Search Results (264)

Acromegaly is caused by an excessive secretion of growth hormone and the secondary elevation of IGF-1 levels, leading to progressive changes in multiple body systems, including the craniofacial region and oral cavity. Dental manifestations such as mandibular overgrowth, macroglossia, malocclusion, periodontal disease, and prosthetic difficulties represent not only a clinical component of the disease but also a significant therapeutic and diagnostic challenge. The aim of this review is to present the current state of knowledge on the relationship between acromegaly and oral health and to analyze the role of interdisciplinary collaboration between endocrinologists and dentists in patient care. For this narrative review, a literature search was conducted in the PubMed, Scopus, and Web of Science databases covering the period from 2000 to 2025. Sixty-two peer-reviewed publications meeting the methodological and thematic criteria were included in the analysis, including original studies, meta-analyses, systematic reviews, and case reports. The results indicate significant correlations between disease activity and the severity of periodontal and microbiological changes, while effective endocrine treatment only results in the partial regression of morphological changes. Particular attention was given to the role of the dentist in recognizing the early symptoms of the disease, planning prosthetic and surgical treatment, and monitoring therapy-related complications. Interdisciplinary collaboration models, including integrated clinics and co-managed care, were also described as optimal systemic solutions for improving treatment quality. The conclusion drawn from the analysis are as follows: there is a need for the permanent integration of dentistry into the standard of interdisciplinary care for patients with acromegaly, in both diagnostic and therapeutic dimensions. Increasing awareness among dentists and developing integrated collaboration models may reduce the time to diagnosis, improve patients’ quality of life, and enable the more effective management of craniofacial complications in the course of this rare disease. Full article

Background/Objectives: Heart transplantation (HTx) is a lifesaving procedure for end-stage heart failure patients; however, postoperative infections remain a major challenge due to immunosuppressive therapy and surgical complications. Traditional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have limitations in distinguishing infections from systemic inflammatory response syndrome (SIRS). Emerging markers such as Presepsin and interleukin-6 (IL-6) may improve diagnostic accuracy. This study aimed to evaluate the kinetics and reliability of these four inflammatory biomarkers in heart transplant recipients in the immediate postoperative period. Methods: This retrospective observational study included 126 patients who underwent HTx at Policlinic of Bari between January 2022 and November 2024. Patients were categorized into infected (n = 26) and non-infected (n = 100) groups based on clinical and microbiological criteria. Biomarkers (CRP, PCT, Presepsin, and IL-6) were measured preoperatively and on postoperative days (PODs) 1, 2, 3, 4, 5, and 10. Statistical analyses included the Mann–Whitney U test and logistic regression to identify the independent predictors of infection. Results: CRP and PCT levels differed significantly between the groups only on day 10, limiting their use as early infection markers. In contrast, Presepsin levels were significantly elevated in infected patients from day 1 (p < 0.001), whereas IL-6 levels showed significant differences from day 3 onward. Presepsin showed the strongest association with infection in the early postoperative phase. Conclusions: Presepsin and IL-6 outperformed CRP and PCT in detecting early postoperative infections in heart transplant recipients. Their early elevation supports their use as reliable markers for guiding timely clinical intervention and improving patient outcomes. Further research is needed to validate these findings in larger cohorts and with different immunosuppressive regimens. Full article

Background/Objectives: Acetazolamide is widely used for acute mountain sickness (AMS) prophylaxis. Whilst generally safe, acute kidney injury (AKI) is a rare but serious adverse event. We present a case of anuric AKI following minimal exposure to acetazolamide, contributing to the limited literature on its nephrotoxicity at prophylactic doses. Methods: A 54-year-old previously healthy male ingested 250 mg/day of oral acetazolamide for two days. He developed acute anuria and lumbar pain. Diagnostic evaluation included laboratory tests, imaging, microbiological cultures, autoimmune panels, and diuretic response. No signs of infection, urinary tract obstruction, or systemic disease were found. Results: The patient met KDIGO 2012 criteria for stage 3 AKI, with peak serum creatinine of 10.6 mg/dL and metabolic acidosis. Imaging confirmed non-obstructive nephrolithiasis. Conservative treatment failed; intermittent hemodialysis was initiated. Renal function recovered rapidly, with the normalization of serum creatinine and urinary output by day 4. Conclusions: This case represents the lowest cumulative dose of acetazolamide reported to cause stage 3 AKI. The findings support a pathophysiological mechanism involving sulfonamide-induced crystalluria and intratubular obstruction. Physicians should consider acetazolamide in the differential diagnosis of AKI, even with short-term prophylactic use. Full article

Background: Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of microbiological sampling from macroscopically unremarkable tissue during TKA implantation remains controversial. Objective: To retrospectively evaluate the rate of periprosthetic joint infection (PJI) following TKA after PTOA and to assess the potential benefit of intraoperative microbiological sampling. The secondary objective was to evaluate the presence of prior colonization in osteosynthetic hardware among the affected cases. Patients and Methods: A retrospective screening of the hospital database was conducted between 2008 and 2022, including only AO/OTA type 41-B and 41-C fractures. Patients were assigned to a sampling group (with microbiological sampling during TKA) or a control group (without sampling). All patients received structured follow-up to assess postoperative complications. Results: A total of 40 patients met the screening criteria. In the sampling group (n = 29), 17.24% required surgical revision, and the rate of PJI was 3.45%. In the control group (n = 11), 18.14% underwent revision surgery, with a PJI rate of 9.09%. The average follow-up period was 4.35 years (range 2–11.6 years). Discussion: TKA in patients with PTOA is associated with a heightened risk of complications. A noteworthy possible correlation between systematic microbiological sampling and reduced PJI incidence was observed. While the small sample size limits definitive conclusions regarding causality, the findings support the potential value of consistent intraoperative sampling. Full article

Starting Active Materials for Synthesis (SAMS) represents a critical stage in drug manufacturing, directly influencing the microbiological quality and safety of the final product. The introduction of SAMS marks the point where Good Manufacturing Practices (GMP) begin to apply, which are essential for ensuring sterility and preventing microbial contamination during the synthesis process. However, defining the exact point in the process that qualifies as the SAMS is subject to uncertainties, as earlier stages are not always governed by stringent GMP standards. The regulatory differences between various countries further contribute to this issue. This study explores the implications of SAMS selection and use in relation to sterility and infection control, analyzing the guidelines of major Regulatory Authorities and comparing their approaches to GMP. Regulations from several international regulatory agencies were examined, with a particular focus on microbiological control measures and infection protection in the SAMS manufacturing process. The analysis focused on the microbiological control requirements and safety measures applicable to the stages preceding the introduction of SAMS into the production of the final Active Pharmaceutical Ingredients (APIs). Documents published between 2015 and 2025 were included based on predefined criteria regarding relevance, accessibility, and regulatory authority. The analysis revealed significant discrepancies between regulations regarding the definition and management of SAMS. In particular, the regulations in Mexico and India have notable gaps, failing to provide clear guidelines on SAMS sterility and protection against infectious contamination. Conversely, China has introduced risk-based approaches and early-stage microbiological controls, especially for sterile products, aligning with international standards. The European Medicines Agency (EMA), the U.S. Food and Drug Administration (FDA), the Pharmaceutical Inspection Co-operation Scheme (PIC/S), and the World Health Organization (WHO) have well-established systems for microbiological quality control of SAMS, including rigorous measures for the validation of suppliers and risk management to ensure that SAMS does not compromise the microbiological safety of the final product. The regulations in Brazil and Canada introduce additional measures to protect the microbiological quality of SAMS, with specifications for contamination control and certification of critical stages. The lack of a harmonized language for the definition of SAMS, coupled with a fragmented regulatory framework, presents a challenge for infection protection in pharmaceutical manufacturing. Key issues include the absence of specific regulations for stages prior to the introduction of SAMS and the lack of standards for inspections related to these stages. A desirable solution would be the mandatory extension of GMPs to the stages before SAMS introduction, with centralized control to ensure sterility and protection against infection throughout the entire manufacturing process. Full article

Background/Objectives: The main objective of the study is to assess the clinical utility of microbial cell-free DNA (mcfDNA) in neutropenic patients diagnosed with acute myeloid leukemia (AML) undergoing chemotherapy in the outpatient setting. Neutropenia is a common complication in this patient cohort and enhances the risk of fatal opportunistic bacterial and fungal infections. Accurate and timely diagnosis of these infections in outpatient asymptomatic individuals is critical. Methods: Fourteen patients were studied in this prospective observational case series. Traditional blood cultures (BCs) were obtained when clinically indicated and blood samples were collected for plasma mcfDNA metagenomic sequencing up to two times a week at outpatient oncology appointments. Results were compared in identifying potential infectious agents. Results: BCs identified pathogens in only two patients, despite several cases where infection was suspected. In contrast, mcfDNA testing detected pathogens in 11 of the 14 patients, including bacteria, such as Staphylococcus aureus, and invasive fungi, such as Candida and Aspergillus species, and Pneumocystis jirovecii. Conclusions: In the outpatient setting, mcfDNA surveillance offers a more reliable method for detecting pathogens. This approach identified actionable microbiologic results in immunocompromised individuals who did not meet standard clinical criteria for suspicion of infection. Further research is required to confirm the potential of mcfDNA surveillance in an outpatient setting to guide more accurate treatment decisions, reduce extensive clinical investigations, and improve neutropenic patient outcomes. Full article

Edible insects are gaining traction worldwide; however, the existing data regarding their microbiological quality remain inadequate. This study investigated the bacterial communities and microbiological quality of five types of frozen edible insects commercially available in Thailand. Amplicon sequencing revealed Firmicutes (Bacillota) and Proteobacteria (Pseudomonadota) as the main phyla across all samples; Bacteroidota was predominant in house crickets, Actinobacteriota in silkworms, and Desulfobacterota was exclusively found in house and mole crickets. Culture-based assays showed total viable counts, lactic acid bacteria, yeasts–molds, and spore-formers ranging from 3.41–6.58, 2.52–7.41, 1.83–5.62, to 2.00–4.70 log CFU·g⁻¹, respectively. In some samples, Enterobacteriaceae and Escherichia coli, key hygiene indicators, reached 5.05 and 2.70 log CFU·g⁻¹, respectively. Among foodborne pathogens, presumptive Bacillus cereus was found to vary from <1.70 to 3.93 log CFU·g⁻¹, while Clostridium perfringens and Staphylococcus aureus were under the quantitation limit, and Salmonella was absent. Overall, the results indicate significant variation in microbial diversity and quality among different insect types. The high levels of microbial hygiene indicators and foodborne pathogens in some samples raised food safety concerns and point to the need to develop or implement production guidelines and microbiological criteria for frozen edible insects to ensure food safety. Full article

Clinical mastitis in small ruminants is usually seen with an incidence of less than 5% and most cases, especially with hyperacute evolution, are not referred for hospital care. During the 5-year survey, 16 goats and 7 sheep, totaling 23 small ruminants, met the inclusion criteria with a definitive diagnosis of clinical mastitis. Clinical signs ranged greatly among cases, varying from septic state in hyperacute cases, and enlarged, pendulous udder associated with chronic pain and abnormal gait in chronic cases. Microbiological culture revealed a wide array of bacterial pathogens, including Staphylococcus aureus, Escherichia coli, Streptococcus spp., and Pasteurella spp. In vitro antimicrobial susceptibility profiles varied greatly among bacteria isolates, ranging from sensitive to all tested antimicrobials to a multi-resistant profile. Pathological features included hyperemia and dark red areas of necrosis in the skin, marked hyperemia of the affected gland at the cut surface, lactiferous ducts and gland cisterns filled by cloudy or suppurative fluid, abscesses, and hardness of the mammary gland parenchyma. This retrospective study highlights the multifactorial nature and clinical variability of mastitis in small ruminants, demonstrating its significant impact on animal health, welfare, and production. Full article

Photodynamic therapy (PDT) using indocyanine green (ICG) has gained attention as an adjunctive treatment for periodontitis due to its antimicrobial and anti-inflammatory properties and its ability to penetrate deep periodontal tissues via near-infrared light activation. We aimed to evaluate the clinical and microbiological efficacy of ICG-mediated PDT as an adjunct to conventional periodontal therapy in patients with periodontitis based on data from randomized controlled trials (RCTs). A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted to identify randomized controlled trials (RCTs) exclusively investigating ICG-PDT in periodontitis based on predefined eligibility criteria. Studies were selected based on predefined inclusion criteria, and methodological quality was assessed using a 14-point scoring system. Data were extracted on clinical outcomes (e.g., probing depth, clinical attachment level) and microbiological changes. Sixteen RCTs met the inclusion criteria. Most studies reported improvements in probing depth, clinical attachment level, and microbial reduction following ICG-aPDT; however, some trials found no significant differences compared to control groups. These discrepancies may be attributable to variations in laser settings, ICG concentration, treatment frequency, or initial disease severity. Microbiological benefits included significant reductions in key periodontal pathogens. The therapy was well tolerated, with no adverse effects reported. However, variability in treatment protocols and limited long-term follow-up restricted the ability to draw definitive conclusions. ICG-mediated PDT is a promising, safe, and effective adjunct in periodontal therapy. Future trials should aim for protocol standardization and long-term outcome assessment to strengthen clinical guidance. Full article

Vaginitis is a major health concern among women, with inadequate treatment potentially leading to reproductive complications. This study aimed to assess vaginitis prevalence, identify predominant pathogens, and evaluate associated risk factors among female patients at Da Nang Dermato-Venereology Hospital. A prospective study of 796 female patients undergoing physical examinations was conducted, with demographic, clinical, and microbiological data collected. Vaginitis was diagnosed in 180 (22.6%) of 796 female patients, predominantly caused by Candida spp. (66.1%) and bacterial pathogens (31.7%), with no Trichomonas vaginalis detected, and was most prevalent in women aged 20–30 years. Poor hygiene practices, including infrequent sanitary pad changes (OR = 5.01, p < 0.001) and routine vaginal douching (OR = 6.77, p < 0.001), were significantly associated with vaginitis. The Amsel criteria showed high specificity (99.1%) for bacterial vaginosis diagnosis. The absence of T. vaginalis suggests a potential shift in the epidemiology of vaginal infections. The Amsel criteria are a practical diagnostic tool in resource-limited settings. Our findings highlight the need for targeted hygiene education to reduce vaginitis prevalence in Vietnam. Full article

This study aimed to evaluate the microbiological quality of colostrum on three dairy farms with different colostrum management hygiene practices and to compare it with the current colostrum quality guidelines. On farm A, colostrum was fed raw, while on farms B and C it was heat treated. On farms A and B, the feeding equipment was cleaned manually, while on farm C, an automated cleaning system was used. Samples were collected from the calf-feeding equipment and submitted for microbial culture: total plate count (TPC); total coliform count (TCC); and E. coli, enterobacteria (ENTB), staphylococci (STAP), and lactic acid bacteria counts. In addition, pH, water activity (a_W), and Brix were analyzed. Colostrum quality was defined as follows: good quality (GQ)—TPC < 100,000, TCC < 10,000, STAP < 50,000 cfu/mL, and Brix ≥ 22%; excellent quality (EQ)—TPC < 20,000, TCC < 100, STAP < 5000 cfu/mL, and Brix ≥ 25%. Mean concentrations were as follows: TPC was 3.99 × 10⁵ cfu/mL (min: 40.00, max: 1.32 × 10⁷ cfu/mL); TCC was 1.17 × 10⁴ cfu/mL (min: <detection limit, max: 6.37 × 10⁵ cfu/mL); and STAP was 1.77 × 10⁴ cfu/mL (min: <detection limit, max: 3.50 × 10⁵ cfu/mL). Approximately 54% (GQ) and 32% (EQ) of samples met the defined criteria. Farm C consistently showed lower microbial counts across all culture types. Colostrum from farm B had lower TCC, LAB, and E. coli counts than farm A but not TPC, STAP, and ENTB. These results showed that a considerable proportion of calves were fed colostrum with suboptimal quality, especially when less rigorous hygiene practices were implemented. Full article

Background: Histoplasma capsulatum is an environmentally acquired dimorphic fungus. Infection results in histoplasmosis, a clinical syndrome often underdiagnosed and that may progress to life-threatening disseminated infection not only in immunocompromised individuals but also, following high-level exposure, in immunocompetent hosts. Epidemiological data from Caribbean regions, and particularly from Guadeloupe, remain limited. Methods: We performed a retrospective cohort study of all microbiologically confirmed histoplasmosis cases managed at the University Hospital of Guadeloupe between January 2014 and October 2024. Demographic, clinical, diagnostic, therapeutic, and outcome data were retrieved from medical records and analyzed using descriptive statistics. Results: Forty-two patients met the inclusion criteria, corresponding to an estimated annual incidence rate of 1 per 100,000 inhabitants. The median age was 52 years, and the male-to-female ratio was 4:1. An underlying immunocompromising condition was present in 85% of cases, most commonly HIV infection (48%). Common clinical features included weight loss (97%), fever (89%), and pulmonary manifestations (81%). The mean time to diagnosis from hospital admission was 3.5 ± 10.3 days. Direct microscopy was positive in 67% of cases, and culture was positive in 88% of cases. Intravenous liposomal amphotericin B constituted the initial therapy in 71% of patients. Overall, the in-hospital mortality was 29%, rising to 40% among HIV-positive individuals. The 30-day survival rate was 71%. Conclusions: Histoplasmosis in Guadeloupe is under-recognized and associated with appreciable morbidity and mortality in both immunocompromised and immunocompetent patients. The wider availability of rapid diagnostics and heightened clinical vigilance are essential to shorten diagnostic delays and improve outcomes in this Caribbean population. Full article

Due to its high digestibility, rich nutrient profile, and potential probiotic content, goat milk is an essential nutritional resource, particularly for individuals with cow milk allergies. This review summarises the current state of microbial diversity in goat milk, emphasising the implications for quality, safety, and probiotic potential. This systematic review adhered to PRISMA guidelines, conducting a comprehensive literature search across PubMed, ScienceDirect, and Google Scholar using keywords related to microbial profiling in goat milk. The inclusion criteria targeted English-language studies from 2000 to 2025 that utilised high-throughput or next-generation sequencing methods. Out of 126 articles screened, 84 met the eligibility criteria. The extracted data focused on microbial diversity, profiling techniques, and their respective strengths and limitations in evaluating probiotic potential and spoilage risks. The review addresses the challenges linked to microbial spoilage and the composition and functional roles of microbial communities in goat milk. With species such as Bacillus and Pseudomonas playing crucial roles in fermentation and spoilage, key findings emphasise the prevalence of microbial phyla, including Proteobacteria, Firmicutes, and Actinobacteria in goat milk. The review also explores the probiotic potential of the goat milk microbiota, highlighting the health benefits associated with strains such as Lactobacillus and Bifidobacterium. Significant discoveries underline the necessity for advanced multi-omics techniques to thoroughly define microbial ecosystems and the substantial gaps in breed-specific microbiota research. Important findings illustrate the need for enhanced multi-omics techniques, given the challenges of host RNA and protein interference, low microbial biomass, and limited goat-specific reference databases, for optimising probiotic development, spoilage prevention strategies, and integrating metagenomics, metabolomics, metaproteomics, and metatranscriptomics to improve milk quality and safety as some of the future research objectives. This study emphasises the importance of understanding goat milk microbiology to advance dairy science and enhance human health. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is a severe complication following both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). While the microbiological profile of TKA PJI has been well characterized, limited data exist regarding UKA PJIs. This study aimed to compare the causative microorganisms and surgical treatment outcomes in PJI cases following UKA and TKA. Methods: This retrospective cohort study included 82 patients (71 TKA and 11 UKA) who underwent surgical treatment for PJI between January 2017 and May 2024. PJI was diagnosed based on the Musculoskeletal Infection Society (MSIS) criteria. Treatment strategies included debridement, antibiotics, and implant retention (DAIR) or two-stage revision arthroplasty. Microbiological data were extracted from intraoperative cultures. Fisher’s exact test and the Mann–Whitney U test were used for statistical comparisons. Results: Gram-positive organisms, primarily Staphylococcus aureus and coagulase-negative staphylococci, were isolated in all UKA PJIs. In contrast, the TKA group demonstrated greater microbial diversity, including Gram-negative bacilli, polymicrobial infections, and a higher rate of culture-negative cases (33.8% vs. 18.2%). DAIR was performed more frequently in UKA cases (72.7% vs. 28.2%, p = 0.002). Recurrence rates following DAIR were similar in both groups (12.5% in UKA, 20.0% in TKA, p = 1.000). Two-stage revision resulted in no recurrence in UKA and a 9.8% recurrence rate in TKA patients. Conclusions: UKA PJIs appear to be microbiologically less complex than TKA PJI cases, with Gram-positive organisms predominating. Despite these differences, the outcomes of surgical treatment—both DAIR and two-stage revision—were comparable between groups. Standard PJI treatment principles may be applicable to both arthroplasty types; however, larger prospective studies are needed to confirm these findings. Full article

Chronic endometritis (CE) is a persistent, often asymptomatic inflammatory condition of the endometrium, increasingly recognized as a potential contributor to infertility and recurrent implantation failure. Despite its clinical significance, CE remains underdiagnosed due to a lack of standardized diagnostic criteria and its subtle clinical presentation. Objective: This review aims to synthesize the current evidence on the pathophysiology, diagnosis, and treatment of CE, highlighting its impact on reproductive outcomes and the effectiveness of therapeutic interventions. A comprehensive literature review was conducted, analyzing 85 peer-reviewed studies published in the last decade, of which 65 were deemed relevant and retained for further analysis. These studies were selected based on their relevance to the pathophysiology, diagnostic methodologies, and treatment outcomes for CE, focusing on their implications for fertility and assisted reproductive technologies (ARTs). The findings suggest that CE is associated with impaired endometrial receptivity, increased inflammatory markers, and reduced implantation and pregnancy rates with ARTs. Histopathological assessment using CD138 immunostaining remains the gold standard for diagnosis, while hysteroscopy and molecular microbiological techniques provide complementary diagnostic value. Antibiotic treatment has been shown to significantly improve implantation rates and pregnancy outcomes, particularly in women with recurrent implantation failure. Emerging therapies, including probiotics and regenerative medicine approaches, are being explored as potential adjuncts to the conventional treatment. Early and accurate diagnosis of CE is essential for optimizing reproductive outcomes. Standardized diagnostic protocols and individualized treatment strategies are crucial for improving implantation success and pregnancy rates in affected women. Future research should focus on refining the diagnostic methods and exploring novel therapeutic options to enhance endometrial health and fertility outcomes. Full article