Enterococci are potential pathogens in many human body sites. This study determined the subgingival occurrence and the in vitro antimicrobial susceptibility of enterococci in 100 persons with early-onset periodontitis and 545 persons with advanced adult periodontitis. Subgingival microbial samples were collected with paper points, transported in VMGA III and plated onto anaerobic enriched brucella blood agar or selective Enterococcosel agar (BBL Microbiology Systems). Enterococcal speciation was performed using commercial micromethod kit systems. In vitro sensitivity was determined using a commercial kit system and an agar dilution assay. Subgingival enterococci occurred in 1% of early-onset periodontitis patients and in approximately 5% of adult periodontitis patients. Enterococcus faecalis was the only enterococcal species recovered, and all but one isolate belonged to the same biotype. In vitro antimicrobial sensitivity testing revealed subgingival enterococci resistant to therapeutic levels of penicillin G, tetracycline, clindamycin and metronidazole, but relatively sensitive to ciprofloxacin and amoxicillin/potassium clavulanate (Augmentin). Enterococci may populate periodontal pockets as superinfecting organisms and, in heavily infected patients, may contribute to periodontal breakdown.

A series of 993 subgingival microbial samples sent to a diagnostic microbiology laboratory included 196 samples that could be identified as compatible with a clinical diagnosis of refractory or recurrent periodontitis. In descending order of prevalence the associated microbiota included Bacteroides forsythus (84%), spirochetes (83%), motile rods (76%), Fusobacterium species (68%), Porphyromonas gingivalis (63%), Campylobacter rectus (47%), Capnocytophaga species (38%), Prevotella intermedia (23%), Peptostreptococcus micros (18%), Actinobacillus actinomycetemcomitans (16%), Candida (14%), enteric rods (9%), Staphylococcus species, not including aureus (5.6%). Eikenella corrodens (3%), Staphylococcus aureus (1.5%), and Enterococcus species (< 1%). Antibiotic resistance to tetracycline, penicillin G, or metronidazole was particularly noticeable for enteric rods, Fusobacterium species, Capnocytophaga species, Staphylococcus, and Actinobacillus actinomycetemcomitans. It was largely absent for Campylobacter rectus. No antibiotic sensitivity data were obtained for Porphyromonas gingivalis or Bacteroides forsythus, as these species were detected by immunofluorescence. The results indicate that a substantial number of microorganisms associated with refractory periodontitis are variably resistant to commonly-used antibiotics. Diagnostic microbiology must be considered an essential adjunct to the therapist faced with periodontal lesions refractory to conventional treatment.

Costs to broiler producers associated with subclinical (mild) necrotic enteritis (SNE) were estimated using published information on impacts on body weight and feed conversion rate (FCR) associated with SNE and costs and revenues associated with broiler production. Estimates were expressed in U.S. dollars from the perspective of poultry producers. SNE was estimated to result in a 12% reduction in body weight and a 10.9% increase in FCR compared with healthy birds. For the purposes of this analysis, we considered scenarios involving hypothetical flocks of 20,000 birds raised to final body weights ranging from 4.63 to 7.94 lb. The incidence of SNE was assumed to occur at 20% based on the literature. For flocks raised for the length of time required to reach these target weights, SNE resulted in a loss to producers ranging from US$878.19 to US$1480.52 per flock. When feed costs required to obtain SNE flocks having a total live body weight equal to equivalent healthy flocks at market age were calculated, the increased cost to producers ranged from US$370.49 to US$739.38 per flock. SNE has the potential to cause a significant negative economic impact in broiler flocks. Strategies to reduce the incidence of SNE may help to increase the profitability of broiler production.

Objective: To assess existing reported human trials of Withania somnifera (WS; common name, ashwagandha) for the treatment of anxiety. Design: Systematic review of the literature, with searches conducted in PubMed, SCOPUS, CINAHL, and Google Scholar by a medical librarian. Additionally, the reference lists of studies identified in these databases were searched by a research assistant, and queries were conducted in the AYUSH Research Portal. Search terms included ''ashwagandha,'' ''Withania somnifera,'' and terms related to anxiety and stress. Inclusion criteria were human randomized controlled trials with a treatment arm that included WS as a remedy for anxiety or stress. The study team members applied inclusion criteria while screening the records by abstract review. Intervention: Treatment with any regimen of WS. Outcome measures: Number and results of studies identified in the review. Results: Sixty-two abstracts were screened; five human trials met inclusion criteria. Three studies compared several dosage levels of WS extract with placebos using versions of the Hamilton Anxiety Scale, with two demonstrating significant benefit of WS versus placebo, and the third demonstrating beneficial effects that approached but did not achieve significance ( p = 0.05). A fourth study compared naturopathic care with WS versus psychotherapy by using Beck Anxiety Inventory (BAI) scores as an outcome; BAI scores decreased by 56.5% in the WS group and decreased 30.5% for psychotherapy ( p < 0.0001). A fifth study measured changes in Perceived Stress Scale (PSS) scores in WS group versus placebo; there was a 44.0% reduction in PSS scores in the WS group and a 5.5% reduction in the placebo group ( p < 0.0001). All studies exhibited unclear or high risk of bias, and heterogenous design and reporting prevented the possibility of meta-analysis. Conclusions: All five studies concluded that WS intervention resulted in greater score improvements (significantly in most cases) than placebo in outcomes on anxiety or stress scales. Current evidence should be received with caution because of an assortment of study methods and cases of potential bias.

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