Torsades de pointes - a report of a case induced by caesium taken as a complementary medicine, and the literature review.

WHAT IS KNOWN AND OBJECTIVE: Complementary medicines are commonly used by many patients. Caesium, a complementary therapy said to be of benefit for cancer treatment, has been associated with cardiac arrhythmias in the literature. We report a case of caesium-induced torsades de pointes and provide an evidence review. CASE SUMMARY: A 46-year-old woman with syncope experienced torsades de pointes and cardiac arrest. Upon admission her QTc was 620 ms. The patient had taken caesium carbonate 10 g daily for 1 month prior to admission. The patient was successfully resuscitated and discharged home after 35 days in hospital. WHAT IS NEW AND CONCLUSION: Ten cases of caesium-induced cardiac arrhythmias have previously been reported in the literature. Treatment strategies differed significantly among the cases. However, all patients recovered from the event. Complementary and alternative medicines should not be overlooked as a potential cause of serious adverse events.

An evaluation of the effect of altering nutrition and nutritional strategies in early lactation on reproductive performance and estrous behavior of high-yielding Holstein-Friesian dairy cows.

Reproductive performance in the high-yielding dairy cow has severely decreased in the last 40 yr. The aim of this study was to compare the effectiveness of 4 nutritional strategies in improving the reproductive performance of high-yielding dairy cows. It was hypothesized that offering cows a high-starch ration in early lactation would enhance the onset of luteal activity, and that decreasing the severity of negative energy balance in the early postcalving period would improve reproductive parameters. Nutritional regimens aimed at improving fertility were applied to 96 Holstein-Friesian dairy animals. Upon calving, animals were allocated in a balanced manner to one of 4 dietary treatments. Primiparous animals were balanced according to live weight, body condition score and calving date. Multiparous animals were balanced according to parity, previous lactation milk yield, liveweight, body condition score and calving date. Treatment 1 was based on an industry best practice diet (control) to contain 170 g of crude protein/kg of dry matter. Treatment 2 was an individual cow feeding strategy, whereby the energy balance (EB) of individual animals was managed so as to achieve a predetermined target daily EB profile (±10 MJ/d). Treatment 3 was a high-starch/high-fat combination treatment, whereby an insulinogenic (high-starch) diet was offered in early lactation to encourage cyclicity and followed by a lipogenic (low-starch, high-fat) diet to promote embryo development. Treatment 4 was a low-protein diet, containing 140 g of crude protein/kg of dry matter, supplemented with protected methionine at an inclusion level of 40 g per animal per day. The nutritional strategies implemented in this study had no statistically significant effects on cow fertility measures, which included the onset of luteal activity, conception rate, in-calf rate, and the incidence of atypical cycles. The individual cow feeding strategy improved EB in early lactation but had no benefit on conception rate to first insemination. However, conception rate to second insemination, 100-d pregnancy rate (from the commencement of breeding), and overall pregnancy rate tended to be higher in this group. The high-starch/high-fat treatment tended to decrease the proportion of delayed ovulations and increase the proportion of animals cycling by d 50 postcalving. Animals that failed to conceive to first insemination had a significantly longer luteal phase in the first cycle postpartum and a longer inter-ovulatory interval in the second cycle postpartum. With regards to estrous behavior, results indicate that as the size of the sexually active group increased, the intensity of estrus and the expression of mounting or attempting to mount another cow also increased. Furthermore, cows that became pregnant displayed more intense estrous behavior than cows that failed to become pregnant.

A simple system to rapidly monitor activated sludge health and performance.

A set of four assays designed to rapidly measure the health and biodegradative performance of pulp and paper mill activated sludges was developed. Three of the assays are specific oxygen uptake rates (SOURs) that measure the normal "working" aeration tank BOD (biochemical oxygen demand) removal rate (SOURAT), a near-maximum BOD removal rate (SOURNMAX), and a rate (SOURTOX) used in combination with the SOURNMAX to indicate the presence of toxic or inhibitory substances. The fourth assay is the specific adenosine triphosphate (SATP) content of the sludge, used as a measure of its viable cell content. Fresh biomass (sludge) samples from one laboratory reactor and four mill biotreatment systems were fed raw mill effluents and used to evaluate the four-assay set. The SOURAT values of all systems were 10-40% of their SOURNMAX values: thus the SOURAT:SOURNMAX ratios indicate that each system's free biodegradative capacity was far greater than its operating rate. It was demonstrated using phenol that the SOURNMAX:SOURTOX ratio can indicate the presence of substances toxic or inhibitory to the biomass. The results also indicated that the SOURNMAX is a much better indicator of improving or worsening sludge performance and capacity than the SOURAT. SATP was shown to be a useful monitor of the proportion of viable cells in an activated sludge and a toxicity indicator complementary to the SOURNMAX:SOURTOX ratio and similar in principle to the commercial Microtox toxicity test. This four-assay set was also applied to three practical situations: (a) at-mill monitoring of a biotreatment system; (b) effects of cold storage on biomass; and (c) effects of decreased BOD loading on biomass.

The effectiveness of topical anesthesia and vibration in alleviating the pain of oral injections.

The goal of the research was to compare the effectiveness of vibration with that of a topical anesthetic in reducing the pain of local anesthetic injections. Injections were given adjacent to maxillary premolars in four locations in 61 patients. Before injection, sites received either placebo or topical anesthetic with or without vibration. Patients rated the injection pain on a five-point scale. The topical anesthetic caused a statistically significant decrease in pain values; however, the amount of decrease was of questionable clinical significance.

Medical management of ocular malakoplakia.

A 14-year-old girl had a granulomatous conjunctival lesion, proven histologically to be malakoplakia. This is the first reported case of malakoplakia arising from conjunctiva, although three others have involved the ocular adnexa. Malakoplakia is a rare disease often associated with immunodeficiency and is characterized by the presence of intracellular inclusions and organisms due to deficient intracellular bacteriolysis. Medical management is difficult because an effective antibacterial agent requires three properties: activity against the organism involved, good intracellular penetration, and the capacity to maintain its effectiveness in the intracellular milieu. Escherichia coli was isolated from a biopsy specimen and from conjunctival swabs. Treatment with systemic ciprofloxacin, which has good intracellular penetration and activity, led to rapid resolution of the lesion. This is the first report concerning the successful use of this drug to treat malakoplakia of any organ.

Cell wall and morphological changes induced by temperature shift in Bacillus subtilis cell wall mutants.

Bacillus subtilis RUB1012 and RUB1013 have the following phenotype when grown at 45 degrees C: no growth on tryptose blood agar base, growth as clumps of spheres in broth culture, a slow autolysis rate, and a low proportion of teichoic acid to peptidoglycan. Revertants of strain RUB1012 (RUB2032, RUB2012, and RUB2042) that could grow on tryptose blood agar base were isolated. Each revertant had a different proportion of teichoic acid to peptidoglycan. The nanomoles of phosphorus per milligram of cell wall at the nonpermissive temperature were 141, 160, 236, and 541 for strain RUB1012 and revertants RUB2032, 2012, and 2042, respectively, as compared with 1,100 for the parent strain. With most bacteriophage tested, plating efficiency was related to the amount of glucosylated teichoic acid. Scanning electron microscopy was used to study strain RUB2032 during a shift from growth at 30 degrees C to growth at 45 degrees C. The change from rod to sphere began with the thickening of the cylindrical portion of the cell. Caps of the cells appeared to be immune to the thickening process. During growth, the cells became progressively shorter and thicker, and cell separation was inhibited. When cells of strain RUB2032 were shifted from growth at 45 degrees C to growth at 30 degrees C, accumulation of an amorphous material on the outer surfaces of the cells preceded the change from sphere to rod morphology. Cells remained clumped, with rods appearing at the periphery of the clumps. Analysis by DNA-mediated transformation and PBS1-mediated transduction indicated that strains RUB1012 and RUB1013 have multiple mutations mapping in the same region as other cell wall mutations.

Rapid method for auxotyping multiple strains of Neisseria gonorrhoeae.

A rapid method for auxotyping strains was developed that uses microtiter plates. This miniplate technique enables rapid identification of major auxotypes present in clinical strains. Additional growth requirements can be identified by adding individual amino acid supplements to complete gonococcal genetic medium. Analysis of 8 clones from 40 patients revealed that 10 had more than 1 auxotype. Deoxyribonucleic acid-mediated transformation can be used to establish whether the strains with apparently more than one auxotype are defective in the same locus in each of the involved biosynthetic pathways. Selection of more than one clone is required in precise epidemiological studies.

Cell walls of group D streptococci. II. Chemical studies on the type 1 antigen purified from the autolytic digest of cell walls.

Autolysis of group D, type I cell walls by an indigenous autolytic enzyme results in the solubilization of the type I antigen. The antigen was purified from the autolytic digest by diethylaminoethyl cellulose chromatography. Chemical analysis of the purified type 1 antigen revealed glucose, glucosamine, galactosamine, rhamnose, ribitol, phosphorus, and residual peptoglycan components. This analysis suggested that the type I antigen is a heteropolymer which may contain a ribitol teichoic acid. The antigen purified by the procedure outlined here is higher in phosphorus content, lower in peptidoglycan, and more reactive serologically than the antigen prepared by methods previously described.