Invasive Candidiasis in the Elderly:Considerations for Drug Therapy

Candida infections in the elderly are an important and expanding clinical problem, with significantly higher mortality in this group than in younger patients. The increasing problem of invasive Candida infections may be related to higher prevalence of immunocompromised older people and the emergence of treatment resistance. Older people, especially the frail and critically ill, are at higher risk of medication-related harmful effects due to changes in pharmacokinetics and pharmacodynamics, which may be further complicated by organ dysfunction, diminished homeostatic control, co-morbidities and polypharmacy. Here, we review the available options for the treatment of Candida infections and provide insights into the challenges surrounding the optimal use of antifungal drugs in the elderly

Enhancement of Opsonophagocytosis of Bacteroides Spp. By Clindamycin in Subinhibitory Concentrations

Radioactively labelled bacteria were incubated overnight in the presence or absence of one-half the MIC of clindamycin, then preopsonized with normal human serum or homologous rabbit antiserum and incubated with human polymorphonuclear leucocytes. Clindamycin in subinhibitory concentrations significantly enhanced the phagocytosis of all four Bacteroides strains. Complement-dependent as well as antibody-dependent phagocytosis was enhanced by clindamycin in one Bacteroides strain. In the other three strains, only antibody dependent phagocytosis was enhanced by clindamycin. Transmission electron microscopy confirmed phagocytosis of the bacteroides

The Role of Glycocalyx in Surface Phagocytosis of Baeteroides Spp., in the Presence and Absence of Clindamycin

The influence of isolated glycocalyx from Bacteroides thetaiotaomicron and B.fragilis on surface phagocytosis of clindamycin-treated and -untreated homologous and heterologous species was studied. When homologous or heterologous isolated glycocalyx was added to clindamycin-treated B. thetaiotaomicron or B. fragilis before incubation with PMNL, phagocytosis was reduced to levels observed in the untreated control bacteria, but addition of glycocalyx to untreated control strains showed no reduction of phagocytosis. When isolated bacteroides-glycocalyx was added to Staphylococcus aureus or S. epidermidis, phagocytosis of both clindamycin-treated and -untreated bacteria was significantly reduced. The isolated glycocalyx preparations were analysed by thin layer and gas-liquid chromatography; these preparations were free of lipopolysaccharides. The isolated glycocalyx did not affect PMNL viability. Our findings suggest that the glycocalyx is an important virulence factor because it impairs phagocytosis of Bacteroides spp. by PMNL. Clindamycin may enhance opsonophagocytosis of baeteroides by altering the glycocalyx

Phagocytosis of Bacteroides in Suspension and on a Glass Surface Determined by a Modified Fluorochrome Assay

Phagocytosis of Bacteroides fragilis and Bacteroides thetaiotaomicron by human polymorphonuclear leukocytes (PMNL) was studied using a modified fluorochrome assay. Bacteria were grown overnight, washed and opsonized in normal, human, pooled serum. Preopsonized bacteria, either in suspension or preadhered onto a glass cover slip, were then incubated with PMNL. Afer appropriate incubation, the mixtures were centrifuged onto the cover glasses. The cover glasses were stained with acridine orange, while duplicate cover glasses were also stained with Giemsa solution. The total number and distribution of bacteria and PMNL, as well as morphological changes in PMNL, were observed with the Giemsa stain. The acridine orange stained only ingested bacteria which provided an accurate indication of phagocytosis. Bacteroides cells adhered to a glass surface were phagocytized significantly more efficiently than Bacteroides in suspension

Evaluating Mindful With Your Baby/Toddler: Observational Changes in Maternal Sensitivity, Acceptance, Mind-Mindedness, and Dyadic Synchrony

Studies on the effectiveness of mindful parenting interventions predominantly focused on self-report measures of parenting, whereas observational assessments of change are lacking. The present study examined whether the Mindful with your baby/toddler training leads to observed changes in maternal behavior and mother-child interaction quality. Mindful with your baby/toddler is a 8- or 9-week mindful parenting training for clinically referred mothers of young children (aged 0-48 months), who experience parental stress, mother-child interaction problems, and/or whose children experience regulation problems. The study involved a quasi-experimental non-random design including a sample of 50 mothers who were diagnosed with a mood disorder (n = 21, 42%), an anxiety disorder (n = 7, 14%), post-traumatic stress disorder (n = 6, 12%), or other disorder (n = 7, 14%). Mothers completed a parental stress questionnaire and participated in home observations with their babies (n = 36) or toddlers (n = 14) during a waitlist, pretest, and posttest assessment. Maternal sensitivity, acceptance, and mind-mindedness were coded from free-play interactions and dyadic synchrony was coded from face-to-face interactions. Sensitivity and acceptance were coded with the Ainsworth's maternal sensitivity scales. Mind-mindedness was assessed by calculating frequency and proportions of appropriate and nonattuned mind-related comments. Dyadic synchrony was operationalized by co-occurrences of gazes and positive facial expressions and maternal and child responsiveness in vocal interaction within the dyad. Coders were blind to the measurement moment. From waitlist to pretest, no significant improvements were observed. At posttest, mothers reported less parenting stress, and were observed to show more accepting behavior and make less nonattuned comments than at pretest, and children showed higher levels of responsiveness. The outcomes suggest that the Mindful with your baby/toddler training affects not only maternal stress, but also maternal behavior, particularly (over)reactive parenting behaviors, which resulted in more acceptance, better attunement to child's mental world, and more "space" for children to respond to their mothers during interactions. Mindful with your baby/toddler may be a suitable intervention for mothers of young children with (a combination of) maternal psychopathology, parental stress, and problems in the parent-child interaction and child regulation problems.Stress and Psychopatholog