Sixty two patients (mean age 45.6 years) were assessed for oral hygiene and periodontal disease by dental examination before endoscopy. Information about oral care, smoking, and dentures was obtained and samples of dental plaque collected. The presence of Helicobacter pylori in plaque as sought by culture and polymerase chain reaction (PCR), and gastric antral biopsy specimens were taken for histological examination. Although H pylori was detected in the antral specimens of 34 patients (540/o) all of the cultures of dental plaque were negative, and PCR was only positive from the dentures of one patient. Smokers had poor oral hygiene, visited their dentist less often, and brushed their teeth less frequently. There was no correlation of H pyloni gastritis with either dental hygiene or periodontal disease. These results suggest that dental plaque or dentures are not an important reservoir for H pylon and are probably not a significant factor in transmission of the organism. The conflicting results in published works may be caused by differences in sample collection, culture techniques, or oral contamination from gastric juice as a result of gastro-oesophageal reflux at the time of endoscopy. (Gut 1995; 37: 44-46)

This study was designed to document the occurrence and the type of sleep problems in stroke patients and to examine the importance of shoulder pain in stroke in relation to sleep disturbances. Forty-six stroke patients were evaluated for the presence of sleep disturbances, general health problems (Nottingham Health Profile) and anxiety-depression (Hospital Anxiety Depression Scale) and compared with 47 age- and sex-matched subjects who had not had strokes. A four-item sleep questionnaire was used to assess different components of insomnia disorders through the previous month. The results showed that stroke patients had significantly more problems in initiating sleep than controls (p < 0.01). Other components of insomnia, difficulty in maintaining sleep or nonrestorative sleep did not differ between the two groups (p < 0.05). Factors found to be associated with poor sleep such as pain (p < 0.01), anxiety (p < 0.01) and depression (p < 0.01) were more common in the patient group but these did not otherwise result in a significant increase in all components of insomnia, probably because of the high level of benzodiazepine and tricyclic antidepressant intake amongst patients. Stroke patients with shoulder pain showed significantly more sleep disturbances (p < 0.01 ) and less general well-being ( p < 0.05) than patients without shoulder pain. It is concluded that attention must be paid to shoulder pain and to ensuing sleep disturbances among stroke patients.

This pilot study highlights the problems of benzodiazepine (BDP) usage in patients attending a rheumatology clinic. Of 127 consecutive patients attending the rheumatology clinic a total of 29% (37) had been taking night sedation for mean duration of 4.1 years. The majority of BDP users (92%) were women. In 78% night sedation was taken for insomnia associated with night pain. We recommend that if BDP is to be prescribed it should be only in selected cases for a short time.

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but a number of pyrogenic exotoxins which are potential culprits. Stevens et al. studied ten strains of Group A streptococci isolated from patients with toxic-shock-like syndrome and found that eight produced toxin A.5 It is noted for increased virulence and the rash of scarlet fever.6 Its protein sequences resemble that of the enterotoxin B of Staphylococcus aureus that is associated with toxic shock syndrome.7 However, the role of toxin A is incompletely understood. Gram-positive bacteraemia itselfmay lead to shock and fulminating infections have been reported with B-haemolytic streptococci of other groups that do not produce toxins.3'8 Fulminating infection with severe hypotension may be secondary to Gram-negative endotoxaemia. However, one should consider toxin-producing Group A streptococci as alternative causative agents especially in the presence of skin rashes.