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Objectives: Huntington's disease (HD) is an inherited autosomal dominant condition in which there is a CAG repeat expansion in the huntingtin gene of 36 or more. Patients display progressive motor, [...]

The article presents a study in which cashew-specific T cell responses in cashew-allergic subjects were characterized and cross-reactivity of cashew-specific T cells towards other tree nut allergens was examined. Topics include the tendency for cashew allergens Anacardium occidentale (Ana o) 1, Ana o 2, and Ana o 3 to be allergenic in other tree nuts, the use of tetramer-guided epitope mapping to identify Ana o 1 and Ana o 2 derived epitopes, and the use of Basophil stimulation tests.

Common haematological [haematocrit (Hct)], primary (serum cortisol) and secondary (serum glucose and plasma lactate) analytes were utilized to compare blood biochemical status of Gadus morhua captured rapidly by jig with that of G. morhua captured by commercial demersal longline. In general, the physiological status of G. morhua, despite blind hook times, was significantly more disrupted (pronounced haemo-concentration and significantly elevated concentrations of cortisol, glucose and lactate) following longline capture relative to capture by jig, while no differences were detected among longline-caught fish as a function of dehooking method (or concomitant extent of overt physical trauma). Blood profiles from the more stressed G. morhua, a possible function of more extended longline hook times, were similar to the most stressed values reported for this species. The results also demonstrate that, although acute blood biochemical status is an effective gauge of relative stress, it does not reflect physical injury status, which has been shown to exert a strong influence on delayed mortality in previous studies in this species. Thus, acute blood chemical status alone may not be the most complete predictor of mortality. Future studies should evaluate physiological repercussions from capture-handling against physical trauma during more extended post-release periods for this species. [ABSTRACT FROM AUTHOR]

This article reports an evidence-based practice project using the Iowa Model of Evidence-Based Practice to Promote Quality Care for a common nursing procedure, nasogastric tube placement verification in children. Little research exists regarding the care of nasogastric tubes in children, and traditional verification methods prevail. Auscultation of air insufflation over the abdomen is still used to check placement in many settings, despite research dating back to the 1980s questioning this approach. X-ray remains the only certain way to verify placement, but getting an X-ray before each feeding would be costly and impractical. Additional bedside methods are needed. Project results demonstrate a decrease (93.3% to 46.2%) in the use of auscultation and improved use of other, more reliable methods to determine nasogastric tube placement. Changing practice can be challenging. However, with persistence and re-infusion, this project provides an important example of how the evidence-based practice process leads to excellence and improves patient care. [ABSTRACT FROM AUTHOR]

Introduction: Wearing hearing aid earmoulds has been implicated as a predisposing factor in the development of chronic otitis externa. Audiologists come into contact with a large number of hearing aid earmoulds and these could potentially harbour pathogenic micro-organisms, with the risk of subsequent cross infection. Cleaning with dilute alcohol is widely used in an attempt to break the chain of infection.Objective: To determine the presence and nature of microbial flora on hearing aid earmoulds and the efficacy of cleaning methods used to prevent cross infection.Setting: Secondary health care within the audiology department of Addenbrooke's Hospital, Cambridge, UK.Design: A prospective, observational study.Methods: Hearing aid earmoulds were swabbed before and after cleaning. Samples were cultured to determine qualitatively and quantitatively the microbiological flora present before and after cleaning.Results: Twenty out of 21 (95 per cent) earmoulds had microbes present and, of these, 19/20 (95 per cent) had a polymicrobial profile. Coagulase negative staphylococci and diphtheroids were the most frequent microbial isolates, but pathogenic bacteria and fungi were also demonstrated on earmoulds both before and after cleaning.Conclusions: The polymicrobial flora, including recognized pathogens, that colonizes earmoulds may lead to chronic otitis externa. Cleaning with 70 per cent alcohol solution was ineffective, in particular for pathogenic fungi on earmoulds. [ABSTRACT FROM AUTHOR]

Summary: [1.] From September 2003, acute National Health Service trusts in England have been required by the Department of Health to undertake mandatory surveillance of bacteraemias caused by glycopeptide-resistant enterococci (GRE). [2.] In total, 4855 enterococcal bacteraemias (including 256 reports of ‘Group D streptococci’) were reported through the voluntary reporting system to the Communicable Disease Surveillance Centre (CDSC) in England and Wales in 2002, and 8.9% of the reports that contained information on vancomycin susceptibility indicated that the isolate was resistant to vancomycin. Most hospitals reported fewer than five GRE bacteraemias per year to the CDSC, with only 13 hospitals reporting more than five episodes per year, although there is undoubtedly an element of under-reporting. [3.] This Working Group was established to review the methods used to identify and test the susceptibility of enterococci to glycopeptides, and to make recommendations on the reporting of GRE bacteraemias, as there were indications that current methods would not provide a suitable basis for this surveillance. [4.] A review of methods was undertaken, including a national questionnaire on methods, approaches to testing and risk factors for GRE bacteraemia. This, together with data from routine laboratory reports and special surveys, revealed the following. [–] A significant proportion of enterococci are not identified to species level. [–] There are problems with identification of enterococci. Commercially available kits do not identify some enterococcal species reliably. [–] Not all laboratories test vancomycin susceptibility of enterococci from bacteraemia. This does not allow a robust assessment of GRE bacteraemia rates because the prevalence of glycopeptide resistance will be underestimated if laboratories test teicoplanin alone or no glycopeptides against enterococci. [–] There are technical difficulties in detecting non-VanA resistance in enterococci and this will also contribute to under-reporting of glycopeptide resistance. [5.] Clinically significant GRE infection is associated with a worse prognosis than infection with susceptible strains, but this factor has not been clearly separated from the possible influence of co-morbidities and antibiotic usage. [6.] GRE bacteraemia occurs mainly on specialist units, particularly transplantation, renal, haematological malignancy and intensive care units. Hospitals with such units will inevitably have a higher risk of featuring prominently in surveillance studies. Hence, meaningful denominators for surveillance of GRE bacteraemia are required. Recommendations for GRE bacteraemia surveillance: [1.] As the mandatory surveillance of glycopeptide-resistant enterococci (GRE) bacteraemias has already started, this report recommends a phased approach to some of the developments, such as using meaningful denominators for the bacteraemia rates. [2.] Rates of GRE bacteraemias in trusts should not be used as a performance indicator because the numbers are too small for valid analysis in this way. [3.] GRE bacteraemias as a proportion of all clinically significant bacteraemias in the trust should be measured as an indicator of changing trends. [4.] Since most GRE are likely to be associated with specialist units, reports of GRE bacteraemia should indicate the specialty in which the patient acquired the infection. [5.] Data on clinical activity in the special units where patients acquired GRE bacteraemias should be obtained from trusts with more than five GRE bacteraemias in a year. [6.] The significance of blood cultures containing GRE should be assessed clinically. If the bacteraemia that includes GRE is deemed to be clinically significant (according to the case definitions for bacteraemia), whether mono- or polymicrobial, it should be reported as a GRE bacteraemia. [7.] Enterococci from blood cultures should be identified to species level to provide data on resistance rates in different species. [8.] Biochemical identification should be augmented by antimicrobial susceptibility patterns. The identification is suspect if Enterococcus faecalis appears to be ampicillin resistant and/or quinupristin/dalfopristin susceptible, or if Enterococcus faecium appears to be ampicillin susceptible and/or quinupristin/dalfopristin resistant. The identification and susceptibility of such isolates should be checked and, if confirmed, the isolate should be sent to a reference laboratory for further investigation. [9.] Enterococci from blood cultures should be tested for susceptibility to vancomycin. Teicoplanin is not an acceptable alternative to vancomycin for these purposes. [10.] Standardized methods should be used for glycopeptide susceptibility testing of enterococci, and the technical requirements of the methods must be adhered to. [11.] The situation should be reviewed after a year and the methodology should be amended as appropriate. Recommendations for further research: [1.] A group should be established to explore methods of data collection for global and individual risk factors for GRE bacteraemia. [2.] Further studies on the performance of commercial identification kits with a range of enterococcal species are necessary. [3.] Further studies to improve the reliability of susceptibility testing methods for detection of GRE are necessary. [Copyright &y& Elsevier]

AIM--To develop an internal quality assessment (IQA) scheme in a clinical bacteriology laboratory. METHODS--Over 24 months, 1230 diagnostic specimens, representing 0.42% of laboratory workload, were anonymised and resubmitted for analysis. Six hundred and twenty one (48.7%) of these gave positive culture results; 44 fecal and upper respiratory specimens were "spiked" (artificially inoculated) to increase the proportion of positive samples. RESULTS--Discrepancies between IQA and clinical sample results occurred in 188 cases (14.8%): 76.6% of these were in culture results, 13.3% in microscopy performance, and 10.1% in clerical recording. The culture discrepancy rate for each positive sample was lowest for wound (17.5%) and urine (18.1%) specimens, and highest for faeces (34.9%) and upper respiratory (37.7%) samples. Discrepancies in several areas responded to staff training and improvement in technical methods. CONCLUSIONS--An IQA programme of this type assesses the reproducibility of tests within a diagnostic laboratory when analysing common specimen types and organisms. It permits blind assessment of many areas of diagnostic work that are not readily amenable to other quality assurance methods, and it raises the awareness of all staff to the importance of quality in every aspect of specimen and data processing. [ABSTRACT FROM PUBLISHER]

Reverse passive haemagglutination, a novel microtitre based assay, was compared with the Streptex (Wellcome UK) latex slide agglutination kit for streptococcal grouping in a diagnostic microbiology laboratory. Three hundred and fifty two extracts from 349 consecutive primary isolation plates were assayed by both methods. Reverse passive haemagglutination gave identical grouping results for 98.0% of the 345 streptococci identified by Streptex, and the kappa coefficient of agreement between the methods for all 352 extracts tested was 0.973. Cross reactions with Listeria spp seen with Streptex were not found by reverse passive haemagglutination. In the reverse passive haemagglutination method 11 streptococci could be grouped on each 96-well plate and most reactions were stable for at least 30 minutes. Reverse passive haemagglutination is more rapid to perform than latex slide agglutination when many organisms are to be grouped, and the patterns of haemagglutination are easily recognised. If the method was taken into routine use in a diagnostic laboratory, the persistence of reverse passive haemagglutination reactions would enable grouping results to be checked for quality control purposes. [ABSTRACT FROM PUBLISHER]

Potentially, the clinical microbiologist is able to influence empirical and definitive therapy of bacteraemia. Definitive therapy of the individual can only be affected after the results of routine culture and sensitivity tests are available. Some so-called ‘rapid’ laboratory techniques enable early identification and sensitivity testing of isolates from blood cultures. Empirical therapy is more difficult to influence, with microbiologists relying on epidemiologically based education of the prescriber or encouragement of him to seek advice at an early stage. Newer, truly rapid methods that do not rely on culture may come to have an impact on individual empirical therapy. Microbiologists acquire information upon which to base their recommendations by a variety of local surveillance measures, from the published literature and (particularly for organisms of infection control significance) through professional contacts with their colleagues in other hospitals. Influence may be exerted on clinicians by direct contact, through manipulation of the content of laboratory reports, or by regular circulation of locally-collected summary data. The assessment of the real impact on bacteraemia of blood culture techniques and microbiological advice is in its infancy, but new data collection and handling methods make this an achievable ideal. [ABSTRACT FROM PUBLISHER]

Per-operative serum and wound fluid concentrations achieved by two flucloxacillin dosage regimens were measured in twelve patients undergoing open heart surgery. One 500 mg bolus dose given after the induction of anaesthesia in six patients resulted in adequte serum concentrations (means decreasing from 69 to 9 mg/l) during surgery, but low wound fluid concentrations (mean 4·6 mg/l, range <2–7·8 mg/l) at the time of closure. An additional 500 mg bolus dose given after bypass in six further patients gave more satisfactory wound concentrations (mean 16 mg/l, range 8·6–22·5 mg/l). Disc absorption is a useful technique for assaying antibiotics in wound fluid, but the results are difficult to interpret since they represent a sum of concentrations in a complex and changing mixture of interstitial tissue fluid, blood and cardioplegia solution. [ABSTRACT FROM PUBLISHER]

We report a case of mixed haematogenous endophthalmitis in which Candida albicans and Centres for Disease Control (CDC) corynebacterium group A-4 were isolated together from an aspirate of vitreous humour. [ABSTRACT FROM PUBLISHER]

Summary: Meticillin-resistant Staphylococcus aureus (MRSA) remains endemic in many UK hospitals. Specific guidelines for control and prevention are justified because MRSA causes serious illness and results in significant additional healthcare costs. Guidelines were drafted by a multi-disciplinary group and these have been finalised following extensive consultation. The recommendations have been graded according to the strength of evidence. Surveillance of MRSA should be undertaken in a systematic way and should be fed back routinely to healthcare staff. The inappropriate or unnecessary use of antibiotics should be avoided, and this will also reduce the likelihood of the emergence and spread of strains with reduced susceptibility to glycopeptides, i.e. vancomycin-intermediate S. aureus/glycopeptide-intermediate S. aureus (VISA/GISA) and vancomycin-resistant S. aureus (VRSA). Screening for MRSA carriage in selected patients and clinical areas should be performed according to locally agreed criteria based upon assessment of the risks and consequences of transmission and infection. Nasal and skin decolonization should be considered in certain categories of patients. The general principles of infection control should be adopted for patients with MRSA, including patient isolation and the appropriate cleaning and decontamination of clinical areas. Inadequate staffing, especially amongst nurses, contributes to the increased prevalence of MRSA. Laboratories should notify the relevant national authorities if VISA/GISA or VRSA isolates are identified. [Copyright &y& Elsevier]