Factors that may influence adherence of Candida albicans to exfoliated human vaginal and buccal epithelial cells were studied in vitro. Factors that enhanced germination enhanced adherence. Heat-killed, germinated Candida organisms demonstrated poorer adherence than viable Candida organisms and no better adherence than nonviable, ungerminated Candida organisms. The difference between adherence of C. albicans to buccal epithelial cells and that to vaginal epithelial cells was significant, as were differences among volunteers. Preincubation in fucose but not mannose, glucose or galactose solutions, preincubation of germinated yeast or of epithelial cells in chymotrypsin or trypsin, a culture supernatant of germinated yeast killed by ultraviolet light, or precoating of epithelial cells with lactobacilli each inhibited adherence. These studies indicate that adherence of C. albicans is enhanced by a surface component of germinated yeast, probably a surface protein that binds to the epithelial receptor, possibly a glycoprotein.
Objective To identify a credible explanation for the excessively high mortality associated with general practitioners who were flagged up by the Shipman inquiry. Design Retrospective analysis of routine data. Setting Primary care. Participants Two general practitioners in the West Midlands who were associated with an unacceptably high mortality of patients during 1993-2000. Main outcome measures Observed and expected number of deaths and deaths in nursing homes. Results Preliminary discussions with the general practitioners highlighted deaths in nursing homes as a possible explanatory factor. No relation was found between the expected number of deaths and deaths in nursing homes in each year during 1993-2000 for either general practitioner. In contrast, the magnitude and shape of the curves of a cumulative sum plot for excess number of deaths (observed minus expected) in each year were closely mirrored by the magnitude and shape of the curves of the number of patients dying in nursing homes; and this was reflected in the high correlations (R 2 = 0.87 and 0.89) between excess mortality and the number of deaths in nursing homes in each year for the general practitioners. These findings were supported by administrative data. Conclusions The excessively high mortality associated with two general practitioners was credibly explained by a nursing home effect. General practitioners associated with high patient mortality, albeit after sophisticated statistical analysis, should not be labelled as having poor performance but instead should be considered as a signal meriting scientific investigation.
In view of findings from this study, it is important for commissioners in the new reconfigured National Health Service to ensure that enhanced ophthalmic services are commissioned only on the basis of hard evidence sourced from local data rather than opinion or on data from another geographical area.
The adherence of four bacterial species and Candida albicans to a new in vitro tissue culture model of human vaginal stratified squamous epithelium was investigated and compared with in vitro adherence to vaginal exfoliated cells. Gardnerella vaginalis, group B streptococci, Lactobacillus sp., and C. albicans adhered well to both exfoliated and tissue culture cells. Similarly, a piliated fecal isolate of Escherichia coli, but not a nonpiliated vaginal isolate of E. coli, adhered well to both cell types. Adherence of the piliated E. coli was markedly inhibited by preincubation of bacteria with D-mannose. No inhibition of adherence by D-mannose of G. vaginalis, nonpiliated E. coli, and C. albicans was demonstrated. Scanning electron microscopy of tissue cultures showed nonuniform distribution of adherent microorganisms with diminished adherence in areas of active mitosis and proliferation and increased adherence to mature flat cells, often in the process of desquamation.
Patients awaiting tonsillectomy experience considerable morbidity. This study does not support the hypothesis that untreated patients will 'outgrow' their condition.
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