ΦΑΡΜΑΚΟΚΙΝΗΤΙΚΗ ΤΩΝ ΝΕΩΤΕΡΩΝ ΚΙΝΟΛΟΝΩΝ ΣΕ ΑΣΘΕΝΕΙΣ ΜΕ ΚΙΡΡΩΣΗ ΗΠΑΤΟΣ ΚΑΙ ΑΣΚΙΤΗ

THERE IS LITTLE INFORMATION TO OUR KNOWLEDGE REGARDING THE PHARMACOKINETICS OF NEWER QUINOLONES PEFLOXACIN (P), CIPROFLOXACIN (C) AND OFLOXACIN (O) IN PATIENTS SUFFERING FROM LIVER CIRRHOSIS ACCOMPANIED BY ASCITES. THE PRESENT STUDY WAS CARRIED OUT IN ORDER TO OBTAIN MORE INFORMATION ON THIS ASPECT. (P) WAS GIVEN TO SEVEN PATIENTS AT A DOSE OF 400 MG I.V. BIOL AND OFLOXACIN TO SIX PATIENTS AT A DOSE OF 400 MG BIOL I.V., (C) WAS GIVEN TO THREE PATIENTS AT A DOSE OF200 MG AND TO SIX PATIENTS AT A DOSE OF 300 MG, WITHOUT ANY EVIDENCE OF INFECTION, RENAL INSUFFICIENCY OR ADMINISTRATION OF ANTIMICROBIALS OR DIURETICS IN THE PREVIOUS WEEK. BLOOD AND ASCITIC FLUID WAS DRAWN JUST BEFORE THE INFUSION OF THE THIRD DOSE (OH), AT 30 MIN, 1H, 2H, 4H, 6H, 8H, 12H, 18H, 24H AFTER THEEND OF INFUSION. URINE WAS COLLECTED FROM 0-2H, 2-4H, 4-6H, 6-8H, 8-12H, 12-18H, 18-24H POST THE LATE DOSE, LEVELS IN SERUM, ASCITIC FLUID AND URINE DETERMINED BY THE AGAR DIFFUSION METHOD WITH ISOTONIC SENSITEST AGAR. RESULTS: 1) T 1/2 FOR (P) AND (O) WAS PROLONGED, FOR (C) SHORT. 2) LEVELS OF QUINOLONES IN BLOOD ARE LOWER THAN THE EXPECTED ONES PROBABLY CAUSE OF THE DIFFUSION TO ASCITIC FLUID. 3) AS A RESULT OF PROLONGED T 1/2 WE OBSERVE PROLONGED ELIMINATION IN URINE OF (P) AND (O), BUT ALSO AND (C). 4) ASCITIC FLUID CONCENTRATIONS OF (O) AND (P) ARE EXCELLENT BUT LOW FOR (C).ΥΠΑΡΧΟΥΝ ΛΙΓΑ ΒΙΒΛΙΟΓΡΑΦΙΚΑ ΔΕΔΟΜΕΝΑ ΟΣΟΝ ΑΦΟΡΑ ΤΗΝ ΦΑΡΜΑΚΟΚΙΝΗΤΙΚΗ ΤΩΝ ΝΕΩΤΕΡΩΝ ΚΙΝΟΛΟΝΩΝ ΠΕΦΛΟΞΑΣΙΝΗΣ (Π), ΣΙΠΡΟΦΛΟΞΑΣΙΝΗΣ (Σ) ΚΑΙ ΟΦΛΟΞΑΣΙΝΗΣ (Ο) ΣΕ ΑΣΘΕΝΕΙΣ ΠΑΣΧΟΝΤΕΣ ΑΠΟ ΚΙΡΡΩΣΗ ΗΠΑΤΟΣ ΜΕ ΣΥΝΟΔΟ ΑΣΚΙΤΗ. Η ΠΑΡΟΥΣΑ ΜΕΛΕΤΗ ΕΓΙΝΕ ΜΕ ΣΚΟΠΟ ΤΗΝ ΛΗΨΗ ΠΕΡΙΣΣΟΤΕΡΩΝ ΠΛΗΡΟΦΟΡΙΩΝ Σ'ΑΥΤΟ ΤΟ ΑΝΤΙΚΕΙΜΕΝΟ. Η (Π) ΧΟΡΗΓΗΘΗΚΕ ΣΕ ΕΠΤΑ (7) ΑΣΘΕΝΕΙΣ ΣΕ ΤΡΕΙΣ ΔΟΣΕΙΣ ΤΩΝ 400 MG ΚΑΙ N(O) ΣΕ ΕΞΙ (6) ΑΣΘΕΝΕΙΣ ΣΕ ΤΡΕΙΣ ΔΟΣΕΙΣ ΤΩΝ 400 MG ΕΝΔΟΦΛΕΒΙΩΣ. Η (Σ) ΧΟΡΗΓΗΘΗΚΕ ΣΕ ΕΝΝΙΑ (9) ΑΣΘΕΝΕΙΣ ΣΕ ΔΥΟ ΔΙΑΦΟΡΕΤΙΚΑ ΔΟΣΟΛΟΓΙΚΑ ΣΧΗΜΑΤΑ, 200 MG ΣΕ ΤΡΕΙΣ ΑΣΘΕΝΕΙΣ ΚΑΙ 300 MG ΣΕ ΕΞΙ ΑΣΘΕΝΕΙΣ ΑΝΤΙΣΤΟΙΧΑ, ΧΩΡΙΣ ΕΝΔΕΙΞΕΙΣ ΛΟΙΜΩΞΗΣ, ΝΕΦΡΙΚΗΣ ΑΝΕΠΑΡΚΕΙΑΣ Η ΧΟΡΗΓΗΣΗΣ ΑΝΤΙΜΙΚΡΟΒΙΑΚΩΝ Η ΔΙΟΥΡΗΤΙΚΩΝ ΤΗΝ ΤΕΛΕΥΤΑΙΑ ΕΒΔΟΜΑΔΑ. ΔΕΙΓΜΑΤΑ ΑΙΜΑΤΟΣ ΚΑΙ ΑΣΚΙΤΙΚΟΥ ΕΛΗΦΘΗΣΑΝ ΤΗΝ ΩΡΑ 0 (ΠΡΟ ΤΗΣ ΕΓΧΥΣΗΣ ΤΗΣ Γ' ΔΟΣΗΣ), 30', 1, 2, 4, 6, 8, 12, 18, 24 ΩΡΕΣ. ΕΓΙΝΕ ΣΥΛΛΟΓΗ, ΟΓΚΟΜΕΤΡΗΣΗ ΟΥΡΩΝ ΣΤΟΥΣ ΧΡΟΝΟΥΣ 0-2, 2-4, 4-6, 6-8, 8-12, 12-18, 18-24 H. ΤΑ ΕΠΙΠΕΔΑ ΣΤΟΝ ΟΡΟ, ΑΣΚΙΤΙΚΟ ΚΑΙ ΟΥΡΑ ΠΡΟΣΔΙΟΡΙΣΘΗΚΑΝ ΜΕ ΜΙΚΡΟΒΙΟΛΟΓΙΚΗ ΜΕΘΟΔΟ. ΑΠΟΤΕΛΕΣΜΑΤΑ: 1) Ο Τ 1 /2 ΓΙΑ ΤΗΝ (Π) ΚΑΙ (Ο) ΕΙΝΑΙ ΠΑΡΑΤΕΤΑΜΕΝΟΣ ΓΙΑ ΤΗΝ C ΒΡΑΧΥΣ. 2) ΤΑ ΕΠΙΠΕΔΑ ΣΤΟ ΑΙΜΑ ΤΩΝ ΚΙΝΟΛΟΝΩΝ ΕΙΝΑΙ ΧΑΜΗΛΟΤΕΡΑ ΤΩΝ ΑΝΑΜΕΝΟΜΕΝΩΝ (ΠΙΘΑΝΩΝ ΛΟΓΩ ΔΙΑΧΥΣΗΣ ΣΤΟ ΑΣΚΙΤΙΚΟ).3) ΣΥΝΕΠΕΙΑ ΤΟΥ ΠΑΡΑΤΕΤΑΜΕΝΟΥ Τ 1/2 ΕΧΟΥΜΕ ΠΑΡΑΤΑΣΗ ΚΑΙ ΤΗΣ ΑΠΕΚΚΡΙΣΗΣ ΤΗΣ (Π)ΚΑΙ (Ο) ΣΤΑ ΟΥΡΑ. ΠΑΡΑΤΕΤΑΜΕΝΗ ΟΜΩΣ ΕΙΝΑΙ ΚΑΙ ΤΗΣ (Σ). 4) Η ΣΥΓΚΕΝΤΡΩΣΗ ΣΤΟ ΑΣΚΙΤΙΚΟ ΤΗΣ (Ο) ΚΑΙ (Π) ΕΙΝΑΙ ΕΞΑΙΡΕΤΙΚΗ, ΕΝΩ ΓΙΑ ΤΗΝ (Σ) ΧΑΜΗΛΗ

Mitral valve in hypertrophic cardiomyopathy: a three-dimensional transesophageal study

Background: It is reported that the mitral valve (MV) in hypertrophic cardiomyopathy (HCM) has structural abnormalities. Purpose: To assess the MV in HCM patients using Three-Dimensional Transesophageal Echocardiography (3DTEE). Methods: Transthoracic and 3DTEE studies focused on the mitral valve were performed prospectively in 21 HCM patients with obstruction (Group I), 37 HCM patients without obstruction (Group II) and 28 controls (Group III). Results: The aortomitral angle was less obtuse in groups I and II compared with group III (104.6 +/- 6.7 degrees vs 107.6 +/- 8.5 degrees vs 112.9 +/- 3.2 degrees, p < 0.001) and the annulus height was larger (11.6 +/- 1.3 mm vs 11.6 +/- 2 mm vs 9.3 +/- 1.1 mm, p < 0.001). Patients in group I compared with groups II and III had increased ratio of anterior leaflet length to left ventricular outflow tract (LVOT) diameter (1.9 +/- 0.1 vs 1.7 +/- 0.3 vs 1.3 +/- 0.1, p < 0.05) and anterior displacement of the coaptation line as showed by the reduced ratio of anterior to posterior leaflet length in the projection plane (1.7 +/- 0.4 mm vs 2.2 +/- 0.7 mm vs 2.4 +/- 0.7 mm, p < 0.05). In groups I and II there was a positive correlation between the MV annulus height and the presence of non-sustained ventricular tachycardia (r(s) = 0.25, p < 0.05). Conclusion: The MV in HCM patients with or without obstruction shares some common anatomic features. Additionally, the MV in patients with obstruction has unique characteristics that appear to contribute to LVOT obstruction. (C) 2019 Hellenic Society of Cardiology. Publishing services by Elsevier B.V

A Prospective Multicenter Cohort Surveillance Study of Invasive Aspergillosis in Patients with Hematologic Malignancies in Greece: Impact of the Revised EORTC/MSGERC 2020 Criteria

Data concerning the incidence of invasive aspergillosis (IA) in high-risk patients in Greece are scarce, while the impact of the revised 2020 EORTC/MSGERC consensus criteria definitions on the reported incidence rate of IA remains unknown. A total of 93 adult hematology patients were screened for IA for six months in four tertiary care Greek hospitals. Serial serum specimens (n = 240) the sample was considered negative by PCR were collected twice-weekly and tested for galactomannan (GM) and Aspergillus DNA (PCR) detection. IA was defined according to both the 2008 EORTC/MSG and the 2020 EORTC/MSGERC consensus criteria. Based on the 2008 EORTC/MSG criteria, the incidence rates of probable and possible IA was 9/93 (10%) and 24/93 (26%), respectively, while no proven IA was documented. Acute myeloid leukemia was the most (67%) common underlying disease with most (82%) patients being on antifungal prophylaxis/treatment. Based on the new 2020 EORTC/MSGERC criteria, 2/9 (22%) of probable and 1/24 (4%) of possible cases should be reclassified as possible and probable, respectively. The episodes of probable IA were reduced by 33% when GM alone and 11% when GM + PCR were used as mycological criterion. The incidence rate of IA in hematology patients was 10%. Application of the 2020 EORTC/MSGERC updated criteria results in a reduction in the classification of probable IA particularly when PCR is not available

Performance, Correlation and Kinetic Profile of Circulating Serum Fungal Biomarkers of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies

As conventional microbiological documentation of invasive aspergillosis (IA) is difficult to obtain, serum fungal biomarkers are important adjunctive diagnostic tools. Positivity rates and the kinetic profiles of galactomannan (GM), 1,3-β-D-glucan (BDG) and Aspergillus DNA (PCR) were studied in high-risk patients with hematologic malignancies. GM, BDG and PCR data from serial serum specimens (n = 240) from 93 adult hematology patients with probable (n = 8), possible (n = 25) and no (n = 60) IA were retrospectively analyzed. Positivity rates and sensitivity/specificity/positive/negative predictive values (NPV) of each fungal biomarker alone and in combination were estimated. The three markers were compared head-to-head and correlated with various biochemical, demographic and patient characteristics. The positivity rates for patients with probable/possible/no IA were 88%/8%/0% for GM (X2 = 55, p < 0.001), 62%/46%/35% for BDG (X2 = 2.5, p = 0.29), 62%/33%/27% for PCR (X2 = 3.9, p = 0.15), 50%/4%/0% for GM + BDG and GM + PCR (X2 = 31, p < 0.001), 50%/8%/22% for BDG + PCR (X2 = 6.5, p = 0.038) and 38%/4%/0% for GM + BDG + PCR (X2 = 21, p < 0.001). Higher agreement (76%) and negative correlation (rs = −0.47, p = 0.0017) was found between GM index and PCR Ct values. The sensitivity and NPV was 45–55% and 90–92% when biomarkers assessed alone and increased to 75–90% and 93–97%, respectively when combined. Weak significant correlations were found between GM, PCR and BDG results with renal/liver function markers (r = 0.11–0.57) with most GM+ and PCR+ samples found in the first and second week of clinical assessment, respectively and BDG later on. Different positivity rates, time profiles and performances were found for the three biomarkers advocating the combination of GM with PCR for the early diagnosis of IA, whereas the high NPV of combined biomarkerscould help excluding IA

The Effect of Different Colistin Dosing Regimens on Nephrotoxicity: A Cohort Study

(1) Background: It is not known whether different daily dosing schemes have different effects on colistin nephrotoxicity. We examined the effect of once- versus twice- or thrice-daily doses of colistin on renal function. (2) Methods: We performed a multicenter retrospective cohort study of hospitalized patients with a baseline glomerular filtration rate ≥ 50 mL/min who received intravenously the same colistin dose once (regimen A), twice (regimen B) or thrice daily (regimen C). The primary endpoint was acute kidney injury (AKI), defined as fulfilment of any of the RIFLE (Risk-Injury-Failure-Loss-End stage renal disease) criteria. (3) Results: We included 306 patients; 132 (43.1%) received regimen A, 151 (49.3%) regimen B, and 23 (7.5%) regimen C. Ninety-nine (32.4%) patients developed AKI; there was no difference between regimen A vs. B and C [45 (34.1%) vs. 54 (31.0%), p = 0.57]. In a propensity score–matched cohort, AKI was similar in patients receiving Regimen A, Regimen B, and Regimen C (31.6% vs. 33.3%, p = 0.78). On logistic regression analysis, diabetes was an independent predictor of AKI (OR = 4.59, 95% CI 2.03–10.39, p = 0.001) while eGFR > 80 mL/min (OR = 0.50, 95% CI 0.25–0.99, p = 0.048) was inversely associated with AKI. (4) Conclusions: Colistin once daily is not more nephrotoxic than the standard colistin regimens. The only independent predictor of nephrotoxicity was diabetes mellitus, while eGFR > 80 mL/min had a protective effect