Randomized open comparison of the safety of SLIT in a no-updosing and traditional updosing schedule in patients with Parietaria allergy

BackgroundDue to optimal safety of sublingual immunotherapy (SLIT), it was suggested that a slow up-dosing phase maybe not necessary, and therefore the treatment will be more patient-friendly, avoiding dosing mistakes.PatientsTwenty adult patients suffering allergic rhinitis due to Parietaria, were enrolled. Half of them received the traditional schedule and the other half immediately started with 200 STU.ResultsNo difference was observed between the traditional up-dosing treatment schedule and no-updosing treatment schedule in terms of side effects, even mild local side effects was grater with traditional regimen.     

Thrombolysis With Alteplase: A Non‐Invasive Treatment for Occluded Arteriovenous Fistulas and Grafts

Thrombolysis with recombinant tissue type plasminogen activator (t‐PA) has been successfully used in occluded arteriovenous (AV) hemodialysis grafts and tunneled catheters, especially as an adjunctive regimen to invasive or semi‐invasive procedures. We performed a retrospective study to evaluate the effectiveness and outcomes of thrombolysis with t‐PA in occluded AV hemodialysis accesses. We used low doses of t‐PA in 40 cases of thrombosed AV fistulas and grafts. Primary success was noted in 55% of the cases ensuring patency rates of 30 and 90 days at 90.9 and 69.8%, respectively. Inflammation (increased C‐reactive protein concentration) and shorter functioning time of AV access were independently associated with primary outcome, whereas there was no difference in outcome between AV fistulas or grafts. No major complications were noted. We conclude that the use of t‐PA is a safe and easy treatment for clotted AV accesses that can be applied in an outpatient setting.     

Serotyping and antibiotic resistance of Streptococcus pneumoniae isolated from pediatric infections in central Greece

Objective: To determine the distribution of serogroups/serotypes and antibiotic resistance pattern of Streptococcus pneumoniae isolated from pediatric infections in central Greece.
Methods: In total, 306 S. pneumoniae strains isolated from children, aged from 18 days to 14 years (median 18 months), during a 21-month period, from different specimen sources, were studied. Susceptibility testing was carried out by the Kirby-Bauer method and by the Etest, and serotyping by the Quellung reaction.
Results: Of the S. pneumoniae isolates, 3.9% were highly resistant to penicillin (PR), while 17.6% were intermediately resistant (IPR). PR and IPR isolates were found to be, in general, more resistant to other antibiotics than penicillin-susceptible isolates. The PR and IPR isolates belonged to the serogroup/serotypes 19, 23, 9, 6 and 14 (in descending order of frequency). The penicillin-susceptible isolates belonged to 20 different groups/serotypes, the most common being 19, 6, 14, 9, 3, 23 and 1 (in descending order of frequency). Serogroup 23 was often found to be multiresistant.
Conclusions: Resistance to penicillin in S. pneumoniae isolates is relatively low and differs according to the specimen type. All the pneumococcal serogroups/serotypes isolated from the children were found to be included in the 23-valent polysaccharide vaccine. Most of the children with a pneumococcal infection, however, were less than 2 years old and could not be protected by the existing vaccine.     

Prophylactic effect of brinzolamide–brimonidine fixed combination on intraocular pressure spikes after intravitreal anti-VEGF injections

International Ophthalmology - To evaluate the effect of topical prophylaxis with brinzolamide–brimonidine fixed combination on short-term intraocular pressure (IOP) elevation after...     

Estimated glomerular filtration rate independently predicts outcome of azacitidine therapy in higher-risk Myelodysplastic syndromes. Results from 536 patients of the Hellenic National Registry of Myelodysplastic and Hypoplastic syndromes

Higher-risk Myelodysplastic syndromes (MDS) patients undergoing treatment with 5-azacytidine (AZA) are typically elderly with several comorbidities. However, the effect of comorbidities on the effectiveness and safety of AZA in real-world settings remains unclear. We analyzed data from 536 AZA-treated patients with higher-risk MDS, Myelodysplastic/Myeloproliferative neoplasms and low blast count Acute Myeloid Leukemia enrolled to the Hellenic National Registry of Myelodysplastic and Hypoplastic Syndromes. Multivariate analysis adjusted also for the International Prognostic Scoring System (IPSS), its revised version (IPSS-R) and the French Prognostic Scoring System (FPSS), demonstrated independent associations of overall and leukemia-free survival with estimated glomerular filtration rate (eGFR) <45 mL min⁻¹/1.73 m² (P = .039, P = .023, respectively), ECOG performance status <2 (P = .015, P = .006), and presence of peripheral blood blasts (P = .008, P = .034), while secondary MDS also correlated with significantly shorter leukemia-free survival (P = .039). Addition of eGFR <45 mL min⁻¹/1.73 m², in IPSS-R and FPSS increased the predictive power of both models. Only FPSS ≤2 and eGFR <45 mL min⁻¹/1.73 m² predicted worse response to AZA in multivariate analysis, whereas eGFR <45 mL min⁻¹/1.73 m² correlated significantly with death from hemorrhage (P = .003) and cardiovascular complications (P = .006). In conclusion, in the second largest real-world series of AZA-treated MDS patients, we show that an eGFR <45 mL min⁻¹/1.73 m² is an independent predictor of worse response and survival. This higher cut-off, instead of the commonly used serum creatinine >2 mg/dL, can be utilized as a more precise indicator of renal comorbidity during AZA therapy. Incorporation of eGFR in the prognostic assessment of AZA-treated MDS patients may prove useful not only in routine practice, but also for the appropriate patient stratification in clinical trials with AZA combinations.     

Hb Agrinio [α29(B10)Leu→Pro (α2)] in Combination with – –MED I Results in a Severe Form of Hb H Disease

We report two cases of compound heterozygote patients for the – –^{MED I} and Hb Agrinio [α29(B10)Leu→Pro (α2)] anomalies in two unrelated Greek Cypriot families. The first patient had a serious form of Hb H disease and died at the age of 21 due to complications arising during an operation. The second patient showed a severe hematological picture and has been regularly transfused since an early age. This patient exhibits bone abnormalities as well as hepatosplenomegaly. The severity of these two incidences emphasizes the need for the inclusion of a screening test for the – –^{MED I}/α^Agrinioα genotype among those already offered during prenatal diagnosis. Two homozygotes, as well as a number of simple, compound, and double heterozygotes for Hb Agrinio have been identified in Cyprus and their hematological indices are presented.     

Pulmonary co‐infections by Pneumocystis jirovecii and Aspergillus fumigatus in non‐HIV patients: A report of two cases and literature review

Pneumocystis jirovecii is the causative agent of Pneumocystis pneumonia (PcP), a common and often life‐threatening opportunistic infection in HIV‐infected patients. However, non‐HIV, immunocompromised patients are at risk of PcP as well, whereas the mortality appears to be higher among these patients. Pneumocystis co‐infections with other microorganisms are less frequent and only sparse reports of combined PcP and invasive pulmonary fungal infections exist in the literature, especially in the non‐HIV patients. Two cases of pulmonary co‐infections by P. jirovecii and Aspergillus fumigatus are presented. Both patients were non‐HIV infected, the first one was suffering from crescentic IgA nephropathy under immunosuppressive treatment and the second from resistant non‐Hodgkin lymphoma under chemotherapy. Both patients were treated with intravenous trimethoprim/sulphamethoxazole (TMP/SMX) combined with voriconazole. The first patient showed gradual clinical improvement while the outcome for the second patient was unfavourable. In addition, a literature review of the previous published cases of co‐infection by P. jirovecii and other fungi in non‐HIV patients was performed. Our target was to provide comprehensive information on this kind of infections, highlighting the importance of clinical suspicion.     

Anti-CD40 antibodies in antiphospholipid syndrome and systemic lupus erythematosus

Anti-beta2glycoprotein I (anti-beta2GPI) antibodies constitute the main autoantibody specificity in the sera of patients with antiphospholipid syndrome (APS). There is evidence that anti-beta2GPI antibodies induce the precoagulant activity of the endothelium by cross-linking the beta2 glycoprotein I (beta2GPI) on the cell surface. Since beta2GPI lacks intracellular domains, homology with other molecules such as CD40 that could initiate signaling, was extensively searched. A 86% homology between the amino acid position 239-245 of the CD40 and 7-13 of the beta2glycoprotein was found. The CD40 peptide corresponding to amino acids 239-245 of the CD40 molecule was synthesized and coupled to a multiple antigenic peptide carrier. Antibodies to CD40 peptide were found in 61.5% APS patients (n = 39), in 72.7% of systemic lupus erythematosus (SLE) positive for anti-beta2GPI antibodies (n = 11) and 31.6% of SLE negative for anti-beta2GPI antibodies (n = 19), but not in rheumatoid arthritis patients (n = 28) or controls (n = 36). Antibodies to CD40 peptide were associated with arterial thrombosis and/or brain microinfarcts. Affinity purified anti-CD40 peptide antibodies as well as affinity purified anti-beta2GPI antibodies recognized both, the beta2GPI and the CD40 peptide. The specificity of this recognition was confirmed with homologous and heterologous inhibition experiments. Confocal microscopy experiments demonstrated this cross-recognition of CD40 and beta2GPI molecules, by the purified anti-CD40 peptide antibodies, at the protein level. Thus, antibodies reacting with the beta2GPI can react and potentially activate different cells which express CD40 molecules at their surface.