Infecciones del tracto urinario en pacientes con esclerosis múltiple y los diferentes sistemas de vaciado vesical / Urinary tract infections in patients with multiple sclerosis and different methods of bladder evacuation

Introducción y objetivos: Evaluar la incidencia y la evolución de las infecciones del tracto urinario (ITU) en pacientes con esclerosis múltiple (EM) y su relación con el sistema de vaciado vesical. Materiales y métodos: Se incluyeron en el estudio pacientes con disfunciones miccionales neurógenas debido a la EM (n=111). Durante un año de seguimiento, se realizó una evaluación clínica con cultivo de orina cada 4 meses o ante la presencia de síntomas. El grupo de control incluyó a pacientes con ITU sintomática sin enfermedad neurológica o autoinmune. Se evaluó estadísticamente la incidencia de bacteriuria sintomática y asintomática, el efecto del drenaje urinario en la incidencia de ITU y el efecto del tratamiento antibiótico. Resultados: Cincuenta y cuatro pacientes con EM completaron el protocolo. La incidencia media de bacteriuria sintomática y asintomática en el grupo de EM fue del 12,5% y del 29,6%, respectivamente. Se observó una tendencia decreciente en la incidencia de la bacteriuria sintomática y una tendencia creciente en la incidencia de la asintomática. La erradicación de la ITU en los pacientes sintomáticos con EM fue significativamente menor que en los controles (37,75% frente a 92,93%, p<0,05). Los agentes causales fueron significativamente diferentes en ambos grupos (p=0,0005). No se rechazó la hipótesis de que la incidencia de ITU en los pacientes con EM es independiente del sistema de evacuación vesical (p>0,99 en las visitas 0, 1 y 3; p=0,078 en la visita 2). Conclusiones: Existe una diferencia significativa entre los agentes causales de la ITU en ambos grupos. La erradicación de la bacteriuria en los pacientes sintomáticos con EM es difícil en comparación con la población normal. No disponemos de pruebas suficientes para confirmar la relación entre la incidencia de ITU y el sistema de evacuación vesical. (AU)

Introduction and objectives: To evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation. Materials and methods: Patients with neurogenic bladder dysfunction due to MS (n=111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated. Results: Fifty-four MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P<.05). Causative agents significantly differed in both groups (P=.0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P>.99 at visit 0, 1 and 3, P=.078 at visit 2). Conclusions: There is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation. (AU)

Urinary tract infections in patients with multiple sclerosis and different methods of bladder evacuation.

INTRODUCTION AND OBJECTIVES: To evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation. MATERIALS AND METHODS: Patients with neurogenic bladder dysfunction due to MS (n=111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated. RESULTS: 54 MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P<0.05). Causative agents significantly differed in both groups (P=0.0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P>0.99 at visit 0, 1 and 3, P=0.078 at visit 2). CONCLUSIONS: There is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation.

[Biodegradation of silicone in voice prosthesis]. / Biodegradace silikonu hlasových protéz.

The most important problem of the useful life of vocal prostheses is bacterial and especially mycotic colonization of their surface which impaired tightness of the closing valve of the prosthesis and caused subsequent leakage of fluids and food into the airways. The objective of the present study was to prevent colonization of the silicone surface and to prolong the service life of the prosthesis. The implanted prostheses were examined under microscope after varying intervals in vivo. The silicone of the implanted prosthesis was colonized by numerous microorganisms, in particular moulds. Seventeen bacterial and mycotic strains were identified. They behave to Candida, Acinetobacter, Micrococcus, Pseudomonas, Bacillus and Chryseomonas. The results confirmed the deep degradation of silicone rubber located in islets. Plant of bacterial tissue were inoculated on two types of silicone disks. Two types of silicone were tested (Silastic Q7-4550-50ShA and Q7-4765-65) after 4, 8 and 12-week exposure. Neither of these materials was attacked by mycotic agents in vitro. Only frame print was appreciable in five hundred times magnification. The second object of the study was to recognize the main degradation factor that means a kind of microorganism. The ability of microorganisms to assimilate oligo- and polyorganosiloxans was studied. Candida albicans does not seem like a typical microorganism assimilating silicon rubber. The results of our study proved Microccus as a typical vector which assimilates silicone.

Effect of cytochrome P-450 inhibition and stimulation on intensity of polyethylene degradation in microsomal fraction of mouse and rat livers.

Polyethylene (PE) is degraded in microsomal fractions of mouse and rat livers with the formation of carbonyl groups. Infrared spectroscopy demonstrated formation of predominantly ketone groups and to a lesser degree ester and aldehyde groups. The inhibition and stimulation of cytochrome P-450 in mouse livers affected the formation of oxidative groups on PE. Phenobarbital doses of 3 x 0.05 mg per mouse increased the concentration of cytochrome P-450 and ketone groups on PE, whereas the vaccine Propionibacterium acnes (0.5 mg) and its pyridine fraction (0.5 and 1 mg) had the opposite effect. The coherence of cytochrome P-450 with oxidative changes on PE is compared and discussed with findings on implants in man.

Biodegradation of polyethylene foils by bacterial and liver homogenates.

The evaluation of structural changes of single linear and bifurcated polyethylene foils exposed to bacterial and liver homogenates was carried out by infrared spectrography, along with observations of changes of mechanical properties. Cell homogenates were fractionated by centrifugation and by coagulating the microsomal fraction using Ca2+ ions. Stimulation as well as inhibition of the presumed enzyme system were studied in bacterial cultures and liver homogenates of experiment animals. Results suggest that oxidation structures in polyethylene, after exposure to these cell homogenates, are caused by the monooxygenase hydroxylation system of the bacterial or liver cells.