Single thyroid nodules

No Abstrac

Hymie Barney Klugman

N/

'Atypical' bacteria are a common cause of community-acquired pneumonia in hospitalised adults

Objectives. To assess the proportion of cases of community· acquired pneumonia caused by 'atypical' bacteria, inclUding the recently discovered Chlamydia pneumoniae, and to compare the clinical, radiographic and laboratory features of patients with and without 'atypical' bacteria.Methods. A prospective serological study was carried out on consecutive adult pneumonia patients from July 1987 to July 1988. Acute and convalescent sera were tested in batches for antibodies against Legionella pneumophila serogroup 1, C. pneumoniae, Chlamydia psittaci, Coxiella burnetii (phase-2 antigen) and Mycoplasma pneumoniae (lgG and IgM). Records and chest radiographs were examined retrospectively.Results. Acute and convalescent sera were available from 113 patients. The records of 4 patients could not be traced and 17 patients did not fulfil the inclusion criteria. Thirty-two of these 92 patients (35,9%) were found to be infected with 'atypical' bacteria. The two most common organisms were C. pneumoniae (20,7%) and L. pneumophila (8,7%). There. were no differences in the clinical and radiographic features of patients with and without 'atypical' bacteria. Clinicians prescribed erythromycin or tetracyclines with equal frequency in the two groups.Conclusions. 'Atypical' bacteria, especially C. pneumoniae, are a common cause of community-acquired pneumonia in adults in South Africa. This is the first demonstration of an aetiological role of C. pneumoniae in this country. We confirmed the finding of other studies that there are no clinical, radiographic or laboratory features characteristic of 'atypical' bacterial infection in hospitalised patients. This has major implications for therapy, as these organisms respond to erythromycin and tetracyclines, but· not to β-lactam antibiotics

Surveillance of resistance in bacteria causing community‐acquired respiratory tract infections

Bacterial resistance to antibiotics in community‐acquired respiratory tract infections is a serious problem and is increasing in prevalence world‐wide at an alarming rate. Streptococcus pneumoniae, one of the main organisms implicated in respiratory tract infections, has developed multiple resistance mechanisms to combat the effects of most commonly used classes of antibiotics, particularly the β‐lactams (penicillin, aminopenicillins and cephalosporins) and macrolides. Furthermore, multidrug‐resistant strains of S. pneumoniae have spread to all regions of the world, often via resistant genetic clones. A similar spread of resistance has been reported for other major respiratory tract pathogens, including Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. To develop and support resistance control strategies it is imperative to obtain accurate data on the prevalence, geographic distribution and antibiotic susceptibility of respiratory tract pathogens and how this relates to antibiotic prescribing patterns. In recent years, significant progress has been made in developing longitudinal national and international surveillance programs to monitor antibiotic resistance, such that the prevalence of resistance and underlying trends over time are now well documented for most parts of Europe, and many parts of Asia and the Americas. However, resistance surveillance data from parts of the developing world (regions of Central America, Africa, Asia and Central/Eastern Europe) remain poor. The quantity and quality of surveillance data is very heterogeneous; thus there is a clear need to standardize or validate the data collection, analysis and interpretative criteria used across studies. If disseminated effectively these data can be used to guide empiric antibiotic therapy, and to support—and monitor the impact of—interventions on antibiotic resistance

BEHAVIOR OF SANDHILL CRANES HARNESSED WITH DIFFERENT SATELLITE TRANSMITTERS

The effectiveness of various attachment methods and designs of platform transmitting terminals (PIT\u27s) was tested on captive sandhill cranes (Grus canadensis) at the Patuxent Wildlife Research Center, Laurel, Maryland, during 1989-91. Combinations of attachment and transmitter designs included neoprene cord harness with batteries separate from the transmitter (2 harness designs), Teflon ribbon harness with batteries incorporated into the transmitter package (4 transmitter models), and a package attached directly to the bird with epoxy glue only. Physical effects seen on cranes wearing PTT\u27s ranged from skin lacerations (caused by rubbing of harness material) to no observed effects (other than feather wear). The most successful harness material and design utilized a Teflon ribbon harness with the 4 ribbon ends from the transmitter forming a neck loop and a body loop joined at the sternum. Time spent by sandhill cranes performing most activities did not change after transmitter attachment using this harness method

Imputing direct and indirect vaccine effectiveness of childhood pneumococcal conjugate vaccine against invasive disease by surveying temporal changes in nasopharyngeal pneumococcal colonization

The limited capabilities in most low-middle income countries to study the benefit of pneumococcal conjugate vaccine (PCV) against invasive pneumococcal disease (IPD), calls for alternate strategies to assess this. We used a mathematical model, to predict the direct and indirect effectiveness of PCV by analyzing serotype specific colonization prevalence and IPD incidence prior to and following childhood PCV immunization in South Africa. We analyzed IPD incidence from 2005-2012 and colonization studies undertaken in HIV-uninfected and HIV-infected child-mother dyads from 2007-2009 (pre-PCV era), in 2010 (7-valent PCV era) and 2012 (13-valent PCV era). We compared the model-predicted to observed changes in IPD incidence, stratified by HIV-status in children >3 months to 5 years and also in women aged >18-45 years. We observed reductions in vaccine-serotype colonization and IPD due to vaccine serotypes among children and women after PCV introduction. Using the changes in vaccine-serotype colonization data, the model-predicted changes in vaccine-serotype IPD incidence rates were similar to the observed changes in PCV-unvaccinated children and adults, but not among children <24 months. Surveillance of colonization prior and following PCV use can be used to impute PCVs' indirect associations in unvaccinated age groups, including in high HIV-prevalence settings

A probabilistic model of the economic risk to Britain’s railway network from bridge scour during floods

Scour (localized erosion by water) is an important risk to bridges, and hence many infrastructure networks, around the world. In Britain, scour has caused the failure of railway bridges crossing rivers in more than 50 flood events. These events have been investigated in detail, providing a data set with which we develop and test a model to quantify scour risk. The risk analysis is formulated in terms of a generic, transferrable infrastructure network risk model. For some bridge failures, the severity of the causative flood was recorded or can be reconstructed. These data are combined with the background failure rate, and records of bridges that have not failed, to construct fragility curves that quantify the failure probability conditional on the severity of a flood event. The fragility curves generated are to some extent sensitive to the way in which these data are incorporated into the statistical analysis. The new fragility analysis is tested using flood events simulated from a spatial joint probability model for extreme river flows for all river gauging sites in Britain. The combined models appear robust in comparison with historical observations of the expected number of bridge failures in a flood event. The analysis is used to estimate the probability of single or multiple bridge failures in Britain's rail network. Combined with a model for passenger journey disruption in the event of bridge failure, we calculate a system-wide estimate for the risk of scour failures in terms of passenger journey disruptions and associated economic costs