Genetic diversity and antimicrobial resistance of Staphylococcus aureus from recurrent tonsillitis in children

The aim of this study was to analyze the prevalence of Staphylococcus aureus in the tonsils of children subjected tonsillectomy due to recurrent tonsilitis and to determine the spa types of the pathogens, carriage of virulence genes and antimicrobial resistance profiles. The study included 73 tonsillectomized children. Bacteria, including S. aureus were isolated from tonsillar surface prior to tonsillectomy, recovered from tonsillar core at the time of the surgery, and from posterior pharynx 2–4 weeks after the procedure. Staphylococcus aureus isolates were compared by spa typing, tested for antimicrobial susceptibility and for the presence of superantigenic toxin genes (sea-seu, eta, etb, tst, lukS/lukF-PV) by multiplex polymerase chain reaction. Seventy-three patients (mean 7.1 ± 4.1 years, 61.6% male) were assessed. The most commonly isolated bacteria were S. aureus. The largest proportion of staphylococcal isolates originated from tonsillar core (63%), followed by tonsillar surface (45.1%) and posterior pharynx in tonsillectomized children (18.2%, p = 0.007). Five (6.3%) isolates were identified as MRSA (mecA-positive). Up to 67.5% of the isolates synthesized penicillinases (blaZ-positive isolates), and 8.8% displayed MLS_B resistance. The superantigenic toxin genes were detected in more than half of examined isolates (56.3%). spa types t091, t084, and t002, and clonal complexes (CCs) CC7, CC45, and CC30 turned out to be most common. Staphylococcus aureus associated with RT in children showed pathogenicity potential and considerable genetic diversity, and no clones were found to be specific for this condition although further studies are needed.     

Calcium and bicarbonate ions mediate the inhibition of mast cell histamine release by Avène spa water

Avène spa water (ASW) inhibits the histamine release induced in mast cells by substance P; the inhibition is reversed by EDTA and by EGTA. Calcium and magnesium ions, the major cations present in ASW, were experimented in simple saline solutions in the presence of various counter-ions. Only calcium salts inhibited the peptidergic stimulation, with different potencies ruled by the nature of the counter-anion (HCO3- > Cl- > SO4(2)). On a Ca2+ concentration basis, ASW was, however, more inhibitory, suggesting that other compounds present in ASW potentiate the effect of calcium.     

Balneotherapy in dermatology

Balneotherapy and spa therapy emerged as an important treatment modality in the 1800s, first in Europe and then in the United States. Balneotherapy involves immersion of the patient in mineral water baths or pools. Today, water therapy is being practiced in many countries. Examples of unique and special places for balneotherapy are the Dead Sea in Israel, the Kangal hot spring in Turkey, and the Blue Lagoon in Iceland. Bathing in water with a high salt concentration is safe, effective, and pleasant for healing and recovery. This approach needs no chemicals or potentially harmful drugs. There are almost no side effects during and after treatment, and there is a very low risk to the patient's general health and well-being. Mineral waters and muds are commonly used for the treatment of various dermatologic conditions. The major dermatologic diseases that are frequently treated by balneotherapy with a high rate of success are psoriasis and atopic dermatitis. The mechanisms by which broad spectrums of diseases are alleviated by spa therapy have not been fully elucidated. They probably incorporate chemical, thermal, mechanical, and immunomodulatory effects. The major importance of balneotherapy and spa therapy both individually and as complements to other therapies lies in their potential effectiveness after standard medical treatments have failed to give comfort to these patients.     

Thermal care of functional dyspepsia based on bicarbonate-sulphate-calcium water: a sequential clinical trial

Drug treatment of functional dyspepsia is often unsatisfactory.We assessed the efficacy of a bicarbonate-sulphate-calcium thermalwater cycle of 12 days, in patients with functional dyspepsia.Patients with functional dyspepsia were sent by their generalpractitioners to 12 days of treatment with thermal water, 200–400ml in the morning, at temperature of 33°C (91.4 F) and wereevaluated on a strict intention to treat basis. Four efficacyendpoints were analyzed as follows: (i) reduction of the globalsymptoms score, (ii) reduction of intensity to a level not interferingwith everyday activities, (iii) specific efficacy on ulcer-likeor dysmotility-like dyspepsia and (iv) esophageal or abdominal-associatedsymptoms. Statistical significance was reached for all threeprimary outcomes after the first 29 consecutive patients. Thermalwater reduced the global symptom score, reduced intensity ofsymptoms to a level not interfering with everyday activity,but was unable to completely suppress all symptoms. A paralleleffect emerged for ulcer-like and dyspepsia-like subgroups.The effect on heartburn and abdominal symptoms was not significant,suggesting a specific effect of the water on the gastric andduodenal wall. The Roma II criteria identify a natural kindof dyspepsia that improves with thermal water. Ulcer-like anddysmotility-like are not therapeutically distinguishable subgroups.Patients with dominant esophageal or abdominal symptoms shouldreceive a different therapy. Sequential methods are very effectivefor the evaluation of traditional care practices and shouldbe considered preliminary and integrative to randomized controlledtrials in this context.     

A preliminary guideline for the assignment of methicillin-resistant Staphylococcus aureus to a Canadian pulsed-field gel electrophoresis epidemic type using spa typing

BACKGROUND

Increasing rates of methicillin-resistant Staphylococcus aureus (MRSA) infections on a global scale is a major health concern. In Canada, there are 10 known epidemic types of MRSA as determined by pulsed-field gel electrophoresis (PFGE). Despite the excellent discriminatory power of PFGE, there are several disadvantages of using this technique, such as high degree of labour intensity and the inability to easily develop an MRSA typing database due to the subjective interpretation of results.

OBJECTIVES

The purpose of the present study was to determine whether spa typing, an established DNA sequence-based typing method, could be used as an alternative to PFGE for the typing of Canadian MRSA (CMRSA) epidemic isolates.

RESULTS

spa types were determined for 1488 CMRSA isolates, and the method was analyzed for its ability to identify and cluster CMRSA1-10 strains. Minimal spanning tree analysis of 1452 spa types revealed individual clonal clusters for PFGE epidemic types CMRSA1, 2, 7 and 8, but spa typing could not distinguish CMRSA5 from CMRSA9 and CMRSA10, and CMRSA3 from CMRSA4 and CMRSA6. However, specific spa types were generally associated with only one PFGE epidemic type. Based on these results, a spa typing guideline for CMRSA isolates was developed and tested using the first 300 MRSA isolates received in 2007 through the Canadian Nosocomial Infection Surveillance Program.

CONCLUSIONS

The high concordance of spa types with PFGE epidemic types using this guideline demonstrated the feasibility of spa typing as a more rapid and less technically demanding alternative typing method for MRSA in Canada.     

水疗加康复护理对痉挛性脑瘫患儿的临床疗效分析

目的：探讨水疗加水中康复护理对改善痉挛型脑瘫患儿痉挛症状的效果,为脑瘫患儿提供更合理、有效的康复治疗方法。方法：98例患儿随机分为治疗组和对照组各49例,两组均给予功能锻炼、理疗、推拿、药物等常规综合康复治疗,治疗组在常规综合治疗的基础上接受每天1次的水疗加水中康复护理。结果：治疗后患儿粗大运动功能分级明显提高,治疗组改善比对照组更明显（P〈0．01）;治疗组患儿的肌张力明显改善,优于对照组（P〈0．01）。结论：常规的综合康复训练能改善脑瘫患儿的痉挛状态,而辅以水疗加水中康复护理改善脑瘫患儿痉挛状态的效果更佳。     

Community‐acquired,methicillin‐resistant Staphylococcus aureus isolated from children with community‐onset pneumonia in China

Community‐acquired, methicillin‐resistant Staphylococcus aureus (CA‐MRSA) has been associated with morbidity and mortality in various countries. In this study, we characterized the molecular and clinical features of pediatric CA‐MRSA pneumonia in China. Between June 2006 and February 2008, 55 previously healthy children confined in eight hospitals countrywide were found to be afflicted with CA‐MRSA pneumonia. A total of 55 strains collected from these children were analyzed by multilocus sequence typing (MLST), Staphylococcus cassette chromosome mec (SCCmec) typing, and spa typing. The Panton–Valentine leukocidin (PVL) gene was also detected. Overall, nine STs were obtained, with ST59 (40.4%) established to be the most prevalent type. We first registered the new ST1409 from a child with necrotizing pneumonia. SCCmecIVa was the most predominant type, followed by SCCmec type V. Twelve spa types were identified, of which one new spa type, t5348, was first detected and registered. One typical livestock‐associated spa type, t034, was found in a 4‐month‐old girl living in the countryside. We also found that 40% of those isolates were PVL‐positive. In addition, the median age of the children in this study was 10 months. A total of 69% (38/55) of the children with community‐acquired pneumonia (CAP) had preceding influenza or influenza‐like illness, and three ST910‐MRSA‐IV strains (PVL gene‐positive) were associated with severe necrosis. The results indicated that the recent CA‐MRSA found in Chinese children with CAP was largely associated with the spread of the ST59‐MRSA‐IV clone, and most of the PVL‐positive strains in this study did not cause necrotic cases. Pediatr Pulmonol. 2010; 45:387–394. © 2010 Wiley‐Liss, Inc.     

医院感染耐甲氧西林金黄色葡萄球菌耐药性与SCCmec分型及同源性研究

目的 研究医院耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性及分子流行病学特点,为预防和控制医院感染提供参考.方法 采用药敏纸片法(K-B法)、SCCmec分型及葡萄球菌A蛋白(spa)分型技术,2009年3-4月对烧伤科、ICU、呼吸内科、急诊科、血液内科、儿童急救科和儿童呼吸科住院患者、医务人员及环境分离的MRSA,进行了药敏试验和同源性分析,并检测其杀白细胞毒素(pvl)基因.结果 从1352份标本中分离出108株金黄色葡萄球菌,MRSA为54株占50.0％,主要分离于烧伤科42株占77.8％;分离的临床菌株总体耐药率较高,除万古霉索外耐药率均＞50.0％,未发现万古霉素耐药株;SCCmec分型结果显示,54株MRSA以Ⅲ型为主占68.5％,pvl基因均为阴性;进行spa分型研究的23株MRSA中,22株为t030,1株为t2270,呈现高度的克隆一致性.结论 医护人员MRSA带菌率较高,部分医务人员、住院患者和环境中分离的MRSA有较高的同源性,存在人与人和人与环境之间的MRSA传播.     

Spa treatments as a potential tool in the rehabilitation of people with alcohol and drug problems: a personal perspective

There is a lack of non‐pharmacological options for the treatment of people with substance misuse problems. However, service users often mention their use of steam rooms and home baths to help aid their problem of detoxification and aid relaxation of muscle cramps. These anecdotes prompted this current review, to establish whether spa bathing is used for this purpose and whether there is any evidence of its effectiveness. The review was carried out in 2003 and includes a literature review together with written and oral responses from individuals and organizations. The review provided an overview of the extent of uses of spa bathing and describes a variety of examples.