Lactococcus lactis bacteraemia in a patient on probiotic supplementation therapy

2021 ◽  
Vol 14 (7) ◽  
pp. e243915
Author(s):  
Amelia Gurley ◽  
Thomas O'Brien ◽  
Joseph M Garland ◽  
Arkadiy Finn
Keyword(s):  
Blood Culture ◽  
Clinical Improvement ◽  
Lactococcus Lactis ◽  
Clinical Presentation ◽  
Food Product ◽  
Antibiotic Regimen ◽  
Probiotic Supplementation ◽  
Over The Counter ◽  
Dairy Food ◽  
Patient Reported

A 59-year-old woman presented with fever and malaise and was found to have Lactococcus lactis bacteraemia. L. lactis infection is rare in humans with few reported cases, with most associated with dairy food product ingestion. The patient reported use of a multistrain over-the-counter probiotic supplement. After isolation of L. lactis from blood culture, the patient was treated empirically with ertapenem and amoxicillin and displayed clinical improvement. She remained well after completion of antibiotic regimen and discontinued probiotic supplementation use. We review the clinical presentation of L. lactis infection including diagnosis, identification and treatment.

scholarly journals Do Adult Spinal Deformity Patients Undergoing Surgery Continue to Improve From 1-Year to 2-Years Postoperative?

2021 ◽  
pp. 219256822110193
Author(s):  
Scott L. Zuckerman ◽  
Christopher S. Lai ◽  
Yong Shen ◽  
Meghan Cerpa ◽  
Nathan J. Lee ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Adult Spinal Deformity ◽  
Minimum Clinically Important Difference ◽  
Time Interval ◽  
Symptom Scale ◽  
Patient Reported ◽  
Chi Squared ◽  
Sagittal Malalignment ◽  
Coronal Malalignment ◽  
Patients Experience

Objective: Evaluate clinical improvement as measured by patient-reported outcomes (PROs) during the 1 to 2-year interval. Study Design: Retrospective Cohort. Methods: A single-institution registry of ASD patients undergoing surgery was queried for patients with ≥6 level fusions. Demographics and radiographic variables were collected. PROs collected were the ODI and SRS-22r scores at: preoperative, 1-year and 2-years. Outcome measures of clinical improvement during the 1-2 year time interval were: 1) group medians, 2) percent minimum clinically important difference (MCID), and 3) percent minimal symptom scale (MSS)(ODI < 20 or SRS-pain + function >8). Wilcoxon rank-sum tests, chi-squared tests, Kruskal-Wallis tests, and logistic regression were performed. Results: 157 patients undergoing ASD surgery with minimum of 1-year follow-up were included. Mean age was 53.2 and mean instrumented levels was 13.1. Preoperative alignment was: Neutral Alignment (NA) 49%, Coronal Malalignment (CM) 17%, Sagittal Malalignment (SM 17%), and Combined Coronal/Sagittal Malalignment (CCSM) 18%. Preoperative to 1-year, and preoperative to 2-years, all ODI/SRS-22r significantly improved ( P < .001). In all patients, the only significant improvement in PROs between 1-and 2-year postoperative were those reaching ODI MCID (69% 1-year vs. 84% 2-years; P < .001). Subgroup analysis: ≥55 years had an improved median ODI (18 vs. 8; P = .047) and an improved percent achieving ODI MCID (73% vs. 84%, P = .048). CCSM patients experienced significant improvement in SRS-appearance score (75% vs. 100%; P = .050), along with those with severe preoperative SM >7.5 cm (73% vs. 100%; P = .032). Conclusions: Most ASD patients experience the majority of PRO improvement by 1-year postoperative. However, subsets of patients that may continue to improve up to 2-years postoperative include patients ≥55 years, combined coronal/sagittal malalignment, and those with severe sagittal malalignment ≥7.5 cm.

scholarly journals Early outcomes and predictors of patient satisfaction after TKA: a prospective study of 200 cases with a contemporary cemented rotating platform implant design

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Corné van Loon ◽  
Niels Baas ◽  
Verdonna Huey ◽  
James Lesko ◽  
Geert Meermans ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Improvement ◽  
Patient Characteristics ◽  
Patient Reported Outcome ◽  
Implant Design ◽  
Rotating Platform ◽  
Radiographic Outcomes ◽  
Operative Outcomes ◽  
Patient Reported ◽  
Time Point

Abstract Purpose The purpose of the study was to identify the earliest time point where subjects realized the greatest clinical improvement after TKA, and the time when post-operative scores became superior to pre-operative scores. Post-hoc exploratory analyses were conducted to investigate predictors of early post-operative outcomes and patient satisfaction. Methods Six investigators across 4 sites in the Netherlands prospectively implanted 200 subjects with a contemporary cemented rotating platform device. Patient Reported Outcome Measurements (PROMs) KOOS-PS, PKIP, and EQ-5D were collected pre-operatively and post-operatively through 2-years. PROMs change from pre-operative baseline were summarized, along with radiographic outcomes and adverse events (AEs). Pre-operative patient characteristics were explored for correlation with patient outcomes, and patient satisfaction for correlation with KOOS-PS. Results Follow-up compliance was 99% at 6-months, and 95.5% at 2-years. The percentage with higher KOOS-PS compared to baseline was 81.3% at 6-months. KOOS-PS, PKIP, and PKIP subscore means were all better at 6-weeks versus baseline. Gender, BMI, hypertension, and pre-operative KOOS-PS were weakly correlated with 6-week KOOS-PS (multivariate R-squared = 14.1%), but only pre-operative KOOS-PS demonstrated correlation with post-operative KOOS-PS at 6-months or later (R-squared < 5% at 6-months and 2 years). Satisfaction was moderately correlated with concurrent KOOS-PS at each post-operative time point, with (R-squared = 35.3% at 6-months, and 37.5% at 2 years). Conclusion The greatest mean clinical improvement occurred within the first 6-weeks. Although some pre-operative factors were correlated with higher early post-operative KOOS-PS outcomes, these advantages disappeared by 6-months aside from weak correlation with pre-operative KOOS-PS. Post-operative KOOS-PS was moderately correlated with concurrent post-operative satisfaction. These results may be used for pre-operative counseling and management of patient’s postoperative expectations. Trial registration Clinicaltrials.gov, NCT02339610. Registered 15 January 2015.

Letter to the Editor

PEDIATRICS ◽  
1969 ◽  
Vol 43 (5) ◽  
pp. 905-906
Author(s):  
Aubrey Milunsky
Keyword(s):  
Cystic Fibrosis ◽  
Bone Marrow ◽  
Clinical Presentation ◽  
Pancreatic Insufficiency ◽  
Chloride Concentration ◽  
Letter To The Editor ◽  
Patient Reported ◽  
Sweat Sample ◽  
Chloride Concentrations

The patient reported in the foregoing letter is of particular interest in view of the recent observations on patients with tnisomy 21 and cystic fibrosis. The multiple possibilities that could explain the clinical presentation have no doubt been considered by the authors. However, the description of "hypoplastic thrombocytopenia" and later pancytopenia in this patient, associated with pancreatic insufficiency, leads to the serious consideration of Shwachman's syndrome (pancreatic insufficiency and bone marrow dysfunction). The wide discrepancy between the sodium and chloride concentrations in the sweat reported in their letter indicates that evaporation of water may have occurred from the sweat sample, leading to an apparently higher sodium and chloride concentration.

scholarly journals Characteristics and Clinical Outcomes of Open Surgery for Trigger Digits in Diabetes

2018 ◽  
Vol 11 (02) ◽  
pp. 080-083
Author(s):  
Sean Wei Loong Ho ◽  
Ching Yee Chia ◽  
Vaikunthan Rajaratnam
Keyword(s):  
Clinical Outcomes ◽  
Open Surgery ◽  
Clinical Presentation ◽  
Clinical Severity ◽  
High Rate ◽  
Dominant Hand ◽  
Diabetes Group ◽  
Initial Surgery ◽  
Patient Reported ◽  
Surgical Release

Abstract Introduction Trigger digit is a common condition of the hand. Diabetes has a known association with the development of trigger digit. It is thought to influence the clinical presentation and efficacy of open surgical release. This study aimed to assess the differential characteristics of trigger digits and the clinical outcomes of open surgery for trigger digits in diabetics. Materials and Methods This was a retrospective study of all patients who underwent open surgical release of trigger digits in a single institution from 2012 to 2013. Patients were divided into two groups with group 1 consisting of all patients with a history of diabetes. Group 2 consisted of all patients without diabetes. Demographics and clinical presentation were reviewed. All patients were reviewed via a telephone questionnaire at least 2 years after the initial surgery and were assessed for patient-reported outcomes. Results There were 201 patients who met the inclusion criteria, of which 191 patients were recruited. This included 87 (45.5%) males and 104 (54.5%) females. A total of 260 open releases were performed. Sixty-one (31.9%) patients were diabetic, and 130 (68.1%) patients were nondiabetic. The diabetic group was significantly older than the nondiabetic group (p = 0.002). The dominant hand was not significantly more affected than the nondominant hand (p = 0.51). The middle finger was most commonly involved (43.5%), and the little finger was the least commonly involved (1.2%). There was no significant increase in multiple-digit presentation in the diabetic population when compared with the nondiabetic population (p = 0.52). There was a low complication rate and a high rate of postoperative satisfaction after open surgery in both groups. Conclusion Diabetes does not predispose patients to increased rates of multiple trigger digit presentation or increased clinical severity on presentation. Open surgery for trigger digit is an effective and safe treatment modality for diabetics.

scholarly journals T231. QUALITY OF LIFE IN ANTIPSYCHOTIC-NAïVE YOUTH: EXPLORING THE INTERPLAY WITH METABOLIC SIDE-EFFECTS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S321-S321
Author(s):  
Araba Chintoh ◽  
Mahavir Agarwal ◽  
Nicole Mackenzie ◽  
Gary Remington ◽  
Margaret Hahn
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Waist Circumference ◽  
Clinical Improvement ◽  
Clinical Presentation ◽  
Well Being ◽  
Small Sample ◽  
Metabolic Side Effects ◽  
Metabolic Indices

Abstract Background This observational, exploratory pilot study aims to understand changes in clinical presentation and quality of life (QoL) in antipsychotic-naïve youth. Outcomes for these first-episode psychosis patients will be explored in the context metabolic changes during their first three months of treatment. Methods Participants (n = 10) aged 14–29 years were followed throughout their first three months of treatment with an antipsychotic medication (of physician’s/patient’s choice). Participants were evaluated on metabolic indices including weight, waist circumference, and BMI, as well as QoL [Pediatric Quality of Life Index (PedsQL) and PedsQL General Well-Being Scale] and clinical presentation [Clinical Global Impression (CGI) scale]. Descriptive statistics and nonparametric tests were conducted to compare significant changes across these variables. Results Significant changes in metabolic indices were observed over the first three months of treatment, as measured in weight gain (p = 0.02), increased waist circumference (p = 0.02) and increased BMI (p = 0.01). Physicians rated clinical improvement in participants, CGI score (p = 0.03). However, patient-rated QoL remained unchanged within all subcategories, including psychosocial (p = 0.52) and general well-being (p = 0.35). Discussion It appears that antipsychotic-related metabolic side effects may not impede upon early clinical improvement or impact QoL. In addition, there does not appear to be a relationship between clinical presentation and QoL as our small sample show QoL remains neutral or positive. Taken together, these findings suggest that clinical presentation and metabolic side effects may not be influential in early psychosis. From a clinical perspective, these early pilot data add to the literature highlighting the significant, early, antipsychotic-induced metabolic side effects in youth, and also encouraging clinicians to attend to the interplay between treatment and related QoL. This study is limited by its small sample size and naturalistic treatment allocation. These participants will be followed longitudinally to monitor development of adverse metabolic outcomes as well as changes in QoL in later stages of treatment/illness. The field must to understand how treatment and management of metabolic side effects can be augmented to promote clinical improvement and QoL, given the prevalence of adolescent patients who eventually wish to discontinue antipsychotic drugs because of metabolic side effects.

Canine Bacterial Endocarditis: A Review

2007 ◽  
Vol 43 (5) ◽  
pp. 258-263 ◽  
Author(s):  
Gordon Peddle ◽  
Meg M. Sleeper
Keyword(s):  
Blood Culture ◽  
Effective Treatment ◽  
Antimicrobial Therapy ◽  
Clinical Presentation ◽  
Bacterial Endocarditis ◽  
Diagnosis And Treatment ◽  
High Morbidity ◽  
Culture Techniques ◽  
Proper Diagnosis ◽  
Echocardiographic Findings

Bacterial endocarditis is a disease of primarily middle-aged to older, large-breed dogs that is associated with high morbidity and mortality. It presents many challenges with respect to diagnosis and effective treatment. This paper reviews the pathogenesis, clinical presentation, progression, methods of diagnosis, and treatment of bacterial endocarditis in dogs. Methods for proper diagnosis, including echocardiographic findings and blood culture techniques, and recommendations for effective antimicrobial therapy are also provided.

scholarly journals Improved Stress Tolerance of GroESL-Overproducing Lactococcus lactis and Probiotic Lactobacillus paracasei NFBC 338

2004 ◽  
Vol 70 (10) ◽  
pp. 5929-5936 ◽  
Author(s):  
C. Desmond ◽  
G. F. Fitzgerald ◽  
C. Stanton ◽  
R. P. Ross
Keyword(s):  
Heat Shock ◽  
Lactococcus Lactis ◽  
Expression System ◽  
Polyacrylamide Gel Electrophoresis ◽  
Gastrointestinal Transit ◽  
Food Product ◽  
Cellular Protein ◽  
Lactobacillus Paracasei ◽  
Solvent Tolerance ◽  
Unit Increase

ABSTRACT The bacterial heat shock response is characterized by the elevated expression of a number of chaperone complexes. Two-dimensional polyacrylamide gel electrophoresis revealed that GroEL expression in probiotic Lactobacillus paracasei NFBC 338 was increased under heat adaptation conditions (52°C for 15 min). Subsequently, the groESL operon of L. paracasei NFBC 338 was PCR amplified, and by using the nisin-inducible expression system, two plasmids, pGRO1 and pGRO2, were constructed on the basis of vectors pNZ8048 and pMSP3535, respectively. These vectors were transferred into Lactococcus lactis(pGRO1) and L. paracasei(pGRO2), and after induction with nisin, overexpressed GroEL represented 15 and 20% of the total cellular protein in each strain, respectively. Following heat shock treatment of lactococci (at 54°C) and lactobacilli (at 60°C), the heat-adapted cultures maintained the highest level of viability (5-log-unit increase, approximately) in each case, while it was found that the GroESL-overproducing strains performed only moderately better (1-log-unit increase) than the controls. On the other hand, the salt tolerance of both GroESL-overproducing strains (in 5 M NaCl) was similar to that of the parent cultures. Interestingly, both strains overproducing GroESL exhibited increased solvent tolerance, most notably, the ability to grow in the presence of butanol (0.5% [vol/vol]) for 5 h, while the viability of the parent strain declined. These results confirm the integral role of GroESL in solvent tolerance, and to a lesser extent, thermotolerance of lactic acid bacteria. Furthermore, this study demonstrates that technologically sensitive cultures, including certain probiotic lactobacilli, can potentially be manipulated to become more robust for survival under harsh conditions, such as food product development and gastrointestinal transit.

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