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To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.
Three-arm nonmasked randomized controlled trial.
Five academic medical centers in Southeastern Pennsylvania.
Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.
Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.
MAIN OUTCOME MEASURES
Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.
Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).
Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance
To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Prospective cohort study conducted from January 1, 2010, through December 31, 2012.
Five adult and pediatric academic medical centers.
Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.
Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.
The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.
A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
Infect. Control Hosp. Epidemiol. 2015;36(7):786–793
Previous numerical simulations have shown that vortex breakdown starts with the formation of a steady axisymmetric bubble and that an unsteady spiralling mode then develops on top of this. We investigate this spiral mode with a linear global stability analysis around the steady bubble and its wake. We obtain the linear direct and adjoint global modes of the linearized Navier–Stokes equations and overlap these to obtain the structural sensitivity of the spiral mode, which identifies the wavemaker region. We also identify regions of absolute instability with a local stability analysis. At moderate swirls, we find that the
$m= - 1$
azimuthal mode is the most unstable and that the wavemaker regions of the
$m= - 1$
mode lie around the bubble, which is absolutely unstable. The mode is most sensitive to feedback involving the radial and azimuthal components of momentum in the region just upstream of the bubble. To a lesser extent, the mode is also sensitive to feedback involving the axial component of momentum in regions of high shear around the bubble. At an intermediate swirl, in which the bubble and wake have similar absolute growth rates, other researchers have found that the wavemaker of the nonlinear global mode lies in the wake. We agree with their analysis but find that the regions around the bubble are more influential than the wake in determining the growth rate and frequency of the linear global mode. The results from this paper provide the first steps towards passive control strategies for spiral vortex breakdown.
We discuss the use of balloon dilatation to relieve supraglottic stenosis caused by mucous membrane plasmacytosis.
A 54-year-old man with a known diagnosis of mucous membrane plasmacytosis presented with dysphonia and worsening airway obstruction which required a tracheostomy. He underwent balloon dilatation of the supraglottic larynx using an angioplasty balloon within sequentially sized endotracheal tubes. This enabled successful decannulation, with minimal re-stenosis at eight-month follow up.
To our knowledge, this is the first reported case of supraglottic stenosis caused by plasmacytosis to be successfully treated using this method. We have shown that this minimally invasive technique deals effectively with a complex airway and minimises re-stenosis.
Intracellular vitamin C acts to protect cells against oxidative stress by intercepting reactive oxygen species (ROS) and minimising DNA damage. However, rapid increases in intracellular vitamin C may induce ROS with subsequent DNA damage priming DNA repair processes. Herein, we examine the potential of vitamin C and the derivative ascorbate-2-phosphate (2-AP) to induce a nucleotide excision repair (NER) response to DNA damage in a model of peripheral blood mononuclear cells. Exposure of cells to elevated levels of vitamin C induced ROS activity, resulting in increased levels of deoxycytidine glyoxal (gdC) and 8-oxo-2′-deoxyguanosine (8-oxodG) adducts in DNA; a stress response was also induced by 2-AP, but was delayed in comparison to vitamin C. Evidence of gdC repair was also apparent. Measurement of cyclobutane thymine–thymine dimers (T < >T) in DNA and culture supernatant were included as a positive marker for NER activity; this was evidenced by a reduction in DNA and increases in culture supernatant levels of T < >T for vitamin C-treated cells. Genomics analysis fully supported these findings confirming that 2-AP, in particular, induced genes associated with stress response, cell cycle arrest, DNA repair and apoptosis, and additionally provided evidence for the involvement of vitamin C in the mobilisation of intracellular catalytic Fe.
Following a previous paper in which we documented the otological side effects of drug therapy, we here review other drug side effects that ENT surgeons may encounter when dealing with patients. Although otological drug side effects such as hearing loss and tinnitus are well recognized there are many rhinological, laryngeal, oropharyngeal and other head and neck drug side effects. Our data were sourced from the British National Formulary and Electronic Medical Compendium websites.
Cystic lesions of the larynx are most commonly benign. However, we report a case of non-Hodgkin’s lymphoma (NHL) of the larynx which presented as a supraglottic cyst. This form of presentation has not been previously described in the medical literature.
Otolaryngologic symptoms are common and patients presenting to the otolaryngologist will often be taking drugs for the treatment of unrelated diseases. As a doctor, one must not forget the potential of these drugs to cause otologic side effects and, in some cases, to be the cause of the presenting symptom.
We performed a comprehensive search of the British National Formulary and Electronic Medical Compendium websites to classify the otologic side effects caused by drugs. Not all the data were found at both websites. We have compiled all the data together, subclassified them and produced a review of the otologic side effects of drugs, in table form.
Femtosecond pulsed laser damage of Silicon (100) with thermal oxide thin films was studied in order to further understand the optical and electrical properties of thin films and to evaluate their influence on the damage of the substrate. The damage threshold as a function of film thickness (2 – 1200 nm) was measured. The damage morphology produced by single laser pulses was also investigated. Two primary morphologies were observed, one in which the oxide film is completely removed, and the other in which the film is delaminated and expanded above the surface producing a bubble feature.