Short- and long-term cure rates of short-duration trimethoprim-sulfamethoxazole treatment in female dogs with uncomplicated bacterial cystitis

Background

Long‐duration beta‐lactam antibiotics are used for empirical treatment in female dogs with uncomplicated bacterial cystitis. However, women with bacterial cystitis are treated with short‐duration potentiated sulfonamides because longer courses of beta‐lactams result in lower cure and higher recurrence rates.

Hypothesis/Objectives

Short‐duration potentiated sulfonamide treatment is more efficacious than long‐duration beta‐lactam treatment in achieving clinical and microbiological cures in female dogs with uncomplicated bacterial cystitis.

Animals

Thirty‐eight client‐owned female dogs.

Methods

Randomized, double‐blinded, placebo‐controlled clinical trial. Dogs were treated with TMP‐SMX (15 mg/kg PO q12h for 3 days followed by a placebo capsule PO q12h for 7 days; Group SDS; n = 20) or cephalexin (20 mg/kg PO q12h for 10 days; Group LDBL; n = 18). Dogs were monitored for clinical and microbiological cure during treatment and at short‐ and long‐term follow‐up.

Results

No statistically significant differences were found between treatment groups in clinical cure rates after 3 days of treatment (89% SDS, 94% LDBL; P = 1.00) and 4 days (85% SDS, 72% LDBL; P = .44) or >30 days (50% SDS, 65% LDBL; P = .50) after conclusion of treatment or in microbiological cure rates 4 days (59% SDS, 36% LDBL; P = .44) or >30 days (44% SDS, 20% LDBL; P = .40) after conclusion of treatment.

Conclusions and Clinical Importance

We did not identify a difference in cure rates between short‐duration sulfonamide and long‐duration beta‐lactam treatments in female dogs with uncomplicated cystitis. Long‐term cure rates in both treatment groups were low. In some female dogs, “uncomplicated” bacterial cystitis may be more complicated than previously recognized.

Glucose regulation of β-cell stress in type 2 diabetes

In type 2 diabetes, the β-cell is exposed to chronic hyperglycaemia, which increases its metabolic activity, with excess generation of reactive oxygen species (ROS) as a consequence. ROS accumulation induces both oxidative and endoplasmic reticulum (ER) stress, which may lead to β-cell dysfunction and apoptosis. Recent data suggest that oxidative and ER stress are interconnected, although the mechanisms involved in nutrient regulation of the different stress pathways are dissimilar. Several components of the oxidative and ER stress machineries have important roles in the physiological response to glucose and are thus necessary for normal β-cell function. Glucose stimulates signalling pathways that provide crucial messages for β-cell adaptation to metabolic stress; however, the same pathways may eventually lead to apoptosis. Dynamic, temporally fluctuating activation of stress signalling is probably required for the maintenance of β-cell survival, whereas its persistent activation results in β-cell dysfunction and apoptosis. Thus, stress signalling is a 'double-edged sword' that may promote adaptation or apoptosis according to the balance between the divergent outputs of the various pathways. Developing new strategies for β-cell protection based on inhibition of oxidative and/or ER stress requires comprehensive understanding of the switch from β-cell adaptation to β-cell apoptosis under conditions of metabolic stress, such as occurs under hyperglycaemic conditions.

Neuronal nitric oxide synthase protects the pancreatic beta cell from glucolipotoxicity-induced endoplasmic reticulum stress and apoptosis

AIMS/HYPOTHESIS

Cytokines stimulate nitric oxide production in pancreatic beta cells, leading to endoplasmic reticulum (ER) stress and apoptosis. Treatment of beta cells with glucose and NEFA induces nitric oxide synthase (NOS) as well as ER stress. However, the role of NO in glucolipotoxicity-induced ER stress in beta cells is not clear.

METHODS

We studied the effect of high glucose and palmitate levels on NOS isoform production in rat and Psammomys obesus islets and in insulinoma-1E beta cells. The effects of neuronal NOS (nNOS) inhibition by small interfering RNA or by N (omega)-nitro-L-arginine methyl ester (L-NAME) on beta cell function, ER stress and apoptosis under conditions of glucolipotoxicity were investigated.

RESULTS

Overnight incubation of rat and P. obesus islets at 22.2 mmol/l glucose with 0.5 mmol/l palmitate induced the production of nNOS but not inducible NOS (iNOS), in contrast with the robust stimulation of iNOS by cytokines. NOS inhibition by L-NAME did not prevent the decrease in glucose-stimulated insulin secretion and proinsulin biosynthesis or the depletion of islet insulin content observed under conditions of glucolipotoxicity. Moreover, treatment of beta cells with palmitate and L-NAME together resulted in marked activation of the IRE1alpha and PERK pathways of the unfolded protein response. This was associated with increased JNK phosphorylation and apoptosis in islets and beta cells. Moreover, partial nNos knockdown increased JNK phosphorylation and CHOP production, leading to apoptosis.

CONCLUSIONS/INTERPRETATION

In beta cells subjected to glucolipotoxic conditions, chronic inhibition of NOS exacerbates ER stress and activates JNK. Therefore, induction of nNOS is an adaptive response to glucolipotoxicity that protects beta cells from stress and apoptosis.

The impact of parental death versus separation from parents on the mental health of Israeli adolescents

Early research suggested that the loss of a parent during childhood can lead to depression and other psychopathology in children and adults. More recent research has differentiated between loss due to death and separation from parents and has questioned the link between early parental death and psychopathology. We examined the hypothesis that separation from parents has a more detrimental effect than the death of a parent on the mental health of adolescents in the community. Israeli adolescents (N = 844) with a mean age of 16.7 +/- 1.0 years (mean +/- SD) participated in this study. Seventy reported that a parent did not live at home during one of three 5-year periods until they reached the age of 15; 37 reported the death of a parent and 777 were from intact families. All participants completed the Brief Symptom Inventory (BSI), General Well Being Schedule (GWB), Parental Bonding Instrument (PBI), and Perceived Social Support Family/ Friends Scales (PSS-Fam and PSS-Fr). Adolescents who had experienced separation from parents had more psychiatric symptoms (BSI), expressed a lower sense of well-being (GWB), experienced less support from their family (PSS-Fam), and felt less cared for and more controlled by their parents (PBI) compared with those belonging to intact families. The death of a parent was not associated with significantly different scores on these variables. When we controlled for parental bonding (PBI) and perceived social support from family (PSS-Fam), the differences between the separation group and the intact family group were no longer significant. The psychological impact of separation from parents involves a greater risk for psychopathology than the death of a parent. The quality of the relationship with the parents moderates the negative impact of separation from them.

Childhood imaginary companionship and mental health in adolescence

An imaginary companion (IC) is a frequently encountered childhood fantasy, invisible to anyone but the child, who may be named, addressed or played with. Whether the presence of an IC is a normal developmental feature has not been determined. We examined psychometric measures and the presence/absence of childhood IC in a sample of 850 mentally healthy adolescents. 17.6% of our subjects, more often females, reported having had such a companion. Subjects who reported having had an IC in childhood exhibited higher levels of distress and emotional discontrol, displayed prolonged transitional object attachment and immature modes of coping with stress. Thus, although childhood imaginary companionship is not indicative of psychopathology, it may denote a vulnerability for adolescent perturbation and difficulty in coping with emotionally laden situations.

Empirical comparison of two psychological therapies. Self psychology and cognitive orientation in the treatment of anorexia and bulimia

The authors investigated the applicability of self psychological treatment (SPT) and cognitive orientation treatment (COT) to the treatment of anorexia and bulimia. Thirty-three patients participated in this study. The bulimic patients (n = 25) were randomly assigned either to SPT, COT, or control/nutritional counseling only (C/NC). The anorexic patients (n = 8) were randomly assigned to either SPT or COT. Patients were administered a battery of outcome measures assessing eating disorders symptomatology, attitudes toward food, self structure, and general psychiatric symptoms. After SPT, significant improvement was observed. After COT, slight but nonsignificant improvement was observed. After C/NC, almost no changes could be detected.

Psychotherapy--an active agent: assessing the effectiveness of psychotherapy and its curative factors

In the last two decades there has been a remarkable expansion in research on psychotherapy in two areas: (a) assessing the effectiveness of psychotherapy compared to wait-list, no-treatment patient groups and groups treated with pharmacotherapy; (b) investigating curative factors in the therapeutic process: the extent of the psychotherapist's experience and kinds of interventions and errors in handling techniques. The first section of the review deals with the first of these areas and the second with the other. The following are the main research findings: 1. The effectiveness of psychotherapy compared to wait-list and non-treatment groups has been proven by so many research papers that there is hardly any need t do so again; 2. Psychotherapy was found to be effective in treating focused psychiatric disorders such as OCD, depression and anxiety disorders (with preference to cognitive-behavioral approaches) over psychodynamic approaches, and in some instances in preference to pharmacotherapy). Psychotherapy was also effective in less focused disorders, such as personality disorders and mixed neurotics (with preference to psychodynamic approaches over cognitive-behavioral approaches); 3. The advantages of patients receiving psychotherapy over those who did not receive it persisted in follow-up studies of one year's duration or more; 4. Psychotherapy was more effective than "psychotherapeutic placebo" (the encounter between therapist and patient where systematic psychotherapeutic work using one out of the three main psychotherapeutic approaches is experimentally prevented), which in turn was more effective than wait-list or non-treatment groups; 5. Psychotherapeutic maintenance of one session a month was effective in preventing relapse; 6. Experienced psychotherapists are more effective than beginners; 7. Empathy, the ability to identify the central thread of the session, and encouragement of the patient to reflect were found to be the key factors in techniques most associated with therapeutic success.

The contributions of self psychology to the treatment of anorexia and bulimia

This article reviews the contribution of self psychology to the treatment and understanding of anorexia and bulimia. It tries to show that the unique conceptualization of self, selfobject relations, and this theory's conceptualization of resistance and defenses constitutes a therapeutic stance which especially fits the therapeutic needs of eating-disordered patients. Clinical vignettes illuminate three main issues exemplifying the opportunities and dilemmas that this new development in psychoanalytic theory brings to the fore in the treatment of eating disorders: (1) empathy with deeds and attitudes of the patient that the therapist finds difficult to empathize with; (2) empathic understanding "from within" from an experience-near stance vs. experience-distant interpretation "from without"; (3) self, selfobject relations with food and as a result of progress in therapy, with human beings.

Childhood vs. adolescence transitional object attachment, and its relation to mental health and parental bonding

871 participants, 375 boys and 496 girls, mean age 16.7 + 1, were administered the Parental Bonding Instrument (P.B.I.), the Brief Symptom Inventory (B.S.I.), the General Well-Being Questionnaire (G.W.B.) and the Chestnut Lodge Transitional Object Scale. Results supported Winnicott's theory: participants reporting attachment to a Transitional Object (T.O.) in their childhood reported significantly more optimal maternal bonding than participants who were not attached to a T.O. Participants reporting attachment to a T.O. in adolescence had significantly more psychiatric symptoms and less general well-being. Adolescence T.O. attachment might be considered a marker of mental distress in the general, normal population.

Word Association Test and psychosexual cues in assessing persons with eating disorders

The present study aimed to detect psychosexual conflicts in patients with eating disorders using the Word Association Test which tests the perceptual sensitivity of the subject to conflictual words. We also expected patients to show concern about food and eating. 19 anorexic patients, 21 bulimic patients, and 20 control subjects without eating disorders provided associations to four groups of words: psychosexual words, food words, emotionally loaded words, and neutral words. Reaction times were recorded. Analysis showed that anorexic patients were slower than controls in responding to food-related words but bulimic patients were not significantly different from controls. Anorexic patients reacted more slowly than controls to psychosexual words. Bulimic patients were also somewhat slower than controls but faster than anorexic patients; however, these differences were not statistically significant. Results are congruent with research that points to sexual problems and delays in the psychosexual development of anorexic patients and to a lesser extent of bulimic patients.

Physical punishment and signs of mental distress in normal adolescents

Adolescents (375 males and 496 females) were administered the Brief Symptom Inventory (BSI), the General Well-Being Scale (GWB), the Parental Bonding Instrument (PBI), and two questions about each parent, supplementing the PBI, tapping violent punitive behavior. Signs of mental distress in adolescents and reported physical punishment from parents were analyzed. Results indicated that greater physical punishment was associated with higher levels of psychiatric symptoms and lower general well-being. These results persisted after controlling for parental attitudes, as quantified by the PBI, and socioeconomic status. The findings of this study can contribute to efforts to raise public awareness of the negative consequences of physical punishment on the mental health of children.

Parental bonding and mental health in adolescence

Attachment between parent and child plays a crucial role in the healthy development of the child. Accordingly disturbances in parental bonding will be linked with the development of mental disorders later in life. The present study examines the relationship between parental bonding and mental health in healthy adolescents. Participants were 847 Israeli high school students who completed the Parental Bonding Instrument (PBI), the Brief Symptom Inventory (BSI), the General Well-Being (GWB), the Perceived Social Support (PSS), and the Social Desirability scale (SDS). In general, Israeli adolescents reported more parental care and less control than did Australian adolescents and adults. Female subjects reported more maternal care than did males. Subjects who reported high care and low control (optimal bonding) reported less distress, better general well-being and better social support that did all other groups. In contrast, those who reported low care and high control (affectionless control bonding) had the highest BSI scores and the lowest GWB and PSS scores. These results are in line with Bowlby's theory of attachment. They also show that specific configuration of parental bonding are linked with distress and isolation in adolescents.

Pre-adolescent chumship as a buffer against psychopathology in adolescents with weak family support and weak parental bonding

This study examines the degree to which the existence of a pre-adolescent "chum" interacts with family and social environments to buffer mental distress in adolescents. 831 high school students participated in this study, (male: 355; female: 476; mean age 16.7 +/- 1.0). Subjects were administered questionnaires assessing psychopathology and support systems. A pathway analyses model was used to investigate pathways and their interrelationships from chum to psychopathology and from social and family support to psychopathology. Only when adolescents experience weak parental bonding does chumship have a role in buffering distress.

Psychological well-being and ratings of psychiatric symptoms in bereaved Israeli adolescents: differential effect of war-versus accident-related bereavement

Eight hundred seventy-one Israeli adolescents, 375 boys and 496 girls, mean age 16.7 +/- 1, participated in this study. Twenty-three of them lost relatives in war and 19 in road accidents. All participants were administered the Brief Symptom Inventory (BSI), the General Well-being Scale (GWB), the Parental Bonding Instrument (PBI) and the Perceived Social Support-Family/Friend (PSS-Fa and PSS-Fr) measures. War-bereaved adolescents showed significantly higher scores in psychological well-being (GWB) and significantly lower scores in reported psychiatric symptoms (BSI) than accident-bereaved adolescents. War-bereaved adolescents also had significantly better BSI and GWB scores than the general nonbereaved adolescent population. These results persisted after controlling for family socio-economic status, gender, and the degrees of closeness of the deceased relative. War-bereaved adolescents did not differ either from accident-bereaved adolescents or from the nonbereaved general adolescent population in social and family support systems (PSS-Fr, PSS-Fa) and did not experience different basic parental attitudes (PBI). Results are discussed in terms of the different meanings ascribed to death in battle versus death in a road accident.

Long lasting blindness, availability of resources, and early aging

The present paper studied the influence of long lasting blindness on processes of aging. It addressed the broader issue of the effects of familiarity with and earlier experience of stress on the capacity of individuals to deal successfully with similar stressful situations at a later point of development. 75 chronically blind men and women, aged 45 to 65, were compared with 75 sighted individuals (matched by age, sex, and cultural origin) on scores on the Shanan Sentence Completion Technique, an interview designed to assess perception of change in various areas of everyday living, and on scores on the Wechsler-Bellevue Intelligence Test. Blind subjects showed less psychological and less social engagement with the outer world. Availability of resources, education, and assistance considerably reduced differences between the nonsighted and sighted subjects. These findings were interpreted as pointing to a potentially preventable process of premature aging.

Auditory startle response in blind subjects

Blindness is often associated with hypervigilance and arousal. The auditory startle response has been suggested as a measure of arousal. This study evaluated the auditory startle response of 10 blind individuals and 10 sighted controls who were exposed to a series of 15 1000-Hz, 95-db, 0-rise-time pure-tone stimuli, administered to both ears. The subjects' heart-rate, skin-conductance, and orbicularis-oculi-electromyogram responses to the tones were measured. Blind subjects did not differ from controls in the magnitude and in the habituation-rate of their responses. Results were interpreted as showing that blind persons' capacity for discriminative learning and for regulation of arousal is unimpaired. Task-related anxiety of blind persons should be differentiated from stimulus-related anxiety.

Reminiscing as a technique in the group psychotherapy of depression: a comparative study

Reminiscing as a technique of group psychotherapy for severely depressed hospitalized patients was found by patients and staff to be more efficacious than the traditional reflective non-directive group psychotherapy approach. The therapeutic potential of reminiscing in combatting depressed mood was supported by the present findings. The suitability of reminiscing to the difficult task of handling groups of severely depressed hospitalized patients was demonstrated.

Ciliary ganglia and spinal cord explants release an ascorbate-like compound which stimulates proline hydroxylation and collagen formation in muscle cultures

A low-molecular-weight factor from embryonic rat brain stimulates collagen production in rat muscle cultures. This effect is associated with increased hydroxylation of proline residues in collagenous proteins produced by the cells. Here, we show that increased hydroxylation (22-and 7.5-fold) was also observed with extracts of rat embryonic spinal cord and extracts of the rat pheochromocytoma cell line PC12. A 5-25-fold stimulation in proline hydroxylation was obtained when muscle cells were cocultured with chick ciliary ganglia or with embryonic rat spinal cord explants. Medium conditioned by rat spinal cord explants also increased prolyl hydroxylation. Incubation of the muscle-nerve cocultures with ascorbate oxidase markedly reduced the observed increase in proline hydroxylation. These results show that the cultured explants release a factor which promotes proline hydroxylation and collagen production by muscle. This factor seems to be ascorbic acid or an ascorbate-like compound.

Collagen-stimulating factor from embryonic brain has ascorbate-like activity and stimulates prolyl hydroxylation in cultured muscle cells

Embryonic rat-brain extract contains a collagen-stimulating factor which enhances the production of collagen types I, III, IV and V by cultured rat muscle cells. Here we report on the partial characterization and possible mechanism of action of a low-molecular-mass fraction with ascorbate-like activity isolated from embryonic rat brain extracts. This activity eluted very close to ascorbate when filtered through Bio-Gel P-2 and Sephadex G-10. The peak of biological activity showed properties of a reducing agent. Both the biological and reducing activities were lost when the fraction was treated with the enzyme ascorbate oxidase. This factor enhanced in a time-dependent manner, the secretion of procollagen, pulse-labeled with [3H] proline. Incubation of the muscle cultures with the factor increased by 15-fold the ratio of hydroxyproline to proline residues in secreted macromolecules over controls. A fourfold increase in the above ratio was obtained for the cellular proteins. Crude homogenates from control and factor-stimulated cultures were tested for prolyl hydroxylase activity using [3H](Pro-Gly-Pro)n as a substrate. Cultures treated with the collagen-stimulating factor showed a 5-50-fold increase in prolyl hydroxylation activity compared to controls. No effect on prolyl hydroxylation was found when the factor was added in vitro to either control or stimulated enzyme preparations. Our results suggest that the collagen-stimulating factor contains ascorbate-like activity which promotes the secretion of collagenous proteins by increasing hydroxylation of proline residues in their polypeptide backbone.

Protection of enkephalins from enzymatic degradation utilizing selective metal-chelating inhibitors

Metal ion-chelating agents inhibited enkephalin degradation by a rat striatal membrane-associated endopeptidase termed 'enkephalinase'. The combination of a hydrophobic dipeptidyl moiety and a transition metal-chelating moiety in the same molecule resulted in very efficient and selective inhibitors of enkephalinase. The mercaptoacetyl dipeptides (2-mercaptoacetyl-Leu-Phe and 2-mercaptoacetyl-Phe-Leu) and the N-phosphorylated dipeptides (phosphoryl-Leu-Phe and phosphoramidon) inhibited enkephalinase with IC50 values of 15, 70, 0.3 and 1 nM respectively, but were much less potent against the aminopeptidase and angiotensin converting enzyme, two other metalloenzymes implicated in the degradation of the enkephalins in brain. The inhibition of enkephalinase, using phosphoryl-Leu-Phe as a selective inhibitor, resulted in a 4 fold increase in the amount of enkephalin recovered following K+ depolarization of rat striatal slices.

Validity of students' ratings of clinical instructors

The validity of students' rating of clinical instruction was correlated with students' performance in a clinical examination. One-way analysis of variance showed that the students' ratings discriminated among instructors, and that the instructors were a significant source of variance in their students' adjusted examination scores on a written clinical simulation. There was no significant correlation between students' performance in the examinations and their ratings of the clinical instructors.

Multiple regression analysis predictor models in exotropia surgery

We developed a statistical model based on multiple regression analysis from a sample population of 30 patients with intermittent exotropia who underwent bilateral recession of the lateral recti muscles. We also identified predictor variables, which accounted for most of the change in deviation per millimeter of surgery performed. The application of multiple regression analysis to the problem of exotropia may be limited by variation in predictor variables according to sample population, multicollinearity, measurement unreliability, and the unproven assumption that the preoperative calculation of effect per millimeter correlates well with postoperative clinical success. Controlled clinical trials are needed to determine the value of multiple regression analysis in exotropia surgery. Discriminant analysis may represent an alternative statistical technique with application to this particular problem.

Penetrating keratoplasty in Lesotho

Sixty-four Basotho patients underwent therapeutic penetrating keratoplasty in Lesotho, a developing African nation. The overall long-term success rate of 60.7% was comparable to similar series in developed countries. Analysis of variables found to significantly affect graft outcome included size of graft, anterior segment pathology, postoperative iris adhesion to graft wound, and onset of graft rejection during hospitalization or after discharge. McCarey-Kaufman medium was found to be highly successful for corneal storage up to seven days, and corneal transplantation across racial lines was not associated with increased immune rejection reactions.