Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient

Trichosporon asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease but developed an ultimately lethal T. asahii systemic infection. There is a strong possibility that our patient had been colonized at the site infection as part of the normal skin flora. After a period of one month bed rest due to an accidental fall and fracture of the right shoulder-blade, a 61-year old woman experienced severe oedema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphoedema. Samples collected from affected areas revealed T. asahii and the patient was referred to a hospital for infection diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted in our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the outcome. Nowadays physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.</p

Low-Grade Systemic Inflammation Profile, Unrelated to Homocysteinemia, in Obese Children

To investigate in prepubertal obese children (POC) the profile of chronic low-grade systemic inflammation (CLGSI) and its relation to homocysteinemia, 72 POC were evaluated for serum C-reactive protein (CRP) and amyloid A (SAA) levels, both markers of CLGSI, and plasma levels of total homocysteine (tHcy), an independent risk factor for adult atherosclerosis, in comparison to 42 prepubertal lean children (PLC). The main observations in POC were higher CRP levels compared to PLC, positive association of SAA levels to CRP levels, no association of CRP or SAA levels to tHcy levels. Thus, in POC, positively interrelated to each other, elevated CRP and unaltered SAA levels reveal a unique profile of the CLGSI, not explaining homocysteinemia-induced risk for future atherosclerosis

Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient

Trichosporon asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease but developed an ultimately lethal T. asahii systemic infection. There is a strong possibility that our patient had been colonized at the site infection as part of the normal skin flora. After a period of one month bed rest due to an accidental fall and fracture of the right shoulder-blade, a 61-year old woman experienced severe oedema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphoedema. Samples collected from affected areas revealed T. asahii and the patient was referred to a hospital for infection diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted in our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the outcome. Nowadays physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.</p

Oral versus intravenous ibandronic acid: a comparison of treatment options for metastatic bone disease

Purpose This trial is the first to compare directly the clinical response to and safety of oral and intravenous (IV) ibandronic acid for metastatic bone disease. Methods Patients &gt;= 18 years with breast, prostate, lung, urogenital or colon cancer received IV ibandronic acid 6 mg infused over 15 min every 28 days or oral ibandronic acid 50 mg/day. Clinical response was determined using bone scintigraphy, radiography and serum C-terminal telopeptide of type I collagen (S-CTX) at months 3-6. Adverse events and biochemical safety measures were recorded. Results A total of 84.6 and 88.5% of patients had a complete/partial response to IV and oral ibandronic acid, respectively. Median percentage decreases in S-CTX were -39 and -35%, respectively. Bone pain scores decreased and analgesic use increased from month 0-3 and were stable from months 3-6. Both formulations improved physical and functioning scores. Conclusion Oral and IV ibandronic acid for bone metastases have similar efficacy and tolerability

Preoperative Fascia Iliaca Compartment Block for Positioning Patients With Hip Fractures for Central Nervous Blockade A Randomized Trial

Background and Objectives: Appropriate pain management may positively affect outcome following hip fractures. Positioning patients for spinal anesthesia (SA) can be extremely painful. Peripheral nerve blockades are gaining popularity in this setting. This prospective, randomized study compares the efficacy of fascia iliaca compartment block (FICB) to intravenous (IV) fentanyl for positioning hip fracture patients for SA. Methods: Forty-one patients scheduled for hip fracture surgery were randomized to receive a bolus dose of IV fentanyl (IVFE) 1.5 g/kg (IVFE group) or an FICB using 40 mL ropivacaine 0.5% (FICB group) 5 or 20 minutes before positioning for SA, respectively. Numeric rating pain scale scores before and following the analgesic intervention, time needed and quality of patient position for SA performance, postoperative analgesia in terms of time to first IV morphine dose demand and morphine consumption during the first 24 hours, and patient satisfaction were documented. Results: Compared with the IVFE group, the FICB group showed significantly lower numeric rating pain scale scores in all instances following the analgesic intervention (P &lt; 0.001), shorter spinal performance time (P = 0.001), and better quality of position (P = 0.001). Postoperative morphine consumption was lower (P = 0.026), the time to first dose demand was longer (P = 0.001), and patient satisfaction rates were higher (P &lt; 0.001) in the FICB group. Conclusions: Performing an FICB before positioning for SA provides superior pain management compared with IVFE administration, facilitates spinal performance, and yields satisfactory postoperative analgesia and wide patient acceptance, hence improving overall quality and efficiency of care

Inflammation on the Cervical Papanicolaou Smear: Evidence for Infection in Asymptomatic Women?

Background. The significance of the possible presence of infection on the Pap smear of asymptomatic women based on cytological criteria is practically unknown. Materials and Methods. A total of 1117 asymptomatic nonpregnant women had Pap smear tests and vaginal as well as cervical cultures completed (622 with and 495 without inflammation on the Pap smear). Results. Out of the 622 women with inflammation on Pap test, 251 (40.4%) had negative cultures (normal flora present), while 371 (59.6%) women had positive cultures with different pathogens. In contrast, the group of women without inflammation on Pap test displayed significantly increased percentage of negative cultures (67.1%, ) and decreased percentage of positive cultures (32.9%, ). Bacterial vaginosis was diagnosed more frequently in both groups and significantly more in the group with inflammation on Pap smear compared to the group without inflammation (). Conclusions. A report of inflammatory changes on the cervical Pap smear cannot be used to reliably predict the presence of a genital tract infection, especially in asymptomatic women. Nevertheless, the isolation of different pathogens in about 60% of the women with inflammation on the Pap smear cannot be overlooked and must be regarded with concern