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While I M. ulcerans i infections are usually managed with oral therapy, this patient required prolonged intravenous therapy and multiple medication changes due to adverse effects, drug interactions, and the development of oral medication refusal. She tolerated the intravenous therapy well, with no central line-associated complications, and the only adverse reaction to intravenous therapy a borderline prolonged PR interval which remained stable throughout treatment. I Mycobacterium ulcerans i is a complex infection endemic to Victoria and far north Queensland, but may occur elsewhere in Australia, necessitating high clinical suspicion in patients with chronic ulcers. [Extracted from the article]

Background Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology and predictors of poor outcome remain inadequately defined in childhood. Methods ISAIAH (Invasive Staphylococcus aureus Infections and Hospitalizations in children) is a prospective, cross-sectional study of S. aureus bacteremia (SAB) in children hospitalized in Australia and New Zealand over 24 months (2017–2018). Results Overall, 552 SABs were identified (incidence 4.4/100 000/year). Indigenous children, those from lower socioeconomic areas and neonates were overrepresented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), intensive care unit admission (20%), relapse (4%), or death (3%). Predictors of mortality included prematurity (adjusted odds ratio [aOR],16.8; 95% confidence interval [CI], 1.6–296.9), multifocal infection (aOR, 22.6; CI, 1.4–498.5), necrotizing pneumonia (aOR, 38.9; CI, 1.7–1754.6), multiorgan dysfunction (aOR, 26.5; CI, 4.1–268.8), and empiric vancomycin (aOR, 15.7; CI, 1.6–434.4); while infectious diseases (ID) consultation (aOR, 0.07; CI.004–.9) was protective. Neither MRSA nor vancomycin trough targets impacted survival; however, empiric vancomycin was associated with nephrotoxicity (OR, 3.1; 95% CI 1.3–8.1). Conclusions High SAB incidence was demonstrated and for the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, while ID consultation was protective. The need to reevaluate pediatric vancomycin trough targets and limit unnecessary empiric vancomycin exposure to reduce poor outcomes and nephrotoxicity is highlighted. One in 3 children experienced considerable SAB morbidity; therefore, pediatric inclusion in future SAB comparator trials is paramount to improve outcomes. [ABSTRACT FROM AUTHOR]

Aims: To investigate overused laboratory test of haemoglobin Ac1 (HbA1c) in one medicine centre in southern Taiwan. Methods: Data were extracted from the database of the Medical Center from March 2013 to March 2015. These patients were classified into five groups, including group A (diabetic patients with HbA1c value ≥7), group B (healthy people with HbA1c value ≥7), group C (diabetic patients with HbA1c test value <7), group D (healthy people with HbA1c value <6.5) and group E (prediabetic people with HbA1c value 6.5‐7). The divisions requested for HbA1c test were divided into four categories, including endocrinology, internal medicine, surgery and the others. Repeat testing at the time of the second test was investigated using survival analysis. Results: The percentage of overall inappropriate repeat testing was as high as 34%. The percentages among the five patient groups were relatively different. Group C had the largest percentage of inappropriate repeat testing (48%) and group A had the second largest (30%), followed by groups D (25%), E (13%) and B (10%). The percentages of inappropriate repeat testing of the five patient groups were also relatively different among the four categories of division, with Kaplan‐Meier curves showing significant differences. The time to repeat testing was the shortest for group A and was the second shortest for group C, followed by groups B, E and D. Conclusions: The results provided detailed information about the percentages of inappropriate repeat testing of HbA1c of the five patient groups among the four categories of division. [ABSTRACT FROM AUTHOR]

In case 1, we hypothesise that the cephalohaematoma developed into subgaleal abscess with bacterial seeding from the antecedent urinary tract infection. The blood culture was also negative, white cell count (WCC) was 5.7 × 10 SP 9 sp /L and C-reactive protein (CRP) was 77.4 mg/L. Cranial ultrasound showed a lentiform 8.9 × 6.9 cm collection consistent with a large uncomplicated cephalohaematoma. If the cephalohaematoma does show signs of localised infection with possible extension, appropriate imaging with high diagnostic yield for osteomyelitis (CT or magnetic resonance imaging) is warranted with consideration given to debridement. [Extracted from the article]

Pioglitazone (PIO), a thiazolidinedone, was reported to stimulate peroxisome proliferator-activated receptor-γ (PPAR-γ) with anti-inflammatory, anti-proliferative, anti-diabetic, and antidepressive activities. However, whether this compound exerts any perturbations on Ca2+-activated K+ and M-type K+ currents in central neurons remains largely unresolved. In this study, we investigated the effects of PIO on these potassium currents in hippocampal neurons (mHippoE-14). In whole-cell current recordings, the presence of PIO (10 μM) increased the amplitude of Ca2+-activated K+ current [ I K(Ca)] in mHippoE-14 cells. PIO-induced stimulation of I K(Ca) observed in these cells was reversed by subsequent addition of paxilline, yet not by TRAM-39 or apamin. In inside-out current recordings, PIO applied to the bath concentration-dependently increased the activity of large-conductance Ca2+-activated K+ (BKCa) channels with an EC50 value of 7.6 μM. Its activation of BKCa channels in mHippoE-14 cells was voltage-dependent and accompanied by both a lengthening in mean open time and a shortening in slow component of mean closed time. The activation curve of BKCa channels after addition of PIO was shifted to less depolarized potential without any change in the gating charge. PIO also suppressed the amplitude of M-type K+ currents inherently in mHippoE-14 neurons. Taken together, in addition to its agonistic action on PPAR-γ, PIO-induced perturbation of these potassium channels may be responsible for its widely pharmacological actions on hippocampal neurons. [ABSTRACT FROM AUTHOR]