• A factor increasing venous contamination on bolus chase three-dimensional magnetic resonance imaging: Charcot neuroarthropathy

      Cildag, MehmetB; Ertuğrul, MustafaB; Köseoğlu, ÖmerFK; Armstrong, DavidG; Univ Arizona, Coll Med, Dept Surg (MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2018-04-05)
      Background: The study aimed to evaluate the ratio of venous contamination in diabetic cases without foot lesion, with foot lesion and with Charcot neuroarthropathy (CN). Materials and Methods: Bolus-chase three-dimensional magnetic resonance (MR) of 396 extremities of patients with diabetes mellitus was analyzed, retrospectively. Extremities were divided into three groups as follows: diabetic patients without foot ulcer or Charcot arthropathy (Group A), patients with diabetic foot ulcers (Group B) and patients with CN accompanying diabetic foot ulcers (Group C). Furthermore, amount of venous contamination classified as no venous contamination, mild venous contamination, and severe venous contamination. The relationship between venous contamination and extremity groups was investigated. Results: Severe venous contamination was seen in Group A, Group B, and Group C, 5.6%, 15.2%, and 34.1%, respectively. Statistically significant difference was seen between groups with regard to venous contamination. Conclusion: Venous contamination following bolus chase MR was higher in patients with CN.
    • Medication burden of treatment using oral cancer medications

      Given, BarbaraA; Given, CharlesW; Sikorskii, Alla; Vachon, Eric; Banik, Asish; Univ Arizona, Coll Nursing (MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017)
      Objective: With the changes in healthcare, patients with cancer now have to assume greater responsibility for their own care. Oral cancer medications with complex regimens are now a part of cancer treatment. Patients have to manage these along with the management of medications for their other chronic illnesses. This results in medication burden as patients assume the self-management. Methods: This paper describes the treatment burdens that patients endured in a randomized, clinical trial examining adherence for patients on oral cancer medications. There were four categories of oral agents reported. Most of the diagnoses of the patients were solid tumors with breast, colorectal, renal, and gastrointestinal. Results: Patients had 1u4 pills/day for oral cancer medications as well as a number for comorbidity conditions (3), for which they also took medications (10u11). In addition, patients had 3.7u5.9 symptoms and side effects. Patients on all categories except those on sex hormones had 49%u57% drug interruptions necessitating further medication burden. Conclusions: This study points out that patients taking oral agents have multiple medications for cancer and other comorbid conditions. The number of pills, times per day, and interruptions adds to the medication burden that patients' experience. Further study is needed to determine strategies to assist the patients on oral cancer medications to reduce their medication burden.
    • A novel way of treating multidrug-resistant enterococci

      Desai, Hem; Wong, Ryan; Ahmed, Khurshid Pasha; Univ Arizona, Coll Med, Dept Internal Med (MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2016)
      Context: Daptomycin is the only antibiotic available with in vitro bactericidal activity against vancomycin-resistant enterococci (VRE). Its increased use has resulted in cases of decreased daptomycin efficacy. Recent in vitro studies have shown effective use of beta (beta)-lactam and daptomycin antibiotics, as a combination therapy, in the treatment of VRE. We describe a case of effective treatment in a patient with VRE infection using dual ampicillin and daptomycin therapy that shows bench-to-bedside application of the abovementioned finding. Case Report: A 76-year-old gentleman with a history of bilateral arthroplasty was admitted with a swollen left knee. Blood cultures were positive for Enterococcus faecium. Left knee joint aspiration showed leukocytosis and alpha defensins. Extensive imaging did not show any other source of infection. Culture sensitivity results showed multidrug-resistant enterococci sensitive to daptomycin. The patient was started on intravenous (IV) daptomycin. His left knee prosthesis was explanted and a spacer was placed. The patient continued to be bacteremic for 10 days after removing the knee prosthesis. The patient was trialed on combination IV ampicillin and daptomycin. His blood culture turned negative 2 days later. The patient was discharged home to continue 6 weeks of IV ampicillin and daptomycin. Conclusion: The exact mechanism of the daptomycin/ampicillin synergy effect is unclear. Current hypothesis suggests that ampicillin causes a reduction in the net positive charge of the bacterial surface, possibly by releasing lipoteichoic acid (LTA) from the cell wall. This process increases the ability of the cationic daptomycin/calcium complex to bind to the cell wall more effectively. Our case shows the clinical application of the same. A prospective randomized control trial to explore the effectiveness of dual antibiotic therapy in vivo is needed. If proven, daptomycin/-lactam can become a standard of care to treat VRE and decrease daptomycin nonsusceptibility.
    • Percutaneous management of complex acquired aortic coarctation in an adult with tetralogy of Fallot and pulmonary atresia

      Seckeler, Michael D; Lawson, Emily; Barber, Brent J; Klewer, Scott E; Univ Arizona, Dept Pediat Cardiol (MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017-09)
      We present the case of a female adult with complex cyanotic congenital heart disease who had long-standing thoracic aortic obstruction due to scarring from earlier surgical procedures. She was symptomatic but felt to be too high risk for surgical intervention. With careful planning, she was able to undergo successful stenting of her aorta with subsequent clinical improvement. This case highlights some of the complexities of caring for adults with congenital heart disease and the importance of a thorough understanding of their anatomy and physiology and prior interventions before undertaking interventions.
    • Time dependent differences in gray matter volume post mild traumatic brain injury

      Singh, Prabhjyot; Killgore, WilliamD.S.; Univ Arizona, Dept Psychiat (MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2016-06)