In vitro antibacterial activity of bioactive glass S53P4 on multiresistant pathogens causing osteomyelitis and prosthetic joint infection.

BACKGROUND: Conventional local treatment for medullary osteomyelitis (OM) includes insertion of antibiotic-loaded polymethylmethacrylate (PMMA) cement. Nevertheless, PMMA may delivery irregular concentration of antibiotic to surrounding tissue. We aimed to compare the in vitro antibacterial activity of Bioactive Glass (BAG) S53P4, which is a compound showing local antibacterial activity, to that of antibiotic-loaded PMMA against multidrug resistant bacteria from OM isolates. METHODS: We studied convenience samples of multidrug resistant (MDR) microorganisms obtained from patients presenting OM and prosthetic joint infection (PJI). Mixtures containing tryptic soy broth (TSB) and inert glass beads (2 mm), BAG-S53P4 granules (0.5-0.8 mm and < 45 mm) and Gentamicin or Vancomycin-loaded PMMA beads were inoculated with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MR-CoNS), Pseudomonas aeruginosa or Klebsiella pneumoniae isolates. Glass beads (2.0 mm) were used as a control. Antibacterial activity was evaluated by means of time-kill curve, through seeding the strains on blood agar plates, and subsequently performing colony counts after 24, 48, 72, 96, 120 and 168 h of incubation. Differences between groups were evaluated by means of two-way analysis of variance (ANOVA) and Bonferroni's t test. RESULTS: Inhibition of bacterial growth started soon after 48 h of incubation, reached zero CFU/ml between 120 and 168 h of incubation for both antibiotic-loaded PMMA and BAG S53P4 groups, in comparison with inert glass (p < 0.05). No difference regarding time-kill curves between antibiotic-loaded PMMA and BAG S53P4 was observed. CONCLUSIONS: BAG S53P4 presented antibacterial properties as much as antibiotic-loaded PMMA for MDR bacteria producing OM and PJI.

Validation of an Equation Model to Predict Intracranial Pressure in Clinical Studies.

Objective: There has been an interest regarding the possible role intracranial pressure (ICP) plays in the pathogenesis of the glaucoma optic neuropathy. A major impediment to the understanding of the possible role of ICP on glaucoma is the reliance on alternative noninvasive methods to measure the ICP. A formula was developed to estimate the ICP for the Chinese population. This was cross-sectional, observational study aimed to compare the predicted ICP with the real ICP measured with an aneroid manometer through lumbar puncture in a cohort of 39 subjects. Main points of discussion: The Bland-Altman plot of the differences between the two techniques against their averages revealed that most data points were sited between the two limits of agreement. Conclusion: The results of this study favor the use of the equation as a proxy method to predict ICP and it could be used in clinical studies.

Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients

Abstract Objectives To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. Methods Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. Results Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p = 0.996), and fungi (p = 0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. Conclusions Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.

Microbial investigation of biofilms recovered from endotracheal tubes using sonication in intensive care unit pediatric patients.

OBJECTIVES: To compare cultured microorganisms identified on endotracheal tubes biofilms through sonication technique with traditional tracheal aspirate collected at extubation of pediatric intensive care unit patients. METHODS: Demographic and epidemiological data were analyzed to identify factors possibly related with the microbiological profile of the two collection methods. Associations between categorical and continuous variables were analyzed using the chi-square or Fisher's exact test, or Student's t test. p-Value <0.05 were considered significant. RESULTS: Thirty endotracheal tubes and tracheal aspirates samples from 27 subjects were analyzed. Only one patient presented the clinical diagnosis of ventilator-associated pneumonia. Overall, 50% of bacteria were Gram-negative bacilli, followed by Gram-positive bacteria in 37%, and fungi in 10%. No statistically significant difference on the distribution of Gram-positive or Gram-negative bacteria (p=0.996), and fungi (p=0.985) were observed between the collection methods. Pseudomonas spp. was the most frequent microorganism identified (23.8%), followed by Streptococcus spp. (18.5%), Acinetobacter spp. (15.9%), coagulase-negative staphylococci (11.2%), and Klebsiella spp. (8.6%). Concordant results between methods amounted to 83.3%. Pseudomonas aeruginosa and Acinetobacter baumannii showed carbapenem resistance in 50% and 43.7% of the isolates, respectively. In general, cultures after endotracheal tubes sonication (non-centrifuged sonication fluid and centrifuged sonication fluid) yielded bacteria with higher rates of antimicrobial resistance compared to tracheal aspirates cultures. Additionally, in 12 subjects (40%), we observed discrepancies regarding microbiologic profiles of cultures performed using the collection methods. CONCLUSIONS: Our study demonstrated that sonication technique can be applied to ET biofilms to identify microorganisms attached to their surface with a great variety of species identified. However, we did not find significant differences in comparison with the traditional tracheal aspirate culture approach.

Concentration of Sonication Fluid through Centrifugation Is Superior to Membrane Filtration for Microbial Diagnosis of Orthopedic Implant-Associated Infection.

Microbial identification of orthopedic implant-associated infections using sonication fluid (SF) submitted to a concentration step by membrane filtration (SMF) was compared with the standard centrifugation (SC) method. Among 33 retrieved infected implants, sonication identified microorganisms in 26 (78.8%). The sensitivity of SC was higher than that of SMF (78.8% versus 30.3%; P < 0.001).

Microbial diagnosis of infection and colonization of cardiac implantable electronic devices by use of sonication.

OBJECTIVES: The clinical utility of sonication as an adjunctive diagnostic tool for the microbial diagnosis of cardiac implantable device-associated infections (CIDAIs) was investigated. METHODS: The implants of 83 subjects were investigated, 15 with a CIDAI and 68 without a clinical infection. Clinical data were analyzed prospectively and sonication fluid cultures (83 patients, 100%) and traditional cultures (31 patients, 37.4%) were performed RESULTS: Generator pocket infection and device-related endocarditis were found in 13 (86.7%) and four (26.7%) subjects, respectively. The mean numbers of previous technical complications and infections were higher in the infected patients compared to the non-infected patients (8 vs. 1, p<0.001; 2 vs. 0, p<0.031, respectively). The sensitivity and specificity for detecting CIDAI was 73.3% (11/15) and 48.5% (33/68) for sonication fluid culture, and 26.7% (4/15) and 100% (16/16) for traditional culture (p<0.001), respectively. A higher number of organisms were identified by sonication fluid than by tissue culture (58 vs. 4 specimens; p<0.001). The most frequent organisms cultured were Gram-positive cocci (66.1%), mainly coagulase-negative staphylococci (35.5%). Thirty-five (51.5%) non-infected subjects were considered colonized due to the positive identification of organisms exclusively through sonication fluid culture. CONCLUSIONS: Sonication fluid culture from the removed cardiac implants has the potential to improve the microbiological diagnosis of CIDAIs.

Improved diagnosis of infection associated with osteosynthesis by use of sonication of fracture fixation implants.

Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diagnosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared sonication fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n = 156), spinal implants (n = 26), and intramedullary nails (n = 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respectively. The sensitivity for detecting OAI was 90.4% for sonication fluid culture and 56.8% for periprosthetic tissue cultures (P < 0.05), and the specificities were 90.9% and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-implant tissue culture (113 versus 71; P < 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8% and 8% (P < 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibiotics, the identification of the organisms occurred in 38.5% and 82.1% of the tissue and sonication fluid cultures, respectively (P < 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI.

Uso da EDTACaNa2 por via intramuscular no tratamento por intoxicação por chumbo: a propósoto de um caso clinico / Use EDTACaNa2 intramusculary in the treatment of lead poisoning: a report of a clinical case

This essay aims at evaluating the amount of lead excreted in urine right after taking the chelating calcium disodium salt of ethylenediaminetetracetic acid (EDTACaNa2) IM. EDTACaNa2 was absorbed by an worker chronically intoxicated by lead. The dose was 300mg daily for three days, IM. During the in- patient treatment there lead was dosed in blood (Pb-S), in urine (Pb-U) and urinary d -aminolevulinic (ALA-U). No side effects of the drug were observed. The therapy diminished 26 per cent Pb-S concentration. The serial evaluation of Pb-U excretion showed a meaningful increase after the first dose; its peak occurred 9 hours after it was taken and this increase persisted in the following days, while the drug was maintained, but in a lower proportion. The ALA-U value did not alter during the treatment. In this case the use of the chelating EDTACaNa2, IM, was effective and safe to treat lead poisoning. To control the effectiveness of the chelating course of treatment and the eventual necessity of another cycle of chelating therapy, the Pb-U dosing must be carried out in the urine collected up to 12 hours after the drug is taken via IM.

O objetivo deste estudo é avaliar a concentração de chumbo excretado na urina nas horas subseqüentes à administração do quelante etilenodiaminotetracetato cálcico dissódico (EDTACaNa2) por via intramuscular (IM). Foi administrado EDTACaNa2 em um trabalhador com intoxicação crônica por chumbo. A dose aplicada foi de 300mg/dia, por 3 dias consecutivos, via IM. Durante o tratamento, realizado em regime hospitalar, foram dosados chumbo no sangue (Pb-S), chumbo na urina (Pb-U) e ácido delta aminolevulínico na urina (ALA-U). Não foram observados efeitos adversos da droga. A terapia diminuiu em 26 por cento a concentração de Pb-S. A avaliação seriada da excreção de Pb-U mostrou um aumento significativo após a primeira dose da medicação, tendo seu pico após 9 horas da sua administração; este aumento persistiu nos dias subsequentes,enquanto se mantinha a medicação, mas em menor proporção. O valor de ALA-U não teve alterações durante o tratamento. O uso do quelante EDTACaNa2 via IM, mostrou-se eficaze seguro para o tratamento de saturnismo neste caso. Para controle da efetividade da sua administração e da eventual necessidade de outro ciclo de terapia quelante, a dosagem de Pb-U deverá ser realizada na urina coletada até no mínimo 12 horas após a administração da droga via IM.

Antibiotic resistance patterns of pediatric community-acquired urinary infections.

Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77%. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55% and 51%). The antibiotic resistance rates for E. coli were: nitrofurantoin (6%), nalidixic acid (14%), 1st generation cephalosporin (13%), 3rd generation cephalosporins (5%), aminoglycosides (2%), norfloxacin (9%) and ciprofloxacin (4%). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population.

Antibiotic resistance patterns of pediatric community-acquired urinary infections

Knowledge about antimicrobial resistance patterns of the etiological agents of urinary tract infections (UTIs) is essential for appropriate therapy. Urinary isolates from symptomatic UTI cases attended at Santa Casa University Hospital of São Paulo from August 1986 to December 1989 and August 2004 to December 2005 were identified by conventional methods. Antimicrobial resistance testing was performed by Kirby Bauer's disc diffusion method. Among the 257 children, E. coli was found in 77 percent. A high prevalence of resistance was observed against ampicillin and TMP/SMX (55 percent and 51 percent). The antibiotic resistance rates for E. coli were: nitrofurantoin (6 percent), nalidixic acid (14 percent), 1st generation cephalosporin (13 percent), 3rd generation cephalosporins (5 percent), aminoglycosides (2 percent), norfloxacin (9 percent) and ciprofloxacin (4 percent). We found that E. coli was the predominant bacterial pathogen of community-acquired UTIs. We also detected increasing resistance to TMP/SMX among UTI pathogens in this population.

Açäo da colchicina na fibrose hepática: estudo experimental em camundongos esquistossomóticos / Action of colchicine in hepatic fibrosis: an experimental study in schistosomic mice

Os autores estudam a açäo da colchicina sobre a fibrogênese hepática em camundongos esquistossomóticos e verificam, através da microscopia óptica e de polarizaçäo, evidente reduçäo da mesma nos camundongos tratados com esse alcalóide

Schwannoma gástrico gigante: apresentaçäo de um caso / Giont gastric chwannoma: a case report

Os AA apresentam um caso raro de schwannoma gástrico gigante, fazendo uma revisäo da literatura e tecendo comentários sobre a conduta cirúrgica e os aspectos anatomopatológicos

Avaliaçäo da imunidade celular e aspectos anatomopatológicos em portadores de esquistossomose mansônica / Evaluation of cellular immunity and anatomo-pathological aspects in schistosomiasis mansoni patients

Estudaram-se 98 pacientes portadores de esquistossomose mansônica quanto a aspectos imunológicos e anatomopatológicos. De 67 pacientes com a forma hepatointestinal, 46% apresentaram biópsias hepáticas normais, 25% com aspectos sugestivos de esquistossomose e 33% com achados inespecíficos. Em 31 pacientes com a forma hepatosplênica encontraram-se granulomas esquistossomóticos em 32%. A hepatite crônica ativa foi somente encontrada nesse grupo, em 6% dos doentes. Na forma HE foi maior a incidência de respostas negativas aos antígenos cutâneos de hipersensibilidade tardia (intradérmicos e sensibilizados de contato). Contudo, a avaliaçäo por estímulo de linfócitos in vitro com PHA näo mostrou diferença entre os dois grupos de pacientes

Distribuiçäo do colágeno I e III nas pancreatites crônicas alcoólicas e näo alcoólicas pelo método picro sirius polarizaçäo / Distribution of collagen I and III in alcoholic and non-alcoholic chronic pancreatitis by the picro sirius polarizations method

Estuda-se a distribuiçäo dos colágenos I e III nas pancreatites crônicas alcoólicas e näo alcoólicas utilizando o método picro sirius polarizaçäo, notando-se em ambas o predomínio das fibras tipo I sobre as do tipo III com aspectos característicos (densas e fragmentadas) e invadindo a regiäo intralobular. Um elemento característico das pancreatites crônicas alcoólicas é o aumento relativo das fibras do tipo III intralobular

Leiomioma gástrico gigante / Giant gastric leiomyoma

Descreve-se um caso de leiomioma gástrica de grandes dimensöes (14 x 16cm) cuja sintomatologia era dor epigástrica e no hipocôndrio direito. A massa tumoral deslocava a vesícula biliar, fato evidenciado pelo colecistograma e era extrínseca ao estômago, como evidenciou a ultra-sonografia. É destacada a raridade de um leiomioma gástrico dessas dimensöes e descrita tanto a conduta como os aspectos anatomopatológicos