Analysis of pathogens and antimicrobial treatment in different groups of patients with chronic otitis media.

OBJECTIVE: Microbial infection plays an important role in exacerbation of chronic otitis media. The aim of this study was to analyse the microbiota in chronic otitis media in the context of local treatment. METHOD: In this prospective study, samples for microbiological examination were taken from 119 patients who underwent operation because of chronic otitis media. RESULTS: The results were compared between groups depending on the type of operation (none, tympanoplasty or radical), the presence of cholesteatoma or granulomatous tissue or discharge from the ear as a symptom of exacerbation. Antibiotic susceptibility of germs was analysed to define the strategy of treatment. A total of 209 samples were collected from 119 patients with chronic otitis media. CONCLUSION: Pseudomonas aeruginosa and Staphylococcus aureus were pathogens most frequently identified from the ear in the course of chronic otitis media. Pseudomonas aeruginosa was concerned with major pathology of the middle ear (radical surgery, cholesteatoma or granulomatous tissue, persisting discharge after treatment), whereas Staphylococcus aureus was obtained in dry perforations without other pathology in the middle-ear cavity. Ciprofloxacin was effective against Staphylococcus aureus, but Pseudomonas aeruginosa strains were ciprofloxacin resistant.

Assessment of endoscope cleaning and disinfection efficacy, and the impact of endoscope storage on the microbiological safety level.

AIMS: The aim of the study was microbiological evaluation of the efficacy of cleaning and disinfection of endoscopes carried out with the use of endoscope washer-disinfector EndoCleaner and evaluation of the endoscope storage cabinet providing a controlled environment. METHODS AND RESULTS: The efficacy evaluation of endoscope cleaning and disinfection using the endoscope washer-disinfector EndoClener (AORT) was carried out in accordance with the PN-EN ISO 15883 standard, and the validity of endoscope storage cabinet (TRIBO LLC) was evaluated in accordance with the PN-EN 16442 standard. The micro-organism tested used in the study were as follows: Pseudomonas aeruginosa ATCC® 15442™, Enterococcus faecium ATCC® 12952™, Clostridium sporogenes ATCC® 19404™ (spores), Candida albicans ATCC® 90028™ and Aspergillus brasiliensis DSM® 1988™ (surrogate for Asperigllus niger ATCC® 16404™). It was demonstrated that the endoscope reprocessing carried out in the washer-disinfector EndoCleaner guaranteed the elimination of the micro-organism tested, and the tested endoscope storage cabinet met the microbiological criteria defined by the Polish standard PN-EN 16442 in the scope of tests. CONCLUSION: The obtained results showed that usage of washer-disinfector EndoCleaner and endoscope storage cabinet ensures the microbiological safety of using endoscopes. SIGNIFICANCE AND IMPACT OF STUDY: The increase in the frequency of procedures applying endoscopes contributes to the increased risk of transmission of potentially pathogenic micro-organisms remaining after insufficient cleaning and disinfection of these devices. Research allows assessing the effectiveness of antimicrobial cleaning and disinfection of endoscopes and the safety of storing this equipment in an endoscope cabinet. A particularly innovative aspect is equipping the cabinet with a module generating the phenomenon of radiant catalytic ionization, which is a unique solution on the market. This is one of the very few works involving the assessment of each stage, that is contamination, washing and disinfection, drying and storage of endoscopes.

Environmental factors driving the occurrence of the invasive cyanobacterium Sphaerospermopsis aphanizomenoides (Nostocales) in temperate lakes.

Cyanobacterial blooms are an increasing threat worldwide. Invasions of certain cyanobacterial species, mainly towards higher latitudes, add to this concern as they enrich the pool of potential bloom-formers in the invaded region. Among the numerous causes of this escalating process, climate warming is commonly considered the most crucial factor, but empirical studies of this issue are lacking. The aim of our study was to identify physical, chemical and biological factors related to the occurrence of an invasive cyanobacterium at the northern border of its putative current range, and thus enabling its expansion. This study focuses on the relatively little studied species Sphaerospermopsis aphanizomenoides (Nostocales, Cyanobacteria; synonyms: Aphanizomenon aphanizomenoides, Anabaena aphanizomenoides), which is predicted to become one of the main nuisance species of the future. Forty-nine freshwater lakes located between latitudes 51° and 55°N were examined for the presence of S. aphanizomenoides, and environmental factors that could drive its occurrence were studied simultaneously. To identify factors correlated with the presence of the species, principal component analysis (PCA) and Mann-Whitney U test were performed. Water temperature did not differentiate lakes with or without S. aphanizomenoides, however the study was conducted in a particularly hot summer. Total phosphorus concentration was identified as the primary driving factor of the occurrence of S. aphanizomenoides. The species grew in poor light conditions and high phytoplankton biomass, mainly in shallow lakes. As shown by detrended correspondence analysis (DCA), the species accompanied shade tolerant, eutrophic species of native and invasive cyanobacteria as well as eukaryotic algae. Our results indicate that eutrophication may be the primary factor enabling the increasing occurrence of S. aphanizomenoides in temperate environments, and suggest that this process may stimulate expansion of cyanobacterial species towards high latitudes.

MEASUREMENTS OF THE IONISING RADIATION LEVEL AT A NUCLEAR MEDICINE FACILITY PERFORMING PET/CT EXAMINATIONS.

This paper presents the results of radiation level measurements at workplaces in a nuclear medicine facility performing PET/CT examinations. This study meticulously determines the staff radiation exposure in a PET/CT facility by tracking the path of patient movement. The measurements of the instantaneous radiation exposure were performed using an electronic radiometer with a proportional counter that was equipped with the option of recording the results on line. The measurements allowed for visualisation of the staff's instantaneous exposure caused by a patient walking through the department after the administration of 18F-FDG. An estimation of low doses associated with each working step and the exposure during a routine day in the department was possible. The measurements were completed by determining the average radiation level using highly sensitive thermoluminescent detectors.

Serum neutrophil gelatinase-associated lipocalin (NGAL) correlates with clinical and endoscopic activity in ulcerative colitis but fails to predict activity in Crohn's disease.

Serum neutrophil gelatinase-associated lipocalin (NGAL) is a low molecular weight protein released from activated neutrophils and intestine epithelium whose mRNA expression is increased in inflamed intestinal tissue. The purpose of this study was to explore the relationship between serum NGAL level and activity of inflammatory bowel diseases. A total of 120 patients, 79 with Crohn's disease (CD) and 41 with ulcerative colitis (UC) were prospectively included into the study. Serum NGAL was measured by ELISA. The inflammatory activity of UC was assessed by Mayo score and of CD by CDAI and SES-CD scoring systems. Increasing endoscopic severity of UC from remission/mild to moderate/severe was associated with increasing NGAL levels from 46.9 to 66.4 ng/ml (P = 0.002). NGAL concentrations were significantly lower in patients with complete endoscopic and histologic remission than in the active UC (46.9 versus 66.4 ng/ml, P = 0.009). Also deterioration of the clinical activity of UC patients was associated with increasing level of NGAL from 44.9 in remission/mild to 68.0 ng/ml in moderate/severe grade (P = 0.002). NGAL levels correlated with CRP (r = 0.49), ESR (r = 0.48) and iron concentrations (r = -0.63), but not with faecal calprotectin. NGAL showed ability to distinguish endoscopically active from inactive UC with AUC-ROC of 0.758 (sensitivity 96% and specificity 54%). However NGAL levels showed no significant relationship with either clinical or endoscopic activity of CD. We conclude that serum NGAL level corresponds to clinical and endoscopic activity of UC and accurately predicts disease endoscopic remission.

Differentiation of pancreatobiliary cancer from benign biliary strictures using neutrophil gelatinase-associated lipocalin.

Aim of the study was to investigate the value of serum and bile neutrophil gelatinase-associated lipocalin (NGAL) for distinguishing malignant strictures caused by cholangiocarcinoma (CCA) or pancreatic cancer from benign biliary strictures. The study was performed prospectively on patients admitted for endoscopic or radiologic biliary decompression. Forty patients with dilated biliary ducts, including 16 cases of CCA, 6 cases of pancreatic cancer, and 18 cases of benign biliary stricture were enrolled. Their sera and bile were collected to measure NGAL. Routine biochemistry including measurement of serum levels of carbohydrate antigens (CA) 19-9 and carcinoembryonic antigen (CEA) was also performed. The serum CA19-9, serum CEA, and bile NGAL levels were significantly increased in patients with malignant strictures as compared with patients with benign biliary diseases. Serum NGAL had no significant value for discriminating between malignant and benign biliary strictures. Bile NGAL levels had a receiver characteristic area under the curve of 0.74, sensitivity 77.3, and specificity 72.2% for discriminating between pancreatobiliary cancer and benign biliary diseases. Bile NGAL and serum CA19-9 were independent parameters and their combined use improved diagnostic accuracy (sensitivity 91%, negative predictive value 85.7%). We conclude that measurement of biliary, but not serum NGAL, may differentiate malignant pancreatobiliary from benign biliary strictures, serving as a complementary biomarker for serum CA19-9.

Antimicrobial and anti-biofilm properties of new taxodione derivative from hairy roots of Salvia austriaca.

The aim of the present report was to evaluate antimicrobial/anti-biofilm activity of 7-(2-oxohexyl)-taxodione, a novel taxodione derivative isolated from n-hexane extract of Salvia austriaca hairy roots. Antimicrobial assays showed that 7-(2-oxohexyl)-taxodione was at least 4 times more active than taxodione against methicillin-susceptible as well against methicillin-resistant staphylococci with MIC of 1.25-2.5 µgml(-1). This compound was less active against vancomycin-resistant enterococci (VRE), on the same level as taxodione (MIC ranged 10.0-20.0 µgml(-1)). The presence of 7-(2-oxohexyl)-taxodione in the culture medium (at MIC, ½ MIC or » MIC) decreased adhesion of staphylococci to abiotic surfaces, which in turn caused a reduction in biofilm formation during 24h, by approximately 25-30%. Also, the extent of established biofilm eradication was found to be significant, although it required an increased concentration of the compound. This is the first report on the antimicrobial activity of this, up to now not known compound, isolated from transformed roots of S. austriaca.

A prospective, randomized, placebo-controlled trial of prednisone and allopurinol in the prevention of ERCP-induced pancreatitis.

BACKGROUND AND STUDY AIMS: Acute pancreatitis is the most frequent and difficult-to-avoid complication of endoscopic retrograde cholangiopancreatography (ERCP). Corticosteroids, potent anti-inflammatory drugs, and allopurinol--a xanthine oxidase inhibitor that blocks the generation of oxygen-derived free radicals--may be potentially effective in preventing post-ERCP pancreatitis. The aim of this prospective study was to determine the effect of prophylactic oral corticosteroids and allopurinol on the incidence and severity of procedure-induced pancreatitis. PATIENTS AND METHODS: 300 patients were randomly assigned to receive oral prednisone (40 mg), allopurinol (200 mg), or placebo 15 h and 3 h prior to ERCP. The diagnosis and grading of ERCP complications were based on commonly accepted criteria. Patients receiving prednisone or allopurinol were compared with the placebo group in a search for differences in pancreatitis rates associated with endoscopic techniques. RESULTS: The overall incidence of pancreatitis was 10.7 %, with 12 % in the prednisone group, 12.1 % in the allopurinol group, and 7.9 % in the placebo group. There were no statistical differences in the incidence or distribution of severity grades between the groups, although severe pancreatitis occurred only in the prednisone and allopurinol groups. Multiple cannulations and prolonged manipulations of the papilla of Vater were identified as risk factors for ERCP-induced pancreatitis. CONCLUSIONS: Neither prednisone nor allopurinol showed a beneficial influence on the incidence and severity of post-ERCP pancreatitis.

Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.G.E.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy.

There are two situations when antibiotic prophylaxis is recommended. The first is associated with procedures known to be followed by high rates of bacteraemia, involving organisms prone to cause endocarditis. These include oesophageal dilatation, variceal sclerotherapy and laser therapy in the upper gastrointestinal tract. As bacteraemia following these procedures is usually harmless in average risk patients antibiotic prophylaxis is recommended only for a patient with a lesion susceptible to endocarditis or one who is at increased risk of symptomatic bacteraemia due to neutropenia or immunosuppression. In most cases parenteral amoxycillin and gentamicin is recommended plus metronidazole for neutropenic patients. Vancomycin or teicoplanin replace amoxycillin in a case of allergy. The second situation concerns procedures with a high incidence of local infection or which may lead to serious sepsis. These include therapeutic retrograde cholangiopancratography and percutaneous endoscopic gastrostomy where antibiotic prophylaxis is recommended even in average risk patients. Several antibiotics are recommended including oral ciprofloxacin or parenteral gentamicin or quinolone for ERCP and amoxycillin for PEG or cephalosporin or ureidopenicillin for both.