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Flucloxacillin (FLU) administered by the oral route is widely used for treating various infections, but there are no published retrospective or prospective trials of its efficacy, or its advantages or disadvantages compared to parenteral treatment or other antibiotics for treating osteomyelitis. Based on published in vitro data and expert opinions, other non-β-lactam oral antibiotics that have better bone penetration are generally preferred over oral FLU. We reviewed the literature for studies of oral FLU as therapy of osteomyelitis (OM), stratified by acute versus chronic and pediatric versus adult cases. In striking contrast to the prevailing opinions and the few descriptive data available, we found that treatment of OM with oral FLU does not appear to be associated with more clinical failures compared to other oral antibiotic agents. Because of its narrow antibiotic spectrum, infrequent severe adverse effects, and low cost, oral FLU is widely used in clinical practice. We therefore call for investigators to conduct prospective trials investigating the effectiveness and potential advantages of oral FLU for treating OM.

The omega-3 fatty acid (n-3 FA) eicosapentaenoic acid (EPA) reduces stroke in patients with atherosclerotic cardiovascular disease. Whether EPA affects stroke or cerebral small vessel dis-ease in patients with atrial fibrillation (AF) remains uncertain. EPA, docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and alpha-linolenic acid (ALA) were determined by gas chromatography in 1657 AF patients from the Swiss Atrial Fibrillation study. All patients underwent brain MRI to detect ischemic brain infarcts, classified as large noncortical or cortical infarcts (LNCCIs), markers of small vessel disease, classified as small noncortical infarcts (SNCIs), number of microbleeds, and white matter lesion (WML) volumes. Individual and total n-3 FAs (EPA + DHA + DPA + ALA) were correlated with LNCCIs and SNCIs using logistic regression, with numbers of microbleeds using a hurdle model, and WML volumes using linear regression. LNCCIs were detected in 372 patients (22.5%). EPA correlated inversely with the prevalence of LNCCIs (odds ratio [OR] 0.51 per increase of 1 percentage point EPA, 95% confidence interval [CI] 0.29–0.90). DPA correlated with a higher LNCCI prevalence (OR 2.48, 95%CI 1.49–4.13). No associations with LNCCIs were found for DHA, ALA, and total n-3 FAs. Neither individual nor total n-3 FAs correlated with markers of small vessel disease. In conclusion, EPA correlates inversely with the prevalence of ischemic brain infarcts, but not with markers of small vessel disease in patients with AF.

BACKGROUND: The occurrence of congestive heart failure (CHF) hospitalization among patients with atrial fibrillation (AF) is a poor prognostic marker. OBJECTIVE: The purpose of this study was to assess whether insulin-like growth factor-binding protein 7 (IGFBP-7), a marker of myocardial damage, identifies AF patients at high risk for this complication. METHODS: We analyzed 2 prospective multicenter observational cohort studies that included 3691 AF patients. Levels of IGFBP-7 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from frozen plasma samples at baseline. The primary endpoint was hospitalization for CHF. Multivariable adjusted Cox regression analyses were constructed. RESULTS: Mean patient age was 69 ± 12 years, 1028 (28%) were female, and 879 (24%) had a history of CHF. The incidence per 1000 patient-years across increasing IGFBP-7 quartiles was 7, 10, 32, and 85. The corresponding multivariable adjusted hazard ratios (aHRs) (95% confidence interval [CI]) were 1.0, 1.05 (0.63-1.77), 2.38 (1.50-3.79), and 4.37 (2.72-7.04) (P for trend

The aim of the study was to retrospectively evaluate safety and patient satisfaction of same-day discharge after elective radial coronary angiography/percutaneous coronary intervention (PCI) after the implementation of a radial lounge facility.All patients admitted to our radial lounge with a planned same-day discharge after an uncomplicated coronary angiography/PCI, having a co-living caregiver, were day enrolled in the study. Rates of same-day discharge, unplanned overnight stay, and in-hospital and first complications [death, myocardial infarction (MI), unplanned coronary angiography, access site hematoma, bleedings requiring hospitalization] were analysed; satisfaction was also evaluated through a questionnaire.From February 2015 to January 2016, 312 patients with a mean age of 66.6 ± 10.8 years were admitted to the radial lounge (coronary angiography, n = 232; PCIs, n = 80). Of them, 245 (78.5%) were discharged the same day. Mean radial lounge monitoring was 6:35 h (interquartile range 5:30-7:30 h). No episodes of death/MI/unplanned coronary angiography were observed both in same-day discharged and postponed patients. Reasons to postpone discharge were: PCI deemed to need prolonged monitoring in 31, patient's preference in 14, femoral shift in 13, surgery in four, chest pain in four, and bleeding in one. At day 1, 11 access site hematoma and one hospitalization for access site bleeding were reported. Patients reported complete satisfaction in 97% of cases. Unplanned overnight stay was common among PCIs patients (RR 6.2, 95% CI 3.9-9.9, P 0.001).A low rate of minor complications was observed in elective radial coronary angiography and PCIs showing the feasibility and safety of the development of an institutional protocol for same-day discharge after the implementation of a radial lounge facility.

Background Chronic rhinosinusitis (CRS) is a frequent disease with high social impact and multifactorial pathogenesis. Recently, single nucleotide polymorphisms within the TAS2R38 gene have been implicated as possible contributors to the complex gene-environment interactions in CRS. The purpose of this study was to confirm the proposed correlation between TAS2R38 genotype, CRS and related comorbidities. Methods Fifty-three CRS patients and 39 healthy individuals were genotyped at the TAS2R38 locus. CRS patients were treated by endoscopic sinus surgery and medical therapies and subdivided in CRS with nasal polyps (CRSwNPs) and CRS without nasal polyps (CRSsNPs). The effect of genotype on CRS and CRS-related comorbidities was assessed. Results The distribution of the different genotypes at the TAS2R38 locus was not significantly different between CRS patients, either with or without nasal polyps, and controls. Besides, no association was found between the different genotypes at the TAS2R38 locus and CRS-related comorbidities. Conclusions No association was found between TAS2R38 alleles or genotypes and CRS, thus questioning its role in the pathogenesis of CRS. Electronic supplementary material The online version of this article (doi:10.1186/s12881-016-0321-3) contains supplementary material, which is available to authorized users.

Mucociliary clearance is a key defence mechanism in human upper and lower airways and its impairment predisposes to chronic infections of the nose, paranasal sinuses and respiratory tract. Nasal mucociliary clearance is a first-line physiological function of nasal cavity, that helps protecting the lower respiratory tract from undesirable organic and inorganic matter, including microorganisms. On one hand, multiple investigations have demonstrated a marked decrease in nasal mucociliary clearance in patients with rhinitis or chronic rhinosinusitis. Ciliary motility analysis allows us to have an index of our defense mechanisms functionality and of our ability to react to microorganisms. The ciliary motility can be evaluated with a light microscope using phase contrast. Sampling should be performed through a brushing at the level of the middle third of the inferior turbinate and the sample must be analyzed immediately after collection. Through the analysis of the sample, it is possible to evaluate the presence of ciliated cells with a functional edge, to calculate the length of the ciliary motilia, to assess the direction of movement and to evaluate the coordination of the lashes. The time needed for this examination is short, it only takes 5 to 10 minutes, and it appears to be not invasive, repeatable and not painful. The ciliary function may also be influenced by the use of certain medications, such as anti-histamines, whereas it may be stimulated and improved by the use of topical hyaluronic acid. HA may be an important regulator of the inflammatory process. During nasal inflammation, high-molecular weight HA breaks down under the influence of free radicals and enzymes. Low-molecular weight fragments deliver signals regarding tissue damage and mobilize immune cells, while the high molecular weight form suppresses immune cells function and prevents excessive exacerbation of inflammation. Based on the known background of the effects of HA in the regulation of vasomotor tone, mucous gland secretion and in the modulation of the inflammatory process, it is suggested that HA may improve ciliary motility, nasal mucosa cellularity and inflammatory status.

Background Chronic rhinosinusitis (CRS) is a frequent disease with a high social impact and multifactorial pathogenesis. Recently, single nucleotide polymorphisms (SNPs) within the TAS2R38 gene were pointed at as possible contributors to the complex gene-environment interactions in CRS. This hypothesis was supported by in vitro evidence of the protective effect exerted by the functional bitter taste receptor T2R38 on sinonasal mucosa, due to its role in innate immunity. The purpose of this study was to confirm the proposed correlation between TAS2R38 genotype and CRS comorbidities and to assess whether the presence of a particular allele can be considered a prognostic marker.

Nasal cytology is a diagnostic method in the field rinology used to detect changes into the endonasal epithelium exposed to physical and/or chemical irritation, acute or chronic inflammation due to different angents (viral, bacterial, fungal or parasitic). Nasal cytology was born in 1889 thanks to H. Gollash who found many eosinophilic cells into the nasal secretions of a patient affected by asthma, and thought of them as important elements in the pathogenesis of this disease. The main evolution of nasal cytology occurred in 1927, thanks to the report done by C. Eyermann, who noted the presence of eosinophilic cells into the nasal secretions of allergic patients. Since then great importance is given to the recognition of specific cell types into the pathogenesis of different nasal diseases. Nasal cytology is nowadays more frequently used in the study of allergic, vasomotor, inflammatory and infectious rhinitis. It is a simple, non-invasive and repeatable examination which is useful in the follow-up and monitoring of the real effectiveness of medical and surgical treatments. Patients affected by allergic rhinitis (AR) develop an endonasal immediate response, so-called “early phase”, followed by a “late phase” response to the allergenic agent. From the microscopic point of view, both these responses are always characterized by an infiltration of the mucosa by immunoflogistic cells (eosinophils, mast cells, neutrophils and lymphocytes) that, following the release of several chemical mediators, are the main cause of the symptoms that characterize the IgE-mediated disease. In AR the main cells type released during the immunological response will change depending on whether the patient is examined during or outside the pollinic season. In the first condition, the patient will present all the clinical signs and his nasal cytology examination will be characterized by neutrophils, lymphocytes, eosinophils and mast cells largely degranulated. Nasal cytology allows us to differentiate between various forms of rhinitis which are resumed as: non-allergic rhinitis with neutrophil (Narne); non-allergic rhinitis with eosinophilia (NARES); non-allergic rhinitis with mast cells (NARMA); non-allergic eosino.