Kefir as a therapeutic agent in clinical research: a scoping review

Increasing research has been conducted on the role of probiotics in disease treatment. Kefir, a safe, low-cost probiotic fermented milk drink, has been investigated in many in vitro and animal studies, although parameters for human therapeutic dose or treatment time have not yet been determined. Here we perform a scoping review of clinical studies that have used kefir as a therapeutic agent, compiling the results for perspectives to support and direct further research. This review was based on Joanna Briggs Institute guidelines, including studies on the effects of kefir-fermented milk in humans. Using the term KEFIR, the main international databases were searched for studies published in English, Spanish or Portuguese until 9 March 2022. A total of 5835 articles were identified in the four databases, with forty-four eligible for analysis. The research areas were classified as metabolic syndrome and type 2 diabetes, gastrointestinal health/disorders, maternal/child health and paediatrics, dentistry, oncology, women's and geriatric health, and dermatology. The many study limitations hampered generalisation of the results. The small sample sizes, methodological variation and differences in kefir types, dosage and treatment duration prevented clear conclusions about its benefits for specific diseases. We suggest using a standard therapeutic dose of traditionally prepared kefir in millilitres according to body weight, making routine consumption more feasible. The studies showed that kefir is safe for people without serious illnesses.

Bioactive properties of clove (Syzygium aromaticum) essential oil nanoemulsion: A comprehensive review

Syzygium aromaticum, commonly called clove, is a culinary spice with medical uses. Clove is utilized in cosmetics, medicine, gastronomy, and agriculture due to its abundance of bioactive components such as gallic acid, flavonoids, eugenol acetate, and eugenol. Clove essential oil has been revealed to have antibacterial, antinociceptive, antibacterial activities, antifungal, and anticancerous qualities. Anti-inflammatory chemicals, including eugenol and flavonoids, are found in clove that help decrease inflammation and alleviate pain. The anti-inflammatory and analgesic qualities of clove oil have made it a popular natural cure for toothaches and gum discomfort. Due to its therapeutic potential, it has been used as a bioactive ingredient in coating fresh fruits and vegetables. This review article outlines the potential food processing applications of clove essential oil. The chemical structures of components, bioactive properties, and medicinal potential of clove essential oil, including phytochemical importance in food, have also been thoroughly addressed.

Rational use of Ashwagandha in Ayurveda (Traditional Indian Medicine) for health and healing

ETHNOPHARMACOLOGICAL RELEVANCE

Withania somnifera (L.) Dunal (Physalis somnifera L.) is a fairly known perennial shrub of Solanaceae family, and is used in Ayurveda- Traditional Indian Medicine (TIM), since ancient times. It is well known as Ashwagandha in Sanskrit language in Ayurvedic classics. Its Mula (root) is recommended for health and healing, and the number of single and compound formulation is prescribed rationally. It is believed that the species name-somnifera is coined based on popular use to "induce sleep" in Ayurveda.

AIM OF THE STUDY

The present study was aimed to bring out the experience-based traditional uses of Ashwagandha for health and healing with an emphasis on the pharmacological and biochemical scientific evidences to corroborate them. The scientific evidences have been explored from the national and international publications.

MATERIALS AND METHOD

A comprehensive literary search of Ayurvedic classics was carried out systematically regarding Ashwagandha for its rationality behind the traditional uses. To excavate the subject matter, the original Ayurvedic scriptures and several standard Ayurvedic texts of different period was studied insightfully for meaningful contribution. It is to be noted that the primary source of knowledge was considered in writing this manuscript without any biased attitude. The available literature on Ashwagandha was also searched to ascertain the basis of scientific Latin name and correct identity. The Ayurvedic Pharmacopoeia and other relevant scientific works were also taken into consideration to make the subject matter more clearly to the scientific world. For the scientific evidence of the uses, the international and national Journals and other published material were also searched to make it inquisitiveness to the scholars interested in Ayurvedic medicinal plants.

RESULTS

The present paper throws ancient luminosity behind the therapeutic uses of one of the promising plant drug i.e., Ashwagandha of ancient India even to the present time. The scientific evidences corroborate the rationality ascribed in available Ayurvedic classics of various period of India has been gained.

CONCLUSION

The study explores that the first reference of Ashwagandha with its significant nomenclature, useful part, properties, action, and eloquent uses has its footprint in the original texts of Ayurveda. In later works enhanced knowledge with traditional uses continued even today. Several single and compound formulations have been found to maintain the health and to alleviate the disorders rationally. It is worthy to note here that the scientific evidences corroborate the uses practiced in Ayurveda.

Role of agmatine in the application of neural progenitor cell in central nervous system diseases: therapeutic potentials and effects

Agmatine, the primary decarboxylation product of L-arginine, generated from arginine decarboxylase. Since the discovery of agmatine in the mammalian brain in the 1990s, an increasing number of agmatine-mediated effects have been discovered, demonstrating the benefits of agmatine on ischemic strokes, traumatic brain injury and numerous psychological disorders such as depression, anxiety, and stress. Agmatine also has cellular protective effects and contributes to cell proliferation and differentiation in the central nervous system (CNS). Neural progenitor cells are an important component in the recovery and repair of many neurological disorders due to their ability to differentiate into functional adult neurons. Recent data has revealed that agmatine can regulate and increase proliferation and the fate of progenitor cells in the adult hippocampus. This review aims to summarise and discuss the role of agmatine in the CNS; specifically, the effects and relationship between agmatine and neural progenitor cells and how these ideas can be applied to potential therapeutic application.

Remdesivir therapy in patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials

Purpose

To perform a systematic review and meta-analysis of randomized controlled trials that examined remdesivir treatment for COVID-19.

Materials and methods

A systematic literature search was performed using Pubmed, Embase, and ClinicalTrials.gov to identify studies published up to October 25, 2020 that examined COVID-19 treatment with remdesivir. A total of 3 randomized controlled trials that consisted of 1691 patients were included in the meta-analysis.

Results

The odds for mechanical ventilation (MV) or extracorporeal membrane oxygenation (ECMO) following treatment was significantly lower in the remdesivir group compared to the control group (OR = 0.48 [95% CI: 0.34; 0.69], p < 0.001). The odds of early (at day 14/15; OR = 1.42 [95% CI: 1.16; 1.74], p < 0.001) and late (at day 28/29; OR = 1.44 [95% CI: 1.16; 1.79], p = 0.001) hospital discharge were significantly higher in the remdesivir group compared to the control group. There was no difference in the odds for mortality in patients treated with remdesivir (OR = 0.77 [95% CI: 0.56; 1.06], p = 0.108).

Conclusions

Remdesivir attenuates disease progression, leading to lower odds of MV/ECMO and greater odds of hospital discharge for COVID-19 patients. However, remdesivir does not affect odds of mortality.

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Remdesivir reduces the odds for mechanical ventilation or extracorporeal membrane oxygenation in COVID-19 patients.

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Remdesivir improves the odds for hospital discharge.

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Remdesivir does not lower the odds for mortality.

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Remdesivir can attenuate COVID-19 progression, but it is less effective in treating critically-ill patients.

[Use (and abuse) of antibiotics in perinatal medicine]

INTRODUCTION

The rational use of antibiotics (ATB) implies that patients receive those adequate for their clinical needs, in correct doses according to their individual conditions, during an adequate period of time, and at the lowest cost for them and their community. The highest rate of ATB abuse occurs during the perinatal period, despite the fact that there is evidence of multiple short- and long-term negative effects. Furthermore, this abuse is associated with increased costs of medical care.

OBJECTIVE

To update and report the evidence on the use, abuse, and adverse effects of ATB in perinatal medicine, and possible measures to prevent them, and thus improve health care outcomes and costs.

METHODS

A review and analysis was performed from the literature related to the use of ATB in perinatal medicine up to February 2020.

RESULTS

ATB abuse in perinatal medicine ranges from 50% to 70%, with even higher rates in some neonatal centres. Adverse effects include death, increased microbial resistance, along with microbiome abnormalities and dysbiosis that lead to serious life-long complications such as infections, allergies, autoimmune disorders, gastrointestinal disorders, arthritis, asthma, obesity, and perhaps cancer. Preventing and reducing the abuse of ATB would lead to better health and to significant savings in the health sector. In only 4neonatal intensive care units, with 1000 admissions per year, savings are estimated at US$230,000 per year.

CONCLUSION

The need to optimise the use of ATB in perinatal medicine has never been more urgent.

Factors associated with children's health facility visits for primaquine treatment in rural Papua New Guinea

Background

To control and eventually eliminate vivax malaria, radical treatment with primaquine (PQ) is essential after completion of blood-stage treatment. Although in many malaria-endemic countries, village health volunteers (VHVs) are engaged in diagnostic treatment of malaria in remote communities, they principally provide blood-stage treatment. In such a situation, access to PQ following blood-stage treatment can be a barrier to complete treatment. However, studies on access to PQ treatment have been scarce and limited in health facility-based settings. This study aimed to identify factors associated with access to PQ treatment in rural Papua New Guinea (PNG) from the community case management perspective.

Methods

A community-based, cross-sectional survey was conducted to collect sociodemographic information on children under 15 years of age, their households, and their caretakers in East Sepik Province, PNG. Data collection lasted from February to March, 2015. Information on the diagnoses of potential non-falciparum malaria and prescription of PQ in preceding year (January to December 2014) were obtained from child health-record books. Then, multilevel logistic regression model was used to determine the factors associated with formal health facility visits for PQ treatment among children with potential non-falciparum malaria.

Results

Of 420 episodes diagnosed as potential non-falciparum malaria, 46 (11%) were immediately given PQ. The rest were instructed to visit formal health facilities (HFs) for PQ, and the patients obtained PQ during the second visit to HFs was 44%. Consequently, the overall proportion of PQ prescription was 50%. Logistic regression analysis suggested that among the patients who were instructed to visit HFs for PQ treatment, the initial visit to VHV and higher transportation costs to HF were inversely associated with PQ prescription during the second visit to an HF.

Conclusions

Few children received PQ treatment during the second visit to HFs following diagnosis of potential non-falciparum malaria. These findings suggest a need to establish a policy to reduce structural and economic barriers and improve rural inhabitant access to PQ treatment.

Electronic supplementary material

The online version of this article (10.1186/s12936-019-2675-4) contains supplementary material, which is available to authorized users.

Predicting tumor responses and patient survival in chemoradiotherapy-treated patients with non-small-cell lung cancer using dynamic contrast-enhanced integrated magnetic resonance-positron-emission tomography

PURPOSE

We investigated whether radiologic parameters by dynamic contrast-enhanced (DCE) integrated magnetic resonance-positron-emission tomography (MR-PET) predicts tumor response to treatment and survival in non-metastatic non-small-cell lung cancer (NSCLC) patients receiving chemoradiotherapy (CRT).

METHODS

Patients underwent DCE integrated MR-PET imaging 1 week before CRT. The following parameters were analyzed: primary tumor size, gross tumor volume, maximal standardized uptake value (SUV_max), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC), volume transfer constant (K^trans), reverse reflux rate constant (k_ep), extracellular extravascular volume fraction (v_e), blood plasma volume fraction (v_p), and initial area under the time-concentration curve defined over the first 60 s post-enhancement (iAUC₆₀). CRT responses were defined using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1).

RESULTS

Thirty patients were included. Non-responders demonstrated higher baseline TLG (p = 0.012), and lower baseline K^trans (p = 0.020) and iAUC₆₀ (p = 0.016) compared to responders, indicating the usefulness of DCE integrated MR-PET to predict treatment responses. Receiver operating characteristic curve indicated that TLG has the best differentiation capability to predict responders. By setting the threshold of TLG to 277, the sensitivity, specificity, and accuracy were 66.7%, 83.3%, and 75.0%, respectively, with an area under the curve of 0.776. The median follow-up time was 19.6 (range 7.8-32.0) months. In univariate analyses, baseline TLG >277 (p = 0.005) and baseline K^trans <254 (10^-3 min^-1; p = 0.015) correlated with poor survival after CRT. In multivariate analysis, baseline TLG >277 remained the significant factor in predicting progression (p = 0.012) and death (p = 0.031).

CONCLUSIONS

The radiologic parameters derived from DCE integrated MR-PET scans are useful for predicting treatment response in NSCLC patients treated with CRT; furthermore, these parameters are correlated with clinical and survival outcomes including tumor progression and death.

The Horizon of Gene Therapy in Modern Medicine: Advances and Challenges

Gene therapy as a novel study in molecular medicine will have a significant impact on human health in the near future. In recent years, the scope of gene therapy has been developed and is now beginning to revolutionize therapeutic approaches. Accordingly, many types of diseases are now being studied and treated in clinical trials through various gene delivery vectors. The emergence of recombinant DNA technology which provides the possibility of fetal genetic screening and genetic counseling is a good case in point. Therefore, gene therapy advances are being applied to correct inherited genetic disorders such as hemophilia, cystic fibrosis, and familial hypercholesterolemia as well as acquired diseases like cancer, AIDS, Alzheimer's disease, Parkinson's disease, and infectious diseases like HIV. As a result, gene therapy approaches have the ability to help the vast majority of newborns with different diseases. Since these ongoing treatments and clinical trials are being developed, many more barriers and challenges have been created. In order to continue this positive growth, these challenges need to be recognized and addressed. Accordingly, safety, efficiency and also risks and benefits of gene therapy trials for each disease should be considered. As a result, sustained manufacturing of the therapeutic gene product without any harmful side effects is the least requirement for gene therapy. Herein, different aspects of gene therapy, an overview of the progress, and also the prospects for the future have been discussed for the successful practice of gene therapy.

[Application and prospect of three-dimentional printing in stomatology]

Three dimentional printing is a new rapid prototyping technology based on digital model files, which developed through a combination of multi-disciplines such as information technology, precision machinery and materials science. With rapid development in recent years, three dimentional printing technology has been widely used in the medical fields, stomatology especially. It gradually penetrates into various parts of stomatology, such as education, practice and innovation, making stomatology clinical medicine more and more efficient, accurate and minimally invasive. Combined with basic research and clinical cases, this article describes the application and developent prospects of three dimentional printing technology in stomatology.

Efficacy and safety of Shaoyang Xibi decoction in patients with knee osteoarthritis: a multi-center, single-blind, randomized controlled trial

PURPOSE

To observe the efficacy and safety of Shaoyang Xibi decoction (SYXBD) in patients with knee osteoarthritis (KOA), and to verify that the theory of ""Shaoyang dominating bone"" in Traditional Chinese Medicine (TCM) can be applied to KOA treatment.

METHODS

Participants were randomly allocated to two groups: SYXBD (treatment group, n = 66) and Meloxicam (control group, n = 66). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 36-Item Short Form Health Survey (SF-36) were used to assess efficacy before the treatment and 8 weeks after the treatment.

RESULTS

Baseline data before the treatment between the two groups were similar. The WOMAC scores significantly decreased and the SF-36 scores significantly increased after 8- week treatment in both groups compared with before the treatment (P < 0.05). SYXBD significantly decreased pain scores (P < 0.001), physical function scores (P < 0.001) and the total scores (P < 0.001) in WOMAC compared to Meloxicam. SYXBD significantly improved physical function (P = 0.021), bodily pain (P = 0.002) and general health (P = 0.014), with no significant difference in role emotional (P = 0.053), role physical (P = 0.517), vitality (P = 0.241), social function (P = 0.712) and mental health (P = 0.800) in SF-36 compared to Meloxicam. No adverse events were reported in the treatment group while 13 adverse events happened in the control group during the study.

CONCLUSION

SYXBD, prepared based on the theory of ""Shaoyang dominating bone"", has a better curative efficay and safety in patients with KOA compared with Meloxicam. The TCM theory of ""Shaoyang dominating bone"" may be useful in KOA treatment.

Star-Shaped Intense Uptake of ¹³¹I on Whole Body Scans Can Reflect Good Therapeutic Effects of Low-Dose Radioactive Iodine Treatment of 1.1 GBq

BACKGROUND

After initial radioactive iodine (RAI) treatment in differentiated thyroid cancer patients, we sometimes observe a star-shaped region of intense uptake of ¹³¹I on whole body scans (WBSs), called a 'star artifact.' We evaluated the clinical implications of star artifacts on the success rate of remnant ablation and long-term prognosis.

METHODS

Total 636 patients who received ¹³¹I dose of 1.1 GBq for the initial RAI therapy and who did not show distant metastasis at the time of diagnosis were retrospectively evaluated. A negative second WBS was used for evaluating the ablation efficacy of the RAI therapy. Among them, 235 patients (36.9%) showed a star artifact on their first WBS.

RESULTS

In patients with first stimulated thyroglobulin (sTg) levels ≤2 ng/mL, patients with star artifacts had a higher rate of negative second WBS compared with those without star artifacts (77.8% vs. 63.9%, P=0.044), and showed significantly higher recurrence-free survival (P=0.043) during the median 8.0 years (range, 1.0 to 10.0) of follow-up. The 5- and 10-year recurrence rates (5YRR, 10YRR) were also significantly lower in patients with star artifacts compared with those without (0% vs. 4.9%, respectively, P=0.006 for 5YRR; 0% vs. 6.4%, respectively, P=0.005 for 10YRR). However, ablation success rate or recurrence-free survival was not different among patients whose first sTg levels >2 ng/mL regardless of star artifacts.

CONCLUSION

Therefore, star artifacts at initial RAI therapy imply a good ablation efficacy or a favorable long-term prognosis in patients with sTg levels ≤2 ng/mL.

A review on phytochemistry and therapeutic uses of Hibiscus sabdariffa L

Hibiscus sabdariffa L. (roselle) belonging to the Malvaceae family is widely grown in many countries. This plant is often used in the traditional medicine being rich in phytochemicals like polyphenols especially anthocyanins, polysaccharides and organic acids thus having enormous prospective in modern therapeutic uses. The study aimed to review and document all the available evidence and information about the calyces of Hibiscus sabdariffa (roselle) with the special focus on their nutritional composition, bioactive constituents and therapeutic uses. The electronic database was searched up to 2017, using keywords Hibiscus sabdariffa, chemical constituents of roselle, therapeutic uses of roselle. Journals, books and conference proceedings were also searched. The review provides valuable information about the nutraceutical component of Hibiscus sabdariffa L. and their utilization for curing various degenerative diseases like hypertension, hyperlipidemia, cancer and other inflammatory diseases of liver and kidney. Their toxicological effects have also been discussed from a safety point of view. Most studies supported and provided the scientific basis for the statement that Hibiscus sabdariffa and their active constituents play an important role in the prevention of chronic and degenerative diseases that are associated with oxidative stress. Our study suggests, that good research is needed, to establish a potential strategy that can balance the pharmacological and toxic effects of roselle and standardized fingerprint of Hibiscus sabdariffa is required internationally for quality control.

Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial

Background

Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions.

Methods

Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67.

Results

Patients in this trial on average received 5.6 ± 2.6 procedures over a period of 2 years, with average relief over a period of 2 years of 82.8 ± 29.6 weeks with 19 ± 18.77 weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY.

Conclusions

The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.

[Application of improved regional citrate anticoagulation in continuous hemofiltration in children]

Objective: To investigate the application of regional citrate anticoagulation with calcium hemofiltration basic solution in continuous hemofiltration in children. Method: The clinical data of 18 patients with citrate anticoagulation in continuous hemofiltration in children, excluding the hepatic failure and septic shock cases, were analyzed retrospectively, from September 2015 to August 2016 in Intensive Care Unit of the Children's Hospital of Chongqing Medical University.The commercial calcium hemofiltration basic solution was used as displacement liquid . The blood gas analysis, electrolyte, four coagulation tests during the treatment and the corresponding relations of quantity of blood flow(QB), quantity of citrate flow(QCi), quantity of sodium bicarbonate flow(QSB), quantity of calcium flow(QCa), quantity of filtered solution flow (Qf) were monitored. Meanwhile, the blood gas analysis, electrolyte, four coagulation tests, useful life of filter, bleeding and clotting events internal and external before, during and after the treatments were monitored, too. And the common complications of citrate anticoagulation, such as hypocalcaemia, metabolic alkalosis, citrate accumulation and hypernatremia were observed. Result: Continuous hemofiltration was applied in 18 patients for 734.5 hours, and the average useful life of filter was (25±11)h.There was no obvious clotting event. There were 168 groups of datum of the blood gas analysis, electrolyte, four coagulation tests during the treatment and the relationships of QB, QCi, QSB, QCa, Qf had been collected. The relationships of the initial parameter settings of QB, QCi, QSB, QCa and Qf were concluded as QCi=1.8×QB, QCa=0.12×QB, QSB=0.01×Qf . There were 150 times(89.3%)of extracorporeal ionized calcium(iCa(E)(2+)) and 162 times(96.4%) of intracorporal ionized calcium(iCa(I)(2+)) reached the anticoagulation target. Although all the comparisons of Na(+) ((136.2±4.1)vs.(138.2±2.4)vs.(138.5±3.9)mmol/L), iCa(2+) ((1.07±0.11)vs.(1.21±0.12)vs.(1.17±0.09)mmol/L), HCO(3)(-) ((22±4)vs.(28±5)vs. (26±4)mmol/L) among before, during and after treatment had significant difference(F=6.414, 18.950, 19.151; P=0.002, 0.000, 0.000). Each mean parameter was within the nearly normal range, except that the HCO(3)(-) increased slightly. High HCO(3)(-) was the most common complications, which happened 87 times (51.8%) during the treatment and 11 cases(37.9%) after the treatment. There was none with refractory hypocalcemia and total ionized calcium(TCa(2+) )/iCa(2+) above 2.5, which hints the accumulation of citrate. Conclusion: The commercialized displacement liquid containing calcium can be used in RCA-CHF in children safely and simply.

[Advances in the research of mechanism in prevention and treatment of scar with botulinum toxin type A and its clinical application]

Scar is a common complication in wound healing process, and how to effectively prevent and treat it is a hot and difficult problem in burns and plastic surgery field. Botulinum toxin type A is a neurotoxin that has been widely and effectively used in the cosmetic surgery field such as anti-wrinkle and thin face. In recent years, botulinum toxin type A has been applied in prevention and treatment of scar, which causes a great concern. Nowadays, the relevant reports have gradually increased, and the mechanisms have been explored more deeply. This article aims to summarize the possible mechanisms and clinical reports on the prevention and treatment of scar by botulinum toxin type A to provide a new way for the prevention and treatment of scar after surgery.

[Development and preliminary clinical application of home-made temporomandibular joint prostheses]

Objective: To explore the clinical application of home-made temporomandibular joint (TMJ) prostheses. Methods: Self-developed TMJ prostheses were applied for end stage osteoarthritis, TMJ ankylosis, condylar tumors after biomechanical examination. The stability of the prostheses toward bone was evaluated during operation. Post-operative CT scans and clinical follow-ups were taken to check changes of mouth opening, position of the prostheses, bone resorption around the screws, and heterotopic bone formation around artificial condyle. Results: There were 6 patients accepted 7 prostheses smoothly without infection and other complications. Post-operative follow-ups were from 6 to 13 months with a mean of 7.6 months. Mouth opening was significantly improved from (16.2±14.4) mm before operation to (31.5±4.8) mm during follow-ups (P=0.01). All prostheses were stable without screw loose and heterotopic bone formation. Conclusions: Home-made TMJ prostheses were stable after primary clinical application, but the long-term results need to be observed.

Dose-Dependent Effects of Common Antibiotics Used to Treat Staphylococcus aureus on Biofilm Formation

BACKGROUND & OBJECTIVE

Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA), represent serious nosocomial and community infections. Biofilm formation as an important virulence factor may be affected by sub-inhibitory levels of antibiotics. Few studies examined the effects of all therapeutic antimicrobial agents on clinical S.aureus. The current study aimed at observing the inducing and reducing effects of antibiotics, commonly used to treat staphylococcal infections on the production of staphylococcal biofilm.

METHODS

Four MRSA (1ATCC and 3 clinical) and 1 methicillin-susceptible Staphylococcus aureus (MSSA) strains with biofilm forming ability, evaluated by the Congo red agar (CRA) plate test, were employed. Biofilm formation was measured by crystal violet microtiter plate assay. Cefazolin, rifampicin, vancomycin, oxacillin, clindamycin, cotrimoxazole, minocycline, linezolid, azithromycin, and clarithromycin were added to wells ranging from 0.06to 128 µg/mL (1× to 1/1024 MIC dependent on the MIC value of each strain).

RESULTS

The current study showed that azithromycin and vancomycin had a significant inducing effect on biofilm formation. In contrast, linezolid, cefazolin, and clarithromycin, and in the second place, clindamycin and minocycline could inhibit the level of biofilm production in the sub-minimal inhibitory concentrations.

CONCLUSION

The findings demonstrated that the biofilm formation as an important virulence factor may be affected by the subinhibitory levels of antibiotics.

Therapeutic role of template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract

Lymphadenectomy for urothelial carcinoma of the upper urinary tract has attracted the attention of physicians. The mapping study of lymphatic spread has shown that a relatively wide area should comprise the regional nodes for tumors of the right renal pelvis or the right upper two-thirds of the ureter. A prospective study showed that an anatomical template-based lymphadenectomy significantly improved patient survival in tumors of the renal pelvis. This benefit was more evident for patients with pT2 stage tumors or higher. The risk of regional node recurrence is significant reduced by template-based lymphadenectomy, which is likely to be associated with improved patient survival. The removal of lymph node micrometastases is assumed to be the reason for therapeutic benefit following lymphadenectomy. The number of resected lymph nodes can be used to assess the quality of lymphadenectomy, but not to determine the extent of lymphadenectomy. The guidelines currently recommend lymphadenectomy for patients with muscle-invasive disease, even though the current recommendation grades are still low. The present limitation of lymphadenectomy is the lack of standardization of the extent of lymphadenectomy and the randomized trials. Further studies are warranted to collect the evidence to support lymphadenectomy.

Drug utilisation study in patients receiving antiepileptic drugs in Colombia

INTRODUCTION

This study examines the indications according to which antiepileptic drugs are prescribed and used in a population of patients enrolled in the Colombian national health system (SGSSS).

METHODS

Retrospective cross-sectional study. From the pool of individuals in 34 Colombian cities who used antiepileptic drugs between 18 July, 2013 and 31 August, 2014 during a period of no less than 12 months, we obtained a random sample stratified by city. Socio-demographic, pharmacological and comorbidity variables were analysed. Continuous and categorical variables were compared, and logistic regression models were used.

RESULTS

Our patient total was 373 patients, with 197 women (52.1%) and a mean age of 41.9 ± 21.7 years; 65.4% of the patients were treated with monotherapy. The most frequently used drugs were valproic acid (53.1%) and carbamazepine (33.2%). Epilepsy was the most frequent indication (n=178; 47.7%); however, 52.3% of the patients were prescribed antiepileptics for different indications, especially neuropathic pain (26.8%), affective disorders (14.2%) and migraine prophylaxis (12.3%). A total of 81 patients with epilepsy (46.6%) displayed good seizure control while another 25 (14.4%) had drug-resistant epilepsy. In the multivariate analysis, medication adherence was associated with a lower risk of treatment failure in patients with epilepsy (OR: 0.27; 95%CI, 0.11-0.67).

CONCLUSIONS

In Colombia, antiepileptic drugs are being used for indications other than those originally intended. Monotherapy is the most commonly used treatment approach, together with the use of classic antiepileptic drugs.