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Macesic N, Nelson B, Mcconville TH, Giddins MJ, Green DA, Stump S, Gomez-Simmonds A, Annavajhala MK, Uhlemann AC. Emergence of Polymyxin Resistance in Clinical Klebsiella pneumoniae Through Diverse Genetic Adaptations: A Genomic, Retrospective Cohort Study. Clin Infect Dis 2021; 70:2084-2091. [PMID: 31513705 DOI: 10.1093/cid/ciz623] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 07/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Polymyxins are antimicrobials of last resort for the treatment of carbapenem-resistant Enterobacteriaceae, but resistance in 5% to >40% isolates has been reported. We conducted a genomic survey of clinical polymyxin-resistant (PR) Klebsiella pneumoniae to determine the molecular mechanisms of PR and the role of polymyxin exposure versus transmission in PR emergence. METHODS We included 88 patients with PR K. pneumoniae from 2011-2018 and collected demographic, antimicrobial exposure, and infection data. Whole-genome sequencing was performed on 388 isolates, including 164 PR isolates. Variant calling and insertion sequence detection were performed, focusing on key genes associated with PR (mgrB, crrAB, phoPQ, and pmrAB). We conducted phylogenetic analyses of key K. pneumoniae multi-locus sequence types (ST258, ST17, ST307, and ST392). RESULTS Polymyxin exposure was documented in 53/88 (60%) patients prior to PR detection. Through an analysis of key PR genes, we detected 129 individual variants and 72 unique variant combinations in PR isolates. This included multiple, distinct changes in 36% of patients with serial PR isolates. Insertion sequence disruption was limited to mgrB (P < .001). Polymyxin minimum inhibitory concentrations showed stepwise increases with the number of PR genes affected (P < .001). When clusters containing PR isolates in ≥2 patients were analyzed, 10/14 had multiple genetic events leading to PR. CONCLUSIONS Molecular mechanisms leading to PR in clinical K. pneumoniae isolates are remarkably heterogenous, even within clusters or individual patients. Polymyxin exposure with de novo PR emergence led to PR in the majority of patients, rather than transmission. Optimizing polymyxin use should be a key strategy in stopping the spread of PR.
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Affiliation(s)
- Nenad Macesic
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York City, New York.,Central Clinical School, Monash University, Melbourne, Australia
| | - Brian Nelson
- Department of Pharmacy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York City, New York
| | - Thomas H Mcconville
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York City, New York
| | - Marla J Giddins
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York City, New York.,Microbiome & Pathogen Genomics Core, , New York City, New York
| | - Daniel A Green
- Clinical Microbiology Laboratory, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York City, New York
| | - Stephania Stump
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York City, New York.,Microbiome & Pathogen Genomics Core, , New York City, New York
| | - Angela Gomez-Simmonds
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York City, New York
| | - Medini K Annavajhala
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York City, New York.,Microbiome & Pathogen Genomics Core, , New York City, New York
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York City, New York.,Microbiome & Pathogen Genomics Core, , New York City, New York
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Yuzefpolskaya M, Bohn B, Nasiri M, Zuver AM, Onat DD, Royzman EA, Nwokocha J, Mabasa M, Pinsino A, Brunjes D, Gaudig A, Clemons A, Trinh P, Stump S, Giddins MJ, Topkara VK, Garan AR, Takeda K, Takayama H, Naka Y, Farr MA, Nandakumar R, Uhlemann AC, Colombo PC, Demmer RT. Gut microbiota, endotoxemia, inflammation, and oxidative stress in patients with heart failure, left ventricular assist device, and transplant. J Heart Lung Transplant 2020; 39:880-890. [PMID: 32139154 DOI: 10.1016/j.healun.2020.02.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/13/2020] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Gut microbial imbalance may contribute to endotoxemia, inflammation, and oxidative stress in heart failure (HF). Changes occurring in the intestinal microbiota and inflammatory/oxidative milieu during HF progression and following left ventricular assist device (LVAD) or heart transplantation (HT) are unknown. We aimed to investigate variation in gut microbiota and circulating biomarkers of endotoxemia, inflammation, and oxidative stress in patients with HF (New York Heart Association, Class I-IV), LVAD, and HT. METHODS We enrolled 452 patients. Biomarkers of endotoxemia (lipopolysaccharide and soluble [sCD14]), inflammation (C-reactive protein, interleukin-6, tumor necrosis factor-α, and endothelin-1 adiponectin), and oxidative stress (isoprostane) were measured in 644 blood samples. A total of 304 stool samples were analyzed using 16S rRNA sequencing. RESULTS Gut microbial community measures of alpha diversity were progressively lower across worsening HF class and were similarly reduced in patients with LVAD and HT (p < 0.05). Inflammation and oxidative stress were elevated in patients with Class IV HF vs all other groups (all p < 0.05). Lipopolysaccharide was elevated in patients with Class IV HF (vs Class I-III) as well as in patients with LVAD and HT (p < 0.05). sCD14 was elevated in patients with Class IV HF and LVAD (vs Class I-III, p < 0.05) but not in patients with HT. CONCLUSIONS Reduced gut microbial diversity and increased endotoxemia, inflammation, and oxidative stress are present in patients with Class IV HF. Inflammation and oxidative stress are lower among patients with LVAD and HT relative to patients with Class IV HF, whereas reduced gut diversity and endotoxemia persist in LVAD and HT.
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Affiliation(s)
- Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Bruno Bohn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Mojdeh Nasiri
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Amelia M Zuver
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Drew D Onat
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Eugene A Royzman
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Joseph Nwokocha
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Melissa Mabasa
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Alberto Pinsino
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Danielle Brunjes
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Antonia Gaudig
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Autumn Clemons
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Pauline Trinh
- Department of Environmental and Occupational Health Sciences, University of Washington, School of Public Health, Seattle, Washington
| | - Stephania Stump
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Marla J Giddins
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - A Reshad Garan
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Renu Nandakumar
- Biomarkers Core Laboratory, Irving Institute for Clinical and Translational Research, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases and Microbiome and Pathogen Genomics Core, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Columbia University, New York City, New York
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York.
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Annavajhala MK, Gomez-Simmonds A, Macesic N, Sullivan SB, Kress A, Khan SD, Giddins MJ, Stump S, Kim GI, Narain R, Verna EC, Uhlemann AC. Colonizing multidrug-resistant bacteria and the longitudinal evolution of the intestinal microbiome after liver transplantation. Nat Commun 2019; 10:4715. [PMID: 31624266 PMCID: PMC6797753 DOI: 10.1038/s41467-019-12633-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/23/2019] [Indexed: 02/06/2023] Open
Abstract
Infections by multidrug-resistant bacteria (MDRB) remain a leading cause of morbidity and mortality after liver transplantation (LT). Gut dysbiosis characteristic of end-stage liver disease may predispose patients to intestinal MDRB colonization and infection, in turn exacerbating dysbiosis. However, relationships between MDRB colonization and dysbiosis after LT remain unclear. We prospectively recruited 177 adult patients undergoing LT at a single tertiary care center. 16 S V3-V4 rRNA sequencing was performed on 723 fecal samples collected pre-LT and periodically until one-year post-LT to test whether MDRB colonization was associated with decreased microbiome diversity. In multivariate linear mixed-effect models, MDRB colonization predicts reduced Shannon α-diversity, after controlling for underlying liver disease, antibiotic exposures, and clinical complications. Importantly, pre-LT microbial markers predict subsequent colonization by MDRB. Our results suggest MDRB colonization as a major, previously unrecognized, marker of persistent dysbiosis. Therapeutic approaches accounting for microbial and clinical factors are needed to address post-transplant microbiome health.
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Affiliation(s)
- Medini K Annavajhala
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Microbiome and Pathogen Genomics Core, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Angela Gomez-Simmonds
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Nenad Macesic
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sean B Sullivan
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Microbiome and Pathogen Genomics Core, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Anna Kress
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Sabrina D Khan
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Microbiome and Pathogen Genomics Core, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Marla J Giddins
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Microbiome and Pathogen Genomics Core, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Stephania Stump
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
- Microbiome and Pathogen Genomics Core, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA
| | - Grace I Kim
- Division of Digestive and Liver Diseases, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - Ryan Narain
- Division of Digestive and Liver Diseases, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - Elizabeth C Verna
- Division of Digestive and Liver Diseases, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, NY Presbyterian Hospital, New York, NY, USA
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA.
- Microbiome and Pathogen Genomics Core, Columbia University Irving Medical Center, 630W 168th Street, New York, NY, 10032, USA.
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Snider EJ, Compres G, Freedberg DE, Khiabanian H, Nobel YR, Stump S, Uhlemann AC, Lightdale CJ, Abrams JA. Alterations to the Esophageal Microbiome Associated with Progression from Barrett's Esophagus to Esophageal Adenocarcinoma. Cancer Epidemiol Biomarkers Prev 2019; 28:1687-1693. [PMID: 31466948 DOI: 10.1158/1055-9965.epi-19-0008] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/17/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence of esophageal adenocarcinoma has risen dramatically over the past half century, and the underlying reasons are incompletely understood. Broad shifts to the upper gastrointestinal microbiome may be partly responsible. The goal of this study was to describe alterations in the esophageal microbiome that occur with progression from Barrett's esophagus to esophageal adenocarcinoma. METHODS A case-control study was performed of patients with and without Barrett's esophagus who were scheduled to undergo upper endoscopy. Demographic, clinical, and dietary intake data were collected, and esophageal brushings were collected during the endoscopy. 16S rRNA gene sequencing was performed to characterize the microbiome. RESULTS A total of 45 patients were enrolled and included in the analyses [16 controls; 14 Barrett's esophagus without dysplasia (NDBE); 6 low-grade dysplasia (LGD); 5 high-grade dysplasia (HGD); and 4 esophageal adenocarcinoma]. There was no difference in alpha diversity between non-Barrett's esophagus and Barrett's esophagus, but there was evidence of decreased diversity in patients with esophageal adenocarcinoma as assessed by Simpson index. There was an apparent shift in composition at the transition from LGD to HGD, and patients with HGD and esophageal adenocarcinoma had decreased Firmicutes and increased Proteobacteria. In addition, patients with HGD or esophageal adenocarcinoma had increased Enterobacteriaceae and Akkermansia muciniphila and reduced Veillonella. In the study population, patients taking proton pump inhibitors had increased Streptococcus and decreased Gram-negative bacteria overall. CONCLUSIONS Shifts in the Barrett's esophagus-associated microbiome were observed in patients with HGD and esophageal adenocarcinoma, with increases in certain potentially pathogenic bacteria. IMPACT The microbiome may play a role in esophageal carcinogenesis.
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Affiliation(s)
- Erik J Snider
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Griselda Compres
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel E Freedberg
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hossein Khiabanian
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Yael R Nobel
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Stephania Stump
- Department of Medicine, Columbia University Irving Medical Center, New York, New York.,Microbiome Core Facility, Columbia University Irving Medical Center, New York, New York
| | - Anne-Catrin Uhlemann
- Department of Medicine, Columbia University Irving Medical Center, New York, New York.,Microbiome Core Facility, Columbia University Irving Medical Center, New York, New York
| | - Charles J Lightdale
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Julian A Abrams
- Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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5
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Hill-Ricciuti A, Ferguson S, Geng W, Stump S, Messina M, Zachariah P, Sahni R, Green D, Whittier S, Saiman L, Uhlemann AC. 1217. Staphylococcus Protein A (spa) Typing Demonstrates Genetic Heterogeneity of Methicillin-Susceptible Staphyloccus aureus (MSSA) in a Neonatal Intensive Care Unit (NICU). Open Forum Infect Dis 2018; 5. [PMCID: PMC6252977 DOI: 10.1093/ofid/ofy210.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | | | - Wenjing Geng
- Columbia University Medical Center, New York, New York
| | | | - Maria Messina
- Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
| | - Philip Zachariah
- Pediatrics, Columbia University Medical Center, New York, New York,Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
| | - Rakesh Sahni
- Neonatology, Columbia University Medical Center, New York, New York
| | - Daniel Green
- Pathology, Columbia University Medical Center, New York, New York
| | - Susan Whittier
- Pathology, Columbia University Medical Center, New York, New York
| | - Lisa Saiman
- Pediatrics, Columbia University Medical Center, New York, New York,Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
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Cuaresma E, Laszkowska M, Stump S, Moscoso D, Chong D, Freedberg D. 1772. Vancomycin-Resistant Enterococcus Alters the Gastrointestinal Microbiome in Critically Ill Patients. Open Forum Infect Dis 2018. [PMCID: PMC6252724 DOI: 10.1093/ofid/ofy209.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Edward Cuaresma
- Medicine, Columbia University Medical Center, New York, New York
| | | | | | | | - David Chong
- Columbia University Medical Center, New York, New York
| | - Daniel Freedberg
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
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Tawde SN, Puschner B, Albin T, Stump S, Poppenga RH. Death by caffeine: presumptive malicious poisoning of a dog by incorporation in ground meat. J Med Toxicol 2013; 8:436-40. [PMID: 23104127 DOI: 10.1007/s13181-012-0254-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A 4-year-old, 37 kg, male German shepherd developed hyperthermia, tachycardia, and agitation following consumption of ground meat found in the backyard of its owner. When presented to a veterinary clinic, plasma ethylene glycol (EG) testing was positive, and the dog was given ethanol and lactated Ringer's solution intravenously. Approximately 11 h postexposure the dog died. DISCUSSION Among tissues submitted for toxicological analysis, urine was negative for EG, ground meat was negative for certain drugs of abuse, and gastric contents were negative for zinc/aluminum phosphide and metaldehyde. Analysis of gastric contents by gas chromatography-mass spectrometry confirmed the presence of caffeine. Caffeine concentration in the ground meat was estimated at 1 %. Caffeine is a methylxanthine alkaloid with a reported canine oral median lethal dose (MLD(50)) of 140 mg/kg (range 120-200 mg/kg). A commercially available 200-mg tablet formulation of caffeine was considered to be a possible source but this was not confirmed. By conservative estimates, the dog would need to ingest approximately 500-550 g of the meat to reach the MLD(50). Acute intoxication affects the cardiovascular, pulmonary, neurologic, gastrointestinal, and metabolic systems. Although no tablet remnants were observed in the bait, tablets could have been crushed and/or dissolved. Other potential caffeine sources include guarana, brewed and concentrated coffee, and caffeine-containing beverages. Based on the history, clinical signs, and the detection of caffeine in the gastric contents and meat, a presumptive diagnosis of malicious caffeine poisoning was made. A suggested treatment regimen for caffeine intoxication in dogs is described. While few cases of accidental ingestion of caffeine by dogs have been described, the intentional use of a concentrated caffeine source to cause mortality in a dog has not been previously reported.
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Affiliation(s)
- S N Tawde
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California-Davis, West Health Sciences Drive, Davis, CA 95616, USA.
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Schulz H, Winzer A, Stump S, Koch U. Beeinflussung der Lebensqualität von Tumorpatienten durch psychoonkologische Interventionen. Der Onkologe 2001. [DOI: 10.1007/s007610170152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Perlman SE, Postlethwaite D, Stump S, Bielan B, Rudy SJ. Taking a sexual history from and counseling women on teratogenic drugs. J Reprod Med 2001; 46:163-8. [PMID: 11255824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVES After studying this article, the reader should be able to: 1. Describe the relationship of sexual history taking and counseling to the safe prescription of teratogenic drugs. 2. Define the scope of the problem of unintended pregnancy and the importance of sexual history taking and counseling. 3. Review the skills of sexual counseling and taking a sexual health history. Although the need to take a sexual history and counsel patients about conception and contraception appears in several clinical situations, the process can be uncomfortable, and some physicians may avoid it or do it incompletely. When a patient is receiving a teratogenic agent, the need for proper history taking and counseling is critical. This article reviews ways to make the process more comfortable and rewarding for both the patient and physician.
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Affiliation(s)
- S E Perlman
- Department of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Weis J, Heckel U, Muthny F, Nowak C, Stump S, Kepplinger J. [Experiences with psychosocial liaison service on oncologic units of an acute clinic]. Psychother Psychosom Med Psychol 1993; 43:21-9. [PMID: 8441798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Within the last years psychosocial care in acute medicine has become more and more important. Therefore different conceptional structures are discussed to optimize the integration into primary care medicine, especious psychosomatic or psychosocial consultation and liaison services. Having resumed the concepts and practice of psychosocial care in oncology this paper describes a psychosocial liaison service accompanying a research project in psychooncology. The representation focuses the experience with psychosocial care of cancer patients over the last three years. Based on a systematic clinical documentation the activities are described with regard to psychosocial indication, patient assignment, patients needs during acute treatment and the different kinds of psychosocial interventions applied. The experiences are evaluated regarding the target groups (patients, relatives, medical staff) and associated problems of cooperation and organisation met with medical staff. Finally needs, possibilities and limits of psychosocial liaison services are discussed comparing the experiences with others reported in the literature.
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Affiliation(s)
- J Weis
- Abteilung für Rehabilitationspsychologie, Universität Freiburg
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12
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Abstract
A device is described that permits continuous measurement of electrophysiological parameters in epithelial tissues in the open-circuit mode. Transepithelial potential (VT) and microelectrode (either conventional or ion-selective) potential (VM) are directly measured. Application of transepithelial current pulses allows continuous monitoring of transepithelial resistance (RT) and the ratio between the changes in VM and VT induced by these pulses. Measurement of this ratio, which under some circumstances reflects the apical fractional resistance of the cellular pathway, is important in assessing membrane damage during microelectrode impalement and/or as an index that the microelectrode tip is inside a cell. This is particularly useful when the change in VM during impalement is small. Application of 0.5-nA current pulses through open-tip microelectrodes allows continuous recording of the microelectrode resistance (RM). In epithelia where the individual cells are electrically coupled this permits acceptable impalements (RM remains nearly constant) to be distinguished from those affected by tip potential artifacts due to plugging of the microelectrode tip (RM increases after penetration of the cell membrane). The device provides compensation for the IR voltage drop in the solution between the potential measuring salt bridges and the epithelial surfaces. The microelectrode electrometer has an input impedance greater than 10(15) and is provided with stray capacitance neutralization.
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