Emerging issue of fluconazole-resistant candidemia in a tertiary care hospital of southern italy: time for antifungal stewardship program

An increased number of patients is at risk of Candida spp. bloodstream infection (CBSI) in modern medicine. Moreover, the rising of antifungal resistance (AR) was recently reported. All consecutive CBSI occurred in our Hospital (consisting of 1,370 beds) between 2015 and 2018, were reviewed. For each case, Candida species, AR pattern, ward involved and demographic data of patients were recorded. Overall, 304 episodes of CBSI occurred, with a median (q1:first-,q3:third quartile) of 77 (71-82) CBSI/year. Over the years, a significant increase of CBSI due to C. albicans compared to non-albicans strains was recorded in medical wards (from 65% to 71%, p=0.030), while this ratio remained stable in others. An increase of resistant strains to multiple antifungals such as C. guillermondii was noticed in recent years (from 0% to 9.8%, p=0.008). Additionally, from 2015 to 2018 an increase in fluconazole-resistance was recorded in our Hospital (from 7.4% to 17.4%, p=0.025) and a slight increase in voriconazole-resistance (from 0% to 7% in 2018, p=0.161) was observed, while resistance to echinocandin and amphotericin B remained firmly below 2%.This study suggests a rapid spread of antifungal resistance in our Hospital; therefore, an appropriate antifungal stewardship programs is urgently warranted.     

Trends in Cervical Cancer Mortality in Brazilian Women who are Screened and Not Screened

Objective: This study aimed to analyze the trend in cervical cancer (ICD C53) mortality in Brazilian regions in women who are who are screened and not screened from 1996 to 2015. Methods: An epidemiological study, of time series of mortality from cervical cancer performed in 90,856 women under 24 years old (343 women), between 25 and 64 years old (32,703 women), and over 65 years old (10,909 women). The data from this research were collected from the DATASUS, from the SIM Health Surveillance Secretariat files, captured through TABNET selecting the resident population by gender and age group and ICD 10 C53 from 1996 to 2015. Results: Among women, 43.8% were white, and 76% had less than eight years of formal education. Polynomial regression showed an increasing trend in cervical cancer mortality in Brazil for women aged 15 - 24 years (p=0.01). Between 25 - 64 and 65 years or older it remained constant, but high (p=0.07; 0.99). The Northeast region pointed a growing trend in women aged 15 to 24 (p=0.01), 25 to 64 years (p=0.01) and 65 or older (p=0.001). The Northeast presented the highest average growth per year. In the Southeast, South and Midwest regions, decreasing trends were observed despite the high rates. The Joinpoint regression showed a 95% confidence interval, and that mortality from cervical cancer in the North region increased throughout the period analyzed. an increasing trend was observed from 1996 to 1998, whereas in the Midwest region, the trend remained stable throughout the period analyzed. The Federal District presented an upward trend from 1996 to 2015. In Brazil, an upward trend was observed throughout the whole period analyzed. Conclusions: Cervical cancer mortality in younger women is becoming more predominant, in addition to the high rate observed for women aged 65 or older.     

Dietary Fatty Acids and Other Nutrients in Relation to Inflammation and Particularly to Oral Mucosa Inflammation. A Literature Review

Oral mucosa is site of inflammatory process development. When they are chronic, they provide a microenvironment based on cytokines and inflammatory mediators that contribute to cancer initiation, progression, invasion, and metastasis. Certain dietary fatty acids (FAs) have immunomodulatory, inflammatory, and antiinflammatory effects. This review examined the literature on inflammation, mainly referred to the oral mucosa, and its association with dietary FAs and other nutrients. A Pubmed search of studies published in English until June 2018 was carried out. N-3 FAs have shown immunomodulatory and antiinflammatory activity in certain human diseases. These FAs and their mediators may inhibit inflammation, angiogenesis, and cancer via multiple mechanisms. Studies on cellular models of murine and human intestinal mucosa indicate association between dietary n-3?FA intake and the inflammatory state of mucosa membranes. Nevertheless scarce information on the association between dietary FAs and oral inflammation could be found. Based on the evidence, we hypothesize that n-3 FAs reduce the oral mucosa inflammation thus decreasing the risk of developing precancerous lesions and cancer. Molecular and clinical studies referred to this topic should be carried out as a contribution to the oral cancer prevention.     

An open-label,prospective, randomized,controlled, multicenter,phase 1b study of StrataGraft skin tissue versus autografting in patients with deep partial-thickness thermal burns

ObjectiveThis open-label, controlled, randomized study assessed the safety, tolerability, and efficacy of StrataGraft tissue compared to autograft in the treatment of deep partial-thickness (DPT) burns.MethodsThirty subjects with DPT thermal burns (3%–43% total body surface area) were treated with StrataGraft tissue as follows: cohort 1, ≤220 cm² refrigerated tissue; cohort 2, ≤440 cm² refrigerated tissue; and cohort 3, ≤440 cm² cryopreserved tissue. On each subject, two comparable areas of DPT burn were randomized to receive StrataGraft tissue or autograft. Coprimary end points were the percent area of the StrataGraft tissue treatment site undergoing salvage autografting by Day 28 and wound closure of treatment sites by 3 months.ResultsBy Day 28, no StrataGraft tissue treatment sites underwent autografting. By 3 months, 93% and 100% of the StrataGraft tissue and autograft treatment sites achieved complete wound closure, respectively. No significant differences in observer total and overall opinion POSAS scores between StrataGraft tissue and autograft treatment sites were observed at any timepoint. The most common adverse event was pruritus (17%).ConclusionsStrataGraft tissue treatment of DPT thermal burns reduced the need for autograft, resulted in wound closure and treatment-site cosmesis comparable to that of autograft, and was well tolerated.     

Does Body Position Affect Ultrasound Measurements of Bladder-Wall Elasticity?

Ultrasound bladder vibrometry (UBV) parameters have been shown in previous studies to strongly correlate with measurements from urodynamic studies. Just like urodynamic studies, UBV can be performed in supine and sitting positions. The objective of this study is to compare UBV parameters obtained in the two different positions using statistical methods. We recruited eight volunteers with healthy bladders for this purpose. The elasticity, group velocity squared and thickness of the bladder were the UBV parameters of interest, and their values were recorded at different bladder volumes for each volunteer. The results presented indicate that the measurements made in the two positions are in agreement using the Bland–Altman method and a parameter q which compares the values at each bladder volume for each volunteer. UBV parameters were also repeatable for measurements recorded in the supine and sitting positions.     

Digital tools and 3D printing technologies integrated into the workflow of restorative treatment: A clinical report

The development of technologies including intraoral scanners, dental software for digital restoration design, and additive manufacturing has improved the digital workflow of restorative treatment. The present article describes a digital workflow with intraoral scanning, computer-aided design (CAD) software, and subtractive and additive manufacturing procedures for a patient receiving lithium disilicate laminate veneers.     

Relationship between pharyngeal response time and lateralized brain lesion in stroke

Objectives: To analyze the relationship between pharyngeal response time (PRT) and lateralization of brain lesions.

Methods: A Cross-sectional study. 73 videofluoroscopic swallow studies (VFSS)were conducted on patients after stroke The study subjects were divided into : group 1 (G1) consisting of 39 individuals with left cortical lesion and group 2 (G2) consisting of 34 individuals with right cortical lesions. The VFSS of G1 and G2 subjects were analyzed using puree (A) and liquid (B) consistencies, and were also subdivided into young adults and older persons. . The mean PRT was divided into times shorter and longer than 250 ms.

Results: No statistically significant difference was observed between G1 and G2 for the A and B consistencies, being obtained : G1 (A mean: 56.6 ms; B mean: 99.5 ms; A mean: 3627 ms; B mean: 1712 ms) and G2 (A mean: 79.6 ms; B mean: 110.7 ms; A mean: 2040 ms, B mean: 1529 ms), for PRT shorter (A:p = .673; B: p = 1.000) and longer (A: p = .435; B: p = .847) than 250 ms, respectively. No statistically significant difference was found regarding the variable age in the comparison between young and old adults for mean PRT according to the A and B consistencies in G1 (A: p = .260; B: p = .732) and G2 (A: p = .586; B: p = .104).

Conclusion: No relationship between PRT and lateralization of brain lesion was observed with respect to subject age and to the swallowing of different food consistencies.