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FIG 14:

Tape-strip cytology of a cutaneous pyoderma in a dog stained with a modified Wright-Giemsa stain (1000× immersion oil). There are several degenerate neutrophils with swollen, pale and fragmenting nuclei, with some nuclear streaming from ruptured cells. There are numerous blue-staining coccoid bacteria. These are most likely to be staphylococci—they are the most common cause of skin infections, and they typically form pairs or small groups on cytology. Extracellular bacteria may simply be contaminants, but the presence of intracellular phagocytised bacteria confirms the diagnosis of infection in this case

Macrophages containing phagocytosed microorganisms, degenerate cells and other debris, are often seen in chronic and/or deep pyoderma (Fig 15 ). Multinucleate giant cells are much larger than other cell types seen on cytology, and have multiple nuclei, ranging from 2 or 3 to 10 or more in very large cells. Large numbers of macrophages and/or giant cells (ie, granulomatous or pyogranulomatous inflammation) could be consistent with mycobacterial or fungal infections. Low to moderate numbers of lymphocytes, plasma cells and eosinophils are seen in most inflammatory reactions, and are of little diagnostic significance.

FIG 15:

Indirect impression smear of material expressed from a furuncle stained with a modified Wright-Giemsa stain (1000× immersion oil). The cytology is dominated by large, activated macrophages with a pale, foamy cytoplasm. Several cells have ingested debris, including dead or dying neutrophils. Other cells include degenerate neutrophils, lymphocytes, plasma cells and erythrocytes. By contrast with Fig 14, bacteria are sparse and hard to find

All bacteria that take up modified Wright-Giemsa stains are basophilic, that is, they stain blue-purple. This does not reflect whether they are Gram-positive or Gram-negative. Their identity can, therefore, only be inferred from morphology and knowledge of the likely organisms on most cytology preparations. Full identification will require further tests and culture.

Bacterial overgrowth syndrome is characterised by large numbers of bacteria, often of several different forms, with no or only minimal numbers of inflammatory cells (Fig Christian Louboutin Metallic PointedToe Pumps outlet latest discount cheapest price free shipping ebay Manchester for sale clearance fashionable silwRLMw
). Bacteria are also readily seen with other surface and superficial infections (Fig sale under René Caovilla Rene Caovilla Leather Embellished Sandals clearance deals FYaPp91o
). They may, by contrast, be difficult to detect in deep pyodermas, particularly if there is a lot of fibrosis and scarring. The presence of intracytoplasmic bacteria is a definite indicator of infection (Fig 14 ) (Pappalardo and others 2002). Extracellular bacteria, however, particularly in low numbers, may simply be contaminants from the surface of the skin.

FIG 16:

Tape-strip cytology of canine bacterial overgrowth syndrome stained with haemacolor (1000×, immersion oil). There are large numbers of bacteria (mostly large cocci-forming pairs and groups) and one round budding yeast (bottom left). Courtesy of Dr Stefano Toma, Italy

Staphylococci are relatively large cocci that often form diploid or irregular arrangements of 2–8 organisms (Scott and others 2001, Pappalardo and others 2002, Mendelsohn and others 2006). Streptococci are smaller and often appear to form chains. Micrococci and enterococci are also small, but form irregular groups. Rod bacteria (bacilli) are easily differentiated from cocci; common species recovered from the skin include Pseudomonas , Proteus and coliforms. Mycobacteria and some related forms do not take up Wright-Giemsa stains, but pyogranulomatous inflammation and the presence of small, clear, rod-shaped vacuoles in macrophages is suggestive. Clear rod-like shapes may be also highlighted against stained background debris.

(appellant’s assertion of a right to speedy review is entitled to strong evidentiary weight in determining whether he was deprived of the right).

(in order to prevail on the question whether appellant was prejudiced by excessive post-trial delay, appellant must specifically identify how he was prejudiced due to the delay; mere speculation is not enough).

(assertions by appellant’s defense counsel in his post-trial clemency submissions to the convening authority that, because of the excessive delay in the post-trial processing, appellant was unable to produce the discharge documentation necessary to apply for college financial aid, failed to substantiate a claim of prejudice; there was no substantive evidence from persons with direct knowledge of the pertinent facts, nor was there adequate detail to give the government a fair opportunity to rebut the contention).

(despite the fact that appellant failed to show prejudice, a two-year delay in commencing review under Article 66(c), UCMJ, can diminish the public’s perception of the fairness of military justice; therefore, under the Barker -factor analysis in this case, appellant was denied his due process right to speedy review and appeal).

United States v. Gosser , 64 M.J. 93 (a two-year delay in commencing review under Article 66(c), UCMJ, that violated appellant’s right to due process was harmless beyond a reasonable doubt where there was no showing that appellant was prejudiced).

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, 63 M.J. 372 (in analyzing whether appellate delay has violated the due process rights of an accused, an appellate court first looks at whether the delay in question is facially unreasonable; if it is, then it examines and balances the four factors set forth in Barker v. Wingo : (1) the length of the delay; (2) the reasons for the delay; (3) appellant’s assertion of the right to timely review and appeal; and (4) prejudice).

(if an appellate court concludes that appellant has been denied the due process right to speedy post-trial review and appeal, it will grant relief unless it is convinced beyond a reasonable doubt that the constitutional error is harmless).

(in cases involving claims that appellant has been denied his due process right to speedy post-trial review and appeal, an appellate court may look initially to whether the denial of due process, if any, is harmless beyond a reasonable doubt; an appellate court will apply a similar analysis where, even though the denial of due process cannot be said to be harmless beyond a reasonable doubt, there is no reasonable, meaningful relief available).

(even assuming that the delay of over six years to complete appellant’s appeal of right denied him his right to speedy review and appeal, no additional relief is appropriate or warranted where appellant had served his full term of confinement and reduction of adjudged forfeitures would have no meaningful effect in light of the provisions for automatic forfeitures; in addition, reducing the period of confinement enough to have a significant impact upon collected forfeitures would also require a dramatic reduction in the period of confinement that is unwarranted under the circumstances of this case; to fashion relief that would be actual and meaningful in this case would be disproportionate to the possible harm generated from the delay).


“The second I looked at him, I knew he was gone,” Chris says. He was 27 years old.

He dragged Carl out of the bathroom, called a code blue, and began trying to give him CPR. Hospital staff rushed in and whisked Chris out of the room. While they tried to resuscitate Carl, Chris called Joyce and tried to tell her calmly to come to the hospital because Carl’s doctors wanted to talk to them. He didn’t tell her then that Carl was dead. He didn’t want her driving to the hospital knowing. When she arrived, he went to the elevator to wait for her. Chris calls it the 27 seconds of hell.

Carl Romm (left) with his mother Joyce

“I flashed back over 27 years in that time period, and relived every good moment, while at the same time knowing what the future was going to bring us,” says Chris. “All I could think about was grabbing my wife and holding on for dear life because I knew that it would irrevocably change us.”

The Centers for Disease Control and Prevention (CDC) estimates that Carl is one of 23,000 people who die annually from antibiotic-resistant infections, in addition to another 2 million who develop infections. But those are fuzzy numbers. When the CDC released the estimates, then-CDC Director Tom Frieden , “I want to emphasize, this is a bare minimum, a very conservative estimate.” Additionally, in an emailed statement, the CDC said it doesn’t have any estimate of the number of people who die from conditions that are complicated by an antibiotic-resistant infection.


The reality is that we really don’t know how many people die directly or indirectly from antibiotic-resistant infections, but it’s likely more than we think.

In the United States, much of our mortality data Jimmy Choo Lang Wedge Sandals sast for sale 3V5W4
from death certificates. They help public health and health care systems identify emerging threats, determine the scope of the problem, craft prevention and treatment programs, and monitor their progress addressing them.

But according to Martha Sharan, a media relations specialist for the CDC, US death certificates often fail to capture the role antibiotic-resistant infections play in victims’ death. Carl’s death certificate says he died from cardiac arrest. It doesn’t mention that the reason he went into cardiac arrest was because an antibiotic-resistant infection attacked his tricuspid valve.

One reason for this discrepancy is that capturing antibiotic-resistance-related deaths isn’t standardized. Instead, attendant doctors often make judgment calls on death certificates, Sharan says. They decide how to parse the cause of death, which can be difficult if the patient has multiple conditions.

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“If someone has a chronic disease and then gets an antibiotic-resistant infection, was it the chronic disease? Was it the infection? Was it both?” Sharan says.

Without reliable death certificates, CDC relies on data from Christian Louboutin Suede CutOut Pumps free shipping for nice Inexpensive sale online uPvB7d
, the National Healthcare Safety Network (NHSN) and the Emerging Infections Program Healthcare-Associated Infections Community-Interface, to track infections that patients caught in a health care setting, including many antibiotic-resistant infections.

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