Platelet Kinetics in Canine Ehrlichiosis: Evidence for Increased Platelet Destruction as the Cause of Thrombocytopenia

A significant (P < 0.025) increase in the mean platelet diameter occurred in five Ehrlichia canis-infected dogs when platelet numbers decreased to 100,000/mul or less. Maximal incorporation of [(75)Se]selenomethionine into platelets of six uninfected dogs was 0.080 +/- 0.019% (mean +/- standard error) and occurred 5 to 6 days after dosage, whereas maximal incorporation was 0.036 +/- 0.004% within 2 to 3 days after dosage in seven chronically infected dogs that had thrombocytopenia. Analysis of the [(75)Se]selenomethionine curves yielded a platelet lifespan of 9 days in uninfected dogs versus 4 days in chronically infected dogs. Thus, megakaryocyte maturation and/or platelet release occurred at an accelerated rate in infected dogs, whereas increased destruction of newly produced labeled platelets diminished their number of peripheral blood. [(51)Cr]sodium chromate-labeled platelet survival was exponential, with a half-life of approximately 1 day in two dogs at 2 to 4 days postinfection and three chronically infected dogs. Platelet survival time was 8 days and rectilinear in four uninfected dogs. Platelet recovery was 39.43 +/- 2.86% in infected dogs as compared with 68.2 +/- 10.72% in uninfected dogs. Whole-body scans of one dog prior to and 7 days after infection showed that labeled platelets were destroyed primarily in the spleen. It is concluded that the thrombocytopenia in E. canis-infected dogs is the result of increased platelet destruction which begins within a few days after infection.     

The incidence of congenitally absent foot pulses.

The pedal pulses of 547 young healthy subjects were examined using digital palpation and a Doppler probe to determine the incidence of congenitally absent foot pulses. The posterior tibial (PT) pulse was absent in only one subject (0.18%), while the dorsalis pedis (DP) pulse was bilaterally absent in nine subjects (1.8%) and unilaterally absent in a further six subjects. The low incidence of congenital absence makes the clinical finding of an absent pedal pulse in later life a more significant marker of peripheral vascular disease than current surgical texts would have us believe.     

Ultrastructural observations on Ehrlichia equi organisms in equine granulocytes.

The ultrastructure of the etiological agent of equine ehrlichiosis, Ehrlichia equi, was studied in equine peripheral leukocytes. The organisms occurred within membrane-lined cytoplasmic vacuoles of neutrophils and eosinophils. Ovoid, round, and rod-shaped profiles were observed. From 1 to 33 organisms were present in a thin-section profile of a cytoplasmic vacuole. Many cells contained multiple organism-containing vacuoles. The organisms had a cell wall and plasma membrane, and internally they consisted of electron-dense and lucid areas. A great variation in size was observed. The morphological features were most consistent with agents of the genus Ehrlichia.     

Acceptability of a reusable insulin pen,HumaPen Ergo,by patients with type 1 and type 2 diabetes

A reusable insulin pen (HumaPen Ergo) was tested for patient acceptability and safety in two multinational studies involving a total of 230 patients with either type 1 (27%) or type 2 (73%) diabetes. Prior to the studies, all patients used other insulin injection pen models. During the 5-7-week studies, the acceptability of HumaPen Ergo was assessed with a questionnaire which was issued to all patients. The HumaPen Ergo was considered easy/very easy with respect to learning to use (97%), reading dose numbers (95%) and correcting dose mistakes (97%), and 62% considered it easy/very easy to hold during use. HumaPen Ergo features considered easier/much easier compared to the previously used model of pen were ease of correcting dose (Study 1/Study 2: 89%/93%), ease of reading the dose number (77%/61 %) and ease of changing cartridge (54%/68%). At the end of the studies the majority of patients (60%/69%) said that they would continue to use HumaPen Ergo and would recommend it to other patients, even though they had expressed satisfaction with the pen that they had used previously. Health-care professionals evaluated HumaPen Ergo according to the same criteria as the patients and said that they would recommend the HumaPen Ergo owing to ease of dialling back without wasting insulin (80%) and reading dose numbers (74%). The HumaPen Ergo was well accepted by both patients and health-care professionals and provides an important tool to combat the trauma and inconvenience associated with insulin self-injection.     

Transmeatal direct myringoplasty

A surgical method of transmeatal direct myringoplasty (TDM) was performed in 30 patients. Out of those, 21 patients were previously treated for chronic otitis media, 4 patients were with dry perforations of neomembrane following myringoplasty, and 5 patients were with blasttraumatic ruptures of the eardrum. Fascia of the temporal muscle was used in the defect reconstruction. Graft healing and closure of the eardrum defect were observed in all patients 3 months after the surgery. Postoperative improvement of hearing in an interval of 15-20 dB was found in 21 patients. Milder sensorineural hearing damage was found in 1 patient, while in the others the hearing was on the preoperative level. Simplicity of the method, minimal surgical procedure and favorable postoperative results were the reason why the authors recommended TDM as the method of choice in the reconstruction of the eardrum defects caused by an inflammation or blasttraumatic damages of the eardrum.     

The bulk crystallization of alpha-lactose monohydrate from aqueous solution.

The bulk crystallization of alpha-lactose monohydrate from aqueous solution by primary nucleation has been studied under controlled conditions of supersaturation, temperature, and pH. The induction times to nucleation were extremely long compared with those generally observed for other materials, even at the high supersaturations used in the experiment. As a result, it was necessary to stir the supersaturated solution vigorously to induce nucleation in a reasonable but still lengthy working time. Even then, nucleation only occurred to a limited extent, following which growth ceased for 8-10 h before resuming. After this period, growth recommenced but again slowed to a low rate after another 8 h. At this stage, the yield of product was low and in most cases the particles had achieved sizes close to the maximum noted. The yields increased with further crystallization time (22-72 h total from the recommencement of growth) to give, under high initial supersaturation conditions, amounts of product close to the theoretical value. For the most part, however, the particle size did not increase with this later increase in yield, showing only significant changes after the extremely long total crystallization times. It is proposed that these extreme properties result from the formation in solution by mutarotation of the anomer alpha-lactose, which inhibits nucleation as well as its previously observed influence on growth.     

Bilateral nevus of Ota in a light-skinned woman

Nevus of Ota is a dermal melanocytosis, clinically localized on skin that is innervated by the first and second branches of the trigeminal nerve. It occurs almost entirely in Asian people. This manifestation is rarely described in light-skinned non-Asian persons. We present a case of bilateral Ota nevus in a 47-year-old light-skinned non-Asian woman.     

Canine ehrlichiosis (tropical canine pancytopenia) in Thailand.

An epizootic of canine ehrlichiosis has occurred in military working dogs in Thailand. During the epizootic, 161 cases of ehrlichiosis were identified serologically in a population of 316 dogs, and 54 dogs exhibited clinical signs of disease. The epizootic is being controlled by elimination of ticks, by serologic identification and treatment of carriers with 30 mg/lb body weight/day of tetracycline for 14 days, and by continuous daily prophylactic administration of 3 mg/lb body weight/day of tetracycline. Clinical and serologic recognition of ehrlichiosis among pet dogs in widely separated regions of Thailand suggest that the disease has been endemic in Thailand for an extended time. Under such circumstances it is possible that pet and stray dogs have served as a source of infection for the epizootic in military working dogs.     

News of Humalog and Humalog mix in the treatment of type 2 diabetes

Fast-acting insulin analog (lispro insulin), as well as slow/fast-acting analog mixtures (NPL-lispro insulin) allow a better control of postprandial glycemia in type 1 and type 2 diabetic patients (35% mean reduction in area under curve for postprandial glycemia, 2 mmol/l reduction in postprandial glucose peak), as compared with regular insulin or conventional mixtures of NPH and regular insulin. Analog pharmacokinetics allow to procede to insulin injection immediately before meal, which is convenient for the patients. When used alone, lispro insulin has no impact on basal glycemia, whereas twice daily injections of NPL-lispro mixtures allow a 1.8 mmol/l mean reduction of basal glycemia, as compared with conventional mixtures, meaning a more specific effect of NPL intermediate insulin. Other premeal blood glucose levels (lunch and dinner) are not improved by lispro insulin. Most studies did not establish a clear reduction in HbA1c with insulin analogs. When this is the case, this reduction averages 1.5% and could be more frequently observed in studies dealing with type 2 diabetic patients. Finally, the reduced incidence of delayed hypoglycemic episodes, which is one of the most attractive effects of insulin analogs, was only reported in a minority of studies. Surprisingly, the reduction of hypoglycemia incidence with analogs was more frequently reported in type 2 diabetics than in type 1 patients. Thus fast-acting insulin analogs feature interesting characteristics, noteworthy immediate premeal injection and a better postprandial glucose control. However, it is established that the determination of diabetes complications (particularly microangiopathy) mostly relies on average glucose control and not solely on postprandial glycemia. Indeed, most studies suggest that insulin analogs are at least as efficient as conventional insulins on HbA1c, but possibly not more.     

Haemodynamic and clinical effects of ularitide in decompensated heart failure.

AIMS: Ularitide is a synthetic form of urodilatin, a natriuretic peptide produced in the kidney with vasodilating, natriuretic, and diuretic effects, that offers promise for the management of decompensated heart failure (DHF). We assessed the efficacy and safety of ularitide in treating patients with DHF. METHODS AND RESULTS: In this Phase II randomized, double-blind, placebo-controlled trial, 221 DHF patients received either placebo (n=53) or ularitide at 7.5 ng/kg/min (n=60), 15 ng/kg/min (n=53), or 30 ng/kg/min (n=55) as a 24-h continuous infusion. At 6 h, ularitide demonstrated a significant decrease in pulmonary capillary wedge pressure (P=0.052, P=0.000004, P=0.000002, respectively) and improved dyspnoea score in the 7.5, 15, and 30 ng/kg/min ularitide group (P=0.0026, P=0.0026, P=0.0013, respectively). Ularitide reduced systemic vascular resistance and increased cardiac index for the 15 and 30 ng/kg/min groups (P=0.017, P=0.00002, respectively). Systolic blood pressure (BP) decreased dose dependency. Heart rate and serum creatinine were unchanged through day 3. Most frequently reported drug-related adverse events through day 3 in all ularitide groups were dose-dependent BP decrease and hypotension. CONCLUSION: Ularitide lowered cardiac filling pressures and improved dyspnoea without apparent early deleterious effects on renal function in DHF patients. These results suggest that ularitide may play a role in the management of DHF.