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 evaluate the organisms recovered from infected sinuses and associated intracranial abscesses (IAs). Design Retrospective review of findings from aspirate of pus from 10 infected sinuses and their corresponding IAs. Setting Academic medical center. Patients Ten patients diagnosed as having sinusitis (age range, 7-58 years). Main Outcome Measure Aerobic and anaerobic bacteria findings from infected sinuses and IAs. Results Polymicrobial flora was found in 9 sinuses and 8 IAs. Anaerobes were isolated from all sinuses and 9 IAs. A total of 26 isolates (2.6 isolates per specimen) were recovered from the sinuses: 19 anaerobic, 6 aerobic or facultative, and 1 microaerophilic; 17 isolates were found in the IAs (1.7 isolates per site): 13 anaerobic, 2 aerobic or facultative, and 2 microaerophilic. The predominant anaerobes wereFusobacteriumspecies (in 5 corresponding sinuses and abscesses, 1 in a sinus only, and 1 in an IA only),Prevotellaspecies (in 3 corresponding sinuses and abscesses),Peptostreptococcusspecies (in 2 corresponding sinuses and abscesses, and 4 in a sinus only),Staphylococcus aureus, Haemophilus influenzaetype b, microaerophilic streptococci, andBacteroides ureolyticus(in 1 corresponding sinus and abscess each).Streptococcus pneumoniaewas recovered 2 times, only from a sinus. α-Hemolytic streptococci and β-hemolytic streptococci group F were each isolated once from the sinus. Concordance in the microbiological findings between the sinus and the IA was found in all instances. However, certain organisms were present at only one or the other site. Conclusion These data illustrate the concordance in the recovery of organisms from infected sinuses and their associated IA and confirm the importance of anaerobic bacteria in sinusitis and IA.

https://jamanetwork.com/journals/jamaotolaryngology/articlepdf/649715/ooa50066.pdf

Microbiology of intracranial abscesses and their associated sinusitis.

Microbiological Analysis of Pancreatic Abscess

Anaerobes of oral origin are common in chronic upper respiratory tract and other head and neck infections. Anaerobes are the predominant components of the normal human oropharyngeal flora, and are therefore a common cause of bacterial infections of the upper respiratory tract that are of endogenous origin. These bacteria can be isolated in chronic otitis media, sinusitis, and tonsillitis, and their complications. Anaerobes also predominate in deep oral and neck infections and abscesses. Their isolation requires appropriate methods of collection, transportation, and cultivation of specimens. In addition to their active pathogenic role in these infections, many anaerobes express an indirect effect through their ability to produce the enzyme beta-lactamase. This enables these organisms to shield non-beta-lactamase-producing bacteria (BLPB) from penicillins. Inadequate therapy against BLPB may lead to clinical failures. Treatment of anaerobic infection is complicated by their slow growth, their polymicrobial nature, and the growing resistance of anaerobic bacteria to antimicrobials. Antimicrobial therapy is often the only form of therapy needed, whereas in other instances it is an important adjunct to a surgical approach. Because anaerobes generally are isolated mixed with aerobic organisms, therapy should provide for adequate coverage of both types of pathogens.

Antibiotic resistance of oral anaerobic bacteria and their effect on the management of upper respiratory tract and head and neck infections.

Bacteriology and beta-lactamase activity in ear aspirates of acute otitis media that failed amoxicillin therapy

The objective of the review was to study the aerobic and anaerobic microbiology of subphrenic abscesses in relation with predisposing conditions. A retrospective review of clinical and laboratory data of 52 patients treated between 1974 and 1988 was conducted. Forty-three (83%) patients developed the abscesses after an operative procedure. These included 11 patients after colonic, 9 patients after gastric or duodenal, 7 patients after abdominal trauma, 7 patients after biliary, and 6 patients after appendix surgery. A total of 194 organisms (3.7 isolates/specimen), 83 aerobic (1.6/specimen), and 111 anaerobes (2.1/specimen) were recovered. Aerobic bacteria only were recovered in 7 (13%) abscesses, anaerobic bacteria only in 11 (21%), and mixed aerobic and anaerobic bacteria in 34 (65%). Polymicrobial infection was present in 47 (90%). The predominant aerobic isolates were Escherichia coli (28 isolates), Enterococcus group D(9), and Staphylococcus aureus (9). The predominant anaerobes were Peptostreptococcus species (33 isolates), Bacteroides fragilis group (25), Clostridium species (13), and Prevotella species (6). The number of isolates/site varied. The number of anaerobic bacteria/site outnumbered or was equal to the number of aerobic or facultatives in all instances, except in abscesses after biliary surgery. Their number/site was especially high in abscesses after appendectomy, and the number of aerobic and anaerobic bacteria was the lowest after gastric or duodenal surgery. S. aureus predominated after gastric, duodenal and posttrauma surgery; B. fragilis predominated after colonic, appendix, and postabdominal trauma surgery; Enterococcus group D predominated after biliary surgery; Fusobacterium and Prevotella species predominated after gastric or duodenal surgery; and Clostridium species predominated after colonic or appendix surgery. These data highlight the polymicrobial aerobic-anaerobic nature of subphrenic abscesses and their correlation with predisposing surgery.

Itzhak Brook

Papers

Microbiology of intracranial abscesses and their associated sinusitis.

Microbiological Analysis of Pancreatic Abscess

Antibiotic resistance of oral anaerobic bacteria and their effect on the management of upper respiratory tract and head and neck infections.

Bacteriology and beta-lactamase activity in ear aspirates of acute otitis media that failed amoxicillin therapy

Microbiology of subphrenic abscesses: a 14-year experience.