Bacterial biofilms are complex surface attached communities of bacteria held together by self-produced polymer matrixs mainly composed of polysaccharides, secreted proteins, and extracellular DNAs. Bacterial biofilm formation is a complex process and can be described in five main phases: (i) reversible attachment phase, where bacteria non-specifically attach to surfaces; (ii) irreversible attachment phase, which involves interaction between bacterial cells and a surface using bacterial adhesins such as fimbriae and lipopolysaccharide (LPS); (iii) production of extracellular polymeric substances (EPS) by the resident bacterial cells; (iv) biofilm maturation phase, in which bacterial cells synthesize and release signaling molecules to sense the presence of each other, conducing to the formation of microcolony and maturation of biofilms; and (v) dispersal/detachment phase, where the bacterial cells depart biofilms and comeback to independent planktonic lifestyle. Biofilm formation is detrimental in healthcare, drinking water distribution systems, food, and marine industries, etc. As a result, current studies have been focused toward control and prevention of biofilms. In an effort to get rid of harmful biofilms, various techniques and approaches have been employed that interfere with bacterial attachment, bacterial communication systems (quorum sensing, QS), and biofilm matrixs. Biofilms, however, also offer beneficial roles in a variety of fields including applications in plant protection, bioremediation, wastewater treatment, and corrosion inhibition amongst others. Development of beneficial biofilms can be promoted through manipulation of adhesion surfaces, QS and environmental conditions. This review describes the events involved in bacterial biofilm formation, lists the negative and positive aspects associated with bacterial biofilms, elaborates the main strategies currently used to regulate establishment of harmful bacterial biofilms as well as certain strategies employed to encourage formation of beneficial bacterial biofilms, and highlights the future perspectives of bacterial biofilms.

/pdf/beyond-risk-bacterial-biofilms-and-their-regulating-4xnboj91j5.pdf

Beyond Risk: Bacterial Biofilms and Their Regulating Approaches.

The biofilm is a bacterial colony wrapped in an auto-produced polymer matrix of polysaccharides, proteins, and DNA. Bacterial biofilms cause persistent infections because they are more resistant to antibiotics, disinfectants, and the immune system of the body. Other significant biofilm characteristics are a gradient of oxygen and nutrition from the top layer to the bottom layer of biofilms. Lower bacterial cell metabolic activity and longer doubling rates are linked to the gradients; these are the quiescent cells responsible for some of the resistance to antibiotics. Biofilms may be avoided and cured with vigorous antibiotic prophylaxis or treatment early on and with continuous suppressive medication. This review discusses the development of antibiotic resistance and tolerance in bacteria due to biofilm formation, the tolerance mechanisms, and the development of persistent cells that induce antibiotic resistance in bacteria. Recent strategies to combat antibiotic resistance are also discussed. 

Biofilms: Understanding the structure and contribution towards bacterial resistance in antibiotics

Mesoporous silica materials (MSM) have a great surface area and a high pore volume, meaning that they consequently have a large loading capacity, and have been demonstrated to be unique candidates for the treatment of different pathologies, including bacterial infection. In this text, we review the multiple ways of action in which MSM can be used to fight bacterial infection, including early detection, drug release, targeting bacteria or biofilm, antifouling surfaces, and adjuvant capacity. This review focus mainly on those that act as a drug delivery system, and therefore that have an essential characteristic, which is their great loading capacity. Since MSM have advantages in all stages of combatting bacterial infection; its prevention, detection and finally in its treatment, we can venture to talk about them as the “nightmare of bacteria”.

https://www.mdpi.com/1999-4923/10/4/279/pdf

Mesoporous Silica Materials as Drug Delivery: "The Nightmare" of Bacterial Infection.

Background The lifetime prevalence of epistaxis is approximately 60%, and 6-10% of the affected persons need medical care. In rare cases, severe bleeding calls for the rapid initiation of effective treatment. Methods This review is based on pertinent articles that were retrieved by a selective search PubMed, and on the authors' clinical experience. Results There are no German guidelines for the management of epistaxis. The available evidence consists mainly of retro spective analyses and expert opinions. 65-75% of the patients who require treatment can be adequately cared for by their primary care physician or by an emergency physician with baseline measures. If there is persistent anterior epistaxis, an otorhinolaryngologist can control the bleeding sastisfactorily in 78-88% of cases with chemical or electrical cauterization. Nasal packing is used if this treatment fails, or for posterior epistaxis. In a retrospective study, surgical treatment was found to be more effective than nasal packing in the treatment of posterior epistaxis (97% versus 62% treatment success). Percutaneous embolization is an alternative treatment for patients whom general anesthesia would put at high risk. Conclusion The treatment of severe or recurrent epistaxis requires the interdisciplinary collaboration of the primary care physician, the emergency physician, the practice-based otolaryngologist, and the hospital otolaryngology service. Uniform guidelines and epidemiological studies on this topic would be desirable.

Current Approaches to Epistaxis Treatment in Primary and Secondary Care.

Staphylococci are Gram-positive bacteria that are ubiquitous in the environment and able to form biofilms on a range of surfaces. They have been associated with a range of human health issu...

Biofilm formation by staphylococci in health-related environments and recent reports on their control using natural compounds.

Biofilm formation is present in the middle-ear mucosa of chronic otitis media (COM) patients and COM is a biofilm-related disease. Biofilms are organized and complex communities in which bacteria communicate to each other and gain tremendous advantages. In this unique structure, bacteria can diffuse nutrients, gain resistance to antimicrobials agents and host defense mechanisms. Recently bacterial biofilms have been proven to be important in infectious diseases of head and neck region. A prospective case–control study was conducted. The study group comprised of patients with chronic otitis media and patients undergoing surgery for cochlear implantation was involved in the control group. Study group also divided to subgroups SSA and SSB according to history of ear discharge within last six months. Direct microscopy (DM) and transmission electron microscopy (TEM) were used to assess presence of biofilms. Totally 19 patients, 10 with ear discharge history within last 6 months and 9 without discharge comprised the study group. Control group comprised of 9 patients undergone cochlear implantation. In all of the patients with ear discharge history and in two of the patients without ear discharge history, biofilm formation was detected by both DM and TEM. All control group members were free of biofilm formation. The differences were statistically significant between study and control groups (p = 0.002) and between study subgroups (p < 0.001); but not significant between study subgroup without ear discharge history and control group (p = 0.470). In the middle ear mucosa of patients with chronic otitis media, biofilm formation is common, especially when ear discharge history is present.

Bacterial biofilm formation in the middle-ear mucosa of chronic otitis media patients.

OBJECTIVES The aim of this study was to determine safety, pain perception, and the factors that may affect pain perception in patients undergoing certain otorhinolaryngologic procedures under local anesthesia with sedation. DESIGN Prospective clinical study. SETTING Tertiary care academic medical centre. METHODS Two hundred thirteen patients operated on under local anesthesia with sedation were included in the study. A visual analogue scale (VAS) and a questionnaire were employed to measure pain perception during surgery and evaluate possible pain-related variables. RESULTS The mean VAS values were 2.86 (+/-1.84) for the myringoplasty group, 2.54 (+/-1.76) for the otosclerosis surgery group, 1.70 (+/-1.25) for the somnoplasty group, 1.00 (+/-0.94) for the oral biopsy group, 2.15 (+/-1.49) for the inferior turbinate radiofrequency reduction (ITRR) group, 3.47 (+/-2.18) for the septoplasty plus ITRR group, 5.56 (+/-2.01) for the septorhinoplasty group, 4.94 (+/-2.16) for the open technique septoplasty group, and 3.30 (+/-1.87) for the septoplasty group. No variable was shown to affect pain perception when all patients were evaluated in common. When surgical procedures were evaluated individually, the level of acquaintance of patients in the myringoplasty group (p=.007) and operative time for the septoplasty group (p<.001) were found to independently affect pain perception. CONCLUSIONS Given that septorhinoplasty and open technique septoplasty are found to be more painful, it is advisable to perform these procedures under general anesthesia. To increase the level of acquaintance of patients and to shorten operative time as possible may be helpful for minimizing pain perception.

Pain and safety in otorhinolaryngologic procedures under local anesthesia.

Of 97 extracranial complication cases, 41 (42.3%) were female and 56 (57.7%) were male with ages ranging from 5 to 83 years (mean age, 43.9 years). Two (2.1%) patients were in the first decade, 9 (9.3%) in second, 16 (16.5%) in third, 22 (22.7%) in fourth, 8 (8.2%) in fifth, 17 (17.5%) in sixth, 13(13.4%) in seventh, 7 (7.2%) in eighth and 3 (3.1%) in ninth decade. Table 1 shows the distribution of ages of the patients with extracranial complications of COM. Objective; To discuss the incidence, clinical presentation, diagnosis and management of extracranial complications of chronic otitis media (COM). Materials & Methods; In this retrospective study conducted between 1983 and 2007, 97 extracranial complications of COM were included. Intracranial complications of COM and complications of acute otitis media were not included in the study. The analyses included clinical and surgical findings and overall management strategy of the patients who had COM complication. Results; Labyrinthitis was the most common of 97 extracranial complications, occurring in 43 (44.3%) patients. This was followed by facial palsy in 34 (35%), mastoid abscess in 11 (11.3%), postauricular fistula in 7 (7.3%), and Bezold’s abscess in 2 (2.1%). Surgery in addition to antibiotic therapy was the basis of the treatment for these conditions. Conclusion; Although the extracranial complications rarely cause mortality, early diagnosis and prompt surgical treatment are important in order to reduce the morbidity.

Extracranial Complications of Chronic Otitis Media

Background Nasal packing is frequently used after surgical interventions to prevent bleeding and synecchia formation and for the treatment of diseases such as epistaxis. One of the most morbid complications of nasal packing applications is the toxic shock syndrome (TSS). Owing to the microbiological structure of nasal mucosa, antibiotics are administered to all patients who are applied nasal packages for prevention of TSS. Aim The aim of this study is the evaluation of microbiological and histopathological changes taking place in nasal mucosa with nasal packing containing probiotics. Methods Three groups were formed with 6 rats in each group. The nasal packings with the same characteristics were applied to nasal cavities of rats in all 3 groups. In group 1, only nasal packs were used. Probiotics or parenteral antibiotics were not used. In group 2, parenteral antibiotics were used along with nasal packs. In group 3, nasal packs with probiotics containing Lactobacillus strains were applied. No parenteral antibiotics were used. After 3 days packages were removed and nasal cavity was irrigated with saline. Both packages and irrigation materials were analyzed for microbiological content. After scarification, nasal and paranasal structures were examined for histopathological changes. Results In group 3 statistically the total bacteria load was significantly lower in comparison to the other groups. However, in the histopathological evaluation of the mucosa of rats in group 3, bleeding and inflammation findings were significantly higher statistically. Conclusions It has been determined that the total microbiological load significantly decreases with the application of packing containing probiotics. So, the use of probiotics along with nasal packings is promising to prevent unnecessary use of medications.

Microbiological and Histopathological Effects of Nasal Packing Containing Probiotics on Nasal Mucosa.

Materials and Methods: Fourteen consecutive patients with ISHL who did not respond to conventional parenteral treatment (methyl-prednisolone 3 mg/kg/day which was tapered after 10 days, and acyclovir 3 gr/day for two weeks) were treated with intratympanic dexamethasone, and evaluated with pure tone audiometry. Results: The PTAs on initial admission and after completion of the parenteral treatment were 80.9 and 71.64 dB, respectively (p>0.05). The PTA recovered to 57.1 dB after intratympanic injection, which was significantly better than with the parenteral treatment (p<0.05). No serious complication was encountered. Conclusion: Intratympanic steroid injections can be used safely and successfully in patients who do not response to the conventional intravenous treatment. It can also be applied as the treatment of choice in ISHL, especially in patients who have contraindication to systemic treatment with corticosteroids.

Use of Intratympanic Dexamethasone as a Salvage Treatment in Idiopathic Sudden Hearing Loss

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