Multiple Transferable Drug Resistance In Enterobacteria In Mashonaland

A CAJM article on the prevalence of drug resistance in Mashonaland Province, Zimbabwe (formerly Rhodesia.)The development of resistance to antibiotics is so prevalent that it is prudent continuously to monitor the patterns of sensitivity in organisms likely to become involved. Particularly important are the staphylococci and the enterobacteria. The phenomenon is with staphylococci, a problem found largely within hospitals and similar “close contact” institutions and, while the same may apply to some extent to the enteric organisms, increase in resistance in bacteria in non-hospitalised patients is becoming fairly common

The Single-Particle Spectral Function of 16O^{16}{\rm O}

The influence of short-range correlations on the $p$-wave single-particle spectral function in $^{16}{\rm O}$ is studied as a function of energy. This influence, which is represented by the admixture of high-momentum components, is found to be small in the $p$-shell quasihole wave functions. It is therefore unlikely that studies of quasihole momentum distributions using the $(e,e'p)$ reaction will reveal a significant contribution of high momentum components. Instead, high-momentum components become increasingly more dominant at higher excitation energy. The above observations are consistent with the energy distribution of high-momentum components in nuclear matter.Comment: 5 pages, RevTeX, 3 figure

An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis

Background &amp; Aims: Patients with autoimmune hepatitis (AIH) almost invariably require lifelong immunosuppressive treatment. There is genuine concern about the efficacy and tolerability of the current standard combination therapy of prednisolone and azathioprine. Mycophenolate mofetil (MMF) has emerged as an alternative option. The aim of this study was to compare MMF to azathioprine as induction therapy for AIH. Methods: In this 24-week, prospective, randomised, open-label, multicentre superiority trial, 70 patients with treatment-naive AIH received either MMF or azathioprine, both in combination with prednisolone. The primary endpoint was biochemical remission defined as normalisation of serum levels of alanine aminotransferase and IgG after 24 weeks of treatment. Secondary endpoints included safety and tolerability. Results: Seventy patients (mean 57.9 years [SD 14.0]; 72.9% female) were randomly assigned to the MMF plus prednisolone (n = 39) or azathioprine plus prednisolone (n = 31) group. The primary endpoint was met in 56.4% and 29.0% of patients assigned to the MMF group and the azathioprine group, respectively (difference, 27.4 percentage points; 95% CI 4.0 to 46.7; p = 0.022). The MMF group exhibited higher complete biochemical response rates at 6 months (72.2% vs. 32.3%; p = 0.004). No serious adverse events occurred in patients who received MMF (0%) but serious adverse events were reported in four patients who received azathioprine (12.9%) (p = 0.034). Two patients in the MMF group (5.1%) and eight patients in the azathioprine group (25.8%) discontinued treatment owing to adverse events or serious adverse events (p = 0.018). Conclusions: In patients with treatment-naive AIH, MMF with prednisolone led to a significantly higher rate of biochemical remission at 24 weeks compared to azathioprine combined with prednisolone. Azathioprine use was associated with more (serious) adverse events leading to cessation of treatment, suggesting superior tolerability of MMF. Impact and implications: This randomised-controlled trial directly compares azathioprine and mycophenolate mofetil, both in combination with prednisolone, for the induction of biochemical remission in treatment-naive patients with autoimmune hepatitis. Achieving complete remission is desirable to prevent disease progression. Patients assigned to the mycophenolate mofetil group reached biochemical remission more often and experienced fewer adverse events. The findings in this trial may contribute to the re-evaluation of international guidelines for the standard of care in treatment-naive patients with autoimmune hepatitis. Trial registration number: #NCT02900443.</p