Catheter-Related Sepsis by Candida pararugosa in an Adult Patient under Chemotherapy Regimen

Candida pararugosa is present in animals and humans in different organs and biological liquids, usually as a saprophyte. We report the case of a 61-year-old woman diagnosed with de novo stage IV metastatic lobular breast cancer, carrying a central venous catheter (port-a-cath) and bilateral stents for perirenal infiltration by malignancy. During chemotherapy regimen, a febrile episode occurred, along with a high level of serum glucan. The port-a-cath was removed after blood collection for culture, which gave isolation of Candida pararugosa strains. Given high glucan level and the patient's frailty, empirical treatment with fluconazole was started with load-dose, 800 mg orally, at day 1 and, afterwards, with 400 mg daily for two weeks. The phenotype of susceptibility to antibiotics of the strain demonstrated lower minimal inhibitory concentration to fluconazole than that reported in the literature. The patient remained asymptomatic, and inflammation parameters showed normalization. Unfortunately, three weeks later, meningeal localization of cancer caused rapid deterioration and death

Organ procurement requiring the authorization of the judicial authority. An epidemiological investigation in the Veneto region (Italy)

Background: When death occurs through a mechanism requiring a forensic investigation, consent for organ harvesting must be sought from the Judicial Authority (JA). Aim: To perform a retrospective study of potential organ donors in the Veneto region over a six-year period (2012–2017), analysing any differences between cases in which the JA approved or denied organ harvesting. Material and methods: Both non-heart beating (NHB) and heart beating (HB) donors were included. For HB cases, personal and clinical data were collected. To evaluate the correlation between the JA response and the circumstantial and clinical data a logistic multivariate analysis was performed, estimating the adjusted odds ratios (adjORs). Results: Between 2012 and 2017, 17,662 organ and/or tissue donors were included, of which 16,418 were NHB donors and 1,244 HB-donors. Among the 1,244 HB-donors, JA authorization was asked in 200 cases (16.1%), approved in 154 cases (77.0%), limited in 7 cases (3.5%) and denied in 39 cases (19.5%). The JA denied the authorization for organ harvesting in 53,3% of cases with hospitalizations of less than 1 day and in 9,4% of cases with hospitalization exceeding one week [adjOR(95%CI) = 10.67 (1.92–59.22)]. The performance of an autopsy was linked to a higher chance of denied outcome from the JA [adjOR(95%CI): 3.45 (1.42–8.39)]. Conclusions: Improvements in the communication between organ procurement organizations and the JA through efficient protocols furnishing detailed information on the cause of death might lead to a better procurement process with an increase in the number of transplanted organs

Liver Transplantation for T2 Hepatocellular Carcinoma during the COVID-19 Pandemic: A Novel Model Balancing Individual Benefit against Healthcare Resources

The COVID-19 pandemic caused temporary drops in the supply of organs for transplantation, leading to renewed debate about whether T2 hepatocellular carcinoma (HCC) patients should receive priority during these times. The aim of this study was to provide a quantitative model to aid decision-making in liver transplantation for T2 HCC. We proposed a novel ethical framework where the individual transplant benefit for a T2 HCC patient should outweigh the harm to others on the waiting list, determining a “net benefit”, to define appropriate organ allocation. This ethical framework was then translated into a quantitative Markov model including Italian averages for waiting list characteristics, donor resources, mortality, and transplant rates obtained from a national prospective database (n = 8567 patients). The net benefit of transplantation in a T2 HCC patient in a usual situation varied from 0 life months with a model for end-stage liver disease (MELD) score of 15, to 34 life months with a MELD score of 40, while it progressively decreased with acute organ shortage during a pandemic (i.e., with a 50% decrease in organs, the net benefit varied from 0 life months with MELD 30, to 12 life months with MELD 40). Our study supports the continuation of transplantation for T2 HCC patients during crises such as COVID-19; however, the focus needs to be on those T2 HCC patients with the highest net survival benefit

Physical activity associated with urban environmental characteristics: A correlational study of active women of high socioeconomic status from Brazilian cities of Santa Catarina

Abstract The study aimed to identify urban environmental characteristics, which may be associated with the physical activity (PA) level of women from Brazilian cities of Santa Catarina. The sample was composed of 2047 women aged 20 to 59 from six Santa Catarina cities: Blumenau, Chapecó, Criciúma, Florianópolis, Itajaí, and São José. The PA was evaluated through the IPAQ (short version), and the NEWS to environmental variables. An inferential and descriptive statistic was used: Chi-squared test, ANOVA with post hoc, and raw and adjusted multinomial regression analysis (p < .05). The participants from São José presented greater chances to PA practice when they reside close to appropriated areas, sidewalks, fitness centers, well-lit streets, and when invited by relatives to the practice. The PA Program for the community enables greater chances of practice for women in Florianópolis, São José, Criciúma and Blumenau. As a conclusion, some environmental factors appeared to influence PA practice positively in Catarinense women. Besides that, the fact of belonging to the high economic status could increasingly enable practice, since they seem broader access to gyms and PA private professionals