Endocarditis de la válvula aórtica causada por Brucella melitensis / Aortic valve endocarditis caused by Brucella melitensis

La endocarditis bacteriana secundaria a la infección por Brucella spp., en este caso B. melitensis, como complicación de la brucelosis humana tiene una incidencia baja y, aunque es la presentación clínica con la que se asocia más frecuentemente la mortalidad, no todos los casos son letales, si son tratados oportunamente. Se describe el caso clínico de una endocarditis bacteriana por B. melitensis, diagnosticada en un adulto por el aislamiento del microorganismo en el hemocultivo. Paciente del sexo masculino, de 40 años, con antecedentes de realizar partos en el ganado bovino y consumir leche no pasteurizada. Acudió al médico por presentar durante siete días de evolución de las siguientes manifestaciones clínicas: fiebre, mialgias, artralgias, tos seca y pérdida de peso (15 kg). El hemograma informa: leucopenia, trombocitopenia y anemia; mientras que en un ecocardiograma transesofágico se observó vegetación en la válvula aórtica con una disminución de la función sistólica y en el hemocultivo se aisló B. melitensis. Debido a estos antecedentes, se inició el tratamiento antibacteriano con rifampicina, doxiciclina y gentamicina. El paciente se recuperó y tuvo una evolución clínica satisfactoria. La brucelosis es una enfermedad infrecuente. Debe considerarse en toda persona con fiebre de foco desconocido que resida en zonas endémicas o esté expuesto al cuidado de animales de granja. En esta enfermedad se impone un diagnóstico y tratamiento preciso, por ser una complicación con alta letalidad.

Bacterial endocarditis, secondary to Brucella spp. infection, in this case by B. melitensis, as a complication of human brucellosis has a low incidence. Although it is the clinical presentation most frequently associated with mortality, not all cases are lethal if timely treatment is provided. We describe a clinical case of bacterial endocarditis due to B. melitensis in a 40-year-old male patient with a history of conducting cattle deliveries and consuming unpasteurized milk, diagnosed after isolating the microorganism in blood culture. He presented with the following clinical manifestations after seven days of evolution: fever, myalgias, arthralgias, dry cough and weight loss (15 kg). The hemogram revealed leukopenia, thrombocytopenia, and anemia; while a transesophageal echocardiogram showed vegetation on the aortic valve with decreased systolic function, and B. melitensis was isolated in a blood culture. Considering this medical history, antibacterial treatment was initiated with rifampicin, doxycycline and gentamicin. The patient recovered and had satisfactory clinical evolution. Brucellosis is a rare disease. It should be considered in any person with a fever of unknown origin who lives in endemic areas or is exposed to the care of farm animals. Endocarditis is a highly lethal complication of human brucellosis; therefore, it requires a precise diagnosis and treatment.

Sepsis precoz, osteoartritis y meningitis: a propósito de un caso clínico / Early sepsis, osteoarthritis and meningitis: a clinical case / Sepse precoce, osteoartrite e meningite: relato de caso

Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.

We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.

Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.

Gentamicina intratimpánica comparado con placebo para la enfermedad de Ménière / Intratympanic gentamicin compared with placebo for Ménière's disease

INTRODUCCION La enfermedad de Ménière es una anomalía del oído interno de etiología multifactorial, caracterizada por episodios de vértigo espontáneo y recurrente, hipoacusia fluctuante y tinnitus. La terapia con gentamicina intratimpánica para la enfermedad de Ménière ha sido utilizada buscando reducir la intensidad y frecuencia de las crisis, pero se ha asociado a pérdida auditiva, por lo que existe controversia respecto a su eficacia y seguridad. MÉTODOS Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos 13 revisiones sistemáticas que en conjunto incluyeron 80 estudios primarios, de los cuales tres corresponden a ensayos aleatorizados. Concluimos que la gentamicina intratimpánica podría reducir el control del vértigo y resultar en poca o nula diferencia sobre el tinnitus, pero la certeza de evidencia es baja. Además, no es posible establecer con claridad si el uso de gentamicina intratimpánica disminuye la audición o la frecuencia de los ataques de vértigo porque la certeza de la evidencia existente ha sido evaluada como muy baja.

INTRODUCTION Ménière's disease is a multifactorial disorder affecting the inner ear, characterized by episodes of spontaneous and recurrent vertigo, fluctuating hearing loss and tinnitus. Intratympanic gentamicin therapy has been used to reduce the intensity and frequency of attacks in intractable Ménière's disease, but it is associated with hearing loss. There is controversy regarding its efficacy and safety. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 13 systematic reviews that included 80 primary studies overall, of which three correspond to randomized trials. We concluded that intratympanic gentamicin may improve the control of vertigo, and result in little or no difference to tinnitus, but the certainty of the evidence is low. Furthermore, we are uncertain whether intratympanic gentamicin reduces hearing or the frequency of vertigo attacks as the certainty of the evidence has been assessed as very low.

Ecocardiografia Tridimensional na avaliação de endocardite de válvula nativa: um relato de caso e semelhança entre achados ecocardiográficos e cirúrgicos / Three-Dimensional transesophageal echocardiography in native valve endocarditis: a case report and similarities between echocardiography and surgical findings

A endocardite de valva nativa é uma doença incomum, complexa, e de alta morbimortalidade. Requer tratamento clínico prolongado, com várias complicações possíveis, e o seu tratamento cirúrgico é complexo e tecnicamente difícil. O ecocardiograma transtorácico e transesofágico são fundamentais na avaliação da doença, inclusive seus achados são parte dos critérios diagnósticos de endocardite. Adicionalmente, o ecocardiograma tridimensional (3D) contribui com detalhamento anatômico na avaliação das estruturas cardíacas acometidas pela doença. Mostramos um caso em que é ilustrado o papel da ecocardiografia no diagnóstico e avaliação de complicações da endocardite, comparando as imagens do ecocardiograma 3D pré-operatórias, com os achados durante o ato cirúrgico. (AU)

Native valve bacterial endocarditis is an uncommon, complex, and highly morbid disease that requires prolonged clinical treatment and challenging surgical interventions. Transthoracic and transesophageal echocardiography are paramount assessment tools whose findings are included in the diagnostic criteria. Three-dimensional echocardiography shows further realistic imaging details. Here we present a case demonstrating the role of echocardiography in the diagnosis of endocarditis and the identification of its complications to show how advanced imaging techniques may have a remarkable resemblance with in vivo surgical findings. (AU)

Infecção do sítio cirúrgico após cesariana em uma maternidade de Manaus, Brasil: a importância do uso racional da antibioticoterapia / Surgical site infection after cesarean section in a maternity hospital in Manaus, Brazil: the importance of rational antibiotic therapy

Objetivo: Descrever o perfil epidemiológico e microbiológico das puérperas com diagnóstico de infecção após cesárea, caracterizando as infecções de sítio cirúrgico e o tratamento. Métodos: Coorte prospectiva de parturientes submetidas a parto cesáreo em maternidade pública de Manaus, Amazonas, Brasil, com diagnóstico de infecção de sítio cirúrgico, entre 1º de julho de 2019 e 30 de abril de 2020. Foram coletados dados epidemiológicos. Para a investigação do perfil microbiológico, foi realizada a identificação da cultura a partir da secreção da infecção do sítio cirúrgico e do antibiograma das culturas. Resultados: Um total de 81 pacientes foi diagnosticado com infecção de sítio cirúrgico durante o período de estudo. A taxa de infecção de sítio cirúrgico na maternidade em estudo foi de 6,0%. As pacientes possuíam baixa escolaridade e baixa renda mensal, com ocupações que requerem menor qualificação, sendo a maioria solteira. Entre as pacientes, 70,4% eram obesas e 28,4% apresentaram sobrepeso; 45,6% delas tiveram parto cesáreo de emergência e 29,6% não usaram antibióticos profiláticos. Staphylococcus aureus foi a cultura identificada mais frequentemente e apresentou resistência ao antibiótico mais prescrito: a gentamicina. Conclusão: A taxa de infecção do sítio cirúrgico foi alta durante o período do estudo. Ressaltamos a necessidade de um protocolo eficaz de identificação bacteriana e acompanhamento da puérpera. O conhecimento das características epidemiológicas e microbiológicas pode auxiliar no planejamento dos cuidados realizados pelas instituições de saúde para minimizar os casos de infecção de sítio cirúrgico e suas consequências.(AU)

Objective: To describe the epidemiological and microbiological profiles of puerperal women diagnosed with the infection after cesarean sections, characterizing the surgical site infections and treatment. Methods: Prospective cohort of parturients underwent cesarean delivery at a public maternity hospital in Manaus, Amazonas, Brazil, diagnosed with surgical site infection between July 1, 2019, and April 30, 2020. Epidemiological data were collected. To investigate the microbiological profile, both culture identification from surgical site infection secretion and antibiogram for the cultures were performed. Results: A total of 81 patients were confirmed to have surgical site infection during this study period; The surgical site infection rate in the maternity hospital under study was 6.0%. The patients presented a low level of education and monthly income, with occupations that require lower qualification, and most of them are single. Seventy point four percent of the patients were obese, and 28.4% were overweight. Forty-five point six percent of patients had an emergency cesarean delivery, and 29.6% did not use prophylactic antibiotics. Staphylococcus aureus was the most frequent culture identified from surgical site infection secretion and presented resistance to the most prescribed antibiotic, Gentamicin. Conclusion: The rate of surgical site infection was high during the study period. We highlight the need for an effective bacterial identification protocol and monitoring of puerperal women. Knowledge of epidemiological and microbiological characteristics can assist in the planning of care performed by the health institutions to minimize cases of surgical site infection and its consequences.(AU)

Evaluating the effect of gentamicin-clindamycin lavage on post-operational pain and infection through laparoscopic colectomy surgery / Avaliação do efeito da lavagem com gentamicina-clindamicina sobre a dor e a infecção após colectomia laparoscópica

Abstract Introduction Peritoneal antibiotic or normal saline lavage is seen to be beneficial in order to reduce the pain or infection risk through laparoscopic surgeries. It can also be applied for laparoscopic colectomy surgeries. In this study, we have compared the effects of antibiotic solution lavage (gentamycin-clindamycin) with normal saline lavage in patients undergoing laparoscopic colectomy surgery. Method In this double-blind Randomized Controlled Trial (RCT), 40 patients undergoing laparoscopic colectomy surgery were divided into antibiotic and normal saline lavage groups (20 patients in each group). Post-operational pain, need for painkiller, white blood cells count, C-reactive protein level, duration of hospitalization and wound infection were compared in 30 days between the groups. Results Antibiotic lavage group had significantly less pain than the normal saline group (p < 0.05) through 3, 6, 12 and 24 h after surgery. C-reactive protein level, white blood cells count, painkiller use, and hospitalization duration were significantly lower in antibiotic group. However, there was no difference regarding wound or intra-abdominal infection between the both groups. Conclusion Using gentamicin-clindamycin peritonea lavage helps patients undergoing laparoscopic colectomy surgery in pain reduction, need for painkillers and hospitalization duration.

Resumo Introdução A lavagem peritoneal com antibiótico ou com soro fisiológico normal é benéfica para reduzir o risco de dor ou de infecção durante cirurgias laparoscópicas, além de poder ser aplicada também em colectomias laparoscópicas. Neste estudo, comparamos os efeitos da lavagem com solução antibiótica (gentamicina-clindamicina) e da lavagem com solução salina normal em pacientes submetidos à colectomia laparoscópica. Método Neste Ensaio Clínico Randomizado (ECR), controlado e duplo-cego, 40 pacientes submetidos à colectomia laparoscópica foram divididos em dois grupos (20 pacientes em cada grupo) para receberem antibiótico ou solução salina normal. Dor pós-operatória, necessidade de analgésico, contagem de leucócitos, nível de proteína C-reativa, tempo de internação e infecção da ferida foram comparados entre os grupos em 30 dias. Resultados De forma significativa, o Grupo Antibiótico apresentou menos dor que o Grupo Salina Normal (p < 0,05) em 3, 6, 12 e 24 horas após a cirurgia. O nível de proteína C-reativa, a contagem de leucócitos, o uso de analgésicos e o tempo de internação foram significativamente menores no Grupo Antibiótico. Porém, não houve diferença em relação à infecção da ferida ou intra-abdominal entre os dois grupos. Conclusão O uso da lavagem peritoneal com gentamicina-clindamicina ajuda a reduzir a dor, a necessidade de analgésicos e o tempo de internação de pacientes submetidos à colectomia laparoscópica.

Effects of an intratympanic injection of dexamethasone combined with gentamicin on the expression level of serum p0 protein antibodies in patients with meniere's disease

OBJECTIVES: To investigate the effects of an intratympanic injection of dexamethasone combined with gentamicin on the expression level of serum P0 protein antibodies in patients with Meniere's disease (MD). METHODS: A total of 136 patients with MD treated in our hospital were enrolled in this study. Among them, 68 patients were treated with an intratympanic injection of dexamethasone combined with gentamicin (observation group). Another 68 patients were treated with gentamicin alone (control group). RESULTS: After treatment, the expression levels of IgG and IgM in the two groups significantly decreased (p<0.05); the levels in the observation group were significantly lower than those in the control group (p<0.05). The incidences of vertigo, tinnitus, and gait instability in the observation group were significantly lower than those in the control group (p<0.05). Vestibular symptom index (VSI) scores in the observation group were significantly lower than those in the control group (p<0.05). We observed no significant difference between the two groups in the number of vertigo attacks 6 months after treatment (p>0.05). CONCLUSION: For patients with MD, dexamethasone combined with gentamicin can reduce the incidence of vertigo, tinnitus, and gait instability, but it has no effect on the efficacy or number of vertigo attacks 6 months after treatment. Therefore, the levels of myelin P0 protein antibodies after treatment can be used as predictors of vertigo at 6 months after treatment.

Uso de gentamicina transtimpánica: experiencia del Hospital Clínico de la Universidad de Chile / Transtympanic gentamicin: experience in Hospital Clínico Universidad de Chile

RESUMEN Introducción: La gentamicina transtimpánica se utiliza en el manejo de pacientes con vértigo crónico refractario al manejo médico. Objetivo: Describir y analizar las características clínicas, epidemiológicas, y resultados de pacientes sometidos a tratamiento con gentamicina transtimpánica en el Hospital Clínico de la Universidad de Chile. Material y método: Estudio retrospectivo, descriptivo, incluyendo los pacientes con patología otorrinolaringológica que hayan recibido gentamicina transtimpánica entre los años 2008 y 2018. Se analizaron variables epidemiológicas, clínicas, y función vestibular. Resultados: La serie está constituida por diez pacientes, con una edad promedio de 52,4 años; siete mujeres y tres hombres. El diagnóstico fue en su mayoría enfermedad de Ménière (7 pacientes). El número promedio de inyecciones de gentamicina fue de 2,8. En el período de seguimiento (rango 1-96 meses), se logró mejoría del vértigo en la mayoría de los pacientes (8 de 10). Conclusión: El tratamiento con inyecciones de gentamicina transtimpánica es una opción importante para aliviar la sintomatología de pacientes con vértigo crónico intratable. Debe indicarse en casos seleccionados, y siempre realizar un estudio auditivo y vestibular completo antes y después del tratamiento con gentamicina.

ABSTRACT Introduction: Transtympanic gentamicin is used for treatment of patients with chronic vertigo refractory to medical management. Aim: To describe and analyze the clinical outcome of patients whom underwent treatment with transtympanic gentamicin at the Clinical Hospital Universidad de Chile. Material and method: Retrospective and descriptive study including patients with otolaryngologist disease whom underwent treatment with transtympanic gentamicin between 2008 and 2018. Epidemiological, clinical variables and vestibular function were analyzed. Results: The serie consists of ten patients, 7 men and 3 women, with an average age of 52,4 years. The most frequent diagnosis was Ménière disease (7 patients). The average number of gentamicin injections was 2,8. The follow up varies from 1 to 96 months, presenting improvement of vertigo in the majority of the cases (8 of 10 patients). Conclusion: The treatment with transtympanic injections of gentamicin is a relevant option to decrease symptoms in patients with chronic intractable vertigo. It should be indicated in selected patients. Prior and posterior the treatment, patients must be studied with a complete evaluation of the auditory and vestibular function.

Características clínico-epidemiológicas y evolución del tratamiento en pacientes con úlceras corneales / Clinical-epidemiological characteristics and treatment evolution of patients with corneal ulcer

Las úlceras corneales de origen infeccioso son una emergencia oftalmológica que amenaza la visión y la integridad estructural del ojo, causando ceguera en 1,5 a 2 millones de casos al año por lo que requiere tratamiento inmediato. El objetivo fue determinar el patrón epidemiológico, factores de riesgo y efectividad del tratamiento en pacientes con úlcera corneal en la Fundación Visión en el periodo 2015-2017. Estudio de cohorte prospectivo donde se evaluó 53 pacientes con úlcera corneal de causa infecciosa que consultaron en la Fundación Visión en el periodo 2015-2017, y tuvieron un seguimiento mínimo de 4 meses. Se encontró un predominio del sexo masculino (69,8%), edad 45-65 años (49,1%), casados (54,7%), de condición socioeconómica baja (56,6%), agricultores (26,4%), con antecedente de traumatismo corneal (69,8%) o uso de lentes de contacto (17%). El agente etiológico fue bacteriano en el 49,1% y micótico en el 37,7%; para los de origen bacteriano el tratamiento más empleado fueron colirios fortificados de Cefazolina + Gentamicina y Natamicina/Fluconazol en caso de ser micótico. La evolución fue favorable en 90,9% y 80,0% de los bacterianos y micóticos, respectivamente. Los grupos de riesgo detectados fueron pacientes varones, agricultores, de condición socioeconómica baja, con antecedente de traumatismo corneal o uso de lentes de contacto. La efectividad del tratamiento utilizado fue mayor al 80%, siendo en su mayoría patógenos bacterianos(AU)

Mammary gland health of Santa Inês ewes at the drying and puerperium and evaluation of a dry-off terapy with gentamicin / Sanidade da glândula mamária de ovelhas Santa Inês na secagem e no puerpério e avaliação da terapia intramamária com gentamicina na secagem

Mastitis represents an important health problem for Santa Inês breed, causing losses to the producer, due to loss of ewes or the decrease in weight gain of lambs. The aim of this work was to assess the health of the mammary gland of Santa Inês ewes at the drying and puerperium and to investigate the efficacy of a dry-off therapy with gentamicin. In this study, 64 ewes were divided in a control group (GC) and treatment group (GT), and the health of the mammary gland was assessed at the drying and puerperium. The GT ewes received 250mg of gentamicin (Gentocin® DryCow/Schering-Plough, product indicated for use in dairy cows) in each mammary half. For diagnosis, clinical examination, California Mastitis Test, somatic cell count and milk culture was performed. In the GC, of the 45 (70.3%) healthy mammary halves at the drying, 12 developed subclinical mastitis and nine clinical mastitis at the puerperium. In the GT, among 51 (79.7%) healthy mammary halves at the drying, six developed subclinical mastitis and 11 clinical mastitis at the puerperium. No association was observed between treatment and the occurrence of mastitis at puerperium. Of the 19 (29.7%) mammary halves of the GC that presented subclinical mastitis at the drying, three remained with subclinical mastitis and five developed clinical mastitis at the puerperium. In the GT, of the 13 (20.3%) mammary halves that had subclinical mastitis at the drying, four remained with subclinical mastitis and four developed clinical mastitis. No association was observed between treatment and cure or persistence of mastitis at the puerperium. The main microorganisms isolated, at the drying and puerperium, from animals with subclinical or clinical mastitis were Staphylococcus spp., predominantly coagulase negative Staphylococcus (CSN). At the puerperium, 29 cases of clinical mastitis occurred, 19 with isolation, where 10 were CNS and six S. aureus. Mannheimia haemolytica was isolated in one case of subclinical mastitis and other of clinical mastitis. News protocols and different ways of handling at drying and at puerperium must be investigated.(AU)

A mastite é um problema sanitário importante em ovelhas da raça Santa Inês, ocasionando prejuízo ao produtor em virtude do descarte de matrizes e da queda no ganho de peso dos cordeiros. O objetivo deste trabalho foi avaliar a saúde da glândula mamária de ovelhas da raça Santa Inês na secagem e no puerpério e pesquisar a eficácia da terapia intramamária com gentamicina na secagem. Sessenta e quatro ovelhas foram divididas em grupos controle (GC) e tratamento (GT), cada um contendo 32 animais, e a saúde da glândula mamária avaliada na secagem e no puerpério. As ovelhas do GT receberam 250mg de gentamicina (Gentocin® Mastite Vaca Seca/ Schering-Plough Veterinária, produto indicado pela empresa para utilização em vacas de leite) em cada metade mamária. Para o diagnóstico, foram realizados exame físico da glândula mamária, California Mastitis Test, contagem de células somáticas e cultura do leite. No GC, das 45 (70,3%) metades mamárias sadias na secagem, 12 desenvolveram mastite subclínica e nove mastite clínica no puerpério. No GT, das 51 (79,7%) metades mamárias sadias na secagem, seis desenvolveram mastite subclínica e 11 mastite clínica no puerpério. Não houve associação entre o tratamento e a ocorrência de mastite no puerpério. Das 19 (29,7%) metades mamárias do GC que apresentaram mastite subclínica na secagem, três permaneceram com mastite subclínica e cinco desenvolveram mastite clínica no puerpério. No GT, das 13 (20,3%) metades mamárias com mastite subclínica na secagem, quatro permaneceram com mastite subclínica e quatro desenvolveram mastite clínica. Não houve associação entre o tratamento e a cura ou persistência da mastite no puerpério. Os principais micro-organismos isolados, na secagem e puerpério, de animais com mastite subclínica ou clínica foram Staphylococcus spp., com predominância de Staphylococcus Coagulase Negativa (SCN). No puerpério, ocorreram 29 casos de mastite clínica, sendo 19 com isolamento, 10 com SCN e seis com S. aureus. Mannheimia haemolytica foi isolado em um caso de mastite subclínica e um caso de mastite clínica. Novos protocolos e diferentes formas de manejo na secagem e no puerpério devem ser pesquisados.(AU)

Intratympanic Gentamicin for Intractable Ménière's Disease - A Review and Analysis of Audiovestibular Impact

Abstract Introduction Intratympanic gentamicin regulates the symptoms in most patients with incapacitating Ménière's disease. The treatment protocols have changed over the years from medical labyrinthectomy to preservation of vestibular function. Objectives This study aims to review the audiovestibular response related to the effect of the drug in controlling vertigo. Data Synthesis Articles were identified by means of a search in the PubMed database using the key words Meniere and intratympanic or transtympanic gentamicin. Total 144 articles were reviewed after excluding those that were technical reports, those based on experimental animal studies, those that focused on outcomes other than vertigo (tinnitus or aural fullness), those with delivery methods other than tympanic membrane injection, and those with bilateral cases. If there was more than one article by the same author(s) or institution, only the most recent one matching the aforementioned criteria and those that were not overlapping were included. Conclusion Titration methods or multiple injections on a daily basis can be preferred if the patients have profound or non-serviceable hearing, since these methods have significant incidence of hearing loss. Treatment protocols with a frequency of injection not shorter than once a week, or those with injections on a monthly basis as "needed" provide the same level of vertigo control with better preservation of hearing. Caloric testing is not an ideal tool to analyze the correlation between vertigo control and the effect of gentamicin as compared with gain asymmetry of the vestibulo-ocular reflex. Vestibular-evoked myogenic potentials and the head thrust test are more reliable than other vestibular tests for the follow-up of patients undergoing gentamicin treatment.

Síndrome de Gradenigo: una complicación poco frecuente de la otitis media aguda / Gradenigo syndrome: a rare complication of acute otitis media

El síndrome de Gradenigo consiste en una tríada clínica dada por otitis media aguda, parálisis unilateral del VI par craneano y dolor retroorbitario ipsilateral. Se atribuye a una petrositis apical aguda, complicación evolutiva de una infección del oído medio. La disponibilidad, el acceso y el uso adecuado de la terapia antibiótica han contribuido a una disminución de la frecuencia de estas complicaciones intratemporales o intracraneales de elevado riesgo de morbimortalidad. El tratamiento de la petrositis aguda ha evolucionado, desde la cirugía radical en la era preantibiótica, al tratamiento médico y cirugía menor combinados, en los últimos años. La oftalmoplejia externa plantea diagnósticos diferenciales con otras entidades clínicas: traumatismos, neoplasias, hipertensión endocraneana y procesos infecciosos intracraneales, como trombosis del seno venoso lateral, abscesos intracraneales epi y subdurales. En esta comunicación se jerarquiza el reconocimiento oportuno de las manifestaciones clínicas de esta complicación poco frecuente con el objetivo de sensibilizar a los profesionales para su abordaje diagnóstico y terapéutico oportuno y adecuado.

The Gradenigo syndrome consists in a clinical triad of acute otitis media, unilateral paralysis of the VI cranial nerve and ipsilateral retroorbital pain. It is attributed to an acute apical petrositis by evolutionary complication from an infection of the middle ear. The availability, the access and adequate use of antibiotic therapy have contributed to decrease the frequency of this intratemporal or intracranial complications with high risk of morbidity and mortality. The treatment of acute petrositis has evolved from radical surgery in the pre-antibiotic era, to medical treatment and minor surgery combined, in recent years. The external ophthalmoplegia raises differential diagnosis with other clinical entities: trauma, neoplasms, endocranial hypertension and intracranial infections like venus thrombosis of the lateral sinus, epi and subdural abscesses. In this communication we rank the early recognition of the clinical manifestations of this rare complication to sensitize the professionals for its diagnostic and therapeutic approach timely and adequate.

Avaliações comparativas da associação entre antibióticos frente à Pseudomonas aeruginosa / Evaluación comparativa del uso asociado de antibióticos frente a Pseudomonas aeruginosa / Evaluation of the association antibiotics against Pseudomonas aeruginosa

Introdução: Pseudomonas aeruginosa caracteriza-se como bastonete gram-negativo reto ou ligeiramente curvo, aeróbio estrito, podendo ser encontrado na água, solo, vegetais, esgoto e animais. É um patógeno nosocomial com envolvimento em infecções hospitalares provocando infecções oportunistas em pacientes, principalmente naqueles imunocomprometidos. Uma das características de P. aeruginosa é seu alto nível de resistência intrínseca a agentes antimicrobianos estruturalmente diferentes. Objetivo: avaliar as atividades microbiológicas e comparar as atividades decorrentes da associação entre antibióticos que atuam no mesmo alvo e também em alvos diferentes frente às cepas bacterianas de Pseudomonas aeruginosa. Métodos: a Concentração Inibitória Mínima (CIM) foi realizada pelo método de microdiluição em caldo. Foi realizada modulação com bactérias associando os antibióticos. Resultados: as associações claritromicina‒imipenem e claritromicina ‒ciprofloxacina apresentaram sinergismo frente à P. aeruginosa, porém a associação claritromicina‒gentamicina demonstrou indiferença. Por outro lado as associações imipenem‒claritromicina, ciprofloxacino‒claritromicina e gentamicina ‒claritromicina apresentaram antagonismo. Conclusão: o resultado deste ensaio sugere que a associação de dois antibióticos testados aumenta o seu potencial antimicrobiano, podendo ser usado em combinação mediante investigações posteriores que comprovem a segurança de tal uso(AU)

Introduction: Pseudomonas aeruginosa is an anaerobic and gramnegative rod, they can be isolated from water, soil, vegetables, waste and animals. This microorganism is a nosocomial opportunistic infectious agent, mainly for immunocompromised patients. One of the main traits of P. aeruginosa is its intrinsic drug resistance to structurally different antibiotics. Objective: to evaluate the microbiological effect and to compare the activities derived from the antibiotic association s acting on the same target and on different targets against P. aeruginosa strains. Methods: the Minimun Inhibitory Concentration (MIC) was determined by broth microdilution method. The modulation of the activity on the bacteria was based on the antibiotic association. Results: the association of clarithromycin-imipenem and of clarothromycin-ciprofloxacin demonstrate synergism against P. aeruginosa. However, the association of clarithromycin?gentamycin did not show differences. On the other hand, the association of imipenem-clarihtromycin, of ciprofloxacine-clarithromycin and of gentamycin-clarithromycin showed antagonistic effect. Conclusions: the results of this study indicated that the association of two antibiotics enhances the antimicrobial potential of these drugs, and that they can be used in combination whenever other research studies confirm the safety of such use(AU)

Introducción: la Pseudomonas aeruginosa se caracteriza por ser gramnegativos con imagen de bastones rectos o ligeramente curvos, aeróbios, se pueden encuentrar en el agua, el suelo, en plantas, animales y aguas residuales. Es un patógeno nosocomial implicado en infecciones hospitalarias, causando infecciones oportunistas en pacientes, especialmente en aquellos inmunocomprometidos. Una de las características de la P. aeruginosa es su alto nivel de resistencia intrínseca a agentes antimicrobianos estructuralmente diferentes. Objetivo: evaluar las actividades microbiológicas y comparar las actividades derivadas de la asociación de antibióticos que actúan sobre la misma diana y también sobre diferentes dianas frente a cepas bacterianas de Pseudomonas aeruginosa. Métodos: el cálculo de la Concentración Mínima Inhibitoria (CMI) se realizó por el método de microdilución en caldo. La modulación de la actividad sobre bacterias se realizó por asociación de antibióticos. Resultados: las asociaciones claritromicina‒imipenem y claritromicina ‒ciprofloxacina mostraron sinergismo frente a P. aeruginosa; sin embargo la asociación claritromicina‒gentamicina no mostro diferencias. Por otro lado las asociaciones imipenem‒claritromicina, ciprofloxacino‒claritromicina y gentamicina ‒claritromicina demostraron antagonismo. Conclusión: los resultados de este estudio indican que la combinación de dos antibióticos aumenta su potencial antimicrobiano, y que pueden ser utilizadas en combinación, una vez que otras investigaciones confirmen la seguridad de dicho uso(AU)

Healthcare-associated vancomycin resistant Enterococcus faecium infections in the Mansoura University Hospitals intensive care units, Egypt

Vancomycin resistant Enterococcus faecium (VREF) ia an emerging and challenging nosocomial pathogen. This study aimed to determine the prevalence, risk factors and clonal relationships between different VREF isolates in the intensive care units (ICUs) of the university hospitals in our geographic location. This prospective study was conducted from July, 2012 until September, 2013 on 781 patients who were admitted to the ICUs of the Mansoura University Hospitals (MUHs), and fulfilled the healthcare-associated infection (HAI) criteria. Susceptibility testing was determined using the disk diffusion method. The clonal relationships were evaluated with pulsed field gel electrophoresis (PFGE). Out of 52 E. faecium isolates, 12 (23.1%) were vancomycin resistant. The significant risk factors for the VREF infections were: transfer to the ICU from a ward, renal failure, an extended ICU stay and use of third-generation cephalosporins, gentamicin, or ciprofloxacin. PFGE with the 12 isolates showed 9 different patterns; 3 belonged to the same pulsotype and another 2 carried a second pulsotypes. The similar pulsotypes isolates were isolated from ICUs of one hospital (EICUs); however, all of the isolates from the other ICUs had different patterns. Infection control policy, in conjunction with antibiotic stewardship, is important to combat VREF transmission in these high-risk patients.

Salmonelosis neonatal: reporte de un caso y revisión de la literatura / Neonatal Salmonella infections: a case report and literature review

En Chile aún existe la salmonelosis como causal de enfermedad entérica, prevaleciendo el serotipo Enteritidis. En sepsis neonatal el germen más frecuente es Streptococcus grupo B (SGB); los bacilos Gram negativos entéricos ocupan el segundo lugar. La Salmonella spp. es infrecuente. Las vías de transmisión pueden ser hematógena, canal del parto, ascendente u horizontal. CASO CLÍNICO: Mujer sana, 31 años, embarazo de 39 semanas. Cultivo de SGB negativo. Presenta cuadro diarreico el día previo al parto, el cual fue vaginal, dilatación de cuatro horas, expulsivo de 15 minutos, líquido amniótico claro, destaca temperatura (T°) intraparto de 38,3°C. Recién nacido (RN)sexo masculino, adecuado para la edad gestacional, Apgar 9/9,con T° rectal 38,1°C al nacer. Al segundo día de vida presenta deposiciones líquidas verdosas con estrías de sangre, descenso de peso de 10,6 por ciento (367,82 gr) y T° rectal 37,7°C. Ingresa a neonatología, destacando Proteína C Reactiva elevada de 2,7 mg/dL. Por persistir cuadro se solicitan cultivos previo a antibioterapia con Ampicilina y Gentamicina. Test APT-Downey positivo, cultivo orina y líquido cerebroespinal negativos, hemocultivo y coprocultivo positivo a Salmonella tipo D subtipo Panamá. Evoluciona favorablemente, es dado de alta al noveno día con diagnóstico de sepsis por Salmonella tipo D connatal. Coprocultivo de madre positivo para Salmonella. DISCUSIÓN: La prevalencia de infecciones por Salmonella se ha incrementado en neonatos. Es importante realizar prevención durante el embarazo además de un diagnóstico y tratamiento precoz. Se debe considerar este agente según factores de riesgo y como diagnóstico diferencial de hemorragia digestiva baja en el RN...

Salmonella infections are still a cause of entericdisease in Chile, with a predominance of the Enteritidis serotype. In neonatal sepsis the most frequent etiology is Group B Streptococcal (GBS) infection; enteric Gram-negative bacilli occupy second place. Salmonella spp. is infrequent. The transmission routes can be hematogenous, by birth canal, vertical, or horizontal. CASE REPORT: Healthy 31 year old female, 39 week pregnancy. Negative GBS culture. Presents with diarrhea the day before labor, with vaginal delivery, four hour dilation period,15 minute expulsion period, clear amniotic fluid, intra delivery temperature (T°) of 38.3°C. Male, adequate for gestational age newborn, Apgar 9/9, with rectal T° of 38.1°C at birth. During second day of life, presents green liquid stools with blood streaks, weight loss of 10.6 percent (367.82 gr), and rectal T° of 37.7°C. Patient is admitted to neonatology service, where he presents elevated C-Reactive Protein of 2.7 mg/dL. Cultures were taken due to persistent findings, before antibiotic therapy with Ampicillinand Gentamicin. Positive APT-Downey test, negative urine and cerebrospinal fluid cultures, positive blood and stool cultures for type D, subtype Panama Salmonella. Favorable evolution, discharged on day nine with diagnosis of sepsis due to connatal type D Salmonella. Mother’s stool culture is positive for same bacteria. DISCUSSION: The prevalence of Salmonella infections has increased in neonates. Prevention during pregnancy, along with early diagnosis and treatment, are important. This agent should be considered according to risk factors, and as a differential diagnosis of lower gastrointestinal bleeding in newborns...

Estudo prospectivo e comparativo do uso de lock antibioticoterapia profilática em cateteres tunelizados para hemodiálise / Prospective and comparative study of the use of prophylactic antibiotics therapy lock in tunneled catheter for hemodialysis

Hemodiálise (HD) é modalidade de terapia renal substitutiva mais amplamente utilizada no mundo, sendo necessária a disponibilidade de acesso vascular adequado para sua realização. Atualmente, o número de cateteres venosos centrais (CVC) tem aumentado como forma de acesso vascular, paralelamente ao envelhecimento da população em diálise e presença de comorbidades como diabetes mellitus. Apesar da vantagem de obtenção imediata de acesso, a forte associação do CVC com infecções de corrente sanguínea (ICS) e consequente elevada morbi-mortalidade vem direcionando diversos estudos com a finalidade de prevenção dos eventos infecciosos relacionados ao uso de CVC na população em HD. Os objetivos deste trabalho foram avaliar a eficácia do uso de antibioticoterapia em lock (gentamicina e cefazolina) na redução de ICS relacionada a cateteres tunelizados em pacientes em HD e identificar os efeitos adversos da lock terapia. Estudo prospectivo, não randomizado, realizado em dois centros para avaliação de lock terapia profilática em cateteres tunelizados nos pacientes em HD seguidos por 25 meses consecutivos e divididos em 2 grupos de acordo com o tipo de tratamento em lock prescrito e o serviço de HD de origem: grupo controle (GC=126 pacientes: heparina 5.000 UI/ml) e grupo intervenção (GI=107 pacientes: cefazolina 10mg/ml + gentamicina 5mg/ml + heparina 5000 UI/ml). Os dois grupos foram semelhantes quanto ao sexo, idade, doença de base, comorbidades, tempo em HD e sítio de implante de cateter. Houve diferença estatisticamente significante entre os grupos quanto à densidade de incidência de ICS (GI=0,57 eventos por 1000 cateteres-dia x GC=1,74, p=0.005), sobrevida livre de ICS (log-rank=17,62 no GI, p<0,0001) e número de dias com cateter (GC= 171 dias (79-256) x GI = 203 dias (111,5-326), p=0,015)...

The effectiveness of using different pulp-capping agents on the healing response of the pulp.

Background: Some of the disadvantages of calcium hydroxide Ca(OH) 2 as pulp-capping material are related to the inflammatory response, and its poor sealing ability. Cyanoacrylate glue was proposed in this study as pulp-capping agent because of its sealing ability, and diprogenta, on the other hand, was proposed because of its anti-microbial and anti-inflammatory effects. The aim of this study is to evaluate and compare the histopathological response of the pulp toward cyanoacrylate and diprogenta in direct pulp capping (DPC). Materials and Methods: Cyanoacrylate, diprogenta, and calcium hydroxide were applied on 20 permanent teeth of 6 rabbits divided into four groups, each contains five teeth, as follow: G1: Diprogenta and calcium hydroxide. G2: Cyanoacrylate. G3: Diprogenta and cyanoacrylate. G4: Calcium hydroxide (control group). Results: A remarkable dentin bridge formation was found in all groups. No pulp necrosis was found in any tooth of the four groups. Pathological reactions of the pulp were found in 25%, 40%, 20%, and 100% of groups 1, 2, 3, and 4, respectively. Differences between study and control groups were found statistically significant ( P < 0.05). Conclusion: All materials used in this study were biocompatible and suggested to be studied further on human teeth. These materials when used in combination with Ca(OH) 2 , may give better results

First Case of Bartonella quintana Endocarditis in Korea

Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.

Endometrite puerperal e sepse: uma revisão / Postpartum endometritis and sepsis: a review

O diagnóstico de endometrite puerperal baseia-se na existência de febre na ausência de qualquer outra causa. As manifestações clínicas mais comuns são constituídas por: útero amolecido, lóquios purulentos ou de odor fétido e leucocitose. Sua patogenia decorre da contaminação da cavidade uterina por microrganismos vaginais durante o trabalho de parto e invasão do miométrio. São fatores de risco a ruptura prolongada de membranas, múltiplos exames vaginais e parto cesáreo. É geralmente uma infecção polimicrobiana. Suas complicações incluem a extensão da infecção para a cavidade peritoneal, abscesso intra-abdominal ou sepse. Antes do advento dos antibióticos a febre puerperal era causa importante de morte materna. A antibioticoterapia inicial tem na associação clindamicina e gentamicina seu padrão-ouro. (AU)

The diagnosis of postpartum endometritis is based on the presence of fever in the absence of any other cause. The most common clinical manifestations consist of: softened uterus, purulent or malodorous lochia and leukocytosis. Its pathogenesis results from the contamination of the uterine cavity by vaginal microorganisms during labor and myometrial invasion. Risk factors are: prolonged rupture of membranes, multiple vaginal examinations and cesarean. It is usually a polymicrobian infection. Complications include the extension of the infection into the peritoneal cavity, intra-abdominal abscess or sepsis. Before the advent of antibiotics, puerperal fever was an important cause of maternal death. The initial antibiotic therapy has the association of clindamycin and gentamicin as the gold standard. (AU)