Search

Abstract Background How long an antipsychotic is effective in maintaining response is important in choosing the correct treatment for people with schizophrenia. This post-hoc analysis describes maintenance of response over 24 or 28 weeks in people treated for schizophrenia with olanzapine, risperidone, quetiapine, ziprasidone, or aripiprazole. Methods This was a post-hoc analysis using data from 5 double-blind, randomized, comparative trials of 24 or 28 weeks duration in which olanzapine was compared to risperidone (1 study; N = 339), quetiapine (1 study; N = 346), ziprasidone (2 studies; N = 548 and 394) or aripiprazole (1 study; N = 566) for treatment of schizophrenia. For each study, time to loss of response in patients who met criteria for response at Week 8 and the proportion of patients who lost response following Week 8 were compared by treatment group. The number needed to treat (NNT) with olanzapine rather than comparator to avoid loss of one additional responder over 24 or 28 weeks of treatment was calculated for each study. Results Time maintained in response was significantly longer (p < .05) for olanzapine compared to risperidone, quetiapine, and ziprasidone. Olanzapine did not significantly differ from aripiprazole. The proportion of patients who lost response was significantly lower for olanzapine versus risperidone, quetiapine, and ziprasidone (p < .05). NNTs to avoid one additional patient with loss of response with olanzapine versus risperidone, quetiapine and ziprasidone were favourable, ranging from 5 to 9. Conclusion During 24 and 28 weeks of treatment, the antipsychotics studied differed in the time that treated patients with schizophrenia remained in response and the proportion of patients who lost response. Olanzapine treatment resulted in a consistent and statistically significant advantage in maintenance of response compared to treatment with risperidone, quetiapine and ziprasidone; but not compared to treatment with aripiprazole.

Osteoclastomas or brown tumours are named as such due to increased vascularity, subsequent haemorrhage and haemosiderin deposition giving the lesion a reddish brown appearance under gross microscopic examination. It is due to an increase in parathyroid hormone activity from several causes, such as parathyroid adenomas, renal impairment and low vitamin D levels. The lesions increase the tendency of the bone to fracture. The challenging aspect of the diagnosis is that a histological diagnosis without immunohistochemistry is impossible to make. This is because, without special staining, brown tumours cannot be differentiated from giant cell tumours, which are also classed as benign but can be locally destructive and has potential for malignant transformation. Once tissue diagnosis is confirmed as a brown tumour, then aggressive forms of treatment are not needed, and they generally resolve once the underlying cause is treated. We describe a woman in her 80s who presented to the local Orthopaedic service with a pathological ankle fracture due to a brown tumour., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Enterobacteriaceae producing β-lactamases have spread rapidly worldwide and pose a serious threat to human-animal-environment interface. In this study, we present the presence of Salmonella enterica (1.3%) and commensal Escherichia coli (96.3%) isolated from 400 environmental fecal dairy cattle samples over 20 farms in Uganda. Among E. coli isolates, 21% were resistant to at least one antimicrobial tested and 7% exhibited multidrug resistance. Four E. coli isolates displayed extended-spectrum beta-lactamase (ESBL)-producing genes, including bla CTX-M-15 (n = 2/4), bla CTX-M-27 (n = 1/4), bla SHV-12 (n = 1/4), and bla TEM-1B (n = 2/4). Whole genome sequencing confirmed the presence of the plasmid-mediated quinolone resistance qnrS1 gene among three ESBL isolates. No statistically significant differences in seasonal prevalence for E. coli and S. enterica among dairy cattle sampling periods were observed. Furthermore, to our knowledge, this is the first report of E. coli carrying bla CTX-M-15 , bla CTX-M-27 , bla SHV-12 , or qnrS1 isolated from dairy cattle in Uganda. We conclude that the presence of globally disseminated bla CTX-M-15 and bla CTX-M-27 warrants further study to prevent further spread. In addition, the presence of fluoroquinolone resistant ESBL-producing E. coli on dairy farms highlights the potential risk among the human-livestock-environment interaction. This study can be used as a baseline for implementation of a more robust national integrated surveillance system throughout Uganda.

Salmonella Kentucky has become the predominant serovar recovered from broilers slaughtered in the United States, and the prevalence of antimicrobial resistance (AMR) has increased dramatically in this serovar. Relationships between AMR, genotype, and plasmid replicon types were characterized for 600 Salmonella Kentucky isolates recovered from chicken carcasses from 2004 to 2013. Pulsed-field gel electrophoresis cluster analysis revealed 112 unique types sharing 79% similarity. Over half of the isolates studies were assigned to two large clusters (unique restriction patterns) consisting of 190 (A) and 151 (B) isolates. The remaining (n = 259) more diverse isolates (110 unique patterns) shall be designated cluster C for discussion. Clusters A had significantly more (p < 0.05) isolates resistant to streptomycin (68.4%) and tetracycline (91.6%) compared to cluster C (50.6% and 40.9% to streptomycin and tetracycline, respectively) or cluster B, which had the least (p < 0.05) resistance (11.9% and 13.2% to streptomycin and tetracycline, respectively). In addition, there was segregation of plasmid replicon types among clusters. Cluster A had significantly more (p < 0.05) replicon type FIB (90.5%) compared to cluster C (37.1%), which had significantly more compared to cluster B (10.6%). Cluster B had significantly more (p < 0.05) replicon type I1 (87.4%) compared to cluster C (68.7%), which had significantly more (p < 0.05) compared to cluster A (32.6%). Cluster C harbored significantly more (p < 0.05) HI2 replicon type (18.1%) compared to clonal clusters A (1.6%) or B (1.3%). The prevalence of plasmid replicon type A/C did not differ among clusters (A, 0.5%; B, 2.0%; C, 0.4%). Both streptomycin and tetracycline resistance were significantly linked (p < 0.05) to plasmid replicon type FIB. In addition, replicon type HI2 was also significantly linked (p < 0.05) to streptomycin resistance. We conclude that the dramatic increase in streptomycin and tetracycline resistance among Salmonella Kentucky isolated from poultry is due to the expansion of strains harboring plasmid replicon types FIB and HI2.

The Egg Products Inspection Act of 1970 requires that egg products in the U.S. must be pasteurized prior to release into commerce. The USDA Food Safety and Inspection Service (FSIS) is responsible for regulating egg products. Salmonellae are infrequently isolated from pasteurized egg products by food manufacturers or the FSIS and may be present as a result of either pasteurization-resistant bacteria or post-processing contamination. In this study, seventeen strains of Salmonella isolated from pasteurized egg products and three heat-resistant control strains were compared for the following attributes: thermal resistance in liquid whole egg (LWE) at 60 °C, enzymatic profiles, and serotyping and phage typing, antibiotic susceptibility, fatty acid analysis and strain morphological variation evaluated by scanning electron microscopy. Isolates were serotyped as Heidelberg (4 isolates), Widemarsh, Mbandaka, Cerro, Thompson, 4,12:i:-, and Enteritidis (8 isolates). All 20 isolates were sensitive to all 14 antibiotics tested for. The D60 values in LWE ranged from 0.34 to 0.58 min. All 20 strains were recovered from LWE inoculated with 8.5 logCFU/mL of Salmonella and pasteurized at 60 °C for 3.5 min; however, some isolates were not recovered from pasteurized LWE that had been inoculated with only 4.5 logCFU/mL Salmonella and treated at 60 °C for 3.5 min. Although some strains exhibited atypical enzymatic activity (e.g., reduction of adonitol, hydrolysis of proline nitroanilide or p-n-p-beta-glucuronide, and nonreduction of melibiose), differences in biochemical reactions could not be correlated with differences in thermal resistance. Furthermore, fatty acid analysis revealed that differences insaturate/unsaturated profiles may be correlated with differences in heat resistance, in two instances. One heat resistant strain (#13, Enteritidis) had the statistically lowest unsaturated/saturate ratio at 39%. However, one heat sensitive strain (#3, serovar 4,12:i:-) had the highest unsaturated/saturate ratio at 81%, and also the lowest concentration of stearic acid. This data represents the first steps in determining whether Salmonella contamination in pasteurized egg products may be the result of either thermally-resistant isolates or post-processing contamination. Contamination of LWE by Salmonella strains with higher heat resistance, (e.g., isolate #'s 2, 6, 10 and 12) may indicate the ability of Salmonella to survive pasteurization, while contamination of LWE strains with lower heat resistance (e.g., isolate #'s 1, 3, 5, 7, 8, 11, and 15) may indicate post-processing contamination of LWE by this foodborne pathogen., (Copyright © 2015. Published by Elsevier B.V.)