Lactic acid bacteria from kefir grains: Potential probiotics with antagonistic activity against multidrug resistant Gram-negative bacteria

Aims@#This study aimed to isolate and identify lactobacilli strains that have antagonistic activity against multidrug resistant (MDR) isolates of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa and evaluate their probiotic properties.@*Methodology and results@#Twenty-one Lactobacillus isolates were collected, and their antimicrobial activity was assessed by agar well diffusion, broth microdilution and time-kill test. The probiotic potential of the isolates was evaluated as well. The bacterial culture and cell free supernatant (CFS) of all isolates exhibited antibacterial activity against all MDR isolates. Out of 21 isolates, 4 isolates (A31, B35, S20 and S25) displayed the highest antimicrobial activity and further evaluated. The minimum inhibitory percentages of CFS from selected isolates against pathogens ranged from 10 to 30% and the bactericidal percentages ranged from 20 to 50%. The inhibitory activity of CFS was not changed after heating but abrogated as the pH neutralized. The growth kinetic of the MDR pathogens was significantly reduced in the presence of the CFS of all isolates. The isolates had a less than 1-log reduction in their viability in acid tolerance test and could grow in the presence of 0.3% bile salts. Strains S20, S25 and B35 exhibited high coaggregation with E. coli (51.7-73.3%), P. aeruginosa (53.7-69.3%) and K. pneumoniae (49.7-65.3%). Molecular identification revealed that the isolates were Lactobacillus rhamnosus (B35) and Lactobacillus paracasei (S20, S25, A31). @*Conclusion, significance and impact of study@#The results suggest that these lactobacilli isolates may have potential applications for controlling and preventing colonization of infections caused by MDR pathogens.

Distal clavicular fracture treatment with suture anchor method.

OBJECTIVE: The aim of this study was to evaluate the results of the suture anchor fixation in the treatment of distal clavicle fractures. METHODS: This cross series study included 43 patients (27 males, 12 females; mean age: 40.1±10.18 years) with type II unstable distal clavicle fractures. The fractures were fixed by 2 pins and 1 suture anchor. All patients were followed at postoperative months 3, 6, and 12 and underwent clinical and radiographic evaluation after 1 year, ongoing at 6-month intervals thereafter. Demographic data were recorded on the first postoperative day. At third and 12th month follow-up, Constant-Murley Shoulder Outcome Score (CMS) was used to assess performance of the acromioclavicular joint, and Visual Analog Scale questionnaire was used to assess patient satisfaction. RESULTS: Based on CMS scores 1 year after surgery, 37 patients were in excellent condition, and 2 patients were in good condition. Mean surgical case duration was 43.25±4.01 min. These results indicate that there was no significant association between CMS scores and surgical case duration. Mean time to union in our patients was 4.46±0.96 months. CONCLUSION: We were able to observe optimal results in our patients by using closed reduction and suture anchors without opening the fracture site, thus allowing physiological processes in union without complications of complete union, while also preventing additional costs such as removing the device.

Open reduction and posterior instrumentation of type 3 high transverse sacral fracture-dislocation: technical note.

The authors describe an open reduction and fixation through a posterior approach of Roy-Camille Type 3 transverse sacral fractures. This technique involves posterior staged reduction of the fracture applying distraction forces to restore the height, followed by posterior translation to restore sagittal alignment. Tips and pearls of this procedure, described for the first time in the literature, are also discussed in this report.

The effect of continuous ultrasound on chronic non-specific low back pain: a single blind placebo-controlled randomized trial.

BACKGROUND: Non-specific chronic low back pain (NSCLBP) is one of the most common musculoskeletal disorders around the world including Iran. One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound (US). Despite its common use, there is still inconclusive evidence to support its effectiveness in patients with NSCLBP. The objective of this study was to evaluate the effect of continuous US compared with placebo US additional to exercise therapy for patients with NSCLBP. METHODS: In this single blind placebo controlled study, 50 patients with NSCLBP were randomized into two treatment groups: 1) continuous US (1 MHz &1.5 W/cm2) plus exercise 2) placebo US plus exercise. Patients received treatments for 4 weeks, 10 treatment sessions, 3 times per week, every other day. Treatment effects were assessed in terms of primary outcome measures: 1) functional disability, measured by Functional Rating Index, and 2) global pain, measured by a visual analog scale. Secondary outcome measures were lumbar flexion and extension range of motion (ROM), endurance time and rate of decline in median frequency of electromyography spectrum during a Biering Sorensen test. All outcome variables were measured before, after treatment, and after one-month follow-up. An intention to treat analysis was performed. Main effects of Time and Group as well as their interaction effect on outcome measures were investigated using repeated measure ANOVA. RESULTS: Analysis showed that both groups had improved regarding function (FRI) and global pain (VAS) (P < .001). Lumbar ROM as well as holding time during the Sorensen test and median frequency slope of all measured paravertebral muscles did not change significantly in either group (P > .05). Improvement in function and lumbar ROM as well as endurance time were significantly greater in the group receiving continuous US (P < .05). CONCLUSIONS: The study showed that adding continuous US to a semi supervised exercise program significantly improved function, lumbar ROM and endurance time. Further studies including a third group of only exercise and no US can establish the possible effects of placebo US. TRIAL REGISTRATION: NTR2251.