Clinical experience with linezolid for the treatment of neurosurgical infections

OBJECTIVES

We sought to evaluate the clinical use of linezolid for the treatment of neurosurgical infections.

METHODS

Retrospective observational study of a cohort of hospitalized patients who received linezolid for a culture-positive neurosurgical infection from July 2004 to February 2009 in a tertiary hospital in Spain.

RESULTS

Seventeen patients were included in the study. Main comorbidities among these patients included one or more of the following: subarachnoidal or intraventricular hemorrhage (n=8), solid neurological cancer (n=7), corticosteroids(n=9) and hydrocephalus (n=6). Eight patients underwent a craniotomy and fourteen patients had an external ventricular drainage (EVD) as predisposing factors for infection. Meningitis was the most common infection (11; 64.7%), followed by ventriculitis (4; 23.5%) and brain abscesses (2;11.8%). The main causative organisms were coagulase-negative Staphylococcus spp. (13; 76.5%). Linezolid was used as the initial therapy in 8 episodes, after therapy failure in 6 and for other reasons in 3. The oral route was used in 9 (52.9%) episodes; linezolid was initiated orally in 2 cases. The mean duration of treatment was 26.5 days (range 15-58). No adverse events were reported. Sixteen (94.1%) patients were considered cured.There was one recurrence. The mean length of hospital stay was 45.6 (range 15-112) days and the mean duration of follow-up was 7.2 (range 0.4-32) months. No related deaths occurred during active episodes.

CONCLUSIONS

Linezolid was mainly indicated in post-neurosurgical EVD-associated infections due to coagulase-negative Staphylococcus spp. It was used as initial therapy in most cases. A high rate of clinical cure was observed and no related adverse events were reported. More than half of the patients were benefited by the advantages of the oral route of administration.

Relationship between airborne pollen counts and the results obtained using 2 diagnostic methods: allergen-specific immunoglobulin E concentrations and skin prick tests

BACKGROUND

Patients with pollinosis show allergic symptoms related to airborne pollen levels, although this association is not always close. The use of new diagnostic techniques could improve our knowledge of this relationship.

OBJECTIVE

To evaluate the relationship between pollen counts and the results obtained using 2 diagnostic techniques: the skin prick test and allergen-specific immunoglobulin E (slgE) concentrations in serum.

METHODS

Sixty-eight pollen-allergic patients were diagnosed using a combination of the high-capacity screening approach ADVIA Centaur with a panel of 13 purified allergens and a skin prick test (SPT) with conventional extracts. Pollen levels were obtained by means of a volumetric sampler.

RESULTS

The highest percentages of sensitization were detected for grass mixture allergens and major recombinant grass allergens (Phl p 1 and Phi p 5), followed by olive tree extracts and olive allergens (Ole e 1 and Ole e 9), in SPT and using recombinant allergens, respectively. The main pollen types registered in the atmosphere during 2006 and 2007 were Quercus, Poaceae, and Cupressaceae. A statistically significant correlation was observed between total pollen levels and median values of slgE, especially in 2007.

CONCLUSION

A strong and significant positive correlation was found between pollen counts and slgE levels. This correlation was weaker in the case of SPT and airborne pollen.

Reticulated vitreous carbon: a useful material for cell adhesion and tissue invasion

Diverse carbon materials have been used for tissue engineering and clinical implant applications with varying success. In this study, commercially available reticulated vitreous carbon (RVC) foams were tested in vitro and in vivo for compatibility with primary cell adhesion and tissue repair. Pores sizes were determined as 279 ± 98 μm. No hydroxyapatite deposition was detected after immersion of the foams in simulated body fluid. Nonetheless, RVC provided an excellent support for adhesion of mesenchymal stem cells (MSCs) as well as primary chondrocytes without any surface pre-treatment. Live cell quantification revealed neutral behaviour of the material with plastic adhered chondrocytes but moderate cytotoxicity with MSCs. Yet, rabbit implanted foams exhibited good integration in subcutaneous pockets and most importantly, total defect repair in bone. Probably due to the stiffness of the material, incompatibility with cartilage regeneration was found. Interestingly and in contrast to several other carbon materials, we observed a total lack of foreign body reactions. Our results and its outstanding porous interconnectivity and availability within a wide range of pore sizes convert RVC into an attractive candidate for tissue engineering applications in a variety of bone models and for ex vivo cell expansion for regenerative medical applications.

Belt separation system under slat in fattening pig housing: effect of belt type and extraction frequency

The efficiency of manure separation by a conveyor belt under a partially slatted floor for fattening pigs was determined for two types of belts, a flat belt with an incline of up to 6 degrees transversely and a concave belt with an incline of up to 1 degrees longitudinally. A 31.20% and 23.75% dry matter content of the solid fraction was obtained for the flat and concave belt, respectively. The flat belt was more efficient at 6 degrees than other slope angles. The residence time of the manure on the two belt types influenced the separation efficiency from a live weight of 63.00 kg upwards. The quantity of residue produced with this system was reduced to 25-40% with respect to a pit system under slat. This could mean a remarkable reduction in costs of storage, transport and application of manure.

Fern Distortion Syndrome of Leatherleaf Fern in Costa Rica: Symptoms, Incidence, and Severity

A syndrome has been recognized on leatherleaf fern (Rumohra adiantiformis) in Costa Rica for many years that causes widespread damage but has not been described in the literature. A full description of the syndrome, termed fern distortion syndrome (FDS), is reported here, along with evidence that FDS is a new disease and that it is associated with endophytic fluorescent pseudomonads but not with any other major groups of pathogens or pests. The main aboveground symptoms of FDS are twisting and distortions of fronds, which make the fronds unmarketable. In advanced cases of FDS, fronds are often thickened, new frond growth ceases or slows dramatically, and uneven sporulation is apparent on the underside of fronds. Symptoms of FDS belowground are reduced diameter of rhizomes and reduced overall root mass. The incidence of FDS in Costa Rica was typically over 80%, and severity typically ranged from 1.26 to 2.48 using a 0 to 3 rating scale in fields propagated vegetatively with rhizomes from fields with FDS. In contrast, in three fields planted 1.5 to 4 years previously with rhizomes derived from tissue culture, incidence and severity were markedly lower: 23 to 34% and 0.24 to 0.36, respectively. Paired sampling of symptomatic and asymptomatic plants revealed significantly greater populations of fluorescent pseudomonads inside rhizomes of symptomatic plants.

Toll-like receptor 4 D299G polymorphism and the incidence of infections in cirrhotic patients

BACKGROUND

Toll-like receptor (TLR) 4 genetic polymorphisms, mainly D299G, have been associated with increased predisposition to infection in several populations.

AIM

To retrospectively analyse the relationship between the presence of the TLR4 D299G polymorphism and the incidence of bacterial infections in cirrhotic patients.

METHODS

We included 111 consecutive cirrhotic patients hospitalized with ascites and we determined the presence of the TLR4 D299G polymorphism by PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) and its relationship with the incidence of previous bacterial infections.

RESULTS

Ten out of 111 (9%) cirrhotic patients presented with the TLR4 D299G polymorphism. The mean follow-up from first decompensation of cirrhosis until current admission was longer in D299G polymorphism patients than in wild-type patients (53.8 +/- 40.7 vs. 35.4 +/- 48.3 months, P = 0.03). D299G polymorphism patients showed a trend towards a higher incidence of history of previous infections (80% vs. 56.4%, P = 0.19), as well as a higher number of infections (2.8 +/- 2.3 vs. 1.0 +/- 1.3, P = 0.01) and bacteriaemias (0.4 +/- 1.0 vs. 0.04 +/- 0.2, P = 0.02) per patient than wild-type patients.

CONCLUSIONS

Toll-like receptor 4 D299G polymorphism could influence not only the predisposition to bacterial infections but also the evolution of the disease in cirrhotic patients. Further prospective studies in larger series of patients are warranted.

Characterization of the sea bass melanocortin 5 receptor: a putative role in hepatic lipid metabolism

The melanocortin 5 receptor (MC5R) plays a key role in the regulation of exocrine secretion in mammalian species. This receptor has also been characterized in some fish species but its function is unknown. We report the molecular and pharmacological characterization, as well as the tissue expression pattern, of sea bass MC5R. Cloning of five active alleles showing different levels of sensitivity to endogenous melanocortin and one non-functional allele demonstrate the allelic complexity of the MC5R locus. The sea bass receptor was activated by all the melanocortins tested, with ACTH and desacetyl-MSH and beta-MSH showing the lowest efficiency. The acetylation of the MSH isoforms seems to be critical for the effectiveness of the agonist. Agouti-related protein had no effect on basal or agonist-stimulated activation of the receptor. SbMC5R was mainly expressed in the brain but lower expression levels were found in several peripheral tissues, including liver. Progressive fasting did not induce up- or downregulation of hypothalamic MC5R expression, suggesting that central MC5R is not involved in the regulation of food intake in the sea bass. MTII, a sbMC5R agonist, stimulated hepatic lipolysis in vitro, measured as free fatty acid release into the culture medium after melanocortin agonist exposure of liver fragments, suggesting that MC5R is involved in the regulation of hepatic lipid metabolism. Taken together, the data suggest that different allelic combinations may confer differential sensitivity to endogenous melanocortin in tissues where MC5R is expressed and, by extension, in hepatic lipid metabolism.

Molecular and pharmacological characterization of the melanocortin type 1 receptor in the sea bass

Melanocortin 1 receptor (MC1R) plays a key role in the physiology of the vertebrate pigment system. Point mutations producing hyperactive or inactive receptors result in darkening or paling effects, respectively. We report the molecular and pharmacological characterization, as well as the tissue expression pattern, of the sea bass Mc1r. Similar to other MC1Rs, the sea bass gene is highly polymorphic and nine DNA polymorphisms, seven of them involving an amino acid substitution, were detected. SbMc1r is mainly expressed in the testis, fat and liver with moderate levels in the ventral and dorsal skin. The sea bass receptor was activated by all the melanocortins tested, with ACTH showing the lowest efficiency. The acetylation level of the MSH isoforms seems to be critical for the effectively of the agonist. Agouti-related protein (AGRP) drastically inhibited the basal activity of the receptor in vitro, as an inverse agonist does, but only in the presence of phosphodiesterase inhibitors. This observation suggests that sbMc1r is constitutively activated and inversely regulated by AGRP, which is expressed in the skin of different fish species.

Kinetic evaluation of the psychrophylic anaerobic digestion of synthetic domestic sewage using an upflow filter

A study of the anaerobic digestion process of synthetic domestic sewage (total COD: 705 mg/L) was carried out. The digestion was conducted in an upflow anaerobic filter with corrugated plastic rings as packing media at psychrophilic temperature (15-17 degrees C). For HRTs of between 10.0 and 17.1h, the total COD removal efficiency was almost constant and independent on the HRT, achieving an average value of around 80%. However, when the HRT decreased from 7.0 to 3.2h the efficiency diminished from 77% to 65%. This decrease in removal efficiency was parallel to the increase in the VFA/Alkalinity ratio for this HRT range. The flow pattern observed in the reactor studied was intermediate between plug-flow and CSTR systems, although the plug-flow was predominant. It can also be observed that Young and McCarty's model almost coincided with the CSTR model, when the biodegradable COD was used for fitting the data. The Manariotis equation allowed a better fit of the experimental data (total COD removal efficiency with influent substrate concentration and HRT) than the Young model. The methane yield coefficient obtained was 0.15 L CH(4)/g COD consumed.

2D 1H and 13C NMR conformational studies of thienopyridines and carboline biarylic compounds

In this paper, we report on conformational studies of biarylic compounds, as prepared through the well-known aza-Wittig methodology. The conformational studies were mainly realized by bidimensional (2D) nuclear magnetic resonance spectroscopy (NMR) and NOESY experiments. The conformational behavior showed that these biarylic compounds display an orthogonal symmetry and adopt a characteristic arrangement around the pivotal bond. Molecular modeling calculations were performed to support structure conformations.

Heavy metals removal from acid mine drainage water using biogenic hydrogen sulphide and effluent from anaerobic treatment: effect of pH

Four alternatives (runs A, B, C and D) for heavy metals removal (Fe, Cu, Zn and Al) from acid mine drainage water (AMDW) produced in the mining areas of the Huelva Province, Spain, were evaluated. In run A, the anaerobic effluent from the treatment of acid mine drainage water (cheese whey added as a source of carbon) was mixed with the raw AMDW. The pH increased to 3.5 with the addition of KOH. In run B, biogas with around 30% of hydrogen sulphide obtained in the anaerobic reactor was sparged to the mixture obtained in run A, but in this case at a pH of 5.5. In run C, the pH of the raw AMDW was increased to 3.5 by the addition of KOH solution. Finally, in run D, the pH of the raw AMDW was increased to 5.5 by the addition of KOH solution and further biogas was sparged under the same conditions as in run A. It was found that heavy metal removal was a function of pH. At a pH of 3.5 most of the iron was removed while Zn and Cu were partially removed. At a pH of 5.5 the removal of all metals increased considerably. The best results were obtained in run B where the percentages of removal of Fe, Cu, Zn and Al achieved values of 91.3, 96.1, 79.0 and 99.0%, respectively. According to the experimental results obtained tentative schemas of the flow diagram of the processes were proposed.

Performance evaluation of a two-phase anaerobic digestion process of synthetic domestic wastewater at ambient temperature

A two-phase anaerobic digestion process of synthetic domestic wastewater was studied at ambient temperature in mild to cold climates. The hydrolytic stage was carried out in a continuous stirred tank reactor with an effective volume of 1.2 L. The hydrolytic reactor operated at hydraulic retention times (HRTs) in the range of 1.3 to 2.7 h, which allowed for optimum HRT to be obtained in order to achieve a maximum amount of soluble COD. For the methanogenic stage, an up-flow anaerobic filter with a volume of 1.35 L and corrugated plastic rings as biomass immobilization support were used. During the investigation, the ambient temperature ranged between 21 degrees C and 24 degrees C. Synthetic domestic wastewater with a COD of 700 mg/L was used as substrate. The study was performed at total organic loading rates (OLR(T)) of 2.0-4.3 g COD/L. d, with a global HRT (including both hydrolytic and methanogenic stages) of 2.8-5.8 hours. A maximum percentage of organic matter removed of 88% was achieved at a global HRT of 5.8 hours. Under these operating conditions, the production of biogas was 97% higher than that obtained in the one-phase anaerobic digestion process. Additionally, the kinetics involved in the hydrolytic stage was determined using the Contois kinetic model, which adequately predicted the experimental results.

No evidence for genetic association of interferon regulatory factor 3 in systemic lupus erythematosus

The aim of this study was to determine the potential role of three IRF3 gene polymorphisms (rs2304204, rs7251 and rs2304207) with systemic lupus erythematosus (SLE). Our study population consisted of 610 patients with SLE and 730 healthy controls. All individual were of Spanish Caucasian origin. The IRF3 polymorphisms were genotyped using a PCR system with pre-developed TaqMan allelic discrimination assay. No statistically significant differences were found when allele and genotype distribution of rs2304204, rs7251 and rs2304207 polymorphisms were compared between patients with SLE and controls [overall P values: rs7251, P = 0.06; rs2304204, P = 0.26 and rs2304207, P = 0.36, by chi-squared test on a 3 x 2 contingency table. Overall allelic P values: rs7251, P = 0.8, OR (95%CI) = 1.03 (0.87-1.22); rs2304204, P = 0.2, OR (95%CI) = 1.12 (0.93-1.34) and rs2304207, P = 0.8, OR (95%CI) = 1.02 (0.82-1.26)]. In addition, no evidence of association with haplotypes and clinical features of SLE was found. Our data suggest that the IRF3 polymorphisms do not appear to play a major role in the susceptibility or severity of SLE in a Spanish population.

Investigation of TLR5 and TLR7 as candidate genes for susceptibility to systemic lupus erythematosus

OBJECTIVES

The aim of this study was to evaluate the relevance of genetic variants of TLR5 (rs5744168) and TLR7 (rs179008) gene in systemic lupus erythematosus (SLE) in a Spanish population.

MATERIAL AND METHODS

Our study population consisted of 752 SLE patients and 1107 healthy controls. All individual were of Spanish Caucasian origin. The TLR5 and TLR7 polymorphisms were genotyped using a PCR system with pre-developed TaqMan allelic discrimination assay.

RESULTS

No statistically significant differences were observed when the allele and genotype distribution of TLR5 rs5744168 and TLR7 rs179008 polymorphisms was compared between SLE patients and healthy controls. A significant increase frequency in the CC genotype of the TLR5 rs5744168 polymorphism among SLE patients without nephritis was found (93% vs. 87% in SLE patients with nephritis, p=0.03, OR=2.11 95%CI 0.93-3.51). However, this difference did not reach statistical significance in the allele frequencies (p=0.08).

CONCLUSION

These results suggest that the tested variations of TLR5 and TLR7 genes do not confer a relevant role in the susceptibility or severity to SLE in the Spanish population.

Kinetics of anaerobic degradation of screened dairy manure by upflow fixed bed digesters: effect of natural zeolite addition

The effect of the hydraulic retention time (HRT) on the performance of two up-flow anaerobic fixed bed digesters (UFAFBDs) packed with waste tire rubber (D1) and waste tire rubber and zeolite (D2) as micro-organism immobilization supports was studied. It was found that a first-order kinetic model described well the experimental results obtained. The kinetic constants for COD, BOD5, total solids (TS) and volatile solids (VS) removal were determined to be higher in digester D2 than in digester D1 or control. Specifically, they were 0.28 +/- 0.01, 0.32 +/- 0.02, 0.16 +/- 0.01 and 0.24 +/- 0.01 d(- 1) respectively for D1 and 0.33 +/- 0.02, 0.40 +/- 0.02, 0.21 +/- 0.01 and 0.28 +/- 0.01 d(- 1) respectively for D2. This was significant at the 95% confidence level. In addition, the first-order model was also adequate for assessing the effect of the HRT on the removal efficiency and methane production. Maximum methane yield and the first-order constant for methane production were determined and the results obtained were comparable with those obtained by other authors but operating at higher HRTs. Maximum methane yields and the kinetic constant for methane production were 11.1% and 29.4% higher in digester D2 than in D1.

Cutaneous leishmaniasis due to Leishmania chagasi/Le. infantum in an endemic area of Guarico State, Venezuela

This study reports cutaneous leishmaniasis (CL) caused by Leishmania chagasi/Le. infantum in Venezuela, with some atypical characteristics. Out of 63 cases of CL in the suburbs of Altagracia de Orituco, Guarico State, Venezuela, 30 presented clinical, parasitological, immunological and epidemiological features different from those of the classical CL known in the country. The initial lesion was small and nodular, which, if not treated, might progress to a superficial ulcer. No secondary infection was observed. The identification of the isolates was carried out by molecular techniques. Twelve species of phlebotomine sandflies were caught, the most abundant being Lutzomyia evansi and Lu. longipalpis s.l., known vectors of Le. chagasi/Le. infantum. The existence of Le. chagasi/Le. infantum and its vectors in an endemic area of CL has implications and we suggest that epidemiological studies should be carried out to obtain a clearer picture of the extent of this CL form in Venezuela.

Spanish growth studies 2008. New anthropometric standards

Cross-sectional and longitudinal growth studies have recently been conducted in Spain. These studies have allowed neonatal anthropometry in premature and term neonates and postnatal growth in children and adolescents to be evaluated. Moreover, a longitudinal study that allows pubertal growth to be evaluated for distinct groups according to maturation has also been published. Between 1999 and 2002, birth weight and vertex-heel length were evaluated in 9,362 newborns (4,884 boys and 4,478 girls), with a gestational age of 26-42 weeks. An increase in these values compared with previous Spanish studies (1987-1992) and sexual dimorphism were observed. Between 2000 and 2004, height, weight and body mass index (BMI) were evaluated in 32,064 individuals (16,607 males, 15,457 females) aged 0-24 years. An increasing secular trend was observed compared with data obtained 20 years previously. Increases in BMI exceeded those in height for BMI values above the 50th percentile. A longitudinal growth study of 458 healthy individuals (223 boys, 235 girls) born between 1978 and 1982 yielded pubertal growth and maturity standards for each of the five pubertal maturity groups. In addition, data on skinfolds, bone mass and intellectual development from birth to adulthood were also provided. Adult height in both studies was similar to that reported by European and American studies, but was lower than that reported for German, Swedish and Dutch populations. In males, BMI was higher than in other European populations and was close to that of the US population. In females, BMI was similar to that in European populations and was lower than that in the US population.