The clinical evidence and the role of imiquimod in the extramammary Paget disease

Extramammary Paget disease is a rare disease. Different treatment options are used for its management, among them treatment with imiquimod. Our aim is to clarify the efficacy and safety of the use of topical imiquimod cream in the treatment of extramammary Paget disease.In this article the current literature in Pubmed and Scopus on this topic is reviewed.According to the literature the topical use of imiquimod can be used as first-line treatment in different dosages and durations with excellent results, reaching a 87.5% cure rate with rare complications. The available evidence is currently limited to case reports and a single case series, but is definitely in favor of imiquimod use as an alternative treatment for extramammary Paget disease.</p

Aseptic Meningitis with Urinary Retention: A Case Report

Introduction. Aseptic meningitis is serious inflammation of the meninges caused by agents including viruses, non-viral pathogens, non-infectious conditions and chemicals. Case Presentation. This study concerns the case of a 16-year-old healthy Greek female with persistent fever, mild headache and acute urinary retention, secondary to aseptic meningitis. Physical examination revealed no distinct signs of meningeal irritation. The urinary bladder was palpable, painless and over-distended. Serology carried out for common viruses was as follows: CMV IgG (−), CMV IgM (−), HSV IgG (−), HSV IgM (+), VZ IgG (+), VZ IgM (−), EBV IgG (−) and EBV IgM (+). During recovery in hospital, three trials of removing a urinary catheter were carried out; during the first two attempts the patient was unable to urinate and had a loss of bladder sensation. On the third attempt the patient had modest bladder perception but she left a post-voiding residual, and was instructed to perform bladder self-catheterization. Seven days after being discharged the patient underwent a full recovery. Conclusion. There are few reports concerning aseptic meningitis together with acute urinary retention. A number of these cases concern so-called “meningitis-retention syndrome,” which implies an underlying CNS mechanism, while others concerned an underlying peripheral nervous system mechanism

Fournier's gangrene in a patient after third-degree burns: a case report

<p>Abstract</p> <p>Introduction</p> <p>Fournier's gangrene is characterized by tissue ischemia leading to rapidly progressing necrotizing fasciitis.</p> <p>Case presentation</p> <p>We present the case of a patient with Fournier's gangrene after third-degree burns. Clinical manifestations, laboratory results and treatment options are discussed.</p> <p>Conclusion</p> <p>Fournier's gangrene is a surgical emergency. Although it can be lethal, it is still a challenging situation in the field of surgical infections.</p

Guillain-Barre syndrome presenting with sensory disturbance following a herpes virus infection: a case report

<p>Abstract</p> <p>Introduction</p> <p>We present a case of an unusual clinical manifestation of Guillain-Barre syndrome following a pre-existing herpes virus infection. Although there have been several reports describing the co-existence of herpes virus infection and Guillain-Barre syndrome, we undertook a more in-depth study of the cross-reactivity between herpes viruses and recommend a follow-up study based on serology tests.</p> <p>Case presentation</p> <p>A 39-year-old healthy Caucasian man with Guillain-Barre syndrome presented to our facility initially with sensory disturbance, followed by an atypical descending pattern of clinical progression. On physical examination, our patient showed hot and cold temperature sensory disturbance under the T4 vertebrae level, symmetrically diminished muscle power mainly to his lower limbs, blurred vision, a loss of taste and paresis and diminished reflexes of his lower limbs. Serology test results for common viruses on hospital admission were positive for cytomegalovirus immunoglobulin M, cytomegalovirus immunoglobulin G, herpes simplex virus immunoglobulin M, herpes simplex virus immunoglobulin G, Epstein-Barr virus immunoglobulin M, and varicella zoster virus immunoglobulin G, borderline for Epstein-Barr virus immunoglobulin G and negative for varicella zoster virus immunoglobulin M. At one month after hospital admission his test results were positive for cytomegalovirus immunoglobulin M, cytomegalovirus immunoglobulin G, herpes simplex virus immunoglobulin G, Epstein-Barr virus immunoglobulin G, varicella zoster virus immunoglobulin G, borderline for herpes simplex virus immunoglobulin M and negative for Epstein-Barr virus immunoglobulin M and varicella zoster virus immunoglobulin M. At his six month follow-up, tests were positive for cytomegalovirus immunoglobulin G, herpes simplex virus immunoglobulin M, herpes simplex virus immunoglobulin G, Epstein-Barr virus immunoglobulin G and varicella zoster virus immunoglobulin G and negative for cytomegalovirus immunoglobulin M, Epstein-Barr virus immunoglobulin M and varicella zoster virus immunoglobulin M.</p> <p>Conclusions</p> <p>The clinical manifestation of Guillain-Barre syndrome in our patient followed a combined herpes virus infection. The cross-reactivity between these human herpes viruses may have a pathogenic as well as evolutionary significance. Our patient showed seroconversion at an early stage of Epstein-Barr virus immunoglobulin M to immunoglobulin G antibodies, suggesting that Epstein-Barr virus might have been the cause of this syndrome. Even if this case is not the first of its kind to be reported, it may contribute to a better understanding of the disease and the cross-reaction mechanisms of herpes virus infections. This case report may have a broader clinical impact across more than one area of medicine, suggesting that cooperation between different specialties is always in the patient's best interest.</p

Vaccination Hesitancy among Health-Care-Workers in Academic Hospitals Is Associated with a 12-Fold Increase in the Risk of COVID-19 Infection: A Nine-Month Greek Cohort Study

Health-Care-Workers (HCWs) are considered at high risk for SARS-CoV-2 infection. We sought to compare rates and severity of Coronavirus disease 2019 (COVID-19) among vaccinated and unvaccinated HCWs conducting a retrospective cohort study in two tertiary Academic Hospitals, namely Laiko and Attikon, in Athens, Greece. Vaccinated by BNT162b2 Pfizer-BioNTech COVID-19 mRNA vaccine and unvaccinated HCWs were included and data were collected between 1 January 2021 and 15 September 2021. Overall, 2921 of 3219 HCWs without a history of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection were fully vaccinated during the study period (90.7% at each Hospital). Demographic characteristics were comparable between 102/2921 (3.5%) vaccinated and 88/298 (29.5%) unvaccinated HCWs with COVID-19, although age and occupation differed significantly. None were in need of hospital admission in the vaccinated Group, whereas in the unvaccinated Group 4/88 (4.5%) were hospitalized and one (1.1%) died. Multivariable logistic regression analysis revealed that lack of vaccination was an independent risk factor for COVID-19 with an odds ratio 11.54 (95% CI: 10.75&ndash;12.40). Vaccination hesitancy among HCWs resulted to highly increased COVID-19 rates; almost one in three unvaccinated HCWs was SARS-CoV-2 infected during the 9-month period. The absolute need of vaccination of HCWs, including boosting dose, is highlighted. Evidence should be used appropriately to overcome any hesitancy

Ποσοτικοποίηση των στελεχών του ιού της ηπατίτιδας Β (HBV) με τις μεταλλαγές που προσδίδουν αντοχή στην αντιϊκή θεραπεία

BACKGROUND: Resistance has frequently been associated with the emergence of resistance-associated mutations and is a major problem when treating patients with hepatitis B virus (HBV) infection. Conventional methods often fail to detect HBV viral subpopulations if they are represented in less than 20% of the total.AIM: Development of a novel method for the quantitative detection of HBV subpopulations with major resistance associated mutations (V173L, L180M, A181V, T184A, M204I/V and N236T).METHODS: Amplification Refractory Mutation System real-time PCR (ARMS rt-PCR) was combined with molecular beacon using the LightCycler system.RESULTS: ARMS rt-PCR with molecular beacon showed a sensitivity of 10 copies/reaction and analytical sensitivity 95% for mutant variant and 100% for wild-type variant. Discriminatory ability is 0.01%-0.25%. In HBV naïve patients viral populations with resistance associated mutations (V173L, L180M, A181V, T184A, M204I and N236T) were present in 38/60 (63.3%). In HBV treated patients who have shown resistance, viral populations with resistance associated mutations were present both as dominant and minor variants, probably affecting the patients’ resistance profile.CONCLUSIONS: Although the sensitivity, precision (inter-assay, intra-assay) and discriminatory ability of the ARMS rt-PCR with molecular beacon is similar to other ultra sensitive methods, such as ultra-deep sequencing, we show that the former can be applied in a cost-effective way for the detection of HBV subpopulations with major resistance associated mutations.ΕΙΣΑΓΩΓΗ: Η ανάπτυξη αντοχής στην αντιϊκή θεραπεία έχει σχετισθεί με την εμφάνιση μεταλλαγών και αποτελεί ένα βασικό πρόβλημα στην αντιμετώπιση της λοίμωξης του ιού της ηπατίτιδας Β (HBV). Οι συμβατικές μέθοδοι αδυνατούν να ανιχνεύσουν ιϊκούς υποπληθυσμούς με τις μεταλλαγές αντοχής αν αντιπροσωπεύουν λιγότερο από το 20% του συνολικού πληθυσμού του ιού στο υπό εξέταση δείγμα. ΣΚΟΠΟΣ: Η δημιουργία μιας μεθόδου για την ποσοτικοποίηση των ιϊκών υποπληθυσμών του HBV με τις κυριότερες μεταλλαγές που προσδίδουν αντοχή στην αντιϊκή θεραπεία (V173L, L180M, A181V, T184A, M204I/V και N236T).ΥΛΙΚΟ-ΜΕΘΟΔΟΣ: Η μεθοδολογία του συστήματος αναστολής της γονιδιακής επέκτασης του μεταλλαγμένου τύπου με PCR πραγματικού χρόνου (amplification refractory mutation system, ARMS RT-PCR) συνδυάστηκε με την τεχνολογία του μοριακού φάρου (molecular beacon) χρησιμοποιώντας το σύστημα του LightCycler®. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η μέθοδος ARMS rt-PCR με μοριακό φάρο έχει ευαισθησία 10 αντιγράφων ανά αντίδραση και αναλυτική ευαισθησία 95% για το μεταλλαγμένο τύπο και 100% για το φυσικό τύπο. Η διακριτική ικανότητα της μεθόδου είναι 0.01%-0.25%. Ιϊκοί υποπληθυσμοί με τις μεταλλαγές αντοχής του HBV V173L, L180M, A181V, T184A, M204I και N236T βρέθηκαν σε υψηλή συχνότητα (38/60, 63.3%), σε δείγματα ασθενών με ηπατίτιδα Β, που δεν είχαν λάβει ποτέ θεραπεία με νουκλεοσ(τ)ιδικά ανάλογα. Σε 41 δείγματα ασθενών με HBV λοίμωξη, που είχαν λάβει θεραπεία, εκτός από τις μεταλλαγές αντοχής με επικρατούντα ιϊκό υποπληθυσμό, ανιχνεύθηκαν και ιϊκοί υποπληθυσμοί με μικρότερους λόγους, που πιθανόν να είχαν συμβάλλει στη συνολική εκδήλωση αντοχής για τον κάθε ασθενή.ΣΥΜΠΕΡΑΣΜΑΤΑ: Η μέθοδος ΑRMS rt-PCR με μοριακό φάρο παρουσιάζει συγκρίσιμη ευαισθησία, πιστότητα και διακριτική ικανότητα με άλλες εξαιρετικά ευαίσθητες μοριακές μεθόδους, όπως είναι το ultra-deep sequencing, αλλά πλεονεκτεί σε θέματα κόστους για την ανίχνευση των ιϊκών υποπληθυσμών του ιού της ηπατίτιδας Β με τις κυριότερες μεταλλαγές αντοχής

Outpatient parenteral antimicrobial therapy (OPAT) in the UK: a cross-sectional survey of acute hospital trusts and health boards

This study reviews the current OPAT service provision in the UK and evaluates concordance with the national OPAT practice guidelines (standards of care). We conducted a survey of acute hospital trusts and health boards in the UK regarding OPAT practices between June and September 2017. 165 (93%) of the 178 acute hospital trusts/health boards that were contacted responded to the survey. 100 (61%) indicated they had an OPAT service. Ten (10%) OPAT services did not involve an infection specialist. Bone and joint infections, and skin and soft-tissue infections were the most common conditions treated. Most OPAT services (74%) hold weekly multidisciplinary meetings/virtual ward rounds to review patient’s progress. 73% had a dedicated OPAT database. We identified variations in practice and concordance with the national OPAT good practice guidelines. In an era of increasing demand for home-based care, further studies are required to identify the optimal configuration of OPAT services with regards to quality and patient safety. (C) 2018 Elsevier Inc. All rights reserved

Daptomycin for treatment of patients with bone and joint infections: a systematic review of the clinical evidence

The treatment of bone and joint infections, mainly caused by Gram-positive pathogens, can be difficult and quite challenging since it frequently involves prolonged administration of antibiotics as well as appropriate surgical procedures. First-line drugs have failed in some cases to cure the underlying infection. We performed a systematic review of the available evidence to clarify further the effectiveness and safety of daptomycin in the treatment of bone and joint infections. Cure of infection was achieved in 43/53 cases (81.1%). The results of the reviewed articles are promising with regard to the effectiveness and safety profile of this new antibiotic for bone and joint infections that are not responsive to other traditionally used antimicrobial agents. Although these reports are encouraging, the relatively frequent emergence of antimicrobial resistance associated with prolonged administration of daptomycin should be considered seriously. (C) 2007 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved

The clinical evidence and the role of imiquimod in the extramammary Paget disease

Extramammary Paget disease is a rare disease. Different treatment options are used for its management, among them treatment with imiquimod. Our aim is to clarify the efficacy and safety of the use of topical imiquimod cream in the treatment of extramammary Paget disease.In this article the current literature in Pubmed and Scopus on this topic is reviewed.According to the literature the topical use of imiquimod can be used as first-line treatment in different dosages and durations with excellent results, reaching a 87.5% cure rate with rare complications. The available evidence is currently limited to case reports and a single case series, but is definitely in favor of imiquimod use as an alternative treatment for extramammary Paget disease.</p