Detection of herpes simplex virus in women with acute pelvic inflammatory disease

Four women are described with acute salpingitis confirmed by laparoscopy who had herpes simplex virus (HSV) isolated from the cervix or the upper genital tract (endometrium, fallopian tube, or cul-de-sac) or both. None of the patients had overt genital herpes, but one had typical HSV cervitis on a cervicovaginal smear stained with Papanicolaou's stain, one had a significant change in level of antibodies to HSV, and one had an endometrial biopsy specimen positive for HSV antigen. There are at least three potential explanations for these findings: chronic viral shedding, viral reactivation caused by acute pelvic inflammatory disease (PID), or that the PID was actually caused by HSV. Further prospective studies are needed to document the role of HSV in causing PID.     

Mycoplasma pneumoniae may cause dyspnoea and hospitalisations in young healthy adults

European Journal of Clinical Microbiology & Infectious Diseases - Polymerase chain reaction (PCR)-based diagnostics for Mycoplasma pneumoniae (M. pneumoniae) from the respiratory tract has...     

Environmental facilitators for outdoor walking and development of walking difficulty in community-dwelling older adults

Older adults who report environmental barriers in their neighborhood have a higher risk for walking difficulty. However, environmental facilitators that protect against walking difficulty are not well known. The objective of this study was to identify the effect of environmental facilitators for outdoor walking on development of walking difficulty in community-dwelling older people. This was a prospective study with a 3.5-year follow-up time on 261 community-dwelling people aged 75–81 years, who at baseline were able to walk 0.5 km without difficulty. Environmental facilitators for outdoor walking were self-reported with standardized questionnaires, including having features in one’s home which make it easy to access the outdoors, having a park or other green area within a walking distance from home, having outdoor recreational facilities within a walking distance from home, having features in the nearby environment, which are attractive for outdoor activities, and perceiving the surrounding environment or facilities nearby as motivating factors for physical activity. Self-reported difficulty in walking 0.5 km was assessed every 6 months. Of the participants, 46 % developed walking difficulty during the follow-up. Having a park or other green area within a walking distance from home was the most frequently reported facilitator. Environmental facilitators decreased the risk for development of walking difficulty, hazard ratio per item 0.86, (95 % confidence interval 0.73–1.02). The results indicate that the mobility of older community-dwelling people may be promoted with outdoor recreational facilities that are easy to access and located within a walking distance from home.     

Physicians’ views on patient participation in choice of oral anticoagulants in atrial fibrillation—a qualitative study

Direct oral anticoagulants provide an alternative to vitamin K antagonists for the anticoagulation therapy in atrial fibrillation (AF). The availability of several treatment options with different attributes makes shared decision‐making appropriate for the choice of anticoagulation therapy. The aim of this study was to understand how physicians choose an oral anticoagulant (OAC) for patients with AF and how physicians view patients’ participation in this decision. Semi‐structured interviews with 17 Finnish physicians (eight general practitioners and nine specialists) working in the public sector were conducted. An interview guide on experience, prescribing and opinions about oral anticoagulants was developed based on previous literature. The data were thematically analysed using deductive and inductive approaches. Based on the interviews, patient's opinion was the most influential factor in decision‐making when there were no clinical factors limiting the choice between OACs. Of patient's preferences, the most important was the attitude towards co‐payments of OACs. Patients’ opinions on monitoring of treatment, dosing and antidote availability were also mentioned by the interviewees. The choice of an OAC in AF was patient‐centred as all interviewees expressed that patient's opinion affects the choice.     

Intestinal bacterial translocation and tight junction structure in acute porcine pancreatitis

Background/Aims: To examine whether intestinal bacterial translocation occurs early in acute mild and severe pancreatitis and whether the intestinal expression of tight junction proteins (claudins-2, -3, -4, -5, -7), apoptosis or proliferation would explain the possible translocation. Methodology: Fifteen pigs were randomized to controls (n=5) or to develop mild edematous pancreatitis (n=5, saline infusion to pancreatic duct) or severe necrotic pancreatitis (n=5, taurocholic acid infusion). Translocation was studied by measuring bacterial cultures from portal vein blood and mesenteric lymph nodes. Immunohistochemical expression of the tight junction proteins, apoptosis rate (TUNEL) and Ki-67 were analyzed quantitatively from the epithelium of the jejunum and colon. Results: There was no bacterial translocation during the 6 hours followup, nor changes in the expression of tight junction proteins claudins-2 and -5 in jejunum or colon. Saturation and proportional area of claudin-3 staining decreased in the colon, as did claudins-4 and -7 staining in the jejunum of the necrotic pancreatitis group. Increased apoptosis was found in all samples from controls and the edematous pancreatitis group but not in jejunum in the necrotic pancreatitis group. Ki-67 activity tended to increase in the upper half of the villus in edematous and necrotic pancreatitis. There were no changes in the basic histology. Conclusions: The major finding of this study was that bacterial translocation from the gut is not present at the beginning of acute pancreatitis. Tight junction proteins claudin-2 and -5 do not become altered in the early stages of pancreatitis. Claudin-3 decreases in the colon and claudins-4 and -7 in the jejunum in necrotic pancreatitis. Laparotomy itself causes increased apoptosis in the colon and the jejunum.