1,720,975 research outputs found
HBsAg seroreversion in HBsAg-negative/HBcAb-positive patients with HIV infection treated with direct-acting antivirals for HCV: A retrospective study
No full textNo data on the risk of HBV reactivation in HCV-HIV co-infected patients undergoing DAAs have been published yet. According to international guidelines , all HIV-infected and HBsAg-positive patients should be treated with antiretroviral therapy (ART) containing nucleoside reverse transcriptase inhibitors (NRTI) dually active against HBV and HIV, such as tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) plus lamivudine (3TC) or emtricitabine (FTC), with consequent no risk for HBV reactivation. However, there are not precise indications regarding HBsAg-negative and HBcAb-positive individuals with HIV infection (4.7%–12% of HIV population in Europe). To date, the risk of HBsAg seroreversion in HCV-HIV co-infected patients with HBsAg-negative and HBcAb-positive serology, treated with NRTI-sparing ARV regimens, and exposed to DAAs regimen, is not known. The authors retrospectively included all the HCV-HIV co-infected and HBsAg-negative/anti-HBc positive individuals, who started DAAs from October 2014 to September 2017 in Bologna. Since HBV DNA levels were not routinely measured at DAAs initiation, patients with undetectable or low HBV DNA viral load (VL) were indiscriminately included. the authors enrolled in the study 24 subjects, who met inclusion criteria. Two out of 24 patients (8.3%) developed HBsAg seroreversion during the observation period. Nowadays, DAAs regimens are widely used also among patients with HIV or with HBV coinfection. In the latter group, a risk of HBV reactivation has been reported of 21% in HBsAg positive and a risk of HBsAg seroreversion of 0.5% in HBsAg negative/HBcAb positive patients (all HIV-uninfected) treated with DAAs, by a recent metanalysis. In this study, the authors observed an unexpectedly high rate of 8% of HBsAg seroreversion among HCV-HIV co-infected subjects with HBsAg-negative/HBcAb-positive status.To our knowledge, this is the first study analyzing the risk for HBsAg seroreversion in HCV-HIV patients with isolated positive HBcAb serology who undergo DAA-regimens and receiving NRTI-sparing regimen for HIV. Such a high seroreversion rate (8.3%) was not reported before among patients with the same characteristics, but HIV-negative.
Our findings suggest that low CD4+-T cells nadir and history of AIDS might be potential risk factors for HBsAg seroreversion. Subjects with low CD4+-T cells nadir generally have a more compromised immune system even after they achieve good immunovirological control.
In conclusion, the results of this study suggest that people with HIV and HBsAg-negative/HBcAb-positive status receiving a NRTI-sparing ART might be at “high risk” for HBsAg seroreversion when treated with DAAs. Therefore, from our data one could recommend ART containing TDF, TAF, 3TC or FTC during DAAs treatment to prevent this potentially life-threatening event
Infezioni dell’osso e dei tessuti molli nelle fratture esposte. Approcci diagnostici e terapeutici.
No full textMENINGOENCEFALITE DA LISTERIA RESISTENTE AD AMPICILLINA E CARBAPENEMICO IN PAZIENTE IMMUNOCOMPETENTE
No full textPremessa. Listeria monocytogenes (Lm) è un patogeno ad elevato tasso di mortalità nelle gravide e neonati con possibile esito fatale anche nel soggetto immunocompetente. Eccettuati i rari report di resistenza clinica, Lm è sensibile ad Ampicillina (Amp) farmaco tuttora di 1° scelta per le infezioni da Listeria.
Obiettivo. Descriviamo un caso di meningoencefalite da Lm resistente ad Amp e Carbapenemico.
Risultati. Una donna di 52 anni, immunocompetente, affetta da epatite cronica HCV-relata non cirrogena, si reca in PS per febbre elevata, cefalea, vomito, stato confusionale, agitazione, strabismo. L’esame obiettivo evidenzia rigor nucalis, deficit VI nervo cranico sn, dolenzia addominale diffusa. Gli esami ematochimici mostrano piastrinopenia, monocitosi ed aumento indici di flogosi. E’ presente rabdomiolisi e disfunzione renale. La TC cerebrale rileva edema cerebrale diffuso, mentre la rachicentesi, liquor limpido (prevalente quota monocitaria e neutrofila), glico-clorurorrachia diminuite, proteinorrachia aumentata. La paziente viene trattata empiricamente con Ceftriaxone, Levofloxacina (LF), Acyclovir ed in seguito con Rifampicina (RIF). Dopo 12 h si riscontra Lm in colture liquorali per cui inizia Amp; tuttavia, 24 ore dopo, l’ antibiogramma (ABG) rileva ceppo resistente (R) a Penicillina (Pen), Amp, Meropenem (Mer), per cui ad LF e RIF si aggiungono TMP/STX e Linezolid (LIN). Dopo iniziale miglioramento (TC) compaiono, a distanza di 72 h, stato soporoso e idrocefalo triventricolare; si posiziona quindi derivazione ventricolare esterna, con miglioramento clinico-radiologico. L’ABG supplementare (Vitek-2 con pannello per Stafilococchi) conferma Pen-R, Amp-R (MIC confermata 2 volte con e-test) e Mer-R, sensibilità intermedia a LF, LIN, sensibilità (intermedia o altro??) a TMP/STX, RIF, Gentamicina (*bp EUCAST per Stafilococco ove non disponibili per Listeria). LIN ed TMP/STX sono stati sospesi al 10° giorno e dopo 3 settimane, rispettivamente; LF e RIF, dopo 5 settimane. La paziente viene dimessa ad un mese dall’esordio in buone condizioni. Dopo 4 mesi presenta esiti RMN stabili e lamenta sporadici episodi di amnesia.
Conclusioni. Ceppi di Listeria spp Amp-R mai segnalati da isolati umani, ambientali o alimentari fino al 1999, sono stati in seguito identificati nel cibo ed ambiente con trend di incremento di MIC nell’uomo. Nessun caso di Pen-R umano né resistenza ai carbapenemici erano stati finora documentati microbiologicamente. Due ceppi di Lm MDR sono stati isolati in Francia (1988 e 1990). Dal caso descritto si evidenzia che: 1) il consumo abbondante di formaggi e latticini non controllati alla fonte (Ucraina) per carenza di un’attenta sorveglianza alimentare, può aver favorito, considerata anche la sintomatologia addominale all’esordio, l’invasività del microrganismo, con interessamento del SNC; 2) un monitoraggio adeguato del profilo di resistenza agli antimicrobici diviene essenziale per determinare il trattamento adeguato, soprattutto in caso di resistenza all’Amp
Post-Sternotomy Chronic Infection by Serratia Marcescens. Case Report and Literature Review. Pubblicato in Microbiologica, 2011.
No full textSerratia marcescens is an opportunistic gram negative bacterium, responsible for 2% of nosocomial infections and bacteremia (yearly incidence, 1.03 per 100,000 population) with high morbidity and mortality especially in Neonatal Intensive Care Units. Diagnosis and treatment often represent a problem for clinicians because of spreading of Multi Drug Resistant Bacterial Strains. This case describes the management of a post-surgery infection by AmpC S. marcescens in a 47 years-old immunocompetent man undergone sternotomy following mitral valvuloplasty. After cardiosurgery treatment, complicated by severe left ventricular heart failure, S.marcescens was isolated in blood samples and quinolones were given. Owing to persistence and in vitro resistance to most β-lactamins of S.marcescens in the surgery wound, the patient was repeatedly treated with targeted therapy including aminoglycosides and quinolones without clinical improvement.
The patient was admitted at our Institution for a further exacerbation of sternal infection, with fistula secreting purulent material. Serratia was isolated again. The C-reactive protein was normal. A toracic CT scan showed a sternal mass (foreign body granuloma with dishomogeneous structure of retrosternal soft tissue), while scintigraphy with labeled leukocytes demonstrated the persistence of sternal infectious process without any deep tissues involvement. Microbiological results for Serratia isolates were similar as above, with a good susceptibilty to carbapenems (MIC <=1μg/mL). Ertapenem plus ciprofloxacine administered for 8 weeks with local debridement and removal of a suture string led to a temporary improvement. Because of new exacerbation occurred after several months, we decided to restore ertapenem plus prulifloxacine therapy for further 2 month. This association led to a complete recovery. The follow-up with scintigraphy with labeled leukocytes after 6 and 12 months didn’t show any inflammation process. Management of chronic osteomyelitis represents an important challenge for clinicians. It often occurs without laboratory alterations and can alternate clinically silent periods with new exacerbation phases. A targeted and prolonged antibiotic treatment must be often combined with a surgery debridement considering the frequent formation of biofilm.
Serratia osteomyelitis may be commonly caused exogenously by surgery, as our case demonstrated. We suspected AmpC producer Serratia on the basis of its cefoxitine resistance and its eradication with carbapenems and quinolones. Risk factors for severe Serratia infection were not documented in our patient except for cardio surgery treatment. Reports of post-cardiosurgey infections by Serratia are rare. These, however, must be suspected in immunocompetent patients if undergone major surgery. Use of ertapenem, instead of other carbapenems, in combination to prulifloxacine could represent a valid alternative for osteomielitis due to S.marcescens, with once daily administratio
Detection of Chlamydophila pneumoniae in patients with arthritis: Significance and diagnostic value
No full textThe aim of this study was to assess the potential clinical implications of Chlamydophila pneumoniae in patients with acute and chronic arthritic diseases and to investigate whether blood monocytes might reflect a concomitant synovial or persistent systemic infection. C. pneumoniae was investigated with advanced PCR and reverse transcriptase (RT) PCR techniques targeting different genes and combined with cell line cultures, in synovial fluid (SF) and peripheral blood mononuclear cell (PBMC) specimens collected from 28 patients with arthritis. Five out of twenty-eight patients (17.8%) were found to have C. pneumoniae DNA in either SF or PBMC specimens. Their diagnosis was reactive arthritis (ReA), S.A.P.H.O syndrome, psoriatic arthritis, undifferentiated oligoarthritis (UOA) and ankylosing spondylitis (AS). Specimens from patients with UOA and AS had also mRNA transcripts but those from AS yielded C. pneumoniae growth after co-culture. Moreover, C. pneumoniae DNA levels measured by Real-Time PCR (LightCycler) were higher in PBMC specimens compared to those found in SF at the end of antibiotic treatment. C. pneumoniae may have a role as triggering factor also in chronic arthritides including AS. The combined use of culture and molecular tools increases detection rates and improves the overall sensitivity, suggesting their potential use to detect C. pneumoniae. The different kinetics of bacterial DNA at both peripheral and synovial levels should be taken into consideration when monitoring and evaluating the effectiveness of antibiotic treatment. © 2010 Springer-Verlag
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
Successful antiviral treatment of chronic hepatitis C in patients with rare comorbidities. Two case-reports
No full textAntiviral therapy in patients suffering from chronic hepatitis C virus (HCV) infection and rare comorbidities cannot be easily started, as it can reduce the likelihood of a good therapeutic response with an increased frequency of side effects. We report two patients presenting unusual comorbidities associated with chronic C hepatitis: one with the Ehlers-Danlos Syndrome (EDS), a rare genetic disease caused by a defect in collagen synthesis, the other one with the Charcot Marie Tooth (CMT) disease, an uncommon but severe form of demyelinating peripheral neuropathy. Both patients were successfully treated with pegylated Interferon (Peg-IFN) and ribavirin (RBV) combined therapy, with the achievement of a sustained viral response (SVR) and a low occurrence of adverse effects. Up to now there are no reports of patients suffering from chronic C hepatitis associated with these uncommon but severe comorbidities treated with antiviral therapy. In conclusion, in such clinical situations, anti-HCV therapy may be started and tailored, especially if the patient is highly motivated and if optimal predictors of response (i.e. young age, favourable genotype and low baseline viraemia) do exist
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
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