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.

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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.

L'otite moyenne est une maladie commune de l'enfance et qui peut causer une morbidite significative. Une connaissance des pathogenes responsables de cette maladie peut aider a selectionner un traitement approprie et minimiser les complications qui peuvent necessiter une chirurgie. La microbiologie des otites moyennes aigues sereuses et chroniques est revue. Les principaux organismes retrouves a partir de 3/4 des otities moyennes aigues et la moitie des otites sereuses sont l'Hemophilus influenzae, le Streptocoque pneumoniae et le Moraxella catarrhalis. Le Streptocoque pyogene, les cocci anaerobiques et les virus peuvent chacun etre isoles chez moins de 5% des patients avec otite moyenne aigue. Les organismes predominants isoles a partir de l'otite moyenne chronique sont le Staphylococus aureus, le Pseudomonas aeruginosa et des bacteries anaerobiques. Les anaerobies predominants sont les coccigram positif, le Prevotella pigmente et la Porphyromonas sp., les Bacteroides sp. et le Fusobacterium sp. Plusieurs de ces organismes aerobiques et anaerobiques causant l'otite moyenne peuvent produire des beta-lactamases, qui peuvent contribuer a l'echec du traitement a la Penicilline. Le traitement chirurgical et medical approprie pour les otites aigues, sereuses et chroniques est discute

Otitis media: microbiology and management.

Recovery of anaerobic bacteria from a case of dissecting cellulitis Dissecting cellulitis (DC, also called perifolliculitis capitis abscedens et suffodiens) is manifested with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. Therapies include isotretinoin, antibiotics, steroids, X-ray, surgical excision, laser epilation of hair follicles and skin grafting. 1

Recovery of anaerobic bacteria from a case of dissecting cellulitis.

Aerobic and anaerobic microbiology of infected hemorrhoids.

Colonization of the tracheobronchial tree with microorganisms almost always follows tracheal intubation, tracheostomy, or the use of ventilatory tubes. Infection of the tracheostomy wound site frequently occurs after prolonged use of the tracheostomy. The long-term-ventilated child is at high risk for developing tracheobronchitis or nosocomial pneumonia, generally involving aerobic gram-negative or gram-positive bacteria. Several studies have illustrated the role of anaerobic bacteria in lower respiratory tract and tracheostomy wound site infection in intubated children. The predominant anaerobic bacteria were Peptostreptococcus spp and pigmented Prevotella and Porphyromonas spp. Most of these infections are due to polymicrobial aerobic-anaerobic bacterial flora. Appropriate management of mixed pulmonary aerobic and anaerobic infections requires the administration of antimicrobials that are effective against both the aerobic and anaerobic components of the infection.

Role of anaerobic bacteria in infections following tracheostomy, intubation, or the use of ventilatory tubes in children.

One hundred twenty three microaerophilic streptococci (MS) were isolated from 4,603 specimens submitted for the identification of anaerobic bacteria over the course of 12 years. The MS included 16 Streptococcus constellatus, 43 Streptococcus intermedius and 21 Gemella morbillorum. A total of 81 MS isolates (66%) identified from 75 patients were considered to cause infection. Predisposing or underlying conditions were noted in 48 (64%) patients. The most common conditions were previous surgery (15 instances), trauma (10), diabetes (9), immunodeficiency (6), malignancy, and prosthetic device (5 each). MS were the only bacterial isolates in 23 instances. Mixed infection was encountered in 52 (69%) patients, where the number of isolates varied between two and five (average 2.7). The organisms most commonly isolated with MS were anaerobic cocci, Bacteroides sp. and Enterobacteriaceae; their recovery varied at different sites. Significant infections caused by MS were associated with abscess (29 instances), sinuses (7), obstetrical and gynecological (OBG), chest and wounds (6 each), abdominal (5), and biliary infection (4). Antimicrobial therapy as administered to 71 patients; for 43 patients, in conjunction with surgical drainage or correction. Surgical drainage alone was performed in three patients. Four patients (5%) died. These data illustrate that MS can occasionally be associated with serious infection.

Itzhak Brook

Papers

Otitis media: microbiology and management.

Recovery of anaerobic bacteria from a case of dissecting cellulitis.

Aerobic and anaerobic microbiology of infected hemorrhoids.

Role of anaerobic bacteria in infections following tracheostomy, intubation, or the use of ventilatory tubes in children.

Microaerophilic streptococci as a significant pathogen: a twelve-year review.