Vertebral osteomyelitis and epidural abscesses caused by Prevotella oralis: a case report

An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.

Vertebral osteomyelitis and epidural abscesses caused by Prevotella oralis: a case report.

An interesting case of pyogenic vertebral osteomyelitis with multiple epidural abscesses caused by non-pigmented Prevotella oralis is reported. The patient was a 68-year-old female who presented to the emergency room (ER) with severe pain and tenderness in her lower back with fever. She had recently undergone esophagogastroduodensoscopy (EGD) for complaints of esophageal reflux, which showed submucosal cyst in the esophagus. Magnetic resonance imaging (MRI) of the thoracic spine revealed multiple spinal epidural abscesses with signal enhancement at the level of T6 and T7, suggestive of vertebral osteomyelitis. Two blood cultures drawn one hour apart grew Prevotella oralis. The body fluid aspirated from the abscesses was also positive for the anaerobic commensal P. oralis. Necrosis associated with the submucosal cyst was implicated as the cause of sepsis and osteomyelitis due to this organism.

Do geriatricians stay in geriatrics?.

To evaluate whether formally trained geriatricians remain in the field of Geriatrics, and to determine their job satisfaction and perceived quality of life, we surveyed the 107 fellows trained over the last 25 years in one accredited geriatric program. Of the 88 physicians who consented to participate, 75% devoted at least half of their practice to the care of the elderly. On an academic level, 89.5% had, or planned to pursue, recertification in geriatric medicine. Ninety-five percent of these geriatricians felt that the impact of a formal geriatric fellowship was positive on their medical career and satisfaction index. Sixty-four percent had yearly incomes between $100 and $200k, and 25.6% had income greater than $200k. Eighty-seven percent would recommend pursuing geriatric fellowship training. We need to further explore how recruitment process and job opportunities are presented to potential geriatric fellows.

In vivo and in vitro evaluation of three controlled release principles of 6-N-cyclohexyl-2'-O-methyladenosine.

6-N-Cyclohexyl-2'-O-methyladenosine was formulated into controlled release formulations exhibiting comparable in vitro release profiles using different formulation principles, i.e. osmotic pump tablets, membrane-coated pellets and hydrophilic matrix tablet. Dissolution behaviour of these formulations was evaluated in vitro under various testing conditions to assess the effect of pH and hydrodynamic conditions. It was found that osmotic tablets were not sensitive to dissolution media pH and hydrodynamics change, while drug release from monolithic hydrophilic matrix tablets were pH-dependent. When tested in vivo in dogs, it was found that metabolism of 6-N-Cyclohexyl-2'-O-methyladenosine was extensive and appeared to be saturable based on a pharmacokinetic study. Cumulative percent input in vivo (%dose) was obtained by numerical deconvolution, and compared to in vitro release profiles. A linear correlation between fraction absorbed (FRA) in vivo and fraction dissolved (FRD) in vitro was established for osmotic tablets--a true zero-order release formula, whereas only a nonlinear correlation was obtained for membrane-coated pellets. The difference in the in vivo behaviour of these formulations, despite their similar in vitro release characteristics, demonstrated the effect of different controlled release principles on their in vivo bioavailability. The curvature of fraction absorbed in vivo vs. fraction dissolved in vitro for membrane-coated pellets indicated that there was a time-scale difference between in vivo and in vitro testing. In conclusion, drug release from the osmotic system was independent of in vitro and in vivo conditions, where best sustained release effect was achieved, whereas the in vitro dissolution test employed for membrane-coated pellets and hydrophilic matrix tablets needed to be optimized to be biorelevant.