Prophylactic Saccharomyces boulardii versus nystatin for the prevention of fungal colonization and invasive fungal infection in premature infants

Aim

This study aims to compare the efficacy of orally administered Saccharomyces boulardii versus nystatin in prevention of fungal colonization and invasive fungal infections in very low birth weight infants.

Method

A prospective, randomized comparative study was conducted in preterm infants with a gestational age of ≤32 weeks and birth weight of ≤1,500 g. They were randomized into two groups, to receive S. boulardii or nystatin. Skin and stool cultures were performed for colonization and blood cultures for invasive infections, weekly.

Results

A total of 181 infants were enrolled (S. boulardii group, n?=?91; nystatin group, n?=?90). Fungal colonization of the skin (15.4 vs 18.9 %, p?=?0.532) and the stool (32.2 vs 27 %, p?=?0.441) were not different between the probiotic and nystatin groups. Two patients had Candida-positive blood culture in the nystatin group whereas none in the probiotic group. Feeding intolerance, clinical sepsis, and number of sepsis attacks were significantly lower in the probiotics group than in the nystatin group.

Conclusion

Prophylactic S. boulardii supplementation is as effective as nystatin in reducing fungal colonization and invasive fungal infection, more effective in reducing the incidence of clinical sepsis and number of sepsis attacks and has favorable effect on feeding intolerance.     

Vaginal evisceration after trauma unrelated to previous pelvic surgery

Background  Vaginal evisceration is described as extrusion of intraperitoneal contents secondary to the disruption of the vagina. It is an extremely rare emergency condition. Objectives  To describe a very rare case of vaginal evisceration that occurred after blunt trauma in a patient with no prior pelvic surgery. Case report  This report describes vaginal evisceration in a 73-year-old female with no prior pelvic surgery, after blunt trauma. The patient was handled by the cooperation of gynecology and general surgery departments. An immediate surgery was performed after stabilization of the patient and no postoperative complications occurred. Conclusion  Whatever be the treatment approach, emergency management of vaginal evisceration is critical to the preservation of a viable bowel. Repositioning of viable bowels into the abdominal cavity and appropriate surgical repair are cornerstones of the treatment.     

The effect of multiple transfers of immune serum on maturingSchistosoma bovis infections in calves

To investigate the role of humoral factors in immunity, serum from cattle with naturally acquired immunity toSchistosoma bovis was injected intraperitoneally into calves that had been infected 4 weeks earlier with 10,000S. bovis cercariae. Serum was injected weekly until 12 weeks post-infection to a total of 4,500 ml per calf and controls received normal serum or saline. No significant difference in worm or in faecal or tissue egg counts were seen in the three groups of recipients in spite of the observation that the serum donors had proved highly resistant to experimental challenge. In a second experiment, pre-infection or 4-, 8- or 12-week post-infection serum from donors given a single experimental infection with 10,000S. bovis cercariae was injected intraperitoneally into groups of calves that had been infected 4 weeks earlier with 20,000S. bovis cercariae. Injections were given weekly up to week 10 post-infection to a total of 2000–3500 ml serum per calf. In calves injected with immune serum there was a reduction in faecal and tissue egg counts and in the numbers of worms recovered as compared with the controls. In recipients of 8- and 12-week serum the reductions in faecal and tissue egg counts were higher than those in worm recovery, suggesting that 8- and 12-week post-infection sera contained factors capable of causing, in addition to worm death, suppression of worm fecundity. This provides further evidence of the importance of fecundity suppression in immunity to schistosomiasis.     

Optimal use of L-asparaginase (NSC-109229) in acute lymphocytic leukemia

Between 1971 and 1974, 646 evaluable patients under 20 years of age with previously untreated acute lymphocytic leukemia were treated according to Cancer and Leukemia Group B (formerly Acute Leukemia Group B) Protocol 7111. On a random basis, they received a 10-day course of 1,000 units/kg/day of L-asparaginase before, during, or after a 3-week course of vincristine and corticosteroid. A control group received vincristine and corticosteroid for 4 weeks but no asparaginase. The overall complete remission rate was 85%, which was not altered significantly by any of the induction variables. Patients who received asparaginase for 10 days subsequent to vincristine and corticosteroid had a significantly longer complete remission duration with an estimated median of 45 months, compared to 20 months for the group receiving no asparaginase and 27 months for the other 2 asparaginase regimens. The beneficial effect of asparaginase was noted, irrespective of which 1 of the 2 intensification and maintenance programs the patients received. The 5-year projection indicates a complete remission rate of 50% for those patients receiving subsequent asparaginase as compared to 41% of those induced on other regimens in this study and thus is superior to the use of only vincristine and corticosteroid.     

Coronary artery bypass grafting alone for advanced ischemic left ventricular dysfunction with significant mitral regurgitation: early and midterm outcomes in a small series

In 31 consecutive patients with ischemic left ventricular dysfunction and mitral regurgitation ranging from 2/4 to 3/4 (mean, 2.87 +/- 0.34), we performed coronary bypass grafting alone and assessed early and midterm outcomes. Our patients' mean preoperative New York Heart Association functional class was 3.64 +/- 0.48, and their mean left ventricular ejection fraction was 0.25 +/- 0.05. Preoperative thallium imaging revealed that all patients had at minimum a partially reversible defect in the anterior wall. All patients survived the operation. Hospital length of stay ranged from 5 to 21 days (mean, 8.35 +/- 4.07 days), and mean length of follow-up was 21.35 +/- 13.24 months. Postoperatively, patients' functional classification improved to a mean of 1.32 +/- 0.6; left ventricular ejection fraction improved to a mean of 0.43 +/- 0.09; and severity of mitral regurgitation decreased to a mean of 1.35 +/- 0.96. Statistical analysis showed that all improvements were significant. Five late cardiac deaths occurred. Preoperative variables showed no correlation with late death. However, postoperative left ventricular ejection fraction and mitral regurgitation did correlate with late death, which suggests that the reversibility of damaged ischemic myocardium plays an important role after revascularization. This study supports the concept that ischemic mitral regurgitation might well improve after myocardial revascularization regardless of its severity; therefore, it should not be corrected at the primary operation, except in patients with organic valvular changes.     

Effect of sex steroids on colonic distension-induced delay of gastric emptying in rats

BACKGROUND AND AIM: The objective of the present study was to examine the effect of gonadal hormones on gastric motor response to non-noxious and noxious stimuli of colonic distension. METHODS: Male Wistar albino rats were used. Under ketamine anesthesia some rats underwent castration (n = 24), while the rest of the rats were sham-operated (n = 67) and divided into different groups (n = 7-8 per group). On the 15th day of surgery, liquid gastric emptying studies were commenced. RESULTS: Non-noxious (P < 0.05) or noxious (P < 0.01) colonic distension inhibited gastric emptying rate. Estradiol pretreatment (20 micro g/kg per day, for 5 days, s.c.) inhibited gastric motility, while estradiol pretreatment or castration of the rats prior to noxious distension prevented the delay in gastric emptying. In contrast, blockade of testosterone receptors had no effect on the delay in gastric emptying induced by either modes of distension. CONCLUSIONS: The results suggest that sex steroids have a modulatory role on the feedback control of gastric motility induced by noxious colonic distension.     

Effect of different pharmacologic and chemical agents on the integrity of hydatid cyst membranes

OBJECTIVE: We performed an in vitro investigation of the effects of widely used scolicidal and sclerosing agents, as well as some pharmacologic products, on the integrity of the membrane of hydatid cysts. MATERIALS AND METHODS: Two milliliters each of 22 agents, 2 mL of clear fluid, and one piece of hydatid cyst membrane were put into bottles. The hydatid cyst membranes were evaluated by visual observation and manual palpation. Visual examination of the bottles was performed daily for 7 days, and observations of membrane changes, including translucency, destruction, swelling, and melting, were recorded. Manual evaluation was done on the seventh day by finger examination, and membrane fragility was scored. RESULTS: The hydatid cyst membrane was completely melted in a few minutes in a 2.5% solution of sodium hypochlorite and in 1 hr by a 0.1% sodium hypochlorite solution. The integrity of the hydatid cyst membrane was preserved in alcohol, acetone, glutaraldehyde, albendazole, acetylsalicylic acid, formaldehyde, lidocaine, hydrochloric acid, ammonia, pancreatin, Betadine, methylene blue, and isotonic saline samples. The membranes in the metronidazole and hypertonic saline solutions were not damaged but showed significantly increased fragility. The membranes in levamisole and piperazine hexahydrate became translucent and showed moderate fragility. CONCLUSION: None of the agents that are used in clinical practice had important effects on the dissolution of hydatid cyst membranes. However, sodium hypochlorite solutions completely melted the hydatid cyst membranes. Because the use of this agent on living tissue is limited, further study is needed to investigate its clinical use.     

Acute disseminated encephalomyelitis following hepatitis A virus infection

Acute disseminated encephalomyelitis is an immune-mediated demyelinating disorder usually encountered in children or adolescents and characterized by multifocal neurologic deficits of rapid onset. It is often preceded by various infectious diseases or vaccination, but acute disseminated encephalomyelitis developing after hepatitis A virus infection is rare. We present such a case in a 9-year-old patient who illustrates the importance of considering acute disseminated encephalomyelitis in patients who develop multifocal neurologic signs after hepatitis A virus infection. We suggest that patients with acute disseminated encephalomyelitis be screened for hepatitis A virus because of the occurrence of asymptomatic hepatitis A virus infection.