North Cambridgeshire Hospital

The inhibition of coagulase-negative staphylococci and Staphylococcus aureus of human or animal origin by most free fatty acids was similar, but coagulase-positive staphylococci were sensitive and coagulase-negative cultures were resistant to linolenic acid. Animal strains of S. aureus were more sensitive to linolenic acid than were human strains. These differences were reflected in the relative abilities of the three categories of strains to survive on human skin. The antibacterial effects of 20 mg of linolenic acid were inactivated by 1 ml of serum in vitro. A test organism seeded on to skin also survived better if first suspended in serum. The mechanism of the interaction between serum and linolenic acid may be due to a detergent effect of the serum and could account for colonisation of diseased skin with S. aureus. Cultures of S. aureus seeded on to human skin were rapidly killed after the skin has been covered with linolenic acid. The possibility of therapeutic use of linolenic acid as an antibacterial agent should be explored.

Normal people without symptoms of reflux do in fact reflux small quantities of acid into the oesophagus when either standing or sitting, but do not reflux acid when they are sleeping lying flat. This ;physiological' incompetence in the upright position is not of great importance in that the oesophagus is able to, and consistently does, deal with small concentrations of refluxed acid material. The oesophageal measurements of pH have a limited use as a diagnostic measure and may indicate acid reflux in the relaxed person not demonstrated by radiology.

Thymidine at levels as low as 0.05 mg/1 reduces the activities of sulphamethoxazole and trimethoprim and their combination in vitro. Using a biological assay procedure, levels of thymidine greater than this were interpreted as being present in urine. The addition of sulphamethoxazole and trimethoprim, singly or in combination, to urine obtained from patients with urinary tract infections showed that all the antibacterial effect towards sensitive organisms was due to the trimethoprim component. It is suggested that trimethoprim should replace the combination co-trimoxazole for the treatment of some lower urinary tract infections, and that laboratory media, if they are to resemble the clinical environment, should contain thymidine.

THIs is an account of a case of suicidal poisoning with paraquat. Despite treatment by forced diuresis and peritoneal dialysis the patient died only 2 days after ingestion of the poison.

The activities of some semisynthetic penicillins and cephalosporins have been tested against clinical strains of Staphylococcus aureus. The apparent activity in vitro varies with the method of testing used. Determination of MICs using light inocula fails to detect the destructive effect of penicillinase on the antibiotic. This was, however, demonstrated reproducibly by the use of a technique in which a heavy inoculum was pre-incubated for two hours before application of antibiotic to wells. This method of testing probably represents most of the clinical situations in which the drugs are used since both in vitro and in vivo a growing culture is exposed to an antibiotic gradient. Flucloxacillin was inactivated by penicillinase considerably more than either methicillin, cloxacillin, or nafcillin. Cephaloridine was the most vulnerable of the cephalosporins. Cephazolin, cephalothin, and cephalexin were intermediate. Cephradine was the least hydrolysed by staphylococcal penicillinase. It is recommended that the activities of all penicillins and cephalosporins against staphylococci should be tested by diffusion at 37 degrees C with pre-incubation of the culture for two hours at this temperature.

This article reviews the current place of erythromycin in antibiotic therapy. Overall, erythromycin is thought to be underused because: (1) the fear of resistance has been exaggerated; (2) significant toxicity has been associated with only one derivative (the estolate); (3) newer antibiotics have very rarely been demonstrated to be superior to erythromycin. Erythromycin has an important place in treating acute upper and lower respiratory tract infections, acute otitis media, sinusitis, skin and soft tissue, osteomyelitis, prostatitis, infections due to Mycoplasma spp. and Chlamydia organisms, and infections due to anaerobes.

Of 19 recently isolated cultures of methicillin-resistant Staphylococcus aureus, 18 showed inducible low-level resistance to minocycline, 15 showed high-level resistance to streptomycin, and 4 showed resistance to low levels of streptomycin. Two cultures produced yellow pigment and may have been derived in vivo by loss of a gene(s) determining orange pigment. Treatment of three cultures with serial exposures to N-methyl-N'-nitro-N-nitrosoguanidine resulted in a widening of phage typing pattern that included all reactions in group I, the great majority in group III, but none in group II. The widening in phage lysis was possibly due to the elimination of defective prophages. Transfer of tetracycline resistance occurred from 12 out of the 19 cultures to a recipient in mixed culture; this transfer required either Ca2+ or Mg2+, was abolished by citrate, and enhanced by high cell density. It was probably mediated by defective bacteriophages. No evidence was obtained for the occurrence of recombination within the methicillin-resistant clone in nature. Eleven methicillin-resistant cultures stored for at least 5 years on agar slopes at 20 degrees C had all lost this resistance at high frequency.

Sulphadiazine and trimethoprim in a wide range of concentrations were added to urine from patients with untreated urinary-tract infections. At therapeutic concentrations, the antibacterial activity of trimethoprim was not increased by the addition of sulphadiazine. Exposure of Escherichia coli to trimethoprim in urine was not associated with an increase in resistance to that agent. It was also not possible to select, in vitro, stable resistance to trimethoprim in sensitive cultures of E. coli. At therapeutic levels in blood, trimethoprim and sulphadiazine singly produced mainly a bactericidal action on pathogens responsible for urinary-tract infections. Sulphadiazine occasionally enhanced the effect of trimethoprim at subtherapeutic levels. These findings support the need for further evaluation of trimethoprim alone, rather than its use as a combination with a sulphonamide.

Influenced by corporate America, the commonly labelled 'welfare reforms' began in July 2006 with the introduction of the Welfare Reform Bill by the New Labour government, and guaranteed that claimants of long-term out-of-work sickness and disability benefit were to be coerced and intimidated by the Department for Work and Pensions (DWP) simply for committing the 'crime' of being too ill to work.

EDITOR, - The recent guidelines to doctors1 referred to by Gabriel Scally2 perpetuate the myth that most underage girls obtain contraceptives from family planning clinics. Nine years ago a survey of general practitioners revealed that doctors were providing contraceptives to between 2-12 girls a year.3 On a national level this meant that, at the very least, 60 000 schoolgirls (one in six) were being prescribed the pill by their general practitioners, at a time when only 18 000 were attending family planning clinics. My experience as a parent of …

Summary. This paper considers the apparent absence of house or settlement platforms in Iron Age lowland England. It demands that lowland sites be interpreted using criteria derived from suitable (lowland) contexts. The dangers of using upland‐derived explanatory models are illustrated with selected examples. The Cat's Water subsite, Fengate, Peterborough provides examples of probable house‐platforms, protected from plough‐damage by alluvium; these, in turn, are used to provide criteria to recognise similar features on poorly preserved sites. Comparisons are drawn with recently excavated sites in the Netherlands. The paper concludes with some general observations on the nature of once‐wet sites and the dangers inherent in their interpretation.

BACKGROUND: Hypocalcemia is a relatively common complication after parathyroidectomy for treatment of primary hyperparathyroidism. OBJECTIVES: To retrospectively evaluate clinical variables in dogs with primary hyperparathyroidism to determine whether or not an association exists between pre-surgical variables and the development of post-surgical hypocalcemia. ANIMALS: One hundred three dogs diagnosed with primary hyperparathyroidism and treated by parathyroidectomy in seven referral hospitals between 2010 and 2021. MATERIAL AND METHODS: Data collected from medical records included signalment, physical examination findings, concurrent illnesses, ongoing medications, and clinicopathologic test results (including serum ALP activity, iCa, plasma phosphate and PTH concentrations). Dogs were assigned into groups based on lowest iCa post-surgery: Group1 ≥ 1.1 mmol/L, Group2 < 1.1 mmol/L. The Mann-Whitney U test assessed associations between several variables of interest and the occurrence of post-surgery hypocalcemia. ROC analyses were performed to identify variables that had the potential to predict the development of hypocalcemia after surgery. RESULTS: The median plasma PTH concentration pre-surgery in dogs which developed hypocalcemia after surgery was significantly higher (232 pg/mL {[IQR] 108-421}) than in dogs which did not develop hypocalcemia after surgery (81.5 pg/mL {IQR 58.5-145.0}; p < 0.001). Plasma PTH concentration had a fair to good ability to predict the development of post-surgery hypocalcemia, with AUC being 0.78 [95% confidence interval 0.67-0.89]. Using a cut-off of ≥ 75 pg/mL, pre-surgery plasma PTH concentration had a sensitivity of 96.6% and specificity of 42.3% for the development of post-surgery hypocalcemia. Dogs that developed hypocalcemia after surgery were older and had lower body weights. CONCLUSION: Pre-surgery plasma PTH concentrations might be helpful in predicting those dogs at risk of developing hypocalcemia after parathyroidectomy.

I feel drawn to respond to the letter from David Harding- Price entitled 'Alternative NHS Funding' which appeared in the Nursing Standard of January 9, 1988.

Transcription is regulated in a multitude of ways to ensure lineage- and context-specific gene expression in a coordinated fashion. Hematopoiesis is an exemplary process for studying the mechanisms of tightly regulated activation and repression of gene expression programs through transcription and gene regulatory complexes. These complexes act by posttranslational modification of histones and nonhistone proteins, epigenetic modifications of DNA, ATP-dependent chromatin remodeling, scaffolding and recruitment of combinatorial protein complexes, and alteration of three-dimensional genome conformation to bring about lineage-specific gene expression. This review will focus on the function of these gene regulatory complexes in hematopoiesis and how they are hijacked in acute myeloid leukemia, highlighting therapeutic progress and opportunities.