Clinical field efficacy and safety of pyrantel pamoate paste (19.13% w/w pyrantel base) against Anoplocephala spp. in naturally infected horses.

Clinical field trials were conducted at five geographical locations in the USA (Oklahoma, Wisconsin, Tennessee, Virginia and Idaho) to evaluate the efficacy and safety of pyrantel pamoate paste (19.13%, w/w, pyrantel base) administered at the recommended dosage of 13.2 mg pyrantel base/kg (6.0 mg pyrantel base/lb) body weight (b.w.) against tapeworm infections of Anoplocephala spp. in naturally infected horses. Horses at each study site were allocated by restricted randomization based on the cestode status (positive or negative) of pre-treatment fecal egg counts to complete sets of four animals each or incomplete sets of fewer than four animals. Within sets comprising of two to four horses, one animal was randomly allocated to receive placebo vehicle paste and the remaining horse(s) received pyrantel pamoate paste administered orally at a minimum dosage of 13.2 mg pyrantel base/kg b.w. on Test Day (TD) 0. Single animal sets received pyrantel pamoate paste. Fecal samples of horses were collected and examined for equine tapeworm (Anoplocephala spp.) eggs a minimum of four times (once or thrice between TD -28 and -14, twice between TD -14 and -7, and once on TD 0) prior to treatment on TD 0. Fecal samples of horses that were positive for cestode infection pre-treatment were examined for cestode eggs on TD 7, 8, 9, 14, 15 and 16. Cestode-negative pre-treatment horses were not sampled again after treatment. A total of 241 horses (141 mares, 16 stallions and 84 geldings; 6 months-30 yrs of age; 173-646 kg; 13 recognized breeds and various crossbreds) were evaluated. The prevalence of Anoplocephala spp. determined by pre-treatment fecal examination ranged from 38.3% in Idaho to 68.1% in Tennessee with an overall prevalence of 52.3%. Ninety cestode-positive and 88 cestode-negative horses were treated with pyrantel pamoate paste, 36 cestode-positive and 27 cestode-negative horses were treated with placebo vehicle paste. Overall, 178 horses were treated with pyrantel pamoate paste, and 63 horses were treated with placebo paste. Of the 178 horses treated with pyrantel pamoate paste, no drug related, adverse clinical or neurological health events were observed. No doses of pyrantel pamoate paste were refused or lost during dosing. At each post-treatment time sampling interval, significantly fewer cestode eggs (P < 0.0115) were passed by cestode-positive horses treated with pyrantel pamoate paste compared to cestode-positive horses that received placebo paste. Efficacy of the pyrantel pamoate paste treatment ranged from 92 to 96% from TD 7 to TD 16 with an overall efficacy of 95%. The results of these trials demonstrated that pyrantel pamoate paste (19.13%, w/w, pyrantel base) administered orally at a dosage of 13.2 mg pyrantel base/kg b.w. is highly efficacious (95%) against Anoplocephala spp. and safe for use in horses with no adverse clinical or neurological health events observed under field use conditions.

Transcatheter PFO closure in an aircrew member with cryptogenic stroke: aeromedical disposition.

Stroke is an uncommon event among military aircrew, partly because that population tends to be younger and healthier than typical stroke victims. Aircrew members suffering stroke rarely have identifiable risk factors or etiology that can be treated or modified such that return to flying duties is a consideration. In this case, an aircrew member was found to have a patent foramen ovale (PFO) during his stroke evaluation. Several studies support the association between PFO and cryptogenic stroke, but literature clearly defining the need for PFO repair in the context of cryptogenic stroke is still incomplete. On clinical recommendation from his providers, this aircrew member underwent elective closure of his PFO with a transcatheter device. After complete recovery from his stroke and an apparently successful PFO closure, he requested return to flying duties. History of stroke and PFO closure with transcatheter device were both disqualifying conditions according to United States Air Force Instructions. This case is presented as an example of an aeromedical decision-making process when confronted with an unusual case such as this.

Pneumococcal vaccine rates in persons age 65 years and older: a U.S. Air Force Medical Facility record review.

UNLABELLED: The pneumococcal vaccine is underused according to self-reported surveys and the full scope of the problem remains undetermined. OBJECTIVE: Primary aims were to determine whether the pneumococcal vaccination rates varied between clinics for patients 65 years of age and older and to compare the results with national survey reports and claims data. METHODS: A total of 368 medical records were examined in this prevalence survey with 268 records from the Internal Medicine Clinic and 100 records from the Family Practice Clinic at Wilford Hall U.S. Air Force Medical Center. RESULTS: Documented vaccination rates were 92.9% and 69.0% for Internal Medicine Clinic and Family Practice Clinic, respectively. This difference in vaccination rates was statistically significant (chi2 = 35.462; df = 1; p < 0.001), and both clinics exceeded rates found in surveys and claims data. CONCLUSIONS: Clinics differ in their vaccination rates and self-reported national survey data may not accurately reflect the prevalence of pneumococcal vaccination among military retirees.