RESUMEN
The purpose of this study was to assess the main clinical predictors and microbiological features of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU) environment. This work is a retrospective analysis over one year from September 2010 to September 2011. Patients' risk factors, causes of admission, comorbidities and respiratory specimens collected in six Italian ICUs were reviewed. Incidence and case fatality rate of VAP were evaluated. After stratification for VAP development, univariate and multivariate analyses were performed to assess the impact of patients' conditions on the onset of this infection. A total of 1,647 ICU patients (pts) were considered. Overall, 115 patients (6.9 %) experienced at least one episode of VAP. The incidence rate for VAP was 5.82/1,000 pts-days, with a case fatality rate of 44.3 %. Multivariate analysis showed that admission for neurological disorders (aIRR 4.12, CI 1.24-13.68, p = 0.02) and emergency referral to ICU from other hospitals (aIRR 2.11, CI 1.03-4.31, p = 0.04) were associated with higher risk of VAP, whereas a tendency to a higher risk of infection was detected for admission due to respiratory disease, cardiac disease, trauma and for having obesity or renal failure. A total of 372 microbiological isolates from respiratory specimens were collected in VAP patients. The most common species were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, showing high resistance rates to carbapenems. Neurological disorders and emergency referral at the admission into the ICU are significantly associated with the onset of VAP. A high incidence of multi-drug resistant Gram- species was detected in the respiratory specimens.
Asunto(s)
Bacterias/clasificación , Bacterias/aislamiento & purificación , Candida/aislamiento & purificación , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales , Humanos , Incidencia , Unidades de Cuidados Intensivos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Neumonía Asociada al Ventilador/patología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
We report a case of an immunocompromised patient affected by chronic hepatitis B virus (HBV) with high basal HBV viremia (>8 log(10) IU/ml) who failed an entecavir regimen, despite the absence of primary or secondary drug resistance mutations. The patient achieved sustained virological success (serum HBV DNA <12 IU/ml) when tenofovir was added to the treatment. This case highlights the difficulty in choosing an optimal therapy in such specific conditions and supports the concept of tailoring therapy (including combination regimens) on the basis of the particular conditions of each individual patient.
Asunto(s)
Adenina/análogos & derivados , Antivirales/uso terapéutico , Médula Ósea/inmunología , Guanina/análogos & derivados , Virus de la Hepatitis B/genética , Hepatitis B Crónica/tratamiento farmacológico , Huésped Inmunocomprometido , Organofosfonatos/uso terapéutico , Adenina/uso terapéutico , Adulto , Alanina Transaminasa/sangre , Médula Ósea/fisiopatología , ADN Viral/sangre , Quimioterapia Combinada , Femenino , Guanina/uso terapéutico , Hepatitis B Crónica/virología , Humanos , Italia , Tenofovir , Resultado del Tratamiento , Viremia/tratamiento farmacológico , Viremia/virologíaRESUMEN
Fluconazole susceptibility was tested in 385 clinical yeast isolates (285 Candida albicans, 38 C. glabrata, 31 C. tropicalis, 31 other Candida subsp.) using the agar disk diffusion test. Yeasts were collected from specimens obtained from outpatients (69) and inpatients (intensive care unit: 79 isolates, major burn unit: 31 isolates, hematology ward: 45 isolates, gynecology ward: 67 isolates, other wards: 94 isolates). Three hundred and fifty-six (92%) yeast isolates showed to be susceptible, 18 (5%) were susceptible dose-dependent, and 10 (3%) were resistant to fluconazole. Of the resistant group, 3 isolates were C.albicans, while seven were Candida non-albicans (2 C. rugosa, 2 C. humicola, 1 C. tropicalis, 1 C. ciferrii, 1 C. glabrata). The disk-diffusion method was easy to perform and there were no difficulties in the interpretation of inhibition zone diameters. Fluconazole maintained a good activity against Candida spp despite its extensive use for the prophylaxis and treatment of fungal infections.
Asunto(s)
Antifúngicos/farmacología , Candida/efectos de los fármacos , Fluconazol/farmacología , Candidiasis/microbiología , Farmacorresistencia Fúngica , Hospitales Generales , Hospitales Universitarios , Humanos , Italia , Pruebas de Sensibilidad MicrobianaRESUMEN
The study describes the clinical, virologic and immunological characteristics of a patient with interstitial pulmonary fibrosis during interferon treatment for HCV chronic hepatitis. After the interruption of the interferon and the beginning of immunosuppressive treatment, an improvement of pulmonary pathology was observed. At the reintroduction of interferon, the patient presented a rapid worsening of pulmonary fibrosis with a normalization of biochemical and virologic parameters of hepatitis. The correlation among interstitial pulmonary fibrosis, HCV infection and interferon treatment is discussed; however in the described case, the pulmonary pathology was correlated to interferon treatment.
Asunto(s)
Antivirales/efectos adversos , Hepatitis C Crónica/tratamiento farmacológico , Interferones/efectos adversos , Fibrosis Pulmonar/inducido químicamente , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Oxacillin-resistant staphylococci are the most serious pathogens in chronic osteomyelitis and only glycopeptides have been shown to be efficacious against them. We assessed the safety and efficacy of a regimen of teicoplanin 400 mg/day i.m. as long-term treatment in outpatients with osteomyelitis. A total of 76 patients received teicoplanin. Twenty-five patients had chronic prosthetic osteomyelitis (20 hip) and 51 patients had osteomyelitis caused by osteo-synthesis devices. Oxacillin-resistant Staphylococcus aureus was isolated in pure culture in 55 patients (72%). A total of 21 patients had polymicrobial infection with a total of 48 isolated strains. All patients were treated with teicoplanin 400 mg i.m. once-a-day alone or with other drugs for a minimum of 4 months. Only one patient had side effects requiring discontinuation of treatment. The teicoplanin dose was reduced to 200 mg/day i.m. in 2 patients to decrease creatinine clearance values. Seventy out of 76 patients were cured.
Asunto(s)
Antibacterianos/uso terapéutico , Osteomielitis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Teicoplanina/uso terapéutico , Adolescente , Adulto , Anciano , Antibacterianos/efectos adversos , Enfermedad Crónica , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Osteomielitis/microbiología , Oxacilina/farmacología , Resistencia a las Penicilinas , Penicilinas/farmacología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Teicoplanina/efectos adversos , Resultado del TratamientoRESUMEN
Barbiturates can produce psychological and physical dependence and produce a withdrawal syndrome on the second to fourth day after the drug is suspended. Symptoms include anxiety, restlessness, insomnia, rhythmic intention tremor, dizziness, seizures, and psychosis. If the syndrome is not recognized and correctly treated, hyperthermia, circulatory failure, and death may ensue. Although barbiturates are less frequently used nowadays, they are employed in combination with other drugs in many medications used for the treatment of headache. We report the case of a 54-year-old woman who developed a barbiturate abstinence syndrome when she suspended self-administration of a drug containing butalbital. The patient had been using barbiturates, 900 mg/die, for 2+ years for persistent headache. She was admitted to the hospital because of seizures, hallucinations and delirium not controlled by benzodiazepine and phenothiazine administration. Her symptoms resolved after parenteral phenobarbital administration.
Asunto(s)
Analgésicos/efectos adversos , Barbitúricos/efectos adversos , Cefalea/tratamiento farmacológico , Psicosis Inducidas por Sustancias/etiología , Síndrome de Abstinencia a Sustancias/diagnóstico , Analgésicos/administración & dosificación , Barbitúricos/administración & dosificación , Delirio/inducido químicamente , Diagnóstico Diferencial , Esquema de Medicación , Femenino , Alucinaciones/inducido químicamente , Humanos , Persona de Mediana Edad , Convulsiones/inducido químicamenteRESUMEN
Antibiotic therapy has improved infective endocarditis prognosis. The observance of general rules to choose the more suitable antibiotic drugs, as regard to their effectiveness, pharmacodynamic peculiarities and use, is mandatory. If the infection is due to antibiotic resistant microorganisms, microbiological analyses to estimate the bactericidal effect of the antibiotics, must be carried out. Resistance to penicillins, oligopeptides and aminoglycosides makes endocarditis produced by Enterococcus spp difficult to treat. The identification of patients at risk for infective endocarditis after surgical and invasive instrumental procedures, allows to introduce antibiotic prophylaxis regimens which can reduce the probability of acquiring the disease.
Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis/terapia , Infecciones Estafilocócicas/terapia , Infecciones Estreptocócicas/terapia , Protocolos Clínicos , Endocarditis/microbiología , HumanosRESUMEN
The antibacterial activity of trospectomycin, clindamycin, metronidazole, imipenem, cefoxitin, and piperacillin was tested against 72 Bacteroides spp. strains isolated from the vagina of women with vaginitis by determining the minimal inhibitory concentration using the agar dilution method. Trospectomycin shows a good activity which is comparable to that of imipenem and metronidazole. Its expanded spectrum of activity makes trospectomycin suitable for the use in single-drug therapy of pelvic infections in women.
Asunto(s)
Bacteroides/efectos de los fármacos , Espectinomicina/análogos & derivados , Bacteroides/aislamiento & purificación , Femenino , Humanos , Pruebas de Sensibilidad Microbiana , Especificidad de la Especie , Espectinomicina/farmacología , Vagina/microbiologíaAsunto(s)
Feto Abortado , Ética Médica , Investigación Fetal , Trasplante de Tejido Fetal/legislación & jurisprudencia , Aborto Legal , Comités Consultivos , Investigación Biomédica , Trasplante de Tejido Encefálico/legislación & jurisprudencia , Donación Directa de Tejido , Gobierno Federal , Enfermedades Genéticas Congénitas , Humanos , Mujeres Embarazadas , Obtención de Tejidos y Órganos , Estados UnidosAsunto(s)
Ética Médica , Obtención de Tejidos y Órganos , Programas Voluntarios , Comités Consultivos , Negro o Afroamericano , Gobierno Federal , Cuerpo Humano , Humanos , Consentimiento Informado , Internacionalidad , Principios Morales , New York , Selección de Paciente , Asignación de Recursos , Donantes de Tejidos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Confianza , Estados UnidosRESUMEN
BACKGROUND: A 29-year-old man, who underwent allogeneic bone marrow transplantation (BMT) for acute non lymphoid leukemia (ANLL), presented with blood pancytopenia and mild hypoxemia on day +39, without signs of acute graft versus host disease (GVHD). METHODS AND RESULTS: Cytomegalovirus (CMV) antigens were detected on WBCs and cells from bronchoalveolar lavage by immunofluorescence (IF) with specific murine monoclonal antibodies. Prompt treatment with Ganciclovir and high titer CMV immunoglobulins was followed by disappearance of the laboratory findings of CMV infection. Therapy was well tolerated and no side effects were recorded except for hematological depression that did not reverse after withdrawal of the therapy. The patient is relatively well on day + 210. CONCLUSIONS: Detection of CMV antigenemia appears to be a valuable tool for deciding whether to start CMV therapy with potentially toxic antiviral drugs in BMT patients in early engraftment, with or without overt signs of CMV infection.
Asunto(s)
Anticuerpos Antivirales/uso terapéutico , Trasplante de Médula Ósea , Infecciones por Citomegalovirus/prevención & control , Ganciclovir/uso terapéutico , Adulto , Terapia Combinada , Citomegalovirus/inmunología , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/terapia , Humanos , Huésped Inmunocomprometido , Leucemia Mieloide Aguda/complicaciones , Leucemia Mieloide Aguda/terapia , Leucocitos/microbiología , MasculinoAsunto(s)
Serodiagnóstico del SIDA/psicología , Síndrome de Inmunodeficiencia Adquirida/transmisión , Ética Médica , Seropositividad para VIH/psicología , Inhabilitación Médica/psicología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Revelación , Gobierno Federal , Humanos , Programas Obligatorios , Autonomía Personal , Factores de Riesgo , Programas VoluntariosRESUMEN
The potential usefulness of [C-11]-labeled alpha-aminoisobutyric acid (AIB) for tumor imaging has been demonstrated previously in our findings of increased tumor uptake with C-14-labeled AIB in human melanoma heterotransplants in nude mice, and subsequently, in a single case study using C-11 AIB to demonstrate the extent of metastases in patient with widespread malignant melanoma. We report here on the use of C-11 AIB in ten patients with metastatic or unresectable malignant melanoma. Five patients had intense tracer uptake at all known sites of tumor involvement. A sixth patient had good uptake in metastatic lesions in the shoulder and the pelvis, but did not demonstrate uptake within metastatic lesions in the lungs. Two patients had only minimal uptake over the tumor lesions while the two other patients had essentially normal studies. Further studies with C-11 AIB in patients with melanoma and other tumors are warranted.
Asunto(s)
Ácidos Aminoisobutíricos/uso terapéutico , Melanoma/diagnóstico por imagen , Neoplasias Cutáneas/diagnóstico por imagen , Adulto , Anciano , Animales , Radioisótopos de Carbono , Gatos , Femenino , Humanos , Masculino , Melanoma/secundario , Cintigrafía , Neoplasias Cutáneas/patologíaRESUMEN
Intermediate- and high-grade B-cell non-Hodgkin lymphoma (NHL) occurring in a human immunodeficiency virus (HIV)-infected patient is considered diagnostic of the acquired immunodeficiency syndrome (AIDS). Other neoplasms (both hematopoietic and nonhematopoietic) have also been reported in patients with HIV infection, although none except Kaposi sarcoma carries the same diagnosis of AIDS as B-cell NHL in an HIV-infected host. There have been previous reports in the literature of Hodgkin disease (HD) in HIV-infected patients. We describe our clinical and pathological experience with HD from 1984-1989, in 18 patients with documented HIV infection and also review the literature on HD in HIV-infected patients. Almost all patients described herein presented with advanced disease and mixed cellularity histology and did very poorly despite some good initial responses to therapy. By statistical analysis, we found that the patients with HIV-associated HD had a strong tendency to be outside the age range seen in non-HIV-associated HD (P less than 0.005). We also discuss the possible relationship between HIV and HD and consider whether HIV-associated HD, like B-cell NHL, is a manifestation of AIDS.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedad de Hodgkin/complicaciones , Infecciones Oportunistas/complicaciones , Síndrome de Inmunodeficiencia Adquirida/microbiología , Síndrome de Inmunodeficiencia Adquirida/patología , Adulto , Factores de Edad , VIH/aislamiento & purificación , Enfermedad de Hodgkin/microbiología , Enfermedad de Hodgkin/patología , Humanos , Persona de Mediana Edad , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/patologíaAsunto(s)
Asignación de Recursos para la Atención de Salud , Selección de Paciente , Asignación de Recursos , Valores Sociales , Ética Médica , Gobierno Federal , Asignación de Recursos para la Atención de Salud/economía , Humanos , Obligaciones Morales , New York , Trasplante de Órganos/economía , Diálisis Renal/economía , Medición de Riesgo , Responsabilidad Social , Sociedades Médicas , Valor de la Vida , Poblaciones VulnerablesRESUMEN
Mononuclear leukocytes from 151 patients with cancer of various organs and from 467 apparently cancer-free individuals were exposed, in vitro, to H2O2 (100 microM) and the effects of the exposure on the activity of adenosine diphosphate ribosyl transferase (ADPRT) were determined. First, the reproducibility of this test procedure was established as satisfactory, by comparing the results of assays performed independently by two investigators, and by measuring ADPRT in cells from two individuals over a 9-week period. The test data were analyzed by multiple linear regression, and the correlation of cancer diagnosis, age, sex and smoking habits with ADPRT values was determined. The strongest correlate was cancer diagnosis. We considered categorizing ADPRT values as high and low, with a cut-off value that would substantially distinguish cancer from cancer-free individuals. When a cut-off value of 1200 c.p.m. TCA ppt [3H]NAD+/5 x 10(5) cells was applied to the complete test material, it was found that ADPRT values from cancer patients were more frequently below the cut-off than values from disease-free individuals: the relative risk estimate (odds ratio) was 13.8. When a similar analysis was done on values from lung cancer patients and smoking disease-free individuals, the odds ratio was 73.5. However, a cut-off value of 2000 c.p.m. TCA ppt [3H]NAD+/5 x 10(5) cells was most effective in distinguishing lung cancer patients (the largest cancer group, n = 96) from smoking non-cancer individuals: that value provided better sensitivity (85%) and specificity (81%) than other cut-off values tested in the range 1200-2000 c.p.m. Further, in the case of lung cancer, possible effects of anatomical site, and of staging and pathology on ADPRT values was analyzed by the chi-squared test: no significant associations were found. These data support the value of the ADPRT test in detecting early stage lung cancer regardless of location or pathological type.
Asunto(s)
Peróxido de Hidrógeno/farmacología , Neoplasias Pulmonares/enzimología , Monocitos/enzimología , Neoplasias/enzimología , Poli(ADP-Ribosa) Polimerasas/sangre , Adulto , Biomarcadores/sangre , Neoplasias Encefálicas/sangre , Neoplasias Encefálicas/enzimología , Activación Enzimática , Femenino , Humanos , Técnicas In Vitro , Cinética , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/patología , Masculino , Monocitos/efectos de los fármacos , Estadificación de Neoplasias , Neoplasias/sangre , Valores de Referencia , FumarRESUMEN
When either Doxorubicin or Mitomycin-C was administered to patients, antipyrine clearance was respectively unaltered or increased. Antipyrine was administered to patients two days prior to and one day after their first course of the chemotherapeutic drug. Antipyrine clearance increased an average of 11.2% in the 5 patients that received Doxorubicin (not significant) and 15.2% in the six patients that received Mitomycin-C (P = 0.033, students t-test). The altered clearance is likely due to a rapid induction of the mixed function oxidase system by the chemotherapy as other parameters that could influence clearance were stable throughout the study (volume of distribution, weight, creatinine clearance and liver function tests). It is unlikely that the prechemotherapy antipyrine dose accounted for this change. The administration of these two antitumor antibiotics in humans may modestly increase the mixed function oxidase activity that is responsible for the metabolism of antipyrine. These findings are in direct contrast to markedly decreased mixed-function oxidase activity observed in the rodent pretreated with the same chemotherapy.
Asunto(s)
Antipirina/farmacocinética , Doxorrubicina/uso terapéutico , Mitomicinas/uso terapéutico , Adulto , Femenino , Humanos , Masculino , Tasa de Depuración Metabólica , Persona de Mediana Edad , MitomicinaRESUMEN
Leiomyosarcomas are uncommon malignant neoplasms that rarely arise in the extremities. We report on the clinical characteristics of 17 cases seen at the Memorial Sloan-Kettering Cancer Center over a 32 year period. Most neoplasms occurred in the lower extremities, and most of the tumors recurred after surgery alone, with several late recurrences. The overall prognosis was grim, with a median survival of 24 months. More aggressive multidisciplinary approaches to this disease are warranted.