Doses Of Penicillin Research Articles

Retrospective evaluation of association between perioperative antimicrobial protocol and complications following elective equine synovial endoscopy.

BackgroundProphylactic perioperative antimicrobial protocols in equine synovial endoscopy have been described but not compared with respect to post‐operative outcomes and complications. Increasing antimicrobial resistance in equine practice and interest in promoting judicious use of antimicrobials has prompted reevaluation of drug selection and dosing strategies.ObjectivesTo determine the frequency of and compare post‐operative complications following elective synovial endoscopy between horses receiving different perioperative antimicrobial protocols.MethodsRecords from the Colorado State University Veterinary Teaching Hospital were evaluated (2014–2018) and equine patients undergoing elective synovial endoscopy were identified. Patients undergoing endoscopy for sepsis or internal fixation were excluded. Patient signalment, clinician, joint and limb involved, perioperative antimicrobial regimen, number endoscopic portals and closure technique, and post‐operative complications including incidence of joint infection were recorded. Generalized linear models were used to estimate the odds of post‐operative complications.ResultsElective synovial endoscopies of 516 horses in 537 procedures evaluating 761 synovial structures were performed. No horses developed post‐operative septic synovitis. Administration of post‐operative antimicrobials, type used and patient sex were all significantly associated with increased risk of complications, which were predominantly gastrointestinal‐related. Complication rates in horses receiving a single preoperative dose of cefazolin were lower than in horses receiving potassium penicillin, gentamicin or multiple doses. Complication rates were lower in females compared to castrated or intact males. Other factors evaluated (breed, age, surgeon, anaesthesia duration or hospitalization, joint/limb operated, number endoscopic portals) were not associated with increased risk of complications post‐operatively in this case population.ConclusionsProphylactic perioperative antimicrobial protocols in equine practice deserve periodic reconsideration due to increased antimicrobial resistance. Prolonged antimicrobial usage beyond the time of surgery was unnecessary to prevent septic synovitis following synovial endoscopy in this case population and was furthermore associated with an increased risk of gastrointestinal complications.

1332. Single Dose Oral Amoxicillin Challenge is a Safe and Effective Strategy to Delabel Penicillin Allergies among Low Risk Hospitalized Children

BackgroundOver 90% of children with reported penicillin allergy can tolerate penicillin without incident. Developing effective and safe strategies to remove inappropriate penicillin allergies has the potential to improve care; however, guidance on how to identify, test, and delabel patients is limited.MethodsIn April 2019, Children’s Hospital Colorado (CHCO) implemented a penicillin allergy clinical pathway (CP) alongside a risk assessment tool to stratify patients based on allergic history (Figure 1). Patients at “no increased risk” were educated and delabeled without testing. Low risk patients were offered an oral amoxicillin drug challenge with close observation. A single, non-graded, treatment dose of amoxicillin (45 mg/kg, max dose 1000mg) was used for low risk patients, and no preceding allergic skin testing was performed. Patients with no signs or symptoms of allergic response 60 minutes after amoxicillin administration were delabeled. Children delabeled of penicillin allergies on the CHCO hospital medicine service were compared between the pre-CP (1/1/17-3/31/19) and post-CP (4/1/19-3/31/20) cohorts.Figure 1. Penicillin Allergy Risk Assessment ResultsPre-CP, 683/10624 (6.4%) patients reported a penicillin allergy and 18/683 (2.6%) were delabeled by discharge. Post-CP, 345/6559 (5.3%) patients reported a penicillin allergy and 47/345 (13.6%) were delabeled by discharge (P-value < 0.0001, Figure 2). Among the 47 post-CP patients, 11 were delabeled by history alone, 19 underwent oral amoxicillin drug challenge per CP, and 17 received a different treatment dose penicillin per treatment team. Only one penicillin-exposed patients had a reaction. This patient developed a delayed, non-progressive rash and had penicillin allergy restored to their chart. No patient required emergency medical intervention, and none were “relabeled” penicillin allergic in the 6 months following discharge.Figure 2. Monthly Rate of Penicillin Allergic Patients Delabeled by Discharge ConclusionA drug challenge using a single non-graded dose of oral amoxicillin is a safe and effective strategy to delabel low risk children of inappropriate penicillin allergies when implemented alongside a risk assessment tool. Further studies are needed to evaluate the long-term benefits of delabeling inappropriate penicillin allergies and to continue monitoring for adverse events.Disclosures All Authors: No reported disclosures

An unusual presentation of neurosyphilis with complicated pulmonary involvement in a patient without HIV infection

Background: Neurosyphilis could develop at any time in the course of syphilis; with an annual incidence of 0.7 per 100,000 men. Homosexual and HIV were risk factors. Here we report an unusual case of neurosyphilis in non-HIV patient with complicated pulmonary involvement. Case description: A fifty-six-year-old promiscuity, heterosexual man, active smoker presented with a three-month history of pruritic maculopapular rashes on his body associated with low-grade fever, and a two-week history of productive cough with dyspnea. On physical examination, he was tachypnea, with crackles on the base of the right lung. There was plaque hyperpigmentation on his malar area and multiple maculopapular, erythematous lesions on his trunk, extremities including palms of the hands, and scrotal area. No ulcer was found on his penis. Laboratory results revealed leukocytosis (19.9 × 103/μl), non-reactive HIV test, with high titer of serum VDRL (1/8) and TPHA (1/1280). Chest X-ray showed infiltrate on right perihilar area. Patient was diagnosed as pneumonia with secondary syphilis. The patient was treated with a single dose of benzathine penicillin G 2.4 million units intramuscular and azithromycin 500 mg tablet OD. During observation, he had altered mental status, generalized tonic seizure, high-grade fever with respiratory distress. He had Argyll Robertson pupil, left central facial and hypoglossal nerve paralysis, and positive meningeal signs, with normal brain CT scan result, non-reactive CSF-VDRL and TPHA, with high leucocyte (17 cells/μl) and protein (54 mg/dl). He was diagnosed neurosyphilis with hospital-acquired pneumonia and treated with ceftriaxone and vancomycin, 2 g OD and 750 mg OD intravenous, respectively. The patient showed no significant improvement and unfortunately, he progressed to death caused by multiple organ dysfunctions due to septic shock. Discussion: There is no single, highly sensitive and specific diagnostic test exists for neurosyphilis. The diagnosis of neurosyphilis is based on clinical findings and the results of serologic tests and CSF examination. The CSF-VDRL has sensitivity 30–70%, non-reactive test does not exclude neurosyphilis. Neurosyphilis in a patient without HIV infection could be diagnosed by a high WBC or protein in CSF with symptoms or signs of neurosyphilis even with non-reactive CSF-VDRL. Conclusion: Neurosyphilis could be considered even with a non-reactive CSF-VDRL result in non-HIV patient.

Inclusion of supplemental antibiotics (amikacin – penicillin) in a commercial extender for stallion semen: Effects on sperm quality, bacterial growth, and fertility following cooled storage

In this study, the effectiveness of supplementing INRA-96® extender (INRA-Control; original antibiotic formulation: potassium penicillin G = 38 μg/mL; gentamicin sulfate = 105 μg/mL; amphotericin B = 0.315 μg/mL) with amikacin sulfate and potassium penicillin G (AP) was determined. In Exp. 1, two sources of amikacin (INRA-AP-Sigma or INRA-AP-GoldBio) in combination with penicillin G were compared with ticarcillin/clavulanate (INRA-Tim) or no-supplemental antibiotics (INRA-Control) to examine effects on sperm quality and commensal bacterial growth. No differences were detected in semen quality among treatments after 30 min of exposure (Time 30min) or 24 h of cooled storage (Time 24 h; P > 0.05). At both time periods, commensal bacterial growth was significantly lower in Groups INRA-AP-GoldBio and INRA-AP-Sigma than in INRA-Tim or INRA-Control (P < 0.05). In Exp. 2, increasing doses of amikacin sulfate (GoldBio) plus potassium penicillin G (Sigma) - AP (AP-1000, 2000, 3000, 4000 or 5000 μg-IU/mL, respectively) were added to INRA-96® extender and their effects on sperm quality and commensal bacterial growth were evaluated at Time 30min and Time 24 h. Slight reductions in progressive motility and viability were observed at Time 30min in Groups AP-4000 and AP-5000 as compared to other treatment groups (P < 0.05); however, no differences in sperm quality were detected among treatment groups at Time 24 h (P > 0.05). At both time periods, commensal bacterial growth was significantly lower in Groups AP-3000, AP-4000 and AP-5000 than in AP-1000 and AP-2000 (P < 0.05). In Exp. 3, a breeding trial was conducted to determine the effect of adding a high dose of AP (AP-5000) to INRA-96® extender on resulting pregnancy rates of mares bred with cool-stored semen (Time 24 h). Numerical, but not statistical differences, were observed in pregnancy rates between the mares bred with INRA-Control (6/11; 55%) or INRA-AP-5000 (9/11; 82%; P > 0.05). Supplementation of INRA-96® extender with two different concentrations of AP (AP-1000 or AP-5000) was tested in two clinical cases of stallions where semen was moderately to heavily contaminated with Pseudomonas aeruginosa, or both Klebsiella pneumoniae and Pseudomonas aeruginosa. In both cases, addition of AP resulted in a considerable decrease on bacterial growth in cool-stored semen when compared to the use of the original INRA-96® extender without supplemental antibiotics. In conclusion, the addition of amikacin sulfate and potassium penicillin G to INRA-96® extender allowed for effective control of commensal bacteria without affecting sperm quality. Higher doses of amikacin and penicillin can be safely added to INRA-96® extender to improve the antibacterial activity of this extender against commensal, and potentially pathogenic bacteria, while sperm quality and fertility of cooled semen remains unaffected. Based on the results of the present study, we currently recommend that INRA-96® extender can be safely supplemented with amikacin/penicillin by using a conventional dose of 1000 μg/mL – 1000 IU/mL as a prophylactic measure in cases where contamination of the ejaculates with commensal bacteria is evident. Alternatively, a high dose (5000 μg/mL – 5000 IU/mL) can be used as a control method for potentially pathogenic bacteria.

Association of Obesity With Maternal and Cord Blood Penicillin Levels in Women With Group B Streptococcus Colonization.

To compare maternal and cord blood penicillin concentrations in women with and without obesity who are receiving intrapartum group B streptococcus (GBS) prophylaxis. We performed a prospective cohort study of term women receiving intrapartum penicillin prophylaxis for GBS colonization (determined by antenatal rectovaginal culture). The following outcomes were compared between obese (body mass index [BMI] 35 or higher at delivery) and nonobese (BMI less than 30 at delivery) groups: penicillin concentration in maternal blood (after two penicillin doses) and umbilical cord blood, GBS rectovaginal colonization status on admission and after two completed doses, and neonatal GBS colonization (using a postnatal ear swab). Fifty-five women were needed to detect a 0.75 SD difference in cord blood penicillin concentrations. Fifty-five women were enrolled and had all specimens collected; 49 had complete data for analysis (obese n=25, nonobese n=24). There was no difference in the median maternal penicillin concentration between groups (obese 4.2 micrograms/mL vs nonobese 4.0 micrograms/mL, P=.58). There was, however, a 60% lower median cord blood penicillin concentration in the obese compared with the nonobese group (2.7 micrograms/mL vs 6.7 micrograms/mL, respectively, P<.01), with no significant difference in time from last penicillin dose to delivery (obese 2.9 hours vs nonobese 1.7 hours, P=.07). The difference in cord blood concentrations remained significant after adjustment for nulliparity, hypertensive disorders, and time from last penicillin dose to delivery. Only 59.6% of women tested positive for GBS by rectovaginal culture on admission (obese 60.9% vs nonobese 58.3%, P=.86). The median cord blood penicillin concentration was 60% lower in neonates born to women with obesity compared with those born to women without obesity. However, all concentrations exceeded the minimum inhibitory concentration. Maternal penicillin levels were not significantly different between groups. More than 40% of women who previously tested positive for GBS by antenatal culture tested negative for GBS on admission for delivery.

Overlapping Primary and Secondary Syphilis in Human Immunodeficiency Virus (HIV) Patient

ABSTRACTCoinfection between syphilis and Human Immunodeficiency Virus (HIV) could have varied clinical manifestations. Overlapping of syphilis stages is accounted for 25% of cases, attributable to the defect of the cellular and humoral immune response. We reported 55 years old man who was sexually active since 25 years ago via genito-genital, genito-anal, genito-oral routes, had multiple sexual partners both male and female, seldom used condom, and always being the insertive. Dermatological examination revealed alopecia non-scarring, a painless solitary ulcer on the collum penis, also multiple erythematous macules, patches, and plaques all over the body. Spirochaeta sp. was found from the base of the ulcer with a darkfield microscope. Histopathology examination revealed secondary syphilis lesion. Venereal Disease Research Laboratory (VDRL) 1:16, Treponema Pallidum Haemagglutination test (TPHA) reactive, HIV Determine rapid test reactive, and CD4 (Cluster of Differentiation 4) T-cell count 111 cells/ µL. He was treated with a single dose of benzathine penicillin G 2,4 million units intramuscular and antiretroviral drugs. On sixth month evaluation, VDRL was non-reactive, and CD4 T-cell count 325 cells/µL. This case shows that overlapping clinical manifestations of primary and secondary syphilis on HIV patients could occur with a good general condition. Immediate treatment of antibiotics for syphilis and antiretroviral could improve the clinical and serological conditions.Keyword: primary syphilis, secondary syphilis, HIVCorrespondence: nurul.laili.nahlia@gmail.com

Subcutaneous administration of benzathine benzylpenicillin G has favourable pharmacokinetic characteristics for the prevention of rheumatic heart disease compared with intramuscular injection: a randomized, crossover, population pharmacokinetic study in healthy adult volunteers.

Benzathine penicillin G has been used as monthly deep intramuscular (IM) injections since the 1950s for secondary prevention of acute rheumatic fever and rheumatic heart disease (RHD). Injection frequency and pain are major programmatic barriers for adherence, prompting calls for development of better long-acting penicillin preparations to prevent RHD. We hypothesized that subcutaneous (SC) administration of benzathine penicillin G could delay penicillin absorption when compared with IM injections. To compare the pharmacokinetic profile and tolerability of benzathine penicillin G according to different routes of administration, 15 healthy males participated in a randomized crossover study to receive benzathine penicillin G by either SC or IM routes, with a 10 week washout period before the second dose by the alternative route. Ultrasound guidance confirmed injection location. Penicillin concentrations and pain scores were measured for 6 weeks following injections. SC administration was well tolerated with no significant differences in pain scores. Following SC injection, the principal absorption half-life (95% CI) was 20.1 (16.3-29.5) days and 89.6% (87.1%-92.0%) of the drug was directed via this pathway compared with 10.2 (8.6-12.5) days and 71.3% (64.9%-77.4%) following IM administration. Lower peak and higher trough penicillin concentrations resulted following SC injection. Simulations demonstrated that SC infusion of higher doses of benzathine penicillin G could provide therapeutic penicillin concentrations for 3 months. SC administration of benzathine penicillin G is safe and significantly delays penicillin absorption. High-dose benzathine penicillin G via the SC route would fulfil many product characteristics required for the next generation of longer-acting penicillins for use in RHD.

Sex dependent effects of post-natal penicillin on brain, behavior and immune regulation are prevented by concurrent probiotic treatment

There is increasing awareness of the need to consider potential long-term effects of antibiotics on the health of children. In addition to being associated with immune and metabolic diseases, there is evidence that early-life antibiotic exposure can affect neurodevelopment. Here we investigated the effect of low dose of penicillin V on mice when administered for 1 week immediately prior to weaning. We demonstrated that exposure to the antibiotic during the pre-weaning period led to long-term changes in social behaviour, but not anxiety-like traits, in male mice only. The change in behaviour of males was associated with decreased hippocampal expression of AVPR1A and AVPR1B while expression of both receptors was increased in females. Spleens of male mice also showed an increase in the proportion of activated dendritic cells and a corresponding decrease in regulatory T cells with penicillin exposure. All changes in brain, behaviour and immune cell populations, associated with penicillin exposure, were absent in mice that received L. rhamnosus JB-1 supplementation concurrent with the antibiotic. Our study indicates that post-natal exposure to a clinically relevant dose of antibiotic has long-term, sex dependent effects on the CNS and may have implications for the development of neuropsychiatric disorders. Importantly, we also provide further evidence that probiotic based strategies may be of use in counteracting detrimental effects of early-life antibiotics on neurodevelopment.

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

Lues Maligna in an Immune-Reconstituted Patient with Retroviral Infection: A Case Report

Precision diagnosis and therapy of a case of brain abscesses associated with asymptomatic pulmonary arteriovenous fistulas

BackgroundBrain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses.Case presentationThe patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically.ConclusionsIt is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.

Late latent syphilis accompanied by ocular syphilis in a geriatric patient: a case report

Background: Syphilis is an infectious disease caused by Treponema pallidum and is transmitted primarily through sexual intercourse. However, late latent syphilis accompanied by ocular syphilis in geriatric patients is quite seldom. This study aims to determine a case report regarding late latent syphilis accompanied by ocular syphilis in a geriatric patient.Case Description: A 75 years old man, was consulted from the Ophthalmology Department to the Dermatology and Venereology Department with suspect syphilis. Patient came with a chief complaint of blurred vision in the right eye since 2 weeks ago, which is getting worse since 4 days ago. The laboratory results of complete blood routine, renal function tests, liver function tests, blood sugar levels are within normal limits. The titer result of VDRL was 1:16 and TPHA was 1: 160. Based on anamnesis, physical and laboratory examination, the patient was diagnosed with late latent syphilis and ocular syphilis. The patient was given three weekly interval dose of Benzathine Penicillin G 2.4 million international units intramuscularly.Conclusion: One-month follow-up after the treatment, the patient's condition improved. Blurred vision in the right eye was reduced. There are no complaints of headache and hearing loss.

Amoxicillin Induced Behavioral Neurotoxicity and Histopathological Changes in Organs of Albino Rats

Background: There are various adverse drug reactions of penicillin. Neurotoxicity is attracting the attention of researchers all over the world. It also affects other organs like liver, kidney, heart and testes&#x0D; Methods: The study was conducted at pharmacy and pharmacology department of Gandaki Medical College (GMC) from January till April, 2018. Albino rats were divided six each in test and control group. Tests were administered amoxicillin 90mg/kg/d and control with distilled water for 10 days. After 10 days, rats were tested for neurotoxicity with rota-rod (RR) and modified forced swim test (MFST). They were then sacrificed under anesthesia, organs were dissected and sent for histopathological investigation.&#x0D; Results: The latency to fall from RR apparatus decreased significantly in test rats than control. (P value = 0.0001) In MFST, immobility time was significantly increased than control (P value = 0.0001). Swimming time(ST) was significantly decreased (P value = 0.001) and climbing time (CT) was not significantly altered in test rats than control (P value = 0.352). The liver enzyme, AST and ALT were significantly increased in the test rats (TR) as compared to controls. (P value 0.049 and 0.001 respectively) Brain of test rats (TR) showed shrunken neurons surrounded by perineuronal vacuolations, liver and kidney showed degenerative changes. Vacuolations and pyknotic cells were seen in spermatogonic cells.&#x0D; Conclusions: Neurotoxic effects were seen in test rats which recommends regulation of the administration of high dose of penicillin.

A Rare Type of Balanitis

&#x0D; &#x0D; &#x0D; &#x0D; Syphilis is an old disease and a major public health concern, which is re-emerging in the western world. Atypical syphi- litic presentations can be challenging to diagnose. We present a 23-year-old, HIV-positive man who has sex with men who presented with a 2-week history of an asymptomatic lesion on the glans. Previous topical and systemic treatments proved unsuccessful. Physical examination demonstrated a slightly indurated, ill-defined erythematous plaque over most of the glans. Enlarged, non-tender, bilateral inguinal lymph nodes were palpable. Serological tests revealed a fourfold increase in the VDRL titre (1:8, previously 1:2). A diagnosis of syphilitic balanitis of Follmann was made and complete resolution was achieved with an intramuscular single dose of benzathine penicillin 2.4 MU.&#x0D; Syphilitic balanitis of Follmann represents an uncommon manifestation of primary syphilis, with less than 100 cases reported. Untrea- ted, it will resolve spontaneously, but the patient will remain highly infectious and at-risk for long-term morbidity. In an era in which the number of syphilis cases is increasing sharply both in Western Europe and the United States, all physicians should be aware for the typical and atypical early syphilitic manifestations as they represent opportunities of paramount importance for treatment and epide- mic control.&#x0D; &#x0D; &#x0D; &#x0D;

Beneath a behavioral change

When approaching symptoms suggestive of cognitive decline or dementia, it is important to rule out possible conditions that can lead to the emergence of psychological/behavioral changes. Herein, we present the case of a 69-year-old male, whose wife complained of sudden behavior and memory changes. He was diagnosed with syphilis and treated with three doses of penicillin. We report this case to highlight the importance of considering syphilis in the differential diagnosis of a fast onset cognitive decline. It also demonstrates the value of family physician proximity to the different members of a family, often a determining factor in establishing a diagnostic hypothesis, especially when complaints are not spontaneously exposed by the patient.

Factors affecting the concentration of soluble tumour necrosis factor-α receptor type I in the blood serum of patients with localized scleroderma.

AimThe aim of the study was to assess of sTNFαR1 concentration in the serum of patients with localized scleroderma (in comparison with a control group).Material and methodsThis was a prospective study. The patients with localized scleroderma were divided into two groups: 21 persons treated with PUVA therapy and 20 persons treated with procaine penicillin. In the case of the patients treated with intramuscularly administered procaine penicillin (dose: 2,400,000 IU/day), achievement of a total dose of at least 30 million IU/day was considered as the end of the therapy. In the group of patients treated with photochemotherapy, the single initial dose during a PUVA session was 0.5 J/cm2 and it was increased by 0.5 J/cm2 every other day to reach the maximum value of 10 J/cm2, depending on the clinical condition. The study involved three sessions a week.ResultssTNFαR1 concentration in the serum of patients with localized scleroderma was significantly higher in comparison with the control group and correlated with the skin damage index. The difference in the determined particle level was higher in the group of patients undergoing photochemotherapy (median: 106.25 ng/ml) than in the group taking penicillin (median: 81.50 ng/ml). Patients treated with PUVA sessions demonstrated a greater decrease in sTNFαR1 concentration and an improvement of the clinical condition after therapy completion.ConclusionsThe obtained results suggest a potential role of sTNFαR1 in the pathogenesis of localized scleroderma.

The Settler Colonial Present by Lorenzo Veracini

Reviewed by: The Settler Colonial Present by Lorenzo Veracini Martin Crevier Veracini, Lorenzo – The Settler Colonial Present. New York: Palgrave Macmillan, 2015. Pp. 159. Settler colonial studies is an emerging distinct field of academic inquiry, replete with its own journal (Settler Colonial Studies) and interpretive lens. Drawing on this now wide-ranging literature, in The Settler Colonial Present, Lorenzo Veracini, who has been at the center of this development, aims to show that settler colonialism is a crucial feature of "the global present." His subsidiary objective is to offer pathways for strategies of decolonization. Four chapters structure the argument. Each seeks to situate and contextualize the global and current impact of settler colonialism by proposing a negative definition. As Veracini convincingly shows in the introduction, settler societies have been negatively defined, from inside and outside, against an abiding Indigenous presence or a distant but hovering metropole. As such, chapters argue that settler colonialism "is not colonialism" (chapter 1), that "it is not somewhere else" (chapter 3), and that "it is not finished" (chapter 4). Chapter 2 also frames itself in the negative by arguing that "settlers are not migrants." Readers familiar with Veracini's corpus might be surprised by the seemingly hackneyed themes of the chapters. The distinction between settler colonialism and colonialism tout court is the principle on which the scholarly edifice of settler colonial studies is erected. As for the purported permanent and structural character of settler colonialism, having been so well encapsulated in Patrick Wolfe's memorable phrase, one would expect it to be the premise of Veracini's project. If all chapters expand theoretical debates and offer insightful interventions, too little is nevertheless said on this global "settler colonial present" and how to transcend it. The first chapter is based on an analogy. "Colonialism" and "settler colonialism" are respectively comparable to viruses and bacteria. Both are exogenous elements that "dominate" their locales, but while viruses (colonialism) need living cells to survive, bacteria (settler colonialism) do not necessarily rely on other organisms. The analogy is useful on a conceptual level as a way to distinguish between both modes of domination and to account for their relationships contingent on time and place. Yet, as Veracini takes us from heuristics to contemporaneous times, it obfuscates more than it reveals. There is, for instance, something dehumanizing and needlessly abstract in comparing Second Intifada Palestinian suicide bombers to "repeated doses of penicillin" (p. 30). Apart from a section on settler colonialism's imperviousness to the "viral medicine of traditional decolonization methods" (p. 20) such as declarations of independence, it is not clear how the analogy [End Page 714] helps us apprehend current predicaments. Moreover, although it is intended to nourish thought along the rest of the chapters, few references are made back to the first chapter as the book progresses. Veracini stresses that the analogy is solely metaphorical, but the reliance on a biomedical vocabulary sits uncomfortably with the malign history of technological and biological disruption in settler colonial and colonial contexts. Chapter 2 argues that unlike migrants, settlers are defined by a conquering "sovereign capacity." They create political orders by disavowing Indigenous sovereignties, while migrants recognize the sovereignty they encounter and are therefore subjected to already constituted political orders (p. 41). The distinction matters because migrants are generally characterized as settlers and thus as a force of dispossession. Yet in their subordination to the settler state they in fact resemble Indigenous peoples, especially when they do not fit a predetermined "ethnic mould." Veracini thus encourages us to think of settlers and migrants concurrently, especially since Indigenous sovereignty claims and defiance to migratory regimes both serve to destabilize settler orders (pp. 40–48). These assertions are original in their attempt to link conversations often held in parallel: the immigration to settler states and the displacement that is the founding act of these societies. Yet, one wonders again how to render these ideas on the ground. In contrast, in Elusive Refuge (2016), Laura Madokoro describes a series of workshops she organized to foster dialogue between immigrant and Indigenous communities in Canada and how they exemplify the messiness that these difficult questions entail in reality. Veracini's insistence on remaining at a...

Effect of tadalafil and nitric oxide agonist sodium nitroprusside on penicillin-induced epileptiform activity

ABSTRACTObjective: Comorbidity of erectile dysfunction (ED) and epilepsy is not rare. Tadalafil is widely used in the treatment of ED and shows its effect by increasing nitric oxide (NO) level. Previous studies demonstrated that ED treatment drugs increased epileptiform activity in clinical studies and various experimental epilepsy models. Therefore, it is important to know whether an ED treatment drug has proconvulsion or anticonvulsant properties. This study was designed to demonstrate the effect of tadalafil and NO agonist sodium nitroprusside during penicillin-induced seizures in rats. The experimental penicillin epilepsy model is preferred in clinical studies of partial epilepsy.Methods: A single dose of penicillin (500 units) intracortical (i.c.) injection into the left sensorimotor cortex induced epileptiform activity. In the first set of experiments, tadalafil (20 mg/kg/intraperitoneal [i.p.]) and sodium nitroprusside (50 µg/intracerebroventricular [μg/i.c.v]) were administered 30 min after penicillin injection.In the second set of experiments, tadalafil (i.p) was administered 30 min after penicillin injection and sodium nitroprusside was administered simultaneously with the tadalafil injection.Results: Tadalafil, sodium nitroprusside and tadalafil+sodium nitroprusside groups decreased the frequency and amplitude of epileptiform activity in rats. Spike frequency of all groups decreased significantly 10 min after the administration and this decrease continued for 180 min. The mean amplitude of epileptiform activity significantly decreased 120 min after penicillin application in tadalafil or sodium nitroprusside applications. But this decrease was observed 110 min after tadalafil+sodium nitroprusside combined application.Conclusion: Data from the present study indicate that tadalafil has an anticonvulsion effect against penicillin-induced epileptiform activity in rats.

ORAL PRIMARY SYPHILIS MIMICKING A GINGIVAL SQUAMOUS CELL CARCINOMA: CASE REPORT

Syphilis is a systemic infectious disease caused by Treponema pallidum. This disease is classified into 4 stages of occurrence: primary, secondary, latent, and tertiary. We report a case of a 25-year-old man, nonalcoholic and nonsmoker, who reported a progressive lesion in gingiva with 1-month duration. The clinical examination revealed an infiltrative ulcer with elevated edges located on the palatal gingiva, causing tooth mobility, with a clinical diagnosis of squamous cell carcinoma. Cervical lymphadenopathy was also observed. An incisional biopsy was performed, and the histopathologic examination showed intense inflammatory infiltrate with predominance of plasma cells. A cocktail of cytokeratins was performed by immunohistochemistry, and the hypothesis of squamous cell carcinoma was excluded. After that, the clinical hypothesis was primary syphilis, with a positive result in Venereal Disease Research Laboratory (dilution 1:1024). The patient was treated with 2 doses of penicillin (1000 mg) weekly. After 1 month, the lesion completely regressed.

Clinical feature analysis of 30 cases with pulmonary actinomycosis

Objective: To summarize the clinical characteristics of pulmonary actinomycosis and analyze its diagnostic methods. Methods: The clinical symptoms, underlying diseases, imaging characteristics, preliminary diagnosis, diagnostic methods, treatment and prognosis of 30 patients with pulmonary actinomycetes admitted into the First Affiliated Hospital of Zhejiang University School of Medicine during the 10 years (January 2007 to November 2017) were retrospectively analyzed. Results: The 30 patients with pulmonary actinomycetes included were from 47 to 81 years old, with an average age of (59.5±7.8) years, with a course of disease from 5 days to 48 months, and a median course of disease of 1.5 months; 18 patients (60.0%) were complicated with underlying diseases, 10 patients (33.3%) had a history of smoking, 10 patients (33.3%) had a history of alcohol abuse. The main clinical manifestations were cough in 29 cases (96.7%), followed by sputum in 22 cases (73.3%), hemoptysis in 20 cases (66.7%), fever in 12 cases (40.0%), chest pain in 5 cases (16.7%) and shortness of breath in 3 cases (10.0%). Mass, nodules, consolidation, atelectasis can be seen by imaging, there can be a low-density lesion necrosis, formation of voids or vacuoles. Among the 25 patients (83.3%) who underwent bronchoscopy, 14 cases were abnormal, 5 cases showed endotracheal polypoid neoplasms, 9 cases showed endotracheal mucosal inflammatory changes, 2 cases of them showed bronchial foreign body, and 1 case showed broncholithiasis. All cases were diagnosed by pathology. Nine cases (30.0%) were confirmed by bronchoscopic biopsy. Two cases (6.7%) underwent CT-guided percutaneous lung biopsy, 18 cases (60.0%) underwent surgical resection of pathology, and 1 case (3.3%) was diagnosed by puncture of chest wall mass. Sufficient dose and course of penicillin were effective. Surgical excision of the lesion with antibiotics for 2-4 weeks was effective. Conclusion: The clinical manifestation of pulmonary actinomycosis is lack of specificity, obtaining positive pathological specimens is the key to the diagnosis of this disease, the first choice is bronchoscopy and percutaneous lung biopsy.

Amoxicillin Modulates ApoA-I Transcription and Secretion, Predominantly via PPARα Transactivation Inhibition.

In a recent human study, we observed that amoxicillin treatment decreased HDL-C concentration. We hypothesize that antibiotics lower the transcription and secretion of ApoA-I, the responsible protein for HDL production. HepG2 and Caco-2 cells were exposed to increasing dose of amoxicillin, penicillin, and streptomycin. Secreted ApoA-I protein and mRNA transcripts were analyzed using ELISA and qPCR, respectively. To unravel underlying mechanisms, KEAP1, CPT1, and CHOP mRNA expressions were determined as well as PPARα transactivation. In HepG2 and Caco-2, amoxicillin decreased ApoA-I transcription and secretion. Effects on ApoA-I expression were clearly there for amoxicillin while no effects were observed for penicillin or streptomycin. KEAP1, CPT1, and CHOP mRNA expressions were reduced by amoxicillin treatments. Moreover, a significant correlation between ApoA-I and CPT1 mRNA expressions was found. Furthermore, amoxicillin lowered PPARα transactivation. All together, these data suggest that inhibited PPARα transactivation is involved in the effects of amoxicillin on ApoA-I. In conclusion, the direct effect of amoxicillin in treated HepG2 and Caco-2 cells was a lower ApoA-I secretion and transcription. Based on evaluating alterations in KEAP1, CPT1, and CHOP mRNA expressions plus PPARα transactivation, we suggest that a reduced PPARα activation is a potential mechanism behind the observed amoxicillin effects on ApoA-I expression.