lichen sclerosus et atrophicus in males how to diagnose how to manage

n/

therapy for gonococcal and non gonococcal genital infections is a major problem for clinicians

n/

syphilitic chancres of the mouth three cases

n/

A stringent preemptive protocol reduces cytomegalovirus disease in the first 6 months after kidney transplantation

Background: The optimal strategy to prevent cytomegalovirus (CMV) disease after kidney transplantation continues to be open to debate. The preemptive approach requires regular determination of CMV viremia and prompt initiation of therapy. Methods: We retrospectively compared the incidence of CMV disease during two periods at our center: A first phase (P1, n=84 kidney recipients), during which time the intensity of surveillance was determined by the responsible physician, was compared to a second phase (P2, n=74), when a stringent protocol of CMV surveillance was required for all patients. The preemptive approach was applied for all CMV risk groups; prophylaxis was optional in the case of treatment for rejection or delayed graft function in the intermediate- and high-risk group. Follow-up was truncated at 6months after transplant surgery. CMV syndrome was differentiated from asymptomatic replication by the presence of at least one systemic symptom, while diagnosis of CMV end-organ disease required histological confirmation. Results: Immunosuppression was similar in the two periods. CMV prophylaxis was used equally (26%) in both periods. The probability for asymptomatic viremia episodes was not different for patients in P1 and P2 regardless of the prevention strategy. For patients following the preemptive strategy, the probability for CMV disease was increased during P1 (p=0.016), despite fewer PCR assays being performed in phase 2. Protocol violations were only observed during P1. Conclusions: The probability of CMV disease episodes (CMV syndrome and CMV end-organ disease) was substantially reduced using a very stringent protocol. This study highlights the crucial importance of a stringent protocol with optimal adherence by all caregivers if the preemptive strategy is to be successfu

Viral Escape in the Central Nervous System with Multidrug-Resistant Human Immunodeficiency Virus-1

In this study, we report the case of a patient infected with human immunodeficiency virus (HIV)-1 who developed ataxia and neurocognitive impairment due to viral escape within the central nervous system (CNS) with a multidrug-resistant HIV-1 despite long-term viral suppression in plasma. Antiretroviral therapy optimization with drugs with high CNS penetration led to viral suppression in the CSF, regression of ataxia, and improvement of neurocognitive symptom

Vegetating nodules following erosions on the oral cavity : a quiz

Acta Derm Venereol 95 © 2015 The Authors. doi: 10.2340/00015555-1936 Journal Compilation © 2015 Acta Dermato-Venereologica. ISSN 0001-5555 A 68-year-old Italian man presented with a 7-month history of multiple erosions on the trunk as well as lips and oral cavity. Before admission to our department, he was treated in another institution with systemic corticosteroids (oral prednisone at the initial dose of 1 mg/kg/day, with progressively tapering dosages for 2 months) and other immunosuppressants, such as azathioprine (1.25 mg/kg/ day for 2 months), intravenous immunoglobulins (one cycle consisting of one infusion of 400 mg/kg/day for 5 consecutive days), and rituximab (one cycle consisting of one infusion of 375 mg/m2/every week for 4 weeks), achieving resolution of the cutaneous manifestations but without control of the oral involvement. Upon admission, he had multiple lip and oral erosions (Fig. 1a). In the following days, he developed erythematous-violaceous vegetating nodules that coalesced into ulcerated plaques on the lips and tongue (Fig. 1b). The patient's general condition was compromised; he was asthenic and, due to dysphagia, had lost about 15 kg in the last 3 months. Staging fibroscopy revealed nodules that induced marked stenosis of the larynx and pharynx (Fig. 1c). Within a few days, an emergency tracheotomy was required because of acute dyspnea. Biopsy specimens from a nodule were submitted for histology (Fig. 1d)

A stringent preemptive protocol reduces cytomegalovirus disease in the first 6 months after kidney transplantation

BACKGROUND: The optimal strategy to prevent cytomegalovirus (CMV) disease after kidney transplantation continues to be open to debate. The preemptive approach requires regular determination of CMV viremia and prompt initiation of therapy. METHODS: We retrospectively compared the incidence of CMV disease during two periods at our center: A first phase (P1, n = 84 kidney recipients), during which time the intensity of surveillance was determined by the responsible physician, was compared to a second phase (P2, n = 74), when a stringent protocol of CMV surveillance was required for all patients. The preemptive approach was applied for all CMV risk groups; prophylaxis was optional in the case of treatment for rejection or delayed graft function in the intermediate- and high-risk group. Follow-up was truncated at 6 months after transplant surgery. CMV syndrome was differentiated from asymptomatic replication by the presence of at least one systemic symptom, while diagnosis of CMV end-organ disease required histological confirmation. RESULTS: Immunosuppression was similar in the two periods. CMV prophylaxis was used equally (26 %) in both periods. The probability for asymptomatic viremia episodes was not different for patients in P1 and P2 regardless of the prevention strategy. For patients following the preemptive strategy, the probability for CMV disease was increased during P1 (p = 0.016), despite fewer PCR assays being performed in phase 2. Protocol violations were only observed during P1. CONCLUSIONS: The probability of CMV disease episodes (CMV syndrome and CMV end-organ disease) was substantially reduced using a very stringent protocol. This study highlights the crucial importance of a stringent protocol with optimal adherence by all caregivers if the preemptive strategy is to be successful