Lancet

Background Contrast nephropathy is associated with increased in-hospital morbidity and mortality and leads to extension of hospital stay in patients with chronic renal insufficiency. Acetylcysteine seems to be a safe and inexpensive way to reduce contrast nephropathy. We aimed to assess the efficacy of acetylcysteine to prevent contrast nephropathy after administration of radiocontrast media in patients with chronic renal insufficiency. Methods We did a meta-analysis of randomised controlled trials comparing acetylcysteine and hydration with hydration alone for preventing contrast nephropathy in patients with chronic renal insufficiency. The trials were identified through a combined search of the BIOSIS+/RRM, MEDLINE, Web of Science, Current Contents Medizin, and The Cochrane Library Databases. We used incidence of contrast nephropathy 48 h after administration of radiocontrast media as an outcome measure. Findings Seven trials including 805 patients were eligible according to our inclusion criteria and were analysed. Overall incidence of contrast nephropathy varied between 8% and 28%. Since significant heterogeneity was indicated by the Q statistics (p=0·016) we used a random-effects model to combine the data. Compared with periprocedural hydration alone, administration of acetylcysteine and hydration significantly reduced the relative risk of contrast nephropathy by 56% (0·435 [95% CI 0·215–0·879], P=0·02) in patients with chronic renal insufficiency. Meta-regression revealed no significant relation between the relative risk of contrast nephropathy and the volume of radiocontrast media administered or the degree of chronic renal insufficiency before the procedure. Interpretation Compared with periprocedural hydration alone, acetylcysteine with hydration significantly reduces the risk of contrast nephropathy in patients with chronic renal insufficiency. The relative risk of contrast nephropathy was not related to the amount of radiocontrast media given or to the degree of chronic renal insufficiency before the procedure

Fungal biofilms in human disease

Fungal biofilms are an important clinical problem. A number of factors including the increasing use of indwelling medical devices wider prescription of broad spectrum antibiotics and an aging and more immuno-compromised patient population has combined to create an opportunity for yeasts and moulds to cause infection. It is also becoming increasingly clear that for a number of serious infections the development of a fungal biofilm is important in the pathophysiology of the infection.<p></p> This chapter will discuss the importance of fungal biofilms in different anatomical areas, will try to provide insights into how fungal biofilm infection should be diagnosed and treated and provide an explanation as to why biofilms may be difficult to treat effectively with routine antifungal regimens.<p></p> Finally it will discuss how our current level of knowledge of the development and biology of fungal biofilms may, in future, lead to a wider choice of therapeutic interventions.<p></p&gt

Yeast Biofilms

Yeast biofilms are an escalating clinical problem, which affect both the healthy and immunocompromised, and are related to significant rates of mortality within hospitalized patients. Candida albicans is the most notorious yeast biofilm former and as a result the most widely studied; however, other Candida species and yeasts such as Cryptococcus neoformans are also implicated in biofilm-associated infections. Yeast biofilms have distinct developmental phases, including adhesion, colonization, maturation and dispersal, which have been examined utilizing various in vitro and in vivo model systems. Furthermore, the complex molecular events governing biofilm development are slowly being elucidated, including the role of quorum sensing. Clinically, biofilms act as reservoirs for systemic infection, and also induce localized pathology and tissue damage. However, the key virulence factor is their recalcitrance to antifungal therapy. This chapter will discuss our current understanding of the role that yeast biofilms play in the clinical setting