Practical aspects in the management of hypokalemic periodic paralysis

Management considerations in hypokalemic periodic paralysis include accurate diagnosis, potassium dosage for acute attacks, choice of diuretic for prophylaxis, identification of triggers, creating a safe physical environment, peri-operative measures, and issues in pregnancy. A positive genetic test in the context of symptoms is the gold standard for diagnosis. Potassium chloride is the favored potassium salt given at 0.5–1.0 mEq/kg for acute attacks. The oral route is favored, but if necessary, a mannitol solvent can be used for intravenous administration. Avoidance of or potassium prophylaxis for common triggers, such as rest after exercise, high carbohydrate meals, and sodium, can prevent attacks. Chronically, acetazolamide, dichlorphenamide, or potassium-sparing diuretics decrease attack frequency and severity but are of little value acutely. Potassium, water, and a telephone should always be at a patient's bedside, regardless of the presence of weakness. Perioperatively, the patient's clinical status should be checked frequently. Firm data on the management of periodic paralysis during pregnancy is lacking. Patient support can be found at

Statistical Metamodeling for Revealing Synergistic Antimicrobial Interactions

Many bacterial pathogens are becoming drug resistant faster than we can develop new antimicrobials. To address this threat in public health, a metamodel antimicrobial cocktail optimization (MACO) scheme is demonstrated for rapid screening of potent antibiotic cocktails using uropathogenic clinical isolates as model systems. With the MACO scheme, only 18 parallel trials were required to determine a potent antimicrobial cocktail out of hundreds of possible combinations. In particular, trimethoprim and gentamicin were identified to work synergistically for inhibiting the bacterial growth. Sensitivity analysis indicated gentamicin functions as a synergist for trimethoprim, and reduces its minimum inhibitory concentration for 40-fold. Validation study also confirmed that the trimethoprim-gentamicin synergistic cocktail effectively inhibited the growths of multiple strains of uropathogenic clinical isolates. With its effectiveness and simplicity, the MACO scheme possesses the potential to serve as a generic platform for identifying synergistic antimicrobial cocktails toward management of bacterial infection in the future

A risk assessment for managing non-native parasites

The spread of non-native parasites with the movement of animals is a primary cause of disease emergence worldwide. Such introductions can threaten native biodiversity, hinder conservation efforts and limit the socio-economic development of natural resources. Evaluating the threats from alien parasites can represent a considerable challenge, due to the limited information that often accompanies their introduction. We present a comprehensive modular risk assessment scheme that supports the management of non-native fish parasites in their pre- and post-introduction phases. This scheme addresses some of the shortcomings of current risk analysis, including the risk management of non-notifiable pathogens and impact assessment of parasites following establishment. An initial procedure for hazard identification promotes a rapid assessment of disease risk and prompt imposition of management measures. This is followed by a longer-term assessment of impact that accommodates available and emerging knowledge on the pathogen and its distribution. Consideration is given to ecological and economic consequences of disease at the host, population and fishery levels. Each module provides an easily interpreted output that underpins management responses, ranging from monitoring parasite distribution to their attempted eradication. A final module ensures clear communication of disease risk to relevant stakeholders, using the other modules as a framework. Outputs of this risk assessment will inform the prioritisation of available resources and provides a scientifically robust foundation on which to base practical and proportionate management measures to protect native environments. The scheme presented here was specifically developed for freshwater fisheries in England and Wales, but may be modified for use globally and for the non-native parasite fauna of other taxa