Urticaria crónica y autoinmunidad tiroidea utilidad del testintradérmico de suero autólogo / Chronic urticaria and thyroid autoimmunity utility of autologous intradermal serum test

Introducción: La Urticaria Crónica (UC) es una patología de prevalencia creciente. La relación entre UC y autoinmunidad tiroidea tiene una asociación significativa. El test intradérmico de suero autólogo (TISA) es capaz de inducir un test positivoen la piel de pacientes con urticaria. Objetivo: Determinar la prevalencia de la enfermedad tiroidea autoinmune en pacientes que concurren a la consulta por UC. Correlacionar en pacientes con UC y enfermedad tiroidea autoinmune la positividad de TISA. Comparar resultados del TISA en pacientes con UC y controles sanos. Materiales y Métodos: Se estudiaron51 pacientes, 30 con UC y 21 pacientes sanos del grupo control. Edades: entre 22 y 77 años, desde 01/11/07 hasta el30/04/10. Se realizó historia clínica detallada; dosaje de hormonas tiroideas: hormona estimulante de tirotrofina (TSH), tiroxina libre (T4 libre); dosaje de anticuerpos antitiroideos: anticuerpo antiperoxidasa (ATPO), anticuerpo antitiroglobulina (ATG) y test de TISA. Resultados: Entre los pacientes con UC el 80 % (24) correspondieron al sexo femenino, la franja etaria predominantefue de 51 a 59 años. La mayoría de los pacientes fueron eutiroideos (50%), seguidos de hipotiroideos (30%) y porúltimo hipertiroideos (20%). La prevalencia de enfermedad tiroidea autoinmune en pacientes con UC fue de un 17%. El TISAresultó positivo en un 47% (14), de los sujetos con UC. En todos los pacientes con tiroiditis autoinmune el TISA resultó positivo. Sin embargo se encontró TISA positivo en 8 pacientes con disfunción tiroidea sin autoinmunidad y en un paciente del grupo control (sano). Conclusiones: Se objetivó una tendencia a la autoinmunidad en pacientes con UC. Un TISApositivo enpacientes sin autoinmunidad tiroidea, debería contemplar otros posibles autoanticuerpos y otros factores liberadores de histamina.Un TISA negativo es un marcador útil para determinar ausencia de anticuerpos funcionantes circulantes.

Introduction: Chronic urticaria (UC) is a disease of increasing prevalence. The relationship between UC and thyroid autoimmunityhas a significant association. The autologous intradermal serum test (TISA) is capable of inducing a positive test inthe skin of patients with urticaria. The chemical nature of the factors, defined UC as an antibody-mediated autoimmune disease.Objetive: Determine the prevalence of autoimmune thyroid disease in patients attending the consultation by UC.Correlate the TISA positivity in patients with UC and autoimmune thyroid disease. Compare results of the TISA in UC patientsand healthy controls. Material and Methods: 51 patients were studied, 21 and 30 with UC patients healthy control group.Age: between 22 and 77 years, from 01/11/07 to 04/30/10. It made detailed clinical history; dosing of thyroid hormones: thyrotrophin(TSH)- stimulating hormone, thyroxine l free thyroxine (free T4); dosing of antithyroid antibodies: antibody antiperoxidasa(ATPO), antibody antithyroglobulin (IGT) and test of TISA. Results: Among patients with UC 80% (24) werefemale, the predominant age Strip was 51 to 59 years. The majority of patients were eutiroideos (50%), followed by additivehypothyroid (30%) and finally hipertiroideos (20%). The prevalence of autoimmune thyroid disease in patients with UC was17%. The TISA resulted positive in a 47% (14) of the subjects with UC. The TISA was positive in all patients with autoimmunethyroiditis. However found positive TISA in 8 patients with thyroid without autoimmune dysfunction and a patient of(healthy) control group. Coclusions: We find a tendency to Autoimmunity in patients with UC. A positive TISA in patients withoutthyroid Autoimmunity should consider other possible autoantibodies and other histamine releasing factors. A negativeTISA is a marker that is useful to determine lack of circulating funcionantes antibodies.

Linezolid vancomycin resistant Enterococcus isolated from clinical samples in Tehran hospitals.

Background: Vancomycin-resistant enterococci pose an emerging health risk. The limitation in therapeutic options has resulted in the development of new drugs such as quinupristin/ dalfopristin and linezolid. Aim, Setting and Design: This study investigated the species prevalence and antibacterial resistance among enterococci isolated in selected Tehran hospitals. Materials and Methods: Between March 2006 and August 2007, 200 enterococcal isolates from urine, blood, stool and wound were recovered in 2 teaching hospitals of Tehran province. Susceptibility of all isolates was tested against vancomycin, teicoplanin and linezolid antibiotics by disk diffusion and agar dilution method. Results and Conclusion: Seventeen (8.5%), 6 (3%) and 4 (2%) of the isolates were resistant to vancomycin, teicoplanin and linezolid, respectively. Within the vancomycin-resistant isolates, 6 (35.2%), 4 (25%) and 1 (5.88%) showed vanA, vanB and vanC genotype patterns, respectively. Four (23.5%) of VRE isolates were resistant to linezolid with minimum inhibitory concentrations between 16 and 32 µg/mL. Two linezolid vancomycin resistant enterococci were E. faecium.

[Ex-vivo assessment of meningococcal resistance to natural immunity: serum bactericidal assays versus whole- blood assay]

Literature review indicates that antibiotic resistance of bacteria may be associated with the resistance to host natural immunity. In the previous study we found that: all meningococcal isolates of meningitis cases are less sensitive to typical anti-meningococcal antibiotics. In present study, the association of the above characters was analyzed in an ex-vivo "case-control" study. A randomized controlled trial compared effect two dietary treatments [low glycemic index and low fat] in 46 adults, ages 18-55 years old, BMI >27,who proceed to motahary clinic in shiraz, Iran. Body weight, BMI, WHR [waist/hip ratio], fast and post-prandial Plasma lipid profile [Triacylglycerol, total Cholesterol, LDL-C, HDL-C concentration] level of obese women measured at the beginning and at the end 6 weeks. The resistance of both groups against selected sera were similar in the ratio 1:2- by SIC and SBC methods. The growth of "test" and "control" groups in the pooled sera were stopped at the ratios 1:512 and 1:1024 respectively. In SB A the population of "test" and "control" groups decreased in parallel to each other. However, the invasive [test] meningococcal strains established slower reduction in WBA. Studies on the correlation between antibiotic resistance of bacteria and the resistance to the natural immunity have ended with different results. According to our experience, it seems that for ex- vivo investigation of natural immunity against meningococci the WBA is more reliable

Monitoring the treatment of sepsis with vancomycin in term newborn infants

A prospective study was conducted to determine if standardized vancomycin doses could produce adequate serum concentrations in 25 term newborn infants with sepsis. Purpose: The therapeutic response of neonatal sepsis by Staphylococcus sp. treated with vancomycin was evaluated through serum concentrations of vancomycin, serum bactericidal titers (SBT), and minimum inhibitory concentration (MIC). METHOD: Vancomycin serum concentrations were determined by the fluorescence polarization immunoassay technique , SBT by the macro-broth dilution method, and MIC by diffusion test in agar . RESULTS: Thirteen newborn infants (59.1 percent) had adequate peak vancomycin serum concentrations (20--40 mg/mL) and one had peak concentration with potential ototoxicity risk (>40 æg/mL). Only 48 percent had adequate trough concentrations (5--10 mg/mL), and seven (28 percent) had a potential nephrotoxicity risk (>10 æg/mL). There was no significant agreement regarding normality for peak and trough vancomycin method (McNemar test : p = 0.7905). Peak serum vancomycin concentrations were compared with the clinical evaluation (good or bad clinical evolution) of the infants, with no significant difference found (U=51.5; p=0.1947). There was also no significant difference between the patients' trough concentrations and good or bad clinical evolution (U = 77.0; p=0.1710). All Staphylococcus isolates were sensitive to vancomycin according to the MIC. Half of the patients with adequate trough SBT (1/8), also had adequate trough vancomycin concentrations and satisfactory clinical evolution. CONCLUSIONS: Recommended vancomycin schedules for term newborn infants with neonatal sepsis should be based on the weight and postconceptual age only to start antimicrobial therapy. There is no ideal pattern of vancomycin dosing; vancomycin dosages must be individualized. SBT interpretation should be made in conjunction with the patient's clinical presentation and vancomycin serum concentrations. Those laboratory and clinical data favor elucidation of the probable cause of patient's bad evolution, which would facilitate drug adjustment and reduce the risk of toxicity or failing to achieve therapeutic doses

Microbiological assay of ampicillin in serum and aqueous humor of patients given ampicillin-sulbactam injection.

The aim of this study was to determine the bacterial growth inhibitory activities of ampicillin in aqueous humor and serum of patients administered ampicillin-sulbactam combination intramuscularly prior to cataract surgery. 43 patients received a combination of both antibiotics intramuscularly at varying periods (60-140 minutes) prior to surgery. Aqueous humor and venous blood were collected at the beginning of the surgery. For microbiological assay, spores of Bacillus subtilis were incorporated in the agar. The test sample and the standard solutions (calibrators) of ampicillin and ampicillin-sulbactam combination were placed in 3 mm wells in the agar. The diameter zones of growth inhibitory activities of ampicillin of the calibrators and the test samples measured in mm were extrapolated to the standard curve and were recorded as ampicillin activity in micrograms/ml. The results of the assay were placed in 5 groups according to the time intervals between injection and collection of serum and aqueous humor (< or = 70, 75, 80, 90, > 90 minutes). Ampicillin activities in sera and aqueous humor of group 5 (> 90 minutes) were significantly higher than the others (p < 0.001). The ratio of ampicillin activities of sera and aqueous humor in group 5 patients was significantly lower indicating higher concentration of ampicillin activity in aqueous humor during this period. Bacterial growth inhibitory activities of ampicillin-sulbactam combination were adequate in aqueous humor of all patients with highest activity being 90 minutes after intramuscular administration indicating the potential usefulness of this antibiotic combination as chemoprophylaxis prior to cataract surgery.

Filtrados de cultivos de Neisseria gonorrhoeae GC-9(T4) que la protegen del efecto bactericida del suero humano normal / Culture filtrates of Neisseria gonorrhoeae GC-9(T4) that protect it againts the bactericidal effect of normal human serum

Se determinó el efecto bactericida del suero humano normal contra una suspensión de Neisseria gonorrhoeae (GC-9)T4. Se prepararon cultivos del gonococo en caldo GC, en medio de Catlin y en medio de LaScolea y Young (GGM). Los cultivos se filtraron a través de membranas Millipore. A cada filtrado se le probó su efecto protector contra la actividad bactericida del suero humano normal. Los filtrados preparados en medio GGM mostraron un franco efecto protector. La diferencia entre la población bacteriana sobreviviente al efecto bactericida del suero y la población en presencia del suero y del filtrado protector, fue de alrededor de 1.5 logaritmos. Los filtrados preparados en los otros medios no tuvieron ninguna actividad inhibidora del efecto bactericida del suero. Se hicieron algunos experimentos tendientes a determinar la influencia de diversas condiciones de incubación sobre el desarrollo gonocócico y sobre la actividad protectora de los filtros protectores. Todos los filtrados preparados en medio GGM y en diferentes condiciones de incubación mostraron un efecto protector semejante

Velocidad bactericida del suero: propuesta metodológica para precedir la eficacia de la terapia antimicrobiana / Serum bactericidal rate: metodologic proposal to predict the efficacy of antimicrobial therapy

Se propone a la Velocidad Bactericida del Suero (VBS) como una técnica complementaria a la determinación de la "curva de muerte", al poder bactericida del suero (PBS), o a la concentración bactericida mínima (CIM), y que toma de esos métodos las características más ventajosas. Se basa fundamentalmente en cuantificar a distintos tiempos la sobrevida del inóculo bacteriano expuesto al suero del paciente. De esta manera, se evalúa la velocidad de bactericida producida en las primeras horas de contacto con el microorganismo (como en la "curva de muerte") pero a la concentración de droga que ha alcanzado el paciente en estudio (como en el PBS). Algunos ensayos preliminares sugieren que la VBS tendría mayor capacidad para discriminar la respuesta de un agente infeccioso a distintos esquemas terapéuticos que la que tendrían otras determinaciones, si bien se requieren estudios prospectivos para evaluar su valor predictivo.

A rapid method to evaluate the bactericidal activity of hiperimmune serum against Vibrio cholerae 01 using oxidase test

Desenvolveu-se ensaio rapido para medir o efeito de soros imunes contra o Vibrio cholerae 01, tendo-se por base a atividade de oxidase de culturas de bacterias em placas de ELISA

Use of serum bactericidal activity in assessing previous antibiotic therapy in acute lower respiratory tract infection in children.

Bactericidal activity in sera of children with acute lower respiratory tract infection was assayed to determine its effect on the outcome of blood culture. Parental reporting of prior antibiotic therapy was also determined. 14.4% of samples without serum bactericidal activity yielded pathogens from blood culture, whereas only 2.4% of samples with serum bactericidal activity yielded pathogens. A statistically significant correlation was found between isolation of pathogens by blood culture and serum bactericidal activity. Parental reporting could not be relied upon as there was no positive correlation.

Septicemia por Staphylococcus aureus em crianças: tolerância bacteriana à vancomicina e poder bactericida do soro / Staphylococcus aureus septicemia in children: bacterial tolerance to vancomycin and serum bactericidal test

OBJETIVO. Analisar a sensibilidade e tolerância das cepas de Staphylococcus aureus isoladas de crianças com septicemia e avaliar o poder bactericida sérico na monitorizaçäo terapêutica desses casos. MÉTODOS. Foram estudados 17 casos de crianças com septicemia por Staphylococcus aureus internadas na Enfermaria de cuidados semi-Intensivos do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. Foram realizados testes de sensibilidade antimicrobiana pelo método de difusäo em disco e diluiçäo em tubo. Foram realizados 29 testes no pico e 23 no vale dos antibióticos utilizados, determinando o poder bactericida do soro. RESULTADOS. As cepas de Staphylococcus aureus de origem hospitalar mostraram resistência a quase todos os antibióticos, exceto vancomicina e pefloxacina. Observou-se fenômeno de tolerância em cinco (50 por cento) das cepas testadas para vancomicina, sendo que quatro apresentaram má evoluçäo clínica. Os testes para determinaçäo do poder bactericida sérico revelaram títulos no pico ò1/8 em 55,5 por cento das observaç 8es; neste grupo a evoluçäo clínica foi melhor. CONCLUSäO. As cepas de Staphylococcus aureus de origem hospitalar estudadas säo multirresistentes. O fenômeno de tolerância antimicrobiana, assim como o poder bactericida do soro em níveis baixos, pode estar associado a má resposta terapêutica. A valorizaçäo do PBS como critério de avaliaçäo terapêutica em infecçöes graves e o papel da tolerância do Staphylococcus aureus à vancomicina merecem maiores estudos

Effect of antibiotics on serum bactericidal action on Plesiomonas shigelloides by normal human serum.

Thirteen clinical isolates of Plesiomonas shigelloides were tested for antibiotic susceptibility of tetracycline, kanamycin-sulphate, gentamicin, erythromycin and ciprofloxacin. All the strains were susceptible to all these antibiotics. The minimal inhibitory concentration (MIC) of all these antibiotics were: Kanamycin-sulphate-MIC 0.4-10.0 micrograms/ml, tetracycline-MIC 0.25-2.4 micrograms/ml, gentamicin-MIC 2.0-12.0 micrograms/ml, erythromycin-MIC 0.5-14.0 micrograms/ml and ciprofloxacin-MIC < or = 0.006 micrograms/ml. The MIC and MBC (minimal bactericidal concentration) of the antibiotics kanamycin-sulphate, tetracycline, gentamicin, erythromycin and ciprofloxacin changed little in the presence of serum protein. Different concentrations of sub-MICs played synergistic role in serum bactericidal action on this organism.

A study of lipid profile in Myanmar smokers and nonsmokers

This study was carried out to see the levels of serum lipids in smokers and nonsmoders. A total of 155 healthy subjects from the staff of the Institute of Medicine II, Yangon were studied. Among the 155 subjects, 96 were nonsmokers and 59 were active current smokers, smoking 1-9 cigarettes a day. Over night fasting samples of serum total cholesterol, serum HDL cholesterol, serum trigly-cerides and serum phospholipids were measured. It was found that smokers had significantly higher level of serum total cholesterol than nonsmoders.

Multidrug resistant Salmonella typhi in Bangalore, south India.

A total of 204 strains of salmonella were isolated in blood cultures during the year 1991 outbreak of enteric fever in and around Bangalore. Out of this, 190 were S. typhi, 6 S. paratyphi A, 5 S. typhimurium and 3 S. choloraesuis. Antibiogram of 190 strains of S. typhi showed resistance of 94.7%, 95.8% and 96.9% to chloramphenicol, ampicillin and cotrimoxazole and sensitivity of 65.3%, 88.4% and 94.2% to gentamycin, norfloxacin and ciprofloxacin respectively. Minimum inhibitory concentrations (MIC) of chloramphenicol were between 360 mcg and 640 mcg per ml. There was high degree (94.7%) of triple drug resistance to chloramphenicol, ampicillin and cotrimoxazole.

AçÅo lícita do soro para Pseudomonas aeruginosa mucóide e nåo mucóide de secreçöes respiratórias de pacientes com fibrose cística / Bactericidal activity of serum for mucoid and non-mucoid Pseudomonas aeruginosa isolated from cystic fibrosis patients

As infecçöes pulmonares por P. aeruginosa såo a causa de morte mais freqüente nos pacientes com fibrose cística, sobretudo as causadas pelas formas mucóides. Ao testarmos a sensibilidade à açåo bactericida do soro humano normal (SHN) e do soro autólogo (SA) de 44 amostras de P. aeruginosa, sendo 21 mucóides e 23 nåo mucóides, obtidas do trato respiratório de pacientes com Fibrose Cística, nåo encontramos diferença significativa no percentual de amostras soro-sensíveis entre as duas linhagens (SHN: 71,4 e 56,5; SA: 47,6 e 34,8, respectivamente para amostras mucóides e nåo mucóides; p>0,05). Sete amostras mostraram-se sensíveis ao SHNe resistentes ao SA, apesar da presença de anticorpos e de níveis normais ou aumentados de complemento, indicando a possível presença de fatores bloqueadores séricos. Nos pacientes que retornaram para estudo, verificamos que tanto com SHN como com SA, amostras de um mesmo morfotipo passaram de sensíveis a resistentes e vice-versa, evidenciando a necessidade de investigaçöes para melhor esclarecimento das interaçöes parasito-hospedeiro nestes pacientes

In vitro antimicrobial activity of cefodizime, a third generation cephalosporin.

Cefodizime is one of the new broad-spectrum cephalosporins. It is an aminothiazolyl iminomethoxy cephalosporin which is metabolically stable and has a prolonged serum half life. Cefodizime was primarily active against gram-negative bacilli and at the concentration of 0.5 mg/L, it inhibited 90 per cent of Enterobacteriaceae. P. mirabilis was the most susceptible species tested (MIC90 of 0.02 mg/L). E.coli, K.pneumoniae, Salmonella spp., Shigella spp. and M. morganii were also very sensitive to cefodizime, with the MIC90 of 0.25-0.5 mg/L. Cefodizime, however, was not active against most gram-negative bacilli possessing Type I beta-lactamases of Richmond and Sykes, namely, Enterobacter spp., P. aeruginosa and A. anitratus (MIC90 of > 128 mg/L). Among gram-positive bacteria, only S.pyogenes was highly susceptible (MIC90 of 0.05 mg/L), while S. aureus (methicillin-sensitive) was moderately susceptible and Enterococcus spp. was resistant. Cefodizime appeared to be bactericidal and was not affected by serum. High inoculum (10(7) cfu/ml) of K.pneumoniae and Enterobacter spp. resulted in increase of the MIC of cefodizime. This study shows that local bacterial isolates in a university hospital in Bangkok, Thailand were not different in susceptibility pattern from those reported in developed countries. The in vitro activity of cefodizime as a third generation cephalosporin, with its good pharmacokinetic property, and the property of the agent as a biological response modifier, should prove that this is a promising new agent in treating serious infections especially in immunosuppressed hosts.