Biologically synthesized silver nanoparticles as potent antibacterial effective against multidrug-resistant Pseudomonas aeruginosa.

Pseudomonas aeruginosa is one of the most worrisome infectious bacteria due to its intrinsic and acquired resistance against several antibiotics and the recalcitrance of its infections; hence, the development of novel antimicrobials effective against multidrug-resistant P. aeruginosa is mandatory. In this work, silver nanoparticles obtained by green synthesis using a leaf extract and fungi were tested against a battery of clinical strains from cystic fibrosis, pneumonia and burnt patients, some of them with multidrug resistance. Both nanoparticles showed a potent antibacterial effect, causing severe damage to the cell wall, membrane and DNA, and inducing the production of reactive oxygen species. Moreover, the nanoparticles derived from fungi showed synergistic antibacterial effects with the antibiotics meropenem and levofloxacin for some clinical strains and both kinds of nanoparticles were nontoxic for larvae of the moth Galleria mellonella, encouraging further research for their implementation in the treatment of P. aeruginosa infections.

Training caregivers: disabilities and dental hygiene.

OBJECTIVES: The purpose of the study was to measure the effectiveness of oral health education and training among caregivers. METHODS: Controlled study design. Participants were randomized from the sample n = 30. n = 14 participants in the experimental group and n = 10 in the control group. The experimental group received a lecture and hands-on training in oral hygiene procedures. The control group received a facilitated group discussion. Both groups received a pre-post test. RESULTS: Considering the two groups independently, using a paired t-test, the experimental group, n = 14 had a score difference of 0.0607 (P-value = 0.01) and the control group n = 10, had a score difference of 0.035 (P-value = 0.14). CONCLUSION: This study found that knowledge was improved among caregivers following the implementation of formal oral hygiene training. Although the control group also showed some improvements with the facilitated discussion, the results are not significant to say that both the formal training and the facilitated discussion are equally important in training caregivers effectively.

Therapy of intractable pruritus with MARS.

INTRODUCTION: Pruritus is the most disabling symptom in patients with cholestatic liver diseases. Many drug therapies have been used for the treatment of these diseases, with different outcomes. The molecular adsorbent recirculating system (MARS) has been used in the treatment of intractable pruritus in cholestatic syndromes. We report our experience with MARS in 3 patients with intractable pruritus on the waiting list: 2 liver transplant recipients and a patient with primary biliary cirrhosis. PATIENTS AND RESULTS: Two middle-aged women and 1 middle-aged man, who were recipients of an orthotopic liver transplant for primary biliary cirrhosis, underwent three (n = 2) and two (n = 1) 6-hour sessions of MARS due to medically uncontrollable pruritus. All noted marked improvement of pruritus, with decreased bilirubin levels, but this improvement lasted only a few days in all cases. We observed no changes in transaminase or albumin levels, or prothrombin time. Complications included an episode of angina due to anemia caused by jugular catheter bleeding, and thrombocytopenia in all patients. CONCLUSIONS: MARS is an effective treatment for intractable pruritus in cholestatic liver diseases, although its beneficial effect is short. This extracorporeal liver device is safe, because most related adverse events are mild.

Results of liver transplantation in patients with previous portosystemic shunts.

INTRODUCTION: Although liver transplantation is performed successfully in some patients with previous portosystemic shunts (PSS), these surgical procedures have been considered a relative contraindication for orthotopic liver transplantation (OLT). We aimed to determine whether a previous PSS worsens the prognosis of patients who undergo OLT. PATIENTS AND METHODS: Between March 1986 and October 2003, 520 liver transplants were performed in 467 patients in our center. Thirteen patients had undergone a PSS before OLT. The types of PSS were: portocaval (n = 8), splenorenal (n = 3), mesocaval (n = 1), and portoatrial (n = 1). We compared patients with previous PSS (cases) and the three patients with an OLT immediately before each case (controls). We analyzed the following variables: age, Child-Pugh stage, pretransplant liver disease, surgical times, transfusion requirements, infections, intensive care unit (ICU) stay, postoperative evolution, and survival. RESULTS: Age, Child-Pugh stage, and pretransplant liver disease were similar in both groups. There were no statistical differences in age, surgical times, ischemia time, anhepatic phase, transfusion requirements, ICU stay, infections, or hospital stay. The postoperative course was similar in both groups. Long-term survival was 84.62% in cases versus 78.5% in controls. CONCLUSIONS: Previous PSS should not be considered a contraindication for liver transplantation, even though this group of patients involves a special surgical challenge.

Hepatitis C recurrence after liver transplantation: Viral and histologic response to full-dose PEG-interferon and ribavirin.

Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-alpha-2a (n = 4) or alpha-2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients > or =12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 +/- 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease > or =1-log10 at week 4 and/or 2-log10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.

[Granulocytopenia and fever in children with leukemia as indicator of quality of medical care]. / Granulocitopenia y fiebre en niños con leucemia como indicador de calidad de la atención médica.

OBJECTIVES: 1. To identify the quality degree of medical care in patients with acute leukaemia who had fever and granulocytopenia during the hospitalization period. 2. To establish the relationship between the medical care process and the results in this concern. DESIGN: Retrospective survey. STUDY AREA: Children's Hospital of the Mexican Institute of Social Security. STUDY SUBJECTS: Twenty three patients with acute leukaemia were studied. Also, hospitalization episode of these patients, in which they suffered fever and granulocytopenia, was randomly selected. MAIN MEASUREMENTS: Compliance of diagnostic and therapeutic process was measured during hospitalization, according to the protocolized recommendations made by consensus of the hospital expert group. In order to identify the quality degree of medical care, it was taken into account the protocol compliance besides the results observed in the patients. Results were assessed based on patients' survival to fever and granulocytopenia episode, as well as on fever's duration. The correlation was calculated by using Spearman's coefficient. RESULTS: The medical care quality of the hospital was "adequate" (85% on average). Compliance degree, including the total process was 71%; with diagnostic process 63%, and with therapeutic process 76%. The results observed in the patients were considered as "adequate" (89%). By evaluating individual cases, the medical care quality was considered excellent or adequate in 17 patients (74%) regular in five (22%) and poor in one (4%). Diagnostic process was adequate in 6 patients (26%) regular in 12 (53%) poor in three (13%) and very bad in two (8%). On the other hand, therapeutic process was excellent in 14 patients (60%) regular in one (4%) poor in six (26%) and very bad in two (9%). Results observed in 13 cases were excellent (57%) adequate in eight (35%) regular in one (4%) and very bad in one (4%). The relationship between process and result was 0.41 (P < 0.05) between diagnostic process and result 0.14 and, between therapeutic process and result 0.34. CONCLUSIONS: The medical care quality rendered to patients with leukaemia, who suffered a granulocytopenia episode and fever, was considered as adequate. Therapeutic recommendations were followed accurately, meanwhile, diagnostic process had a lower adherence. A positive relationship between process and result was observed.