1,721,144 research outputs found
McCormick, Lewis Russell
No full textLewis Russell McCormick, L.L.B.
Big Stone Gap, Virginia
-The Kentuckian, 1931----------------------------------
Lewis Russell McCormick (October 1, 1907 - January 21, 1948) was born in Big Stone Gap, Virginia to James Lincoln McCormick and Mary Shanklin. McCormick first practiced law in Wise, Virginia with the firm Vicars and Vicars. He later returned to Big Stone Gap and opened his own solo firm. McCormick married Margaret Cundriff on June 23, 1934.https://uknowledge.uky.edu/klapp_1931/1020/thumbnail.jp
Homegoing Service of Mr. Robert Lewis Russell
No full textFuneral program for Mr. Robert Lewis Russell, born September 18, 1939 and died October 8, 2007. The funeral was held Saturday, October 13, 2007 at F. E. Lewis Memorial Chapel, officiated by Rev. Robert Douglas. Funeral arrangements were made through Lewis Funeral Home and he was buried in Southern Memorial Park in San Antonio, Texas
Overview of antifungal dosing in invasive candidiasis
No full textIn the past, most antifungal therapy dosing recommendations for invasive candidiasis followed a 'one-size fits all' approach with recommendations for lowering maintenance dosages for some antifungals in the setting of renal or hepatic impairment. A growing body of pharmacokinetic/pharmacodynamic research, however now points to a widespread 'silent epidemic' of antifungal underdosing for invasive candidiasis, especially among critically ill patients or special populations who have altered volume of distribution, protein binding and drug clearance. In this review, we explore how current adult dosing recommendations for antifungal therapy in invasive candidiasis have evolved, and special populations where new approaches to dose optimization or therapeutic drug monitoring may be needed, especially in light of increasing antifungal resistance among Candida spp
Antifungal Prophylaxis in the Era of Targeted Chemotherapy for Acute Myelogenous Leukemia
Full text linkPurpose of ReviewThis review will provide an overview of the potential drug-drug interactions (DDIs) that may occur when using small-molecule kinase inhibitors (SMKIs) for the treatment of acute myeloid leukemia (AML) with triazole antifungals. We aim to discuss the management strategies for these interactions, including the assessment of invasive fungal disease (IFD) risks, alternative antifungal treatments, and dosage adjustments of SMKI therapy.Recent FindingsRecent advances in molecular and cell biology have led to the approval of several SMKIs for the treatment of AML. These targeted therapies, while more tolerable than traditional cytotoxic chemotherapy regimens, are metabolized via the cytochrome P450 3A4 pathway, making them susceptible to potential DDIs with triazole antifungals. Managing these interactions requires a tailored approach, taking into consideration the patient's specific IFD risks, treatment status, and comorbidities. While specific dosing guidance is available for using venetoclax or ivosidenib with triazole antifungals, recommendations for other SMKIs are less certain.The use of SMKIs in AML treatment has revolutionized patient care by providing more targeted and tolerable therapies. However, the potential for DDIs, particularly with triazole antifungals, necessitates careful management. Clinicians must carefully assess the specific IFD risks associated with SMKI therapies, evaluate the limitations of current and future antifungal treatments, and consider evidence supporting dosage adjustments when co-administering SMKIs with triazoles. Ongoing research in model-informed precision dosing and therapeutic drug monitoring holds promise for improving the safety and efficacy of managing drug interactions with SMKI therapy
Development and Applications of Prognostic Risk Models in the Management of Invasive Mold Disease
No full textPrognostic models or risk scores are frequently used to aid individualize risk assessment for diseases with multiple, complex risk factors and diagnostic challenges. However, relatively little attention has been paid to the development of risk models for invasive mold diseases encountered in patients with hematological malignancies, despite a large body of epidemiological research. Herein we review recent studies that have described the development of prognostic models for mold disease, summarize our experience with the development and clinical use of one such model (BOSCORE), and discuss the potential impact of prognostic risk scores for individualized therapy, diagnostic and antifungal stewardship, as well as clinical and epidemiological research
Beyond biomarkers: How enhanced CT imaging can improve the diagnostic-driven management of invasive mould disease
No full textCT imaging remains an essential diagnostic test for identification, staging and management of invasive mould infection (IMI) in patients with hematological malignancies. Yet the limited specificity of standard CT imaging can drive excessive antifungal use in patients, especially when more definitive diagnosis cannot be established through microbiology or invasive diagnostic procedures. CT pulmonary angiography (CTPA) is a complimentary, non-invasive approach to standard CT that allows for direct visualization of pulmonary arteries inside infiltrates for signs of angioinvasion, vessel destruction and vessel occlusion. Experience from several centers that are using CTPA as part of a standard diagnostic protocol for IMI suggests that a positive vessel occlusion sign (VOS) is the most sensitive and a specific sign of IMI in both neutropenic and non-neutropenic patients. CTPA is particularly useful in patients who develop suspected breakthrough IMI during antifungal prophylaxis because, unlike serum and/or BAL galactomannan and polymerase chain reaction (PCR) testing, the sensitivity is not reduced by antifungal therapy. A negative VOS may also largely rule-out the presence of IMI, supporting earlier discontinuation of empirical therapy. Future imaging protocols for IMI in patients with hematological malignancies will likely replace standard chest X-rays in favor of early low radiation dose CT exams for screening, with characterization of the lesions by CTPA and routine follow-up using functional/metabolic imaging such as 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (FDG-PET/CT) to assess treatment response. Hence, enhanced CT imaging techniques can improve the diagnostic-driven management of IMI management in high-risk patients with hematological malignancies
The role of extended infusion β-lactams in the treatment of bloodstream infections in patients with liver cirrhosis
No full textINTRODUCTION: Bloodstream infections (BSIs) in patients with liver cirrhosis are associated with significant morbidity and mortality. Early appropriated antibiotic treatment is essential for the correct management of these patients. Areas covered: This review covers several aspects of how the pharmacokinetic/pharmacodynamic behavior of antimicrobials may change in patients with liver cirrhosis. Common features of cirrhosis, including hypoproteinemia, third space expansion and impairment of renal function may alter drug distribution in patients receiving hydrophilic drugs like β-lactams, which are often frontline agents. β-lactams exhibit time-dependent pharmacodynamics and achieve maximal bacterial killing when serum drug and tissue concentrations exceed a multiple of the minimal inhibitory concentration (MIC) during the dosing interval (%fT>MIC). Administration of β-lactams by extended infusion strategies improves the rate of this pharmacodynamic target attainment and has been associated with improved outcomes in several randomized trials in critically-ill patients. Expert commentary: Observational studies have suggested that cirrhotic patients have improved outcomes when beta-lactam therapy is administered by extended or continuum infusion. Given the multiple pathophysiological features of liver cirrhosis that impact antimicrobial behavior and the high incidence of multidrug resistance in this population, additional studies are needed to understand how cirrhosis affects the pharmacokinetics and pharmacodynamics of antibacterial therapy
Bloodstream infections in patients with liver cirrhosis
No full textABSTRACT: Bloodstream infections are a serious complication in patients with liver cirrhosis. Dysregulated intestinal bacterial translocation is the predominant pathophysiological mechanism of infections in this setting. For this reason enteric Gram-negative bacteria are commonly encountered as the first etiological cause of infection. However, through the years, the improvement in the management of cirrhosis, the recourse to invasive procedures and the global spread of multidrug resistant pathogens have importantly changed the current epidemiology. Bloodstream infections in cirrhotic patients are characterized by high mortality rate and complications including metastatic infections, infective endocarditis, and endotipsitis (or transjugular intrahepatic portosystemic shunt-related infection). For this reason early identification of patients at risk for mortality and appropriated therapeutic management is mandatory. Liver cirrhosis can significantly change the pharmacokinetic behavior of antimicrobials. In fact hypoproteinaemia, ascitis and third space expansion and impairment of renal function can be translated in an unpredictable drug exposure
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