Will it be a Survivor to Add Clavulanic Acid to Cephalosporins in Order to Overcome Resistance Problem?.

Background: Bacterial resistance is closely associated with the use of antimicrobial agents. Prolonged therapy with antibiotics can lead to the development of resistance in a microorganism that initially is sensitive to antibiotics, but later it can adapt gradually and develop resistance to antibiotics. Aims: We reviewed whether clavulanic acid plus cephalosporin combinations help to solve the resistance problem. Methods: We evaluated and reviewed this topic via “Antibiotic Resistance”, “Cephalosporin and β-Lactamase Inhibitor Combinations” and our suggestions. Results: Acquired resistance arises from: (1) mutations in cell genes (chromosomal mutation) leading to cross-resistance, (2) gene transfer from one microorganism to other by plasmids (conjugation or transformation), transposons (conjugation), integrons and bacteriophages (transduction). β-Lactamases hydrolyze nearly all β-lactams that have ester and amide bond, e.g., penicillins, cephalosporins, monobactams, andcarbapenems. Serine β-lactamases – cephalosporinases, e.g. AmpC enzyme – are found in Enterobacter spp. and P. aeruginosa and penicillases in S. aureus. Amoxicillin-clavulanate resistance (MIC >16 microg/ml) in Escherichia coli is reported previously. Therefore, development of new drugs or combination is necessary for the antimicrobial resistance. To manage the Cephalosporin resistance, Cephalosporin and β-Lactamase Inhibitor Combinations, such as Ceftolozane/tazobactam or Ceftazidime/avibactam have been used. Conclusion: As resistance to cephalosporins have been increasing, cephalosporin + clavulonate combination will be another choice for managing the antibiotic resistance to the cephalosporins. Our suggestion is based on the success of the clavulonate combination of amoxicillin to manage the antibiotic resistance.

Office-Based Olfaction Assessment.

A simple assessment of olfactory acuity is essential and can play a vital role in patient care and quality-of-life parameters. Any process that interferes with the physiologic environment of the nasal mucosa can be associated with restricted olfaction. Studies have examined how the human sense of smell likely integrates information from complex arrays of odorant chemicals that, individually, would seem to produce conflicting odorous sensations. “Scratch and sniff” format screening tests are readily available and have been standardized for age, gender, and ethnicity. It is important to identify a scent that can be used as in an initial olfactory test If a patient cannot identify this scent, they should take further diagnostic testing. In this review, we give some essential information on office-based olfaction assessment and attempt to cover important aspects of the evaluation, especially from a clinical perspective.

Restless Legs Syndrome in Gun Factory Workers Exposed to Solvents.

Background: Restless legs syndrome (RLS) is a sensorimotor disorder characterized by a complaint of an almost irresistible urge to move the legs. Aims: We investigated whether long-term low-level exposures to solvents affects the development of restless legs syndrome. Methods: 388 workers were questioned for RLS, psychological distress and somatic symptoms. Results: The prevalence of RLS was not different in workers exposed to solvents than in those without (n: 192; 5.2% vs. n: 196; 5.6%, p = 0.8, respectively). Exposure to solvents was not associated with an increased risk of RLS. In solvent-exposed group, there was positive correlation between daytime sleepiness, frequent awakening, kicking during sleep, sleep duration, time spent in bed, apnea and snoring scores. Alcohol consumption were related to higher kicking during sleep and difficulty falling asleep scores. The RLS percentages were 7/173 (4.0%) for daytime working subjects; and 2/16 (12.5%) for shift-workers. Conclusion: Chronic exposure to low doses of solvents doesn’t affect the development of RLS.