Tumescent Injections in Subcutaneous Pig Tissue Disperse Fluids Volumetrically and Maintain Elevated Local Concentrations of Additives for Several Hours, Suggesting a Treatment for Drug Resistant Wounds.

PurposeBolus injection of fluid into subcutaneous tissue results in accumulation of fluid at the injection site. The fluid does not form a pool. Rather, the injection pressure forces the interstitial matrix to expand to accommodate the excess fluid in its volume, and the fluid becomes bound similar to that in a hydrogel. We seek to understand the properties and dynamics of externally tumesced (swollen) subcutaneous tissue as a first step in assessing whether tumescent antibiotic injections into wounds may provide a novel method of treatment.MethodsSubcutaneous injections of saline are performed in live and dead pigs and the physical properties (volume, expansion ratio, residence time, apparent diffusion constant) of the resulting fluid deposits are observed with diffusion-weighted magnetic resonance imaging, computed tomography, and 3D scanning.ResultsSubcutaneous tissue can expand to a few times its initial volume to accommodate the injected fluid, which is dispersed thoroughly throughout the tumescent volume. The fluid spreads to peripheral unexpanded regions over the course of a few minutes, after which it remains in place for several hours. Eventually the circulation absorbs the excess fluid and the tissue returns to its original state.ConclusionsGiven the evidence for dense fluid dispersal and several-hour residence time, a procedure is proposed whereby tumescent antibiotic injections are used to treat drug-resistant skin infections and chronic wounds that extend into the subcutaneous tissue. The procedure has the potential to effectively treat otherwise untreatable wounds by keeping drug concentrations above minimum inhibitory levels for extended lengths of time

Farmers' practices and factors associated with the prevalence of all lameness and lameness attributed to interdigital dermatitis and footrot in sheep flocks in England in 2004

The aim of this study was to investigate whether the risk factors associated with all causes of lameness in sheep differed from those associated with the lesion specific causes of lameness, interdigital dermatitis (ID) and footrot (FR). A total of 809 randomly selected English sheep farmers participated in a postal survey in 2005. Data were requested on their management of lameness in 2004 and whether this had changed from 2003 and the prevalence of all lameness, and lameness caused by ID and FR. The farmer ability to recognise ID and FR was assessed from their responses to a written and pictorial description. On 443 farms where both ID and FR were correctly named by the farmer, the mean prevalence of all lameness, and lameness caused by ID and FR were 10.0% (95% CI: 8.9, 10.8), 6.5% (95% CI: 5.8, 7.3) and 3.1% (95% CI: 2.8, 3.6), respectively. The mean prevalence of all lameness on all 809 farms was not significantly different at 10.2% (95% CI: 9.2, 11.0). The data were analysed using negative binomial regression models with the three outcomes farmer estimated prevalence of all lameness and lameness caused by ID or FR in 2004. Farmers who changed management of sheep between 2003 and 2004 were excluded from the analysis, thus all fixed effects were the farmers’ managements in 2003 and 2004 to ensure that the management was in place for at least one year before the prevalence estimates. Routine foot trimming ≥once/year compared with no routine foot trimming was significantly associated with an increased prevalence of all lameness (prevalence ratio (PR) = 1.34), ID (PR = 1.50) and FR (PR = 1.35). Footbathing was also significantly associated with increased prevalence of all lameness (PR = 1.67), ID (PR = 1.68) and FR (PR = 1.76). A stocking density of >8 ewes/ha was associated with a significantly increased prevalence of all lameness (PR = 1.26) and ID (PR = 1.39). There was a significantly lower prevalence of FR (PR = 0.73; PR = 0.70, respectively) on farms in the North East and South East of England. Separating lame sheep at pasture was associated with a decreased prevalence of all lameness and ID (PR = 0.75; PR = 0.73) and location of the farm in South East England was associated with a lower prevalence of all lameness and ID (PR = 0.75; PR = 0.71, respectively). We conclude that management factors associated with all lameness, and lameness attributed to ID and FR are similar

Quantitative Analysis of Medication Management and Use in Bima Regional Public Hospital

Banyaknya jumlah obat-obatan di rumah sakit seringkali meningkatkan risiko ketidaktepatan dalam manajemen persediaan farmasi, oleh karena itu, perlu dilakukan studi pengelolaan dan penggunaannya. Penelitian ini dimaksudkan untuk mengkaji efektivitas pengelolaan dan penggunaan obat di Bima, Nusa Tenggara Barat. Adapun metode penelitian ini bersifat observasional retrospektif. Analisa data dilakukan secara deskriptif. Evaluasi pengelolaan dilakukan pada tahap perencanaan, pengadaan, penyimpanan dan pendistribusian, sedangkan evaluasi penggunaan dilakukan dengan menghitung DDD/100 patient-days untuk antibiotika yang paling banyak digunakan. Hasil penelitian pada evaluasi perencanaan, diperoleh tiga jenis obat pada matrik AV yaitu Ringer Lactat, Fentanil dan Tetagam; satu jenis obat vital pada Matrik BV, yaitu anti bisa ular; dan sembilan jenis obat pada matrik CV yaitu Aminophylline inj 24mg, Serum anti tetanus 1.500IU, Fenobarbital inj, Levosol inj, Magnesium sulfat inj 20%, Norepinefrin inj, Otsu D40, Otsu MgSO4 40, Pethidine 50mg/ml. Kesesuaian dana pengadaan obat 107,3% dan rerata ketepatan pengadaan 275%; terdapat 2 jenis obat rusak pada penyimpanan (0,476 %). Analisa DDD/100 patient-days untuk 12 injeksi antibiotika diperoleh total 45,44 DDD/100 patient-days. Kesimpulan: Hasil temuan pada penelitian ini memberikan gambaran informasi awal yang dapat digunakan untuk menyempurnakan praktek pengelolaan obat yang lebih efektif dan efisien di rumah sakit-rumah sakit khususnya di RSUD Bima di masa mendatang.The large number of medications circulating in hospitals may increase the risks of mismanagement of pharmaceutical inventory; hence studies on the management and use of medication are needed. This present study aims to analyse medication management and use  in  Bima Regional Public Hospital. This is a retrospective observational study, using descriptive data analysis. The analysis of medication management was conducted for the planning, procurement, storage and distribution stages; while the evaluation of medication use was done on antibiotic injections commonly prescribed using DDD/100 patient-days. The results showed that in the planning stage, three medications were in the AV category (i.e. Lactated Ringer’s Infusion, Fentanyl and Tetagam Inj.); one vital medication was in the BV category (i.e. anti-snake venom serum); and nine medications were in the CV category (i.e. Aminophylline Inj. 24mg, Anti-Tetanus Serum 1500 IU, Phenobarbital Inj., Levosol Inj., Magnesium Sulphate Inj. 20%, Norepinephrine Inj., OTSU D40 Infusion, OTSU MgSO4-40 Inj., Pethidine Inj. 50 mg/ml). The conformity of procurement funding was 107.3%, while the accuracy of procurement process (medication purchased/prescribed) was 275%; and there were two damaged products during storage (0.476 %). The evaluation of medication use for 12 antibiotic injections found a total 45.44 DDD/100 patient-days. The findings in this study provides a baseline data in optimising future practices of medication management and use in hospitals, especially in Bima Regional Public Hospital

Postoperative endophthalmitis.

Endophthalmitis may have devastating consequences for a patient’s vision and therefore should be treated as an emergency. The time from diagnosis to treatment is critical for favourable outcomes. In order to achieve a rapid response, it is important to have an accessible protocol and an endophthalmitis kit at hand for all eye surgeons who see postoperative patients. We have produced a simple protocol of recommended practice collated from a range of sources

Antibiotic-resistant Escherichia Coli from Retail Poultry Meat with Different Antibiotic Use Claims

Background We sought to determine if the prevalence of antibiotic-resistant Escherichia coli differed across retail poultry products and among major production categories, including organic, “raised without antibiotics”, and conventional. Results We collected all available brands of retail chicken and turkey—including conventional, “raised without antibiotic”, and organic products—every two weeks from January to December 2012. In total, E. coli was recovered from 91% of 546 turkey products tested and 88% of 1367 chicken products tested. The proportion of samples contaminated with E. coli was similar across all three production categories. Resistance prevalence varied by meat type and was highest among E. coli isolates from turkey for the majority of antibiotics tested. In general, production category had little effect on resistance prevalence among E. coli isolates from chicken, although resistance to gentamicin and multidrug resistance did vary. In contrast, resistance prevalence was significantly higher for 6 of the antibiotics tested—and multidrug resistance—among isolates from conventional turkey products when compared to those labelled organic or “raised without antibiotics”. E. coli isolates from chicken varied strongly in resistance prevalence among different brands within each production category. Conclusion The high prevalence of resistance among E. coli isolates from conventionally-raised turkey meat suggests greater antimicrobial use in conventional turkey production as compared to “raised without antibiotics” and organic systems. However, among E. coli from chicken meat, resistance prevalence was more strongly linked to brand than to production category, which could be caused by brand-level differences during production and/or processing, including variations in antimicrobial use

Clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery

Background - Postoperative endophthalmitis is a rare but dreaded complication of intraocular surgery and often results in severe visual impairment or blindness. The present study describes the clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery. Methods - Among 290 patients who underwent uneventful phacoemulsification cataract surgery at one outpatient clinic between January 4th and 28th 2019, 6 cases developed Burkholderia contaminans endophthalmitis. Clinical data were collected by retrospective review of patient records. Microbiological samples from vitreous aspirates, intraocular lenses (IOL) and lens capsules were cultured, and recA and draft whole genome sequences analysed. Results - The recA sequences of all Burkholderia contaminans isolates and the allelic profile of the isolates were identical. All cases had a similar clinical presentation with rapid development of endophthalmitis symptoms with variable time to onset. The mean time to admission was 34 days (12–112 days). All cases had a seemingly favourable response to intravitreal antibiotics. However, acute recurrences occurred after long time periods (12–71 days). The cases experienced between 0 and 3 recurrences. Due to persistent infection, the cases received between 5 and 15 treatments (mean 7.8) including IOL and lens capsule explantation in 5 of 6 cases. Burkholderia contaminans was detected in all explanted lens capsules. The final corrected distance visual acuity (CDVA, Snellen chart) was between 0.8 and 1.2 and all cases had final CDVA ≥0.8. Conclusions - A persistent and intensive treatment approach including total lens capsule and IOL explantation is recommended for Burkholderia contaminans endophthalmitis following cataract surgery and may lead to a favourable visual result

Exploring the behavioural drivers of veterinary surgeon antibiotic prescribing: a qualitative study of companion animal veterinary surgeons in the UK

Background: Multi-drug resistant bacteria are an increasing concern in both human and veterinary medicine. Inappropriate prescribing and use of antibiotics within veterinary medicine may be a contributory factor to antimicrobial resistance (AMR). The ‘One Health’ Initiative aims to work across species and environments to reduce AMR, however; little is currently known about the factors which influence antibiotic prescribing among veterinary surgeons in companion animal practice. This paper reports on qualitative data analysis of interviews with veterinary surgeons whose practice partially or wholly focuses on companion animals (N = 16). The objective of the research was to explore the drivers of companion animal veterinary surgeons’ antibiotic prescribing behaviours. The veterinary surgeons interviewed were all practising within the UK (England (n = 4), Scotland (n = 11), Northern Ireland (n = 1)). A behavioural thematic analysis of the data was undertaken, which identified barriers and facilitators to specific prescribing-related behaviours. Results: Five components of prescribing behaviours were identified: 1) confirming clinical need for antibiotics; 2) responding to clients; 3) confirming diagnosis; 4) determining dose, duration and type of antibiotic; and 5) preventing infection around surgery (with attendant appropriate and inappropriate antibiotic prescribing behaviours). Barriers to appropriate prescribing identified include: business, diagnostic, fear, habitual practice and pharmaceutical factors. Facilitators include: AMR awareness, infection prevention, professional learning and regulation and government factors. Conclusion: This paper uses a behavioural lens to examine drivers which are an influence on veterinary surgeons’ prescribing behaviours. The paper contributes new understandings about factors which influence antibiotic prescribing behaviours among companion animal veterinary surgeons. This analysis provides evidence to inform future interventions, which are focused on changing prescribing behaviours, in order to address the pressing public health concern of AMR