46 research outputs found
Real-world effectiveness of molnupiravir and nirmatrelvir/ritonavir as treatments for COVID-19 in patients at high risk
Background Using a retrospective cohort study design, we aimed to evaluate the effectiveness of molnupiravir and nirmatrelvir/ritonavir in patients with SARS-CoV-2 who were highly vulnerable. Methods The impact of each drug was determined via comparisons with age-matched control groups of patients positive for SARS-CoV-2 who did not receive oral antiviral therapy. Results Administration of molnupiravir significantly reduced the risk of hospitalization (odds ratio [OR], 0.40; P < .001) and death (OR, 0.31; P < .001) among these patients based on data adjusted for age, previous SARS-CoV-2 infection, vaccination status, and time elapsed since the most recent vaccination. The reductions in risk were most profound among elderly patients (≥75 years old) and among those with high levels of drug adherence. Administration of nirmatrelvir/ritonavir also resulted in significant reductions in the risk of hospitalization (OR, 0.31; P < .001) and death (OR, 0.28; P < .001). Similar to molnupiravir, the impact of nirmatrelvir/ritonavir was more substantial among elderly patients and in those with high levels of drug adherence. Conclusions Collectively, these real-world findings suggest that although the risks of hospitalization and death due to COVID-19 have been reduced, antivirals can provide additional benefits to members of highly vulnerable patient populations
Eosinophilic pneumonia associated with daptomycin: a case report and a review of the literature
<p>Abstract</p> <p>Introduction</p> <p>Although several studies did not demonstrate that daptomycin may cause significantly higher rates of pulmonary adverse effects when compared with vancomycin or penicillinase-resistant penicillins, there have been a few case reports of severe pulmonary complications associated with daptomycin administration.</p> <p>Case presentation</p> <p>A rare case of eosinophilic pneumonia occurring 10 days after daptomycin administration in a 78-year-old Caucasian man with possible infectious endocarditis is described. He developed new onset fever, up to 38.5°C, with bilateral pulmonary crackles on physical examination and with no signs of severe respiratory failure. A chest computed tomography-scan showed bilateral nodular consolidations with air bronchograms and pleural effusions. Immediate discontinuation of daptomycin was followed by vigorous improvement of clinical signs and symptoms with progressive resolution of pulmonary consolidations a month later.</p> <p>Conclusion</p> <p>Physicians should be aware of this rare but serious complication during daptomycin treatment, and prompt discontinuation of the offending agent, with or without additional supportive treatment, must occur immediately.</p
Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)
Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics
Primary aortoduodenal fistula without abdominal aortic aneurysm in association with psoas abscess
Primary aortoenteric fistula (PAEF) is a communication between the aorta
and the enteric tract without any previous vascular intervention, e.g.,
aortic grafting. Although rare, PAEF is a potentially lethal condition
that requires a high index of suspicion and prompt surgical
intervention. Most of the reported cases involve an abdominal aortic
aneurysm. However, in this report, we describe a rare case of a primary
aortoduodenal fistula in a nonaneurysmal aorta in association with a
psoas abscess, which was treated successfully. At 2-year follow-up, the
patient is alive without episodes of bleeding or fever
Markovian Models for the Output of Real Word Mpeg-1 Encoders
In this paper we survey the output of real world MPEG-1 encoders. This output consists of packets whose sizes are multiple of 20Kbytes, while the arrival intervals are mainly gathering around 220 msec. Two markov models are proposed. The first model, which is called model A, takes into account only the packet sizes ignoring the arrival intervals. The second model (model B) quantizes the arrival intervals so as to better approximate them. Finally a combination of the two models is proposed (hybrid model) so that it can better approach the traffic behavior
Emergency stenting of a ruptured infected anastomotic femoral Pseudoaneurysm
A 74-year-old man presented with a ruptured infected anastomotic femoral
pseudoaneurysm. Due to severe medical comorbidities he was considered
unsuitable for conventional surgical management and underwent an
emergency endovascular repair with a balloon-expandable covered stent.
The pseudoaneurysm was excluded successfully and the patient had an
uneventful postoperative recovery with long-term suppressive
antimicrobials. He remained well for 10 months after the procedure with
no signs of recurrent local or systemic infection and finally died from
an acute myocardial infarction. To our knowledge, emergency endovascular
treatment of a free ruptured bleeding femoral artery pseudoaneurysm has
not been documented before in the English literature. This case
illustrates that endovascular therapy may be a safe and efficient
alternative in the emergent management of ruptured infected anastomotic
femoral artery pseudoaneurysms when traditional open surgery is
contraindicated
Infected femoral artery pseudoaneurysm in drug addicts: The beneficial use of the internal iliac artery for arterial reconstruction
Background. Infected femoral artery pseudoaneurysm (IFAP) is a severe
complication in parenteral drug abusers, with difficult and
controversial management. Ligation alone without revascularization is
frequently associated with later intermittent claudication and limb
amputation. Furthermore, arterial reconstruction with a synthetic or
venous conduit is limited because of a contaminated field and, often,
unavailability of autologous venous grafts. In this study, we present
our experience with the internal iliac artery (IIA) as a graft for
arterial reconstruction after IFAP excision in these patients.
Methods. Data of 14 consecutive patients who presented with IFAP
secondary to parenteral drug abuse from 2001 to 2005 were analyzed.
Twelve patients (85.7%) were male. The median age was 27 years (range,
19-42 years). In 13 cases, the IFAP involved the common femoral artery,
and in I case it involved the profunda femoris artery (PFA). In nine
patients, we used the IIA for arterial reconstruction (five as a patch
and four as an interposition graft), whereas in two patients the
arterial deficit was repaired with a great saphenous vein patch. In two
cases, an extra-anatomic bypass with a synthetic polytetrafluoroethylene
graft was performed. In one patient, the pseudoaneurysm involved the PFA
and was treated with excision and ligation of the PFA.
Results. All nine patients who underwent revascularization with the use
of IIA were free of claudication symptoms. None of them experienced any
perioperative complications, had signs of reinfection, or required limb
amputation during the follow-up period (median, 19 months; range, 4-52
months). Regarding the remaining five patients, one died 25 days after
surgery because of multiorgan failure, and one underwent reoperation
because of proximal anastornotic rupture of a synthetic graft. The
latter patient finally underwent a transmetatarsal amputation.
Conclusions. The use of IIA for arterial reconstruction after IFAP
excision in drug abusers is safe and effective. These preliminary
results indicate that the implementation of this technique offers many
advantages compared with traditional treatment options
Markovian models for the output of real word MPEG-1 encoders
In this paper we survey the output of real world MPEG-1 encoders. This output consists of packets whose sizes are multiple of 20Kbytes, while the arrival intervals are mainly gathering around 220 msec. Two markov models are proposed. The rst model, which is called model A, takes into account only the packet sizes ignoring the arrival intervals. The second model (model B) quantizes the arrival intervals so as to better approximate them. Finally a combination of the two models is proposed (hybrid model) so that it
can better approach the tra c behavior
Low Bit Rate Coding of Image Sequences using Regions of Interest and Neural
In this article we study the transmission of video signals at very low bitrates and we propose a new coding scheme that improves the quality of image sequences at bitrates below 64Kbits/sec. Our technique relies on the extraction of the moving object or objects in a frame using a neural network and quantising these regions with finer quantiser step size than the remaining part of the image. The inputs of the neural network are groups of motion vectors which are calculated with a block-based estimtation scheme. The output of the network defines the regions of interest in the image. However, this output is extended in the space and in the time so that the final masks to be computed. The results show a significant improvement of the quality of the frames at low bitrates