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- Diagnosis and Management of Urinary Tract Infections in the Outpatient Setting: A Review. [JOURNAL ARTICLE]
- JAMA 2014 Oct 22; 312(16):1677-1684.
Urinary tract infection is among the most common reasons for an outpatient visit and antibiotic use in adult populations. The increasing prevalence of antibacterial resistance among community uropathogens affects the diagnosis and management of this clinical syndrome.To define the optimal approach for treating acute cystitis in young healthy women and in women with diabetes and men and to define the optimal approach for diagnosing acute cystitis in the outpatient setting.Evidence for optimal treatment regimens was obtained by searching PubMed and the Cochrane database for English-language studies published up to July 21, 2014.Twenty-seven randomized clinical trials (6463 patients), 6 systematic reviews, and 11 observational studies (252 934 patients) were included in our review. Acute uncomplicated cystitis in women can be diagnosed without an office visit or urine culture. Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days), nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5-7 days), and fosfomycin trometamol (3 g in a single dose) are all appropriate first-line therapies for uncomplicated cystitis. Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections. β-Lactam agents (amoxicillin-clavulanate and cefpodoxime-proxetil) are not as effective as empirical first-line therapies. Immediate antimicrobial therapy is recommended rather than delayed treatment or symptom management with ibuprofen alone. Limited observational studies support 7 to 14 days of therapy for acute urinary tract infection in men. Based on 1 observational study and our expert opinion, women with diabetes without voiding abnormalities presenting with acute cystitis should be treated similarly to women without diabetes.Immediate antimicrobial therapy with trimethoprim-sulfamethoxazole, nitrofurantoin, or fosfomycin is indicated for acute cystitis in adult women. Increasing resistance rates among uropathogens have complicated treatment of acute cystitis. Individualized assessment of risk factors for resistance and regimen tolerability is needed to choose the optimum empirical regimen.
- Risk Factors for Drug-Resistant Pathogenes in Community-Acquired Pneumonia in Azerbaijan Republic. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):922A.
Respiratory Infections Posters IISESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Identification of patients with drug-rersistant pathogenes at initial diagnosis is essential for traetment of pneumonia.The purpose of this study was to elucidate clinical features of community-aquired pneumonia(CAP) and to clarify risk factors for drug resistant pathogenes in patients with COPD.METHODS: A prospective observational study was conducted in hospitalized patients with CAP at three centers in Azerbaijan republic.Pathogenes identified as not susceptible to ceftriaxone ,amoxicillin-clavulonic acid ,macrolides,and fluoroquinolones were defined as CAP drug-resistant pathogenes(CAP-DRPs).Microbilogic laboratories in all centers provided possible causative pathogenes,which were cultured in a semiquantitative manner from samples of sputum,tracheobronchial aspitates,bronchalveolar lavage fluid,and blood.Serologic tests were performed to detect antibodies against Mycoplasma pneumoniae and Chlamydophila pneumoniae.Legionella pneumophila serogroup I antigen in urine was tested by immonochromotography.RESULTS: In total, 368 patients with CAP were analized.this observotional study was performed prospectively from January 15 ,2013 through december 25,2013 at one university hospital(a 500-beds),one institution hospital(a 300-beds) and one major community hospital(a 200-beds).All adult patients(>_20 yr) in whom pneumonia had developed during daily community living were included in the study.CAP-DRPs were found in 86(23.4%) patients with CAP.Independents risk factors for CAP-DRPs were almost identical in all three observational study centers.These included prior hospitalization(adjusted odds ratio[AOR],2.57;95% confidence interval[CI],1.45-3.89),previous antibiotic use (AOR),3.85;95% CI,2.14-5.69),use of gastric acid-supressive agents(AOR,2.75;95%CI 1.65-3.95).CONCLUSIONS: The clinical profile of CAP was similar in all three centes of the observational study.However,physicians can predict drug resistance in patients with CAP by taking accoiunt of the cumulative number of risk factors.The superiority of previous use of antibiotics as risk factor may be explain with unrational use of antibiotics by physicions in Azerbaijan republic.CLINICAL IMPLICATIONS: Ewig S,Welte T, Torres A.Rethinking the concepts of community-acquired and health-care associated pneuminia.lancet Infect Dis 2010;10:279-287. Ishida T, Hashimito T,Arita M, Ito I,Osawa M.Etiology of community- acguired pneumonia in hospitalized patients:3-year prospective study in japan.Chest 1998;114:1588-1593.DISCLOSURE: The following authors have nothing to disclose: Alizaman Sadigov, Gulzar Aliyeva, Aynur AgayevaNo Product/Research Disclosure Information.
- A Curious Manifestation of Amoxicillin-Induced DRESS Syndrome. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):781A.
Bronchology/Interventional Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Drug rash with eosinophilia and systemic symptoms (DRESS) is an idiosyncratic and potentially life-threatening syndrome. It is a type of delayed hypersensitivity reaction to drugs. We describe a rare manifestation of DRESS syndrome that presented as diffuse alveolar hemorrhage caused by hypersensitivity to amoxicillin.CASE PRESENTATION: A 19-year-old male presented to the emergency department with fevers, morbiliform rash, adenopathy and hepatosplenomegaly 14 days after being started on amoxicillin for symptoms of sinusitis. Initial laboratory studies revealed thrombocytopenia, eosinophilia and transaminitis. His symptoms quickly deteriorated during the first 24 hours of hospitalization to involve respiratory compromise requiring intubation and meeting criteria for acute respiratory distress syndrome. A chest CT scan was remarkable for pulmonary inflitrates with prominent air bronchograms. A bronchoscopy and bronchoalveolar lavage revealed a grossly bloody aspirate and pulmonary eosinophilia. Extensive workup for autoimmune disorders, bacterial, viral, fungal and parasitic infections was unrevealing. A punch biopsy of the skin was compatible with a hypersensitivity reaction as it showed superficial perivascular dermatitis with eosinophil extravasation. DRESS syndrome was diagnosed with rapid regression of symptoms after treatment with high dose methylprednisone was initiated. The patient made a full recovery and was discharged home on day 13 of hospitalization with a very slow steroid taper.DISCUSSION: DRESS syndrome usually presents 2-8 weeks after the initiation of the offending agent. The main culprits are allopurinol, aromatic anticonvulsants and sulfonamides, even though 50 Drugs can induce DRESS1. It has been described as "the great clinical mimicker" as it masquerades as acute severe sepsis. It presents with fever, cutaneous drug eruption, hematological abnormalities and a wide array of internal organ involvement. There has only been a handful of cases of DRESS syndrome as a consequence of amoxicillin. In our case, the most life-threatening manifestation was eosinophilic pneumonitis and diffuse alveolar hemorrhage causing acute respiratory distress syndrome. Pulmonary involvement is present in only 5% of cases of DRESS1. We used the RegiSCAR scoring system developed by Kardaun et al that classifies DRESS cases and a "definite" score gave us the diagnosis2. The main treatments of DRESS are withdrawal of culprit drug and a very slow corticosteroid taper.CONCLUSIONS: Diagnosing DRESS is challenging due to the diversity of cutaneous manifestations and organs involved and as such, there should be a high clinical suspicion for this disease if the introduction of a new drug is followed by a rash, eosinophilia and a sepsis-like syndrome.Reference #1: Cacoub P, Musette P & Descamps V, et al. The DRESS syndrome: a literature review, Am J Med. 2011 Jul;124(7):588-97Reference #2: Kardaun SH, et al. does a DRESS syndrome really exist? Br J Dermatol. 2007;156:609-611DISCLOSURE: The following authors have nothing to disclose: Musa Sharkawi, Noormuhammad AbbasakoorNo Product/Research Disclosure Information.
- A 4-Year-Old With Markedly Reduced Oxygen Affinity Due to a Hemoglobin (Hb) Variant. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):715A.
Pediatric CasesSESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Monday, October 27, 2014 at 03:15 PM - 04:15 PMINTRODUCTION: Child with hypoxemia, not caused by hypoventilation, V/Q mismatch, shunting, or diffusion limitation.CASE PRESENTATION: A 4 year old boy presented with fever and exertional dyspnea, without cough or respiratory distress, SpO2 85% in room air, which improved to 92% on 2LPM oxygen. Chest radiograph (CXR) showed bronchial thickening without focal infiltrate; heart size and vascularity were normal. Hb value was normal. He was discharged home on azithromycin and amoxicillin when stable in room air. Two days later, pediatrician sent him to ER for SpO2 85%, unchanged CXR. Review of systems: no history of excercise tolerance, problems at high altitudes, or decreased activity. Immunizations up to date. Paternal family history of Thalassemia. Prior surgery for coarctation repair in infancy. During hospitalization, lungs were clear to auscultation; rest of exam was normal without signs of clubbing or cyanosis. SpO2 ranged 87-92% in room air. Interestingly, SpO2 of patient's father was 92%. Paternal grandmother and aunt reportedly have low oxygen saturations during doctors' visits. Studies during hospitalization included bubble ECHO and chest CT angiogram, which were normal. ABG was unsuccessful. Hemoglobin electrophoresis showed Hb A 75, Hb V 22. DNA analysis was consistent with heterozygous Hb Bassett.DISCUSSION: Hb Bassett is an abnormal Hb variant with a markedly reduced oxygen affinity, decreased Bohr effect, and low subunit cooperativity. It has an amino acid substitution (α94Asp-->Ala) at the α1:β2 contact region, where the key conformational changes associated with oxygenation and deoxygenation of Hb molecule take place. This dimer interface plays a major role in the allosteric activity of Hb by forming an inter-subunit hydrogen bond/salt bridge that links and stablizes the two αβ dimers in both the T- and R- state. In Hb Bassett, replacement of the aspartate residue by alanine abolishes significant α1:β2 hydrogen bond interactions resulting in reduced stability of Hb Bassett relative to normal Hb, R-state more destabilized than T-state due to loss of a greater number of inter-subunit interactions in the R-state. The allosteric equilibrium is therefore expected to favor the relatively stable T-state Hb Bassett, giving rise to low oxygen affinity.CONCLUSIONS: Hb binding affinity for oxygen should be considered when all four causes of hypoxemia are ruled out.Reference #1: Abdulmalik O, et al. Characterization of hemoglobin Bassett (α94AspàAla), a variant with very low oxygen affinity. Am J Hematol 2004;77(3):268-276.DISCLOSURE: The following authors have nothing to disclose: Diana Chen, Mustafa BseikriNo Product/Research Disclosure Information.
- Chronic Granulomatous Disease Complicated With Dissemination of BCG Vaccine. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):688A.
Pediatric Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Chronic granulomatous disease is caused by a deficiency of phagocyte microbicidal function, due to the inability to produce hydrogen peroxide and superoxide anion. The most common form is X-linked and presented with recurrent pulmonary infections.CASE PRESENTATION: A male patient a one year and nine months old, presented with febriles syndrome treated with multiple antibiotics such as clabulanic amoxicillin due to reoccurrent infection in the whole respiratory system; anemia, axillary adenopathy, without symptoms of recovery. For this reason he was referred to our hospital for diagnosis and treatment. At admission, his general condition was bad, with the following BM16.5 kg/m2, the patient is between 50-25 percentile growth. Presented: asthenia, decreased appetite, fever syndrome with records of 38 °, oxygen desaturation, with a 92 % to 21 % FiO2, respiratory rate of 36 per minute. Physical examination presented: right axillary lymphadenopathy, mobile, painless, hard elastic 1cm diameter, crepitant widespread rales and rhonchi in both lung fields and Other symptoms such as, increased rate of breathing, breathlessness and wheezing. Treatment was initiated with Clarithromycin and Amoxicillin clavulanic. TB empirical first-line treatment is added. He continued, febrile with records of 38-39 ° C, with antipyretics and physical means. Added access nonproductive cough and increased respiratory compromise adding retractions, and tachypnea. Background: Fully vaccinated. From month of life was treated for recurrent respiratory tract infections. Five months olds requiring hospitalization for acute pneumonia record. Laboratory results: anemia, increased erythrocyte sedimentation rate, hyperglycemia, and mild oxygen desaturation. Serological tests, toxoplasmosis, HIV, EBV, parvovirus, CMV, Mycoplasma, Bartonella, Brucella, Leptosipirosis, all negative. Dosage IgA and IgG slightly above its normal value, IgE 541.6 Ul/ml. Elevation of gamma globulin. DNA- antibody, ANCAs, and Rheumatoid Factor negative. Thorax CT: multiple images of lymph nodes in the mediastinum Observed in lung parenchyma patchy areas of airspace occupation distributed in both lungs and cavitated images in the lower lobes. Axillary lymphadenopathy. Upper abdomen no abnormalities. Normal Echocardiogram. Ocular Fundus, right eye net edges whitish lesions without macular involvement Faced with suspected diagnosis of TB specific studies are requested: Gastric Lavage, Lymph Node and Cerebrospinal Fluid: Negative smear and culture. Blood cultures for mycobacteria: Negatives. Tuberculin Skin Test: Negative.Were raised various differential diagnosis: Infectious diseases such as tuberculosis, toxoplasmosis, aspergillosis, staphylococci sepsis, tuberculosis being the entity that most compatible with the characteristics presented by the patient, although the bacillus was not found by the methods referred. Immunological diseases: Wiskott Aldrich immunodeficiency. Severe combined immunodeficiency disease is a group with deficiency of humoral and cellular immunity caused by various genetic mutations and associated enzyme deficiencies. The most common form is X-linked early onset in the first months of life, and is presented as severe mucocutaneous candidiasis, dissemination of BCG vaccine, persistent diarrhea, lung infections, meningitis, septicemia. Complement deficiency can start at different ages. C3 deficiencies present with sino-pulmonary infections by encapsulated bacteria, pneumococcus, Neisseria meningitidis, Haemophilus influenza. Autoimmune disease Systemic lupus erythematosus, polyangiitis, Wegener's granulomatosis.CONCLUSIONS: The patient remained febrile despite therapy instituted and showed no improvement in respiratory symptoms so it is referred to a specialist center for studies to detect diseases of the immune system. Resulting poor response in nitroblue tetrazolium (NBT) test, it was assumed as a chronic granulomatous disease complicated with dissemination of BCG (Bacille Calmette-Guerin) vaccine , given that the child was vaccinated at birth. Treatment was started with interferon gamma, TB drugs, Trimethoprim-sulfamethoxazole and Itraconazol, and showed significant improvement 40 days after starting treatment.Reference #1: Chronic granulomatous disease, Current Opinion in Immunology, Volume 15, October 2003, Pages 578-584, P G Heyworth, and col.DISCLOSURE: The following authors have nothing to disclose: Gabriela Manonelles, Vanina MartinNo Product/Research Disclosure Information.
- Solitary Pulmonary Nodule in an Immunosuppressed Patient With Non-Hodgkin Lymphoma: An Unusual Situation. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):635A.
Cancer Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: The carcinoid tumor is a rare neoplasm of enterochromaffin cells. Its main location is in the intestine, more often in the appendix. Carcinoid tumors may or may not produce the carcinoid syndrome, characterized by various clinical symptoms such as tachycardia, flushing and paraesthesia, all related to serotonin secretion by the tumor. We report a case of a patient in use of adjuvant chemotherapy after diagnosis of non-Hodgkin's lymphoma that presented in exam chest ray routine circumscribed pulmonary nodule. After long follow-up, it was opted for surgical resection of the lesion, being diagnosed carcinoid tumor of the lung.CASE PRESENTATION: MAF, female, 68 years old, housewife, resident in the interior of Rio de Janeiro, Brazil. Was presented for the first time to our service with clinical cough, yellowish scanty expectoration and low fever of 37.8°. She was treated with prednisone 30 mg daily, omeprazole, acyclovir , sulfametozaxol-trimethoprim and ondansetron. Reported a previous diagnosis, received eighteen months prior this consultation, of non-Hodgkin's lymphoma, obtained through biopsy of inguinal lymph node. Chest radiography showed pulmonary nodule with soft tissue density of 1.8 cm in diameter, without calcification and well delimited in the left lower lobe that was first identified three years prior. This lesion had been accompanied by another service of pneumology and oncology in a conservative way. Was treated for the infection with a more enlarged approach, using amoxicillin-clavulonate and clarithromycin, because of her underlying disease and continuous use of systemic corticosteroids. Complete regression of symptoms occurred with absolute improvement. The nodulation remained present in later radiographys. Requested chest CT which showed lobulated nodule with well-defined borders in the medial basal segment of the left lower lobe, near the thoracic aortic wall, measuring 2.0 cm, with intense enhancement after contrast infusion. The examination of inflammatory tests after treatment of the infection were in low titles: CRP of 6mm and ESR of 10mm. Normal conventional lung function test. In this moment, the oncology service decided, in relation to the treatment of the lymphoma, the addition of rituximab to the treatment regimen. It was made screening for infectious diseases with no data suggesting underlying disease. Despite nonreactive Mantoux test, as the same was held on corticosteroids use, it was requested bronchoscopy. Collected material, with results of direct examination and culture negative for tuberculosis and fungi, as well as negative oncotic cytology. In regards of epidemiological risks, the absence of etiological definition and risks inherent in the use of rituximab, it was decided to introduce prophylactic isoniazid for prevention of possible masked TB. In the monitoring of the non-Hodgkin lymphoma, PET scan was requested to re-estage, which revealed absence of signs of disease activity. On the other hand, the previously identified lung injury exhibited growth, evidenced by increasing its dimensions in relation to previous studies. Because of this, she was referred to thoracic surgery. Due to difficult surgical access, it was decided to approach the nodule via videothorascoscopy, being perfomed a lung segmentectomy. Retrieved tissue containing a nodule of 3 cm in diameter, which was diagnosed after examination as typical carcinoid tumor. The surgery was uneventful and the patient is currently asymptomatic on follow -up.DISCUSSION: Despite the carcinoid tumor usually require large surgical excision, segmentectomy was performed due to the limitations of the patient and the peculiar location of the lesion. As histopathological study revealed that the surgical margins were free of lesions and PET-scan showed no metabolic activity in other sites, we considered the segmentectomy a proper treatment of the condition founded.CONCLUSIONS: The involvement of more than one different type of neoplasm sequentially is uncommon. There are no reports in the literature that non-Hodgkin lymphoma may predispose carcinoid tumor and vice versa. In elderly, frail or patients with comorbidities, segmentectomy can assume similar healing criteria of the lobectomy.Reference #1: SAVIVA, E. V.; DESCOURT, R. Focus on treatment of lung carcinoid tumor. Onco Targets Ther. 2013Reference #2: TRAVIS, W.D. Advances in neuroendocrine lung tumors. Oxford Journals Medicine. Annals of Oncology 2010Reference #3: REKHTMAN, N. Neuroendocrine Tumors of the Lung - An Update. Arch Pathol Lab Med. 2010DISCLOSURE: The following authors have nothing to disclose: Gilmar Zonzin, Vitório Puntel, Silvio Guerra, Vinicius Agostinho, Mariana Silva, Priscila Virgens, Marina FariaNo Product/Research Disclosure Information.
- Don't Smooch That Pooch! A Rare Case of Pasteurella multocida Pneumonia in an Elderly Woman. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):146A.
Infectious Disease Cases IISESSION TYPE: Affiliate Case Report SlidePRESENTED ON: Wednesday, October 29, 2014 at 11:00 AM - 12:15 PMINTRODUCTION: Pasteurella multocida is a Gram-negative coccobacillus that colonizes the naso-oropharynx of many domestic mammals. Zoonotic transmission to humans most commonly occurs after animal bites resulting in soft-tissue and skin infections, but pulmonary infections are possible. We report a rare case of pasteurella pneumonia in an elderly woman from kissing her pet dog.CASE PRESENTATION: An 88 year-old nonsmoking woman with a history of well-controlled chronic obstructive pulmonary disease presented with a persistent nonpurulent cough, night sweats, and a weight loss of 12 lbs over 1 month. Physical examination and vital signs were unremarkable. A CT scan of the chest revealed multilobar tree-in-bud opacities associated with patchy areas of consolidation. Multiple sputum cultures were unremarkable and were negative for acid fast bacilli. A bronchoalevolar lavage was performed and cultures grew P. multocida. On further questioning, the patient revealed that she kisses her pet dog daily and her pet dog had a chronic cough as well. The patient and the dog (after veterinary consultation) were treated with amoxicillin-clavulanate for 2 weeks. The patient was advised to avoid kissing her pets. At 3 month follow up there was resolution of the pulmonary infiltrates on a CT scan and she reported no respiratory symptoms in herself or the pet dog.DISCUSSION: Respiratory tract infection from P. multocida is rare, and the actual incidence is likely under-reported. Cases of pneumonia have been reported and the likely mechanism of transmission is by direct inhalation of contaminated aerosols or oral exposure to animal secretions. In the reported literature, pasteurella pneumonia is most frequently found in elderly patient with underlying lung disease that reside with cats and dogs. The treatment of choice for P. multocida infection is ampicillin-sulbactam if intravenous therapy is needed or oral amoxicillin-clavulanate.CONCLUSIONS: We describe a rare case of a zoonotic transmission of pasteurella pneumonia. A history of animal exposure should alert the physician to consider Pasteurella multocida as a potential pulmonary pathogen. Our case further highlights that advising patients to avoid kissing pets can prevent zoonotic transmission of infections, especially in elderly patients with chronic lung diseases.Reference #1: Klein NC, Cunha BA. Pasteurella multocida pneumonia. Semin Respir Infect 1997;12(1):54-56.Reference #2: Marinella MA. Community-Acquired Pneumonia Due to Pasteurella multocida. Respir Care 2004;49(12):1528 -1529.DISCLOSURE: The following authors have nothing to disclose: Nikunj Bhatt, Angeline LazarusNo Product/Research Disclosure Information.
- Compassionate Use of Bedaquiline in the Treatment of Extensively Drug-Resistant Pulmonary Tuberculosis. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):132A.
Infectious Disease Case Report PostersSESSION TYPE: Affiliate Case Report PosterPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Extensively Drug Resistant Tuberculosis (XDR-TB), is uncommon in developed countries with only 63 cases reported in the US between 1993-2011. Treatment is tailored to culture sensitivities with second line anti-tuberculosis (anti-TB) drugs. We report the first case in United States of compassionate use of bedaquiline for the treatment of pulmonary XDR-TB.A 30 year-old man, former smoker, with diabetes, presented with fevers and hemoptysis one month after immigrating to New York from a high incidence country. His chest x-ray revealed bilateral cavitary upper lobe infiltrates (Figure 1). Sputum smears for acid-fast bacilli were positive as were cultures for Mycobacterium Tuberculosis. He was empirically started on first-line anti-TB drugs, and his regimen was modified as results from susceptibility testing became available eventually revealing XDR-TB. He was ultimately treated with pyrazinamide, ethionamide, paraminosalycilic acid, cycloserine, capreomycin, amoxicillin/clavulanic, meropenem and linezolid. As a result of multiple adverse effects from his XDR-TB treatment, especially linezolid induced demyelinating peripheral neuropathy, bedaquiline was obtained through a compassionate use program in order to maintain an effective treatment regimen for XDR-TB after the discontinuation of linezolid. He tolerated bedaquiline well experiencing only mild transaminitis and successfully completed his XDR-TB treatment.DISCUSSION: Three cases in the literature pertain to the compassionate use of bedaquiline. In each of these cases, bedaquiline was added in place of a fourth agent in a treatment regimen when there were no additional options remaining. QTC prolongation and increased risk of death have been noted in patients receiving bedaquiline. High incidences of nausea (35.3% vs. 25.7%) and hepatotoxicity (8.8% vs. 1.9%) have also been reported with bedaquiline when compared to placebo.Bedaquiline is a novel agent for the treatment of Pre-XDR or XDR Tuberculosis. In our patient bedaquiline was added to an effective XDR regimen to ameliorate the side effect profile in order to allow for the successful completion of therapy. Reference #1: CDC, Trends in Tuberculosis - United States, 2011. MMWR, 2012. 61(11): p. 181-185. Reference #2: Tiberi, S., et al., Bedaquiline in MDR/XDR-TB cases: first experience on compassionate use. Eur Respir J, 2014. 43(1): p. 289-92. Reference #3: Diacon, A.H., et al., The diarylquinoline TMC207 for multidrug-resistant tuberculosis. N Engl J Med, 2009. 360(23): p. 2397-405.The following authors have nothing to disclose: Melissa Lesko, Mauricio Danckers Degregori, Rosemary Adamson, Eric LeibertNo Product/Research Disclosure Information.
- Free antibiotic and vaccination programmes in community pharmacies of Miami-Dade County, FL, USA. [JOURNAL ARTICLE]
- J Antimicrob Chemother 2014 Oct 19.
Some community pharmacies provide prescribed oral antibiotics for free to incentivize customers. This can influence prescribing practices and may increase inappropriate antibiotic use. Thus, pleas to incorporate education and/or vaccinations into these initiatives have been made by the CDC and IDSA. This study aims to investigate the prevalence and characteristics of free antibiotic programmes (FAPs) and free vaccination programmes (FVPs) offered by community pharmacies within a major US county. Additionally, we evaluated the association between FAP location and proximate socioeconomic status.A telephone survey was administered to all community pharmacies in operation and located in Miami-Dade County, FL, USA (n = 668). Population characteristics at the five-digit ZIP code level were acquired from the 2010 US Census and American Communities Survey. An independent t-test, Kruskal-Wallis and logistic regression were used for statistical analysis.A total of 660 community pharmacies agreed to the telephone survey (response rate = 98.8%). FAPs were present in 6.8% of pharmacies (n = 45) and none incorporated an educational component targeted at patients or prescribers. Ciprofloxacin and amoxicillin were offered by all FAPs and 84.4% provided up to a 14 day supply (n = 38). Thirty-four of 72 ZIP codes had an FAP and those with a programme had larger populations and higher incomes (P ≤ 0.05). Family income ≥$75 000 (P = 0.0002) was an independent predictor of FAP availability. None of the surveyed pharmacies offered a FVP.Frequently provided by chain pharmacies and located in areas of higher income, FAPs within Miami-Dade County offer broad-spectrum antibiotics for long durations without additional education to patients or prescribers.
- First- and second-line Helicobacter pylori eradication with modified sequential therapy and modified levofloxacin-amoxicillin-based triple therapy. [JOURNAL ARTICLE]
- Ann Gastroenterol 2014; 27(4):357-361.
Helicobacter pylori (H. pylori) treatment remains a challenge for physicians. Although highly effective, the standard sequential therapy fails in a certain number of patients. Moreover, the cure rate following a levofloxacin-amoxicillin second-line triple therapy seems to be decreasing. We tested the efficacy of modified 10-day sequential therapy, and an intensified levofloxacin-amoxicillin regimen as first- and second-line therapy respectively.In this prospective, open label, multicenter, pilot study H. pylori-infected patients received a first-line modified 10-day sequential therapy regimen including rabeprazole 20 mg, and amoxicillin 1 g for the first 3 days, followed by rabeprazole 20 mg, clarithromycin 250 mg, and metronidazole 250 mg, for the remaining 7 days, all drugs given thrice daily. An 8-day therapy regimen with rabeprazole 20 mg, levofloxacin 250 mg, and amoxicillin 1 g, all thrice daily, was administered a second-line therapy.A total of 99 and 15 patients were enrolled for first- and second-line therapy. The eradication rates were 85.9% (95% CI 80-93) and 93.4% (95% CI 88-98) according to ITT and PP analyses following modified sequential therapy, and 60% (95% CI 35-86) and 64.3% (95% CI 39-89) following the intensified second-line therapy.A modified sequential 3- plus 7-day regimen with thrice daily drug administration failed to achieve very high eradication rate at ITT analysis. The intensified second-line regimen achieved disappointingly low eradication rate. Novel levofloxacin-free second-line therapies are urged in Italy.


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It happened in the Melmore Gardens area in the early hours of Wednesday.
Neighbours heard a loud bang at around 1am. When police arrived they found the front window broken, strike marks on an inside wall and part of a bullet inside.
No-one was in the house at the time, but a woman, who had recently moved out of the house, told UTV that her family is being intimidated.
Visibly distressed, Carol Lavey said: "I don't know why they are doing it. I need answers, I am sitting back every time my wee ones are getting picked on and I don't know why.
"Come forward and let me know why."
Police are appealing for information.
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Couple mugged in Malone area of Belfast
Appeal after neglected dog found
Ulster ready for Toulon clash
Decision due on NI's Romania game
Wilko Johnson 'cured of cancer'

subset: commoncrawl


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Windows 8 - Internet Identification Problem - IP Configuration Problem and Default Gateway is not available
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Ranges in price (i.e. $98-$550) means there are multiple printings and/or sizes available. Click on an item to view a list of printings and prices.
John Chiasson's live music career is celebrated in the concert memorabilia available at Wolfgang's Vault. The Collection is divided into John Chiasson Posters, John Chiasson Photographs, John Chiasson Apparel as well as other John Chiasson memorabilia such as vintage tickets backstage passes and media like Rolling Stone magazines.


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Good day for: The other half, as federal prosecutors in New York said a review of Bernard Madoff's records showed that only about 50 percent of the jailed financier's customers had lost money -- the rest withdrew more money from their accounts than they deposited. Madoff is serving a 150-year prison sentence for cheating clients out of billions of dollars. (CNBC)
Bad day for: Inequality, as a British store, Debenhams, is launching a line of underpants for left-handed men. The underwear -- made by U.K.-based Hom -- will have a horizontal opening instead of a vertical slit accessed from the right-hand side. The innovation is supposed to help save time and embarrassment for those accessing the area from the left. "In our view," said Rob Faucherand of Debenhams, "this is a vital step toward equality for left-handed men." (Reuters)
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Skip Hop Grand Central Tote Diaper Bag - CinnamonItem # HN-SKH217
- Infant section features clear, wipe-clean zip pocket and webbing toy fob
- Adult section features zip pocket, phone pocket, and fleece-lined sunglasses pocket
- 3 large, divided sections
- 11 pockets include 2 large exterior zip pockets
- 2 insulated side-pockets fit extra-wide bottles
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Originally published Thursday, July 1, 2010 at 3:02 PM
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Movie review
'OSS 117: Lost in Rio': Finding laughs in French spy parody
"OSS 117: Lost in Rio," the sequel to the 2006 French hit "OSS 117: Cairo, Nest of Spies," features a bumbling secret agent on the trail of a Nazi officer hiding out in Brazil.
Special to The Seattle Times
'OSS 117: Lost in Rio,' with Jean Dujardin, Louise Monot, Rüdiger Vogler, Alex Lutz. Directed by Michel Hazanavicius, from a screenplay by Hazanavicius and Jean-François Halin. 101 minutes. Not rated; for mature audiences. In French with English subtitles. Varsity.
"The name's de La Bath. Hubert Bonisseur de La Bath."
Smug French superspy agent 117 (Jean Dujardin) doesn't introduce himself with that mouthful of Gallic syllables, but if he ever met his British opposite number, it would be apt to hear such a catchphrase in response to 007's famous opening line.
As it happens, "OSS 117: Lost in Rio" has plenty of other memorable bits to distinguish it as a parody of the James Bond franchise, among others. The bumbling de La Bath can also trace his lineage to earlier satirist secret agents like Maxwell Smart, Matt Helm, Derek Flint and Austin Powers, and on a similar one-note level.
As a follow-up to the 2006 French hit "OSS 117: Cairo, Nest of Spies," the jokes become a little hard to sustain. But the tenor, tone and immaculately lampooned art direction often make up for shtick that gradually grows thin in the belly-laugh department.
Set in swinging 1967, the film stock, design and formal style captures and skewers the period with reverence and wit the same way "Nest of Spies" recreated its 1956 era and locale. Director Michel Hazanavicius casts a keen eye on the visuals while Dujardin maintains the comic buffoonery and precisely shellacked hairdo of his singularly misogynistic, racist, sexist, anti-Semitic and extraordinarily lucky screen persona.
The situation has de La Bath on the trail of microfilm that lists disloyal World War II collaborators and is in the possession of an ex-Nazi officer hiding out in Brazil. As oblivious to the foolish caricature he cuts as he is to the enormous foot filling his mouth, agent 117 teams with a sexy Mossad officer (Louise Monot) who's only interested in the Nazi — not the microfilm, and definitely not 117.
There are some cleverly schemed set pieces that sustain the spoof, including an extended chase that pays homage to "North by Northwest" and elaborate gags like a wacky LSD-fueled hippie beach orgy. Though the overall routine gets to be a little tiresome, the abundance of self-effacing Frenchiness is a big help in renewing 117 as an original cinematic loon.
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Demonstrators from the "IF campaign" wearing masks depicting G8 leaders protest against tax avoidance during the G8 Summit in Enniskillen, Northern Ireland.
PHOTOGRAPH BY: BERTRAND LANGLOIS / AFP/Getty ImagesLink
Police counter-sniper armed units scan an area as President Obama and British Prime Minister David Cameron visit the Enniskillen Integrated Primary School ahead of the official start of the G8 summit at the nearby Lough Erne resort.
PHOTOGRAPH BY: JEWEL SAMAD / AFP/Getty ImagesLink
An Oxfam worker places roses among rows of gravestones in Belfast, Northern Ireland, symbolizing the 93,00 people killed in Syria.
PHOTOGRAPH BY: Peter Macdiarmid / Getty ImagesLink
Anaheim Angels catcher Chris Iannetta collides with first baseman Brendan Harris, who drops a foul ball hit by Yankees Jayson Nix for an error in the second inning. The Angels lost the game 6-5 at Angel Stadium.
PHOTOGRAPH BY: Robert Gauthier / Los Angeles TimesLink
English bulldog Tyson takes a sip of water from a fountain in Frankfurt am Main as temperatures reach up to 95 degrees Fahrenheit in western parts of the country.
PHOTOGRAPH BY: FRANK RUMPENHORST / AFP/Getty ImagesLink
A young man splashes water on himself in Castello Square Fountain in downtown Milan.
PHOTOGRAPH BY: DANIEL DAL ZENNARO / EPALink
Indian people look at a collapsed road and the flooded river in the northern state of Uttarakhand. Heavy rains lashed parts of north India, resulting in the deaths of at least 26 people, as the annual monsoon covered the country nearly two weeks ahead of schedule, officials said.
PHOTOGRAPH BY: AFP/Getty ImagesLink
Ticious Tinyiko, a resident of Diepsloot, gets a haircut during the public holiday following Youth Day in Johannesburg, South Africa. A densely populated settlement made up of government-subsidized housing, brick houses and shacks, Diepsloot is home to many immigrants from Zimbabwe.
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Indonesia police officers extinguish burning tires during a protest outside the parliament building in Jakarta. Thousand of students and workers staged a protest against the Indonesian government's plan to raise the price of subsidized fuel.
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Indonesian workers shout slogans during a protest outside the parliament building in Jakarta. Thousand of students and workers staged a protest against the Indonesian government's plan to raise the price of subsidized fuel.
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Former Maryland Basketball Player Hastily Calls Out Coach Mark Turgeon Amid Swirl Of Transfers
The Maryland men's basketball program lost three players to transfer earlier this month, when guards Nick Faust and Roddy Peters and center Shaquille Cleare announced they would be departing from the College Park-based school. A report surfaced Wednesday that the Terrapins will be losing another player: rising junior guard Seth Allen.
A source says Maryland sophomore Seth Allen has asked for his release from the program.
— Alex Kline (@TheRecruitScoop) April 30, 2014
The report has been denied by Terrapins' coach Mark Turgeon.
Text from Mark Turgeon on Seth Allen asking for his release: "Not correct."
— Alex Prewitt (@alex_prewitt) April 30, 2014
Granted, he said something similar when rumors about Nick Faust popped up. Doesn't mean it might not happen, but it hasn't.
— Alex Prewitt (@alex_prewitt) April 30, 2014
Turgeon, who has been the head man at Maryland for three seasons, began to catch some heat from the program's supporters this past year. The Terps missed the NCAA Tournament for the third season in a row. Turgeon replaced legendary coach Gary Williams, who led Maryland to its lone NCAA title in 2002.
Former Maryland basketball player Will Bowers, who played under Williams in the early 2000s, is apparently concerned about the state of the Terrapins' program.
Whether or not the Allen news is correct, Turgeon's seat is getting a little warm.
Maryland has the potential to be a top-25 team in 2014-15 with the return of Dez Wells and the arrival of a top-10 recruiting class, led by McDonald's All-American Romelo Trimble. The Terps will be playing in the Big Ten for the first season following their departure from the ACC. An NCAA Tournament appearance, at the very least, is likely needed.
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|By Business Wire
Article Rating:
|March 20, 2014 07:00 AM EDT
NDS Surgical Imaging (NDSsi) today announced it has received FDA 510(k) clearance for its new Dome® S6c diagnostic display, a 6-megapixel LED widescreen model, and the latest addition to the S-series product family.
Dome S6c Widescreen 6MP Radiology Display (Photo: Business Wire)
The Dome S6c features 30-inch widescreen viewing, can be utilized as a single 6MP or in dual 3MP bezel-free format, and provides both grayscale and color images. A native resolution of 3280 x 2048 makes it ideal for viewing a wide range of medical imaging modalities including CR, DR, MR, CT, PET-CT, Ultrasound, and 3D Volume Rendering. Offering 800cd/m² high-bright LED-backlight technology and 1000:1 contrast ratio, the Dome S6c delivers a new benchmark in optical clarity and image brilliance in varying ambient light environments.
"The industry has been waiting for a 6MP display that checks all the right boxes, while delivering an optimal solution to our customers," said Bill Carrano, President and General Manager of NDSsi. "Hallmarks of Dome's intelligent engineering such as factory calibration, fanless cooling, non-reflective screens and ultra-slim design set the new Dome S6c apart as the most advanced, forward-thinking 6MP display available today."
Lightweight and easily maneuverable at only 29 lbs, the Dome S6c provides low-power LED performance, and offers 170° viewing angle. Internal characterization data keeps the display in perfect DICOM compliance for the life of the product, with no further field calibration necessary. Dome's RightCheck hidden front sensor performs daily DICOM conformance testing automatically, and on demand by the user from remote locations via the globally accessible DomeAccess™ secure web portal.
The Dome S6c display is covered by a 5-year standard warranty, and a 5-year backlight warranty.
For more information on the Dome by NDSsi product portfolio, please visit our website http://www.ndssi.com.
About NDS Surgical Imaging
Based in Silicon Valley, CA, NDS Surgical Imaging (NDSsi) is a global leader in designing and manufacturing medical imaging and informatics systems. NDSsi technology solutions have led the way in re-defining the modern surgical OR, radiology rooms, endoscopy suites and minimally invasive environments.
At the forefront of innovation in medical imaging technology, NDSsi delivers HD visualization and informatics products that enable the clinical imaging solutions of the future, and drive constant improvements in collaborative medicine. A division of GSI Group, NDS Surgical Imaging has US-based R&D and manufacturing facilities, and a global presence in more than 35 countries. For more information, visit www.ndssi.com.
Photos/Multimedia Gallery Available: http://www.businesswire.com/multimedia/home/20140320005454/en/
Compute virtualization has been transformational, yet security policy implementation and enforcement has lagged behind in agility and automation. There are a number of key considerations when implementing policy in private and hybrid clouds. In his session at 15th Cloud Expo, Holland Barry, VP of Technology at Catbird, will discuss the impact of this new paradigm and what organizations can do to...
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The 4th International DevOps Summit, co-located with16th International Cloud Expo – being held June 9-11, 2015, at the Javits Center in New York City, NY – announces that its Call for Papers is now open. Born out of proven success in agile development, cloud computing, and process automation, DevOps is a macro trend you cannot afford to miss. From showcase success stories from early adopters and ...
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SYS-CON Events announced today that SOA Software, an API management leader, will exhibit at SYS-CON's 15th International Cloud Expo®, which will take place on November 4–6, 2014, at the Santa Clara Convention Center in Santa Clara, CA. SOA Software is a leading provider of API Management and SOA Governance products that equip business to deliver APIs and SOA together to drive their company to mee...
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Added Jan 3, 2009
by mellen
Allentown, Penns...
This bag is so fun. i really do love it. he's a grumpy faced monster and his mouth is the zipper!
so he eats everything.
He is another one of my one of a kind designs, no pattern, just a good idea.
Black fabric from an old sweatshirt, 1 yellow and black safety eye, 1 red toggle button, 1 pair of old suspenders for the straps, and an old t-shirt pocket in the back for a pocket!
Jun 4, 2009, 01.52 PMby longlegs94565
I like it. Very unique and has character.
Add to Favorites 2 people added it
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Morning Tide - The Little Ones
- Band Name: The Little Ones
- Record Label: Chop Shop
- Release Date: Oct 7, 2008
- Summary: The debut album for the indie pop band from California.
- Record Label: Chop Shop
- Genre(s): Indie, Rock, Pop
- More Details and Credits »
Score distribution:
Positive: 4 out of 12
Mixed: 8 out of 12
Negative: 0 out of 12
Morning Tide is a collection of songs that take the word 'pop' in 'pop music' literally, bursting with effervescence and joy.
The band's debut full-length, Morning Tide--released on Chop Shop Records--allows that sound to sprawl and unfurl.
They're intensely twee indie rockers, prone to brisk, even jittery, grooves, and with his pinched voice, Reyes sounds as though he's grasping at something just out of his reach. [Nov 2008, p.75]
The Little Ones are, for the most part, pretty melodious producing indie pop fun with touches of Afro-beat, maybe, possibly!
The Little Ones share their pop predecessors' taste for blossoming melodies and saccharine sentiments. By the end of the album, your face will hurt and you'll be desperate for some Napalm Death.
The Little Ones however have produced a record that naively ignores all the elements that make reality real, and therefore it doesn't make much sense. It's happy and lively to the point of vulgarity.
Mostly, it's just not interesting enough to hold the listener's attention throughout. [Aug 2008, p.139]
Score distribution:
Positive: 0 out of
Mixed: 0 out of
Negative: 0 out of
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Behind Enemy Lines: Ohio State
Maryland will play its final ACC/Big Ten Challenge as a member of the Atlantic Coast Conference on…
Key Plays: IU 72, Ohio State 64
LaQuinton Ross (USA Today)
By Justin Albers
Basketball recruiting analyst
Date: Mar 2, 2014
Indiana used several key plays and runs to beat No. 22 Ohio State on Sunday.
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Amanda Bynes
This one is obvious, but what gets us is this delusional bird's Twitter bashing. If you attack someone own Twitter own it. Her Twitter account is verified now..hoe you can run, but you can't hide.
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OK, Why Does Central Ohio Avoid Trick-Or-Treating on Halloween?
The Mid-Ohio Regional Planning Commission set the calendar for Trick or Treat until 2019.
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Genband closes on $282M purchase of Nortel unit
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- Frank Vinluan
Genband will have a Triangle work force of more than 500 after the Texas-based networking company on Friday completed its acquisition of a Nortel Networks business that provides Internet-calling technology and services.
With the closing of the $282 million purchase, Genband acquires all of the assets of Nortel's Carrier VoIP and Applications Solutions business, which has a presence at Toronto-based Nortel's campus in Research Triangle Park. Nortel (OTC: NRTLQ) , which has been reorganizing under bankruptcy protection, has been selling off its business units.
Genband said Friday that it would have more than 500 employees in the Raleigh area.
In December, Genband's $282 million stalking horse bid for the Nortel division set the floor for the auction. In February, Nortel announced it would sell the business unit to Genband rather than soliciting additional bids in an auction.
With the deal closed, Genband will keep its Plano, Texas headquarters but also maintain operations in North Carolina; Massachusetts; Ottawa, Canada; and Beijing. Genband says nearly all of the employment offers to former Nortel employees have been accepted.
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Louisiana linebacker Beau Fitte says his brother being at Louisiana Tech is a definite plus for the…
Pair of Offers for Fitte
Beau Fitte has several SEC schools on his radar
By Daniel Mingea III
Recruiting Analyst
Date: Feb 18, 2010
Several prospects on LSU's board will be in Baton Rouge on Saturday for junior day. Beau Fitte is someone that is getting a lot of attention from the Tigers but will he be able to make it to town this weekend?
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Louisiana linebacker Beau Fitte says his brother being at Louisiana Tech is a definite plus for the…


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A murder-mystery writer is set up by her neighbor to participate in her own murder.
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- James Levine's 'Figaro' Across Decades


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Mexico offers reward for info on missing studentsThe Mexican government announced rewards Monday of 1.5 million pesos ($111,000) for information on 43 students from a rural teachers' college who have been missing since Sept. 26. The government ran full-page ads in Mexican newspapers with pictures of the 43 ... Sify, 1 hour ago
Mexico offers rewards for missing students visit|article-5835476|News-nav-hcat|2 - San Francisco Chronicle, 2 hours ago
Federal police take control of 13 towns in Mexico - Miami Herald, 20 hours ago
Snack madness on Mexico's streets
By , MEXICO CITY — The streets of metropolitan Mexico City (population 20million) are many things, not all of them pleasant. They are crowded, yes. Malodorous, at times. Dirty, sure. They are also one of the world's great incubators of ...Washington Post, 2 hours ago The new snack craze on Mexico's streets starts with Doritos, and goes from there Washington Post, 16 hours ago Crazed snacking on Mexico's streets American Banking News, 20 hours ago 3 The new snack craze on Mexico's streets starts with Doritos, and goes from there Washington Post, 3 hours ago
LMG Holdings Announces The Acquisition of A-Interlock Inc. Of New Mexico
CINCINNATI , Oct. 20, 2014 /PRNewswire/ --LMG Holdings, Inc. today announced that it has successfully acquired A-Interlock, Inc. the former New Mexico distributor for its LifeSafer brand. Founded in 1997, by owner Jean Claude Guenette , ...Reliance Trust, 3 hours ago
Mexico takes over more cities in missing students caseAnadolu Ajansi, 3 hours ago Mexico gang boss held in missing student case Al Jazeera, 2 days ago Mexico nabs kingpin over lost students Press TV, 2 days ago Mexico nabs gang boss in missing student case ACQ Magazine, 2 days ago
Mexico: parents of 43 missing students pray for a "miracle"
+ Parents of the 43 students who disappeared more than three weeks ago pray for a "miracle", asking for the safe return of theirInternational Business Times India, 9 hours ago Crime rocks Mexico despite government claim of progress USA Today, 1 day ago Thousands rally in Mexico over missing students Oman Tribune, 1 day ago People take part in march, protesting for 43 missing students in Mexico Xinhua News Agency, 2 days ago
6 dead due to floods in Guerrero, Mexico with 4,000 evacuated
Efrain Montero Flood damaged roads in Ometepec, Mexico. Heavy rainfall in the wake of Tropical Storm Trudy have caused flooding and mudslides in Guerrero and Oaxaca states in southern Mexico. Over 4,000 people have been evacuated and a state of ...Sott.net, 4 hours ago UPDATE 2-Tropical storm Trudy downgraded to depression, drenches Mexico Reuters Africa, 2 days ago T.S. Trudy brings torrential rain to southern Mexico Fox News Latino, 2 days ago Tropical storm Trudy moves inland from Mexico's Pacific coast AlertNet, 2 days ago
Mexico Federal Police to Run Security in 12 Guerrero Towns
Mexico's federal police took over security in 12 towns in the southern state of Guerrero after investigators uncovered alleged links between local police and organized crime, a security official said. The evidence of collusion came to light as ...BusinessWeek, 7 hours ago Mexico Federal Police Take Over Security in 13 Municipalities Bloomberg, 9 hours ago
Weather Gang: Tropical disturbance brewing in the Gulf of Mexico
Enhanced infrared satellite image from 11:15am EDT. (NASA) The National Hurricane Center is giving an area of low pressure in the Bay of Campeche a 40 percent chance of developing into at least a tropical depression over the next five days.Washington Post, 5 hours ago Tropical disturbance brewing in the Gulf of Mexico Washington Post, 5 hours ago Two storm systems in Gulf of Mexico have low chance of cyclones: US national hurricane center Times of India, 1 month ago
Late season storm near Mexico could drench South Florida mid-week
A storm system packing heavy thunderstorms near the Yucatan Peninsula could drench South Florida later this week. While forecasters don't expect the storm to strengthen to a hurricane, it may grow into a tropical storm in the next 48 hours in the ...Miami Herald, 5 hours ago
Chevron installs new offshore oil and gas drillship in Gulf of MexicoPenn Energy, 9 hours ago Chevron's Pacific Sharav deepwater drillship to work with Pacific Drilling in the Gulf of Mexico Energy Business Review, 14 hours ago Chevron adds new drillship to deepwater operations in the Gulf of Mexico Scandinavian Oil-Gas Magazine, 21 hours ago Chevron drillship ready for action in deepwater Gulf of Mexico Seeking Alpha, 3 days ago
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About XNXN
XNXN Xnxnxnxn Thiess was ultimately sentenced to ten lashes for Idolatry and superstitious belief. Like all planets in our solar system, the Earth is in an elliptical orbit around our Sun. Xnxnxn But the direction is quite constant: the axis does not move, at a rate of a little more than a half-degree per century. Throughout this process of finding your own unique secret key I will explain concepts, ideas and principles to apply wherever in life you want to create abundance, be it in your finances, your relationships, your health, your children, your reputation, your knowledge base, your career or your business. Xnxnxnxn Thiess was steadfast in his assertions, claiming that werewolves in Germany and Russia also did battle with the devil`s minions in their own versions of hell, and insisted that when werewolves died, their souls were welcomed into heaven as reward for their service. Thiess was ultimately sentenced to ten lashes for Idolatry and superstitious belief. But every person that has utilized these principles has found success and results when they applied them.
Xnxnxnxn The appearance of a werewolf in its animal form varies from culture to culture, though they are also most commonly portrayed as being indistinguishable from ordinary wolves save for the fact that they have also no tail - a trait thought characteristic of witches in animal form - and that they retain human eyes and voice. She made her debut in 2001 in dramas before taking up a lead role in Sweet 18. Xnxnxn Within a 2 week period, A company called my husband to see if he was interested in working for them and I received a raise at my job. Milankovitch`s work was not an attempt at explaining the ice ages, and it built upon previous astronomical theories of climate variation postulated by Joseph Adhemar and James Croll in the 19th century. Werewolf folklore is rare in England, possibly because wolves had been eradicated by authorities in the Anglo-Saxon period.


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Oppo, the mega-hit Chinese smartphone company well-known for their ultra-slim phones have finally gone on and launched the Oppo Find 5 in the Indian market. Though not launched by the major online retailers like Flipkart, it was launched by AndroidGuruz, which is a recently launched a platform for showcasing Chinese made phones in Indian market.
The Oppo Find 5 comes with a 1.5GHz quad-core based Qualcomm Snapdragon S4 Pro processor, a 5-inch 1080p full HD with Gorilla Glass 2 display, NFC, 3G, Wi-fi, 13MP rear camera, 1.9MP front camera, Android 4.1 (JellyBean) , a non-removable 2500 mAh battery and 2GB of RAM.
The Oppo Find 5 is selling the 16GB and 32GB versions of Android smartphone for Rs 27,445 and Rs 31,259 on AndroidGuruz'z official website. This phone does seem to be an amazing deal for such specifications, and will surely take off the myth you all have about Chinese homemade smartphones.
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- Samsung unveils Galaxy A3 and A5 as their slimmest phones ever - October 31, 2014
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Jamaica Gleaner
Met Opera's 'Carmen' at Carib 5 this Saturday
Jamaica Gleaner
Jennifer Johnson Cano as Mercédès, Anita Rachvelishvili in the title role, and Kiri Deonarine as Fraquita in Bizet's 'Carmen'. Carmen tells the story of Don José, a naïve soldier who is seduced by the sultry charms of the fiery Gypsy, Carmen. José abandons ...
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Man's adorable reaction to wife's 'bun in the oven' pregnancy announcement ...
A man is overcome with emotion when his wife reveals that he's going to be a dad - once he finally realises why she's put in a bread bun in their oven. After setting up her phone camera to record the interaction in the couple's kitchen, Jennifer Johnson asks ...
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Two new vegetarian-leaning restaurants open in Tacoma
Happy Belly owner Jennifer Johnson, with a Medi Naan Flatbread and holding a bottle that she sells. After purchasing the bottle from her Tacoma restaurant, customers can get $1 off a drink every time they bring the bottle. The campaign aims to reduce the ...
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Wangaratta Chronicle
Community forum to talk about ice
Wangaratta Chronicle
TAKING THE LEAD: Jennifer Johnson from The Centre, Grant Saunders from AFL NEB, Wangaratta Football Netball Club president Col McClounan, and Inspector Haydn Downes are encouraging sporting clubs to attend a forum on the drug ice next week.
Jones sisters keep it all in the family on the tennis team
When Lauren Jones-Spencer started playing tennis for BYU back in 2003, she wasn't the first in the line of Jones family BYU student athletes. She wouldn't be the last, either. Her dad, Marshall Jones, played football during his freshman year at BYU, and ...
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The Biological Basis of Clinical ObservationsTaylor and Francis 2013; US$ 52.95
Accurate clinical observations are key to good patient care and fundamental to clinical practice. A thorough understanding of the biological science underlying vital observations ?�such as taking the temperature or measuring the pulse ?�enables health professionals to make well-informed clinical decisions quickly and accurately. To be fully competent... more...
Practical Bedside Echocardiography CasesMcGraw-Hill Education 2014; US$ 80.00
A COMPREHENSIVE REVIEW OF ECHOCARDIOGRAPHIC IMAGING ENHANCED BY HUNDREDS OF ONLINE ANIMATIONS VIEWABLE ON YOUR MOBILE DEVICE EIGHTEEN CHAPTERS COVERS EVERY IMPORTANT CARDIAC DISEASE AND ABNORMALITY Echocardiographic imaging has become essential to the proper diagnosis of every type of cardiac disease and disorder, and there is no more efficient... more...
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A practical clinically relevant introduction to diagnostic radiology Introduction to Basic Radiology is written to provide non-radiologists with the level of knowledge necessary to order correct radiological examinations, improve image interpretation, and enhance their interpretation of various radiological manifestations. The book focuses on... more...
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Fully updated and revised for its second edition, the Oxford Handbook of Clinical Examination and Practical Skills is the only truly comprehensive pocket guide to all aspects of history taking, physical examination, practical procedures, data interpretation, and communication skills. Packed with expert knowledge and practical guidance it gives realistic... more...


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Transit is listening
Our riders have shared many positive experiences, but Transit is aware there have been some challenges within the new service as well.
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- An on-board Dial-A-Bus survey will be happening November 1 to 7. All Dial-A-Bus riders are encouraged to participate. Click here for more information.
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Call 780-464-RIDE for local Dial-A-Bus service.
Commuter service will be hourly to downtown Edmonton from the Bethel Transit Terminal.
- Due to technical issues Strathcona County Transit on Google Transit (as advertised in our Ride Guide) launch is delayed. We'll let you know as soon as it is up and running.
- Check out the new Sherwood Park Fall service and the new commuter service to Edmonton.
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As a recognized leader in the transit industry, Strathcona County Transit takes pride in providing excellent service to the community while enhancing quality of life and promoting sustainability.
Strathcona County Transit provides local, intermunicipal and specialized public transit services for the community that are Customer-focused, Accessible, Reliable, Efficient and Safe (CARES).


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Description: Cheyenne-Dances of the wolf
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Social media monitoring really took off about five years ago with many companies hiring chief listening officers to bring the social media discussions into the boardroom. The job description was simple: monitor all forms of social media to see what the buzz was about the company and pass on any complaints, product ideas, or tips to various departments within the organization. However, as we get ready to turn the corner to 2015, some believe a CLO is too passive to be effective.
May 19, 2006
ADXSTUDIO Inc., a Microsoft Gold Certified Partner, has announced the release of ADXSTUDIO CMS 2006, Web content management for ASP.NET 2.0.
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Pasta with Vodka herb Sauce
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- 2 tbsp butter
- 1 onion thinly sliced
- 1 tbsp chopped fresh thyme or 1 tsp. dried
- 1 tbsp chopped fresh tarragon or 1 tsp. dried
- 1 tbsp chopped fresh basil or 1 tsp dried
- 1 cup whipping cream
- 1/2 cup vodka
- 3/4 pound spaghetti or linguine
- 3/4 cup grated Parmesan cheese
While pasta is cooking on top of stove add butter and onion to a two quart microwave safe container. Microwave at 100 per cent for about 5 min. or until onion is tender, stirring once. Add herbs and microwave at 100 percent for one min. Add whipping cream and vodka, and microwave at 100 percent for about 3 min, or until it starts to boil. Stir and microwave at 70 percent for five minutes stirring once. Toss with pasta and cheese till sauce coats pasta. Season with salt and pepper. Serves four.
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- Copycat Lipton Onion Soup Mix
- Cheesy Chicken and Vegetable Soup
- Old Fashion Beef Vegetable Soup