Methicillin-resistant Staphylococcus epidermidis (MRSE) endocarditis treated with linezolid

Linezolid is not yet recognized as a standard therapy for infective endocarditis but its use becomes a necessity when infection is due to multidrug-resistant microorganisms. This report describes 1 patient with endocarditis treated with linezolid and 45 similar cases from the medical literature.     

Platelet function profiles in the elderly: results of a pharmacodynamic study in patients on clopidogrel therapy and effects of switching to prasugrel 5 mg in patients with high platelet reactivity

Studies specifically designed to assess clopidogrel response in the elderly as well as treatment alternatives to improve platelet inhibition in this high-risk population are lacking. This study aimed to define pharmacodynamic (PD) profiles, including high platelet reactivity (HPR) rates, among elderly patients on maintenance clopidogrel therapy and to assess the PD effects of prasugrel 5 mg/day in elderly with HPR. This was a prospective observational PD study enrolling consecutive ≥ 75-year-old patients on maintenance clopidogrel therapy (75 mg/day) who were tested for clopidogrel response by the VerifyNow P2Y12 assay and light transmittance aggregometry (LTA). HPR rates were estimated using multiple definitions. HPR patients identified by the VerifyNow P2Y12 assay [P2Y12 reaction unit (PRU) ≥ 230] were switched to prasugrel 5 mg/day, and platelet function testing was performed after 15 days of treatment. PD testing was completed in 100 patients. The HPR prevalence varied between 25% and 32%, depending on the definition used. A PRU ≥ 230 was observed in 25 patients; of these, 20 switched to prasugrel 5 mg/day. This resulted in significant reduction in PRU mean values (279.8 ± 45.1 vs. 171.7 ± 65.2, p=0.0002) with an absolute between-treatment difference of 108.1 (95% confidence intervals 75.2-140.9). Accordingly, switching to prasugrel 5 mg/day overcame HPR in most (80%) patients. Consistently, all LTA measures were significantly lower after prasugrel compared with clopidogrel. In conclusion, a considerable proportion of elderly patients exhibit HPR while on standard clopidogrel therapy. Switching to 5 mg/day prasugrel in elderly patients with HPR is associated with enhanced platelet inhibition and overcomes HPR in the majority of these patients.     

Randomized crossover antiemetic study in cisplatin-treated patients

Summary This prospective, randomized, nonblind study comparing the antiemetic effectiveness of high-dose IV metoclopramide and high-dose IV dexamthasone was performed in 78 advanced cancer patients. Chemotherapeutic treatment consisted in cisplatin at a high-dose (120 mg/m²) (HD-CDDP) and at a low-dose (LD-CDDP), either alone (60 mg/m²) or in combination with other chemotherapeutic agents (50 mg/m²). The evaluation of the effectiveness of antiemetic therapy was based on three parameters: prevention of vomiting (major protection), number of emetic episodes, and subjective preference. Out of 78 study patients, 67 were evaluable. Overall, metoclopramide proved to be statistically superior to dexamethasone in preventing vomiting (P<0.005), in reducing the median/mean number of emetic episodes (P<0.001/0.001), and in subjective preference (P<0.01). The results divided between HD-CDDP and LD-CDDP groups were also in favor of metoclopramide for reduction of the median/mean number of emetic episodes (P<0.001/0.001 for the HD-CDDP group and P<0.001/0.005 for the LD-CDDP group) and in subjective preference (P<0.001 and P<0.001 for the HD- and LD-CDDP groups, respectively). No statistical differences were noted when LD-CDDP was used in monochemotherapy, whereas when LD-CDDP was used in combination chemotherapy, statistical differences in favor of metoclopramide were noted again for the median/mean number of emetic episodes (P<0.01/0.05) and for subjective preference (P<0.01), even though the effectiveness of both antiemetic agents was greatly reduced. The evaluation of previously untreated patients reflected the overall results: for the HD-CDDP group all three parameters demonstrated statistical significance in favor of metoclopramide; for the LD-CDDP group, of all three parameters, prevention of vomiting (major protection) was the only one for which there was no significant difference.Mild sedation was the only side effect of metoclopramide. No extrapyramidal reactions were noted during this trial, but concomitant orphenadrine treatment was given. Dexamethasone was always well tolerated. In conclusion, high-dose IV metoclopramide demonstrated its superiority over high-dose IV dexamethasone in all subsets of our population except the LD-CDDP monochemotherapy group, in which the two antiemetics were found to be equivalent in effect.Oral presentation at the 19th annual meeting of the American Society of Clinical Oncology, San Diego, CA, May 22–24, 1983     

Case report: Ocular gnathostomiasis in northwestern Mexico

A 42-year-old woman from Culiacan in the Sinaloa State of Mexico presented with a four-year history of migratory, pruritic, painful swellings of the face. Palpebral edema with conjunctival erythema developed when lesions developed near the eye. Routine eye examination showed a mobile worm in the anterior chamber. Following surgical removal, the parasite was identified by light and electron microscopy as an advanced third-stage larva of Gnathostoma sp. This prevalence of this helminthiasis may be increasing in areas where eating freshwater raw fish ("cebiche") is customary.     

Use of epoetin beta during combination therapy of infection with hepatitis c virus with ribavirin improves a sustained viral response

The aim of the study was to evaluate the effects of epoetin‐beta on anemia and sustained viral response in patients with chronic hepatitis C receiving treatment with pegylated interferon and ribavirin. Forty‐two Caucasian patients with chronic hepatitis C infection, treated with pegylated interferon α‐2a or α‐2b plus ribavirin, who experienced at least a 2 log decline in HCV‐RNA in the first month of therapy and a ≥2.5 g/dl hemoglobin drop from baseline, were recruited. They were divided into two groups: 22 patients received epoetin‐beta 30,000 U administered s.c. q.w. (group A) and 20 patients received a reduced ribavirin dose of 600 mg daily (group B). The end‐of‐treatment response was 95.4% (21/22) in group A and 80% (16/20) (P = 0.2) in group B. Sustained viral response in group A was 81.8% (18/22), statistically higher than in group B (45%, 9/20) (P = 0.03). Mean corpuscular volume of erythrocytes was statistically lower in group A than in group B 4 weeks after starting epoetin‐beta or reduced ribavirin dose (P < 0.001), end‐of‐treatment (P < 0.001) and after 6 months follow‐up (P < 0.001). A negative correlation between the levels of ferritin serum was found in group A at the baseline and mean corpuscular volume value after 1 month of combination antiviral therapy (r = ?0.45; P = 0.35), 4 weeks after starting epoetin‐beta (r = ?0.43; P = 0.04) and after 6 months follow‐up (r = ?0.45; P = 0.03). Administration of epoetin‐beta increases sustained viral response rates among patients developing anemia, because the standard dose of ribavirin is maintained, thereby reducing the side‐effects of antiviral treatment. J. Med. Virol. 82:49–56, 2010. © 2009 Wiley‐Liss, Inc.     

Phylogenetic distance between Giardia intestinalis isolates from symptomatic and asymptomatic children

The purpose of the present investigation, was to analyze the sequences of 16S ribosomal genes partially amplified from 17 isolated Giardia intestinalis obtained from faces of 13 children with intestinal pathology and four symptoms-free children with intestinal pathology. Analysis was made also with Giardia Portland-I and four Giardias isolated from dogs. Children ages in both groups ranged from six to twelve years. Genomic DNA was isolated using the phenol-chloroform-isoamyl alcohol technique, and partial amplification of 16S rRNA ribosomal gene was carried out by the Polymerase Chain Reaction. Sequences of rDNA were compared with Portland-I by using CLUSTAL-W (1.81) and PHYLIP (3.6) software in order to determine phylogenic associations. Our results showed that only one isolate from symptoms-free children and three from the symptomatic children were associated with Portland I. The other isolated Giardias were associated between them and with two samples obtained from dogs that are phylogenetically distant from Portland-I. Two isolates from dog constituted a different group. These results suggest a zoonotic infection and presence of symptoms in children from the present investigation; probably it was associated with host or special characteristics of Giardia strains. The last two situations have a special epidemiological and public health interest.     

Ocular manifestations in chronic fatigue syndrome

A case-control masked study was performed in 37 patients with chronic fatigue syndrome (GFS) to evaluate ocular signs, symptoms, and functional parameters. A significant association was found between CFS and blurred vision at near, foggy vision, shadowed vision, headaches, and photophobia. Blurred vision, foggy vision, and headaches were associated with abnormal oculomotor function, and shadowed vision and photophobia were associated with tear deficiency. These data suggest that CFS affects the ocular system.     

Combined radiotherapy and chemotherapy with cyclophosphamide,adriamycin, methotrexate,procarbazine (camp) in 64 consecutive patients with epidermoid bronchogenic carcinoma,limited disease: A prospective study

Sixty-four consecutive patients with inoperable epidermoid bronchogenic carcinoma (limited disease) were treated with radiotherapy to the primary and nodal areas and combination chemotherapy with cyclophosphamide, adriamycin, methotrexate and procarbazine. The overall response rate (CR + PR) to combined treatment was 62%. The median survival time was 12.7 months. The toxicity was acceptable and no treatment-related death occurred.