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34-year-old man with chronic renal and pancreas failure in complicated diabetic disease received a kidney-pancreas transplantation. On the 32nd postoperative day, an acute kidney rejection occurred and resolved with OKT3 therapy. The patient also presented refractory urinary infection by E. Fecalis and M. Morganii, and a focal bronchopneumonia in the right-basal lobe resolved with elective chemotherapy. During the 50th post-operative day, an intense soft tissue inflammation localized in the first left metatarsal-phalangeal articulation occurred (Figure 1) followed by an abscess with a cutaneous fistula and extension to the almost totality of foot area. The radiological exam revealed a small osteo-lacunar image localized in the proximal phalanx head of the first finger foot. From the cultural examination of the purulent material, N. Asteroides was identified. An amoxicillin-based treatment was started and continued for three months, with the complete resolution of infection This case is reported for its rarity in our casuistry, and for its difficult differential diagnosis with other potentially serious infections.

Lead tin telluride solid solutions are excellent candidates for the p-type conduction legs of the thermoelectric generator modules. The investigation of their microstructure properties is an important issue, that can effectively modify their electronic and thermal transport properties. In this work, we show the experimental dependences of the Pb1-xSnxTe component distribution, which were identified as periodic nanostructures with an amplitude of λ ≈ 50-500 nm. The observed periodicity is explained by the generation and recombination of point defects due to diffusion processes during the synthesis, sintering, and annealing of samples. A model describing the formation of such inhomogeneities in Pb1-xSnxTe ternary alloys during isothermal annealing is proposed.

Introduction: Prothrombotic is considered a condition that leads to the development of venous or arterial thrombosis and its consequences. There are many factors that cause a violation of the hemostatic potential in patients undergoing surgery with existing risk factors for thromboembolism, a more detailed study of the blood coagulation system, including the study of the compensatory capabilities of the hemocoagulation system, should be conducted. One of these methods is a functional test with double local hypoxia of the upper limb (DLHUL) under the control of thromboelastography (TEG). Goals: The purpose of the study - to identify the degree of thrombotic risk in patients preparing for planned surgical intervention, who belong to the risk group of thrombotic complications, to compare and evaluate the state of the hemostasis system in healthy volunteers and in this cohort of patients using a functional test with double local hypoxia of the upper limb by the method of thromboelastography. Materials and methods: A randomized prospective study was conducted. Patients were divided into two groups depending on the presence of risk factors for thrombosis. Group 1 consisted of healthy volunteers (n = 40) who are not at risk of thrombosis. Group 2 includes patients with existing factors of thrombotic risk (n = 120) who are preparing for scheduled surgical interventions. These patients underwent a functional test of "double local hypoxia of the upper limb" (DLHUL) using thromboelastographic (TEG) methods of studying the hemocoagulation system. The main task of this functional test is to create a trigger component to determine the limits of hemostasis, the origin and duration of adaptive and compensatory reactions of the hemostasis system. Indicators of the hemostasis system are recorded using a thromboelastograph before and after the test. The links of hemostasis are reflected by the following indicators: aggregate state of blood (A0), contact coagulation intensity (CCI), coagulation drive intensity (ICD), maximum clot density - maximum activity (MA), fibrinolytic activity - clot retraction and lysis index (IRCL). The results. Analyzing the data of thromboelastography after performing DLHUL, among the patients of Group 1, two types of reaction of the hemostasis system were found in patients without predictors of thrombotic risk: compensated (n= 20) (characterized by a decrease in the indicators of the vascular-platelet component; subcompensated (n = 20) (characterized by an increase in the indicators of the vascular -platelet component). In subjects of Group 1, TEG indicators indicate an increase in the external mechanism of prothrombinase formation, and the reaction of the procoagulant link of the blood coagulation system in response to the influence of a trigger indicates a change in the directionality of the hemostatic potential towards hypercoagulation. In subjects of group 1 with a compensated type, there is an increase in the components of fibrinolysis and a deviation of the hemostatic potential towards hypocoagulation is observed. The state of the hemostasis system in patients of Group 2 is characterized by pronounced changes in the hemostatic potential in all links. In the vascular-platelet link, a violation of platelet aggregation was noted, with an increase in indicators in response to a stimulus. When conducting the DLHUL test in the subjects of group 2, a decompensated (n = 98) and exhausted (n = 22) type of reaction to the test with local hypoxia of the upper limb was determined. That is, with increased platelet aggregation, hypercoagulation, inhibition of the anticoagulant system and fibrinolysis before the action of the trigger factor, after performing the DLHUL test, these disorders in the hemostasis system progress towards hypercoagulation, which is indicated by the increase in platelet aggregation, the strengthening of the coagulation link of the hemostatic system, the depression of fibrinolysis increases . However, the intensity of these changes is not as high as in patients of group 1 after the DLHUL test. Conclusions: The test with double local hypoxia of the upper limb is effective as a trigger factor to determine the compensatory capabilities of the HS. Depending on the type of reaction of the platelet-vascular, coagulation components of hemostasis and fibrinolysis to the influence of the trigger, two types of reaction of the blood aggregate state regulation system are possible in people who do not have an anamnesis of factors provoking a hypercoagulable state: compensated and subcompensated. Therefore, when planning surgical intervention in this cohort of patients, the risk of thrombotic complications is low. Depending on the type of reaction of the platelet-vascular, coagulation components of hemostasis and fibrinolysis to the influence of the trigger, two types of reaction of the blood aggregate state regulation system are possible in people with an anamnesis of factors provoking a hypercoagulable state: decompensated (more often) and depleted (less often). Patients with a history of factors provoking a hypercoagulable state have a high risk of perioperative thrombotic complications and a possible risk of thrombo-hemorrhagic complications, including the syndrome of disseminated intravascular coagulation. Changes in all links of the hemostasis system in response to the DLHUL test indicate the need to use anticoagulant therapy in patients with an anamnesis of factors provoking a hypercoagulable state as one of the components of preoperative preparation.

The experience of operating switches shows that load-bearing elements fail for two main reasons: defects and wear. The percentage failure of elements due to one reason or another depends on the operating conditions in which they operate. In this case, the most worn elements of switches are pointers and point frogs and their service life is determined by the amount of tonnage passed through them before reaching the standard values of wear or the appearance defects. The article is devoted to the study of wear resistance of switches operated in various transport systems, namely, mainline transport and subways. The article considers the issues of predicting the standard service life cross elements of typical angles using operational studies for subway conditions and a new theoretical methodology based on the analysis of switches withdrawn from operation after they reach the standard wear values for mainline transport. For analytical calculations, the method of modeling the interaction process and graph-analytical methods were used. As a result of the study, the analytical equations predictive curves for the formation vertical wear as a function of the passed tonnage for the switches point frogs operated on lines of mainline railway transport and the Kyiv subway were established.

Recently, many studies are based on the study of innate immunity genes, namely the role of TLRs in the development of various diseases. Severe burn injury is characterized by the development of hyperimmune reactions, which further leads to the development of multiple organ complications and sepsis. The aim of our study was to identify the frequency and prognostic value of polymorphism of TLR-2 Arg753Gln and TLR-4 Thr399 Ile genes and their role in the development of sepsis and MOD in children with severe burns. Materials and methods: genetic analysis of TLR-2 Arg 753 Gln and TLR-4 Thr399 Ile gene polymorphisms was performed in children with severe and extremely severe burns (n ​​= 22) who were treated in the anesthesiology department with intensive care beds. Results: as a result of the obtained data, the heterozygous genotype TLR-2 Arg 753 Gln was detected in 69.5% (n = 16), in 31.8% (n = 7) patients with burn injury polymorphism was not detected. In 13.6% (n = 3) cases, polymorphism was associated with sepsis and MOD. Sepsis and normal homozygous genotype were diagnosed in 4.5% (n = 1). Heterozygous genotype TLR-4 Thr399 Ile was observed in 18.2% (n = 4) patients, of which only 4.5% (n = 1) patients had polymorphism associated with sepsis and MOD. Analysis of the association of TLR 2 genotypes and markers of acute inflammation revealed statistically significant differences between the heterozygous TLR 2 Arg 753 Gln genotype and C-reactive protein (CRP) levels in the blood of patients on day 3 of burn disease. Conclusions: The study of the role of innate immune system genes is promising in predicting the development of sepsis and complications in severe burns and requires further careful study.

Abstract   Cunninghamella bertholletiae infection occurs most frequently in neutropenic patients affected by haematological malignancies, is associated with an unfavourable outcome. We report a case of rhino-mastoidal fungal infection in a leukaemic patient. Bioptical tissue cultures yield the isolation of a mould with typical properties of Cunninghamella species. Liposomal amphotericin B (L-Amb) therapy combined with surgical intervention brought the lesion to recovery. Nevertheless, the patient died 14 days after bone marrow transplantation (BMT) from bacterial sepsis. Mastoiditis was documented at CT-scan. The conditioning regimen probably caused the reactivation of the Cunninghamella infection that led to the patient’s fatal outcome; fungal hyphae were detected after autopsy of brain and lung tissue. [ABSTRACT FROM AUTHOR]

We report the genome sequences of four Enterococcus faecium phages isolated from environmental wastewater in Kenya. They are double-stranded DNA phages with genomes varying in length from 42,231 to 43,348 bp, with G+C contents ranging from 34.96% to 35.2%. The genomes contain 78-82 coding sequences., Competing Interests: The authors declare no conflict of interest.

We report the genome sequences of 12 Enterococcus faecalis phages isolated in Kenya, belonging to the genus Copernicusvirus , Efquatrovirus , Saphexavirus , and Kochikohdavirus . They have double-stranded DNA with lengths varying from 17,979 to 147,374 bp and G+C content from 33.14% to 40.05%. The genomes contain 28-250 coding sequences., Competing Interests: The authors declare no conflict of interest.

Enterococcus faecalis ( E. faecalis ) is a growing cause of nosocomial and antibiotic-resistant infections. Treating drug-resistant E. faecalis requires novel approaches. The use of bacteriophages (phages) against multidrug-resistant (MDR) bacteria has recently garnered global attention. Biofilms play a vital role in E. faecalis pathogenesis as they enhance antibiotic resistance. Phages eliminate biofilms by producing lytic enzymes, including depolymerases. In this study, Enterococcus phage vB_Efs8_KEN04, isolated from a sewage treatment plant in Nairobi, Kenya, was tested against clinical strains of MDR E. faecalis . This phage had a broad host range against 100% (26/26) of MDR E. faecalis clinical isolates and cross-species activity against Enterococcus faecium . It was able to withstand acidic and alkaline conditions, from pH 3 to 11, as well as temperatures between -80 °C and 37 °C. It could inhibit and disrupt the biofilms of MDR E. faecalis . Its linear double-stranded DNA genome of 142,402 bp contains 238 coding sequences with a G + C content and coding gene density of 36.01% and 91.46%, respectively. Genomic analyses showed that phage vB_Efs8_KEN04 belongs to the genus Kochikohdavirus in the family Herelleviridae. It lacked antimicrobial resistance, virulence, and lysogeny genes, and its stability, broad host range, and cross-species lysis indicate strong potential for the treatment of Enterococcus infections.

Cunninghamella bertholletiae infection occurs most frequently in neutropenic patients affected by haematological malignancies, is associated with an unfavourable outcome. We report a case of rhino-mastoidal fungal infection in a leukaemic patient. Bioptical tissue cultures yield the isolation of a mould with typical properties of Cunninghamella species. Liposomal amphotericin B (L-Amb) therapy combined with surgical intervention brought the lesion to recovery. Nevertheless, the patient died 14 days after bone marrow transplantation (BMT) from bacterial sepsis. Mastoiditis was documented at CT-scan. The conditioning regimen probably caused the reactivation of the Cunninghamella infection that led to the patient's fatal outcome; fungal hyphae were detected after autopsy of brain and lung tissue.

We describe a case of primary cutaneous Absidia corymbifera infection in an AIDS patient with renal complications. The Sensititre YeastOne panel was adopted to determine antifungal susceptibility and liposomial amphotericin B was used which initially produced a significant clinical response.

In recent decades, Candida spp. emerged as the fourth most common cause of nosocomial bloodstream infections. The incidence of candidemia was 0.13 per 100 persons. Eighty-three cases (61%) of candidemia were due to Candida albicans and 53 (39%) to nonalbicans Candida spp. Twelve strains of Candida (9%) had shown in vitro resistance to fluconazole, 5 (4%) to itraconazole, 2 (1.5%) to voriconazole, 12 (9%) to 5-flucytosine, and 1 (0.7%) to amphotericin B. Multivariate logistic regression analysis of risk factors showed that length of hospitalization, presence of a central venous catheter, previous episodes of candidemia or bacteremia, parenteral nutrition, and chronic renal failure were variables independently associated with the development of candidemia. Multivariate logistic regression analysis of prognostic indicators showed that the independent variables associated with poor prognosis were inadequate initial therapy (P < .001) and high APACHE III score (P = .004). The inadequate initial therapy associated with mortality indicates the need for additional investigations to define high-risk patients for beneficial antifungal prophylaxis.

We determined the in vitro activity of fluconazole against 1565 clinical Candida spp. isolates collected from different specimens of non-AIDS outpatients and inpatients in 3 different regions of Italy. Susceptibility testing was performed by agar disk diffusion using the NCCLS document M44-A guidelines. Candida albicans was the most frequently isolated yeast (68%) followed by C. glabrata (15%), C. tropicalis (5%), C. parapsilosis (5%), and C. krusei (5%). Other yeasts represented 4% of all isolates. Of the 1565 isolates tested, 1449 (92.6%) were susceptible (S) to fluconazole, 43 (2.7%) were susceptible dose-dependent (S-DD) and 73 (4.7%) were resistant (R). Almost all (98.2%) of the C. albicans isolates were classified as S or S-DD. Despite its widespread use, fluconazole displayed good activity against the isolates we tested, and the disk diffusion method was confirmed as a reliable approach to the evaluation of in vitro susceptibility of yeasts to this antimycotic agent.

Expression of HLA and CD1b molecules was investigated in the THP-1 macrophage cell line within 2 weeks following phagocytosis of mycobacteria or Escherichia coli. During the first 2-3 days, cell surface expression of HLA class II and CD1b was drastically down-modulated, whereas HLA class I expression was up-modulated. In the following days both HLA class II and CD1b expression first returned to normal, then increased and finally returned to normal with kinetics similar to that observed for the steadily increased HLA class I. The initial down-modulation of HLA class II and CD1b cell surface antigens was absolutely dependent on phagocytosis of bacteria. Further studies indicated that initial HLA class II cell surface down-modulation (1) was not due to reduced transcription or biosynthesis of mature HLA class II heterodimers, (2) was only partially, if at all, rescued by treatment with IFN-gamma, although both mRNA and corresponding intracellular proteins increased up to sixfold with respect to untreated cells, and (3) resulted in failure of THP-1 cells to process and present mycobacterial antigens to HLA-DR-restricted antigen-specific T cell lines. The existence of a transient block of transport of mature HLA class II heterodimers to the cell surface in the first days after phagocytosis of bacteria may have negative and positive consequences: it decreases APC function early but it may increase it later by favoring optimal loading of bacterial antigens in cellular compartments at high concentration of antigen-presenting molecules.

The phosphatase activities of 114 micrococcal strains belonging to seven different species and of an additional 150 unspeciated micrococcal strains were evaluated on solid media at various pHs containing or not containing phosphates. In the presence of phosphates, only nine strains (five unspeciated strains, one Micrococcus luteus strain, and three Micrococcus varians strains) yielded a positive reaction on plates at pH 8. In media (at pH 8) deprived of phosphates, in contrast, all but 15 strains demonstrated clear-cut phosphatase activity. Acid phosphatase could not be evaluated on solid media since none of the strains grew satisfactorily on plates at pH 5. The phosphatase activities of seven (one or two for each species, which included phosphatase-negative strains) of the strains whose colonies proved phosphatase negative at pH 8 and of 18 (two or three strains per species) of those with phosphatase-positive colonies were evaluated at pH 5 and 8.5 in toluene-treated cells which had been grown in liquid media at pH 7 containing or not containing phosphates. All strains demonstrated distinct phosphatase activity at both pHs when grown in media not containing phosphates. In contrast, when strains were grown in the presence of such substances, virtually no activity was observed at pH 8.5, and, generally, a much reduced activity was observed at pH 5. The phosphatase activity of micrococci of the various species (three to eight strains per species) was also compared with that of staphylococci of different species (5 to 10 strains per species) by the methyl green-phenolphthalein diphosphate method, the sensitivity of which can be varied by using different enzyme substrates.(ABSTRACT TRUNCATED AT 250 WORDS)

The phosphatase activities of colonies of staphylococcal strains belonging to the 10 species most frequently isolated from specimens of human origin were evaluated on media with undetermined inorganic phosphate contents and on media supplemented with known amounts of phosphates. All strains of all species tested were phosphatase positive on plates that were not supplemented with inorganic phosphates when the pH of the medium was high. In media supplemented with 0.3% phosphates at low and high pH, all strains of Staphylococcus aureus, almost all strains of S. epidermidis and S. xylosus, and none of the other species tested were phosphatase positive. Thirty S. simulans strains were grown in broths at pH 7 with and without phosphates, and the phosphatase activities of the cells were assayed at pH 5.5 and 8 in the absence of phosphates. At pH 8, all strains gave a strong positive reaction when grown in the absence of phosphates and a negative reaction when grown in the presence of these salts at 0.3%. It was concluded that all the species of staphylococci tested possess phosphatase activity and that the staphylococcal phosphatases are constitutive in some species and repressed in others.

Urinary tract infections in 32 patients were treated with 250 mg of ciprofloxacin twice daily for seven to eight days. Clinical and laboratory examinations were performed before and after treatment. The infections were eradicated in 30 of the 32 patients. Ciprofloxacin was well tolerated by all patients.

A simplified system for routine identification of the six lyogroups of human staphylococci is described. The method is based on the determination of the lytic activity on five different test media and of the phosphatase activity of each isolate. A total of 689 staphylococci isolated from clinical material over a 6-month period were identified according to this simplified system. The same strains were identified in parallel using three other methods designed for routine identification of staphylococci: the Kloos and Schleifer abbreviated scheme (J Clin. Microbiol. 1:82-88, 1975) the scheme proposed by the Subcommittee on the Taxonomy of Staphylococci and Micrococci (Int. J. Syst. Bacteriol. 26:332-334, 1976), and the API STAPH micromethod. Isolated whose identification was in disagreement were identified on a taxonomic level according to the extensive classification scheme of Schleifer and Kloos. In addition, 42 reference staphylococci of known identity were reidentified using the simplified lyogroup system as well as the three other routine methods. The results of this comparative study was detailed and discussed. A primary advantage of the simplified lyogroup system is that it also provides separation of staphylococci from micrococci, which must be performed separately when the other methods are used. Other significant advantages concerned with reliability, speed, and practicality are shown.

A total of 842 staphylococci isolated from clinical material over an eight-month period and regarded as probable pathogens were identified according to lyogroup. Almost half the isolates belonged to lyogroups other than lyogroup I (Staphylococcus aureus), suggesting that coagulase-negative staphylococci are increasingly involved in human infections. All isolates were tested for sensitivity to 12 antibiotics. A greater resistance was observed in non-lyogroup I isolates, which again suggests a pathogenic significance of coagulase-negative staphylococci. Only lyogroup I strains, however, were obtained more frequently from clinical isolates than from healthy human skin. The distribution of the isolates in each lyogroup according to their clinical source is reported.

Thirty-six patients with severe aplastic anemia or acute leukemia undergoing bone marrow transplantation or intensive hematologic treatments were randomized to receive gentamicin (1 mg/kg/iv q8h) or tobramycin (1 mg/kg/iv q8h) in combination with carbenecillin (500 mg/kg/day i.v. in 4 doses) and cephalotin (200 mg/kg/day i.v. in 6 doses), at the onset of fever during granulocytopenia. Patients in the gentamicin group were treated for a total of 541 patient days (minimum 5, maximum 106), and patients in the tobramycin group for 426 patient days (minimum 9, maximum 48). All patients received oral decontamination, which included the amino glycoside (either gentamicin or tobramycin) given intravenously. This study showed that 1) no patient had an increase in creatinine level above 1.3 mg % and no patient developed renal failure, 2) there was no difference between gentamicin and tobramycin in the efficacy of treating febrile episodes and/or major infections, 3) prolonged intravenous administration (up to 48 consecutive days in the tobramycin group and 106 consecutive days in the gentamicin group) was well tolerated and effective in treating fever of unknown origin in granulocytopenic patients: 45 of 72 febrile episodes resolved while the patients had a granulocyte count below 500/mm3.

9 patients with severe aplastic anemia (SAA) were treated with bone marrow transplantation (BMT). 5 were conditioned with cyclophosphamide and received and HLA-identical graft (4 patients) or a mismatched graft (1 patient): 1 rejected the graft on day 30 and died on day 34 during conditioning for a second transplant; 1 died on day 15 with acute and severe graft versus host disease (GvHD) in the absence of haemopoietic engraftment; 3 are alive and complete chimeras at 1,069, 490 and 332 days after transplantation. GvHD developed in 4 patients and was treated successfully in 3 with high dose methylprednisolone and/or antilymphocytic globulin (ALG). 4 patients were conditioned with ALG and received bone marrow from a haploidentical sibling or parent: 1 patient was refractory; 3 patients showed evidence of hematologic reconstitution, but 2 of these required a second course of ALG. 3 patients in this group are alive between 60 and 490 days; 1 patient died on day 121 of HBSAg-negative acute hepatitis.

The purpose of this study was to determine whether lysostaphin would enhance its anti-staphylococcal efficacy in combination with lysozyme. Minimum inhibitory concentrations (MICs) of lysostaphin and lysozyme were separately determined for 41 strains belonging to 10 different species of human staphylococci. Lysozyme was virtually inactive and showed MICs of 15 mg/ml. On the contrary, all strains were susceptible to lysostaphin and showed MICs ranging from 2.5 to 60 micrograms/ml for the different Staphylococcus species. When the MIC of lysostaphin was determined in media containing submultiples of the MIC of lysozyme, the values obtained were much lower. The reduction of the lysostaphin MIC ranged from 16- to 200-fold in the different species tested. In Staphylococcus aureus, in particular, the combination of lysostaphin with 1.5 mg of lysozyme per ml reduced the MIC of lysostaphin by 25-fold. The activities of two combinations of the two enzymes were evaluated: one combination was expected to be active on S. aureus only, and the other combination was expected to inhibit all Staphylococcus strains. The first combination (0.5 micrograms of lysostaphin plus 0.5 mg of lysozyme per ml) was inhibitory to all of the 84 S. aureus strains tested, whereas 137 of 151 strains of other Staphylococcus species were unaffected. On the contrary, all of the 235 Staphylococcus strains tested were inhibited by the second combination (4 micrograms of lysostaphin plus 5 mg of lysozyme per ml). The possible mechanisms of lysostaphin potentiation by lysozyme are considered, and the potential use of a lysostaphin-lysozyme combination for topical therapy of staphylococcal infections resistant to other antibiotics is discussed.

The in vitro activity of ceftizoxime against 200 clinical isolates of Enterobacteria and Pseudomonas, was compared with those of other beta-lactam antibiotics such as: cefotaxime, cefoperazone, cefuroxime, and the aminoglycosides gentamicin and amikacin. Ceftizoxime inhibited Escherichia coli and Klebsiella pneumoniae with doses from two to four fold lower than cefotaxime. Ceftizoxime and cefotaxime were more active than cefuroxime and cefoperazone against Enterobacter spp., and Proteus morganii. Ninety percent of the Serratia spp. were inhibited at 0.2 microgram/ml of ceftizoxime whereas the other cephalosporins needed doses up to thirty-two fold higher. The rest of the Proteus spp. were inhibited 90% with 0.8 or 3.2 micrograms/ml of ceftizoxime; on the contrary, to inhibit the same percentage of these bacteria, doses two to sixteen fold higher than cefotaxime or other cephalosporins were needed. Ceftizoxime was less active than amikacin against multiresistant Pseudomonas spp. Strains isolated from urine were generally more resistant to antibiotics than those encountered in other clinical material.