Successful use of secnidazole to manage a giardiosis outbreak in a shelter.

Giardia duodenalis is a common parasite in dogs in shelters where new introductions, including numerous juvenile individuals, are ongoing. A safe and effective single dose parasiticide is highly desirable for shelters experiencing disease caused by G. duodenalis (giardiosis). Secnidazole is an efficacious, low-cost medication used for the treatment of giardiosis in humans and has the advantage of requiring only a single oral dose. The aim of this study was to determine retrospectively the effectiveness of secnidazole on dogs of all ages during an outbreak of giardiosis in a shelter. Patients recruited into this retrospective study were divided into two groups. Group A consisted of adult dogs and weaned dogs (>10 weeks-of-age). Group B was comprised of puppies (<10 weeks-of-age). Giardiosis resolved in all 14 patients in Group A within 13 days following a single oral dose of secnidazole (30 mg/kg). There were no individuals with both gastrointestinal signs and a positive G. duodenalis antigen test at the time of the first and second follow-up examination. For the young puppies in Group B, giardiosis was reduced by 90% (9/10) within 22 days following two consecutive doses of secnidazole (30 mg/kg; 2 weeks apart). No adverse reactions were observed in any patients treated with secnidazole. Secnidazole is an effective and easily administered drug for the treatment of clinical canine giardiosis.

Preoperative warming and undesired surgical and anesthesia outcomes in pediatric spinal surgery-a retrospective cohort study.

BACKGROUND: Underbody forced air warming is a method commonly used for intraoperative temperature maintenance in children. We previously reported that preoperative forced air warming of children undergoing spinal surgery substantially reduces the incidence and duration of intraoperative hypothermia (<36°C). OBJECTIVE: The aim of this study was to evaluate the effects of preoperative warming before spinal deformity surgery on surgical site infection rate, length of hospitalization, and bleeding (estimated blood loss and incidence of cell salvaged and/or allogeneic packed red blood cell transfusions). METHODS: Demographic, anesthetic, and surgical data of all patients who underwent spinal deformity surgery between December 2009 and December 2012 were obtained by retrospective chart review. Temperature data were abstracted from an existing repository; the incidence and duration of hypothermic episodes were identified. For each outcome, logistic regression models and propensity score analysis were used to estimate the effect of prewarming, adjusted for potential confounders. The issue of missing data was handled by a multiple imputation method. Data from 334 procedures were used in modeling and propensity score stratification. RESULTS: Adjusted odds ratios for the effects of prewarming were 0.47 (95% CI 0.15-1.49) for surgical site infections; 0.89 (95% CI 0.55-1.41) for cell salvaged blood transfusion; 0.43 (95% CI 0.22-0.83) for allogeneic packed red blood cell transfusion; and 1.24 (95% CI 0.77-1.99) for a length of hospitalization >6 days. Adjusted mean decrease in estimated blood loss for prewarming was 72 (95% CI -29 to 173) ml. CONCLUSION: In this study, prewarming was associated with a reduction in allogeneic packed red blood cell transfusion. However, no causal relationship between prewarming and reduced allogeneic blood transfusion should be assumed. Prewarming was not associated with reductions in estimated blood loss, length of hospitalization, or the incidence of surgical site infection.

Dexmedetomidine and hydromorphone: a novel pain management strategy for the oncology ward setting during anti-GD2 immunotherapy for high-risk neuroblastoma in children.

BACKGROUND: Treatment of neuroblastoma with targeted immunotherapy using chimeric anti-GD2 monoclonal antibodies (ch14.18) is associated with significant pain requiring management with a high-dose opioid infusion. We present a case series of six children, for whom dexmedetomidine and hydromorphone infusions safely and effectively reduced the pain of ch14.18 therapy in the oncology ward setting. PROCEDURE: The ch14.18 infusion is administered for ≥ 10 hr over four consecutive days in each of 5 cycles. Hydromorphone (2-8 mcg.kg(-1) .hr(-1) ) and dexmedetomidine (0.1-0.6 mcg.kg(-1) .hr(-1) ) infusions were commenced 1 hr before starting ch14.18 immunotherapy and titrated to optimal clinical effect. One hour after stopping the ch14.18 infusion, dexmedetomidine was discontinued and hydromorphone weaned as tolerated. This strategy was supervised by the Acute Pain Service with strict monitoring and nursing policies. Patient charts were reviewed for evidence of side effects and quality of analgesia. RESULTS: Data from six patients, with median (range) age of 3.5 (2-12) years are reported. Median (range) utilization of hydromorphone was 2.9 (2.0-4.7) mcg.kg(-1) .hr(-1) , and of dexmedetomidine was 0.17 (0.10-0.20) mcg.kg(-1) .hr(-1) . A drop in mean arterial pressure ≥ 30% below baseline was identified during 30% of treatment days, but only prompted interrupting or reducing the ch14.18 infusion on 7% of treatment days; only one episode of grade 3 hypotension was recorded during this series. Hypoxemia occurred during 8% and bradycardia during 4% of treatment days. CONCLUSIONS: Dexmedetomidine infusion may be an effective and safe pain management adjunct to opioid therapy for the pain of ch14.18 infusion.