Detection of Rickettsia amblyommatis and Ehrlichia chaffeensis in Amblyomma americanum Inhabiting Two Urban Parks in Oklahoma.

For the past 30 years, the number of people infected with causative agents of ehrlichiosis, Rocky Mountain spotted fever, and spotted fever group rickettiosis (SFGR) has increased in Oklahoma. However, there is a lack of data on pathogen prevalence within urban environments. To assess the prevalence of tick-borne pathogens in different environments, 434 Amblyomma americanum (lone star) ticks were collected from the environment in two parks in Edmond, Oklahoma. The presence of Ehrlichia spp. and spotted fever group (SFG) Rickettsia spp. was determined using quantitative real-time polymerase chain reaction (qPCR). 33.6% (146/434) of the A. americanum ticks were positive for Rickettsia amblyommatis and 15.2% (66/434) were positive for Ehrlichia chaffeensis. No ticks were positive for other SFG Rickettsiae (R. rickettsii, R. parkeri) or other Ehrlichiae (E. ewingii, and Panola Mountain Ehrlichia). These studies provide increased understanding of the potential risk for encountering tick-borne pathogens in urban environments.

The Utility of the Cl:PO4 Ratio in Patients With Variant Versions of Primary Hyperparathyroidism.

OBJECTIVE: To determine the significance and impact of additional chloride testing as part of a diagnostic laboratory test battery for borderline primary hyperparathyroidism (pHPT). STUDY DESIGN: Retrospective database review of parathyroidectomy patients. SETTING: A tertiary care, academic health sciences center. SUBJECTS AND METHODS: Patients referred to a head and neck endocrine clinic for evaluation and treatment for pHPT. RESULTS: After exclusions, there were a total of 226 patients who underwent parathyroidectomy for primary hyperparathyroidism with the requisite preoperative and postoperative labs. Seventy-seven additional patients who had a thyroid operation for a nonmalignant cause were included as controls. Of the 303 total patients, 166 had normal calcium levels (<10.4 mg/dL), and 54 (32.5%) also exhibited hyperchloremia (>106 mmol/L). Of the 47 patients with normal calcium and parathyroid hormone (PTH) levels (<88 pg/mL), 6 (12.8%) had hyperchloremia, and of the 118 patients with normocalcemic pHPT, 48 (40.7%) were hyperchloremic. The area under the curve for the Cl:PO4 was 0.712. When using a cutoff of 33, the reported sensitivity and specificity of the curve were 58.4% and 28.6%, respectively. CONCLUSION: The Cl:PO4 ratio was a moderately sensitive test for the diagnosis of the borderline variants of primary hyperparathyroidism. The Ca:PO4 ratio was superior to the Cl:PO4 ratio. Our data also showed the superiority of preoperative calcium and ionized calcium over PTH when predicting the presence of pHPT.

Tick species establishment in Oklahoma County, Oklahoma, U.S.A., identified by seasonal sampling in residential and non-residential sites.

In recent years, human tick-borne disease occurrence has risen in Oklahoma, U.S.A., but year-round data on tick presence in frequently used recreational areas is not widely available. In this study, ticks were collected monthly for one year at residential and non-residential sites in a suburban area of Oklahoma County, OK, U.S.A. At each trapping site, dry ice traps were used in both woodland and grassland areas and fabric tick drags were used in grassland areas. Four species were collected from each park: Amblyomma americanum, Amblyomma maculatum, Dermacentor variabilis, and Ixodes scapularis. Prior to this study, A. americanum was the only species with an established population in Oklahoma County. Consistent with this, A. americanum was collected in all months of the year and accounted for over 90% of ticks collected at each site. Based on our tick survey, we report that A. maculatum, D. variabilis, and I. scapularis, which were each collected in numbers greater than six within a single sampling occasion, are now each confirmed as established populations in Oklahoma County.

Voice and Swallowing Outcomes of Unilateral Vocal Fold Paralysis: Comparing Younger Adult and Geriatric Patients.

Objective To compare voice and swallowing outcomes after treatment in younger adult (<65 years) and geriatric (≥65 years) patients with unilateral vocal fold paralysis (UVFP). Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods The cases of patients presenting to a tertiary voice clinic with UVFP between June 2005 and February 2015 were reviewed. Clinical characteristics and outcomes in a geriatric subset were compared with those in younger adult group. Results A total of 206 patients met our inclusion criteria (n = 110, <65 years; n = 96, ≥65 years). Etiology was most commonly iatrogenic (59.2%), and computed tomography led to diagnosis for 62.3% of patients for whom it was obtained. The Voice Handicap Index improved on average by 31.3 points after treatment ( P < .001), with equal improvement between the patient subsets ( P = .71). Swallowing, as objectively assessed by the National Outcomes Measurement System for modified barium swallow, showed a statistically significant improvement in the patient population as a whole (-0.9, P = .02) but was not significantly different within the subgroups (younger, P = .07; geriatric, P = .25). Conclusion Geriatric patients have similar voice and swallowing outcomes as younger adults and should be treated equally aggressive.