Aging and T cell development: interplay between progenitors and their environment

Thymic involution is the hallmark of hematopoietic aging. Because T cell differentiation is a multistep process that occurs non-cell autonomously, aging defects can occur at multiple points along the developmental pathway, both in the T progenitors themselves and in the thymic stromal cells that support their development. Here we review the evidence for age-related thymopoiesis defects at key steps in the production of na?ve mature T cells, highlighting the importance of the interaction between stromal aging and progenitor aging.     

Management of septic arthritis

Septic arthritis in children remains a serious disease with the potential for significant systemic and musculoskeletal morbidity. Staphlococcus aureus is the most common cause of bone and joint infections in all age groups. Microbial invasion of the synovial space occurs typically results from hematogenous seeding. Diagnosis in neonates and young infants can be difficult since the clinical signs are much less specific in these age groups. Early diagnosis by needle aspiration of the affected joint and prompt initiation of appropriate antimicrobial therapy in conjunction with drainage of the affected joint is critical to avoid destruction of the articular cartilage and prevent disability. Septic arthritis in infants and children should always be managed by a pediatrician in close consultation with an orthopedic surgeon. Empiric antibiotic regimens should always include adequate anti-staphylococcal coverage. Antibiotic treatment should be started with appropriate doses of intravenous antibiotics. Switch to oral antibiotic therapy can be made when patient demonstrates clinical improvement. A minimum of 3-4 weeks of therapy is recommended. Close follow-up is warranted to monitor the growth of the affected limb until skeletal maturity.     

Oral delivery of medications to companion animals: palatability considerations

There is an increased need for highly palatable solid oral dosage forms for companion animals, which are voluntarily accepted by the dog or cat, either from a feeding bowl or from the outstretched hand of the pet owner. Such dosage forms represent an emerging trend in companion animal formulations with major impact on medical needs such as convenience and compliance, particularly for chronically administered medications, and on marketing needs such as product differentiation. This review focuses on the science of taste, food and flavor preferences of dogs and cats, and palatability testing, in the context of applying these principles to the development of an oral palatable tablet for companion animals.     

Management of vitreous haemorrhage

Vitreous hemorrhage is one of the most common differential diagnoses for sudden painless decrease in vision. Often, it is caused by retinal vascular disorders secondary to common systemic ailments such as diabetes mellitus, systemic hypertension and haematological abnormalities. Sometimes it may be the beginning of a retinal tear and consequent retinal detachment that can be vision threatening if not operated early. This paper lays out practical guidelines for a tailored approach needed to arrive at the aetiology of vitreous haemorrhage so that appropriate, timely treatment can be planned.     

Dentigerous cyst in the maxillary sinus: a rare cause of nasolacrimal obstruction

The main types of maxillary cysts are antral mucoceles, retention cysts, pseudocysts, dentigerous cysts and keratocysts. Despite the theoretical possibility of maxillary sinus cysts leading to nasolacrimal duct obstruction, only two cases have been reported in the literature so far. The present authors report this rare presentation of a dentigerous cyst with a tooth in the roof of the maxillary sinus, which led to nasolacrimal duct obstruction.     

Targeted early rehabilitation at home after total hip and knee joint replacement: Does it work?

PURPOSE: This study evaluates the benefits of targeted early rehabilitation at home after total hip or knee replacement surgery and analyses the cost effectiveness of such a scheme. METHOD: Patients recovering from Total hip replacement (THR, n = 220) and Total knee replacement (TKR, n = 174) were assessed in a NHS District General Hospital setting. Suitability of patients for early rehabilitation at home scheme (RAHS) was assessed at the pre-operative clinic by rehabilitation team. Length of in-patient stay (LOSH), duration on the scheme, number of bed days saved, cost appraisal, readmission rates and complications were recorded. RESULTS: Targeted early rehabilitation resulted in reduced hospital stay (from 14-8.17 days for THR and from 12-8.21 days for TKR), without any increase in complication rates. Significance testing revealed no statistical difference between the patient groups with regards to age, residence status, mobility and transfer ability on their length of stay in hospital or on the rehabilitation scheme. The patients who underwent total knee replacement required significantly more number of visits by the rehabilitation team than those who underwent total hip replacement (p value < 0.05). This resulted in an overall saving of pound 301,124 for the trust over the study period. CONCLUSIONS: Targeted early rehabilitation resulted in reducing the length of hospital stay without an increase in complication rates. The use of such a scheme brought significant savings to the trust without an increase in readmission rates.     

Occurrence,antimicrobial susceptibility patterns and genotypic relatedness of Salmonella spp. isolates from captive wildlife,their caretakers,feed and water in India

Occurrence of Salmonella spp. in captive wild animal species in India is largely unknown. The purpose of this study was to determine the occurrence of different Salmonella serotypes, antimicrobial resistance patterns and genotypic relatedness of recovered isolates. A total of 370 samples including faecal (n = 314), feed and water (n = 26) and caretakers stool swabs (n = 30) were collected from 40 different wild animal species in captivity, their caretakers, feed and water in four zoological gardens and wildlife enclosures in India. Salmonellae were isolated using conventional culture methods and tested for antimicrobial susceptibility with the Kirby–Bauer disc diffusion method. Salmonella isolates were serotyped and genotyping was performed using enterobacterial repetitive intergenic consensus (ERIC) PCR and 16S rRNA sequencing. Animal faecal samples were also subjected to direct PCR assay. Salmonella was detected in 10 of 314 (3.1%) faecal samples by isolation and 18 of 314 (5.7%) samples by direct PCR assay; one of 26 (3.8%) feed and water samples and five of 30 (16.7%) caretakers stool swabs by isolation. Salmonella was more commonly isolated in faecal samples from golden pheasants (25%; 2/8) and leopard (10%; 2/20). Salmonella enterica serotypes of known public health significance including S. Typhimurium (37.5%; 6/14), S. Kentucky (28.5%; 4/14) and S. Enteritidis (14.3%; 2/14) were identified. While the majority of the Salmonella isolates were pan-susceptible to the commonly used antibiotics. Seven (43.7%; 7/16) of the isolates were resistant to at least one antibiotic and one isolate each among them exhibited penta and tetra multidrug-resistant types. Three S. Kentucky serotype were identified in a same golden pheasants cage, two from the birds and one from the feed. This serotype was also isolated from its caretaker. Similarly, one isolate each of S. Typhimurium were recovered from ostrich and its caretaker. These isolates were found to be clonally related suggesting that wildlife may serve as reservoir for infections to humans and vice versa. These results emphasise the transmission of Salmonella among hosts via environmental contamination of feces to workers, visitors and other wildlife.Key words: Antimicrobial resistance, ERIC-PCR, India, Salmonella enterica, wild animals