Evaluation of piperacillin-tazobactam in experimental meningitis caused by a beta-lactamase-producing strain of K1-positive Escherichia coli.

We evaluated the pharmacokinetics and therapeutic efficacy of piperacillin combined with tazobactam, a novel beta-lactamase inhibitor, in experimental meningitis due to a beta-lactamase-producing strain of K1-positive Escherichia coli. Different doses of piperacillin and tazobactam, as single agents and combined (8:1 ratio; dosage range, 40/5 to 200/25 mg/kg per h), and of ceftriaxone were given to experimentally infected rabbits by intravenous bolus injection followed by a 5-h constant infusion. The mean (+/- standard deviation) rates for penetration into the cerebrospinal fluid of infected animals after coadministration of both drugs were 16.6 +/- 8.4% for piperacillin and 32.5 +/- 12.6% for tazobactam. Compared with either agent alone, combination treatment resulted in significantly better bactericidal activity in the cerebrospinal fluid. The bactericidal activity of piperacillin-tazobactam was dose dependent: cerebrospinal fluid bacterial titers were reduced by 0.37 +/- 0.19 log10 CFU/ml per h with the lowest dose versus 0.96 +/- 0.25 log10 CFU/ml per h with the highest dose (P less than 0.001). At the relatively high doses of 160/20 and 200/25 mg of piperacillin-tazobactam per kg per h, the bactericidal activity of the combination was comparable to that of 10 and 25 mg of ceftriaxone per kg per h, respectively.     

High-risk acute coronary syndrome patient and cardiac biomarkers in the emergency department: where do we stand?

Each year, more than five million patients are seen in emergencydepartment (ED) for evaluation of symptoms of myocardial ischaemia.The use of cardiac markers is a standard practice to risk-stratifythese patients. The interaction between duration of symptoms,timing of testing, and clearance kinetics of biomarkers determineswhether a marker will be positive. Current guidelines of theACC/ESC recommend serial measurements of CK-MB and/or cardiactroponins. Cardiac troponins are regulatory proteins with cytosolic andstructural pools. They are released upon myocardial necrosis.Troponin levels at admission provide much needed informationfor the evaluation and prognostication of patients who presentwith myocardial necrosis.^1,2     

Drugs associated with development of porokeratosis: A systematic review

Porokeratosis is a rare disorder characterized by atrophic macules or patches, with a well‐defined ridge‐like hyperkeratotic border called cornoid lamella. Although the exact pathogenesis is unknown, drug associated cases have recently been reported in the literature. As such, we systematically reviewed and identified drugs associated with drug‐induced porokeratosis, their resultant effects, and whether there was a casual relationship between the use of a drug and the development of porokeratosis. We searched for articles which reported drug‐induced porokeratosis in MEDLINE and Embase in June 2020. After full‐text review, 25 studies were included for analysis. We identified 26 patients with drug‐induced porokeratosis. The most common therapies associated with development of porokeratosis is biologic use, phototherapy, and radiotherapy. The most common clinical variants were the disseminated superficial or actinic types (60%), which occurred in psoriasis patients undergoing phototherapy, and eruptive disseminated type (24%) which occurred in the context of biologic therapies. The Naranjo score ranged from possible to probable for the identified treatments. Clinicians should consider drug reactions as possible triggering events for porokeratosis, especially for patients taking biologics, phototherapy, and radiotherapy. Large‐scale studies are required to confirm our findings and further explore the pathogenesis for drug‐induced porokeratosis.     

Cystatin C and neutrophil gelatinase-associated lipocalin as markers of renal function in pediatric heart transplant recipients

Abraham BP, Frazier EA, Morrow WR, Blaszak RT, Devarajan P, Mitsnefes M, Bryant JC, Sachdeva R. Cystatin C and neutrophil gelatinase‐associated lipocalin as markers of renal function in pediatric heart transplant recipients.
Pediatr Transplantation 2011: 15: 564–569. © 2011 John Wiley & Sons A/S. Abstract: We hypothesized that use of Schwartz formula underestimates the prevalence of CKD in PHT recipients. This study determined the prevalence and risk factors for CKD in PHT using novel methods‐serum cystatin C, CKiD formula, Revised Schwartz formula, s‐ and u‐NGAL. Serum BUN, creatinine, cystatin C and s‐ and u‐NGAL were measured after prospective enrollment. Schwartz formula GFR was compared with novel methods. CKD was defined as CKiD GFR < 90 mL/min/1.73 m². The s‐ and u‐NGAL were compared between those with and without CKD. Potential risk factors for CKD were analyzed. Seventy‐nine patients (46 male children or boys), mean age 9.9 ± 5.8 yr formed the study cohort. The prevalence of mild and moderate CKD was 2‐ to 3‐fold higher using novel methods compared to Schwartz formula. u‐NGAL and u‐NGAL/Cr were significantly higher in patients with CKD. u‐ and s‐NGAL had negative correlation with estimates of GFR. Women were at a higher risk for CKD (odds ratio 8.7) as was longer duration since transplant (p = 0.009). In conclusion, use of novel methods of GFR estimation unmasked 2‐ to 3‐fold increased prevalence of CKD in PHT. Women and those with longer duration since transplant are at higher risk for CKD.     

Determinants of vitamin a deficiency amongst children in Aligarh district,Uttar Pradesh

Objectives  

To determine the prevalence and determinants of xerophthalmia among children aged 0–60 months.     

National efforts to reform residency education in surgery.

Major changes in surgical practice and myriad external mandates have affected residency education in surgery. The traditional surgery residency education and training model has come under scrutiny, and calls for major reform of this model have been made by a variety of stakeholders. The American Surgical Association appointed a Blue Ribbon Committee in 2002 to consider the recent changes in surgical practice and surgical education and propose solutions that would ensure a well-educated and well-trained surgical workforce for the future. This committee included representatives from the American Surgical Association, the American College of Surgeons, the American Board of Surgery, and the Residency Review Committee for Surgery. The committee made several far-reaching recommendations relating to residency education in surgery. After the Blue Ribbon Committee completed its task in 2004, representatives from the aforementioned four organizations, the Association of Program Directors in Surgery, and the Association for Surgical Education created a national consortium called the Surgical Council on Resident Education (SCORE). This consortium is pursuing efforts to reform residency education in surgery and implement several key recommendations of the Blue Ribbon Committee. The principal area of focus of SCORE is the development of a national curriculum for surgery residency education and training. Other activities of SCORE include the development of a Web site to support surgery residency education and pursuit of international collaboration. SCORE's efforts will be key to offering surgery residents the best educational experiences, preparing residents for future practice, and supporting delivery of surgical care of the highest quality. The authors examine the current state of residency education in surgery and explore efforts underway to reform this educational model.     

Evaluation of a blended learning surgical skills course for rural surgeons

Background

Rural surgeons have unique learning needs not easily met by traditional continuing medical education courses.

Methods

A multidisciplinary team developed and implemented a skills curriculum focused on leadership and communication, advanced endoscopy, emergency urology, emergency gynecology, facial plastic surgery, ultrasound, and management of fingertip amputations.

Results

Twenty-five of 30 (89%) rural surgeons who completed a follow-up course evaluation reported that the knowledge acquired during the course had improved their practice and/or the quality of patient care, particularly by refining commonly used skills and expanding the care options they could offer to their patients. The surgeons reported incorporating changes in their communication and interaction with colleagues.

Conclusions

This course was successful, from participants' perspectives, in providing hands-on mentored training for a variety of skills that reflect the broad scope of practice of surgeons in rural areas. Attendees felt that their participation resulted in important behavior and practice changes.