Association between Indoor Environmental Contamination by Salmonella enterica and Contamination of Eggs on Layer Farms

This study involves longitudinal and point-in-time surveys of Salmonella carriage and environmental contamination on two commercial cage layer farms positive for Salmonella enterica subsp. enterica serovar Typhimurium (flock A age, 32 weeks; flock B age, 34 weeks). Salmonella-positive fecal, egg belt, and dust samples were all unconditionally associated with eggshells testing positive for Salmonella. The odds of an eggshell testing positive for Salmonella were 91.8, 61.5, and 18.2 times higher when fecal, egg belt, and dust samples, respectively, tested positive for Salmonella. The agreement between the culture-based methods and real-time PCR on preenriched broths for detecting Salmonella was almost perfect for eggshell (observed agreement, 99.19%; kappa coefficient, 0.94) and egg belt samples (observed agreement, 95%; kappa coefficient, 0.88), and it was substantial for fecal (observed agreement, 87.14%; kappa coefficient, 0.47) and floor dust samples (observed agreement, 80.61%; kappa coefficient, 0.58). A 1-log increase in the load of Salmonella detected in the fecal, egg belt, and floor dust samples resulted in 35%, 43%, and 45% increases, respectively (P < 0.001), in the odds of an eggshell testing positive for Salmonella. The multilocus variable-number tandem-repeat analysis (MLVA) patterns of the S. Typhimurium strains isolated from flock A were distinct from those of flock B. S. Typhimurium strains detected from human food poisoning cases exhibited an MLVA pattern similar to those of the strains isolated from flocks A and B.     

Cardiovascular and plasma catecholamine response to static exercise in normotensive blacks and whites

Objectives. The objectives of the present study were (1) to evaluate the presser response to an isometric handgrip exercise in normotensive black and white males; (2) to measure plasma catecholamine levels pre‐ and post‐exercise, as an index of sympathetic nervous system activity; and (3) to quantify the pressor response to bolus intravenous injections of phenylephrine (an α‐specific agonist).

Methods. Cardiovascular and catecholamine responses to an isometric handgrip exercise (3 minutes at 30% MVC) were measured in 15 normotensive blacks and whites. In another phase of the study, pressor responses to bolus injections of phenylephrine were assessed to evaluate α‐adrenergic sensitivity.

Results. The blood pressure in the blacks increased from 119/69 to 160/120 mm HG during isometric exercise, while in the whites it increased from 118/67 to 153/110 mm HG. The blacks exhibited a greater diastolic blood pressure reactivity, as evidenced by a significant race × time interaction (p < 0.05). The heart rate responses were not significantly different between the two groups. The plasma levels of norepinephrine were similar at rest, but were 25% lower in the blacks than in the whites following isometric exercise (p < 0.01). Black subjects also demonstrated an increased pressor response to intravenous injections of phenylephrine at rest (p<0.05).

Conclusions. The enhanced vascular sensitivity to norepinephrine may have contributed to the greater exercise pressor response in the blacks.     

The economic impact of clinical pharmacists' unsolicited recommendations

Clinical pharmacists in a 580-bed teaching hospital reported all targeted recommendations that occurred during a 5-month evaluation period. Five types of clinical recommendations were identified: (1) to start drug therapy, (2) to stop drug therapy, (3) to increase drug dose, (4) to decrease drug dose, and (5) to suggest alternative drug therapy. Two thousand sixty-four unsolicited, accepted recommendations were submitted to the investigator by approximately eight holders of full-time equivalent positions dedicated to clinical pharmacy services during the evaluation period. Three hundred forty-four recommendations were selected (every sixth submitted recommendation) and evaluated for their economic impact. The costs of drugs, monitoring, and treatment for the drug regimens were compared before and after each recommendation. Three classes of drugs (antineoplastics, anti-infectives, and gastrointestinal agents) contributed more than 90% of the economic impact. The net economic impact of the evaluated recommendations was a cost saving of $4636.06; this extrapolated to a net cost saving of $34.10 per pharmacist-day.     

Discrete palmar and plantar symptoms in children with dermatitis herpetiformis Duhring

Unusual, discrete palmar and plantar symptoms observed in thirty of forty-seven children with dermatitis herpetiformis are described. The diagnosis was verified in every case by the demonstration of granular IgA deposits in the skin. Forty-five of the children showed villous atrophy in jejunal biopsy specimens. In four cases extensive, exudative, bullous palmar symptoms, similar mild plantar changes, and healing with desquamation were observed. At least once during treatment we found very discrete, reddish-brown spots or small blisters on the flexor surface of the fingers and on the palms in thirty patients. Similar lesions occurred on the soles and plantar surface of the toes in only three patients. In asymptomatic patients and those treated with either a gluten-free diet or sulfone/sulfapyridine, the phenomenon was not manifest.     

Hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%: a safe and efficacious 12-month treatment for melasma

This article describes a long-term, multicenter, open-label, 12-month study of once-daily fluocinolone acetonide 0.01%, hydroquinone 4%, tretinoin 0.05% (Tri-Luma Cream, hereinafter called TC [triple combination]) application in the treatment of melasma. A total of 228 patients with facial melasma were enrolled and treated; 173 patients (76%) completed the study. Most patients had 1 to 2 courses of treatment lasting approximately 6 months in total. TC cream showed a favorable safety profile. only 3 patients (1%) withdrew from the study due to treatment-related adverse events (AEs). A total of 129 patients (57%) experienced at least one treatment-related AE. Most AEs were expected application-site reactions that were mild and transient in nature and did not require remedial therapy. There were no cases of skin atrophy or skin thinning and only 6 cases of telangiectasia (5 mild and 1 moderate), most of which had improved by the end of the study. Results of the efficacy assessments were positive, with both the patient and the physician assessing melasma to be either completely or nearly cleared by the end of the study in more than 90% of cases. In this study, a once-daily application of TC cream over an extended period of 12 months showed no notable safety concerns and offered an effective treatment for melasma.     

Consolidation Radiation Therapy for Patients With Advanced Hodgkin Lymphoma in Complete Metabolic Response According to PET-CT or Gallium Imaging

Introduction

The purpose of this study was to evaluate the role of consolidation radiation therapy (RT) in advanced Hodgkin lymphoma (HL) in the setting of a complete metabolic response (CR) to chemotherapy (ChT).

Pediatric versus adult meningioma: comparison of epidemiology,treatments, and outcomes using the Surveillance,Epidemiology, and End Results database

Pediatric meningiomas, which account for <?1% of all meningiomas, are thought to have unique features, including being more aggressive than their adult counterparts. The goal of this investigation was to compare pediatric and adult meningiomas in a large head-to-head comparison. We used the Surveillance, Epidemiology, and End Result (SEER) datasets to compare meningioma demographics, first treatments, and outcomes among children/adolescents (0–21 years), young adults (22–45 years), and older adults (>?45 years). During 2004–2012, SEER contained 59148 patients age 0–107 years diagnosed with meningioma, with children/adolescents accounting for 381 (0.64%) patients. Unlike older and young adults, children/adolescents with meningioma did not demonstrate female predominance, and had an equal 1:1 male-to-female ratio. Children/adolescents also had almost three-times as many spinal tumors (13.1%) than young adults (4.2%) and older adults (4.4%). Both children/adolescents and young adults had undergone more gross total resections (both 43%) versus older adults (25%), and were treated more with radiation (14.6%, and 12.0% respectively) than their older counterparts (8.5%). In addition, both children/adolescents and young adults had significantly lower all-cause mortality (4.5% in both) than older adults (24.6%), during median 35-month follow-up. Inherent limitations of the SEER datasets restrict our ability to answer important questions regarding comparisons of tumor grading, histological diagnosis, cause-specific mortality, and neurofibromatosis status. Pediatric meningiomas appear distinct from their adult counterparts as they do not display the typical female predominance and include more clinically relevant spinal tumors. More extensive surgeries, greater use of radiation therapy, and lower all-cause mortality were seen in both children/adolescents and young adults, which raises questions regarding the perceived uniquely aggressive nature of pediatric meningiomas. However, due to the significant limitations of the SEER datasets, our results must be interpreted cautiously and stand only to foster novel questions, which would be better answered in well-designed, prospective studies.