Proliferative glomerulonephritis with monoclonal immunoglobulin deposits triggered by COVID-19: a case report.

Acute kidney injury (AKI) frequently complicates corona virus disease 2019 (COVID-19) and is associated with significant mortality. Kidney disease in COVID-19 is usually due to acute tubular injury, but a variety of glomerular processes, especially collapsing glomerulopathy, have been increasingly described. Until recently, proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) had not been reported in the setting of COVID-19. We present a case of dialysis-dependent AKI developing soon after symptomatic COVID-19 which, on kidney biopsy, was found to be due to PGNMID with IgG3 kappa deposits. As is typical of PGNMID, a search for evidence of extra-renal monoclonal immunoglobulin or clonal lymphocyte population was negative. However, the patient had a favorable response to anti-plasma cell therapy and was ultimately able to stop hemodialysis. Though monoclonal gammopathy of renal significance (MGRS) is usually not associated with infection, other cases of post-viral MGRS, including PGNMID, have been previously reported. PGNMID has recently been linked specifically to COVID-19, with this representing one of only four cases reported thus far. Though causality between the preceding viral infection and the subsequent glomerulonephritis cannot be proven in these reports, nephrologists should be aware that not all kidney disease occurring in the aftermath of COVID-19 is due to tubular injury or collapsing glomerulopathy. As such, kidney biopsy should be routinely considered in the setting of COVID-19-associated glomerular disease as findings may change management. In the case of COVID-19-associated PGNMID data to guide treatment are limited, but our report suggests that anti-plasma cell therapy may be effective.

Systematic analysis of leisler's bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan / Análise sistemática do morcego de leisler Nyctalus leisleri (Kuhl, 1817) capturado na região das FATA, Paquistão

Abstract Extensive field surveys were carried out to explore the distribution of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.

Resumo Extensas pesquisas de campo foram realizadas para explorar a distribuição do morcego de Leisler Nyctalus leisleri (Kuhl, 1819), em uma área selecionada das regiões das FATA, Paquistão. Espécimes do morcego de Leisler Nyctalus leisleri (Kuhl, 1819) (n = 5) foram coletados na Agência Kurram (Shublan) (N33.8229788 E70.1634414), na elevação 1.427 m, e na Agência Khyber (Landi Kotel) (N34.0909899 E71.1457517), na elevação 1.091 m, por dois anos de pesquisa, estendendo-se de maio de 2013 a agosto de 2015. Os comprimentos médios da cabeça, do corpo, do pé traseiro, da orelha e da cauda dos espécimes de Nyctalus leisleri capturados na área de estudo foram de 65,08 ± 1,58 mm, 44,06 ± 0,52 mm, 8,38 ± 0,60 mm, 13,20 ± 0,99 mm e 39,46 ± 1,46 mm, respectivamente. Para análise molecular, foram obtidas e analisadas as sequências do gene COI. A média das divergências intraespecíficas de Nyctalus leisleri foi de 0,04%. As divergências interespecíficas médias de Nyctalus noctula e Nyctalus leisleri foram de 0,2%. A concentração média de cada nucleotídeos foi A = 26,3%, T = 32,8%, G = 15,9% e C = 25%. Os conteúdos médios de A + T foram de 59,2% e de C + G foram de 40,9%. Na árvore filogenética, Nyctalus leisleri e Nyctalus noctula agruparam-se com um valor significativo de suporte de bootstrap.

Comparative brain analysis of wild and hatchery reared Mahseer (Tor putitora) relative to their body weight and length / Análise comparativa do cérebro de Mahseer (Tor putitora) selvagem e criado em incubatório em relação ao peso e comprimento corporal

Abstract The present study was aimed at comparing the brain size of mahseer (Tor putitora) in relation to their body weight and standard length, to investigate the potential impact of rearing environment on brain development in fish. The weight of the brain and three of its subdivisions cerebellum (CB), optic tectum (OT), and telencephalon (TC) were measured for both wild and hatchery-reared fish. The data was analysed using multiple analysis of covariance (MANCOVA), analysis of covariance (ANCOVA), and discriminate function analysis (DFA). We found the fish reared under hatchery conditions exhibit smaller brain size related to body weight, when compared to the wild ones. A significant (p<0.5) difference was observed in the length of CB and OT concerning the standard body length while no significant difference was found in TC of the fish from both the origins. The results of the current study highlight a logical assumption that neural deficiency affects the behaviour of fish, that's why the captive-reared fish show maladaptive response and face fitness decline when released to the natural environment for wild stock enhancement. The current study concluded that hatchery-reared fish exhibit variations in gross brain morphology as compared to their wild counterpart.

Resumo O presente estudo teve como objetivo comparar o tamanho do cérebro de mahseer (Tor putitora) em relação ao seu peso corporal e comprimento padrão, para investigar o impacto potencial do ambiente de criação no desenvolvimento do cérebro em peixes. O peso do cérebro e três de suas subdivisões — cerebelo (CB), tectum óptico (OT) e telencéfalo (TC) — foram medidos para peixes selvagens e criados em incubadoras. Os dados foram analisados usando análise múltipla de covariância (MANCOVA), análise de covariância (ANCOVA) e análise de função discriminante (DFA). Descobrimos que os peixes criados em condições de incubação apresentam menor tamanho do cérebro em relação ao peso corporal quando comparados aos selvagens. Uma diferença significativa (p <0,5) foi observada no comprimento do CB e OT em relação ao comprimento corporal padrão, enquanto nenhuma diferença significativa foi encontrada no CT dos peixes de ambas as origens. Os resultados do estudo atual destacam uma suposição lógica de que a deficiência neural afeta o comportamento dos peixes. É por isso que os peixes criados em cativeiro mostram uma resposta mal adaptativa e enfrentam declínio de aptidão quando liberados no ambiente natural para o aprimoramento do estoque selvagem. O estudo atual concluiu que os peixes criados em incubadoras exibem variações na morfologia cerebral bruta em comparação com suas contrapartes selvagens.

Biodiversity of orb-web spiders (family: araneidae) of buner valley, Pakistan / Biodiversidade de aranhas construtoras de teia (família: araneidae) do vale buner, Paquistão

Abstract The present research was carried out to explore the spider fauna of Buner valley with taxonomic study from February 2018 to January 2019. For this purpose samples were collected, four times at each month from 4 tehsils: Daggar, Gagra, Mandan and Totalai. Two methods were used, hand picking and sweep net for collection of samples. During day and night, three habitats, arid area, agriculture land and building area were search for collection. A total of 534 samples of spider were collected from four sampling sites, in which 379 were belonging to family Araniedae. After confirmation, the identified species were belonging to 8 genera (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia and Poltys) and 19 species. 18 of them were identified to specie level while a single specie to its generic level. The genus Neoscona was the dominant genus 26.31% having 5 species while the genus Argiope 21.05% is the second dominant having 4 species followed by Cyclosa 15.78% having 3 species followed by Cyrtophora and Araneus 10.52% having two species both. The Poltys and Larinia 5.26% are the rarest genera represent single-single specie both. Statistical analysis show that specie richness (D) = 5.77, Simpson index (1-D) = 0.87, Shannon index (H) = 2.33. Diversity of spiders was evenly distributed and calculated Evenness value was H/InS = 0.5408. There is also few atypical species and Fisher alpha estimate high value (Fisher α) = 4.42. Chao-1 estimated we have reported 22 species.

Resumo A presente pesquisa foi realizada para explorar a fauna de aranhas do vale Buner, em um estudo taxonômico realizado de fevereiro de 2018 a janeiro de 2019. Para esse fim, foram coletadas amostras, quatro vezes por mês, a partir de 4 subdistritos: Daggar, Gagra, Mandan e Totalai. Foram utilizados dois métodos, coleta manual e rede de varredura, para a obtenção das amostras. Durante o dia e a noite, foram pesquisados ​​três habitats: área árida, área agrícola e área de construção. Foram coletadas 534 amostras de aranha em quatro locais de amostragem, sendo que 379 pertenciam à família Araneidae. Após a confirmação, as espécies identificadas pertenciam a 8 gêneros (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia e Poltys) e a 19 espécies (18 delas foram identificados em seu nível de espécie, enquanto uma única foi identificada em seu nível genérico). O gênero Neoscona foi dominante (26,31%), com 5 espécies, seguido pelos gêneros Argiope (21,05%), com 4 espécies, Cyclosa (15,78%), com 3 espécies, e Cyrtophora e Araneus (10,52%), com 2 espécies. Poltys e Larinia (5,26%) são os gêneros mais raros, representando a mesma espécie. A análise estatística mostrou que a riqueza de espécies (D) foi de 5,77, o índice de Simpson (1-D) foi de 0,87 e o índice de Shannon (H) foi de 2,33. A diversidade de aranhas foi distribuída uniformemente, e o valor calculado da uniformidade foi H / InS = 0,5408. Também existem poucas espécies atípicas, e o alfa de Fisher (Fisher α) estimou o valor de 4,42. Já Chao-1 estimou 22 espécies.

Severe methanol poisoning treated with a novel hemodialysis system: a case report, analysis, and review.

In May and June 2020, an outbreak of methanol poisoning arose in the southwest United States linked to ingestion of contaminated hand sanitizer imported during the coronavirus disease 2019 pandemic, ultimately resulting in over a dozen hospitalizations and at least four deaths in New Mexico and Arizona. In this report, we describe one of these cases in which profound methanol intoxication was successfully treated with the Tablo® Hemodialysis System, the first reported case of toxic alcohol poisoning treated with this novel device. We carry out a formal regression analysis of the serial methanol levels obtained in this case to conservatively estimate that intermittent hemodialysis with Tablo achieved a clearance of methanol of 239 mL/min (95% confidence interval, 173-305 mL/min), a clearance that is well within the previously published standard of care. We conclude by reviewing both the treatment of toxic alcohol poisoning and the determinants of small molecule clearance with hemodialysis, emphasizing the importance of optimizing the dialytic treatment of intoxications with extended treatment times and the use of high-efficiency dialyzers.

Comparative brain analysis of wild and hatchery reared Mahseer (Tor putitora) relative to their body weight and length.

The present study was aimed at comparing the brain size of mahseer (Tor putitora) in relation to their body weight and standard length, to investigate the potential impact of rearing environment on brain development in fish. The weight of the brain and three of its subdivisions cerebellum (CB), optic tectum (OT), and telencephalon (TC) were measured for both wild and hatchery-reared fish. The data was analysed using multiple analysis of covariance (MANCOVA), analysis of covariance (ANCOVA), and discriminate function analysis (DFA). We found the fish reared under hatchery conditions exhibit smaller brain size related to body weight, when compared to the wild ones. A significant (p<0.5) difference was observed in the length of CB and OT concerning the standard body length while no significant difference was found in TC of the fish from both the origins. The results of the current study highlight a logical assumption that neural deficiency affects the behaviour of fish, that's why the captive-reared fish show maladaptive response and face fitness decline when released to the natural environment for wild stock enhancement. The current study concluded that hatchery-reared fish exhibit variations in gross brain morphology as compared to their wild counterpart.

Biodiversity of orb-web spiders (family: araneidae) of buner valley, Pakistan.

The present research was carried out to explore the spider fauna of Buner valley with taxonomic study from February 2018 to January 2019. For this purpose samples were collected, four times at each month from 4 tehsils: Daggar, Gagra, Mandan and Totalai. Two methods were used, hand picking and sweep net for collection of samples. During day and night, three habitats, arid area, agriculture land and building area were search for collection. A total of 534 samples of spider were collected from four sampling sites, in which 379 were belonging to family Araniedae. After confirmation, the identified species were belonging to 8 genera (Neoscona, Argiope, Cyclosa, Araneus, Cyrtophora, Larinia, Erivoxia and Poltys) and 19 species. 18 of them were identified to specie level while a single specie to its generic level. The genus Neoscona was the dominant genus 26.31% having 5 species while the genus Argiope 21.05% is the second dominant having 4 species followed by Cyclosa 15.78% having 3 species followed by Cyrtophora and Araneus 10.52% having two species both. The Poltys and Larinia 5.26% are the rarest genera represent single-single specie both. Statistical analysis show that specie richness (D) = 5.77, Simpson index (1-D) = 0.87, Shannon index (H) = 2.33. Diversity of spiders was evenly distributed and calculated Evenness value was H/InS = 0.5408. There is also few atypical species and Fisher alpha estimate high value (Fisher α) = 4.42. Chao-1 estimated we have reported 22 species.

Systematic analysis of leisler's bat Nyctalus leisleri (Kuhl, 1817) captured from FATA region, Pakistan.

Extensive field surveys were carried out to explore the distribution of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) in selected area of FATA regions, Pakistan. Specimens of Leisler's Bat Nyctalus leisleri (Kuhl, 1819) (n5) were collected from Kurram Agency (Shublan) (N33.8229788 E70.1634414) at elevation 1427m and Khyber Agency (Landi Kotel) (N34.0909899 E71.1457517) at elevation 1091m for two years survey extending from May 2013 through August 2015. The mean head and body length, hind foot length, ear length and tail length the Nyctalus leisleri specimens captured from the study area was 65.08 ± 1.58 mm, 44.06 ± 0.52 mm, 8.38 ± 0.60 mm, 13.20 ± 0.99 mm and 39.46 ± 1.46 mm, respectively. For molecular analysis the sequences of COI gene were obtained and analyzed. The mean intraspecific divergences of Nyctalus leisleri was 0.04%. The mean interspecific divergences of Nyctalus noctula and Nyctalus leisleri was 0.2%. The mean concentration of each nucleotides was A = (26.3%), T = (32.8%), G = (15.9%) and C = (25.0%). The mean A+T contents were 59.2%and C+G were 40.9%. In the phylogenetic tree Nyctalus leisleri and Nyctalus noctula clustered with significant bootstrap support value.

Spatial knowledge and flood preparedness in Victoria Island, Lagos, Nigeria.

There is inadequate flood preparedness in Victoria Island, Lagos, Nigeria; because when the flood struck on 08 July 2017, several properties were destroyed without any extant means to salvage them. This article investigated the relationship between spatial knowledge and flood preparedness in Victoria Island. The variables employed to measure spatial knowledge include knowledge of: elevation of land, distance between Lagos lagoon and Atlantic Ocean, characteristics of surrounding water bodies and building-plot ratio. Major roads were used to subdivide Victoria Island into four zones. Zone A had 799 buildings, zone B had 813 buildings, zone C had 749 buildings and zone D had 887 buildings. Of the total 3248 buildings, 344 buildings were selected, and one household head per building was selected and systematically sampled. A multinomial logit regression model was used in data analysis at p ≤ 0.05. The findings revealed that spatial knowledge accounted for only 25.8% of the explanation of inadequate flood preparedness. Only 6.1% of the respondents could distinguish height from elevation; those who explained density and setbacks correctly were 7.85% and 12.2%, respectively. Respondents who stated the distance between Lagos lagoon and Atlantic Ocean correctly and exhibited means of preparedness were 13.7%, respectively. However, 74.4% described the primary and secondary water bodies and their flow pattern correctly. Although inadequate spatial knowledge did not statistically account for poor flood preparedness, yet majority of the respondents neither prepared adequately for the annual flood event, nor exhibited adequate spatial knowledge. Therefore, other factors require investigation, whilst residents should acquire spatial flood-related education to influence their sense of flood preparedness.

Potential effective inhibitory compounds against Prostate Specific Membrane Antigen (PSMA): A molecular docking and molecular dynamics study.

One of the most prevalent cancers in men is prostate cancer and could be managed with immunotoxins or antibody treatment. Because of the substantial rise of the Prostate-Specific Antigen and the Prostate-Specific Membrane Antigen (PSMA), cancer vaccination should be rendered with these antigens. Through pharmacodynamic experiments in a library of natural compounds from ZINC database, the current research sought to identify compounds that could suppress PSMA protein. To test the most productive compounds for further research, the Library has been scanned with Pharmacophore and ADMET analysis followed by molecular docking methods in the first phase. After selecting 15 ligands with the best pose related to docking results, to evaluate the stability of the ligand-protein bounds of the compounds, a molecular dynamics simulation considering the effect of the presence of zinc ions on the protein structure was performed. The measurement of ligand binding modes and free energy has shown that four compounds, including Z10, Z06, Z01, and Z03, have formed critical interactions with the active site's residues. Besides, multiple approaches were employed to determine their inhibition rating and describe the variables that facilitate the attachment of ligands to the protein active site. The results are obtained from the MMPBSA/GBSA analysis of four selected small molecules (Z10, Z06, Z01, and Z03), which are very close to the IC50 value of reference ligand (DCIBzl); they are -13.85 kcal/mol, -12.58 kcal/mol, -10.71 kcal/mol and -9.39 kcal/mol respectively. Finally, we evaluate the results obtained from selected ligands using hydrogen bond and decomposition analyzes. We have examined the effective interactions between ligands and S1/S1'pockets in protein. Our computational results illustrate the design of more efficient inhibitors of PSMA.

Single-use lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical spray; can it now be employed as a multi-use atomiser?

OBJECTIVE: This study investigated the risk of contamination of lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution after modification of the application technique. METHODS: This paper reports a prospective basic sciences study involving 22 study samples and 1 control sample of the lidocaine hydrochloride and phenylephrine hydrochloride topical anaesthetic spray. The samples were assessed for microbiological contamination after a single use on patients using a modified application technique. The modification involves keeping the nozzle (actuator) pressed down whilst withdrawing the spray to at least 30 cm (1 ft) from the patient, before releasing the nozzle (actuator) and subsequently reapplying the spray. RESULTS: Three of the 23 samples confirmed bacterial growth in the bottle contents, but there was no growth in any of the samples from the pump. These bacteria are considered to be contaminants. CONCLUSION: There is a potential to use the lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution as a multi-use spray by changing the actuator between patients. This would have significant beneficial cost implications without the attendant infection control risk.

Gamer's Thrombosis: A Review of Published Reports.

Background: Thrombosis, well known as a condition of the elderly, is occurring in the otherwise healthy adolescent population. Immobility is a significant risk factor for venous thromboembolism (VTE), and adolescents who play video games are immobile for extended periods of time. Some are presenting with VTE. When other risk factors such as obesity are present, the risk of VTE formation increases. We provide a review of published case reports regarding gaming and thrombosis. Methods: We searched PubMed, Scopus, Web of Science, and EBSCO for articles published through July 2019, using the keywords "computer game thrombosis," "computer game pulmonary embolism," "computer game deep vein thrombosis," "video game thrombosis," "video game pulmonary embolism," and "video game deep vein thrombosis." Results: Of the 26 articles we identified, we included 12 articles in our review that report a total of 15 cases, of which 2 resulted in fatalities. Modifiable risk factors included cigarette use, being overweight, birth control use, and prolonged immobility. Anticoagulation was the principal treatment modality in patients presenting with gaming thrombosis. Conclusion: We strongly encourage screening gamers for possible VTEs if clinically warranted.

Treating Non-fentanyl-derived Synthetic Opioid Overdose with a Traditional Opioid Reversal Agent.

As the opioid crisis in the United States continues to grow, non-fentanyl-derived synthetic opioids (NSOs) are growing in both availability and popularity. NSO use comes with considerable risk including a high potential for both abuse and overdose. In this editorial, we review the consequences of overdose with the NSOs U-47700 and butyrfentanyl (BF) and the potential for the use of naloxone as a treatment for such instances. Naloxone administration was found to be successful in reversing opioid effects and re-establishing independent breathing in a patient taking U-47700 or BF. With a high rate of success in treating opioid overdose and a low chance of negatively affecting healthy non-dependent persons, naloxone is an ideal medication in these situations. We recommend the use of naloxone in cases of NSO opioid overdose and advocate for the increased availability of naloxone products to improve overdose outcomes nationwide.

Optimizing Patient Outcomes with PD-1/PD-L1 Immune Checkpoint Inhibitors for the First-Line Treatment of Advanced Non-Small Cell Lung Cancer.

The rapidly expanding repertoire of immune checkpoint inhibitors (ICIs) now includes two agents, pembrolizumab and atezolizumab, approved for first-line treatment of advanced non-small cell lung cancer (aNSCLC) as monotherapy or as part of chemoimmunotherapy. This review summarizes the clinical evidence supporting these indications, with a focus on strategies to optimize patient outcomes. These strategies include patient and tumor factors, adverse-effect profiles, pharmacokinetic and pharmacodynamic drug interactions, and quality of life and cost-effectiveness considerations. We performed a systematic literature search of the PubMed, Scopus, and Google Scholar databases, as well as a search of the conference proceedings of the American Society of Clinical Oncology, European Society for Medical Oncology, and American Association for Cancer Research (through August 31, 2019). The addition of ICIs to conventional chemotherapy as first-line treatment against aNSCLC is now part of the standard of care options. However, even though ICIs may be cost-effective in patients with aNSCLC, high drug and other associated costs can still be a barrier to treatment for patients. Moreover, the adverse-effect profiles of ICIs differ significantly from conventional chemotherapy, and some immune-related adverse effects may have a lasting impact on quality of life. Therefore, in adhering to a patient-centered model of care, clinicians should be mindful of patient- and treatment-specific factors when considering therapeutic options for patients with aNSCLC. Although the role of the immune system in cancer progression and regression has not been fully elucidated, the full clinical potential of immunotherapeutics in the treatment of cancer likely remains to be unleashed.

The Road to a Hypoglycemic Care Model.

Hypoglycemia is a modifiable condition that causes mortality and readmission rates to increase in a hospital setting. The condition is worsened by its complications, quick onset, and an absence of a protocol mapped out by hospitals. This complication does not come from one origin, but rather from a range of barriers. Research from a variety of sources, such as those found from the American Diabetes Association, have shown great promises in ways to treat and prevent hypoglycemia that are of importance to highlight for practitioners in the inpatient setting.

Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea.

BACKGROUND: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection?

BACKGROUND: Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood. AIMS: To assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee; and to determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI. METHODS: Patients who had total/unicondylar knee or total hip arthroplasty were reviewed retrospectively over a five-year period. Pre-operative urine samples within one year of surgery were analysed, and those with ASB were identified. The primary outcome was PJI within the first postoperative year. FINDINGS: In total, 5542 patients were included. Of these, 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with PJI, 33 had a pre-operative urine sample recorded. The infection rates were 5% (seven of 140) in the ASB group, 0.61% (26 of 4228) in the no-ASB group and 1.96% (23 of 1174) in the group without a urine sample (P < 0.001). The ASB isolate was the same micro-organism as the PJI isolate in one of the seven cases. CONCLUSION: The association between ASB and PJI is statistically significant, but the urine isolates did not relate to the isolates in the prosthetic joint, suggesting that the relationship is unlikely to be causal.

The Relationship of UGT2B15 Pharmacogenetics and Lorazepam for Anxiety.

Anxiety affects over 260 million people worldwide. Benzodiazepines are a class of agents used in combination with other therapies for the management of anxiety. Lorazepam is a commonly prescribed benzodiazepine metabolized by uridine 5'-diphosphate-glucuronosyltransferases. Herein, we discuss recent findings regarding the pharmacogenetics of uridine 5'-diphosphate-glucuronosyltransferase 2B15 (UGT2B15), lorazepam, and its role in the treatment of anxiety.