Τετάρτη 15 Ιουνίου 2022

HIV Drug Resistance in Persons Initiating or Re‐initiating First‐line Antiretroviral Therapy in Paraguay: Results of a National Patient Survey

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ABSTRACT

Background

HIV drug resistance increases mortality and morbidity and antiretroviral therapy (ART) costs. We describe Paraguay's first nationally representative survey on pretreatment drug resistance (PDR) conducted among persons who initiated or re-initiated ART in 2019.

Material and Methods

We conducted a cross-sectional survey of antiretroviral drug resistance in Paraguay during 2019. Participants were sampled at four comprehensive care clinics where 90% of patients with HIV in Paraguay initiate ART. Patients included were adults ≥18 years old who initiated first-line ART or re-initiated the same first-line ART regimen after ≥3 months of discontinuation.

Results

Of 208 patients, 93.8% had no prior ART exposure, 3.8% re-initiated the same regimen, 2.4% had unknown prior ART exposure; 31.3% had a CD4 count <200 cells/µL. Mutations associated with resistance were present in 15.4% of patients. Mutations associated with resistance to non-nu cleoside reverse transcriptase inhibitors (NNRTI) were present in 13.0% of patients, nucleoside reverse transcriptase inhibitors in 4.3%, and integrase inhibitors in 3.4%. Mutations associated with resistance to tenofovir were present in 1.0% of patients and emtricitabine/lamivudine in 1.4%.

Conclusions

Nearly one in six patients had PDR in Paraguay's first nationally representative sample. High NNRTI PDR prevalence underscores the need to accelerate the transition to dolutegravir-based first-line ART. Low PDR prevalence to tenofovir and emtricitabine is reassuring as these antiretrovirals are part of the WHO-recommended oral pre-exposure prophylaxis (PrEP) regimen. The high proportion of individuals initiating ART at a late disease stage highlights the need to improve treatment linkage strategies and implement WHO rapid ART initiation recommendations.

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Correlation between lifestyles of tobacco smoking and alcohol drinking, and expression of p53 and GLUT1 in synchronous oral squamous cell carcinoma with colorectal cancer

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Publication date: Available online 14 June 2022

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Fumitaka Asahara, Masae Yamazaki, Katsutoshi Kokubun, Kenichi Matsuzaka, Hiroshi Kishikawa, Junichi Matsui, Takeshi Nomura

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Giant solitary synovial osteochondromatosis of the temporomandibular joint: A case report

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Publication date: Available online 15 June 2022

Source: Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology

Author(s): Hisashi Ozaki, Masatoshi Chiba, Yoshioki Hamamoto, Mitsuyoshi Iino

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Clinical and laboratory responses to tigecycline in children

alexandrossfakianakis shared this article with you from Inoreader
Clinical and laboratory responses to tigecycline in children

Resistant bacterial infections have become more common in recent years, its treatment becomes a difficult problem. Tigecycline has a broad-spectrum antibacterial activity including resistant pathogens. Tigecycline may be a safe and important option in pediatric nosocomial infections due to resistant bacteria. Paediatric patients treated with tigecycline from 1 January 2010 to 31 October 2018 were analysed retrospectively to assess the efficacy and safety of tigecycline in children. Clinical response was considered cure in patients with all clinical signs of tigecycline-induced infection disappearing, a complete laboratory response, and improvement without further antibacterial therapy. The clinical response in patients who were not cured but recovered to the extent deemed appropriate by the researcher was evaluated as remission. Clinical response was considered failure in patients with no clinical improvement, culture positivity, acute-phase reactant elevation, and need for additi onal antibacterial therapy. There was a total of 25,251 patients, 1301 of whom were hospitalized in paediatric intensive care during the study. Paediatric patients who received tigecycline for at least 2 days (at least four doses) were analysed. This study included 91 children who received tigecycline treatment and met the inclusion criteria, aged 7 months to 17.5 years (median 8 years). The median length of hospital stay was 62 days (14–251 days). The median duration of antibiotic treatment before tigecycline treatment was 27 days (4–30 days). Among the most common were glycopeptides (95.6%) and carbapenems (89%). There were no significant differences in clinical response between tigecycline as monotherapy and as combined therapy (p = 0.742). Studies on the efficacy of tigecycline in children are not prospective due to safety concerns but contain data from limited cases in which it was used as salvage therapy. In our study, tigecycline was gi ven to 73.6% of patients as monotherapy, and this is the largest series involving monotherapy. The fact that the patients used long-term and multiple antimicrobial agents before tigecycline treatment (95.6% glycopeptides and 89% carbapenems) limited the options of antibiotics. Therefore, the rate of monotherapy was high, and clinical success did not differ significantly between patients who started tigecycline as monotherapy and combination therapy.


Abstract

What is known and objective

The frequency of multidrug-resistant bacterial infections is increasing worldwide. Tigecycline may be an important option for children with life-threatening nosocomial infections due to multidrug-resistant bacteria. However, there are few published data on the use of tigecycline in paediatric patients. By examining the results of tigecycline use in children, we aimed to draw attention to the fact that tigecycline may be an alternative in the treatment of resistant infections in children.

Methods

Paediatric patients treated with tigecycline from 1 January 2010 to 31 October 2018 at Eskişehir Osmangazi University Medical Faculty, which is a tertiary hospital, were analysed retrospectively to assess the efficacy and safety of tigecycline treatment in children. Patients using tigecycline were identified using the pharmacy database. Clinical and laboratory data were obtained from the files.

Results and discussion

This study included 91 children aged 7 months to 17.5 years; 52 were female (57.1%). At least one predisposing factor was present in 98.9% of the patients. Fifty-one bacteria were isolated from 44 patients. The tigecycline resistance rate was 3.9%. Only 2 of 91 patients experienced one or more side effects of tigecycline. Tigecycline can be used as salvage therapy in resistant infections where options are limited, although definitive conclusions about the efficacy and safety of tigecycline in children cannot be reached.

What is new and conclusion

Tigecycline may be a safe and important option in paediatric nosocomial infections due to resistant bacteria. Resistant bacterial infections have become more common in recent years, its treatment becomes a difficult problem. Tigecycline has a broad-spectrum antibacterial activity including resistant pathogens.

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Multi‐institutional analysis of central nervous system germ cell tumors in patients with Down syndrome

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Abstract

Purpose

Primary germ cell tumors (GCTs) are the most common central nervous system (CNS) neoplasm in patients with Down syndrome (DS). However, a standard of care has not been established due to paucity of data.

Methods

A retrospective multi-institutional analysis was conducted, in addition to a comprehensive review of the literature.

Results

Ten patients from six institutions (five USA, one Brazil) were identified, in addition to 31 patients in the literature from 1975 to 2021. Of the 41 total patients (mean age 9.9 years; 61% male), 16 (39%) had non-germinomatous germ cell tumors (NGGCTs), 16 (39%) had pure germinomas, and eight (19.5%) had teratomas. Basal ganglia was the most common tumor location (n = 13; 31.7%), followed by posterior fossa (n = 7; 17%). Nine patients (22%) experienced disease relapse or progression, of which four died from tumor progression (one germinoma, three teratomas). Sixteen patients (39%) experienced treatment-related complications, of which eight (50%) died (five germinomas, three NGGCTs). Of the germinoma patients, two died from chemotherapy-related sepsis, one from postsurgery cardiopulmonary failure, one from pneumonia, and one from moyamoya following radiation therapy (RT). Of the NGGCT patients, one died from chemotherapy-related sepsis, one fr om postsurgical infection, and one from pneumonia following surgery/chemotherapy/RT. Three-year overall survival was 66% for all histological types: 62% germinomas, 79% for NGGCTs, and 53% for teratomas.

Conclusion

Patients with DS treated for CNS GCTs are at an increased risk of treatment-related adverse events. A different therapeutic approach may need to be considered to mitigate treatment-related complications and long-term neurocognitive sequelae.

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Thrombosis and hemorrhage experienced by hospitalized children with SARS‐CoV‐2 infection or MIS‐C: Results of the PICNIC registry

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Abstract

Introduction

Coagulopathy and thrombosis associated with SARS-CoV-2 infection are well defined in hospitalized adults and leads to adverse outcomes. Pediatric studies are limited.

Methods

An international multicentered (n = 15) retrospective registry collected information on the clinical manifestations of SARS-CoV-2 and multisystem inflammatory syndrome (MIS-C) in hospitalized children from February 1, 2020 through May 31, 2021. This sub-study focused on coagulopathy. Study variables included patient demographics, comorbidities, clinical presentation, hospital course, laboratory parameters, management, and outcomes.

Results

Nine hundred eighty-five children were enrolled, of which 915 (93%) had clinical information available; 385 (42%) had symptomatic SARS-CoV-2 infection, 288 had MIS-C (31.4%), and 242 (26.4%) had SARS-CoV-2 identified incidentally. Ten children (1%) experienced thrombosis, 16 (1.7%) experienced hemorrhage, and two (0.2%) experienced both thrombosis and hemorrhage. Significantly prevalent prothrombotic comorbidities included congenital heart disease (p-value .007), respiratory support (p-value .006), central venous catheter (CVC) (p = .04) in children with primary SARS-CoV-2 and in those with MIS-C included respiratory support (p-value .03), obesity (p-value .002), and cytokine storm (p = .012). Comorbidities prevalent in children with hemorrhage included age >10 years (p = .04), CVC (p = .03) in children with primary SARS-CoV-2 infection and in those with MIS-C encompassed thromb ocytopenia (p = .001) and cytokine storm (p = .02). Eleven patients died (1.2%), with no deaths attributed to thrombosis or hemorrhage.

Conclusion

Thrombosis and hemorrhage are uncommon events in children with SARS-CoV-2; largely experienced by those with pre-existing comorbidities. Understanding the complete spectrum of coagulopathy in children with SARS-CoV-2 infection requires ongoing research.

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BCAP31 is involved in modulating colorectal cancer cell proliferation via the Emerin/β-catenin axis

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Publication date: Available online 15 June 2022

Source: Experimental Cell Research

Author(s): Liping Han, Junyang Shi, Lili Zhao, Jiaqiang Deng, Yan Li, Hong Zhao, Huani Wang, Yan Yan, Fangdong Zou

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Primary tumor volume and prognosis for patients with p16-positive and p16-negative oropharyngeal squamous cell carcinoma treated with radiation therapy

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The prescribed radiation dose to patients with oropharyngeal squamous cell carcinoma (OPSCC) is standardized, even if the prognosis for individual patients may differ. Easy-at-hand pre-treatment risk stratific...
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Analgesia for Retinopathy of Prematurity Screening: A Systematic Review

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Abstract

Background and Aims

Premature neonates require regular ophthalmological examination, generally indirect ophthalmoscopy, to screen for retinopathy of prematurity (ROP). Conventional analgesia is provided with topical anaesthetic eyedrops and oral sugar solution, but neonates still experience significant pain. Here, the literature base was examined to evaluate the usefulness of other pharmacological analgesics.

Materials and Methods

A systematic review was undertaken, adhering to a PROSPERO preregistered protocol in accordance with PRISMA guidelines (identifier CRD42022302459). Electronic databases were searched for primary research articles on pharmacological pain interventions used for ROP screening in neonates. The primary outcome measure was pain scores recorded using validated pain scoring tools, with and without pharmacological interventions in neonates during eye examination. For analysis, studies were separated into two categories: topical anaesthesia and alternative pharmacological treatments.

Results

Eleven studies met the inclusion criteria. Topical analgesia, oral paracetamol, and intranasal fentanyl were found to be effective in reducing the pain of eye examination. Oral morphine and inhaled nitrous oxide had no significant effect on premature infant pain profile (PIPP) scores during indirect ophthalmoscopy.

Discussion

In addition to topical anaesthesia, premedication with oral paracetamol is recommended during screening examination for ROP. The routine use of fentanyl is not recommended due to the risk of potential side effects. Non-pharmacological measures, such as sweet oral solutions and comfort techniques may also be employed. Further research is required to determine whether the use of nitrous oxide has a role, and to develop a safe and effective analgesic strategy to fully ameliorates the pain of ROP screening.

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