Primary haemostasis was evaluated by measurements of bleeding time and platelet count in 26 dogs with leishmaniasis and 10 normal dogs. Bleeding time was significantly (P = 0.02) longer in the infected dogs than in the control group, and in infected dogs with creatinine concentrations > 1.5 mg/dl than in infected dogs with normal creatinine levels. There was a significant linear regression between the concentration of creatinine and bleeding time (P = 0.02) although the coefficient of determination was low (r2 = 0.194). There were no significant differences in platelet counts between the normal and diseased dogs, and there were no significant differences between male and female dogs in either group.
To examine the effects of poor sanitation and hygiene on the prevalence of antimicrobial-resistant bacteria, we surveyed households in two rural and two urban communities in Guatemala (N = 196 randomly selected households). One adult (≥ 18-years old) and, when available, one child (≤ 5 yearsold) provided a stool sample. Up to 48 presumptive Escherichia coli isolates were collected from each stool sample (n = 21,256 total) and were subjected to breakpoint assays for ten antibiotics. Mixedeffects logistic models were used to identify potential factors influencing the likelihood of harboring antibiotic-resistant bacteria. For nine out of ten antibiotics, the odds of detecting resistant bacteria decreased by ~ 32% (odds ratios, OR 0.53-0.8, P < 0.001) for every unit of improvement of a hygiene scale. Hygiene differences between households had a greater impact on prevalence compared to antibiotic use differences. The likelihood of detecting resistant isolates was lower for five antibiotics among households that boiled raw milk before consumption (OR 0.31-0.69), and higher for nine antibiotics in urban households (OR > 1.89-9.6). Poor hygiene conditions likely obscure effects of individual antibiotic use, presumably due to enhanced microbial transmission. Consequently, efforts to improve antibiotic stewardship should be coupled with improving hygiene conditions. Antimicrobial-resistant infections contribute to hundreds-of-thousands of deaths worldwide 1. To address this threat, public and private organizations are engaged in programs to improve surveillance for antimicrobialresistant organisms, to improve antibiotic stewardship, and to identify novel therapeutics, all of which are considered priority actions for combating antimicrobial resistance (AMR) 2-4. The strategies adopted to limit AMR will vary globally, particularly across countries with different degrees of wealth and development. The most effective intervention will likely depend on prevailing conditions. For example, high-income countries and low-income countries can differ in antimicrobial resistance patterns, antimicrobial use practices, access to healthcare services (human and animal), sanitation and regulation infrastructures 5-9. Studies conducted within high-income countries, particularly those concerning healthcare facilities 10-12 and the agricultural sector 13-15 , have associated reductions in antimicrobial use and improved stewardship with decreases in the prevalence of antimicrobial resistance. In contrast, studies examining global patterns of AMR find that antibiotic use is not positively correlated with resistance in all cases and may instead be correlated with
Secondary haemostasis was evaluated in 26 dogs with leishmaniasis and 10 normal dogs by measurements of modified one-stage prothrombin time (m-OSPT), activated partial thromboplastin time (APTT), thrombin time, fibrinogen concentration and fibrin degradation products. There were no significant differences between the groups in the m-OSPT, fibrinogen concentration, or levels of fibrin degradation products. The APTT was significantly (P = 0.006) longer in the infected dogs than in the control group, and in infected dogs with alanine aminotransferase (ALT) activities > 50 U/litre. There was a significant linear regression between ALT and APTT. Thrombin time was significantly (P = 0.003) longer in the infected dogs than in the normal dogs. There were no significant differences between the thrombin times of sick dogs with different levels of creatinine or activities of ALT, or between male and female dogs, whether diseased or normal.
Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter sales result from laissez-faire enforcement of antibiotic dispensing regulations in Guatemala combined with patient demand. This study serves as a baseline to document changes in the availability of antibiotics in informal establishments in light of new pharmacy regulations for antibiotic dispensing, which were adopted after this study was completed.
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