Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases

BACKGROUND: The presentation and causes of adult meningitis in South Africa have changed substantially as a result of HIV. Knowledge of aetiology and laboratory findings in patients presenting with meningitis are important in guiding management. We performed a retrospective study to determine these findings in a setting of high HIV and TB prevalence in Cape Town. METHODS: Patients undergoing lumbar punctures between 1st January 2006 and 31st December 2008 at a public sector referral hospital were studied. Cases were classified by microbiological diagnosis, or in the absence of definitive microbiology as 1) normal CSF (neutrophils or =1.5 mmol/L), 2) minor abnormalities (neutrophils 2-5, lymphocytes 6-20, protein 0.51-1.0, glucose 1.0-1.49) or 3) markedly abnormal (neutrophils>5, lymphocytes>20, protein>1.0, glucose<1.0). RESULTS: 5578 LPs were performed on 4549 patients, representing 4961 clinical episodes. Of these, 2293 had normal CSF and 931 had minor abnormalities and no aetiology identified. Of the remaining 1737, microbiological diagnoses were obtained in 820 (47%). Cryptococcus accounted for 63% (514) of microbiological diagnoses, TB for 28% (227), bacterial meningitis for 8% (68). Of the remaining 917 who had marked abnormalities, the majority (59%) had a sterile lymphocytic CSF. Of note 16% (81) patients with confirmed Cryptococcus, 5% (12) with TB and 4% (3) with bacterial meningitis had normal CSF cell-counts and biochemistry. CONCLUSIONS: Cryptococcal and tuberculous meningitis are now the commonest causes of adult meningitis in this setting. TB meningitis is probably underdiagnosed by laboratory investigation, as evidence by the large numbers presenting with sterile lymphocytic markedly abnormal CSFs

A new framework for designing programmes of assessment

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals

Pancreatic carcinoma

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44375/1/10620_2005_Article_BF02235997.pd

Neonatal Myocardial Infarction or Myocarditis?

We report a 29 week-gestation preterm infant who presented during his second week of life with cardiogenic shock. Clinical presentation and first diagnostics suggested myocardial infarction, but echocardiographic features during follow-up pointed to a diagnosis of enteroviral myocarditis. The child died of chronic heart failure at 9 months of age. Autopsy showed passed myocardial infarction. No signs for active myocarditis were found. We discuss the difficulties in differentiating between neonatal myocardial infarction and myocarditis. Recognizing enteroviral myocarditis as cause for cardiogenic shock is of importance because of the therapeutic options

MoS 2 and WS 2 nanocone arrays: Impact of surface topography on the hydrogen evolution electrocatalytic activity and mass transport

We report the fabrication and electrochemical study of edge-abundant transition metal dichalcogenide (TMD) nanocone arrays. Time-dependent etching by sequential use of isotropic O2 and anisotropic SF6/C4F8 plasmas on nanosphere monolayer-modified TMD crystals results in very high coverage nanocone array structures with tunable aspect ratios and interspacings. Electrochemical characterization of these arrays via the hydrogen evolution reaction (HER), using a low proton concentration electrolyte (2 mM HClO4, 0.1 M NaClO4) to reveal morphology-dependent mass transport features at the proton diffusion-controlled region, show significant changes in electrocatalytic behaviour at both WS2 and MoS2: notably onset potential shifts of 100 and 200 mV, and Tafel slope decreases of 50 and 120 mV dec−1 respectively. These improvements vary according to the geometry of the arrays and the availability of catalytic edge sites, and thus the observed electrochemical behaviour can be rationalized via kinetic and mass transport effects

Search for new phenomena in final states with an energetic jet and large missing transverse momentum in pp collisions at √ s = 8 TeV with the ATLAS detector

Results of a search for new phenomena in final states with an energetic jet and large missing transverse momentum are reported. The search uses 20.3 fb−1 of √ s = 8 TeV data collected in 2012 with the ATLAS detector at the LHC. Events are required to have at least one jet with pT > 120 GeV and no leptons. Nine signal regions are considered with increasing missing transverse momentum requirements between Emiss T > 150 GeV and Emiss T > 700 GeV. Good agreement is observed between the number of events in data and Standard Model expectations. The results are translated into exclusion limits on models with either large extra spatial dimensions, pair production of weakly interacting dark matter candidates, or production of very light gravitinos in a gauge-mediated supersymmetric model. In addition, limits on the production of an invisibly decaying Higgs-like boson leading to similar topologies in the final state are presente

Long-term follow-up of patients with previous myocarditis using radionuclide ventriculography

A prospective long-term follow-up study is reported of 18 of 19 patients who survived a bout of presumed myocarditis 6–136 months (average 54 months) previously. The study included 14 males and four females, ranging from 27 to 63 years of age (mean, 44 years). Chest X-ray, ECG, echocardiogram, and resting and exercise radionuclide ventricular ejection fraction (RNVEF) for assessment of ventricular function were evaluated at follow-up. Resting and exercise RNVEF from seven control subjects were evaluated for comparison. Residual abnormalities were noted in chest X-ray (16%), echocardiogram (30%), and ECG (55%) in these predominantly asymptomatic patients (17/18 or 95%). The resting RNVEF (mean ±SD) for the myocarditis group versus controls were 0.57±0.1 and 0.65±0.1 ( P =NS), respectively. The exercise RNVED for the myocarditis group versus controls were 0.56±0.1 and 0.74±0.05 ( P <0.01), respectively. Abnormal resting RNVEF was noted in six (33%) and exercise RNVEF in 14 (77%) patients in the myocarditis group. Two patients with abnormal exercise RNVEF subsequently developed findings consistent with dilated cardiomyopathy. It is unclear as to whether the abnormal ventricular function may serve as a marker for future development of dilated cardiomyopathy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41583/1/380_2005_Article_BF02072391.pd

Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the Dementia Study in Northern Norway

Inappropriate medical treatment of co-morbidities in Alzheimer’s disease (AD) is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway. Setting: Nine rural municipalities with 70 000 inhabitants in Northern Norway. Participants: Participants with and without AD recruited in general practice and by population based screening. 187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression. A co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1 ± 3.6 and 2.9 ± 2.4 respectively, p < 0.001 age and gender adjusted), also when adjusted for co-morbidity. AD participants used significantly more anticholinergic, sedative and antidepressant drugs. For nursing home residents with AD the mean number of drugs was significantly higher compared to AD participants living at home (6.9 ± 3.9 and 4.5 ± 3.3, respectively, p < 0.001). AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors