21 research outputs found
Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon)
BACKGROUND: Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. We discuss one such rare case, outlining the fact that an intra-operative surprise diagnosis could have been facilitated by previous investigations. CASE PRESENTATION: A 56 year-old man presented in A&E department with small bowel ileus. He had a history of 6 similar episodes of small bowel obstruction in the past 4 years, which resolved with conservative treatment. Pre-operative work-up did not reveal any specific etiology. At laparotomy, a fibrous capsule was revealed, in which small bowel loops were encased, with the presence of interloop adhesions. A diagnosis of abdominal cocoon was established and extensive adhesiolysis was performed. The patient had an uneventful recovery and follow-up. CONCLUSION: Idiopathic sclerosing encapsulating peritonitis, although rare, may be the cause of a common surgical emergency such as small bowel ileus, especially in cases with attacks of non-strangulating obstruction in the same individual. A high index of clinical suspicion may be generated by the recurrent character of small bowel ileus combined with relevant imaging findings and lack of other plausible etiologies. Clinicians must rigorously pursue a preoperative diagnosis, as it may prevent a "surprise" upon laparotomy and result in proper management
Risk factors for nasopharyngeal carriage of drug-resistant Streptococcus pneumoniae: data from a nation-wide surveillance study in Greece
<p>Abstract</p> <p>Background</p> <p>A nation-wide surveillance study was conducted in Greece in order to provide a representative depiction of pneumococcal carriage in the pre-vaccination era and to evaluate potential risk factors for carriage of resistant strains in healthy preschool children attending daycare centers.</p> <p>Methods</p> <p>A study group was organized with the responsibility to collect nasopharyngeal samples from children. Questionnaires provided demographic data, data on antibiotic consumption, family and household data, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and resistant strains were serotyped.</p> <p>Results</p> <p>Between February and May 2004, from a total population of 2536 healthy children, a yield of 746 pneumococci was isolated (carriage rate 29.41%). Resistance rates differed among geographic regions. Recent antibiotic use in the last month was strongly associated with the isolation of resistant pneumococci to a single or multiple antibiotics. Serotypes 19F, 14, 9V, 23F and 6B formed 70.6% of the total number of resistant strains serotyped.</p> <p>Conclusion</p> <p>Recent antibiotic use is a significant risk factor for the colonization of otherwise healthy children's nasopharynx by resistant strains of <it>S pneumoniae</it>. The heptavalent pneumococcal conjugate vaccine could provide coverage for a significant proportion of resistant strains in the Greek community. A combined strategy of vaccination and prudent antibiotic use could provide a means for combating pneumococcal resistance.</p
Early alterations of the innate and adaptive immune statuses in sepsis according to the type of underlying infection
Chemoprophylaxis with trovafloxacin against experimental streptococcal aortic valve endocarditis
HIV continuum of care: expanding scope beyond a cross-sectional view to include time analysis: a systematic review
Introduction The continuum of care (CoC) model has been used to describe
the main pillars of HIV care. This study aims to systematically review
methods and elucidate gaps in the CoC analyses, especially in terms of
the timing of the progression through steps, recognized nowadays as a
critical parameter for an effective response to the epidemic. Methods A
PubMed and EMBASE databases search up to December 2019 resulted in 1918
articles, of which 209 were included in this review; 84 studies
presented in major HIV conferences were also included. Studies that did
not provide explicit definitions, modelling studies and those reporting
only on metrics for subpopulations or factors affecting a CoC stage were
excluded. Included articles reported results on 1 to 6 CoC stages.
Results Percentage treated and virally suppressed was reported in 78%,
percentage diagnosed and retained in care in 58%, percentage linked to
care in 54% and PLHIV in 36% of the articles. Information for all
stages was provided in 23 studies. Only 6 articles use novel CoC
estimates: One presents a dynamic CoC based on multistate analysis
techniques, two base their time-to-next-stage estimates on a risk
estimation method based on the cumulative incidence function, weighted
for confounding and censoring and three studies estimated the HIV
infection time based on mathematical modelling. Conclusion A limited
number of studies provide elaborated time analyses of the CoC. Although
time analyses lack the straightforward interpretation of the
cross-sectional CoC, they provide valuable insights for the timely
response to the HIV epidemic. A future goal would be to develop a model
that retains the simplicity of the cross-sectional CoC but also
incorporates timing between stages
Mecillinam/clavulanate combination: a possible option for the treatment of community-acquired uncomplicated urinary tract infections caused by extended-spectrum -lactamase-producing Escherichia coli
Extended-spectrum -lactamases (ESBLs) have emerged as an important
mechanism of -lactam resistance among community uropathogens. We
characterized the ESBLs of a collection of Escherichia coli isolates
recovered from outpatients with urinary tract infection during
nationwide surveillance conducted from 2005 to 2006 in Greece, and
evaluated the in vitro activity of mecillinam and mecillinam/clavulanate
against them.
ESBLs were characterized with PCR and sequencing. In vitro interactions
were evaluated with agar dilution with and without clavulanate (4 mg/L)
using an inoculum of 10(4) or 10(6) cfu/spot as well as with timekill
methodology.
Among 48 ESBL producers, 47 (97.9) were susceptible to mecillinam.
CTX-M-type enzymes were produced by 87.2, with CTX-M-3 being the most
prevalent. SHV enzymes were found in 10.6, VEB enzymes in 2.1, TEM
enzymes in 19.2 and OXA-type enzymes in 12.8. Synergy with clavulanate
was detected in 60.4 using the agar dilution method and in 43.8 using
the timekill methodology. An inoculum effect was detected in 64.6 of
isolates, but this phenomenon was inverted and synergy was evidenced for
85.4 with clavulanate. When a high inoculum was used, 60.4 (29/48) were
resistant to mecillinam, but 97.9 (47/48) were susceptible in the
presence of clavulanate.
CTX-M-type enzymes were the most prevalent among ESBL-producing E. coli
uropathogens in Greece. Mecillinam may be useful in uncomplicated
cystitis caused by ESBL producers with low MICs. The addition of the
inhibitor could improve and extend the activity of mecillinam, even in
the setting of infection with a high bacterial inoculum, and merits
clinical evaluation
Cefditoren: Comparative efficacy with other antimicrobials and risk factors for resistance in clinical isolates causing UTIs in outpatients
Background: To investigate a possible role of Cefditoren, a recently
marketed in Greece third-generation oral cephalosporin in urinary
infections of outpatients.
Methods: During a multicenter survey of Enterobacteriaceae causing UTIs
in outpatients during 2005-2007, Cefditoren MICs were determined by agar
dilution method in a randomly selected sample of uropathogens.
Susceptibility against 18 other oral/parenteral antimicrobials was
determined according to Clinical and Laboratory Standards Institute
methodology.
Results: A total of 563 isolates (330 Escherichia coli, 142 Proteus
mirabilis and 91 Klebsiella spp) was studied; MIC50/MIC90 of Cefditoren
was 0.25/0.5 mg/L respectively, with 97.1% of the isolates being
inhibited at 1 mg/L. All 12 strains producing ESBLs or AmpC enzymes were
resistant to cefditoren. Susceptibility rates (%) for
amoxicillin/clavulanic acid, cefuroxime axetil, cefotaxime,
ciprofloxacin, trimethoprim/sulfamethoxazole and fosfomycin were
93.1-94.1-96.8-93.1-71.9 and 92.8% respectively. Cefditoren MIC was
significantly higher in nalidixic/ciprofloxacin non-susceptible strains;
resistance to cefditoren was not associated with resistance to
mecillinam, fosfomycin nitrofurantoin and aminoglycosides. Multivariate
analysis demonstrated history of urinary infection in the last two weeks
or three months as risk factors for cefditoren resistance.
Conclusions: Cefditoren exhibited enhanced in vitro activity against the
most common uropathogens in the outpatient setting, representing an
alternative oral treatment option in patients with risk factors for
resistance to first-line antibiotics
Severe dysphagia as the presenting symptom of Wernicke-Korsakoff syndrome in a non-alcoholic man
Reliability, validity and psychometric properties of the Greek translation of the posttraumatic stress disorder scale
The Greek version of the Davidson Trauma Scale (DTS) was developed to respond to the need of Greek-speaking individuals. The translated questionnaire was administered to 128 HIV outpatients (aged 37.1±9.1) and 166 control patients (aged 32.4±13.4). In addition to the DTS Greek scale, subjects were assessed with two other scales useful for assessing validity. For each factor analyses two components were extracted, based on Cattell’s scree test. The two components solution accounted for 55.34% of the total variation in case of frequency variables and 61.45% in case of severity variables. The Cronbach’s alpha coefficient and Guttman split-half coefficient of the DTS scale were 0.93 and 0.88 respectively. The test-retest reliability of the Greek version of DTS scale proved to be satisfactory. Individual items had good intra-class correlation coefficients higher than 0.5, which means that all questions have high levels of external validity. The psychometric strength of interview for posttraumatic stress disorder-Greek version it’s reliable for its future use, particularly for screening subjects with possible diagnosis of posttraumatic stress disorder