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Rifampicin (RFP) is a potential treatment for canine multidrug-resistant (MDR) meticillin-resistant staphylococci (MRS), yet the use of lower doses based on recent MIC data has not been evaluated in vivo.To provide information on the efficacy and safety of low-dose range RFP (≤6 mg/kg/day) for the treatment of canine MDR MRS pyoderma.Fifty-one client-owned dogs.Retrospective review of dogs medical records. Dogs were from 11 US dermatology referral practices and had oral RFP at ≤6 mg/kg/day. Data evaluated included response to treatment, adverse events, and serum changes in alanine aminotransferase (ALT) and alkaline phosphatase (ALP).Complete resolution of pyoderma occurred in 39 of 51 dogs (76.5%). Topical antimicrobials were used concurrently in most cases (47 of 51; 92.2%). ALP elevation1.5-fold of baseline or the high end of the reference range occurred in nine of 37 (24.3%) dogs, while ALT elevation above baseline and the high end of the reference range occurred in two of 36 (5.6%). Only six of 51 (11.8%) had clinical adverse events during treatment; five of six (83.3%) were mild reactions consisting of lethargy and gastrointestinal signs, while one dog had a possible cutaneous adverse drug reaction. Of those that experienced clinical adverse events, four of six (66.7%) did not have concurrent increased liver enzyme activity, while two of six (33.3%) had elevations in ALP alone.Low-dose RFP (≤6 mg/kg/day) appears to be a relatively safe and effective single-agent systemic antibiotic in combination with topical antimicrobials for canine MDR MRS pyoderma.La rifampicine (RFP) est un traitement potentiel des staphylocoques canins multirésistants (MDR) résistants à la méticilline (MRS), mais l'utilisation de doses plus faibles sur la base de données récentes sur la CMI n'a pas été évaluée in vivo. Hypothèse/Objectifs : Fournir des informations sur l'efficacité et l'innocuité des RFP à faible dose (≤ 6 mg/kg/jour) pour le traitement de la pyodermite MDR-MR canine. Animaux : Cinquante et un chiens de propriétaires. Matériels et méthodes : Revue rétrospective de chiens ayant reçu RFP par voie orale à des doses ≤ 6 mg/kg/jour provenant des dossiers médicaux de 11 centres de référés en dermatologie aux États-Unis. Les données évaluées comprenaient la réponse au traitement, les événements indésirables et les modifications sériques de l'alanine aminotransférase (ALT) et de la phosphatase alcaline (ALP). Résultats : Une résolution complète de la pyodermite s'est produite chez 39 des 51 chiens (76,5 %). Des antimicrobiens topiques ont été utilisés simultanément dans la plupart des cas (47 sur 51 ; 92,2 %). Une élévation de l'ALP 1,5 fois la ligne de base ou l'extrémité supérieure de la plage de référence s'est produite chez neuf des 37 (24,3%) chiens, tandis qu'une élévation de l'ALT au-dessus de la ligne de base et de l'extrémité supérieure de la plage de référence s'est produite chez deux des 36 (5,6%). Seuls six sur 51 (11,8 %) ont eu des événements indésirables cliniques pendant le traitement ; cinq des six (83,3 %) étaient des réactions bénignes consistant en une léthargie et des signes gastro-intestinaux, tandis qu'un chien a eu un possible effet indésirable cutané au médicament. Parmi ceux qui ont subi des événements indésirables cliniques, quatre sur six (66,7 %) n'ont pas eu d'augmentation simultanée de l'activité des enzymes hépatiques, tandis que deux sur six (33,3 %) ont présenté des élévations de l'ALP seule. Conclusions et pertinence clinique : La RFP à faible dose (≤ 6 mg/kg/jour) semble être un antibiotique systémique à agent unique relativement sûr et efficace en association avec des antimicrobiens topiques pour la pyodermite MDR MRS canine.Introducción- la rifampicina (RFP) es un tratamiento potencial para los estafilococos resistentes a múltiples fármacos (MDR) y meticilina (MRS), sin embargo, el uso de dosis más bajas basado en datos recientes de MIC no se ha evaluado in vivo. Hipótesis/Objetivos- Proporcionar información sobre la eficacia y seguridad de RFP en el rango de dosis bajas (≤6 mg/kg/día) para el tratamiento de la pioderma canina MDR MRS. Animales- Cincuenta y un perros propietarios particulares. Materiales y métodos- revisión retrospectiva de perros que recibieron RFP oral a dosis ≤6 mg/kg/día obtenida de historiales clínicos de 11 prácticas de referencia de dermatología de los Estados Unidos. Los datos evaluados incluyeron la respuesta al tratamiento, los eventos adversos y los cambios séricos en la alanina aminotransferasa (ALT) y la fosfatasa alcalina (ALP). Resultados- una resolución completa de la pioderma ocurrió en 39 de 51 perros (76,5 %). Antimicrobianos tópicos se usaron al mismo tiempo en la mayoría de los casos (47 de 51; 92,2%). En nueve de 37 (24,3 %) perros se produjo una elevación de ALP1,5 veces respecto al valor inicial o el extremo superior del rango de referencia, mientras que en dos de 36 (5,6 %) se produjo una elevación de ALT por encima del valor inicial y en el límite superior del rango de referencia. Solo seis de 51 (11,8%) tuvieron eventos adversos clínicos durante el tratamiento; cinco de seis (83,3 %) fueron reacciones leves que consistieron en letargo y signos gastrointestinales, mientras que un perro tuvo una posible reacción cutánea adversa al medicamento. De los que experimentaron eventos adversos clínicos, cuatro de seis (66,7 %) no tuvieron un aumento simultáneo de la actividad de las enzimas hepáticas, mientras que dos de seis (33,3 %) tuvieron elevaciones en la ALP por sí sola. Conclusiones y relevancia clínica- la dosis baja de RFP (≤6 mg/kg/día) parece ser un antibiótico sistémico de uso único relativamente seguro y efectivo en combinación con antimicrobianos tópicos para la pioderma canina MDR MRS.Hintergrund: Rifampicin (RFP) ist eine mögliche Behandlung für multi-resistente (MDR) Methicillin-resistente Staphylokokken (MRS) des Hundes, wobei allerdings der Einsatz niedrigerer Dosen basierend auf jüngsten MIC Daten bis jetzt noch nicht in vivo evaluiert wurden. Hypothese/Ziele: Informationen zu liefern in Bezug auf die Wirksamkeit und die Sicherheit von niedrig-dosiertem RFP (≤6 mg/kg/Tag) zur Behandlung der MDR MRS Pyodermie des Hundes. Tiere: Einundfünfzig Hunde in Privatbesitz Material und Methoden: Es handelt sich hierbei um eine retrospektive Review von Hunden, die RFP bei einer Dosierung von ≤6 mg/kg/Tag per os erhielten; diese wurden aus den Patientenkarteien von 11 dermatologischen Überweisungspraxen in den Vereinigten Staaten herausgesucht. Die Daten, die evaluiert wurden, betrafen Antwort auf die Behandlung, Nebenwirkungen, Serumveränderungen der Alanin Aminotransferase (ALT) und der alkalischen Phosphatase (ALP). Ergebnisse: Eine komplette Abheilung der Pyodermie erfolgte in 39 von 51 Hunden (76,5%). Topische antimikrobielle Substanzen wurden in den meisten Fällen (47 von 51; 92,2%) gleichzeitig angewendet. Eine ALP Erhöhung auf das 1,5-fache der Ausgangsbasis oder dem oberen Rand der Referenzwerte erfolgte in neun von 37 (24,3%) der Hunde während ALT Erhöhungen über den Ausgangswert und das obere Limit des Referenzwertes nur bei zwei von 36 (5,6%) Hunden auftrat. Nur sechs von 51 (11,8%) zeigten klinische Nebenwirkungen während der Behandlung; fünf von sechs (83,3%) zeigten milde Reaktionen, die aus Lethargie und gastrointestinalen Beschwerden bestanden, während ein Hund eine mögliche kutane Nebenwirkungsreaktion zeigte. Von jenen Hunden, die klinische Nebenwirkungen zeigten, hatten vier von sechs (66,7%) keine bleibenden erhöhten Leberwerte, während zwei von sechs (33,3%) nur eine erhöhte ALP zeigten. Schlussfolgerungen und klinische Bedeutung: RFP niedrig dosiert (≤6 mg/kg/Tag) in Kombination mit topischen antimikrobiellen Substanzen scheint eine relativ sichere und wirksame Methode zu sein, um mit einem einzigen Antibiotikum die MDR MRS Pyodermie des Hundes systemisch zu behandeln.背景- リファンピシン(RFP)は犬の多剤耐性(MDR)メチシリン耐性ブドウ球菌(MRS)に対する治療薬として期待されているが，最近のMICデータに基づく低用量の使用はin vivoでは評価されていない。 仮説/目的- 本研究の目的は、犬のMDR MRS膿皮症に対する低用量域RFP(≦6 mg/kg/day)の有効性および安全性に関する情報を提供することであった。 供試動物- オーナー所有犬 51 頭。 材料と方法- 米国11カ所の皮膚科紹介施設の診療記録から入手した、6mg/kg/day以下の用量のRFPを経口投与された犬の回顧的レビュー。評価したデータは、治療に対する反応、有害事象、アラニンアミノトランスフェラーゼ(ALT)およびアルカリホスファターゼ(ALP)の血清変化などである。 結果 51頭中39頭(76.5%)で膿皮症は完治した。ほとんどの症例で外用抗菌薬が併用された(51頭中47頭，92.2%)。ALPが基準値の1.5倍以上または基準値の上限を超えたのは37頭中9頭(24.3%)、ALTが基準値の上限を超えたのは36頭中2頭(5.6%)であった。臨床的有害事象は51頭中6頭(11.8%)に発現し，6頭中5頭(83.3%)が嗜眠や消化器症状からなる軽度の反応であり，1頭が皮膚の副作用の可能性があった。また，臨床的有害事象のうち，6頭中4頭(66.7%)は肝酵素活性の上昇を同時に認めず，6頭中2頭(33.3%)はALPのみの上昇を認めた。 結論と臨床的関連性 犬のMDR型MRS膿皮症に対する低用量RFP(≦6 mg/kg/day)は，外用抗菌薬との併用で比較的安全かつ有効な単剤全身用抗菌薬と思われた。.背景:利福平 (RFP) 是治疗犬多重耐药 (MDR) 耐甲氧西林葡萄球菌 (MRS) 的潜在药物，但基于最近的 MIC 数据，尚未评价在体内较低剂量的使用。 假设/目的:提供低剂量范围RFP(≤6 mg/kg/天)治疗犬 MDR MRS 脓皮病的疗效和安全性信息。 动物:51只私家犬。 材料和方法:回顾性审查接受剂量≤6 mg/kg/天 RFP 经口给药的犬，来自11家美国皮肤科转诊诊所的病历。评价的数据包括治疗效果、不良反应和血清丙氨酸氨基转移酶 (ALT) 和碱性磷酸酶 (ALP) 变化。 结果:51只犬中有39只 (76.5%) 的脓皮病完全消退。大多数病例同时使用外部抗菌剂 (47/51；92.2%)。37只犬中有9只 (24.3%) 发生 ALP 升高 1.5倍基线值或参考范围上限，而36只犬中有2只 (5.6%) 发生 ALT 升高高于基线值和参考范围上限。治疗期间，51只犬中仅6只 (11.8%) 发生临床不良反应；6只犬中的5只 (83.3%) 为轻度反应，包括嗜睡和胃肠道症状，而1只犬可能发生皮肤药物不良反应。在发生临床不良反应的犬中，6例中的4例 (66.7%) 未同时发生肝酶活性升高，而6例中的2例 (33.3%) 仅发生 ALP 升高。.Contexto - A rifampicina (RFP) é um tratamento potencial para estafilococos resistentes à meticilina (MRS) multirresistentes (MDR) e a utilização de doses mais baixas baseado em dados recentes de MIC não foi avaliada in vivo. Hipótese/Objetivos: Fornecer informações sobre a eficácia e segurança de RFP em menor dosagem (≤6 mg/kg/dia) para o tratamento de piodermite canina por MRS MDR. Animais: Cinquenta e um cães de clientes. Materiais e métodos: Uma revisão retrospectiva dos prontuários de cães que receberam RFP oral na dose de ≤6 mg/kg/dia em 11 clínicas dermatológicas nos Estados Unidos. Os dados avaliados incluíram resposta ao tratamento, eventos adversos, alterações séricas de alanina aminotransferase (ALT) e fosfatase alcalina (FA). Resultados: Resolução completa da piodermite ocorreu em 39 de 51 dos cães (76,5%). Antimicrobianos tópicos foram utilizados concomitantemente na maioria dos casos (47 de 51; 92,2%). Elevação de mais de 1,5 vezes na FA ou para o limite superior do intervalo de referência ocorreu em nove de 37 cães (24,3%), enquanto a elevação de ALT acima do valor inicial e o limite superior do valor de referência ocorreu em dois de 36 (5,6%). Apenas cinco de 51 (11,8%) apresentaram efeitos adversos durante o tratamento; cinco de seis (83,3%) tiveram reações leves caracterizadas por letargia e sinais gastrointestinais, enquanto um cão apresentou uma possível farmacodermia. Dos que apresentaram eventos adversos, quatro de seis (66,7%) não apresentaram aumento concomitante de enzimas hepáticas, enquanto dois de seis (33,3%) tiveram aumento de FA isoladamente. Conclusões e relevância clínica - RFP em baixa dosagem (≤6 mg/kg/dia) aparenta ser relativamente segura e eficaz em monoterapia no tratamento da piodermite canina por MRS MDR por via sistêmica, associada a antimicrobianos tópicos.

Commercial quantitative (q)PCR and fungal culture can be used concurrently or individually to test for dermatophytosis with a reported high sensitivity and specificity.The aims of this retrospective study were: (i) to evaluate the concordance of a commercial qPCR with in-house fungal culture for the initial diagnosis of dermatophytosis and for monitoring for mycological cure during treatment in dermatology private practice; and (ii) determine the sensitivity and specificity of qPCR overall, (iii) for initial diagnosis and (iv) for treatment monitoring in dogs and cats.Four-hundred and twenty-seven client-owned dogs and 188 client-owned cats.Retrospective evaluation of electronic medical records from 615 client-owned dogs and cats presented to 16 dermatology referral practices across the USA from 2018 to 2019. Concordance of qPCR with in-house fungal culture and sensitivity and specificity were determined from 667 paired samples.qPCR agreed with in-house fungal culture in 63 of 85 positive tests and 571 of 582 negative tests, with an overall sensitivity and specificity of 74.1% [95% confidence interval (CI) 63.5-83.0] and 98.1% (95%CI 96.6-99.0), respectively. qPCR sensitivity and specificity for the initial diagnosis of dermatophytosis and for treatment monitoring were 72.4% (95%CI 59.1-83.3) and 98.7% (95%CI 97.3-99.5), and 77.8% (95%CI 57.7-91.4) and 92.0% (95%CI 80.1-97.8), respectively.Compared to in-house fungal culture, qPCR was less sensitive and more specific than reported previously. These findings suggest that a diagnosis of dermatophytosis and determining mycological cure should continue to be based on a combination of complementary diagnostic tests.La PCRq quantitative commerciale et la culture fongique peuvent être utilisées simultanément ou individuellement pour le diagnostic de dermatophytose avec une sensibilité et une spécificité élevées. Hypothèses/Objectifs: Les objectifs de cette étude rétrospective étaient : (i) d'évaluer la concordance d'une PCRq commerciale avec culture fongique interne pour le diagnostic initial de dermatophytose et pour le suivi de la guérison mycologique lors d'un traitement en cabinet libéral de dermatologie ; et (ii) déterminer la sensibilité et la spécificité de la PCRq dans son ensemble, (iii) pour le diagnostic initial et (iv) pour le suivi du traitement chez les chiens et les chats. Animaux: Quatre cent vingt-sept chiens de clients et 188 chats de clients. Matériels et méthodes: Évaluation rétrospective des dossiers médicaux électroniques de 615 chiens et chats appartenant à des clients présentés à 16 consultations de référence en dermatologie aux États-Unis de 2018 à 2019. La concordance de Qpcr avec la culture fongique interne et la sensibilité et la spécificité ont été déterminées à partir de 667 paires d’échantillons. Résultats: La PCRq concordait avec la culture fongique interne dans 63 des 85 tests positifs et 571 des 582 tests négatifs, avec une sensibilité et une spécificité globales de 74,1 % [intervalle de confiance (IC) à 95 % 63,5-83,0] et 98,1 % (95 % IC 96,6-99,0), respectivement. La sensibilité et spécificité de la qPCR pour le diagnostic initial de dermatophytose et pour le suivi du traitement étaient de 72,4 % (IC à 95 % 59,1-83,3) et 98,7 % (IC à 95 % 97,3-99,5), et 77,8 % (IC à 95 % 57,7-91,4) et 92,0 % (IC à 95 % 80,1-97,8), respectivement. Conclusions et pertinence clinique : Par rapport à la culture fongique interne, la PCRq était moins sensible et plus spécifique que celle rapportée précédemment. Ces résultats suggèrent que le diagnostic de dermatophytose et la détermination de la guérison mycologique doivent continuer à reposer sur une combinaison de tests diagnostiques complémentaires.Introducción- la (q)PCR cuantitativa comercial y el cultivo de hongos se pueden usar de forma simultánea o individual para detectar dermatofitosis con una alta sensibilidad y especificidad reportadas. Hipótesis/Objetivos- Los objetivos de este estudio retrospectivo fueron: (i) evaluar la concordancia de una qPCR comercial con cultivo fúngico interno para el diagnóstico inicial de dermatofitosis y para el seguimiento de la curación micológica durante el tratamiento en la práctica privada de dermatología; y (ii) determinar la sensibilidad y especificidad de la qPCR en general, (iii) para el diagnóstico inicial y (iv) para el seguimiento del tratamiento en perros y gatos. Animales- 427 perros y 188 gatos de propietarios particulares. Materiales y métodos: evaluación retrospectiva de historiales clínicos electrónicos de 615 perros y gatos de propietarios particulares presentados en 16 prácticas de referencia de dermatología en los EE.UU. de 2018 a 2019. La concordancia de qPCR con el cultivo y la sensibilidad y especificidad de cada uno se determinó en 667 muestras pareadas. Resultados: qPCR presentó concordancia con el cultivo fúngico interno en 63 de 85 pruebas positivas y 571 de 582 pruebas negativas, con una sensibilidad y especificidad generales del 74,1 % [95 % intervalo de confianza (IC) 63,5-83,0] y 98,1 % (IC 95 % 96,6-99,0), respectivamente. La sensibilidad y especificidad de qPCR para el diagnóstico inicial de dermatofitosis y para el seguimiento del tratamiento fueron 72,4% (IC 95% 59,1-83,3) y 98,7% (IC 95% 97,3-99,5), y 77,8% (IC 95% 57,7-91,4) y 92,0% (IC 95% 80,1-97,8 ), respectivamente. Conclusiones y relevancia clínica- en comparación con el cultivo de hongos interno, la qPCR fue menos sensible y más específica que lo informado anteriormente. Estos hallazgos sugieren que el diagnóstico de dermatofitosis y la determinación de la curación micológica debe seguir basándose en una combinación de pruebas diagnósticas complementarias.Hintergrund: Ein kommerzieller quantitativer (q)PCR und eine Pilzkultur können gleichzeitig oder individuell angewendet werden, um auf eine Dermatopytose zu testen, beides wurde mit einer hohen Sensibilität und Spezifität beschrieben. Hypothese/Ziele - Die Ziele dieser retrospektiven Studie waren: (i) eine Evaluierung der Übereinstimmung des kommerziellen qPCR Tests mit einer Pilzkultur, die im Haus angelegt wurde, für die Erstdiagnose einer Dermatophytose und für eine Verlaufskontrolle der mykologischen Heilung in einer dermatologischen Privatpraxis; und (ii) die Bestimmung der Sensibilität und der Spezifität des qPCR insgesamt, (iii) zur Erstdiagnose und (iv) zum Monitoring des Behandlungsverlaufs bei Hunden und Katzen. Tiere - Vierhundertsiebenundzwanzig Hunde und 188 Katzen in Privatbesitz. Material und Methoden - Eine retrospektive Evaluierung der elektronischen Patientenkarteien von 615 Hunden und Katzen in Privatbesitz, die an 16 Überweisungspraxen für Veterinärdermatologie in ganz USA zwischen 2018 und 2019 vorgestellt wurden. Eine Übereinstimmung des qPCR mit der hauseigenen Pilzkultur sowie die Sensibilität und die Spezifität wurden anhand von 615 gepaarten Proben bestimmt. Ergebnisse - Der qPCR stimmte mit der hauseigenen Pilzkultur in 63 von 85 positiven Tests sowie bei 571 von 582 negativen Tests überein, mit einer insgesamten Sensibilität und Spezifität von 74,1% [95% Konfidenzintervall (CI) 63,5-83,0] bzw. 98,1% (95%CI 96,6-99,0). Die qPCR Sensibilität und Spezifität für die Erstdiagnose einer Dermatophytose und für die Beobachtung des Behandlungsverlaufs lag bei 72,4% (95%CI 59,1-83,3) bzw. 98,7% (95%CI 97,3-99,5), sowie bei 77,8% (95%CI 57,7-91,4) bzw. 92,0% (95%CI 80,1-97,8). Schlussfolgerungen und klinische Bedeutung - Im Vergleich zur hauseigenen Pilzkultur zeigte der qPCR eine geringere Sensibilität und eine höhere Spezifität als bisher beschrieben wurde. Diese Ergebnisse sind ein Hinweis darauf, dass die Diagnose einer Dermatophytose und die Bestimmung der mykologischen Heilung weiterhin auf einer Kombination von sich ergänzenden diagnostischen Tests basieren sollte.背景: 皮膚糸状菌症の検査には、市販の定量(q)PCR、真菌培養を同時あるいは個別に用いることができ、高い感度と特異度が得られると報告されている。 仮説/目的: 本回顧的研究の目的は以下の通りである。(i) 皮膚糸状菌症の初期診断および治療中の真菌学的治癒のモニタリングに対する市販qPCRおよび院内真菌培養の一致を評価すること、(ii) 犬および猫の初期診断および治療モニタリングに対するqPCR全体の感度および特異度を決定すること、(iii) 犬および猫の治療モニタリングに対するqPCRの感度および特異度を決定することであった。 供試動物: 飼育犬 47 頭、飼育猫 188 頭。 材料と方法: 2018年から2019年にかけて米国内の16の皮膚科紹介診療所に来院した飼育犬・猫615匹の電子カルテを回顧的に評価した。667のペアサンプルからqPCRおよび院内真菌培養の一致および感度・特異度を決定した。 結果:qPCRは85件の陽性検査のうち63件、582件の陰性検査のうち571件で院内真菌培養と一致し、全体の感度および特異度は74.1%[95%信頼区間(CI)63.5-83.0]、98.1% [95%信頼区間(CI)96.6-99.0]であった。 皮膚糸状菌症の初期診断および治療モニタリングの感度・特異度はそれぞれ72.4%(95%CI 59.1-83.3)、98.7%(95%CI 97.3-99.5)、77.8%(95%CI 57.7-91.4)、92.0%(95%CI 80.1-97.8)であった。 結論と臨床的意義: 院内真菌培養と比較して、qPCRは従来報告されているよりも感度が低く、特異度が高かった。これらの結果から、皮膚糸状菌症の診断および真菌学的治癒の判定は、今後も補完的な診断検査の組み合わせに基づくことが望ましいと考えられた。.背景:市售定量(q)PCR和真菌培养可同时或单独用于检测皮肤癣菌病，报告具有较高的敏感性和特异性。 假设/目的:本回顾性研究的目的是:(i)评价市售qPCR与院内真菌培养用于皮肤癣菌病初步诊断和皮肤科私人诊所治疗期间真菌学治愈监测的一致性；(ii)确定qPCR的总体敏感性和特异性，(iii)用于犬和猫的初步诊断和(iv)用于治疗监测。 动物:427只私家犬和188只私家猫。 材料和方法:回顾性评价2018年至2019年在美国16家皮肤科转诊诊所就诊的615只私家犬和猫的电子病历。从667样本中确定Qpcr与院内真菌培养的一致性以及敏感性和特异性。 结果:85次阳性检测中有63次qPCR与院内真菌培养一致，582次阴性检测中有571次qPCR与院内真菌培养一致，总体敏感性和特异性分别为74.1%[95%置信区间(CI)63.5-83.0]和98.1%(95%CI 96.6-99.0)，分别为。qPCR对皮肤癣菌病初诊和治疗监测的敏感性和特异性分别为72.4%(95%CI 59.1-83.3)和98.7%(95%CI 97.3-99.5)，77.8%(95%CI 57.7-91.4)和92.0%(95%CI 80.1-97.8)。 结论和临床相关性:与院内真菌培养相比，qPCR的敏感性和特异性低于先前报告。这些发现表明，皮肤癣菌病的诊断和确定真菌学治愈应保持基于联合其他替代诊断试验。.Contexto - PCR quantitativa (q) comercial e cultura fúngica podem ser utilizadas concomitantemente ou individualmente no diagnóstico de dermatofitose com alta sensibilidade e especificidade. Hipótese/Objetivos - Os objetivos deste estudo retrospectivo foram: (i) avaliar a concordância de uma qPCR comercial com uma cultura fúngica in-house para o diagnóstico inicial de dermatofitose e para o monitoramento de cura micológica durante o tratamento em clínicas privadas de dermatologia veterinária; e (ii) determinar a sensibilidade e especificidade o qPCR de forma geral, (iii) no diagnóstico inicial e (iv) para o monitoramento do tratamento em cães e gatos. Animais - Quatrocentos e vinte e sete cães e 188 gatos de clientes. Materiais e métodos - Avaliação retrospectiva de prontuários eletrônicos de 615 cães e gatos de clientes apresentados a 16 centros de referência em dermatologia nos EUA de 2018 a 2019. A concordância entre qPCR e a cultura fúngica in-house foi determinada para 667 amostras pareadas. Resultados: Houve concordância entre qPCR e cultura fúngica interna em 63 dos 85 testes positivos e 571 dos 582 testes negativos, com sensibilidade e especificidade gerais de 74,1% [intervalo de confiança de 95% (IC) 63,5-83,0] e 98,1% (IC 95% 96,6-99,0), respectivamente. Sensibilidade e especificidade da qPCR para o diagnóstico inicial de dermatofitose e para acompanhamento do tratamento foram 72,4% (IC 95% 59,1-83,3) e 98,7% (IC 95% 97,3-99,5), e 77,8% (IC 95% 57,7-91,4) e 92,0% (IC 95% 80,1-97,8), respectivamente. Conclusões e relevância clínica: Em comparação à cultura fúngica in-house, a qPCR foi menos sensível e mais específica do que o relatado anteriormente. Esses achados sugerem que o diagnóstico da dermatofitose e a determinação da cura micológica devem continuar baseados na combinação de exames complementares de diagnóstico.

Recreational hiking in the mountains is a common activity, whether for a single day or for several days in a row. We sought to measure blood pressure (BP) response during a 10-day trek at moderate-altitude elevation (6500&ndash, 13,000 feet) and observe for uncontrolled hypertension and/or adverse cardiovascular outcomes. A total of 1279 adult participants completed an observational study of resting BP during a 10-day trek in the Sangre de Cristo mountains. Following initial recruitment, participants were issued a trail data card to record BP measurements at day 0 (basecamp), day 3, day 6 and day 9. BP was measured using a sphygmomanometer and auscultation. Demographic data, height, weight, home altitude, daily water and sports drink intake, existence of pre-arrival hypertension and BP medication class were also recorded. We observed a rise in mean blood pressure for the cohort during all exposures to moderate altitudes. The increases were greatest for individuals with pre-existing hypertension and/or obesity. There were no observed life-threatening cardiovascular events for participants. We conclude that for individuals with a modestly controlled blood pressure of 160/95 mmHg, hiking at a moderate altitude is a safe activity.

Background Post-transplant weight gain affects 50–90% of kidney transplant recipients adversely affecting survival, quality of life, and risk for diabetes and cardiovascular disease. Diet modification and physical activity may help prevent post-transplant weight gain. Methods for effective implementation of these lifestyle modifications are needed. The objective of this study is to assess the feasibility and acceptability of a remotely delivered nutrition and physical activity intervention among kidney transplant recipients. Secondary aims were to estimate the effectiveness of the intervention in producing changes in physical activity, qualify of life, fruit and vegetable intake, and consumption of whole grains and water from baseline to 6 months. Methods A randomized controlled study for stable kidney transplant recipients between 6 and 12 months post-transplantation was conducted. Participants were randomly assigned 1:1 to a technology-based, lifestyle modification program (intervention) or to enhanced usual care (control). Results The first 10 kidney transplant recipients screened were eligible and randomized into the intervention and control groups with no significant between-group differences at baseline. Health coaching attendance (78%) and adherence to reporting healthy behaviors (86%) were high. All participants returned for final assessments. The weight in controls remained stable, while the intervention arm showed weight gain at 3 and 6 months. Improvements were found for physical activity, quality of life, and fruit and vegetable intake in both groups. All participants would recommend the program to other transplant recipients. Conclusions Our data suggest that a remotely delivered televideo nutrition and physical activity intervention is feasible and valued by patients. These findings will aid in the development of a larger, more prescriptive, randomized trial to address weight gain prevention. Trial registration Clinicaltrials.gov Identifier NCT03697317. Retrospectively registered on October 5, 2018.

OBJECTIVES: An estimated 20 billion pounds of edible fruits and vegetables are wasted at the farm level every year, often due to being unmarketable or the farm growing excess.(1) This wasted food could go towards meeting the hunger and nutritional needs of the one in eight Americans who are food insecure.(2) Food distribution agencies are typically unable to provide a balanced diet for their clients.(3) Rescuing or gleaning excess produce from farms can reduce food waste while providing fresh, nutritious food to people in need. However, there is limited information on what factors farmers take into consideration when deciding to donate excess produce. The purpose of this project was to learn about farmers’ views towards donating excess produce to food agencies. METHODS: Semi-structured interviews with fruit and vegetable farmers in the greater Kansas City metro area were completed as part of a larger program evaluation of the gleaning and food rescue agency, After the Harvest. Interviews were digitally recorded, transcribed, and analyzed for common themes across responses. RESULTS: Interviews were completed with 32 farmers. Sixteen farmers had previously donated produce to the gleaning agency and sixteen had not. Most reported having excess produce because they had grown more than they could harvest or sell. Excess produce was either donated to the gleaning agency, left in the field, composted, fed to animals, or donated directly by the farmer to food banks or churches. Farmers who had donated liked doing so because they want the food they grow to be consumed, the produce goes to people who need it, and the donation took very little time and effort. Those who had not donated were concerned about the amount of time it would take to organize the donation, having volunteers in their fields, and that the crops with excess amounts would be worth gleaning and donating to food agencies. Overall, farmers were very willing to donate excess produce and most were willing to have volunteer gleaners at their farms. CONCLUSIONS: Farmers like to know the food they grow gets consumed but often do not have the time or resources to handle excess produce and are most likely to donate when it is made easier for them to do so. Food rescue agencies should provide flexible donation options to farmers and communicate to farmers that they can donate produce without losing time or money. FUNDING SOURCES: The Hall Family Foundation.

Nosocomial infections are a growing concern in veterinary hospitals, and identifying fomites is imperative to reducing the risk of pathogen transmission. In veterinary medicine, shaving of hair is necessary prior to many procedures. Contaminated clipper blades have been cited as potential fomites involved in the transmission of pathogens in veterinary and human medicine. The primary goal of this study was to evaluate bacterial contamination of clipper blades in veterinary practices. A secondary goal was to assess whether there was an association between bacterial contamination of clipper blades and clipper blade cleaning solutions, clipper blade cleaning protocols, clipper blade storage, and type of practice. Sixty clipper blades from 60 different practices were cultured. Information regarding blade cleaning solutions, protocols, and storage was collected from each practice. Fifty-one percent (31/60) of clipper blades sampled were contaminated with bacteria. Category of cleaning solutions had a significant association with bacterial contamination (P < 0.02). Cleaning frequency (P = 0.55), storage location (P = 0.26), and practice type (P = 0.06) had no significant association with bacterial contamination. This study documented bacterial contamination of clipper blades in veterinary practices, and clipper blades should be considered potential fomites.

OBJECTIVES: Kidney transplant recipients often experience weight gain in the first year after transplantation and this weight gain is associated with higher rates of cardiovascular disease, new-onset diabetes, metabolic syndrome and loss of graft function. The purpose of this study was to examine the characteristics of transplant recipients at our institution and describe post-transplant weight change. METHODS: Utilizing the institution's research data repository, we searched for adult kidney transplant patients from January 2014 through February 2019. Percent weight change at 6 and 12 months was calculated as a percentage of total body weight from time of transplant. Weight gain was defined as an increase of 5% or more while weight stable was classified as no weight change or less than 5% gain. Weight loss was defined as losing 5% or more of body weight from baseline. RESULTS: Of 598 cases, the sample was predominantly male (n = 361; 60%), married (n = 355; 59%) and white (n = 415; 69%). At transplant, mean age was 51.3 ± 13.5 years and mean weight was 85.26 ± 20.10 kg (males = 90.62 ± 20.73 kg; females = 77.53 ± 16.33 kg). At 6 months post-transplant, 87% of recipients (n = 518) had recorded weights. Of those individuals, 26% (n = 133) experienced weight gain (mean + 11.9%; median + 9.9%), gaining on average 8.9 ± 5.09 kg. Thirty one % (n = 163) lost weight (mean −10.3%; median - 8.8%), and 43% (n = 222) were weight stable. At 12 months post-transplant, 78.1% (n = 467) of patients had recorded weights. Of those individuals, 42% (n = 195) experienced weight gain (mean + 13%, median + 10%), 18% (n = 86) lost weight (mean −10.95%, median - 8.94%), and 40% (n = 185) maintained baseline weight. Those who gained weight during this period experienced a 10.16 ± 6.00 kg increase. CONCLUSIONS: Post-transplant weight gain is a critical issue among our institution's kidney transplant recipients with more than 40% gaining significant weight, placing them at risk for early mortality and decreased graft survival. Healthcare professionals should continue to educate and direct recipients to weight management programs to control the amount of weight gained following transplantation. Helping kidney transplant recipients prevent unnecessary weight gain is essential to their prolonged survival and quality of life. FUNDING SOURCES: None.

SEC24 family members are components of the coat protein complex II (COPII) machinery that interact directly with cargo or with other adapters to ensure proper sorting of secretory cargo into COPII vesicles. SEC24C is 1 of 4 mammalian SEC24 paralogs (SEC24A-D), which segregate into 2 subfamilies on the basis of sequence homology (SEC24A/SEC24B and SEC24C/SEC24D). Here, we demonstrate that postmitotic neurons, unlike professional secretory cells in other tissues, are exquisitely sensitive to loss of SEC24C. Conditional KO of Sec24c in neural progenitors during embryogenesis caused perinatal mortality and microcephaly, with activation of the unfolded protein response and apoptotic cell death of postmitotic neurons in the murine cerebral cortex. The cell-autonomous function of SEC24C in postmitotic neurons was further highlighted by the loss of cell viability caused by disrupting Sec24c expression in forebrain neurons of mice postnatally and in differentiated neurons derived from human induced pluripotent stem cells. The neuronal cell death associated with Sec24c deficiency was rescued in knockin mice expressing Sec24d in place of Sec24c. These data suggest that SEC24C is a major cargo adapter for COPII-dependent transport in postmitotic neurons in developing and adult brains and that its functions overlap at least partially with those of SEC24D in mammals.

A four-year-old female spayed mongrel dog was presented in May 2015 with a two-year history of poorly controlled atopic dermatitis (AD) and increased pruritus over the last few months. Current medications included Apoquel, prednisone, diphenhydramine and cephalexin. A deep skin scrape revealed Demodex canis and Demodex cornei and superficial cytology revealed coccoid bacteria. Aerobic skin culture revealed meticillin-resistant Staphylococcus pseudintermedius (MRSP) and dermatophyte culture grew Microsporum canis . Therapy included discontinuation and taper of immunosuppressive medications, oral enrofloxacin and ivermectin and Malaseb shampoo. Complete resolution of demodicosis, dermatophytosis and MRSP was accomplished in four months. Long-term control of AD was established by using low-dose prednisone therapy with no relapse in infectious disease. This case illustrates the risk of development of multiple infectious diseases secondary to immunosuppression with multimodal drug therapy for treatment of AD, and it exemplifies the importance of performing in-house diagnostic testing.

OBJECTIVES: The purpose of this study was to understand food security and fruit/vegetable consumption among individuals receiving aid from food pantries and other food assistance agencies. METHODS: Across the US, 12.9% of people are affected by food insecurity(1) and 5.5% of households report obtaining food from a food pantry(2). Similarly, food insecurity affects 12.9% of the population in Kansas and 14.7% in Missouri(1). After the Harvest is a nonprofit organization that helps address food insecurity by rescuing fruits and vegetables from going to waste and donating them to agencies that serve hungry people in the Kansas City metropolitan area. As part of a larger evaluation of the After the Harvest program, intercept surveys with individuals receiving aid from food pantries and other food assistance agencies were conducted at selected locations in the Kansas City area. In each survey, a demographic questionnaire and a Dietary Screener Questionnaire were administered. Food insecurity was screened using two items derived from the USDA's Food Security Survey Module. Additionally, skin carotenoids were measured using the Veggie Meter™ as a biomarker of fruit and vegetable intake. RESULTS: A total of 57 food agency clients participated in the study. About 67% of the clients indicated that within the past 12 months, they had worried about their food running out before having money to buy more. Additionally, 74% reported that the food they bought didn't last and they didn't have money to buy more. On average, the food agency clients reported eating 1 cup of fruit per day and 1.4 cups of vegetables per day, which fell far below recommendations set by the Dietary Guidelines for Americans. Similarly, they had a Veggie Meter™ score of 175 ± 77, indicating a very low level of fruit and vegetable intake. CONCLUSIONS: Food agency clients were food insecure and had very low fruit and vegetable intakes. Efforts to increase the amount of fresh fruit and vegetable donations at food assistance agencies may represent an opportunity to improve the diets among clientele. FUNDING SOURCES: The Hall Family Foundation.

For hospitals located in the United States, appropriate use of cardiac telemetry monitoring can be achieved resulting in cost savings to healthcare systems. Our institution has a limited number of telemetry beds, increasing the need for appropriate use of telemetry monitoring to minimise delays in patient care, reduce alarm fatigue, and decrease interruptions in patient care.This quality improvement project was conducted in a single academic medical centre in Kansas City, Kansas. The aim of the project was to reduce inappropriate cardiac telemetry monitoring on intermediate care units. Using the 2004 American Heart Association guidelines to guide appropriate telemetry utilisation, this project team sought to investigate the effects of two distinct interventions to reduce inappropriate telemetry monitoring, huddle intervention and mandatory order entry. Telemetry utilisation was followed prospectively for 2 years.During our initial intervention, we achieved a sharp decline in the number of patients on telemetry monitoring. However, over time the efficacy of the huddle intervention subsided, resulting in a need for a more sustained approach. By requiring physicians to input indication for telemetry monitoring, the second intervention increased adherence to practice guidelines and sustained reductions in inappropriate telemetry use.

160 Background: Childhood cancer survivors (CCS) face complex psychological late effects. The need for systematic screening for psychosocial distress has been clearly identified; however, less clarity exists around characterizing factors that might identify patients at higher risk to support targeted treatment. The purpose of this study was to examine the results of psychological screening in a clinic for adult survivors of childhood cancer using the validated NCCN Distress Screening Thermometer and modified Needs Assessment and exploring the results with other patient factors. Methods: Retrospective chart review was completed on 117 CCS seen in our Survivorship Transition Clinic (STC) between 2014 and 2017. The NCCN Distress Thermometer and Needs Assessment were administered to patients attending the STC. Results were then analyzed with a number of additional factors to explore association. These factors included intensity of treatment (by Children’s Hospital of Philadelphia Intensity of Treatment Rating scale or ITR3), gender, and age at diagnosis. Results: Of 117 patients, 54 had low intensity ITR3 scores (1 or2) and 63 had high intensity ITR3 scores (3 or 4). Mean distress score was 2.669 for the group. A weak but statistically significant association existed between ITR3 scores and distress scale scores (r = 0.2, n = 117, p = 0.022). Mean distress scale scores did not differ between men (2.26 +/- 2.09) and women (2.92 +/- 2.6) nor were they significantly related to age at diagnosis (p = 0.242). Needs assessment identified emotional, nutritional, and physical as the most frequent concerns. Care needs mostly commonly identified were feeling anxious/worried/irritable, being concerned with weight control, or problems with pain / fatigue. Conclusions: While we did not identify statistically significant differences in distress based on gender or age at diagnosis, we did find weak statistical association between higher treatment intensity and higher distress scores. Needs assessment helped guide care plan development. As childhood cancer survivor rates increase, we have an obligation to evolve our understanding of not only physical late effects but also psychological late effects.

33 Background: With growing numbers of childhood cancer survivors (CCS), having systems for survivorship care coordination is imperative. While studies have compared the comfort and knowledge between primary care and oncology physicians in providing CCS care, few have analyzed primary and subspecialty care rates. Referral trends can be informative for institutions developing systems of care. Correlative measures with referral needs may help institutions prioritize process development for patients. Methods: Retrospective chart reviews were completed on 117 adult CCS from Survivorship Transition Clinic (STC) between 2014-2017. Upon arrival, STC patient self-reports were recorded regarding existing PCP status. Patients with PCPs were enrolled in survivorship consultation care, those without enrolled in survivorship and PCP care. Referrals were tracked by electronic medical record. Two oncology providers performed blinded independent reviews treatment summaries and scored treatments using Children’s Hospital of Philadelphia Intensity of Treatment Rating scale (ITR-3). If scores differed, discussion determined consensus. Final scores were matched with data on subspecialty referral patterns. Results: Of 117 patients, 65 (57%) needed both PCP and survivorship care while 50 (43%) had established PCPs. ITR3 scores were low intensity (1 or2) for 54 patients and high intensity (3 or 4) for 63 patients. The low intensity group had 157 total referrals (3 per patient) compared to 391 total referrals (6 per patient) in the high intensity group. The top 5 subspecialty referrals (by patients referred) were psychological services (46), dermatology (44), fertility (29), hematology / oncology / BMT (22), cardiology (20). Conclusions: Our care coordination trends suggest many CCS do not have established PCPs despite their complex care needs. Not surprisingly, higher intensity treatment correlates with higher subspecialty care needs. Psychological care remains the most prevalent need in our patient population. [Table: see text]