Podcasts about Enterococcus

Dr. Jackie Sherbuk, Assistant Professor of Medicine at the USF Morsani College of Medicine, Division of Infectious Diseases, presents a case-based discussion of gram positive organisms producing disease in humans. Infections discussed include Staphylococcus aureus, Coagulase negative Staphylococcus, Pneumococcus, Streptococcus spp., Enterococcus, Corynebacterium, Bacillus, and Erysipelothrix. Associated clinical syndromes are also discussed.

I've touched on the topic of endotoxemia in past episodes of the Defiant Health podcast. In this episode, let's dive deeper into this topic that is absolutely crucial to understanding and managing SO many aspects of health, from subduing anxiety and panic, to depressive, to joint pain and skin rashes, to gastrointestinal conditions, even weight management. What is endotoxemia? Fecal microbes, so-called Gram-negative species because of the way these microbes take up stain for examination under a microscope, species such as E. coli and Salmonella, have something called lipopolysaccharide endotoxin in their cells walls. Other species, so-called Gram positive species such as Enterococcus, Staphylococcus, and Streptococcus, that stain in a different manner, have something called lipoteichoic acid in their cell walls. When these microbes die, both Gram-negative and Gram-positive, these toxic factors are released into the intestines. If these fecal microbes are confined to the colon, where they belong, a section of GI tract adapted to their presence, the entry of these toxic components are limited and current evidence is unclear in how importat this process is. The real trouble occurs, however, when fecal microbes have invaded the 24-feet of small intestine, a process we label small intetinal bacterial overgrowth, or SIBO, because the small intestine—the stomach, duodenum, jejunum, and ileum are not well-adapted to the invasion of fecal species. Here, they die, release their toxic components, which then enter the bloodstream, the process labeled endotoxemia. People with SIBO therefore have high blood levels, typically 200-400% higher, levels of endotoxin. This is how microbes in the GI Tract export their effects to all other parts of the body. So let's discuss this process and how you can take control over it to be be better able to take control over your emotions, mood, sleep, energy, weight, and numerous other aspects of health. _______________________________________________________________________________For BiotiQuest probiotics including Sugar Shift, go here.A 15% discount is available for Defiant Health podcast listeners by entering discount code UNDOC15 (case-sensitive) at checkout.*_________________________________________________________________________________Get your 15% Paleovalley discount on fermented grass-fed beef sticks, Bone Broth Collagen, low-carb snack bars and other high-quality organic foods here.* For 12% off every order of grass-fed and pasture-raised meats from Wild Pastures, go here._____________________________________________________________________________MyReuSupport the showBooks: Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose Weight Wheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health; revised & expanded ed

Could a common antibiotic for liver disease be creating a superbug nightmare? New research has found that rifaximin is driving the rise of a super-resistant strain of vancomycin-resistant Enterococcus faecium (VRE), now untreatable with even the strongest antibiotics. This spells danger, especially for vulnerable hospital patients.With the UN sounding the alarm on antibiotic resistance, these findings are a major wake-up call! Are we fueling the next big health crisis?Watch to learn what this means for the future of antibiotic prescriptions!Supplements Featured In This Episode:• Acceleradine® Iodine https://www.acceleratedhealthproducts.com/products/acceleradine-iodine-supplement • Accelerated Liver Care™ https://www.acceleratedhealthproducts.com/products/accelerated-liver-care • Accelerated Leaky Gut Bundle https://www.acceleratedhealthproducts.com/products/accelerated-leaky-gut-bundle

Az Euclid űrtávcső elküldte a világegyetem eddigi legnagyobb térképének első részét Telex     2024-10-24 04:30:03     Tudomány Világűr Térkép 14 millió galaxis látszik rajta, és a következő években még 99 hasonlót küld majd az űrtávcső. A szélvédőre vetítené a teljes infotainmentet a Hyundai Bitport     2024-10-24 08:01:00     Mobiltech Nyugdíj Dél-Korea Hyundai A dél-koreaiak a német Zeiss mérnökeivel fognak össze, hogy nyugdíjazzák a középkonzolok elmaradhatatlan elemét, az érintőképernyős kijelzőt. 78 éve készítették a fotót, ami először mutatta meg az űrből a Föld felszínét Player     2024-10-24 04:54:02     Tudomány USA Műhold Lehet, hogy a szovjetek voltak az elsők, akik műholdat állítottak pályára, de az amerikaiak készítették az első fotót az űrből. Mutatjuk is. A nárcisztikus fiatalokat rokonszenvesebbnek tartják kortársaik Mínuszos     2024-10-24 10:33:57     Tudomány ELTE Az Eötvös Loránd Tudományegyetem (ELTE) Pedagógiai és Pszichológiai Kar (PPK) kutatói új tanulmányukban azt vizsgálták, hogy van-e kapcsolat az úgynevezett sötét triád – nárcizmus, pszichopátia, machiavellizmus – és a társas elfogadás között serdülőkorban. Eredményeik szerint a nárcisztikus vonásokat mutató fiatalokat rokonszenvesebbnek és népszerű Fordított galaxist fedezett fel a James Webb űrtávcső ICT Global     2024-10-24 15:33:35     Infotech Világűr James Webb A világegyetem keletkezésének korai szakaszában a galaxisok fordítva léteztek – erősítették meg kutatók a James Webb űrtávcső felvételeinek elemzése alapján. Gyógyszer miatt alakult ki a veszélyes kórokozó 24.hu     2024-10-24 13:40:33     Tudomány Gyógyszer A kutatók azt vizsgálták, hogy miként fejlődhettek ki az ellenálló Enterococcus faecium törzsek. Jó üzlet a digitális pénztárcánk ITBusiness     2024-10-24 09:33:06     Cégvilág Infotech Fintech Két oldalról is szorongatják a hagyományos bankokat. Egyfelől a fintechek jelentek meg a színtéren: újszerű üzleti modelljeikkel és a szokványos banki szolgáltatásokhoz képest friss kínálatukkal alaposan beleharaptak a banki piacokba. Másrészt a világ legnagyobb tech cégei is meglátták a lehetőséget a pénzügyi szolgáltatásokban, és masszív globális Berobbant a bionika mérnöki tudománya Márkamonitor     2024-10-24 07:36:07     Tudomány Befektető A bionika az egyik leggyorsabban növekvő mérnöki tudományterület, a szektor a befektetők szerint is kiemelt profitábilitással rendelkezik. A The Business Research Company 2024 októberében publikált elemzése szerint piaca a 2023-as 12,39 milliárd dollárról 2024-re várhatóan 13,62 milliárd dollárra, míg 2028-ra 19,93 millió dollárra emelkedik, évenké Magyar ötlettől lehet jobb a gyémántkeresés First Class     2024-10-24 09:38:29     Tudomány Csongrád-Csanád Szeged Olcsó Dollármilliókkal olcsóbb, illetve kevésbé környezetterhelő lehet a jövőben a gyémántbányászat folyamata egy, a Szegedi Tudományegyetem zajló kutatás szerint. Elérhettük a várható élettartam maximumát, miközben a világ multimilliárdosai extrém módon epekednek az örök fiatalságért refresher.hu     2024-10-24 12:07:00     Tudomány Jay Olshansky legújabb tanulmányában az öregedés genetikai és környezeti tényezőinek összefüggését vizsgálta, amelyből kiderül, hogy a 21. században még a világ legfejlettebb országaiban is lassulni fog az átlagéletkor növekedése. Az AI-buborék kipukkanása után csak a cégek 1%-a marad életben PhoneBazis     2024-10-24 10:03:58     Infotech Kína Mesterséges intelligencia Startup A generatív mesterséges intelligencia (AI) növekvő népszerűsége számos startupot ösztönzött arra, hogy merész kijelentéseket tegyenek a technológia képességeiről. Sokan a jelenséget egy klasszikus piaci buborékhoz hasonlítják, amit a kínai technológiai óriás, a Baidu vezérigazgatója, Robin Li is oszt. Li úgy véli, hogy amikor az AI-vel kapcsolatos Jöhet az AI-alapú virtuális munkatársak következő generációja PhoneBazis     2024-10-24 08:06:35     Infotech Mesterséges intelligencia Generáció Microsoft A Microsoft új vállalati szintű Copilot funkcióján dolgozik, amely lehetővé teszi a cégek számára, hogy saját, testreszabott mesterséges intelligencia (AI) alapú virtuális munkatársakat hozzanak létre. Ez a projekt, amely a “Microsoft Copilot Studio” nevet kapta, az AI munkahelyi alkalmazásának következő lépését jelenti. Az év elején zárt béta tesz "Valakinek majdcsak briefelnie kell a Chat Gpt-t is" Digital Hungary     2024-10-24 05:37:00     Média Mesterséges intelligencia Reklám ChatGPT Chat Nem tart attól, hogy a mesterséges intelligencia elvenné a marketingszakemberek munkáját, és abban hisz, hogy ötvözni kell a már meglévő szaktudást az AI-eszközök adta újításokkal. Érzékeli, hogy a fiatal marketingeseknél olykor hiányoznak a biztos alapok – mint amilyen a briefírás képessége, amit ő még a McCann Ericskson reklámügynökségnél sajátít A további adásainkat keresd a podcast.hirstart.hu oldalunkon.

Az Euclid űrtávcső elküldte a világegyetem eddigi legnagyobb térképének első részét Telex     2024-10-24 04:30:03     Tudomány Világűr Térkép 14 millió galaxis látszik rajta, és a következő években még 99 hasonlót küld majd az űrtávcső. A szélvédőre vetítené a teljes infotainmentet a Hyundai Bitport     2024-10-24 08:01:00     Mobiltech Nyugdíj Dél-Korea Hyundai A dél-koreaiak a német Zeiss mérnökeivel fognak össze, hogy nyugdíjazzák a középkonzolok elmaradhatatlan elemét, az érintőképernyős kijelzőt. 78 éve készítették a fotót, ami először mutatta meg az űrből a Föld felszínét Player     2024-10-24 04:54:02     Tudomány USA Műhold Lehet, hogy a szovjetek voltak az elsők, akik műholdat állítottak pályára, de az amerikaiak készítették az első fotót az űrből. Mutatjuk is. A nárcisztikus fiatalokat rokonszenvesebbnek tartják kortársaik Mínuszos     2024-10-24 10:33:57     Tudomány ELTE Az Eötvös Loránd Tudományegyetem (ELTE) Pedagógiai és Pszichológiai Kar (PPK) kutatói új tanulmányukban azt vizsgálták, hogy van-e kapcsolat az úgynevezett sötét triád – nárcizmus, pszichopátia, machiavellizmus – és a társas elfogadás között serdülőkorban. Eredményeik szerint a nárcisztikus vonásokat mutató fiatalokat rokonszenvesebbnek és népszerű Fordított galaxist fedezett fel a James Webb űrtávcső ICT Global     2024-10-24 15:33:35     Infotech Világűr James Webb A világegyetem keletkezésének korai szakaszában a galaxisok fordítva léteztek – erősítették meg kutatók a James Webb űrtávcső felvételeinek elemzése alapján. Gyógyszer miatt alakult ki a veszélyes kórokozó 24.hu     2024-10-24 13:40:33     Tudomány Gyógyszer A kutatók azt vizsgálták, hogy miként fejlődhettek ki az ellenálló Enterococcus faecium törzsek. Jó üzlet a digitális pénztárcánk ITBusiness     2024-10-24 09:33:06     Cégvilág Infotech Fintech Két oldalról is szorongatják a hagyományos bankokat. Egyfelől a fintechek jelentek meg a színtéren: újszerű üzleti modelljeikkel és a szokványos banki szolgáltatásokhoz képest friss kínálatukkal alaposan beleharaptak a banki piacokba. Másrészt a világ legnagyobb tech cégei is meglátták a lehetőséget a pénzügyi szolgáltatásokban, és masszív globális Berobbant a bionika mérnöki tudománya Márkamonitor     2024-10-24 07:36:07     Tudomány Befektető A bionika az egyik leggyorsabban növekvő mérnöki tudományterület, a szektor a befektetők szerint is kiemelt profitábilitással rendelkezik. A The Business Research Company 2024 októberében publikált elemzése szerint piaca a 2023-as 12,39 milliárd dollárról 2024-re várhatóan 13,62 milliárd dollárra, míg 2028-ra 19,93 millió dollárra emelkedik, évenké Magyar ötlettől lehet jobb a gyémántkeresés First Class     2024-10-24 09:38:29     Tudomány Csongrád-Csanád Szeged Olcsó Dollármilliókkal olcsóbb, illetve kevésbé környezetterhelő lehet a jövőben a gyémántbányászat folyamata egy, a Szegedi Tudományegyetem zajló kutatás szerint. Elérhettük a várható élettartam maximumát, miközben a világ multimilliárdosai extrém módon epekednek az örök fiatalságért refresher.hu     2024-10-24 12:07:00     Tudomány Jay Olshansky legújabb tanulmányában az öregedés genetikai és környezeti tényezőinek összefüggését vizsgálta, amelyből kiderül, hogy a 21. században még a világ legfejlettebb országaiban is lassulni fog az átlagéletkor növekedése. Az AI-buborék kipukkanása után csak a cégek 1%-a marad életben PhoneBazis     2024-10-24 10:03:58     Infotech Kína Mesterséges intelligencia Startup A generatív mesterséges intelligencia (AI) növekvő népszerűsége számos startupot ösztönzött arra, hogy merész kijelentéseket tegyenek a technológia képességeiről. Sokan a jelenséget egy klasszikus piaci buborékhoz hasonlítják, amit a kínai technológiai óriás, a Baidu vezérigazgatója, Robin Li is oszt. Li úgy véli, hogy amikor az AI-vel kapcsolatos Jöhet az AI-alapú virtuális munkatársak következő generációja PhoneBazis     2024-10-24 08:06:35     Infotech Mesterséges intelligencia Generáció Microsoft A Microsoft új vállalati szintű Copilot funkcióján dolgozik, amely lehetővé teszi a cégek számára, hogy saját, testreszabott mesterséges intelligencia (AI) alapú virtuális munkatársakat hozzanak létre. Ez a projekt, amely a “Microsoft Copilot Studio” nevet kapta, az AI munkahelyi alkalmazásának következő lépését jelenti. Az év elején zárt béta tesz "Valakinek majdcsak briefelnie kell a Chat Gpt-t is" Digital Hungary     2024-10-24 05:37:00     Média Mesterséges intelligencia Reklám ChatGPT Chat Nem tart attól, hogy a mesterséges intelligencia elvenné a marketingszakemberek munkáját, és abban hisz, hogy ötvözni kell a már meglévő szaktudást az AI-eszközök adta újításokkal. Érzékeli, hogy a fiatal marketingeseknél olykor hiányoznak a biztos alapok – mint amilyen a briefírás képessége, amit ő még a McCann Ericskson reklámügynökségnél sajátít A további adásainkat keresd a podcast.hirstart.hu oldalunkon.

Enterococci are commensal microbes, part of the healthy microflora populating the human gut. But they are also opportunistic pathogens and notorious nosocomial agents with intrinsic traits that promote their pathogenesis and make them difficult to kill. In the third instalment of the Nightmare Series, hosts Angela Huttner and Thomas Tängdén are joined by enterococcal experts Kimberly Kline (University of Geneva) and Louis Rice (Brown University) to discuss what make vancomycin-resistant enterococci, or VRE, such a clinical nightmare. Enterococcus faecalis and Enterococcus faecium are the focus. This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Nunzia Esposito of the University of Naples Federico II, Naples, Italy. Literature  Stellfox ME et al. J Antimicrob Chemother 14 Feb 2024. doi: 10.1128/mbio.03396-23  Rogers R & Rice LB. Clin Infect Dis 15 Jan 2024. doi: 10.1093/cid/ciad613 Lebreton F et al. Cell 18 May 2017. doi: 10.1016/j.cell.2017.04.027 Donskey CJ et al. N Engl J Med 28 Dec 2000. doi: 10.1056/NEJM200012283432604

2024. július 23., kedd 6.30-8 óra NÉVNAPOK, ÉVFORDULÓK, HÍRES SZÜLETÉSNAPOSOK, JELES NAPOK LAPSZEMLE és TŐZSDEI HELYZETKÉP BUDAPEST, TE CSODÁS: hírek a fővárosból. Hol nézheted az 2024-es olimpiát Budapesten? Invazív gekkók élnek a budapesti utcákon. Túl koszos a Duna, két szabadstrandot bezártak E.coli és Enterococcus miatt. ÉBRESZTŐ TÉMA: Csődhullám söpör végig Magyarországon Fékezhetetlennek és visszafordíthatatlannak látszik a boltok számának csökkenése az országban, de ennek egyszerre több oka is van, a szakértők szerint. Tendenciózus csökkenésről van szó, a Szövetség szerint: mikor indult ez, és minek köszönhető? Milyen negatív hatásai lehetnek a boltbezárásonak? Mit jelent ez a cégek, kkv-k, gdp szempontjából? Miért elsősorban az élelmiszerboltok száma esett vissza? Milyen szektorok érintettek még komolyabban? Kozák Tamás, az Országos Kereskedelmi Szövetség főtitkára. PULZUS: nincs klíma, nincs műtét… A kánikulában bedöglöttek a kórhézi klímák, műtéteket kellett halasztani. Mennyire fenntartható ez az állapot? Dr. Nagy Marcell, igazságügyi foglalkozás-orvostan szakértő.

O torneio de tênis de Roland Garros começou no dia 20 de maio e está sendo considerado um sucesso para testar a organização dos Jogos Olímpicos de Paris. Entretanto, uma hashtag que apareceu recentemente nas redes sociais, propondo a poluição deliberada do rio Sena com excrementos, em forma de protesto contra a prefeita Anne Hidalgo, preocupa as autoridades. Ainda não foram divulgados números oficiais, mas o torneio de tênis de Roland Garros deve bater um novo recorde de público neste ano. Apesar do tempo chuvoso e frio para um mês de maio, os espectadores têm feito longas filas para assistir às partidas e estão em geral satisfeitos com a organização, que já aplica o mesmo esquema de segurança dos Jogos Olímpicos de Paris 2024.O visitante não se dá conta, mas o esquema de policiamento se estende desde a linha 10 do metrô em Paris, que dá acesso ao estádio, a um amplo perímetro ao redor das instalações. As quadras de Roland Garros ficam ao lado do Parque dos Príncipes, que é o estádio de futebol do PSG. Os dois locais vão acolher competições na Olimpíada, de 26 de julho a 11 de agosto.A diretora de Roland Garros, a ex-tenista Amélie Mauresmo, está satisfeita com o resultado das medidas de segurança tomadas. Entretanto, continuam surgindo hashtags de protesto nas redes sociais contra a prefeitura da Paris pela organização dos eventos olímpicos.Há uma semana, apareceu uma piada de mau gosto nas redes sociais, do tipo escatológica, contra a prefeita de Paris, Anne Hidalgo, logo depois dela anunciar que vai mergulhar e nadar no rio Sena no dia 23 de junho, para provar que ele está limpo e apto para receber provas de maratona aquática e a natação do triatlo durante os Jogos.Logo depois desse anúncio, surgiu uma hashtag na rede social X (#JechiedanslaSeinele23juin) incentivando as pessoas a defecar nas águas do Sena nessa data, em uma provocação que demonstra insatisfação de uma parcela dos parisienses com a prefeita.Esta hashtag, por mais inusitada e desagradável que pareça, viralizou, ganhou um grande número de apoiadores e migrou para programas de TV. Irritada, a prefeita socialista reagiu dizendo que não aguentava mais as críticas à organização da Olimpíada e sugeriu aos parisienses que não estivessem contentes que deixassem a cidade.Custo de despoluição do rio e gestão de Hidalgo atraem hatersO debate gerado por essa hashtag aponta uma insatisfação dos internautas com o custo das obras de tratamento do rio. Para eliminar a poluição do Sena, onde é proibido nadar há cem anos, o governo francês e as autoridades locais já gastaram cerca de € 1,4 bilhão, cerca de R$ 8 bilhões, desde 2016. No ano passado, o conselho municipal de Paris, presidido pela prefeita, aumentou o IPTU em 62%, de uma só vez, depois de Anne Hidalgo ter afirmado durante a campanha para a reeleição, em 2020, que não iria aumentar os impostos para pagar a dívida municipal, estimada em € 8,8 bilhões em 2024 e € 9,9 bilhões em 2025, ou financiar a Olimpíada.A insatisfação dos parisienses com a prefeita também foi crescendo com a insistência dela em promover os Jogos Olímpicos no centro da cidade e outros projetos polêmicos, como a expulsão dos carros do centro de Paris e gastos apontados como “extravagantes”. Entre eles, a instalação de projetos de moradia popular em bairros de alto padrão, onde o metro quadrado custa caro, para forçar a convivência social entre pobres e ricos.Nesta quinta-feira (30), em entrevista ao canal BFMTV, Michel Riottot, um engenheiro ex-pesquisador do Centro Nacional de Pesquisas Científicas (CNRS), disse que apesar dos esforços realizados nos últimos 30 anos, que melhoraram o grau de limpeza das águas do Sena, ainda existem ligações irregulares entre a rede de esgoto doméstico e a rede de esgoto pluvial que levam dejetos diretamente para o Sena. Ele citou um ponto crítico, que seria a estação de saneamento de Valenton, em Val-de-Marne, na periferia de Paris.Piada de mau gosto ou ingerência externa? Os franceses são criativos nos protestos e às vezes justificam o uso da violência para demonstrar repúdio diante de medidas que consideram arbitrárias das autoridades. Por enquanto, a prefeitura está alertando que usar o rio Sena como banheiro é passível de uma multa de € 68 (cerca de R$ 390,00), enquanto os internautas continuam fazendo planos de jogar sacos plásticos com excrementos no rio no dia D, 23 de junho, para manter o tom de provocação em relação à prefeita.Ninguém sabe a origem desta hashtag. Alguns chegaram a cogitar se não seria mais uma ingerência externa para prejudicar a imagem de Paris. Mas os internautas têm mantido um debate técnico de um nível elevado que não parece ser promovido por robôs automáticos. Por outro lado, o envolvimento da Rússia em campanhas de desinformação para prejudicar a imagem de Paris e dos Jogos Olímpicos tem sido evidenciado por investigações feitas pelos serviços de inteligência franceses. Em março, a ONG Surfrider Foundation publicou resultados de análises que realizou durante seis meses para medir a qualidade da água do Sena. A ONG apontou que 13 das 14 medições realizadas estavam “acima, ou mesmo muito acima” dos limites recomendados para natação. Os resultados foram atribuídos à alta concentração de duas bactérias de origem fecal (Escherichia coli e Enterococcus faecalis). Desde então, persiste esta dúvida sobre a qualidade das águas, e a prefeita Anne Hidalgo é alvo de haters. Ela garante que foram feitas as obras necessárias para sanear os problemas de contaminação.

How Election Science Can Support DemocracyThis week, the election season shifted into full gear with the Super Tuesday slate of primaries. But as the ballot options become more cemented, it's not just pollsters and campaign operatives who are preparing for the elections—scientists are too.The Union of Concerned Scientists has established what it calls an election science task force, looking at everything from ballot design to disinformation to voting security. Dr. Jennifer Jones, program director for the Center for Science and Democracy at the Union of Concerned Scientists, joins Ira to describe the goals of the effort in the weeks and months ahead.The Genetic Roots Of Antibiotic ResistanceAntibiotic resistance—when pathogens no longer respond to the conventional antibiotic medications—is a serious medical problem. According to the CDC, over 2.8 million antibiotic-resistant infections occur in the U.S. each year, causing some 35,000 deaths. It's in part due to overprescription of antibiotics in medicine, and the widespread use of antibiotics in animal agriculture. But the problem isn't entirely of humans' making. The roots of antibiotic resistance go back millions of years.A recent study in the Proceedings of the National Academy of Sciences collected hundreds of soil and poop samples from around the world, to try to trace back the genetics of how resistance arose in Enterococcus, a genus of bacteria that live in the guts of pretty much every land animal. In the course of their analysis, the researchers identified 18 entirely new species in the genus Enterococcus, with over 1,000 genes that had never been seen before.Dr. Michael Gilmore, the Chief Scientific Officer at Mass Eye and Ear, joins Ira to talk about the study and what the team hopes to learn about the causes of antibiotic resistance.Transcripts for each segment will be available the week after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Originally released as episode 53, in this episode I go over Enterococcus species. What are the most clinically significant species of Enterococcus? Morphology? Biochemicals? Tune in to find out more about these organisms, and why are they so significant in healthcare settings.

La Alcaldía Venustiano Carranza instaló una pista de hielo en la explanada Atacan a familia que venia de Utha, EU, en la carretera Altar-Santa Ana, SonoraLos chilenos dijeron NO por segunda ocasión a cambiar la constituciónMás información en nuestro podcast

Trial of the Week: Linezolid v Daptomycin in VRE BSI Special Guest: Nick Britt, PharmD, MS, BCPS, BCIDP Nick Britt joins to highlight his first-author research comparing the use of linezolid v. daptomycin for treatment of vancomycin-resistant Enterococcus bloodstream infection (VRE BSI) published in Clinical Infectious Diseases in 2015. We review what the standard of care was for treatment at this time, how this study became to be, covering this featured article and discussing outcomes/results, then reviewing studies published since, how we still use results from this study, and much, much more. Reference list: https://pharmacytodose.files.wordpress.com/2023/09/dapto-v-linez-vre-bsi-references.pdf PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Antibiotic resistance is a global challenge, but the solution may come from the natural predator of bacteria. Bacterial infections can be nasty, but you can engineer a phage to help better identify and treat them. Knowing exactly which bacteria is causing problems can help doctors target treatment more precisely and tailor antibiotic courses. Using bacteriophages  you can quickly identify and then eliminate common types of bacterial infections. Jiemin Du, Susanne Meile, Jasmin Baggenstos, Tobias Jäggi, Pietro Piffaretti, Laura Hunold, Cassandra I. Matter, Lorenz Leitner, Thomas M. Kessler, Martin J. Loessner, Samuel Kilcher, Matthew Dunne. Enhancing bacteriophage therapeutics through in situ production and release of heterologous antimicrobial effectors. Nature Communications, 2023; 14 (1) DOI: 10.1038/s41467-023-39612-0 Susanne Meile, Jiemin Du, Samuel Staubli, Sebastian Grossmann, Hendrik Koliwer-Brandl, Pietro Piffaretti, Lorenz Leitner, Cassandra I. Matter, Jasmin Baggenstos, Laura Hunold, Sonja Milek, Christian Guebeli, Marko Kozomara-Hocke, Vera Neumeier, Angela Botteon, Jochen Klumpp, Jonas Marschall, Shawna McCallin, Reinhard Zbinden, Thomas M. Kessler, Martin J. Loessner, Matthew Dunne, Samuel Kilcher. Engineered reporter phages for detection of Escherichia coli, Enterococcus, and Klebsiella in urine. Nature Communications, 2023; 14 (1) DOI: 10.1038/s41467-023-39863-x

Peat-free and peat-reduced growing media may lack beneficial microbes to promote break down of plant residues, improve soil carbon and pH; and help to provide plants with available nutrients throughout the season. ICL's technical controls manager Sam Rivers explains that the microbial inoculant Vitalnova Triboost consists of a population of beneficial microbes. It contains enzymes and three live cultures of Bacillus subtilis, Enterococcus faecium and Lactobacillus plantarum – all freeze-dried.TriBoost treated plants saw better rooting and were ready for sale 2-3 weeks earlier. Hosted on Acast. See acast.com/privacy for more information.

This is part 2 of a two part series. Dr. Rachael Liesman goes over scenarios where genotypic and phenotypic testing do not match and what to do. What do you do when your molecular instrument detects mec-A and Staphylococcus aureus but your susceptibility report shows oxacillin susceptible? What about VanA and Enterococcus? As Medical Laboratory Scientists in Microbiology, we encounter this type of situations. Tune in to find out how to troubleshoot these discrepancies. Link to Dr. Patricia Simner's article: https://journals.asm.org/doi/full/10.1128/JCM.00138-20

Episode Notes Episode Notes Inspired by lamentations on Twitter, Drs. Bobbi Jo Stoner (@BobbiJo_Stoner), Jonathan Ryder (@JonathanRyderMD) and Sami El-Dalati join Dr. Jillian Hayes (@thejillianhayes) to hash out some of the controversies we encounter while managing infective endocarditis. Do we really need gentamicin and rifampin for all cases of staphylococcal prosthetic valve endocarditis? Where do oral antimicrobials fit into this disease state? Who should have a seat at the table to provide the most comprehensive care to these patients? Tune in for the answers to these questions and more! Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ References: IDSA/AHA Infective Endocarditis Guidelines: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000296 Deconstructing the Dogma: Systematic Literature Review and Meta-analysis of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve Endocarditis: https://pubmed.ncbi.nlm.nih.gov/36408468/ Twitter Poll – Gabe Vilchez (March 2021): https://twitter.com/IdVilchez/status/1372148761112240131?s=20&t=fYuyNWGmzZACWrpUb7Fp3g Survey of ID Physicians on Gent and Rifampin Use: https://pubmed.ncbi.nlm.nih.gov/32964063/ Bacteriological outcome of combination versus single-agent treatment for staphylococcal endocarditis: https://academic.oup.com/jac/article/52/5/820/760105 Treatment of experimental foreign body infection caused by methicillin-resistant Staphylococcus aureus: https://journals.asm.org/doi/abs/10.1128/AAC.34.12.2312 Successful therapy of experimental chronic foreign-body infection due to methicillin-resistant Staphylococcus aureus by antimicrobial combinations: https://journals.asm.org/doi/abs/10.1128/aac.35.12.2611 Rifampin Combination Therapy for Nonmycobacterial Infections: https://journals.asm.org/doi/10.1128/CMR.00034-09 ARREST Trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32456-X/fulltext Is Rifampin Use Associated With Better Outcome in Staphylococcal Prosthetic Valve Endocarditis? A Multicenter Retrospective Study: https://pubmed.ncbi.nlm.nih.gov/32706879/ Nephrotoxicity of vancomycin, alone and with an aminoglycoside: https://pubmed.ncbi.nlm.nih.gov/2351627/ Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia: https://journals.asm.org/doi/10.1128/AAC.02483-18 Multicenter Cohort of Patients With Methicillin-Resistant Staphylococcus aureus Bacteremia Receiving Daptomycin Plus Ceftaroline Compared With Other MRSA Treatments: https://academic.oup.com/ofid/article/7/1/ofz538/5691187 CERT Trial (in process): https://clinicaltrials.gov/ct2/show/NCT04886284 Rifampin for Surgically Treated Staphylococcal Infective Endocarditis: A Propensity Score-Adjusted Cohort Study: https://pubmed.ncbi.nlm.nih.gov/26872729/ A step-by-step guide to implementing a multidisciplinary endocarditis team: https://journals.sagepub.com/doi/10.1177/20499361211065596 Management of Infective Endocarditis in People Who Inject Drugs: A Scientific Statement from the American Heart Association: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001090?cookieSet=1 Infectious Complications of Addiction: A Call for a New Subspecialty Within Infectious Diseases: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7319263/ A Cross-sectional Analysis of Linezolid in Combination with Methadone or Buprenorphine as a Cause of Serotonin Toxicity: https://academic.oup.com/ofid/article/9/7/ofac331/6625822 POET Trial: https://www.nejm.org/doi/full/10.1056/nejmoa1808312 Risk of New Bloodstream Infections and Mortality Among People Who Inject Drugs With Infective Endocarditis: https://pubmed.ncbi.nlm.nih.gov/32785635/ Comparing right- and left sided injection-drug related infective endocarditis: https://pubmed.ncbi.nlm.nih.gov/33441950/ Evaluation of Partial Oral Antibiotic Treatment for Persons Who Inject Drugs and Are Hospitalized With Invasive Infections: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745005/ Dalbavancin as Primary and Sequential Treatment for Gram-Positive Infective Endocarditis: 2-Year Experience at the General Hospital of Vienna: https://pubmed.ncbi.nlm.nih.gov/29659732/ Impact of the duration of antibiotic therapy on relapse and survival following surgery for active infective endocarditis: https://academic.oup.com/ejcts/article/55/4/760/5126415 Bacteriological Outcome after Valve Surgery for Active Infective Endocarditis: Implications for Duration of Treatment after Surgery: https://academic.oup.com/cid/article/41/2/187/529954 Long-term Risk of Hemorrhagic Stroke in Patients With Infective Endocarditis: A Danish Nationwide Cohort Study: https://academic.oup.com/cid/article/68/4/668/5039147 Sign of the Times: Updating Infective Endocarditis Diagnostic Criteria to Recognize Enterococcus faecalis as a Typical Endocarditis Bacterium: https://pubmed.ncbi.nlm.nih.gov/35262664/ Prevalence of colorectal disease in Enterococcus faecalis infective endocarditis: results of an observational multicenter study: https://pubmed.ncbi.nlm.nih.gov/31444092/ Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

3.05 Streptococcus Species   Microbiology review for the USMLE Step 1 Exam.   Streptococcus bacteria are gram positive cocci that form linear chains Hemolysis refers to the ability of bacteria to break down red blood cells and is classified as alpha (partial), beta (complete), or gamma (none) Alpha hemolytic streptococci include viridans streptococci and Streptococcus pneumoniae Viridans streptococci, particularly Streptococcus mutans, are common causes of dental cavities and endocarditis, while Streptococcus pneumoniae is a common cause of pneumonia Beta hemolytic streptococci include Group A streptococci (Streptococcus pyogenes) and Group B streptococci (Streptococcus agalactiae) Group A streptococci can cause strep throat, impetigo, and cellulitis, as well as more serious infections like scarlet fever and rheumatic fever Group B streptococci are commonly found in the vagina and rectum, and can cause infections in newborns and pregnant women, as well as urinary tract infections and pneumonia Gamma hemolytic streptococci include the Enterococcus species, which can cause urinary tract infections, endocarditis, and other infections, and can be resistant to some antibiotics Lancefield grouping refers to the presence of different types of carbohydrate antigens on the surface of streptococcus bacteria and is used in classification and identification of streptococcus species

Çocuklarda ateş yüksekliği acil servislerde sık karşılaştığımız bir durum olup, çoğunlukla viral enfeksiyonlara bağlıdır. Ancak tedavi yönünü tamamen değiştirecek bakteriyel enfeksiyonlara bağlı nedenleri de gözden kaçırmamak gerekir. Çocuklarda ateşin yaklaşık % 7'si idrar yolu enfeksiyonlarından (İYE) kaynaklanır. Uzun dönemde böbrek hastalıklarına da yol açabilecek bu tabloya acilci gözüyle yaklaşmak istedim. Yazıda yenidoğan dönemi dışındaki çocukluk çağı idrar yolu enfeksiyonlarından bahsedilmiştir. Keyifli okumalar dilerim. ​1​ ​2​ ​3​ Giriş İYE'nin genel prevalansı ateşli çocuklar arasında yaklaşık % 7 olsa da özellikle üç aydan küçük sünnetsiz erkek çocuklarda en yüksektir. Kız çocuklarda İYE sünnetli erkek çocuklara kıyasla iki ila dört kat daha fazla görülür. E. coli, % 80 oranıyla İYE'nin en yaygın bakteriyel nedenidir, diğer gram negatif bakteriyel patojenler arasında Klebsiella, Proteus, Enterobacter ve Citrobacter bulunur. Gram-pozitif bakteriyel etkenler arasında Staph. saprophyticus, Enterococcus ve nadiren Staph. aureus yer alır. E. coli dışındaki bir nedenle enfeksiyon, daha yüksek renal skar (dolayısıyla hipertansiyon ve son dönem böbrek hastalığı) olasılığı ile ilişkilidir. Virüsler ve mantarlar çocuklarda İYE'nin yaygın olmayan nedenleridir. Viral İYE genellikle alt üriner sistemle sınırlıdır. Fungal İYE için risk faktörleri, immünsüpresyon, geniş spektrumlu antibiyotik tedavisinin uzun süreli kullanımı ve kalıcı üriner kateter varlığıdır. Kime Test Yapalım? Nasıl Değerlendirelim? Verilmesi gereken ilk karar kimden idrar testi isteyeceğimizdir. Bu konudaki ilk zorluk küçük çocukların karın ağrısı, sırt ağrısı, dizüri, sık idrara çıkma gibi İYE ilişkili semptomları tanımlayamamasıdır. Bu gruptaki çocuklarda ateş, kusma ve huzursuzluk gibi non-spesifik semptomlar görülür. İYE olasılığını tahmin edebilen ve Pittsburg Üniversitesi'ne ait ‘UTICalc' hesaplayıcısı, idrar testi isteme konusundaki yardımcılardan biridir. Peki kimlerde risk fazladır ve dolayısıyla test eşiği düşük tutulmalıdır? Geçirilmiş İYE öyküsü Kadın cinsiyet Küçük yaş 1 yaşından küçük sünnetsiz erkekler > 39 derece ateş 48 saati geçen ateş Kusma Başka net bir ateş kaynağı olmaması Bağırsak ve mesane disfonksiyonu (kronik kabızlık dahil) VUR başta olmak üzere genitoüriner anormallikler Peki örnek nasıl alınmalıdır? Tuvalet eğitimi olmayan çocuklarda dipstick analizi, mikroskobik inceleme ve idrar kültürü için tercih edilen idrar toplama yöntemi kateterizasyon veya suprapubik aspirasyondur. Deneyimli personel varlığında quick-wee gibi teknikler kullanılabilir. Steril idrar poşeti ile örnek alınacaksa kültür için kullanılmamalıdır. Poşet örnekleri, dipstick analizi ve mikroskobik inceleme için ilk adım olarak kullanılabilir. Tuvalet eğitimi olan çocuklarda tüm bu tetkikler için orta akım idrarı kullanılabilir. Tüm idrar örnekleri alındıktan sonra yanlış sonuçlara sebebiyet vermemek için mümkün olan en kısa sürede incelenmelidir. İYE tanısı için kullanılan karakteristik testler. Kaynak: uptodateLE: lökosit esteraz Kimi Hastaneye Yatıralım? Kimi Taburcu Edelim? Hastaneye yatırılması gereken hasta grupları şu şekilde özetlenebilir: Yaş

This episodes is about microbes in food. It features a conversation with Dr. Andrea Prinzi. Those of us that work in Microbiology are familiar with foods such as yogurt containing microbes. What about feta cheese? Enterococcus in your food? Tune in to find out more about this interesting topic that includes a popular meat substitute.Link to article: https://asm.org/Articles/2021/January/Microbes-That-Span-the-Clinical-Lab-and-Your-Groce

Dr. Jacqueline Sherbuk, Assistant Professor at the Morsani College of Medicine Division of Infectious Diseases, presents a review on several important classes of clinically significant gram-positive bacteria. Dr. Sherbuk begins by discussing Staphylococcus aureus, MRSA, and Coagulase negative Staphylococci and some of the clinical syndromes they can cause. Next, Dr. Sherbuk introduces Streptococcus pneumonia and the syndrome of invasive pneumococcal disease. Then, Group A strep pyogenes, the viridans streptococci, and the variant streptococci are related. Also presented are Enterococcus faecalis and vancomycin resistant enterococcus faecium. Lastly, Dr. Sherbuk references Corynebacterium spp., Listeria, Bacillus, and Erysipelothirx spp.

On episode #12 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the previous two weeks, 9/15/22 – 9/28/22. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of Puscast! Links for this episode Use of long-acting cabotegravir plus rilpivirine for people living with HIV-1 (HIV Medicine) Effectiveness of different antimicrobial strategies for staphylococcal prosthetic joint infection (OFID) Antibiotic Treatment Duration in Pseudomonas aeruginosa ventilator associated pneumonia (CID) Polymicrobial Foot Infection Patterns are common & associated With treatment failure (OFID) Faecal microbiota transplantation for first or second C. difficile infection (EarlyFMT)  Impact of Enterococcus faecalis endocarditis treatment on risk of relapse (CID) Comparison between culture-positive and culture-negative septic shock in patients (NIH) Evaluation of serum mucorales PCR for the diagnosis of Mucormycoses (CID) Humanized transgenic mice are resistant to chronic wasting disease prions from Norwegian reindeer and moose (JID) Dentist's visits and risk of brain abscess (CID) Music is by Ronald Jenkees

In this episode I go over Enterococcus species. What are the most clinically significant species of Enterococcus? Morphology? Biochemicals? Tune in to find out more about these organisms, and why are they so significant in healthcare settings.

Drs. Tom Dilworth and Stephanie Shealy May (@stephshealymay) join Dr. Rachel Britt (@RachelBPharmD) in the first episode of Breakpoints Dosing Consults to discuss questions and debates around ceftriaxone dosing. When should we use 1g over 2g? How does critical illness affect what dose to use? Is ceftriaxone the most approachable antibiotic? Tune in for answers to these questions and more!   Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References Ettestad PJ, Campbell GL, Welbel SF, Genese CA, Spitalny KC, Marchetti CM, Dennis DT. Biliary complications in the treatment of unsubstantiated Lyme disease. J Infect Dis. 1995 Feb;171(2):356-61. doi: 10.1093/infdis/171.2.356. PMID: 7844372. Hasegawa S, Sada R, Yaegashi M, Morimoto K, Mori T; Adult Pneumonia Study Group-Japan. 1g versus 2 g daily intravenous ceftriaxone in the treatment of community onset pneumonia - a propensity score analysis of data from a Japanese multicenter registry. BMC Infect Dis. 2019 Dec 26;19(1):1079. doi: 10.1186/s12879-019-4552-8. PMID: 31878894; PMCID: PMC6933656. Barber KE, Loper JT, Morrison AR, Stover KR, Wagner JL. Impact of Obesity on Ceftriaxone Efficacy. Diseases. 2020 Jul 9;8(3):27. doi: 10.3390/diseases8030027. PMID: 32660113; PMCID: PMC7563366. Herrera-Hidalgo L, de Alarcón A, López-Cortes LE, Luque-Márquez R, López-Cortes LF, Gutiérrez-Valencia A, Gil-Navarro MV. Is Once-Daily High-Dose Ceftriaxone plus Ampicillin an Alternative for Enterococcus faecalis Infective Endocarditis in Outpatient Parenteral Antibiotic Therapy Programs? Antimicrob Agents Chemother. 2020 Dec 16;65(1):e02099-20. doi: 10.1128/AAC.02099-20. Erratum in: Antimicrob Agents Chemother. 2021 May 18;65(6): PMID: 33046488; PMCID: PMC7927845. Herrera-Hidalgo L, Lomas-Cabezas JM, López-Cortés LE, Luque-Márquez R, López-Cortés LF, Martínez-Marcos FJ, de la Torre-Lima J, Plata-Ciézar A, Hidalgo-Tenorio C, García-López MV, Vinuesa D, Gutiérrez-Valencia A, Gil-Navarro MV, De Alarcón A. Ampicillin Plus Ceftriaxone Combined Therapy for Enterococcus faecalis Infective Endocarditis in OPAT. J Clin Med. 2021 Dec 21;11(1):7. doi: 10.3390/jcm11010007. PMID: 35011748; PMCID: PMC8745305. Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34292926; PMCID: PMC8344968. Whittles LK, White PJ, Paul J, Didelot X. Epidemiological Trends of Antibiotic Resistant Gonorrhoea in the United Kingdom. Antibiotics (Basel). 2018 Jul 13;7(3):60. doi: 10.3390/antibiotics7030060. PMID: 30011825; PMCID: PMC6165062. Ackerman A, Zook NR, Siegrist JF, Brummitt CF, Cook MM, Dilworth TJ. Comparison of Clinical Outcomes among Intensive Care Unit Patients Receiving One or Two Grams of Ceftriaxone Daily. Antimicrob Agents Chemother. 2020 May 21;64(6):e00066-20. doi: 10.1128/AAC.00066-20. PMID: 32205348; PMCID: PMC7269488. Ulldemolins M, Roberts JA, Rello J, Paterson DL, Lipman J. The effects of hypoalbuminaemia on optimizing antibacterial dosing in critically ill patients. Clin Pharmacokinet. 2011 Feb;50(2):99-110. doi: 10.2165/11539220-000000000-00000. PMID: 21142293. Dailly E, Arnould JF, Fraissinet F, Naux E, Letard de la Bouralière MA, Bouquié R, Deslandes G, Jolliet P, Le Floch R. Pharmacokinetics of ertapenem in burns patients. Int J Antimicrob Agents. 2013 Jul;42(1):48-52. doi: 10.1016/j.ijantimicag.2013.02.021. Epub 2013 Apr 8. PMID: 23578794. Pai MP. Treatment of bacterial infections in obese adult patients: how to appropriately manage antimicrobial dosage. Curr Opin Pharmacol. 2015 Oct;24:12-7. doi: 10.1016/j.coph.2015.06.004. Epub 2015 Jun 25. PMID: 26119488. Mahmood I. Theoretical versus empirical allometry: Facts behind theories and application to pharmacokinetics. J Pharm Sci. 2010 Jul;99(7):2927-33. doi: 10.1002/jps.22073. PMID: 20127826. Kang N, Housman ST, Nicolau DP. Assessing the Surrogate Susceptibility of Oxacillin and Cefoxitin for Commonly Utilized Parenteral Agents against Methicillin-Susceptible Staphylococcus aureus: Focus on Ceftriaxone Discordance between Predictive Susceptibility and in Vivo Exposures. Pathogens. 2015 Jul 30;4(3):599-605. doi: 10.3390/pathogens4030599. PMID: 26264030; PMCID: PMC4584275. Gern BH, Greninger AL, Weissman SJ, Stapp JR, Tao Y, Qin X. Continued in vitro cefazolin susceptibility in methicillin-susceptible Staphylococcus aureus. Ann Clin Microbiol Antimicrob. 2018 Feb 20;17(1):5. doi: 10.1186/s12941-018-0257-x. PMID: 29463249; PMCID: PMC5819674. Bremmer DN, Balada-Llasat JM, Goff DA, Bauer KA. Ceftriaxone Etest non-susceptible methicillin susceptible Staphylococcus aureus time-kill responses. Diagn Microbiol Infect Dis. 2017 Jun;88(2):192-194. doi: 10.1016/j.diagmicrobio.2017.02.019. Epub 2017 Mar 2. PMID: 28291629. Kosowska-Shick K, McGhee PL, Appelbaum PC. Affinity of ceftaroline and other beta-lactams for penicillin-binding proteins from Staphylococcus aureus and Streptococcus pneumoniae. Antimicrob Agents Chemother. 2010 May;54(5):1670-7. doi: 10.1128/AAC.00019-10. Epub 2010 Mar 1. PMID: 20194704; PMCID: PMC2863635. Palmer SM, Kang SL, Cappelletty DM, Rybak MJ. Bactericidal killing activities of cefepime, ceftazidime, cefotaxime, and ceftriaxone against Staphylococcus aureus and beta-lactamase-producing strains of Enterobacter aerogenes and Klebsiella pneumoniae in an in vitro infection model. Antimicrob Agents Chemother. 1995 Aug;39(8):1764-71. doi: 10.1128/AAC.39.8.1764. PMID: 7486916; PMCID: PMC162823. Craig WA. Interrelationship between pharmacokinetics and pharmacodynamics in determining dosage regimens for broad-spectrum cephalosporins. Diagn Microbiol Infect Dis. 1995 May-Jun;22(1-2):89-96. doi: 10.1016/0732-8893(95)00053-d. PMID: 7587056. Garot D, Respaud R, Lanotte P, Simon N, Mercier E, Ehrmann S, Perrotin D, Dequin PF, Le Guellec C. Population pharmacokinetics of ceftriaxone in critically ill septic patients: a reappraisal. Br J Clin Pharmacol. 2011 Nov;72(5):758-67. doi: 10.1111/j.1365-2125.2011.04005.x. PMID: 21545483; PMCID: PMC3243010. Joynt GM, Lipman J, Gomersall CD, Young RJ, Wong EL, Gin T. The pharmacokinetics of once-daily dosing of ceftriaxone in critically ill patients. J Antimicrob Chemother. 2001 Apr;47(4):421-9. doi: 10.1093/jac/47.4.421. PMID: 11266414. Van Wart SA et al., ICAAC 2009, poster # A1-010 Housman ST, Sutherland CA, Nicolau DP. Pharmacodynamic profile of commonly utilised parenteral therapies against meticillin-susceptible and meticillin-resistant Staphylococcus aureus collected from US hospitals. Int J Antimicrob Agents. 2014 Sep;44(3):235-41. doi: 10.1016/j.ijantimicag.2014.05.012. Epub 2014 Jun 24. PMID: 25052866. Zelenitsky SA, Beahm NP, Iacovides H, Ariano RE, Zhanel G. Limitations of ceftriaxone compared with cefazolin against MSSA: an integrated pharmacodynamic analysis. J Antimicrob Chemother. 2018 Jul 1;73(7):1888-1894. doi: 10.1093/jac/dky120. PMID: 29635472. Paul M, Zemer-Wassercug N, Talker O, Lishtzinsky Y, Lev B, Samra Z, Leibovici L, Bishara J. Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia? Clin Microbiol Infect. 2011 Oct;17(10):1581-6. doi: 10.1111/j.1469-0691.2010.03425.x. Epub 2010 Dec 14. PMID: 21073629. Carr DR, Stiefel U, Bonomo RA, Burant CJ, Sims SV. A Comparison of Cefazolin Versus Ceftriaxone for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia in a Tertiary Care VA Medical Center. Open Forum Infect Dis. 2018 May 18;5(5):ofy089. doi: 10.1093/ofid/ofy089. PMID: 30568987; PMCID: PMC5961173. Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Dr. Austin Morrison, Infectious Diseases/Antimicrobiaql Stewardship pharmacist at Moffitt Cancer Center and Research Institute, presents a lecture on the use of dual therapy in gram positive infections. Dr. Morrison begins by discussing dual therapy for Staphylococcus aureus infections, and then transitions to discuss similar therapy for Enterococcus faecalis. Dr. Morrison shares information on mechanisms of action, the rationale for dual beta lactams, and the use of daptomycin with beta-lactams.

Dr. Scott Crabtree joins Sara for this Febrile Digest to discuss the https://sites.google.com/view/pharmageddon (Pharmageddon )game and a few questions and pearls about Enterococcus. When do we treat Enterococcus in intra-abdominal infections? Are patients with Enterococcus + IAI at risk for treatment failure/death? Don't forget!!  Please consider filling out this research survey to help us better understand how you use the Febrile learning resource and what can be improved!  Your input will help guide future programming and only takes 5-10 min!! https://hms.az1.qualtrics.com/jfe/form/SV_6o2iYLc1Sq7PMQC (https://hms.az1.qualtrics.com/jfe/form/SV_6o2iYLc1Sq7PMQC) Survey is voluntary, and all responses are anonymous.  If you have questions regarding this survey, please email swdong@bidmc.harvard.edu. Check out the Kickstarter: https://www.kickstarter.com/projects/pharmageddon/pharmageddon-bugs-vs-drugs (https://www.kickstarter.com/projects/pharmageddon/pharmageddon-bugs-vs-drugs) https://febrilepodcast.com/episodes/ (Episodes) |https://febrilepodcast.com/consult-notes/ ( Consult Notes) |https://febrilepodcast.captivate.fm/listen ( Subscribe) |https://twitter.com/febrilepodcast ( Twitter) | febrilepodcast@gmail.com

Episode 86: Abdominal Pain Case. Spikevax® is the brand name of the Moderna COVID-19, and it received full FDA approval in January 2022. Hepatitis B vaccine is now universally recommended to all adults between 19-59 years of age, or older than 60 with risk factors. Deidra Sieck presents a case of abdominal pain in pregnancy and differential diagnosis are discussed.  Introduction: Spikevax ® and Hepatitis B universal vaccination.  Written by Hector Arreaza, MD. Participation by Cecilia Covenas, MD.Spikevax®. This is the brand name given to the mRNA COVID-19 vaccine manufactured by Moderna. It was given full FDA approval for the prevention of COVID-19 in adults 18 years and older. This is the second vaccine approved by the FDA for the prevention of COVID-19 (the first vaccine was Comirnaty®, formerly known as Pfizer Vaccine.) The primary series of Spikevax for immunocompetent adults is comprised of 2 doses, 4 weeks apart. Immunocompromised patients receive a 3rd dose as part of the primary series, one month after the second dose. A booster shot of Spikevax is given at least 5 months after completing the primary series. Spikevax was also authorized for use as a “mix and match” single booster dose following completion of primary vaccination with a different COVID-19 vaccine. It means that recipients of the Pfizer and J&J vaccines who are 18 years and older may receive a single booster dose of Spikevax. The full FDA approval was granted to Spikevax on January 31, 2022.Did you know that Hepatitis B has killed 40 times more unvaccinated healthcare workers than HIV?  Yes, that's right. Hepatitis B is 50 to 100 times more infectious than HIV. It is transmitted by percutaneous or mucosal exposure to infected blood or other bodily fluids. As a reminder, immunizations against many diseases have been required for health care workers for decades, and hepatitis B is one of those required vaccines. That's not new, what's new is the new recommendation about universal Hep B vaccination. In November 2021, the ACIP (Advisory Committee on Immunization Practices from CDC) recommended universal adult Hepatitis B vaccination. After reviewing clinical evidence, the ACIP has unanimously voted to recommend the Hep B vaccine for all adults ages 19-59. Patients who should receive hep B vaccines are: all adults between 19 and 59 years of age, and adults older than 60 with risk factors for hepatitis B infection. However, adults older than 60 without risk factors may also receive hep B vaccines. Vaccinating against Hep B is done to decrease new infections, prevent transmission, and reduce health disparities. HHS has called for the elimination of viral hepatitis as a public health threat by 2030. There are some reasons to recommend universal Hep B vaccination for adults: many infected patients did not have any risk factors for infection and still got infected; almost 85% of adults in the U.S. fall into a higher-risk group, including patients with diabetes and kidney disease; hepatitis B cases in the U.S. rose by 11% between 2014 and 2018 despite having highly effective vaccines; Hep B is one of the primary causes of liver cancer, one of the deadliest cancers; universal vaccination of newborns started in 1991 in the U.S., so, many adults are not immune to Hep B, but now they can be vaccinated without the many restrictions imposed in the past.Remember, Spikevax is the new name for the Moderna vaccine; and you can start vaccinating all adults between 19 and 59 years of age against hep B, regardless of risk factors.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.___________________________Abdominal Pain Case.  By Deidra Sieck, MS4, Ross University School of Medicine. Hosted by Hector Arreaza, MD.   Abdominal pain in pregnancy is quite common and has a wide differential. I want to begin with a case and then highlight a few of the “do-not-miss” diagnoses when a patient comes with the chief complaint of abdominal pain during her pregnancy. Case presentation: 23-year-old G2P1 at 32 weeks of gestation complains of 12 hours of right lower quadrant abdominal pain, anorexia, and nausea with vomiting. She denies vaginal bleeding or leakage of fluid from the vagina. Denies diarrhea or eating stale foods. No medical history and has been in good health. Denies dysuria and has had no previous surgeries. Her vital signs include a blood pressure of 100/70 mm Hg, heart rate of 105 beats per minute, and temperature of 101.5 F. On abdominal examination, bowel sounds are hypoactive. The abdomen is tender in the right lower quadrant to right flank with significant involuntary guarding. The cervix is closed. The fetal heart tones are in the range of 160 BMP (modified vignette from case files obstetrics and gynecology 5th ed.)What are some of the differentials that come to mind? The 6 differentials that should come to mind that are do not miss diagnoses include:  Placental abruptionAppendicitis Cholecystitis Ectopic Pregnancy Hemorrhagic cyst Ovarian TorsionI want to discuss each of these diagnoses and then devise a plan for the patient in this case. Placental abruptionThis is the most common cause of third trimester bleeding and is an obstetric emergency. It occurs during the second and third trimesters and is described as a midline persistent suprapubic pain. The pain is also accompanied by vaginal bleeding as well as an abnormal fetal heart rate tracing.  Mothers at risk have had a previous abruption, hypertension during the pregnancy, cocaine use, smoking, or preterm premature rupture of the membranes, or trauma as the most common cause of the abruption. This diagnosis is made clinically. The ultrasound is an unreliable modality to see the abruption. If the mother is stable and it is not a complete abruption, the mother usually delivers the baby very quickly vaginally. However, if the abruption is complete, the fetal heart tracing is category III, or the mother is hemodynamically unstable, it is best to deliver by c-section. Appendicitis. Appendicitis can occur any trimester during pregnancy and has been found to occur in 0.1-1.4/1000 pregnancies. The typical nonpregnant patient with appendicitis will come with complaints of right lower quadrant pain that may radiate to the right upper quadrant. This is usually associated with other complaints of nausea, vomiting, anorexia, or fever. [Anorexia: 80% sensitive, The sign of the hamburger] However, this diagnosis may be missed later in pregnancy because of an atypical presentation. As the gravid uterus grows, it can displace the appendix upward and lateral toward the flank. This leads to a presentation that appears to be more consistent with pyelonephritis, leading to a missed diagnosis. Because of the delay in diagnosis pregnant women are 2-3 times more likely to have a ruptured appendix, and the resulting peritonitis increases the likelihood of morbidity and mortality for the patient.  If appendicitis progresses to appendiceal rupture, there is a 30% chance of spontaneous abortion of the fetus. These patients need an ultrasound to make the diagnosis since they cannot have a CT scan in pregnancy despite a CT scan being the preferred modality in nonpregnant patients. The ultrasound should show a non-compressible, blind-ended tubular structure in the right lower quadrant with a maximal diameter greater than 6mm.After the ultrasound confirms the diagnosis, these patients should be taken immediately for an appendectomy. However, the decreased resolution of imaging seen with ultrasound can also lead to delays in these patients receiving the appendectomy.Cholecystitis. Cholecystitis is more common in pregnancy, with occurrence in 1/1600 pregnancies. This can occur anytime in pregnancy after the first trimester. Pregnant women are especially high risk of cholecystitis since they are female and fertile. The other two “f's” that are commonly listed as risk factors for cholecystitis include forty, and obesity. [the F word is banned in this podcast]. Pathophysiology: The increased progesterone and estrogen increase bile lithogenicity. Progesterone also decreases gallbladder contractility. This increase in gallbladder volume and decreased contractility lead to an increase in “biliary sludge” in the gallbladder. The biliary sludge acts as a precursor to gallstones and obstruction of the cystic duct or the common bile duct. The patient with cholecystitis typically comes with complaints of pain in the right upper quadrant which can be associated with nausea, vomiting, anorexia, and fever. This is the same presentation as a patient in pregnancy. The complication of missing this diagnosis includes secondary infection with enteric flora such as: E. coli, Klebsiella, and Enterococcus faecalis.  Fetal loss is seen in 3-20% of pregnancies complicated by cholecystitis. The diagnosis is made with a careful history as well as an ultrasound showing gallstones with dilation and thickening of the gallbladder and gallbladder wall. Treatment should be started with bowel rest, IV hydration, correction of electrolytes, analgesics. They should be given antibiotics if no improvement after 12-24 hours or are experiencing systemic symptoms. If the medical management does not work, these patients should have a cholecystectomy.  The cholecystectomy will most likely be laparoscopic due to the gravid uterus making it difficult to perform an open approach. If in the third trimester and the patient is stable, the surgeon may opt to wait until after delivery to remove the gallbladder.Ectopic pregnancy. This is the leading cause of maternal mortality in the first and second trimesters. It usually presents during the first trimester as pelvic or abdominal pain that is usually unilateral. The patient could also complain of nausea, vomiting, syncope, or vaginal spotting. The diagnosis is made using a serum hCG that meets the threshold and transvaginal ultrasound. The treatment can be surgical or medical. If the pregnancy is early, methotrexate can be used. However, the hCG needs to be trended and followed to zero. A D&C can also be used to treat ectopic pregnancy. Surgery is the first treatment in a patient that is hemodynamically unstable. This diagnosis is not likely in our patient.Ruptured corpus luteum or ruptured hemorrhagic cyst. The corpus luteum cyst is part of a normal endocrine function or a result of prolonged progesterone. In pregnancy, the corpus luteum produces progesterone until 7-10 weeks' gestation until the placenta can produce steroids including hCG and progesterone to maintain the pregnancy. However, intrafollicular bleeding can occur because of the thin-walled capillaries that invade the granulosa cells from the theca interna. If there is excessive hemorrhage, the cyst can enlarge and rupture. The patients presenting with this complaint present with unilateral cramping and lower abdominal pain 1-2 weeks before the rupture. If the corpus luteum becomes hemorrhagic, a hemoperitoneum can develop. These women should undergo an ultrasound, which will show free intraperitoneal fluid. This could also include some fluid around the ovary. The confirmatory method for diagnosis is laparoscopy. Culdocentesis is a procedure that checks for abnormal fluid in the space just behind the vagina. This area is called the cul-de-sac. During a culdocentesis, a long thin needle is inserted through the vaginal wall just below the uterus and a sample is taken of the fluid within the abdominal cavity.Once the bleeding is controlled, there is no further treatment needed. However, if the patient requires a cystectomy due to continued bleeding and the pregnancy is less than 10 weeks, she will need exogenous progesterone because of the loss of the corpus luteum. Ovarian Torsion. Pregnancy is a risk factor for ovarian torsion, especially around 14 weeks and after delivery. Torsion is most likely between 10-17 weeks, and more likely to happen in masses 6-8 cm in diameter. Pregnant and nonpregnant patients have the same presentation, suprapubic or lower quadrant pain, nausea, and vomiting, up to 20% can have a fever. Plan for the patient in the case:1. Ultrasound: Showed a non-compressible, blind-ended tubular structure in the right lower quadrant with a maximal diameter of 7mm.2. Appendectomy: Take the patient to the OR.____________________________Now we conclude our episode number 86 “Abdominal Pain Case.” We started by giving you an update on Spikevax®, formerly known as “the Moderna vaccine”. This is the newest COVID-19 vaccine fully approved by the FDA for patients 18 years and older. Also, Hepatitis B vaccination is now recommended universally to all adults 19-59 regardless of risk factors. Then, Deidra presented a case of a patient who was pregnant and had abdominal pain. Surprisingly, her diagnosis was appendicitis. This is a good reminder that pregnant and nonpregnant patients can get appendicitis. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Cecilia Covenas, and Deidra Sieck. Audio edition: Suraj Amrutia. See you next week! _____________________References:Coronavirus (COVID-19) Update: FDA Takes Key Action by Approving Second COVID-19 Vaccine, US Food and Drug Administration, January 31, 2022. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/spikevax-and-moderna-covid-19-vaccine. ACIP fully recommends Spikevax, as CDC expands wastewater surveillance, University of Minnesota, Center for Infectious Disease Research and Policy (CIDRAP), February 04, 2022. https://www.cidrap.umn.edu/news-perspective/2022/02/acip-fully-recommends-spikevax-cdc-expands-wastewater-surveillance.  ACIP recommends universal hepatitis B vaccination for adults aged 19 to 59 years, Healio.com, https://www.healio.com/news/infectious-disease/20211103/acip-recommends-universal-hepatitis-b-vaccination-for-adults-aged-19-to-59-years. Landmark vote by CDC's Advisory Committee on Immunization Practices (ACIP) to recommend universal hepatitis B vaccination, Hepatitis B Foundation, November 4, 2021. https://www.hepb.org/news-and-events/news-2/the-cdcs-advisory-committee-on-immunization-practices-acip-voted-to-recommend-universal-hepatitis-b-vaccination/ Ananth, Cande Vanessa V, and Wendy L Kinzler. “Placental Abruption: Pathophysiology, Clinical Features, Diagnosis, and Consequences.” Edited by Charles J Lockwood, and Vanessa A Barss,  22 Feb. 2021, https://www.uptodate.com/contents/placental-abruption-pathophysiology-clinical-features-diagnosis-and-consequences.  Brooks, David C. Edited by Stanley W Ashley et al., Gallstone Disease in Pregnancy, 26 July 2021, https://www.uptodate.com/contents/gallstone-diseases-in-pregnancy.   H., De Cherney Alan, et al. “Chapter 25: Surgical Disorders In Pregnancy.” Current Diagnosis and Treatment: Obstetrics and Gynecology, McGraw Hill Medical Publishing Division, 2019.  “Obstetrics and Gynecology.” Case Files: Obstetrics and Gynecology 5th Edition, by Eugene C. Toy et al., McGraw-Hill Medical, 2016, pp. 135–144.  Rebarber, Andrei, et al. “Acute Appendicitis in Pregnancy.” Edited by Martin Weiser et al., Up To Date , 17 Sept. 2021, https://www.uptodate.com/contents/acute-appendicitis-in-pregnancy.  Runowicz, Carolyn D, and Molly Brewer. “Adnexal Mass in Pregnancy.” Edited by Barbara Goff and Alana Chakrabarti, UpToDate, 10 Feb. 2022, https://www.uptodate.com/contents/adnexal-mass-in-pregnancy.  Tulandi, Togas. “Ectopic Pregnancy: Clinical Manifestations and Diagnosis.” Edited by Deborah Levine et al., UpToDate, 18 Jan. 2022, https://www.uptodate.com/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis.

＜お知らせ＞◆各種イベント：ぜひご参加ください！ ◆１１月２日２２時１０分~ Sara先生のお悩み相談会：後半はInstagramにて！ https://bit.ly/3bjG06K ＜当院メルマガ登録先（ココだけの情報！不定期更新）＞ https://forms.gle/sAyQeLYTLtaQwuW98 ◆Clubhouse クラブ【ペットのホリスティックケア】 https://bit.ly/3tXtMbn ◆Clubhouseアカウント名：ホリスティック獣医Sara (@holistic_sara) ◆YouTubeチャンネル【Sara先生のペットの暮らしと健康】 ◆ワクチンの副反応はどのくらい起きている？打つなら●年毎がイイ？ https://youtu.be/UJZ8UvlDX10 ◆ペットフードの選び方（プレイリスト：動画１５本） https://youtu.be/OYJa65o1AL8 ◆おススメ配信： ●Standfm 421回目 新型コロナにイベルメクチンは効くの？ https://bit.ly/3b7seE4 ●Standfm 426回目 お腹の調子が悪いときに気をつけたほうが良い栄養素●● https://bit.ly/2ZoCyF4 著書： 【ペットのお悩み解決！メール相談室：犬猫に長生きしてもらうためのホームケア】 ◆電子版（Kindle）：https://amzn.to/3cR7kIa ◆一般（ペーパーバック）：https://amzn.to/2W7C94I ◆無料で聞ける質問箱！ ⇒　https://peing.net/ja/sarapa101mayu Attribution: Otologic, https://otologic.jp Dova syndrome, https://dova-s.jp 往診専門 Saraホリスティックアニマルクリニック DVM(獣医師) / 英国VetLFHom　濱田真由美（Sara） ウェブサイト等: https://linktr.ee/holisticvet.sara References: - Zhou L, et al. H3N2 canine influenza virus and Enterococcus faecalis coinfection in dogs in China. BMC Vet Res 2019; 15(1): 113. ーコメント・シェアはお気軽にどうぞー ホリスティック獣医Saraでした

Fred, Kaue e Luísa conversam um pouco sobre Infecção de Corrente Sanguínea Associada ao Cateter - Como diagnosticar? Como fazer antibioticoterapia? Quando investigar complicações? Como manejar Cateter de Longa Permanência? Referências: EcoTT vs EcoTE - Em pacientes com os seguintes achados talvez EcoTT seja suficiente: Bacteremia nosocomial Culturas de controle negativas dentro de 4 dias do início do tratamento. Ausência de dispositivo intracardíaco Sem hemodiálise Sem sinais clínicos de endocardite ou infecção secundária Holland, Thomas L., Christopher Arnold, and Vance G. Fowler. "Clinical management of Staphylococcus aureus bacteremia: a review." Jama 312.13 (2014): 1330-1341. Diretrizes: Manian FA. IDSA guidelines for the diagnosis and management of intravascular catheter-related bloodstream infection. Clin Infect Dis. 2009 Dec 1;49(11):1770-1; author reply 1771-2. doi: 10.1086/648113. PMID: 19891568. Chaves F. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva (Engl Ed). 2018 Jan-Feb;42(1):5-36. Cultura de Sangue do Cateter: Orihuela-Martín J, Rodríguez-Núñez O, Morata L, et al. Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience. Clin Microbiol Infect 2020; 26:383.e1. Bouzidi H, Emirian A, Marty A, et al. Differential time to positivity of central and peripheral blood cultures is inaccurate for the diagnosis of Staphylococcus aureus long-term catheter-related sepsis. J Hosp Infect 2018; 99:192. Freeman JT, Elinder-Camburn A, McClymont C, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013; 34:89. Diagnóstico pela Ponta do Cateter: Peterson LR, Smith BA. Nonutility of catheter tip cultures for the diagnosis of central line-associated bloodstream infection. Clin Infect Dis 2015; 60:492. Ecocardiograma em Enterococco: Berge, Andreas, et al. "The DENOVA score efficiently identifies patients with monomicrobial Enterococcus faecalis bacteremia where echocardiography is not necessary." Infection 47.1 (2019): 45-50. Cateter Arterial e Cateter Periférico: Mermel LA. Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review. Clin Infect Dis. 2017 Oct 30;65(10):1757-1762. Chopra V, O'Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):908-18. doi: 10.1086/671737. O'Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med. 2014 Jun;42(6):1334-9. Sítios e Risco Infeccioso: Parienti JJ, du Cheyron D, Timsit JF, et al.

Did you know that the oral cavity has the second largest and most diverse microbiota after the gut, harboring over 700 species of bacteria? The progression of health or regression toward disease is critically influenced by the microbiota. In addition to being the initiation point of digestion, the oral microbiome is crucial in maintaining both oral and systemic health.   The oral microbiome rests within biofilms throughout the oral cavity and forms an ecosystem that maintains health in a state of homeostasis. However, particular imbalances in this state of equilibrium allow pathogens to develop and cause disease. This disruption of the oral microbiome leads to dysbiosis, which is an imbalance in the microbial community that is associated with a myriad of diseases -- most of which show up in various organs and systems throughout our entire body!In this episode, you will be learning about the multitude of negative downstream health effects of a dysbiotic oral cavity and why more of your health and wellness begins in your mouth than you may have previously thought. We will also go through the photobiomodulation research on oral health, where you will see that there are countless ways that red light therapy can help optimize your oral hygiene and oral "vigor." Lastly, you will hear about the newest piece of red light therapy technology that was developed specifically for the mouth and oral health. - Dr. Mike Belkowski talks about the following: An innovative way to use red light therapy for oral health How the oral biome impacts a multitude of health systems How connected your oral health is to gut health 70% or more of the immune system is located in the gut; however, immunity begins in the mouth Cardiovascular health A link between bacteria that causes both gum disease and Alzheimer's in the brain The direct correlation between poor dental health, tooth pain, bleeding gums, and anxiety/ depression The endocrine system Obesity and its link to the oral microbiome Nitric oxide production, how it supports the body's natural repair processes, and how red light therapy helps with it Diets that support the gut microbiome More electrons = less inflammation; ways to get free electrons Factors that affect the oral microbiome such as how you were born Photobiomodulation research as it relates to oral health (see works cited below) How the power of light reduces pain, improves quality of life, and improves functionality Low level laser therapy (LLLT) and how it is an effective treatment for canker sores, oral health, and more The Guardian - BioLight's newest red light therapy product that improves oral health - The Guardian is the first red light therapy oral care device of its kind, with patent-pending technology that implements dual LEDs, giving you the healing power from both red and near-infrared (NIR) light! - To learn even more about how you can improve your health via your oral microbiome, check out The Dental Diet, by Dr. Steven Lin or Heal Your Oral Microbiome, by Cass Nelson-Dooley. - Pre-order The Guardian here! - Listen to the Dr. Kelly Blodgett episode on oral health here - Works Cited   Cronshaw, Mark et al. “Photobiomodulation and Oral Mucositis: A Systematic Review.” Dentistry journal vol. 8,3 87. 5 Aug. 2020, doi:10.3390/dj8030087 Uslu MÖ, Akgül S. Evaluation of the effects of photobiomodulation therapy and ozone applications after gingivectomy and gingivoplasty on postoperative pain and patients' oral health-related quality of life. Lasers Med Sci. 2020;35(7):1637-1647. doi:10.1007/s10103-020-03037-8 Mikami, R., Mizutani, K., Sasaki, Y., Iwata, T., & Aoki, A. (2020). Patient-reported outcomes of laser-assisted pain control following non-surgical and surgical periodontal therapy: A systematic review and meta-analysis. PLoS One, 15(9) doi:http://dx.doi.org.weblib.lib.umt.edu:8080/10.1371/journal.pone.0238659 Zhao, H., Hu, J. & Zhao, L. The effect of low-level laser therapy as an adjunct to periodontal surgery in the management of postoperative pain and wound healing: a systematic review and meta-analysis. Lasers Med Sci 36, 175–187 (2021). https://doi.org/10.1007/s10103-020-03072-5 Hanna R, Dalvi S, Bensadoun RJ, Benedicenti S. Role of Photobiomodulation Therapy in Modulating Oxidative Stress in Temporomandibular Disorders. A Systematic Review and Meta-Analysis of Human Randomised Controlled Trials. Antioxidants (Basel). 2021;10(7):1028. Published 2021 Jun 25. doi:10.3390/antiox10071028 Zadik Y, Arany PR, Fregnani ER, et al. Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2019;27(10):3969-3983. doi:10.1007/s00520-019-04890-2 Pesevska, S., Nakova, M., Ivanovski, K., Angelov, N., Kesic, L., Obradovic, R., … Nares, S. (2009). Dentinal hypersensitivity following scaling and root planing: comparison of low-level laser and topical fluoride treatment. Lasers in Medical Science, 25(5), 647–650. doi:10.1007/s10103-009-0685-0  de-Melo, M. A. S., Passos, V. F., Alves, J. J., Barros, E. B., Santiago, S. L., & Rodrigues, L. K. A. (2010). The effect of diode laser irradiation on dentin as a preventive measure against dental erosion: an in vitro study. Lasers in Medical Science, 26(5), 615–621.doi:10.1007/s10103-010-0865-y   Aggarwal H, Singh MP, Nahar P, Mathur H, Gv S. Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers - a sham controlled, split mouth follow up study. J Clin Diagn Res. 2014;8(2):218–221. doi:10.7860/JCDR/2014/7639.4064  Imani, M., Golshah, A., SafariFaramani, R., & Sadeghi, M. (2018). Effect of Low-level Laser Therapy on Orthodontic Movement of Human Canine: a Systematic Review and Meta-analysis of Randomized Clinical Trials. Acta Informatica Medica, 26(2), 139. doi:10.5455/aim.2018.26.139-143  Rios, A., He, J., Glickman, G. N., Spears, R., Schneiderman, E. D., & Honeyman, A. L. (2011). Evaluation of Photodynamic Therapy Using a Light-emitting Diode Lamp against Enterococcus faecalis in Extracted Human Teeth. Journal of Endodontics, 37(6), 856–859.doi:10.1016/j.joen.2011.03.014  Basso, F. G., Oliveira, C. F., Fontana, A., Kurachi, C., Bagnato, V. S., Spolidório, D. M. P., … Costa, C. A. de S. (2011). In Vitro effect of low-level laser therapy on typical oral microbial biofilms. Brazilian Dental Journal, 22(6), 502–510. doi:10.1590/s0103-64402011000600011 - Don't forget to check out these health-related recommendations from previous podcast guests! - To learn more about red light therapy and shop for the highest-quality red light therapy products, visit www.biolight.shop Stay up-to-date on social media: Instagram YouTube Facebook

Welcome To The MedFlashGo Podcast. This Is Your Daily 4 Minutes Or Less Rapid Review for medical students. Topics are based on medical board examinations including USMLE, COMLEX, And Shelf Exams. We release a new episode every weekday! In this question of the day, Sean asks students to identify the correct infectious organism. These questions are powered by MedFlashGo The First Voice-based interactive medical question bank currently available on Alexa. This tool allows medical students to study medical topics and be interactively tested without the use of a screen. You can study on your couch, in your car, and on the move without the use of a screen. To get access to the free audio-interactive question bank, click here or go to your Alexa application and search medflashgo In the skills section. To learn more details go to medflashgo.com and check out our frequently asked questions section. Please know that these questions were creatively designed by medical students and physicians for the purpose of education and do not replace health information given from your health professionals. We have tried our best to make sure the information is accurate please, so please let us know if you find any errors and we will be sure to correct them. --- Send in a voice message: https://anchor.fm/medflashgo/message

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.10.30.342212v1?rss=1 Authors: Jaeger, F., Lamy, A., Guerini, N., Sun, W.-S., Berntsson, R. P.-A. Abstract: Multidrug resistant bacteria are one of the most important current threats to public health and a serious problem in hospital acquired infections (HAIs). Most antibiotic resistance genes are acquired via conjugative gene transfer, in a process that is mediated by a protein machinery called the Type 4 Secretion System (T4SS). The core of the T4SS is a multiprotein complex that spans both the cell wall and cellular membrane(s), serving as a channel for macromolecular secretion. Although the majority of multidrug resistant bacteria responsible for HAIs are of Gram-positive origin, with Enterococci being major contributors, mostly Gram-negative T4SSs have been characterized. Here we describe the structure and organisation of PrgL, one of the seven membrane proteins forming the translocation channel of the T4SS encoded by the pCF10 plasmid from Enterococcus faecalis. We present the structure of the C-terminal domain of PrgL, which displays similarity to VirB8 proteins of Gram-negative secretion systems. PrgL forms dimers and higher order oligomers but does not interact strongly with the other T4SS components. In vitro experiments show that the soluble domain alone is enough to drive both dimerization and dodecamerisation, with a dimerization interface that differs from all other known VirB8-like proteins. Our findings provide insight into the molecular building blocks of Gram-positive T4SS, highlighting similarities but also unique features in PrgL compared to other VirB8-like proteins. Copy rights belong to original authors. Visit the link for more info

This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Peds RAP show. Earn CME on your commute while getting the latest practice-changing peds information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/PEDSRAPPOD. Pediatric ID specialist Michael Neely, MD, and Michael Cosimini, MD discuss how cephalosporins work and which bugs they do and do not kill. Pearls: In general, cephalosporins do not cover anaerobes, enterococcus, listeria and MRSA. Oral cephalosporins are generally not first line in pediatrics.  Some exceptions include the treatment of UTIs and some skin and soft tissue infections; group A strep and sinopulmonary infections in penicillin allergic patients are other common indications. 1st generation cephalosporins do have gram positive coverage, but do not work well against strep pneumo, MRSA, enterococcus. They do cover some enteric gram negative bacteria, the “PECK” organisms.   What are cephalosporin antibiotics and how do they compare to penicillins?  Chemically, both penicillins and cephalosporins are beta-lactam antibiotics, with the beta-lactam portion responsible for bacterial killing.  The chemical portions off the beta-lactam ring make the antibiotics different. Beta-lactam antibiotics work by binding to the penicillin-binding protein on the bacterial cell wall.  These proteins have structural functions that maintain the integrity of the bacterial cell wall and therefore, when these antibiotics bind, the penicillin-binding protein is disrupted, the cell wall falls apart and the bacterial dies.       How do you keep a straight spectrum of activity for antibiotics?  To help with this, think of bacteria into big categories: gram-positive, gram-negative and “other”. Gram-positive bacteria include: Staph aureus (MSSA, MRSA), Streptococcus (Group A Strep, Group B Strep, Strep pyogenes, Strep viridans), Enterococcus, Pneumococcus, Listeria Gram-negative bacteria are a much bigger group and can be divided into: Respiratory gram-negatives include Moraxella, Haemophilus, Meningococcus Enteric gram-negatives include the “PECK” bacteria: Proteus, E.coli, Klebsiella What bacteria do cephalosporins not cover?  In general, cephalosporins do not cover anaerobic bacteria, enterococcus, listeria and MRSA.  There are a few exceptions to this rule. Cefoxitin (a second generation cephalosporin), for example, does have anaerobic coverage.  It is commonly used in the treatment of PID as it covers enteric anaerobes and Neisseria gonorrhea. There is a 5th generation cephalosporin that does cover MRSA (discussed later). Are cephalosporins well absorbed?  Generally speaking, cephalosporins in oral formulations are not as well absorbed as penicillins and are more difficult to get where they need to go outside the urinary tract. Also, generally speaking, no beta-lactam really gets into the spinal fluid in very high concentrations; all of them do have better penetration when there is inflammation.  Practically, remember that the penetration into the CSF between ampicillin and ceftriaxone is negligible. What bacteria do first generation cephalosporins cover?  Although the classic teaching is that cephalosporins are good for gram-positive coverage (staph and strep), this is not a hard and fast rule.  As stated, enterococcus is not covered by any cephalosporin and MRSA is not covered by most cephalosporins.  First generation cephalosporins are also good for coverage of the “PECK” enteric gram negative bacteria, but not good for coverage of other gram negative bacteria.  These organisms tend to cause UTIs and therefore, first generation cephalosporins (for example, cephalexin) are frequently used for UTI treatment. Of course, resistance can occur.    Even though strep pneumo is a gram-positive organism, when it comes to first generation cephalosporins, it acts like a gram-negative organism and therefore, first generation cephalosporins do not work well against strep pneumo.   What about bacteria that develop resistance?  A patient with an E. Coli UTI, for example, may have a microbiology laboratory report stating that the E. Coli is resistant to a first generation cephalosporin but the patient is still getting better.  This may have to do with the type of infection the patient had; for example, a healthy patient with a simple cystitis may have been able to stay well hydrated and the normal immune system was able to clear the E. Coli. This question can also be answered in the context of breakpoints, that is when the bacteria become susceptible or resistant to the antibiotic depending on the site of infection.  Some labs will actually label a bacteria resistant or susceptible depending on whether the infection is in the urine, spinal fluid or blood. Therefore, if a lab that reports site-specific breakpoints suggests that an E. Coli is resistant to a first generation cephalosporin in the urine, the lab has already taken into account the higher concentration of drug in the urine.  Similarly, a pneumococcal isolate that may be resistant to ceftriaxone in the CNS may be susceptible to ceftriaxone as a pneumonia because there are much higher concentrations of ceftriaxone in the lungs than in the spinal fluid. When should a skin or soft tissue infection be treated with a first-generation cephalosporin?  When should MRSA be suspected? This can be a tricky question as an outpatient, but there are some clues to gauge whether or not the infection may be caused by MRSA.   One, it is helpful to know the community prevalence of MRSA.  In some communities, community acquired staph aureus infections are up to 80-90% MRSA.  In these communities, MRSA coverage should of course be given. If the prevalence is much lower, using a first generation cephalosporin, such as cephalexin may be reasonable.   Other clues can be more specific to the patient the their families.  Is the patient or family known to be colonized with MRSA? Have they had an MRSA infection in the past? If MRSA coverage is needed, either trimethoprim-sulfa or clindamycin generally is a good approach.  A randomized controlled trial published in the NEJM showed no difference in outcomes when treating a known MRSA infection. Miller LG et al.  Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections.  N Engl J Med. 2015 Mar 19;372(12): 1093-103. https://www.ncbi.nlm.nih.gov/pubmed/25785967 In general, the quality of the infection does not help point to MRSA or not.  There is some suggestion that if there is a soft-tissue abscess this is more likely staph aureus and if there is just pure erythema, tenderness and warmth without abscess, this is more likely to be Group A strep.   Remember, no matter what antibiotic is started for cellulitis (or any infection, for that matter), follow up is essential.  If you are on the right antibiotics, cellulitis should be improving within 24 hours.

Dr. Mercurio reviews antimicrobial susceptibility testing methods and explains how this data reported with culture results can be best used to make informed antibiotic treatment decisions. Dr. Mercurio begins by discussing the difference between MIC and MBC, and the misconceptions about MIC values for different antibiotic agents. Next, she reviews recent changes in the susceptibility breakpoints for several bacterial organisms, including Enterococcus spp., Staphylococcus aureus, Enterobacteriaceae, and Pseudomonas. Lastly, she reviews the resistance issues with the “SPACE/SPICE” bacteria as well as inducible clindamycin resistance, and closes with comments on heteroresistance issues in bacterial populations.

It’s case study time again! This particular horse suffers from Lyme Disease and is “running out of gas” during normal workouts. Dr. Nichols walks through her process for evaluating this horse in a virtual nutrition consult and provides recommendations for the owner. Show Notes: Products mentioned in this episode are: Ex-Factor Low Starch – a 10% NSC, extruded feed designed for horses with metabolic conditions and sugar sensitivities. Intensify Feeds – contains unique probiotic strains that support a healthy microbial population in the gut. Transform DSI – probiotic containing Kluyveromyces marxianis, Lactobacikkus acidophilus, and Enterococcus faecium. ADR Paste – megadose probiotic paste. LIFELINE+- plasma supplement which supports a healthy immune system and normal inflammatory response. Immune Health Program – a carefully formulated 30 day program containing 3 unique technologies for supporting the immune system. If you have a topic or question you would like addressed on a future episode please email info@acbluebonnet.com Dr. Jyme Nichols is Director of Nutrition for Bluebonnet Feeds and Stride Animal Health. For more information on these brands or a free virtual nutrition consult from our team just visit bluebonnetfeeds.com/nutrition-consult --- Send in a voice message: https://anchor.fm/FeedRoomChemist/message

Mor idrar torbası sendromu (MİTS), kabızlık, idrar yolu enfeksiyonu ve eş zamanlı olarak mesane kateteri olan yaşlı kadınlarda tipik olarak görülen idrarın mor renkte değişikliği olarak tanımlanır. Bu durum genellikle idrar yolu enfeksiyonu ile ilişkilidir. İdrar torbasının renk değişim nedeni ise; mesane kateteri ve idrar torbasındaki sentetik materyal çökelekleriyle reaksiyona giren indigo (mavi) ve indiburin (kırmızı) pigmentlerinden kaynaklanır. İlk olarak 1978 yılında Barlow tarafından tanımlanan bu sendrom hastaları genellikle yaşlı, kadın, immobil, kabızlık, kronik mesane kateterizasyon, alkali idrar, idrar yolu enfeksiyonu ve böbrek yetmezliği gibi risk faktörleri ile ilişkilidir.​1​ MİTS hastalarında yaygın olarak izole edilmiş bakteriler aşağıda listelenmiştir.​2​ [box type="info" align="" class="" width=""]MİTS hastalarında yaygın olarak izole edilmiş bakterilerPseudomonas aeruginosa,Proteus mirabilis, Providencia spp., Escherichia coli, Klebsiella pneumoniae, Morganelli morganii, Citrobacter spp., metisiline dirençli Staphylococcus aureus,grup B streptokoklar ve Enterococcus spp[/box] Patogenezinde kabızlığın önemli bir rolü vardır. Kabızlık nedeniyle bağırsak geçişi uzar, triptofan bağırsak florasındaki bakteriler tarafından indole deamine olur. İndol karaciğerde konjugasyonla indoksil sülfata çevrilir. İdrara sekrete edilen indoksil sülfat, mesane kateterinde kolonize bakteriler tarafından sültafaz ve fosfataz enzimleri sayesinde indoksile dönüştürülür. İndoksilin oksidasyonu sonucu indigo (mavi) ve indivurin (kırmızı) pigmentleri meydana gelir. Bu pigmentler plastik idrar torbası ile temas ettikten sonra meydana gelen reaksion sonucunda idrar torbasında mor bir renk oluşur. Mor idrar Torbası Sendromu’nda metabolik yollar “+” ile patogeneze katkıda bulunan faktörler belirtilmiştir Hastanın altta yatan risk faktörlerini kontrol altına almak, mesane kateterinin değişimi, uygun üriner antisepsisi ve etkene uygun antibiyoterapi MİTS tedavisinde yapılması gerekenler arasındadır.​3​MİTS görünüm itibariyle hastaları, hastaya bakan aile üyelerini, arkadaşlarını ve bakıcılarını endişe verici bir tabloya sokan bir durum olsa da prognozu görünümü kadar kötü değildir. ​4​ Geriatrik popülasyonun her yıl daha belirgin hale geldiği, opioid tedavilere bağlı kabızlığın arttığı immobil hastalarda, altta yatan patolojik faktörler, idrar sondalarının yanlış bakımı ve uygun olmayan temizliği nedeniyle tekrarlayan idrar yolu enfeksiyonları önemli bir morbidite ve mortalite nedeni olmasından dolayı akılda tutulması gereken bir klinik tablodur. [box type="warning" align="alignleft" class="" width=""]Sonuç olarak; MİTS, kabızlık ve kronik kateterizasyon öyküsü olan yaşlılarda idrar yolu enfeksiyonunun nadir görülen bir prezentasyonudur. Patofizyolojisi net değildir; ama kostipasyona sekonder artan bakteriyel büyüme ve triptofanın karmaşık bir dizi reaksiyonu sonucunda idrar pigmentlerinin dönüşümü ile karakterize bir tablo diyebiliriz. Tedavi, uygun mikroflorayı ve varsa foley kateter değişimini kapsayan antibiyoterapi.[/box] Teşekkürler 1. Al Montasir A, Al Mustaque A. Purple urine bag syndrome. J Fam Med Primary Care. Published online 2013:104. doi:10.4103/2249-4863.109970 2. Dealler SF, Hawkey PM, Millar MR. Enzymatic degradation of urinary indoxyl sulfate by Providencia stuartii and Klebsiella pneumoniae causes the purple urine bag syndrome. Journal of Clinical Microbiology. Published online 1988:2152-2156. doi:10.1128/jcm.26.10.2152-2156.1988 3. Worku DA. Purple urine bag syndrome: An unusual but important manifestation of urinary tract infection. Case report and literature review. SAGE Open Medical Case Reports. Published online January 2019:2050313X1882310. doi:10.1177/2050313x18823105 4. Su Y-J, Yang H-W. Risk factors of mortality in patients with purple urine bag syndrome. Journal of Drug Assessment. Published online January 1, 2019:21-24. doi:10.1080/21556660.2019.1579727

Welcome to the Whole View, episode 406. (0:27) Stacy is so jazzed about this show. Sarah and Stacy have been talking about it and preparing for it since this show was called the Whole View. Stacy personally is jazz hands about educating a dear loved one on why filtering water is a good idea. To kick things off, Stacy is going to share a little story from their trip last summer. While on the road, Stacy saw what she thought was a fresh spring and encouraged the boys to fill their water bottles. Stacy basically gave her kids dysentery. This is Stacy's story about why water filtration is important. Stacy ran a poll last week and only 21% were on team Stacy and thought it was a harmless stream. What Stacy thinks is fascinating is that it is not just runoff water that is not good for you. Oftentimes our municipal water is not meeting the standards. It is important to understand that, and beyond that, it is important to know what you should be aware of when it comes to water. Sarah has so much science.   This Week's Sponsor But first, Stacy wants to take a moment to thank this week's sponsor, AquaTru. (4:27) Their reverse osmosis system has been sitting on Stacy's counter for a month now, but there is one person in the house who is not convinced that it is a good idea. Stacy first loved this system because of the information that Sarah shared, but second loved that it is endorsed by Erin Brockovich. Sarah has had an AquaTru for over four years, and what she loves about them is how different their technology is. It’s the only counter-top reverse osmosis system —  in a category all its own. It is not bottled water, not a fridge filter pitcher like Brita or Pur, and is not an under the counter or whole house system needing installation. AquaTru is the only purifier to remove the ‘forever chemicals’ known as PFOAs and at the center of the movie Dark Waters. Most reverse osmosis (RO) systems waste four gallons of water for every one gallon they produce. AquaTru uses a patented water conservation technology that is about 12x more efficient than professionally installed under-the-sink RO systems. RO is the best way to filter water. They are giving our podcast listeners $150 off their AquaTru purchase.   Listener Question Jessica says, "new podcast name! Love it! (10:44) Thanks for continuing to podcast. Crazy times in the world and you and Sarah’s voice is so utterly comforting. Anyway, podcast question! Water intake. I don’t think you guys have done a, 'how much water do we need', podcast episode. A deep dive into this would be really helpful. The standard advice seems to be either one amount for men and one amount for women, or, half your body weight in oz.  Which is correct? Or is there another answer? What about just drinking when thirsty? I also have wondered, how much water did our ancestors drink? I assume the water was maybe harder to come by back then so maybe they were drinking less? This is the assumption I’ve always made and has led to me drinking intuitively, which has more than likely led to me being chronically dehydrated :) I feel like with all the conflicting info, it would be great to hear the science.  By the way Stacy, as a side note, after about a year I finished catching up on the podcast. I know you are sorry, I am not ;). When searching for a water-related episode, I and came upon an episode called Thirsty Brain. I was like, for sure this has to be about how water intake affects our brain. Nope. Lol. But that was a great episode about Matt’s podcast, called Thirsty Brain :) love you guys.   Thanks again for all you do!"   How Much Let's start with how much water. (14:15) This has been a debated topic within the medical and scientific community. The classic 8, 8 oz. glasses a day is actually not enough. However, this original recommendation was based on how much water we lose over the course of a day and was not based on how much we actually need. The question now is, how much water makes us healthy? The latest research suggests that men should consume about 13 cups (104 ounces, or 3 liters) of fluid per day, and women should consume about 9 cups (74 ounces, or 2.2 liters). The reason it is different between men and women is basically a reflection of body size and BMR. This amount is not pure water intake. It includes the water that we get from all sources, factoring in all beverages, and the water we get from food. From there, our needs would shift up if we are highly active, if it is hot out, certain dietary needs, etc. Sarah thought the hunter-gather aspect of Jessica's question was very interesting. So she spent some time trying to track that information down. However, she couldn't find a good estimate. That being said, Sarah did find a really interesting paper looking at human evolution. We only find remains of early humans near water sources, and so we know that early humans tended to congregate near water. Communities were and still are centered around ways of getting water. There has been some anthropological research showing that this might have been very important in human evolution. Our brains use a lot of energy, which creates a lot of metabolic byproducts, which have to be filtered by the liver and kidneys, which increases our need for water to make urine to effectively detoxify. So our ability to grow these awesome brains would have relied on proper hydration, in addition to high-quality food. We can't say how many ounces of water hunter-gathers consumed on average, but we can say that it was very likely that they drank a lot of water and likely drank intuitively.   Intuitive Hydration Studies looking at hydration have been really interesting. (19:56) Overall they show that humans in general as a species are pretty good at drinking intuitively. Studies have come at this from a bunch of different ways, where they have looked at what happens when you have given people free access to water and you measure how much water they drink? In general, people are really good at staying hydrated, provided water is around. On average people will drink about two liters of water per day, just driven by thirst. Which is probably the right amount of water, considering other beverages and water from food sources. There have been studies showing that this is true in different populations. Athletes' performance is best when they just follow their thirst for drinking. 'Follow your thirst' does seem to work best for performance. However, there are a variety of things that have been shown to reduce our thirst relative to our water needs. Which basically means you are not thirsty enough for how much water you need. These people need to focus more on hydration and drink with intention, versus just following thirst. There are a bunch of drugs that are used for cardiovascular disease that impact thirst. Elderly people also tend to end up dehydrated and are do not have strong enough thirst signals for their water needs. Menopause causes this is women and high estrogen in general. Swimming can actually reduce our thirst. Exercising in the heat can also impact our thirst awareness. When Sarah looks at this list this means that there are so many exceptions that overall it is a pretty good idea to at least be mindful of hydration. There are bad things that happen when we don't drink enough water on a regular basis. Stacy shared her experience with her lack of thirst and dehydration.   What Happens if you Don't Drink Enough? What is interesting is that acute dehydration will make you feel extremely ill, but chronic-mild dehydration kind of creeps up on you in terms of the symptoms. (27:03) Like so many chronic things, the human body is remarkable in terms of how it adapts to not feeling good. You can end up not noticing for a while. There has been a huge variety of studies showing that even mild dehydration puts a strain on the kidneys, which can cause high blood pressure, reduced energy, fatigue, constipation, dry skin, and more. What is interesting to Sarah is the number of cognitive issues associated with mild dehydration. It can cause frequent headaches, impair mood, increase anxiety, reduce concentration, impair memory, reduce cognitive performance and it also has a pretty measurable impact on exercise performance. The thing that nerds Sarah out is that our microbiome is sensitive to our hydration status. This is because we have this whole collection of bacterial species that actually live in or attached to the mucus barrier. Sarah explained the mucus layer in greater detail. This is why inadequate hydration can cause constipation. What happens when we are not drinking enough, that the mucus layer gets harder and less viscus. This makes it a less hospitable environment for really important probiotic bacteria. It also makes it a more hospitable environment for pathogens. This has been confirmed in some really interesting animal studies. Acute hydration would include feeling dizzy, rapid heartbeat, rapid breathing, extreme fatigue and sleepiness, confusion, and irritability and it can cause things like fainting. You would see severe dehydration in having UTIs, kidney infections, and kidney stones.   Alkaline Water Sarah feels that alkaline water is one of the biggest scams in the health community. (34:48) Alkaline water has an alkaline pH. Commercial alkaline water typically has a pH of 8.8 or higher with high dissolved mineral content, typically calcium, potassium, and magnesium. Alkaline water is known to neutralize stomach acid, which on the surface may sound like an awesome thing for anyone who suffers from acid reflux. However, because the acidity of chyme is a key signal to the pancreas to secrete digestive enzymes and to the gallbladder to secrete bile, neutralizing stomach acid can hinder digestion in a big way! So anything that neutralizes stomach acid actually hinders digestion, which can cause a whole pile of problems. The other thing is the impact on the gut microbiome. If you are neutralizing those acidic molecules with alkaline water, you are actually suppressing the growth of really key probiotic species and increasing the growth of potential pathogens. Studies confirm that drinking alkaline water causes an undesirable shift in gut microbiome composition. One study in mice showed that drinking alkaline water for 4 weeks caused a huge decrease in probiotic Clostridiumspecies with smaller decreases in Bifidobacterium and Lactobacillus, and a rise in Prevotella. A randomized, controlled cross-over intervention in adult men compared the impact on the gut microbiome of consuming 2 liters per day of alkaline water (pH 9) compared to neutral water (pH 7) for two weeks. While the alkaline water had no effect on overall species diversity or richness, the men benefited from higher hydration levels from neutral pH water, which significantly increased richness by 15% when comparing pre- and post-intervention samples. The benefits of alkaline water that have been measured are probably completed attributed to the fact that many of us are not getting enough calcium or potassium. So we can benefit from getting these in their elemental form dissolved into water.   Spring Water Spring/mineral waters can be slightly acidic. (38:50) Most natural sources of mineral water in the world are acidic, not alkaline. Acidic water, because our gut bacteria love living in an acidic environment, has been shown to improve the gut microbiome to reduce a diabetes-associated microbiome. It also improves the growth of probiotic species, at least in animal studies. So it is much more important to look for mineral water or to add mineral drops to your water. Sarah adds mineral drops to her water before she drinks it. There is definitely benefit to mineral content, but that alkaline water is not doing your gut any favors. Stacy has experienced this with the digestive piece before.   Tap Water The water that comes out of our taps originates from lakes, rivers, and or groundwater. (41:37) Then it goes under extensive filtration and then disinfection. Disinfection uses one of two chemicals - chlorine or chloramine. It is important for safety to go through this disinfection process. When you think about the community of microbes that live in our gut and think about a disinfectant being added to our water, you think about the impact this has on your gut bacteria. Studies have shown that they absolutely do. The chlorine/chloramine that is added to drinking water not only decreases the growth of really important probiotic species, but it actually allows the growth of multi-resistant pathogens. There have been a variety of studies showing that feeding animals chlorinated tap water actually increases the number of bacteria that are growing in their digestive tract. These bacteria strains are associated with hospital inquired infections. Studies have shown that there is a potential link between chlorinated drinking water and the incidence of colorectal cancer. To understand whether this effect is mediated via the microbiome, a study compared the effect of drinking chlorinated water versus tap water in transgenic mice susceptible to colon cancer. Chlorinated water causes a substantial increase in tumor development in the colon, associated with reduced levels of Clostridium perfringens, a species believed to have anti-tumor effects. Interestingly, mice drinking tap water tended instead to develop tumors in the small intestine. Removing the chlorine/chloramine after the water comes out of our tap before we drink it, is a really good idea for our gut microbiome.   More on Fluoride There are also a lot of municipalities in North America that add fluoride to tap water, with the rationale of reducing tooth decay. In episode 34 Stacy and Sarah discussed fluoride, and the science has not changed. The science showing that fluoride is beneficial for dental health when it makes prolonged contact with tooth surfaces is really strong. However, the science showing any benefit to oral health from drinking fluoridated water is basically nonexistent. There have been some really large studies showing that fluoridation does not increase the risk of anything of the things that have been rumored to be true. However, there have been a few studies showing a correlation between fluoride levels and lower IQ in children. This has opened up the question if fluoride can open up the blood-brain barrier, and potentially negatively impact early brain development. But this is still a big open question where more science is needed. We do know that fluoride seems to accumulate in the pineal gland as we age.  The pineal gland is located in our brain and secretes melatonin to help us sleep. We don't know if this is what is behind sleep disturbances, but its something to point to that shows how fluoride crosses the blood-brain barrier. Overall, more research is needed to clarify if there are actual risks with fluoridation. We do know that the benefits are not measurable. In a study of broiler chickens, high levels of dietary fluorine resulted in lower microbial diversity, significantly lower levels of Lactobacillus and Bifidobacterium species. The study also showed significantly higher levels of Escherichia coli and Enterococcus compared to the control group. In a mouse study, 12 weeks of exposure to fluoride altered the oral microbial community by selectively depleting probiotic Parabacteroides distasonis, Bacteroides uniformis, and an unclassified Bacteroides species. However, if we are using fluoridated toothpaste, drinking non-fluoridated water appears to pose no risk to oral health. There is a strong case for filtering water for removing chlorine, chloramine, and fluoride. Stacy isn't yet adding minerals to her water but is going to give it a try and is excited. You can get those minerals on the AquaTru.   Pesticide Residues in Tap Water While an inexpensive activated carbon (charcoal) water filter can remove chlorine, chloramine, and fluoride from tap water. Unfortunately, these common water filtration systems can’t remove pesticide residues. Heavy metals are a well-known problem. (53:57) If you have lead in your tap water there is so much information out there that you would understand the importance of not showering in this level of contaminated water. We talked about how glyphosate impacts the gut microbiome in last week’s episode (405). Glyphosate exposure increases the ratio of pathogenic bacteria to probiotic microbes, reducing Bifidobacteria, Lactobacillus, and Enterococcus while increasing Salmonella and Clostridium. There is no dose-response. Any glyphosate exposure is problematic. In the US, glyphosate has been used for over 40 years and is used mostly to kill weeds that interfere with agricultural crops (typically corn, soy, and canola). We know that runoff from industrial agriculture is a major source of contaminants in streams, rivers, and lakes, which is where we get our tap water from. Third-party testing was done on 85 tap water samples by Moms Across America and Sustainable Pulse. The results showed that 35 of the samples had glyphosate levels up to 0.3 ppb. On average, 87% of Americans have measurable glyphosate residues inside their bodies. For more on how glyphosate impacts our health, see this study. We know we are getting exposed to glyphosate and it looks as though tap water may be a key root of exposure. This is the most compelling reason for filtering water using reverse osmosis.   Closing Thoughts Sarah is so grateful for AquaTru for giving our listeners such a steep discount on their filtration systems. Last week we talked about foundational principles, and Sarah considers filtering water as a foundational principle. Reverse osmosis is the next level thing. However, depending on where you live, if you live in an area where your water is likely to be contaminated, that shifts that priority. Stacy and Sarah are on a mission to educate, they never want to make listeners feel burdened with one more thing to worry about. Instead, you make informed decisions from education and we are here to educate you. Stacy doesn't want someone to spend a lot of money on a water filtration system without looking fully into the research and which system to buy. It is fascinating to Stacy that this is beyond heavy metal contamination, it is beyond glyphosate, that three out of four homes have contaminants beyond the prescribed measures in America. This was a fact that once she heard it, Stacy couldn't un-hear it. Is this a burden that you should be stressed out about - absolutely not. This is to educate you so that you can plan for if you want to make changes. A great place to start is to look at what is in your water. Use this site as a reference point. For you to be aware and to start looking at that is all that we are trying to provide. If you are concerned about your water quality and do feel like a good water filtration system is a good investment to make, AquaTru has given our listeners $150 off. Simple visit this site to get that discount. Sarah wanted to thank AquaTru again for sponsoring this week's episode and for being such a good sponsor to provide listeners with such an amazing discount. Thank you listeners for being a part of the show. We love hearing from you and your feedback. Jessica, thank you for your nice complement. If you have questions that you want us to follow up on or different topics that you want to hear about, we welcome you to email us using the contact forms on our blogs. Please engage with us on social media. If you learned something from listening to one of our shows, the best thing you can do is share about it. Please also leave a review in whatever platform you are listening to. Thank you so much, listeners! We will be back next week. (1:05:22)

Welcome back to episode 405 of the Whole View. (0:27) Today Stacy and Sarah are talking about a super interesting topic submitted a listener. Which, if you didn't know this already, we love it when you email us. Sarah shared some behind the scenes information on where listener questions come from. There are Stacy's requests, listener questions, and the really challenging listener questions. The question in discussion in this episode is one of those really hard ones that has been in the queue for a long time. Sarah was able to pull together the information for this show because she actually did a lot of research on this topic for her gut microbiome book. And of course, Sarah did extra research to address the many facets of this challenging question. Stacy is excited about this science rich show.   Listener Question Is the EWG's dirty dozen list based on strong science? (3:37) My husband listened to two episodes of the Skeptoid podcast on organic vs. conventional farming. Mr. Dunning said that we are being duped into paying extra for organic produce. It is sprayed with larger amounts of pesticides than those used in conventional farming and the organic pesticides have been shown to cause disease. My husband believes Mr. Dunning because he provides references and appears to be liberal and non-biased in other podcasts.   I have been purchasing organic produce according to the Environmental Working Group's dirty dozen list. It says on the Activist Facts website that "There’s really only one thing you need to know about the Environmental Working Group when it comes to its studies of toxins: 79 percent of members of the Society of Toxicology (scientists who know a little something about toxins) who rated the group say that the Environmental Working Group overstates the health risk of chemicals. I am walking around with holes in my shirts, and I haven't gotten the air conditioning fixed in my car, so that I can afford organic food. Am I wasting my money? I feel like I cannot trust anyone but you.   Preface Stacy wanted to refer listeners to listen back to previous episodes for information on how both Stacy and Sarah have evolved the way they purchase and prioritize their own foods within their budget. (5:06) Neither Stacy nor Sarah buys everything organically. Nothing that Stacy and Sarah are going to discuss in this episode is intended to be a judgment on you or your family or what you did in the past or what you are doing now. This is all education so that you can be empowered to make the choices that are best for your family at the correct time for you. Where Stacy's family is today, ten years later, is a lot different than where they were ten years ago. The goal of this episode is to help you so that you can walk away and ask questions. There is a larger philosophy that each family needs to adapt to what works best for them. No one is perfect. If you are starting in your journey, you don't need to forego the necessities to have organic food. There is a way to prioritize your budget in a way that is consistent with what your family believes in. Healthy living choices are so personal.   Foundational Choices & Next Level Choices Sarah wanted to emphasize that there are foundational health principles. Nutrient density diet, eating a lot of fruits and vegetables, getting enough sleep, managing stress, and living an active lifestyle. Then Sarah thinks of the next level steps like adding some biohacks, supplements, purchasing grass-fed beef, and organic fruits and vegetables. We need to first make sure that we are focusing on the foundational principles and adding in the next level choice if and when it makes sense. Eating organic is beyond the basic principles, but is overall a better choice. The EWG's overall approach is in many ways more rigorous than the American regulatory agencies. The EWG tends to align with the European Union, Health Canada, and these other regions of the world where the criterion for approving a chemical or pesticide is firmer. In America, the thought process is that chemicals are assumed fine unless proven bad. In Europe, a chemical is not ok until proven safe.   Conventional Evaluation of Pesticide Safety The FDA's safety assessment for chemicals in foods have a variety of criteria. (13:11) They look at acute chronic and subchronic toxicity, carcinogenicity, genotoxicity, reproductive and developmental toxicity, neurotoxicity, and immunotoxicity. Pesticides also go through additional impact evaluation on the environment and ecology. The vast majority of the studies evaluating the effects of pesticides show problems to human health only with occupational exposure, rather than the much lower exposure the majority of us would have simply by eating produce from crops treated with these chemicals. However, there are some challenges with this. We can see high exposure in rodents causing all kinds of problems. The assumption is that acute exposure is not the same as low dose chronic exposure.   Where the Standards Differ One of the challenges that we have in evaluating pesticides is that our exposure is already so vast. There are no humans that don't already have multiple points of exposure to pesticides. There are studies that are linking the chronic low dose exposure to pesticide residues that have correlated pesticide exposure in the food supply with a number of health issues. In the United States, there are 72 pesticides that are routinely used that are completely banned or are in the process of being completely phased out in Europe. Of the pesticides used in USA agriculture in 2016, 322 million pounds were of pesticides banned in the EU. Twenty-six million pounds were of pesticides banned in Brazil and 40 million pounds were of pesticides banned in China. Pesticides banned in the EU account for more than a quarter of all agricultural pesticide use in the USA. It is important to understand that the European Union is looking at the same science as the EPA. And they are making a different judgment based on the strength of the data. We have a challenge that our metric is, 'is it toxic' and 'does it cause cancer'. WHO Guidelines for Safety of Chemicals in Food are much more thorough, and add to the above. They include general system toxicity, allergy and hypersensitivity, and GI Tract Considerations (includes microbiome).   Pesticides and the Microbiome (Sarah’s Biggest Concern) Microbial diversity is generally considered to be the most important measurable criteria for a healthy microbiome. (24:31) The more different species you have, they tend to keep each other in balance. The bacteria basically control the growth of each other. We are also looking for the growth of these really important probiotic strains. In addition, we are looking for completely absent levels of pathogens. We are also looking at the balance between the two main phylum of bacteria in the gut. It is important to understand that rodent studies are actually really good studies for understanding the gut microbiome. We would want to eventually be able to do a similar study in humans. But what Sarah wants to emphasize is that these rodent studies are a really good model for understanding what is happening in humans. Let’s go through some of the most commonly-used pesticides in agriculture for food crops. Permethrin is a broad-spectrum chemical often used as an insecticide for cotton, corn, alfalfa, and wheat crops—unfortunately, it’s also lethal to bees. It’s also used to treat lice, ticks, and scabies.  For more on this, visit this link here. PEM has higher antibacterial activity against some beneficial bacteria, (including Lactobacillus paracasei and Bifidobacterium). Than against pathogens (such as Staphylococcus aureus and Escherichia coli, which only respond to higher concentrations of PEM). Carbendazim (CBZ) is a broad-spectrum benzimidazole fungicide, widely used in agriculture. In mice, 28 days of exposure to CBZ resulted in gut dysbiosis. It suppresses the growth of some of the most important probiotic families while increasing the growth of some problematic families of bacteria. And it decreases bacterial diversity. To learn more about this pesticide, see here. Epoxiconazole (EPO) is a broad-spectrum fungicide often used on grain crops, and that works by inhibiting the metabolism of fungal cells. It reduces the production of conidia—the asexual spores of a fungus that facilitate reproduction. In rats, EPO for 90 days decreased the relative abundance of Firmicutes and increased the abundance of Bacteroidetes and Proteobacteria, while also selectively enriching Lachnospiraceae and Enterobacteriaceae. To learn more about this pesticide, see here.   More Commonly Used Pesticides Imazalil (IMZ) is a systemic fungicide used to combat fungi on vegetables and fruit (especially citrus), as well as tubers during storage. (30:39) In mice, IMZ exposure (at doses of 100 mg per kg of body weight daily for up to 14 days) reduced the cecal relative abundance of Bacteroidetes, Firmicutes, and Actinobacteria, while also reducing microbiota richness and diversity. The IMZ-treated mice also exhibited colonic inflammation. In another study of mice, low-dose, environmentally relevant exposure to IMZ (0.1, 0.5, or 2.5 mg per kg of body weight daily) for 15 weeks resulted in gut microbiota changes. These changes included reduced mucus secretion, decreased the expression of genes related to cystic fibrosis transmembrane conductance regulator (CTFR) in the ileum and colon, and generally disturbed intestinal barrier function. Stacy shared her perspective on how she looks at this information. Think through the way how these pesticides are more heavily used on grains. Chlorphyrifos (CPF) is an extremely common organophosphate pesticide used to kill insects and worms, by interfering with acetylcholine signaling and disrupting their nerve processes. It’s commonly used on fruit and vegetable crops, as well as vineyards. This is one that was going to be banned in the USA, but Scott Pruitt reversed the planned ban. You can learn more about this here. Sarah shared on this study, this study, this study, and this study. This information should stimulate a reevaluation of the use of these chemicals in the food supply. Diazinon is an organophosphate insecticide used on a variety of crops—including fruit trees, rice, sugarcane, nuts, potatoes, and corn. You can learn more about this pesticide here. It causes different changes in male rodents versus female rodents. The researchers speculated that these differences—with male mice experiencing the most severe changes—were due to sex-dependent gut microbiota profiles present before treatment. You can read more about this study here.   Two More Commonly Used Pesticides Propamocarb (PMEP) is a systemic fungicide used to control root, leaf, and soil diseases caused by oomycetes (water molds) by interfering with fatty acid and phospholipid biosynthesis and therefore changing the membrane in fungi. (41:41) It can accumulate in fruit at high levels, thus reaching humans.  You can find more information on this pesticide here. In mice, 28 days of exposure to PMEP (at levels of 300 mg/L in drinking water) induced gut dysbiosis and changes in 20 fecal metabolites, including SCFAs, succinate, bile acids, and TMA. You can read more about this study here. Glyphosate is a broad-spectrum herbicide that can kill both grasses and leafy weeds. It works by inhibiting an enzyme (5-enolpyruvylshikimic acid-3-phosphate synthase, or EPSP synthase), which is used by bacteria, archaea, fungi, algae, some protozoans and plants to synthesize folates (vitamin B9), ubiquinone, menaquinones (vitamin K2), phenolic compounds, and the aromatic amino acids tyrosine, tryptophan, and phenylalanine. The pathway this affects doesn’t exist in animals, which is part of why glyphosate has historically been considered to have low toxicity in animals.  Now that we understand that we have at least as many bacterial cells living within our body as we do human cells and that those bacteria are essential to our health, the relevance of glyphosate exposure comes into focus. Many bacterially-derived compounds that benefit human health are produced via the shikimate pathway. One rat study evaluated the impact on the microbiome of two weeks of glyphosate consumption, and showed a dose-dependent increase in fecal pH attributable to a reduction in acetic acid production, implying the metabolomic impact of glyphosate exposure.   More on Glyphosate It's not that glyphosate is necessarily directly impacting our cells, but it is dramatically impacting the gut microbiome at levels that we are already being exposed to in the food supply. (48:50) In studies in poultry, cattle, and pigs, glyphosate exposure increases the ratio of pathogenic bacteria to probiotic microbes, reducing Bifidobacteria, Lactobacillus, and Enterococcus while increasing Salmonella and Clostridium. In a long-term rat study, the impact on the gut microbiome was evaluated following nearly two years of glyphosate exposure via drinking water at three different doses. Glyphosate caused a large increase in the Bacteroidetes family S24-7 (associated with obesity and inflammation) and a decrease in Lactobacillus species in females (more modest changes in males). It also altered the Firmicutes to Bacteroidetes ratio to one more closely associated with chronic disease. The authors concluded “our data suggests that the exposure to an environmental concentration of [Roundup] residues could have a role in the current epidemic of gut dysbiosis”. This occurs even at levels well below the US ADI of 1.75 mg/kg body weight /day.  There is no strong dose-response. Sarah wants to emphasize that our glyphosate exposure in food is quite high. It is definitely above the cusp for an impact on our gut microbiome composition. The FDA has a report where they have been mandated to measure glyphosate residue in the food supply. In their 2016 report they measured measurable levels of glyphosate residues in 63% of corn food crops and in 67% of soybean food crops. However, they did not say how much residue was there. The 2018 report goes to a dead link now. A Swiss study of foods purchased at a grocery store showed that legumes had the highest concentrations of glyphosate residues, up to 2.95 mg/kg. United Kingdom government testing of glyphosate residues in wholegrain bread showed levels up to 0.9 mg/kg. A study of foods purchased in Philadelphia, USA metropolitan area showed 59 percent of honey samples contained glyphosate residues, and 36 percent of soy sauce contained glyphosate residues. Third-party testing of popular breakfast cereals, crackers, and cookies by the Detox Project and Food Democracy Now! showed alarming levels of glyphosate residues in all products. Roundup Ready GMOs have the highest level of glyphosate residues. Studies prove that our current levels of exposure are sufficient for measurable amounts of glyphosate to get into our bodies.  One study showed that 44% of city dwellers in 18 countries in Europe had detectable glyphosate residues in their urine, despite Europe’s more aggressive campaign against GMO foods. A pilot study in the United States of America evaluating 131 urine samples from across the country detected glyphosate residues in the urine of 86.7% of them. The highest observed detection frequency in the Midwest was at 93.3% and the lowest in the South at 69.2%.   How to Look at this Science The EWG is looking at this much more broad group of criteria and they are taking a very similar standpoint to the European Union. (58:09) A small effect is still an effect and we need to be concerned about it. When Sarah does a deep dive look to look at the impact on the gut microbiome this is where Sarah sees the biggest area of concern. Sarah thinks it is especially important because it is not currently part of the criteria by the FDA and the EPA for whether or not these chemicals are going to be approved for use. This is the thing that Sarah really thinks needs to change. The good news is that a healthy gut microbiome and high fiber consumption can actually protect us from absorbing a lot of these pesticides.  There have been studies that showed that lactobacilli can help reduce how much pesticide on our food gets into our bodies.  There are also studies that show that higher fiber consumption can at least partially reverse the gut dysbiosis. As we get back to the heart of this question, there are studies that show that the answer is no. High vegetable consumption is still really important because it does support a healthy gut microbiome, to begin with. And a healthy gut microbiome is going to protect us in a lot of ways. For example, they can protect us against heavy metals. Even if we can't afford organic to not let that dissuade us from eating that high vegetable consumption because of this. Sarah sees this as an exciting two-way street. Even though pesticide residues are impacting the composition of our guts, the composition of our gut is influenced by more than just that. It is influenced by how many fruits and vegetables we eat, mushrooms, nuts and seeds, variety, how much fish, how quality the olive oil is that we are consuming, etc. All of these things help to determine the composition of our gut microbiome. Doing all of these foundational things becomes more important when we are not necessarily in a position to be able to seek out and afford the highest food quality. It is still really important to eat a vegetable-rich diet. That's why Sarah wants to classify all of this science as the next level. The foundational principle is still eating a lot of fruits and vegetables, even if our only access to that is conventional. Beyond that, yes the Dirty Dozen and Clean Fifteen lists from the EWG are a wonderful tool. Not that Sarah agrees with everything the EWG has said, Sarah thinks that these are spot on in the sense of trying to minimize our exposure to pesticide residues.   How to Limit Pesticide Exposure Stacy feels that the podcast referenced and the information they are sharing aren't so far apart. (1:02:10) Sarah and Stacy discussed a point shared in the documentary Food Inc. that really hit this information home. We do the best that we can with what we can, and become educated on what other things we can do to support healthy living. Nothing is ever perfect. Prioritize the foods you purchase and do the best you can. It is not good to stress about these things. The dirty dozen list includes strawberries, spinach, kale, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery and potatoes The clean fifteen list includes avocados, sweet corn, pineapple, onions, papaya, sweet peas (frozen), eggplants, asparagus, cauliflower, cantaloupes, broccoli, mushrooms, cabbage, honeydew melon, and kiwifruit. If you are going to get something off the dirty dozen conventional, look at ways that you can wash that food very well or ways you can peel the food to remove the majority of the pesticide residue. USDA certification is very expensive, so a lot of small family farms are growing organically, but don't have the certification. Talk to farmers and find out how they are growing their food. Stacy can't handle the sight of bugs in her fresh vegetables. Eating fruits and vegetables is a good thing. Perfection is not the goal. Neither Stacy nor Stacy eats 100% organic, they both do the best that they can. Sarah has found that the prices at her local farmer's market are best. Develop relationships with your local farmers, and shop at the end of the market. Stacy subscribes to Hungry Harvest, which has a waiting list right now. Sarah prescribes to MisFit Market, there is also one called Imperfect Produce. One of the things that Sarah loves about her subscription is the surprise element of it, which forces her to get creative with her meal planning. At Stacy's house they meal plan when their box arrives, based on what they received. Stacy shared more information on their meal planning process as a family, and how focused they have become to make sure they are not wasting food. Building relationships with your local farmers is a point that Stacy echoed from Sarah. Buying things in season or frozen can also be a helpful way to save money. Stacy's organic box is at least 30% off had they purchased those items at a grocery store regularly. The thing that Stacy most loves about Hungry Harvest is that they give back to the community.   Closing Thoughts Stacy thanked Sarah for all the research she did for this show! (1:23:13) If you have any follow up questions on all of this, you are welcome to email Stacy and Sarah using the contact forms on their blogs. You can comment on social media posts as well. Stacy and Sarah are always happy to hear from you! If you have been loving this show, please help spread the word to others by sharing a link to an episode you enjoyed with a family or friend, or leave a review. Stacy and Sarah so greatly appreciate your support! Thank you again for tuning in! Next week is another science-heavy show that builds off of this week's episode. We will be back again next week! (1:25:57)

Enterococcus - E. Faecalis and E. Faecium

According to the National Center for Complementary and Integrative Health, a division of the National Institutes of Health (NIH), probiotics—found in yogurt, and other fermented foods, such as kefir and buttermilk, dietary supplements, and even beauty products—are live microorganisms that are intended to have health benefits, when consumed or applied to the body.Most probiotics contain a variety of microorganisms—for instance, Lactobacillus and Bifidobacterium—with certain yeasts like Saccharomyces Boulardi qualifying, as well.Many of probiotics sources will also have prebiotics—nondigestible food—inulin—to support the healthy probiotic bacteria. When pre and probiotics are combined together, the term becomes synbiotics.Probiotics create healthy microorganisms in the gastrointestinal tract—where as much as 70% of our immunity is derived from the mucosa-associated lymphoid tissue (MALT) and the gut-associated lymphoid tissue (GALT). Probiotics produce substances—among them butyrate—that influence our immune response.The community of organisms that lives on and in the human body is called the “microbiome.”The Human Microbiome Project, which was funded by the NIH from 2007 to 2016, played a key role in this research by mapping the normal bacteria that live in and on the healthy human body.The NIH says that, “probiotics have shown promise for a variety of health purposes, including prevention of antibiotic-associated diarrhea (including diarrhea caused by Clostridium difficile), prevention of necrotizing enterocolitis and sepsis in premature infants, treatment of infant colic, treatment of periodontal disease, and induction or maintenance of remission in ulcerative colitis.”It was also pointed out that how much of the probiotic a person would have to take, or who would be most likely to benefit, is under ongoing research.From the NIH research, it appears that probiotics are a first line defense against harmful bacteria and, “have an extensive history of apparently safe use, particularly in healthy people.” What is still outstanding is whether the same can be said for those people with severe illness and the associated compromised immune systems.Probiotic supplements are measured by how many CFU’s—colony forming units usually in the billions—are delivered. The NIH says, “the seven core genera of microbial organisms most often used in probiotic products are Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Escherichia, and Bacillus.”It’s further noted that, “because probiotics must be consumed alive to have health benefits and they can die during their shelf life, users should look for products labeled with the number of CFU at the end of the product’s shelf life, not at the time of manufacture.”For more information, I suggest you sign up for my free, weekly wellness update—Mackie Mail.

Today we'll talk about Streptococcus agalactiae, which is most associated with neonatal infections, and Enterococcus spp. which can cause enteritis and urinary tract infections. High-yield information and board-style questions. --- Send in a voice message: https://anchor.fm/bradleysmicroboardreview/message Support this podcast: https://anchor.fm/bradleysmicroboardreview/support

Ya estamos de vuelta, amig@s. En este episodio (BS10, grabado el 5-12-2019) encontraréis lo siguiente: 0:00 Intro y editorial 3:08 Tertulia: Francis nos comenta la nueva y poderosa técnica de edición genética, desarrollada por el grupo de David Liu (PRIME EDITING). Con probabilidad, será uno de los acontecimientos científicos del año. https://www.nature.com/articles/s41586-019-1711-4 21:40 Tertulia: Pepe comenta un interesante estudio en el que analizan el espectro de mutaciones causadas por algunas quimioterapias clásicas utilizadas contra el càncer. https://www.nature.com/articles/s41588-019-0525-5 36:10 Entrevista a Abel González que, junto a Nuria López-Bigas (ambos del IRB) son los autores senior del trabajo comentado por Pepe. 52:30 Bionoticias, con nuestros reporteros más dicharacheros, Belén e Íker. 1:12:30 Tertulia: Silvana (desde Noruega) nos comenta una novedosa estrategia experimental (no implementada aún) basada en el uso de fagos para eliminar las bacterias de la especie Enterococcus faecalis (citolisina+) que, según el estudio, contribuyen decisivamente al daño hepático causado por el consumo de alcohol.https://www.nature.com/articles/s41586-019-1742-x 1:25:20 El libro de la semana: reseñamos "Vida de Margarita Salas" la única biografía que se ha publicado de esta gran investigadora (fallecida el pasado 7 de noviembre) y entrevistamos a una de sus autoras, Jesusa Álvarez. Como complemento a la reseña del libro y a modo de pequeño homenaje a Margarita Salas, hemos recordado su trayectoria entrevistando a algunos de sus discípulos y colaboradores: 1:45:40 Entrevista a Jesús Ávila (CBMSO) 1:55:40 Entrevista a Mario Mencía (UAM) 2:08:00 Entrevista a Luís Blanco (CBMSO) 2:26:18 Entrevista a César Nombela (UCM) Esperamos que os guste. Si es así, os animamos a que nos agregéis a favoritos. Y, para no perderos ningún episodio, recomendamos que os suscribáis a nuestro programa. También podéis descargaros la aplicación oficial iVoox (para móvil o tablet) con la que oiréis este y otros podcast con mayor comodidad. ¡Gracias por vuestro apoyo y... hasta el próximo episodio!

In 2004, a 64-year-old woman in Indiana had a catheter put in to help with dialysis. Soon after the procedure, she came to a local hospital with low blood pressure and what turned out to be a dangerous antibiotic-resistant infection from a bacteria called Enterococcus faecalis. Today, that woman's blood samples helped solve a long-standing mystery: how this deadly bacteria neutralizes the most powerful antibiotic used to fight it.

Our bodies are filled with molecular and cellular machines, pumping, spinning and moving. How do tiny single molecules pump sodium ions across a cell? What is the connection between a single molecule pump and cells producing electricity? How can a single molecule pump be more efficient than our modern ones? How do we make pacemakers safer? Overtime a pacemaker grows to become part of the heart fibre. How do we make pacemakers less likely to be overgrown and easier to replace?  References:  Tatsuya Iida, Yoshihiro Minagawa, Hiroshi Ueno, Fumihiro Kawai, Takeshi Murata, Ryota Iino. Single-molecule analysis reveals rotational substeps and chemo-mechanical coupling scheme of Enterococcus hirae V1-ATPase. Journal of Biological Chemistry, 2019; 294 (45): 17017 DOI: 10.1074/jbc.RA119.008947 Francesco Robotti, Ita Sterner, Simone Bottan, Josep M. Monné Rodríguez, Giovanni Pellegrini, Tanja Schmidt, Volkmar Falk, Dimos Poulikakos, Aldo Ferrari, Christoph Starck. Microengineered biosynthesized cellulose as anti-fibrotic in vivo protection for cardiac implantable electronic devices. Biomaterials, 2020; 229: 119583 DOI: 10.1016/j.biomaterials.2019.119583

Commentary by Dr. Valentin Fuster

近日，最新一期《科学》杂志发表了一篇来自耶鲁大学的重磅文章，研究者们发现一种肠道细菌-鹑鸡肠球菌（Enterococcus gallinarum）竟然会迁移到肝脏、肠系膜等组织器官，造成自身免疫性疾病；采用抗生素或者疫苗来消灭鹑鸡肠球菌之后，能够有效地控制自身免疫性疾病。

-----Criador_do_Podcast----- Prof. Nilton Vivacqua Gomes Instagram/Facebook: NiltonVivacqua -----Cursos----- Clique nos Links abaixo para: Curso VIP: http://bit.ly/vivacquavip Aperf. e Imersões: http://bit.ly/aperfeic Especializações: http://bit.ly/especializ Materiais - Dentalbox Conceito (85) 98180-9804 ------------------------------------------------ -----Apoio----- Você pode apoiar essa iniciativa, para incentivá-la a continuar indefinidamente. É só acessar www.apoia.se/ENDOdontoCast e escolher o valor com o qual deseja apoiar mensalmente. Vale até mesmo 1 real. Quanto maior o valor, maior o benefício. -----Apoiadores----- Categoria Ouro: Indyanara Chinaqui André Quiudini Igor Trindade Categoria Prata: Sandro Rodrigues Pinheiro Ana Paula Santos Flavia Darius Vivacqua ------------------------------------------------ -----Podcast_Apps----- Podcasts (Nativo), Overcast, Breaker (IOS), Google Podcasts (Android), Acast, Ivoox, Wecast, Castbox, Spotify, PocketCasts (IOS/Android). Instale o app e na aba busca e procure pelo ENDOdonto Cast. Inscreva-se clicando no botão destinado a isso. Selecione a config. p/ baixar novos episódios automaticamente. ------------------------------------------------ -----Referências_Científicas----- In vivo evaluation of microbial reduction after chemo-mechanical preparation of human root canals containing necrotic pulp tissue. Vianna et al., Int End J, 2006. The effect of chlorhexidine as an endodontic disinfectant. Zamany et al., Oral Surg, 2003. In vivo microbiological evaluation of the effect of biomechanical preparation of root canals using different irrigating solutions. Tanomaru Filho et al., J Appl Oral Sci, 2006. Comparative evaluation of antimicrobial substantivity of different concentrations of chlorhexidine as a root canal irrigant: An in vitro study. Mahendra et al., J Oral Biol Craniofac Res, 2014. Residual antimicrobial activity after canal irrigation with chlorhexidine. White et al., J Endod, 1997. Comparison of antimicrobial substantivity of root canal irrigants in instrumented root canals up to 72 h: an in vitro study. Shahani & Reddy, J Indian Soc Pedod Prev Dent, 2011. In vitro assessment of the immediate and prolonged antimicrobial action of chlorhexidine gel as an endodontic irrigant against Enterococcus faecalis. Dametto et al., Oral surg, 2005. Residual activity of cetrimide and chlorhexidine on Enterococcus faecalis-infected root canals. Ferrer-Luque et al., Int J Oral Sci, 2014. Effect of Different Obturation Materials on Residual Antimicrobial Activity of 2% Chlorhexidine in Dentin at Different Time Intervals: An Ex Vivo Study. Bolhari et al., J Dent , 2015. Chlorhexidine gluconate, its properties and applications in endodontics. Mohammadi, Iran Endod J, 2008. Antimicrobial substantivity of root canal irrigants and medicaments: a review. Mohammadi & Abbott, Aust Endod J, 2009. Chlorhexidine in endodontics. Gomes et al., Braz Dent J, 2013. A Review of Antibacterial Agents in Endodontic Treatment. RahimiIran et al., Int Endod J, 2014. Chlorhexidine a new purposal in endodontics. Vivacqua et al., Dent Press, 2019. ------------------------------------------------ -----Site_e_Contato----- EndodontiaAvancada.com EndodontiaAvancada.com@gmail.com --- Send in a voice message: https://anchor.fm/endodontiaavancada/message

Lung cancer (LC) is one of the most serious malignant tumors, which has the fastest growing morbidity and mortality worldwide. A role of the lung microbiota in LC pathogenesis has been analyzed, but a comparable role of the gut microbiota has not yet been investigated. In this study, the gut microbiota of 30 LC patients and 30 healthy controls were examined via next-generation sequencing of 16S rRNA and analyzed for diversity and biomarkers. We found that there was no decrease in significant microbial diversity (alpha diversity) in LC patients compared to controls (P observed = 0.1422), while the composition (beta diversity) differed significantly between patients and controls (phylum [stress = 0.153], class [stress = 0.16], order [stress = 0.146], family [stress = 0.153]). Controls had a higher abundance of the bacterial phylum Actinobacteria and genus Bifidobacterium, while patients with LC showed elevated levels of Enterococcus. These bacteria were found as possible biomarkers for LC. A decline of normal function of the gut microbiome in LC patients was also observed. These results provide the basic guidance for a systematic, multilayered assessment of the role of the gut microbiome in LC, which has a promising potential for early prevention and targeted intervention. Zhuang H, Cheng L, Wang Y, et al. Dysbiosis of the Gut Microbiome in Lung Cancer. Front Cell Infect Microbiol. 2019;9:112. Published 2019 Apr 18. doi:10.3389/fcimb.2019.00112. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Sections of the Abstract, Introduction, Materials and Methods,and Discussion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489541/

In this week's episode, Sarah and Stacy go one level deeper in the connection between gut health and probiotics, this time with a focus on infants and children. What factors impact the formation of the gut microbiome? How does a vaginal birth and breastfeeding affect a baby's gut bacteria species? And how can you support a healthy gut microbiome, especially in C-section or formula fed children? Click here to listen in iTunes If you enjoy the show, please review it in iTunes! The Paleo View (TPV), Episode 330: Probiotics for Infants and Children (0:00) Intro (0:40) News and views Sarah says she is extra bubbly, but possibly not that coherent of a mood today. Who knows what will happen! Sarah has come to the realization that we never really grow up, but she's learned that her capacity to juggle everything and "just keep swimming" has increased dramatically. Stacy agrees and adds that this time of year results in a lot more stress - both good and bad - which can quickly fill our plates! This week's topic is a continuation of last week's, The Link Between Carb Intolerance and Gut Health, but focused on infants and children, particularly those that aren't breast fed or are born via C-section. (6:53) Kari's Question "Hi Sarah and Stacy,First let me say that I love your show! I've been following AIP for a couple of years now, but just discovered the podcast. I love going through the old episodes (I just switched out all my Pampers baby wipes for Water Wipes!)Anyway, I recently read this article in the NY Times on the lack of B. infantis in babies. Would love to hear your thoughts on this. Is this a contributor to autoimmune issues? Is there really nothing we can do about it? I found a probiotic supplement (Evivo) - thoughts on giving this to my 1-year old? What about my 4 year old (who already has Graves and Hashimoto's)? Or even giving it to myself?? Thanks! Kari" (10:00) The development of the gut microbiome  Evidence shows there's some bacteria seeding our gut in utero. But the dominant exposure that sets our gut microbiome off on the right foot is exposure to the vaginal canal microbiome. C-Section babies get exposure to bacteria from skin to skin contact, which does not produce as much beneficial bacteria as a vaginal delivery. Stacy wants to make it abundantly clear that there is no judgement here on anyone's parenting techniques! Whether you had a vaginal delivery, C-Section, breastfeed/fed, or not, we support you! We're just sharing facts as well as suggestions for how to improve whatever situation you're in. Sarah emphasizes that our gut microbiome changes as we age and there are many opportunities for exposure to beneficial bacteria. Breast milk has a ton of bacteria including Bifidobacterium (including B. infantis - mentioned in the NY Times article), Lactobacillus, Enterococcus, and Clostridium. There are broad types of bacteria that encompass many different species that have important probiotic effects. Typically a formula-fed baby's gut microbiome looks quite different than one who was breastfed. It's not necessarily the probiotics, more so the sugars in breast milk that aren't in formula. Breast milk has carbohydrates that babies can't digest and instead they feed the gut microbiome. Formula hasn't been able to replicate this yet. If you're born via C-section or formula-fed, it increases risk of obesity, developing diabetes, asthma, etc. There is a correlation that if you have good bacteria in the beginning, it remains throughout your life. However, other factors such as socioeconomic factors, stress, poor sleep, etc, may be the more direct determinants of good bacteria. The mother's gut microbial composition is really key because you can only pass on the good bacteria you have in your body. (23:13) Bifidobacterium Infantis is a very key probiotic strain that has anti-inflammatory properties, is an immune modulator, vitamin producer, lactic acid producer (lowering the pH of the intestines, creating a good environment for other important species). Has been used as a supplement to treat ulcerative colitis, psoriasis, chronic fatigue syndrome, autoimmune disease. The NY Times article Kari referenced provides new research showing babies lacking B. Infantis are more likely to develop allergies, Type I Diabetes, and more likely to be overweight. This strain is disappearing because there is a raise in C-sections and formulas, increasing use of antibiotics, and more sterile environments. This one strain seems to be really, really important for basically setting up the gut microbiome environment later in life. Study found that 9 out of 10 infants didn't have the B. Infantis bacteria in their guts. If we don't have this, should we be supplementing with it? Some companies are adding it to formula but there are questions of whether or not it's actually making it to the gut alive. Evivo, the probiotic Kari referenced, is showing evidence from several well-done studies that, adding this probiotic is well tolerated and is having a noticeably positive impact on the gut microbiomes of infants. Study: Safety and tolerability of Bifidobacterium longum subspecies infantis EVC001 supplementation in healthy term breastfed infants: a phase I clinical trial. Study: Persistence of Supplemented Bifidobacterium longum subsp. infantis EVC001 in Breastfed Infants. If you're giving an infant or child with a dairy allergy a probiotic, be sure to check if it contains milk. Some babies are so sensitive that they may have a reaction even if the mother is drinking milk and then breastfeeding. You can do stool testing to see if B. Infantis is present in your child's stool before supplementing. B. Infantis can be found in some foods like sauerkraut and yogurt. You can usually find the strains of bacteria used in the starter culture on the label. Other types of exposure include playing in the dirt and babies putting everything in their mouths! These expose babies to environmental challenges to help educate their immune system. If you are taking a probiotic of the wrong species, there's the potential to inhibit the growth of some good guys you might want. Ultimately we want to feed our gut bacteria through our diet and lifestyle and also expose ourselves to as much variety as possible through probiotic foods and environments. 60% of our gut bacteria comes from diet. Back to Kari - Sarah says she can definitely try Evivo for her kids, but she can probably replicate that in a lot of ways by seeking out wild ferments or eating fermented foods that contain B. Infantis. (46:30) Knowing what she knows now, what would Sarah do? Stacy says that realistically, she was so busy doing so many other things for her kids' health (cloth diapers, breast feeding, co-sleeping) she didn't prioritize fermenting her own foods to feed to her children or giving them a probiotic. Instead, she prioritized skin to skin contact (especially since her boys were all born by C-section). Sarah says knowing what she knows now, before having kids she would: Take a probiotic like Just Thrive, plus Bifidobacterium, Lactobacillus, and B. Infantis. Get 15% off Just Thrive Probiotics here with code PALEOVIEW15 Eat all the vegetables, seafood, and probiotic foods. Be obsessing about all the things she could do to improve her gut microbiome. For a new baby, she would Breastfeed And if she didn't have a great gut microbiome (to pass on to her child), would supplement with Evivo. She would have prioritized probiotics over the fear of milk or soy causing an allergy. For kids 1+, she would do what she does now: Make homemade water kefir Buy good, local sauerkraut Buy kombucha Go camping, hiking, and visit lots of different environments like farms. Stacy asks, if you have a C-section and you're unable to breastfeed, what would you do? Sarah says she would've given her baby a B. Infantis probiotic like Evivo. Once they could eat solid foods, she'd start feeding them fermented foods. Sarah recommends having a conversation with your pediatrician about giving your baby a probiotic supplement. If you think there's a chance your baby will develop an allergy to the dairy proteins in the probiotic, definitely keep your pediatrician in the loop! Signs of an allergy in infants: mucus or blood in the stools or colic. If you don't jive with your doctor, find a new one that's more in line with your values. Disclaimer: just because Sarah shares her choice, that doesn't mean it's the right choice for you. Do your research, consult your doctors, and make an educated choice... but we know you'll do that anyways!

-----Convidado_de_Hoje----- Prof. Dr. Ricardo Ferreira http://avantis.edu.br/ http://www.institutoioa.com.br/ ----------------------------------------------------------------- -----Criador_do_Podcast----- Prof. Nilton Vivacqua Gomes • Especialista, Mestre e Doutor em Endodontia pela UNICAMP. • Professor-Coord. dos Cursos de Aperfeiçoamento, Especialização e Imersão em Endodontia da ABO-CE e ELEVA-CE. • Professor-Coord. do Mestrado de Excelência em Endodontia da Faculdade SL Mandic – Fortaleza-CE. • Professor Convidado dos Cursos de Aperfeiçoamento e Especialização do IOA-Balneário Camboriú-SC. ----------------------------------------------------------------- -----Cursos----- Clique nos Links abaixo para: Aperf. e Imersões: goo.gl/TEgyfW Especializações: goo.gl/vkLWuE Dentalbox Conceito (85) 98180-9804 ----------------------------------------------------------------- -----Apoio----- Você pode apoiar essa iniciativa para incentivá-la a continuar indefinidamente. É só acessar www.apoia.se/ENDOdontoCast e escolher o valor c/ o qual deseja apoiar mensalmente. Vale até mesmo 1 real. Quanto maior o valor, maior o benefício. -----Apoiadores----- Sandro Rodrigues Pinheiro ----------------------------------------------------------------- -----Podcast_Apps----- Podcasts (Nativo), Overcast, Breaker (IOS), Google Podcasts (Android), Acast, Ivoox, Wecast, Castbox, Spotify, PocketCasts (IOS/Android). Instale o app e na aba busca e procure pelo ENDOdonto Cast. Inscreva-se clicando no botão destinado a isso. Selecione a config. p/ baixar novos episódios automaticamente. ----------------------------------------------------------------- ---Referências_Científicas_Endodônticas--- -Effectiveness of ozone against endodontopathogenic microorganisms in a root canal biofilm model. Huth et al., Int Endod J 2009. -Treatment of root canal bofilms of Enterococcus faecalis with ozone gas and passive ultrassonic activation. Case et al., J Endod 2012. -Antimicrobial efficacy of ozonated water, gaseous ozone, sodium hypochlorite and chlorhexidine in infected human root canals. Estrela et al., Int Endod J 2007. -Role of Ozone Therapy in Minimal Intervention Dentistry and Endodontics - A Review. Reddy et al., Journal of International Oral Health 2013. -Antibacterial Efficacy of Aqueous Ozone in Root Canals Infected by Enterococcus faecalis. Hubbezoglu et al., Jundishapur J Microbiol. 2014. -Synergistic antimicrobial action of chlorhexidine and ozone in endodontic treatment. Noites et al., Biomed Res Int. 2014. -Comparison of ozone gas and sodium hypochlorite/chlorhexidine two-visit disinfection protocols in treating apical periodontitis: a randomized controlled clinical trial. Kist et al. Clin Oral Investig. 2017. -Effects of Diode Laser, Gaseous Ozone, and Medical Dressings on Enterococcus faecalis Biofilms in the Root Canal Ex Vivo. Bitter et al., Biomed Res Int. 2017. The Effect of Gaseous Ozone in Infected Root Canal. Ajeti et al., Open Access Maced J Med Sci. 2018. ----------------------------------------------------------------- -----Site_e_Contatos----- EndodontiaAvancada.com EndodontiaAvancada.com@gmail.com EndodontiaAvancada.com@hotmail.com ----------------------------------------------------------------- -----Redes_Sociais----- Instagram: Nilton Vivacqua LinkedIn: Nilton Vivacqua Twitter: NiltonVivacqua e EndoAvancada* Facebook: Nilton Vivacqua e Endodontia Avançada Página do Facebook: EndodontiaAvancada.com Grupo do Facebook: EndodontiaAvancada.com* ----------------------------------------------------------------- -----Perguntas,_Críticas_e_Sugestões----- Envie-nos um e-mail ou use a #ENDOdontoCast em uma das redes sociais com asterisco, logo acima. Válido apenas para o grupo do Facebook e Twitter! Sua mensagem pode ser lida nos próximos episódios. --- Send in a voice message: https://anchor.fm/endodontiaavancada/message

This episode: Roundworms and not-too-irritating bacteria quickly evolve a beneficial relationship when under threat from other bacterial pathogens! Download Episode (7.5 MB, 8.1 minutes) Show notes: Microbe of the episode: Siegesbeckia yellow vein betasatellite News item Journal Paper: Rafaluk‐Mohr C, Ashby B, Dahan DA, King KC. 2018. Mutual fitness benefits arise during coevolution in a nematode-defensive microbe model. Evol Lett 2:246–256. Other interesting stories: Phages can hide in bacterial spores and attack when the bacteria revive (paper) Probiotics seemed to increase risk in mice from gut parasite Studying the value of using probiotics before or after antibiotics More microbes than realized, even in gut, may be able to generate electricity Magnetotactic bacteria are really cool   Email questions or comments to bacteriofiles at gmail dot com. Thanks for listening! Subscribe: Apple Podcasts, RSS, Google Play. Support the show at Patreon, or check out the show at Twitter or Facebook

The TWiM team considers the increasing tolerance of Enterococcus to handwash alcohols, and how the study of DNA in ancient dung reveals the diet and parasite burden of extinct New Zealand birds. Subscribe to TWiM (free) on iTunes, Google Podcasts, Stitcher, Android, RSS, or by email. You can also listen on your mobile device with the Microbeworld app. Become a Patron of TWiM! Episode Links: Hand sanitizer alert (Emerg Inf Dis) Bacteria becoming hand sanitizer tolerant (NPR) Increasing tolerance of Enterococcus to handwash alcohols (Sci Transl Med) Coprolites and the Moa (PNAS) After Hurricane Florence, Significant Worry Over Infectious Diseases Music used on TWiM is composed and performed by Ronald Jenkees and used with permission. Send your microbiology questions and comments to twim@microbe.tv  

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I’m looking forward to sharing with you some of our community’s questions that have come in over the past few weeks… Let’s get started!  Anonymous: I am curious about your thoughts on iron levels. I don’t recall hearing you ever talk about it on the podcast. A few months ago I thought I had mono - I had all the classic symptoms. Though I didn’t check my blood work I started taking iron and felt much better. My doctor said I was most likely anemic as I was a vegetarian at the time. What are your thoughts on iron levels as it relates to mood, energy etc? Vivian; After listening to your podcast on signs that a disease is coming , i got really concerned cause my husband showed one , very clearly - the diagonal crease on ear lob - His mom passed in 2010 at age of 60 , suddenly from heart disease they never knew she had. After that , in 2011 , he did a full scan and all showed fine. I told him about the podcast and forced him to do it over....we just got a call from the doctor , saying that he has the early stage of a heart disease...that one one of the markers that in 2011 came as zero, came as a 4 now and his red blood cells are kind of "sticky" and can result in heart problems if he doesn't eat right and follow the recommendations. Since i met him , over 2 years ago, his diet has changed completely, i thought him how to eat and all i have learned about nutrition. He finished a doctor Cabral 7 days detox couple weeks ago. Please , what are your recommendations ( what to avoid and what to supplement with) so we can do our best to have him with us for many ,many, years?? I appreciate your help and all you do. Suzanne:  Hello Stephen! Thank you for all the wonderful work you do in the healing world! My question involves a few different sicknesses I’ve accumulated over the last year. Last year during a stressful teaching stint I was diagnosed with an Epstein Bar (Glandular Fever) relapse, despite having the condition in my late teenage years. (I am now 25 years old.I suffered with a chronic sore throat initially which turned into fatigue, muscle aches and peeling fingers and toes. After changing a huge amount of my lifestyle and stress I have helped things but still suffer from the sore throat every few days, fatigue and constant peeling of my fingers and toes. (Despite many coconut oil applications I can’t seem to stop the peeling) On a side note: I have travelled a lot (and did get bitten by a tick in Nepal.) I have been on far too many antibiotics (If only I knew) and did go on a course of Roaccutane for three months. I was also vegan for almost four years in an attempt for perfect health which has since changed since the long absence of my period. My sickness also began when I was vegan. I now eat a small amount of meat including salmon, organic chicken and kangaroo which has fixed my hormones. (Still no dairy, eggs and limited gluten.) BUT Despite my best efforts I’m still fatigued and working part time as a result with peeling fingers and a sore throat most of the time) I believe I will get there I just need a little help and advice. Thank you for all the work you do in this field. The path to wellness in the best gift you could give. Elizabeth: Hi Dr Cabral, I don't think you have done a podcast on this but I was wondering if there is anything you would specifically recommend for PMLE? I have read online that Shirudo AGR+E lotion is good but I wondered if there is also anything else or any supplements that would help (and/or potentially reverse) this? It may help to mention, I believe I have hypothyroidism (which I am naturally treating the past year or so) and that I have changed my sunscreen various times (minor PMLE occurs with each different sunscreen brand; I am also trying to find a natural sunscreen). The PMLE type reaction is relatively minor and has only started to happen the last couple of years. Last summer vacation I had a minor reaction on my arms, legs/ankles and chest and this vacation this past week (mid-June) I had it only on my hands, knees, feet and partly on my collarbone/upper chest. It's not immediate, it seems to take a few days to occur. I remain out of the sun when it does, although using more sunscreen does not help. Not sure if reaction on different areas of the body signifies anything? I am from London, where we don't get much sun. Perhaps there is a relation with thyroid but it would be useful to know what may help it going forward and what may have caused it. I am going away again soon so I did contact your support email in hope for a earlier response but they directed me to ask cabral, however hopefully this may help some others... Thank you so much for you and your podcasts! Andrea: My 25 yr old daughter has had gut issues for years and has been to many dr,’s but still no relief. She was then diagnosed with Hashimotos and thyroid cancer and had her thyroid removed 12/2016. She now also has psoriasis. She now see’s a local Functional medicine dr here in STL who has been trying to help her. She tried a candida cleanse late last year but still has gut pain. She is gluten free and has done food allergy tests that show mild allergy to yogurt but that’s it. She decided to do a GI Map and here are the things that seem off:Enterotoxigenic E. coli LT/ST 1.19e6 High; Normal Bacterial Flora; Bacteroides fragilis 8.8e8 Low; Bifidobacterium spp. 1.6e10; Enterococcus spp. 5.7e6; Escherichia spp. 7.9e5 Low; Lactobacillus spp. 2.6e6; Clostridium spp. 9.66e4; Enterobacter spp. 1.69e5 Low; Phyla Microbiota Result; Bacteroidetes 1.94e10 Low; Firmicutes 7.87e9 Low; Firmicutes:Bacteroidetes Ratio 0.40; Additional Dysbiotic/Overgrowth Bacteria Result Normal; Bacillus spp. 2.71e4; Enterococcus faecalis

Researchers have discovered that hand sanitizers might be losing their effectiveness. Hand sanitizers contain alcohol, a substance that keeps bacteria at bay. However, researchers from Australia recently found that a certain type of bacteria might have developed a tolerance for alcohol. In fact, it can endure being exposed to the substance for extended periods of time. The bacterium is called Enterococcus faecium [en-te-roh-KOK-us FEE-see-um] (E. faecium), a notorious cause of infections in hospitals. Normally, it is harmless and lives in people's stomachs. But once activated, it may bring about infection in the stomach, blood, and urinary tract. For the study, the researchers examined 139 samples of E. faecium that were collected before and after the widespread use of hand sanitizers in Australian hospitals. They exposed the samples to different alcohol strengths. Results revealed that the bacteria acquired after 2010 were 10 times more resistant to alcohol. The researchers stated that the bacteria's genes have mutated to survive even when exposed to the substance. Despite the findings, the researchers admitted that more studies are needed to prove that E. faecium is fully tolerant to alcohol. However, Professor Timothy Stinear, one of the researchers, said that hospitals need to take extra precautions to make sure that this bacterium will not spread. He emphasized the importance of washing hands using soap. On another note, Professor James Scott at the Dalla Lana School of Public Health at the University of Toronto stressed that people should continue using hand sanitizers. Hand sanitizers may not be effective at fighting off E. faecium, but they prevent the spread of other bacteria that can contaminate food.

No episódio de hoje vamos discutir no artigo principal um novo mecanismo pelo qual tumores metastáticos suprimem o sistema imune e favorecem o seu crescimento através da liberação de microvesículas contendo uma potente molécula imunomoduladora e como isso pode ser usado como indicador de prognostico de tumores metastáticos, aqueles tumores que tem a capacidade de se espalhar para outros órgãos além do inicial. No Microlitros de Notícias falamos sobre o aumento na resistência a álcool em bactérias que causam infecções hospitalares; sobre uma nova classe de antibióticos, os nano antibióticos; e também trazemos notícias da China sobre um novo composto capaz de impedir a metástase de alguns tumores. Na Filogenia da Ciência falaremos sobre Rosalind Franklin, a cientista que fotografou o DNA   Tópicos comentados nesse episódio Tumor Cancêr Metástase Imunossupressão Vesículas Microvesículas PD-L1 Prognóstico de cancêr Keytruda Bactérias resistentes a álcool Enterococcus faecium Nano-antibióticos Ginesteína Anti-metástase Rosalind Franklin XXIV Semana de Microbiologia e Imunologia da UFRJ Inscrições para o II Workshop on Inflammation, clique aqui   Referências desse episódio 2018. Chen G, Huang AC, Zhang W, Zhang G, Wu M, Xu W, Yu Z, Yang J, Wang B, Sun H, Xia H, Man Q, Zhong W, Antelo LF, Wu B, Xiong X, Liu X, Guan L, Li T, Liu S, Yang R, Lu Y, Dong L, McGettigan S, Somasundaram R, Radhakrishnan R, Mills G, Lu Y, Kim J, Chen YH, Dong H, Zhao Y, Karakousis GC, Mitchell TC, Schuchter LM, Herlyn M, Wherry EJ, Xu X, Guo W. Exosomal PD-L1 contributes to immunosuppression and is associated with anti-PD-1 response. Nature, 560:382-386. 2012. Peinado H, Alečković M, Lavotshkin S, Matei I, Costa-Silva B, Moreno-Bueno G, Hergueta-Redondo M, Williams C, García-Santos G, Ghajar C, Nitadori-Hoshino A, Hoffman C, Badal K, Garcia BA, Callahan MK, Yuan J, Martins VR, Skog J, Kaplan RN, Brady MS, Wolchok JD, Chapman PB, Kang Y, Bromberg J, Lyden D. Melanoma exosomes educate bone marrow progenitor cells toward a pro-metastatic phenotype through MET. Nat Med, 18:883-891. Portal ANVISA. Anvisa aprova indicação inédita para câncer de pulmão. 2018. PIDOT, Sacha J. et al. Increasing tolerance of hospital Enterococcus faecium to handwash alcohols. Science Translational Medicine, v. 10, n. 452. 2017. de Oliveira, J. F. A., Saito, Â., Bido, A. T., Kobarg, J., Stassen, H. K., e Cardoso, M. B. Defeating bacterial resistance and preventing mammalian cells toxicity through rational design of antibiotic-functionalized nanoparticles. Scientific Reports, 7(1), 1326. 2018. Li Xu, Ryan Gordon, Rebecca Farmer, Abhinandan Pattanayak, Andrew Binkowski, Xiaoke Huang, Michael Avram, Sankar Krishna, Eric Voll, Janet Pavese, Juan Chavez, James Bruce, Andrew Mazar, Antoinette Nibbs, Wayne Anderson, Lin Li, Borko Jovanovic, Sean Pruell, Matias Valsecchi, Giulio Francia, Rick Betori, Karl Scheidt & Raymond Bergan. Precision therapeutic targeting of human cancer cell motility. Nature.   Sobre o Podcast Microbiando A ideia do Microbiando é discutir artigos científicos de ponta em todas as áreas da microbiologia e imunologia. Vamos utilizar uma linguagem bem acessível para destrinchar esses artigos para vocês, mas sem perder o rigor científico e analítico necessário para essa tarefa. Além de discutir artigos nós teremos o quadro Microlitros de Notícias, onde nossos microbiologistas e imunologistas de plantão irão abordar pequenas reportagens e trazer novidades para vocês. No quadro filogenia da Ciência vamos contar um pouco sobre a vida de grandes personalidades que revolucionaram a Microbiologia e Imunologia com suas descobertas. Você pode nos ouvir no Spotify, Google Podcast, Player FM, Podcast Addict, CastBox, Blubrry Podcasting, iTunes e outros agregadores de podcasts.   Contatos E-mail: microbiando@micro.ufrj.br Twitter Facebook Instagram   Expediente

Welcome back to our 2nd Cabral HouseCall of the weekend! We have some amazing questions lined up for you today, so let's get started: Amanda: Hi Dr. Cabral. Love the show. Last September I switched birth control contraceptives. I had been on the pill for about 10 years. I switched to the cooper IUD (paragard). I've had spotting almost every single month since the switch. I was told this was normal, however, I didn't expect it to last this long. Is there anything I can do to help stop the spotting?  Anonymous: Hi Dr Cabral, is it fine to start taking probiotics after a few weeks of a decent candida cleanse even if you are still experiencing candida symptoms, i.e. bloating, gas etc; is it usual to still experience the symptoms until you start on probiotics or should you completely wait or avoid probiotics until those symptoms are fully gone? I also wondered what your take is on the controversial probiotic Enterococcus faecalis (found in Threelac/Fivelac)? Learnt so much thanks for your amazing podcast! Amanda: Hi Dr Cabral, I am a holistic nutritionist and love your show. Almost 5 months ago I ended up with leaky gut which led me to having perioral dermititis. My skin problems were really bad until I started Going on a leaky gut protocol; healing with bone broths, fermented foods, green juices and probiotics. Today I am much better but there is still a slight rash around my nose that hasn't totally gone away. Some days it's better than others. Do you have any experience of what could keep this lingering dermatitis? Is it bacteria or fungal? And any suggestions on a cure? Thanks for all that you do  Elizabeth: Hi Dr Cabral, similar to the CBD oil I was very intrigued on your 483 episode on CoQ10. I purchased a CoQ10 supplement & serum about a year ago from "MitoQ"; unfortunately I wasn't consistent with either but since your episode, I have looked back into them and noticed this supplement contains 5mg Mitoquinol and wondered how that compares to the supplements you suggested of 100mg Ubiquinol? I have read reviews for both and both seem to be very effective but the price range is quite significant. Thanks and awesome podcast!! Tony: Hi Doctor Cabral, I am mid fight with my gf about microwaving food. I do not see the issue, she is telling me it disrupts the food on a cellular level and I just don't believe her. Is there truly any harm in microwaving your food for best health. Also, What makes GMO food GMO? I do not see gmo as hurtful, again my gf thinks otherwise, so we come to you! I do not see the harm in eating gmo plants since cross pollination is inherently natural. My gf believes its the seed that is corrupt and therefore needs more pesticides. it is all confusing to me. please help explain. Does gmo food truly connect to disease? Thank you!  Geena: I have been breaking out on the front of my neck and LOWER back and shoulders, and eyebrow area of my face. I have tried to learn about Chinese facial mapping and I think it points to a bad liver? Any ideas? The acne on my neck is the most troublesome and creates anxiety. thank you for your help and podcast, I am sure to spread the news you give.   Stephanie: Hello! I have extremely bad lower back pain the first 2 days of my period when it is the heaviest, any reason? I can't really work or do much on these days. I heard it is just normal and my doc just wants to put me on birth control, but I know better. Any advice? I am 32 years old an would like to have kids in the next couple years. Also since on the topic, is it true women get to "clean out their blood" through their period monthly, so it is really something we should look at as a good nuisance....? I also break out on my back the week before my period. normal? Thank you! Great show. I hope you enjoyed today's Q&A and all the tips added in along the way! - - - Show Notes & Resources: http://StephenCabral.com/499 - - - Get Your Question Answered: http://StephenCabral.com/askcabral  

Nuestros intestinos están poblados por cientos de especies bacterianas que viven en simbiosis con nosotros. Estas bacterias nos ayudan a digerir determinados alimentos, producen algunas vitaminas y han aprendido a convivir sin ser atacadas por nuestro sistema inmune. No obstante, algunas especies, como Enterococcus faecium, van aún más allá, proporcionan protección contra ciertos tipos de bacterias patógenas. Ahora un equipo de investigadores de la Universidad de Rockefeller, en Nueva York, han realizado una serie de experimentos que demuestran cómo E. faecium protege de la peligrosa salmonella y contra otras bacterias patógenas.

In today's VETgirl online veterinary continuing education podcast, we review whether or not the urine dipstick paddle works to help identify urinary tract infections (UTIs) in dogs and cats. Being that 14% of dogs will develop a UTI at some point in their life, and that UTIs are more prevalent in older (versus younger cats), veterinarians should be well aware of how to treat UTIs. Keep in mind that most UTIs in dogs and cats involve a single bacterial species, with E.coli being the #1 isolated bacteria from the urine of dogs and cats (followed by Staph, Proteus, Klebsiella, Enterococcus, and Strep).

In today's VETgirl online veterinary continuing education podcast, we review whether or not the urine dipstick paddle works to help identify urinary tract infections (UTIs) in dogs and cats. Being that 14% of dogs will develop a UTI at some point in their life, and that UTIs are more prevalent in older (versus younger cats), veterinarians should be well aware of how to treat UTIs. Keep in mind that most UTIs in dogs and cats involve a single bacterial species, with E.coli being the #1 isolated bacteria from the urine of dogs and cats (followed by Staph, Proteus, Klebsiella, Enterococcus, and Strep).

Ein voll entwickeltes Immunsystem ist für die Tiergesundheit und damit auch für das Tierwohl von entscheidender Bedeutung. Dies gilt insbesondere in der intensiven Geflügelhaltung, in der das häufige Auftreten von Infektionserkrankungen durch präventive Impfmaßnahmen oder den Einsatz von Antibiotika kontrolliert wird. Letzterer steht derzeit stark in der Kritik und hat zur intensiven Suche nach Alternativen geführt. Arbeiten der letzten Jahre haben gezeigt, dass die strukturelle und funktionelle Entwicklung des Immunsystems von Mäusen entscheidend von der intestinalen Mikroflora beeinflusst wird. Für landwirtschaftliche Nutztiere und insbesondere für das Geflügel gibt es hierzu nur wenige, überwiegend sehr alte Untersuchungen. Im Rahmen dieser Arbeit sollte daher die Bedeutung einer mikrobiellen Besiedelung des Darms nach dem Schlupf für die Entwicklung des Immunsystems und insbesondere des Darmimmunsystem von Hühnern untersucht werden. Als methodischer Ansatz wurde der Vergleich von keimfrei gehaltenen und konventionell gehaltenen Hühnern gewählt. In die Studie miteinbezogen wurden zwei weitere Tiergruppen, welche mit probiotischen Bakterien rekonstituiert wurden. Eine dieser Gruppen wurde mit dem Escherichia coli Nissle 1917 Stamm mono-rekonstituiert (Mono-Gruppe), die zweite Gruppe erhielt eine Mischung aus den vier Bakterienstämmen Escherichia coli Nissle, Enterococcus faecium, Lactobacillus rhamnosus und Clostridium butyricum (Tetra-Gruppe). Die Untersuchung des Darms der Tiere erfolgte auf morphologischer (Immunhistologie), transkriptioneller (Genexpressionsanalysen) und funktioneller (Immunglobulin-quantifizierung) Ebene. Dabei konnte bei keimfrei gehaltenen Hühnern morphologisch eine massiv reduzierte Anzahl an B-Lymphozyten und das Fehlen von Germinalen Zentren, isolierten lymphatischen Follikeln und der IgA- und IgY-Produktion im Darm festgestellt werden. Dagegen war der Effekt einer fehlenden mikrobiellen Besiedlung auf die T-Lymphozyten im Darm vergleichsweise gering. Für die Zellen des angeborenen Immunsystems konnten morphologisch keinerlei Unterschiede zwischen den untersuchten Tiergruppen festgestellt werden. Der Phänotyp der mono-rekonstituierten Hühner lag hinsichtlich des histologisch erfassten Entwicklungsstandes zwischen der Keimfrei- und der Tetra-Gruppe, die Tetra-Gruppe kam der konventionellen Gruppe am nächsten. Die auf morphologischer Ebene beobachtete Unterentwicklung des Darmimmunsystems der Keimfrei-Gruppe konnte auch auf transkriptioneller Ebene bestätigt werden. Bei den mikrobiell kolonisierten Tiergruppen (konventionell, mono-rekonstituiert, tetra-rekonstituiert) waren zahlreiche immunrelevante Gene signifikant höher exprimiert als bei den keimfreigehaltenen Tieren. Analog zur Morphologie, waren Gene des B-Lymphozyten Systems bei den höher exprimierten Genen überrepräsentiert. Die bei keimfrei gehaltenen Tieren stärker exprimierten Gene wiesen darauf hin, dass bei diesen Transportprozesse, insbesondere des Energiestoffwechsels und des Wasser- und Elektrolythaushalts, eine Rolle zu spielen scheinen. Es fanden sich außerdem Hinweise auf eine Dysregulation der Immunantwort bei den rekonstituierten, insbesondere den tetra-rekonstituierten Tieren, da es in der Tetra-Gruppe zu einer erhöhten Expression von Genen für proinflammatorische Zytokine und Effektorzellen (CD4+, CD8+) kam. Die makroskopische und histologische Untersuchung der tetra-rekonstituierten Tiere lieferte jedoch keinen Hinweis auf ein inflammatorisches Geschehen in dieser Tiergruppe. Die Immunglobulinproduktion wurde ebenfalls signifikant durch die Mikrobiota beeinflusst. Bis zum 28. Lebenstag konnte im Plasma der keimfrei gehaltenen Tiere keinerlei IgA und lediglich deutlich reduzierte Mengen an IgM nachgewiesen werden, wobei die Mono-Rekonstitution mit E.coli Nissle ausreichte, um annähernd normale IgA- und IgM-Plasmakonzentrationen zu induzieren. Am 55. Lebenstag war die Immunglobulin-Konzentration im Plasma der tetra-rekonstituierten Tiere zwar signifikant höher als in der Keimfrei-Gruppe, fiel jedoch geringer aus als in der konventionellen Gruppe. Die diverse Mikroflora der konventionellen Tiere konnte demnach die humorale Immunantwort längerfristig effizienter stimulieren als die Kolonisierung mit nur vier Bakterienstämmen. Des Weiteren konnte für den probiotischen E.coli Nissle Stamm eine effektive spezifische humorale Immunantwort nachgewiesen werden, wogegen der Enterococcus faecium Stamm weniger immunogen erschien. Die Ergebnisse dieser Arbeit zeigen, dass eine frühe Kolonisierung des Darms mit der richtigen Flora entscheidend für die Entwicklung des Darmimmunsystems des Huhns ist. Die gewonnenen Erkenntnisse liefern wichtige Hinweise für die Entwicklung einer probiotischen Flora, welche an Eintagsküken verabreicht, eine schnelle und korrekte Entwicklung des Immunsystems gewährleistet. Als effektive und unbedenkliche Möglichkeit zur Verbesserung der Tiergesundheit, würde sie längerfristig auch einen Beitrag zur Reduktion des Antibiotikaverbrauchs in der Geflügelindustrie leisten.

There is an urgent need for an efficient technology of disinfection and sterilization in view of the alarming dimensions health care-associated infections (HAIs) have reached. Cold atmospheric pressure plasma (CAP) can be utilized for hygienic and medical purposes, in particular in surface decontamination applications, and provides a promising alternative to the conventionally used sterilization techniques. Surface Micro-Discharge (SMD) offers a technology for generating CAP that can be applied to wide areas. In the present work, I investigate the plasma chemistry involved in the inactivation of microorganisms by application of the SMD in order to optimize the antimicrobial effect. For this purpose, different strains of vegetative bacteria and bacterial endospores are exposed to the SMD with experimental parameters such as the gas composition, power input, treatment duration and humidity varied. At the same time, the concentration of ozone produced by the SMD is monitored, and its correlation with the antimicrobial efficacy is investigated. I demonstrate that the bactericidal effect of the SMD on both the Gram-negative Escherichia coli and Gram-positive Enterococcus mundtii is similar and strongly correlates with the ozone concentration. The sporicidal effect on Geobacillus stearothermophilus is crucially affected by the humidity, whereas the ozone concentration appears to have no influence. In addition, I investigate the dynamic behavior of ozone produced by the SMD by varying the geometry and the time interval for the plasma generation and by igniting the plasma in two subsequent phases with different frequencies. Possible explanations for the obtained results are provided. This work fortifies the role of SMD as an efficient sterilization method and discloses diverse possibilities for optimizing the antimicrobial effect.

Reading by Daniel Morgan, MD, author of Reconsidering Isolation Precautions for Endemic Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus

The aim of the present study was to evaluate the relevance of an Avian Orthoreovirus (ARV) isolated from broiler chicken suffering from infectious runting and stunting syndrome (RSS) after simulated vertical infection of chicken. The influence of the age at infection on the progression of ARV infection is of particular importance. At first, the consequences of an early in ovo inoculation with the ARV-isolate 8474DP4-6 in specific pathogen free (spf) embryonated chicken eggs were evaluated. Infected embryos that survived until the 19th day of incubation were observed regularly after inoculation into the allantoic cavity of embryonated chicken eggs with varying doses of the ARV-isolate 8474DP4-6 on the ninth day of incubation. The inoculation into the yolk sac of embryonated chicken eggs on the sixth day of incubation with the same virus resulted in surviving infected embryos only in singular cases. On the other hand, infected embryos died after in ovo inoculation with the ARV vaccine strain S1133 into the allantoic cavity or the yolk sac on the corresponding days of hatch. The mean death time for the infected embryos displayed a high variability. The mean death time after in ovo inoculation with the ARV strain S1133 was observed between 100 and 168 hours while embryos infected with the ARV-isolate died between 60 and 120 hours post inoculation. For a subsequent animal experiment embryonated chicken eggs (Lohmann Selected White Leghorn) were inoculated with the ARV-strain 8474DP4-6 into the allantoic cavity on the 14th day of incubation and the hatched chickens were raised until the age of 36 days. Inoculated birds were kept together with non-inoculated sentinels while a mock-infected group was raised separately. The in ovo inoculation resulted in the hatch of ARV-infected chicks. The hatchability was reduced in the infected group (56%) as well as in the mock-infected control group (46%). ARV was reisolated regularly from organs of infected chicks until the 12th day post hatch and sporadically until day 36 post hatch. Several organs (liver, duodenum and pancreas [pooled], proventriculus, jejunoileum and bursa of Fabricius) were sampled in order to evaluate the organotropism and the progression of infection in inoculated chicks. ARV was reisolated from all kinds of examined organs, whereas the isolation from intestinal organs occurred more frequently. The transmission to non-inoculated sentinels was demonstrated by reisolation of ARV. The inoculated as well as the sentinel chicks developed antibodies against ARV. The results demonstrate the possibility of a vertical and likewise a horizontal transmission for the ARV-strain 8474DP4-6. An increased mortality became evident within the infected group. From the day of hatch and the seventh day of life 52,2% of the animals died, until the 12th day of life the mortality peaked to 56,5%. Within the control group a mortality of 6 and 12% respectively was observed during the corresponding period. Inoculated as well as control animals were of poor condition and suffered from diarrhea. Not inoculated control birds recovered quickly after an antibiotic treatment while the inoculated chicken did not respond well to the therapy. The gross pathology did not reveal any alterations in neither of the groups. Histopathological changes included myocarditis, pancreatic degeneration and lymphocyte depletion in the spleen. Within the bacteriological examination various ubiquitous bacterial species including Staphylococcus sp., Streptococcus sp., Enterococcus sp., Bacillus sp., Escherichia coli, Citrobacter freundii and Enterobacter cloacae were cultivated from organ swabs from animals of both groups. Body weight and weight gain were significantly decreased in inoculated chicks from day seven post hatch on. In ovo infection of embryonated eggs from ARV-vaccinated broiler breeders with the ARV-isolate 8474DP4-6 resulted in a hundredfold lower egg infectious dose 50 compared to embryonated spf chicken eggs. Furthermore, a larger proportion of infected embryos survived until the 19th day of incubation. In conclusion, the in ovo inoculation of embryonated eggs with the RSS-associated ARV strain resulted in the impairment of hatched chicks. The bacteriological findings indicate an increased susceptibility of the ARV-infected chicks to bacterial overgrowth. Future experiments evaluating the effects of early ARV-infections with the focus on alterations of the immune-response will help to elucidate the role of early ARV-infections in chicks.

Ziel der Arbeit war es, das Vorkommen Antibiotika-resistenter Keime in Fleisch zu erfassen, um das Risiko des Übergangs resistenter Keime von Fleisch auf den Menschen besser einschätzen zu können. Gleichzeitig sollte geprüft werden, inwieweit die quantitative Erfassung von Resistenzgenen hierzu einen Beitrag leisten kann. Hierzu wurden in dem Zeitraum von November 2003 bis Februar 2005 aus 500 „Hähnchen-" und 500 „Schweinefleisch-Proben“ Bakterien der Gattungen Escherichia (E. coli, n=677), Salmonella (n=89), Campylobacter (n=421), Listeria (n=417), Enterococcus (n=782), Enterobacter (n=167), Citrobacter (n=83), Serratia (n=116) und Klebsiella (n=125) isoliert. Die untersuchten Fleischproben stammten jeweils zu gleichen Teilen vom Schlachthof und von der Verkaufstheke. Die Prüfung der Isolate hinsichtlich ihres Empfindlichkeitsverhaltens erfolgte gegenüber bis zu 31 ausgewählten, größtenteils human-relevanten Antibiotika im Mikrodilutionsverfahren. Weitere 100 „Hähnchen-" und 100 „Schweinefleisch-Proben“ wurden mittels real-time PCR nach Direkt-Extraktion der DNA auf das quantitative Vorkommen der Tetrazyklin-Resistenzgene tet (M) und tet (O) untersucht. Die Analyse der Prävalenzzahlen ergab zum einen, dass aus den „Schweinefleisch-Proben“ weit weniger Isolate (ausgenommen coliformer Keime) als aus den „Hähnchenfleisch-Proben“ gewonnen werden konnten. Zum anderen war das Vorkommen von Listeria spp., aber auch von coliformen Keimen und Salmonella spp. bei den „Verkaufstheke-Proben“ deutlich höher als bei den entsprechenden „Schlachthof-Proben“; gegensätzlich dazu verhielten sich die Campylobacter-Prävalenzraten. Im Rahmen der phänotypischen Empfindlichkeitsuntersuchungen wurde das Vorkommen resistenter und hochmehrfach-resistenter Keime in zum Verzehr geeignetem Fleisch nachgewiesen. Hinsichtlich der verschiedenen Bakterienspezies wurden sehr große Differenzen beobachtet. So mussten 69,0 % der E. coli, 61,8 % der Salmonella spp., 67,1 % der C. jejuni, 76,9 % der C. coli, 74,1 % der E. faecalis, hingegen nur 4,7 % der L. monocytogenes und nur 6,2 % der L. innocua als zumindest einfach-resistent eingestuft werden. Hierbei trugen die untersuchten E. coli-Stämme vor allem Resistenzen gegen Penicilline, die Aminoglykoside Streptomycin und Spectinomycin sowie gegen die Antibiotika Doxyzyklin, Sulfamethoxazol+Trimethoprim. Bei Campylobacter spp. wurden Resistenzraten von bis zu 30 % gegenüber Enrofloxacin, Ciprofloxacin, Ampicillin und Doxyzyklin ermittelt; zudem war bei den C. coli-Stämmen ein hohes Resistenzvorkommen gegenüber Sulfamethoxazol+ Trimethoprim zu beobachten. Bei dem Genus Enterococcus traten vor allem gegen Makrolide und die Wirkstoffe Doxyzyklin, Rifampicin und Fosfomycin Resistenzen auf. Die Auftrennung der Ergebnisse entsprechend der Fleischarten ergab ein weit häufigeres Vorkommen von resistenten Keimen in Hähnchenfleisch als in Schweinefleisch. Diese Tendenz war auch bezüglich mehrfach-resistenter Keime zu beobachten. So waren z. B. bei E. coli 46,1 % der aus Schweinefleisch und 61,1 % der aus Hähnchenfleisch isolierten Stämme als mehrfach-resistent einzustufen; bei den E. faecalis-Isolaten 20,3 % bzw. 47,8 %. Des Weiteren wiesen die Proben von der Verkaufstheke tendenziell häufiger Keime mit Resistenzen auf als solche vom Schlachthof. Vergleicht man die erhobenen Resistenzraten mit denen des GENARS-Projektes, so lagen in der überwiegenden Mehrzahl der Fälle die Resistenzraten der „aviären“ und „porcinen“ Isolate deutlich unter denen „humaner“ Isolate. Bei den molekularbiologischen Untersuchungen wurden relativ geringe Konzentrationen von tet (M) und tet (O) auf Fleischoberflächen gefunden. So ist ein Übergang von resistenten Keimen von Fleisch auf den Menschen durchaus möglich. Allerdings dürfte diesem Weg der Verbreitung Antibiotika-resistenter Keime eine geringere Bedeutung zukommen als mitunter angenommen.

By investigating the resistance characteristics of bacteria from organic and conventional keeping systems of laying hens, it was to be determined to what extent different rearing systems influence bacterial resistance patterns. For this purpose, samples from 10 organic and 10 conventional flocks were investigated 4 times between January 2004 and April 2005. In total, 799 cloacal swabs and 800 egg samples were taken and examined. The isolation and identification of Salmonella spp., Listeria spp., E. coli/Coliforms, Campylobacter spp., and Enterococcus spp. was performed with standardized, cultural methods. Selected isolates of the genera Salmonella (n = 44), Listeria (n = 13), Campylobacter (C. jejuni, n = 218; C. coli, n = 46), Escherichia (E. coli, n = 545; E. fergusonii n = 18; E. hermanii n = 1 ) Citrobacter (Citrobacter freundii n = 9), Enterobacter (Enterobacter cloacae n = 5; Enterobacter sakazakii n = 3; Enterobacter gergoviae n = 2; Enterobacter asburiae n = 1), Pantoea (Pantoea agglomerans n = 2) and Enterococcus (E. faecalis, n = 361; E. faecium, n = 57; other enterococci [E. nonfaecalis/nonfaecium], n = 569) were tested for their resistance behaviour with respect to 29 different antibiotics by means of microdilution. During the bacteriological investigation of the cloacal swabs, prevalences were found for all bacteria groups in the same order of magnitude in the different rearing systems (Salmonella spp. 3.5 % (organic [org.]) vs. 1.8 % (conventional [con.]); Listeria spp.: 1.3 % (org.) vs. 1.6 % (con.); Campylobacter spp : 34.8 % (org.) or 29.0 % (con.); E. coli: 66.4 % (org.) vs. 72.0 % (con.); Enterococcus spp.: 95.5 % (org.) vs. 97.5 % (con.). Eggs were generally infected with less bacteria, most of which were of the genera Enterococcus and Escherichia, whereas Listeria, Salmonella and Campylobacter were only rarely isolated from the samples. Salmonella of the serovar type S. Typhimurium were resistant to up to nine antibiotics; Salmonella of the serogroup B were resistant to up to 6 different antibiotics. All Salmonella isolates proved to be resistant towards spectinomycin. A high percentage of C. jejuni and C. coli isolates showed resistance to flourquinolones; a similar resistance was observed in the case of ampicillin and doxycycline. The Listeria isolates were mostly sensitive towards the tested antibiotics, and only a few strains showed resistance to clindamycin and imipenem. E. coli isolates showed a high resistance prevalence to ß-lactames, doxycycline, streptomycin, and cefaclor. High percentages (54.8 %) of E. faecalis were found to be resistant to doxycycline; macrolides were also only marginally effective. The investigated E. faecium isolates proved to have high resistance rates to clindamycin, fosfomycin and erythromycin, while a significant percentage (9.1 %) of E. faecium had already been classified as resistant to the reserve antibiotic synercid. Other enterococci showed higher resistance rates to doxycycline, erythromycin, fosfomycin, and rifampicine. There were no glykopeptide-resistant enterococci. The analysis of the prevalence rates of sensitive and resistant isolates depending on the keeping system showed a correlation between rearing system and resistance rates: In the case of E. faecalis, a significantly lower prevalence of resistance to tylosin, streptomycin and doxycycline was determined among isolates from organic farms, while significantly higher amounts of isolates were found to be sensitive to enrofloxacin and ciprofloxacin; however, when tested on rifampicin and imipenem, E. faecalis behaved contrary to this. E. coli isolates from organic layers showed significantly lower resistance rates or significantly higher amounts of sensitive isolates with regard to nine agents, while in the case of E. coli from conventional rearing systems, these results could only be observed for two antibiotics. In the case of C. jejuni, significantly better rates were observed for isolates from organic flocks with regard to imipenem and amoxicillin/clavulanic acid, whereas fosfomycin favoured isolates from conventional layer flocks. In the case of 8 antibiotics, the amounts of sensitive and resistant enterococci of the E. nonfaecalis/nonfaecium group originating from organic farms were found to be higher and lower respectively compared to the isolates from conventional farms. Overall, the comparison of the amounts of sensitive and resistant bacteria isolates and the mean MIC values showed that the isolates from organic layer rearing systems scored much better statistically than those from conventional systems. The results show that organic layer flocks reduce the amount of bacteria resistant to antibiotics, as both the resistance rates of the selected bacteria to certain antibiotics as well as the mean MIC values for certain antibiotic agents were lower in organic systems than in conventional ones. Thus, organic livestock farming contributes towards securing the continued effectiveness of anti-infectives.

In der vorliegenden in-vitro Studie wurden die physikalischen, chemischen und biologischen Eigenschaften eines experimentellen Calciumperoxidhaltigen Sealermaterials und die von drei verschiedenen konventionellen Sealermaterialien (Apexit, Ivoclar Vivadent; AH Plus, Dentsply DeTrey; Sealapex, Kerr Sealapex) untersucht. Die statistische Auswertung der physikalischen und biologischen Eigenschaften ergab: 1. Abbindezeit. Der experimentelle calciumperoxidhaltige Sealer besitzt eine ausreichende Abbindezeit von 137,5 Minuten unter standardisierten Testbedingungen (ISO 6876). 2. Fließverhalten. Die Ergebnisse nach der ISO Methode (ISO 6876) zeigen, dass der experimentelle calciumperoxidhaltige Sealer (53,09 mm) und AH Plus (49,39 mm) eine höheres Fließverhalten haben als Sealapex (38,89 mm) und Apexit (45,45 mm). 3. Löslichkeit. Der empfohlene Löslichkeitswert für Sealer beträgt 3% (Britisches Standart BS 6934 1988). Der Löslichkeitswert des experimentellen calciumperoxidhaltigen Sealers (2,75%) entsprach dieser Vorgabe. 4. Wasseraufnahme. Zur Vermeidung einer Reinfektion des Wurzelkanals sollten Wurzelkanalsealer formstabil und porenfrei sein. Die Wasseraufnahme während eines 4 wöchigen Zeitraumes nahm in folgender Reihenfolge zu: AH Plus 0,37% (Gruppe B) < experimenteller (CaO2)-haltigen Sealer 2,13% (Gruppe D) < Sealapex 2,46% (Gruppe A) < Apexit 9,47% (Gruppe C). 5. pH-Wert. Ziel dieser Studie war es, pH-Werte des experimentellen calciumperoxidhaltigen Sealers mit denen der drei anderen konventionellen Sealer (Sealapex, Apexit und AH Plus) über einen Zeitraum von 6 Monaten zu vergleichen. Der pH-Wert des experimentellen calciumperoxidhaltigen Sealers war im Gegensatz zu den calciumhaltigen Sealer in allen Testgruppen niedriger und blieb konstant. Dies könnte einen positiven Effekt auf den biologischen Knochenanbau am Foramen apicale haben. 6. Dimensionsstabilität. Eine erfolgreiche endodontische Therapie sollte eine komplette Obturation des Wurzelkanalsystems voraussetzen. Aus diesem Grund sollten Sealer eine volumetrische Stabilität oder nur eine geringe Volumenzunahme zeigen. Der experimentelle calciumperoxidhaltige Sealer zeigte eine Expansion von 3,9% und blieb nach 2 Wochen konstant. 7. Farbstoffpenetrationstest. Die Dichte des experimentellen calciumperoxidhaltigen Sealers (1,1 mm) war mit der von AH Plus (0,97 mm) nahezu identisch. Beide Sealer zeigten erheblich bessere Ergebnisse als Sealapex (1,3 mm) und Apexit (2,35 mm). 8. Die antimikrobielle Wirkung der 7 untersuchten Sealers und temporalen Einlagen zeigte sowohl im Agardiffusionstest als auch im Keimträgerversuch an humanen Zahnpräparaten deutliche Unterschiede. 9. Agardiffusionstest. Calciumhydroxid- und calciumoxideinlagen waren gegen alle Mikroorganismen wirkungsvoll. Calciumperoxidhaltige Einlagen und calciumperoxidhaltige Sealer zeigten einen geringfügig kleineren antimikrobiellen Effekt. Der Hemmhof bei Enterococcus faecalis war am größten. Sealapex hatte ebenfalls gute antimikrobielle Wirkungen. AH Plus zeigte wenig antibiotische Effekte und war gegen Enterococcus faecalis wirkungslos. Apexit hatte auf Escherichia coli und Candida albicans keine antimikrobielle Wirkung. 10. Keimträgerversuch an humanen Zahnpräparaten. An humanen Zahnpräparaten applizierte calciumperoxidhaltige Sealer und calciumperoxidhaltige Einlagen waren gegen alle verwendete Mikroorganismen wirkungsvoll. Calciumoxid- und calciumhydroxidhaltige Einlagen und Sealapex führten zu einer Beseitigung von Escherichia coli, hatten aber auf Candida albicans, Enterococcus faecalis, Streptococcus sanguinis und Staphylococcus lentus keinen Effekt. AH Plus zeigte bei Escherichia coli und Streptococcus sanguinis antimikrobielle Eigenschaften. Apexit hatte keinen antibakteriellen Effekt. 11. Zusammenfassend waren calciumperoxidhaltige Sealer und Einlagen gegen alle geprüften Mikroorganismen wirkungsvoll. Die Materialien führten zu einer Eliminierung aller Mikroorganismen in den Dentintubuli und zeigten eine effiziente Wachstumshemmung im Agardiffusionstest. 12. Die antibakteriellen Experimente zeigen, dass der calciumperoxidhaltige Sealer und Einlage für eine Behandlung von infizierten Wurzelkanälen geeignet ist. 13. Die Verwendung von Calciumperoxid als Wurzelkanalfüllung, verglichen mit Calciumoxid und Calciumhydroxid, hatte auf die untersuchten Mikroorganismen ein größeres Wirkungsspektrum. Dabei konnten vor allem antibiotische Effekte gegen Enterococcus faecalis und Candida albicans nachgewiesen werden. 14. Vor einem möglichen klinischen Einsatz von Calciumperoxid als neue Wurzelkanalsealer und temporale Einlage müssen die toxikologischen Eigenschaften und die Bioverfügbarkeit untersucht werden. 15. Diese Studie stützt sich allein auf in-vitro-Untersuchungen. Für die Anwendung von Calciumperoxid in vivo sollten klinische Studien folgen.

In der vorliegenden Arbeit wurde erstmals der antioxidative Status von neugeborenen Hundewelpen bestimmt. Zusätzlich wurde untersucht, ob die Zufütterung von Lactoferrin bzw. Enterococcus faecium einen Einfluss auf den antioxidativen Status der Tiere ausübt. Dazu wurden 42 neonatale Beagle-Welpen am 3. Tag nach der Geburt von den Muttertieren getrennt und in zwei unabhängigen Fütterungsversuchen von Hand aufgezogen (Lactoferrin-Versuch und Ec. faecium-Versuch). Der antioxidative Status wurde als TEAC an Tag 3, 7, 14, 28, 56, 70, 84 und 98 im Blut der Welpen gemessen. Zusätzlich wurden die Plasmakonzentrationen des antioxidativ wirksamen Vitamin E bestimmt. Als Vergleich zur mutterlosen Aufzucht dienten 11 neugeborene Beagle-Welpen, die bei ihren Mutterhündinnen aufwuchsen. An Tag 1, 3, 7 und 14 wurden bei ihnen neben der TEAC die Vitamine E und C im Blut gemessen. Außerdem wurde freies Eisen, die latente Eisenbindungskapazität sowie Gesamteisen bestimmt und die totale Eisenbindungskapazität und Transferrinsättigung berechnet. Nach der Geburt kam es bei den neugeborenen Hundewelpen durch erhöhten oxidativen Stress zu einer deutlichen Verminderung des antioxidativen Status im Blut. Dabei konnte kein Einfluss der Lactoferrin- bzw. Ec. faecium-Supplementierung festgestellt werden. Es wurde kein Zusammenhang zwischen dem erniedrigten antioxidativen Status und einem vermehrten Auftreten von Neugeborenenerkrankungen oder einer erhöhten Welpensterblichkeit offensichtlich.

This study aimed at establishing a method for checking the efficacy of probiotic substances in beagle puppies, in accordance with the requirements of the Guidelines for the assessment of micro-organisms in the animal categories dogs, cats and horses of the European Commission of October 2000. The orphan rearing of neonatal puppies was chosen as trial method, the only method to ensure avoidance of interindividual differences such as quality and quantity of mother milk. Another advantage is exact standardisation by exact prerequisites (time of weaning, type and frequency of feeding, keeping facilities, sample collection, choice of parameter, methods of analysis). In two different feeding trials with beagle puppies (duration 14 weeks) the efficacy of the prebiotic substance Lactoferrin (n=23) and of the probiotic bacteria Enterococcus faecium (n=12) on neonatal organisms was analysed. It has become clear that the general status of the puppies could be sufficiently assessed by general clinical parameters (clinical examination, food intake, weight development, quantity and consistency of faeces, blood parameter). As far as these parameters could be determined based on scoring systems, they contributed to the assessment of the substances as so-called “supporting data“. The specific parameters directly related to the probiotic action that could be established in this model are, among others, ph analysis, ammonia and lactate determination as well as microbiological analyses of faeces. Furthermore gut wall samples of duodenum and colon could be taken for immunohistochemical analysis. Antioxidative and immunmodulatory effects were assessed by means of determining trolox equivalent antioxidative capacity, vitamine E and C, uric acid, bilirubin, free ferrum, lactate, CK and GOT, the overall content of IgG and IgA, and the specific content of antibodies against humane serumalbumine in plasma. The two feeding experiments show what principles can be applied for examining the effect of prebiotically or probiotically effective substances in small animals by means of scientific standards for carrying out experiments, documenting and analysing them. Thus these experiments provide a basis for appropriate application of minimum quality standards in examining these substances, according to the requirements of the European Commission in October 2000.

The present study aimed to investigate the effect of oral administration of a probiotic containing Ec. faecium (Total concentration 1 x 108 cfu / 100 g dry matter of feed) on the development and health status of hand reared beagle puppies. For this experiment each control group, respectively each trial group consisted of 6 puppies. The trial began on day 3 after the birth of the puppies in order to ensure sufficient intake of colostrum, and ended on day 98. General health status, clinical parameters, daily feed intake, weight gain, amount of faeces and faeces consistency were recorded. Apart from that 8 blood samples were taken to determine immune status, and 4 for establishing blood parameters. Faeces samples were taken continually in order to determine the dry matter. At 4 different periods there were microbiological analyses as well as a determination of lactate and ammonia in each individual puppy’s faeces. To determinate a specific immune response, humane serumalbumin (hsa) was applied in week 8 and 12, and the serum concentration of total IgG, IgA and specific antibodies against hsa were measured. The probiotic affected the puppies´ general health status slightly negatively during the first 8 days of the trail, resulting in sleepiness, yawning, reduced suckling, reduced muscular tone and reduced feed intake. Besides that no negative effects of the probiotic on the puppies´ health were discovered. The feeding of Ec. faecium did neither influence weight gain nor feed intake. The trail group showed a 6.5 % better feed conversion during the period of mixed feeding with Pedigree® and milk-replacer. No effect of the probiotic on red blood cells and thrombocytes was discovered, but the trial group showed on average a tendentious higher count on lymphocytes, neutrophil granulocytes and monocytes. Ec. faecium feeding resulted possibly in a raised number of macrophages, and herewith monocytes, a stronger immune response with more lymphocytes and a higher phagocytotic activity of neutrophil granulocytes. The lower IgG serum concentration of the trail group from week 2 on could be related to the probiotic, higher average values of IgA in week 2 and 4 suggested a stimulation of mucosal immunity by the additive. In the trial group, the probiotic feeding seemed to result in a higher count of total aerobe bacteria with a lower share of E. coli, in higher Enterococcus counts and throughout lower shares of Cl. perfringens positive animals. These facts are as desirable for the maintenance of the intestinal eubiosis, as is the discovery of a higher average count on Lactobacillus spp. in the trail group. The count on aerobe bacteria, Cl. perfringens, Enterococcus spp. and Lactobacillus spp. decreased with ongoing age of the puppies. In the period of milk-replacer feeding, probiotic feeding seemed to result in a decrease of fecal dry matter. Considering the high spread of single values, no significant effect of Ec. faecium on fecal lactate and ammonia concentration was discovered, although the probiotic seemed to lower fecal ammonia concentration at the beginning of the trail.