Propofol versus sodium thiopentone for the treatment of status epilepticus and refractory status epilepticus in dogs.

AIMS: To compare the effect on mortality and length of hospital stay of propofol with that of sodium thiopentone for the management of dogs with status epilepticus (SE) and refractory status epilepticus (RSE). METHODS: In this cohort study, medical records of a veterinary referral clinic in Argentina were retrospectively searched for dogs that were hospitalised and required induction of therapeutic coma (TC) with either propofol or sodium thiopentone for the management of SE or RSE of any cause. A logistic regression model was performed to evaluate the association between the type of anaesthetic used and in-hospital mortality adjusting for the type of epilepsy (idiopathic, structural, or reactive). Kaplan-Meier estimated survival curves for the length of hospital stay by the type of anaesthetic drug were compared using the log-rank test (deaths were considered censored events). Cox proportional hazards regression was used to estimate hazard ratios for time to hospital discharge, unadjusted and adjusted for type of epilepsy. RESULTS: A total of 24 dogs with SE were included in the study: eight treated with propofol and 16 treated with sodium thiopentone. Four dogs treated with propofol (proportion = 0.50; 95% CI = 0.15-0.84), and eight treated with sodium thiopentone (proportion = 0.50; 95% CI = 0.50-0.74) died during hospitalisation. The median hospitalisation time was 43 (IQR 24-56) hours for dogs that were treated with propofol and 72 (IQR 64-96) hours for dogs that were treated with sodium thiopentone. There was no evidence of a difference in the median duration of TC in dogs treated with propofol (12 (IQR 8-24) hours) or with sodium thiopentone (12 (IQR 7.5-20) hours; p = 0.946). In the logistic regression model, no evidence of association between the anaesthetic protocol for the management of RSE and in-hospital mortality, adjusted for the type of epilepsy, was found (OR 1.09 (95% CI = 0.17-6.87); p = 0.925). Cox regression analysis revealed a difference in the time to hospital discharge, adjusted by the type of epilepsy, between treatment groups (HR = 0.05 (95% CI = 0.01-0.54); p = 0.013). CONCLUSIONS AND CLINICAL RELEVANCE: The time spent in hospital before discharge was longer in dogs with RSE treated with sodium thiopentone compared to those treated with propofol. However, as the sample size was very small, the results obtained in the present study should be analysed with caution. Further studies including a greater number of dogs are required.

Caracterización morfológica del músculo bíceps femoral del perro / Morphological characterization of biceps femoris muscle in the dog

A partir de estudios previos realizados sobre la anatomía del musculo bíceps femoral en el perro y con el objetivo de avanzar en la caracterización inmunohistoquímica y nerviosa de este musculo, estudiamos la existencia de subvolúmenes musculares. Utilizamos la disección roma en piezas musculares aisladas fijadas y tratadas con ácido nítrico al 25%. Las divisiones de las ramas del nervio isquiático involucradas fueron utilizadas como guía en la disección. Se determinaron tres subvolúmenes, uno involucrando a la cabeza caudal y dos en el vientre correspondiente a la cabeza craneal que fueron denominados caudal, proximal y distal respectivamente. Realizamos mediciones del largo de las fibras musculares, dirección, dirección y densidad macroscópica de las mismas para caracterizar los compartimientos. Estos subvolúmenes deberán tenerse en cuanta al realizar estudios electromiográficos del musculo bíceps femoral y al evaluar las alteraciones en la locomoción producto de las alteraciones nerviosas y musculares en el nervio pelviano del canino.

From previous studies on the anatomy of the femoral biceps muscle in the dog and with the aim of advancing in immunohistochemical and nervous characterization of this muscle, we studied the existence of subvolumes in muscle structure. We used blunt dissection in isolated muscle pieces fixed and treated with 25% nitric acid. The divisions of the sciatic nerve branches involved were used to guide the dissection. Three subvolumes were identified; one, involving the caudal head, and two in the cranial head belly; they were called caudal, proximal and distal respectively. We measured muscle fiber length, orientation, and macroscopic density to characterize these compartments. These subvolumes must be considered when muscle electromyography research is carried out, and for locomotion changes evaluation due to lesions in nerve and muscle structure of the canine pelvic limb.

Simultaneous pyometra and viable puppies' gestation in a bitch.

Here we describe a case of pyometra coexisting with gestation in a 4.5 year-old miniature short-haired Dachshund. The dog exhibited depression, vaginal discharge, polydipsia and dehydration. Ultrasound examination revealed the presence of low to moderate anechoic fluid collection in the left uterine horn. Blood analysis revealed mild neutrophilia with a left shift. Based on these findings a presumptive diagnosis of pyometra was made and the bitch was treated using amoxicillin-clavulanate with dopaminergic agonist (cabergoline). A second ultrasound scan revealed the presence of two gestational vesicles in the right uterine horn that were successfully carried to term. Unusually, while pyometra persisted in the left uterine horn, two viable puppies were delivered by caesarean section from the right uterine horn.

Severe infection in a lung transplant recipient caused by donor-transmitted carbapenem-resistant Acinetobacter baumannii.

We describe a case of proven donor transmission of carbapenem-resistant Acinetobacter baumannii, which resulted in severe infectious complications after lung transplantation. A single bla(OXA-23) positive strain, belonging to a new multilocus sequence type (ST231), was isolated from donor and recipient, who died 65 days after transplantation. This report highlights the current challenges associated with the potential transmission of multidrug-resistant infections through organ transplantation.

Revisión anatómica del músculo bíceps femoral del canino / Anatomical review of canine biceps femoris muscle

El músculo bíceps femoral (BF) desempeña un rol fundamental en la biomecánica del miembro pelviano de los caninos, actuando en la flexoextensión de la articulación femorotibiorotuliana y la abducción del miembro. La evaluación correcta de su función es importante en la clínica veterinaria. Existen puntos controversiales entre los autores consultados acerca de la morfología de este músculo. El presente estudio tiene como objetivo discutir las distintas descripciones, reparando en las inserciones, la estructura e inervación del músculo. Se han realizado las disecciones bilaterales en 12 animales. La conservación de las piezas se realizó por inmersión en piletas, con una dilución de formol al 10 por ciento y ácido fenico al 4 por ciento en agua. Se utilizaron diferentes técnicas de abordaje al músculo en cuestión, para obtener distintas observaciones de las estructuras. Se halló que el músculo BF se origina por medio de dos cabezas, como queda implícito en su denominación, una cabeza craneal, más voluminosa y una cabeza caudal más pequeña. La primera originada en el ligamento sacrotuberal y en la superficie lateral de la tuberosidad isquiática. La cabeza caudal, se origina de la tuberosidad isquiática. Estas partes a pesar de hallarse estrechamente unidas se individualizan a nivel de los vientres musculares por medio de una delgada lámina de tejido conectivo que se extiende hasta el tercio distal del músculo. Respecto a la inervación, no se encontraron ramas del nervio glúteo caudal que inerven las partes al músculo.

The biceps femoris (BF) muscle plays a fundamental role in the biomechanics of the canine pelvic limb, acting in flexion ­ extension on knee articulation and abduction of the limb. Correct evaluation plays an important role in veterinary clinic. There are controversial issues among the authors consulted about the morphology of this muscle. The present study aims to discuss the various descriptions proposed for this muscle, considering insertions, structure and innervation. Bilateral dissections of 12 animals were carried out. Pieces conservation was done by immersion in pools with 10 percent formaldehyde and 4 percent carbolic acid in water. Different techniques were used in order to achieve various observations of muscle structures. It was found that BF muscle originates by two heads, as is implicit in its name, a craneal head, bulkier and a smaller caudal head. The first takes origin in the sacrotuberal ligament and the lateral surface of the ischial tuberosity. The caudal head, originates from the ischial tuberosity. These parts are closely linked but they can be identified at the level of the muscle bellies through a thin layer of connective tissue that extends to the distal part of the muscle. Regarding the innervation, we found that no caudal gluteal nerve branches reach this muscle.

Genotyping of methicillin-resistant Staphylococcus aureus isolates obtained in the Northeast region of Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) is a major agent of hospital infections worldwide. In Brazil, a multiresistant MRSA lineage (ST239-SCCmecIIIA), the so-called Brazilian epidemic clone (BEC), has predominated in all regions. However, an increase in nosocomial infections caused by non-multiresistant MRSA clones has recently been observed. In the present study, 45 clinical isolates of MRSA obtained from a university hospital located in Natal city, Brazil, were identified by standard laboratory methods and molecularly characterized using staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis. Antimicrobial susceptibility testing was carried out using CLSI methods. The MRSA isolates studied displayed a total of 8 different pulsed-field gel electrophoresis patterns (types A to H) with predominance (73 percent) of pattern A (BEC-related). However, MRSA harboring SCCmec type IV were also identified, 3 (7 percent) of which were genetically related to the pediatric clone - USA800 (ST5-SCCmecIV). In addition, we found a considerable genetic diversity within BEC isolates. MRSA displaying SCCmecIV are frequently susceptible to the majority of non-β-lactam antibiotics. However, emergence of multiresistant variants of USA800 was detected.

Genotyping of methicillin-resistant Staphylococcus aureus isolates obtained in the Northeast region of Brazil.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major agent of hospital infections worldwide. In Brazil, a multiresistant MRSA lineage (ST239-SCCmecIIIA), the so-called Brazilian epidemic clone (BEC), has predominated in all regions. However, an increase in nosocomial infections caused by non-multiresistant MRSA clones has recently been observed. In the present study, 45 clinical isolates of MRSA obtained from a university hospital located in Natal city, Brazil, were identified by standard laboratory methods and molecularly characterized using staphylococcal chromosome cassette mec (SCCmec) typing and pulsed-field gel electrophoresis. Antimicrobial susceptibility testing was carried out using CLSI methods. The MRSA isolates studied displayed a total of 8 different pulsed-field gel electrophoresis patterns (types A to H) with predominance (73%) of pattern A (BEC-related). However, MRSA harboring SCCmec type IV were also identified, 3 (7%) of which were genetically related to the pediatric clone--USA800 (ST5-SCCmecIV). In addition, we found a considerable genetic diversity within BEC isolates. MRSA displaying SCCmecIV are frequently susceptible to the majority of non-beta-lactam antibiotics. However, emergence of multiresistant variants of USA800 was detected.

Pseudomonas aeruginosa epidemic strain carrying bla(SPM) metallo-beta-lactamase detected in Rio de Janeiro, Brazil.

The present study was designed to characterize beta-lactamase genes and evaluate polymerase chain reaction (PCR) typing for multidrug-resistant Pseudomonas aeruginosa pulsed-field gel electrophoresis (PFGE) genotype A isolates from Rio de Janeiro, Brazil, collected between April 1999 and March 2000 and one additional isolate collected in June 2002. As reported previously, all of the genotype A isolates produced non-characterized metallo-beta-lactamase. These isolates (22) were screened for the bla(SPM) gene by PCR and dot-blotting. Isolates were typed by PCR fingerprinting with primers RAPD-1, 272, 208, 1290, ERIC-1 and ERIC-2. The bla(SPM) gene was detected in 18 (82%) of the 22 isolates. PCR fingerprinting gave results that correlated with PFGE, except with primer 1290. In Rio de Janeiro and other Brazilian states, nearly all SPM-producing P. aeruginosa isolates belong to a single PFGE type accounting for a large proportion of drug-resistant P. aeruginosa hospital infections. RAPD PCR fingerprinting may be a useful technique to screen for an epidemic multidrug-resistant strain in Brazil.

Claritromicina oral como opción terapéutica en endoftalmitis post-quirúrgicas tardías / Oral clarithromycin as a therapeutic option form the management of late postsurgical endophthalmitis

El objetivo de este trabajo es evaluar la respuesta al tratamiento médico con claritromicina oral de pacientes con endoftalmitis post-quirúrgica crónica

Claritromicina oral como opción terapéutica en endoftalmitis post-quirúrgicas tardías / Oral clarithromycin as a therapeutic option form the management of late postsurgical endophthalmitis

El objetivo de este trabajo es evaluar la respuesta al tratamiento médico con claritromicina oral de pacientes con endoftalmitis post-quirúrgica crónica(AU)

[Oral clarithromycin as a treatment option in chronic post-operative endophthalmitis]. / Claritromicina oral como opción terapéutica en endoftalmitis post-quirúrgicas tardías.

PURPOSE: To assess the outcome of medical treatment with oral clarithromycin in patients with chronic post-surgical endophthalmitis. METHODS: This prospective study was performed between January 1999 and September 2003. Patients with a diagnosis of chronic post-surgical endophthalmitis of bacterial etiology were included. All received 500 mg of oral clarithromycin twice a day for 14 days. The initial and final visual acuity, etiology, post-surgical time of presentation, treatment-delay time, and follow up were recorded. According to the treatment results, patients were distributed into 3 separate groups: 1) complete response, 2) partial response, 3) no response. Data from these groups were compared by means of the Student's t test and Fisher exact test, depending on which was considered most suitable. RESULTS: Fifteen cases of chronic endophthalmitis (11 of Propionibacterium acnes, 4 of Staphylococcus epidermidis) were diagnosed. A complete response was observed in 4 cases, partial response in 4 cases, and no response in 7 cases. Final visual acuity greater than 0.5 was significantly more likely in the complete response group when compared with the no response group (Fisher exact test = 0.0454, p=0.05), however, the same comparison between the complete response group and the partial response group was not significant. CONCLUSION: Medical treatment with oral clarithromycin could be useful in some patients with chronic post-surgical endophthalmitis.

Identification of an imipenem-resistant Pseudomonas aeruginosa clone among patients in a hospital in Rio de Janeiro.

A total of 85 Pseudomonas aeruginosa isolates were obtained from October 1999 to April 2000 in a tertiary care hospital in Rio de Janeiro, Brazil. The imipenem susceptibility was evaluated by disk diffusion and agar dilution methods, and the clonal relationship among 67 isolates was examined by macrorestriction profile analysis following pulsed-field gel electrophoresis. Imipenem resistance was observed in 52 (61.2%) isolates. Imipenem-resistant P. aeruginosa isolates were separated into 10 genotypes, 73% of which belonged to genotype A. Identification of a single P. aeruginosa clone with a high rate of imipenem resistance emphasizes the need to control the transmission of this organism among patients.

Ralstonia pickettii and Burkholderia cepacia complex bloodstream infections related to infusion of contaminated water for injection.

Ralstonia pickettii and Burkholderia cepacia complex isolates are causes of healthcare-associated infection related to contamination of intravenously administered products. Based on microbiological and epidemiological data and molecular typing by pulsed-field gel electrophoresis, we report the occurrence of two outbreaks of R. pickettii and B. cepacia complex bloodstream infections. The first outbreak occurred from August 1995 to September 1996, and the second outbreak occurred from 28 March to 8 April 1998, affecting adults and neonates, respectively. Infusion of contaminated water for injection was the source of infection.

Criterios de homologación entre las cinturas escapular y pélvica y sus estructuras asociadas / Homologation criterion between the scapular and pelvic waists and their associated structures

Habitualmente las cinturas se estudian en forma separada junto al miembro correspondiente. Los músculos asociados a ellas se reunen en base a un criterio exclusivamente topográfico, resultando los siguientes grupos; músculos del dorso, del cuello, del tórax y del miembro pelviano. Para el miembro torácico se los trata como músculos comunes del miembro, sin tener en cuenta su inserción ni su intervación. En este trabajo se establecen los criterios de homotipia entre ambas cinturas y se proponen pautas para homologar los músculos que unen los miembros torácicos y pelvianos con el esqueleto axial. Para ello, se recurre a su clasificación en extrínsecos e intrínsecos, en base a su origen embriológico, inserción e inervación

Criterios de definición y sistematización de la musculatura hiposomática en la enseñanza de la anatomía veterinaria / Definition and systematizing criteria of the hiposomatic musculature in the teaching of veterinary anatomy

La musculatura hiposomática está constituida por una masa muscular continua que envuelve las cavidades corporales, situada entre la columna vertebral y la línea media ventral. Está integrada por un conjunto de musculos con características comunes en cuanto a origen embriológico e inervación, posible de ser sistematizado en virtud de sus propiedades morfológicas y funcionales. Como consecuencia de la división del cuerpo en regiones diferentes, así como también, de la superposición de estructuras extrínsecas relacionadas a ella, la musculatura hiposomática sufre grandes modificaciones regionales que dificultan su tratamiento como unidades anatómicas coherentes. Por esta causa, su estudio se realiza fragmentado, en forma topográfica, según la división corporal que afecta a los mamíferos. En este trabajo se analizan posibles pautas para definir, caracterizar y sistematizar la musculatura hiposomática, que permitan un aprendizaje constructivo y asociativo, en el marco global del estudio de un modelo anatómico básico, teórico, común a todas las especies con el que se compara la anatomía particular de cada una de ellas. Se logra definir y sistematizar a la musculatura hiposomática en base a su inervación y orígen embriológico y se concluye que la presencia de grandes variaciones regionales no constituyen obstáculo para reconocer un patrón de organización lógico, que permite relacionar los músculos, funcional y estructuralmente