Probiotic supplements might not be universally-effective and safe: A review.

Last few decades have witnessed the unprecedented growth in the application of probiotics for promoting the general gut health as well as their inception as biotherapeutics to alleviate certain clinical disorders related to dysbiosis. While numerous studies have substantiated the health-restoring potentials for a restricted group of microbial species, the marketed extrapolation of a similar probiotic label to a large number of partially characterized microbial formulations seems biased. In particular, the individuals under neonatal stages and/or those with some clinical conditions including malignancies, leaky gut, diabetes mellitus, and post-organ transplant convalescence likely fail to reap the benefits of probiotics. Further exacerbating the conditions, some probiotic strains might take advantage of the weak immunity in these vulnerable groups and turn into opportunistic pathogens engendering life-threatening pneumonia, endocarditis, and sepsis. Moreover, the unregulated and rampant use of probiotics potentially carry the risk of plasmid-mediated antibiotic resistance transfer to the gut infectious pathogens. In this review, we discuss the safety perspectives of probiotics and their therapeutic interventions in certain at-risk population groups. The embodied arguments and hypotheses certainly will shed light on the fact why probiotic usage should be treated with caution.

[Early cardiotoxicity of Hydroxychloroquine]. / Cardiotoxicité précoce de l'hydroxychloroquine.

INTRODUCTION: Hydroxychloroquine (HCQ) is most frequently used in the treatment of systemic inflammatory diseases. Cardiac complications of anti-malarial drugs are uncommon, and most of the time are the result of a long-term exposition. In this case, cardiotoxicity is the consequence of the lysosomal dysfunction and the result of intracytoplasmic granular material inclusions. CASE REPORT: We report a 77-year-old woman who presented a very early and reversible cardiotoxicity, probably related to the quinidine like effect of the HCQ, 10 days after initiation of therapy for Whipple endocarditis. CONCLUSION: We discuss the different mechanisms of cardiotoxicity of anti-malarial drugs and their clinical manifestations.

Cardiac infection and sepsis in 3 intravenous bath salts drug users.

The street drug "bath salts" are psychoactive mixtures of cathinone derivatives. We report 3 cases of disseminated Staphylococcus aureus infection with cardiac involvement (2 endocarditis and 1 pericarditis), secondary to intravenous bath salts use.

Infective endocarditis secondary to intravenous Subutex abuse.

INTRODUCTION: Subutex (buprenophine) was approved by the Health Science Authority of Singapore for heroin detoxification in 2002. The number of heroin addicts has decreased in Singapore since the introduction of Subutex. However, Subutex abuse and its associated complications became arising medical problems. We report the management of a series of infective endocarditis cases secondary to Subutex abuse. METHODS: We identified 12 cases of infective endocarditis in former heroin addicts treated with Subutex from August 2005 to April 2006. All patients were interviewed by the research coordinator and prospectively followed-up for two years. RESULTS: The treatment period of Subutex endocarditis was often prolonged with a mean hospitalisation stay of 48 days, with 3.8 days in the intensive care unit. Multiple medical complications were noted. Staphylococcus aureus septicaemia accounted for 92 percent of cases. Mortality rate was 42 percent. Failure rate of medical therapy alone was common. 25 percent underwent open heart valve surgery. All patients were subsidised. Mean hospitalisation expenses was S$31,218. CONCLUSION: Subutex endocarditis causes significant morbidity and mortality. It imposes a heavy medical and financial burden to the patient and society. Multidisciplinary treatment involving cardiologists, infectious disease physicians, psychiatrists, surgeons, medical counsellors and social workers is required to manage these patients.

[Infectious complications and misuse of high-dose buprenorphine]. / Complications infectieuses et mésusage de la buprénorphine à haut dosage.

BACKGROUND: High-dose buprenorphine (HDB) treatment began in France in 1996 according to relatively unrestricted prescription rules. Continued heroin injection by patients on HDB maintenance treatment and even HDB injection remain underestimated and may lead to a variety of infectious diseases. OBJECTIVES: Description of infectious complications occurring in patients receiving HDB maintenance treatment. METHODS: Retrospective study of drug addicts receiving HDB maintenance treatment, injecting (or highly suspected of injecting) it, and hospitalized for infections (other than HIV or viral hepatitis) in the department of infectious and tropical diseases in Nancy University Hospital. Data collection covered 1998 through 2003. RESULTS: We identified 21 case reports, 9 concerning infectious endocarditis, 8 cutaneous abscesses, 2 osteoarticular infections, 1 meningitis and 1 Candida retinitis. The sex-ratio was of 1 woman for 2 men, and the patients' mean age was 29.8 years. Globally 13 patients had systemic infections. Nine patients admitted having injected HDB (and no other drugs) (including the case of Candida retinitis), while in the other 12 cases, the patients continued injecting heroin as well. The role of misused HDB was strongly suspected in those 12 infections, but was not clearly confirmed. All patients recovered from the infections. The long-term psychosocial outcome remains unknown. CONCLUSION: The cases analyzed illustrate the dual reality that HDB is often ineffective as a maintenance treatment, since some patients continue to inject heroin, and that its misuse can have infectious consequences. The results of HDB maintenance treatment substitution are mixed. The individual benefit/risk ratio must be improved. Networking is crucial, notably between physician and pharmacist, and the monitoring system must be reinforced.

Quantification of left ventricular dimensions on line with biplane transesophageal echocardiography and lateral gain compensation.

To determine the feasibility and accuracy of biplane transesophageal echocardiography (TEE) with automatic boundary detection (ABD) for the estimation of left ventricular areas, we examined 19 consecutive patients with the use of this technique. In addition, we evaluated the utility of lateral gain compensation (LGC) to improve the online tracking of the ABD algorithm on the lateral endocardial-blood boundary of the echocardiographic image. The transverse plane short-axis TEE view and the longitudinal plane two chamber TEE view were used for the analysis. A semiquantitative estimate (in degrees) of the endocardial circumference, in which the boundary was correctly identified and tracked on line, improved from a mean of 198 degrees to 360 degrees with LGC (P less than 0.001). Results of comparisons of offline and online biplane TEE cavity areas revealed excellent correlations of values for the 16 patients (84%) in whom adequate transverse plane short-axis images were obtained (r values greater than 0.9 at systole and diastole). The correlation was also excellent (r values greater than 0.9) in the nine patients in whom longitudinal plane two-chamber views adequate for ABD analysis were obtained at systole and diastole. LGC significantly improved the accuracy of endocardial detection and tracking, which otherwise would be limited due to the anisotropic properties of the myocardium. Thus, ABD during biplane TEE may be feasible in a significant number of patients and accurately reflects left ventricular areas when compared with offline methods.

[Course of bacterial infections in high-dose therapy with clozapine]. / Verlauf bakterieller Infektionen während hochdosieter Therapie mit Clozapin.

The influence of neuroleptic drugs on body temperature regulation is well established. Even with atypical neuroleptic drugs such as clozapine, hyperthermia has been observed as well as the malignant neuroleptic syndrome. It is likely that the influence of clozapine affects the immune response. A case is reported in which afebrile angina tonsillaris and endocarditis developed, as a result of high-dosage therapy with clozapine over several years. Besides the special features of the course, differential diagnosis, therapy and possible influence on the body temperature and the immune response are discussed.

[Neurologic complications of cocaine abuse]. / Accidents neurologiques liés à l'usage de la cocaïne.

Cocaine is increasingly used by drug addicts. It is considered harmless, but numerous, varied and often serious complications due to its abuse have been published. Among these, neurological complications are in the forefront. They include generalized or partial epileptic seizures, ischaemic or haemorrhagic cerebral vascular accidents, visual loss caused by optic neuropathy or by retinal artery occlusion, headaches and exacerbation of tics. Infections of the central nervous system are possible via endocarditis or septicaemia of venous or nasal origin. Neurological disorders may also occur as a consequence of a major cardiovascular complication induced by cocaine (myocardial infarction and/or dysrhythmia, aortic dissection). These neurological complications are unpredictable, and they weigh heavily on the functional and sometimes vital prognosis in habitual or occasional cocaine abusers.

Neurological complications of drug abuse.

Widespread drug abuse, a comparatively recent medicosocial phenomenon, presents protean clinical patterns and challenging diagnostic problems daily that mimic classical medical syndromes. However, few reports have delineated predominantly neurologic syndromes associated with drug abuse. Five patients were observed illustrating the critical importance of considering drug abuse in the differential diagnosis of neurologic disease, particularly in the young population. It has been found that attention directed to four sources of information will substantiate the diagnosis of drug abuse in the large majority, thus expenditing the prompt initiation of appropriately directed treatment. In addition careful history and neurologic examination, a routine screeen of blood and urine should be run for barbiturates, bromides, alcohol and salicylates. An electroencephalogram is highly recommended as an initial study. It is informative, non-traumatic and inexpensive. Low voltage fast activity is consistent with drug effect and usually rules out other metabolic causes of coma. Other diagnostic principles are enumerated and illustrative cases are cited.