Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas,Brazil

We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI), as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas). A prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. Their clinical evolution was followed up for 30 days from October 2005 to December 2006. The relation among the qualitative variables was verified through Chi-square test. The significance level was 5%. The statistical package adopted was SPSS 15.0 for Windows. Up to the thirtieth day, 30.1% of the patients presented bacteremia and 69.9% developed sepsis. Among these, 20.3% developed severe sepsis and 10.5% septic shock. The mortality attributed to it was 37.8%. In bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3%, 50%, 65.5%, and 84.6%, respectively. Respiratory (32.2%) and urinary (14%) sources and the ones related to central venous catheter (14%) were prevalent. In the wards 55.12% of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69% (p < 0.05). Chronic renal failure, diabetes melitus, and neuropathy were present in 21.7%, 26.6%, and 29.4% of the cases, respectively. Coagulase-negative Staphylococcus (25.9%), Staphylococcus aureus (21%), and Klebsiella pneumoniae (14%) were the most present microorganism in the sample. The high morbidity and mortality rates in this study are attributed to the lack of knowledge on BSI characteristics and on instituted protocols for detection and treatment in early stages.     

Is adiponectin involved in the pathogenesis of nonalcoholic steatohepatitis? A preliminary human study

BACKGROUND: Animal studies have suggested that adiponectin may play a role in the pathogenesis of alcoholic and nonalcoholic fatty liver disease. Studies are limited that evaluated the role of adiponectin in the pathogenesis of nonalcoholic steatohepatitis (NASH). METHODS: To further our understanding of the role of adiponectin in the pathogenesis of NASH, the following studies were conducted. Serum adiponectin was measured and correlated with anthropometric and nutritional variables in 21 patients with biopsy-proven NASH and 19 age-, gender-, body mass index-, and body fat-matched controls. The effect of a mixed meal on serum adiponectin levels in a subgroup of patients (n = 24) with NASH and controls was assessed. In a separate cohort, liver samples belonging to healthy (n = 11), steatotic (n = 12), and NASH (n = 12) patients were used to further explore the role of adiponectin by measuring the expression of adiponectin and adiponectin receptor (AdipoR2) mRNA. RESULTS: Patients with NASH had significantly lower levels of serum adiponectin than controls (4.9 +/- 2.7 vs. 7.3 +/- 3.5 microg/mL, P = 0.02). While no significant correlation existed between serum adiponectin and anthropometric or nutritional variables, it was independently associated with age, high density lipoprotein, and triglycerides. Mixed meal had no effect on serum adiponectin either in patients with NASH or in controls. There was no expression of adiponectin mRNA in any of liver samples studied. However, AdipoR2 mRNA expression was higher in NASH than in steatotic and normal liver tissue. CONCLUSION: These data show that adiponectin may have a role in the pathogenesis of human NASH and should be investigated further.     

Does neoplastic gastrin expression remodel the embryonal pattern of the protein? A study in human pancreas

BACKGROUND/AIMS: To determine the immunoreactivity of gastrin during the development of the human fetal pancreas and ductal pancreatic adenocarcinoma, given that, gastrin positive cells were demonstrated either into its embryonic anlage or into pancreatic cancer. METHODOLOGY: Tissue sections from 15 pancreatic fetal specimens, and an equal number of ductal adenocarcinoma specimens, were assessed using immunohistochemical methods for gastrin. RESULTS: The density of positive cells in the primitive exocrine ductal walls and outgrowing buds was significantly higher than the relevant density in the neoplastic pancreatic tissue of mixed (ductal endocrine) and pure ductal type (p1=0.017, p2<0.0001, p3<0.0001 and p4=0.019, respectively). The above values were estimated from 20-22 weeks of gestation. There was no significant difference in the density of positive cells in the islet cell epithelium from 25-30 weeks, and the neoplastic tissue of mixed (p5=0.24) and pure ductal type (p6=0.55). CONCLUSIONS: The immunostaining for gastrin identifies a subgroup of pancreatic ductal adenocarcinomas with a neuroendocrine component (initially considered as pure ductal tumors), and mixed ductal-endocrine tumors. This pattern of expression in neoplasms recapitulates the normal pattern during the embryonal development of the organ, and may be important for the development of new therapeutic approaches with eventual clinical utility.     

Does recombinant human erythropoietin accelerate correction of post-ulcer-bleeding anaemia?A pilot study

AIM:Anaemia caused by acute upper gastrointestinalbleeding is treated with blood transfusion or iron,but patientsusually face a two-month recovery period from post-haemorrhage anaemia.This prospective,randomised,open,pilot study was designed to investigate whether recombinanthuman erythropoietin(Epoetin)therapy acceleratehaematocrit increase in the post-bleeding recovery period.METHODS:We studied hospitalised patients admittedbecause of acute ulcer bleeding or haemorrhagic gastritis,who had a haematocrit of 27-33% and did not receive bloodtransfusions.One day after the endoscopic confirmation ofcessation of bleeding,they were randomised either toerythropoietin(20 000 IU Epoetin alfa subcutaneously,ondays 0,4 and 6)plus iron(100 mg im,on days 1-6,(G_1)oriron only(G_2).Haematocdt was measured on days 0,6,14,30,45,and 60,respectively.RESULTS:One patient from G_1 and two from G_2 were lost tofollow-up.Therefore,14 and 13 patients from G_1 and G_2respectively were analysed.Demographic characteristics,serumiron,ferritin,total iron binding capacity,reticulocytes,andhaernatoait were not significantly different at entry to the study.Median reticulocyte counts were significantly different betweengroups on day six(G_1:4.0,3.0-6.4 vs G_2:3.5,2.1-4.4%,P=0.03)and median haematocrit on day fourteen [G_1:35.9,30.7-41.0 vs G_2:32.5,29.5-37.0%(median,range),P=0.04].CONCLUSION:Erythropoietin administration significantlyaccelerates correction of anemia after acute ulcer bleeding.The haematocrit gain is equivalent to one unit of transfusedblood two weeks after the bleeding episode.     

Advances in Imaging and Surveillance of AAA: When,How, How Often?

Despite rapid technological developments for imaging the aorta, ultrasonography remains the method of choice for abdominal aortic aneurysm screening and surveillance. Randomised trials, conducted in the 20th century, have provided convincing evidence in favour of screening men at age 65 years, or older. However, in the 21st century the prevalence of aneurysms in 65 year old men has fallen by more than half, probably because of lower smoking prevalence and better cardiovascular risk prevention: screening or rescreening at an older age may be helpful. A recent meta-analysis has provided good evidence for surveillance intervals, with the majority of patients with screen-detected aneurysms (up to 4.5 cm diameter) being safely managed with 3-year surveillance intervals. Even for larger aneurysms, annual surveillance intervals are likely to be acceptable. This would reduce the number of surveillance visits by approximately half.     

Does leukofiltration reduce pulmonary infections in CABG patients? A prospective, randomized study with early results and mid-term survival

BACKGROUND: We present the first prospective randomized study of primary coronary artery bypass grafting (CABG) patients who were analyzed for postoperative infections after undergoing blood and/or blood product transfusion (BBPT) with a Pall Purecell leukoreducing filter. METHODS AND RESULTS: One hundred and four patients were enrolled between March 1998 and March 1999. Seventy-two of the patients received BBPT (average 5.6 units BBPT/filter patient and 5.6 units/control patient). Three patients who had CABG without extracorporeal circulation or mixed transfusions of filtered and unfiltered BBPT were excluded. The remaining 69 transfused patients (38 filtered, 31 control) were analyzed and the incidence of culture proven infections was recorded. Mid-term survival data were obtained from the National Death Index and Kaplan-Meier survival plots were constructed. All patients were stratified and matched according to the EuroSCORE.Thirty-day mortality was 2.6% and 3.2% for the filtered and control patients, respectively.There were 5 cases of culture proven infections in 38 filtered patients (13.2%) and 8 in 31 controls (25.8%), P = 0.224. No pulmonary tract infections were recorded in the filter group vs. 4 (12.9%) in controls, P = 0.048. Reduced length for mechanical ventilation (16.3 hours vs. 57.8, P = 0.103), length of stay (9.1 vs. 10.8 days, P = 0.685), as well as increased 50-month actuarial survival, (45.5 vs. 42.3 months, P=0.695) in filtered vs. control, respectively, were recorded. CONCLUSIONS: The use of leukoreduced BBPT reduced the incidence of pulmonary tract infections in patients undergoing CABG.     

Did ossification of the posterior longitudinal ligament of the spine evolve in the modern period? A paleopathologic study of ancient human skeletons in Japan

OBJECTIVE: To investigate the historical origins of ligamentous ossifications of the spine in Japan. METHODS: We studied skeletons of Jomonese of the period 5000-2300 years BP, of Japanese of the 17th-19th century Edo Period, and of Ainu of the 18th-20th century in Japan with special emphasis on spinal ligament ossifications as in the posterior longitudinal ligament. A comparison to our previous study on ancient Chinese skeletons was done. RESULTS: Cervical ossification of the posterior longitudinal ligament (OPLL) was the only ossification that increased significantly in prevalence in people of the near-modern period in comparison to the Neolithic gathering-hunting people. CONCLUSION: Socioeconomic changes from a subsistence gathering-hunting economy to the near-modern livelihood depending on rice-eating and a diet high in vegetable protein are speculated to be responsible for the prevalence increase of cervical OPLL.     

Use of posaconazole in the treatment of invasive fungal? infections

The emergence of invasive fungal infections as an increasingly important clinical problem in immunocompromised patients highlights the need for more effective antifungal agents and better strategies for prevention, diagnosis and treatment. Posaconazole is an extended-spectrum triazole with broad activity against a variety of fungal pathogens, both yeasts and molds. In particular, it has activity against several emerging pathogens, such as the Zygomycetes, which are resistant to many currently available antifungals, making it an attractive agent for use in both prophylactic and therapeutic situations. Studies demonstrating the prophylactic utility of posaconazole in neutropenic patients with acute myelogenous leukemia or myelodysplastic syndrome, and in patients with graft-versus-host disease following allogeneic stem cell transplantation has led to the approval of the drug in the USA. These data have been reviewed elsewhere in detail. Published data on posaconazole as primary antifungal therapy are very limited, although there is a considerable amount of experience with the drug in the salvage setting following failure of or intolerance to other antifungal agents. In this review we will focus on the use of posaconazole for treatment of established invasive fungal infections, with a focus on opportunistic infections in immunocompromised patients.     

Symptomatic post-vaccination SARS-CoV-2 infections in healthcare workers– A multicenter cohort study

Background and aimsDuring the COVID-19 vaccination program in India, the healthcare workers were given the first priority. There are concerns regarding the occurrence of breakthrough infections after vaccination. We aimed to investigate the effictiveness of COVID-19 vaccines in preventing and reducing the severity of post-vaccination infections.MethodsThis retrospective test-negative case-control study examined 28342 vaccinated healthcare workers for symptomatic SARS-CoV-2 infections between January 16 to June 15, 2021. They worked at 43 Apollo Group hospitals in 24 Indian cities. These cohorts received either ChAdOx nCOV-19 (Recombinant) or the whole virion inactivated Vero cell vaccines. Various demographic, vaccination related and clinical parameters were evaluated.ResultsSymptomatic symptomatic post-vaccination infections occurred in a small number of vaccinated cohorts (5.07%, p < 0.001), and these were predominantly mild and did not result in hospitalization (p < 0.0001), or death. Both vaccines provided similar protection, with symptomatic infections in 5.11% and 4.58%, following ChAdOx nCOV-19 (Recombinant) and the whole virion inactivated Vero cell vaccines, respectively (p < 0.001). Nursing and Clinical staff and cohorts >50 years contracted more infections (p < 0.001). Two-dose vaccination has significantly lower odds of developing symptomatic infection (0.83, 95%CI – 0.72 to 0.97). Maximum infections occurred during the peak of the second COVID-19 wave from mid-April to May 2021 (p < 0.001). No significant difference existed in the infection between sex, vaccine type, and the number of vaccine doses received (p ≥ 0.05).ConclusionSymptomatic infections occurred in a small percentage of healthcare workers after COVID vaccination. Vaccination protected them from not only infection but also severe disease.     

Should we continue to study high-dose chemotherapy in metastatic breast cancer patients? A critical review of the published data

Data from eight randomised trials on high-dose chemotherapy (HDC) for metastatic breast cancer (MBC) have been published, but only seven studies are evaluable after the Bezwoda trial was discredited. Moreover, overall survival (OS) has been evaluated in only four out of seven studies since three had a crossover design. OS was similar for the HDC and standard-dose chemotherapy (SDC) group in the four evaluable trials, while disease-free survival (DFS) was improved in the HDC group in six of the seven trials. The delay in relapse for patients with metastatic disease represents an important clinical outcome; furthermore, since none of the reported studies randomised more than 220 patients, their statistical power may have been too limited to detect meaningful survival differences. Finally, preliminary experiences have shown that HDC seems to be the ideal platform upon which to build novel therapies. In conclusion, HDC remains an important field of clinical research for breast cancer patients with stage IV disease and, from the studies reported in this article, there is some evidence for offering this therapeutic modality to selected patients who are interested in a medically aggressive approach.