SURGICAL MANAGEMENT OF A TARSAL LUXATION IN A RED KANGAROO (OSPHRANTER RUFUS).

Joint luxations commonly occur in animals secondary to traumatic injury. Because of the unique hind-limb anatomy of macropods, surgical stabilization of orthopedic injuries is considered challenging, and reports of successful management are limited. A 4-yr-old male neutered red kangaroo (Osphranter rufus) presented with a dorsolateral luxation of the left tibiotarsal joint. Surgical reduction and tarsal arthrodesis were performed. Although the full range of motion of the tarsal joint was limited, this kangaroo was still able to ambulate normally at slow speeds following surgery and recovery. The aim of this report was to describe the surgical and postoperative management of a tibiotarsal luxation in a kangaroo. There were significant postoperative complications in this kangaroo, and antibiotic regional limb perfusion was used to treat wound and implant infection.

Dialysis Water Supply Faucet as Reservoir for Carbapenemase-Producing Pseudomonas aeruginosa.

During June 2017-November 2019, a total 36 patients with carbapenem-resistant Pseudomonas aeruginosa harboring Verona-integron-encoded metallo-ß-lactamase were identified in a city in western Texas, USA. A faucet contaminated with the organism, identified through environmental sampling, in a specialty care room was the likely source for infection in a subset of patients.

Assessment and Revision of the Veterinary Internship and Residency Matching Program Standardized Letter of Reference.

The Veterinary Internship and Residency Matching Program (VIRMP) recently revised its electronic standardized letter of reference (SLOR) to improve the quality and usefulness of the data obtained from it and to enhance the relevance of non-cognitive and cognitive candidate attributes assessed. We used a stepwise process including a broad survey of SLOR readers and writers, analysis of past SLORs, and a multi-wave iterative revision that included key stakeholders, such as residency and internship program directors from academia and private practice. Data from the SLOR survey and analysis of past SLOR responses identified opportunities to improve applicant differentiation, mitigate positive bias, and encourage response consistency. The survey and other analytics identified and confirmed performance domains of high relevance. The revised SLOR assesses four performance domains: knowledge base and clinical skills, stress and time management, interpersonal skills, and personal characteristics. Ratings within the revised SLOR are predominantly criterion-referenced to enhance discernment of candidate attributes contained within each domain. Questions assessing areas of strength and targeted mentoring were replaced with free-text boxes, which allow writers to comment on positive and neutral/negative ratings of attributes within domains. Minor revisions were made to certain questions to enhance readability, streamline responses, or address targeted concerns identified in the SLOR survey or stakeholder review. The revised SLOR was deployed in the 2020 VIRMP; data from a survey of writers (n = 647) and readers (n = 378) indicate that the redesign objectives were achieved.

Disseminated Scytalidium infection in a German shepherd dog.

We report a systemic mycosis in a German shepherd dog caused by Scytalidium spp. The patient presented for progressive cervical pain and forelimb hemiparesis. Cervical computed tomography revealed lysis associated with multiple vertebrae and a soft tissue mass adjacent to the spinal cord, as well as prescapular lymphadenopathy. Fine needle aspirates of the lymph nodes yielded hyphae, and a subsequent culture obtained a Scytalidium spp. Itraconazole therapy was initiated, but the subject was euthanized three months later due to progressive neurologic disease and discomfort. This appears to be the first report of disseminated disease by this species in veterinary medicine.

Accessing antiretroviral therapy following release from prison.

CONTEXT: Interruption of antiretroviral therapy (ART) during the first weeks after release from prison may increase risk for adverse clinical outcomes, transmission of human immunodeficiency virus (HIV), and drug-resistant HIV reservoirs in the community. The extent to which HIV-infected inmates experience ART interruption following release from prison is unknown. OBJECTIVES: To determine the proportion of inmates who filled an ART prescription within 60 days after release from prison and to examine predictors of this outcome. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of all 2115 HIV-infected inmates released from the Texas Department of Criminal Justice prison system between January 2004 and December 2007 and who were receiving ART before release. MAIN OUTCOME MEASURE: Proportion of inmates who filled an ART prescription within 10, 30, and 60 days of release from prison. RESULTS: Among the entire study cohort (N = 2115), an initial prescription for ART was filled by 115 (5.4%) inmates within 10 days of release (95% confidence interval [CI], 4.5%-6.5%), by 375 (17.7%) within 30 days (95% CI, 16.2%-19.4%), and by 634 (30.0%) within 60 days (95% CI, 28.1%-32.0%). In a multivariate analysis of predictors (including sex, age, race/ethnicity, viral load, duration of ART, year of discharge, duration of incarceration, parole, and AIDS Drug Assistance Program application assistance), Hispanic and African American inmates were less likely to fill a prescription within 10 days (adjusted estimated risk ratio [RR], 0.4 [95% CI, 0.2-0.8] and 0.4 [95% CI, 0.3-0.7], respectively) and 30 days (adjusted estimated RR, 0.7 [95% CI, 0.5-0.9] and 0.7 [95% CI, 0.5-0.9]). Inmates with an undetectable viral load were more likely to fill a prescription within 10 days (adjusted estimated RR, 1.8 [95% CI, 1.2-2.7]), 30 days (1.5 [95% CI, 1.2-1.8]), and 60 days (1.3 [95% CI, 1.1-1.5]). Inmates released on parole were more likely to fill a prescription within 30 days (adjusted estimated RR, 1.3 [95% CI, 1.1-1.6]) and 60 days (1.5 [95% CI, 1.4-1.7]). Inmates who received assistance completing a Texas AIDS Drug Assistance Program application were more likely to fill a prescription within 10 days (adjusted estimated RR, 3.1 [95% CI, 2.0-4.9]), 30 days (1.8 [95% CI, 1.4-2.2]), and 60 days (1.3 [95% CI, 1.1-1.4]). CONCLUSION: Only a small percentage of Texas prison inmates receiving ART while incarcerated filled an initial ART prescription within 60 days of their release.

Excessive production of sex hormones in a cat with an adrenocortical tumor.

CASE DESCRIPTION: A 13-year-old neutered male domestic shorthair cat was evaluated because it was spraying urine that had a strong odor and had developed aggressive behavior. CLINICAL FINDINGS: Physical examination did not detect any palpable testes within the scrotum; however, spines were detected on the penis. Abdominal ultrasonography revealed a mass in the region of the right adrenal gland. Results of adrenal hormonal analyses revealed considerable increases in serum concentrations of androstenedione and testosterone. TREATMENT AND OUTCOME: A mass associated with the right adrenal gland was found during exploratory laparotomy. There was no invasion of the mass into the caudal vena cava. No ectopic gonadal tissue was seen within the abdomen. Adrenalectomy of the right adrenal gland was performed, and histologic evaluation of the mass revealed an adrenocortical adenoma. Two weeks after surgery, serum concentrations of androgens had decreased. Eight weeks after surgery, the cat was no longer spraying urine and was acting affectionate toward the owner. CLINICAL RELEVANCE: Adrenal gland tumors can produce a variety of hormones other than cortisol. An adrenal gland tumor should be considered in neutered cats with newly developed physical and behavioral changes of a sexual nature. In the absence of debilitating conditions that are often associated with hyperadrenocorticism, cats undergoing adrenalectomy for an adrenal gland tumor that is producing sex hormones may have resolution of clinical signs and a good prognosis.

Does prior acute exercise affect postexercise substrate oxidation in response to a high carbohydrate meal?

BACKGROUND: Consumption of a mixed meal increases postprandial carbohydrate utilization and decreases fat oxidation. On the other hand, acute endurance exercise increases fat oxidation and decreases carbohydrate utilization during the post-exercise recovery period. It is possible that the resulting post-exercise increase in circulating nonesterified fatty acids could attenuate the ability of ingested carbohydrate to inhibit lipid oxidation. The purpose of this study was to determine whether prior exercise attenuates the usual meal-induced decline in lipid oxidation. METHODS: Six healthy, physically active young subjects (x age = 26.3 years, 4 males, 2 females) completed three treatments in random order after a ~10 h fast: (a) Exercise/Carbohydrate (Ex/CHO) - subjects completed a bout of exercise at 70% VO2peak (targeted net energy cost of 400 kcals), followed by consumption of a carbohydrate-rich meal; (b) Exercise/Placebo (Ex/Placebo) - subjects completed an identical bout of exercise followed by consumption of a placebo; and (c) No Exercise/Carbohydrate (NoEx/CHO) - subjects sat quietly rather than exercising and then consumed the carbohydrate-rich meal. Blood samples were obtained before and during the postprandial period to determine plasma glucose, insulin, and non-esterified fatty acids (NEFA). Respiratory gas exchange measures were used to estimate rates of fat and carbohydrate oxidation. RESULTS: Plasma NEFA were approximately two-fold higher immediately following the two exercise conditions compared to the no-exercise condition, while meal consumption significantly increased insulin and glucose in both Ex/CHO and NoEx/CHO. NEFA concentrations fell rapidly during the 2-h postprandial period, but remained higher compared to the NoEx/CHO treatment. Carbohydrate oxidation increased rapidly and fat oxidation decreased in response to the meal, with no differences in the rates of carbohydrate and fat oxidation during recovery between the Ex/CHO and NoEx/CHO conditions. CONCLUSION: The plasma NEFA concentration is increased during the post exercise period, which is associated with elevated fat oxidation when no meal is consumed. However, when a mixed meal is consumed immediately following exercise, the initially elevated plasma NEFA concentration decreases rapidly, and postexercise fat oxidation during this 2-h postexercise, postprandial period is no higher than that of the 2-h postprandial period without prior exercise.

Alta prevalência de deficiência de imunoglobulina A detectada por ELISAem pacientes com diabetes mellitus / High prevalence of immunoglobulin A deficiency in patients with type 1 diabetes mellitus detected by ELISA

Objetivo: Medir as concentrações séricas de imunoglobulina A por ensaio imunoenzimático (ELISA) em pacientes com diabetes mellitus tipo 1 (DM-1) e verificar a prevalência da deficiência de imunoglobulina A (DIgA) em pacientes diabéticos. Métodos: A concentração sérica de imunoglobulina A foi determinada em 149 pacientes portadores de DM-1 por três métodos. A DIgA foi definida como sendo nível sérico inferior a 5 mg/dl. Quando os níveis séricos de imunoglobulina A eram indetectáveis por turbidimetria, realizou-se imunodifusão radial em concentração de placa baixa. Para os pacientes em que os níveis séricos de imunoglobulina A foram indetectáveis pelos dois métodos anteriores, a imunoglobulina sérica foi quantificada por ELISA. Em pacientes com DIgA, os níveis de imunoglobulina G e M foram medidos por turbidimetria para excluir outras deficiências humorais. Resultados: Dos 149 pacientes portadores de DM-1 avaliados, 141 (94,6%) tinham níveis séricos normais de imunoglobulina A por turbidimetria. Oito pacientes (5,3%) apresentavam níveis séricos indetectáveis de imunoglobulina A por turbidimetria e imunodifusão radial. Nesses oito pacientes, a determinação sérica de imunoglobulina A foi realizada por um método mais sensível, ELISA. Níveis séricos muito baixos de imunoglobulina A foram detectados nesses pacientes diabéticos. Em todos os pacientes diabéticos, os níveis séricos de imunoglobulinas G e M medidos por turbidimetria foram normais para a idade. Todos os 150 pacientes do Grupo Controle tiveram níveis séricos normais de imunoglobulina A por ELISA. Conclusões: Houve uma prevalência significativamente alta de DIgA entre os pacientes diabéticos tipo 1 (5,3%). A dosagem de imunoglobulina A em todos os pacientes diabéticos do tipo 1 é necessária, especialmente na fase anterior a alguns testes de triagem baseados em anticorpos de imunoglobina A. Pacientes com DIgA podem ter resultados falsos-negativos para testes de triagem de doença celíaca envolvendo anticorpos antiendomisio e antigliadina.

Effect of acute prior exercise on glycemic and insulinemic indices.

BACKGROUND: Acute exercise is associated with increased insulin sensitivity characterized by increased insulin-induced glucose transport for periods of up to 48 h after the bout of exercise. This suggests that the glycemic response to a meal may be altered by prior exercise. OBJECTIVE: We tested the hypothesis that the glycemic and insulinemic responses to a test food consumed following exercise would be lower than when consumed without prior exercise. DESIGN: Four lean males (age: 27 +/- 4 y) and 4 females (age: 23 +/- 3 y) completed 3 experimental conditions in random order: ExCHO-Subjects exercised on a cycle ergometer at 70% VO2peak with a net energy cost of 400 kcal, which was followed by consumption of a high carbohydrate (CHO) energy bar; NoExCHO-Same as ExCHO except subjects sat quietly rather than exercised; and NoExGlc-Same as NoExCHO except subjects consumed a 50 g glucose (glc) drink as the reference CHO for GI and insulinemic index (II) determination. For each condition, following exercise or rest, baseline venous blood samples were obtained. Postprandial blood samples were obtained at 15 min intervals for 2 h. RESULTS: Neither the 2-h glucose area under the curve (AUC) or the GI were different between ExCHO and NoExCHO. The insulin AUC for ExCHO was 28% lower than the insulin AUC for NoExCHO (p = 0.03). The calculated II for the ExCHO condition was 30% lower than that of NoExCHO (p = 0.05). CONCLUSIONS: An acute bout of prior exercise had no effect on the GI of an energy bar compared to that of the same food determined under the standard no-exercise conditions. However, prior exercise resulted in a lower 2-h insulin response to the CHO-rich energy bar.