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Impact of Fluconazole Prophylaxis on Cortisol Levels in Critically Ill Surgical Patients. Shelley S. Magill, 2004.Fluconazole is widely used in the intensive care unit for prevention and treatment of fungal infections . Case reports have described an association between fluconazole and adrenal dysfunction, an important cause of morbidity and mortality in critically ill patients . We sought to determine whether 400 mg of fluconazole per day administered to critically ill surgical patients was associated with a reduction in cortisol levels . Cortisol levels were measured in stored plasma specimens drawn from 154 critically ill surgical patients randomized in 1998-1999 to receive fluconazole or placebo for the prevention of candidiasis . The primary outcome measure was the median plasma cortisol level  1 day after study drug initiation (MPCL) . Secondary outcomes were adrenal dysfunction, defined as an MPCL of <15 µg/dl, changes in cortisol levels over time, and mortality . The median MPCL was 15.75 µg/dl (interquartile range [IQR], 11.65 to 21.33 µg/dl) in 79 patients randomized to fluconazole and 16.71 µg/dl (IQR, 11.67 to 23.00 µg/dl) in 75 patients randomized to placebo (P = 0.52) . Patients randomized to fluconazole did not have significantly increased odds of adrenal dysfunction compared to patients randomized to placebo (odds ratio, 0.98; 95% confidence interval, 0.48 to 2.01) . Randomization to fluconazole was not associated with a significant difference in cortisol level changes over time . Mortality was not different between patients with and without adrenal dysfunction, nor was it different between patients with adrenal dysfunction who were randomized to fluconazole and those randomized to placebo . Fluconazole prophylaxis in this population of critically ill surgical patients did not result in significant adrenal dysfunction .
N-Acetyl-L-Cysteine Affects Growth, Extracellular Polysaccharide Production, and Bacterial Biofilm Formation on Solid Surfaces. Ann-Cathrin Olofsson, 2003.N-Acetyl-L-cysteine (NAC) is used in medical treatment of patients with chronic bronchitis . The positive effects of NAC treatment have primarily been attributed to the mucus-dissolving properties of NAC, as well as its ability to decrease biofilm formation, which reduces bacterial infections . Our results suggest that NAC also may be an interesting candidate for use as an agent to reduce and prevent biofilm formation on stainless steel surfaces in environments typical of paper mill plants . Using 10 different bacterial strains isolated from a paper mill, we found that the mode of action of NAC is chemical, as well as biological, in the case of bacterial adhesion to stainless steel surfaces . The initial adhesion of bacteria is dependent on the wettability of the substratum . NAC was shown to bind to stainless steel, increasing the wettability of the surface . Moreover, NAC decreased bacterial adhesion and even detached bacteria that were adhering to stainless steel surfaces . Growth of various bacteria, as monocultures or in a multispecies community, was inhibited at different concentrations of NAC . We also found that there was no detectable degradation of extracellular polysaccharides (EPS) by NAC, indicating that NAC reduced the production of EPS, in most bacteria tested, even at concentrations at which growth was not affected . Altogether, the presence of NAC changes the texture of the biofilm formed and makes NAC an interesting candidate for use as a general inhibitor of formation of bacterial biofilms on stainless steel surfaces .
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