Prevalence of the microbiological causes of canine otitis externa and the antibiotic susceptibility of the isolated bacterial strains.

Otitis externa is a canine disease of multifactorial etiology in which bacteria plays a significant role. Due to the predominant bacterial etiology otitis is usually treated with antibiotics. However, non-prudent use of antibiotics promotes the emergence of antibiotic-resistant bacteria thus compromising the therapy effectiveness. Currently, the increase of antimicrobial resistance (AMR) is one of the biggest threats to global health. For this reason, the aim of the study was to investigate prevalence of the microbiological causes of canine otitis externa and the antibiotic susceptibility of the isolated bacterial strains. The research and sampling were conducted at Veterinary Clinics for small pets in Serbia. Samples were sent to laboratory for bacteriological and mycological testing. Additionally, the sensitivity of the isolated bacteria to antibiotics was evaluated using disc diffusion method. Sixty dogs with otitis externa clinical symptoms were included in the study. Out of a total of 53 positive samples for pathogen presence, bacteria were present in 40. The most prevalent bacteria was Staphylococcus pseudintermedius, followed by Pseudomonas aeruginosa and Proteus spp., while Malassezia pachydermatis was the only isolated yeast pathogen occurring in 36 samples. Generally, the lowest resistance against all bacteria showed enrofloxacin. On the contrary, high resistance to penicillin and amoxicillin was a common finding for G+ and G- bacteria. These results indicate the need for laboratory testing in terms of isolation, identification and antibiotic susceptibility testing, not only in the case of otitis externa in dogs, but in all diseases when it is possible, in order to enhance antimicrobial stewardship and consequently to contribute AMR reduction.

Spatial social polarization and birth outcomes: preterm birth and infant mortality - New York City, 2010-14.

AIMS: This study assessed the relationship between spatial social polarization measured by the index of the concentration of the extremes (ICE) and preterm birth (PTB) and infant mortality (IM) in New York City. A secondary aim was to examine the ICE measure in comparison to neighborhood poverty. METHODS: The sample included singleton births to adult women in New York City, 2010-2014 ( n=532,806). Three ICE measures were employed at the census tract level: ICE - Income (persons in households in the bottom vs top 20th percentile of US annual household income), ICE -Race/Ethnicity (black non-Hispanic vs white non-Hispanic populations), and ICE - Income + Race/Ethnicity combined. Preterm birth was defined as birth before 37 weeks' gestation. Infant mortality was defined as a death before one year of age. A two-level generalized linear model with random intercept was utilized adjusting for individual-level covariates. RESULTS: Preterm birth prevalence was 7.1% and infant mortality rate was 3.4 per 1000 live births. Women who lived in areas with the least privilege were more likely to have a preterm birth or infant mortality as compared to women living in areas with the most privilege. After adjusting for covariates, this association remained for preterm birth (ICE - Income: Adjusted Odds Ratio (AOR) 1.16 (1.10-1.21); ICE - Race/Ethnicity: AOR 1.41 (1.34-1.49); ICE - Income + Race/Ethnicity: AOR 1.36 (1.29-1.43)) and IM (ICE - Race/Ethnicity (AOR 1.80 (1.43-2.28) and ICE - Income + Race/Ethnicity (AOR 1.54 (1.23-1.94)). High neighborhood poverty was associated with PTB only (AOR 1.09 (1.04-1.14). CONCLUSIONS: These results provide preliminary evidence for the use of the ICE measure in examining structural barriers to healthy birth outcomes.

Evaluation of ultrasonography for measuring solar soft tissue thickness as a predictor of sole ulcer formation in Holstein-Friesian dairy cows.

The aim of this research was to investigate the correlation between the thickness of solar soft tissue (SST; i.e. the corium and subcutaneous tissue) in early lactation and sole ulcer formation in late lactation. Fifty Holstein-Friesian cows were examined three times: (1) 30 days after calving (locomotion scoring, trimming, claw examination, measurement of SST); (2) 70 days after calving (locomotion scoring); and (3) 180 days after calving (locomotion scoring, trimming, claw examination). SST thickness was measured using an 8 MHz linear probe, at two points (SST1 below the apex of the pedal bone, and SST2 below the flexor tubercle). Mean values for SST1 and SST2 were 3.26 ± 0.43 mm and 4.35 ± 0.46 mm, respectively; the two measures were positively correlated (r=0.95, P<0.001). At 180 days after calving, a sole ulcer was diagnosed in 12/50 cows (24%). Cows with a thinner SST had a higher risk of developing sole ulcers than those with a thicker SST. The optimal cut-off values of SST1 and SST2 in predicting cows with sole ulcers (as calculated by ROC analysis) was ⩽ 3 mm for SST1 and ⩽ 3.9 mm for SST2. The relative risk of a sole ulcer developing, based on those cut-off values was 4.25 (95 CI, 1.77-24.88) for SST1 ⩽ 3 mm and 3.63 (95 CI, 1.18-10.8) for SST2 ⩽ 3.9 mm.

Rumination as a common mechanism relating depressive risk factors to depression.

Rumination was examined as a potential common mechanism linking risk factors with depression. Initially nondepressed individuals (N = 137) were assessed for presence of a ruminative response style and 4 other hypothesized risk factors for depression. They were followed for 2.5 years. Negative cognitive styles, self-criticism, dependency, neediness, and history of past depression were all significantly associated with rumination. Rumination mediated the predictive relationships of all risk factors except dependency with the number of prospective Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) major depressive episodes (MDEs; definite and subthreshold) during the follow-up period. In contrast, private self-consciousness did not mediate any relationships between risk factors and subsequent MDEs. Thus, rumination, as a special kind of self-focus, may act as a general proximal mechanism through which other vulnerability factors affect depression.

[Hematologic characteristics of leishmaniasis]. / Hematoloske karakteristike lajsmanijaze.

INTRODUCTION: Leishmaniasis is a chronic infectious disease from the group of anthropozoonoses. It is caused by protozoa in the genus leishmania flagellate. There are five major foci of this disease in the world: India, Mediterranean countries, East Africa, South China and South America. Endemic regions in the Balkans are as follows: Montenegro, Macedonia, Herzegovina and the Morava's valley (1,2). Reservoirs of infection are infected humans and animals (dogs and rodents). Infection is transmitted by insects the most significant representative of which is a sandfly. The course of the disease may be acute, subacute and chronic and several forms are differentiated such as visceral, cutaneous and mucocutaneous. Signs of disease are elevated temperature, gastrointestinal disorders, splenomegaly and hepatomegaly and rarely generalized lymphadenomegaly. Laboratory findings point to pancytopenia. The diagnosis is established on the basis of parasitological findings in macrophages of the bone marrow and is confirmed by serologic tests (4,5). However, mortality is decreased to 5% after the application of 5-valent antimony and amphotericin B (6,7). CASE REPORT: A female patient aged 19 year from Novi Sad was admitted at the Clinic of Hematology due to unclear febrile state lasting 3 months accompanied by pancytopenia and enlarged spleen. The first discomforts were experienced in the second half of August in 1997 upon the patient's return from Sutomore. The disease started gradually with uncharacteristic manifestations. Firstly, discomforts developed in the region of the gastrointestinal tract and were characterized by loss of appetite, nausea, and vomiting in addition to drastic weight loss. Secondly, fatigue occurred during effort, later on at rest as well, accompanied by increased body temperature. Temperature increased twice a day and was followed by shuddering, fever, shivering and very often by nocturnal sweating. Antibiotics and antipyretics were used, but without fall of temperature. Subjective discomforts were increasingly pronounced, so that due to unclear febrile state and in addition to the present pancytopenia the patient was referred to hospital treatment and was therefore admitted at the Clinic of Hematology. Febrile state, tachycardia, a striking paleness of the skin and visible mucosa as well as splenomegaly were confirmed. Basic laboratory findings (Table 1) pointed to pancytopenia. Apart from anemia and mild thrombocytopenia, leukopenia with neutropenia, lymphocytosis and monocytosis were pronounced. Sternal puncture was the most significant diagnostic procedure on the basis of which the diagnosis was established. In hypocellular bone marrow in macrophages, both intra- and extracellular, protozoa were found in smaller and greater groups which resembled leishmaniasis (Figure 1). The diagnosis was confirmed by serologic tests to leishmaniasis, antibody titre was > 1:32. In order to exclude other infections and hematologic diseases, other diagnostic tests were performed (Table 1) and the findings were normal. After the establishment of diagnosis the patient was transferred to the Clinic of Infectious Diseases where the causal therapy with 5-valent antimony was introduced, parenterally. As early as the first week of therapy, the patient was afebrile, subjective discomforts disappeared, she regained appetite and put on weight. Also, the decrease of the spleen was observed as well as improvement in hematological findings. DISCUSSION AND CONCLUSION: This paper predominantly deals with hematological findings which are characteristic for leishmaniasis on the basis of which the diagnosis of this disease has been quickly established (1,2). Hematological findings were the key of diagnosis being confirmed by serologic and other tests. The disease is very rare in this region, so that there is a difficulty in recognizing it. In our case, the diagnosis was made on the basis of sternal puncture survey, because protozoa were found in hy

Effects of posttraumatic stress and acculturation on marital functioning in Bosnian refugee couples.

Forty Bosnian refugee couples living in the United States completed a translated version of the PTSD Symptom Scale--Self Report, the Behavioral Acculturation Scale, the Marital Satisfaction Inventory--Revised, and a demographic questionnaire. Posttraumatic stress disorder (PTSD) symptomatology was the best predictor of marital functioning and was related negatively to acculturation. After controlling for PTSD, acculturation did not predict marital functioning. Wives' marital satisfaction was best predicted by husbands' PTSD, husbands' acculturation, and their own PTSD. Husbands' marital satisfaction was not predicted significantly by any of these variables. These findings suggest several implications for mental health professionals dealing with refugees and other traumatized populations.

[Complications in the use of blood transfusions--alloimmunization in polytransfused patients]. / Komplikacija primanja transfuzija krvi--aloimunizacija politransfundovanih bolesnika.

INTRODUCTION: The objective of this paper was to examine the frequency of red blood cell (RBC) alloantibodies in polytransfused hematologic patients. MATERIAL AND METHODS: Blood samples of 2669 polytransfused hematologic patients were examined on clinical significant alloantibodies using antibody screening and identification according to Standards of AABB Technical Manual (1). Available medical charts were reviewed for sex, age and medical history and total number of given transfusions. RESULTS: During a three year period blood samples of 2669 polytransfused hematologic patients were examined for RBC alloantibodies. Alloantibodies were detected in 48 cases with the incidence of 1.79%. 36 patients (1.35%) developed single antibody while in 12 patients (0.45%) multiple antibodies were detected. Antibodies were registered more frequently in females than in males (37:17). In patients with single antibody next specificity was detected: anti-D (38.89%), anti-K (22.22%), antibodies to antigens MNSs system (22.22%), while anti-Le, anti-Fy and anti-P specificity was detected in 13.89%. Patients with multiple antibodies had specificity to Rhesus, Kell, Duffy, MNSs, Lewis and P blood group systems. All patients received more than 10 RBC transfusions. CONCLUSION: The incidence of alloimmunization was 1.79%. Sensibilization occurred more frequently in females than in males. Usually, the discovered alloantibodies were clinically significant and made problems in pretransfusion testings and required special efforts in blood selection for transfusion. For patients with the risk of frequent transfusions we suggest to include blood transfusion charts with complete phenotyping against antigens in Rhesus, Kell, Kidd and MNSs blood group systems and the data of all received transfusions.

[Successful treatment of patients with thrombotic thrombocytopenic purpura]. / Uspesno lecenje bolesnika sa tromboznom trombocitopenijskom purpurom.

The paper presents the case of a 23 years old patient diagnosed with thrombotic thrombocytopenic purpura on the basis of increased body temperature, thrombocytopenia, microangoipathic hemolytic anemia, renal function disorders and a rapid development of coma after the epileptic seizure of Jacsonian type. The treatment included the therapy with antithrombocytic drugs such as lysin acetysalicylate, dipridamol, methylprednisolon, and other symptomatic and substitutional therapies. Fifteen therapeutic plasmaphereses were made with the replacement of 33.150 ml of plasma substituted with albumin and freshly frozen plasma (20.080 ml totally). The applied therapy gradually improved patient's neurologic finding. The patient was discharged from the hospital with normal neurological finding and magnetic resonance of the brain. In the conclusion we emphasize the importance of therapeutic replacement of plasma with the infusion of freshly frozen plasma, antithrombocytic therapy and the application of corticosteroids in the treatment of thrombotic thrombocytopenic purpura.

[Postpolycythemic myeloid metaplasia in patients with polycythemia vera]. / Postpolicitemijska mijeloidna metaplazija u bolesnika s pravom policitemijom.

This study group comprised 58 patients with polycythemia vera. A retrospective study included 23/58 (39.60%) patients treated from 1968 to 1987, while a prospective study included 35/58 (60.34%) patients. Over the period 1986.-1996., 19/58 (32.76%) patients died: 10/23 (43.48%) from the retrospective group where mean disease duration was 12.7 years (6-24), and 9/35 (25.71%) from the prospective group where mean disease duration was 2.22 years (1-4). Erythrocytic phase of the disease was established in 50/58 (86.21%) patients; in 2/58 (3.45%) patients phase of spent hematopoiesis and postpolycythemic myeloid metaplasia in 6/58 (10.34%) patients. Postpolycythemic myeloid metaplasia has occurred after a mean time of 10.33 years (6-15) from establishing the first polycythemia. Two patients (10.53%) with postpolycythemic myeloid metaplasia died, one immediately after the diagnosis was established, the other patient two years after establishing the diagnosis. 16/19 (84.21%) patients died during the erythrocytic phase of the polycythemia vera, while 1/19 (5.26%) patient died in the phase of spent hematopoiesis. In regard to alive patients postpolycythemia myeloid metaplasia has been established in 4/39 (10.26%) patients, the phase of spent hematopoiesis in 1/39 (2.56%), while 34/39 (87.18%) patients are in the erythrocytic phase.

[Modern treatment of leukemia and hematopoietic stem cell transplantation]. / Savremeno lecenje leukemija i transplantacija maticne celije hematopoeze.

The paper presents the possibilities of contemporary treatment of acute and chronic leukemia that have been based on new knowledge and experience we have gathered through clinical and scientific work. Contemporary treatment of leukemia is very complex and requires the application of cytostatics, biological therapy and transplantation of hematopoietic stem cells. The treatment of acute leukemia by cytostatics and induction protocols results in a rather high percentage of remissions, but unfortunately most of them cannot be preserved. Allogenic transplantation of hematopoietic stem cells from bone marrow or peripheral blood have given the best results in the treatment of acute and chronic leukemia. Anti-leukemic effect is bound to the previous chemoradiotherapy, particularly to the activity of donor's immunocompetent cells in the transplant, having an effect of a graft against leukemia. The cleansing of the autograft and isolation of stem cells together with the application of IL-2 will be a significant improvement of the efficacy of autologous transplantation in leukemia. It is realistic to expect that the treatment of malignant diseases such as leukemia will in near future, besides the already existing treatment methods, include molecular therapy at various cell levels, which will make possible a correction of the basic disorder in the process of malignant alteration of hematopoietic cells.

[Prognosis in patients with myelodysplastic syndromes based on cytomorphologic and clinico-biologic parameters]. / Prognoza obolelih od mijelodisplasticnih sindroma na osnovu citomorfoloskih i klinicko-bioloskih parametara.

Under myelodysplastic syndromes we presume a heterogeneous group of malignant hemopathies with clearly described characteristics of the disease given by a cooperative group of French, American and British authors. Myelodysplastic syndromes most frequently occur at older age. Survival of these patients, after the diagnosis is made, is mostly short because the disease evolves into acute leukemia. Myelodysplastic syndrome is characterized by appearance of refractive anemia, leukemia, thrombocytopenia with signs of expressed dishematopoiesis of the bone marrow. Clear criteria which could define forms with fast or slow course leading to acute leukemia don't exist, so there is a need to group patients into those with good or with bad outcome. The investigation included following parameters important for the outlook of the disease: 1. enlargement of lymph nodes, liver and spleen, 2. biochemical examination of peripheral blood, 3. cytomorphologic changes in the peripheral blood cells and bone marrow. By a follow-up of described parameters a statistically significant influence on survival of the sick concerning the degree of present anemia, absolute number of granulocytes, number of thrombocytes, dishematopoiesis of the peripheral blood and bone marrow, lymphadenomegaly, hepatomegaly and splenomegaly was not found. The percentage of blast in the peripheral blood and bone marrow has a statistically significant influence on patients' short survival.

[Prophylaxis and therapy of infections in allogenic bone marrow transplantation in patients with hematologic diseases]. / Profilaksa i lecenje infekcije kod alogene transplantacije kosne srzi bolesnika sa hematoloskim oboljenjima.

Infection and acute graft versus host disease (GVHD) are the most common complications of allogeneic bone marrow transplantation, which compromise this therapeutical method for hematologic diseases. Beside the appreciation of customary preventive measures and the treatment of infections, it is necessary for every bone marrow transplantation center to analyze the development of bacterial, fungal and viral infections in the patients and to generate the most efficient and most rational program for their prevention and treatment. At the Hematology Department in Novi Sad seven allogenic bone marrow transplantations were performed in patients with malignant hematologic diseases and severe form of aplastic anemia. Prevention of the infection by isolation of the patient in a sterile unit, selective decontamination of the digestive tract with sterile food, skin and mucus hygiene and prophylactic drug administration proved rather beneficial and adequate for patients with the graft accepted, hematopoiesis recovered and immunity reconstructed. Risks of infections were increased by permanent vein catheter, acute GVHD and rejection of the bone marrow graft. Prompt isolation and identification of bacteria and fungi, especially in blood, the establishment of a minimal suppressing and bactericide antibiotic concentration, along with the assessment of their synergism, as well as early diagnosis of cytomegalovirus and administration of specific drugs, can significantly contribute to the more successful treatment of infections in transplanted patients.

[Our experiences in the treatment of myelodysplastic syndromes]. / Nase iskustvo u lecenju obolelih od mijelodisplasticnih sindroma.

From 1987 an abrupt increase of the number of patients presented with MDS has been registered. We present our experiences in the treatment of 42 patients. The number of the male patients was two times larger than of the females. They were most frequently diagnosed as having RAB (43%) and RAEBt (28.5%). RA was found in 14%, RARS in 9.5% and CMML. in only 5% of the cases. The treatment was accomplished with ultralow (3 mg/m2/12h s.c.) and low doses (10 mg/m2/12h s.c.) of ARA-C in 75% of the patients with RAEBt and 44.4% with RAEB, while the CMML group received hydroxyurea. The treatment improved hematologic results but the complete remission lacked. In 23.8% of the cases the disease developed into acute nonlymphoblastic leukemia. Patients excepted from cytostatic therapy were observed by the use of androgens, anabolics, vitamin A+D3 and transfusion of separated erythrocytes. In 38% of the patients with MDS a lethal outcome followed. Life of those in whom the disease developed into acute leukemia in statistically significatly shorter (p < 0.05). There was no statistically significant difference in the survival rate between the treated and nontreated patients (p > 0.05). Further treatment of these patients includes, apart from ultralow doses of ARA-C, the use of retinoic acid, a growth factor (GM-CSF) and bone marrow transplantation.