Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections.

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.

Surgical correction of a bilateral congenital tarsal hyperextension deformity in a cat.

CASE DESCRIPTION: An approximately three-month-old, 0.45 kg female Domestic Shorthaired kitten with stiff hyperextended hindlimbs distal to the talo-central joint is reported. Attempts at repositioning of the joints by flexion failed while increased manipulative forces caused signs of pain and vocalization. Orthogonal radiographic views revealed a significant malarticulation of the tarsus. Goniometric measurments revealed a 145° extensor and 95° internal torsional deformity. TREATMENT AND OUTCOME: Pantarsal arthrodesis with a transarticular external fixation system was performed for both limbs in two separate stages. Pre-assembled frames were composed of two 40 mm diameter half rings (on the medial side) and two 40 mm diameter full rings connected with two pre-contoured (125° flexion) rods from proximal to distal. Following transection of the superficial and deep digital flexor tendons, cartilage was removed from the articular surfaces, autologous cancellous bone graft was inserted, and joints were fixed in 125° flexion with pre-contured external frames. The cat commenced weight-bearing bilaterally immediately postoperatively. Frames were removed 32 and 27 days after application. Two months after frame removal, joint fusion was confirmed and full weight-bearing at the walk and run was achieved. CLINICAL RELEVANCE: To our knowledge, this is the first report of surgical correction of a bilateral congenital tarsal hyperextension deformity by pantarsal arthrodesis using a transarticular external fixation system.

Comparison of tenofovir and entecavir in patients with chronic HBV infection.

BACKGROUND: Sustained suppression of serum HBV DNA levels with nucleos(t)ide analogues is the most important success obtained in the treatment of chronic HBV infection today. Tenofovir and entecavir provide more robust viral suppression. AIM: The aim of this study is to compare tenofovir and entecavir in terms of viral kinetics, side effects and virological response in patients with chronic HBV infection. PATIENTS AND METHODS: Patients with chronic hepatitis B treated with tenofovir or entecavir were included in this retrospective study. Using survey analysis, we evaluated independent variables reflecting virological response to treatment and determined whether use of tenofovir or entecavir was one of them. We compared the decline in serum HBV DNA levels at the 3rd, 6th, 12th, 18th and 24th months of treatment between two groups. We also compared entecavir and tenofovir in terms of side effect rates. RESULTS: 117 patients [average age: 44 (20-73), 65 males (55.6%), 30 HBeAg positive (25.6%)] were enrolled in the study. Sixty-six patients (56.4%) used tenofovir and 51 (43.6%) patients used entecavir. Virological response was better in patients using tenofovir (Odd's ratio of 1.796 and p = 0.014) and having high fibrosis score (Odd's ratio of 0.182 and p = 0.018). Entecavir was more effective in reducing serum HBV DNA levels at the 3rd month of treatment (serum HBV DNA decline of 4.45 and 3.96 log10 units for entecavir and tenofovir respectively, p = 0.031), but decline rates were similar at other months. There was no difference between patient groups in terms of side effects and discontinuation of treatment due to side effects. CONCLUSIONS: Patients with chronic HBV infection using tenofovir have better virological response than those using entecavir.

Effect of osteoblast cell culture on the bone implant contact.

PURPOSE: The aim of this study is to acquire an ideal bone implant contact under the cover of osteogenic effect of osteoblasts derived from Mesenchymal Stem Cells (MSCs). MATERIALS AND METHODS: Thirty dental implants were used for this study. Implants were placed in sheep mandibles and defects were created 4 mm coronally in the dental implants. These defects were filled with Platelet Rich Plasma (PRP) in one group and with PRP + Osteoblast Cell Culture (OCC) in another group. No procedure was conducted on the control group defects (empty defect group). Eight weeks later, osseointegration was investigated with Bone Implant Contact (BIC) measurements histomorphologically. Data were checked statistically. RESULTS: The variation of BIC rates between Empty Defect Group and PRP groups was significant (p <0.05). The BIC rate of the PRP group was higher than that of the Empty Defect Group. The variation of BIC rates between Empty Defect Group and PRP + OCC groups was significant (p <0.05). The BIC rate of the PRP + OCC group was higher than that of the Empty Defect Group. The variation of BIC rates between PRP and PRP + MSC groups was significant (p<0.05). The BIC rate of the PRP + OCC group was higher than that of the PRP group. At the end of the 8-week healing period, it was observed that the percentage of BIC was highest in the PRP + OCC group. CONCLUSIONS: Implant-bone connection was better in the OCC-PRP group compared with the PRP group and the empty defect group. The use of OCC-PRP combination was effective on healing. The BIC value was increased significantly by OCC.

Correction of severe congenital flexural carpal deformities with semicircular external skeletal fixation system in calves.

OBJECTIVE: To present a novel technique for the treatment of severe congenital flexural forelimb deformities in calves. METHODS: Thirteen calves of different breeds and sex with severe congenital flexural forelimb deformities were enrolled in the study. A semicircular external skeletal fixation system composed of 6-hole, 45° carbon-fiber arches, 6 mm threaded rods, half-pin fixation bolts, 6 mm hexagonal nuts, and negative profile end-threaded half-pins were used for pancarpal arthrodesis. Complications, time to first use of the limb, fixator removal time, preoperative and postoperative sagittal plane angles of the fused joints, and functional outcomes were evaluated clinically and radiographically. Final assessments were determined according to functional and cosmetic outcomes. RESULTS: All of the surgically treated carpal joints obtained fusion. Seven of the calves started to use the limb immediately after recovering from anesthesia. In the other six calves, the time ranged from one to two days. Time to fixator removal ranged from 25 to 36 days (mean 30 days). Final outcome was excellent in 11 cases, and good in two cases. CLINICAL SIGNIFICANCE: The technique was found to be a useful method for the treatment of severe congenital flexural forelimb deformities in calves. The cost of the operation is negligible compared to the economic value of beef cattle.

Treatment of unilateral congenital flexural and torsional limb deformities with circular external skeletal fixation system in two calves.

CASE DESCRIPTION: Two calves with unilateral congenital flexural and torsional limb deformities below the hock joint of the left hindlimb were presented to Veterinary Teaching Hospital of the Ondokuz Mayis University. According to clinical, goniometric and radiological examinations, flexural (130°-40°) and torsional (90°-180°) deformities were diagnosed. Except for the limb deformities, both animals were otherwise completely healthy. TREATMENT AND OUTCOME: In case 1, hock joint arthrodesis was performed using a circular external skeletal fixation system with four full rings 160 mm in diameter. In case 2, the deformity was corrected by fixation after transverse osteotomy at the level of the proximal metatarsals with four full rings 150 mm in diameter, and arthrodesis of the fetlock joint with three full rings 100 mm in diameter. According to clinical examinations and follow-up telephone interviews performed 15 and 24 weeks after discharge, functional use with slight lameness in case 1 and full functional use in case 2 had been achieved. CLINICAL RELEVANCE: None of the previously reported cases of flexural deformity had radiographic signs similar to those of the calves in our report, and the deformities were not as severe as those reported here. To our knowledge, this is the first report of treatment of unilateral congenital flexural and torsional deformities in calves with a circular external skeletal fixation system.

Stabilisation with dorsal and ventral fixation of a traumatic cervical instability in a dog.

This case study reports the outcome of dorsal and ventral stabilisation of a traumatic cervical instability in a dog. A 2-year-old, male Pointer was admitted following a motor vehicle accident. Clinical examination revealed non-ambulatory tetraparesis, severe neck pain and upper motor neuron changes in all limbs. Deep pain response was present. Subluxation of C2/3 and fractures of the dorsal spinous process and lamina of C2 were observed on radiographs. Ventral stabilisation was performed with screws and bone cement (polymethylmethacrylate). For dorsal fixation of the fractures, screws and cerclage wire were used. The dog stood up independently after 1 month, was able to walk 1.5 months postoperatively and had recovered completely at 1 year following surgery. We conclude that combined stabilisation techniques are effective for this type of cervical fracture in which the dorsal, middle and ventral structures of the vertebra are severely disrupted.

CYP450 2B4 covalently attached to carbon and gold screen printed electrodes by diazonium salt and thiols monolayers.

An easy covalent immobilization method used to develop enzyme biosensors based on carbon and gold screen printed electrodes (SPCEs and gold SPEs) is described. The linkage of biomolecules through 4-nitrobenzenediazonium tetrafluoroborate, mercaptopropionic acid and thioctic acid monolayers has been attempted using bare SPCEs and gold SPEs, as well as gold nanoparticles (AuNPs) modified SPCEs and gold SPEs. Direct covalent attachment of Cytochrome P450 2B4 (CYP450 2B4) to the transducer has been carried out by carbodiimide and hydroxysuccinimide. Experimental variables in the immobilization process and in the chronoamperometric determination of Phenobarbital (PB) have been optimized by the experimental design methodology. Reproducibility of the different biosensors has been checked under the optimum conditions, yielding values lower than 6%. Their performances have been shown by the determination of PB in pharmaceutical drugs.

Carpal laxity syndrome in forty-three puppies.

Forty-three dogs with carpal laxity syndrome were included in the study. The cases were assessed with clinical and radiographical examinations. The case histories were obtained from patient owners. We recommended exercise and commercially available balanced diets for the treatment. In all cases, the clinical recovery period varied between one to four weeks. Healing occurred by the second week in the majority of cases (65.11%). The deformity was observed more frequently in male dogs (n = 30) than in female dogs (n = 13), and in six- to eight-week-old dogs. Carpal Laxity Syndrome is a more general term, used for both hyperextension and hyperflexion deformity. Malnutrition or over-nutrition of rapidly growing large breed puppies causes weakness and irregular tension between extensor and flexor muscle groups, which leads to laxity of the carpal joint. Exercise and commercially available balanced diets without any other treatment is usually enough to achieve physical and functional recovery.

Electrochemical studies and differential pulse polarographic analysis of lansoprazole in pharmaceuticals.

The electrochemical reduction of lansoprazole was investigated by cyclic voltammetry and direct current and differential pulse polarography. The reduction potential was -1.32 V vs. Ag/AgCl with a dropping mercury electrode in a supporting electrolyte consisting of phosphate buffer (pH 9.0)-tetramethylammonium iodide (4 + 1). The reversibility of the electrode reaction and the type of limiting current were studied. The temperature coefficient and the diffusion constant were determined. A mechanism for the electrode reaction was proposed. A new simple and sensitive differential pulse polarographic method was also developed for the quantification of lansoprazole. A linear calibration graph was obtained in the range 0.04-11.35 micrograms ml-1. The limit of detection was 0.03 microgram ml-1 and the intra- and inter-day precisions were 0.84-2.32 and 0.72-3.09%, respectively. The developed method was applied to six different commercial pharmaceutical capsule preparations containing enteric-coated granules. The relative standard deviations ranged from 1.36 to 2.85%. Recovery studies for the accuracy of the method were performed by adding a synthetic mixture to known amounts of lansoprazole and the mean recovery was 100.45%. The data obtained from commercial preparations were compared with those from a published spectrophotometric method. No difference was found statistically.

The relationship between the lumbosacral enlargement and the conus medullaris during the period of fetal development and adulthood.

The spinal cord is situated within the vertebral canal by the third month of intrauterine life. The spinal cord possesses two symmetrical enlargements, which constitute the segments of the plexuses: the cervical enlargement for the brachial plexus and the lumbosacral enlargement for the lumbar and sacral plexus. In our study, we aimed to investigate the relationship between the termination level of the lumbosacral enlargement (TLLE) and that of the conus medullaris (TLCM) during the period of fetal development and adulthood. We used a total of 75 cases: 25 fetuses (male: 16, female: 9) whose crown-rump length ranged between 90-190 mm, 25 premature and full-term neonates (male: 17, female: 8) whose post-menstrual ages ranged between 33-55 weeks, and 25 adults (male: 12, female: 13) aged between 22-72 years. The dissection technique for fetuses, ultrasonography for premature and full-term newborns, and magnetic resonance imaging (MRI) for adults were used to determine lumbosacral enlargement and TLCM. The differences between the TLCM and the termination level of the largest part of the transverse diameter of the lumbosacral enlargement were investigated. The differences between the TLLE and TLCM were found in different ratios from the period of fetal development to adulthood. Therefore, during medical treatment and surgical procedures this should be taken into account to avoid complications.