Leukolysis reaction in the diagnosis of allergy to antibacterial preparations in pulmonology]

The experiment included 109 patients with non-specific pathological processes in the lungs. i.e. 21 cases with acute and 55 cases with chronic pneumonia and 33 cases with bronchial asthma with or without chronic pneumonia. Clinically intolerance of the antibacterial drugs was observed in 39 patients and increased leucolysis (above 15 per cent) was observed sometimes more frequently. Only with the use of penicillin the difference was 1.6 times. Out of 39 patients with clinical signs of allergy to antibiotics or sulphanilamide only 20 showed the signs of increased leucolysis on the use of the respective drug. No correlation between the percentage of the leucolysis cases due to antibiotics or sulphanilamides and the clinical signs of their intolerance was observed. The use of such drugs by a person or even only his presence in the hospital often induced increased leucolysis which may be considered as an indication of the person sensibilization to them.     

Evaluation of the effect of medicines on biological properties of Clostridium difficile

The presence of the persistence factors (anti-lysozyme and anti-complement activity) in the vegetative forms of C. difficile was experimentally proved. The effect of different medicines (vitamins B1, B6 and C, prebiotic inulin, probiotics Bifidumbacterin and Enterol) on the persistence factors of C. difficile and microbial resistance to vancomycin, thienam, lincomycin, clindamycin was evaluated. The anti-lysozyme and anti-complement activity of C. difficile was found to decrease under the influence of vitamins B1, B6, C, inulin, exometabolites of bifidobacteria. Under the impact of the preparations used in this study changes in the sensitivity of C. difficile to antibiotics of the lincoamide, carbapenem, glycopeptide groups were found to occur. The data obtained reveal one of the possible mechanisms of the corrective action of the medicines under study on the intestinal microbiocenosis in patients with antibiotic-associated colitis.     

Experimental grounds for the effectiveness of ciprofloxacin and oxytocin combined use

In order to determine the influence of combined use of ciprofloxacin and oxytocin on susceptibility of microflora to antibiotics as well as level of microbial anti-lysozyme (ALA) and anti-complement activity (ACA) 148 anaerobic and aerobic microorganisms were isolated from 80 patients with purulent infections of soft tissues. Susceptibility of staphylococci, streptococci, and enterobacteria to the most commonly used antibiotics was assessed by agar-diffusion method with standard disks. ALA and ACA of the isolated strains were defined by routine methods. Minimal inhibitory concentration (MIC) of ciprofloxacin and oxytocin for isolated pathogens were determined according to standards of NCCLS. Influence of oxytocin on MIC of ciprofloxacin was determined as well as inhibitory effect of the latter on factors of bacterial persistence. Decrease of MIC of ciprofloxacin as well as increase of its inhibitory effect on pathogens' ALA and ACA when it used in combination with oxytocin were noted. Usefulness of combined use of ciprofloxacin and oxytocin for treatment of different infections has been proposed.     

非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎病原菌组成及耐药性分析

目的分析非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎临床特征、病原菌组成及耐药性,指导临床诊断及合理使用抗菌素。方法回顾性分析46例前瞻性观察诊断的非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎临床及微生物学资料。结果平均起病时间为人院后（14．3±13．2）d,最常见基础疾病依次为脑血管意外（16／46）,慢性肺部疾病（13／46）和糖尿病（5／46）。培养阳性率58．7％,最常见细菌依次为鲍曼不动杆菌（8／27）、铜绿假单胞菌（6／27）、阴沟肠杆菌（3／29）及金黄色葡萄球菌（3／29）。80．4％患者入院72h内使用过抗生素,初始经验性治疗最常使用的抗菌素依次为头孢菌素（29／46）、碳青霉烯类（9／46）、糖肽类（5／46）。8株鲍曼不动杆菌对头孢哌酮／舒巴坦中介MIC〉32mg／L,对其他抗生素耐药;2株铜绿假单胞菌对美罗培南高度耐药MIC=128mg／L。结论非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎多发生在有脑血管疾病及慢性肺疾病老年患者,我院非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎最常见的病原菌多药耐药鲍曼不动杆菌,铜绿假单胞菌对碳青霉烯类耐药率较高。应优化医院获得性肺炎及呼吸机相关肺炎初始抗生素使用。     

The role of persistence and virulence factors in microecological changes in a humans

The patterns of persistence and virulence factors expression in the representatives of human microbial biocenosis depends on a complex of the environmental conditions: influence of microbes-symbionts, biotope peculiarities, properties of microorganisms located within eukaryotes. Interactions of symbionts in pairs "indigen-indigen" isolated from mucous membrane of tonsils in healthy persons, did not lead to changes in expression of pathogenic properties. Interinfluence in pairs "pathogen-indigen" and "indigen-indigen", isolated from patients with chronic tonsilitis were accompanied by an increase of anti-lysozyme, hemolytic and lecithovitellase activities. Migration of strains of non-enzymatized gram-negative bacteria (NEYNB) from nasal into tympanic cavity in experimental acute purulent otitis is connected with an earlier increase of their number in the nasal cavity and the expression of anti-lysozyme activity. In acute and chronic pyoderma, expression of ALA is more marked in bacteria from a perifocal damage in contrast to focal damage of normal skin. In conditions of interaction between erythrocytes and staphylococcal clones with different levels of expression of pathogenic factors, differences were observed in dynamics of hemolytic and anti-hemoglobin activities.     

A potentiometric rapid method of determining the level of phenylacetic acid during the production of beta-lactam antibiotics

A potentiometric rapid method for control of phenylacetic acid (PAA) concentration in production of ++beta-lactam antibiotics is described. The method is based on ion selective electrodes with a film membrane. The results of the theoretical and experimental studies on estimation of the electrode selectivity specific of PAA in the presence of various interfering ions are presented. It was shown possible to use the electrodes for PAA control in the media containing nitrates, bicarbonates and chlorides. Recommendations how to use the ion selective electrodes at various stages in production of ++beta-lactam antibiotics are given. Prospects for improving the method and designing an instrument for rapid assay of phenyl acetate ion activity are discussed.     

The role of antibiotics in the prevention of cross infections in newborn infants and mothers during the puerperium]

Epidemiological efficiency of antibiotic prophylaxis of hospital infections (HIs) in maternity homes was analyzed by the materials on the clinical observation of 43995 newborns and their mothers within a period of 1986 to 1989 as well as by the data on the bacteriological examination of 6616 smears from the mucosa of the nose, pharynx, rectum and umbilical wounds of 1890 newborns carried out within the same period. It was shown that the prophylactic use of the antibiotics in the maternity homes led to changes in the microflora colonizing the newborns. The more massive was the use of the antibiotics in the departments of newborns and the postnatal departments, the more intensive was replacement of gram-positive microflora in the newborns by gram-negative organisms among which Klebsiella strains with high antibiotic resistance predominated. This involved an increase in the incidence of pneumonia and sepsis in the newborns and a higher death rate among the newborns due to HIs. In parallel there was observed an increase in the incidence of metro-endometritis in the puerperae++ and a simultaneous decrease in the number of the cases with lactational mastitis as a result of lower numbers of Staphylococcus aureus cultures isolated from various loci of the newborns. It was concluded that antibiotics were not the drugs to be used as prophylactic agents in control of HIs in maternity homes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effectiveness of acipole in prevention of enteric dysbacteriosis due to antibacterial therapy]

Acipole (Lactobacillus acidophilus + Kefir greins) was used to manage antibiotic dysbacteriosis as an adverse reaction of antibacterial therapy. 120 patients treated with antibacterial drugs for acute pneumonia and exacerbations of chronic bronchitis were observed. 54 of them were treated under the routine regimen with antibiotics and 66 were additionally treated with the eubiotic acipole: 1 tablet (5 doses) 3 times a day 30 minutes before meal. Routine bacteriological examination of the feces was applied to all the patients. High frequency of bacteriologically revealed dysbacteriosis was stated. The therapy under the antibiotic + acipole regimen lowered the frequency of dysbacteriosis events and their severity. The fact that the use of acipole simultaneously with the routine antibacterial therapy prevented the development of dysbacteriosis clinical signs is of practical importance.     

Natural killer and lymphokine-activated killer cell functions in chronic myeloid leukemia

Summary The natural killer (NK) and lymphokine-activated killer (LAK) cell activities of peripheral blood lymphocytes from chronic myeloid leukemia (CML) patients in remission and from healthy donors have been studied. Regression analysis to compare both cytotoxic responses in individual donors and the frequency of LAK cell precursors was also carried out. About 42% of CML patients in remission showed low NK activity (less than the mean percentage NK activity of healthy donors — 2 SD) and were categorised as low NK responders. The stage of remission or the drugs used to bring about remission did not influence the NK status. The LAK activity of low NK as well as normal NK responder CML patients was significantly low against the NK-sensitive K562 cell line and the NK-resistant VIP (melanoma) and T-24 (bladder carcinoma) tumor targets, as assessed by linear regression analysis. Allogeneic leukemic cells were more resistant to killing, especially by patients' LAK cells. The frequency analysis of LAK cell precursors revealed a significant reduction in the LAK cell progenitor frequency in CML patients in remission.     

The surgical management of Melkersson-Rosenthal syndrome.

A triad of facial palsy, orofacial edema, and furrowed tongue constitutes an uncommon condition known as Melkersson-Rosenthal syndrome (MRS). We report on 14 patients with Melkersson-Rosenthal syndrome. Two patients had facial palsy, 12 had orofacial edema, and 1 patient had a furrowed tongue. Nine patients were treated medically. Intralesional steroid therapy had a 75 percent recurrence rate. Systemic steroid therapy resulted in remission in two of three patients. Surgical excision and reconstruction were carried out in five patients with chronic lip or eyelid edema. This provided relief in all cases. The etiology, clinical presentation, and histologic features are discussed. Three illustrative cases are presented. An algorithm is provided that guides the surgeon with regard to both the medical and surgical treatment of the patient with Melkersson-Rosenthal syndrome.     

Evaluation of liposomal forms of rifampicin and prodigiozan in the treatment of experimental chronic tonsillitis

Therapeutic effect of liposomal dosages of rifampicin and prodigiozan was studied on rabbits with simulated chronic tonsillitis in comparison to that of commercial ones of the drugs. The treatment schemes included daily intra-tonsillar++ injections of the dosage forms for 5 days. A high efficacy of their liposomal dosage forms in treatment of experimental chronic tonsillitis was confirmed microbiologically and immunologically. Approval of the liposomal dosage forms used in the therapy of patients with chronic tonsillitis requires clinical trials.     

Restoration of the immune balance by autologous bone marrow transplantation in juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is one of the most frequent autoimmune diseases in childhood and is characterized by chronic inflammation of the synovial fluid in joints. Several drugs are available for the treatment of JIA, including various biological agents that interfere with critical cytokine pathways. Though very effective in suppressing disease activity, none of these drugs can cure the disease and induce a lasting medication free remission. A small proportion of JIA patients will become or are unresponsive to any form of medical treatment. For these severely ill patients autologous bone marrow transplantation (aBMT) is a last resort treatment. aBMT is remarkably effective in suppressing disease activity, with beneficial outcome reported in around 70% of these previously refractory patients. Moreover aBMT is the only treatment that can induce a lasting medication-free-disease remission in these patients. In the very long term (after 7 years of remission) however, some disease relapses are observed, with the disease returning in a less severe form compared to prior aBMT. The exact mechanism of how aBMT is inducing this lasting disease remission is still largely unknown, but data from both animal models and humans suggest a prominent role for regulatory T cells. In this review we reviewed the current views of the cellular mechanisms that lay beneath disease induction of JIA and the disease remission caused by aBMT therapy.     

Osilodrostat: A Review of Recent Clinical Studies and Practical Recommendations for its Use in the Treatment of Cushing Disease

ObjectiveCushing disease (CD) is characterized by chronic hypercortisolism caused by an adrenocorticotropic hormone-secreting pituitary adenoma. Surgery remains the first-line treatment option; however, medical therapy is essential if surgery is contraindicated or fails to achieve remission or when recurrence occurs after surgical remission. Osilodrostat (Isturisa), a novel steroidogenic inhibitor, is now approved for the treatment of CD in the United States and Cushing syndrome in Europe. Herein, we review pharmacology and data on the efficacy, safety, and clinical use of osilodrostat and provide guidance on its use in treating patients with CD.MethodsWe reviewed the literature and published clinical trial data of osilodrostat use in patients with Cushing syndrome. Detailed information related to the clinical assessment of osilodrostat use, potential drug-to-drug interactions, drug initiation, dose titration, and the monitoring of drug tolerability were discussed.ResultsClinical trial data demonstrated that osilodrostat, by virtue of inhibiting 11-β hydroxylase, potently and rapidly decreased the 24-hour urinary free cortisol levels and sustained these reductions, with improved glycemia, blood pressure, body weight, and quality of life as well as lessened depression. Osilodrostat may interact with certain drugs, resulting in QT prolongation, which requires careful assessment of concomitant medications and periodic monitoring using electrocardiogram, respectively. The common adverse effects include adrenal insufficiency, hypokalemia, edema, and hyperandrogenic symptoms, which can be minimized using a slower up-titration dosing regimen.ConclusionOsilodrostat is an effective, new treatment option for CD, with positive effects on cardiovascular and quality of life parameters as well as tolerable adverse effects. This article provides a review of the pharmacology of osilodrostat and offers practical recommendations on the use of osilodrostat to treat CD.     

Are amoxycillin and folate inhibitors as effective as other antibiotics for acute sinusitis? A meta-analysis

Objectives: To examine whether antibiotics are indicated in treating uncomplicated acute sinusitis and, if so, whether newer and more expensive antibiotics with broad spectra of antimicrobial activity are more effective than amoxycillin or folate inhibitors. Design: Meta-analysis of randomised trials. Setting: Outpatient clinics. Subjects: 2717 patients with acute sinusitis or acute exacerbation of chronic sinusitis from 27 trials. Interventions: Any antibiotic versus placebo; amoxycillin or folate inhibitors versus newer, more expensive antibiotics. Main outcome measurements: Clinical failures and cures. Results: Compared with placebo, antibiotics decreased the incidence of clinical failures by half (risk ratio 0.54 (95% confidence interval 0.37 to 0.79)). Risk of clinical failure among 1553 randomised patients was not meaningfully decreased with more expensive antibiotics as compared with amoxycillin (risk ratio 0.86 (0.62 to 1.19); risk difference 0.9 fewer failures per 100 patients (1.4 more failures to 3.1 fewer failures per 100 patients)). The results were similar for other antibiotics versus folate inhibitors (risk ratio 1.01 (0.52 to 1.97)), but data were sparse (n=410) and of low quality. Conclusions: Amoxycillin and folate inhibitors are essentially as effective as more expensive antibiotics for the initial treatment of uncomplicated acute sinusitis. Small differences in efficacy may exist, but are unlikely to be clinically important.

Key messages

• A major question in managing acute sinusitis is whether antibiotics should be used, and if so which drugs should be chosen
• In a comprehensive meta-analysis we evaluated evidence from randomised controlled trials comparing, firstly, antibiotics against placebo and, secondly, amoxycillin and folate inhibitors against newer, more expensive antibiotics
• Antibiotics were significantly more efficacious than placebo in achieving cure of clinical symptoms, but over two thirds of placebo patients showed spontaneous resolution or improvement of symptoms
• Amoxycillin and folate inhibitors had overall similar efficacy compared with newer antibiotics
• The current evidence does not justify the use of expensive, broad spectrum antibiotics in the community for treating uncomplicated acute sinusitis

     

Identification of potential causative infectious agents of chronic prostatitis

Analysis of the data on etiology and pathogenesis of inflammatory processes in prostate including acute and chronic prostatitis as well as chronic pelvic pain syndrome is presented. It has been noted that about 50% of men of fertile age had clinical signs of chronic prostatitis at least once in life and that more than 60% of admissions to urologists in outpatient practices are related with clinical signs of chronic prostatitis. An appreciable decrease in quality of life similar to that due to myocardial infarction or Crohn's disease is observed in patients with chronic prostatitis. Prostatitis often has a chronic cyclic course with exacerbation and remission phases. Not rarely the disease has primary chronic course--without an apparent beginning as acute prostatitis. This leads to late diagnostics and difficulties with identification of etiologic factor, which commonly is a conditionally pathogenic microorganisms and mixed infections. Such difficulties can be a reason for inadequate treatment and complications of chronic prostatitis such as abscess, paraprostatitis, impotence, and infertility.     

Microbial inhibitors of lysozyme

Lysozyme is one of the most important factors of innate immunity, possessing anti-microbial action against a wide range of microorganisms due to cationic nature of protein and, in a lesser degree, due to muramidase activity. In the process of evolution, different mechanisms of lysozyme inhibition, defined as anti-lysozyme activity (ALA), were formed in microorganisms. The usage of the delayed antagonism principle allowed to reveal anti-lysozyme sign in microorganisms of different phylogenetic groups. In the review, data on the occurrence and level of anti-lysozyme activity in pathogens and representatives of normal microflora were presented; findings on nature and genetic determinants of lysozyme inhibitors are given. questions on drug regulation of ALA of the causative agents in infectious diseases and dysbiotic conditions are discussed.     

Early antibiotic treatment of reactive arthritis associated with enteric infections: clinical and serological study.

OBJECTIVE--To find out whether a 10-14 days'' course of antibiotics early in the course of reactive arthritis associated with enteric infections could reduce the severity and duration of the disease and whether the antibody response in patients with reactive arthritis associated with yersinia infection differed between those treated and those not treated with the antibiotics. DESIGN--Prospective multicentre trial in which patients were randomised to treatment or no treatment with antibiotics. Patients were seen at three and six weeks and three, six, nine, 12, and 18 months after their first visit. SETTING--Departments of infectious diseases in three hospitals in Linköping, Malmö, and Stockholm, Sweden. PATIENTS--40 Consecutive patients who had had symptoms of reactive arthritis associated with enteric infection for less than four weeks. INTERVENTIONS--20 Patients were allocated to treatment with antibiotics and 20 patients did not receive antibiotics. All patients received non-steroidal anti-inflammatory drugs, and four also received intra-articular steroid injections after at least six weeks'' observation. MAIN OUTCOME MEASURES--Arthritic symptoms assessed clinically and by using Ritchies'' index; blood measurements reflecting inflammatory activity; serum IgG, IgM, and IgA antibody titres; HLA tissue type. RESULTS--No difference was observed concerning duration of arthritis, grade of inflammation, and number of joints affected between patients treated and those not treated with antibiotics. Furthermore, there was no significant difference between the two groups in erythrocyte sedimentation rate and haptoglobin, IgG, and IgA concentrations. All values had returned to normal within three months. No patient developed chronic arthritis, but sustained slight arthralgia occurred in three patients. The HLA-B27 antigen was found in 23 (58%) of the patients, and its presence did not affect clinical outcome. The IgG, IgM, and IgA antibody responses were similar in patients treated with antibiotics and those not treated. CONCLUSION--Short term antibiotic treatment has no beneficial effect on the clinical outcome of reactive arthritis associated with enteric infection.     

Effect of the leukotriene LTD4/LTE4 antagonist, SR 2640, in ulcerative colitis: an open clinical study.

This investigation was performed in order to examine the role of sulfidopeptide-leukotrienes in a chronic inflammatory bowel disease, ulcerative colitis, by use of the recently developed LTD4/LTE4 antagonist, SR 2640 (2-[3-(2-quinolylmethoxy)phenylamino]benzoic acid). Eight ulcerative colitis patients with a mild to moderate disease activity were included in this open and uncontrolled study and SR 2640, 250 mg t.i.d., was administered for 6 weeks. Treatment of the patients with SR 2640 reduced the inhibitory effect of LTD4 on LTB4-directed chemotaxis of neutrophils purified from their blood. This indicates that the dose administered was sufficiently high to obtain systemic LTD4 receptor antagonism. Three of the 8 patients were in clinical remission at the end of the study, and the lack of clinical symptoms persisted for at least 2 months after discontinuing the drug. The condition of 3 patients was unchanged, and that of 2 patients deteriorated after 5 weeks, requiring treatment with sulphasalazine and steroids. SR 2640 was well tolerated by all patients. In a previously published study dealing with 4 weeks sulphasalazine treatment in the same category of patients, remission rates of 5% and 25% were found in the placebo and sulphasalazine groups, respectively, and the remission rate of SR 2640 thus seems to be of the same magnitude as that of sulphasalazine. The serum and faecal concentrations of SR 2640, and its metabolite, the beta-glucuronide, were found to be lower in ulcerative colitis patients as compared to healthy volunteers, and it is therefore possible that altered pharmacokinetics of SR 2640 is present in patients with chronic inflammatory bowel disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

我院抗菌药物实行分级管理后使用情况分析

目的:分析抗菌药物分级管理干预措施的实施及效果。方法:选择2011年5月至2013年5月间我院全院出院患者6622例的病案资料。其中实施分级管理制度之前的患者3238例,实施分级管理制度之后的患者3384例,分析分级管理前后医院抗菌药物使用情况。结果:实施分级管理制度后抗菌药物使用率,人均使用频次及人均抗菌药物费用均明显降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理制度后一线抗菌药物使用率显著提高,二线、三线抗菌药物使用率降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理后三联用药比例显著降低(P0.05),送检标本及检出阳性率较实施分级管理前无统计学意义(P0.05)。结论:实施抗菌药物分级管理可以有效的限制抗菌药物滥用情况,对于临床抗菌药物合理应用有积极意义。