Novel case of combination antibiotic therapy for treatment of a complicated polymicrobial urinary tract infection with one organism harboring a metallo-β-lactamase (MBL) in a pregnant patient

Carbapenem resistance due to metallo-beta-lactamases (MBLs) is a global phenomenon and an important challenge for antibiotic therapy (Boyd et al., 2020 [1]). While previous reports have demonstrated both in vitro and in vivo synergy using the combination of ceftazidime-avibactam and aztreonam against Stenotrophomonas maltophilia, an MBL-harboring organism, this treatment strategy has not been reported during pregnancy (Mojic et al., 2017 [2], [3], Mojica et al., 2016 [4], Alexander et al., 2020 [5]). We describe a 33-year-old pregnant female with polymicrobial, bilateral pyelonephritis caused by Stenotrophomonas maltophilia and other gram-negative bacteria. The organisms were eradicated with the combination of ceftazidime-avibactam and aztreonam followed by successful delivery with no observed adverse effects in either mother or child post-partum.

Edwardsiella tarda, a rare human pathogen isolated from a perihepatic abscess: Implications of transient versus long term colonization of the gastrointestinal tract

Although gastroenteritis is the most commonly described manifestation of Edwardsiella tarda infection, the pathogenesis and transient or long-term colonization of the gastrointestinal tract of this organism in human disease is not clear. We describe a rare manifestation of E. tarda infection in a perihepatic abscess in the setting of a patient with perforated cholecystitis and its successful eradication following antibiotic treatment.

Evaluation of historical atmospheric pollution in an industrial area by dendrochemical approaches

We conducted a dendrochemical study in order to evaluate the exposure of territories and populations to different types of pollutants and to characterise the history of pollution in one of the most intensely industrialised areas of Europe: the industrial port zone of Fos, also heavily urbanised. To perform the study, two tree species have been selected, Pinus halepensis and Populus nigra, on a rural plot located roughly 20 km away from the industrial harbour, an urban plot located in the city of Fos-sur-Mer and an industrial plot. Our study indicated that poplar was a more relevant model for the dendrochemical studies, exhibiting a higher bioaccumulation capacity than pine except for Hg, Sb and Mn. Moreover, thanks to this work, we observed significant exposure of the trees in the urban and industrial areas to As, Cd, Co, Cu, Mo, Sb, Zn, Al, Ca, and Mg, highlighting the exposure of the territory and populations living in the vicinity of the industrial harbour. The temporal variability of the concentrations measured in the tree rings corresponds to the increasing industrialisation of the territory as well as to the evolution of the industrial processes. Thus, this project highlighted the exposure of the Gulf of Fos to atmospheric emissions (industrial, road and urban) of the industrial harbour as well as the changes over time. It also pointed out the relevance of using dendrochemistry to measure atmospheric exposure of metals and metalloids and its temporal variability.

Long Term Outcome in Adolescents with Hodgkin's Lymphoma: Poor Results using Regimens Designed for Adults

It is unclear whether the outcome in adolescents with Hodgkin's lymphoma is as good as that in children and there are no prospective randomized trials comparing regimes used in children and adults in this setting. We have therefore performed an analysis of 210 adolescent patients diagnosed with Hodgkin's lymphoma between 1970-1997 and registered on the database held by the British National Lymphoma Investigation. Patients were treated according to adult regimens current at the time of their diagnosis. The complete response rate recorded in 209 patients was 76%. This was highly dependent on disease stage being 95% in patients with localized disease but 63% in those with advanced disease. The 5 year event free survival for the whole cohort was 50% falling to 41% at 20 years with overall survival of 81% falling to 68% at 5 and 20 years respectively. There is no significant difference in the 3 decades pertaining to this analysis. Of the 62 deaths in this cohort, 70% were due to Hodgkin's lymphoma but of the 13 deaths occurring beyond 10 years, only 3 were due to Hodgkin's lymphoma, the reminder being attributable to the late effects of therapy. Results from paediatric groups have been much more encouraging than those presented from this cohort. It seems the use of risk-adjusted combined modality therapy with minimization of radiation fields and doses and reduction of anthracycline and alkylator exposure has been successful in children and should be used in adolescents.

Primary sciatic nerve lymphoma: a case report and review of the literature

A patient with primary B cell non-Hodgkin's lymphoma of the sciatic nerve is described. He presented with neuropathic symptoms in the left leg, initially diagnosed as tarsal tunnel syndrome. Magnetic resonance imaging (MRI) identified the abnormality in the sciatic nerve. A fascicular biopsy of the sciatic nerve showed a diffuse large B cell non-Hodgkin's lymphoma. The patient was treated with chemotherapy and rituximab (anti-CD20 monoclonal antibody). Four months later he was in remission, and remains so 48 months from presentation. Primary lymphoma of single peripheral nerves may be a unique subtype of extranodal lymphoma, which usually follows an aggressive course and has a variable response to current therapeutic strategies. MRI is useful, alongside electrophysiological studies, in patients with atypical peripheral nerve symptoms.

Protein binding and antimicrobial activity of ceftriaxone: comparative assessments by gradient plate technique and time-kill study

In conjunction with initial bactericidal rate measurements, this study evaluated the impact of protein binding on the antimicrobial activity of ceftriaxone employing the gradient plate technique. Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 25923 were employed as test organisms. At various albumin concentrations (0 to < or = 16% w/v), the effects of albumin binding were estimated by the shift in concentration-responses (via initial bactericidal rate) and the distance of inhibition zone (DIZ) on gradient agar plates. Supplementation with 4% albumin reduced the antimicrobial activity of ceftriaxone against E. coli as suggested by the similar 1.5-fold shift in both initial bactericidal rate and DIZ when compared to those with no albumin. As with S. aureus, the inclusion of albumin increased the initial bactericidal rate but the DIZ assessments showed a reduction in antimicrobial activity. The reason for the difference observed on the initial bactericidal effect between the two species is unknown. However, the similar patterns of change in the DIZ data at increasing albumin concentrations from 0 to 4% for both organisms suggest consistency and reproducibility of the gradient plate technique. This technique appears to be an attractive alternative for the assessment of the effect of protein binding on antibiotics.

Fludarabine, adriamycin and dexamethasone (FAD) in newly diagnosed advanced follicular lymphoma: a phase II study by the British National Lymphoma Investigation (BNLI)

The optimal first-line treatment for symptomatic patients with advanced stage follicular lymphoma remains unclear. Fludarabine-based combination regimens have been extensively used in relapsed disease and merit consideration as first-line therapy. We here report the results of a phase II study of FAD (fludarabine, adriamycin, dexamethasone) regimen in 30 patients with advanced stage follicular lymphoma requiring treatment. The response rate was in excess of 90% with 39% achieving a complete remission. The major toxicity was myelosuppression, but only 3% of cycles were associated with grade IV leucopenia. The high response rate has not translated into major improvements in failure-free survival and consideration must be given to alternative treatment modalities to consolidate the high rate of initial responses.

Distribution of muscle spindles in a simply structured muscle: integrated total sensory representation

BACKGROUND

The distribution of muscle spindles (Sps) in a small muscle of simple architecture, the capsularis at the cat's hip joint, was quantified to reveal the patterns of proprioceptive representation in the transverse and sagittal planes as well as to model the effect a local disturbance in muscle length would have on total Sp discharge.

METHODS

Locations in serial cross-sections of the 32 and 38 Sps in 2 muscles, 1 perfused with the hip joint flexed and the other extended, were plotted, and their patterns of integrated sensitivity calculated assuming that (1) the discharge rate of a Sp afferent varies linearly with change in length along the Sp's axis, and (2) that within a local disturbance produced by contraction of a motor unit (MU), lengths decrease either linearly or as the square of the distance from its center.

RESULTS

The isomeric pattern of "integrated, total Sp representation on cross-section" showed two peaks of sensitivity in the half of the muscle that had been next to the joint capsule, offset by low representation in a small, central area and along the extensive zone bordering the laterally facing "superficial surface." The equivalent radius of an idealized symmetrical MU territory was estimated from distributions of the few fast, oxidative-glycolytic fibers found in two muscles, and the effect of a MU's contraction on net Sp discharge predicted when the unit was positioned at distinctive sites within the pattern. As an index of Ia and II afferent representation in the sagittal plane, the distribution of the nucleated regions of Sps and the summed lengths of segments of Sp axial bundles and capsules, respectively, within successive 1-mm segments of the muscle were graphed.

CONCLUSIONS

The longitudinal representation and structure of the muscle are not suited for reflex adjustment of differences in length along the muscle. The isomeric pattern of high relief in the transverse plane suggests that in this approximately 0.2 g muscle, the localization of myotatic reflexes might be accommodated but the need for adjustment in activation of MUs seems minimal. This is because the muscle is not compartmentalized, its fibers extend between the muscle's origin and insertion, their angle of pinnation is low, and greater than 90% are of slow type. The distribution of Sps is consistent with gauging length of the entire muscle and hence angulation at the hip joint.

Spindle representation relative to distribution of muscle fiber types in the cat capsularis muscle

The spatial representation of muscle spindles (Sps) in the small (approximately 0.2 g), simply structured capsularis muscle that crosses anterior to the cat's hip joint was compared with the distribution of the slow oxidative (SO) and few (< 10%) fast oxidative-glycolytic (FOG) fibers of which it is composed to see if their distributions were consistent with a hypothesis that sensory input from Sps influences the incidence of extrafusal fiber types. In frozen sections from 4 muscles, FOG fibers were enumerated along 1-mm strips across the muscle's maximum width, and between the 'superficial' surface and the 'deep' one that contacts the joint. The locations of Sps in complete serial sections of 2 paraffin-embedded muscles, one perfused with the hip joint flexed and the other with it extended, were plotted on an outline of each muscle at its midlength, and their numbers and density in horizontal and sagittal 'strata' determined. In general, the incidence of Sps increased down the superficial-to-deep axis, while FOG fibers became fewer, as is consistent with support of SO status by Sp input. Along the craniocaudal axis, i.e. width, the numbers of FOG fibers rose toward the hip joint, but this was not associated with a monomodal gradient of Sps. In the extended muscle, however, the lengths of the axial bundle and capsular space of Sps in the half of the muscle next to the joint exceeded those in the longer, cranial half, implying that under stretch the input from Sps became higher toward the joint. In the non-extended muscle these lengths did not differ, although the lengths of extrafusal fibers isolated from 2 macerated muscles and normalized according to sarcomere length decreased linearily by approximately 50% along craniocaudal axis. It is explained that if elastic resistance of a Sp's sensory region exceeded that of an equivalent length of septal tissue in-series, the progressive shift in the ratio of compliances across this trapezoidally-shaped muscle should result in relatively greater lengthening of Sps at the shorter border as the muscle was extended. Levels of discharge conducive to transition of some motor units to the FOG type might be attained. Thus, gradients in the discharge of Sps (but not necessarily incidence) along both transverse and superficial-to-deep axes may be consistent with Sp sensory input influencing the distribution of at least these types of motor units.

The diabetic alcoholic: characteristics and treatment outcome

We had previously found a correlation between a recovering alcoholic's propensity to choose free sugar in his diet and his ability to remain sober. To determine if chronic hyperglycemia in itself is a predictor of sobriety, we examined the outcome of alcoholism treatment in 138 diabetics we could identify among 9000 alcoholism treatment outpatients. In general, the diabetics did no better or worse in alcoholism treatment than the whole clinic population, but a subset of the diabetics, those whose diabetes resulted from pancreatitis or pancreatectomy, did very badly. The implications of these findings for future research are discussed.

Dietary choices and likelihood of abstinence among alcoholic patients in an outpatient clinic

Animal experimentation and informal clinical observation both suggest a possible relation between diet and drinking. Sixty-four newly sober out-patients at the Elmhurst Alcoholism Treatment Program were interviewed at each clinic visit using the 24-h dietary recall method. Patients were interviewed an average of 3 times each. We analyzed for calories, carbohydrates, sucrose, sugar added to beverages, protein, fats, vitamins and minerals. Patients were grouped according to the number of days they remained sober from their last drink. Those who stayed sober longer chose diets containing twice as much sugar added to beverages and more overall carbohydrates (P less than 0.05). At this time we cannot say whether longer sobriety increased appetite for sugar or whether the choice of sugar influenced the patients' ability to stay sober.

Dietary choices of recovering alcoholics

Nutritional therapy can play an important role in the rehabilitation of an alcoholic. To teach these patients proper eating habits, we need to know what they eat and whether their dietary choices are nutritionally adequate compared to the recommended daily allowances (RDA). We investigated dietary choices of 70 recovering (abstinent) alcoholics who lived in a halfway house but who ate and worked elsewhere everyday. Diets were analyzed for calories, protein, B vitamins, vitamins A and C, calcium, phosphorous, magnesium, iron and zinc. We found that these recovering alcoholics ate adequate amounts of all nutrients except for vitamin B6, magnesium, iron and zinc. With the exception of vitamin B6, the other three nutrients are also found to be low in the diets of the average population. We cannot say at present whether recovering alcoholics need more than the RDA for recovery, but we conclude that their freely chosen diet resembles that of non-alcoholic adult Americans.