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.     

Cardiac Surgery in Patients With Liver Cirrhosis (CASTER) Study: Early and Long-Term Outcomes

1. Download : Download high-res image (165KB)
2. Download : Download full-size image

     

On the Production of Chitosan-Coated Polycaprolactone Nanoparticles in a Confined Impinging Jet Reactor

This work is focused on the synthesis of polycaprolactone nanoparticles, coated with chitosan, in a confined impinging jet reactor using the solvent displacement method. The role of the various reacting species was investigated, evidencing that a biocompatible polymer, for example, polycaprolactone, is required to support chitosan to obtain a monomodal particle size distribution, with low particle diameters. A surfactant is required to reduce the nanoparticle size (down to a mean diameter of about 260 nm) and obtain a positive zeta potential (about +31 mV), perfectly suitable for pharmaceutical applications. Different surfactants were tested, and Poloxamer 388 appeared to be preferable to polyvinyl alcohol. The effect of the concentration of Poloxamer 388 (in the range 0.5-5 mg mL^?1) and of chitosan (in the range 1.5-5 mg mL^?1) on both the mean particle size and zeta potential was also investigated, evidencing that chitosan concentration has the strongest effect on both parameters. Finally, the effect of solvent evaporation, quenching and feed flow rate was investigated, showing that the evaporation stage does not affect particle characteristics, quenching is required to avoid particle aggregation, and a minimum liquid flow rate of 80 mL min^?1 is required in the considered reactor to minimize the particle size.     

Prise en charge d’un patient adulte atteint de mucoviscidose

The authors describe the case report of a patient with cystic fibrosis. The nutritional management is discussed during the different stages of disease treatment and progression.     

The use of bone-anchored implants for absent ear

The sample of patients analyzed has been selected from 66 cases treated for extraoral bone-anchored implantology at the Plastic and Reconstructive Surgery Department of the "Tor Vergata" University of Rome. Optimal results can be obtained in the ear district because of the low surgical risks and few postsurgical complications. Advantages offered by extraoral bone integrated implants are obvious when compared with more traditional techniques: it is possible to obtain a better cosmetic result only from 2 surgical sessions; and adhesive prosthesis may be better placed without the usual local irritation, achieving a correct positioning. The authors present their experiences in using extraoral implants for the reconstruction of the ear area malformation.     

Evaluation of the biomechanical behavior of maxillary central incisors restored by means of endocrowns compared to a natural tooth: a 3D static linear finite elements analysis.

OBJECTIVE: The present study aimed at evaluating different restoring configurations of a crownless maxillary central incisor, in order to compare the biomechanical behavior of the restored tooth with that of a sound tooth. MATERIALS AND METHODS: A 3D FE model of a maxillary central incisor is presented. An arbitrary static force of 10 N was applied with an angulation of 125 degrees to the tooth longitudinal axis at level of the palatal surface of the crown. Different material configurations were tested: composite, syntered alumina, feldspathic ceramic endocrowns and glass post resorations with syntered alumina and feldspathic ceramic crown. RESULTS: High modulus materials used for the restoration strongly alter the natural biomechanical behavior of the tooth. Critical areas of high stress concentration are the restoration-cement-dentin interface both in the root canal and on the buccal and lingual aspects of the tooth-restoration interface. Materials with mechanical properties underposable to that of dentin or enamel improve the biomechanical behavior of the restored tooth reducing the areas of high stress concentration. SIGNIFICANCE: The use of endocrown restorations present the advantage of reducing the interfaces of the restorative system. The choice of the restorative materials should be carefully evaluated. Materials with mechanical properties similar to those of sound teeth improve the reliability of the restoartive system.     

Light shielding effect of overlaying resin composite on the photopolymerization cure kinetics of a resin composite and a dentin adhesive.

OBJECTIVES: The purpose of this study was to simultaneously determine the impact of exposure times and incremental resin composite overlaying thickness on the cure kinetics of a light activated composite and a dentin adhesive at selected depths of a simulated restoration. METHODS: Levels and kinetics of polymerization of a light activated resin composite (Z250, 3M-ESPE) and dentin adhesive (Excite, Ivoclar) cured with a halogen light unit (Demetron, Kerr, USA) operating at low/medium intensity (500 mW/cm2) for different exposure durations (20 and 60 s) were measured at selected depths (0.3, 0.6 and 1mm) using a modified calorimetric analyzer (DSC 25, METLLER-TOLEDO). RESULTS: Final polymerization levels of materials up to 1mm through the composite are not significantly different while the light shielding effect of incremental resin composite overlaying progressively reduces their reaction rates. SIGNIFICANCE: Prolonged irradiation time at low/medium energies is effective for proper conversion of a resin composite and dentin adhesive; 60 s irradiation time provides the maximum obtainable conversion through the dental resin composite for thicknesses up to 1mm.     

Atrophic maxillary floor augmentation by mineralized human bone allograft in sinuses of different size: an histologic and histomorphometric analysis

Objective: The aims of this work were to histologically examine the healing of mineralized human bone allograft (MHBA) in sinus augmentation for elevating a severe maxillary atrophy ridge (≤2 mm residual ridge height) and to correlate the results to the sinus cavity size. Material and methods: A two‐stage protocol was conducted in 23 patients, all having crestal bone ≤2 mm. A mixture of 80/20 cortical/cancellous of MHBA particles was used to augment sinus using the lateral window approach in narrow (NS; <15 mm bucco‐palatal distance) and wide (WS; ≥15 mm bucco‐palatal distance) sinuses, based upon computerized tomography (CT) assessment. A bone core biopsy was taken at implant placement, 6 and 9 months after surgery. Microradiography, histology and histochemistry of methacrylate‐embedded sections were performed to analyze and to evaluate the bone and graft amount. Results: Newly formed bone around MBHA particles was found in all 28 biopsies. Bone showed a woven structure at 6 months after surgery and a lamellar structure 9 months after surgery. At 6 months after surgery, the 13 NS and 15 WS had 30.5±8.8% and 20.7±4.9% mean±SD bone formation, respectively. At 9 months after surgery, it was 38.8±7% (NS) and 30.7±3% (WS). Residual graft was about 16% (6 months) and 6% (9 months), in both NS and WS. The Mann–Whitney test showed a greater bone formation in NS than in WS (P<0.005). Conclusions: The used 80/20 MHBA mixture appears to promote, in the severe atrophic maxilla, a satisfactory bone formation. Our results prove that the larger the sinus, the longer the maturation time needed to achieve a suitable amount of new bone formation. To cite this article:
Maria Soardi C, Spinato S, Zaffe D, Wang H‐L. Atrophic maxillary floor augmentation by mineralized human bone allograft in sinuses of different size: an histologic and histomorphometric analysis.
Clin. Oral Impl. Res. 22 , 2011; 560–566
doi: 10.1111/j.1600‐0501.2010.02034.x