Diagnostic and therapeutic aspects of recurrent renal stone disease

Recurrent renal stones occur in 7.5% ofCaucasian men and 3% of all women. Even withincreasing urbanisation, renal calculi are reported inless than I% of black South African men and women. Four hundred recurrent stone formers were studied at the metabolic stone clinic using routine and special tests. The appropriate therapy for each subgroup is outlined and studies on various different treatments are presented. In addition, lithogenic risk factors were studied in normal black and white subjects and in black stone formers, in order to clarify the low incidence in the black population.Patients were classified according dietary andmetabolic lithogenic risk factors. 10% of stoneformers had pure dietary factors. The percentage ofstone formers in each of the various metabolicsubgroups was as follows: Renal hypercalciuria 12%, Absorptive hypercalciuria 10%, Mild metabolichyperoxaluria 20%, Hypocitraturia 50%. Successfultherapy in terms of preventing further stoneformation was reported using indapamide, calciumcarbonate and potassium citrate in renal hypercalciuria,mild metabolic hyperoxaluria and hypo-citraturia respectively. Black volunteer subjects hadsignificantly higher 24hr urinary sodium excretionand significantly lower 24hr urinary calcium, citrateand cystine excretion than white volunteer subjects. Twenty-four hours urinary values in black stoneformers were found to be approaching those levelsfound in white.As urbanisation occurs in the black population, the incidence of urolithiasis would be expected to increase. We conclude that a detailed metabolic work-up is essential in the elucidation of the various metabolic risk factors. in so-called "idiopathic" CaOx stone formers. It allows appropriate, specific and highly cost-effective therapy aimed at the prevention of recurrence. [Erratum appears in AJN, 2017; 20(1):200.

Correction: Diagnostic and therapeutic aspects of recurrent renal stone disease

In Table 3 of the original publication of this article [1], the citrate excretion in white subjects is given as 1.39(0.92), which is incorrect. The correct value is 2.39(0.92). Reference1. Meyers A, Whalley N, Martins M. Diagnostic and therapeutic aspects of recurrent renal stone disease. Afr J Nephrol. 1998; 2(1):12-17

A study on the bacteria of dog bite wounds in dogs and their susceptibility to antimicrobials

To investigate the bacterial composition of infected and non-infected dog bite wounds (DBW), a prospective study was performed on dogs with various grades of bite wounds presenting at the Onderstepoort Veterinary Academic Hospital, University of Pretoria, and a nearby animal shelter. Fifty dogs with bite wounds inflicted within the previous 72 hours were selected. This represented 104 wounds. Wounds were clinically graded according to severity. Swabs were collected from all wounds for bacterial culture and cytology. Infection was diagnosed if 2 of the following 3 criteria were met: macroscopic purulence, microscopic presence of phagocytosed bacteria, or pyrexia. Non-infected wounds were either classed as sterile (established by culture) or contaminated (culture positive but bacteria not phagocytosed on cytology). To determine the origin of the bacteria, swabs were collected from the skin near the wounds and gingiva of 15 bite victims. All swabs were cultured aerobically and anaerobically and all aerobic cultures were evaluated for antimicrobial susceptibility using the Kirby Bauer disk diffusion test. The victims were predominately male, uncastrated, small-breed dogs. Of the 104 wounds studied, 21 were judged to be infected and 83 non-infected. Infected wounds were significantly more likely to culture positive (Fisher's exact test: p = 0.02). Sixteen per cent of wounds did not culture bacteria, 67% grew aerobes only, 1% anaerobes only and 67% a mixture of aerobes and anaerobes. A total of 213 isolates were cultured representing a mean of 2 isolates per wound. Of the aerobe species cultured, 22%, 19% and 17% belonged to the genera of Pasteurella, Streptococcus and Staphylococcus respectively. The species of Pasteurella multocida (66%) and Staphylococcus intermedius (70%) were predominant. Pasteurella canis and pyogenic streptococci were common in infected wounds, whereas Bacillus spp., Actinomyces spp. and oral streptococci were usually found in contaminated wounds. Three anaerobic genera were cultured, namely, Prevotella, Clostridium and Peptostreptococcus, and were usually associated with wounds with dead space. This study also describes the first documented case of Capnocytophaga canimorsus in an infected dog bite wound. Notably clinical and cytological assessment was capable of establishing whether antimicrobials were required or not. Although no single antimicrobials was considered to be effective against all the bacteria, amoxycillin plus clavulanic acid, 1st and 3rd generation cephalosporins, ampicillin or amoxycillin and potentiated sulphonamides gave the best in vitro sensitivity results.Dissertation (MMedVet(Surgery) Small Animal Surgery)--University of Pretoria, 2007.Companion Animal Clinical Studiesunrestricte

Characterization of “Neo-Dermis” Formation Beneath Cultured Human Epidermal Autografts Transplanted on Muscle Fascia

Cultured human keratinocyte autografts were transplanted to burn wounds that had been completely excised down to muscle fascia such that all cutaneous elements were removed from the wounds. Healing autografts were biopsied from days 6-153 in five patients, and the "neo-dermis" beneath the autografts was examined by immunofluorescent staining using antibody probes to connective tissue molecules, by histochemical staining for elastin fibers, and by electron microscopy. We found that the neo-dermis contained most of the major connective tissue elements early in the post-transplantation period. However, regardless of the time examined, there was a paucity of elastin fibers and poor organization of linkin (microthread-like fibers) in the neo-dermis beneath autografts. The perturbations of these connective tissue components in the neo-dermis may play a role in the poor recoil and elastic properties of burn wounds treated with autografts

Extroversion and conscientiousness predict deteriorating job outcomes during the COVID-19 transition to enforced remote work

At the beginning of the COVID-19 pandemic, organizations around the world rapidly transitioned to enforced remote work. We examined the relationship between personality and within-person changes in five job outcomes (self-reported performance, engagement, job satisfaction, burnout, and turnover intentions) during this transition. We conducted a four-wave longitudinal study, from May to August 2020, of employees working from home due to COVID-19, N = 974. On average, self-reported performance decreased over the course of the study, whereas the other outcomes remained stable. There was also significant between-person variability in job outcomes. Extroversion and conscientiousness, two traits traditionally associated with desirable outcomes, were associated with deteriorating outcomes over time. Extroverted employees and conscientious employees became less productive, less engaged, and less satisfied with their jobs; and extroverted employees reported increasing burnout. These results add to our understanding of how personality predicts within-person changes in performance, well-being, and turnover intentions during the pandemic

A Culturally Responsive School Leadership Approach to Developing Equity-Centered Principals: Considerations for Principal Pipelines

Principals are important. A recent synthesis of two decades of research on school leadership has documented that effective principals can have a positive impact on school climate, teacher satisfaction and retention, and student academic and other outcomes such as attendance and disciplinary behaviors (Grissom, Egalite, & Lindsay, 2021). Earlier research found that adopting a particular district-wide approach to principal development—known as building "a comprehensive, aligned principal pipeline"—was a powerful way to recruit and support a large corps of effective school leaders (Gates et al., 2019). The research about this approach, however, stopped short of fully addressing one of the most pressing issues in American education: educational equity, where all students learn and flourish in a welcoming, caring, and inclusive environment. Equity requires a commitment to fair and just treatment of each student, a willingness to address structural barriers to their success, and the delivery of resources aimed at providing equitable outcomes

Mycobacterium liflandii Infection in European Colony of Silurana tropicalis

Mycobacterium liflandii causes a fatal frog disease in captive anurans. Here we report, to our knowledge, the first epizootic of mycobacteriosis in a European colony of clawed frogs (Silurana tropicalis), previously imported from a United States biologic supply company. Our findings suggest the emerging potential of this infection through international trade

Duration of adjuvant chemotherapy for stage III colon cancer

BACKGROUND Since 2004, a regimen of 6 months of treatment with oxaliplatin plus a fluoropyrimidine has been standard adjuvant therapy in patients with stage III colon cancer. However, since oxaliplatin is associated with cumulative neurotoxicity, a shorter duration of therapy could spare toxic effects and health expenditures. METHODS We performed a prospective, preplanned, pooled analysis of six randomized, phase 3 trials that were conducted concurrently to evaluate the noninferiority of adjuvant therapy with either FOLFOX (fluorouracil, leucovorin, and oxaliplatin) or CAPOX (capecitabine and oxaliplatin) administered for 3 months, as compared with 6 months. The primary end point was the rate of disease-free survival at 3 years. Noninferiority of 3 months versus 6 months of therapy could be claimed if the upper limit of the two-sided 95% confidence interval of the hazard ratio did not exceed 1.12. RESULTS After 3263 events of disease recurrence or death had been reported in 12,834 patients, the noninferiority of 3 months of treatment versus 6 months was not confirmed in the overall study population (hazard ratio, 1.07; 95% confidence interval [CI], 1.00 to 1.15). Noninferiority of the shorter regimen was seen for CAPOX (hazard ratio, 0.95; 95% CI, 0.85 to 1.06) but not for FOLFOX (hazard ratio, 1.16; 95% CI, 1.06 to 1.26). In an exploratory analysis of the combined regimens, among the patients with T1, T2, or T3 and N1 cancers, 3 months of therapy was noninferior to 6 months, with a 3-year rate of disease-free survival of 83.1% and 83.3%, respectively (hazard ratio, 1.01; 95% CI, 0.90 to 1.12). Among patients with cancers that were classified as T4, N2, or both, the disease-free survival rate for a 6-month duration of therapy was superior to that for a 3-month duration (64.4% vs. 62.7%) for the combined treatments (hazard ratio, 1.12; 95% CI, 1.03 to 1.23; P=0.01 for superiority). CONCLUSIONS Among patients with stage III colon cancer receiving adjuvant therapy with FOLFOX or CAPOX, noninferiority of 3 months of therapy, as compared with 6 months, was not confirmed in the overall population. However, in patients treated with CAPOX, 3 months of therapy was as effective as 6 months, particularly in the lower-risk subgroup. (Funded by the National Cancer Institute and others.

Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD II

BACKGROUND: Psychotic depression (PD) is a severe disabling disorder with considerable morbidity and mortality. Electroconvulsive therapy and pharmacotherapy are each efficacious in the treatment of PD. Expert guidelines recommend the combination of antidepressant and antipsychotic medications in the acute pharmacologic treatment of PD. However, little is known about the continuation treatment of PD. Of particular concern, it is not known whether antipsychotic medication needs to be continued once an episode of PD responds to pharmacotherapy. This issue has profound clinical importance. On the one hand, the unnecessary continuation of antipsychotic medication exposes a patient to adverse effects, such as weight gain and metabolic disturbance. On the other hand, premature discontinuation of antipsychotic medication has the potential risk of early relapse of a severe disorder. METHODS/DESIGN: The primary goal of this multicenter randomized placebo-controlled trial is to assess the risks and benefits of continuing antipsychotic medication in persons with PD once the episode of depression has responded to treatment with an antidepressant and an antipsychotic. Secondary goals are to examine age and genetic polymorphisms as predictors or moderators of treatment variability, potentially leading to more personalized treatment of PD. Individuals aged 18-85 years with unipolar psychotic depression receive up to 12 weeks of open-label treatment with sertraline and olanzapine. Participants who achieve remission of psychosis and remission/near-remission of depressive symptoms continue with 8 weeks of open-label treatment to ensure stability of remission. Participants with stability of remission are then randomized to 36 weeks of double-blind treatment with either sertraline and olanzapine or sertraline and placebo. Relapse is the primary outcome. Metabolic changes are a secondary outcome. DISCUSSION: This trial will provide clinicians with much-needed evidence to guide the continuation and maintenance treatment of one of the most disabling and lethal of psychiatric disorders. TRIAL REGISTRATION AND URL: NCT: NCT01427608