The nasopharyngeal microbiota of preweaned dairy calves with and without ultrasonographic lung lesions.

The primary objective of this cross-sectional study was to identify associations between the diversity and composition of the nasopharyngeal (NP) microbiota and pneumonia status, as diagnosed by ultrasonography (US), in preweaned dairy calves. Characteristics of the NP microbiota were compared between calves with and without pneumonia, as diagnosed by US. Secondary objectives were to compare the composition of the NP microbiota between calves by age, clinical respiratory score (CRS), and previous antibiotic therapy. Holstein heifer calves (n = 50) from a southern Wisconsin dairy were enrolled at either 3 or 6 wk of age; 4 calves were sampled at both time points. Antibiotic treatment history was also collected for the 30 d before enrollment. For the purpose of this study, pneumonia was defined as having lobar pneumonia, as diagnosed by US, in at least 1 lung lobe. Following examination by CRS and US, a deep nasopharyngeal swab was obtained for 16S rRNA amplicon sequencing. Alpha diversity was reduced in calves that were CRS positive, and beta diversity tended to be different in calves previously treated with antibiotics and in calves that were CRS positive. Microbial diversity was not different between calves with and without pneumonia. The most dominant genus identified was Mycoplasma spp.; however, there was no association between relative abundance (RA) and pneumonia status. The median RA of Mycoplasma spp. was increased by 25 (95% confidence interval, CI: 3, 40) in calves at 3 wk of age compared with 6 wk of age. The median RA of Pasteurella spp. was increased by 1.5 (95% CI: 0.1, 3) in calves with pneumonia, as diagnosed by US, compared with calves without pneumonia. Additionally, Pasteurella spp. was increased by 2.3 (95% CI: 0, 9) in CRS-positive calves compared with CRS-negative calves. The median RA of Psychrobacter spp. was increased by 2 (95% CI: 0, 12) and median RA of Chryseobacterium spp. was increased by 0.15 (95% CI: 0, 2) in calves that were not treated previously with antibiotics compared with calves previously treated with antibiotics.

The impacted maxillary canine: revisiting the clinical guideline, with case illustrations.

The key to managing canine impaction is early identification, interception and follow-up. In these case reports, we discuss four patients presenting with palatally impacted maxillary canines and their management. Guidelines to aid the early detection of an impacted maxillary canine and a subsequent management strategy are presented.

Angioedema following the intravenous administration of metoprolol.

A 72-year-old woman was admitted to the hospital with "flash" pulmonary edema, preceded by chest pain, requiring intubation. Her medical history included coronary artery disease with previous myocardial infarctions, hypertension, and diabetes mellitus. A history of angioedema secondary to lisinopril therapy was elicited. Current medications did not include angiotensin-converting enzyme inhibitors or beta-blockers. She had no previous beta-blocking drug exposure. During the first day of hospitalization (while intubated), intravenous metoprolol was given, resulting in severe angioedema. The angioedema resolved after therapy with intravenous steroids and diphenhydramine hydrochloride.

The tourniquet test as a diagnostic aid for the study of telangiectasia.

Telangiectasia, commonly called Rendu-Osler disease, in its uncomplicated state is a genetic trait, not a disease, which is transmitted as a dominant. It is difficult to diagnose because the identifying characteristics, which are collectively called telangiectases, are multiform. They often do not appear until adult life and frequently are secondary to extraneous or environmental factors such as alcohol, various drugs of which aspirin is an example, and, in a few subjects, exposure to sunlight. The tourniquet test is positive in a high percentage of cases. Eight patients have been selected for discussion to illustrate the application and helpfulness of this test in attaining a better evaluation of the clinical aspects of telangiectasia.

The bleeding time as a test of hemostatic function.

The vascular component of hemostatis is determined by the bleeding time as designed by Duke or by the Ivy modification, which is a combined bleeding time-tourniquet test. A prolonged bleeding time is observed: (1) in thrombopathic thrombocytopenia, which may be (a) hereditary or (b) acquired, as in the immune types or from depression of bone marrow, and (2) athrombocytopenically, as in von Willebrand's disease, Glanzmann's thrombasthenia, or from aspirin intolerance. The role of a specific bleeding time determinant in the plasma (labile bleeding time factor of Perkins) is discussed and its possible relation to platelets suggested.

Vitamin B12 absorption after allogeneic bone marrow transplantation.

The B12 absorption test (Schilling test) with intrinsic factor was used to examine ileal B12 absorption in 26 patients after allogeneic transplantation. The test was well tolerated and showed a profound fall in B12 absorption, which was maximal at two weeks after transplantation and recovered by eight weeks. The predominant influence on absorption at this stage was probably the conditioning schedule, and the presence of acute graft versus host disease (GVHD) was not associated with a further impairment of absorption. Six patients with chronic GVHD were studied. When compared with nine patients without GVHD there was a significant (p less than 0.005) reduction of B12 absorption. These findings suggest that the B12 absorption test may be a useful non-invasive method of studying bowel function after bone marrow transplantation.

The effect of increased bed numbers on MRSA transmission in acute medical wards.

An 18-month prospective survey was performed to examine the effect of adding a fifth bed to four-bedded bays in three acute medical wards on colonization by methicillin-resistant Staphylococcus aureus (MRSA). Screening procedures were in accordance with the UK national guidelines. All patients newly colonized with MRSA were visited, and their bed location determined. Data from the five-bedded bays were compared with those from four-bedded bays in similar wards. Potential routes of transmission were investigated by observational surveys. The relative risk of colonization in five-bedded medium dependency bays was 3.15 compared with that of similar four-bedded bays (P < 0.005), and in five-bedded low dependency bays was 3.16 (P < 0.005). Increasing the number of beds in a fixed area heightens the risk of cross-infection with MRSA.

Problems encountered in recruiting patients to an ophthalmic drug trial.

Two clinical trials to assess the efficacy of two topical beta-blocker preparations involved the recruitment of 60 and 40 patients respectively. The greatest obstacle encountered in carrying out the trials was recruiting patients. This difficulty is reported in detail and comparisons are made with the experience of others who have met similar problems.

Native aortic valve tissue systemic embolization complicating bacterial endocarditis.

Systemic embolic events are known complications of bacterial endocarditis. Embolization of prosthetic valves has previously been reported in the literature. We report a case of embolization of native aortic valve tissue to the popliteal artery as the presenting event in a patient with subacute bacterial endocarditis. To our knowledge, this rare complication has not been previously reported.

Plasma lidocaine levels following hematoma block for distal radius fractures.

Venous plasma levels of lidocaine were determined in 8 patients presenting to the emergency department with acute distal radius fractures and who had had anesthesia with fracture hematoma block. The block was performed in an aseptic fashion via a dorsal approach with a dose of 2.2-2.4 mg/kg of lidocaine without epinephrine. Onset of anesthesia was in less than 5 min which reduced pain from manipulation of the fracture to modest levels. Plasma lidocaine levels determined by gas chromatography-mass spectrometry reflected rapid systemic absorption of lidocaine from the fracture hematoma. Maximum systemic concentrations were seen at 20-30 min and ranged from 100 to 1,100 ng/ml, well below the toxic threshold of 5,000 ng/ml.

Effect of reduced water intake by lactating dairy cows on behaviour, milk yield and blood composition.

A herd of lactating British Friesian cows was divided into two equal groups. After 14 days during which all the cows had free access to water one group (restricted) was allowed only 50 per cent of the voluntary water intake of the other group (control). After four days when the experiment was terminated, the milk yield of the restricted group had fallen to 74 per cent of that of the control group and their mean body-weight was reduced by 14 per cent. In the restricted group there were significant increases in the concentrations of urea, sodium, total protein and copper in serum, in the osmolality of serum, in the plasma activities of the enzymes creatine kinase and glutamate-oxaloacetate transaminase and in the packed cell volume of blood. The restricted cows behaved very aggressively around their water trough and spent more time in its vicinity. They spent less time lying down than the cows of the control group and some of them were not seen to drink and were withdrawn from the experiment before the end of four days. In a second experiment half the herd was allowed approximately 90 per cent of the water intake of the control group for 14 days. Decreases in milk yield and body-weight and changes in blood composition were much smaller and difficult to detect. However, changes in behaviour were still easily recognised although not as marked as in the first experiment.

Management of a simple anterior crossbite in a child with autism: a review and case report.

This case report describes a simple treatment used to correct an anterior crossbite in a child with autism. A review of autism and the treatment of simple anterior crossbite are given. It is possible for children with special needs to be managed in the general practice setting, although treatment plans may need to be modified to meet the capabilities of individual patients. Follow-up is required for cases of anterior crossbite treated in the early mixed dentition.

Accidental ingestion of a component of a fixed orthodontic appliance--a case report.

Most dental patients are treated in the supine position, enhancing the risk of accidental aspiration or swallowing of foreign objects. This article presents a case report of an orthodontic patient who accidentally ingested a section of orthodontic wire and coil spring from a fixed expansion device placed in the maxillary dental arch. Some guidelines for the prevention of such occurrences in the practice and at home, and possible courses of remedial action, are discussed.