ABSTRACT
Tenofovir use is associated with lower risk of mother-to-infant transmission of the virus, and discontinuation of the treatment is not safe. However, the safety of the drug during pregnancy and breastfeeding is not clear. In this study, we aimed to determine the tenofovir concentration in plasma of mother-infant pairs along with breast milk in chronic hepatitis B patients during the lactation period. A total of 11 mother-infant pairs were enrolled in the study. All the mothers received tenofovir disoproxil fumarate (TDF) 245 mg/day for at least 1 month because of chronic hepatitis B infection. Maternal blood, breast milk, and infant blood samples were obtained concomitantly. Tenofovir concentrations were determined by liquid chromatography-tandem mass spectrometry. The median concentrations of tenofovir in maternal plasma and breast milk samples were 88.44 (interquartile range [IQR], 62.47 to 116.17) ng/ml and 6.69 (IQR, 4.88 to 7.03) ng/ml, respectively. Tenofovir concentrations were undetectable (<4 ng/ml) in all of the infant plasma samples. The ratio of tenofovir concentration in breast milk to that in maternal plasma was 0.07. Tenofovir disoproxil fumarate passes through the breast milk in a small amount. Infants had no detectable tenofovir level in their plasma. Our study suggests that tenofovir disoproxil fumarate treatment is safe during the breastfeeding period in chronic hepatitis B patients.
Subject(s)
Hepatitis B, Chronic , Pharmaceutical Preparations , Antiviral Agents/therapeutic use , Female , Hepatitis B, Chronic/drug therapy , Humans , Infant , Milk, Human , Mothers , Pregnancy , Tenofovir/therapeutic use , Viral LoadABSTRACT
Infective endocarditis (IE) is a severe form of heart valve disease and is associated with a poor prognosis and high risk of mortality. We report the first known case of bioprosthetic aortic valve endocarditis associated with spondylodiscitis as a result of posterior nasal packing coated with antibiotics but without systemic antibiotic prophylaxis.
Subject(s)
Discitis/diagnosis , Endocarditis, Bacterial/diagnosis , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/diagnosis , Streptococcal Infections/diagnosis , Viridans Streptococci , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Aortic Valve/abnormalities , Aortic Valve/surgery , Discitis/drug therapy , Discitis/etiology , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/etiology , Epistaxis/diagnosis , Epistaxis/etiology , Epistaxis/prevention & control , Female , Heart Valve Prosthesis Implantation , Humans , Magnetic Resonance Imaging , Male , Nasal Surgical Procedures , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/etiology , Streptococcal Infections/drug therapy , Streptococcal Infections/etiologyABSTRACT
There is not an established consensus on the treatment of coronary steal syndrome caused by unligated thoracic side branches of internal mammary artery. Occlusion of thoracic side branch is not recommended without objective evidence of ischemia. This case report presents transbrachial coil occlusion of thoracic side branch of left internal mammary artery causing silent ischemia in a diabetic patient with atypical chest pain and palpitation.
Subject(s)
Diabetes Complications , Embolization, Therapeutic/methods , Mammary Arteries , Myocardial Ischemia/therapy , Aged , Brachial Artery , Chest Pain/etiology , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/methods , Heart Rate , Humans , Ligation , Male , Mammary Arteries/surgery , Myocardial Ischemia/etiologyABSTRACT
BACKGROUND: Thrombus formation around the intracardiac end of the catheter, thromboembolism, and infection are the most important and life-threatening complications of ventriculoatrial shunts. In this article we report a patient with a large right atrial mass that was diagnosed by 2-D echocardiogram and removed via standard median sternotomy and cardiopulmonary bypass. CASE DESCRIPTION: A 63-year-old man who had a right ventriculoatrial shunt was admitted to our department in a septic clinical condition. His hemoglobin was 10.7 grams, white blood cell count was 22,900/mm3, and sedimentation rate was 50 mm/hr. Blood cultures grew coagulase negative staphylococcus. The echocardiogram showed a right atrial mass at the tip of the shunt catheter. The mass had a cystic and "glove-like" appearance and had a pendulous motion in the right atrium. After combined antibiotic therapy for 10 days, symptoms were relieved but echocardiographic findings did not change. A surgical approach was chosen because of the unchanged size of the mass and the risk of pulmonary embolism. First, the distal part of the ventriculoatrial shunt was separated from its pump and a new ventriculoperitoneal shunt was placed. After this, a standard median sternotomy, cardiopulmonary bypass and right atriotomy was performed. The tip of the shunt catheter with the attached pedunculated mass was removed. CONCLUSION: There are few cases of a large right atrial thrombus secondary to a ventriculoatrial shunt in the literature. Because of these serious complications of ventriculoatrial shunting, careful 2-D transthoracic echocardiographic examination should be mandatory for patients with ventriculoatrial shunts.