1,720,975 research outputs found
Monitoraggio terapeutico degli azoli e sviluppo di resistenza antifungina in una popolazione adulta affetta da Fibrosi Cistica con infezione delle vie aeree da funghi filamentosi
Full text linkIntroduzione. La peculiare suscettibilità alle infezioni croniche delle vie aeree da parte di una moltitudine di patogeni rappresenta uno dei segni distintivi della Fibrosi Cistica (FC). Negli ultimi anni sempre più attenzione è stata dedicata al ruolo della colonizzazione da funghi filamentosi, Aspergillus spp. e non-Aspergillus (NAFF). I triazoli rappresentano frequentemente la terapia di prima scelta nel trattamento di queste infezioni. Tuttavia, il loro utilizzo implica necessariamente il ricorso al monitoraggio terapeutico farmacologico (TDM), a causa di una farmacocinetica estremamente variabile e della recente comparsa, a livello mondiale, di farmacoresistenza agli azoli.
Obiettivi. Analizzare l’utilizzo del TDM nella gestione clinica real-life di una popolazione adulta affetta da FC in terapia con azoli, identificare i fattori di rischio associati al riscontro di livelli plasmatici sub-terapeutici e valutare lo sviluppo di resistenza antifungina da parte delle specie isolate.
Metodi. È stata effettuata un’analisi retrospettiva longitudinale su di un’ampia casistica monocentrica inglese, selezionando tutti i pazienti adulti in trattamento con azoli nel periodo incluso tra il 2018 ed il 2019. Per ciascun paziente reclutato sono stati raccolti i dati relativi a: caratteristiche demografiche e indici di controllo della malattia, risultati degli esami microbiologici, terapia antifungina in atto e relativa indicazione, frequenza e risultati del TDM. Analisi di regressione logistica multivariata sono state effettuate per identificare i fattori di rischio associati al riscontro di livelli plasmatici sub-terapeutici e per indagare in merito all’eventuale associazione tra TDM sub-terapeutici e sviluppo di ceppi resistenti agli azoli. La probabilità di sviluppare resistenza antifungina nel periodo di osservazione è stata valutata mediante regressione univariata di Cox.
Risultati. Sono stati selezionati 91 pazienti adulti in trattamento con triazoli nel periodo di studio. È stata riscontrata un’elevata frequenza di TDM sub-terapeutici in corso di trattamento con itraconazolo in capsule (59.6%) e voriconazolo (60.8%), il cui utilizzo è stato identificato come unico fattore di rischio significativo associato al riscontro di livelli plasmatici sub-terapeutici (P = 0.036). Si è registrata una rapida emergenza di specie fungine resistenti ai triazoli, in particolare tra i pazienti trattati per colonizzazione da NAFF e bronchite da Aspergillus, con una probabilità del 21.4% dei partecipanti di sviluppare resistenza antifungina al termine dei 2 anni di osservazione. Non è stata osservata alcuna associazione significativa tra la presenza di livelli sub-terapeutici e lo sviluppo di resistenza agli azoli.
Conclusioni. Il presente studio evidenzia un’elevata prevalenza di livelli sub-terapeutici in corso di trattamento antifungino con azoli tra pazienti adulti affetti da FC, in particolare tra coloro in terapia con itraconazolo in capsule e voriconazolo. Il rapido e preoccupante sviluppo di ceppi resistenti ai triazoli sottolinea la necessità di istituire un’efficace stewardship antifungina per questi pazienti. Ulteriori studi longitudinali sono necessari per comprendere gli effetti della resistenza antifungina sui principali outcome clinici in FC e le implicazioni dei livelli sub-terapeutici dei triazoli sullo sviluppo della farmacoresistenza
Reduced ventilatory efficiency during exercise predicts major vascular complications and mortality for interstitial lung disease in systemic sclerosis
No full textObjective. Major vascular complication, such as digital ulcers (DUs), pulmonary arterial hypertension (PAH) and scleroderma renal crisis (SRC) are hallmarks of systemic sclerosis (SSc). Interstitial lung disease (ILD) is the major cause of mortality in SSc. The aim of study is to identify cardiopulmonary exercise testing (CPET) vari- ables that predict MVC and mortality for ILD in SSc patients.
Methods. In this cohort study, 45 SSc patients underwent clinical evaluation, echocardiography, pulmonary function tests (PFTs), high resolution computerized tomography (HRCT) and CPET. PFTs and echocardiography were performed annually for a 5-year follow-up.
Results. 16 (35.6%) SSc patients had MVC: 14 new DUs (31.1%), 1 PAH (2.2%) and 1 SRC (2.2%). At univariate regression analysis, mRss [HR 1.099 (1.008-1.199), p<0.05], NVC patterns (active and late) [HR 0.032 (0.004-0.250), p<0.001], V’E/V’CO2 slope [HR 1.123 (1.052-1.198), p<0.001] were predictive of new onset of MVC. In multivariate analysis, NVC patterns (active and late) (HR 0.044 (0.004-0.486), p<0.05), V’E/V’CO2 (HR 1.094(1.020-1.198), p<0.05) were predictive of new onset of MVC. The 5-year mortality for ILD is 8.9%. In univariate analysis, DLco [(HR 0.927(CI 0.874-0.983), p<0.05], V’E/V’CO2 slope and lung parenchymal with radiological patterns of ILD [(1.2.02 (CI 1.018-1.419), p<0.05], represent risk factors for 5-year mortality for ILD [HR 1.142 (1.030-1.267), p<0.05]. In multivariate analysis, only V’E/V’CO2 slope [1.268 (CI 1.003- 1.602), p<0.05] represents a risk factor for 5-year mortality for ILD. Conclusions. V’E/V’CO2 slope is a prognostic marker of MVC and five-year mortality for ILD
A case of acanthosis nigricans in a HIV-infected patient
Full text linkBackground: To date, very little information is available concerning the relationship between acanthosis nigricans (AN) and infection with human immunodeficiency virus type 1 (HIV-1).
Case presentation: Herein, we report the case of a middle-aged man admitted for fever and progressively worsening dyspnea in the context of an opportunistic pneumonia and firstly diagnosed with acquired immunodeficiency syndrome (AIDS). At the time of diagnosis, physical examination revealed the presence of a palpable, hyperpigmented skin lesion on the left areola with surface desquamation and velvety texture consistent with AN. Of note, the most common primary etiologies related to AN were excluded and the complete regression of the skin lesion was observed once antiretroviral therapy was started.
Conclusion: This is the second report of AN found in patients with AIDS and apparently responsive to prolonged antiretroviral treatment. Possible explanations of this association are still not completely understood, probably related to virus-induced changes in lipid metabolism. Our experience suggests that HIV testing should always be considered in the setting of apparently idiopathic AN
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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