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Background: The opportunistic fungus Pneumocystis jiroveci is a common cause of respiratory infection in immunocompromised patients. By contrast, pneumocystis pneumonia (PCP) occurs only rarely in immunocompetent individuals. Asymptomatic colonisation with P jiroveci has recently been described in patients who are either minimally immunosuppressed or who have underlying lung disorders such as bronchiectasis. We sought to determine the prevalence of asymptomatic colonisation by P jiroveci in a cohort of adult patients undergoing diagnostic bronchoscopy. Methods: A prospective observational cohort study was performed in patients who required bronchoscopy and bronchoalveolar lavage (BAL) as part of their routine clinical assessment. All the samples underwent standard microbiological analysis and a Grocott methenamine silver stain was performed where clinically indicated to detect the presence of P jiroveci. Polymerase chain reaction for detection of P jiroveci specific DNA was also performed. Results: Ninety three consecutive BAL fluid samples were analysed, 17 (18%) of which contained P jiroveci DNA. Of the potential predictors examined, only glucocorticoid use was significantly associated with detectable P jiroveci DNA. Eighteen patients were receiving oral glucocorticoids (equivalent to >20 mg/day prednisolone) at the time of bronchoscopy, of whom eight (44%) had detectable P jiroveci DNA. In contrast, P jiroveci was detected in only nine of 75 patients (12%) who were not receiving glucocorticoids (difference between proportions 32%, 95% CI 8 to 57; p=0.004, two tailed Fisher’s exact test). Conclusions:P jiroveci colonisation, as determined by detection of P jiroveci DNA in BAL fluid, is common in HIV negative patients with primary respiratory disorders undergoing bronchoscopy and BAL. The higher prevalence in patients receiving corticosteroids suggests that oral glucocorticoid therapy is an independent risk factor for colonisation. In contrast, underlying lung cancer or COPD did not appear to be risk factors.

This research developed two real-time PCR assays, employing high-resolution melt and allele-specific analysis to accurately genotype the F94L mutation in cattle. This mutation (g.433C > A) in the growth differentiation factor 8 or myostatin gene has recently been shown to be functionally associated with increased muscle mass and carcass yield in cattle. The F94L mutation is not, like other myostatin mutations, associated with reduced fertility and dystocia. It is therefore a candidate for introgression into other breeds to improve retail beef yield and the development of a simple and accurate test to genotype this specific mutation is warranted. Variations in the efficiency of enzyme cleavage compromised the accuracy of genotyping by published methods, potentially resulting in an overestimation of the frequency of the mutant allele. The frequency of the F94L mutation was determined by real-time PCR in 1140 animals from 15 breeds of cattle in Australia. The mutation was present in Simmental (0.8%), Piedmontese (2%), Droughtmaster (4%) and Limousin (94.2%) but not found in Salers, Angus, Poll Hereford, Hereford, Gelbvieh, Charolais, Jersey, Brahman, Holstein, Shorthorn or Maine Anjou. The low prevalence of F94L in all beef breeds except Limousin indicates the significant potential for this mutation to improve retail yield in Australian beef cattle.

IntroductionThe National Optimal Lung Cancer Pathway (NOLCP) aims for CT imaging within 72 hrs. In our centre, increased referral rates and significant variations in weekly numbers can saturate our pathway. We aimed to scope whether the process could be refined.MethodsSet up in 2018, patients with suspected lung cancer without a chest radiograph (CXR) could be referred directly for a CXR followed by a CT scan if indicated. A patient navigator collected a standardised symptom questionnaire. Symptoms, alone and in combination were assessed pre and post CXR, and outcomes recorded. In addition, a patient with an abnormal CXR could be entered into the pathway to expedite a CT scan. A normal CXR was defined as no radiographical evidence of lung pathology or cancer. The positive and negative predictive values were calculated pre and post the finding of a normal CXR.ResultsOver 18 months 1081/1100 patients entering the pathway had complete data. Primary referrals (CXR naive) accounted for 677, while 404 patients were pulled into the pathway following an abnormal CXR. Overall 154 cancers were diagnosed, of which 126 were of thoracic origin. Of the primary referrals 51/677(7.5%) were subsequently diagnosed with cancer, 40 of which were thoracic.Pre-CXR, the symptoms with the highest positive predictive values (PPV) were haemoptysis (12.1%) and loss of weight (LOW) (11.7%) dropping to 5.1% and 6.5% respectively following a normal CXR. Patients with a normal CXR and cough, chest pain, breathless or fatigue all had a PPV <4%. Thrombocytosis was present in 29/620(5%) patients referred pre-CXR, and in no patients with a normal CXR and susbsequent diagnosis of cancer.Symptom combinations showed a PPV of >10% in those with Loss of appetite+haemptysis, LOW+ haemoptysis and LOW+hoarse voice after a normal CXR, while a PPV <4% was seen in those with cough plus either haemoptysis, chest pain, breathlessness or fatigue, SOB+chest pain, fatigue+chest pain, and SOB+fatigue – with the PPV ranging from 2.7–3.5%.ConclusionThe use of symptom combinations in the context of a normal CXR may help streamlining CT resources to ensure that those with the greatest risk have immediate access. However, given the overall relative high pre-test probability most patients will require a CT scan.

Introduction and ObjectivesPrevious studies have suggested that bronchial lavage does not improve the yield of bronchoscopy if tumour is visible and biopsies and brushings are taken (1). However, no assessment was made of the microbiological yield from lavage samples. The aim of this study was to determine the prevalence and nature of positive bronchial culture in patients presenting with lung cancer.MethodsA retrospective review was conducted of the case notes of all patients between November 2009 and May 2012 who underwent a flexible bronchoscopy for the diagnosis of lung cancer, and were determined by the operator to have either a definite or probable visible malignancy. In all patients BAL had been performed and sent for microbiological investigation in addition to cytology. Type and frequency of culture were analysed, along with the relationship between culture and lung cancer histology, stage, and the performance status of the patient.Results95 patients underwent a flexible bronchoscopy at the time of diagnosis within the time period. The majority were male (62%) with an average age of 70 years (range 31-91). Culture was positive in 37.7% of samples. 32.5% of these organisms were gramme negative (mostly Pseudomonas spp. and coliform bacilli), 20.9% gramme positive (S. pneumoniae, S. aureus, MRSA), 41.9% Candida spp., and 4.7% Aspergillus spp. The predominant form of lung cancer was non-small cell (56%, of which 58.4% were squamous), the majority of patients having advanced disease (92% stage IIIA-IV) with a good performance status (55.8% PS 0-1). Patient characteristics, tumour histology, or stage were not significantly different in patients with, or without, positive culture.ConclusionsThis study has shown that more than a third of patients investigated for lung cancer had evidence of bronchial colonisation with potentially pathogenic bacteria at the time of diagnosis. This suggests that lavage ought to remain a routine aspect of bronchoscopy for cancer, as identification of bacteria at this early stage might be used to guide the choice of effective antibiotics for the treatment of subsequent pulmonary infections.Waine DJ et al. Am J Resp Crit Care Med 2004; 169(7):A332.

The nasal secretions of 59 asthmatic children aged 7-16 years who had been stable for at least 2 months and 30 non-asthmatic non-atopic controls matched for age and residence were studied. 93% of asthmatics and 83% of controls had TTV carriage (no significant difference). Because of the low number of subjects without TTV carriage, the analysis compared those with high TTV load and those with low or absent TTV load.

The increasing integration of livestock production systems of Australia and elsewhere, including the implementation of traceability programs such as the National Livestock Identification System (NLIS), means that animals are tagged early in life. These programs must accommodate a range of production systems, including those extensive operations where the animal may be handled only sporadically for weaning or other husbandly. With the increased use of genetic and genomic technologies for research and as decision making tools in selective breeding programs, these occasions are being seen as an opportunity to sample animals for genetic testing, including parentage analysis, disease diagnostics, and more recently genomics for use in estimating genetic estimated breeding values. Sample types commonly include hair, blood, semen, and most recently tissues collected during the tagging process. Tissue sampling units (TSU) are now marketed by a range of companies as a convenient way to collect tissue for DNA in parallel with tagging, providing benefits, which include labor reduction, trace-ability, and reduced risk of transcription errors. These TSUs commonly come with or without preservative, with the dry type being used to great effect in Europe and New Zealand. However, dry TSUs have proven problematic under Australian conditions. Transit times for postage under hot and often humid conditions often lead to rapid deterioration of the tissue, such that DNA quality is compromised and testing impossible. To optimize the collection of workable samples for industry, heat challenges were performed that confirmed the superiority of preservative-filled TSUs for genetic testing. These preservative-filled TSUs were further evaluated for tissue stability and quality of DNA extracted for a range of genetic and genomic tests performed in the laboratory, including microsatellite-and SNP-based parentage testing, diagnostics, and genomic applications using SNP genotyping microarray teclinology. An important research question of this study was also how best to maintain (biobank) tissue or DNA in a cost-effective manner for testing in the future. The current study potentially has insights for future application in studies across a range of tropical and sub-tropical climates.

Introduction and Objectives Previous studies have suggested that bronchial lavage does not improve the yield of bronchoscopy if tumour is visible and biopsies and brushings are taken (1). However, no assessment was made of the microbiological yield from lavage samples. The aim of this study was to determine the prevalence and nature of positive bronchial culture in patients presenting with lung cancer. Methods A retrospective review was conducted of the case notes of all patients between November 2009 and May 2012 who underwent a flexible bronchoscopy for the diagnosis of lung cancer, and were determined by the operator to have either a definite or probable visible malignancy. In all patients BAL had been performed and sent for microbiological investigation in addition to cytology. Type and frequency of culture were analysed, along with the relationship between culture and lung cancer histology, stage, and the performance status of the patient. Results 95 patients underwent a flexible bronchoscopy at the time of diagnosis within the time period. The majority were male (62%) with an average age of 70 years (range 31–91). Culture was positive in 37.7% of samples. 32.5% of these organisms were gramme negative (mostly Pseudomonas spp. and coliform bacilli), 20.9% gramme positive (S. pneumoniae, S. aureus, MRSA), 41.9% Candida spp., and 4.7% Aspergillus spp. The predominant form of lung cancer was non-small cell (56%, of which 58.4% were squamous), the majority of patients having advanced disease (92% stage IIIA-IV) with a good performance status (55.8% PS 0–1). Patient characteristics, tumour histology, or stage were not significantly different in patients with, or without, positive culture. Conclusions This study has shown that more than a third of patients investigated for lung cancer had evidence of bronchial colonisation with potentially pathogenic bacteria at the time of diagnosis. This suggests that lavage ought to remain a routine aspect of bronchoscopy for cancer, as identification of bacteria at this early stage might be used to guide the choice of effective antibiotics for the treatment of subsequent pulmonary infections. Waine DJ et al. Am J Resp Crit Care Med 2004; 169(7):A332.

THIRD CASE.--On the 27th of June, 1843, a young lady from the country, accompanied by her mother, called on me, bringing a note from Dr. John Elliotson, whom she had that morning consulted respecting an abdominal enlargement, which had for some time past been a source of anxiety to herself and her friends. Dr. Elliotson having ascertained the presence of dropsical disease of one of the ovaries, and the result of his extensive experience being a conviction of the inefficacy of medicine in the treatment of that malady, had \"at once told her not to be tapped, nor to take medicine likely to weaken or even annoy her,\" and advised her to put herself under my care, if I were willing to operate upon her.