Interferon free antiviral treatment of chronic hepatitis C in patients affected by β-thalassemia major

Chronic hepatitis C (CHC) significantly affects the prognosis of liver disease [1] and health related quality of life (HRQOL) in patients with β-thalassemia major [2, 3]. CHC cure is a crucial event in the prognosis of the disease, since prevents fibrosis progression, decreases the risk of hepatocellular carcinoma (HCC), and improves survival. Standard antiviral therapy with Pegylated Interferon (PEG-IFN) and Ribavirin (RBV) has long been the standard of care, despite its limited efficacy and increased ribavirin induced hematological adverse events in thalassemic patients [4]. Recently, several novel highly effective direct antiviral agents (DAAs) have been approved for HCV treatment, with impressive cure rates, higher than 90%, after 8–12 weeks of therapy and mild adverse events [5], but there are no published reports documenting the efficacy, safety and impact on QOL of available interferon-free antiviral regimens in patients with βthalassemia majo

Serum Bactericidal Activity Levels Monitor to Guide Intravenous Dalbavancin Chronic Suppressive Therapy of Inoperable Staphylococcal Prosthetic Valve Endocarditis: A Case Report

Here we describe a case of a methicillin-resistant coagulase-negative staphylococci prosthetic valve endocarditis in a patient considered not eligible for valve replacement due to high perioperative mortality risk and who did not tolerate oral antibiotic treatment. Under these circumstances, intravenous long-term chronic suppressive antibiotic therapy with dalbavancin, scheduling the doses using the serum bactericidal activity titers, proved to be safe and effective

Autochthonous acute hepatitis E: treatment with sofosbuvir and ribavirin

Introduction: Hepatitis E virus (HEV) is an emerging cause of autochthonous-acute-hepatitis and acute-on-chronic-liver-failure in western countries. Treatment is not routinely used, despite ribavirin has a good antiviral effect. In vitro sofosbuvir inhibits HEV replication, but clinical data are lacking. Case report: We report a case of acute-on-chronic-liver-failure due to HEV treated with sofosbuvir and ribavirin. The treatment was capable of rapidly inducing both HCV and HEV viral suppression. Conclusion: In conclusion, although more data are required before firm conclusions could be drawn, the combination of sofosbuvir and ribavirin in not immunosuppressed patients with acute hepatitis E may be able to clear HEV infection

Does lung ultrasound have a role in the clinical management of pregnant women with SARS COV2 infection?

Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is a major health threat. Pregnancy can lead to an increased susceptibility to viral infections. Although chest computed tomography (CT) represents the gold standard for the diagnosis of SARS-CoV-2 pneumonia, lung ultrasound (LUS) could be a valid alternative in pregnancy. The objectives of this prospective study were to assess the role of LUS in the diagnosis of lung involvement and in helping the physicians in the management of affected patients. Thirty pregnant women with SARS-CoV-2 infection were admitted at the obstetrical ward of our Hospital. Mean age was 31.2 years, mean gestational age 33.8 weeks. Several LUS were performed during hospitalization. The management of the patients was decided according to the LUS score and the clinical conditions. Mean gestational age at delivery was at 37.7 weeks, preterm birth was induced in 20% of cases for a worsening of the clinical conditions. No neonatal complications occurred. In 9 cases with a high LUS score, a chest CT was performed after delivery. CT confirmed the results of LUS, showing a significant positive correlation between the two techniques. LUS seems a safe alternative to CT in pregnancy and may help in the management of these patient

Prognostic Value of 12-Leads Electrocardiogram at Emergency Department in Hospitalized Patients with Coronavirus Disease-19

BackgroundElectrocardiogram (ECG) offers a valuable resource easily available in the emergency setting.ObjectiveAim of the study was to describe ECG alterations on emergency department (ED) presentation or that developed during hospitalization in SARS-CoV-2-infected patients and their association with 28-day mortality.MethodsA retrospective, single-center study including hospitalized patients with SARS-CoV-2 was conducted. ECG was recorded on ED admission to determine: heart rhythm, rate, and cycle; atrio-ventricular and intra-ventricular conduction; right ventricular strain; and ventricular repolarization. A specialized cardiologist blinded for the outcomes performed all 12-lead ECG analyses and their interpretation.Results190 patients were included, with a total of 24 deaths (12.6%). Age (p < 0.0001) and comorbidity burden were significantly higher in non-survivors (p < 0.0001). Atrial fibrillation (AF) was more frequent in non-survivors (p < 0.0001), alongside a longer QTc interval (p = 0.0002), a lower Tp-e/QTc ratio (p = 0.0003), and right ventricular strain (p = 0.013). Remdesivir administration was associated with bradycardia development (p = 0.0005) but no increase in mortality rates. In a Cox regression model, AF (aHR 3.02 (95% CI 1.03-8.81); p = 0.042), QTc interval above 451 ms (aHR 3.24 (95% CI 1.09-9.62); p = 0.033), and right ventricular strain (aHR 2.94 (95% CI 1.01-8.55); p = 0.047) were associated with higher 28-day mortality risk.ConclusionsQTc interval > 451 ms, right ventricular strain, and AF are associated with higher mortality risk in SARS-CoV-2 hospitalized patients. ECG recording and its appropriate analysis offers a simple, quick, non-expensive, and validated approach in the emergency setting to guide COVID-19 patients' stratification

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Efeito da monensina sódica sobre a produção e composição do leite, a produção de mozzarela e o escore de condição corporal de búfalas Murrah

Avaliou-se o efeito da adição de monensina sódica sobre a produção, composição do leite, produção de mozzarela e o escore de condição corporal de búfalas da raça Murrah. O experimento foi conduzido na Área de Produção de Bubalinos da UNESP- FMVZ Botucatu/SP, utilizando-se vinte e quatro búfalas da raça Murrah, submetidas a dois tratamentos, T1: sem adição de monensina sódica na dieta T2: adição de 300 mg de monensina sódica por búfala por dia na dieta, durante os primeiros 150 dias de lactação. Os animais receberam dieta composta por silagem de sorgo, capim-elefante e concentrado. Semanalmente, foram anotadas as produções de leite, coletando-se amostras, para a determinação dos teores de proteína, gordura, sólidos totais, e avaliando-se o peso vivo e escore de condição corporal. Foram calculadas as produções de mozzarella, leite (total e média diária), produção de leite corrigida para 270 dias de lactação, produções de proteína e de gordura e relação proteína:gordura. O delineamento experimental foi inteiramente casualizado. Não houve diferenças estatísticas entre os tratamentos para produção média diáriade leite, produção total corrigida para 270 dias, produção de leite no pico da lactação, produção de mozzarella, porcentagens de proteína e sólidos totais, relação proteína:gordura, peso vivo e escore de condição corporal. A monensina influenciou positivamente, com diferenças estatísticas entre os tratamentos na produção diária de proteína (T1 = 47,10 g, T2 = 162,07 g), gordura (T1 = 226,90 g, T2 = 259,62 g) e a porcentagem de gordura do leite (T1 = 5,41%, T2 = 5,84%).The effect of monensin on milk production, milk composition and body condition score of buffaloes cows in early lactation was evaluated. Twenty four Murrah buffalo cows were submitted to two treatments T1 (0 mg of monensin/buffalo cow/day) T2 (300 mg of monensin/buffalo cow/day) evaluated during the 150 first days of lactation. The total ration was composed by sorghum silage, elephant grass, and concentrate. The effect of monensin on milk production, milk composition and body condition score of buffaloes cows in early lactation was evaluated. Weekly, data on milk production recorde, and milk samples were collected, for determination of protein, fat and total solids analysis were measured. The buffaloes cows were also evaluated for live weight and the body condition score. Mozzarela production, milk production (total and daily mean), milk production corrected for 270 days of lactation, protein and fat productions and protein: fat ratio were recorded. A completely randomized experimental design was used. There was no differences between treatments for daily milk and for total milk production corrected for 270 days, milk production at the peak of lactation, mozzarela production, protein and total solids percentage, protein:fat ratio, live weight and body condition score. Monensin influenced positively, with differences between treatments for daily protein (T1 = 147.10 g, T2 = 162.07 g) and fat production, (T1 = 226.90 g, T2 = 259.62 g) and fat percentage (T1 = 5.41%, T2 = 5.84%).Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Changed epidemiology of ICU acquired bloodstream infections over 12 years in an Italian teaching hospital

Background: We compared the etiology of 203 ICU-acquired laboratory confirmed bloodstream infections (LC-BSI) prospectively collected between January 2000-December 2007 (first period) with 83 LC-BSI recorded between January 2010-December 2012 (second period), after the diffusion in 2008 of K. pneumoniae expressing carbapenem-resistance due to K. pneumoniae carbapenemases production (KPC-CR-Kp). Methods: In the general ICU of teaching hospital "Umberto I" in Rome, all ICU-acquired LC-BSI episodes occurring in patients admitted to ICU ≥ 48h were included. Baseline characteristics, clinical features, antimicrobial resistance and outcome were recorded. All isolated strains multidrug resistance (MDR) were evaluated according to the European Centre for Disease Control (ECDC) guidelines. Results: Overall the study included 329 isolates, 214 in 2000-2007 and 115 in 2010-2012. In the second period we registered a Gram-positive reduction (55.1% vs. 26.9%; P<0.01) and Gram-negative increase (40.2% vs. 69.6%; P < 0.01). In 2000-2007 staphylococci were responsible for 45.8% LC-BSI's, whereas 18.3% during 2010-2012. Enterobacteriaceae increased dramatically (15.4% vs. 39.2%; P < 0.01), especially Klebsiella spp. (5.6% vs. 31.3%; P < 0.01). LC-BSI associated mortality decreased among Gram-positive (56.8% vs. 51.6%), but increased in Gram-negative (41.9% vs. 60.0%; P < 0.03), especially in Enterobacteriaceae (RR 2.13; 95% CI 1.21 - 3.73; P < 0.01). MDR increased remarkably among Enterobacetriaceae (51.5% vs. 73.3%). The study highlighted the associated mortality for Enterobacteriaceae when comparing MDR to non-MDR microorganisms. Conclusion: ICU-acquired LC-BSI etiology shifted from Gram-positive to Gram-negative during the study period in our ICU. Also associated mortality decreased among the former, whereas it increased in the latter. Last MDR increased enormously among Enterobacteriaceae with the diffusion of KPC (75% of strains), adding significantly to associated mortality (RR 2.17; 1.16-4.05; P < 0.01). COPYRIGHT © 2015 EDIZIONI MINERVA MEDICA