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1.
Georgian Med News ; (294): 10-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687941

RESUMO

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to second-line antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gram-negative aerobic and anaerobic infection pathogens, is recommended.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Bacterianas/complicações , Abscesso Encefálico/tratamento farmacológico , Traumatismos Craniocerebrais/complicações , Infecção da Ferida Cirúrgica/complicações , Infecção dos Ferimentos/tratamento farmacológico , Ferimentos Penetrantes/complicações , Adulto , Bactérias/classificação , Bactérias/isolamento & purificação , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/microbiologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Ucrânia/epidemiologia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia
2.
Zhonghua Zhong Liu Za Zhi ; 41(10): 771-774, 2019 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-31648500

RESUMO

Objective: To compare the efficiency of saline irrigation, antibiotics irrigation and high-concentration antibiotics perfusion with tube drainage in the treatment of infectious effusion. Methods: Clinical and sonographic features of abdominal and pelvic infectious effusion of 64 patients with malignant tumor collected from September 2013 to September 2017 were retrospectively analyzed. The changes of effusion size and temperature, catheterization time were evaluated in saline irrigation group and antibiotics irrigation group. The catheterization time was compared between antibiotics irrigation group and high-concentration antibiotics perfusion group. Results: The effective rates of the saline irrigation group and the antibiotics irrigation group were 68.6% and 86.8%, respectively, and the times of catheterization were 11.9±8.4 days and 7.8±4.8 days, respectively, with significantly statistical difference (both P<0.05). However, the effective rates of the antibiotics irrigation group and the high concentration antibiotic perfusion group were 86.8% and 100.0%, respectively (P=0.067), while the times of catheterization were 7.8±4.8 days and 3.6±3.1 days, respectively (P<0.001). Conclusion: The antibiotic irrigation with tube drainage, especially the high concentration perfusion is more effective than saline in the treatment of abdominal and pelvic infection effusion.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/terapia , Drenagem , Infecção Pélvica/terapia , Cloreto de Sódio/uso terapêutico , Irrigação Terapêutica , Infecções Bacterianas/complicações , Humanos , Infecção Pélvica/microbiologia , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
3.
Psychiatr Danub ; 31(Suppl 3): 561-567, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488791

RESUMO

INTRODUCTION: Female sexuality may be affected by many somatic and psychological factors. Somatic conditions have impact on psychological well-being. We assumed that chronic disease like Irritable Bowel Syndrome (IBS), when producing the long-term distress, may greatly influence sexual functioning. AIM: The aim of this study was to determine whether the severity of IBS influences sexual functions of women and take into consideration other factors like Small Intestinal Bacterial Overgrowth (SIBO) comorbidity and duration of IBS. SUBJECTS AND METHODS: Study patients were recruited by contacting IBS patients at Gastroenterology Ward of Clinical University Centre in Katowice. The survey consisted of 3 parts. The first part were socio-demographic questions. The second part was polish translation of Female Sexuality Functions Index (FSFI) questionnaire. The third part consisted of questions about the patient condition, pharmacotherapy and Irritable Bowel Syndrome Severity Score (IBSSS) questionnaire. 307 women were included in the study and completed the questionnaire. 143 participants were diagnosed with IBS. The mean age of participants was 27 (IQR=23-33). 29% of the patients (n=41) had severe, 47% (n=68) moderate and 24% (n=34) mild IBS. RESULTS: The prevalence of sexual dysfunctions was greater in women with IBS (48%) than in healthy control group (23%) (p<0.001). The median of FSFI was: 30.1 (26.3-32.8) for healthy control group, 30 (23.5-32.6) for mild IBS, 26.2 (22.2-31.6) for moderate and 24.4 (20.1-28.9) for severe. CONCLUSION: IBS decreases all domains of women sexual activity. Severity of sexual dysfunctions relate to intensity of IBS symptoms. All physicians treating IBS-patients should take sexual dysfunctions into their clinical consideration.


Assuntos
Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/psicologia , Disfunções Sexuais Fisiológicas/complicações , Disfunções Sexuais Psicogênicas/complicações , Sexualidade/psicologia , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Infecções Bacterianas/fisiopatologia , Feminino , Humanos , Intestinos/microbiologia , Intestinos/fisiopatologia , Síndrome do Intestino Irritável/microbiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Disfunções Sexuais Psicogênicas/fisiopatologia , Disfunções Sexuais Psicogênicas/psicologia
4.
Cancer Invest ; 37(9): 453-462, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31469000

RESUMO

Cancer is a proficient evader of the immune system and is responsible for a high number of deaths annually. Most of these cancer cases are associated with genetic mutations, viruses, radiations or other carcinogenic substances like tobacco smoke. However, a significant number of cases arise as a result of infection by certain parasitic organisms other than viruses. This review tries to explore various less studied mechanisms by which these parasites induce cancer and lead to its progression. The changes brought by organisms in the genetic makeup are enumerated along with the effects of various protein products synthesised by these organisms.


Assuntos
Infecções Bacterianas/complicações , Micoses/complicações , Neoplasias/etiologia , Doenças Parasitárias/complicações , Animais , Infecções Bacterianas/genética , Carcinogênese , Progressão da Doença , Redes Reguladoras de Genes , Humanos , Micoses/genética , Neoplasias/genética , Doenças Parasitárias/genética
5.
Transplant Proc ; 51(7): 2466-2468, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405745

RESUMO

OBJECTIVE: Despite advances in immunosuppressive drugs, postoperative care, and surgical techniques, bacterial infections remain the most important cause of morbidity and mortality in liver transplant patients. The aim of this study is to evaluate the influence of culture results taken on the first day of admission to intensive care unit on mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay. Our study has clinical importance because it is the first study evaluating the cultures obtained on the first day of intensive care unit stays in liver transplant patients. METHODS: Patients' demographic data, transplant type, rates of deceased and living donors, culture results, amount of blood and blood products used intraoperatively, previous hospital admission, mortality, incidence of graft rejection, mechanical ventilation duration, and length of intensive care unit stay were recorded. RESULTS: Mortality and graft rejection were 14.8% and 9%, respectively. The mortality was significantly higher in all 3 cultures and/or in only blood culture-positive patients. Graft rejection, mechanical ventilation duration, and length of intensive care unit stay were significantly higher in patients whose 3 cultures were all positive. Only body mass index had a significant effect on mortality, graft rejection, and positive culture results. CONCLUSIONS: Liver transplant patients' first postoperative day culture results were correlated with mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay.


Assuntos
Infecções Bacterianas , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/microbiologia , Transplante de Fígado/efeitos adversos , Adolescente , Adulto , Idoso , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Criança , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
6.
Medicine (Baltimore) ; 98(26): e16016, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261505

RESUMO

Spontaneous bacterial peritonitis (SBP) is one of the most frequent and severe complications in patients with decompensated cirrhosis. Early antibiotic therapy is extremely important for successful treatment and reducing mortality. Prostaglandin E2 (PGE2) is a regulator of the immune response and infection. This study aimed to explore whether ascitic PGE2 could be used as a marker for diagnosing SBP and predicting in-hospital mortality.Patients with cirrhosis and ascites undergoing abdominal paracentesis were enrolled in our study. Demographic, clinical, and laboratory parameters were recorded at the time of paracentesis and ascitic PGE2 levels were determined by ELISA. The correlation between ascitic PGE2 level and SBP as well as in-hospital mortality were analyzed.There were 224 patients enrolled, 29 (13%) patients diagnosed as SBP based on the current guideline criteria. The ascitic PGE2 level of patients with SBP [32.77 (26.5-39.68) pg/mL] was significantly lower than that of patients without SBP [49.72 (37.35-54.72) pg/mL]. In ROC analysis, the AUC of ascitic PGE2 for the diagnosis of SBP was 0.75, and the AUC of ascitic PGE2 combined with WBC and ascitic PGE2 combined with neutrophils were 0.90 and 0.90, respectively, which were significantly higher than that of ascitic PGE2. In multivariate analysis, ascites PGE2≤32.88 pg/mL (OR: 9.39; 95% CI: 1.41-67.44, P = .026), hepatic encephalopathy (OR: 18.39; 95% CI: 3.00-113.13, P = .002) and a higher MELD score (OR: 1.25; 95% CI: 1.05-1.40, P = .009) remained independent predictors of in-hospital mortality.Ascitic PGE2 level is likely to be a valuable marker in prediction of in-hospital mortality in patients with decompensated cirrhosis, and its value in diagnosis of SBP was not superior to other inflammatory indicators.


Assuntos
Líquido Ascítico/metabolismo , Infecções Bacterianas/metabolismo , Dinoprostona/metabolismo , Mortalidade Hospitalar , Cirrose Hepática/complicações , Peritonite/metabolismo , Área Sob a Curva , Ascite/complicações , Ascite/metabolismo , Ascite/mortalidade , Infecções Bacterianas/complicações , Infecções Bacterianas/mortalidade , Biomarcadores/metabolismo , Feminino , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/mortalidade , Prognóstico , Estudos Prospectivos , Curva ROC
7.
Zoonoses Public Health ; 66(6): 622-635, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31222965

RESUMO

Traditionally, zoonotic pathogen ecology studies in wildlife have focused on the interplay among hosts, their demographic characteristics and their pathogens. But pathogen ecology is also influenced by factors that traverse the hierarchical scale of biological organization, ranging from within-host factors at the molecular, cellular and organ levels, all the way to the host population within a larger environment. The influence of host disease and co-infections on zoonotic pathogen carriage in hosts is important because these factors may be key to a more holistic understanding of pathogen ecology in wildlife hosts, which are a major source of emerging infectious diseases in humans. Using wild Norway rats (Rattus norvegicus) as a model species, the purpose of this study was to investigate how host disease and co-infections impact the carriage of zoonotic pathogens. Following a systematic trap and removal study, we tested the rats for the presence of two potentially zoonotic bacterial pathogens (Bartonella tribocorum and Leptospira interrogans) and assessed them for host disease not attributable to these bacteria (i.e., nematode parasites, and macroscopic and microscopic lesions). We fitted multilevel multivariable logistic regression models with pathogen status as the outcome, lesions and parasites as predictor variables and city block as a random effect. Rats had significantly increased odds of being infected with B. tribocorum if they had a concurrent nematode infection in one or more organ systems. Rats with bite wounds, any macroscopic lesion, cardiomyopathy or tracheitis had significantly increased odds of being infected with L. interrogans. These results suggest that host disease may have an important role in the ecology and epidemiology of rat-associated zoonotic pathogens. Our multiscale approach to assessing complex intrahost factors in relation to zoonotic pathogen carriage may be applicable to future studies in rats and other wildlife hosts.


Assuntos
Infecções Bacterianas/veterinária , Portador Sadio , Coinfecção , Doenças Parasitárias em Animais/complicações , Doenças dos Roedores/microbiologia , Zoonoses , Animais , Infecções Bacterianas/complicações , Mordeduras e Picadas , Feminino , Masculino , Ratos
8.
Parasit Vectors ; 12(1): 216, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064387

RESUMO

BACKGROUND: Humans are susceptible to over 1400 pathogens. Co-infection by multiple pathogens is common, and can result in a range of neutral, facilitative, or antagonistic interactions within the host. Soil-transmitted helminths (STH) are powerful immunomodulators, but evidence of the effect of STH infection on the direction and magnitude of concurrent enteric microparasite infections is mixed. METHODS: We collected fecal samples from 891 randomly selected children and adults in rural Laos. Samples were analyzed for 5 STH species, 6 viruses, 9 bacteria, and 5 protozoa using a quantitative reverse transcription polymerase chain reaction (qRT-PCR) assay. We utilized logistic regression, controlling for demographics and household water, sanitation, and hygiene access, to examine the effect of STH infection on concurrent viral, bacterial, and protozoal infection. RESULTS: We found that STH infection was associated with lower odds of concurrent viral infection [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.28-0.83], but higher odds of concurrent bacterial infections (OR: 1.81, 95% CI: 1.06-3.07) and concurrent protozoal infections (OR: 1.50, 95% CI: 0.95-2.37). Trends were consistent across STH species. CONCLUSIONS: The impact of STH on odds of concurrent microparasite co-infection may differ by microparasite taxa, whereby STH infection was negatively associated with viral infections but positively associated with bacterial and protozoal infections. Results suggest that efforts to reduce STH through preventive chemotherapy could have a spillover effect on microparasite infections, though the extent of this impact requires additional study. The associations between STH and concurrent microparasite infection may reflect a reverse effect due to the cross-sectional study design. Additional research is needed to elucidate the exact mechanism of the immunomodulatory effects of STH on concurrent enteric microparasite infection.


Assuntos
Coinfecção/epidemiologia , Helmintíase/complicações , Helmintíase/transmissão , Enteropatias/etiologia , Solo/parasitologia , Adulto , Infecções Bacterianas/complicações , Criança , Pré-Escolar , Estudos Transversais , Fezes/microbiologia , Fezes/parasitologia , Fezes/virologia , Feminino , Helmintíase/epidemiologia , Humanos , Enteropatias/microbiologia , Enteropatias/parasitologia , Enteropatias/virologia , Enteropatias Parasitárias/complicações , Laos/epidemiologia , Masculino , Prevalência , Viroses/complicações
9.
Biochim Biophys Acta Rev Cancer ; 1872(1): 1-10, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31059737

RESUMO

Pyroptosis, a type of inflammatory programmed cell death, is mediated by multiple inflammasomes which can recognize danger signals and activate the secretion of pro-inflammatory cytokines like IL-181 and IL-1ß2. It can induce cancer cell death within the gastrointestinal tract. NLRs3, AIM24, GSDM5 family play important roles in pyroptosis signaling pathways in intestinal cancer such as gastric cancer, colitis-associated colorectal cancer and esophageal cancer, etc. Furthermore, several inflammasomes are elucidated to be involved in mucosal innate immune responses and modulate specific enteric pathogens infection. Precise modulation of inflammasome activation and exploration of potential diagnostic markers can contribute to the diagnosis, prevention and treatment of intestinal tumors and inflammatory or infectious disorders in human patients in the near future.


Assuntos
Infecções Bacterianas/genética , Neoplasias Gastrointestinais/genética , Intestinos/microbiologia , Piroptose/genética , Infecções Bacterianas/complicações , Infecções Bacterianas/imunologia , Infecções Bacterianas/microbiologia , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/imunologia , Neoplasias Gastrointestinais/microbiologia , Humanos , Imunidade Inata/genética , Inflamassomos/genética , Interleucina-18/genética , Interleucina-1beta/genética , Intestinos/patologia
10.
Immunity ; 50(6): 1401-1411.e4, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31076358

RESUMO

Inflammasome activation and subsequent pyroptosis are critical defense mechanisms against microbes. However, overactivation of inflammasome leads to death of the host. Although recent studies have uncovered the mechanism of pyroptosis following inflammasome activation, how pyroptotic cell death drives pathogenesis, eventually leading to death of the host, is unknown. Here, we identified inflammasome activation as a trigger for blood clotting through pyroptosis. We have shown that canonical inflammasome activation by the conserved type III secretion system (T3SS) rod proteins from Gram-negative bacteria or noncanonical inflammasome activation by lipopolysaccharide (LPS) induced systemic blood clotting and massive thrombosis in tissues. Following inflammasome activation, pyroptotic macrophages released tissue factor (TF), an essential initiator of coagulation cascades. Genetic or pharmacological inhibition of TF abolishes inflammasome-mediated blood clotting and protects against death. Our data reveal that blood clotting is the major cause of host death following inflammasome activation and demonstrate that inflammasome bridges inflammation with thrombosis.


Assuntos
Coagulação Sanguínea , Inflamassomos/metabolismo , Piroptose , Trombose/etiologia , Trombose/metabolismo , Animais , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Biomarcadores , Caspases/metabolismo , Micropartículas Derivadas de Células/imunologia , Micropartículas Derivadas de Células/metabolismo , Modelos Animais de Doenças , Humanos , Lipopolissacarídeos/imunologia , Macrófagos/imunologia , Macrófagos/metabolismo , Camundongos , Monócitos/imunologia , Monócitos/metabolismo , Transdução de Sinais , Tromboplastina/metabolismo , Trombose/sangue , Trombose/mortalidade
11.
EBioMedicine ; 43: 587-593, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31056472

RESUMO

BACKGROUND: Autoimmunity and allergy have been associated with decreased number and function of regulatory T-cells (Tregs) and low interleukin-2 (IL-2) levels. We aimed to investigate if the release of IL-2 from peripheral blood mononuclear cells (PBMCs) stimulated with pathogenic airway bacteria was associated with development of allergy-outcomes in early childhood. METHODS: PBMCs were isolated at age 6 months in 331 infants from the Copenhagen Prospective Studies on Asthma in Childhood 2000 (COPSAC2000) mother-child cohort, and subsequently stimulated with H. influenzae, M. catarrhalis and S. pneumoniae in in vitro cultures. Levels of cytokines (IL-2, IL-10, IFN-γ, TNF-α, IL-5, IL-13 and IL-17A) were determined in the supernatant by electrochemiluminescence immunoassays. The immune profiles were analyzed for association with development of total-IgE, allergic sensitization and rhinitis during the first 7 years of life using regression models and principal component analysis (PCA). FINDINGS: An attenuated IL-2 response to stimulation with H. influenzae (p = 0∙011) and M. catarrhalis (p = 0∙027) was associated with elevated total-IgE at age 7, which was confirmed in a multivariate PCA model including all cytokine measurements (PC2, p = 0∙032). An immune profile with both reduced IL-2 and elevated IL-5 was associated with increased risk of allergic rhinitis (PC3, p = 0∙038). We found no associations with development of allergic sensitization. INTERPRETATION: A reduced IL-2 response from PBMCs exposed to common pathogenic airway bacteria at age 6 months was associated with elevated total-IgE and allergic rhinitis during the first 7 years of life. These findings suggest that suppressed Treg activity in early life may herald onset of allergy in early childhood, which could be a target for low-dose IL-2 trials in the future. FUND: COPSAC is funded by private and public research funds all listed on www.copsac.com.


Assuntos
Bactérias/imunologia , Imunoglobulina E/imunologia , Interleucina-2/metabolismo , Leucócitos Mononucleares/imunologia , Leucócitos Mononucleares/metabolismo , Rinite Alérgica/etiologia , Rinite Alérgica/metabolismo , Fatores Etários , Alérgenos/imunologia , Infecções Bacterianas/complicações , Infecções Bacterianas/imunologia , Infecções Bacterianas/microbiologia , Estudos de Coortes , Citocinas/metabolismo , Suscetibilidade a Doenças , Feminino , Humanos , Imunização , Imunoglobulina E/sangue , Imunofenotipagem , Lactente , Recém-Nascido , Masculino , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo
12.
Wiad Lek ; 72(4): 645-649, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31055549

RESUMO

OBJECTIVE: Introduction: Small intestinal bacterial overgrowth may cause the hyperlipidemia appearance by enterohepatic circulation disturbance which evolves on the background of the early bile acids deconjugation with further endotoxin production and oxidative stress in the liver with hyperproduction of cholesterol and atherogenic lipoproteins. The aim: the determination of prevalence and features of SIBO in a series of patients with hyperlipidemia and in control subjects. PATIENTS AND METHODS: Materials and methods: Nineteen patients with hyperlipidemia and ten control subjects were studied. Small intestinal bacterial overgrowth was assessed by a lactulose breath test. Such biochemical markers as CRP, ALT, AST, GGTP, apolipoprotein B, bilirubin, cholesterol and lipid profile were determined. Except the routine interpretation of lactulose breath test, which contains the SIBO detection, small intestinal transit time and hydrogen level evaluation with next comparison between groups of patients was realized. RESULTS: Results: Small intestinal bacterial overgrowth was present in 78.9% of patients with hyperlipidemia and 40% in control subjects. The maximal dose of H2 was particularly higher in patients with hyperlipidemia in comparison with control group (94,7±13,69 vs. 36,13±5,4). There was a strong correlation between AST level and SIBO existence in both groups (r=1). Positive connection between LDL, TG, VLDL and the dose of exhaled hydrogen on 120 minute (r=0.6, r= 0.62, r=0.7 respectively) and strong negative correlation between HDL and 120 minute dose (r=-0.74) in main group was marked. CONCLUSION: Conclusions: Patients with hyperlipidemia have a higher prevalence of small intestinal bacterial overgrowth and there is a relationship between H2 rate and LDL, TG, VLDL.


Assuntos
Infecções Bacterianas/complicações , Disbiose/complicações , Hiperlipidemias/microbiologia , Intestino Delgado/microbiologia , Testes Respiratórios , Estudos de Casos e Controles , Humanos , Lactulose
13.
Wiad Lek ; 72(3): 350-356, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31050979

RESUMO

OBJECTIVE: Introduction: In recent years, NAFLD is considered as the key of the so-called metabolic inflammation, in which the intestinal microbiota plays an important role. The aim: To determine the effect of small intestine bacterial overgrowth on the liver structural and functional parameters in children with obesity and overweight. PATIENTS AND METHODS: Materials and methods: The object of the study was 89 children with obesity/overweight. Depending on the presence of SIBO based on the results of the hydrogen breath test with glucose, the patients were divided into 2 groups: first (I) consisted of 31 children with SIBO, the second (II) included 58 children without SIBO. All the patients under study performed a general blood analysis and a biochemical blood test, immuno-enzyme test method with insulin level determination HOMA index calculation. For diagnostics of the liver steatosis, transient elastography with the CAP (controlled attenuation parameter) function was carried out using FibroScan® 502 touch (Echosens, Paris, France). RESULTS: Results: According to fibroscan data, the presence of SIBO in obese children can lead to raise of CAP level; liver steatosis was diagnosed in 22 patients (70.9%) of the 1st group and 24 patients (41.4%) of the 2 group (p<0,05). We found significant differences in the the ratio of neutrophils and lymphocytes (NLR) (p <0.05). The average glucose level and HOMA index were significantly higher in SIBO group (p<0,05). The analysis of risk factors of SIBO showed that metabolic syndrome and NAFLD as the risk factors for SIBO development (p<0,05). CONCLUSION: Conclusions: SIBO has an effect on the structural and functional characteristics of the liver resulting in higher insulin and glucose level, higher NLR level and greater prevalence of NAFLD.


Assuntos
Infecções Bacterianas , Hepatopatia Gordurosa não Alcoólica , Infecções Bacterianas/complicações , Testes Respiratórios , Criança , Humanos , Intestino Delgado/microbiologia , Obesidade , Sobrepeso/complicações
14.
Z Gastroenterol ; 57(5): 600-605, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31083748

RESUMO

We report on a 40-year-old patient who presented with fever, right upper abdominal pain, right-sided chest pain and acute dyspnea. Imaging revealed several liver abscesses, as well as extensive right pleural empyema. Sixteen weeks previously, the patient underwent tooth extraction of the third molars (18, 28, 38, 48) and a first molar (46), and systematic closed periodontitis treatment. Four different species of the physiological microbiota of the oral cavity were detected in the pleura or liver abscess punctate (Streptococcus anginosus, Streptococcus constellatus, Actinomyces odontolyticus, Prevotella denticola). An underlying immune defect was ruled out. Ultrasound-guided drainage of liver abscesses and surgical treatment of pleural empyema by video-assisted thoracoscopy (VATS) and insertion of thoracic suction drains was performed, accompanied by targeted antibiotic therapy. Over a course of 6 weeks, the patient recovered completely. The case report illustrates severe infectious side effects of major dental interventions, and it critically summarizes current dental guideline recommendations on peri-interventional antimicrobial therapy. Therefore, a good clinical follow up after major tooth extractions is imperative.


Assuntos
Infecções Bacterianas/complicações , Empiema Pleural/diagnóstico por imagem , Abscesso Hepático/diagnóstico por imagem , Extração Dentária/efeitos adversos , Actinomyces viscosus/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Drenagem , Empiema Pleural/microbiologia , Empiema Pleural/cirurgia , Humanos , Abscesso Hepático/microbiologia , Abscesso Hepático/cirurgia , Masculino , Pleura/diagnóstico por imagem , Pleura/cirurgia , Complicações Pós-Operatórias , Prevotella intermedia/isolamento & purificação , Streptococcus anginosus/isolamento & purificação , Streptococcus constellatus/isolamento & purificação , Cirurgia Torácica Vídeoassistida , Toracoscopia , Resultado do Tratamento
15.
Bone Joint J ; 101-B(5): 582-588, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31039037

RESUMO

AIMS: The aims of this study were to report the efficacy of revision surgery for patients with co-infective bacterial and fungal prosthetic joint infections (PJIs) presenting to a single institution, and to identify prognostic factors that would guide management. PATIENTS AND METHODS: A total of 1189 patients with a PJI were managed in our bone infection service between 2006 and 2015; 22 (1.85%) with co-infective bacterial and fungal PJI were included in the study. There were nine women and 13 men, with a mean age at the time of diagnosis of 64.5 years (47 to 83). Their mean BMI was 30.9 kg/m2 (24 to 42). We retrospectively reviewed the outcomes of these PJIs, after eight total hip arthroplasties and 14 total knee arthroplasties. The mean clinical follow-up was 4.1 years (1.4 to 8.8). RESULTS: The median number of risk factors for PJI was 5.5 (interquartile range (IQR) 3.25 to 7.25). All seven patients who initially underwent debridement and implant retention (DAIR) had a recurrent infection that led to a staged revision. All 22 patients underwent the first of a two-stage revision. None of the nine patients with negative tissue cultures at the second stage had a recurrent infection. The rate of recurrent infection was significantly higher in the presence of multidrug-resistant bacteria (p = 0.007), a higher C-reactive protein (CRP) at the time of presentation (p = 0.032), and a higher number of co-infective bacterial organisms (p = 0.041). The overall rate of eradication of infection after two and five years was 50% (95% confidence interval (CI) 32.9 to 75.9) and 38.9% (95% CI 22.6 to 67), respectively. CONCLUSION: The risk of failure to eradicate infection with the requirement of amputation associated with this diagnosis is much higher than in patients with PJI without bacterial and fungal co-infection, and this risk is heightened when the fungal organism is joined by polymicrobial and multidrug-resistant bacterial organisms. Cite this article: Bone Joint J 2019;101-B:582-588.


Assuntos
Infecções Bacterianas/complicações , Micoses/complicações , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Bacterianas/cirurgia , Coinfecção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/cirurgia , Prognóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
16.
J Clin Neurosci ; 66: 87-91, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31126848

RESUMO

Recent evidence into an infectious etiology of discogenic back pain/leg pain are ongoing with contradictory data in literature. We sought to validate the clinical relevance of histopathological evidence of inflammation through a previously proposed histological grading system. In this prospective cohort study, 124 consecutive patients undergoing an elective spinal decompression and/or fusion procedure involving discectomy were selected with intraoperative tissue sampling of intervertebral disc and paraspinal tissue at a single institution. The histological domains were correlated with positive disc cultures to assist in identifying relevant positive infections. Inter-observer analysis of the scoring system was also performed. There were 124 samples (36 cervical and 88 lumbar) obtained. 29 (23.4%) disc specimens and 37 (29.8%) of ligament samples demonstrated growth of C. acnes. In total, 38/124 (30.6%) of disc specimens were positive for growth of any species. There was poor association between positive disc culture and the presence of neutrophilia (p = 0.123) or chronic inflammatory changes (p = 0.092) on histopathological assessment. There was no statistical significance noted across all histological domains examined within the finalised scoring system and positive culture across disc specimens. There was moderate agreement in between observers (kappa range: 0.41-0.60) in the assessment of inflammatory changes using the proposed scoring system. The current study suggests poor correlation between histopathological evidence of chronic or acute inflammation and positive disc cultures questioning the idea that disc infection is the root cause of acute or chronic back pain/leg pain.


Assuntos
Infecções Bacterianas/patologia , Degeneração do Disco Intervertebral/patologia , Disco Intervertebral/patologia , Adulto , Infecções Bacterianas/complicações , Feminino , Humanos , Inflamação/patologia , Degeneração do Disco Intervertebral/etiologia , Degeneração do Disco Intervertebral/microbiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Índice de Gravidade de Doença
19.
ACS Appl Mater Interfaces ; 11(18): 16380-16390, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-30973702

RESUMO

Dysregulated vascular inflammation is the underlying cause of acute lung inflammation/injury (ALI). Bacterial infections and trauma cause ALI that may rapidly lead to acute respiratory distress syndrome (ARDS). There are no pharmacological therapies available to patients with ALI/ARDS, partially as drugs cannot specifically target the lungs. Herein, we developed a stimuli-responsive nanoparticle (NP) to target inflammatory lungs for ALI therapies. The NP is composed of a sharp acid-sensitive segment poly(ß-amino esters) as a core for drug loading and controlled release and a polyethylene glycol-biotin on the particle surface available for bioconjugation, enabling lung targeting and extended circulation. The studies on dissipative particle dynamics simulation and characteristics of NPs suggest that anti-ICAM-1 antibodies can be coated to the particle surface and this coating is required to enhance lung targeting of NPs. A model drug of anti-inflammatory agent TPCA-1 is encapsulated in NPs with a high drug-loading content at 24% (w/w). In the mouse ALI model, our TPCA-1-loaded NPs coated with anti-ICAM-1 can target inflamed lungs after intravenous injection, followed by drug release triggered by the acid environment, thus mitigating lung inflammation and injury. Our studies reveal the rational design of nanotherapeutics for improved therapy of ALI, which may be applied to treating a wide range of vascular inflammation.


Assuntos
Lesão Pulmonar Aguda/tratamento farmacológico , Nanopartículas/administração & dosagem , Pneumonia/tratamento farmacológico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Lesão Pulmonar Aguda/complicações , Lesão Pulmonar Aguda/patologia , Amidas/administração & dosagem , Amidas/química , Animais , Anticorpos Anti-Idiotípicos/administração & dosagem , Anticorpos Anti-Idiotípicos/química , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Portadores de Fármacos/administração & dosagem , Portadores de Fármacos/química , Humanos , Concentração de Íons de Hidrogênio , Molécula 1 de Adesão Intercelular/efeitos dos fármacos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Camundongos , Nanopartículas/química , Pneumonia/complicações , Pneumonia/patologia , Polietilenoglicóis/química , Ratos , Tiofenos/administração & dosagem , Tiofenos/química
20.
J Orthop Surg Res ; 14(1): 100, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971277

RESUMO

BACKGROUND: Spondylodiscitis is a chameleon among infectious diseases due to the lack of specific symptoms with which it is associated. It is nevertheless a serious infection, with 7% mortality of hospitalized patients, in large part because of delayed diagnosis. The aim of this study was to develop a diagnosis and course-of-disease index to optimize its treatment. MATERIAL AND METHODS: Through analysis of 296 patients between January 1998 and December 2013, we developed a scoring system for spondylodiscitis, which we term SponDT (Spondylodiscitis Diagnosis and Treatment) based on three traits: (1) the inflammatory marker C-reactive protein (CRP) (mg/dl), (2) pain according to a numeric rating scale (NRS) and (3) magnetic resonance imaging (MRI), to monitor its progression following treatment. RESULTS: The number of patients receiving treatment increased over the past 15 years of our study. We also found an increasing age of patients at the point of diagnosis across the study, with an average age of 67.7 years. In 34% of patients, spondylodiscitis developed spontaneously. Almost 70% of them did not receive treatment until the first diagnosis using SponDT. Following treatment against spondylodiscitis, pain intensity decreased from 6.0 to 3.1 NRS. The inflammatory markers also decreased (CRP from 119.2 to 46.7 mg/dl). Similarly, MRI revealed a regression in inflammation following treatment. By employing SponDT, patients were diagnosed and entered into treatment with a score of 5.6 (severe spondylodiscitis) and discharged with a score of 2.4 (light/healed spondylodiscitis). CONCLUSION: SponDT can be used to support the diagnosis of spondylodiscitis, particularly in patients suffering from back pain and elevated levels of inflammation, and can be used during the course of treatment to optimize control of therapy. LEVEL OF EVIDENCE: IIa-evidence from at least one well-designed controlled trial which is not randomized.


Assuntos
Infecções Bacterianas/diagnóstico , Discite/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Dor nas Costas/microbiologia , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Discite/complicações , Discite/tratamento farmacológico , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Índice de Gravidade de Doença , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico
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