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Disseminated strongyloidiasis is often associated with enteric bacterial infections. This study was undertaken to determine if enteric organisms caused extraintestinal infections in patients infected with Strongyloides stercoralis but without apparent dissemination. The medical records of hospitalized patients from central Kentucky with strongyloidiasis (1993-2003) were examined to determine the occurrence of extraintestinal infections with enteric organisms. Of 30 patients with S stercoralis, 16 had invasive infections, including sepsis, meningitis, pneumonia, peritonitis, and endocarditis caused by enteric bacteria and Candida organisms. Infections were seen in 8 (62%) of 13 patients with disseminated strongyloidiasis and 8 (47%) of 17 with disease apparently limited to the gastrointestinal tract. Fifteen patients were receiving corticosteroids or other immunosuppressive therapy. Peripheral eosinophilia was seen in only 23% (7/30). Infection with S stercoralis, even without obvious dissemination, may predispose to invasive infections caused by enteric organisms. In Strongyloides-endemic areas, patients with invasive infections caused by enteric organisms should be examined for coinfection with S stercoralis.

Gram-negative bacilli causing infective endocarditis (IE) is rare, even in intravenous drug users. This case report underscores several clinically important aspects of Delftia acidovorans IE: the organism's ability to cause rapid destruction of normal native valves and to cause embolic occlusion of large arteries and its resistance to all aminoglycosides. CASE REPORT In November 2010, a 30-year-old male, with a history of intravenous drug use (IDU), hepatitis C, and posttraumatic stress disorder, presented to the Lexington Veterans Affairs Medical Center (VAMC) with a 2-to 3-week history of malaise and right knee pain. The patient reported having a fever for 2 days prior to presentation, with a temperature of 103°F (noted at home). He was in his usual state of health until a month prior to presentation, when he developed right knee pain, which was first observed when he jogged for exercise. The pain progressively worsened, and he stopped jogging 2 weeks prior to presentation. One week prior to presentation, the patient went to the VAMC emergency room and was diagnosed with a viral illness; flu PCR was negative, and he was instructed to follow up with his primary care physician. No anti-infective medication was given. On the day of hospitalization, he returned to the VAMC emergency department with increased pain in his right leg, fever, and a painful red lesion on the ring finger of his left hand. Upon physical examination, his temperature was 104°F and he was found to have a new grade 3/6 diastolic murmur (not previously noted in his clinic records), diminished pedal pulse and posterior tibial pulse in his right leg, without knee effusion, and a tender erythematous nodule on the 4th digit of his left hand. The patient's laboratory studies were unremarkable. His human immunodeficiency virus test and urine drug screening were both negative. Blood cultures were drawn, and vancomycin and piperacillin-tazobactam (2 days) were started empirically. The echocardiogram demonstrated a severe aortic insufficiency with aortic valve vegetation of 1.0 by 1.4 cm. An arteriogram of his right leg showed occlusions in the right posterior tibial artery and right peroneal artery.The patient's social history was only remarkable for past IDU. He stated that he was in a drug rehabilitation facility for 6 weeks prior to the onset of symptoms but confessed to occasional relapses in his IDU behavior. The patient admitted using the water from the bathroom and kitchen faucets to prepare his drugs for injection. He denied smoking and drinking alcohol regularly.The patient became afebrile on antibiotics in 48 h. He was evaluated by cardiothoracic surgery and, on the third hospital day, was transferred to the adjacent University of Kentucky Hospital (UKH) where he underwent successful aortic valve replacement.Two sets of blood cultures at VAMC and a culture of tissue from the patient's aortic valve at UKH grew a Gram-negative bacillus. The Gram-negative bacillus was identified as Delftia acidovorans, resistant to all aminoglycosides. His anti...

Purpose The purpose of this paper is to evaluate if sudden retail price increases for beef products have affected consumers purchasing behaviors. Little research has been conducted that integrates retail price volatility with subdued food consumption motivations. Prior research about consumers’ meat-purchasing habits and systemic concerns linked to sustainability and animal welfare is limited or de-contextualized. This study also attempts to assess if retail price increases have triggered a change in perception of the meat industry, by looking at specific values related to animal protein production and consumption. Design/methodology/approach This study is based on an inductive, quantitative analysis of primary data obtained from a survey on beef consumption. For convenience and validity, all respondents had to be living in Canada for 12 months, and were at least 18 years old. The choice of country is not trivial. First, access to data were convenient for this study. Second, and most importantly, Canada has supply managed commodities that include poultry and chicken. In effect, Canada produces the amount of chicken it needs. Beef production is vulnerable to market volatility. As a result, demand-focussed market conditions for one often influence conditions for the other. Findings Findings indicate that higher prices have compelled 37.9 percent of the sample to reduce or to stop beef consumption altogether in the last 12 months. Beyond the issue of price, sustainability, food safety and health appear to be significant factors, more so than ethics (animal welfare). Results also show that education can be considered as a determinant for sustainable aspects of beef production when prices increase. Age and gender had no statistical significance on survey results. Some limitations are presented and future research paths are suggested. Research limitations/implications Since the sample in this study was mainly composed of consumers based in Canada, the generalizations of the findings should be approached with some caution. The same research should be conducted with consumers from other parts of the Western world to verify if the results can be generalized. Practical implications This survey help the authors to understand some aspects of beef consumption at retail. Findings of this empirical study have implications for future communications to consumers, in that greater emphasis should be given to the connection consumers have with other nutritional alternatives. Since meat consumption in the Western world is intrinsically linked to culinary traditions, behaviors can be challenging to change. Social implications The economic implications of a rapid adoption of a plant-based diet for the agricultural economy would be significant. However, the reality is that according to many studies of consumer behavior, customers still place a higher value on buying and eating meat than on any other food group. Canada’s relationship with animal proteins has deep cultural roots, particularly during holidays and summertime. Originality/value The present study has given important insights into the determinants of meat consumption reduction, a behavior which could both have long-term economic implications for the cattle and beef industries. This paper provides a deeper insight into some socio-economic factors that contribute to slow erosion of meat consumption reduction, and the effects of higher prices at retail. This is, as far as the authors know, likely the first study of its kind.

Lumbar plexus infusion is a reasonable alternative to epidural anaesthesia for total knee arthroplasty.