Effects of acute oral exposure to acrylamide on histological structures of the stomach in Wistar rats / Efectos de la exposición oral aguda a la acrilamida sobre las estructuras histológicas del estómago en ratas Wistar

SUMMARY: Acrylamide is a toxic chemical substance with wide implementation in chemical industry. In 2002 the presence of acrylamide was discovered in foods rich in starch which are prepared at high temperatures. The aim of this study was to investigate the histopathological changes in the gastric tissue in Wistar rats induced with injection of oral acrylamide. The research was carried out 6 groups of 5 animals (Wistar rats), two control groups and four experimental groups. Histological changes in the stomach tissue of Wistar rats are seen as a direct slight damage of the surface epithelium, accompanynig inflammatory reaction and renewal of the epithelium. Examined inflammatory and degenerative parameters show a positive correlation with respect to dose and time of exposition to acrylamide. Knowing the mechanism of action of these toxic substances, allows to apply adequate prevention in nutrition and make an appropriate choice of therapeutic methods.

RESUMEN: La acrilamida es una sustancia química tóxica con amplia aplicación en la industria química. En el año 2002 se determinó la presencia de acrilamida en alimentos ricos en almidón preparados a altas temperaturas. El objetivo de este estudio fue investigar los cambios histopatológicos en el tejido gástrico en ratas Wistar inducidos con inyección de acrilamida oral. La investigación se llevó a cabo en 6 grupos de 5 animales, dos grupos control y cuatro grupos experimentales. Los cambios histológicos en el tejido del estómago de las ratas Wistar se ven como un ligero daño directo del epitelio superficial, que acompaña a la reacción inflamatoria y la renovación del epitelio. Los parámetros inflamatorios y degenerativos examinados muestran una correlación positiva con respecto a la dosis y el tiempo de exposición a la acrilamida. El conocimiento del mecanismo de acción de estas sustancias tóxicas permite aplicar una prevención adecuada en nutrición y hacer una elección oportuna de los métodos terapéuticos.

Predictors of inferior outcome in community acquired bacterial meningitis.

The aim of this study was to assess mortality and sequellae within cases from Nationwide survey of community acquired meningitis and identify risk factors for inferior outcome. Risk factors such as underlying disease (diabetes mellitus, cancer, trauma, neonatal age, splenectomy, alcoholism, sepsis, other infections), etiology, clinical symptoms and outcome (death, improvement and cured after modifications of ATB therapy, cured without change of therapy, cured with neurologic sequellae) were recorded and analysed with univariate analysis (chi2 or t test for trends, CDC Atlanta 2004). Analysing risk factors for inferior outcome (death or cured with neurologic sequellae), we compared patients who died or survived with neurologic sequellae to all patients with community acquired bacterial meningitis. Univariate analysis showed that trauma (p<0.05), alcohol abuse (p<0.05), diabetes, S. aureus (p<0.05) and gram-negative etiology (A. baumannii, Ps. aeruginosa or Enterobacteriaceae) (36% vs. 11,9%, p<0.05) were predicting inferior outcome. Analysing risk factors for treatment failure (death or failed but cured after change of antibiotic treatment) prior sepsis (34.1% vs. 13.9%, p<0.01) and gram-negative etiology (25% vs. 11.9%, p<0.02) were statistically significant predictors of treatment failure. Neisseria meningitis had less failures (p<0.05). Concerning infection associated mortality again diabetes mellitus (p<0.05), alcoholism (p<0.05) staphylococcal and gram-negative etiology (p<0.05) were significant predictors of death. N. meningitis had surprisingly less treatment failures (appropriate and rapid initial therapy). Neurologic sequellae were more common in patients with alcohol abuse (p<0.05), craniocerbral trauma (p<0.05) and less common in meningitis with pneumococcal etiology (p<0.05).

Comparison of postsurgical and community acquired bacterial meningitis--analysis of 372 cases within a nationwide survey.

The aim of this study was to assess if differences in etiology and risk factors among 372 cases of bacterial meningitis acquired after surgery (PM) or in community (CBM) have impact on outcome of infected patients. Among 372 cases of bacterial meningitis within last 17 years from 10 major Slovak hospitals, 171 were PM and 201 CBM. Etiology, risk factors such as underlying disease, cancer, diabetes alcoholism, surgery, VLBW, ENT infections, trauma, sepsis were recorded and mortality, survival with sequellae, therapy failure were compared in both groups. Significant differences in etiology and risk factors between both groups were reported. Those after neurosurgery had more frequently Coagulase negative staphylococci (p<0.001), Enterobacteriaceae (p=0.01) and Acinetobacter baumannii (p=0.0008) isolated from CSF and vice versa Streptococcus pneumoniae (p<0.001), Neisseria meningitis (p<0.001) and Haemophillus influenza (p=0.0009) were more commonly isolated from CSF in CBM. Neurosurgery (p<0.001), sepsis (p=0.006), VLBW neonates (p=0.00002) and cancer (p=0.0007) were more common in PM and alcohol abuse (p<0.001) as well as otitis/sinusitis (p<0.001) and Roma ethnic group (p=0.001) in CAM. Initial treatment success was significantly more frequently observed among CAM (p<0.001) but cure after modification was more common in PM (p=0.002). Therefore outcome in both groups was similar (14.6% vs. 12.4%, p=NS).

Bacterial meningitis after craniocerebral trauma in the community.

Craniocerebral trauma is one of major risk factors for development of meningitis. We reviewed 30 cases of bacterial meningitis occurring in community after craniocerebral trauma. Alcohol abuse was significant risk factor occurring in trauma patients with meningitis present in 50% in our cohort (p=0.0001). The most common pathogen in posttraumatic meningitis was Str. pneumoniae (90% vs. 33.8%, p=0.0001). However mortality was very low, only 5% probably because of early diagnosis and treatment of patients at risk for bacterial meningitis but neurologic sequellea were significantly more common (p=0.00001) in patients after craniocerebral trauma.

Bacterial meningitis after sinusitis and otitis media: ear, nose, throat infections are still the commonest risk factors for the community acquired meningitis.

We investigated how many cases of bacterial meningitis in our national survey were associated with sinusitis or otitis media. Among 372 cases of bacterial meningitis within our nationwide 17 years survey, 201 cases were community acquired (CBM) and in 40 (20%) otitis media or sinusitis acuta/chronica were reported 1-5 weeks before onset of CBM. Diabetes mellitus (20% vs. 7.5%, p=0.01), alcohol abuse (35% vs. 15.4%, p=0.003) and trauma (30% vs. 14.9%, p=0.02) were significantly associated with CBM after ENT infections. Concerning etiology, CBM after sinusitis/otitis was insignificantly associated with pneumococcal etiology (50% vs. 33.8 %, NS) and significantly associated with other (L. monocytogenes, Str. agalactiae) bacterial agents (9.9 % vs. 25 %, p=0.008) . However those significant differences for new ENT related CBM had no impact on mortality (12.4 % vs. 5%, NS), failure after initial antibiotics (10 % vs. 9.5%, NS) and neurologic sequellae (12.5 % vs. 15.4 %, NS).

Pneumococcal meningitis in community is frequent after craniocerebral trauma and in alcohol abusers.

Aim of this short communication was to assess risk factors and outcome of community acquired pneumococcal meningitis and compare it to all cases of community acquired meningitis. Univariate analysis was used for comparison of 68 pneumococcal to 201 CBM within a Slovak nationwide database of CBM. Significant risk factors for pneumococcal meningitis were previous craniocerebral trauma within 7 days (39.7% vs. 14.9%, p=0.00002), splenectomy (10.3% vs. 3.5%, p=0.03) and alcohol abuse (36.8% vs. 15.4%, p=0.0001). Concerning outcome, mortality was similar (8,8% and 12,4%, NS), proportion of those with neurologic sequellae after CBM due to Str. pneumoniae was insignificantly higher (20.6% vs. 15.4%, NS) in comparison to all CBM. All but 2 strains Str. pneumoniae were susceptible to penicillin and macrolides (3.3% resistance).

Gram-negative bacillary community acquired meningitis is not a rare entity in last two decades.

The aim of this short note is to assess gram-negative bacillary community acquired meningitis (CBM) and nosocomial meningitis (NM) within 17 years nationwide survey. All cases of gram-negative bacillary CBM within 1990-2007 were assessed in national database of 372 patients with bacterial meningitis: 69 of gram-negative cases were nosocomial and 24 of gram-negative meningitis cases were CBM. Those 24 cases were compared with all CBM (201 cases) for risk factors and outcome. Among nosocomial gram-negative pathogens, A. baumannii in 23 cases, Ps. aeruginosa in 15 cases and Enterobacteriaceae in 31 cases were isolated. Among CBM, in 13 cases Enterobacteriaceae (Escherichia coli 6, Klebsiella pneumoniae 3, Proteus mirabilis 2, Enterobacter cloacae 2), in 5 cases Ps. aeruginosa and in 6 cases Acinetobacter baumannii were isolated from cerebrospinal fluid (CSF). The only significant risk factor for CBM due to gram-negative bacilli was neonatal age (12.5% vs. 3.5%, p=0.04) as underlying disease. However, mortality among gram-negative bacillary meningitis was significantly higher (12.4% vs. 37.5%, p=0.001) in comparison to other meningitis.

Bacteremic meningitis is associated with inferior outcome in comparison to community acquired meningitis without bacteremia.

Meningitis associated with bacteremia is rare. Bacteremic form of meningitis occurred in 28 of 201 cases of community acquired meningitis (14%) in Slovakia within last 17 years. Bacteremic meningitis was associated with diabetes (21.4% vs. 7.5%, p=0.02) and with higher treatment failures (32.1% vs. 9.5%, p=0.01) and higher mortality (25% vs. 12.4%, NS). In univariate analysis comparing 28 cases of bacteremic community acquired bacterial meningitis (BCBM) to all CBM, no significant risk factor concerning underlying disease (cancer, ENT infection, alcohol abuses, trauma, splenectomy, etc.) or etiology was observed apart of diabetes mellitus, which was more common among bacteremic meningitis (21.4% vs. 7.5%, p=0.02). Mortality (25% vs. 12.4%, NS) insignificantly but therapy failure (32.1% vs. 9.5%, p=0.01) was significantly more frequently observed among meningitis with bacteremia. N. meningitis was the commonest causative agent (8 of 28 cases) followed by Str. pneumoniae (6), gram-negative bacteria (6), S. aureus (4) and H. influenzae (2).

Haemophillus influenzae community acquired meningitis occurrence in children despite 10 years vaccination.

Despite of 10 years vaccination of all children within 1st year in Slovakia against H. influenzae, this severe infection still occurs. Among 201 cases of community acquired bacterial meningitis, 14 (7%) were caused by H. influenzae serotype B. Outcome however, after early institution of treatment was fortunately positive - only 1 patient died (7.1% mortality) and in 2 other neurologic sequellae occurred (14.3%), which were transient and mild.

Etiology, risks factors, therapy of nosocomial cerebrovascular infections.

Nosocomial cerebrovacsular infections are substantial cause of mortality and morbidity in patients after neurosurgery. Risk factors, etiology, treatment strategies and outcome of nosocomial meningitis and brain abscess are briefly reviewed.

[Personal experience with laparoscopic treatment of sterility]. / Nase zkusenosti s laparoskopickou lécbou sterility.

OBJECTIVE: Evaluation of laparoscopy in treatment of sterility. DESIGN: Retrospective clinical study. SETTING: Department of Gynaecology and Obstetrics, Hospital in Bruntal, Czech Republic. METHODS: In 1997 and 1998 we performed 36 laparoscopic operations in patients with primary or secondary sterility at our department. In women with anovulatory cycles we performed drilling of the ovaries. Adhesions both in and beyond the pelvis were treated by lysis of adhesions, in women under 35 with mild or moderate hydrosalpinx we performed terminal salpingostomy while large hydrosalpinges were treated with salpingectomy and the patients were recommended for assisted reproduction. Success of the treatment was evaluated at least half a year after laparoscopy. RESULTS: In the anovulatory group, 60% conceived on average 2 months after operation. 36.4% conceived in the group with pelvic adhesions, on average in 5 months and 50% in the salpingostomy group conceived in 8 months. CONCLUSIONS: Although the number of patients is small, the obtained results prove the usefulness of operative laparoscopy in the treatment algorithm of sterile patients.

[A 3-year study of ultrasound examination of the central nervous system in high risk neonates at the hospital in Senta]. / Trogodisnje iskustvo ultrazvucnog pregleda centralnog nervnog sistema kod rizicne novorodencadi u bolnici u Senti.

INTRODUCTION: Transfontanellar neurosonography is a noninvasive, precise method for detection and follow-up of morphological and functional changes of the central nervous system in infants and newborn infants, which has been used as sonoscreening since 1996 in General Hospital in Senta in high-risk infant newborns. MATERIAL AND METHODS: In the period 1996-1998 there were 2831 newborn infants at the Labor and Delivery Department. There were 551 (19.46%) newborn infants in the high-risk group. Ultrasonographic examinations of the brain were performed by SIEMENSSONOLINE SL2 apparatus, with a sector probe 3.5 Mhz. Out of the examined high-risk newborn infants 62.25% had a pathological ultrasound finding of the brain including: intracranial hemorrhage and hypoxic ischemic encephalopathies; 117 (21.23%) of newborn infants had intracranial hemorrhage Papile grade I-II; 66 (11.98%) newborn infants had III-IV grade intracranial hemorrhage and 160 (29.04%) had hypoxic ischemic encephalopathies. DISCUSSION: Correlation between pathological CNS findings and Apgar Score (AS) in 143 newborn infants, revealed that all newborn infants with AS: 0-3 had a pathological finding of the brain: HIC or HIE (4 newborn infants). In the group with AS 4-7 (51 newborn infants) pathological sonogram was established in 44 (86.28%), whereas in the group with AS 8-10 (88 newborn infants) pathological ultrasound finding of CNS including HIC or HIE was registered in 40.09% of newborn infants. Changes in regard to HIC of various degree and HIE changes depend on the localization, volume, time of onset (vulnerable period) and spreading time. Compensatory mechanisms as well as great brain plasticity at this age and early rehabilitation can reduce the consequences of brain damages a great deal. That is why it is necessary to inform parents about the changes that have occurred properly in order to ensure correct relationship to their high-risk newborn infant. In this way they cooperate at check-ups and are able to follow the development of their child, noticing possible aggravation going on with multiple stimulation treatment.

[Physiologic neonatal body weight loss in a "baby friendly hospital"]. / Fizioloski pad telesne mase novorodencadi u uslovima "baby friendly hospital".

INTRODUCTION: It has been known for centuries that mother's milk is the most optimal nutritive and energetic substance for nutrition of newborn infants. Human milk is naturally adapted to physiological possibilities of nutrition and nutritive requirements of newborn infants. Baby Friendly Hospital Initiative of WHO experts and International Children's Fund are directed to introduction of natural diet and breast feeding as long as possible and they have been accepted in our environment as well. Health workers of these Departments and Hospitals help in education of women giving birth for successful breast-feeding. Successful establishment of lactation should affect physiological body-weight loss reduction in newborn infants. The aim of this paper was to prove that babies' presence induces earlier lactation, and that is how physiological body-weight loss is reduced. MATERIAL AND METHODS: This study included 100 newborn infants of the Baby Friendly Hospital and 100 newborn infants born at the Maternity Ward of the Hospital in Senta in 1997 who were situated in a special ward for newborns. The paper deals with vaginally delivered babies without signs of disease. The study registered as follows: sex of newborn infants, the lowest body-weight during their stay at the Department, date when the body-weight was measured, taking into consideration the parity of their mothers. RESULTS: Statistical data processing revealed that in the group of newborn infants included in the Baby Friendly Program physiological body-weight loss was less (5.32% of the body-weight at birth) than in newborn infants classically managed (5.77% of body-weight at birth). The physiological body-weight loss in the group of the Baby Friendly Program was significantly smaller when expressed in grams. DISCUSSION: According to pediatric literature a 10% physiological loss of body weight in regard to body weight at birth is considered to be normal. Investigations performed at the Maternity Wards in Zrenjanin and Novi Sad (geographically the nearest to our town) have shown results similar to ours. CONCLUSION: Results of our investigation support the Baby Friendly Hospital Initiative of the WHO and International Children Fund and their recommendations for initiating breast-feeding of newborn infants as early as possible. We also consider efforts for providing conditions necessary for Baby Friendly Hospital justified because of mother-child close relationship and possibilities for breast-feeding without strict regimens.

[Effect of the "baby friendly" program on the number of neonatal infections at the maternity ward in Senta]. / Uticaj "baby friendly" programa na broj neonatalnih infekcija na porodajnom odeljenju u Senti.

INTRODUCTION: The aim of this paper was to assess how the Baby Friendly Hospital Initiative affects occurrence, structure and outcome of neonatal infections at our department. MATERIAL AND METHODS: This retrospective study included all newborn infants born in 1995, when all the babies were at the neonatal ward and all the babies born in 1998, who were with their mothers. Newborn infants with low-birth-weight or shortened gestation were excluded. The assumption was that faster onset of lactation and thus breast-feeding decrease incidence of infections, but that there is an increased risk due to hygienic habits of mothers, especially those with no qualifications and difficult living conditions. The paper assesses the percentage of infections occurrence. RESULTS: Occurrence of infection was established clinically, whereas general signs of infection, as well as local signs of infection were confirmed by laboratory and bacteriological findings. Antibiotic therapy was applied. In great number of infections Staphylococcus aureus was isolated. In 1998 a certain increase of low-birth-weight and low gestation newborn infants was registered. In mature babies included into the Baby Friendly Program, number of infections has not changed, but the treatment was a little shorter. Infections were much more frequent in low-birth-weight and low gestation newborn infants. On the average the treatment in such cases was a little longer, but not only due to infection. DISCUSSION: Baby Friendly Hospital Initiative has not significantly affected the incidence of intrahospital infections in newborn infants. On the average the treatment in mature newborn infants was shorter, probably due to better lactation and transfer of immunoglobulins from mother to child. CONCLUSION: If Baby Friendly Hospital Initiative means adequate epidemiological supervision of mothers, this program does not significantly affect the risk from intrahospital infections.

[The significance of gestational age and body mass in the manifestations of hypoglycemia in neonates]. / Znacaj gestacione starosti i telesne mase u pojavi hipoglikemije kod novorodencadi.

In this paper the author studies the influence of body mass and gestational age on the range of glycemia. A group of 204 children which were born under the influence of various risk factors was studied; 54 of these children had low glycemia values, and 150 of them had other risks. The glycemia values of these children were compared to the glycemia values of 30 children from the control group. The author found that the gestation of age and body mass at birth are of great significance for the appearance of hypoglycemia. The mean body mass is much lower in the group of children with hypoglycemia (X = 2741.6) than in the control group (X = 3306.6 gr) and the group of children with all the other risks (X = 3112.7 gr). The group of children with a body mass that is small for their gestation of age (SGA) stands out in particular. In this paper there have been 9 SGA children, and 6 of them belonged to the group of children with hypoglycemia, and 3 of them had symptomatic hypoglycemia, while out of the entire group (54) 15 children had symptomatic hypoglycemia. None of the children from this group had convulsions. Glycemia was registered every 2 hours even after 24 hours following birth. If low values happened to be discovered, every 4 hours following birth 10% glucose was introduced per os. In all the children feeding was introduced 12 hours after birth, and in children with hypoglycemia this was supplemented by adding 10% glucose which was mixed with the milk which was drawn from the mother.(ABSTRACT TRUNCATED AT 250 WORDS)