Search Results (299)

Background and Clinical Significance: To report a case of bilateral sterile intraocular inflammation following intravitreal aflibercept 8 mg (Eylea HD) injections. Case Presentation: An 89-year-old woman with bilateral neovascular age-related macular degeneration (nAMD) developed blurred vision and mild ocular pain in both eyes four days after receiving aflibercept 8 mg injections in both of her eyes. Examination revealed a marked anterior chamber reaction with Descemet’s folds, 2+ vitreous cells, and 3+ vitreous haze bilaterally. Intraocular pressures were normal, and B-scan ultrasonography confirmed attached retinas with bilateral vitreous opacities. The clinical presentation initially raised concern for infectious endophthalmitis; however, the bilateral presentation, quiet conjunctivae, and prior history of sterile inflammation after aflibercept 2 mg supported a diagnosis of sterile intraocular inflammation. The patient was hospitalized and treated with intensive topical corticosteroids, antibiotics, and cycloplegics, resulting in rapid improvement and complete resolution of symptoms within four days with recovery of baseline vision. Conclusions: Intravitreal aflibercept 8 mg can be associated with bilateral sterile intraocular inflammation, even in patients who previously tolerated standard-dose aflibercept. Awareness of this potential adverse event is essential to avoid unnecessary interventions and to guide appropriate management. Full article

Background: Increasing antimicrobial resistance (AMR) is one of the leading causes of death worldwide. The predominant pathogens that exacerbate the AMR problem are multidrug-resistant (MDR) Gram-negative bacteria (GNB). Due to the increasing adaptation of MDR GNB to commercially available antimicrobial drugs, such as carbapenems as well as third- and fourth-generation cephalosporins, pharmaceutical companies around the world have been forced to produce increasingly innovative chemotherapeutics. Cefiderocol (CFDC) is a novel injectable cephalosporin 5 generation developed by Shionogi, directed against MDR GNB, including strains resistant to carbapenems. Results: Analysis demonstrated its significant efficacy across a wide range of in vitro and in vivo studies against MDR GNB, including Carbapenem-resistant Pseudomonas aeruginosa (CRPA), Carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Enterobacterales (CRE) (WHO Critical Priority Pathogens). Clinical studies have shown CFDC to be an effective drug with few adverse effects. Conclusions: When used CFDC appropriately within antibiotic stewardship guidelines, this drug is an effective, well-tolerated targeted treatment option for patients with severe clinical conditions. Full article

To describe unusual findings and management of neuroretinitis in patients with cat scratch disease (CSD), their functional outcome after a case-oriented treatment was anaylsed, and the current literature was reviewed. A retrospective monocentric case series and a literature review. Review of medical records, multimodal imaging, and literature review. Five patients (four females and one male) with a mean age of 29.75 years (range: 11–71 years) had unusual findings of ocular bartonellosis, including inner retinitis, focal choroiditis, retinal microaneurysms, and bilateral sectorial optic nerve swelling. Bartonella-related ocular infections were not limited to the posterior segment of the eye. Molecular tests, such as polymerase chain reaction (PCR), showed that elevated markers of IgG titers were used and were positive in the aqueous humour of one patient. Reference to the use of intravitreal treatment in one of the cases was useful. Case-oriented management is associated with improvement in visual acuity, retinal, and choroidal lesions. The range of ocular signs of Bartonella infection could be extended. Molecular tests, such as PCR, are useful diagnostic approaches in the diagnosis of posterior uveitis. Treatment could require intravitreal antibiotic injections in unusual ocular bartonellosis. Full article

Salmonella is a major zoonotic pathogen and phage cocktails offer a novel strategy against its infections. This study aimed to characterize Salmonella phages and assess the efficacy of various phage combinations, both in vitro and in vivo. Three phages (PJN012, PJN042, PJN065) were isolated, showing stability across a broad range of temperatures and pH values, and lacking genes associated with lysogenicity, virulence, and antibiotic resistance. Combined with two known phages (PJN025, vB_SalS_JNS02), they formed cocktails tested for lytic activity against S. Enteritidis and S. Typhimurium. Phage cocktails (comprising 2–5 phages) that demonstrated efficacy in vitro were validated using Galleria mellonella models. For S. Enteritidis strain 015, prophylactic cocktail C18 increased larval survival to 90% at 48 h (vs. 3% control). For S. Typhimurium strain 024, phage cocktail 26 showed the best therapeutic effect when co-injected with the bacterium, with a survival rate of up to 85% at 96 h, compared to 30% in the positive control group. Biofilm assays showed cocktails inhibited formation more effectively (e.g., at 24 h, C14 and C17 reduced biofilm formation by 93.74% and 94.21%, respectively) than removed established ones. The cocktails depended on bacterial type, phage genera, combinations, and incubation time. Robust in vitro screening remains crucial for optimizing phage formulations despite potential in vivo discrepancies. Full article

Rational use of medicines, particularly antimicrobials, is critical for reducing antimicrobial resistance. In 2021, a study conducted at the outpatient department (OPD) of a district hospital in Ghana, identified high antibiotic prescribing and suboptimal adherence to World Health Organization (WHO) prescribing indicators. Based on those findings, antimicrobial stewardship (AMS) intervention was extended to the OPD. This before-and-after study was used to compare WHO prescribing indicators and patterns of antibiotic use, using WHO AWaRe (Access, Watch and Reserve) categorization of the years 2021 and 2023. A total of 65,157 patients visited the OPD in 2023 with 171,517 patient encounters and 247,313 prescriptions. Encounters resulting in antibiotic prescriptions halved from 36% to 18%. The average number of medicines prescribed per encounter reduced from three to two. Prescriptions using generic names increased from 76% to 80% and injection use reduced from 7% to 6%. However, prescriptions from the Ghana essential medicines list reduced from 90% to 79%. Access antibiotics use remained unchanged while Watch and Reserve categories increased by 5% and 2%, respectively. The AMS interventions potentially improved three of five WHO indicators. Continued efforts are needed to achieve complete compliance with all indicators and increase access antibiotic use to above 70%. Full article

Prophylactic measures and treatment strategies of implant-related bone and joint infections frequently involve the local delivery of high doses of antimicrobial drugs into the affected bone tissue or articular space in addition to the use of systemic antibiotics. Antibiotic-loaded biomaterials, such as Polymethyl Methacrylate (PMMA) cement, calcium sulfate, calcium phosphate, bioglass, and others, have proven to be clinically effective. However, they suffer from important limitations regarding elution and freedom of choice of admixable antimicrobial drugs. In order to overcome these shortcomings, the techniques of direct intraosseous or intra-articular injection/infusion of antibiotics via needles/cannulas or catheters are gaining popularity. Their attractiveness is based on the potential to achieve extremely high drug concentrations in situ, which can be maintained for as long as the catheters are left in place without increased risks of systemic toxicity. Although these methods are still in an experimental stage, reports on their clinical outcomes look promising. This articles summarizes the knowledge of when, how, and in which clinical settings the different modes and philosophies of local antibiotic delivery work best, with the aim to provide surgeons and infectious disease physicians guidance in clinical practice. This will help to optimize the use for the sake of the patients. Full article

Minocycline (MINO), a classic antibiotic, may have psychotropic activity related to the modulation of the tryptophan-kynurenine pathway. In this study, we investigated the effects of MINO on (1) memory and anxiety behaviors, (2) the modulation of brain levels of amyloid precursor protein (APP) and 2,3-indoleamine dioxygenase (IDO1) levels, and (3) peripheral inflammatory markers in a streptozotocin (STZ)-induced rat model of sporadic Alzheimer’s disease (sAD). After repeated treatment with a dose of 35 mg/kg MINO for seven consecutive days, male Wistar rats with sAD showed (1) improvements in early (29 days after injection, probe test) reference memory (decreased latency to reach the platform, increased time in the critical quadrant of the Morris water maze) and anxiety disorders (increased time in the open arms of the elevated plus maze; increased exploration and entrances in the center of the white–light illuminated open field) 45–46 and 90–91 days after STZ injection; (2) reduced APP and IDO1 levels in the hippocampus and prefrontal cortex; and (3) induction of anti-inflammatory response in blood (increased TCD4⁺ lymphocyte number and interleukin-10 production). This suggests that MINO, due to its anti-inflammatory action, improves memory and anxiety behavior related to sAD, indicating its neuroprotective and psychotropic properties. Full article

White line disorders represent the most prevalent claw horn disruption lesion in dairy cattle. Recent studies have yielded new insights into the appropriate treatment modalities for these lesions. The aims of this study are to elucidate the pathogenesis of white line disorders and its associated claw lesions, such as toe tip necrosis, and to discuss practical treatment applications. In Western Europe, many herds are endemically infected with digital dermatitis. White line disorders in zone 3 and toe tip necrosis starting in zone 1—often beginning as axial white line lesions—frequently exhibit a suboptimal response to standard treatments, including corrective trimming, the application of a hoof block on the healthy claw and the administration of NSAIDs, due to secondary infections with Treponema spp. This study addresses the current perspectives on the aetiopathogenesis of white line disorders and the therapeutic challenges in promoting complete recovery and the correct use of antibiotics, along with preventive measures, such as good flooring. An important factor of its pathogenesis is a decrease in body condition around parturition, Correct diagnosis can be made via the use of regular locomotion scoring and good diagnostic tools, and thin soles by among others overtrimming should be prevented. Current therapeutic methods consist of the prompt application of a block and an NSAID and, in some circumstances, a parenteral injection with antibiotics when there is no good response to the applied therapies. Full article

This study presents the development of a degradable and biocompatible calcium phosphate cement (CPC) co-loaded with gentamicin (1.25 wt%) and vancomycin (4.25 wt%) for the local treatment of polymicrobial bone infections. The antibiotics were incorporated—individually or in combination—into the solid phase of Graftys^® Quickset (GQS), an injectable CPC. Antibiotic loading modifies some of the intrinsic properties of the GQS cement. Porosity exceeded 53%, compressive strength reduced around 5 MPa, which is comparable to calcium sulphates cements, and the setting time, although extended, remained within the clinically acceptable threshold (<20 min), ensuring suitable handling. A burst release of both antibiotics was observed within the first 24 h, with sustained release over time and no cytotoxic effects on human osteoblasts. The dual-loaded cement exhibited broad-spectrum antibacterial activity against both Gram-positive and Gram-negative strains, including methicillin-resistant isolates, in both planktonic and biofilm forms. Notably, the combination of both antibiotics demonstrated superior efficacy compared to either antibiotic alone. These findings suggest that this dual-antibiotic-loaded CPC offers a promising strategy for localised treatment of complex bone infections such as osteomyelitis, where polymicrobial involvement and antibiotic resistance pose significant therapeutic challenges. Full article

Objectives: The current study focused on the kidney protection and antioxidant properties along with the potential anti-ferroptotic activity of Geranium macrorrhizum L. (G. macrorrhizum) oil to ameliorate the acute renal oxidative tissue damage and toxicity of the aminoglycoside antibiotic gentamicin (GM) in an experimental murine model. Methods: The research was carried out with mature Balb/c mice distributed into four groups (n = 6). Application of GM (200 mg kg⁻¹ intraperitoneal injection for 10 days) was performed to induce kidney injury. Only saline was administered to the controls. The remaining groups were administered G. macrorrhizum oil (50 mg kg⁻¹ per dose) either used alone or in combination with GM. To assess the renal antioxidant status, the activities of specific antioxidant enzymes, indicators of lipid and DNA peroxidation and renal functional damage were examined using standard commercial kits, ELISA and EPR spectroscopy. Results: G. macrorrhizum oil analysis revealed 20 organic components belonging to mono- and sesquiterpenoids and long-chain hydrocarbons. The antioxidant and anti-inflammatory effects of G. macrorrhizum oil were demonstrated by reduced malondialdehyde, ROS, 8-hydroxy-2′-deoxyguanosine and cytokine levels (especially interleukin-1β) compared with GM. Furthermore, increased activation of superoxide dismutase, catalase and glutathione (GSH) were observed in the kidney homogenates of the animals which received GM in combination with G. macrorrhizum oil compared with the GM group. Additional changes in the GSH/glutathione peroxidase-4 axis were detected, suggesting the possible anti-ferroptotic potential of the oil. Nephroprotection was also demonstrated by elevated PGC-1α expression (peroxisome proliferator-activated receptor γ coactivator 1-alpha) and reduced KIM-1 levels (kidney injury molecule-1) following application of the oil. Conclusions: The preserved kidney antioxidant and functional properties in the groups treated with oil suggest that Geranium macrorrhizum L. could be utilized clinically to mitigate the toxic effects of GM application. Full article

The emergence and spread of pathogens pose significant challenges to the sustainability and productivity of aquaculture globally. For the Chilean salmon farming industry, salmonid rickettsial septicemia (SRS), caused by the facultative intracellular bacterium Piscirickettsia salmonis, constitutes one of the main disease challenges. In this study, the efficacy of various oral doses of florfenicol (FFC) (5, 7.5, and 10 mg/kg BW/day) against SRS was assessed in Atlantic salmon, when treatment was initiated at an early stage of infection. Since salmonids infected with P. salmonis typically lose appetite as the disease progresses, and the therapeutic FFC dose is dependent on a normal specific feeding rate (SFR), the treatments were administered 5 days post-challenge (DPC5). On the day of challenge, experimental fish were intraperitoneally (IP) injected with 0.2 mL of P. salmonis genogroup LF-89 inoculum (9.07 × 10⁷ CFU mL⁻¹). Fish mortality, behavior, clinical signs of disease, feed intake and SFR were monitored throughout the study. Conclusions: An important finding in this study was that all tested antibiotic doses halted disease progression and prevented mortality in fish challenged with P. salmonis when administered DPC5. In the control group, mortality reached 32.2% with fish displaying clinical signs of SRS. Full article

The systemic delivery of oxytetracycline (OTC) by trunk injection has emerged as a viable strategy to manage huanglongbing (HLB, also known as citrus greening), a bacterial disease devastating citrus production around the world. This study examines the efficacy of delivering OTC systemically into the trunk of young, HLB-affected citrus trees using a drill-based or a drill-free system to improve tree health and productivity. Two field trials were conducted in two commercial production sites in Florida. Trees were four years old at the start of the study and composed of ‘Valencia’ or ‘OLL-8’ sweet orange (Citrus sinensis) scion grafted on X-639 (C. reticulata × Poncirus trifoliata) rootstock. Injections were performed in spring or late summer/early fall in 2022 and 2023. Using the drill-based system, 0.79 g of OTC was administered into each tree, whereas 0.15 g or 0.3 g was administered using the drill-free system. Delivering a higher dose of OTC by drill-based injection increased fruit yield and improved juice quality more than delivering lower doses by drill-free injection, though responses varied between cultivars. Injections in late summer/early fall increased the juice total soluble solids content considerably more than injections in spring. However, fall injections resulted in OTC fruit residues exceeding the maximum allowed level. Trunk injury was more extensive when OTC was applied with the drill-free system than when it was applied with the drill-based system. Full article

Background/Objectives: Infectious endophthalmitis is a vision-threatening complication of intraocular surgery and intravitreal injections. Standard treatment involves intravitreal antibiotics; however, concerns regarding multidrug resistance and vancomycin-associated hemorrhagic occlusive retinal vasculitis (HORV) highlight the need for alternative antimicrobial strategies. This study aimed to evaluate the clinical efficacy and safety of a protocol combining intravitreal injection of 1.25% povidone-iodine (PI) with intraoperative irrigation using low concentrations of vancomycin and ceftazidime. Methods: We retrospectively analyzed 11 eyes from patients diagnosed with postoperative or injection-related endophthalmitis. Six of the eleven cases received an initial intravitreal injection of 1.25% PI, followed by pars plana vitrectomy with irrigation using balanced salt solution PLUS containing vancomycin (20 μg/mL) and ceftazidime (40 μg/mL). A second intravitreal PI injection was administered at the end of surgery in all cases. Additional PI injections were administered postoperatively based on clinical response. Clinical outcomes included best-corrected visual acuity (BCVA), microbial culture results, corneal endothelial cell density, and visual field testing. Results: All eyes achieved complete infection resolution without recurrence. The mean BCVA improved significantly from 2.18 logMAR at baseline to 0.296 logMAR at final follow-up (p < 0.001). No adverse events were observed on specular microscopy or visual field assessment. The protocol was well tolerated, and repeated PI injections showed no signs of ocular toxicity. Conclusions: This combination protocol provides a safe and effective treatment strategy for infectious endophthalmitis. It enables rapid and complete infection resolution while minimizing the risks associated with intravitreal antibiotics. These findings support further investigation of this protocol as a practical and globally accessible alternative to standard intravitreal antimicrobial therapy. Full article

Background/Objectives: In Japan, task shifting reduces the working hours of pediatricians, who face excessive workloads. The status of task shifting under the Ministry of Health, Labor, and Welfare’s reforms remains unclear. This study aimed to evaluate the current status and barriers of task shifting in pediatric care in Japan. Methods: A questionnaire survey was conducted among pediatricians working in hospitals in Japan. The results were compared with those from 2020. Results: Questionnaires were sent to 835 hospitals, and valid responses were received from 815 pediatricians in 316 hospitals (response rate: 37.8%). The largest group (31.0%) was 40–49 years, and 34.4% of the participants were women. Among the items surveyed, most pediatricians indicated “shifted” in “Patient transfer (transporting between hospitals using an ambulance)” and “Intravenous injection of antibiotics.” Most physicians believed task shifting improved care quality; 10.3% felt it worsened. The most common estimate for daily working hour reduction due to task shifting was “1 to <2 h” (44.9%). Precisely 15.8% of pediatricians believed that task shifting had “not progressed at all,” with rural areas and non-university hospitals showing lower task-shifting implementation. National university hospitals had a higher likelihood of task shifting than public hospitals. No significant associations were observed for the total hospital bed count or the number of full-time pediatricians. Conclusions: Task shifting in pediatric care remains underdeveloped. While many pediatricians support the concept and report modest reductions in working hours, actual implementation remains limited. Future efforts must address systemic, institutional, and regulatory challenges to facilitate meaningful task redistribution and improve healthcare delivery. Full article

The anti-inflammatory effect of trypsin in animals and humans is the basis for the development of new veterinary and medical drugs and alternatives to antibiotics. The current experiment analyzed the effect of pig pancreatic tissue lyophilizate and crystalline trypsin on the hemodynamic and morpho-biochemical parameters of rabbit blood. The experiments were carried out on 20 rabbits of the Soviet chinchilla breed of 6–8 months of age. Animals were intramuscularly injected with sterile solution of 0.9% NaCl in 0.5 mL (group 1, n = 5), sterile solution of crystalline trypsin in 0.9% NaCl at a concentration of 0.25 mg/kg body weight (group 2, n = 5), sterile solution of crystalline trypsin in 0, 9% NaCl at a concentration of 0.5 mg/kg body weight (group 3, n = 5), or sterile suspension of pig pancreas lyophilizate at a concentration of 1 mg/kg body weight (group 4, n = 5). Animals were injected once daily for five consecutive days. Significant changes in arterial blood pressure, serum enzymes activity, and the count of various blood cellular components were induced by the administration of different trypsin preparations. All data obtained indicate the presence of a biologically active substance in the lyophilizate, the effect of which requires further animal studies to create a prototype for the development of new drugs for human and animal use. Full article