Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Assessment and characterization of gut microbiota has become a major research area in human disease, including type 2 diabetes, the most prevalent endocrine disease worldwide. To carry out analysis on gut microbial content in patients with type 2 diabetes, we developed a protocol for a metagenome-wide association study (MGWAS) and undertook a two-stage MGWAS based on deep shotgun sequencing of the gut microbial DNA from 345 Chinese individuals. We identified and validated approximately 60,000 type-2-diabetes-associated markers and established the concept of a metagenomic linkage group, enabling taxonomic species-level analyses. MGWAS analysis showed that patients with type 2 diabetes were characterized by a moderate degree of gut microbial dysbiosis, a decrease in the abundance of some universal butyrate-producing bacteria and an increase in various opportunistic pathogens, as well as an enrichment of other microbial functions conferring sulphate reduction and oxidative stress resistance. An analysis of 23 additional individuals demonstrated that these gut microbial markers might be useful for classifying type 2 diabetes.

/pdf/a-metagenome-wide-association-study-of-gut-microbiota-in-4gng2ouuna.pdf

A metagenome-wide association study of gut microbiota in type 2 diabetes

Infectious Diseases Society of America.

The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

/pdf/european-position-paper-on-rhinosinusitis-and-nasal-polyps-mj734vsl7p.pdf

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

Background
People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects.

Objectives
To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions.

Search methods
We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles.

Selection criteria
Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings.

Data collection and analysis
Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis.

Main results
For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 83 interventions reported in 70 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes.

Authors' conclusions
For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.

Interventions for enhancing medication adherence.

Objective: To study the microbiologic and clinical characteristics of patients with mediastinitis. Methods: Retrospective review of clinical and laboratory data of 17 patients treated between 1980 and 1987. Results: Aerobic or facultative bacteria only were present in three patients (18%), anaerobic bacteria only in seven (41%), and mixed aerobic-anaerobic flora in seven (41%). In total, there were 42 isolates, 13 aerobic or facultative and 29 anaerobic bacteria, an average of 2.5 per specimen. Anaerobic bacteria predominated in infections that originated from esophageal perforation and orofacial, odontogenic, and gunshot sources. The predominant aerobes were α-hemolyticStreptococcus(three isolates),Staphylococcus aureus(two isolates), and Klebsiella pneumoniae(two isolates). The predominant anaerobes were Prevotella andPorphyromonasspecies (eight isolates),Peptostreptococcusspecies (seven isolates), andBacteroides fragilisgroup (three isolates). Conclusion: These data highlight the polymicrobial aerobic-anaerobic nature of mediastinitis. (Arch Intern Med. 1996;156:333-336)

https://jamanetwork.com/journals/intemed/articlepdf/621597/archinte_156_3_017.pdf

Microbiology of Mediastinitis

Eighteen isolates of Bifidobacterium species, 99 of Eubacterium species, and 38 of anaerobic Lactobacillus species were recovered from 3,971 clinical specimens submitted to the anaerobic microbiology laboratory at the National Naval Medical Center over a period of 10 years (June 1978 to June 1988). Clinically significant infection was documented in association with 53 isolates recovered from 52 patients: 8 (44%) of the 18 Bifidobacterium isolates, 30 (30%) of the 99 Eubacterium isolates, and 15 (39%) of the 38 Lactobacillus isolates. The rest of the isolates were considered to be contaminants or to be of uncertain pathogenic significance. The significant infections that were documented mostly involved abdominal abscesses, obstetric and gynecologic sites, and wounds. Predisposing conditions (primarily prior surgery, immunodeficiency, malignancy, presence of a foreign body, or diabetes) were apparent in 7 (87.5%) of the 8 patients infected with Bifidobacterium species, in 23 (85%) of the 27 patients infected with Eubacterium species for whom clinical records were available, and in 8 (67%) of the 12 patients infected with Lactobacillus species for whom clinical records were available. Antimicrobial therapy was administered to 40 (85%) of the 47 patients for whom clinical records were available; such treatment was given in conjunction with surgical drainage or correction for 31 of these 47 patients (66%). No patient died of infection due to anaerobic, nonsporulating, gram-positive rods. These data illustrate that, although Bifidobacterium, Eubacterium, and Lactobacillus species are infrequently associated with infections, they occasionally do cause serious illness.

Significant Recovery of Nonsporulating Anaerobic Rods from Clinical Specimens

The role of anaerobic bacteria in sinusitis.

Objective: To assess the bacteriology and β-lactamase enzyme activity in aspirates of 10 acutely and 13 chronically inflamed maxillary sinuses. Results: The predominant organisms isolated in acute sinusitis were Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis , and those found in chronic sinusitis were Prevotella species, Fusobacterium species, and Peptostreptococcus species. Four β-lactamase-producing organisms (BLPOs) were isolated in four specimens (40%) obtained from acutely inflamed sinuses, and 14 BLPOs were recovered from 10 chronically inflamed sinuses (77%). The predominant BLPOs in acute sinusitis were H influenzae , and M catarrhalis ; those in chronic sinusitis were Staphylococcus aureus , Prevotella species, Fusobacterium species, and Bacteroides fragilis. Conclusions: β-Lactamase activity was detected in 12 (three in acute and nine in chronic sinusitis) of the 14 aspirates that contained BLPOs. The detection of β-lactamase activity in sinus aspirates provides support for the role of BLPOs in the failure of penicillin therapy in sinusitis. (Arch Otolaryngol Head Neck Surg. 1996;122:418-423)

Bacteriology and β-lactamase activity in acute and chronic maxillary sinusitis

The objective of the study was to compare the proportions of the recovery of pathogens of acute maxillary sinusitis in adults in the 4-year period prior to the 5-year period that followed the introduction of vaccination of children with the 7-valent pneumococcal vaccine (PCV7). Cultures were obtained through endoscopy from 385 adults with acute maxillary sinusitis, 156 between 1997 and 2000, and 229 between 2001 and 2005. One hundred and seventeen potentially pathogenic organisms were isolated from the cultures obtained between 1997 and 2000. The predominant organisms were Streptococcus pneumoniae (54 or 46 % of all isolates), Haemophilus influenzae non-type b (42 or 36 %), Moraxella catarrhalis (7 or 6 %), Streptococcus pyogenes (8 or 7 %) and Staphylococcus aureus (6 or 5 %). One hundred and sixty-seven potentially pathogenic organisms were isolated from the cultures obtained between 2001 and 2005. The most predominant organisms were H. influenzae non-type b (71 or 43 % of all isolates), Strep. pneumoniae (58 or 35 %), M. catarrhalis (13 or 8 %), Strep. pyogenes (12 or 7 %) and Staph. aureus (13 or 8 %). Significant statistical differences were noted in the rates of recovery of H. influenzae non-type b (P < 0.05) and Strep. pneumoniae (P < 0.05). A decrease occurred in the recovery of Strep. pneumoniae resistant to penicillin from 41 to 29 %, and an increase was noted in the isolation of beta-lactamase-producing H. influenzae from 33 to 39 %; however, neither change was statistically significant. These data illustrate that a significant shift occurred in the causative pathogens of acute maxillary sinusitis in adults in the 5 years after the introduction of vaccination of children with the PCV7 compared to the previous 4 years.

Frequency of recovery of pathogens causing acute maxillary sinusitis in adults before and after introduction of vaccination of children with the 7-valent pneumococcal vaccine.

Itzhak Brook

Papers

Microbiology of Mediastinitis

Significant Recovery of Nonsporulating Anaerobic Rods from Clinical Specimens

The role of anaerobic bacteria in sinusitis.

Bacteriology and β-lactamase activity in acute and chronic maxillary sinusitis

Frequency of recovery of pathogens causing acute maxillary sinusitis in adults before and after introduction of vaccination of children with the 7-valent pneumococcal vaccine.