ABSTRACT Background: Invasive Zygomycosis (IZ) is an emerging mould infection with high morbidity... more ABSTRACT Background: Invasive Zygomycosis (IZ) is an emerging mould infection with high morbidity and mortality. Recent reports suggest a worldwide increase in the incidence of IZ. The aim of the study was to review and characterize the cases identified in our institution between January 1989 and April 2008. Methods: Retrospective analysis of all cases with an emphasis on clinical presentation, diagnosis and outcome. Results: Out of 53 cases identified, 17 cases were included as they fulfilled the proven EORT criteria and 36 were excluded as they were considered as colonization. The incidence ranged between 0 and 4 cases per year. Three cases were reported between 1989 and 2003 and 14 cases between 2003 and 2008. Voriconazole (Vo) was introduced in our institution in 2002 and its consumption is still increasing. The median age of patients was 52 years and 70% were female. The most frequent underlying conditions were haematological malignancies in 35% (33% of whom were neutropenic), high dose of steroids in 24%, solid organ transplantation and diabetes mellitus in 18% each. IZ was classified as pulmonary in 41%, disseminated in 23%, rhinosinusal in 12% and rhinocerebral, renal, hepatic and cutaneous in 6% each:. Rhizopus spp was isolated in 47%, Rhizomucor spp. in 29%, Absidia spp. in 18% and Cunninghamella spp. in 6%. Seven patients (41%) were under antifungal prophylaxis (median: 23 days, range 4 to 300 days) before diagnosis, 5 of them (71%) were receiving Vo. The patients were treated with Amphotericin B (29.5%), Posaconazole (23.5%) and a combination of Amphotericin B + Posaconazole (23.5%). Surgery was associated with antifungal treatment in 41% of cases. Mortality was 83% for patients with antifungal treatment alone and 14% for patients with antifungal treatment and surgery. Conclusions: Our results showed that IZ is emerging in our centre. We noticed an increasing incidence of IZ after the introduction of Vo. Mortality was lower for patients who were treated with the combination of antifungal therapy and surgery.
Swiss Medical Weekly Official Journal of the Swiss Society of Infectious Diseases the Swiss Society of Internal Medicine the Swiss Society of Pneumology, Jul 1, 2002
In this case report, we describe two patients who received a kidney-pancreatic transplant through... more In this case report, we describe two patients who received a kidney-pancreatic transplant through technique of exocrine pancreatic drainage into the bladder, and who subsequently developed arterial mycotic aneurysms at the site of the arterial anastomosis of the homograft.
Introducción. La fibrilación auricular (FA) es una arritmia frecuente asociada a aumento de morbi... more Introducción. La fibrilación auricular (FA) es una arritmia frecuente asociada a aumento de morbimortalidad. La mayoría de los pacientes presentan cambios microarquitecturales y anisotrópicos en el miocardio auricular que ocurren lentamente en el transcurso del tiempo y podrían evidenciarse por variaciones entre electrocardiogramas (ECG) que preceden al desarrollo de la FA. Objetivos.Evaluar la asociación entre las variaciones (deltas) de los distintos componentes de la onda electrocardiográfica entre 2 ECG separados en el tiempo y evaluar su valor pronóstico para la predicción de FA. Materiales y métodos. Cohorte retrospectiva depacientes mayores de 18 años en seguimiento ambulatorio pertenecientes al Plan de Salud del Hospital Italiano que realizaron 2 ECG durante el período de seguimiento (2004-2011). Se determinó la presencia de FA a través de la revisión de la historia clínica electrónica y se seleccionó en estos pacientes el ECG previo al episodio. Se excluyeron los pacientes ...
To investigate the effects of Lenercept , a recombinant soluble TNF receptor p55 fused to an immu... more To investigate the effects of Lenercept , a recombinant soluble TNF receptor p55 fused to an immunoglobulin heavy chain IgG1, on the balance of pro- and anti-inflammatory mediators in sepsis. Post hoc analysis of a subgroup of patients enrolled in a multicenter phase III, prospective, double-blind, placebo-controlled, randomized study of Lenercept in severe sepsis. Surgical and medical intensive care units, and postoperative recovery room of a tertiary care teaching hospital. A total of 57 patients were enrolled in the multicenter study in our center. Septic patients were randomly assigned to receive either Lenercept 0.125 mg/kg or placebo. The patients were followed for up to 28 days after randomization. Circulating levels of TNF-alpha, IL-6, TNFsR75 and IL-1Ra were measured before and after treatment. The two groups were comparable with regard to age, gender and diagnosis distribution. The total level of TNF-alpha increased significantly in treated patients, compared to patients receiving placebo. The levels of the other inflammatory mediators did not differ between the two groups Lenercept -treated patients experienced a protracted TNF-alpha half-life, leading to higher total TNF-alpha levels throughout the study. However, the treatment had no effects on anti-inflammatory mediators. Therefore, peripheral inflammatory processes might not have been significantly modified by the treatment. This might account for the lack of efficacy this treatment in septic patients
ABSTRACT Background: Invasive Zygomycosis (IZ) is an emerging mould infection with high morbidity... more ABSTRACT Background: Invasive Zygomycosis (IZ) is an emerging mould infection with high morbidity and mortality. Recent reports suggest a worldwide increase in the incidence of IZ. The aim of the study was to review and characterize the cases identified in our institution between January 1989 and April 2008. Methods: Retrospective analysis of all cases with an emphasis on clinical presentation, diagnosis and outcome. Results: Out of 53 cases identified, 17 cases were included as they fulfilled the proven EORT criteria and 36 were excluded as they were considered as colonization. The incidence ranged between 0 and 4 cases per year. Three cases were reported between 1989 and 2003 and 14 cases between 2003 and 2008. Voriconazole (Vo) was introduced in our institution in 2002 and its consumption is still increasing. The median age of patients was 52 years and 70% were female. The most frequent underlying conditions were haematological malignancies in 35% (33% of whom were neutropenic), high dose of steroids in 24%, solid organ transplantation and diabetes mellitus in 18% each. IZ was classified as pulmonary in 41%, disseminated in 23%, rhinosinusal in 12% and rhinocerebral, renal, hepatic and cutaneous in 6% each:. Rhizopus spp was isolated in 47%, Rhizomucor spp. in 29%, Absidia spp. in 18% and Cunninghamella spp. in 6%. Seven patients (41%) were under antifungal prophylaxis (median: 23 days, range 4 to 300 days) before diagnosis, 5 of them (71%) were receiving Vo. The patients were treated with Amphotericin B (29.5%), Posaconazole (23.5%) and a combination of Amphotericin B + Posaconazole (23.5%). Surgery was associated with antifungal treatment in 41% of cases. Mortality was 83% for patients with antifungal treatment alone and 14% for patients with antifungal treatment and surgery. Conclusions: Our results showed that IZ is emerging in our centre. We noticed an increasing incidence of IZ after the introduction of Vo. Mortality was lower for patients who were treated with the combination of antifungal therapy and surgery.
Swiss Medical Weekly Official Journal of the Swiss Society of Infectious Diseases the Swiss Society of Internal Medicine the Swiss Society of Pneumology, Jul 1, 2002
In this case report, we describe two patients who received a kidney-pancreatic transplant through... more In this case report, we describe two patients who received a kidney-pancreatic transplant through technique of exocrine pancreatic drainage into the bladder, and who subsequently developed arterial mycotic aneurysms at the site of the arterial anastomosis of the homograft.
Introducción. La fibrilación auricular (FA) es una arritmia frecuente asociada a aumento de morbi... more Introducción. La fibrilación auricular (FA) es una arritmia frecuente asociada a aumento de morbimortalidad. La mayoría de los pacientes presentan cambios microarquitecturales y anisotrópicos en el miocardio auricular que ocurren lentamente en el transcurso del tiempo y podrían evidenciarse por variaciones entre electrocardiogramas (ECG) que preceden al desarrollo de la FA. Objetivos.Evaluar la asociación entre las variaciones (deltas) de los distintos componentes de la onda electrocardiográfica entre 2 ECG separados en el tiempo y evaluar su valor pronóstico para la predicción de FA. Materiales y métodos. Cohorte retrospectiva depacientes mayores de 18 años en seguimiento ambulatorio pertenecientes al Plan de Salud del Hospital Italiano que realizaron 2 ECG durante el período de seguimiento (2004-2011). Se determinó la presencia de FA a través de la revisión de la historia clínica electrónica y se seleccionó en estos pacientes el ECG previo al episodio. Se excluyeron los pacientes ...
To investigate the effects of Lenercept , a recombinant soluble TNF receptor p55 fused to an immu... more To investigate the effects of Lenercept , a recombinant soluble TNF receptor p55 fused to an immunoglobulin heavy chain IgG1, on the balance of pro- and anti-inflammatory mediators in sepsis. Post hoc analysis of a subgroup of patients enrolled in a multicenter phase III, prospective, double-blind, placebo-controlled, randomized study of Lenercept in severe sepsis. Surgical and medical intensive care units, and postoperative recovery room of a tertiary care teaching hospital. A total of 57 patients were enrolled in the multicenter study in our center. Septic patients were randomly assigned to receive either Lenercept 0.125 mg/kg or placebo. The patients were followed for up to 28 days after randomization. Circulating levels of TNF-alpha, IL-6, TNFsR75 and IL-1Ra were measured before and after treatment. The two groups were comparable with regard to age, gender and diagnosis distribution. The total level of TNF-alpha increased significantly in treated patients, compared to patients receiving placebo. The levels of the other inflammatory mediators did not differ between the two groups Lenercept -treated patients experienced a protracted TNF-alpha half-life, leading to higher total TNF-alpha levels throughout the study. However, the treatment had no effects on anti-inflammatory mediators. Therefore, peripheral inflammatory processes might not have been significantly modified by the treatment. This might account for the lack of efficacy this treatment in septic patients
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