Cilostazol reduces dry eye symptoms and improve walking distance in patients with peripheral artery disease.

AIM OF THE STUDY: Cilostazol is a phosphodiesterase III inhibitor that has anti-inflammatory and immunomodulatory effects and can act with beneficial effect in Dry Eye Syndrome (DES). This clinical trial evaluates the effects of cilostazol on the tear film. MATERIALS AND METHODS: Following the run-in period, subjects were randomly into two groups: 40 subjects treated with cilostazol and 40 no-treated subjects. The Walking Impairment Questionnaire (WIQ) has been administered to all patients. RESULT: The data obtained from comparison of the two study groups A and B were, respectively, the following: Schirmer I: 10.2±0.2 Vs 13.8±0.4 (p< 0.001); Schirmer II: 3.8±0.1 Vs 4.6±0.2 (p<0.001); Break-up time (BUT) 4.2±0.3 Vs 6.5±0.2 (p<0.001) with disappearing of symptoms. The WIQ showed a significant difference in the walking distance (p<0.05) and calf pain severity (p<0.005) of treated patients. In comparison with the placebo group, treated patients showed an improvement (p<0.03) in calf pain severity. CONCLUSION: The administration of cilostazol was effective, in reducing DES and improve walking distance questionnaire.

Etiology of chronic skin lesions in subjects with peripheral arterial disease.

INTRODUCTION: Skin lesions can be defined as lesions that result in loss of tissues and their joints, and often this cutaneous skin process is a primary or secondary consequence of the structural changes in the skin itself. Subjects with peripheral arteripathies that develop chronic skin lesions in the lower extremities of the Western world are constantly increasing. We conducted a study on the etiologic incidence of chronic skin lesions in peripheral arterial disease CSLpa subjects in the lower limbs compared to subjects with chronic skin lesions CSL (controls). MATERIALS AND METHODS: 30 subjects with peripheral atheropathies PA (22 F - 8 M mean age 74,5 ± 4,9) and with chronic skin lesions (CSLpa) in the lower limbs "A" group were admitted to our study according to a randomized and compared to 30 no peripheral atheropathies subjects (19 F-11 M, mean age 81,5 ± 7,3 - controls) group B with chronic skin lesions (CSL). These two groups "A" and "B" have been studied and compared on the basis of infectious etiology responsible for the infectious skin process. RESULTS: In the subjects of the "A" group we found a 12 positive assay of 40.0% of the examinations, while in the group "B" we achieved a total cultured positivity of 9 cases corresponding to 30.0% of the examinations . For the number of bacterial species identified for "A" group we obtained 3 mono microbial and 6 poly microbial bacteriological tests and for group "B" we observed 7 mono microbial and 2 poly microbial tests. All bacteriological isolates showed "in vitro" sensitivity to satisfactory ciprofloxacin with MICs range of 0.78-1.56mg/L. The data observed after 4 weeks after the amniotic membrane (MA) in the two study groups A and B were respectively the following: and for group A 50% scarring, 46.6% partial resolution and in one case worsening for the B-healing group in 63.3%, the partial resolution in the remaining 36.6. CONCLUSIONS: The data from this study show a different etiology between subjects with CSLpa than subjects with CSL. This phenomenon confirms an alteration of the skin microbioma of subjects with peripheral arteriopathy and chronic skin lesions with modification of the opportunistic role of some species of cutaneous bacterial flora.

The mixture of bifidobacterium associated with fructo-oligosaccharides reduces the damage of the ocular surface.

BACKGROUND: Despite its high prevalence Dry Eye Syndrome (DES) in frequently under-recognized owing to its negative influence on patients visual function. METHODS: This clinical trial was a pilot study to evaluate the effects of supplementation with mixture (Bifidobacterium lactis and Bifidobacterium bifido) on the tear film. Following the run-in period subjects were randomized in two groups: group A (N°20 subjects) and group B (N°20 subjects). Group A (control) treated only with substitute tear and group B treated with substitute tear + mixture (symbiotic). RESULTS: The data obtained in the two study groups A and B were, respectively the following: Schirmer 9.1±0.2 vs 12.7±0.4 (p< 0.001); Schirmer II 3.5±0.1 VS 4.7±0.2 (p<0.001); BUT 3.9±0.3 vs 6.3±0.2 (p<0.001). Culture test showed initial bacterial growth in group "A" (placebo) 18 out of 40 samples tested, corresponding to 45.0% and "B" after treatment ((symbiotic) was found positive culture whit growth of bacteria in 12 tests equal to 30.0%. The total numbers of isolations of aerobic and anaerobic bacteria found group A and B after treatment. A reduction of 15 to 11 strains of aerobic and anaerobic isolates from 9 to 5 has been found. CONCLUSIONS: The present study shows that the administration of bifidobacterium may represent a success full treatment in ameliorating dry eye syndrome (DES). The effect of imbalanced microbiota are not restricted by gastrointestinal abnormalities but could have systemic impact on immunity. Commensal bacteria or probiotics interact with the endogenous enteric microbiota and gut cells therein confereing health benefit to the host.

Visual outcome after excimer laser refractive surgery in adult patients with amblyopia.

PURPOSE: To evaluate the visual and refractive outcome in adult patients wi th refractive and anisometropic amblyopia treated with photorefractive keratectomy. METHODS: An interventional non-comparative study was performed on 50 consecutive patients with amblyopia treated with photorefractive keratectomy. Sixty-eight eyes of 18 participants with bilateral refractive amblyopia and 32 participants with unilateral anisometropic amblyopia were studied. The photorefractive keratectomy was performed with MEL 70 G-Scan excimer laser. Follow-up was 1, 3, 6, and 12 months after the treatment. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), refraction, and corneal transparency. RESULTS: In 64.7% of eyes, the UCVA at 12 months after the treatment was better than or equal to their preoperative BCVA. A total of 82.4% of eyes improved their BCVA one or more lines. No eye lost lines of BCVA, 17.6% remained unvaried, 50% gained one line, 20.6 % gained two lines, and 11.8% gained three lines of BCVA. The number of lines gained correlated strongly with diopters of anisometropia between eyes (p<0.01). The mean sphere changed from -5.62+/-3.37 D to -0.47+/-1 D, mean cylinder varied from -2.36+/-1.57 to -0.18+/-0.41 D, and the spherical equivalent varied from -6.82+/-3.1 to -0.45+/-1.08 D. No clinically significant haze was observed. CONCLUSIONS: Excimer laser refractive surgery appears to be a safe and efficient procedure in the treatment of ametropic and anisometropic amblyopia in adults. Adult patients with anisometropic and refractive amblyopia could benefit from the refractive treatment with significant improvement of the visual acuity.

Ciprofloxacin as treatment for conjunctivitis.

The authors studied the bactericidal action and therapeutic effectiveness of ciprofloxacin in treating external ocular infections (bacterial conjunctivitis and bacterial blepharoconjunctivitis). 108 ambulatory patients with clinical signs of conjunctivitis and blepharoconjunctivitis were enrolled in the study. All subjects underwent a conjunctival swab before starting therapy and at 10 days, to identify the causative bacteria and their susceptibility to ciprofloxacin, following routine microbiological methods. The reported therapeutic success rate (95%) and bacteriological analysis confirmed the effectiveness of ciprofloxacin in subjects with bacterial conjunctivitis and bacterial blepharoconjunctivitis. In vitro tests conducted 10 days after treatment confirmed the in vivo therapeutic effectiveness, even for those infections characterized by a difficult etiological identification which interferes with specific antibiotic therapy.

Presurgical antimicrobial prophylaxis: effect on ocular flora in healthy patients.

OBJECTIVE: Evaluation of presurgical antimicrobial prophylaxis for reduction of ocular flora. SETTING: Ophthalmology Section, Department of Medicine and Surgery, University of Catania, Italy. METHODS: Three days before photorefractive keratectomy (PRK), conjunctiva of 70 healthy patients (100 eyes) were swabbed. After 3 days of instillation of ofloxacin 0.3% (3 times daily), conjunctival swabs were taken again. Bacteria were isolated and identified from each swab. RESULTS: A total of 191 independent isolates were obtained prior to antimicrobial treatment. Bacteria were isolated from all 100 eyes sampled. Gram-positive species predominated, with Staphylococcus epidermidis and Staphylococcus aureus cultured from 69% and 25% of eyes sampled, respectively. Species of the anaerobic genera Peptococcus and Peptostreptococcus were found in 22% and 14% of eyes, respectively. After prophylaxis with ofloxacin, bacteria could be cultured from only 7% of eyes (10 independent isolates). All isolates were sensitive to ofloxacin except 5 strains of S. epidermidis, which displayed intermediate sensitivity. No infections occurred after PRK. CONCLUSION: Prophylaxis by instillation of ofloxacin 0.3% 3 times daily for 3 days substantially reduced the ocular flora of 100 healthy eyes prior to refractive surgery.

Effect of aminoglycosides (sub-MICs) on adherence of coagulase-negative Staphylococci to intraocular lens surface.

The authors evaluated the in vitro effects of subinhibitory concentrations (sub-MICs) of aminoglycosides (gentamicin, netilmicin and tobramycin) on the adherence of coagulase-negative staphylococcus to intraocular lens (PMMA, acrylic and heparin) surface. The five strains of coagulase-negative Staphylococcus epidermidis used (S. epidermidis IMe7, IMe11, IMe27, IMe29 and IMe31) were tested for their ability to produce slime. The minimum inhibitory concentrations (MIC) indicated high susceptibility in vitro to the antibiotics and homogeneous values. The adhesion tests without antibiotics (K1, K2 and K3) for every time considered (30 min, 60 min and 180 min) and for all examined strains showed more constant adhesive activity on the surface of acrylic intraocular lens (IOLs) than on the surface of heparin IOLs. The aminoglycosides tested were able to reduce adhesivity by coagulase-negative S. epidermidis slime to the IOL surfaces, even at sub-MICs. The documentation obtained by scanning electron microscope shows the growth of a strain of S. epidermidis IMe11 after 180 minutes of contact which remains adherent to the surface of the acrylic IOLs.

Sub-MIC ciprofloxacin effect on fimbrial production by uropathogenic Escherichia coli strains.

The urine from 210 patients with acute urinary tract infection (UTI) was examined to study the in vitro effect of ciprofloxacin on fimbriae production by uropathogenic Escherichia coli isolates. Forty-nine bacterial samples of density 10(5) CFU/ml were not considered. From the resulting 161 samples, E. coli was the major strain found, present in 54 samples. Other microoganisms found were: Enterococcus sp. (34 samples), Staphylococcus epidermis (22), yeasts (11), Proteus sp. (11), Pseudomonas sp. (11), Klebsiella sp. (8), Enterobacter sp. (6), Citrobacter sp. (3), and Acinetobacter sp. (1). The uropathogenic E. coli strains found were P-fimbriated, as demonstrated by hemoagglutination activity against human erythrocytes with and without mannose, SDS-PAGE of fimbrial proteins and transmission electron microscopy (TEM). All E. coli strains found were exposed in vitro to sub-inhibitory concentrations of ciprofloxacin (1/8 MIC). Our results showed that: 1) P-fimbriated E. coli is the most prevalent microorganism in acute UTI (34%); 2) exposure to sub-MICs of ciprofloxacin inhibits fimbrial production in 79% of E. coli strains; 3) the pattern of SDS-PAGE fimbrial proteins is modified after exposure; in particular, the most affected synthesis involves the protein at 18 kD known as P-fimbriae.

The in vitro activity of trospectomycin against anaerobic bacteria.

The authors evaluated the activity of trospectomycin, a new aminocyclitol which is characterized by good antibacterial and broad spectrum activity, in comparison with clindamycin and ampicillin on a sample of recent isolates: Bacteroides fragilis (15 strains), Bacteroides urealyticus (5 strains), Bacteroides vulgatus (5 strains), Bacteroides spp. (15 strains), Prevotella melaninogenica (6 strains), Porphyromonas asaccharolytica (7 strains), Mobiluncus spp. (3 strains), Peptococcus niger (3 strains), Peptococcus variabilis (9 strains), Peptococcus spp (30 strains), Peptostreptococcus anaerobius (5 strains), Peptostreptococcus asaccharolyticus (3 strains), Peptostreptococcus spp. (25 strains) and Propionibacterium spp. (7 strains). The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were determined for all strains by microtiter serial dilutions in Wilkins-Chalgren broth in an anaerobic chamber in an atmosphere of 10% H2, 10% CO2, 80% N2. All the drugs tested exert their activity against Gram-positive and Gram-negative anaerobic isolates. In particular, trospectomycin is quite active against Gram-positive cocci (MIC 90 = 4 - 8 mg/l), Gram-negative rods (MIC 90 = 8 - 16 mg/l), Gram-positive rods (MIC 90 = 4 mg/l) and Mobiluncus spp. (MIC 90 = 0.5 mg/l).

[A microbiological evaluation of the use of roxithromycin in oral odontogenic infections]. / Valutazione microbiologica dell'uso di roxitromicina in infezioni orali odontogeniche.

Odontogenic infections are the primary infections caused by indigenous oral bacteria, when a factor changes their perfect equilibrium. We studied 30 samples from patients with odontogenic infections that were submitted to therapy with roxithromycin. Our results showed that 79% of aerobic and 71% of anaerobic bacteria, responsible for odontogenic infections, were sensitive to roxithromycin.

Efficacy of azithromycin compared with spiramycin in the treatment of odontogenic infections.

Sixty patients with acute odontogenic infections were randomly allocated to oral treatment with azithromycin 500 mg/day once-daily for three days (n = 30) or spiramycin 3,000,000 units three-times daily for seven days (n = 30). Baseline and post-treatment oral specimens were collected from patients to test for pathogenic bacteria. Aerobic bacteria were tested using the Kirby-Bauer disc diffusion method, and anaerobic bacteria with a broth microdilution method, for their susceptibility to azithromycin and spiramycin. A greater incidence of resistance was found in the spiramycin group than in the azithromycin group. The bacteriological assessment showed that the normal balance of microflora was re-established in 67% of patients treated with azithromycin vs 53% in the group treated with spiramycin. Clinical cure was higher in the azithromycin treatment group (97%) compared with the spiramycin group (73%). These results indicate that three-day azithromycin, possibly because of its unusual pharmacokinetics, is more effective than seven-day spiramycin in the treatment of odontogenic infections.

[The effect of Lactobacillus acidophilus and Bifidobacterium bifidum on the intestinal ecosystem of the elderly patient]. / Lactobacillus acidophilus e Bifidobacterium bifidum sull'ecosistema intestinale dell'anziano.

The authors have tested the therapeutic efficacy of a multibacterial combination consisting of Lactobacillus acidophilus (10(9)) and Bifidobacterium bifidum (10(9)) in elderly patients with bowel disorders. Bacteriological and histopathologic investigation showed this combination to yield excellent biologic results with restoration of duodenal bacterial flora and subsidence of clinical symptoms. The function of the muciparous glands was restored and the duodenal mucosa was normalized.

Increased rate of survival in Streptococcus pneumoniae-infected rats treated with the new immunomodulator Pidotimod.

Wistar rats infected with Streptococcus pneumoniae (type III ATCC) rapidly develop an acute form of experimental lobar pneumonia (ELP) with death of 80-90% of the animals by 6 days after the infection. Prophylactic treatment of these animals with the novel immunomodulator Pidotimod, at the dose of 25 mg/kg bw, significantly increased their rate of survival as compared to the control group (50 vs. 90% respectively). Recovery from the infection appeared definitive since all the Pidotimod-treated survivors were alive and in good condition at the end of the observation period (45 days post infection). Prophylactic treatment with higher or lower doses of the drug was ineffective. Therapy with Pidotimod was not effective. This preliminary study suggests that Pidotimod may have contributed to activation of specific and non-specific immune effectors involved in the host response to S. pneumoniae infection.

[Adhesion capacity of Enterococcus faecium (SF 68) and Enterococcus faecalis to various substrates]. / Capacità aderente di Enterococcus faecium (SF 68) e di Enterococcus faecalis a diversi substrati.

The author's studied the adherence ability of Enterococcus faecium SF 68 compared to that of Enterococcus faecalis IM 11f, on various substrates: vascular catheters and cardiac valves of rabbit, immunodepressed rats and diabetic rats. The bacterial adherence test was calculated by the number of bacteria adhered for microscopic field enlarged to 2000. The data obtained by scanning electron microscope SEM (Cambridge Stereoscan 150 MK2) revealed a different adherence action of the two germs on the various substrates. All the adherence tests showed a higher and uniform adherence activity of E. faecalis compared to that of E. faecium.

[Study on the activity of a therapeutic bacterial combination in intestinal motility disorders in the aged]. / Studio sull'attività di un'associazione batterioterapica nei disturbi dell'alvo dell'anziano.

The possible beneficial effects and changes in the histology of the duodenojejunal and colonic mucosa brought about by oral bacterial therapy were studied in 60 elderly patients (mean age +/- SD: 76.6 +/- 5.3 years) with bowel disorders mainly represented by diarrhea accompanied by abdominal pain and meteorism. All patients were submitted to a 7-day washout followed by treatment with 6 capsules daily, each capsule containing live, lyophilized Lactobacillus acidophilus (10(9) CFU/ml). The clinical course was observed in 50 patients while the remaining 10 were hospitalized and submitted to esophago-gastro-duodenoscopy and colonoscopy both before and after treatment for withdrawal of duodenal secretion and fragments of duodenojejunal and colonic mucosa biopsies. Duodenal secretion was examined bacteriologically, and after treatment an increase of the anaerobic flora at the expense of the aerobic one was found together with improved quality of the former. Histologic examination showed reduction of the inflammatory infiltration by lymphocytes and plasma cells and increased muciparous activity of the glands. Clinically, a marked improvement of the symptoms was observed in all 60 patients.

[The interference of miocamycin on the adhesiveness and coaggregation of the bacteria responsible for periodontopathies]. / Interferenza di miocamicina sull'adesività e sulla coaggregazione di germi responsabili di parodontopatie.

The authors studied the effect miocamycin has on the adherence and coaggregation of pathogenic bacteria in periodontopathy. The data obtained by optic microscopy, after treatment of the strains with doses of miocamycin equal to 1/4 and 1/8 of the MIC after 3 and 6 hours, shows the interference effect on the coaggregation and adhesivity of the antibiotic. These results have been confirmed by the observations obtained by scanning electron microscope (SEM).

In vitro activity against aerobes and anaerobes of trospectomycin versus spectinomycin.

The general antibacterial properties of trospectomycin (TRO) were compared with those of spectinomycin (SPEC) in an in vitro study using a collection of recent clinical isolates: 50 Gram-positive and 25 Gram-negative aerobes and 30 Gram-positive and 15 Gram-negative anaerobes. Minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) were determined for all strains by microtitre using serial dilutions in Mueller-Hinton broth for aerobes and Brucella broth for anaerobes. The final inoculum in each well was 10(5) cfu/ml. This study shows that none of the Gram-negative organisms was sensitive to TRO; the most sensitive were streptococci aerobic strains; TRO exhibited antibiotic activity against all anaerobes tested, which was not seen with SPEC, and also exhibited bactericidal activity. The MICs of Staphylococcus epidermidis and Bacteroides fragilis tested with TRO and SPEC were not significantly affected by the size of bacterial inoculum tested, and the nature of the growth medium did not alter the susceptibility tests.

Effect of ampicillin and sulbactam/ampicillin on the immune system.

An investigation was carried out into the possible effects of ampicillin and a sulbactam/ampicillin combination on the immune system of healthy subjects. The following immunological variables were compared before and after antibiotic therapy: proliferation response of peripheral mononuclear cells to phytohaemagglutinin; variation of T- and B-lymphocytes; dosage of interleukin-2; and production of immunoglobulin A. The data obtained did not demonstrate any immunodepressive activity by either ampicillin or the sulbactam/ampicillin combination.

Microbiological study of Enterococcus faecium SF68: post-antibiotic effect and growth curves.

We studied the microbiological characteristics of Enterococcus faecium SF 68 (an oral vaccine) assessing post-antibiotic effect of ampicillin and growth curves in different media. Results showed a good resistance of the microorganism tested which has important implications in clinical practice. The growth ability of Enterococcus faecium SF 68 was similar on all media tested.

[Effect of spiramycin on the interbacterial aggregation process in dental plaque formation]. / Interferenza della spiramicina sui processi di aggregazione interbatterica nella formazione della placca dentale.

The Authors valued on 18 periodontal patients the bleeding, probing depth, plaque indexes before and after antibiotic therapy with spiramycin. After bacteriological test and coaggregation test the Authors concluded spiramycin all day long is endowed with a good activity in periodontal diseases.