Urinary tract infection caused by Myroides spp. in diabetic patients: To be or not to be

Myroides is a non-fermentative, Gram-negative rod-like bacteria. It is a rare opportunistic pathogen which has been reported to cause many serious infections. Management of infections caused by Myroides can be challenging due to its high resistance to most antibiotics. We report three cases of urinary tract infection (UTI) due to Myroides species in patients with diabetes mellitus Type II. Myroides spp. isolated were resistant to all the antibiotics tested: Amoxicillin-clavulanic acid, piperacillin-tazobactam, cefepime, ceftriaxone-cefoperazone sulbactam, amikacin, gentamicin, imipenem, meropenem, ciprofloxacin, colistin, tigecycline, and co-trimoxazole. Two strains were sensitive to minocycline (minimum inhibitory concentration <1 μg/mL). Two patients had Foley’s catheter in place and one patient had urinary retention at the time of diagnosis. The infection in two cases was nosocomial, whereas one case appeared to have a community-acquired infection with Myroides. Clinicians should consider the possibility of Myroides as a pathogen in UTI in diabetic patients, especially in nosocomial settings

Experimental Analysis of Friction Stir Welding of Dissimilar Alloys AA6061 and Mg AZ31 Using Circular Butt Joint Geometry

AbstractThe Aluminium alloy 6061 and Magnesium alloy AZ31 plates of 6mm thickness are welded in circular butt joint geometry by friction stir welding (FSW) process, using CNC vertical milling machine. Process parameters such as welding speed and tool rotational speed play an important role to obtain a better weld joint for dissimilar metals/materials. The friction stir welding tool is one of the critical components to the success of this process. It consists of a cylindrical shoulder and a pin with different geometry. In the experimental work, the said tool has been designed with cylindrical pin having four different geometries for friction stir welding of the dissimilar circular metal plates. Friction stir welding has been carried out at welding speed varying from 10 to 40mm/min and tool rotational speed from 800 to 2000rpm. Effects of process parameters on butt welded circular joint were investigated for weld strength. In this research work, it is found that welded joint between dissimilar metals alloys Al 6061 and Mg AZ31 can be formed using friction stir welding by selecting proper tool pin profile and welding parameters. It is suggested that friction stir welding of Aluminium alloy and Magnesium alloy with circular butt joint geometry would be useful in the future for automobile applications by getting the benefits from each material in a functional way

Long-term effect of antiepileptic drug switch on serum lipids and C-reactive protein.

BACKGROUND: Prior studies have shown that switching patients from inducing antiepileptic drugs (AEDs) to lamotrigine, levetiracetam, or topiramate reduces serum lipids and C-reactive protein (CRP). These studies were all of short duration, and some drugs, such as zonisamide, have not been investigated. METHODS: We recruited 41 patients taking phenytoin or carbamazepine who were being switched to zonisamide, lamotrigine, or levetiracetam. We measured serum lipids and CRP before the switch, \u3e6weeks after, and \u3e6months after. An untreated control group (n=14) underwent similar measurement. We combined these data with those of our previous investigation (n=34 patients and 16 controls) of a very similar design. RESULTS: There were no differences in outcome measures between the two inducing AEDs nor among the three noninducing AEDs. Total cholesterol (TC), atherogenic lipids, and CRP were higher under inducer treatment than in controls. All measures were elevated under inducer treatment relative to noninducer treatment, including TC (24mg/dL higher, 95% CI: 17.5-29.9, p CONCLUSIONS: We demonstrate that switching from inducing to noninducing AEDs produces an enduring reduction in serum lipids and CRP. These results provide further evidence that inducing AEDs may be associated with elevated vascular disease risk. These are the first vascular risk marker data in patients taking zonisamide, which shows a profile similar to that of other noninducing AEDs

Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml) and bupivacaine 0.5% (20ml) for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries.Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset.Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects.Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief

Cerebral Microbleeds in a Stroke Prevention Clinic.

The objective of this study is to assess the effectiveness of a stroke clinic in stroke prevention and progression of cerebral microbleeds (CMB). We conducted a retrospective observational study of patients who visited a stroke clinic between January 2011 and March 2017. Susceptibility-weighted imaging (SWI) MRI studies were obtained at baseline and follow-up visits to identify new infarctions and CMB progression. Patients with CMB who also underwent brain computed tomography (CT) imaging were identified and their cerebral arterial calcification was quantified to evaluate the relationship between the extent of intracranial calcification and CMB burden. A total of 64 stroke patients (mean age 73.1 ± 11.0, 47% males) had CMB on baseline and follow-up MRI studies. During a mean follow-up period of 22.6 months, four strokes occurred (4/64, 6%; 3 ischemic, 1 hemorrhagic), producing mild neurological deficit. Progression of CMB was observed in 54% of patients with two MRIs and was significantly associated with length of follow-up. Subjects with intracranial calcification score > 300 cm3 had higher CMB count than those with scores <300 cm3 at both baseline (12.6 ± 11.7 vs. 4.9 ± 2.2, p = 0.02) and follow-up (14.1 ± 11.8 vs. 5.6 ± 2.4, p = 0.03) MRI evaluations. Patients with CMB had a relatively benign overall clinical course. The association between CMB burden and intracranial calcification warrants further study

Tofacitinib in a Recalcitrant Case of Alopecia Areata

Alopecia areata (AA) is a non-cicatricial alopecia that is postulated to be a hair-specific autoimmune disease, with genetic factors playing a role in disease susceptibility and severity. The most common form of disease manifests as smooth, discrete, round patches of hair loss and can be referred to as alopecia areata focalis (AF). Tofacitinib is emerging as a promising therapy for severe AA. An increasing number of studies have demonstrated the efficacy of tofacitinib in treatment of alopecia areata. Herein we report a case of recalcitrant alopecia areata in a 14-year-old female treated successfully with oral tofacitinib based therapy

Chronic Kidney Disease Increases Cerebral Microbleeds in Mouse and Man.

Brain microbleeds are increased in chronic kidney disease (CKD) and their presence increases risk of cognitive decline and stroke. We examined the interaction between CKD and brain microhemorrhages (the neuropathological substrate of microbleeds) in mouse and cell culture models and studied progression of microbleed burden on serial brain imaging from humans. Mouse studies: Two CKD models were investigated: adenine-induced tubulointerstitial nephritis and surgical 5/6 nephrectomy. Cell culture studies: bEnd.3 mouse brain endothelial cells were grown to confluence, and monolayer integrity was measured after exposure to 5-15% human uremic serum or increasing concentrations of urea. Human studies: Progression of brain microbleeds was evaluated on serial MRI from control, pre-dialysis CKD, and dialysis patients. Microhemorrhages were increased 2-2.5-fold in mice with CKD independent of higher blood pressure in the 5/6 nephrectomy model. IgG staining was increased in CKD animals, consistent with increased blood-brain barrier permeability. Incubation of bEnd.3 cells with uremic serum or elevated urea produced a dose-dependent drop in trans-endothelial electrical resistance. Elevated urea induced actin cytoskeleton derangements and decreased claudin-5 expression. In human subjects, prevalence of microbleeds was 50% in both CKD cohorts compared with 10% in age-matched controls. More patients in the dialysis cohort had increased microbleeds on follow-up MRI after 1.5 years. CKD disrupts the blood-brain barrier and increases brain microhemorrhages in mice and microbleeds in humans. Elevated urea alters the actin cytoskeleton and tight junction proteins in cultured endothelial cells, suggesting that these mechanisms explain (at least in part) the microhemorrhages and microbleeds observed in the animal and human studies