Evaluation of a Standardized Tacrolimus Therapeutic Drug Monitoring Protocol in Stable Kidney Transplant Recipients.

Introduction: Transplant nurse coordinators have assisted in accurately adjusting tacrolimus doses under a collaborative practice agreement for kidney transplant recipients in the early post-operative period. This study evaluated the efficiency of a standardized tacrolimus therapeutic drug monitoring (TDM) protocol in stable outpatient recipients. Design: We conducted a single-center, retrospective study of adult patients who received a kidney transplant at least 3 years ago and were taking immediate-release tacrolimus. Before September 2019, transplant coordinators consulted transplant providers for management of all tacrolimus trough levels (Pre-Arm). Under the standardized protocol, coordinators directly responded to out-of-range tacrolimus trough levels (Post-Arm). The primary outcome was the time to intervention for out-of-range levels. Secondary outcomes included adverse events, time in therapeutic range, coefficient of variation (CV), and protocol compliance. Results: Of 1712 levels (from 174 patients), 259 levels (15.1%) were out-of-range. The overall time to intervention was 13.2 hours shorter (95% CI: -26.4 to -0.1 hours; P = 0.048) in the Post-Arm. There was no rejection, graft loss, or death during the study period. The time in therapeutic range was 89.3% (17.6%) vs 89% (19.4%; P = 0.816) and CV was 19.7% (15.8%) vs 18.4 (10.7%; P = 0.358) in the Pre-Arm and Post-Arm, respectively. Within the Post-Arm, the protocol required coordinators to independently intervene on 96 out-of-range levels (65.8%), which were accurately addressed 57.5% of the time. Conclusion: Implementation of a standardized TDM protocol improved efficiency without compromising major clinical outcomes or intrapatient variability (IPV) of tacrolimus levels for stable kidney recipients in the outpatient setting.

Observations on little known diseases of camels (Camelus dromedarius) in the Horn of Africa.

The camel is a comparatively hardy animal and is less susceptible to many of the diseases that affect other livestock species in the same areas. Despite that, the camel may contract many other diseases, some of which are still unknown. Pastoralists have for centuries herded camels in the arid and semi-arid areas of Kenya, and elsewhere in the Horn of Africa, and they have encountered and named many new diseases. However, the exact causes of many of these illnesses, such as Lahaw-Gaal, Firaanfir, Laaba, Jajabsa and Yudleye remain unknown. This paper presents the observations of pastoralists on some of the diseases which have been found among camels in northern Kenya. These observations offer intriguing clues to modern veterinarians who are trying to establish and characterise the aetiology of the diseases and ultimately find effective treatments. The authors also provide examples of ethno-veterinary knowledge and practices that could be useful for the development of animal health and production in Africa.

Characterization of camel leukocytes by flow cytometry and microscopic evaluation of granulocyte phagocytosis of fluorescent bacteria.

Peripheral blood was obtained from four lactating camels (Camelus bactrianus) and flow cytometry was used to characterize cell populations. The ability of the granulocytes to engulf fluorescent bacteria was studied in vitro using fluorescence microscopy. Three clusters of blood cells (mononuclear cells, neutrophils and eosinophils) were identified by flow cytometry and fluorescent microscopy. Milk, on the other hand, was dominated by cell fragments and no distinct cluster formation was found. The mean yield of blood granulocytes and monocytes isolated on Ficoll gradient was 92.2 +/- 5.4% and 7.9 +/- 5.7%, respectively. Cell viability was 95%. The mean percentage of phagocytic cells was 71.8 +/- 5.9% at 10 min and increased to 97.3 +/- 0.5% at 60 min when observation was terminated. The average number of bacteria per phagocyte was 8.7 +/- 2.1 and 13.1 +/- 0.9 at 10 and 60 min incubation time.

The detection of subclinical mastitis in the bactrian camel (Camelus bactrianus) by somatic cell count and California mastitis test.

Milk samples (n = 160) from 7 clinically healthy bactrian camels were cultured to detect subclinical udder infection. The samples were assessed by the Californian mastitis test (CMT) and somatic cell count (SCC). Bacteria were recovered from 36 (22.5%) of the milk samples. Staphylococcus aureus and coagulase-negative staphylococci (CNS) were the main organisms found. Infected quarters had significantly higher mean values for the SCC (p < 0.01) and CMT (p < 0.001) than non-infected quarters. All 7 camels were infected with CNS but only 4 with S. aureus. CMT values for S. aureus-infected camels were significantly higher than for those only infected with CNS. The values for SCC and CMT were significantly influenced by the stage of lactation (p < 0.05). No significant difference was found from the effect of the quarters. Both SCC and CMT were of value in predicting the infection status of the udder.

Milk N-acetyl-beta-D-glucosaminidase and serum albumin as indicators of subclinical mastitis in the camel.

NAGase activity (NAGase) and serum albumin concentrations were determined in milk from 101 traditionally managed camels in the Sudan. NAGase, a lysosomal enzyme released from damaged epithelial cells as well as other somatic cells in milk, was recorded for quarter milk samples from camels (n = 353) using the fluoroscan method. NAGase activity in major pathogen-infected quarters was significantly (P < 0.05) higher than in minor pathogen-infected and non-infected quarters. Means for minor pathogen-infected quarters were also significantly higher than non-infected quarters. Concentrations of serum albumin, resulting from increased vascular permeability, in quarter milk samples (n = 320) were measured by the radial immunodiffusion test. Serum albumin content in milk was not affected by infection status of the quarter. There were, however, large variations in serum albumin levels and, to a lesser extent, NAGase values between samples in both infected and non-infected quarters. NAGase was more effective in predicting bacteriological status of the quarter than serum albumin.

Relations between udder infection and somatic cells in camel (camelus dromedarius) milk.

Quarter milk samples (n = 391) from 101 camels were examined to study the occurrence and causes of mastitis in traditionally managed camels in eastern Sudan and to evaluate the value of the California Mastitis Test (CMT), somatic cell count (SCC) and adenosine triphosphate (ATP) in the detection of subclinical mastitis in the camel. One hundred and seventy (43.5%) of the quarter milk samples yielded pathogenic bacteria. Streptococcus agalactiae, other Streptococcus spp., Staphylococcus aureus, coagulase-negative staphylococci, and Escherichia coli were isolated from milk. Thirty-two (8.2%) quarter milk samples yielded mixed cultures, and 189 (48.3%) yielded no growth. Mean values for CMT, SCC and ATP were higher for quarters infected with major pathogens. However, a significant number of quarter milk samples had elevated values in these tests but were from quarters from which no bacteria were isolated. The ability of the tests to predict a positive bacteriology increased slightly when 2 or 3 tests were combined.

The ultrastructure of cells and cell fragments in mammary secretions of Camelus bactrianus.

The fine structure of leucocytes from the udders of 7 lactating and 3 non-lactating bactrian camels and from peripheral blood were studied. The most important finding was the presence of large numbers of cell fragments in milk. The cell fragments were bounded by a plasma membrane, had no nuclei and contained mitochondria and abundant rough endoplasmic reticulum (RER). Macrophages were the dominant cells recovered from milk and udder washings during the dry period. Neutrophils and lymphocytes were also present. The dominating leucocytes in blood were neutrophils, followed by lymphocytes, eosinophils, monocytes and basophils.

Silicate pneumoconiosis in camels (Camelus dromedarius L.).

In a random screening of camel diseases in Somalia dust-laden macrophages in lungs and/or bronchial lymph nodes were discovered in 94 of 134 animals. In 44 cases the dust-laden macrophages occurred in a number of small or large aggregates. There was a significant positive correlation between dust-laden macrophage aggregates in the lungs and pulmonary fibrosis not related to other chronic lung diseases, such as echinococcosis and chronic pneumonia. Six cases showed a cellular reaction and hyalinized nodules of the classic silicotic type. Energy dispersive X-ray analysis of the dust particles revealed presence of silica, aluminium, potassium and iron in that order. The possible clinical significance as well as the comparative pathology of the observations is discussed.