Citrobacter freundii and Acinetobacter baumanii infection in a patient with neoplastic lung disease - Case report

An 85-year-old male with a tumour in his right lung was admitted to Internal Diseases Ward to continue treatment after suffering a sudden cardiac arrest. An empiric antibiotic therapy with amoxycillin was introduced due to increased inflammation markers. Blood and sputum were collected. An abundant growth of AmpC β-lactamase-producing Citrobacter freundii was observed in culture grown from the sputum. The antibiogram showed retained sensitivity to fluoroquinolones. The therapy was modified by replacing β-lactam with ciprofloxacin. Neither clinical nor laboratory improvement were observed. Blood culture indicated sepsis of Acinetobacter baumannii etiology. The strain was suspected of producing OXA carbapenemase (CARBA test positive), KPC (-), MBL (-). Antibiogram illustrated retained sensitivity to gentamicin and colistin with complete resistance to ciprofloxacin. Another modification in treatment was implemented and ciprofloxacin was replaced with colistin.

Evaluation of the effectiveness of rehabilitation of people diagnosed with schizophrenia using clinical tools, psychological tests, QEEG, and the brain-derived neurotrophic factor (BDNF)

OBJECTIVES

The aim of the study was to evaluate the level of cognitive and social functioning in two groups of schizophrenia patients using clinical tools, psychological tests, QEEG, and changes in the brain-derived neurotrophic factor (BDNF) activity in subjects' serum.

METHODS

Randomly selected men diagnosed with schizophrenia were enrolled in the study and divided into two groups. Gr. 1 was formed by patients who did not undergo a structured rehabilitation program, while Gr. 2 was formed by patients undergoing standard rehabilitation, as provided in theprogramof the Psychiatric Rehabilitation Unit. Both groups underwent a comparative analysis of demographic parameters and based on: PANSS, AIS, GSES, and BCIS, psychological tests CTT-1, CTT-2, d2, QEEG, and changes in blood BDNF levels. To assess the effect of rehabilitation, the results obtained in both groups were compared after 12 weeks and their analysis was performed in accordance with assumptions for the experimental project. The study presents research hypotheses and pre-test and post-test comparisons of the groups, on the basis of selected research tools.

RESULTS

The data obtained in measurement 1 indicate that both groups did not differ significantly in terms of: age, education, place of residence, treatment at outpatient facilities, medicines taken, and suicide attempts. Differences concerned: marital status, children, number of hospitalizations, and employment status. Furthermore, no significant differences were found for the studied groups concerning: serum levels of the brain-derived neurotrophic factor, values obtained on the PANSS, AIS, and GSES, and alpha/theta, theta/beta and theta/SMR ratios. The analyses performed in measurement 2 indicate that structured rehabilitation influences reduce negative symptoms, cause an increase in BDNF levels, cause an improvement in cognitive and social functioning and positively influence the perception speed and accuracy.

CONCLUSIONS

The positive effect of structured rehabilitation influences allows to say that rehabilitation represents a necessary part of the comprehensive psychiatric treatment and should already be implemented during the first episode of the illness.

Can brain-derived neurotrophic factor (BDNF) be an indicator of effective rehabilitation interventions in schizophrenia?

The increasing body of evidence implies that brain-derived neurotrophic factor (BDNF) is the most common neurotrophin in the nervous system, playing an important role as an effectiveness indicator for rehabilitation interventions in schizophrenia patients. Currently, with the modern laboratory and instrumental diagnostic methods it is possible to diagnose deficits influencing the level of patient's functioning and use them as a basis for establishing individual re-adaptation programs for schizophrenia patients considering various forms of the therapy in different environments. Based on the PubMed and Scopus search tools a review of the available literature was performed and the paper presents current results of studies analyzing a relationship between selected rehabilitation interventions used in schizophrenia patients and changes in BDNF levels (a correlation between BDNF levels and physical activity and EEG Biofeedback therapy). Out of 240 records identified in total, the ones concerning the subject matter of the paper were taken into account. Studies concerning use of the presented method appear to indicate usefulness of BDNF factor in evaluation of effectiveness of implemented rehabilitation interventions in this group of patients. Changes in neurotrophin levels may indicate a synergy of the central and the peripheral nervous system, and high BDNF levels depending on physical activity and a neuromodulating effect of the EEG Biofeedback therapy may indicate their effectiveness. Use of various neurorehabilitation methods may improve the social functioning in schizophrenia patients. Treating BDNF as a biological indicator of those processes may represent an interesting hypothesis.

Investigations of Heavy Metal Ion Sorption Using Nanocomposites of Iron-Modified Biochar

Magnetic biochar nanocomposites were obtained by modification of biochar by zero-valent iron. The article provides information on the impact of contact time, initial Cd(II), Co(II), Zn(II), and Pb(II) ion concentrations, dose of the sorbents, solution pH and temperature on the adsorption capacity. On the basis of experiments, it was found that the optimum parameters for the sorption process are phase contact time 360 min (after this time, the equilibrium of all concentrations is reached), the dose of sorbent equal to 5 g/dm³, pH 5 and the temperature 295 K. The values of parameters calculated from the kinetic models and isotherms present the best match to the pseudo second order and Langmuir isotherm models. The calculated thermodynamic parameters ∆H ⁰, ∆S ⁰ and ∆G ⁰ indicate that the sorption of heavy metal ions is an exothermic and spontaneous process as well as favoured at lower temperatures, suggesting the physical character of sorption. The solution of nitric acid(V) at the concentration 0.1 mol/dm³ was the best acidic desorbing agent used for regeneration of metal-loaded magnetic sorbents. The physicochemical properties of synthesized composites were characterized by FTIR, SEM, XRD, XPS and TG analyses. The point characteristics of the double layer for biochar pH_PZC and pH_IEP were designated.

Gd-DTPA Adsorption on Chitosan/Magnetite Nanocomposites

The synthesis of the chitosan/magnetite nanocomposites is presented. Composites were prepared by co-precipitation of iron(II) and iron(III) salts by aqueous ammonia in the 0.1 % chitosan solution. It was shown that magnetite synthesis in the chitosan medium does not affect the magnetite crystal structure. The thermal analysis data showed 4.6 % of mass concentration of chitosan in the hybrid chitosan/magnetite composite. In the concentration range of initial Gd-DTPA solution up to 0.4 mmol/L, addition of chitosan to magnetite increases the adsorption capacity and affinity to Gd-DTPA complex. The Langmuir and Freundlich adsorption models were applied to describe adsorption processes. Nanocomposites were characterized by scanning electron microscopy (SEM), differential thermal analysis (DTA), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and specific surface area determination (ASAP) methods.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.

[Preliminary results of research on a new marker of idiopathic membranous nephropathy: anti-PLA2R]

Idiopathic membranous nephropathy (IMN) is a chronic glomerular disease. It is result of new discovery that the production of anti-PLA2R autoantibodies, reacting with phospholipase A2 receptor on the surface of podocytes. Specific antibodies occur in IMN patients blood in exacerbated of disease, and disappear during remission. It suggest that analyse of these parameter can prove quick diagnosis to recognize and monitoring treatment process. The aim of our work was to determine anti-PLA2R in patients with suspected IMN and persons during/after treatment in order to monitor the effectiveness of therapy.

MATERIAL AND METHODS

The study group consisted of 22 patients. Patients were divided into two groups: Group A--patients with symptomatic nephrotic syndrome in the course of membranous nephropathy; Group B--patients diagnosed with IMN who monitored the effectiveness of therapy. We collected the serum samples for all patients and determined of anti-PLA2R autoantibodies by indirect immunofluorescence test.

RESULTS

Antibodies were detected in 12 patients (54.54%): diagnosed (n = 5) and monitor (n = 7). All of patients with exacerbated disease process in monitored group had positive test results.

CONCLUSIONS

Our data suggest that anti-PLA2R is a sensitive diagnostic method and good for monitoring of disease activity, but nevertheless a need for further research on a larger group of patients to confirm that the test is a reliable source of diagnostic information.

Borrelia burgdorferi sensu lato as activators of the complement system in in vitro model

INTRODUCTION

The following parameters were analyzed: C5a, which is significant in classical and alternative pathways of the complement system activation, and factor H, the major function of which is to regulate the alternative pathway. Factor H, in the case of Borrelia infection, is combined by CRASPs proteins of spirochetes, and thus prevents C3b molecules from contact with the pathogen, opsonisation and lysis of bacteria.

MATERIAL AND METHODS

The experimental material in the model for the presented work consisted of whole blood of healthy persons (without the presence of antibodies anti-Borrelia) and persons with clinical symptoms of Lyme disease, which was stimulated with three genospecies of spirochetes recognized as pathogenic in Poland and Europe: B. afzelii, B. burgdorferi s.s. and B. garinii.

RESULTS

The increase in the level of C5a in the experimental model after in vitro stimulation of whole blood with three genospecies Borrelia can be treated as an indicator of an effective activation of the complement's cascade. The increase in level C5a in the plasma relies on the genospecies and the strongest is for B. garinii. The decrease in the level of factor H, observed after the incubation of whole blood with three genospecies Borrelia, shows that this parameter was included in the spirochetes' mechanisms acting against factors of the innate immunity system of a host, which prevents lysis of bacteria via the alternative pathway.

CONCLUSIONS

The results obtained on the basis of the in vitro model can be analysed from the aspect of spirochetes' real contact with a host's organism during the bite of infected ticks. Despite blocking of the alternative pathway, Borrelia initiate the activation cascade regardless of antibodies via the first contact of a host's organism with spirochetes, or in accordance with antibodies during the infection or subsequent contact with bacteria.

Plasma levels of sICAM-1 in patients affected by psoriasis: no relation to disease severity

The aim of the study was to determine the plasma level of sICAM-1 in acute psoriatic patients in contrast to normal subjects. Moreover, we have tried to answer whether disease severity index (PASI) correlates with plasma level of sICAM-1. We have determined the plasma levels of sICAM-1 by ELISA (Genzyme Corporation) in 23 patients with acute psoriasis before and after the treatment of the disease and in 11 controls. Patients with acute psoriasis have displayed higher levels of sICAM-1 (306.4 +/- 226.8 ng/ml) compared with the controls (141.2 +/- 49.2 ng/ml) and the same patients after clearing of the disease (154.7 +/- 126.7 ng/ml). We have not found any correlation between plasma levels of sICAM-1 and severity index of psoriasis (PASI). We have concluded: the plasma levels of sICAM-1 are not related to disease severity in acute psoriasis. Clearing of the psoriasis is followed by significant fall of plasma sICAM-1.

[Results of six-years-term perinatal care of diabetic woman in Silesia district]

Authors had retrospectively analyzed basic exponents of perinatal care of 256 pregnant diabetic woman in years 1993-1998 hospitalized and delivered in Clinic of Obstetrics and Gynaecology in the town of Bytom. Our results were very similar to the other of Referent Centres Of Technical Methods Bank Used in Diagnostic and Therapy of Diabetes: cesarean sections percentage 51.56%, 4.7% of undelivered pregnancies, 2.34% of new-born delivered with multiple congenital defaults, 17.2% of macrosomies and 39.8% pre-term deliveries were noted. Disadvantage perinatal effects in diabetic women might be reduced by very early diagnosis of diabetic and intensive biophysical and biochemical fetal care, which is strongly suggests by the authors.

[The estimation of L-ascorbic acid serum concentration and selected parameters of metabolism of serum lipids in pregnant women with diabetes]

Diabetes during pregnancy is a pathological state causing many metabolic disorders, not only in carbohydrate metabolism. The aim of the study was to estimate the changes of lipids metabolism and changes of L-ascorbic acid serum concentration in pregnancy complicated by diabetes. In tested groups values of lipids metabolism parameters were lower in diabetic group compared to control group. The lowest mean values of concentration of total cholesterol, LDL cholesterol and triglycerides were found in gestational diabetes group, while the lowest mean value of HDL cholesterol concentration was found in pregestational diabetic group. The L-ascorbic acid mean values correlated negatively with total cholesterol concentrations, LDL cholesterol and triglycerides levels.

[Analysis of indications for cesarean section in pregnancy complicated by diabetes mellitus]

The authors analysed a way of pregnancy ending and indications to cesarean section in group 256 diabetic pregnant women. We estimated that percentage for cesarean sections was 51.56%. We noticed downward tendency of elective indications to cesarean section (the most common was gestosis) and upward tendency of intrapartum indications (the most common was fetal distress syndrome). The percentage of cesarean sections in diabetic pregnant women group in our study is similar to results from the other centres.

Plasma erythropoietin level and iron reserves in haemodialysis patients with and without acquired cystic kidney disease

Concentration of erythropoietin (Epo) and iron reserves (IR) belong to the essential factors determining erythropoiesis in haemodialysis patients. Patients on dialysis with acquired kidney disease (ACKD+) can control anaemia better than patients without acquired kidney disease (ACKD-). Therefore we decided to check if plasma Epo levels and IR differ significantly in both groups of patients. Forty chronically haemodialyzed patients after ultrasound diagnosis were divided into 18 patients (45%) with ACKD+ and 22 (55%) without ACKD-. In both groups of patients we compared their plasma levels of Epo and IR. Plasma erythropoietin and ferritin levels were measured by enzymatic immunoassay. Iron reserves were estimated by the formula: IR = 400 x [ln (ferritin)-ln (50)]. In the ACKD+ group 72% of patients and in the ACKD- group 32% of patients did not require rHu Epo therapy. Plasma levels of erythropoietin and iron reserves did not differ significantly between ACKD+ and ACKD- patients. There must be also other factors than erythropoietin levels and iron reserves regulating erythropoiesis in these patients.

Comparison of plasma erythropoietin concentrations and iron status in hemodialyzed patients not requiring and requiring rHuEpo therapy

Fifty patients treated with chronic hemodialysis (HD) were observed for 1 year. 24 of them (48%) did not require treatment with recombinant human erythropoietin (rHuEpo) (group I) because the permanent hemoglobin (Hb) concentration was > 5.9 mmol/l (9.5 g/dl), hematocrit > 30%. The remaining 26 patients (group II) permanently or periodically required rHuEpo treatment. After 6 months of initial observation and after 6 months of clinical study we made a comparison of endogenous erythropoietin (Epo) and iron status in two groups of patients. Patients not requiring treatment with rHuEpo had statistically significant higher Epo concentration and lower iron reserves than patients on rHuEpo treatment. We did not find significant differences in Hb, albumin and creatinine between patients in both groups. Hb concentration did not correlate with the level of Epo, serum creatinine, transferrin saturation, ferritin, iron reserves and time of dialysis therapy in both groups. In both groups we found a significant negative correlation between the concentration of Epo and iron stores. Our results indicate that in patients on HD treatment, plasma Epo level appears to depend either directly or indirectly on iron status.

The effect of recombinant human erythropoietin (r-Hu EPO) administration on the blood chemistries and composition in uremic rats

Recombinant human erythropoietin (r-Hu EPO) therapy improves the anaemia of patients on chronic hemodialysis, on peritoneal dialysis and those with chronic renal failure who have not yet started any form of renal replacement therapy. In the last category there is concern that r-Hu EPO therapy may be associated with deterioration of the reserve renal function. But new data showed that even during more prolonged treatment the correction of anaemia does not have a major detrimental effect on renal function. The study was undertaken to examine the influence of r-Hu EPO therapy on renal function and rheological erythrocytes finding in uremic rats.

[Evaluation of sialic acid levels in serum and degree of sialic acid in gamma-globulin fraction and C-reactive protein in hemodialysed patients]

Regulation of immunological processes associated with complement system activation and immunoglobulin binding depends, among others, on the presence of sialic acids. In haemodialysed patients an increase is found of serum sialic acid level. The purpose of the work was the determination of sialic acid content in gamma-globulins and C-reactive protein, that is in immunologically active glycoproteins. The relationship was also studied between the amount of sialic acids and the level of immune complexes. After examination of a group of 15 haemodialysed patients increased degree of sialization of gamma-globulins was found, as compared with a control group. However, the degree of sialization of C-reactive protein in these patients was decreased in relation to the control group. The changes observed in sialic acid content in gamma-globulins and C-reactive protein in haemodialysed patients modify the function and persistence in circulation of these glycoproteins which may be one of the causes of immunological disturbances in these patients.

Phagocytic activity of polymorphonuclear leukocytes during haemodialysis in relation to some immunological findings

The present study demonstrated prolonged decreases of phagocytic activity by neutrophils in comparison to transitory neutropenias during haemodialysis with cuprophane membranes, remaining in connection with non-equalization immunological findings as C3 complement levels, circulating immune complexes and lysozyme activity at the end of haemodialysis.

Local immunity in pregnant women

Immunoglobulins IgA and IgG levels and Lysozyme-activity were examined in the vaginal fluid of 70 pregnant women and 30 non-pregnant women where microbiological examinations did not detect any pathological microorganisms. To confirm the local character of immune factors produced in the female genital tract, these factors were also examined in the sera. An increase of class A immunoglobulins was noted in the vaginal fluid and examined sera. IgA/IgG ratio as well as statistical calculations confirmed the local origin of antibodies within the classes. The lysozyme activity was 10 times greater in the vaginal fluid than in the sera. Both factors are relatively simple to determine and in women with recurrent inflammatory conditions of the vaginal tract can be used as indicators of the local immunity state.