the role of pelvic floor impairment as a contributory factor to urinary incontinence in patients with bladder instability

Unstable bladder symptomatology often includes different types of urinary incontinence. We assessed the possible correlation between urinary incontinence associated with an unstable bladder and pelvic floor activity. In addition, we assessed when oxybutynin administration has favourable effects on urinary incontinence associated with an unstable bladder. Sixty female patients affected by an unstable bladder, consecutively enrolled in the study, were evaluated by means of urodynamics and diagnostic electromyography. Urinary incontinence, when present, was characterized. Possible correlation between types of urinary incontinence and types of pelvic floor dysfunction was investigated. Oxybutynin 5 mg.x3/day was administered per os. Drug activity was evaluated in terms of outcome for the different types of urinary incontinence. A prevailing reduction in maximal muscle contraction and endurance in the patients affected by stress and mixed urinary incontinence was found. 42% of the patients affected by urge incontinence showed a decrease in endurance, and 52% showed overall good functioning of their pelvic floor. Administration of oxybutynin only improved urinary incontinence in those patients affected by urge incontinence who did not have pelvic floor dysfunction (exact Fisher’s test, p<0.001)

Short test evaluation of the anti-wrinkles efficacy of topical adhesive pads

Introduction. In the last decades, in dermo-cosmetic field, a lot of cosmetic products, invasive treatments and medical devices were popping up to improve aged skin. Recently several cheap and innovative products called anti-wrinkle pad adhesive appeared but their efficiency against winkles is not really certain. Theoretically this product is intended to reduce local muscular contraction getting a reduction of the existing winkles and forming new dynamical winkles. Commercial advertisements claims that the utilization of pads can temporarily delete winkles with just an application and last longer with a continuous application. A recent study demonstrated that using this product for a month don’t have any positive effect on forehead wrinkles but still not demonstrate if this pad have the real ability to temporarily reduce wrinkles (Ryan 2009). For this reason this work focus on the efficiency of this pad in crow’s feet temporarily reduction. Materials and Methods. The anti-wrinkles efficiency was valued on 20 volunteers at baseline and 15, 30, 60 minutes after short time (30 minutes) application of the anti?wrinkles pad using Cutometer MPA580® (Courage + Khazaka Electronic GmbH, Köln, Germany) and siliconic replica technique analized with SEM FEI Quanta 200 in low vacuum and profilometric analysis software 3D MEX® (Alicona Imaging, Graz, Austria). Pads are made out of plastic with a vertical strong support fixed at a soft membrane covered by adhesive gel made by emollient and anti-wrinkles materials. Roughness and elasticity differences on values after pads application were valued using analysis of variance (ANOVA). Results. The short time application of the pad caused a relevant reduction of all roughness standards parameters (Ra, Rt, Rz, Rp, Rv) till 15 minutes after the treatment (p <0,001). These changes not happened in the contralateral area (non treatment control test). Within 30 minutes after the treatment, all roughness parameters reverted to normal baseline values. Analysing the elastometric measure average, it was not noticed any relevant standards changes (R0, R5, R6 e R7) after the treatment. Conclusions. Finally results obtained demonstrate that the sporadically application for 30 minutes of anti-wrinkle pad have the capacity to stretch temporarily the skin. Ryan WR, Most SP. A Prospective Evaluation of the Efficacy of Topical Adhesive Pads for the Reduction of Facial Rhytids. Arch Facial Plast Surg. 2009 Jul-Aug;11(4):252-6

Antifungal susceptibility of invasive yeast isolates in Italy: the GISIA3 study in critically ill patients

<p>Abstract</p> <p>Background</p> <p>Yeasts are a common cause of invasive fungal infections in critically ill patients. Antifungal susceptibility testing results of clinically significant fungal strains are of interest to physicians, enabling them to adopt appropriate strategies for empiric and prophylactic therapies. We investigated the antifungal susceptibility of yeasts isolated over a 2-year period from hospitalised patients with invasive yeast infections.</p> <p>Methods</p> <p>638 yeasts were isolated from the blood, central venous catheters and sterile fluids of 578 patients on general and surgical intensive care units and surgical wards. Etest strips and Sensititre panels were used to test the susceptibility of the isolates to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole in 13 laboratories centres (LC) and two co-ordinating centres (CC). The Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution method was used at the CCs for comparison.</p> <p>Results</p> <p>Etest and Sensititre (LC/CC) MIC₉₀values were, respectively: amphotericin B 0.5/0.38, 1/1 mg/L; anidulafungin 2/1.5 and 1/1 mg/L; caspofungin 1/0.75 and 0.5/0.5 mg/L; fluconazole 12/8 and 16/16 mg/L; itraconazole 1/1.5, 0.5/0.5 mg/L; posaconazole 0.5 mg/L and voriconazole 0.25 mg/L for all. The overall MIC₉₀values were influenced by the reduced susceptibility of <it>Candida parapsilosis </it>isolates to echinocandins and a reduced or lack of susceptibility of <it>Candida glabrata </it>and <it>Candida krusei </it>to azoles, in particular fluconazole and itraconazole. Comparison of the LC and CC results showed good Essential Agreement (90.3% for Etest and 92.9% for Sensititre), and even higher Categorical Agreement (93.9% for Etest and 96% for Sensititre); differences were observed according to the species, method, and antifungal drug. No cross-resistance between echinocandins and triazoles was detected.</p> <p>Conclusions</p> <p>Our data confirm the different antifungal susceptibility patterns among species, and highlight the need to perform antifungal susceptibility testing of clinically relevant yeasts. With the exception of a few species (e.g. <it>C. glabrata </it>for azoles and <it>C. parapsilosis </it>for echinocandins), the findings of our study suggest that two of the most widely used commercial methods (Etest and Sensititre) provide valid and reproducible results.</p

Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon?

Raquel Sabino was not included as an author in the published article. It was corrected a posteriori.Erratum in - Corrigendum: Azole-Resistance in Aspergillus terreus and Related Species: An Emerging Problem or a Rare Phenomenon? [Front Microbiol. 2018] Front Microbiol. 2019 Jan 14;9:3245. doi: 10.3389/fmicb.2018.03245. eCollection 2018.Disponível em: https://www.frontiersin.org/articles/10.3389/fmicb.2018.03245/fullFree PMC Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882871/ | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340063/Objectives: Invasive mold infections associated with Aspergillus species are a significant cause of mortality in immunocompromised patients. The most frequently occurring aetiological pathogens are members of the Aspergillus section Fumigati followed by members of the section Terrei. The frequency of Aspergillus terreus and related (cryptic) species in clinical specimens, as well as the percentage of azole-resistant strains remains to be studied. Methods: A global set (n = 498) of A. terreus and phenotypically related isolates was molecularly identified (beta-tubulin), tested for antifungal susceptibility against posaconazole, voriconazole, and itraconazole, and resistant phenotypes were correlated with point mutations in the cyp51A gene. Results: The majority of isolates was identified as A. terreus (86.8%), followed by A. citrinoterreus (8.4%), A. hortai (2.6%), A. alabamensis (1.6%), A. neoafricanus (0.2%), and A. floccosus (0.2%). One isolate failed to match a known Aspergillus sp., but was found most closely related to A. alabamensis. According to EUCAST clinical breakpoints azole resistance was detected in 5.4% of all tested isolates, 6.2% of A. terreus sensu stricto (s.s.) were posaconazole-resistant. Posaconazole resistance differed geographically and ranged from 0% in the Czech Republic, Greece, and Turkey to 13.7% in Germany. In contrast, azole resistance among cryptic species was rare 2 out of 66 isolates and was observed only in one A. citrinoterreus and one A. alabamensis isolate. The most affected amino acid position of the Cyp51A gene correlating with the posaconazole resistant phenotype was M217, which was found in the variation M217T and M217V. Conclusions:Aspergillus terreus was most prevalent, followed by A. citrinoterreus. Posaconazole was the most potent drug against A. terreus, but 5.4% of A. terreus sensu stricto showed resistance against this azole. In Austria, Germany, and the United Kingdom posaconazole-resistance in all A. terreus isolates was higher than 10%, resistance against voriconazole was rare and absent for itraconazole.This work was supported by ECMM, ISHAM, and EFISG and in part by an unrestricted research grant through the Investigator Initiated Studies Programof Astellas, MSD, and Pfizer. This study was fundet by the Christian Doppler Laboratory for invasive fungal infections.info:eu-repo/semantics/publishedVersio

In vitro interaction of Saquinavir and Azidovudine with some antimycotic drugs on human pathogen yeast

Candidiasis and eryptococcosis are the most common fwigal diseases among patientssuffixhg from HIV infection. Amphotericin B, 5-fiuorocytosine and imidazole derivatives are thedrugs prescribed in such cases. The aim of the present work is to assess whether thecontemporaneous treatment of HIV-positive patients with combined therapies including reversetnmscriptase and proteinase inhiiitors could cause an interaction able to modify the Uierapeutic&ect of antirnycotic agents. Therefore an in vifro study to evaluate the antifimgal effect of antiretroviraiand antimycotic h g s association on yeasts growth was conducted. Methods: The strainsused for this study comprisai C.albicanr ( ~ 1 6a)n d C.neofonnam (n=16).Aii isolates were fkomclinicai specimens from HIV-seropositive subjects. Susceptibility tests of yeasts to amphotericin B,5-fluroqtosine, miwnazole and fluconazole, singuiarly and in association with saquinavir andazidovudine, were performeci according to the NCCLS method for agar dilution. The MIC dueswere obtained by applying the method of increasing scalar concentrations. To esthate theassociation inhibitory effect on yeasts growth, saquinavir and azidovudine were testkd respectively ata concentration of 18.75 pM.5 and 28 CLM/L, while the antimycotic agents were tested at subinhibitoryconcentrations. The FIC index used to estimate the interactions outcomes was alsocalculated. Results: The i n t d o n of saquinavir with al1 the antimycotic drugs caused on yeastsgrowth a synergy effect with potentiation (FIC indexc0.55) , addition (0.55<FIC index<l) andindifference effect (l<FIC index~2), w hereas azidovudine - antirnycotics association alwaysshowed an indifference effect. Antagonism was never obtained. Conclusion: The lack of antagonismindicates that the anti-retrovisal and antimycotic drugs association can be administrated withoutreducing the therapeutic antiibgai effects. The synergy shows that combined therapy could becaxried out using lower doses of antimycotic drugs, with a consequent reduction of toxic side effects

Prenatal diagnosis of a complete mole coexisting with a dichorionic twin pregnancy: case report.

A complete mole coexisting with dichorionic twins was diagnosed by the combined use of sonography and chorionic villus sampling at 10 weeks gestation. The pregnancy resulted in the death of one fetus at 31 weeks from presumed feto-maternal haemorrhage, while the other fetus survived in good condition. A summary of the available literature, combined with this report, reveals a total of seven pregnancies with twins and a coexistent complete mole. Only two out of 14 fetuses survived. Maternal complications included one case of pre-eclampsia and one persistent trophoblastic tumour. Accurate diagnosis of complete mole is possible by genetic analysis of chorionic villi obtained with standard transabdominal sampling. Twins with a coexistent complete mole will usually undergo miscarriage. However, fetal survival is possible and the maternal risks seem limited. A concomitance between gestational trophoblastic disease and the occurrence of feto-maternal haemorrhage is observed