Local Bacterial Infection Research Articles

Use of Punch in the Treatment of Plantar Warts: A Study of 250 Cases

Background: Plantar wart is a frustrating infection for both patients and clinicians that can significantly cause embarrassment, negative gauging by others, and vexation due to persistence and/or recurrence of warts, affecting a patient’s quality of life. Materials and Methods: A prospective observational study from April 2020 to March 2021 was conducted in an Indian tertiary care center on 250 patients aged between 15 and 40 years. Punch excision of solitary to multiple plantar warts was carried out with a 5-mm punch. Results: A total of 342 plantar warts were punch excised in 250 cases with 162 males and 88 females. 214 (85%) patients had a complete cure over 10 days of treatment. Eleven (5%) patients developed local secondary bacterial infections managed with oral and topical antibiotics. Complete healing was achieved in all over 2–4 weeks without any scarring. There was no recurrence among 225 cases over the follow-up period of 3 months, while 25 (10%) were lost to follow-up. Conclusion: Use of punch excision for plantar warts is a simple, affordable, and quick outpatient department procedure, requiring no suturing even with an excision size of 5 mm. It needs minimum postprocedural care and heals without scarring. This methodology of management of plantar wart highlights it as a preferable procedure in primary care centers or resource-poor settings that requires less expertise.

Korelacija koncentracije C-reaktivnog proteina i prokalcitonina sa brojem leukocita u akutnoj infekciji i sepsi

Introduction: Infection is a specific response to an active or passive pathogen penetration and/or its reproduction in the biological system. Unlike the infection, sepsis is characterized by a systemic inflammation response of the host. The most commonly used biomarkers for the diagnosis of infections and sepsis are C-reactive protein (CRP) and procalcitonin (PCT). Aim: The aim of the study was to examine the correlation of CRP and PCT with white blood cells (WBC) count in patients with acute infection and sepsis. Material and methods: This retrospective study included 69 patients who underwent a blood test at the Central Laboratory of the University Clinical Center of Kragujevac to determine the presence of infection/sepsis during hospitalization. Patients were divided into two groups: patients with local bacterial infections of different localization and patients with sepsis. In the group of patients with local infection, four subgroups were distinguished: patients with respiratory tract infections, urinary tract infections, gastrointestinal and hepatobiliary infections, and skin infections. The control group comprised 40 healthy subjects. The study analyzed data about WBC count, neutrophil and lymphocytes count as well as the concentration of CRP and PCT. Results: The analysis of mentioned parameters indicated that patients with infection/sepsis had significantly higher values of WBC (p<0.001), neutrophils (p<0.001), lymphocytes (p=0.007), CRP (p<0.001) and PCT (p<0.001) concerning control subjects. There was a statistically significant difference in PCT between the examined groups of patients (p=0.029), so the highest values have been recorded in septic patients. In patients with sepsis, there was a significant positive correlation between the concentration of CRP and WBC counts (r=0.538, p=0.008). Conclusion: There is a significant increase in the concentration of CRP and PCTin patients with local infections and sepsis. The concentration of CRP is positively correlated with WBC counts in patients with sepsis.

A facile one-stone-two-birds strategy for fabricating multifunctional 3D nanofibrous scaffolds.

Local bacterial infections lead to delayed wound healing and in extreme cases, such as diabetic foot ulcers, to non-healing due to the impaired cellular function in such wounds. Thus, many scientists have focused on developing advanced therapeutic platforms to treat infections and promote cellular proliferation and angiogenesis. This study presents a facile approach for designing nanofibrous scaffolds in three dimensions (3D) with enhanced antibacterial activity to meet the need of treating chronic diabetic wounds. Being a cationic surfactant as well as an antimicrobial agent, octenidine (OCT) makes a 2D membrane hydrophilic, enabling it to be modified into a 3D scaffold in a "one stone, two birds" manner. Aqueous sodium borohydride (NaBH4) solution plays a dual role in the fabrication process, functioning as both a reducing agent for the in situ synthesis of silver nanoparticles (Ag NPs) anchored on the nanofiber surface and a hydrogen gas producer for expanding the 2D membranes into fully formed 3D nanofiber scaffolds, as demonstrated by morphological analyses. Various techniques were used to characterize the developed scaffold (e.g., SEM, XRD, DSC, FTIR, and surface wettability), demonstrating a multilayered porous structure and superhydrophilic properties besides showing sustained and prolonged release of OCT (61% ± 1.97 in 144 h). Thanks to the synergistic effect of OCT and Ag NPs, the antibacterial performance of the 3D scaffold was significantly higher than that of the 2D membrane. Moreover, cell viability was studied in vitro on mouse fibroblasts L929, and the noncytotoxic character of the 3D scaffold was confirmed. Overall, it is shown that the obtained multifunctional 3D scaffold is an excellent candidate for diabetic wound healing and skin repair.

Elution profiles of metronidazole from calcium sulfate beads.

Antibiotic beads are used to treat local bacterial infections by delivering high drug concentrations to infected tissue. This study examined the elution characteristics of metronidazole from metronidazole-calcium sulfate (MCa) and metronidazole-calcium-potassium sulfate (MCaK) beads over 20 days and the antibacterial efficacy of the beads after storage. The MCa and MCaK beads were prepared by mixing 250 mg of metronidazole and 10 g of calcium sulfate hemihydrate with water and a 3% potassium sulfate solution, respectively. The beads were placed in phosphate-buffered saline for the elution study. The metronidazole eluents were determined using high-performance liquid chromatography. The microstructures were examined by scanning electron microscopy (SEM), and the antimicrobial activity was evaluated by a microbioassay. For the 20-day study, the total amount of metronidazole released was greater in the MCa beads than in the MCaK beads by 6.61 ± 0.48 mg (89.11% ± 3.04%) and 4.65 ± 0.36 mg (73.11% ± 4.38%), respectively. The amounts of eluted drugs from the MCa and MCaK beads were higher than the minimum inhibitory concentration at 0.5 µg/mL against anaerobic bacteria at both 20 days and 14 days. SEM showed that calcium crystals on the outer surface had dissolved after elution, and thinner calcium crystals were prominent in the MCaK beads. The MCa and MCaK beads exhibited antibacterial activity after setting, followed by storage at room temperature or 4°C for 21 days. The MCa beads could release more drug than the MCaK beads, but all eluted metronidazole amounts were effective in controlling bacterial infections. Both metronidazole beads could be stored at ambient temperature or in a refrigerator.

Sprayable Antibacterial Hydrogels by Simply Mixing of Aminoglycoside Antibiotics and Cellulose Nanocrystals for the Treatment of Infected Wounds.

Antibiotic hydrogels with sustained release profiles are recognized as promising candidates to treat local bacterial infections with reduced adverse effects. However, it still remains challenging for clinical translation of these antibiotic gels due to safety concern of gel ingredients, complicated synthesis and fabrication procedures, and unsatisfactory rheological properties for practical uses in vivo. Herein, the preparation of a type of sprayable hydrogels by ionic interactions between aminoglycosides and cellulose nanocrystals (CNC) is proposed for the treatment of local infections such as bacteria-infected wounds. The CNC-based hydrogels are applicable for all kinds of aminoglycoside antibiotics and show excellent gel stability and rheological behaviors such as shear thinning and fast self-healing, allowing facile administration by injection or spraying. The hydrogels exhibit efficient antibacterial activity both in vitro and in vivo, and accelerate bacteria-infected wounds by spraying on the infected area. The proposed hydrogels by simply mixing of aminoglycosides and CNC provide great prospects for clinical translation in the treatment of local infections.

Ultrasound Neuromodulation of the Spleen Has Time-Dependent Anti-Inflammatory Effect in a Pneumonia Model.

Interfaces between the nervous and immune systems have been shown essential for the coordination and regulation of immune responses. Non-invasive ultrasound stimulation targeted to the spleen has recently been shown capable of activating one such interface, the splenic cholinergic anti-inflammatory pathway (CAP). Over the past decade, CAP and other neuroimmune pathways have been activated using implanted nerve stimulators and tested to prevent cytokine release and inflammation. However, CAP studies have typically been performed in models of severe, systemic (e.g., endotoxemia) or chronic inflammation (e.g., collagen-induced arthritis or DSS-induced colitis). Herein, we examined the effects of activation of the splenic CAP with ultrasound in a model of local bacterial infection by lung instillation of 105 CFU of Streptococcus pneumoniae. We demonstrate a time-dependent effect of CAP activation on the cytokine response assay during infection progression. CAP activation-induced cytokine suppression is absent at intermediate times post-infection (16 hours following inoculation), but present during the early (4 hours) and later phases (48 hours). These results indicate that cytokine inhibition associated with splenic CAP activation is not observed at all timepoints following bacterial infection and highlights the importance of further studying neuroimmune interfaces within the context of different immune system and inflammatory states.

Clinical features of acute focal bacterial nephritis in adults

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidneys presenting as an inflammatory mass that can develop into renal abscess. The current reports on AFBN mostly are among children and rarely described in adults. This study was aimed to analyze the clinical features of AFBN in adults and make a review for the disease to give the clinicians some clues to suspect and recognize it in adults. From January 2014 to December 2019, AFBN was diagnosed by contrast-enhanced computed tomography (CT) in 238 adults at the Department of Nephrology, the Second Hospital of Hebei Medical University, Shijiazhuang, China. We reviewed the clinical records of these patients and asked them about their post-discharge status via telephone follow-up. Of all the patients, 195 were female and 43 were male, the median age were 46.87 years. 86.13% presented with fever, 55.89% presented with lower urinary tract symptoms and 97.9% presented with pyuria. In renal ultrasonography, abdominal findings were seen only 22.69% patients. E.coli accounted for 74.73% of the isolated pathogen. After 4 weeks of treatment, the patients had no recurrence of symptoms. We recommend that when a patient presents clinically with acute pyelonephritis, but the fever persist longer after antimicrobial treatment (≥ 4 days in our study), AFBN should be suspected. For the diagnosis, contrast-enhanced CT is the “gold standard”, magnetic resonance imaging (MRI) may be a good option, but the ultrasonography is probably not satisfied. 3–4 weeks of antibiotic therapy may be appropriate for AFBN in adults.

Local transport of antibiotics in the treatment of tubular bones chronic osteomyelitis: Literary review

Local bacterial infection after surgery is a formidable complication in traumatology and orthopedics. Local use of antibiotics as an independent type of therapy and in combination with systemic use of antibiotics can lead to the cure of wound infection. Currently, local transport of antibiotics directly into infection focus is increasingly used, in addition to the local use of antiseptics, which has become a traditional method of purulent wounds treating. This method has undeniable advantages in the treatment of osteomyelitis, since due to the variety of forms of local antibiotic transport available today; it allows effective treatment of intraosseous infection without resorting to daily opening and wound trauma. The purpose of this literature review is to analyze all the available data on the treatment of local bacterial infection after surgery in traumatology and orthopedics, as well as on the most promising methods of treating osteomyelitis today.

Management of bacterial infections in young infants in Ethiopia: Facility preparedness, health workers' knowledge and quality of care.

We assessed primary care facility preparedness, health workers' knowledge and their classification and treatment of possible serious bacterial infection and local bacterial infection in young infants aged 0-59days. A cross-sectional survey was conducted in four regions of Ethiopia, including 169health posts with 276health extension workers and 155health centres with 175staff. Registers of 1058sick young infants were reviewed. Antibiotics to treat possible serious bacterial infection were available in 71% of the health centres and 38% of the health posts. Nine of ten health extension workers and eight of ten health centre staff mentioned at least one sign of possible serious bacterial infection and local bacterial infection. Among the registered cases with signs of bacterial infections, the health extension workers classified 49% as having a possible serious bacterial infection and 88% as local bacterial infection. The health centre staff classified 25% as possible serious bacterial infections and 86% as local bacterial infections. One-fourth (26%) of possible serious bacterial infection received the recommended treatment at health posts and 35% at health centres. Many health posts lacked antibiotics. The classification and treatment of possible serious bacterial infection did not follow guidelines. The lack of medicines and poor adherence compromise the quality of care.

Titanium carbide MXene-based hybrid hydrogel for chemo-photothermal combinational treatment of localized bacterial infection

With the increased emergence and threat of multi-drug resistant microorganisms, MXenes have become not only an emerging class of two-dimensional functional nanomaterials, but also potential nanomedicines (i.e., antimicrobial agents) that deserve further exploration. Very recently, Ti3C2 MXene was observed to offer a unique membrane-disruption effect and superior light-to-heat conversion efficiency, but its antibacterial property remains unsatisfactory due to poor MXene-bacteria interactions, low photothermal therapy efficiency, and occurrence of bacterial rebound in vivo. Herein, the cationic antibiotic ciprofloxacin (Cip) is combined with Ti3C2 MXene, and a hybrid hydrogel was constructed by incorporating Cip-Ti3C2 nanocomposites into the network structure of a Cip-loaded hydrogels to effectively trap and kill bacteria. We found that the Cip-Ti3C2 nanocomposites achieved an impressive in vitro bactericidal efficiency of >99.99999% (7.03 log10) for the inhibition of methicillin-resistant Staphylococcus aureus (MRSA) by combining chemotherapy with photothermal therapy. In an MRSA-induced murine abscess model, the hybrid hydrogel simultaneously achieved high-efficiency sterilization and long-term inhibition effects, avoiding the rebound of bacteria after photothermal therapy, and thus maximized the in vivo therapeutic efficacy of Ti3C2 MXene-based systems. Overall, this work provides a strategy for efficiently combating localized bacterial infection by rationally designing MXene-based hybrid hydrogels. Statement of significanceTwo-dimensional Ti3C2 MXene was recently regarded as a promising functional nanomaterial, however, its antibacterial applications are limited by the poor MXene-bacteria interactions, low photothermal therapy efficiency, and the occurrence of bacterial rebound in vivo. This work aims to construct a Ti3C2 MXene-based hybrid hydrogel for chemo-photothermal therapy and enhance the antimicrobial performance via a combination of the high-efficiency sterilization of ciprofloxacin-Ti3C2 nanocomposites with the long-term inhibition effect of ciprofloxacin hydrogel. The present study provides an example of efficient MXene-based antimicrobials to treat localized bacterial infection such as methicillin-resistant Staphylococcus aureus (MRSA)-induced skin abscess.

Клінічні особливості перебігу локалізованих та генералізованих бактеріальних інфекцій у дітей

Актуальність. Cепсис і надалі залишається однією з найактуальніших проблем сучасності, оскільки зберігається тенденція до росту захворюваності та стабільно високої летальності. Мета: дослідити клінічні особливості перебігу бактеріальних інфекцій у дітей. Матеріали та методи. Досліджено 115 дітей із генералізованими та локалізованими формами бактеріальних інфекцій. Основна група (47 дітей) — діти із сепсисом, група порівняння (68 дітей) — діти з локалізованою бактеріальною інфекцією різної локалізації. Їх вік становив від 1 міс. до 18 років. Розподіл на групи проводився за наявності ознак синдрому системної запальної відповіді (ССЗВ) та органної дисфункції. Результати. Під час дослідження було виявлено, що рівень прояву та тривалість основних симптомів ССЗВ (гіпертермія, тахікардія та тахіпное) були статистично значимо вищими в групі сепсису. При збільшенні кількості ознак ССЗВ та розвитку септичного щоку прямо пропорційно зростали тривалість та вираженість клінічних ознак ССЗВ. Тахікардія практично завжди (93 %) супроводжує розвиток сепсису, тоді як при локалізованих бактеріальних інфекціях вона відмічається лише в третини дітей. 40 % дітей при сепсисі потребують оксигенотерапії. Ознаки ССЗВ тривають найдовше в дітей із локалізацією бактеріального вогнища в лор-огранах та грудній порожнині, тоді як при інфекції центральної нервової системи ці прояви минали найшвидше. Іонотропної підтримки найбільше потребували діти з первинним вогнищем у лор-органах — 44,4 % випадків, зовсім не потребували — з локалізацією первинного вогнища в черевній порожнині. Середній термін перебування у відділенні анестезіології та інтенсивної терапії в дітей групи порівняння становив 5,14 дня (ДІ 95% 4,42–5,87), а в дітей основної групи — 13,1 дня (ДІ 95% 9,16–17,00), що було в 2,5 раза більше (р < 0,01). Висновки. Показник та тривалість основних проявів ССЗВ (гіпертермія, тахікардія, тахіпное) статистично значимо вищі в дітей із сепсисом, та вони пропорційно зростають із збільшенням кількості ознак ССЗВ. Основні симптоми ССЗВ у дітей із сепсисом із 2 ознаками ССЗВ спостерігаються тривалий час, та їх рівень статистично значимо менший порівняно з дітьми з 3 і більше ознаками ССЗВ. У 75 % дітей із локалізованою бактеріальною інфекцією відмічається задишка, хоча тривалість її незначна, і вони не потребують проведення оксигенотерапії, тоді як трохи менше половини дітей із сепсисом потребують проведення останньої.

In situ mucoadhesive hydrogel capturing tripeptide KPV: the anti-inflammatory, antibacterial and repairing effect on chemotherapy-induced oral mucositis.

The self-healing of chemotherapy-induced oral mucositis is difficult in practice because of both local bacterial infection and severe inflammation. Herein, in situ mucoadhesive hydrogels (PPP_E) were successfully prepared by using temperature-sensitive PLGA-PEG-PLGA (PPP) as a matrix and epigallocatechin-3-gallate (EGCG) with inherent antibacterial activity as an adhesion enhancer. A series of PPP_E precursor solutions with various EGCG concentrations (1%, 2% and 5%) were prepared by fixing the PPP concentration at 25%. EGCG slightly decreased the sol-gel transition temperature and shortened the sol-gel transition time of the PPP hydrogel. Moreover, the incorporation of EGCG could significantly increase the tissue adhesion properties of the PPP hydrogel at 37 °C. PPP_2%E displayed a suitable gelation temperature (36.2 °C), gelation time (100 s) and storage modulus (48 Pa). Tripeptide KPV as a model drug was easily dissolved in cold PPP_2%E precursor solution to prepare KPV@PPP_2%E hydrogel. The anti-inflammatory activity and promotion of cell migration potential by KPV in PPP-2% E hydrogel were well maintained. Moreover, KPV@PPP_2%E exhibited strong antibacterial efficacy against S. aureus. PPP_2%E precursor solution rapidly transformed to a hydrogel and adhered to the wound surface for 7 hours when administrated to the gingival mucosa of rats. Treatment with KPV@PPP_2%E hydrogel greatly improved the food intake and body weight recovery of rats with chemotherapy-induced oral mucositis. Moreover, the tissue morphology of the ulcerated gingiva after application of KPV@PPP_E hydrogel was also well repaired by promoting CK10 and PCNA expression. In addition, the inflammatory cytokines including IL-1β and TNF-α were significantly inhibited by KPV@PPP_2%E hydrogel while IL-10 was up-regulated. KPV@PPP_2%E hydrogel also had an anti-bacterial effect on MRSA-infected gingival ulcer wounds, which resulted in the obvious inhibition of infiltration by inflammatory cells into submucosal tissues. Conclusively, KPV@PPP_E may be a promising practical application for cancer patients with chemotherapy-induced oral mucositis.

Zašto topikalni kortikosteroid plus antibiotik?

Numerous dermatoses can be treated (at least in certain phases of the disease) exclusively with local therapy. Although there is a large number of dermatological diseases, therapeutic options for local therapy are not numerous. However, adequate and timely application of available topical preparations and their combination, enables a large number of different dermatoses to be treated with a relatively small number of topical preparations. The framework of local dermatological therapy and the most commonly prescribed preparations are corticosteroids. Topical corticosteroids are used to treat inflammatory dermatoses, while they are not recommended for use in acne vulgaris, fungal and bacterial skin infections. Designing preparations that contain a topical corticosteroid and antimycotic, corticosteroid and antibiotic, and sometimes all three substances, enables the use of corticosteroids in the above-mentioned infectious skin diseases. Topically applied antibiotics play a significant role in the treatment of mild forms of acne vulgares, while in localized bacterial skin infections, their importance is such that they often make general antibiotic therapy-unnecessary. Topical corticosteroids are most often combined with oxytetracycline, bacitracin and aminoglycosides - gentamicin and neomycin. The combination of betamethasone and gentamicin in a topical preparation is often used in everyday medical practice. It is recommended for many skin diseases in which betamethasone acts anti-inflammatory, immunosuppressive, vasoconstrictive, reducing erythema, edema and skin inflammation, while gentamicin acts on gram-positive and negative bacteria that are sensitive to it and are present on the surface of affected lesions due to superinfection. Since betamethasone is a potent corticosteroid with a good effect on a large number of dermatoses and gentamicin has antibiotic and anti-inflammatory properties and effect, the combined preparation of betamethasone - gentamicin is an excellent and rational solution in local therapy of many dermatoses.

Bakterijske infekcije kod bolesnika u programu alogene transplantacije koštane srži

Introduction: Bacterial infections are common in patients enrolled in allogenic hematopoietic stem cell transplantation. Infections are the most common cause of illness and mortality in transplanted patients. The most common pathogens are Staphylococcus and Enterobacteriaceae, causing 25% of bacterial infections, each, followed by Enterococcus andP. aeruginosa. Aim: The aim of the paper is calculating the frequency of bacterial infections in patients enrolled in allogenic hematopoietic stem cell transplantation, at the Clinic for Hematology of the University Clinical Center of Serbia, as well as analyzing the epidemiological situation, the frequency of different clinical presentations of bacterial infections, and their effect on overall survival. Materials and methods: This retrospective cohort study enrolled 58 patients. The presence of bacteria was determined with standard microbial cultivation from samples. The diagnosis criteria for localized bacterial infection are a positive culture and characteristic clinical presentation. Sepsis is clinically diagnosed by a combination of a positive hemoculture and the existence of systemic inflammatory response. Management of bacterial infection starts empirically and is continued in keeping with antibiogram results. Patient survival was analyzed with the Kaplan-Meier method and compared with the log-rank test. Results: Bacterial infections were registered in 15 (25.9%) patients. The most common pathogens were Gram-negative bacteria (65.2%). The most common clinical presentation was sepsis (59.0%). Bacterial infection lethality was 60%. The Kaplan-Meier curve showed the median value for estimated patient survival in patients without bacterial infection to be 106.0 months (95% CI 85.2 - 163.3), while, for patients with bacterial infection, it was 14.0 (95% CI 8.9 - 19.1). The log-rank test showed a significant difference in the length of survival between these two groups (p < 0.001). Pseudomonas spp. was sensitive to colistin and/or meropenem. Klebsiella pneumoniae was sensitive to colistin. Conclusion: Bacterial infections are common at our clinic and are caused by endogenous opportunistic bacteria. Therefore, emphasis should be placed on the implementation of preventive measures aimed at preventing hospital-acquired infections.

Tattoos Dermatological Complications: Analysis of 53 Cases from Northern Poland

Background: The frequency of tattoos varies from 10% to 30% across the population worldwide. The growing popularity of tattooing increases the number of cutaneous reactions connected with this procedure. As we have not found any previous studies in the literature concerning tattoo complications in Poland and other Eastern European countries, we believe this to be the first study of this kind. Objective: The primary objective of this study was to evaluate the clinical spectrum of complications associated with the procedure of permanent tattooing among patients from Northern Poland. Methods: Medical data of 53 patients who developed tattoo-related cutaneous conditions were analyzed. All of the patients were consulted in the Dermatology, Venereology and Allergology Clinic in Gdańsk in the years 2018–2021. Medical history, dermatological assessment, and photographic documentation of skin lesions were performed in each case. Dermoscopic examination was carried out in 16 cases and 20 skin biopsies of the tattoo reactions were performed. Results: Twenty-one patients (40%) presented tattoo ink hypersensitivity reactions, out of which 18 were triggered by the red ink. In 11 cases (21%), contact dermatitis has developed after tattooing, while 9 of the patients (17%) presented tattoo infectious complications, including local bacterial infections, common warts, molluscum contagiosum, and demodicosis. We collected 8 cases (15%) of papulonodular reactions in black tattoos, and in 6 of them, histology showed granuloma formation. In 2 cases (4%), symptoms of anaphylaxis were observed after the tattooing procedure, and in another 2 cases (4%), Koebner phenomenon in the tattoo was diagnosed. Dermoscopy was the clue to the diagnosis in 4 cases. Conclusions: This is the first report presenting multiple cases of tattoo complications from Eastern Europe. The results of the study are consistent with other researches, showing a similar distribution of tattoo complications and that across the different pigments used, the red ink is most frequently responsible for tattoo reactions. We emphasize the usefulness of dermoscopic examination in the diagnosis of tattoo-related infections and draw the reader’s attention to the rare, yet hazardous complications connected with peri-tattooing anaphylaxis.

Causes of Mortality and Pathological Findings in European Hedgehogs (Erinaceus europaeus) Admitted to a Wildlife Care Centre in Southwestern France from 2019 to 2020

The European hedgehog (Erinaceus europaeus) is a nocturnal, solitary and non-territorial mammal endemic across Europe and central Asia. Due to population decline in recent decades in Europe, this species was declared as protected and registered as 'Least Concern' on the International Union for Conservation of Nature Red List of Threatened Species. Previous studies pointed to the possible contribution of human activities to hedgehog mortality but few reports provide a complete overview of the pathological processes associated with mortality of the European hedgehog. The aim of this study was to identify the causes of mortality and pathological findings in 35 wild adult European hedgehogs that died spontaneously or were euthanized at the Wildlife Care Centre of the Ecole Nationale Vétérinaire de Toulouse between 2019 and 2020. The main causes of mortality were trauma (41%) including collision (9%), predation (9%), trapping (6%) and trauma of unknown origin (17%). Infectious diseases associated with systemic and local bacterial infections accounted for 34% of the cases and included cutaneous wounds (23%), mandibular abscesses and botryomycosis (23%), exudative bronchopneumonia (9%), suppurative rhinitis (7%) and otitis (3%). One hedgehog (3%) had a large subcutaneous tumour consistent with a malignant peripheral nerve sheath tumour. Parasitism was associated with mortality in 11% of cases with severe debilitation, massive infestation and active larval migration. Incidental findings included splenic and hepatic extramedullary haematopoiesis (100% and 69%, respectively), pulmonary crenosomiasis (91%), gastrointestinal capillariasis (61%), renal lipofuscinosis (59%), chronic renal infarction and interstitial nephritis (50%). These data emphasize the need for further study of hedgehog mortality and of the genetic, behavioural and environmental factors that may contribute to population decline.

Fever and Abdominal Pain in a 10-year-old with Autism.

Fever and Abdominal Pain in a 10-year-old with Autism.

Periodontal Abscess and Pyorrhea: Proposal for a Novel Treatment with Ozone Nanobubble Saline Wash

The evolution of the treatment technologies in dentistry is remarkable. However, despite the advancement of science and therapeutic agents, they have not been able to overcome dental caries, periodontal disease [1], nor alveolar pyorrhea [2]. We are attempting to eliminate hundreds of oral bacteria, partly because we are fighting indigenous oral bacteria [3]. Currently, although many patients are trained in proper oral hygiene, including teeth brushing, flossing, and use of mouthwash daily, many still suffer from periodontal diseases, such as gingivitis [1]. Despite training and the abundance of oral healthcare products [4] widely available, including fluorides, chlorhexidine, and triclosan, oral health diseases remain a prominent issue. Beyond periodontal disease and gingival inflammation, extremely problematic conditions [1], such as periodontal abscesses [1] and alveolar pyorrhea [2], are some of the potential problems for patients and dentists. The most problematic condition is alveolar pyorrhea [2], advanced conditions of gingival inflammation [1], with symptoms including painful chewing, swollen or puffy gums, gum bleeding, and pus in the gums. These symptoms gradually appear, and in untreated conditions, lead to tooth loss. The advent and development of antibiotics have greatly impacted the treatment of bacterial infections. However, local bacterial infection lesions in various parts, such as dental fistulae [5], have not yet been overcome. The emergence of resistant strains is also a problem; the peculiarity of the conditions, such as fistula-like sites and infected wounds, is still a major obstacle to bacterial infections. These periodontal and gingival diseases [1] are treated with systemic antibiotics during the acute phase [4], but they are not always completely cured. It should be noted that bacterial infections in the oral cavity remain unresolved issues.

Study protocol: effect of infection, Modic and inflammation on clinical outcomes in surgery for radiculopathy (EIMICOR)

BackgroundEvidence indicates that inflammatory processes are involved in radicular pain as well as in resorption of herniated disc tissue. Furthermore there are indications that the presence of vertebral end plate pathology (Modic changes; MC) is associated with a negative effect on inflammation. It is hypothesized that in patients with MC, the (possibly bacterial induced) inflammation will be accompanied by pro inflammatory cytokines that worsen the outcome, and that in patients without MC, the inflammation is accompanied by cytokines that induce a resorption process to accelerate recovery.MethodsThis prospective cohort study will include 160 lumbar and 160 cervical patients (total of 320), which are scheduled for surgery for either a lumbar or cervical herniated disc with ages between 18 and 75. The main and interaction effects of local bacterial infection (culture), inflammatory cells in disc material (immunohistology), MC (MRI), and blood biomarkers indicating inflammation or infection (blood sample evaluation) will be evaluated. Clinical parameters to be evaluated are leg pain on the 11 point NRS pain scale, Oswestry (lumbar spine) or Neck (cervical spine) Disability Index, Global Perceived Recovery, Womac Questionnaire, and medication status, at baseline, and after 6, 16, 26 and 52 weeks.DiscussionGaining insight in the aetiology of pain and discomfort in radiculopathy caused by a herniated disc could lead to more effective management of patients. If the type of inflammatory cells shows to be of major influence on the rate of recovery, new immunomodulating treatment strategies can be developed to decrease the duration and intensity of symptoms. Moreover, identifying a beneficial inflammatory response in the disc through a biomarker in blood could lead to early identification of patients whose herniations will resorb spontaneously versus those that require surgery.Trial registrationprospectively enrolled at trialregister.nl, ID:NL8464.

Titanium implant coating based on dopamine-functionalized sulphated hyaluronic acid: in vivo assessment of biocompatibility and antibacterial efficacy

The number of total knee and/or hip replacements are expected to exceed 5 million a year by 2030; the incidence of biofilm-associated complications can vary from 1% in primary implants to 5.6% in case of revision. The purpose of this study was to test the ability of sHA-DA, a partially sulphated hyaluronic acid (sHA) functionalized with a dopamine (DA) moiety, to prevent acute bacterial growth in an in vivo model of an intra-operatively highly contaminated implant. Previously, in vitro studies showed that the DA moiety guarantees good performance as binding agent for titanium surface adhesion, while the negatively charged sHA has both a high efficiency in electrostatic binding of positively charged antibiotics, and bone regenerative effects. The in vitro testing also highlighted the effectiveness of the sHA-DA system in inhibiting bacterial spreading through a sustained release of the antibiotic payload from the implant coating.In this study the chemical stability of the sHA-DA to β-ray sterilization was demonstrated, based on evaluation by NMR, SEC-TDA Omnisec and HPLC-MS analysis, thus supporting the approach of terminal sterilization of the coated implant with no loss of efficacy. Furthermore, an in vivo study in rabbits was performed according to UNI EN ISO 10993-6 to assess the histocompatibility of titanium nails pre-coated with sHA-DA. The implants, placed in the femoral medullary cavity and harvested after 12 weeks, proved to be histocompatible and to allow bone growth in adhesion to the metal surface.Finally, an in vivo model of bacterial contamination was set up by injecting 1 mL of bacterial suspension containing 104 or 106 CFU of methicillin-resistant Staphylococcus aureus (MRSA) into the femoral medullary cavity of 30 rabbits. Titanium nails either uncoated or pre-coated with sHA-DA and loaded directly by the surgeon with 5% vancomycin were implanted in the surgical site. After 1 week, only the animals treated with pre-coated nails did not show the presence of systemic or local bacterial infection, as confirmed by microbiology and histology (Smeltzer score). Further insights into the animal model setup are crucial, however the results obtained suggest that the system can be effective in preventing the onset of the bacterial infective process.