A randomized controlled trial to determine whether a video presentation improves informed consent for hysterectomy.

Background: Informed consent is an integral part of the preoperative counseling process. It is important that we know the best way to relay this information to patients undergoing surgery, specifically, hysterectomy.

Objective: We sought to determine whether supplementing normal physician counseling with a video presentation improves patient comprehension during the informed consent process for hysterectomy.

Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study.

Background: There is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children.

Objective: To assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.

Invasive Propionibacterium acnes infections in a non-selective patient cohort: clinical manifestations, management and outcome.

An increasing number of reports suggest that Propionibacterium acnes can cause serious invasive infections. Currently, only limited data exist regarding the spectrum of invasive P. acnes infections.

Clostridium difficile in children: a review of existing and recently uncovered evidence.

The clinical significance of the presence of Clostridium difficile in children's faeces remains uncertain using current diagnostic procedures. Clostridium difficile is a relatively common finding in infants with no symptoms of gastrointestinal disease, suggesting it may be an incidental finding and form part of the normal gut micro-flora in this age group. On the other hand, particularly in older children or those with significant co-morbidity, there are examples where C.

Managing bone and joint infection in children.

There is little high quality evidence on which to base the management of bone and joint infections in children. This pragmatic practice note aims to provide a consensus framework of best current practice prior to the availability of data from large national randomised controlled trials. For straightforward infection in previously normal children, recent trends suggest that shorter length of intravenous therapy with switch to oral treatment is acceptable, although this is not the case for the management of complex infections including those with multifocal disease, significant bone destruction, resistant or unusual pathogens, sepsis or in immunosuppressed children.

Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria.

Resistance in Gram-negative bacteria has been increasing, particularly over the last 6 years. This is mainly due to the spread of strains producing extended-spectrum β-lactamases (ESBLs) such as CTX-M enzymes or AmpC β-lactamases. Many of the isolates producing these enzymes are also resistant to trimethoprim, quinolones and aminoglycosides, often due to plasmid co-expression of other resistance mechanisms.

Have the organisms that cause breast abscess changed with time?--Implications for appropriate antibiotic usage in primary and secondary care.

Many patients with breast abscess are managed in primary care. Knowledge of current trends in the bacteriology is valuable in informing antibiotic choices. This study reviews bacterial cultures of a large series of breast abscesses to determine whether there has been a change in the causative organisms during the era of increasing methicillin-resistant Staphylococcus aureus (MRSA).

Microbiological aspects of the UK National Institute for Health and Clinical Excellence (NICE) guidance on urinary tract infection in children.

The publication in August 2007 of the UK National Institute for Health and Clinical Excellence (NICE) guidance on urinary tract infection in children provided a fresh and useful review of the management of this condition. However, it has also resulted in some controversy. In particular, the advice to use urgent microscopy for rapid screening of urine in children >or=3 months but <3 years of age has presented practical problems for some laboratories in staffing this service out of hours.

Compliance with hand hygiene in a genitourinary medicine department.

The ability to control hospital-acquired infections is highly dependent upon control of cross-contamination from health-care workers to patients, and from one anatomical area of the patient to another anatomical area. Hand hygiene has been demonstrated to be an essential prerequisite in preventing cross-contamination. Wearing gloves does not afford complete protection against cross-contamination.

Septic arthritis of the knee by Salmonella montevideo.

We describe a case of salmonella septic arthritis of the knee in a middle-aged woman with the following predisposing conditions: long-term corticosteroids and microscopic collagenous colitis. The patient presented with enteritis caused by the same strain 3 months before the arthritis. The first series of cultures were negative and the possibility of a chronic carriage of the disease was not suspected initially.

Once-daily versus multiple-daily gentamicin in empirical antibiotic therapy of febrile neutropenia following intensive chemotherapy.

The clinical efficacy and toxicity of once-daily compared with multiple-daily gentamicin dosing, in combination with azlocillin, were studied retrospectively in febrile neutropenic episodes following intensive chemotherapy. Fifty-two episodes were studied in 28 patients with acute myeloid leukaemia. Reasons for initiation of antibiotic therapy, dose, duration of treatment, organism isolation rates, response, cost comparison and toxicity were studied in the two treatment groups.

Leptin signalling in pancreatic islets and clonal insulin-secreting cells.

Leptin is a cytokine secreted from adipose tissue at a rate commensurate with the size of the body's fat stores. In addition to its anorectic and thermogenic central actions, leptin is known to act on peripheral tissues, including the pancreatic beta-cell where it inhibits insulin secretion and reduces insulin transcript levels. However, the role of leptin signalling through its full-length receptor, OB-Rb, in the beta-cell remains unclear.

Characterisation of new efaroxan derivatives for use in purification of imidazoline-binding sites.

The insulin secretagogue activity of certain imidazoline compounds is mediated by a binding site associated with ATP-sensitive K+ (K(ATP)) channels in the pancreatic beta-cell. We describe the effects of a series of structural modifications to efaroxan on its activity at this site. Substitution of amino-, nitro- or azide- groups onto the 5-position of the benzene ring of efaroxan did not significantly affect the functional interaction of the ligand with the islet imidazoline binding site.

Clotrimazole and efaroxan stimulate insulin secretion by different mechanisms in rat pancreatic islets.

It is now well established that the imidazoline insulin secretagogue efaroxan mediates its effects by inducing closure of ATP-sensitive potassium channels in the pancreatic beta-cell, leading to membrane depolarisation, Ca2+ influx and increased insulin secretion. However, a recent study has shown that efaroxan may also act as a blocker of a second class of potassium channel (the Kmaxi channel) in red blood cells, raising the possibility that its effects in islets could be mediated by interactions with both types of channel. Since the antimycotic imidazole compound clotrimazole is a highly potent blocker of Kmaxi channels, we have studied the effects of this drug on insulin secretion.

Leptin inhibits insulin secretion and reduces insulin mRNA levels in rat isolated pancreatic islets.

The ob gene product leptin over the concentration range 0.1-100 nM demonstrated a U-shaped dose-response inhibition of glucose-stimulated insulin secretion by rat pancreatic islets. Thus, leptin (1 and 10 nM) produced a significant inhibition whereas 100 nM was ineffective.

Evidence that the ability of imidazoline compounds to stimulate insulin secretion is not due to interaction with sigma receptors.

Recent studies have suggested that a variety of ion channels possess a binding site for ligands such as phencyclidine (PCP), dizocilpine and certain sigma ligands and that some imidazoline compounds can also bind to this site. We have investigated whether interaction with this binding site could account for the ability of imidazolines to stimulate insulin secretion from rat islets. Neither PCP nor dizocilpine shared the insulin secretory activity of the imidazoline efaroxan in rat islets suggesting that they do not have similar actions in the pancreatic B-cell.