Effect of Diabetes Mellitus on the Clinical and Microbiological Features of Hospitalized Elderly Patients with Acute Pyelonephritis

OBJECTIVES: To study potential differences in the clinical and microbiological features of hospitalized elderly patients with acute pyelonephritis with and without diabetes mellitus.
DESIGN: Retrospective review of medical records.
SETTING: University hospital.
PARTICIPANTS: Eighty-eight patients aged 65 and older with diabetes mellitus (DM) (57 female; 64.8%) and 118 controls without DM (75 female; 63.6%), matched for age and sex, hospitalized with acute pyelonephritis between January 1997 and December 2005.
MEASUREMENTS: Medical records were reviewed for demographic, clinical, and microbiological characteristics.
RESULTS: The median age of both groups was 74 (range 65–95). Twenty-seven people with DM (30.7%) and 13 controls (11.0%) had bacteremia ( P =.001). People with DM had longer fever (median 4.5 vs 2.5 days; P <.001), longer hospitalization (median 10 vs 7 days; P <.001), and greater mortality (12.5% vs 2.5%; P <.01) than controls. Logistic regression analysis proved DM to be an independent predictor of bacteremia, long hospitalization, and mortality. Escherichia coli was the most common microorganism found in both groups, whereas Candida spp. were implicated more frequently in people with DM than controls (12.7% vs 1.7%; P <.01). Antimicrobial resistance did not increase over the study period.
CONCLUSION: Acute pyelonephritis in elderly people with DM is associated with risk of bacteremia, long hospitalization, and mortality.     

Acute aseptic meningitis during isotretinoin treatment for nodular acne solely presenting with headache: case report and brief review of the literature

Purpose/aim: We describe, in detail, the first case of isotretinoin-induced aseptic meningitis. A brief summary of the literature on drug-induced aseptic meningitis (DIAM) is also presented.

Materials and methods: A 20-year old female patient with probable (Naranjo adverse reaction probability score of 7) DIAM during treatment with isotretinoin therapy for nodular acne solely, presenting with headache. Pseudotumor cerebri was appropriately ruled-out.

Results: Summary of data altogether lead us suggest that isotretinoin triggered DIAM, possible due to a delayed hypersensitivity mechanism type III or IV.

Conclusion: We highlight a quite uncommon cause of DIAM that may be increasing in frequency due to the current increasing use of isotretinoin against nodular acne.     

First report of Hb A2-NYU (HBD:c.39T>A) in the Hellenic population

We report the first heterozygous case of Hb A(2)-NYU (HBD:c.39T>A) in the Hellenic population. The proband, an adult female from the island of Crete, Greece, was identified during routine family screening. DEAE chromatography of the index case revealed a minor hemoglobin (Hb) fraction preceding the elution of the wild-type Hb A(2). DNA sequencing of the entire HBD gene coding regions indicated that the index case was heterozygous for the rare variant Hb A(2)-NYU. Family studies indicated that this Hb variant was inherited from the mother. This finding underlines the vast genetic heterogeneity of the HBD gene in the Hellenic population.     

Effective etanercept treatment for psoriatic arthritis complicating concomitant human immunodeficiency virus and hepatitis C virus infection

High levels of tumor necrosis factor-alpha (TNF-alpha) are associated with hepatitis C virus (HCV) infection and all stages of human immunodeficiency virus (HIV) infection. TNF-alpha may have a role in both the pathogenesis and the response to treatment of these chronic viral diseases. We describe a 42-year-old HIV/HCV coinfected hemophiliac man who developed psoriasis and severe psoriatic arthritis not responding to combination treatment with methotrexate and cyclosporin A. Treatment with etanercept 25 mg twice weekly was followed by remission of the joint inflammation and improvement of the exanthem. This is the first report of anti-TNF-alpha treatment for rheumatic complications in a patient with both HIV and HCV infection.     

Antiemetic prophylaxis with ondansetron and methylprednisolone vs metoclopramide and methylprednisolone in mild and moderately emetogenic chemotherapy.

The purpose of the present study was to examine whether its is possible to successfully replace ondansetron (OND) with metoclopramide (MCP) in patients exposed to moderately emetogenic chemotherapy who did not experience severe nausea and vomiting while undergoing OND treatment during their first chemotherapy cycle. After switching to MCP, patients continued with this drug for three cycles, provided that they had adequate control of nausea and vomiting. Otherwise, they were switched back to OND. There were 76 patients, 60 women and 16 men, whose median age was 56 (mean 58) years. Karnofsky performance status score was 100 in 18 patients, 90 in 23, and 80 in 11 patients. No patient had previous chemotherapy. Thirty-four patients had breast cancer and received fluorouracil 500 mg/m2, epirubicin 100 500 mg/m2, and cyclophosphamide 500 mg/m2. Twelve patients had small cell lung cancer and received carboplatin 400 mg/m2 + etoposide 120 mg/m2 x 3 days. Twenty patients with ovarian cancer received carboplatin 350 mg/m2 and cyclophosphamide 500 mg/m2. Ten patients had cancer of unknown primary and received carboplatin 400 mg/m2, epirubicin 60 mg/m2, and etoposide 120 mg/m2 x 3 days. The OND schedule consisted of methylprednisolone 40 mg intravenous bolus followed by OND 8 mg in a 15-min infusion before chemotherapy, followed by OND 4 mg orally x 3 on the same and the next 2 days. Patients who did not experience nausea and vomiting with OND continued with an MCP schedule consisting of methylprednisolone 40 mg bolus followed by MCP 2 mg/kg in a 15-min infusion before chemotherapy, followed by MCP (20 mg x 4 on the day of therapy and the next 2 days after). Patients who failed with MCP or OND continued with OND. Considering our results as a whole, the intensity of nausea does not appear to influence the results of Gralla's scale. The results of Gralla's scale do not appear to be affected by the analysis of the antiemetic results and nausea on the next 2 days following chemotherapy administration. Overall, patients received 145 cycles with OND and 159 cycles with MCP. Of the 76 patients receiving OND-based antiemetic regimen during the first cycle, 13 (21%) experienced severe vomiting (Grade 2, 3) and the remaining 63 (79%) had mild or no vomiting (Grade 0, 1). Patients with Grade 0, 1 vomiting (63, 83%) continued with MCP in the second cycle. The final number of patients who failed on MCP, after 4 cycles of chemotherapy increased to 33 (43%); 43 (57%) were able to complete chemotherapy with MCP. Headache occurred in 15 (10%) cycles with OND and 8 (5%) with MCP. Flushing was noted in 12 (8%), and constipation occurred in 43 (30%) of OND cycles, and extrapyramidal manifestations occurred in 3 (5%) of patients receiving MCP. Diarrhea was noted in 3 (2%) of cycles with OND and in 28 (18%) with MCP. The cost ratio between MCP and OND was 1:14. If we administered OND only in patients who needed it, the overall cost decreased to 44%. Following the strategy applied in the present study, the cost decreased to 47%.