a rare case of pacemaker lead endocarditis successfully treated with open heart surgery

Background: Cardiac device-related endocarditis has emerged as a serious complication in the era of advanced medical technology. Pacemaker related infections are rare and life-threatening with incidence from 0.06% to 7% and high mortality rate (30-35%). Diagnosis is hard, frequently delayed and could be even missed due to poor clinical findings. The average delay in diagnosis is 5.5 month. We report a case of the late-onset of pacemaker lead endocarditis caused by S. epidermidis successfully treated with open heart surgery. Case Report: Patient with persistent high fever for 11 month and suspicion for infective endocarditis was admitted in Cardiovascular Institute. No clinical signs of endocarditis were observed. TTE revealed large vegetation 30 × 17 mm attached to the atrial electrodes with high embolic potential. This finding was verified by transesophageal echocardiography (TEE), although CT scan did not reveal vegetation. Blood cultures were negative. A sternotomy with cardiopulmonary bypass was performed and electrodes were extracted with large vegetation. Intraoperative finding revealed large thrombus with vegetation around pacemaker leads. Cultures of the electrodes and vegetation revealed Staphylococcus epidermidis. Surgery was followed up with antibiotic treatment for 6 weeks. He has been followed up for the next 2 years, and without complications. Conclusion: The absence of criteria for endocarditis and negative blood cultures should not keep the physician from ruling out lead endocarditis. This complication carries high risk of mortality if left untreated

The impact of different extracts of six Lamiaceae species on deleterious effects of oxidative stress assessed in acellular, prokaryotic and eukaryotic models in vitro

The main objective of this research was to evaluate the impact of methanolic, ethanolic and aqueous extracts of Origanum majorana L., Origanum vulgare L., Teucrium chamaedrys L., Teucrium montanum L., Thymus serpyllum L. and Thymus vulgaris L. (Lamiaceae) on the effects of free radicals using different model systems. The extracts were characterized on the basis of the contents of total phenolics, phenolic acids, flavonoids and flavonols, and also using high-performance liquid chromatography with diode-array detection. Antioxidant activity in vitro was assessed using DPPH assay. The genoprotective properties were tested using plasmid relaxation assay on pUC19 E. coli XL1-Blue, while SOS/umuC assay on Salmonella typhimurium TA1535/pSK1002 and Comet assay on human lung fibroblasts were used to assess the antigenotoxicity of the extracts. Ethanolic extracts had the most phenolics (up to 236.20 mg GAE/g at 0.5 mg/mL), flavonoids (up to 42.47 mg QE/g at 0.5 mg/mL) and flavonols (up to 16.56 mg QE/g at 0.5 mg/mL), and they exhibited the highest DPPH activity (up to 92.16% at 0.25 mg/mL). Interestingly enough, aqueous extracts provided the best protection of plasmid DNA (the lowest IC50 value was 0.17 mg/mL). Methanolic extracts, on the other hand, most efficiently protected the prokaryotic DNA, while all the extracts had a significant impact against genomic damages inflicted on human fibroblasts. O. vulgare extracts are considered to be the most promising in preserving the overall DNA integrity against oxidative genomic damages. Moreover, HPLC-DAD analysis highlighted rosmarinic acid as the most abundant in the investigated samples (551.45 mg/mL in total in all the extracts), followed by luteolin-7-O-glucoside (150.19 mg/mL in total), while their presence correlates with most of the displayed activities. The novelty of this study is reflected in the application of a prokaryotic model for testing the antigenotoxic effects of Lamiaceae species, as no previous reports have yet been published on the genoprotective potential of these species

Position of Entrepreneurship in Serbia Influenced By Transition Process and Macroeconomic Trends

Rapid changes, uncertainty and risk require a new approach to business, new business orientation and strategies. Economic relations that reproduce the transition are directly related to the present and future position of each individual, households, businesses, state and nation in the world. It is necessary to create the conditions for rapid economic development, the need to maintain economic stability, narrowing the technological and social gap between the rich and the poor, the role and influence of multinational companies in the modern world, providing higher living standards and a common understanding of human rights in the homogenized world. At the beginning of this century, developed economies of the world entered a phase of change, and from the century of information technology entered the century of knowledge, and the global economy became based on knowledge and irreplaceable factor of development. Developing and undeveloped countries are in the permanent transition period. Entrepreneurship is interesting for all economies in transition as a factor that can significantly accelerate growth and mitigate the consequences of changes in economic structures through self-employment and job creation, as well as an engine for growth. Entrepreneurship is a feature of developed economies and market economies, and it achieves the best results in such a business climate and business environment. However, entrepreneurship reaffirmed its full creativity and experience in countries that are returning to an open market economy

How to treat jatrogenic ureteral injury after posterior spinal surgery? Case report and review of literature

Introduction Entry into the retroperitoneal space during open posterior spinal surgery introduces the rare possibility of iatrogenic ureteral injury. Case presentation We describe a case of ureteral injury after spinal surgery in a 49‐year‐old female with persistent lumbar pain and high fever 2 weeks after spinal surgery. After admission to the urology department, a computer tomography scan was performed and revealed right‐side hydronephrosis grade III and large retroperitoneal fluid collection. After radiological confirmation of right ureteral injury, a ureteral stent was placed, but 4 weeks later, ureteral stricture was confirmed on antegrade pyelography. Therefore, surgical ureteroplasty was indicated 2 months after initial admission to the urology department. Six weeks later, the stent was removed, and intravenous pyelography revealed a normal ureteral passage. Conclusion There should be a low threshold for ureteral injuries after spinal cord surgery in patients with high fever and elevated blood creatinine levels

Antioxidative, antibacterial and antifungal activity of the essential oil of wild-growing Satureja montana L. from Dalmatia, Croatia

The composition of the essential oil of Satureja montana was examined by gas chromatographymass spectrometry and 1H nuclear magnetic resonance spectroscopy. Forty-three compounds were identified, representing approximately 99% of the oil. Major components were ?-terpinene (8.7%), p-cymene (16.9%) and carvacrol (44.5%). The oil was tested for its antioxidant activity by using the 1,1-diphenyl-2-picryl hydrazyl assay and showed dose-dependent free-radical-scavenging activity with an EC50 value of 4.21 mg/ml. The antimicrobial effect of the essential oil was tested against six strains of Gram-negative bacteria, seven strains of Gram-positive bacteria and two fungi. The human pathogens Burkholderia cepacia ATCC 25416 (Gram negative) and Listeria innocua (Gram positive) were used in the investigation of S. montana for the first time. The minimum inhibitory concentration of the essential oil ranged from 0.625 to 5.0 mu l/well for Gram-negative bacteria, and from 0.312 to 1.125 mu l/well for Gram-positive bacteria. For the two fungi tested, Candida and Saccharomyces, the value was 0.234 mu l/tube. The essential oil tested showed significant activity against fungi and Gram-positive bacteria, especially Bacillus subtilis, Staphylococcus epidermidis and Listeria innocua, and among Gram-negative bacteria extreme sensitivity was detected in Escherichia coli SY252, SY252 lpcA and ATTCC 25922 strains. Copyrigh

An Optimized Checkerboard Method for Phage-Antibiotic Synergy Detection

Phage-antibiotic synergy is a promising therapeutic strategy, but there is no reliable method for synergism estimation. Although the time-kill curve assay is a gold standard, the method is not appropriate for fast and extensive screening of the synergy. The aim is to optimize the checkerboard method to determine phage-chemical agent interactions, to check its applicability by the time-kill curve method, and to examine whether the synergy can be obtained with both simultaneous and successive applications of these agents. In addition, the aim is to determine interactions of the Pseudomonas phage JG024 with ciprofloxacin, gentamicin, or ceftriaxone, as well as the Staphylococcus phage MSA6 and SES43300 with ciprofloxacin, gentamicin, and oxacillin. The results show that the optimized checkerboard method is reliable and that results correspond to those obtained by the time-kill curve. The synergy is detected with the phage JG024 and ciprofloxacin or ceftriaxone against Pseudomonas aeruginosa, and the phage SES43300 with ciprofloxacin against MRSA. The synergy was obtained after simultaneous applications, and in the case of P. aeruginosa, after application of the second agent with delay of one hour, indicating that simultaneous application is the best mode of synergy exploitation for therapy. The checkerboard method can be used for thorough clinical studies on synergy and in the future for personalized therapy when infections are caused by multiple resistant bacteria