Significant Reduction In Adherence Research Articles

Impact of Severe Winter Weather on Operations of a Radiation Oncology Department

IntroductionDuring winter of 2022, Western New York faced two major storms with blizzard conditions and record-breaking snowfall. The severe weather resulted in power outages, and travel bans. This study investigates the impact of these conditions on patient adherence to radiotherapy. Combining data from a large academic center and its satellite clinic, this single-center study is shedding light on the challenges faced by cancer care facilities during severe weather and proposing suggestions to prevent and mitigate harm done by severe weather. MethodsIn this study, data was collected using the MOSAIQ Record and Verify system (v. 2.81) to generate deidentified reports of scheduled and treated patients. The treatment adherence rate was calculated by dividing the number of patients treated by the total number of patients scheduled. Data was specifically collected for patients undergoing treatment on linear accelerators at a primary academic center and a satellite facility. The study focused on working days from November 1, 2022, to March 31, 2023, excluding weekends and holidays (as treatments are not routinely scheduled). Severe weather days were identified using advisories from the National Weather Service and local institution, including specific periods in November, December, and January. ResultsIn the study, 15,010 scheduled treatment visits were recorded across the academic center and the satellite clinic. The mean daily treatment adherence rate was 91.7%. Severe weather conditions led to a significant reduction in adherence, with rates dropping to 77.8%. Adherence rates during non-severe weather days were notably higher at 93.9%. Statistical analysis confirmed the substantial impact of severe weather on adherence (p<0.001). Severe weather had a more pronounced impact on the satellite clinic during periods of severe weather with absolute reduction in adherence rates of 21.9% vs. 15% in primary hospital). Moreover, adherence rates at the satellite clinic vs. primary hospital site was lower even under standard operating conditions (92.2% vs 94.0%, p<0.001). ConclusionAs a part of operational planning, it is important to be aware how severe weather can impact treatment adherence. The study findings underscore the importance of proactive measures to ensure patient access to healthcare services during adverse weather events and highlight the broader significance of incorporating Social Determinants of Health (SDOH) considerations into contingency planning for maintaining treatment continuity.

Synergistic Interaction of Piperine and Thymol on Attenuation of the Biofilm Formation, Hyphal Morphogenesis and Phenotypic Switching in Candida albicans.

The incidence of fungal infections has significantly increased in recent years due to the emergence of antifungal resistance. Biofilm formation is considered to be a major contributor to both the infectious diseases and to antimicrobial resistance. Consequently, biofilm-associated infections are often problematic to treat with existing therapeutics. Adhesion of C. albicans to the host surface or implanted materials followed by hyphal invasion and biofilm formation enhances C. albicans pathogenicity and virulence. Thus, developing a therapeutic agent that inhibits candidal adherence, biofilm development and morphological switching could improve clinical management of infections. The present investigation studied two emerging and alternatives strategies, namely antibiofilm and combinatorial approach, to attenuate biofilm formation and the expression of Candida virulence factors. Piperine and thymol are major bioactive components of pepper and thyme, respectively. These phytochemicals are known to possess numerous biological activities, including recently reported antibiofilm effects against C. albicans. The minimum biofilm inhibitory concentration (MBIC) of both phytochemicals was determined to be 32 µg/ml. The phytochemical treatment of Candida biofilms using piperine and thymol revealed synergistic effects at four different combinations of concentrations, i.e. 8 and 8, 8 and 4, 8 and 2 and 4 and 8 µg/ml. These synergistic combinations resulted in the significant reduction in adherence of Candida, hyphal extension and morphological transformation. Moreover, limited exposure of synergistic combinations controlled the hyphal elongation. Results were validated through the gene expression analysis. Results from the present investigation suggest that piperine and thymol can be synergistically employed for the treatment of biofilm-associated C. albicans infection.

Changing Patterns of Compliance with Protective Behavioral Recommendations in the Post First-Round COVID-19 Vaccine Period Among Healthcare Workers in Southern Ethiopia.

BackgroundHealthcare providers are facing an increasing threat as a result of confronting COVID-19. The aim of the present study was to assess the changes in compliance with the protective behavioral recommendations after taking the first round of COVID-19 vaccine among healthcare workers in Southern Ethiopia.MethodsA cross-sectional study design was used in which quantitative data were collected using a survey method. A self-administered questionnaire was distributed to a sample of healthcare workers who were selected through a multi-stage cluster sampling technique. From the 403 healthcare workers who participated in the survey, 236 properly completed and returned the questionnaires. After inserting it into SPSS software, data were analyzed using frequency tables, percentage distributions, and logistic regression coefficients.ResultsWhile 30.5% of the healthcare workers disclosed a decreasing experience of wearing mask, 30.1% revealed that their experience of regularly washing hands has decreased after taking the first round of COVID-19 vaccine. The main reasons for not regularly wearing a mask are its inconvenience (60%), the need to appear indifferent (38.5%), and that they cannot afford to buy one due to its cost (15.4%). Above all, respondents’ level of compliance with regular wearing of a mask is significantly associated with sex (OR = 3.165, P<0.05; 95% CI: 1.186–8.448), the type of organization in which they are currently working (OR = 3.553, P<0.05; 95% CI: 1.185–10.647), knowing someone ever infected by COVID-19 (OR = 0.091, P<0.001; 95% CI: 0.030–0.275), and the belief that COVID-19 causes a severe illness (OR = 0.249, P<0.05; 95% CI: 0.299–2.615).ConclusionWe have found significant reductions in adherence to the usual protective mechanisms. Therefore, increased access to the personal protective materials, including water, should be created and the healthcare workers should be continuously informed about the serious consequences of ignorance of self-protective behavior.

Changes in chronic disease medication adherence following oral anticancer agent initiation in patients with multiple myeloma.

e18760 Background: Improvements in treatment options for multiple myeloma (MM) have led to double-digit increases in 5-year survival rates over the past 40 years. Such extended survival has increased emphasis for the management of comorbid chronic conditions. Initial analyses suggest that oral anticancer agent (OAA) initiation for MM may correspond to significant reductions in adherence to chronic disease medications. Methods: This was a retrospective cohort study of adults diagnosed with and being treated for MM between 2013-2018 using data from the IBM MarketScan Commercial Claims and Encounters databases and a 20% sample of Medicare claims data. Adults (18 years and older) were included if they were diagnosed with and had at least two claims for an OAA indicated for MM, had continuous enrollment for 12 months both before and after OAA initiation, and were previously diagnosed with two chronic conditions and had prescription fills for select chronic conditions. Medication adherence was determined using the proportion of days covered (PDC) metric and was compared for the 12 months before and after the OAA initiation by Wilcoxon signed-rank tests, McNemar’s tests, and difference-in-differences (DinD) models. Results: A slight majority of the 2,765 patients (total N from both databases) were male (52.3%), and hypertension (94.5%) and hyperlipidemia (69.2%) were the most common comorbid conditions. Mean OAA adherence in the first year of therapy was 55.8% (SD: 23.5) and 63.5% (SD: 26.9) for commercial and Medicare patients, respectively. PDCs for comorbid therapies declined in the first year after OAA initiation, irrespective of payer (table), and the proportion adherent to these therapies (PDC &gt; 80%) also declined consistently. OAA adherence tended to align with the direction of changes in comorbid therapy adherence with those nonadherent to their OAA (PDC &lt; 80%) demonstrating general declines in comorbid therapy PDCs post-OAA initiation (p&lt;0.05 in 4 of 6 DinD models). Conclusions: Among adults with MM and multiple chronic conditions, the pre-OAA initiation level of adherence appears to dictate chronic disease medication use patterns after OAA initiation. The starting of OAA therapy facilitates an opportunity for providers to reinforce the need for total regimen adherence to improve the odds of positive cancer- and non-cancer-related outcomes. [Table: see text]

Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence.

Background:The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis.Methods:A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use.Results:Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use.Conclusion:Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

Influence of adherence to medical recommendations on symptom control in children with bronchial asthma

The search for factors affecting the efficacy of bronchial asthma (BA) therapy in children is an actual problem. subject of many modern scientific studies. Authors note that adherence to therapy in patients with asthma ranges from 30 to 70%. Often this index does not exceed 50%. Analysis of adherence to medical recommendations in children with asthma and the search for compliance reduction factors is one of the ways for optimizing therapy and improving the quality of life for children with asthma.Purpose. In order to optimize bronchial asthma therapy in pediatric practice, we analysed adherence to medical recommendations and its effect on the controllability of the disease in children with asthma.Materials and methods. The study included 94 children aged 6 to 17 years with an established diagnosis of bronchial asthma. All patients had previously been recommended basic therapy in the form of inhaled glucocorticosteroids (ICS) or their fixed combinations with long-acting beta2-adrenomimetikami (LABA). An assessment of BA control symptoms was carried out, and factors affecting adherence to medical recommendations were analyzed. The effect of decreased patient compliance on the control of asthma symptoms was evaluated.Results. 61.7% of children with asthma have insufficient disease control. In 42.55% of patients, a survey revealed insufficient adherence to medical recommendations. 88.3% of children and their parents reported the presence of factors capable of influencing the decrease in compliance. The most frequently occurring factor in reducing adherence to therapy turned out to be insufficient patient awareness of the disease itself, the mechanisms of therapy action, and the prospect of treatment. Statistical data processing showed a statistically significant decrease in adherence to medical recommendations in the group of patients with insufficient asthma symptom control (p = 0.038).Conclusion. Only 38.3% of children had complete asthma symptom control. The statistically significant reduction in adherence to medical recommendations in the group of children with insufficient symptom control suggests the need for educational activities for children with BA and their parents in order to increase adherence to medical recommendations, optimize the effectiveness of therapy and improve the quality of patients’ life.

Characterization and comparison of the adherence and immune modulation of two gut Lactobacillus strains isolated from Paralichthys olivaceus

In order to identify highly-adhesive probiotic lactobacilli, the adherence and immune modulation of Lactobacillus sakei PO11 (LS-PO11) and L. plantarum PO23 (LP-PO23) which were isolated from the intestine of healthy wild olive flounder (Paralichthys olivaceus) were studied in this work. The significant differences in acid resistance, bile resistance, cell surface hydrophobicity and surface-layer proteins (SLPs) were confirmed between two lactobacilli. In comparison with LS-PO11, LP-PO23 exhibited higher adherence to the intestinal epithelial cell and colonization level in the intestine. When treated with LiCl, both LS-PO11 and LP-PO23 exhibited significant reduction in adherence to the intestinal epithelial cell. Finally, the expression of IL-1β, TNF-α, MHC-II, Ig M and TCR-β genes were significantly up-regulated in gill and head kidney treated with two lactobacilli respectively. The peak expression levels of these five genes were much higher in LP-PO23 treated gill and head kidney than that treated with LS-PO11, except for IL-1β in head kidney which was detected almost the same between two lactobacilli. These results indicated that LP-PO23 was more suitable to be a highly-adhesive and potential probiotics and would facilitate better understanding of strain specificity exhibited in lactobacilli adherence and immune modulation.

EFFECTS OF ATRIAL FIBRILLATION TYPE ON THE ISCHEMIC STROKE RECOVERY PERIOD COURSE IN THE PATIENTS WITH ARTERIAL HYPERTENSION

Objective: evaluation of the effects of atrial fibrillation (AF) type on the course of ischemic stroke (IS) recovery period in the patients with arterial hypertension (AH). Design and method: We performed retrospective analysis in 86 patients with AH in the IS recovery period with the anamnesis of non-valvular AF (mean age 56,4 ± 7,6 years; 79% men, 21% women). Patients were of two groups: 1) with persistent/constant AF (73%); 2) patients with paroxysmal AF (27%). Rankin scale was used to determine the degree of disability; Bartel index for social adaptation degree evaluation. Results: In group 1: 44,8% received continuous antiaggregants before index event, 5,6% - anticoagulants, 32,8% - regular antihypertensive treatment, 3,3% - statins; acute period Rankin score was 3,3 ± 0,87, Bartel index - 54,3 ± 9,4. Group 2: 16,3% received regular antihypertensive treatment, 2,5% - statins, 75% - antiaggregants, anticoagulants - none (Rankin score was 2,9 ± 0,87, Bartel index 65,8 ± 8,86). Recovery period. Group 1: 47% took oral anticoagulants, 58,0% - antihypertensive treatment, 26,0% - statins (the latter - all men). Group 2: corresponding percentage for meds classes were 0%, 80,0% and 25,0%, respectively. Comparison of functional status in groups 1 and 2: Rankin scale 2,8 ± 0,96 vs. 1,8 ± 0,83, Barthel index 62,1 ± 12,5 vs. 72,5 ± 8,86. The recurrent IS occurrence during the first year in groups 1 and 2: 38,5% vs. 25,0%, in 2 years – 16,7% vs. 25,0%, respectively. Group 1 showed significant reduction in adherence to treatment with anticoagulants and statins (47,0% vs. 15,4%, and 26,0% vs. 7,7%), with growing complience to antihypertensive treatment (58,0% vs. 76,0%). Group 2: maximum reduction in compliance was for antihypertensive treatment (80,0% vs. 66,7%) and statins (25,0% vs. 0,0%). Conclusions: Patients with AH and persistent/constant AF in IS recovery show higher degree of disability, as well as lower functional independence class vs. patients with paroxysmal AF. Patients with AH after IS regardless of AF form showed lower adherence degree to medication treatment, which is surely is one of the recurrent IS risk factor.

Impact of Out-of-Pocket Pharmacy Costs on Branded Medication Adherence Among Patients with Type 2 Diabetes.

Medication adherence is pivotal for the successful treatment of diabetes. However, medication adherence remains a major concern, as nonadherence is associated with poor health outcomes. Studies have indicated that increasing patients' share of medication costs significantly reduces adherence. Little is known about a potential out-of-pocket (OOP) cost threshold where substantial reduction in adherence may occur. To examine the impact of diabetes OOP pharmacy costs on antihyperglycemic medication adherence and identify the potential threshold at which significant reduction in adherence may occur among patients with type 2 diabetes mellitus (T2DM). This was an observational, retrospective cohort study using longitudinal U.S. pharmacy and medical claims data from the IMS Health Medical Claims (Dx) database. Patients with T2DM who initiated therapy with a branded antihyperglycemic medication during the index period (January 1, 2011, to December 31, 2011) and had 3 years of follow-up data were included. The primary outcome was adherence to antihyperglycemic medications, measured as the number of days covered. Propensity scores were calculated using baseline sociodemographic and clinical characteristics to control for potential confounding factors. Four strata were created based on mean propensity scores. Across each stratum, patients were assigned to 5 diabetes OOP pharmacy (including generics) cost levels: $0-$10, $11-$40, $41-$50, $51-$75, and > $75. Multivariate regression models were used to estimate association of diabetes OOP pharmacy costs and adherence for each stratum. Sensitivity analyses were conducted to assess the impact of total OOP pharmacy costs and index drug category OOP costs on adherence. A total of 15,416 patients were assessed. Across each stratum in the diabetes OOP pharmacy cost analysis group, mean patient age ranged from 52.3 to 56.1 years, mean number of antihyperglycemic medication classes ranged from 1.5 to 3.2, and mean household income ranged from $60,763 to $79,373. Most patients used a commercial plan (55%-85%). The propensity-stratified multivariate regression model revealed an overall negative relationship between diabetes OOP pharmacy costs and adherence across several OOP cost levels. Diabetes OOP pharmacy cost level $51-$75 appeared as the threshold at which adherence reduced significantly (77-78 fewer days of coverage over 3 years of follow-up; P < 0.05) when compared with the lowest OOP costs ($0-$10) across all strata. Adherence reduced further (99-145 fewer days of coverage; P < 0.0001) for the higher diabetes OOP pharmacy cost levels (> $75) when compared with the lowest OOP cost levels. Sensitivity analyses with total OOP pharmacy costs and index drug category OOP costs revealed negative association with adherence across all strata. Diabetes OOP pharmacy cost was negatively associated with patient adherence, and a potential OOP cost threshold ($51-$75) was identified at which adherence reduced significantly. The study findings may be beneficial in informing the design of health care plans to achieve optimal adherence and improve disease management in patients with T2DM. This study was funded by Eli Lilly and Company. Eli Lilly and Company was involved in the study design; collection, analysis, and interpretation of data; preparation of the manuscript; and decision to submit for publication. Fu is an employee of Eli Lilly and Company. Taylor and Kwan are employees of Lilly USA. Fu and Kwan hold stock or stock options in Eli Lilly and Company. Bibeau was an employee of Eli Lilly and Company at the time of this study and initial submission of this manuscript. Bibeau is currently employed by Janssen Scientific Affairs. The abstract for this study was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016; April 19-22, 2016; San Francisco, California. Bibeau and Fu contributed to the study design and collected the data. All authors contributed equally to data interpretation and manuscript preparation and revision.

Factors influencing adherence to anti-craving medications and drinking outcomes in patients with alcohol dependence: A hospital-based study.

Objective:To examine the factors influencing the pattern and extent of anti-craving medication adherence and drinking outcomes in alcohol-dependent patients.Materials and Methods:Demographic data from 102 inpatients were collected at discharge from hospital. The pattern of anti-craving medication, extent of adherence, and drinking outcome was collected at 1st, 3rd, 8th, and 12th week follow-up. Patients’ self-reported adherence, medication diary, and simplified medication adherence questionnaire were used and data were analyzed using SPSS.Results:Majority (99%) were male patients with a mean age of 41.17 ± 9.86 years and 70% belonged to middle socioeconomic status. There was a decrease in the number of patients coming for follow-up over time from 99.01% to 77.45% on day 90. Acamprosate was used in 74% and naltrexone and disulfiram in 7% of patients each. A significant reduction in adherence to acamprosate and naltrexone (P < 0.001) was associated with simultaneous decrease in days to alcohol abstinence and increase in relapse rate compared to adherent group (P < 0.001). Main barriers to adherence included younger age (odds ratio = 1.05 95% [1.01-1.09]; P < 0.01), self-decision, emotional factors, and adverse effects.Conclusions:The study demonstrated the need for safer therapeutic options along with suitable intervention at grass root level for sustenance of adherence to anti-craving medication among young adults to prevent relapse and achieve near-complete abstinence from alcohol dependence.

Role of the Emp Pilus Subunits of Enterococcus faecium in Biofilm Formation, Adherence to Host Extracellular Matrix Components, and Experimental Infection.

Enterococcus faecium is an important cause of hospital-associated infections, including urinary tract infections (UTIs), bacteremia, and infective endocarditis. Pili have been shown to play a role in the pathogenesis of Gram-positive bacteria, including E. faecium We previously demonstrated that a nonpiliated ΔempABC::cat derivative of E. faecium TX82 was attenuated in biofilm formation and in a UTI model. Here, we studied the contributions of the individual pilus subunits EmpA, EmpB, and EmpC to pilus architecture, biofilm formation, adherence to extracellular matrix (ECM) proteins, and infection. We identified EmpA as the tip of the pili and found that deletion of empA reduced biofilm formation to the same level as deletion of the empABC operon, a phenotype that was restored by reconstituting in situ the empA gene. Deletion of empB also caused a reduction in biofilm, while EmpC was found to be dispensable. Significant reductions in adherence to fibrinogen and collagen type I were observed with deletion of empA and empB, while deletion of empC had no adherence defect. Furthermore, we showed that each deletion mutant was significantly attenuated in comparison to the isogenic parental strain, TX82, in a mixed-inoculum UTI model (P < 0.001 to 0.048), that reconstitution of empA restored virulence in the UTI model, and that deletion of empA also resulted in attenuation in an infective endocarditis model (P = 0.0088). Our results indicate that EmpA and EmpB, but not EmpC, contribute to biofilm and adherence to ECM proteins; however, all the Emp pilins are important for E. faecium to cause infection in the urinary tract.

Minimizing &lt;em&gt;Pseudomonas aeruginosa&lt;/em&gt; adhesion to titanium surfaces by a plasma nitriding process

The research of the interaction between bacteria-surface has great importance for titanium biomedical applications once microorganisms offer risks because promoting implant loss. Therefore, study bacterial adhesion and colonization on titanium is interesting because are principal factors infections pathogeny on biomaterials. In this study, commercial grade II titanium was submitted to nitriding treatment to plasma at 2.2 mbar, using gas mixtures of 80% hydrogen (H2) and 20% nitrogen (N2) during 1 hour and 3 hour. The surfaces were physically and chemically characterized. In order to evaluate bacterial response, the surfaces were exposed to <em>Pseudomonas aeruginosa</em>. The titanium surface modified in nitriding plasma, although exposes a higher roughness as compared with untreated samples, exhibited lower bacterial growth. The nitrided sample for 3 hour exhibited the higher amount of TiN phase and the higher concentration of atomic nitrogen on surface and lower bacterial adhered count. These results were confirmed by scanning electron microscopy. Based on these results can be said to the thermochemical treatment of plasma nitriding on titanium samples results a significant reduction of adherence of <em>Pseudomonas aeruginosa</em>. It was found that the Ti surface nitrided offers significant reduction of bacterial adherence which prevent biofilm formation and offersing lower risk of infection and implant remotion.

Blood pressure reductions following catheter-based renal denervation are not related to improvements in adherence to antihypertensive drugs measured by urine/plasma toxicological analysis.

Renal denervation can reduce blood pressure in patients with uncontrolled hypertension. The adherence to prescribed antihypertensive medication following renal denervation is unknown. This study investigated adherence to prescribed antihypertensive treatment by liquid chromatography-high resolution tandem mass spectrometry in plasma and urine at baseline and 6months after renal denervation in 100 patients with resistant hypertension, defined as baseline office systolic blood pressure ≥140mmHg despite treatment with ≥3 antihypertensive agents. At baseline, complete adherence to all prescribed antihypertensive agents was observed in 52 patients, 46 patients were partially adherent, and two patients were completely non-adherent. Baseline office blood pressure was 167/88±19/16mmHg with a corresponding 24-h blood pressure of 154/86±15/13mmHg. Renal denervation significantly reduced office and ambulatory blood pressure at 6-month follow-up by 15/5mmHg (p<0.001/p<0.001) and 8/4mmHg (p<0.001/p=0.001), respectively. Mean adherence to prescribed treatment was significantly reduced from 85.0% at baseline to 80.7%, 6months after renal denervation (p=0.005). The blood pressure decrease was not explained by improvements in adherence following the procedure. Patients not responding to treatment significantly reduced their drug intake following the procedure. Adherence was highest for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta blockers (>90%) and lowest for vasodilators (21%). In conclusion, renal denervation can reduce office and ambulatory blood pressure in patients with resistant hypertension despite a significant reduction in adherence to antihypertensive treatment after 6months.

Effects of penicillin and erythromycin on adherence of invasive and noninvasive isolates of Streptococcus pyogenes to laminin

This study investigated the possible relationship between the invasiveness of group A Streptococcus (GAS) strains and their abilities to adhere to laminin and assessed the effects of subinhibitory concentrations of penicillin and erythromycin on the ability of GAS to adhere to laminin. The adherence of noninvasive and highly invasive isolates of GAS to laminin was significantly higher than the adherence displayed by isolates of low invasiveness. Antibiotic treatment caused significant reductions in adherence to laminin in all three groups of strains. Penicillin was more successful in reducing the adherence abilities of the tested GAS strains than erythromycin.

Adherence Reduction of Campylobacter jejuni and Campylobacter coli Strains to HEp-2 Cells by Mannan Oligosaccharides and a High-Molecular-Weight Component of Cranberry Extract

Campylobacter infections are a leading cause of human bacterial gastroenteritis in the United States and are a major cause of diarrheal disease throughout the world. Colonization and subsequent infection and invasion of Campylobacter require that the bacteria adhere to the surface of host cells. Agents that inhibit adherence could be used prophylactically to reduce Campylobacter carriage and infection. Mannan oligosaccharides (MOS) have been used as a feed supplement in livestock animals to improve performance and to replace growth-promoting antibiotics. However, MOS and other nondigestible oligosaccharides may also prevent pathogen colonization by inhibiting adherence in the gastrointestinal tract. In addition, plant extracts, including those derived from cranberries, have been shown to have antiadherence activity against pathogens. The goal of this study was to assess the ability of MOS and cranberry fractions to serve as antiadherence agents against strains of Campylobacter jejuni and Campylobacter coli. Adherence experiments were performed using HEp-2 cells. Significant reductions in adherence of C. jejuni 29438, C. jejuni 700819, C. jejuni 3329, and C. coli 43485 were observed in the presence of MOS (up to 40 mg/ml) and with a high-molecular-weight fraction of cranberry extract (up to 3 mg/ml). However, none of the tested materials reduced adherence of C. coli BAA-1061. No additive effect in adherence inhibition was observed for an MOS-cranberry blend. These results suggest that both components, MOS and cranberry, could be used to reduce Campylobacter colonization and carriage in livestock animals and potentially limit human exposure to this pathogen.

Diabetes technology and the human factor.

The impressive progress achieved in recent years in diabetes technologies has made diabetes technological devices such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) a significant part of diabetes treatment. Many studies conducted in recent years emphasized the advantages of using these technologies. The concept of the “human factor” in diabetes technologies as discussed in this chapter has several different aspects. First, it can refer to the way patients are satisfied with the use of the device and whether it is perceived convenient or inconvenient. For example, is the device perceived as “user friendly” (easy to learn and to operate, comfortable, does not cause many hassles). Second, there is the issue of effectiveness of the technology as it relates to their day-to-day diabetes management. For example, there is an improvement in glycemic control when one diabetes treatment regimen is compared to another (i.e., CSII vs. multiple daily injections (MDI)). Those two fundamental aspects may have different meanings for different groups. For example, different age groups (toddlers, children, adolescents, young adults, adults, and older people) can see different advantages and disadvantages in technological devices. The feasibility and utility of technological devices also need to fit the environments in which they will be used, such as school, the work place, and/or home. Specific subgroups such as diabetic youth with eating disorders can have unique interactions with diabetes technologies. In addition, diabetes technologies can be used as a measurement device, providing more rich and accurate data about patients' self-care that can contribute to our understanding of concepts such as adherence and satisfaction, and they can provide measurement tools to assess how glycemic control can effect cognition and intelligence. The present chapter will review articles published in the last year that have studied some of these issues.

Inhibitory efficacy of cyclo(l-leucyl-l-prolyl) from mangrove rhizosphere bacterium–Bacillus amyloliquefaciens (MMS-50) toward cariogenic properties of Streptococcus mutans

Since Streptococcus mutans is the principal etiologic agent causing dental caries, by encompassing an array of unique virulence traits, emerging treatment strategies that specifically target the virulence of this pathogen may be promising as alternative approaches compared to conventional antibiotic therapy. In this perspective, we investigated chloroform extract of cell-free culture supernatant from mangrove rhizosphere bacterium Bacillus amyloliquefaciens (MMS-50) in terms of anticariogenic properties of S. mutans, without suppressing its viability. Crude chloroform extract of MMS-50 was subjected to column and high performance liquid chromatographic techniques to obtain the active fraction (AF), and MMS-50 AF was used for all further assays. GC–MS and FT-IR were carried out to identify the major components present in MMS-50 AF. Comparative gene expression analysis of some biofilm-forming and virulence genes (vicR, comDE, gtfC, and gbpB) was done by real-time PCR. Cyclo(l-leucyl-l-prolyl) was found to be the chief compound in MMS-50 AF responsible for bioactivity. The minimum and maximum inhibitory concentrations of MMS-50 AF against S. mutans were found to be 100 and 250 μg/mL, respectively. Anti-virulence assays performed using below-sub-MIC levels of MMS-50 AF (30 μg/mL) resulted in significant reduction in adherence (68%), acid production, acid tolerance, glucan synthesis (32%), biofilm formation (53.5%) and cell surface hydrophobicity, all devoid of affecting its viability. The micrographs of CLSM and SEM further confirmed the antibiofilm and anti-virulence efficacies of MMS-50 AF. Expression data showed significant reduction in expression of all studied virulence genes. Thus, the current study unveils the anticariogenic potential of cyclo(l-leucyl-l-prolyl) from B. amyloliquefaciens, as well as its suitability as a novel and alternative anticariogenic agent against dental caries.

Lipoprotein CD0873 Is a Novel Adhesin of Clostridium difficile

Clostridium difficile is a cause of antibiotic-associated diarrhea and colitis, a healthcare-associated intestinal disease. Colonization of the gut is a critical step in the course of infection. The C. difficile lipoprotein CD0873 was identified as a putative adhesin through a bioinformatics approach. Surface exposure of CD0873 was confirmed and a CD0873 mutant was generated. The CD0873 mutant showed a significant reduction in adherence to Caco-2 cells and wild-type bacteria preincubated with anti-CD0873 antibodies showed significantly decreased adherence to Caco-2 cells. In addition, we demonstrated that purified recombinant CD0873 protein alone associates with Caco-2 cells. This is the first definitive identification of a C. difficile adhesin, which now allows work to devise improved measures for preventing and treating disease.

The effects of silver, silicon-containing apatite towards bacteria and cell responses

An integrated approach is proposed to incorporate silicon and silver into hydroxyapatite (HA) to enhance the biological response and reduce implant-related infection in bone substitutes. This study examined the responses of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) bacteria to silver, silicon-containing apatite (Ag,Si-HA). Scanning electron microscopy images revealed significant reduction in adherence of S. aureus and E. coli bacteria on Ag,Si-HA as compared to HA. The antibacterial property of Ag,Si-HA was shown from a 7-log reduction of S. aureus population in the test solution and on the sample's surface as compared to HA at day 7. Rapid inhibition of the adherent bacteria suggested that the antibacterial action of Ag incorporated in Ag,Si-HA could be attributed to the Ag+ ions on the crystal surface rather than the released Ag+ ions. Presence of Ag may influence the biological response of HA and as such, the long-term interaction between human adipose-derived mesenchymal stem cells and Ag,Si-HA was evaluated in-vitro. An alamarBlue™ assay showed higher cell proliferation for Ag,Si-HA as compared to HA from day 3 onwards. Immunofluorescence staining revealed well-spread actin cytoskeletons on Ag,Si-HA. In addition, signs of extracellular matrix secretion and biomineralization were observed on Ag,Si-HA at day 14 onwards. Results demonstrated enhanced bone differentiation on Ag,Si-HA, as indicated by a higher level of protein expressions (type 1 collagen and osteocalcin) from day 14 to 21. Therefore, the incorporation of Ag and Si complement each other by endowing HA with antibacterial property, and concurrently promoting biological performance of the cells.

Mycobacterium tuberculosis infection of human dendritic cells decreases integrin expression, adhesion and migration to chemokines

Tuberculosis (TB) remains a major global health problem accounting for millions of deaths annually. Approximately one-third of the world's population is infected with the causative agent Mycobacterium tuberculosis. The onset of an adaptive immune response to M. tuberculosis is delayed compared with other microbial infections. This delay permits bacterial growth and dissemination. The precise mechanism(s) responsible for this delay have remained obscure. T-cell activation is preceded by dendritic cell (DC) migration from infected lungs to local lymph nodes and synapsis with T cells. We hypothesized that M. tuberculosis may impede the ability of DCs to reach lymph nodes and initiate an adaptive immune response. We used primary human DCs to determine the effect of M. tuberculosis on expression of heterodimeric integrins involved in cellular adhesion and migration. We also evaluated the ability of infected DCs to adhere to and migrate through lung endothelial cells, which is necessary to reach lymph nodes. We show by flow cytometry and confocal microscopy that M. tuberculosis-infected DCs exhibit a significant reduction in surface expression of the β(2) (CD18) integrin. Distribution of integrin β(2) is also markedly altered in M. tuberculosis-infected DCs. A corresponding reduction in the αL (CD11a) and αM (CD11b) subunits that associate with integrin β(2) was also observed. Consistent with reduced integrin surface expression, we show a significant reduction in adherence to lung endothelial cell monolayers and migration towards lymphatic chemokines when DCs are infected with M. tuberculosis. These findings suggest that M. tuberculosis modulates DC adhesion and migration to increase the time required to initiate an adaptive immune response.