Real-time monitoring of fungal inhibition and morphological changes.

Mold growth constitutes a problem in many food and clinical environments and there is therefore focus on studying antifungal activity. Methods for determining growth inhibition by measuring colony growth or biomass are, however, time-taking and rapid methods for evaluation of antifungal effects are needed. Propionic acid and diacetyl are antifungal compounds produced by a range of dairy-associated bacteria. Their activity against Penicillium spp. was monitored real-time using an optical detection system with tilted focus plane to assess growth and morphological changes of Penicillium spp. by image recording inside a 96 well microplate. Images were used for generation of growth curves by using a segmentation and extraction of surface areas (SESA) algorithm and for quantifying morphology changes. Using image analysis growth could be detected within 15 h compared with more than 30 h when using standard optical density measurements. Induced morphological changes of fungi could furthermore be visualized and quantified using morphological descriptors such as circularity, branch points, perimeter and area of spores and growing hyphae. Propionic acid inhibited two out of two Penicillium spp. while morphological changes were strain dependent at the concentrations tested. Diacetyl inhibited six out of six Penicillium spp. strains and increased spore size and number of germination sites in two out of six of the strains prior to germination.

Randomised clinical trial: a comparison between a GerdQ-based algorithm and an endoscopy-based approach for the diagnosis and initial treatment of GERD.

BACKGROUND: The diagnosis of gastro-oesophageal reflux disease (GERD) remains challenging. An algorithm, facilitated by a questionnaire, may provide a more structured and cost-effective care of patients. AIM: To compare symptom control achieved with empirical therapy for GERD, in an algorithm based on the GerdQ (new structured pathway, NSP), with that of current care after endoscopy (ordinary clinical pathway, OCP). METHODS: Patients with symptoms of GERD, but without alarm features, were randomised in an open, parallel-group study and followed for 4-8 weeks. In the NSP, GerdQ score was used as a basis for both diagnosis and a treatment algorithm. Patients with high likelihood of GERD were treated empirically with a PPI whereas patients with low likelihood of GERD received therapy chosen by the clinician. In the OCP, diagnosis and treatment were based on endoscopy or pH-metry findings. The statistical hypothesis was non-inferiority of NSP to OCP. RESULTS: A total of 147 patients (86.5%) in the NSP and 133 patients (80.1%) in the OCP arm were responders. Overall, NSP was non-inferior to OCP, but not superior (P = 0.14). Patients with high likelihood of GERD had significantly better symptom relief in the NSP (P = 0.03), whereas those with low likelihood of GERD showed a numerical difference in favour of an endoscopy-based approach (OCP). NSP saved 146 € per patient. CONCLUSIONS: A symptom-based approach using GerdQ reduced health care costs without loss in efficacy. Patients with high likelihood GERD benefited from empirical treatment. An algorithm based on GerdQ may provide physicians with a tool for a more structured care of patients (ClinicalTrials.gov NCT00842387).