Evaluation of Pseudomonas aeruginosa Eradication Protocol in Pediatric Patients with Cystic Fibrosis: A Retrospective Medical Chart Review

Background Pseudomonas aeruginosa (Pa) is a leading cause of lung infection in patients with cystic fibrosis (CF), increasing morbidity and mortality. Despite this, there is no standardized treatment among the medical community for Pa eradication in patients with CF. The Nebraska Regional Cystic Fibrosis Center at Children’s Hospital and Medical Center (CHMC) in Omaha, Nebraska has a Pa eradication protocol. This study aims to increase Pa eradication for children with CF by investigating the effectiveness and adherence to the current Pa eradication protocol. Methods This study is a retrospective medical chart review of 1–21-year-olds with CF receiving care at CHMC. Medical records for each patient were screened for Pa culture results and Pa treatments. Primary endpoints were the degree of protocol adherence, eradication success, and subsequent colonization following CHMC’s Pa eradication protocol. The current protocol starts patients on step one with inhaled tobramycin for 28 days and oral ciprofloxacin for 14 days following a positive Pa culture. If still positive after that time, they are started on step two with 10-14 days of intravenous antibiotics. If sustained positivity following IV antibiotics, they progress to step three with six months of alternating monthly inhaled tobramycin, colistin, or aztreonam. If positivity after step three, they are considered colonized. If they have a negative sputum culture following any step, Pa is considered eradicated, they continue quarterly monitoring, and restart the protocol following another positive Pa result. Results Of the 184 CHMC’s CF patients, 172 patients were used for the study (8 excluded for age and 4 for inadequate medical records). For those included, the protocol was fully followed correctly for 70.3% (N=121) of patients. When step one of the protocol was followed, 151/206 (73.3%) of treatments had Pa eradication compared to 36/61 (59.0%) of patients with non-protocol treatment (OR 0.52, 95% CI 0.29-0.95, P=0.03). However, there was no statistically significant difference in eradication when comparing steps two and three to non-protocol treatments. When the complete protocol was followed, 12/121 (9.9%) of patients became chronically colonized with Pa compared to 27/51 (52.9%) of patients who did not follow protocol guidelines (OR 0.099, 95% CI 0.04-0.22, P-value= \u3c0.0001). Discussion Adherence to the CHMC’s current protocol is associated with increased Pa eradication levels when used at step one and decreased colonization cases. Early initiation of treatment using this protocol is vital to improving morbidity and mortality associated with Pa infections in cystic fibrosis children.https://digitalcommons.unmc.edu/chri_forum/1005/thumbnail.jp

Suspected Canine Zinc Toxicosis Caused by Ingestion of Pennies

A 21 pound, nine year old spayed female Shih Tzu was presented to the Oradell Animal Hospital at 3 a.m. on Sunday morning with a complaint of anorexia, lethargy and vomiting for the past two days. The dog\u27s previous medical history was unremarkable, except for being hit by a car in November 1983. A right ilial fracture sustained at that time had been plated. The animal was current on all routine vaccinations

Fossil Cenozoic crassatelline bivalves from Peru: new species and generic insights

Discoveries of new fossil Cenozoic crassatellines in Peru provide a new phylogenetic perspective on “large” Neogene genera, in which four lineages are considered to have arisen independently from different Paleogene Crassatella ancestors. Latest Oligocene and early Miocene species of the new genus Tilicrassatella gen. nov.―T. ponderosa, T. torrens sp. nov., and T. sanmartini sp. nov. from the East Pisco Basin―probably evolved from the late Eocene species, Crassatella rafaeli sp. nov., which itself differed in significant respects from slightly older species of the East Pisco Basin, C. neorhynchus and C. pedroi sp. nov. The paciphilic genus, Hybolophus, is raised to full generic status. Added to its ranks are the East Pisco Miocene species H. maleficae sp. nov., H. terrestris sp. nov., and the oldest species of the genus, the late Eocene or Oligocene H. disenum sp. nov. from the Talara Basin of northern Peru. Kalolophus gen. nov., encompassing circum-Caribbean fossil species, the extant species, K. speciosus, and the trans-isthmus species, K. antillarum, appears to have evolved from the early Oligocene Floridian species, Crassatella portelli sp. nov. The genus Marvacrassatella is a western Atlantic Miocene lineage most likely descended from Kalolophus. The genus Eucrassatella is restricted to Australian and New Zealand taxa. The Eocene New Zealand species, Spissatella media, is transferred to Eucrassatella and deemed a candidate for the most recent common ancestor of younger Eucrassatella and all Spissatella species. In the southern Pacific Ocean, the circum-Caribbean region, and tropical western America, crassatelline lineages developed one or more of the following characters: large resilifers, smooth ventral margins, and an extended left anterior cardinal tooth. Some of these late Paleogene convergent character changes might have countered increased shear forces exerted on the crassatelline valves while burrowing into finer-grained and more cohesive sediments in deeper or quieter water

The temperate marine Peruvian Province: How history accounts for its unusual biota.

The Peruvian Province, from 6° S in Peru to 42° S in Chile, is a highly productive coastal marine region whose biology and fossil record have long been studied separately but never integrated. To understand how past events and conditions affected todays species composition and interactions, we examined the role of extinction, colonization, geologic changes to explain previously unrecognized peculiar features of the biota and to compare the Peruvian Provinces history to that of other climatically similar temperate coasts. We synthesized all available data on the benthic (or benthically feeding) biota, with emphasis on fossilizable taxa, for the interval from the Miocene (23-5.4 Ma) and Pliocene (5.4-2.5 Ma) to the present. We outline the history of ecological guilds including primary producers, herbivores, predators, and suspension-feeders and document patterns of extinction, colonization, and geographic restriction. We identify twelve unusual attributes of the biota, most of which are the result of repeated episodes of extinction. Several guilds present during the Miocene and Pliocene are not represented in the province today, while groups such as kelps and perhaps intertidal predatory sea stars are relative newcomers. Guilds on soft bottoms and in sheltered habitats were severely affected by extinction, whereas those on hard bottoms were most affected by colonists and held their own in diversity. The Peruvian Province has not served as a biogeographic refuge, in contrast to the coasts of Australasia and Argentina, where lineages no longer present in the Peruvian Province survive. The loss of sheltered habitats since the Pliocene explains many of the present-day peculiarities of the biota. The history of the provinces biota explains its unique attributes. High productivity, a rich Southern Hemisphere heritage, and colonization from the north account for the present-day composition and unusual characteristics of the biota

Biological uptake and reversible scavenging of zinc in the global ocean

Zinc (Zn) is a key micronutrient for marine phytoplankton, with a global distribution that is similar to silicic acid. The processes that govern this relationship, despite the very different biological cycling of Zn and silica, remain poorly understood. Here, we use diagnostic and mechanistic models to show that only a combination of Southern Ocean biological uptake and reversible scavenging of Zn onto sinking particles can explain the observations. The distinction between organic and adsorbed Zn can also reconcile the vertical distribution and mass balance of Zn isotopes, which previously appeared at odds. This holistic understanding explains the Zn deficiencies observed throughout the low-latitude ocean and implies a greater sensitivity of the marine Zn cycle to climate-driven changes in organic matter cycling than previously recognized

Species abundance patterns in an ecosystem simulation studied through Fisher's logseries

We have developed an individual-based evolving predator-prey ecosystem simulation that integrates, for the first time, a complex individual behaviour model, an evolutionary mechanism and a speciation process, at an acceptable computational cost. In this article, we analyse the species abundance patterns observed in the communities generated by our simulation, based on Fisher's logseries. We propose a rigorous methodology for testing abundance data against the logseries. We show that our simulation produces coherent results, in terms of relative species abundance, when compared to classical ecological patterns. Some preliminary results are also provided about how our simulation is supporting ecological field results

Accuracy and Longevity of an Implantable Continuous Glucose Sensor in the PRECISE Study: A 180-Day, Prospective, Multicenter, Pivotal Trial

It is known that continuous glucose monitoring (CGM) systems can lower mean glucose compared with episodic self-monitoring of blood glucose. Implantable CGM systems may provide additional benefits. We studied the Eversense (Senseonics Inc.) implantable CGM sensor in 71 participants aged 18 years and older with type 1 and type 2 diabetes in a 180-day multinational, multicenter pivotal trial. Participants used the CGM system at home and in the clinic. CGM accuracy was assessed during eight in-clinic visits with the mean absolute relative difference (MARD) for venous reference glucose values >4.2 mmol/L as the primary end point. Secondary end points included Clarke Error Grid Analysis and alarm performance. The primary safety outcome was device-related serious adverse events. This trial is registered with ClinicalTrials.gov, number NCT02154126. The MARD value against reference glucose values >4.2 mmol/L was 11.1% (95% CI 10.5, 11.7). Clarke Error Grid Analysis showed 99.2% of samples in the clinically acceptable error zones A and B. Eighty-one percent of hypoglycemic events were detected by the CGM system within 30 min. No device-related serious adverse events occurred during the study. Our results indicate the safety and accuracy of this new type of implantable CGM system and support it as an alternative for transcutaneous CG

The Early Stages and Natural History of Antirrhea Adoptive Porphyrosticta (Watkins, 1928) in Eastern Ecuador (Lepidoptera: Nymphalidae: Morphinae)

Here we describe the immature stages and ecological associations of Antirrhea adoptiva porphyrosticta Watkins, 1928 (Lepidoptera:Nymphalidae:Morphinae). The cloud forest bamboo, Chusquea scandens Kunth (Bambusoidea: Poaceae), serves as the larval food plant for this butterfly in eastern Ecuador, the first hostplant record for Antirrhea outside the family Arecaceae. The larvae of A. adoptiva porphyrosticta are superficially similar to those of other Antirrhea species. We also provide observations on adult and larval behavior. Caterpillars of this butterfly species are parasitized by tachinid flies, as well as by Ichneumonidae and a newly described braconid wasp