.26; 12.28); p = 0.43], despite lower fructosamine levels in the liraglutide group at start of Ramadan. Fewer documented symptomatic hypoglycaemic episodes were reported in liraglutide-treated (2%, three subjects) versus sulphonylurea-treated patients (11%, 18 subjects). No severe hypoglycaemic episodes were reported by either group. Body weight decreased more during Ramadan with liraglutide (ETD: -0.54 kg; 95% CI: -0.94;-0.14; p = 0.0091). The proportion of patients reporting adverse events was similar between groups. Liraglutide led to greater HbA1c reduction [ETD: -0.59% (-6.40 mmol/mol), 95% CI: -0.79; -0.38%; -8.63; -4.17 mmol/mol; p < 0.0001]. CONCLUSIONS: Despite lower fructosamine levels and body weight at the beginning of Ramadan, use of liraglutide showed similar glycaemic improvements, fewer hypoglycaemic episodes and greater body weight reduction compared with sulphonylurea. LIRA-Ramadan provides evidence for liraglutide being safe and efficacious for management of T2D during Ramadan fasting.

The International Circumpolar Surveillance interlaboratory quality control program for Streptococcus pneumoniae, 1999 to 2008.

The International Circumpolar Surveillance (ICS) Program was initiated in 1999 to conduct population-based surveillance for invasive pneumococcal disease in select regions of the Arctic. An interlaboratory quality control (QC) program for pneumococcal serotyping and antibiotic susceptibility testing was incorporated into ICS by reference laboratories in northern Canada (Laboratoire de Santé Publique du Québec [LSPQ] in Sainte-Anne de Bellevue, Québec; National Centre for Streptococcus [NCS] in Edmonton, Alberta) and Alaska (Arctic Investigations Program [AIP]). The World Health Organization's Collaborating Centre for Reference and Research on Pneumococci at the Statens Serum Institute (SSI) in Copenhagen, Denmark, joined the QC program in 2004. The Iceland Reference Laboratory (IRL) in Reykjavik, Iceland, joined the QC program in 2006, but due to small sample sizes, data from IRL are not included in this report. From 1999 through 2008, 190 isolates were distributed among four laboratories (AIP, NCS, LSPQ, and SSI). The overall serotype concordance was 95.8%, and the overall serogroup concordance was 97.4%. The overall modal MIC concordance for testing by broth microdilution (BMD) and agar dilution was >96% for all the antibiotics except erythromycin (92.1%) and clindamycin (89.5%). MIC comparisons between the Etest and BMD resulted in lower concordance for erythromycin (73.9%), clindamycin (65.5%), and trimethoprim-sulfamethoxazole (80%); however, categorical concordance (susceptible, resistant) remained high at 98.6%, 89.1%, and 90.9%, respectively. Our data demonstrate a high degree of correlation of serotyping and antimicrobial susceptibility testing results between four participating laboratories.

Simple, rapid latex agglutination test for serotyping of pneumococci (Pneumotest-Latex).

The "gold standard" for epidemiological typing of Streptococcus pneumoniae (pneumococcus) is the capsular reaction test (Neufeld test) with antisera against the 90 pneumococcal polysaccharide capsules, i.e., serotyping. The method is labor intensive and requires a certain level of experience to be performed satisfactory, and thus it has been restricted for use in specialized reference or research laboratories. Surveillance of the serotype distribution of pneumococci that cause infections is important to secure an optimal composition of pneumococcal vaccines and to monitor antibiotic resistance in pneumococci. At Statens Serum Institut, a simple latex agglutination test for serotyping of pneumococci has been developed. The Pneumotest-Latex kit consists of 14 different pooled pneumococcus antisera (pools A to I and pools P to T) applied to latex particles. In a blind test of 352 isolates (with all 90 serotypes represented), 336 (95.5%) were typed or grouped correctly by the Pneumotest-Latex; in addition, 2 (7%) of 30 strains regarded as nontypeable or rough strains were serotyped, and the serotypes of these two isolates were confirmed by the capsular reaction test with type-specific antisera. The Pneumotest-Latex seems to be a sensitive method for serotyping or grouping of the majority of pneumococcal strains. By use of this ready-to-perform latex agglutination kit (Pneumotest-Latex), serotyping of pneumococci can gain more ground as a tool in prevention of pneumococcal diseases.

Comparison of two intervention programmes in young female players in European handball--with and without ankle disc.

INTRODUCTION: The prevention of injuries in all sports calls for a structured plan. The plan consists, as earlier described, of four steps. We have previously presented studies incorporating all four steps. The studies have shown that it is possible to prevent most injuries in young female players in European handball by applying a training programme combining the use of an ankle disc with functional strength training. In the previous studies we were not able to discriminate whether the preventive effect was due to the functional strength training or the training with the ankle disc. The aim of this study was to compare a programme with ankle disc and functional strength training with a programme with functional strength training only. METHODS: Twenty handball teams were asked to participate, and 16 of 20 handball teams agreed to participate. The teams were cluster randomised to either the programme with or without an ankle disc. RESULTS: The group using the programme without the ankle disc had a significantly higher number of traumatic injuries (16 vs. 6). The incidences of traumatic injuries in the ankle disc group were 2.4 (95% CI 0.7; 6.2) injuries per 1000 h of match and 0.2 (95% CI 0.02; 0.7) injuries per 1000 h of practice. In the group without ankle disc the incidences were 6.9 (95% CI 3.3; 12.7) injuries per 1000 h of match and 0.6 (95% CI 0.2; 1.3) injuries per 1000 h of practice. A significantly higher multivariate odds ratio (4.8) was found in the group not using the ankle disc. In addition the group using the ankle disc had significantly fewer moderate and major injuries. CONCLUSION: By adding ankle disc training to a training programme with functional strength training, it is possible to reduce the number of injuries significantly, especially the number of moderate and major injuries.

Prevention of injuries in young female players in European team handball. A prospective intervention study.

Young female players in European handball have a very high injury incidence, up to 50 injuries per 1000 hours of game. More than half of these injuries happen without any external cause. The aim of the study was to investigate the effect of an intervention programme designed to reduce the number of injuries in young female players in European handball, with special emphasis on injuries in the lower extremities. The programme was created using elite athlete training programmes and those designed for rehabilitation of injured athletes with functional instability of their ankles and rupture of the anterior cruciate ligament. It included the use of an ankle disk for 10-15 min at all practice sessions, for one 10-month season (August 1995-May 1996). Twenty-two teams participated in the study, and were randomly assigned to the intervention or control group. Eleven teams with 111 players were randomised to the intervention group and 11 teams with 126 players to the control group. Data were analysed using a t-test for continuous variables, chi2-analysis and Fisher's exact test for dichotomous variables and multivariate methods to determine odds-ratios. The results indicated that using the intervention programme decreased the numbers of both traumatic and overuse injuries significantly. The differences in injuries between the groups were 80% during games and 71% during practice. In addition, the players in the control group had a 5.9 times higher risk of acquiring an injury than the players in the intervention group.

Injuries in young female players in European team handball.

The purpose of this study was to examine the nature, extent and severity of sports injuries in young female players in European team handball and to identify the etiological factors involved in the injuries. Twenty-two teams with 217 players, aged 16-18 years, participated in the study. A very high injury incidence during games was observed, with 40.7 injuries/1000 hours of game. Backplayers had the highest incidence (54.8/1000 hours), which is five times higher than any previously recorded injury incidence in players in European team handball. We found that 92.9% of injuries were traumatic and 7.1% were from overuse. One-hundred and twenty-four of the 211 injuries were traumatic injuries of the lower extremities. Of these 63 (51%) were without contact with an opponent. The study confirmed that European team handball is a sport that has a very high injury rate, especially regarding young female players. Field position and earlier injuries are major risk factors, with an earlier injury being the single highest risk factor and with backplayers having a significantly higher number of injuries than players in other field positions.

Stereochemistry, specificity and kinetics of the hydrolysis of reduced cellodextrins by nine cellulases.

The catalytic activity of nine enzymes (endoglucanases I-III, V, VI and cellobiohydrolases I and II from Humicola insolens; endoglucanases A and C from Bacillus lautus), representative of cellulase families A-C, H, J and K, has been investigated using a series of reduced cellooligosaccharides (cellotriitol to cellohexaitol) as substrates. For each enzyme, the specificity of cleavage was determined by analytical HPLC while the kinetic constants were obtained from a kinetic assay involving a cellobiose dehydrogenase purified from H. insolens as a coupled enzyme using 2,6-dichloroindophenol as the electron acceptor. These data were used to estimate the number of subsites in the enzymes. The stereochemical course of hydrolysis by seven enzymes, representing the six different families, was assessed using 1H-NMR. The enzymes belonging to families which had already been investigated (A-C), showed results in agreement with previous studies. The three other families (H, J and K), for which no mechanistic data was previously available, gave results which indicated that enzymes in group H had retaining-type activity and enzymes in groups J and K had inverting-type activity. The retaining endoglucanases I and III displayed a high glycosyl-transferase activity under the conditions used during the NMR experiments resulting in precipitates of higher oligomers.

Monoclonal antibodies to the human multicatalytic proteinase (proteasome).

Multicatalytic proteinase is an intracellular enzyme composed of at least 12 different subunits. Seven murine hybridoma cell lines secreting antibodies to human multicatalytic proteinase (MCP) were established. The antibodies reacted with 4 different subunits of the oligomeric protein. Three of the antibodies bound to identical or closely spaced epitopes on the largest subunit, as shown by binding competition. Some of the antibodies cross-reacted with MCP from rat or rabbit, but none with lobster MCP. Glycoprotein components could not be detected in human MCP. The monoclonal antibodies and two polyclonal rabbit antibodies did not specifically inhibit the enzymatic activity of human MCP. Electrophoretic analysis of MCP immunoprecipitated from human placenta, liver, kidney, or HeLa cell extracts with antibodies to 3 different subunits suggested that the subunit compositions are very similar or identical.