Nitrofurantoin as an Add-On to Conventional Prophylaxis for the Treatment of Urinary Tract Infections in Kidney Recipients: A Prospective Cohort Study.

Urinary tract infections (UTIs) constitute one of the main complications in kidney recipients, increasing both morbidity and mortality. Due to the resurgence of antimicrobial resistance, new prophylactic approaches are being investigated. Nitrofurantoin is an antibiotic from the nitrofuran group that is effective against several Gram-negative and Gram-positive organisms; hence, there has been a resurgence in its prescription for treating MDR pathogens. Objectives: This study aims to assess the effectiveness of nitrofurantoin as an add-on to conventional therapy (amikacin + ceftriaxone or cefotaxime) for the treatment of urinary tract infections in kidney recipients. Methods: In a prospective cohort study, we included patients who received a kidney in a tertiary-care hospital. According to the intensive care specialist, group 1 patients were treated with the conventional prophylactic treatment plus nitrofurantoin as an add-on. Group 2 patients were treated only with the conventional prophylactic treatment. They were followed-up for 3 months, and the incidence of urinary tract infections was reported. Results: The UTI incidence for group 1 at 3 months was 20.6%, and for group 2, it was 20.0%; no statistical difference between treatments was observed (p = 0.9). The most commonly isolated pathogens were E. coli (28.5) and K. pneumonie (28.5%). The factor most associated with developing a UTI was female gender (aHR: 7.0; 95% IC 2.3-20.9, p < 0.001). Conclusions: In our cohort study, nitrofurantoin as an add-on in conventional therapy did not prove to be effective in preventing UTI development; therefore, other treatment options should be considered as a part of prophylactic treatment.

Double-blind placebo-controlled randomized clinical trial of ginger (Zingiber officinale Rosc.) in the prophylactic treatment of migraine.

BACKGROUND: Previous studies have shown an analgesic effect of ginger in the acute treatment of migraine, and there is anecdotal evidence of its efficacy in migraine prophylaxis. OBJECTIVE: This study aimed to evaluate the potential of ginger to prevent migraine attacks. METHODS: This double-blind, placebo-controlled randomized clinical trial took place at the Headache Clinic, Universidade Federal de Minas Gerais (Belo Horizonte, Minas Gerais, Brazil), involving 107 patients. Only subjects diagnosed with episodic migraine, aged between 18 and 60 years old, and who were not taking any prophylactic medication, were enrolled in the study. After one month of observation, subjects selected for the study were randomized 1:1 into placebo and treatment groups. Patients received capsules three times per day of 200 mg of dry extract of ginger (5% active ingredient) or placebo (cellulose) for three months. Visits were performed monthly and the patients were asked to fill in a migraine diary. The adherence to treatment was evaluated by counting capsules. RESULTS: The percentage of patients who responded to treatment (i.e. a reduction of 50% in the number of migraine attacks at the end of treatment) did not differ between the groups. There was a decrease in the number of days with severe pain, analgesic use for acute migraine and duration of migraine attacks in both groups, without significant difference between ginger and placebo groups. CONCLUSIONS: Ginger provides no greater benefit in the prophylactic treatment of migraine when compared to placebo. This trial is registered at ClinicalTrials.gov (NCT02570633).

Lactobacillus species increase the survival of Galleria mellonella infected with Candida albicans and non-albicans Candida clinical isolates.

Investigation into new therapeutic strategies, such as the use of bacterial isolates with probiotic characteristics, has increased in importance due to the high incidence of Candida albicans and non-albicans Candida infections. This study evaluates Lactobacillus paracasei, Lactobacillus fermentum and Lactobacillus rhamnosus strains as prophylactic and therapeutic agents against infection caused by Candida albicans, Candida glabrata, Candida krusei, and Candida tropicalis in a Galleria mellonella model. Prophylactic treatment provided greater benefits during Candida spp. infection, increasing G. mellonella survival, compared to therapeutic treatment. This study demonstrated that the different Lactobacillus species are potent prophylactic agents of Candida species infection.

Prophylactic Treatment With Simvastatin Modulates the Immune Response and Increases Animal Survival Following Lethal Sepsis Infection.

Chronic use of statins may have anti-inflammatory action, promoting immunomodulation and survival in patients with sepsis. This study aimed to analyze the effects of pretreatment with simvastatin in lethal sepsis induced by cecal ligation and puncture (CLP). Male Swiss mice received prophylactic treatment with simvastatin or pyrogen-free water orally in a single daily dose for 30 days. After this period, the CLP was performed. Naïve and Sham groups were performed as non-infected controls. Animal survival was monitored for 60 h after the CLP. Half of mice were euthanized after 12 h to analyze colony-forming units (CFUs); hematological parameters; production of IL-10, IL-12, IL-6, TNF-α, IFN-γ, and MCP-1; cell counts on peritoneum, bronchoalveolar lavage (BAL), bone marrow, spleen, and mesenteric lymph node; immunephenotyping of T cells and antigen presenting cells and production of hydrogen peroxide (H2O2). Simvastatin induced an increase in survival and a decrease in the CFU count on peritoneum and on BAL cells number, especially lymphocytes. There was an increase in the platelets and lymphocytes number in the Simvastatin group when compared to the CLP group. Simvastatin induced a greater activation and proliferation of CD4+ T cells, as well as an increase in IL-6 and MCP-1 production, in chemotaxis to the peritoneum and in H2O2 secretion at this site. These data suggest that simvastatin has an impact on the survival of animals, as well as immunomodulatory effects in sepsis induced by CLP in mice.

Migraine improvement correlates with posterior cingulate cortical thickness reduction / Variação da espessura cortical no cíngulo posterior em pacientes com enxaqueca. Correlação com a melhora pós-tratamento profilático

ABSTRACT Objective The main goal of this study was to correlate migraine improvement, after prophylactic therapy, with cortical thickness changes. Methods Cortical thickness maps were obtained with magnetic resonance imaging (MRI) from 19 patients with migraine before (first scan) and after (second scan) prophylactic treatment, and these were compared with controls using the FreeSurfer MRI tool. Cortical changes were correlated with the headache index (HI). Results Anincrease incortical thickness was found in the right cuneus and precuneus, somatosensory and superior parietal cortices in both patient scans, compared with the controls. No changes were observed in the left hemisphere. Following correction for multiple comparisons, no areas changed from the first to the second scan. Regression analysis showed a significant negative correlation between the HI improvement and cortical thickness changes in the left posterior cingulate, a region involved with nociception and, possibly, the development of chronic pain. Conclusion There were changes in cortical thickness in patients with migraine relative to controls in areas involved with vision and pain processing. Left posterior cingulate cortical changes correlated with headache frequency and intensity.

RESUMO Objetivos Correlacionar a melhora de pacientes enxaquecosos após tratamento preventivo com alterações na espessura do córtex cerebral. Métodos Espessura cortical foi determinada a partir de imagens de ressonância magnética (RM)em 19 pacientes com enxaqueca, antes (1ᵃ RM) e após (2ᵃ RM) o tratamento profilático, e comparada com controles, usando o programa FreeSurfer. Mudanças corticais foram correlacionadas com o índice de cefaleia (HI). Resultados O hemisfério direito apresentou aumento da espessura no córtex do cúneus e pré-cúneus, parietal superior e somatossensitivo na primeira RM e na segunda RM, em comparação aos controles. Após correção para comparações múltiplas, nenhuma região cortical se mostrou estatisticamente diferente entre a primeira e a segunda RM. A regressão mostrou correlação (negativa) significativa entre melhora do HI e mudanças na espessura cortical do cíngulo posterior esquerdo. Conclusão Existem alterações de espessura cortical em pacientes com enxaqueca em relação a controles em áreas envolvidas com processamento visual e com a dor. As alterações corticais no cíngulo posterior esquerdo variaram de acordo com a frequência e intensidade das crises.

Riesgo de tromboembolismo pulmonar y tratamiento profiláctico en pacientes graves ingresados en una unidad de cuidados intermedios / Risk of pulmonary embolism and prophylactic treatment in critically ill patients admitted to an intermediate care unit

Se realizó un estudio descriptivo, transversal y prospectivo de 96 pacientes, ingresados en la Unidad de Cuidados Intermedios del Hospital Clinicoquirúrgico Docente "Dr. Joaquín Castillo Duany" de Santiago de Cuba, desde enero hasta junio del 2012, con vistas a identificar y estratificar los factores de riesgo del tromboembolismo pulmonar, así como el uso del tratamiento profiláctico durante la estadía hospitalaria de los afectados. Se determinaron los factores de riesgo y se estratificaron en: bajo, moderado, alto y muy alto, teniendo en cuenta si tenían indicación o no de algún tipo de tratamiento profiláctico, lo cual se relacionó con la estadía hospitalaria. Se constató que la mayoría de los afectados tenían asociados más de 2 factores de riesgo, tales como encamamiento prolongado, edad superior a 40 años, sepsis y algún tipo de comorbilidad, que permitieron clasificarlos como de riesgo alto o muy alto de tromboembolismo pulmonar; sin embargo, se indicó tratamiento profiláctico en solo la mitad de ellos.

A descriptive, cross-sectional and prospective study of 96 patients, admitted to the Intermediate Care Unit of "Dr. Joaquín Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out from January to June 2012, with the objective of identifying and stratifying the risk factors of pulmonary embolism, as well as the use of the prophylactic treatment during the hospital stay of the affected patients. The risk factors were determined and they were stratified in: low, moderate, high and very high, keeping in mind if they had indication or not of some type of prophylactic treatment, which was related to the hospital stay. It was verified that most of the affected patients had more than 2 risk factors associated, such as prolonged bedridding, age higher than 40 years, sepsis and certain comorbidity type, that allowed to classify them as high or very high risk cases of pulmonary embolism; however, prophylactic treatment was indicated just in half of them.

Recomendações para o tratamento profilático da migrânea / Recommendations for prophylactic treatment of migraine

A Sociedade Brasileira de Cefaléia (SBCe) designou um Comitê Ad Hoc com o propósito de estabelecer um consenso sobre o tratamento profilático da migrânea e de elaborar recomendações para os profissionais da área médica. O Comitê baseou-se em evidências da literatura médica mundial e na experiência pessoal dos integrantes, respeitando-se a realidade dos medicamentos existentes em nosso meio (AU)

The Brazilian Headache Society assigned an Ad Hoc Committee with the purpose of establishing a consensus about prophylactic treatment for migraine and of elaborating recommendations for professionals. The recommendations of the Committee are based in evidences of the world medical literature and on the personal experience of the members, respecting the reality of the existing medication resources in our country (AU)