Men with genital ulcers that were culture positive for Haemophiluss ducreyi were treated with intramuscular ceftriaxone and randomized to three different dose regimens. All but 1 of 50 men treated with 1 g of intramuscular ceftriaxone were cured. Similarly, 0.5 and 0.25 g cured 43 of 44 men and 37 of 38 men, respectively. A single dose of 250 mg of intramuscular ceftriaxone is an effective treatment for chancroid. Increasing awareness of antimicrobial agent-resistantHaemophilus ducreyi strains has led us' to search for alternate treatment regimens for chancroid (7). A 10-day course of erythromycin and a 1-week course of amoxicillin in combination with clavulanic acid are each satisfactory treatments, with cure rates of over 95% (2,10). More recently, we have shown that a single dose of trimethoprimsulfametrole (11) or of rifampin in combination with trimethoprim (12) can cure most patients with chancroid in Kenya. However, additional effective single-dose treatment regimens are necessary due to the recent emergence of trimethoprim-resistant H. ducreyi strains in Thailand (13).Ceftriaxone is remarkably effective -against H. ducreyi in vitro, with MICs of 0.015 mg/liter or'less for all isolates tested. In the present study, we compared three different single-dose intramuscular ceftriaxone regimens for the treatment of men with genital ulcer disease due to H. ducreyi. MATERIALS AND METHODSBetween April and December 1982, male patients presenting at the Nairobi Special Treatment Clinic with a clihical syndrome compatible with chancroid were enrolled in the study. Men were eligible if'they were older than 18 years, had had no antimicrobial therapy in the preceding week, were willing to return for follow-up, and were negative for Treponema pallidum on dark-field examination. The external genitalia were examined, and the number, size, and clinical characteristics of the ulcers were noted. Buboes, defined as tender inguinal or femoral lymph nodes enlarged to more than 1 cm, were examined for fluctuance, consistency, and size. Ulcers were cultured for H. ducreyi and herpes simplex virus by techniques described in an earlier publication (11). All ulcers were cultured on two different media, which in combination have been shown to support the growth of H. ducreyi from samples of ulcers from over 80% of patients with clinical chancroid (8). Agar dilution ceftriaxone and other cephalosporin MICs for H. ducreyi were determined as described previously (4). One or more dark-field examinations were performed on samples of all ulcers. Serum was obtained for serologic tests for syphilis initially and at 10 and 28 days.Patients who had positive cultures for H. ducreyi and no evidence of T. pallidum infection were assigned by a preconstructed random sequence to treatment with ceftriax-* Corresponding author.one in a dose of 1.0, 0.5, or 0.25 g. The ceftriaxone was administered intramuscularly after dilution in 1% xylocaine. The evaluator' was unaware of the treatment regimen selected.The men were requested to return for follow-up vi...

Staphylococcus epidermidis is the most frequent cause of peritonitis complicating continuous ambulatory peritoneal dialysis. We studied factors that might influence the growth of S. epidermidis in commercially available peritoneal dialysis solution (PDS). Test strains were inoculated into PDS and incubated overnight at 37°C. Samples were removed at appropriate intervals, bacterial counts were performed, and growth curves were constructed. We studied the effects of various osmolarities, the neutralization and acidification of fresh and spent PDS, and the effect of intraperitoneal dwell time on the ability of PDS to support growth of S. epidermidis. In fresh PDS, numbers of bacteria remained constant after 24 h. No significant differences in growth were observed among PDS with 0.5, 1.5, 2.5, and 4.25% glucose. Neutralizing acidic fresh PDS had no effect on bacterial growth. However, growth did occur in spent PDS. PDS which was recovered after only 2 h in the peritoneal cavity supported growth to the same extent as did PDS recovered after 4 to 6 h. Mean logo changes after 24 h of incubation were as follows: for fresh PDS,-1.3; after 2 h dwell time, 2.9; after 4 h dwell time, 1.9; and after 6 h dwell time, 1.3. Acidification of spent PDS to less than pH 6.35 produced less rapid growth; mean lglo increases after 24 h of incubation were 1.9 for pH 7.75, 1.6 for pH 6.35, 0.6 for pH 5.75, and 0.7 for pH 4.95. Fresh PDS of all available osmolarities neither supported the growth of S. epidermidis nor was bactericidal. Spent PDS supported bacterial growth, and this growth was partly independent of the neutralization which occurred during the dialysis.

The systems for accrediting residency programmes in the United States and Canada, although they have developed independently in the two countries, have similar objectives and accreditation requirements. Both have become increasingly focused over the past several decades on the importance of educational programmes structured to provide graded professional responsibility with appropriate guidance and supervision to residents according to their level of training, ability and experience. The Canadian model used by the Royal College of Physicians and Surgeons of Canada is a centrist one, with accreditation decisions on all programmes in all specialties being vested in a single, multidisciplinary accreditation committee. The American model developed by the Accreditation Council for Graduate Medical Education is a distributive one, with accreditation decisions being vested in each specialty Residency Review Committee. In both models, accreditation is based on a system of periodic on-site visits during which both faculty and residents are interviewed by a surveyor to provide the accrediting body with a first-hand evaluation of the extent to which each accredited programme meets the standards of accreditation. While they are similar in purpose, there are significant differences in the operation of the two systems.

Background: From national and international workforce perspectives, Canadians studying medicine abroad (CSAs) are a growing provider group. Some were born in Canada whereas others immigrated as children. They study medicine in various countries, often attempting both American and Canadian medical licensure pathways. Methods: Using data from the Educational Commission for Foreign Medical Graduates (ECFMG) and the Medical Council of Canada (MCC), we looked at CSAs who attempted to secure residency positions in both Canada and the United States. We detailed the CSAs’ countries of birth and medical education. We tracked these individuals through their postgraduate education programs to enumerate their success rate and categorize the geographic locations of their training. Results: The majority of CSAs study medicine in one of 10 countries. The remainder are disbursed across 88 other countries. Most CSAs were born in Canada (62%). Approximately 1/3 of CSA from the 2004-2016 cohort had no record of entering a residency program in Canada or the United States (U.S.). Recently graduated CSAs were most likely to secure residency training in Ontario and New York. Conclusion: Many CSAs attempt to secure residency training in both Canada and the U.S. Quantifying success rates may be helpful for Canadians thinking about studying medicine abroad. Understanding the educational pathways of CSAs will be useful for physician labour workforce planning

Nineteen patients with pneumonia due to Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae, or