The nasopharyngeal microbiota of preweaned dairy calves with and without ultrasonographic lung lesions.

The primary objective of this cross-sectional study was to identify associations between the diversity and composition of the nasopharyngeal (NP) microbiota and pneumonia status, as diagnosed by ultrasonography (US), in preweaned dairy calves. Characteristics of the NP microbiota were compared between calves with and without pneumonia, as diagnosed by US. Secondary objectives were to compare the composition of the NP microbiota between calves by age, clinical respiratory score (CRS), and previous antibiotic therapy. Holstein heifer calves (n = 50) from a southern Wisconsin dairy were enrolled at either 3 or 6 wk of age; 4 calves were sampled at both time points. Antibiotic treatment history was also collected for the 30 d before enrollment. For the purpose of this study, pneumonia was defined as having lobar pneumonia, as diagnosed by US, in at least 1 lung lobe. Following examination by CRS and US, a deep nasopharyngeal swab was obtained for 16S rRNA amplicon sequencing. Alpha diversity was reduced in calves that were CRS positive, and beta diversity tended to be different in calves previously treated with antibiotics and in calves that were CRS positive. Microbial diversity was not different between calves with and without pneumonia. The most dominant genus identified was Mycoplasma spp.; however, there was no association between relative abundance (RA) and pneumonia status. The median RA of Mycoplasma spp. was increased by 25 (95% confidence interval, CI: 3, 40) in calves at 3 wk of age compared with 6 wk of age. The median RA of Pasteurella spp. was increased by 1.5 (95% CI: 0.1, 3) in calves with pneumonia, as diagnosed by US, compared with calves without pneumonia. Additionally, Pasteurella spp. was increased by 2.3 (95% CI: 0, 9) in CRS-positive calves compared with CRS-negative calves. The median RA of Psychrobacter spp. was increased by 2 (95% CI: 0, 12) and median RA of Chryseobacterium spp. was increased by 0.15 (95% CI: 0, 2) in calves that were not treated previously with antibiotics compared with calves previously treated with antibiotics.

The impacted maxillary canine: revisiting the clinical guideline, with case illustrations.

The key to managing canine impaction is early identification, interception and follow-up. In these case reports, we discuss four patients presenting with palatally impacted maxillary canines and their management. Guidelines to aid the early detection of an impacted maxillary canine and a subsequent management strategy are presented.

A randomised clinical trial to investigate bond failure rates using a self-etching primer.

This clinical trial evaluated, over a 12-month period, the performance of brackets bonded to teeth etched and primed with Transbond Plus Self-Etching Primer (SEP) when compared with a conventional separate two-step etch and primer system. Thirty-nine randomly selected patients requiring fixed appliance therapy were entered into the study. Random allocation of each etching system, along with a 'split-mouth cross-quadrant' design was used. A total of 661 brackets were placed by two operators. The failure and survival rates of the brackets were determined for age and gender of the patients, each etching system, operator, mode of failure, tooth position in the dental arch, and number of manipulations prior to curing the adhesive. Statistical analysis showed that SEP had a significantly higher bond failure rate (11.2 per cent) than the conventional etch and primer system (3.9 per cent) at the P = 0.001 level. Cox's proportional hazards regression showed the conventional etch and primer system to have a 60 per cent reduced chance of bracket failure over a 12-month observation period, while males had a 2.4 times increased risk compared with females. The predominant mode of failure was at the composite enamel interface for the SEP, while for the conventional etch and primer system, it was within the composite adhesive. No statistically significant differences were found for the failure rate with respect to the age of the patient, operator, tooth location, or the number of manipulations of the bracket. This in vivo study showed that brackets bonded using SEP had an increased clinical bond failure rate compared with the conventional, separate, etch and prime system.

Oral piercing and oral trauma in a New Zealand sample.

This study investigated the periodontal and dental trauma resultant from tongue and lip piercings in a convenience sample of 43 adult dental patients. Patients underwent an intra-oral examination followed by the administration of a questionnaire. Each patient was examined for lingual or buccal recession of the upper and lower incisors as well as the extent of abnormal toothwear or trauma on these teeth. Following bivariate analyses, regression analyses were conducted to test the study hypotheses and derive adjusted estimates for the dependent variables. Of the 43 individuals who participated (93.0% females; mean age 21 years; age range 14-34 years) 76.7% had a tongue piercing, 34.9% had a lip piercing, and 11.6% had both. Only four had had their piercing procedure provided by a doctor or dentist. Postpiercing complications were reported by 34.9%. Most of those with a labial piercing (80.0%) had 1+ labial site with gingival recession (GR), and almost one-third of those with a tongue piercing had at least one lingual site with GR. Age was a significant predictor of the prevalence of lingual recession, with the odds of having lingual recession increasing by 1.17 (95% CI 1.01, 1.35) for every year older than 14. Age was the only significant predictor of the number of lingual sites with recession, but was not a predictor of the prevalence of labial recession or the number of affected sites. There were no significant associations between piercings and abnormal toothwear or trauma. These findings suggest that oral piercings are associated with localized gingival recession, and that the providers of such procedures should ensure that, as part of the informed consent process, prospective patients are informed of the likelihood that their periodontal health may be compromised.

Management of a simple anterior crossbite in a child with autism: a review and case report.

This case report describes a simple treatment used to correct an anterior crossbite in a child with autism. A review of autism and the treatment of simple anterior crossbite are given. It is possible for children with special needs to be managed in the general practice setting, although treatment plans may need to be modified to meet the capabilities of individual patients. Follow-up is required for cases of anterior crossbite treated in the early mixed dentition.

Accidental ingestion of a component of a fixed orthodontic appliance--a case report.

Most dental patients are treated in the supine position, enhancing the risk of accidental aspiration or swallowing of foreign objects. This article presents a case report of an orthodontic patient who accidentally ingested a section of orthodontic wire and coil spring from a fixed expansion device placed in the maxillary dental arch. Some guidelines for the prevention of such occurrences in the practice and at home, and possible courses of remedial action, are discussed.

Native aortic valve tissue systemic embolization complicating bacterial endocarditis.

Systemic embolic events are known complications of bacterial endocarditis. Embolization of prosthetic valves has previously been reported in the literature. We report a case of embolization of native aortic valve tissue to the popliteal artery as the presenting event in a patient with subacute bacterial endocarditis. To our knowledge, this rare complication has not been previously reported.

The effect of increased bed numbers on MRSA transmission in acute medical wards.

An 18-month prospective survey was performed to examine the effect of adding a fifth bed to four-bedded bays in three acute medical wards on colonization by methicillin-resistant Staphylococcus aureus (MRSA). Screening procedures were in accordance with the UK national guidelines. All patients newly colonized with MRSA were visited, and their bed location determined. Data from the five-bedded bays were compared with those from four-bedded bays in similar wards. Potential routes of transmission were investigated by observational surveys. The relative risk of colonization in five-bedded medium dependency bays was 3.15 compared with that of similar four-bedded bays (P < 0.005), and in five-bedded low dependency bays was 3.16 (P < 0.005). Increasing the number of beds in a fixed area heightens the risk of cross-infection with MRSA.

The effect of an enhanced infection-control policy on the incidence of Clostridium difficile infection and methicillin-resistant Staphyloccocus aureus colonization in acute elderly medical patients.

BACKGROUND: Clostridium difficile (CD) infection and methicillin-resistant Staphylococcus aureus (MRSA) colonization are increasingly common in elderly patients, are associated with cephalosporin or prolonged aminopenicillin courses and can be transmitted by direct contact. Management is by side-room isolation. Ward closure may be required to control outbreaks. METHODS: following prolonged bed closures due to CD and MRSA in an acute age-related geriatric service, an enhanced infection control policy was introduced-emphasis on handwashing, cephalosporin restriction, 7-day time limits on antibiotics and feedback of infection rates. The effect of this policy was evaluated by investigating 2,467 consecutive admissions in the 9 months before and after its introduction. RESULTS: CD infection fell from 36/1,075 admissions (3.35 per 100) to 27/1,392 (1.94 per 100; P < 0.05). MRSA incidence fell from 3.95 per 100 to 1.94 (P < 0.01) whilst that in the rest of the hospital continued to fluctuate. Cephalosporin use fell (and aminopenicillin and trimethoprim use rose) by a factor of three. Unoccupied bed days fell from 1,164 (12.6%) to 513 (5.1%) over the winter, an increase in bed availability of 4.95 a day. CONCLUSIONS: introduction of the policy was associated with significant reductions in CD infection and unoccupied bed-days and helped maintain a lower incidence of MRSA. It is not clear which elements of the policy most influenced outcome. A multi-centre study is needed to determine whether our findings are generally applicable.

Leucine metabolism in chronically hypoglycemic hypoinsulinemic growth-restricted fetal sheep.

We measured leucine flux rates during infusions of L-[1-14C]- and L-[1-1C]leucine in fetal sheep exposed to maternal insulin-induced hypoglycemia over the last 8 wk (40%) of gestation to determine effects of chronic glucose deficiency and hypoglycemia on fetal leucine metabolism. Compared with control fetuses (C, n = 5), hypoglycemic fetuses (HG, n = 8) weighed less (C, 3.43 +/- 0.07 kg; HG, 2.32 +/- 0.24 kg), had lower plasma glucose (C, 1.04 +/- 0.02 mM; HG, 0.59 +/- 0.01 mM), insulin (C, 48 +/- 6 pM; HG, 12 +/- 6 pM), and leucine concentrations (C, 195.6 +/- 8.3 microM; HG, 140.8 +/- 15.0 microM), lower rates of net leucine uptake (C, 4.2 +/- 0.6 mumol.min-1.kg-1; HG, 2.1 +/- 0.4 mumol.min-1.kg-1) and leucine flux into protein accretion (C, 2.8 +/- 0.2 mumol.min-1.kg-1; HG, 0.6 +/- 0.1 mumol.min-1.kg-1), and an increased rate of leucine release from protein breakdown (C, 1.1 +/- 0.1 mumol.min-1.kg-1; HG, 3.3 +/- 0.2 mumol.min-1.kg-1) (P < 0.05 for all). Plasma leucine disposal, flux into protein synthesis, and oxidation were not different between groups. We conclude that adaptations of fetal leucine metabolism to long-term hypoglycemia and decreased glucose apply represent diminished leucine uptake and increased leucine release from protein breakdown, which are associated with decreased incorporation of leucine into protein accretion and a slower rate of fetal growth.

Clinical safety of lidocaine in patients with cocaine-associated myocardial infarction.

STUDY OBJECTIVE: To evaluate the safety of lidocaine in the setting of cocaine-induced myocardial infarction (MI). DESIGN: A retrospective, multicenter study. SETTING: Twenty-nine university, university-affiliated, or community hospitals during a 6-year period (total of 117 cumulative hospital-years). PARTICIPANTS: Patients with cocaine-associated MI who received lidocaine in the emergency department. RESULTS: Of 29 patients who received lidocaine in the setting of cocaine-associated MI, no patient died; exhibited bradydysrhythmias, ventricular tachycardia, or ventricular fibrillation; or experienced seizures after administration of lidocaine (95% confidence interval, 0% to 11%). CONCLUSION: Despite theoretical concerns that lidocaine may enhance cocaine toxicity, the use of lidocaine in patients with cocaine-associated MI was not associated with significant cardiovascular or central nervous system toxicity.

Angioedema following the intravenous administration of metoprolol.

A 72-year-old woman was admitted to the hospital with "flash" pulmonary edema, preceded by chest pain, requiring intubation. Her medical history included coronary artery disease with previous myocardial infarctions, hypertension, and diabetes mellitus. A history of angioedema secondary to lisinopril therapy was elicited. Current medications did not include angiotensin-converting enzyme inhibitors or beta-blockers. She had no previous beta-blocking drug exposure. During the first day of hospitalization (while intubated), intravenous metoprolol was given, resulting in severe angioedema. The angioedema resolved after therapy with intravenous steroids and diphenhydramine hydrochloride.

Biodegradation of sulphosuccinate: direct desulphonation of a secondary sulphonate.

The bacterial biodegradation of a secondary sulphonate, sulphosuccinate, has been shown to occur by direct desulphonation. A bacterium, designated Pseudomonas sp. BS1, was isolated from activated sewage sludge, for its capacity to grow on sulphosuccinate as the sole source of carbon and energy. Cultures grown on sulphosuccinate were able to convert this substrate to sulphite which was subsequently oxidized rapidly to sulphate. The sequence of desulphonation and carbon-chain catabolism of sulphosuccinate was determined from measurements of the kinetics of sulphite and 14CO2 release from specifically radiolabelled sulpho[1,4-14C]succinate and sulpho[2,3-14C]succinate, which were synthesized from the corresponding maleic anhydrides. When each radiolabelled compound was incubated separately with washed-cell suspensions of Pseudomonas BS1, sulphite was released before 14CO2, as shown by chemical assay and radiorespirometry, respectively. Differences in the kinetics and extent of 14CO2 release from the 1,4- and 2,3-labelled substrates were consistent with entry of the intact C4 chain into the citric acid cycle. When carrier oxaloacetate was added to incubation mixtures containing resting-cell suspensions and radiolabelled sulphosuccinate, a radiolabelled metabolite with the same HPLC retention time as oxaloacetate accumulated. No radioactive metabolites accumulated when carrier oxaloacetate was replaced with succinate, fumarate or malate. Collectively, the data indicated co-production of sulphite and oxaloacetate from sulphosuccinate, which is interpreted in terms of an oxidative desulphonation mechanism.

MRSA in the operating department.

In recent years, infection control in the operating department has focused on the concept of universal precautions. This allows protection for both patients and staff in relation to blood borne pathogens. Recent research, however, suggests that the introduction of universal precautions could lead to an increase in the transmission of other pathogens, for example, Methicillin Resistant Staphylococcus Aureus (MRSA). This article aims to provide a brief overview of the universal precautions, followed by an in-depth consideration of MRSA, its history, incidence, transmission, effect and implications for both patients and staff in the operating department.