Acral necrosis by Stenotrophomonas maltophilia

Keywords:necrosis;skin and soft tissue infection;Stenotrophomonas maltophilia Abstract Background Stenotrophomonas maltophilia (SM) has been considered a nosocomial pathogen. Nevertheless, community acquired infection may occur more frequently than usually recognized. Case We describe distal necrosis of the fingers by SM in a farmer, contracted in the community and successfully treated with a combination of cotrimoxazole and ciprofloxacin. The patient was diagnosed with chronic lymphocytic leukaemia 6 months later. Conclusions This unusual presentation shows that infection with SM should be included in the differential diagnosis of the skin and soft tissue infection, even in apparently healthy patients

A warfarin induction regimen for out-patient anticoagulation in patients with atrial fibrillation

Currently available protocols for induction of warfarin anticoagulation employ initial doses of 10 mg and are best suited to in‐patient use. However, with the increasing number of elderly patients with atrial fibrillation requiring anticoagulation, there is a need for a less intense regimen which could be used for out‐patients. We have established such a regimen and report on its prospective evaluation in 37 patients referred for out‐patient initiation of warfarin, and a non‐randomized comparison with 37 in‐patients, with similar diagnoses, commenced on a traditional warfarin protocol. After exclusion of five patients on amiodarone, all of whom experienced supratherapeutic International Normalized Ratio (INR) results, the new out‐patient regimen, employing an initial 5 mg dose, resulted in a lower maximum INR during the first 21 d therapy (median 2.9 v 4.0; P = 0.0001) and fewer INRs > 4.5 (2/36 v 9/33) compared to the traditional 10 mg regimen. Time to reach stable anticoagulation was similar with each regimen; however, the 5 mg regimen gave a more accurate prediction of maintenance dose (correlation coefficient for predicted versus actual maintenance dose, r = 0.985). In comparison to a traditional 10 mg protocol, the proposed 5 mg warfarin induction regimen proved both safer and more reliable for initiation of prophylactic anticoagulation in patients with atrial fibrillation

Stenotrophomonas maltophilia: an increasing problem in patients with acute leukaemia

Stenotrophomonas maltophilia (previously Pseudomonas maltophilia and Xanthomonas maltophilia) is an increasing problem as an opportunistic pathogen in immunocompromised patients such as those with acute leukaemia. Infection is difficult to treat and eradicate due to its inherent and quickly acquired resistance to many antibiotics. Presentation with unusual cutaneous lesions is not uncommon and can present diagnostic difficulties. We present two cases which highlight the classical features of this infection in leukaemic patients, and discuss the need for early antibiotic treatment with regimens including cotrimoxazole, and the consideration of prompt central venous catheter removal

Antithrombin concentrate alone may not prevent venous thromboembolism following neurosurgery

No abstract available

Los conceptos que inspiran el trabajo de los psicoanalistas de pareja y familia: Estudio preliminar del análisis cuantitativo en el contenido de una encuesta

The author's purpose in the present paper is to explore core psychoanalytic concepts that lend support to clinical practice for the members of the International Association of Psychoanalysis of Couple and Family (AIPPF). To achieve this goal the authors have developed a tool that allows to collect information (self-administered questionnaire), briefly presented. The questionnaire requests each member to sort out important concepts in the five following areas: individual psychoanalysis, intersubjective psychoanalysis, group psychoanalysis, family psychoanalysis, couple psychoanalysis, as well as to outline these concepts on three levels: theory, clinic, practice and technique. The sample obtained corresponds to 22 responses which the authors discuss and analyze in detail. In their conclusions, the authors draw attention to the fact that different theoretical orientations are present in couple and family therapy and that the responses to the questionnaire were pondered and on occasion are original and manifest current notions. It can also be observed that current change in family configurations has marked the standpoint concerning certain clinical aspects and links. The authors conclude by highlighting the value of this work to develop new research on more specific aspects, among which several subjected to a more refined approach in recent studies in the institution are mentioned.En este trabajo los autores se proponen explorar qué conceptos psicoanalíticos centrales que hacen de soporte de la práctica clínica para los miembros de la Asociación Internacional de Psicoanálisis de Pareja y Familia (AIPPF). Para ello los autores han desarrollado un instrumento que permite recolectar la información (cuestionario autoadministrado), que exponen brevemente. En el cuestionario se le solicita a cada miembro que mencione los conceptos de importancia en cinco terrenos: psicoanálisis individual, psicoanálisis intersubjetivo, psicoanálisis de grupo, psicoanálisis de familia, psicoanálisis de pareja, y que especifique dichos conceptos en tres niveles: el de la teoría, el de la clínica, el de la práctica y técnica. La muestra obtenida corresponde a 22 respuestas, que los autores comentan y analizan en detalle. En sus conclusiones, los autores destacan que, respecto de la terapia de pareja y familia, están presentes diferentes orientaciones teóricas, que las respuestas al cuestionario han sido meditadas, y que en ocasiones resultan originales y con un aire de modernidad. También se observa que el cambio en las configuraciones familiares en la actualidad ha dejado una marca en los modos de pensar algunos aspectos de la clínica y de los vínculos. Los autores terminan el trabajo destacando la utilidad de este trabajo para desarrollar nuevas investigaciones sobre aspectos más puntuales, entre los cuales mencionan varios que están siendo objeto de un enfoque más refinado en estudios recientes en la institución

Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay

The nutritional status of patients prior to peripheral blood stem cell transplantation (PBSCT) and its impact on length of hospital stay is not well described in the literature. The nutritional status of 66 consecutive patients (46 m:20 f); and the mean age 58.7plusminus12.0 years was determined a maximum of 2 weeks pre-transplantation using the scored Patient-Generated-Subjective Global Assessment (PG-SGA). According to the global assessment, 73% patients were well nourished, 23% moderately malnourished and 4% severely malnourished. There was a significant difference in post transplant length of stay (mean differenceplusminuss.e.m. -7.0plusminus2.1 days) between well-nourished and malnourished patients and a trend towards higher mortality in the malnourished group (2 vs 20%). Although 89% of patients described no problems eating, two or more nutrition impact symptoms were reported in 30% of patients. From stepwise multiple regression analysis, nutritional status as determined by PG-SGA score was significantly associated with length of stay, accounting for 12% of the variance. In conclusion, malnutrition prior to PBSCT is associated with increased length of stay. Routine nutrition assessment of patients prior to PBSCT should be undertaken

Suplementos orais artesanais desenvolvidos para pacientes com câncer: análise descritiva Homemade oral supplements for patients with cancer: descriptive analysis

OBJETIVO: Descrever a elaboração de oito formulações de suplementos artesanais orais desenvolvidos para aumentar o consumo de energia, proteínas e micronutrientes de pacientes com câncer, analisar seu valor nutricional e avaliar a apreciação do sabor, testando dois tipos de lipídeos. MÉTODOS: Os suplementos foram desenvolvidos com base em quatro ingredientes alimentares: leite, ovos, açúcares e óleos para recuperação nutricional. As formulações foram calculadas pelo programa de apoio à nutrição NUTWIN e seu valor nutricional foi comparado às recomendações para pacientes com câncer para macronutrientes e às Ingestões Diárias Recomendadas para micronutrientes. Por meio de degustação, os suplementos foram testados para verificação do sabor quando preparados com óleo ou margarina. RESULTADOS: A quantidade de energia por mililitro variou de 1,35 a 2,17kcal, tendo 39% a 59% de carboidrato, 11% a 13% de proteína e 30% a 49% de lipídeo, fornecendo em média 43% e 77% da recomendação de energia e proteína, respectivamente. Vitaminas C e K, ácido fólico e manganês apresentaram 15% de adequação em relação às recomendações. Com relação ao sabor, 78% dos pacientes que experimentaram com óleo e 85% dos que experimentaram com margarina relataram sabor bom, sem diferença estatística entre os tipos de suplementos. CONCLUSÃO: A avaliação do sabor demonstrou que a maioria dos pacientes considerou o suplemento com sabor bom. Essas taxas foram superiores quando testados com margarina. Os resultados sugerem que o uso de suplementos orais artesanais pode ser uma alternativa viável em situações onde não há recursos suficientes para aquisição dos industrializados.<br>OBJECTIVE: This study aimed to describe the development of eight formulations of homemade oral supplements that propose to increase the energy, protein and micronutrient intakes of patients with cancer, analyze its nutritional value and assess its taste using two different fat sources. METHODS: The supplements were based on four ingredients: milk, eggs, sugars and oils for nutritional recovery. The formulations were calculated by the nutritional support software NUTWIN. The nutritional value of the formulations was compared with the recommendations for cancer patients for macronutrients and with the Recommended Daily Intakes for micronutrients. The supplements were tested. The supplements underwent taste tests to determine if the patients preferred supplements prepared with oil or margarine. RESULTS: The amount of energy per milliliter varied from 1.35 to 2.17kcal. The carbohydrate content varied from 39% to 59%, protein content from 11% to 13% and fat content from 30% to 49%, providing roughly 43% and 77% of the recommended energy and protein intake, respectively. The contents of vitamins C and K, folic acid and manganese represented 15% of the recommended daily intakes. More patients approved the taste of the supplements prepared with margarine (85%) than with oil (78%) but the difference was not significant. CONCLUSION: Taste tests showed that most patients liked the taste of the supplements. Supplements prepared with margarine had better acceptance. The results suggest that the use of homemade oral supplements can be a viable alternative for people who do not have the resources to buy commercial oral supplements