Otitis externa: what is the problem with getting it right? A mixed-methods study in primary and secondary care.

OBJECTIVE: Otitis externa accounts for 1.1-1.3 per cent of patient presentations in primary care and 25 per cent of urgent referrals to ENT. This study aimed to explore otitis externa clinical decision-making at the primary-secondary care interface, otitis externa prevalence and recent trends in antimicrobial resistance in otitis externa related bacterial isolates and ototopical prescribing. METHOD: This is a mixed-methods study drawing on data from primary and secondary care and open National Health Service sources. RESULTS: A total of 101 general practitioner survey respondents reported frequently prescribing oral antibiotics for otitis externa. General practitioner consultations for otitis externa increased 25 per cent over 15 years. General practitioner ototopical preparations cost the National Health Service £7 410 440 in 2006 and £11 325 241 in 2016. A total of 162 consecutive hospital otitis externa-related bacterial isolates yielded 128 pseudomonas species, with 18 that were resistant to gentamicin and 7 that were resistant to ciprofloxacin. Ten guidelines reviewed showed systematic inconsistencies. CONCLUSION: General practitioners reported regularly prescribing oral antibiotics for otitis externa. Antimicrobial drug resistance is common in otitis externa. The available guidance is suboptimal.

An evaluation of methods for the isolation of nontuberculous mycobacteria from patients with cystic fibrosis, bronchiectasis and patients assessed for lung transplantation.

BACKGROUND: RGM medium is an agar-based, selective culture medium designed for the isolation of nontuberculous mycobacteria (NTM) from the sputum of patients with cystic fibrosis (CF). We evaluated RGM medium for the detection of NTM in patients with CF (405 samples), bronchiectasis (323 samples) and other lung diseases necessitating lung transplantation (274 samples). METHODS: In total, 1002 respiratory samples from 676 patients were included in the study. Direct culture on RGM medium, with incubation at two temperatures (30 °C and 37 °C), was compared with conventional culture of decontaminated samples for acid-fast bacilli (AFB) using both a solid medium (Löwenstein-Jensen medium) and a liquid medium (the Mycobacterial Growth Indicator Tube; MGIT). RESULTS: For all three patient groups, significantly more isolates of NTM were recovered using RGM medium incubated at 30 °C than by any other method (sensitivity: 94.6% vs. 22.4% for conventional AFB culture; P < 0.0001). Significantly more isolates of Mycobacterium abscessus complex were isolated on RGM at 30 °C than by AFB culture (sensitivity: 96.1% vs. 58.8%; P < 0.0001). The recovery of Mycobacterium avium complex was also greater using RGM medium at 30 °C compared to AFB culture (sensitivity: 83% vs. 70.2%), although this difference was not statistically significant and a combination of methods was necessary for optimal recovery (P = 0.21). CONCLUSIONS: In the largest study of RGM medium to date, we reaffirm its utility for isolation of NTM from patients with CF. Furthermore; we show that it also provides an effective tool for culture of respiratory samples from patients with bronchiectasis and other lung diseases.

Catalytic aerobic oxidation of phenols to ortho-quinones with air-stable copper precatalysts.

A range of air-stable copper species was examined for catalytic activity in the catalytic aerobic transformation of phenols into ortho-quinones. Efficient catalysis was obtained with commercially available copper(II) acetate. The stability of all constituents before mixing makes for a practical process that advances previously reported copper(I)-based oxygenations.

Responsiveness of the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF).

This study aimed to evaluate the responsiveness of the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) in women undergoing surgery for pelvic floor disorders. Fifty-four women undergoing tension-free vaginal tape (TVT) and 47 women undergoing prolapse surgery completed ePAQ-PF at baseline and 3 months postoperatively. Responsiveness was calculated using effect sizes, standardized response means, responsiveness statistic, and minimally important difference. In the TVT group, the largest effect sizes were seen in the urinary domains for stress urinary incontinence (2.4), quality of life (2.2), and overactive bladder (0.9). In the prolapse group, the largest effect sizes were seen in the vaginal domains for prolapse (2.1) and quality of life (1.0). ePAQ-PF is responsive to change in women undergoing TVT or prolapse surgery in the salient and expected domains of stress incontinence and prolapse and quality of life and can be recommended for outcome measurement in this context.

Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF.

The objective of the study was to test the data quality, scaling assumptions and scoring algorithms underlying the electronic personal assessment questionnaire-pelvic floor (ePAQ-PF). A cross-sectional survey of 599 women with pelvic floor disorders was carried out. Tests of data quality included secondary factor analysis, internal reliability, descriptive statistics, levels of missing data, floor and ceiling effects, item-to-total correlation scores, item discriminant and convergent validity. Secondary factor analysis verified the domain structure of ePAQ-PF. All 19 domains were internally reliable with Cronbach's alpha scores ranging from 0.71 to 0.93. Missing response rates ranged from 0.2% to 1.3%, and all items were found to be most highly correlated with their own corrected scale. Results confirmed the factor structure, data quality and scoring and scaling assumptions of ePAQ-PF, thereby verifying its suitability for measuring symptoms, bother and quality of life in women with pelvic floor disorders.

Total synthesis of mololipids: a new series of anti-HIV Moloka'iamine derivatives.

A new family of bioactive bromotyrosine derivatives, termed mololipids, was recently isolated from a Hawaiian sponge, but could not be resolved into individual components by chromatography. To complete their structural characterization and better understand structure-activity relationships, the first pure samples of dimyristoyl, distearoyl, dioleoyl, and stearoyl/oleoyl mololipids have now been prepared by total synthesis, and their anti-HIV activity investigated.

A new minimally invasive technique for cholecystectomy. Subxiphoid "minimal stress triangle": microceliotomy.

OBJECTIVE: The authors devised a minimally invasive technique for cholecystectomy via microceliotomy that provides safety attainable with the open conventional approach and postoperative results comparable to laparoscopic cholecystectomy. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy has evolved as a minimally invasive outpatient procedure. Patients can return rapidly to preoperative status with minimal postoperative morbidity and pain, and the small scar size is cosmetically desirable. Unfortunately, there are reports of serious intraoperative complications, including injury to blood vessels, bowel, and the bile ducts, caused by failure to identify structures properly. The conventional cholecystectomy technique currently is relegated to patients on whom the laparoscopic procedure cannot be performed. METHODS: Cholecystectomy was performed through a 3-cm transverse high subxiphoid incision in the "minimal stress triangle." The location, anterior to Calot's triangle, was critical in providing a direct vertical view of the biliary ducts during dissection. Direct view cholecystectomy was performed using endoscopic instruments without pneumoperitoneum. Postoperative data were compared with both laparoscopic and open cholecystectomy results. RESULTS: Using the microceliotomy technique in the ambulatory setting, cholecystectomy was performed successfully in 99.3% (N = 143) of cases. Biliary leakage beyond the third postoperative day was caused by failure of clips or obstruction to bile flow. The postoperative morbidity, acceptability of scar, and analgesic requirements compare favorably with other techniques. Microceliotomy is cost effective. Portal hypertension is a contraindication for this procedure. CONCLUSIONS: The microceliotomy approach offers a viable, safe, and cost-effective alternative to the laparoscopic technique for cholecystectomy, especially when facilities for laparoscopy are not available or when the laparoscopic procedure cannot be performed.

The incidence of AIDS among blacks and Hispanics.

Compared with whites, the acquired immune deficiency syndrome (AIDS) has affected blacks and Hispanics disproportionately. The cumulative incidence (CI) for black men was 2.6, and for Hispanic men 2.5, times the rate for white men. Intravenous (IV) needle use alone does not account for this difference. Not counting IV needle-using cases, the CIs for black and Hispanic men were 1.7 times the CI for white men. Although there were fewer cases in women than men, the white-to-minority disparity was greater for women. The CIs for black and Hispanic women were 12.2 and 8.5 times, respectively, the CI for white women. Prevention programs are urgently needed and should focus on risky behavior (IV needle sharing and receptive anal intercourse), not just risk groups.

Computer simulation of biological systems. Current trends.

The current status of mathematical models of biological systems is reviewed. Advances in supercomputer hardware allows more complex models to be constructed. The new generation of microcomputers are quite adequate for many computer simulations of biological systems. A theory of modeling is being developed to improve the relationship between the real biological system and the model. Deterministic models, stochastic models and applications of control theory and optimization methods are discussed. Examples given include models of molecular structure, of experimental techniques, and of biochemical reactions. It is recommended that experimental biologists consider the use of microcomputers to model the system under study as a part of their research program.

AIDS statistics and the risk for minorities.

Analysis of the AIDS case data for the United States reported to the Centers for Disease Control reveals quite different risk group profiles for minorities and for whites. A much higher percentage of minority male AIDS cases are heterosexual, the ratio of bisexual to homosexual cases is two to three times higher, and IV needle use is a greater risk factor in minority populations. Among women and children with AIDS, 75% and 82% respectively are minorities. Whites at risk for AIDS tend to be concentrated in the gay community but blacks at risk for AIDS are dispersed throughout the entire community. As a result, AIDS education programs aimed a gay populations do not reach most of the minority populations at risk. AIDS prevention programs need to take this fact into account.

The value of theoretical models in immunological research.

With the increase in understanding of immunological phenomena has come an increase in availability of mathematical models which describe them. Here Judith Rae Lumb argues that theoretical models should be more widely appreciated and used, especially since helpful computer programs are now becoming available.

Effects of genetically different strains of mice on the microsomal activation of 2-aminofluorene.

Five strains of mice were examined for microsomal cytochrome P450 (Cyt P450) activity and ability of the microsomal preparation to activate 2-aminofluorene (2-AF) to its mutagenic form. Each strain was assayed under normal and induced conditions. Group A strains known to be easily induced to carcinogenesis by chemicals (C57BL/6J and BALB/cJ) showed higher levels of Cyt P450 and increased mutagenesis activity of the metabolized 2-AF than Group B strains which are known to be high spontaneous tumor producers (CE/J, A/HeJ, C3H/HeJ). Induction of the hepatic microsomes with Aroclor 1254 increased the difference between the two groups.

A reinterpretation of phosphatase-N.

In order to determine the substrate specificity of the alkaline phosphatase (APase) which appears in murine lymphomas, two substrates were chosen. p-Nitrophenyl phosphatase (pNPP), the standard substrate, has an oxygen-phosphorus (O-P) bond. Cysteamine-S-phosphate (CASP) has a sulfur-phosphorus (S-P) bond. It has been reported that murine lymphoma APase does not cleave the S-P bond of CASP. These results were not confirmed. Under all conditions tested, the murine lymphoma APase showed consistent hydrolysis of CASP at approximately one-third the rate of hydrolysis of pNPP. Biochemical characteristics used to confirm this include pH optimum, heat inactivation, kinetics, magnesium activation, L-homoarginine inhibition, EDTA inhibition, and activity remaining during stages of partial purification. It is concluded that the murine lymphoma APase shows a preference of pNPP as a substrate but does hydrolyse CASP at a lower rate. The conflict between our laboratory and that of Neumann's may be one of interpretation rather than data. Neumann shows similar data to ours in terms of the 3-fold ratio, but considers all hydrolysis of CASP as representative of 'normal' APase. She uses a formula to calculate the amount of lymphoma APase based on the ratio 1.9 which is the ratio of hydrolysis of pNPP to that of CASP in kidney tissue. Our interpretation would be that the same isozyme is hydrolyzing the S-P bond at one-third the rate that it hydrolyzes the O-P bond.

Murine lymphoma alkaline phosphatase: a cell membrane carcinofetal enzyme.

Alkaline phosphatase (APase) has been shown to have a membrane-bound localization in the murine fetal thymus, in murine thymic lymphoma and in adult spleen. Since it was suggested from these previous experiments that the lymphoma APase might represent an embryonic function, a detailed biochemical comparison of the lymphoma APase with the fetal thymus, placenta, fetus and spleen APases was performed. The parameters investigated were pH optimum, activation, inhibition, heat inactivation, substrate ratios, Michaelis constant, and electrophoretic analysis in the presence and absence of neuraminidase with the substrates alpha-naphthyl phosphate, beta-glycerophosphate, and p-nitrophenyl phosphate. The results indicate that the lymphoma APase is very similar to the fetal thymus, placenta and spleen APases. Furthermore, these results lend support to the hypothesis that the APase activity which appears in thymic lymphoma might represent a derepressed embryonic function. Thus, the murine lymphoma APase may be termed a cell membrane carcinofetal enzyme.