Antimicrobial activity of lupulone against Clostridium perfringens in the chicken intestinal tract jejunum and caecum.

OBJECTIVES: Owing to the spread of antibiotic resistance among human infectious agents, there is a need to research antibiotic alternatives for use in animal agricultural systems. Antibiotic-free broiler chicken production systems are known to suffer from frequent outbreaks of necrotic enteritis due in part to pathogenic type A Clostridium perfringens. Hop (Humulus lupulus) bitter acids are known to possess potent antimicrobial activity. Lupulone was evaluated for in vivo antimicrobial activity to inhibit C. perfringens in a chick gastrointestinal colonization model. METHODS: Using a week-2 per os inoculated C. perfringens chicken colonization model, C. perfringens counts in mid-intestinal and caecal contents were compared between chickens administered lupulone at 62.5, 125 and 250 ppm in drinking water versus 0 ppm control. Results At day 22, post-hatch intestinal C. perfringens counts of lupulone-treated chickens were significantly lower (P < 0.05) than water-treated control groups in both jejunal and caecal sampling sites across all lupulone dosages tested. CONCLUSIONS: Lupulone administered through water inhibits gastrointestinal levels of inoculated pathogenic clostridia within the chicken gastrointestinal tract. Lupulone was effective within the chemically complex mixture of material within the gastrointestinal tract, thereby making this agent a target of further research as an antibiotic alternative for this and possibly other intestinal infections.

Three cases of AIDS-related psychiatric disorders.

Psychiatric disorders related to acquired immune deficiency syndrome (AIDS) can take various and complex forms. The authors present cases of AIDS patients in whom paranoia, organic brain syndrome, depression, or suicidal ideation was present.

Case report of ECT during high-risk pregnancy.

The authors present the case of a depressed woman given ECT during pregnancy and list administrative and monitoring techniques for protection of both fetus and mother when ECT is administered during pregnancy.

Diagnostic considerations and treatment approaches to underlying anxiety in the medically ill.

Autonomic and somatic manifestations of anxiety are common in medically ill patients. When anxiety symptoms occur in such patients, the psychiatrist's ability to rapidly identify anxiety and perform a proper differential diagnosis is important, and can be life-saving. For example, a patient with deteriorating cardiac or pulmonary function may be misidentified as primarily "anxious" and referred to the psychiatrist. The change in the patient's medical status is missed until the situation becomes critical. Medication side effects can also cause anxiety symptoms in the medically ill patient. It is important for the psychiatrist to have knowledge of medications commonly associated with such side effects. Diagnosing primary anxiety disorders, such as generalized anxiety disorder, panic disorder, or posttraumatic stress disorder, can be difficult in medically ill patients, but it is an important skill for the consulting psychiatrist. Anxiety can occur secondary to the stress or fear associated with illness, particularly serious illness. This presentation will discuss all of the aforementioned aspects of anxiety in the patient with concomitant medical illness.

Anxiety and mood disorders in medically ill patients.

In medically ill patients, anxiety symptoms and mood alteration are common. Anxiety or mood alteration may be due to a reaction to the stress of illness, a preexisting psychiatric disorder, a manifestation of the medical condition, or an adverse effect of medication. Psychiatrists are frequently called upon to differentiate among these causes and to recommend treatment. This article reviews anxiety, depression, and mania, which are frequently associated with physical disease, and provides an approach to differential diagnosis and treatment.

A combined treatment approach to anxiety in the medically ill.

Anxiety occurs frequently in patients who are medically ill. A proper search for the underlying cause of the anxiety is essential if the clinician is to make a correct diagnosis and initiate appropriate treatment. Two aspects of the patient's history are particularly important during assessment: the duration and severity of medical illness (and treatments) and the duration and severity of anxiety symptoms. When acute anxiety is encountered, the clinician must rule out a rapidly worsening medical condition, substance-induced anxiety (toxicity or withdrawal), and a psychological reaction to stressors associated with the medical illness. During evaluation of medically ill individuals with chronic anxiety, the clinician must rule out medical disorders that can mimic anxiety disorders, psychiatric disorders associated with anxiety symptoms, and poor adjustment to the medical illness. It is also worth remembering that anxiety disorders occur at an increased frequency in individuals who have chronic medical illness.

A treatment algorithm for the management of anxiety in primary care practice.

Patients frequently present to primary care physicians with somatic symptoms that mask an underlying anxiety disorder. As a result, unnecessary diagnostic tests are ordered, and inappropriate medications are prescribed. Psychiatrists may help improve their primary care colleagues' ability to identify and treat these anxiety disorders. This paper reviews the adverse effects of untreated anxiety in managed care settings and outlines a treatment algorithm that psychiatrists may wish to use to assist primary care physicians in the cost-efficient, pharmacologic treatment of anxiety disorders in their patients.

Factitious disorders.

Reports of factitious disorders, Munchausen's syndrome, and self-induced illness exist throughout medical history. In practice, disease simulation represents a spectrum of behaviors that range from relatively common and benign (e.g., pleading illness to avoid an unwanted social obligation) to rare and malignant forms (e.g., Munchausen's syndrome and factitious disorder by proxy). Factitious disorders are differentiated from malingering by the goal that motivates the individual's behavior. The only apparent goal in factitious illness is to gain the sick role; the goal in malingering is to gain rewards, such as compensation, or to avoid the unwanted, such as military service or jail. This article summarizes clinically relevant information on factitious disorders for primary care physicians.

Psychiatric disorders in the medically ill.

Psychiatric disorders commonly coexist in patients with medical illness. Three disorders encountered frequently are anxiety disorders, depression, and delirium. The authors discuss these psychiatric disorders and their treatment in medically ill patients. Psychiatric consultation may be helpful in such cases.

Psychopharmacology in the elderly.

By the year 2030, it is estimated that 17% of the population (52 million people) will be over age 65. Most of these individuals will be taking several medications, and one or more of these medications may be a psychotropic, that is, an antidepressant, anxiolytic, antipsychotic, or lithium. This article summarizes the pharmacokinetic changes that accompany aging and highlight how these changes impact the elderly.

Quantitative analysis of the intestinal bacterial community in one- to three-week-old commercially reared broiler chickens fed conventional or antibiotic-free vegetable-based diets.

AIMS: To explore the effect of drug-free poultry production on the intestinal microflora of broiler chickens, the bacterial community of this environment was quantitatively profiled in both conventionally reared birds and birds reared without antibiotic growth promotants (AGPs) on a vegetable-based diet. METHODS AND RESULTS: Quantitative, real-time PCR with group-specific 16S rDNA primer sets was used to enumerate the abundance of the following chicken gastrointestinal (GI) tract phylogenetic groups: the Clostridium leptum-Faecalibacterium prausnitzii subgroup (Clostridium genus cluster IV), the Clostridium coccoides - Eubacterium rectale subgroup (Clostridium cluster XIVa and XIVb), the Bacteroides group (including Prevotella and Porphyromonas), Bifidobacterium spp., the Enterobacteriaceae, the Lactobacillus group (including the genera Leuconostoc, Pediococcus, Aerococcus and Weissella), the Clostridium perfringens subgroup (Clostridium cluster I), Enterococcus spp., Veillonella spp., Atopobium spp., Campylobacter spp. and the domain Bacteria. A species-specific 5'-nuclease (Taqman) assay was also employed to specifically assess Cl. perfringens abundance. Ten birds were sampled from each of two commercial chicken houses, one in which feed was supplemented with AGPs and exogenous animal protein, and the other vegetable-based and drug-free, at 7, 14 and 21 days of age. The ileal community was dominated by two large populations, the lactobacilli and the Enterobacteriaceae, with those taxa much more numerous in drug-free vegetable-based diet fed birds than those conventionally reared at the 7- and 14-day time periods. The progressive changes in microflora in both the conventional and drug-free caeca were similar to each other, with the Enterobacteriaceae sequences dominating at day 7, but being replaced by obligate anaerobe signature sequences by day 14. Of note was the finding that all the day 14 and day 21 replicate caecal samples from the drug-free house were positive for Campylobacter spp. averaging >10(8) 16S rDNA gene copies per gram wet weight. CONCLUSIONS: Quantitative, real-time PCR indicates that the effects of drug-free rearing on the chicken GI tract microbial community are most pronounced in the ileal region, but AGPs may be important in controlling Campylobacter colonization of the caecum. SIGNIFICANCE AND IMPACT OF THE STUDY: A quantitative taxonomic understanding of the shifting microbial ecology of the broiler chicken gut microbiota is important in the light of AGP withdrawal. AGP withdrawal has occurred in response to concerns over the transfer of antimicrobial-resistant bacteria to humans via the food production chain.

Molecular subtyping of poultry-associated type A Clostridium perfringens isolates by repetitive-element PCR.

Clostridium perfringens strains (type A) isolated from an integrated poultry operation were subtyped using repetitive-element PCR with Dt primers. Isolates were obtained from fecal, egg shell, fluff, and carcass rinse samples as part of a previously reported temporally linked epidemiological survey. A total of 48 isolates of C. perfringens were obtained from different stages of the broiler chicken production chain from two separate breeder farms that supplied a single hatchery that in turn provided chicks to a single grow-out farm whose flocks were processed at a single plant. All 48 isolates were typeable (100% typeability) by repetitive-element PCR with Dt primers. This subtyping method was highly reproducible and discriminatory. By repetitive-element PCR with Dt primers, isolates were classified into four major branches with 12 subgroups or clades. The Simpson's index of discrimination was calculated to be 0.96 for groupings of >95% correlation. Toxin gene profiles of the isolates indicated that all of the isolates were C. perfringens alpha-toxin gene positive and 46 of 48 isolates were beta2-toxin gene positive. All strains were negative for beta- and epsilon-toxin genes. Repetitive sequence-based PCR was found to be a technically practical and reproducible means of subtyping C. perfringens libraries from specific epidemiological or production environment settings.

Working with medicated clients: a primer for social workers.

The vastly increased use of prescribed and nonprescribed drugs in this society means that even such traditional social work activities as assessment and advocacy now frequently require a knowledge of the effects of drugs. Integrating a knowledge of basic concepts of pharmacology into practice will enable the social worker to help clients more effectively and to improve the health care they receive.

Causes of organic mood disorder.

A retrospective review of the records of 755 patients seen by a psychiatric consultation-liaison service in a general hospital was performed. The authors found that 87% of manic patients and 38% of depressed patients had a diagnosis of organic mood disorder. The most frequent precipitants of mania were corticosteroids, human immunodeficiency virus (HIV) infection, and temporolimbic epilepsy. The most frequent precipitants of depression were stroke, Parkinson's disease, and HIV infection.

The clinical and financial burden of mood disorders. Cost and outcome.

Depressive disorders are a chronic, recurrent, and severe burden to both patients and their families. Depressive disorders represent a major national public health problem, ranking within the top 10 most costly diseases in the United States. In 1990, depressive disorders afflicted at least 11 million Americans and cost the U.S. economy an estimated $44 billion. In addition, affective disorders are associated with increased accident rates, increased rates of substance abuse (especially alcoholism), increased medical hospitalization, and an increase in somatic illnesses and outpatient medical utilization. Despite their ranking as a major health problem, depressive disorders are often underdiagnosed and undertreated. Brief treatment strategies that focus only on acute episodes are often ineffective and result in chronic impairment, impairing performance at work and socially. Inadequate treatment increases costs, suffering, and lost productivity. Recent data suggest that effective treatment of depression requires long-term, skillful follow-up and active pharmacotherapy.

Anxiety and neurological disorders.

Anxiety disorders occur quite frequently in patients who have neurologic disorders. In fact, several studies show that anxiety disorders occur more frequently than mood disorders in patients with neurologic conditions. Despite high prevalence rates, investigators have neglected the study of anxiety disorders in these patients. Two major reasons for the neglect are the diagnostic hierarchy and exclusion criterion found in Diagnostic and Statistical Manual (DSM)-III-R and DSM-IV. This article discusses problems in the diagnosis of anxiety disorders in patients with neurologic conditions and presents a brief literature review of the relationship between anxiety and neurologic disorders. In addition, the authors describe the differential diagnosis of anxiety in neurologic conditions and treatment options.

Choreoathetosis: a sign of lithium toxicity.

Two patients who developed choreoathetosis in the course of lithium treatment are described, and other cases of choreoathetosis in lithium-treated patients are reviewed. Choreoathetosis is suggested to be a sign of lithium toxicity, almost always accompanied by other signs of neurotoxicity, such as delirium and cerebellar dysfunction. Of the reported cases, 44% developed permanent movement disorders, and 63% of the patients with permanent deficits were taking both lithium and neuroleptic. When choreoathetosis was not permanent, the average duration was seven days after discontinuation of lithium (range, 1 to 90 days).

Methylosarcina fibrata gen. nov., sp. nov. and Methylosarcina quisquiliarum sp.nov., novel type 1 methanotrophs.

Two novel species of obligate methane-oxidizing bacteria, isolated from landfill soil, were characterized. Both strains were unusual in that some members of the population grew in irregularly shaped, refractile cell packets that resembled sarcina-like clusters. Electron microscopy revealed that the cell packets were covered with a slime layer and the cells contained many large granular inclusion bodies. The individual cells of each strain were sometimes motile and had differing morphologies. Isolate AML-C10T was always coccoidal in shape, and the cells were covered with extracellular fibrils. Isolate AML-D4T was pleomorphic, changing from rod to coccal form, sometimes exhibiting an unusual fusiform morphology. AML-D4T lacked the extensive fibrillar matrix observed with AML-C10T. Both strains utilized only methane and methanol as carbon sources. In stationary phase, the cells of each strain swelled in size and formed cysts. Aside from morphological differences, strains could also be distinguished from each other by cellular protein patterns, as well as by temperature and pH tolerances. 16S rDNA phylogenetic analysis showed that these are type I methanotrophs (family: Methylococcaceae) most closely related to the Methylobacter/Methylomicrobium clade, although they form a monophyletic grouping supported by moderately high bootstrap values. By 16S rDNA database searches, the most similar species to both isolates were Methylobacter spp. However, partial particulate methane monooxygenase sequence analysis suggested that these bacteria might be more closely related to Methylomicrobium than Methylobacter. Furthermore, cellular fatty acid profiles of the strains more closely resemble those of Methylomicrobium, although the absence of significant levels of 16:1omega5c argues for the uniqueness of these two strains. On the basis of the results described here, it is proposed that a new genus should be created, Methylosarcina gen. nov., harbouring two species, Methylosarcina fibrata sp. nov. (type species) and Methylosarcina quisquiliarum sp. nov. The type strains are AML-C10T (= ATCC 700909T = DSM 13736T) and AML-D4T (= ATCC 700908T = DSM 13737T), respectively.