Cephalasporin antibiotics have been commonly used for prophylaxis against surgical site infection. To prevent Clostridium difficile, the preferential use of agents such as flucloxacillin and gentamicin has been recommended. The aim of this study was to investigate the bone penetration of these antibiotics during hip and knee arthroplasty, and their efficacy against Staphylococcus aureus and S. epidermidis. Bone samples were collected from 21 patients undergoing total knee arthroplasty (TKA) and 18 patients undergoing total hip replacement (THA). The concentration of both antibiotics was analysed using high performance liquid chromatography. Penetration was expressed as a percentage of venous blood concentration. The efficacy against common infecting organisms was measured using the epidemiological cut-off value for resistance (ECOFF). The bone penetration of gentamicin was higher than flucloxacillin. The concentration of both antibiotics was higher in the acetabulum than the femoral head or neck (p=0.007 flucloxacillin; p=0.021 gentamicin). Flucloxacillin concentrations were effective against S. aureus and S. epidermis in all THAs and 20 (95%) TKAs. Gentamicin concentrations were effective against S.epidermis in all bone samples. Gentamicin was effective against S. aureus in 11 (89%) femoral samples. Effective concentrations of gentamicin against S. aureus were only achieved in 4 (19%) femoral and 6 (29%) tibial samples in TKA. Flucloxacillin and gentamicin was found to effectively penetrate bone during arthroplasty. Gentamicin was effective against S. epidermidis in both THA and TKA, while it was found to be less effective against S. aureus during TKA. Bone penetration of both antibiotics was less in TKA than THA.
Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.‡In addition to AIDS cases, in June 2000, New York began requiring that all confirmed HIV diagnostic tests, detectable HIV viral load tests, and CD4 counts of Ͻ500 µL be reported to the health department.Healthcare providers are required to report all cases of HIV diagnosis, HIV illness, and AIDS.In June 2005, reporting requirements were changed to include all HIV viral load tests and all CD4 counts, regardless of value.§Alabama, Alaska, Arizona, Arkansas,
<i>Background/Aims:</i> This study was designed to determine whether previous Cushing’s disease (CD) or prolactinoma (PRL) could exert adverse effects additional to those of growth hormone (GH) deficiency as a consequence of variable degrees of prior hypogonadism or hypercatabolism. We report the effects of 5 years GH treatment in 124 GH deficiency adults; 42 patients with non-functioning pituitary adenomas (NFPA), 43 with treated PRL and 39 with treated CD. <i>Methods:</i> Fasting plasma glucose, HbA<sub>1c</sub>, lipoprotein profile, anthropometry and bone mineral density (BMD) were measured at baseline, 6 months and annually up to 5 years. <i>Results:</i> Mean body mass index remained unchanged in the PRL group and tended to increase in the NFPA group. In contrast, body mass index decreased in the CD group. Decreases in waist and waist/hip ratio were seen in all groups at 6 months. Decreases in total cholesterol and low-density lipoprotein cholesterol were seen in all groups and remained sustained at 5 years. Plasma glucose and HbA<sub>1c</sub> increased at 6 months. Subsequently, plasma glucose returned to baseline values at 5 years; in contrast, HbA<sub>1c </sub>remained unchanged at the end of the study. Baseline lumbar spine and hip BMD were lower in the PRL and CD groups than in the NFPA group, decreased over 1 year in all groups and subsequently increased by 2 years in NFPA with a subsequent increase in lumbar spine BMD in PRL and CD groups delayed to 3–5 years. <i>Conclusions:</i> Baseline characteristics and response to GH replacement are qualitatively similar in NFPA, PRL and CD patients. Because improvements in BMD occur later in PRL and CD patients, an extended trial of GH therapy may be indicated in those patients who were commenced on GH therapy as an additional treatment for reduced BMD.
Coronary atherosclerosis is a continuous process beginning early in life, with a long and clinically asymptomatic phase, before manifestations appear in middle and/or late adulthood. Coronary artery calcification (CAC) is a well-established marker of atherosclerosis; nonetheless, the clinical validity of CAC in young adults – traditionally considered as a population group of low cardiovascular risk – remains unclear. We aimed to assess the prevalence of CAC in a population of young individuals without previous history of coronary artery disease (CAD) in the UK and its association with conventional cardiovascular risk factors. This analysis includes 4186 asymptomatic young individuals who underwent electron beam computed tomography (EBCT) at European Scanning Centre (London, UK) between January 2002 and December 2009 as part of a preventive healthcare examination. Demographic information and the presence of cardiovascular risk factors were abstracted from referral letters and/or questionnaires completed by the patients prior to their tests. Individuals with previously documented CAD or chronic kidney disease were excluded. All EBCT CAC studies were performed using the same scanner (Imatron C300 Ultrafast computed tomography scanner, GE Healthcare, London, UK) and the same scanning protocol. The age (mean SD) of the study cohort was 40.5 3.6 years (range 26–45 years, 83.8% males). The majority (81.6%) of this cohort was Caucasians, followed by South Asians (8%). Hypertension, dyslipidaemia, and diabetes mellitus (DM) were present in 15.5, 7.9, and 2.8% of individuals, respectively. Family history of premature CAD was present in 17%, while 17.4% were smokers. The proportion of individuals with hypertension and dyslipidaemia increased with increasing age, while the prevalence of smoking and that of a positive family history for CAD decreased (Table 1). Overall, CAC was present in 21.8% of the cohort, while individuals with CAC comparing with those with CAC score 0 were males (95.2 vs. 80%, p 1000 were 78.2, 19, 2.1, 0.5, and 0.2%, respectively. The prevalence and distribution of CAC among various age groups are shown in Table 1. CACwas found in 24.8%ofmales (CAC score 1–100, 101–400, 400–1000, >1000 in 21.6, 2.5, 0.5, and 0.1%, respectively) and 6.6% of females (CAC score 1–100, 101–400, 400–1000, >1000 in 5.4, 0.6, 0.15 and 0.4%, respectively) (p 0) was identified in 20%. There was a male preponderance. Assessment of CAC score is a useful clinical tool in young individuals, as it can confirm the presence of subclinical atherosclerosis. In this way, the abnormal levels of calcium may place individuals into a higher risk group in terms of future events and lead to more aggressive treatment with preventative therapies.
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