Preterm infant gut colonization in the neonatal ICU and complete restoration 2 years later

Preterm infants in a neonatal intensive care unit (NICU) are exposed to multidrug-resistant bacteria previously adapted to the hospital environment. The aim of the present study was to characterize the bacterial antibiotic-resistant high-risk lineages colonizing preterm infants during their NICU stay and their persistence in faeces after 2 years. A total of 26 preterm neonates were recruited between October 2009 and June 2010 and provided 144 faecal samples. Milk samples (86 mother's milk, 35 human donor milk and 15 formula milk) were collected at the same time as faecal samples. An additional faecal sample was recovered in 16 infants at the age of 2 years. Samples were plated onto different selective media, and one colony per morphology was selected. Isolates were identified by 16S rDNA nucleotide sequence and MALDI-TOF. Antibiotic susceptibility (agar dilution), genetic diversity (RAPD, PFGE and MLST) and virulence factors (only in enterococcal and staphylococcal isolates) were determined by PCR. A high proportion of antibiotic-resistant high-risk clones was detected in both faecal and milk samples during the NICU admittance. Almost all infants were colonized by Enterococcus faecalis ST64 and Enterococcus faecium ST18 clones, while a wider genetic diversity was observed for the Gram-negative isolates. Multidrug-resistant high-risk clones were not recovered from the faecal samples of the 2-year-olds. In conclusion, the gut of preterm infants admitted to the NICU might be initially colonized by antibiotic-resistant and virulent high-risk lineages, which are later replaced by antibiotic-susceptible community ones.

[Probiotics: from the lab to the consumer]

INTRODUCTION

In the last years, the field of probiotics has grown notably. However, out of the thousands of strains isolated each year in the labs around the world, very few enter in a phase of industrial development and even a lower number go to the market.

OBJECTIVE

In this article, the main aspects that have to be taken into account in the, usually, long and winding road that a strain must follow from isolation to the market are reviewed Results and conclusions: A probiotic microorganism has to be correctly identified at the species and strain levels. The genome sequence is the gold identification standard and provides valuable information on the safety, functionality and technological properties of a strain. The cases in which a link between a probiotic and an adverse effect has been established are scarce and have involved people with underlying pathologies. There is a wide variety of in vitro, ex vivo and animal model assays for the screening of probiotics, which provide useful information throughout the selection process; however, correctly designed clinical trials are the only way to obtain direct results on the safety and efficacy of a probiotic to the target population. Probiotic companies have the need to obtain a very high bacterial biomass in an economically viable manner while preserving the concentration of live bacteria required for exerting the expected beneficial effect until the end of the probiotic's shelf life. Finally, commercial aspects play a key role in the decision of starting an industrial development and, eventually, to place a probiotic in the market.

Probiotics for human lactational mastitis

The use of culture-dependent and -independent techniques to study the human milk microbiota and microbiome has revealed a complex ecosystem with a much greater diversity than previously anticipated. The potential role of the milk microbiome appears to have implications not only for short- and long-term infant health but also for mammary health. In fact, mammary disbiosis, which may be triggered by a variety of host, microbial and medical factors, often leads to acute, subacute or subclinical mastitis, a condition that represents the first medical cause for undesired weaning. Multiresistance to antibiotics, together with formation of biofilms and mechanisms for evasion of the host immune response, is a common feature among the bacterial agents involved. This explains why this condition uses to be elusive to antibiotic therapy and why the development of new strategies for mastitis management based on probiotics is particularly appealing. In fact, selected lactobacilli strains isolated from breast milk have already shown a high efficacy for treatment.

Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa

BACKGROUND

Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons.

METHODS

Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed.

RESULTS

Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected.

CONCLUSIONS

Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.

Are prognostic scoring systems of value in patients with follicular thyroid carcinoma?

PURPOSE

Most prognostic systems for differentiated carcinoma have been designed for papillary carcinoma.

OBJECTIVE

To analyze the value of the existing prognostic systems for evaluating follicular carcinoma and to determine whether any of them have a better predictive effect.

METHODS

A total of 66 follicular carcinomas were analyzed. The following prognostic systems were studied: EORTC, AGES, AMES, MACIS, TNM, and NTCTCS.

RESULTS

The AGES and AMES systems did not demonstrate a good prognostic correlation. In the EORTC system, the rate of disease-free patients was 89% in group 1, 75% in group 2, 69% in group 3, and 0% in group 4. The MACIS system showed 83, 60, 67, and 0% of disease-free patients respectively. The TNM system showed 81, 71, 50, and 0% of disease-free patients respectively. Finally, the NTCTCS system demonstrated 100, 84, 53, and 0% of disease-free patients respectively. Cox's regression analysis was used to calculate the proportion of variation in survival time explained (PVE). The prognostic classification system with the greatest survival prediction was EORTC at 67.64% of PVE, followed by TNM at 62.5% of PVE, and MACIS at 57.82% of PVE.

CONCLUSIONS

MACIS and TNM are good prognostic systems for evaluating follicular thyroid carcinoma, although the one with the most prognostic value was the EORTC system.

The microbiota of human milk in healthy women

Recent work has shown that human colostrum and milk, which had been traditionally considered sterile, provides a continuous supply of commensal and potential probiotic bacteria to the infant gut. More than 200 different bacterial species, including staphylococci, lactic acid bacteria and bifidobacteria, have been isolated from human milk samples so far, although the cultivable bacterial diversity found in individual samples is much lower (2 to 8 different species per women). Interestingly, the same bacterial strains have been found in both breast milk and infant feces of different mother-infant pairs, confirming the role of human milk on the bacterial colonization of the infant gut. These commensal bacteria could protect the infant gut and direct, at least partly, the maturation of the immune system, among other functions. Different studies suggest that some bacteria present in the maternal gut could reach the mammary gland during late pregnancy and lactation through a mechanism involving gut dendritic cells and macrophages. Thus, modulation of maternal gut microbiota during pregnancy and lactation could have a direct effect on infant health.

Do hernia operations in african international cooperation programmes provide good quality?

BACKGROUND

Hernia is especially prevalent in developing countries where the population is obliged to undertake strenuous work in order to survive, and International Cooperation Programmes are helping to solve this problem. However, the quality of surgical interventions is unknown. The objective of the present study was to evaluate the quality of hernia repair processes carried out by the Surgical Solidarity Charity in Central African States.

MATERIALS AND METHODS

A total of 524 cases of inguinal hernia repair carried out in Cameroon and Mali during 2005 to 2009 were compared with 386 cases treated in a Multicentre Spanish Study (2003). General data (clinical, demographic, etc.), type of surgery, complications, and effectiveness and efficiency indicators were collected.

RESULTS

Preoperative studies in the Spanish group were greater in number than in the African group. The use of local anesthesia was similar. Antibiotic prophylaxis was higher in the African group (100% to 75.4%). The use of mesh was similar. The incidence of hematomas was higher in the Spanish group (11.61% to 4.61%), but the incidence of infection of the wound and of hernia recurrence was similar, although follow-up was only carried out in 20.97% in the African group (70% in the Spanish group). Hospital stay of more than 24 h was higher in the Spanish group.

CONCLUSIONS

The standard quality of surgery for the treatment of hernia in developing countries with few instrumental means, and in sub-optimal surgical conditions is similar to that provided in Spain.

New cases of accessory and cavitated uterine masses (ACUM): a significant cause of severe dysmenorrhea and recurrent pelvic pain in young women

BACKGROUND

To raise awareness about the accessory and cavitated uterine masses (ACUM) with functional endometrium as a different entity from adult adenomyosis and to highlight the importance of a correct diagnosis, we studied four new cases of ACUM and 15 cases reported as juvenile cystic adenomyoma (JCA) by reviewing the literature from the last year. This entity is problematic because of a broad differential diagnosis, including rudimentary and cavitated uterine horns; and is generally underdiagnosed, being more frequent than previously thought.

METHODS

We report four cases of young women who underwent surgery in our hospital from January to July 2011 after presenting with an ACUM. We also reviewed and tabulated the cases from literature beginning in 2010. Main outcome measures were diagnostic tools, surgical and histopathological findings and improvement of symptoms.

RESULTS

The addition of the four cases reported here to the 15 published as JCA raises the total number of cases of ACUMs to 19, which is more than all of the cases reported prior to 2010. In our cases, it is interesting to highlight that one of them also had an adjacent accessory rudimentary tube and another had two ACUMs at the same location. All patients suffered from severe dysmenorrhea and pelvic pain and were young women. Suspicion, transvaginal ultrasound and magnetic resonance image were found to be the best diagnostic tools. Most of the cases were treated by laparoscopic tumorectomy.

CONCLUSIONS

ACUMs are generally underdiagnosed and often reported as JCAs but they are not adenomyosis. Early surgical treatment involving the laparoscopic or laparotomic removal of the mass could prevent the usual prolonged suffering of these young women. In our opinion, this entity is a new variety of Müllerian anomaly.

Fungal microbiota from rain water and pathogenicity of Fusarium species isolated from atmospheric dust and rainfall dust

In order to determine the presence of Fusarium spp. in atmospheric dust and rainfall dust, samples were collected during September 2007, and July, August, and October 2008. The results reveal the prevalence of airborne Fusarium species coming from the atmosphere of the South East coast of Spain. Five different Fusarium species were isolated from the settling dust: Fusarium oxysporum, F. solani, F. equiseti, F. dimerum, and F. proliferatum. Moreover, rainwater samples were obtained during significant rainfall events in January and February 2009. Using the dilution-plate method, 12 fungal genera were identified from these rainwater samples. Specific analyses of the rainwater revealed the presence of three species of Fusarium: F. oxysporum, F. proliferatum and F. equiseti. A total of 57 isolates of Fusarium spp. obtained from both rainwater and atmospheric rainfall dust sampling were inoculated onto melon (Cucumis melo L.) cv. Piñonet and tomato (Lycopersicon esculentum Mill.) cv. San Pedro. These species were chosen because they are the main herbaceous crops in Almeria province. The results presented in this work indicate strongly that spores or propagules of Fusarium are able to cross the continental barrier carried by winds from the Sahara (Africa) to crop or coastal lands in Europe. Results show differences in the pathogenicity of the isolates tested. Both hosts showed root rot when inoculated with different species of Fusarium, although fresh weight measurements did not bring any information about the pathogenicity. The findings presented above are strong indications that long-distance transmission of Fusarium propagules may occur. Diseases caused by species of Fusarium are common in these areas. They were in the past, and are still today, a problem for greenhouses crops in Almería, and many species have been listed as pathogens on agricultural crops in this region. Saharan air masses dominate the Mediterranean regions. The evidence of long distance dispersal of Fusarium spp. by atmospheric dust and rainwater together with their proved pathogenicity must be taken into account in epidemiological studies.

Oligodeoxynucleotide IMT504 induces a marked recovery in a streptozotocin-induced model of diabetes in rats: correlation with an early increase in the expression of nestin and neurogenin 3 progenitor cell markers

AIMS/HYPOTHESIS

IMT504 is an oligonucleotide that promotes tissue repair in bone injury and neuropathic pain models by stimulating progenitor cells. Here we evaluated the effect of IMT504 on the recovery of islet function in a streptozotocin (STZ)-induced model of diabetes in the rat.

METHODS

Male Sprague-Dawley rats were injected with STZ (60 mg/kg, i.p., day 1) or citrate buffer (Control). Animals with glycaemia between 11 and 20 mmol/l on day 4 were injected with IMT504 (4 mg/animal in saline, s.c., STZ-IMT504) or with saline (STZ-Saline) for 10 days. Glycaemia and water and food intake were recorded for 33 days. Intraperitoneal glucose tolerance tests (IPGTTs) were performed on day 30. On day 35, overnight-fasted animals were killed and blood samples and pancreases collected for hormonal and histological studies. A second group of STZ-IMT504 rats was killed, together with Control and STZ-Saline rats, after two consecutive days of blood glucose decreases after the beginning of IMT504 treatment. Pancreases were collected and proliferating cell nuclear antigen (PCNA), nestin and neurogenin 3 (NGN3) detected by immunohistochemistry.

RESULTS

IMT504 greatly improved blood glucose and food and water intakes in STZ-IMT504 rats by day 8, as well as IPGTTs on day 30. Significant increases in islet number and beta cell content were observed in STZ-IMT504 rats (day 33). Furthermore, after two to five IMT504 injections, blood glucose decreased, and an increase in pancreatic nestin (mainly in endothelial cells), PCNA and NGN3 production (in islets) was observed in STZ-IMT504 rats.

CONCLUSIONS/INTERPRETATION

IMT504 induced a marked recovery of STZ-induced diabetes that correlated with early production of progenitor cell markers, such as nestin and NGN3.

Intranuclear detection of African swine fever virus DNA in several cell types from formalin-fixed and paraffin-embedded tissues using a new in situ hybridisation protocol

In this study, a new in situ hybridisation (ISH) protocol has been developed to identify African swine fever virus (ASFV) genome in formalin-fixed, paraffin-embedded tissues. Different digoxigenin labelled ASFV-probes were tested, including single ASFV-specific oligonucleotides, an 18.5kb restriction fragment from the viral genome and the entire ASFV genome. The latter showed the highest sensitivity in all tissues tested, independently of the virus used for challenge: E75L or Ba71L. Although a similar ASFV genome distribution was observed, the number of ISH-positive cells was higher for Ba71L compared to E75L infected tissues. As expected, the monocyte-macrophage cell lineage was the main target cell for ASFV infection. Corresponding with the last stages of infection, ISH-positive signals were also found in other cell types, including endothelial cells, hepatocytes and neutrophils. Furthermore, two unexpected findings were also noticed: the detection of a specific ISH-signal in lymphocytes and a tendency to find the signal in the nucleus of infected cells. In summary, the present findings demonstrate the utility of this new ISH protocol to study ASFV pathogenesis and its potential use as a diagnostic tool.

Assessment of the bacterial diversity of breast milk of healthy women by quantitative real-time PCR

AIMS

Breast milk has been described as a source of bacteria influencing the development of the infant gut microbiota. Up to the present, few studies have been focused on the application of culture-independent techniques to study bacterial diversity in breast milk. In this context, the aim of this study was to characterize the breast milk microbiota of healthy women by applying the quantitative real-time PCR technique (qRTi-PCR).

METHODS AND RESULTS

A total of 50 breast milk samples were analysed by qPCR to assess the presence of different bacterial genera or clusters, including the Bifidobacterium, Lactobacillus, Staphylococcus, Bacteroides, Enterococcus, Streptococcus, Clostridium cluster IV and Clostridium cluster XIVa-XIVb groups. Staphylococcus, Streptococcus, Bifidobacterium and Lactobacillus were the predominant groups and were detected in all the samples. Clostridium XIVa-XIVb and Enterococcus were detected in most of the samples in contrast to the Bacteroides and Clostridium cluster IV groups.

CONCLUSIONS

Our results confirm the abundance of bacterial DNA in breast milk samples and suggest that the qRTi-PCR technique has a huge potential in the microbiological analysis of human milk.

SIGNIFICANCE AND IMPACT OF THE STUDY

qRTi-PCR allowed the detection of bacterial DNA of streptococci, staphylococci, lactic acid bacteria and bifidobacteria in the samples of human milk, which confirms that breast milk can be an important source of bacteria and bacterial DNA to the infant gut.

Diversity of the Lactobacillus group in breast milk and vagina of healthy women and potential role in the colonization of the infant gut

AIMS

To evaluate the diversity of the Lactobacillus group in breast milk and the vagina of healthy women and understand their potential role in the infant gut colonization using the 16S rRNA gene approaches.

METHODS AND RESULTS

Samples of breast milk, vaginal swabs and infant faeces were aseptically collected from five mothers whose neonates were born by vaginal delivery and another five that had their babies by caesarean section. After polymerase chain reaction (PCR) amplification using Lactobacillus group-specific primers, amplicons were analysed by denaturing gradient gel electrophoresis (DGGE). Clone libraries were constructed to describe the Lactobacillus group diversity. DGGE fingerprints were not related to the delivery method. None of the species detected in vaginal samples were found in breast milk-derived libraries and only few were detected in infant faeces.

CONCLUSIONS

The bacterial composition of breast milk and infant faeces is not related to the delivery method.

SIGNIFICANCE AND IMPACT OF THE STUDY

It has been suggested that neonates acquire lactobacilli by oral contamination with vaginal strains during delivery; subsequently, newborns would transmit such bacteria to the breast during breastfeeding. However, our findings confirm, at the molecular level that in contrast to the maternal vagina, breast milk seems to constitute a good source of lactobacilli to the infant gut.

A food-grade system for production of pediocin PA-1 in nisin-producing and non-nisin-producing Lactococcus lactis strains: application to inhibit Listeria growth in a cheese model system

Food-grade heterologous production of pediocin PA-1 in nisin-producing and non-nisin-producing Lactococcus lactis strains, previously selected because of their technological properties for cheese making, was achieved. Plasmid pGA1, which contains the complete pediocin operon under the control of the strong P32 promoter and is devoid of any antibiotic marker, was introduced into L. lactis ESI 153 and L. lactis ESI 515 (Nis+). Transformation of L. lactis ESI 515 with pGA1 did not affect its ability to produce nisin. The antimicrobial activity of the pediocin-producing transformants on the survival of Listeria innocua SA1 during cheese ripening was also investigated. Cheeses were manufactured from milk inoculated with 1% of the lactic culture and with or without approximately 4 log CFU/ml of the Listeria strain. L. lactis ESI 153, L. lactis ESI 515, and their transformants (L. lactis GA1 and GA2, respectively) were used as starter cultures. At the end of the ripening period, counts of L. innocua in cheeses made with the bacteriocin-producing lactococcal strains were below 50 CFU/g in the L. lactis GA1 cheeses and below 25 CFU/g in the L. lactis GA2 ones, compared with 3.7 million CFU/g for the controls without nisin or pediocin production.

Two Lactobacillus strains, isolated from breast milk, differently modulate the immune response

AIMS

The ability of two different Lactobacillus strains (Lactobacillus salivarius CECT5713 and Lactobacillus fermentum CECT5716), isolated from human breast milk, to modulate the immune response was examined.

METHODS AND RESULTS

In rodent bone-marrow-derived macrophages (BMDM), the presence of Lact. fermentum CECT5716 induced pro-inflammatory cytokines, in contrast to the activation of IL-10 induced by Lact. salivarius CECT5713. Although both strains reduced the lipopolysaccharide (LPS)-induced inflammatory response in BMDM, the effect of Lact. salivarius CECT5713 was more efficient, probably because of the production of higher amounts of IL-10 cytokine. In vivo assays in mice showed similar results; the consumption of Lact. fermentum CECT5716 enhanced the production of Th1 cytokines by spleen cells and increased the IgA concentration in faeces. However, the consumption of Lact. salivarius CECT5713 induced IL-10 production by spleen cells.

CONCLUSION

Therefore, in general, the effect of Lact. fermentum CECT5716 is immunostimulatory in contrast to the anti-inflammatory effect of Lact. salivarius CECT5713.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results of this study show that two Lactobacillus strains isolated from breast milk can exert different and even opposing effects on immune response demonstrating the specificity of each strain.

Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant program

In Spain, despite its high rate of cadaveric donation, death while on the liver transplant waiting list is high. For this reason, living liver donation is being encouraged despite of the risk of morbidity for the donor. The objective of this study was to analyze attitudes toward living liver donation among hospital personnel in a hospital with a recently authorized living donor liver transplantation program. A random sample was taken and was stratified by type of service and job category (n = 1,262). Attitude was evaluated by means of a validated psychosocial questionnaire. The questionnaire was completed anonymously and was self-administered. Statistical analysis included the Student t test, the chi(2) test, and logistical regression analysis. The questionnaire completion rate was 93% (n = 1,168). Only 15% (n = 170) of respondents were in favor of living liver donation if it were unrelated. An additional 65% (n = 766) were in favor if this donation, but only for relatives. Of the rest, 9% (n = 107) did not agree with living liver donation, and the remaining 11% (n = 125) were undecided. The variables related to this attitude were age (P = 0.044); job category (P = 0.002); type of service (according to whether it is related to organ donation and transplantation) (P = 0.044); participation in prosocial activities (P = 0.026); attitude toward cadaveric organ donation (P <0.001); attitude of a respondent's partner toward organ donation (P = 0.010); a respondent's belief that in the future, he or she may need a transplant (P < 0.001); and a willingness to receive a donated living liver organ if one were needed (P < 0.001). There is also a close relationship between attitude toward living kidney donation and living liver donation (P < 0.001). In the multivariate analysis, the only common independent variable from the bivariate analysis was a willingness to receive a living donor liver transplant if one were needed (odds ratio = 9.3). Attitude toward living liver donation among hospital personnel in a hospital with a solid organ transplant program is favorable and is affected by factors related to cadaveric donation, altruistic activity, and feelings of reciprocity. Physicians and the youngest hospital workers are those who are most in favor, which leads us to think that there is a promising future for living liver transplantation, which is essential given the cadaveric organ deficit and the high mortality rate while on the waiting list.

Safety assessment of two probiotic strains, Lactobacillus coryniformis CECT5711 and Lactobacillus gasseri CECT5714

AIMS

The object of the present study was to evaluate the oral toxicity of the recently isolated probiotic bacteria Lactobacillus coryniformis CECT5711 and Lactobacillus gasseri CECT5714.

METHODS AND RESULTS

Enzymatic activity and antibiotic resistance profile were evaluated in vitro. Then, the oral toxicity was analysed by an in vivo experiment using 20 Balb/C mice, which were orally treated with CECT5711 or CECT5714 (10(10) CFU mouse(-1) day(-1)) during 30 days. Results showed that CECT5711 and CECT5714 have no deleterious enzymatic activities and present intrinsic antibiotic resistance profile. Administration of both strains to mice had no adverse effects on body weight or food intake. No bacteraemia was present in liver or spleen and there was no treatment-associated bacterial translocation to these tissues. Liver glutathione content as well as plasma malondialdehide concentration were not statistically different in probiotic-treated mice when compared with control mice. Probiotic treatment did not cause changes in the biochemical and haematological parameters analysed.

CONCLUSIONS

These results suggest that strains CECT5711 and CECT5714 are nonpathogenic and likely to be safe for human consumption.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study reveals the oral safety of two new lactobacilli strains that are aimed to be used as probiotics in food and pharmaceutical applications.

Estimation of strabismic amblyopia by small-sized concentric gratings in preverbal children

PURPOSE

Evaluate the ability to assess strabismic amblyopia of small-sized Concentric Gratings in comparison with classic linear gratings preferential looking test.

METHODS

Thirty-three preverbal children (age 6-30 months) with esotropia were tested for monocular visual acuity, using small-sized Concentric Gratings (target size 1.6, in 1/3 octave steps) and the Teller Acuity Cards. A fixation preference testing score was also obtained. In 17 of these children, 1-3 years later, after treatment of amblyopia and strabismus, fixation preference testing score, and visual acuity with Teller Acuity Cards, Concentric Gratings, and Glasgow Acuity Cards were measured. In 24 additional verbal untreated strabismic children (age 39-48 months), the same procedures were used. Correlations between interocular acuity difference of each preferential looking test and the Glasgow Acuity Cards were compared. Correlations between interocular acuity difference of each preferential looking procedure and fixation preference testing score were also compared.

RESULTS

Concentric Gratings procedure was correlated significantly better than Teller Acuity Cards with fixation preference testing score (0.7 and 0.49, respectively), in the preverbal group (P=0.04). In treated verbal children, correlation of Concentric Gratings and Glasgow Acuity Cards (0.90) was stronger (P=0.06) than correlation of Teller Acuity Cards and Glasgow Acuity Cards (0.64). In untreated verbal children, correlation of Concentric Gratings and Glasgow Acuity Cards (0.89) was stronger (P=0.045) than correlation of Teller Acuity Cards and Glasgow Acuity Cards (0.67).

CONCLUSIONS

The small-sized Concentric Gratings procedure improves detection and estimation of amblyopia depth in strabismus when compared with classic linear gratings.

Are personnel in transplant hospitals in favor of cadaveric organ donation? Multivariate attitudinal study in a hospital with a solid organ transplant program

INTRODUCTION

A considerable number of professionals who work in a hospital could be against organ donation, which means that when the time comes, they could act as an obstacle to donation. The objective of this study was to analyze the attitude of hospital professionals toward organ donation and to determine the factors that influence this attitude in a Spanish center with a transplant program.

MATERIALS AND METHODS

The study was carried out in a third-level Spanish hospital with a solid organ transplant program. A random sample was taken (n = 1262) and stratified by job category and type of service. Attitude was evaluated using a validated questionnaire. Contact was made in each service with the person responsible for each of the job categories in order to distribute the survey. The survey was completed anonymously and was self-administered. Student's t-test, the chi-squared test, and logistic regression analysis were applied in the statistical analysis.

RESULTS

The survey completion rate was 93% (n = 1168). Most respondents were in favor of donation [69% (n = 808)]. Of those who are not in favor, 29% (n = 105) provide fear of apparent death as the reason whilst most do not give a reason (negative assertion; 57%; n = 206). There are many factors related to this attitude toward donation, which are evident in the multivariate analysis: (i) job category, in which physicians are twice as likely to be in favor of donation than ancillary personnel (OR = 2.02); (ii) a respondent's knowledge of brain death (OR = 1.64); (iii) having discussed the matter of organ donation and transplantation within the family (OR = 1.89); (iv) a preference for other options apart from burial (OR = 3.66); (v) being in favor of the performance of autopsy if it were necessary (OR = 2.76); (vi) not being concerned about mutilation of the cadaver (OR = 2); and (vii) having a partner with a favorable attitude toward donation (OR = 2.2).

CONCLUSIONS

Attitude toward cadaveric organ donation among personnel in a transplant hospital is similar to that described in the general public and is determined by many factors. The following factors are most noteworthy: (i) job category; (ii) knowledge of the concept of brain death; (iii) consideration of the matter of donation in the family; and (iv) fear of manipulation of the cadaver. In view of this attitude, which is similar to that of the general public, it is necessary to carry out promotion activities if we want to increase cadaveric donation rates.

A pharmacokinetic study investigating the rate of absorption of a 500 mg dose of a rapidly absorbed paracetamol tablet and a standard paracetamol tablet

OBJECTIVE

A rapidly absorbed tablet formulation of paracetamol containing sodium bicarbonate (PS) has been previously shown to be absorbed at least twice as fast as a standard paracetamol tablet (P) at a 1 g dose. In South America and Asia it is customary for patients to take a 500 mg dose of analgesic. The objective of this pharmacokinetic study was to compare the rate of absorption of PS versus P at a 500 mg dose.

RESEARCH DESIGN AND METHODS

An open, randomized, single dose, cross-over study. Thirty Hispanic healthy volunteers randomly received a 500 mg dose taken orally with 50 mL of water 2 h after a standard breakfast. Blood samples were taken up to 10 h post-dose. Plasma concentrations of paracetamol were determined by HPLC with UV detection.

MAIN OUTCOME MEASURES

AUC(0-30 min), C(plasma 30 min) and T(max) were analyzed non-parametrically by the Wilcoxon's rank sum test. A linear mixed effects model was used to analyze the logarithmically transformed AUC(0-alpha) and C(max). Bioequivalence was accepted if the 90% confidence intervals (CI) for the ratio of the means of the primary pharmacokinetic variable AUC(0-alpha) lay completely within the range 0.80-1.25.

RESULTS

AUC(0-30 min) and C(plasma 30 min) were significantly greater and T(max) was significantly shorter (all p < 0.0001) for PS versus P. The formulations were bioequivalent for AUC(0-alpha) (90% CI 0.99:1.05) and no statistical difference was seen for C(max) (95% CI 0.91:1.14).

CONCLUSIONS

Paracetamol was absorbed at least twice as fast from PS compared to P at a 500 mg dose. The extent of absorption was equivalent for both formulations.

Antimicrobial potential of four Lactobacillus strains isolated from breast milk

AIMS

The antimicrobial potential of four lactobacilli (Lactobacillus salivarius CECT5713, Lactobacillus gasseri CECT5714, L. gasseri CECT5715 and Lactobacillus fermentum CECT5716), isolated from fresh human breast milk, was evaluated in this study and compared with Lactobacillus coryniformis CECT5711, a reuterin-producing strain isolated from an artisan goat's cheese.

METHODS AND RESULTS

Agar diffusion tests, competitive adhesion assays and mucin expression assays were carried out in order to value the antibacterial properties of the lactobacilli strains. The antibacterial capability of the strains was tested in vivo by using a murine infection model with Salmonella choleraesuis. The results revealed that all the strains studied, displayed antibacterial properties against pathogenic bacteria. However, the antibacterial potential varied among the lactobacilli tested and, in fact, L. salivarius CECT5713 showed not only the best in vitro antibacterial activity, but also the highest protective effect against a Salmonella strain in the murine infection model.

CONCLUSION

The four breast-milk lactobacilli, and particularly L. salivarius CECT5713, possess potent antibacterial activities that result in a higher protection against S. choleraesuis CECT4155 in a mouse infection model.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results suggest that lactobacilli from breast milk could contribute to an anti-infective protection in neonates and would be excellent candidates for the development of infant probiotic products.