Eleanor J. Bell

A six-year study of coxsackievirus B infections in heart disease.

Virological examination of 385 patients with suspected heart disease and 26 with Bornholm disease over a period of 6 years suggested that Coxsackie group B virus infections were associated with at least half the cases of acute myocarditis and one third of the cases of acute non-bacterial pericarditis. Complement-fixation tests revealed only a few cardiac illnesses associated with other infections (influenza and Mycoplasma pneumoniae). No evidence of infection was found in chronic cardiac disease.

ECHO viruses, carditis, and acute pleurodynia.

Statistical analysis of 833 cases of echovirus infection showed a significantly greater association of type-6 infection with acute pleurodynia, and a suggestive association of type 19 and some other types with cardiac disease and pleurodynia. Published reports and international data from W.H.O. support the suggestion that echo type 6 and 19 viruses share the potentiality of type-B Cox-sackie viruses causing acute carditis and pleurodynia.

Enteroviral etiology of the paralytic poliomyelitis syndrome.

Virological investigations of patients in Scotland with poliomyelitis-like paralysis showed near-disappearance of paralytic poliovirus infections after general vaccination and persistence of a few paralytic infections with other enteroviruses. Coxsackieviruses, especially of type A7, were mainly involved, but no enterovirus had presented a serious or increasing threat. Because of occasional importation of virulent poliovirus and some continued circulation of virus in the population, it remains important to continue surveillance and maintain vaccination at a high level.

Coxsackie virus infections in patients with acute cardiac disease and chest pain.

During 1964 and 1965 infections with Coxsackie virus types A4, B1, B2, B4 or B5 were diagnosed in 9 cases of acute pericarditis (2 with myocarditis), 1 of acute myocarditis, 8 of Bornholm disease and 1 of acute chest pain attributed to myocardial ischaemia. Echovirus 6 was isolated from a case of Bornholm disease with antibody response to Coxsackie B1 virus. Echovirus type 25 was isolated from an additional case of acute myocarditis. During epidemics Coxsackie viruses probably contribute significantly to acute cardiac disease. The virological diagnosis is often difficult to achieve, and it is important to attempt virus isolation from early specimens in addition to testing paired sera.

Viruses in diarrhoeal disease

SIR,-The paper by Professor W. J. H. Butterfield and his coworkers (2 December, p. 505) showing that the diagnosis of diabetes mellitus can be made in the absence of glycosuria is of especial importance in the field of geriatrics. I now have records of about 20 elderly patients presenting with neurological symptoms and signs where the diagnosis of diabetes mellitus has been previously dismissed because of the absence of glycosuria. Subsequent glucose tolerance tests have established the true aetiology, and appropriate treatment invariably results in satisfactory improvement.

Poliomyelitis in a Nursery School in Glasgow.

to respond to type 2 also; the third infant not responding to type I had failed to become infected by this type, whereas he gave good responses to types 2 and 3, with which he had been infected. The third infant failing to respond to type 2 responded to types 1 and 3, and the single infant not responding to type 3, which had failed to infect, gave good responses to types 1 and 2, which had infected. In general, gut infection was associated with antibody response, but in some (notably in relation to type 1) a good response was obtained in infants from whom virus was not isolated. This discrepancy is most likely due to the small number of faecal samples taken and failure to isolate virus from short-lived infections.

Points: Antibody state to poliovirus

computer are both prerequisites for establishing a comprehensive scheme for shared diabetes care. The diabetic clinic does indeed lend itself to computerisation because of the regular format of each visit. A structured clinic also ensures that the essential clinical features of each visit are not forgotten. The use of specially designed forms or patient booklets makes for rapid logging of clinic data and helps rapid and accurate entry into a computer system. A shared care booklet has been introduced in our area and is being used by a dozen practices. Some practices with computers have shown an interest in the computerisation of this system but have been unable to find appropriate software. We have therefore developed a microcomputer system, which will operate on any IBM compatible or Apricot microcomputer, based on the shared care booklet. The system has been developed as a tool to help in the management, audit, and research of diabetic patients. As well as having comprehensive data logging and recall facilities it may be used during the clinic to present, on the screen or in writing, a summary ofthe last four clinic visits or a full account of any visit that the clinician may wish to examine. The system also contains comprehensive data inquiry and analysis facilities, which enable the user to generate subsets or groups of patients for audit or further analysis. Non-numerical data items may be analysed using a specially developed analysis program, which produces results in a tabular format. Numerical data may be analysed with either standard statistical tests or the tabular format. Both analysis tools may operate on the diabetic register as a whole or on a previously created subset. Though the system has been based on a diabetic clinic, it could easily be used for other clinics. Similarly structured clinics, in particular, such as those for patients receiving anticoagulant drugs, patients with hypertension, and those attending for antenatal care, lend themselves to shared care. We have already downloaded patient data from mainframe and minicomputer systems and are developing this means of communication; a multiuser system is also being developed.

Coxsackie B infection and arthritis.

rectum at necropsy was described as . . . much thickened in its coats, and of a hardish gristly texture, a good deal like the turtles intestines.3 Few modern human pathologists are familiar with the intestines of reptiles, and it is only relatively recently that veterinary surgeons have developed an interest in this group of animals. These and other cases exemplify Hunters breadth of interest and experience and, at a time when there is increasing contact and cooperation between doctors and veterinary surgeons, are a timely reminder of the importance of comparative studies.