BACKGROUND: Dynapenic obesity and sarcopenic obesity increase cardiovascular disease (CVD) and mortality in nonuremic patients. The present study was designed to determine the prevalence of dynapenic obesity and sarcopenic obesity and their associations with CVD risk factors in peritoneal dialysis (PD) patients. METHODS: All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. Skeletal muscle mass and fat mass were assessed using bioelectrical impedance analysis. Muscle strength and physical performance were determined using hand grip strength and a 4-meter walk gait speed test, respectively. In addition, a 5-mL blood sample was obtained from each patient. RESULTS: The prevalence of dynapenic obesity and sarcopenic obesity were 11.4% and 3.8% in PD patients, respectively. Serum high-sensitive C-reactive protein (hs-CRP), soluble intercellular adhesion molecule type 1, triglyceride, total cholesterol, and low-density lipoprotein cholesterol were significantly higher in PD patients with dynapenic obesity than in dynapenic nonobese and nondynapenic nonobese patients. Similarly, serum concentrations of CVD risk factors in PD patients with sarcopenic obesity were higher than in nonsarcopenic nonobese patients, but these differences were statistically significant only for serum hs-CRP and triglyceride. In addition, muscle strength and skeletal muscle mass percentage were negatively associated with markers of inflammation and dyslipidemia, whereas body fat percentage was positively associated with these CVD risk factors. CONCLUSION: This study indicates that although the prevalence of dynapenic obesity and sarcopenic obesity are relatively low in PD patients, these disorders may be associated with CVD risk factors.
Adipose Tissue ; C-Reactive Protein ; Cardiovascular Diseases* ; Cholesterol ; Cross-Sectional Studies ; Dicloxacillin* ; Dyslipidemias ; Electric Impedance ; Gait ; Hand ; Hand Strength ; Humans ; Inflammation ; Lipoproteins ; Mortality ; Muscle Strength ; Muscle, Skeletal ; Obesity* ; Peritoneal Dialysis* ; Prevalence* ; Risk Factors* ; Triglycerides

BACKGROUND: Dermatitis herpetiformis (DH) is a rare autoimmune blistering disease characterized by pruritic papulovesicular eruptions. It can be differentiated from other vesiculobullous skin diseases by skin biopsy with direct immunofluorescence. DH is most often associated with gluten enteropathy (celiac disease) also an uncommon disease.

CASE PRESENTATION: We report a case of a 20-year-old male with a five-week history of multiple vesicles and bullae associated with fever and body malaise. Lesions were symmetrically found on the entire face, axillae, trunk, buttocks and lower extremities. Hematology revealed leukocytosis with neutrophilic predominance. Skin punch biopsy revealed subepidermal blister with neutrophilic predominance. A direct immunofluorescence (DIP) of the perilesional skin showed granular IgA staining at the tips of the dermal papillae, consistent of DH.

TREATMENT AND OUTCOME: The patient was started with cloxacillin and mupirocin ointment for the infected skin lesions. Dapsone 100 mg daily was started with significant improvement of lesions after seven days. Endoscopy was suggested to investigate for gluten enteropathy, however patient did not consent. The patient was advised on gluten-free diet (GED). Complete resolution of lesions with postinflamamtory hypo- and hyperpigmented scarring were noted after nine weeks of dapsone therapy.

CONCLUSION: Bullous skin lesions present as a great challenge to non-dermatologists, hence a thorough investigation was clearly of utmost importance in arriving at a diagnosis of DH in this case. Internists must be aware that skin lesions could provide clues of other internal diseases, such as in DH and gluten enteropathy. Treatment of DH can be as simple as diet modification and avoidance of gluten¬containing food.

Human ; Male ; Adult ; Diet, Gluten-free ; Dermatitis Herpetiformis ; Glutens ; Celiac Disease ; Blister ; Mupirocin ; Dapsone ; Cicatrix ; Fluorescent Antibody Technique, Direct ; Leukocytosis ; Buttocks ; Cloxacillin

Changes in udder health and antibiotic resistance of mastitis pathogens isolated from dairies upon conversion from conventional to organic management over a 3-year period was studied. Coagulase-negative staphylococci (CNS) were the most prevalent mastitis pathogens isolated. CNS were significantly less resistant to beta-lactam antibiotics when isolated from milk after the herd transitioned to organic management. Cessation of the use of antimicrobial therapies in dairies in combination with organic management could lead to a reduction in the antimicrobial resistance of mastitis pathogens.
Ampicillin/pharmacology ; Animals ; Anti-Bacterial Agents/pharmacology ; Cattle ; Cephalothin/pharmacology ; Cloxacillin/pharmacology ; Drug Resistance, Microbial ; Female ; Lactation ; Mastitis, Bovine/*microbiology ; Microbial Sensitivity Tests ; Organic Agriculture ; Penicillins/pharmacology ; Prevalence ; Staphylococcal Infections/microbiology/*veterinary ; Staphylococcus/*drug effects/*isolation & purification

Acyclovir ; therapeutic use ; Aged, 80 and over ; Anti-Bacterial Agents ; therapeutic use ; Antiviral Agents ; therapeutic use ; Blister ; chemically induced ; etiology ; Female ; Floxacillin ; therapeutic use ; Herpes Zoster ; diagnosis ; drug therapy ; Humans ; Irritants ; adverse effects ; Shoulder Pain ; drug therapy ; etiology

We report a case of staphylococcal septicemia with skin lesions characteristic of septic emboli in a 55-year-old man. Examination of the skin revealed small pustules surrounded by wide ring of erythema on the trunk and extremities. Histopathologic examination of a pustule showed subcorneal pustule and Gram positive septic emboli within blood vessels. There were neutrophilic infiltration and numerous extravasated erythrocytes within dermis. Staphylococcus aureus was isolated on the bacterial culture of blood and small pustules, He was treated with cloxacillin, but died due to respiratory distress syndrome.
Blood Vessels ; Cloxacillin ; Dermis ; Erythema ; Erythrocytes ; Extremities ; Humans ; Middle Aged ; Neutrophils ; Sepsis* ; Skin* ; Staphylococcus aureus

Recently, the incidence of hematogenous osteomyelitis tends to increase dse to abuse of the antibiotics and resistent organisms to antibiotics. The three main causes of complication to be chronic stage in hematogenous osteomyelitis were failure of early diagnosis, inadequate choice of antibiotics with insufficient duration and insufficient surgical intervention. Furthermore, hematogenous osteomyelitis of fibula in children has low incidence, so the possibility of chronicity is able to be increased because of delayed diagnosis and inadequate treatment. During the period of 10 yesrs extending from 1977 to 1986, we have treated 12 cases of hematogenous fibular osteomyelitis in children and clinical analysis was made about comparison with prevalent hematogenous osteomyelitis of distal femur or proximal tibia. The following results were obtained; 1. The incidence in males was 1.4 times grester than females. 2. The incidence of involved sites was 2 times dominant in Rt, and all cases were observed in proximal and distal metaphyseal area of fibula. 3. Clinical symptomes and signs were pain, local heat, redness and local tenderness in all of acute cases and 70% of chronic cases with sinus formation and pathologic Fx. 4. ESR was elevated to average 42 mm/hr in all acute cases highestly, but highest leucocytosis was observed in subacute case. 5. Definite bone changes in radiologic findings was observed in only subacute and chronic cases, and uptake of radioisotope in bone scan was observed in 2 acute cases, which were all performed. 6. Causative organism was only staphylococcus aureus, and high sensitive antibiotics to taphylococcus aureus were Cephalosprin, Cloxacillin, Amikin and observed resistance to penicillin(82.5%) and tetracycline(82.5%). 7. Early diagnosis, adequate antibiotic choice with sufficient duration and early surgical decompression and drainage were considered to be essential part of management of hematogenous fibular osteomyelitis and preventing its chronicity.
Amikacin ; Anti-Bacterial Agents ; Child ; Cloxacillin ; Decompression, Surgical ; Delayed Diagnosis ; Drainage ; Early Diagnosis ; Female ; Femur ; Fibula ; Hot Temperature ; Humans ; Incidence ; Male ; Osteomyelitis ; Staphylococcus aureus ; Tibia

This experiment was performed to determine the stability of antiblotics in cured bone cement and the antibacterial effect with various the amount of antibiotics mixed in bone cement. Experimental animals were divided into control and antibioticimpregnated groups; 3 each for control, cloxacillin, celospor, kanamycln and panimycln groups. Antibiotic activities were measured by disk diffusion method using Staphylococcus aureus and Escherichla coli as standard organisms. The results were as follows: 1. Bone cement itself does not have antibacterial effect on the growth of Staphylococcus aureus and Escherlchia coli. Antlbiotlc impregnated acrylic bone cement showed antibacterial effects which was stable for 4 weeks. 2. In vitro test, the amount to antibiotics released In 24 hours perlod was proportional to the amount of antibiotlcs mixed in bone cement. 3. The duration of antibacterial effect was also roughly proportional to the amount of antiblotics mixed In bone cement. 4. No antibacterial effect could be measured in control groups. 4. In vivo test, the result was revealed similar patterns compared with the result of “In vitro test”, but the amounts of antibiotics released and durations of antibaterial effect was decreased. No antibacterial effect could be measured in control groups. As a result of this sutdy of this study, It is proved that the amount of antiblotics and the duratlon of antibacterial effect are proportional to the amount of antibiotics mixed in bone cemcnt. The impregnation of antiblotics in acrylic bone cement may be used to prevent and treat Infection in the orthopedic fleld.
Animals ; Anti-Bacterial Agents ; Cephacetrile ; Cloxacillin ; Diffusion ; In Vitro Techniques ; Methods ; Orthopedics ; Polymethyl Methacrylate ; Staphylococcus aureus

Pyogenic osteomyelitis is at times tragic disease from which severe deformity and disability may result. The incidence and mortality rate of pyogenic osteomyelitis have decreased strikingly since penicillin became available for general use in the treatment of pyogenic osteomyelitis in 1944 and had a dramatic effect. Recently, since the use of new antlblotics, the effect of treatment has been expected in Pyogenic osteomyelitis. But causative organisms of pyogenic osteomyelitis was gradually increasing in resistance to antibiotics. There is also a trend of gradual increase of pyogenic osteomyelltis due to Gram negative bacilli. The author has been analysed 134 patients on whom followup was observed for a minimum of six months at the Department of Orthopedic Surgery of Hanyang University from May, 1972 to December, 1978. The results were as follows: 1. The incidence of pyogenic osteomyelitis is a trend of gradual increase with 14.2% in 1973, 15.7% in 1975 and 26.9% in 1978. 2. Sex ratio was 2.6: 1 (Male: Female): Age distribution showed the group between 5 and 15 years old was 20 patients(62.5%) in acute osteomyeIitis, and the group between 15 and 30 years oId was 52 Patients (51%) In chronic osteomyelitis. 3. The order of involved bones is femur(41%), tibia(27.8%) and humerus(10.4%). 4. Erythrocyte sedimentation rate was remarkably increased in 92.8% of male and 86.5% of female. 5. The causative organism was mostly staphylococcus aureus(84%) in acute osteomyelitis, and Staphylococcus aureus(44.8%), mixed organisms(20.9%) and Gram negative, bacilli(8.3%) in chronic osteomyelitis. Especially, mixed cases with Staphylococcus aureus and Gram negative bacilli contain 55% of mixed organisms. 6. Penicillin was most resistant (79.7%) to Staphylococcus aureus. Cloxacillin was most susceptable (91.3%) to Staphylococcus aureus. 7. The treatment of acute osteomyelitis showed arrest(72.7%) in case of massive antibiotics by early finding of clinical symptom, but if clinical symptoms were not improved within 48 hours with the use of antibiotics, early decompression was done and was arrested(84.6%) in acute osteomyelitis. Closed continuous irrigatlon with saucerization was done and was arrested(85.7%) in chronic osteomyelitis.
Age Distribution ; Anti-Bacterial Agents ; Blood Sedimentation ; Clinical Study ; Cloxacillin ; Congenital Abnormalities ; Decompression ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mortality ; Orthopedics ; Osteomyelitis ; Penicillins ; Sex Ratio ; Staphylococcus ; Staphylococcus aureus

Failure of total joint replacement is often due to infection. Many efforts have been made to reduce the rate of infection. The use of antibiotic-acrylic bone cement composites for the preventlon and treatment of infection after joint replacement surgery has been advocated. Early reports of clinical success using bone cement containing antibiotics are encouraging, but different results of antibacterial effect of antibiotic-acrylic bone cement were reported in vitro and in vivo studies. The purpose of this experiment is to determine the effectiveness of bone cement itself on bacterial growth, stability of antibiotics in cured bone cement, and whether antibiotic acrylic bone cement composites produce an effective antimicrobial concentration in tissue fluid of hip joint and if so, the duration of it. 30 rabbits were used as test animal: 3 each for hemiarthroplasty and for hemiarthroplasty with the insertion of bone cement as control; 6 each for dicloxacillin, cephacetrile, gentamycin and amlkacin impregnated bone cements. Antibiotic activities were measured by disk diffusion method and tube dilution method using tissue fluid collected through tube inserted in the hip joint of the animals. The results were as follows: 1. Bone cement itself does not have antibacterial effec: on the growth of Staphyiococcus aureus and Escherichia coli. Antibiotic impregnated acrylic bone cements showed antibacterial effects which were stable for 3 weeks in vitro test. 2. After the insertion of antibiotic-acrylic bone cement composites, maximal concentrations of antibiotics in tissue fluid were measured at 1 hour. The concentration of antibiotics remained in tissue fluid at relatively high level for 2 days, and decreased abruptly there after. Inhibition zones in disk diffusion method could be measured until 3rd day in dicloxacillin group and 4th day in cephacetrile, gentamycin and amikacin group. No antibacterial effect could be measured in control groups. 3. On first postoperative day the concentrations of antibiotics in tissue fluid were measured as 64 mcg/ml in dicloxacillin group and 128 mcg/ml in cephacetrille, gentamycin and amikacin group. The antiblotic activities in tissue fluid could be measured for 6 days in dicloxacillin group and 7 days in cephacetrile, gentamycin and amikacin group using tube dilution method. No antibiotic activities were measured in tissue fluid of control groups. As a result of this study, it is proved that the concentration of antibiotics in tissue fluid of hip joint can be maintained above the level of minimal inhibitory concentration for about a week when antibiotic-acrylic bone cement composite is used in joint replacement arthroplasty. The impregnation of antibiotics in crylic bone cement is proved to be effective in the prevention of exogenous infection, especially in the protection of damaged tissue prone to infection postoperatively.
Amikacin ; Animals ; Anti-Bacterial Agents ; Arthroplasty, Replacement ; Bone Cements ; Cephacetrile ; Dicloxacillin ; Diffusion ; Escherichia coli ; Gentamicins ; Hemiarthroplasty ; Hip Joint ; In Vitro Techniques ; Joints ; Methods ; Polymethyl Methacrylate ; Rabbits

Our present knowledge of impetigo contagiosa extends from its first description as a separate clinical entity by Fox in I864, and the proof of its bacterial etiology by Radcliffe-Crocker in 1881. Both staphylococci and streptococci have been discovered from the lesions, but the relative preponderance of each varies greatly, and reports are contradictory. Seventy-eight patients with impetigo contagiosa were studied bacteriologically in order to ascertain the primary etiologic agent. Also, a susceptibility test (Bauer- Kirby method) was done on the isolated organisms with 7 antibiotics which are used frequently in the clinical field. Specimens obtained from the skin lesions were cultured and organisms were isolated. They were identified by various biochemical and serological tests. A DN ase test, a carbohydrate fermentation test, and a coagulase test were done for the isolated staphylococci. A bacitracin disc method and a precipitin test(Lancefield method) were done for the isolated B-hemolytic streptococci. The results were as follows: Fifty-six cases(71.8%) were infected by staphylococcus only. Twenty cases(25.6%) were infected by a mixture of staphylococcus and p-hemo- lytic streptococcus. Only 2 cases(2.6%) were infected by B-hemolytic streptococcus alone. All 76 strains of staphylococci were identified as coagulase positive staphylococci. Among the 22 strains of B-hemolytic streptococci, 15 strains were identified as group A and remaining 7 strains were identified as group B. Coagulnse negative sta,phylococcus was not found. In the susceptibility test to 7 antibiotics, staphylococci showed susceptibility to lincomycin, erythromycin, cloxacillin, and chloramphenicol, and resistance to tetra-cycline, penicillin, and ampicillin. Streptococci showed susc.ptibility to all of the above antibiotics except tetracycline. From the results of this experiment, it was concluded that the primary etiologic agent of impetigo contagiosa was coagulase positive staphylococcus and streptococcus for the most part can be considered as a secondarily infecting agent. Coagulase negative staphylococcus apparently is not implicated as an etiologic agent of impetigo contagiosa. The results of the antibiotic susceptibility tests would seem to indicate that the use of such antibiotics as tetracycline, penicillin, and ampicillin is not indicated in the treatment of impetigo contagiosa.
Ampicillin ; Anti-Bacterial Agents ; Bacitracin ; Chloramphenicol ; Cloxacillin ; Coagulase ; Erythromycin ; Fermentation ; Humans ; Impetigo ; Lincomycin ; Penicillins ; Serologic Tests ; Skin ; Staphylococcus ; Streptococcus ; Tetracycline