Antimicrobial susceptibility patterns of aerobic bacteria isolated from canine urinary samples in South East Queensland, 2013 to 2018.

Urinary tract infections are a common diagnosis in dogs presenting to veterinary practice. Veterinarians often treat suspected infections empirically, either in the absence of culture and susceptibility testing results or whilst waiting for them. This study aimed to identify the bacteria most frequently isolated from canine urinary samples and their antimicrobial susceptibility patterns in South East Queensland (SEQ) to help guide responsible empirical antimicrobial prescription by the veterinary community in this geographical location. Cumulative antibiograms were generated from the results of 1284 culture-positive urinary samples in SEQ, obtained from a commercial veterinary laboratory over a 5-year period. Escherichia coli was the most commonly isolated bacterial species (43%), followed by Staphylococcus spp. (23%), Proteus spp. (21%) and Enterococcus spp. (10%). Of the six most common isolates, 97% had susceptibility to at least one low-importance antimicrobial. Susceptibility to the low-importance and first-line antimicrobial recommendation, amoxicillin, was 81% for E. coli and 24% for Staphylococcus spp. Susceptibility of both E. coli and Staphylococcus spp. to medium-importance and commonly recommended empirical antimicrobials, trimethoprim sulphonamides and amoxicillin-clavulanic acid was ≥85% and >92% for high-importance antimicrobials enrofloxacin and ceftiofur. Of the E. coli and Staphylococcus spp. isolates, 8.8% and 4%, respectively, were considered multidrug resistant. There was no increase in resistance to antimicrobials detected over the study period. Susceptibilities suggest low- and medium-importance antimicrobials remain acceptable first-line empirical treatments. However, this should be continually assessed and updated using local surveillance data.

Diagnosis and Treatment of Lower Motor Neuron Disease in Australian Dogs and Cats.

Diseases presenting with lower motor neuron (LMN) signs are frequently seen in small animal veterinary practice in Australia. In addition to the most common causes of LMN disease seen world-wide, such as idiopathic polyradiculoneuritis and myasthenia gravis, there are several conditions presenting with LMN signs that are peculiar to the continent of Australia. These include snake envenomation by tiger (Notechis spp.), brown (Pseudonaja spp.), and black snakes (Pseudechis spp.), tick paralysis associated with Ixodes holocyclus and Ixodes coronatus, and tetrodotoxins from marine animals such as puffer fish (Tetraodontidae spp.) and blue-ring octopus (Hapalochlaena spp.). The wide range of differential diagnoses along with the number of etiological-specific treatments (e.g., antivenin, acetylcholinesterase inhibitors) and highly variable prognoses underscores the importance of a complete physical exam and comprehensive history to aid in rapid and accurate diagnosis of LMN disease in Australian dogs and cats. The purpose of this review is to discuss diagnosis and treatment of LMN diseases seen in dogs and cats in Australia.

Oxidative modification, inflammation and amyloid in the normal and diabetic cat pancreas.

The pathogenesis of ß-cell dysfunction leading to pancreatic ß-cell failure seen in type 2 diabetes mellitus is incompletely understood. Pancreatic tissues were collected from nine control cats and nine diabetic cats and labelled immunohistochemically to examine expression of interleukin (IL)-1ß, insulin, islet amyloid polypeptide (IAPP) and 4-hydroxynonenal (4-HNE). Thioflavin-S was used to stain for amyloid. All control cats showed positive labelling for IL-1ß and 4-HNE. Diabetic cats showed varying degrees of inflammation and oxidative modification, owing in large part to the very small amount of islet structure remaining in the typical diabetic cat pancreas. Amyloid deposition was identified in 8/9 diabetic cats and 1/9 control cats. In order to validate these findings, paired biopsy samples taken from an additional group of cats enrolled in a study of obesity and hyperglycaemia (sampling at baseline and after 8-16 weeks of obesity and hyperglycaemia) were labelled for IL-1ß and 4-HNE. A similar pattern of labelling was identified in the baseline samples to that seen in control cats. A significant increase in IL-1ß and 4-HNE expression was seen after a period of hyperglycaemia and obesity. Taken together, these findings suggest that while present in normal cats, markers of inflammation and oxidative modification increase very early during the development of disease. Future studies focusing on these earlier time points are needed to understand the factors that function in protection of the islet ß cell and the development of islet pathology in type 2 diabetes mellitus in the cat.

Parkinson's disease revisited.

Parkinson's disease (PD) is a neurodegenerative disorder that affects an estimated 1 million persons in the United States each year. Although PD has been studied for almost 50 years, several shortcomings in management still exist. Symptom management, addressing movement disorders, psychological aspects, sexual dysfunction, and gastrointestinal concerns may all affect the person with PD.

Results of a vesicoureteral reflux practice pattern survey among American Academy of Pediatrics, Section on Pediatric Urology members.

PURPOSE: We evaluated practice patterns among urologists managing vesicoureteral reflux, and identified areas of consensus and controversy requiring further research. MATERIALS AND METHODS: A 1-page questionnaire addressing various aspects of reflux management, including screening, diagnosis, treatment and followup, was mailed to a cohort of 225 practicing urologists identified by the membership roster of the American Academy of Pediatrics, Section on Pediatric Urology. Coded returned mailers were blindly analyzed and tabulated by 2 reviewers. Questionnaires were subdivided using a coding system by decade (1970s or earlier, 1980s and so forth) of participant membership in the American Urological Association. Select questions were analyzed to determine whether time of training affected the response. RESULTS: Of 225 surveys 155 were returned and usable (overall 60.8% response rate). General agreement exists regarding several important points in the management of vesicoureteral reflux, including evaluation of patients at the initial urinary tract infection (78.1% of respondents), use of voiding cystourethrography and ultrasound at the initial evaluation (99.4 and 96.8%, respectively), and evaluation of sibling reflux (83.2%). Certain absolute and relative indications for surgical intervention require further clarification. Various reimplantation techniques are used today, stents are not placed by the majority of practitioners and significant variations exist in the duration of postoperative hospital stay. CONCLUSIONS: Today there is substantial consensus among urologists on many issues regarding vesicoureteral reflux management. However, the areas of controversy will only be clarified by further scientific and clinical outcomes based research.

Buried asparagines determine the dimerization specificities of leucine zipper mutants.

Regulation of gene expression by many transcription factors is controlled by specific combinations of homo- and heterodimers through a short alpha-helical coiled-coil known as a leucine zipper. The dimer interface of a leucine zipper involves side chains of the residues at the a, d, e, and g positions of the (abcdefg)n heptad repeat. To understand the basis for the specificity of dimer formation, we characterized GCN4 leucine zipper mutants with all 16 possible permutations and combinations of isoleucines and asparagines at four a positions in the dimer interface, using a genetic test for the specificity of dimer formation by lambda repressor-leucine zipper fusions. Heterodimers were detected by loss of repressor activity in the presence of a fusion to a dominant-negative mutant form of the DNA-binding domain of repressor. Reconstruction experiments using leucine zippers from GCN4, Jun, Fos, and C/EBP showed that this assay distinguishes pairs that form heterodimers from those that do not. We found that the mutants have novel dimerization specificities determined by the positioning of buried asparagine residues at the a positions. The pattern of buried polar residues could also explain the dimerization specificities of some naturally occurring leucine zippers. The altered specificity mutants described here should be useful for the construction of artificial regulatory circuitry.

Using the Nutrition Screening Initiative to survey the nutritional status of clients participating in a home delivered meals program.

A large percentage of older Americans are at risk for malnutrition. This puts them at risk for premature institutionalization, creating a financial burden. The objective of this survey was to determine the nutritional health of clients receiving home delivered meals in Lake County, Indiana and the impact that home delivered meals had on them. Nutrition Screening Initiative (NSI) Determine Your Nutritional Health Checklists were mailed to recipients of meals; 58.3% were returned. Twenty-eight percent were found to be at no nutritional risk, 39% at moderate nutritional risk and 33% at high nutritional risk. One-hundred-thirty clients that scored three or more on the "Checklist" were visited by a Registered Dietitian for further screening using the NSI Level I Screen. This screen found many nutritional problems but the fact that the clients did receive home delivered meals decreased the risk. It was determined by the author that 68% of these clients could not function in their own homes without home delivered meals.

Assessment of the patient-doctor interaction scale for measuring patient satisfaction.

This study assessed the validity, reliability and usability of the Patient-Doctor Interaction Scale (PDIS) in a university-based family practice center. Health maintenance visits and problem visits were included, and data were collected at the time of the visit and again 1 month later. Three different methods of administration (in-person, telephone, and mail) were used to assess usability. Of 91 patients approached, 1 refused to participate. A total of 64 (70%) patients completed the instrument adequately to permit analysis. PDIS scores correlated with overall assessment of patient satisfaction (P < 0.01), suggesting criterion-based validity. Internal consistency (reliability) of the PDIS was indicated by Cronbach's alpha which were consistently greater than 0.80. Scores and return rates varied by method of administration, with the telephone method performing best. The PDIS appears to fulfill the requirements for a valid, reliable and useful instrument to assess patient satisfaction in family practice settings.

Methods for determining patient improvement following visits to family physicians.

Two instruments were used to assess patient improvement following visits to providers in a university based family practice center--the Modified Williamson Functional Assessment (MWFA) and the Mini-Duke-UNC Health Profile (Mini-DUHP). Of the 90 patients over the age of 18 seen for problem or health maintenance visits who were included in the study, 64 adequately completed the instruments at the time of the visit and one month later. Functional assessments by in-person, mail, and telephone methods of administration were similar. Patients' MWFA scores did not significantly improve by the time of the one-month follow-up. Mini-DUHP subscales for symptom and physical function also did not significantly improve. Mini-DUHP emotional, social, and composite scores indicated a decrease in function following the visits, particularly visits for health maintenance. MWFA and Mini-DUHP scores correlated only modestly, with the highest correlation occurring between Mini-DUHP Physical Score and the MWFA (0.414 or 0.509, P less than .001). Additional study is needed to identify or develop an instrument that can adequately assess broad changes in functioning for multiple diagnoses following specific physician interventions, and the reason for the decline in emotional and social function following visits needs further elucidation and evaluation.

Pediatricians' attitudes toward maternal employment and substitute child care.

In 1979 more than 54% of women with children less than 18 years old were in the labor force. The purpose of this study was to study the attitudes of pediatricians toward maternal employment and substitute child care arrangements. To survey their attitudes toward maternal employment and substitute child care, we sent a questionnaire to 476 North Carolina pediatricians. The response rate was 50%. On the issue of maternal employment the attitudes were 46% favorable, 35% neutral, and 19% unfavorable. Corresponding attitudes for substitute child care were 53%, 30%, and 17%.

Stepfamilies as patients.

Census figures point out the increase in the population of stepfamilies, families in which one adult is a stepparent. Since it is likely that family physicians will have more stepfamilies in their patient populations than in previous times, it is important for physicians to be aware of the characteristics of stepfamilies that are not present in intact nuclear families. These characteristic are (1) the formation of the stepfamily out of loss, (2) a common history of some family members, (3) a parent-child bond that predates the couple bond, (4) a biological parent elsewhere, (5) children as members of two households, and (6) the legal limitations of the step relationship. Functions the physician might be able to serve for the stepfamily as its members work on the tasks associated with each characteristics are described. Recommendations for residency training and resources for physician and patient education are given.

Evaluation of a home visitation program for families of children with cancer.

This paper presents the results of a preliminary evaluation of a home visitation program for families of children with cancer. The visitation program has been well received by the parents and a statistical comparison of visited and nonvisited families suggested favorable effects of the program with respect to helping parents control feelings of anger and in enhancing or maintaining positive interaction with spouse, children, and grandparents. Comments by the parents indicated that the visits create an atmosphere which facilitates communication between members of the health care team and the family. Interviews with parents of deceased children revealed that a particularly important aspect of the program is the contact maintained with the family after the child has died. Overall, the results indicated that the visits can be a valuable addition to the total program of care for the chronically ill child.