Morphometric data for five freshwater turtles in south, central, and west Texas.

From 2008 to 2013, we sampled freshwater turtle populations at 66 sites in south, central, and west Texas, USA. Sampling sites included ponds, lakes, resacas (oxbow lakes), canals, and rivers. We sampled turtle populations using baited hoop nets (66 sites) and basking traps (3 sites), and captured turtles by hand opportunistically in terrestrial habitat. We measured carapace length and width, plastron length and width, body depth, and weight of captured turtles. Excluding recaptures, we measured 356 Apalone spinifera emoryi (Texas Spiny Softshell), 24 Chelydra serpentina (Snapping Turtle), 20 Kinosternon flavescens (Yellow Mud Turtle), 47 Trachemys gaigeae (Big Bend Slider), and 1070 Trachemys scripta elegans (Red-eared Slider). Carapace length of Apalone spinifera emoryi ranged from 85 to 426 mm (mean = 182 mm). Carapace length of Chelydra serpentina ranged from 74 to 320 mm (mean = 233 mm). Carapace length of Kinosternon flavescens ranged from 64 to 147 mm (mean = 114 mm). Carapace length of Trachemys gaigeae ranged from 54 to 203 mm (mean = 141 mm). Carapace length of Trachemys scripta elegans ranged from 30 to 328 mm (mean = 171 mm). These data are useful for assessing spatial and temporal variation in size and body condition of freshwater turtles.

A bronchoscopy-associated pseudo-outbreak of Mycobacterium mucogenicum traced to use of contaminated ice used for bronchoalveolar lavage.

Clonal Mycobacterium mucogenicum isolates (determined by molecular typing) were recovered from 19 bronchoscopic specimens from 15 patients. None of these patients had evidence of mycobacterial infection. Laboratory culture materials and bronchoscopes were negative for Mycobacteria. This pseudo-outbreak was caused by contaminated ice used to provide bronchoscopic lavage. Control was achieved by transitioning to sterile ice.

An update for community-acquired bacterial pneumonia pharmacotherapy: what's new and where does it fit?

In 2007, 1.2 million people in the United States were hospitalized with pneumonia, and more than 52 000 died from the disease. Community-acquired bacterial pneumonia (CABP) can be caused by a variety of organisms as a result of patient factors such as comorbidities, epidemiologic conditions, or the setting in which the infection was contracted. Treatment of CABP differs depending on the types of bacteria that are suspected. In the last several years, due to the concern regarding multidrug-resistant organisms (MDROs), 2 new antibiotics have been developed and approved for use in CABP. Ceftaroline fosamil (Teflaro) was approved by the US Food and Drug Administration (FDA) in October 2010 and tigecycline (Tygacil) in March 2009. In clinical trials, both agents have been shown to be efficacious and are generally well tolerated. Although these agents have received approval as therapy for CABP, it is the responsibility of physicians and pharmacists to prudently use these antimicrobials where they are truly needed. Until these agents show superiority over conventional therapy for selected patient populations, given the wide variety of pharmacotherapy that can prove efficacious for pneumonia, the new agents should be reserved for patients who have known risk factors for MDROs. Further studies are warranted for these agents in the setting of CABP.

Faculty perceptions of appropriate faculty behaviors in social interactions with student pharmacists.

OBJECTIVE: To determine faculty and administrator perceptions about appropriate behavior in social interactions between pharmacy students and faculty members. METHODS: Four private and 2 public colleges and schools of pharmacy conducted focus groups of faculty members and interviews with administrators. Three scenarios describing social interactions between faculty members and students were used. For each scenario, participants reported whether the faculty member's behavior was appropriate and provided reasons for their opinions. RESULTS: Forty-four percent of those surveyed or interviewed considered interactions between faculty members and pharmacy students at a bar to be a boundary violation. Administrators were more likely than faculty members to consider discussing other faculty members with a student to be a boundary violation (82% vs. 46%, respectively, P <0.009). A majority (87%) of faculty members and administrators considered "friending" students on Facebook a boundary violation. CONCLUSIONS: There was no clear consensus about whether socializing with students at a bar was a boundary violation. In general, study participants agreed that faculty members should not initiate friendships with current students on social networks but that taking a student employee to lunch was acceptable.

Use of cetirizine in a 23-month-old male causes insomnia.

Allergic rhinitis affects approximately 40% of children and generally presents in children from 10-19 years of age; however, the condition has been seen in children as young as 6 months. Antihistamines are commonly prescribed in infants and children for the relief of allergic symptoms. A 23-month-old male with a history of chronic otitis media was prescribed cetirizine 2.5 mg daily at bedtime for maintenance of his chronic rhinitis symptoms. Several days into therapy, the child began experiencing frequent and progressive nighttime periods of awakening. Once treatment was discontinued, the child resumed his normal sleeping patterns.

Treatment of hypersexual behavior with oral estrogen in an autistic male.

Hypersexual behavior can be exhibited by patients with autism. Several medications have been used in hypersexual paraphiliac male and elderly patient populations, including antiandrogens, estrogen, gonadotropin-releasing hormone analogues, and selective serotonin reuptake inhibitors. Due to limited research in autistic patients exhibiting hypersexuality, physicians must base their medication selection on outcomes seen in patients with other conditions.

Therapies for diabetes: pramlintide and exenatide.

The American Diabetes Association currently recommends an A1C goal of less than 7 percent. However, many patients are unable to achieve this goal by using oral drug combinations or diet and exercise, leaving insulin as the only treatment option. In most cases, insulin is initiated later in therapy because of its inconvenience and adverse effects (e.g., weight gain, hypoglycemia, possible role in atherogenesis). Although insulin effectively helps patients attain glucose goals, the search for new agents continues. Two injectable agents, pramlintide and exenatide, were approved in 2005 for the treatment of diabetes. Pramlintide, indicated for use in patients with type 1 and 2 diabetes, is a synthetic analogue of human amylin that acts in conjunction with insulin to delay gastric emptying and inhibit the release of glucagon. Exenatide, a glucagon-like peptide-1 mimetic, has multiple mechanisms for lowering glucose levels, including the enhancement of insulin secretion, and is indicated for use in patients with type 2 diabetes. Clinical trials have shown that both agents reduce, by a statistically significant degree, A1C levels (0.3 to 0.7 percent more than placebo), fasting plasma glucose levels, and body weight (3 to 5 lb [1.4 to 2.3 kg]). No studies have examined their effects on diabetic complications, cardiovascular disease, or overall mortality. Pramlintide and exenatide may help make glycemic goals more attainable.

Insulin detemir: a long-acting insulin product.

PURPOSE: The pharmacology, pharmacokinetics, efficacy and tolerability, safety, drug interactions, dosage and administration, cost, and place in therapy of insulin detemir are reviewed. SUMMARY: Insulin detemir is a long-acting, neutral, and soluble insulin analogue with a lower within-subject variability of fasting plasma glucose levels than isophane insulin human (NPH insulin) and insulin glargine. The lower within-subject variability of insulin detemir may decrease hypoglycemic events, especially nocturnal events, and may contribute to a decreased incidence of weight gain. In vivo, insulin detemir is 98-99% bound to albumin-one of the mechanisms contributing to its long duration of action. Several open-labeled, randomized, multicenter trials have been conducted comparing the safety and efficacy of insulin detemir to NPH insulin in patients with type 1 or type 2 diabetes mellitus. In most trials, patients were randomized to receive insulin on three different dosing schedules: basal insulin twice daily before breakfast and at bedtime, basal insulin at 12-hour intervals, or basal insulin before breakfast and dinner. Mealtime insulin was given as part of the basal-bolus therapy. Glycosylated hemoglobin values were similar in patients receiving insulin detemir or NPH insulin. Insulin detemir appears to be well tolerated. The most common adverse effects reported during clinical trials were hypoglycemia, headache, dizziness, and injection-site reactions. CONCLUSION: Insulin detemir given once or twice daily as part of basal-bolus insulin therapy is at least as effective as NPH insulin in maintaining overall glycemic control in adult patients with type 1 or type 2 diabetes mellitus.

A case of skin hypopigmentation secondary to a corticosteroid injection.

A 47-year-old African-American male presented complaining of Achilles tendon pain. The patient was treated for three weeks with a nonsteroidal anti-inflammatory agent with minimal pain relief. The tendon was subsequently injected with triamcinolone acetonide and five months later, the patient presented with an area of hypopigmentation around the injection site. The patient was diagnosed with hypopigmentation secondary to the steroid injection.