The pharmacokinetics of single oral dose extended-release topiramate and adverse effects after multi-dose administration in healthy cats.

Current treatment options for feline epilepsy are limited to medications that require administration of multiple doses per day or administration of a capsule or large tablet. Expanding the current treatment options could improve patient and owner compliance and optimize seizure control. Topiramate has been used sparingly in veterinary medicine, and limited pharmacokinetic studies have focused on immediate release formulations in dogs. If effective and safe, topiramate extended-release (XR) could broaden the current treatment options for feline epilepsy. The aims of this two-phase study were to establish single-dose pharmacokinetics for topiramate XR in cats, identify a dosing regimen that maintains steady-state plasma drug concentrations within a reference range extrapolated from human medicine (5-20 µg/mL), and evaluate the safety of topiramate XR in cats following multidose administration. Topiramate XR administered orally at 10 mg/kg once daily for 30 days was sufficient to achieve the desired concentrations in all cats. While no clinically apparent adverse effects were observed, four out of eight cats developed subclinical anemia, calling into question the safety of topiramate XR with chronic administration. Further studies are necessary to better understand the potential adverse effects and overall efficacy of topiramate XR for the treatment of feline epilepsy.

Canine brucellosis in three littermates, case report.

Three adult littermates were diagnosed with Brucella canis, two of which were diagnosed with discospondylitis. The first littermate, a 2-year-old spayed-female Labrador Retriever, was evaluated for progressive episodes of cervical pain, lethargy, reported circling to the right, and a right-sided head tilt. Magnetic resonance imaging (MRI) of the cervical spine revealed changes consistent with discospondylitis at C6-C7. MRI of the brain was unremarkable and cerebrospinal fluid analysis was declined. Brucella spp. was isolated from aerobic and Brucella blood cultures. PCR performed on the isolate identified Brucella canis and indirect fluorescent antibody (IFA) testing for Brucella canis also confirmed the species. Patient #1 was treated with doxycycline and marbofloxacin for 1 year. Clinical signs returned 2-years after diagnosis. Following the diagnosis of patient #1, a known littermate (patient #2) was tested for Brucella canis. Patient #2 was 2 years old and asymptomatic at the time of diagnosis. Aerobic and Brucella spp. cultures, PCR, and IFA were obtained and were diagnostic for Brucella canis. A 6-month course of marbofloxacin and doxycycline was implemented. The patient remained PCR positive following 4 months of treatment and repeat cultures were planned following 6 months of treatment; however, the patient was lost to follow-up. A third littermate (patient #3) was identified by the family of patient #1. Patient #3 was evaluated at 18 months of age for a 6-month history of progressive lumbosacral pain. Spinal radiographs revealed discospondylitis of the C3-C4, T12-T13, and L7-S1 vertebral endplates. Computed tomography (CT) of the lumbosacral spine was also consistent with discospondylitis at L7-S1. Brucella canis serologic testing consisting of rapid slide agglutination test, 2ME-rapid slide agglutination test, and cytoplasmic agar gel immunodiffusion was positive. Enrofloxacin was administered for 7 months and was discontinued thereafter based on radiographic evidence of healing and resolution of clinical signs. Although Brucella canis is not a rare disease in dogs, the documentation of two out of three adult littermates with associated discospondylitis is an interesting feature. In addition, this report highlights available diagnostic and treatment options, as each patient was managed differently based on clinical signs and the preference of the managing clinician.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Seroprevalence in Decedents Undergoing Forensic Postmortem Examination: Feasibility for Real-Time Pandemic Surveillance.

Background: Population-based seroprevalence studies offer comprehensive characterization of coronavirus disease 2019 (COVID-19) spread, but barriers exist and marginalized populations may not be captured. We assessed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seroprevalence among decedents in Maryland over 6 months in 2020. Methods: Data were collected on decedents undergoing forensic postmortem examination in Maryland from 24 May through 30 November 2020 from whom a blood specimen could be collected. Those with available blood specimens were tested with the CoronaCHEK lateral flow antibody assay. We assessed monthly seroprevalence compared to the statewide estimated number of cases and proportion of positive test results (testing positivity). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs) for associations of demographic characteristics, homelessness, and manner of death with SARS-CoV-2 antibodies. Results: Among 1906 decedents, 305 (16%) were positive for SARS-CoV-2 antibodies. Monthly seroprevalence increased from 11% to 22% over time and was consistently higher than state-level estimates of testing positivity. Hispanic ethnicity was associated with 2- to 3.2-fold higher seropositivity (P < .05) irrespective of sex. Deaths due to motor vehicle crash were associated with 62% increased seropositivity (aPR, 1.62 [95% CI, 1.15-2.28]) vs natural manner of death. Though seroprevalence was lower in decedents of illicit drug overdose vs nonoverdose in early months, this shifted, and seroprevalence was comparable by November 2020. Conclusions: Decedents undergoing forensic postmortem examination, especially those dying due to motor vehicle trauma, may be a sentinel population for COVID-19 spread in the general population and merits exploration in other states/regions.

SARS-CoV-2 Seroprevalence and Drug Use in Trauma Patients from Six Sites in the United States.

In comparison to the general patient population, trauma patients show higher level detections of bloodborne infectious diseases, such as Hepatitis and Human Immunodeficiency Virus. In comparison to bloodborne pathogens, the prevalence of respiratory infections such as SARS-CoV-2 and how that relates with other variables, such as drug usage and trauma type, is currently unknown in trauma populations. Here, we evaluated SARS-CoV-2 seropositivity and antibody isotype profile in 2,542 trauma patients from six Level-1 trauma centers between April and October of 2020 during the first wave of the COVID-19 pandemic. We found that the seroprevalence in trauma victims 18-44 years old (9.79%, 95% confidence interval/CI: 8.33 - 11.47) was much higher in comparison to older patients (45-69 years old: 6.03%, 4.59-5.88; 70+ years old: 4.33%, 2.54 - 7.20). Black/African American (9.54%, 7.77 - 11.65) and Hispanic/Latino patients (14.95%, 11.80 - 18.75) also had higher seroprevalence in comparison, respectively, to White (5.72%, 4.62 - 7.05) and Non-Latino patients (6.55%, 5.57 - 7.69). More than half (55.54%) of those tested for drug toxicology had at least one drug present in their system. Those that tested positive for narcotics or sedatives had a significant negative correlation with seropositivity, while those on anti-depressants trended positive. These findings represent an important consideration for both the patients and first responders that treat trauma patients facing potential risk of respiratory infectious diseases like SARS-CoV-2.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Status in Decedents Undergoing Forensic Postmortem Examination in Maryland, May 24 to June 30, 2020.

Seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies was 10% among the subset of decedents undergoing forensic postmortem examination in June in Maryland. Decedents of motor vehicle crashes had similar seroprevalence compared with those with a natural death (including decedents with SARS-CoV-2 infection). Decedents of motor vehicle crashes may be a sentinel surveillance population.

Imaging and clinical features of a true gastrogastric intussusception in a dog.

An 18-month-old male mixed breed dog was evaluated for acute vomiting and hematemesis. Clinical signs and initial radiographic findings shared commonalities with reported cases of pylorogastric intussusception in dogs. However, unlike previously reported cases, additional imaging [including ultrasound and computed tomography (CT)] revealed invagination of the gastric fundus into the gastric body, consistent with true gastrogastric intussusception. These findings were confirmed with histopathology and on necropsy. Key clinical message: Although extremely rare, gastrogastric intussusception should be included as a differential diagnosis for any patient presenting with acute vomiting, abdominal pain, dehydration, or tachycardia in combination with the diagnostic imaging findings described in this report.

Caractéristiques cliniques et d'imagerie d'une intussusception gastro-gastrique vraie chez un chien. Un chien mâle de race croisée âgé de 18 mois fut évalué pour des vomissements aigus et de l'hématémèse. Les signes cliniques et les trouvailles radiographiques initiales partageaient des similarités avec des cas rapportés d'intussusception pyloro-gastrique chez des chiens. Toutefois, contrairement aux cas rapportés précédemment, des examens d'imagerie supplémentaires [incluant l'échographie et la tomodensitométrie (CT)] ont révélé une invagination du fundus gastrique dans le corps de l'estomac, compatible avec une intussusception gastro-gastrique vraie. Ces données furent confirmées lors de l'examen histopathologique et de la nécropsie.Message clinique clé :Bien qu'extrêmement rare, l'intussusception gastro-gastrique devrait être incluse dans le diagnostic différentiel pour tout patient présenté avec des vomissements aigus, de la douleur abdominale, de la déshydratation ou de la tachycardie en combinaison avec les trouvailles en imagerie diagnostique décrites dans le présent rapport.(Traduit par Dr Serge Messier).

Teaching older drivers to navigate GPS technology.

BACKGROUND AND OBJECTIVES: New technologies are being implemented in motor vehicles. One key technology is the electronic navigation system (ENS) that assists the driver in wayfinding, or actually guides the vehicle in higher level automation vehicles. It is unclear how older adults interact with ENSs and the best approach to train older adults to use the devices. The objectives of this study were to explore how older drivers interacted with an ENS while driving on live roadways and how various training approaches impacted older drivers' ability to accurately enter destinations into the ENS. RESEARCH DESIGN AND METHODS: In Experiment 1, 80 older drivers navigated unfamiliar routes using an ENS or paper directions and completed a series of ENS destination entry tasks. In Experiment 2, 60 older drivers completed one of three training conditions (ENS video only, ENS video with hands-on training, placebo) to examine the impacts of training on destination entry performance. RESULTS AND DISCUSSION: Driving performance was aided by the use of the ENS, but many older drivers had difficulty entering destinations into the device (Experiment 1). The combined video with hands-on ENS training resulted in the best overall destination entry performance (Experiment 2). Practical applications: The results suggest older drivers may experience problems entering destinations into ENSs, but training can improve performance. These performance issues may be especially important as more vehicle features require interaction with computer systems to select destinations or other automation related features. Further research is needed to determine how to prepare the next generation of older drivers who will interact with technologies aimed at increasing mobility.

Efficient transposon mutagenesis mediated by an IPTG-controlled conditional suicide plasmid.

BACKGROUND: Transposon mutagenesis is highly valuable for bacterial genetic and genomic studies. The transposons are usually delivered into host cells through conjugation or electroporation of a suicide plasmid. However, many bacterial species cannot be efficiently conjugated or transformed for transposon saturation mutagenesis. For this reason, temperature-sensitive (ts) plasmids have also been developed for transposon mutagenesis, but prolonged incubation at high temperatures to induce ts plasmid loss can be harmful to the hosts and lead to enrichment of mutants with adaptive genetic changes. In addition, the ts phenotype of a plasmid is often strain- or species-specific, as it may become non-ts or suicidal in different bacterial species. RESULTS: We have engineered several conditional suicide plasmids that have a broad host range and whose loss is IPTG-controlled. One construct, which has the highest stability in the absence of IPTG induction, was then used as a curable vector to deliver hyperactive miniTn5 transposons for insertional mutagenesis. Our analyses show that these new tools can be used for efficient and regulatable transposon mutagenesis in Escherichia coli, Acinetobacter baylyi and Pseudomonas aeruginosa. In P. aeruginosa PAO1, we have used this method to generate a Tn5 insertion library with an estimated diversity of ~ 108, which is ~ 2 logs larger than the best transposon insertional library of PAO1 and related Pseudomonas strains previously reported. CONCLUSION: We have developed a number of IPTG-controlled conditional suicide plasmids. By exploiting one of them for transposon delivery, a highly efficient and broadly useful mutagenesis system has been developed. As the assay condition is mild, we believe that our methodology will have broad applications in microbiology research.

How shall we transfuse Hippolyta?

The US Department of Defense recently made the decision to open direct ground combat roles to women. Blood product transfusion is an essential component of the US Military guidelines for tactical combat casualty care and damage control resuscitation, but blood transfusion carries with it the specific side effect of alloimmunization-a uniquely significant side effect for young women who may desire subsequent pregnancies. Presently to be considered are the changes that may need to be made to blood transfusion in the setting of battlefield medicine to optimally care for combat-injured women, as a majority of the existing data regarding the risks of transfusion in the trauma setting involve predominantly men. This article delves into the possibility of a new cohort of women at risk for hemolytic disease of the fetus and newborn, the need for women's health professionals to appropriately counsel women considering serving in direct ground combat roles about this specific risk, and the appropriate steps that should be considered to provide these women optimal medical care.

The Relationship Between Reminiscence Functions, Optimism, Depressive Symptoms, Physical Activity, and Pain in Older Adults.

The study purpose was to examine the association between reminiscence functions, optimism, depressive symptoms, physical activity, and pain in older adults with chronic lower extremity osteoarthritis pain. One hundred ninety-five community-dwelling adults were interviewed using the Modified Reminiscence Functions Scale, Brief Pain Inventory, Life Orientation Test-Revised, Center for Epidemiologic Studies Short Depression Scale, and Physical Activity Scale for the Elderly in random counterbalanced order. Structural equation modeling supported chronic pain as positively associated with depressive symptoms and comorbidities and unrelated to physical activity. Depressive symptoms were positively associated with self-negative reminiscence and negatively associated with optimism. Spontaneous reminiscence was not associated with increased physical activity or reduced pain. Individuals may require facilitated integrative reminiscence to assist them in reinterpreting negative memories in a more positive way. Facilitated integrative reminiscence about enjoyed past physical activity is a potential way to increase physical activity, but must be tested in future research. [Res Gerontol Nurs. 2016; 9(5):223-231.].

Current approaches and challenges in early detection of breast cancer recurrence.

Early detection of breast cancer recurrence is a key element of follow-up care and surveillance after completion of primary treatment. The goal is to improve survival by detecting and treating recurrent disease while potentially still curable assuming a more effective salvage surgery and treatment. In this review, we present the current guidelines for early detection of recurrent breast cancer in the adjuvant setting. Emphasis is placed on the multidisciplinary approach from surgery, medical oncology, and radiology with a discussion of the challenges faced within each setting.

Future directions for the early detection of recurrent breast cancer.

The main goal of follow-up care after breast cancer treatment is the early detection of disease recurrence. In this review, we emphasize the multidisciplinary approach to this continuity of care from surgery, medical oncology, and radiology. Challenges within each setting are briefly addressed as a means of discussion for the future directions of an effective and efficient surveillance plan of post-treatment breast cancer care.

Future directions for monitoring treatment responses in breast cancer.

In the prior review, we outlined the current standard of care for monitoring treatment responses in breast cancer and discussed the many challenges associated with these strategies. We described the challenges faced in common clinical settings such as the adjuvant setting, neoadjuvant setting, and the metastatic setting. In this review, we will expand upon future directions meant to overcome several of these current challenges. We will also explore several new and promising methods under investigation to enhance how we monitor treatment responses in breast cancer. Furthermore, we will highlight several new technologies and techniques for monitoring breast cancer treatment in the adjuvant, neoadjuvant and metastatic setting.

Current approaches and challenges in monitoring treatment responses in breast cancer.

Monitoring response to treatment is a key element in the management of breast cancer that involves several different viewpoints from surgery, radiology, and medical oncology. In the adjuvant setting, appropriate surgical and pathological evaluation guides adjuvant treatment and follow up care focuses on detecting recurrent disease with the intention of improving long term survival. In the neoadjuvant setting, assessing response to chemotherapy prior to surgery to include evaluation for pathologic response can provide prognostic information to help guide follow up care. In the metastatic setting, for those undergoing treatment, it is crucial to determine responders versus non-responders in order to help guide treatment decisions. In this review, we present the current guidelines for monitoring treatment response in the adjuvant, neoadjuvant, and metastatic setting. In addition, we also discuss challenges that are faced in each setting.

Incidence, predictors, costs, and outcome of renal cell carcinoma after kidney transplantation: USRDS experience.

INTRODUCTION: We carried out an analysis of the United States Renal Data System to determine the incidence, risk factors, prognosis, and costs associated with the diagnosis of renal cell carcinoma (RCC) after kidney transplantation. METHODS: This is a retrospective cohort of 40,821 Medicare primary renal transplant recipients transplanted from January 1, 2000, to July 1, 2005, and followed up till December 31, 2005, excluding those with prior RCC or nephrectomy. Kaplan-Meier analysis was performed to determine the time of occurrence of RCC, and Cox regression was used to determine factors associated with RCC. RESULTS: Three hundred sixty-eight patients were diagnosed with RCC within 3 years after transplant (incidence of 3.16 per 1000 person years). The 3-year incidence of RCC posttransplant was 9.29 per 1000 person years (2.3%) for those with pretransplant cysts and 3.08 per 1000 person years (0.7%) without pretransplant cysts. RCC was diagnosed disproportionately early posttransplant in patients with cysts. Cysts were independently associated with increased risk of RCC, as was male gender, older recipient, donor age, African American recipient, increased time on dialysis and acute rejection within first year posttransplant. RCC was associated with increased risk of mortality with a higher risk with pretransplant cysts. Patients who developed RCC had higher cumulative median costs ($55,456 at 2 years) than those who did not develop RCC ($40,369). There was no "clustering" of RCC in individual states or centers more than would be expected by chance. CONCLUSION: RCC was diagnosed disproportionately early in patients with pretransplant renal cysts and was associated with a worse prognosis and increased costs.