Florindo C.,National Institute of Health |
Florindo C.,New University of Lisbon |
Gomes J.P.,National Institute of Health |
Rato M.G.,New University of Lisbon |
And 4 more authors.
Journal of Medical Microbiology | Year: 2011
Streptococcus agalactiae is a major pathogen of neonates and immunocompromised adults. Prior studies have demonstrated that, beyond the neonatal period, S. agalactiae rarely causes invasive infections in children. However, during 2004-2005, S. agalactiae was the causative agent of 60 meningitis episodes in children aged 3 months to 12 years from Angola. To identify and study the specific causative genetic lineages of S. agalactiae childhood meningitis, which lack characterization to date, we conducted an extensive molecular analysis of the recovered isolates (n521). This constitutes what we believe to be the first molecular study of the population structure of invasive S. agalactiae isolates from Africa. A low genetic diversity was observed among the isolates, where the majority belonged to clonal complex (CC) 17 presenting the capsular subtype III-2 (86% of cases) and marked by the intron group II GBSi1, which has previously been observed to be associated with neonatal hosts. The predominance of single-locus variants of sequence type (ST) 17 suggested the local diversification of this hypervirulent clone, which displayed novel alleles of the fbsB and sip virulence genes. The absence of the scpB-lmb region in two S. agalactiae isolates with the Ia/ST23 genotype is more typical of cattle than human isolates. Globally, these data provide novel information about the enhanced invasiveness of the CC17 genetic lineage in older children and suggest the local diversification of this clone, which may be related to the future emergence of a novel epidemic clone in Angola. © 2011 SGM.
Moll S.,Paediatric ST1 |
Ahmed-Little Y.,ST3 Public Health |
Brown B.,GP Academic |
Abdalla H.,Paediatric |
Owen E.,Palliative Care
British Journal of Health Care Management | Year: 2011
Leadership development for clinicians is a relatively new concept in the NHS. Even more recent is the notion that investment in emerging clinical leadership also has added value. Most previous initiatives have aimed primarily at leadership development amongst senior doctors. However, opportunities to engage more junior colleagues in clinical leadership and medical management within the NHS have started to appear and attract increasing interest. In the NHS Next Stage Review in 2008, Lord Darzi called for the establishment of clinical (Darzi) leadership fellows to support clinicians with a particular interest in leadership. Within the North West 14 such posts were piloted in 2009-10, identifying and recruiting emerging clinical leaders from multidisciplinary backgrounds. This article highlights some of their experiences and lessons learnt.
Squadrito F.,Paediatric |
Bitto A.,Paediatric |
Altavilla D.,Messina University |
Arcoraci V.,Paediatric |
And 9 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014
Context: Foot ulcer is the principal cause of hospitalization for patients with diabetes. Polydeoxyribonucleotide (PDRN), an adenosine A2A receptor agonist, improves wound healing in diabetic mice. Objective: The aim of this study was to evaluate the effect of PDRN on chronic ulcer healing in patients with diabetes. Design and Setting: This randomized, double-blind, placebo-controlled trial, involved two medical centers in Italy. Intervention: Patients with diabetes showing hard-to-heal ulcers (Wagner grade 1 or 2) were randomly assigned to receive placebo (n = 106) or PDRN (n = 110). The treatments (PDRN and placebo) were performed 3 days a week for 8 weeks by intramuscular and perilesional route. Main Outcome Measures: The primary outcome was complete ulcer healing. Secondary outcomes were the days needed to complete wound closure and the reepithelialization of wound surface (as percentage of the original area). Results: After 8 weeks, 91 placebo and 101 PDRN subjects completed the study. Complete healing was achieved in 18.9% [95% confidence interval (CI) 11.4-26.3] of placebo and in 37.3% (95% CI 28.2-46.3) of PDRN-treated patients (P=.0027). After 8 weeks, PDRN increased the closure of foot ulcers in diabetic subjects (hazard ratio 2.20; 95% CI 1.29-3.75; P = .004). The median time to complete wound healing was 49 days for placebo (range 28-56 d) and 30 days for PDRN-treated subjects (range 14-56 d; P = .0027). The median epithelialized area of the ulcers (expressed as percentage) was 49.3% in the placebo and 82.2% in the PDRN group (P .001). Conclusions: PDRN facilitates the healing of Wagner 1 or 2 diabetic foot ulcers. © 2014 by the Endocrine Society.