Detecção de Listeria monocytogenes pela técnica de PCR em leite contaminado artificialmente / Detection of Listeria monocytogenes by PCR in artificially contaminated milk samples

Avaliou-se a técnica de PCR como opção para reduzir o tempo de detecção de Listeria monocytogenes no leite. Para tanto, amostras de leite desnatado esterilizado e de leite cru integral - com baixa, média e alta contagem de microrganismos aeróbios mesófilos - foram inoculadas experimentalmente com diversas concentrações de L. monocytogenes. Os resultados da reação de PCR foram comparados com os da cultura da amostra empregando-se metodologia padronizada tradicional. Não se detectou L. monocytogenes pela reação de PCR quando esta foi realizada a partir do caldo de enriquecimento de Listeria (LEB) após 24 horas de incubação, nem no leite desnatado esterilizado, nem no leite cru integral. Após 48 horas de enriquecimento em LEB, a bactéria foi detectada por PCR nas amostras de leite desnatado esterilizado, com a sensibilidade de 1UFC/mL, mas não nas amostras de leite cru integral. Pela metodologia tradicional, a bactéria foi recuperada de todos os ensaios. Entretanto, nas amostras de leite cru com altas contagens de aeróbios mesófilos, a sensibilidade da metodologia tradicional foi reduzida (a partir de 7UFC/mL). Melhores resultados foram obtidos quando a reação de PCR foi feita utilizando-se DNA obtido diretamente da colônia suspeita em meio sólido (Oxford e Palcam). Foi possível substituir os testes fenotípicos de identificação de L. monocytogenes pela técnica de PCR reduzindo-se o tempo de identificação da bactéria de vários dias para algumas horas.

The polymerase chain reaction (PCR) was used to detect Listeria monocytogenes in inoculated milk samples after selective enrichment. Samples of sterile skim milk and raw whole milk (with low, intermediate, and high counts of aerobic mesophilic microorganisms) were inoculated with several concentrations of L. monocytogenes. The results of PCR assays were compared to the results of culturing the samples using a standardized traditional method for isolation of L. monocytogenes. The pathogen was detected by PCR in Listeria Enrichment Broth (LEB) after 48h-incubation (sensitivity of 1CFU/mL) but not after 24h-incubation from the samples prepared with sterile skim milk. L. monocytogenes was not detected by PCR in LEB after 24 and 48h-incubation from the samples prepared with raw whole milk. Using the traditional method, the pathogen was detected in all experiments. However, sensitivity decreased in raw whole milk with high counts of aerobic mesophilic microorganisms (up to 7CFU/mL). Best results were obtained when PCR was done to identify presumptive L. monocytogenes colonies directly from Palcam and Oxford media, after the enrichment step. This procedure allowed reducing to a few hours the period of several days usually needed to obtain the final identification of L. monocytogenes using phenotypic tests.

Detecção de Escherichia coli O157: H7 inoculada experimentalmente em amostras de leite cru por método convencional e PCR multiplex / Detection of E. coli O157: H7 experimentally inoculated in raw milk samples by conventional method and multiplex PCR

Padronizou-se um método de reação em cadeia da polimerase (PCR) multiplex para detecção de Escherichia coli O157:H7 e avaliou-se a eficiência da PCR e de um método de cultivo convencional em placas na detecção desse patógeno experimentalmente adicionado em leite estéril e em leite cru com baixa contagem bacteriana total (média de 4,01 x 10³ UFC/ml) e com alta contagem bacteriana (média de 2,10 x 10(6) UFC/ml). Foram padronizadas duas reações de PCR com o uso dos primers: "A" (RfbF; RfbR e FLICh7F/FLICh7R) e "B" (SLT-IF/SLTIR e SLT-IIF/SLT-IIR). A detecção de E. coli O157:H7 (1UFC/ml) a partir do leite estéril e do leite cru com baixa contaminação bacteriana foi possível quando se utilizou o método de contagem em placas e a PCR. A sensibilidade dos dois métodos foi menor quando se testou o leite cru com alta contaminação microbiana, sendo o método convencional mais sensível. Os resultados indicam que a presença de outros microrganismos, em alta quantidade no leite, dificulta a detecção de E. coli O157:H7 pelos métodos utilizados.

This experiment was carried out in order to evaluate the effect of the raw milk bacterial count on the efficiency of a multiplex polymerase chain reaction and a conventional plate count method for detection of Escherichia coli O157:H7. This pathogen was experimentally inoculated into sterile milk, raw milk with low bacterial count (count mean of 4.01 x 10³ cfu/ml) and, raw milk with high bacterial count (mean 2.10 x 10(6) cfu/ml). Two protocols of PCR were standardized using primers "A" (Rfbf and Rfbr and FLICh7F/FLICh7R) and "B" (SLT-IF/SLTIR and SLT-IIF/SLT-IIR). Both conventional plate count and PCR methods were able to detect the presence of E. coli O157:H7 in either sterile milk or raw milk with low bacterial count initially inoculated with 1cfu of E. coli O157:H7 per ml. The sensibility of both methods for high-contaminated raw milk samples was lower, being the conventional approach more sensitive. These results indicate that high bacterial count in raw milk can affect E. coli O157:H7 detection.

The MERITO Study: a multicentre trial of the analgesic effect and tolerability of normal-release oral morphine during 'titration phase' in patients with cancer pain.

Adequate and rapid pain control is one of the main goals of cancer pain treatment. The objective of this study was to assess the effect and tolerability of oral normal-release morphine during the initial phase of treatment in patients with moderate-to-severe cancer pain. Consecutive patients naïve to strong opioids received normal-release morphine 5 or 10 mg every 4 h during the titration phase (first 5 days), depending on previous analgesic therapy. Pain intensity was assessed using an 11-point Numerical Rating Scale (0-10), and data were recorded in a patient-compiled diary. The primary endpoint was the proportion of time with pain control (a reduction of at least 50% with respect to the baseline pain score) during the titration phase. A total of 159 consecutive patients (102 men; mean age 65 years) with cancer-related pain were enrolled. Pain control was observed for 75% (95% CI 70-80) of the follow-up period in the intent-to-treat population. Overall, 50% and 75% of patients achieved pain control within 8 and 24 h after starting normal-release morphine therapy respectively. The mean pain score was 7.63 points at baseline, and decreased to 2.43 and 1.67 points (both P<0.001) at days 3 and 5 respectively. The most commonly reported adverse events were somnolence (24% of patients), constipation (22%), vomiting (13%), nausea (10%) and confusion (7%). Normal-release morphine results in rapid and satisfactory pain control, and is well tolerated, during the strong-opioid titration phase in patients with moderate-to-severe cancer pain.

Pain syndromes in the setting of haematopoietic stem cell transplantation for haematological malignancies.

Severe pain syndromes may be recorded during all phases of haematopoietic stem cell transplantation (HSCT) for haematological malignancies: from stem cell mobilization to the long-term post transplant period. Although the major cause of pain in the setting of HSCT is injury to mucosal tissues induced by the conditioning regimen, pain from several other causes has been reported. In this paper, we review pain and its management in the setting of HSCT.

Qualidade microbiológica do leite refrigerado nas fazendas / Microbiological quality of refrigerated milk on farms

Avaliaram-se a qualidade microbiológica do leite obtido mecanicamente e refrigerado durante 48 horas, em 24 rebanhos, e a associação entre a contaminação microbiana e os procedimentos de higienização dos equipamentos de ordenha e armazenamento do leite. Os procedimentos de higiene foram avaliados in loco com auxilio de questionários. Foram realizadas a contagem padrão em placas, a contagem de coliformes totais e a pesquisa de Staphylococcus aureus e Streptococcus agalactiae. No leite de 14 rebanhos, foram pesquisadas Salmonella spp. e Listeria monocytogenes. As médias geométricas da contagem padrão foram <1,0×10(6) UFC/ml em 20 rebanhos, e <7,5×10(5) UFC/ml em 19. Onze rebanhos apresentaram contagem média de <1,0×10(5) UFC/ml. Contagens médias de coliformes >10³ UFC/ml foram verificadas em sete rebanhos. S. aureus e S. agalactiae foram isolados em 22 e 12 dos 24 rebanhos, respectivamente, e não foram encontradas Salmonella spp. e L. monocytogenes. O uso de detergentes alcalino e ácido, mais o de sanitizante foi associado (P<0,05) à contagem padrão <1,0×10(5), e o emprego de apenas um ou de nenhum produto foi associado a contagens >5×10(5) UFC/ml.

The effect of bulk tank and milking machine cleaning procedures (determined from a questionnaire) on bacterial contamination of 48-hour refrigerated milk was examined in 24 herds. Milk samples were analyzed for standard plate count (SPC) and for total coliform, Staphylococcus aureus and Streptococcus agalactiae contamination. Milk samples from 14 herds were cultured for Salmonella and Listeria monocytogenes. Geometrical means of SPC were <1.0×10(6) UFC/ml in 20 herds, <7.5×10(5) UFC/ml in 19 herds and <1.0×10(5) UFC/ml in 11 herds. Geometrical means >10³ UFC/ml of total coliforms were observed in seven herds. S. aureus and S. agalactiae were found in 22 and 12 herds, respectively. Salmonella and L. monocytogenes were not found in any of the samples. The use of alkaline and acid detergents plus sanitizing was associated (P<0.05) with SPC <1.0×10(5), and the use of either alkoline or acid detergent or sanitizing or no chemical product was associated with SPC >5.0×10(5) UFC/ml.

Morphine but not fentanyl and methadone affects mitochondrial membrane potential by inducing nitric oxide release in glioma cells.

We have observed that treatment of human glioma cells with morphine in the nanomolar range of concentration affects the mitochondrial membrane potential. The effect is specific to morphine and is mediated by naloxone-sensitive receptors, and is thus better observed on glioma cells treated with desipramine; moreover, the mitochondrial impairment is not inducible by fentanyl or methadone treatment and is prevented by the nitric oxide (NO) synthase inhibitor L-NAME. We conclude that in cultured glioma cells, the morphine-induced NO release decreases the mitochondrial membrane potential, as one might expect based on the rapid inhibition of the respiratory chain by NO. The identification of new intra-cellular pathways involved in the mechanism of action of morphine opens additional hypotheses, providing a novel rationale relevant to the therapy and toxicology of opioids.

Cutaneous bacterial colonization, modalities of chemotherapeutic infusion, and catheter-related bloodstream infection in totally implanted venous access devices.

GOALS OF WORK: Prospective clinical study to evaluate patients suffering from solid tumor using a totally implanted venous access device (TIVAD) to determine: (1) if there is a relationship between cutaneous contamination at port insertion site and catheter-related bloodstream infection (CRBI); (2) development modalities of CRBI; (3) if there is a relationship between chemotherapy administration modalities by push/ bolus versus continuous infusion and CRBI. PATIENTS AND METHODS: We studied 41 consecutive patients who needed a TIVAD positioned for chemotherapy administration by bolus/ push or continuous infusion. In every patient, we performed blood cultures from blood samples from port catheters and cutaneous cultures from cutaneous tampons of the skin surrounding the implant area on the first (T0) and eight day (T1) postoperatively, after 1 month (T2), and after 3 months (T3) from insertion. MAIN RESULTS: The study was completed on 40 patients; in one case, the port was removed at T2 for septic complications. We obtained four positive blood cultures (two, 5%), two in the same patient, all caused by staphylococcus. Positive cutaneous tampons were 21 (13%) in 11 patients (27%); the four CRBI occurred in this group of patients with none in the remaining 30 patients (73%) for a total number of 120 tampons (p<0.01). In two cases, the same germ was isolated from both the skin and blood. None of the patients presented a local infection of the subcutaneous pocket. Positive cutaneous cultures decrease over time: T0-T2; 24-5%; T1-T3, 20-5% (p<0.04). There were no differences in CRBI incidence and positive cutaneous tampons between the two chemotherapy administration modalities. CONCLUSIONS: Cutaneous microbial flora has a primary role in CRBI development within TIVADs; there is a relationship between cutaneous colonization and CRBI; colonization reaches its maximum during the first days after catheterization in which the use of the system is at high risk; colonization occurs both via extraluminal and endoluminal routes; there is no difference in CRBI incidence between bolus and continuous infusion administration.

Systemic and haemodynamic toxicity after isolated limb perfusion (ILP) with TNF-alpha.

The aim of this study was to evaluate the systemic and haemodynamic postoperative effects of ILP with medium-low dose of TNF alpha in patients diagnosed with primary or recurrent limb melanoma or sarcoma, and to compare the resulting toxicity with Systemic Inflammatory Response Syndrome (SIRS). A prospective study on 17 consecutive patients with primary or recurrent limb tumor (melanoma or sarcoma) subjected to ILP with escalating doses of TNF alpha (0.5-2.0mg) was carried out. Seventeen patients with primary or recurrent limb melanoma or sarcoma were subjected to ILP with escalating doses of TNF alpha. ILP was carried out with the standard techniques, blood being warmed at 42 degrees C for an hour. Serial serum TNF alpha determinations were performed before, during and after limb perfusion in nine patients. Systemic and pulmonary haemodynamics, by a radial and pulmonary artery catheter inserted before the induction of anesthesia, were monitored at 5 different times: before the induction of anesthesia (T0), and 6, 12, 24 and 48 hours after treatment (T1-4). Complete isolation of the limb was not always achieved, therefore leakage of TNF alpha occurred frequently during the perfusion in all patients with maximum systemic TNF alpha concentrations ranging from 431 to 111000 pg/ml. After perfusion only two patients showed detectable TNF alpha levels in peripheral blood which returned to baseline values within nine hours. These two patients had serious systemic toxicity: shock and respiratory failure secondary to pulmonary edema. Acute pulmonary edema was also observed in another patient. All three cases required supportive therapy provided by means of mechanical ventilation. In the remaining 14 patients a sepsis-like syndrome was observed. The most significant haemodynamic changes were due to the CO, which rose by 35%, and the SVR, which remained consistently low throughout. A reduction in Hb was observed in all patients (with an average decrease of 4 g/dl), while DO2 and VO2 levels rose, though not to statistically significant levels. Hypoxia occurred in all 14 patients. In three of the remaining 14 cases bilateral pulmonary leaks were noted, however the use of mechanical ventilation was not required. No perioperative death occurred and the aforementioned side effects were all reversible resulting in a patient's mean postoperative ICU permanence of 4 days (range 3 to 7 days). In conclusion, ILP with TNF alpha induces cardiovascular, respiratory and hematological toxicity with haemodynamic parameters being similar to those noted in SIRS probably due to leakage of TNF alpha in the systemic circulation during the perfusion. Nevertheless, this systemic toxicity was short-lived resulting in an acute reaction following a single application.

Local anesthetic switching for intrathecal tachyphylaxis in cancer patients with pain.

IMPLICATIONS: Switching from bupivacaine to lidocaine may improve intrathecal morphine analgesia in advanced cancer patients, possibly because of different spinal mechanisms limiting the hyperalgesic processes.

Analgesic effect of intravenous ketamine in cancer patients on morphine therapy: a randomized, controlled, double-blind, crossover, double-dose study.

Pain not responsive to morphine is often problematic. Animal and clinical studies have suggested that N-methyl-D-aspartate (NMDA) antagonists, such as ketamine, may be effective in improving opioid analgesia in difficult pain syndromes, such as neuropathic pain. A slow bolus of subhypnotic doses of ketamine (0.25 mg/kg or 0.50 mg/kg) was given to 10 cancer patients whose pain was unrelieved by morphine in a randomized, double-blind, crossover, double-dose study. Pain intensity on a 0 to 10 numerical scale; nausea and vomiting, drowsiness, confusion, and dry mouth, using a scale from 0 to 3 (not at all, slight, a lot, awful); Mini-Mental State Examination (MMSE) (0-30); and arterial pressure were recorded before administration of drugs (T0) and after 30 minutes (T30), 60 minutes (T60), 120 minutes (T120), and 180 minutes (T180). Ketamine, but not saline solution, significantly reduced the pain intensity in almost all the patients at both doses. This effect was more relevant in patients treated with higher doses. Hallucinations occurred in 4 patients, and an unpleasant sensation ("empty head") was also reported by 2 patients. These episodes reversed after the administration of diazepam 1 mg intravenously. Significant increases in drowsiness were reported in patients treated with ketamine in both groups and were more marked with ketamine 0.50 mg/kg. A significant difference in MMSE was observed at T30 in patients who received 0.50 mg/kg of ketamine. Ketamine can improve morphine analgesia in difficult pain syndromes, such as neuropathic pain. However, the occurrence of central adverse effects should be taken into account, especially when using higher doses. This observation should be tested in studies of prolonged ketamine administration.

Peritonectomy and hyperthermic antiblastic perfusion in the treatment of peritoneal carcinomatosis.

AIMS: Some low-grade malignant tumours arising in the abdomen tend to remain loco-regionally confined to peritoneal surfaces, without systemic dissemination. In these cases complete surgical tumour cytoreduction followed by intra- or post-operative regional chemotherapy has curative potential. The aim of this study was to evaluate the outcome for patients treated in this way. METHODS: Peritonectomy was performed, involving the complete removal of all the visceral and parietal peritoneum involved by disease. After peritonectomy, hyperthermic antiblastic perfusion was carried out throughout the abdominopelvic cavity for 90 min, at a temperature of 41.5-42.5 degrees C, with mitomycin C (3.3 mg/m2/l) and cisplatin (25 mg/m2/l) (for appendicular or colorectal primaries), or cisplatin alone (for ovarian primaries). Alternatively, the immediate post-operative regional chemotherapy was performed with 5-fluorouracil (13.5 mg/kg) and Lederfolin (125 mg/m2) (for colonic or appendicular tumours) or cisplatin (25 mg/m2) (for ovarian tumours), each day for 5 days. RESULTS: Thirty-five patients affected by extensive peritoneal carcinomatosis were submitted to peritonectomy, with no residual macroscopic disease in all cases except three. Twenty-six patients were able to undergo the combined treatment involving loco-regional chemotherapy. Complications were observed in 54% of the patients and led to death in four of them. At a mean follow-up of 17 months overall 2-year survival was 55.2%, with a median survival of 26 months. CONCLUSIONS: After a learning curve of 18 months the feasibility of the integrated treatment increased to more than 90%, while mortality decreased dramatically. The curative potential of the combined therapeutic approach seems high in selected patients with peritoneal carcinomatosis not responding to systemic chemotherapy. Careful selection of patients can minimize the surgical risk, but the treatment should currently be reserved for clinical trials.

Effect of local anesthetic ropivacaine on isolated rat liver mitochondria.

Ropivacaine is a new long-acting aminoamide local anesthetic with a reduced systemic and cardiac toxicity. Since the latter seems to be related, at least partially, to an interference with mitochondrial energy transduction, the effect of ropivacaine on the metabolism of rat liver mitochondria was studied. Ropivacaine alone exhibited little effect on mitochondrial metabolism, whereas effects were strongly enhanced by tetraphenylboron (TPB-) anion. At low drug concentrations, state 4 respiration was stimulated and mitochondrial membrane potential collapsed. At higher concentrations, state 4 and uncoupled respiration were inhibited by impairment of electron transfer from NAD- and flavine adenine dinucleotide-linked substrates to the respiratory chain. The fact that TPB- increased drug effects indicated that stimulation of respiration was due to dissipation of the electrochemical proton gradient caused by its electrophoretic uptake, although a classical uncoupling mechanism cannot be excluded. The mechanism for the lower toxicity of ropivacaine in vivo was ascribed to low liposolubility leading to reduced access to the mitochondrial membrane, resulting in a minimal perturbation of mitochondrial metabolism.

The integrated treatment of peritoneal carcinomatosis. A preliminary experience.

Some low-grade malignant tumors arising in the abdomen, lack of infiltrative attitude and "redistribute" on the peritoneum with no extraregional spreading. In this cases the complete tumor cytoreduction followed by intra- or postoperative regional chemotherapy has curative intent. Peritonectomy is the complete removal of all the parietal peritoneum and the visceral peritoneum involved by disease. After peritonectomy hyperthermic antiblastic perfusion is carried out throughout the abdomino-pelvic cavity for 60 minutes, at a temperature of 41.5 degrees C, with mitomycin C (3.3 mg/m2/Lt of perfusate) and cisplatin (25 mg/m2/Lt) (appendicular or colorectal primary), or cisplatin alone is (ovarian primary). Alternatively the immediate postoperative regional chemotherapy is performed with 5-fluorouracil (13.5 mg/Kg) and Lederfolin (125 mg/m2) (colic or appendicular tumor) or cisplatin (25 ng/m2) (ovarian tumor), each day for 5 days. Twenty patients affected by extensive peritoneal carcinomatosis (12 ovarian, 5 colonic, 1 appendicular, 1 mesothelial and 1 gastric primary) were submitted to peritonectomy with no residual macroscopic disease in all cases except three. Six patients were treated with intraoperative intra-abdominal hyperthermic antiblastic perfusion, while immediate postoperative intra-abdominal chemotherapy was given in 4 patients and systemic chemotherapy in other 5. Hospital mortality was 20%. At a mean follow-up of 11 months 14 patients are alive, 11 without disease and the median overall survival is 10.2 months. The curative potential of the combined therapeutic approach seems high in patients with peritoneal carcinomatosis from ovarian or colorectal primary not responding to systemic chemotherapy. Selection criteria of patients can strictly affect the surgical risk and the treatment has to be reserved for controlled clinical trials.

Mu3 opiate receptor expression in lung and lung carcinoma: ligand binding and coupling to nitric oxide release.

The mu3 opiate receptor subtype is expressed in human surgical specimens of both normal lung and non-small-cell lung carcinoma. Nitric oxide (NO) release is mediated through the mu3 receptor, and in lung carcinoma, morphine-stimulated NO release is significantly higher and prolonged than in normal lung. Using reverse transcriptase-polymerase chain reaction (RT-PCR) and Southern blot analysis we show that specific mu opioid receptor transcripts are present in lung carcinoma and other cells with the mu3 profile. Our findings identify a unique role for the mu3 opiate receptor in opiate-mediated NO release and suggest that endogenous opiates, through their release of NO, may play a role in cancer progression.

[Transdermal route as an alternative to oral administration of opioids in cancer pain]. / La via transdermica come alternativa agli oppioidi per os nel dolore oncologico.

Fentanyl TTS, the only transdermal opioid, represents a real tool for a better quality of life in patients with cancer pain. In this paper we report a short description of the pharmacologic properties and administration procedures of this drug that is a useful alternative when other opioids recommended on the third step of the WHO analgesic ladder, are ineffective or present unbearable side effects (nausea and/or vomiting-severe mucosites and dysphagia). In particular we indicated some changes and adjustments switching from morphine per os to fentanyl TTS. In addition we report the results of a study carried out in our Pain Therapy Center on 49 patients with severe oncologic pain, previously treated with opioids and other drugs associations. Our results indicated a good control of continuous nociceptive cancer pain, with a better quality of life and lesser side effects to respect the previous regime of orally opioids.