THE ROLE OF THE PEDIATRICIAN IN RHEUMATIC FEVER CONTROL

PEDIATRICS ◽  
1971 ◽  
Vol 47 (1) ◽  
pp. 5-5
Author(s):  
E. A. M.
Keyword(s):  
Rheumatic Fever ◽  
Agar Plate ◽  
University Hospital ◽  
Blood Agar Plate ◽  
Throat Culture ◽  
Sheep Blood Agar Plate ◽  
Group A ◽  
The One ◽  
The Cost

The following breakdown of the cost of a "strep only" throat culture came to my attention too late for inclusion in the above Commentary. This accounting was prepared by a university hospital laboratory director as justification for charging $7.50 for each such culture. The technique employed is the inoculation of a sheep blood agar plate plus two weak bacitracin disks for differentiation of group A from other hemolytic streptococci. See Table in the PDF File Obviously 40 minutes of personnel time (exclusive of professional supervision) is unreasonable. Granting that many other factors require consideration, ranging from the expense of a case of rheumatic fever on the one hand to the fact that the laboratory helps support other facets of hospital operation on the other, this cost is clearly prohibitive. Pediatricians and laboratory directors must find a better way.–

scholarly journals Improved reliability of the primary plate bacitracin test on throat cultures with sulfamethoxazole-trimethoprim blood agar plates

1979 ◽  
Vol 9 (1) ◽  
pp. 144-146 ◽  
Author(s):  
T Kurzynski ◽  
C Meise ◽  
R Daggs ◽  
A Helstad
Keyword(s):  
Agar Plate ◽  
Susceptibility Test ◽  
Sheep Blood Agar ◽  
Blood Agar ◽  
Blood Agar Plate ◽  
Group A Streptococci ◽  
Sheep Blood Agar Plate ◽  
Group A ◽  
Primary Plate ◽  
Disk Susceptibility

The primary plate bacitracin differentiation disk susceptibility test identified 85% of group A streptococci from throat cultures on SXT-BA(CO2) plates within 24 h, as compared to only 26% on a conventional sheep blood agar plate.

GROUP A STREPTOCOCCAL INFECTIONS IN A CHILDREN'S HOME

PEDIATRICS ◽  
1964 ◽  
Vol 33 (1) ◽  
pp. 5-10
Author(s):  
Hugh L. Moffet ◽  
Henry G. Cramblett ◽  
Joyce P. Black
Keyword(s):  
Agar Plate ◽  
Streptococcal Pharyngitis ◽  
School Age Children ◽  
Blood Agar Plate ◽  
Normal Children ◽  
Simple Method ◽  
Sheep Blood Agar Plate ◽  
Children's Home ◽  
Group A ◽  
Refrigerator Temperature

School-age children living in a children's home had pharyngeal cultures made on 485 consecutive infirmary admissions during a period of 14 months by inoculating the throat swab on the surface of a sheep blood agar plate. ASO titers were determined for the acute and convalescent phases of 95% of the 321 untreated illnesses associated with negative cultures. A rise in ASO titer occurred in 3.6% of these illnesses. ASO titers were also determined on pairs of sera for 51 of 53 untreated febrile illnesses associated with negative streptococcal cultures in 1962 and a rise in ASO titer occurred for only one of these illnesses (2%). This simple method for pharyngeal cultures is adequate and accurate as a laboratory aid to the practicing physician for the diagnosis of streptococcal pharyngitis in normal children. Bacitracin sensitivity showed an excellent correlation with Group A streptococci. Studies of duplicate swabs indicated that overnight storage of a dry swab at room or refrigerator temperature was associated with the recovery of more than 10 colonies of hemolytic streptococci from 80% to 88% of the swabs whose duplicates had more than 50 colonies.

The utility of rapid Group A streptococcus molecular testing compared with throat culture for the diagnosis of Group A streptococcal pharyngitis in a high-incidence rheumatic fever population.

2021 ◽  
Author(s):  
Amanda Taylor ◽  
Susan Morpeth ◽  
Rachel Webb ◽  
Susan Taylor
Keyword(s):  
New Zealand ◽  
Rheumatic Fever ◽  
Predictive Value ◽  
Gold Standard ◽  
Molecular Test ◽  
Throat Culture ◽  
High Incidence ◽  
Group A ◽  
Sensitivity Specificity ◽  
Culture Negative

Background: Group A Streptococcus (GAS) causes significant morbidity and mortality in New Zealand and is responsible for invasive disease and immune sequelae including acute Rheumatic Fever (ARF). Early treatment of GAS pharyngitis reduces the risk of ARF. In settings with a high-burden of GAS disease, a rapid GAS pharyngitis diagnostic test with a strong negative predictive value is needed to enable prompt and accurate treatment. Methods: This prospective study compares the Xpert® Xpress Strep A molecular test (Cepheid) to throat culture and a second molecular method, the BioGX Group A Streptococcus -OSR for BD MAX TM for the diagnosis of GAS pharyngitis. Throat swabs were collected from the emergency department and wards of Middlemore Hospital, New Zealand. The BioGX Group A Streptococcus - OSR for BD MAX TM , contributes to the composite gold-standard: throat culture or both molecular methods positive. Basic demographic, clinical and laboratory data was collected. Results: 205/214 swabs were suitable for analysis. 28/205 (13.7%) were GAS culture positive, 45/205 (22%) Xpert® Xpress Strep A positive and 38/205 (18.5%) BioGX positive. Compared to culture, the sensitivity, specificity, positive and negative predictive values of the Xpert® Xpress Strep A molecular test were 100%, 90.4%, 62.2% and 100%, respectively. Compared to the composite gold-standard, the sensitivity, specificity, PPV and NPV and were 100%, 95.8%, 84.4% and 100% respectively. 17 samples were Xpert® Xpress positive but culture-negative; 6 of these 17 swabs represent true positives with evidence of recent GAS infection. Ten samples were culture negative but both Xpert® Xpress and BioGX positive. Conclusion: The Xpert® Xpress Strep A molecular test is highly sensitive with a strong negative predictive value and rapid turnaround time. It can be safely introduced as a first line test for throat swabs in a high-incidence ARF population.

scholarly journals Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study

2021 ◽  
Vol 18 (21) ◽  
pp. 11534
Author(s):  
Stefano Sartini ◽  
Laura Massobrio ◽  
Ombretta Cutuli ◽  
Paola Campodonico ◽  
Cristina Bernini ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Outcome ◽  
University Hospital ◽  
Rt Pcr ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
The University

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

scholarly journals Adam Smith’s concept of labour: value or measure?

2016 ◽  
Vol 34 (2) ◽  
pp. 152-165
Author(s):  
Adolfo Rodríguez Herrera
Keyword(s):  
Karl Marx ◽  
John Stuart Mill ◽  
Production Theory ◽  
Real Price ◽  
Cost Of Production ◽  
Theory Of Value ◽  
The One ◽  
The Cost ◽  
David Ricardo

Smith is considered the father of the labour theory of value developed by David Ricardo and Karl Marx and simultaneously of the cost-of-production theory of value developed by John Stuart Mill and Alfred Marshall. This polysemy is partly because Smith is developping the terminology to refer to value and measure of value, and often uses it with much imprecision. That has led to different interpretations about his position on these issues, most of them derived from an error of interpretation of Ricardo and Marx. This paper reviews the concepts developed by Smith to formulate his theory of value (value, real price and exchangeable value). Our interpretation of his texts on value does not coincide with what has traditionally been done. According to our interpretation, it would not be correct the criticism made by Ricardo and Marx on Smith’s position about the role of labour as measure of value. For these authors, Smith is not consistent in proposing that the value of a commodity is defined or measured as the amount of labour necessary to produce it and simultaneously as the amount of labour that can be purchased by this commodity. We try to show that for Smith the labour has a double role –as source and measure of value–, and that to it is due the confusion that generates his use of some terms: Smith proposes labour as a measure of value because he conceives it as a source of value. With this interpretation it becomes clear, paradoxically, that Smith holds a labour theory of value that substantially corresponds to the one later developed by Ricardo and Marx.

scholarly journals The cost of evolved constitutive lac gene expression is usually, but not always, maintained during evolution of generalist populations

2021 ◽  
Author(s):  
Kelly Phillips ◽  
Tim Cooper
Keyword(s):  
Lac Operon ◽  
Beneficial Mutation ◽  
General Adaptation ◽  
Genetic Perturbations ◽  
Compensatory Mutations ◽  
Escherichia Coli Bacteria ◽  
The One ◽  
The Cost

Beneficial mutations can become costly following an environmental change. Compensatory mutations can relieve these costs, while not affecting the selected function, so that the benefits are retained if the environment shifts back to be similar to the one in which the beneficial mutation was originally selected. Compensatory mutations have been extensively studied in the context of antibiotic resistance, responses to specific genetic perturbations and in the determination of interacting gene network components. Few studies have focused on the role of compensatory mutations during more general adaptation, especially as the result of selection in fluctuating environments where adaptations to different environment components may often involve tradeoffs. We examine if costs of a mutation in lacI, which deregulated expression of the lac operon in evolving populations of Escherichia coli bacteria, was compensated. This mutation occurred in multiple replicate populations selected in environments that fluctuated between growth on lactose, where the mutation was beneficial, and on glucose, where it was deleterious. We found that compensation for the cost of the lacI mutation was rare, but, when it did occur, it did not negatively affect the selected benefit. Compensation was not more likely to occur in a particular evolution environment. Compensation has the potential to remove pleiotropic costs of adaptation, but its rarity indicates that the circumstances to bring about the phenomenon may be peculiar to each individual or impeded by other selected mutations.

scholarly journals 2605. Mixed Subpopulation of Hemolytic and Non-Hemolytic Phenotype in Clinical Staphylococcus aureus Blood Isolates

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S905-S906
Author(s):  
Seongman Bae ◽  
Eunbeen Cho ◽  
Eunmi Yang ◽  
Hyeonji Seo ◽  
Eun Sil Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Agar Plate ◽  
Surface Protein ◽  
Blood Agar Plate ◽  
Clinical Settings ◽  
Sheep Blood Agar Plate ◽  
Single Colony ◽  
Mixed Pattern

Abstract Background Agr is a key regulator that controls expression of secreted exoproteins and surface protein in Staphylococcus aureus. It has been reported that mixed status of two different phenotypes including agr functional and nonfunctional subpopulations can coexist in vitro and in vivo. However, data on the natural course and clinical implication of the mixed agr status is limited. We thus investigated the frequency and characteristics of the mixed agr in clinical settings. Methods We evaluated isogenic paired MRSA isolates collected from patients with persistent S. aureus bacteremia (SAB) between October 2010 and April 2016, and then prospectively performed surveillance for the presence of mixed agr function in MRSA isolates from patients with SAB between May 2016 and December 2017. The mixed agr status was evaluated by single colony evaluation on sheep blood agar plate containing RN4220 supernatant (β-hemolysin) (Figure 1). Cross-streaking with RN4220 and RNAIII measurement were performed to confirm the agr functionality of each of hemolytic and non-hemolytic colonies, separately. The expression levels of RNAIII, hla, and saeS/saeR were measured by real-time reverse transcription polymerase chain reaction. Results A total of 161 first blood isolates were collected during study period, and 6 isolates (4%) displayed mixed phenotype by single colony test. The mixed hemolytic pattern was observed in 5 out of 52 ST72 isolates (10%) and 1 out of 82 ST5 isolates (1%) (Figure 1). No difference was found in the genotypes between hemolytic and non-hemolytic colonies from each isolate. Of the 6 isolates, three lost mixed hemolytic features in the follow-up blood cultures (Table 1). One ST72 and one ST5 isolate showed agr mixed pattern determined by different RNAIII levels, but remaining four ST72 isolates had mixed hemolytic pattern due to different expression of hla correlated with saeS/saeR expression (Figure 2). Conclusion The mixture of agr function status among the clinical blood isolates of MRSA was rarely observed and isolates displaying heterogeneous hemolytic phenotype were largely due to differential expression of α-hemolysin. Further investigation is needed to unveil the clinical significance of mixture of different hemolytic phenotypes. Disclosures All authors: No reported disclosures.

Rationality at the Brink: The Role of Cognitive Processes in Failures of Deterrence

1978 ◽  
Vol 30 (3) ◽  
pp. 345-365 ◽  
Author(s):  
Jack L. Snyder
Keyword(s):  
Cognitive Theory ◽  
Decision Makers ◽  
The Other ◽  
International Crises ◽  
Value Conflicts ◽  
Long Run ◽  
Short Run ◽  
The One ◽  
The Cost

Decision makers in international crises seek to reconcile two values: on the one hand, avoiding the loss of prestige and credibility that capitulation would entail and, on the other, avoiding war. These values conflict with each other, in the sense that any policy designed to further one of them will jeopardize the other. Cognitive theory suggests that in ambiguous circumstances a decision maker will suppress uncomfortable value conflicts, conceptualizing his dilemma in such a way that the values appear to be consonant. President Kennedy's process of decision and rationalization in the Cuban missile crisis fits this pattern. He contended that compromise would allay the risk of war in the short run only at the cost of increasing it in the long run. Thus, he saw his policy of no compromise as furthering both the goal of maintaining U.S. prestige and credibility and the goal of avoiding war.

THE ROLE OF THE PEDIATRICIAN IN RHEUMATIC FEVER CONTROL

PEDIATRICS ◽  
1971 ◽  
Vol 47 (1) ◽  
pp. 1-5
Author(s):  
Edward A. Mortimer
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Current Status ◽  
Study Group ◽  
Systematic Fashion ◽  
Disease Study ◽  
The Cost ◽  
Rheumatic Heart

In a recent publication1 the Rheumatic Fever and Rheumatic Heart Disease Study Group has reviewed the current status of rheumatic fever and rheumatic heart disease. This review, which should be must reading for all physicians who care for children, emphasizes the persistent significance of the disease and describes in systematic fashion various community approaches to its control. It is first pointed out by the authors that rheumatic fever and rheumatic heart disease remain numerically significant problems. Approximately 100,000 new cases are recognized each year, and in 1968 16,000 deaths were recorded as due to rheumatic fever or rheumatic heart disease. The cost of physicians' visits alone for rheumatic fever and rheumatic heart disease in 1968 approximated 28 million dollars.

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