Antimicrobial treatment of Corynebacterium striatum invasive infections: a systematic review

The aim of this study was to establish an evidence-based guideline for the antibiotic treatment of Corynebacterium striatum infections. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with systemic inflammatory response syndrome, harboring C. striatum isolated from body fluids or tissues in which it is not normally present. C. striatum had to be identified as the only causative agent of the invasive infection, and its isolation from blood, body fluids or tissues had to be confirmed by one of the more advanced diagnostic methods (biochemical methods, mass spectrometry and/or gene sequencing). This systematic review included 42 studies that analyzed 85 individual cases with various invasive infections caused by C. striatum. More than one isolate of C. striatum exhibited 100% susceptibility to vancomycin, linezolid, teicoplanin, piperacillin-tazobactam, amoxicillin-clavulanate and cefuroxime. On the other hand, some strains of this bacterium showed a high degree of resistance to fluoroquinolones, to the majority majority of β-lactams, aminoglycosides, macrolides, lincosamides and cotrimoxazole. Despite the antibiotic treatment, fatal outcomes were reported in almost 20% of the patients included in this study. Gene sequencing methods should be the gold standard for the identification of C. striatum, while MALDI-TOF and the Vitek system can be used as alternative methods. Vancomycin should be used as the antibiotic of choice for the treatment of C. striatum infections, in monotherapy or in combination with piperacillin-tazobactam. Alternatively, linezolid, teicoplanin or daptomycin may be used in severe infections, while amoxicillin-clavulanate may be used to treat mild infections caused by C. striatum

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Factors Influencing Hookah Smoking in High School Students

© 2018 Minela Z. Vapljanin, published by Sciendo. In recent years, the prevalence of hookah smoking has increased worldwide, particularly in young people, which may have potentially serious consequences for their health. The aim of this study was to examine the factors associated with the consumption of hookah by high school students. The present study was conducted in the city of Novi Pazar, and students aged 17-19 years attending the following high schools were included: Medical School, Grammar School, Economic-Commerce School and Catering School. The study was designed as a case-control study. The cases were students who consumed nargile, while the control group consisted of students who had never smoked nargile. A special questionnaire was constructed for the purpose of this research, which was used to evaluate the opinions of adolescents on the consumption of nargile. Our research included a total of 270 seniors in high schools in Novi Pazar. The average age of the students was 18 years. The most important factors that may contribute to start using nargile were: previous consumption of nargile by older family members, divorced parents, and active smoking of cigarettes by other family members. Most students emphasized that hookah smoking is socially unacceptable form of behavior. Also, hookah smoker were neither more attractive nor popular. Nargile consumption is more common by adolescents whose parents are divorced, as well as by adolescents whose family members are smoking nargile or tobacco. The most common reason for nargile consumption among adolescents is a desire for relaxation

Performance of a calculator for diagnosing the cause of liver damage

© 2019, Serbia Medical Society. All rights reserved. Introduction/Objective Making a calculator that would recognize patterns of abnormal liver function tests and link them to the most probable etiology could help clinicians in their initial orientation towards a definitive diagnosis in patients with liver damage. The aim of our study was to design, construct, and validate a calculator that based on a pattern of abnormalities in liver function tests of a patient with liver damage would propose the most probable etiologyMethods Patterns of abnormal liver function tests for certain etiology of liver damage were extracted from distributions of actual values taken from reports in medical literature about patients whose etiology of liver damage was proven by reliable diagnostic tests. After setting up the calculator with the patterns extracted, its diagnostic value was checked under real-life conditions, on a sample of patients with liver damage whose etiology was established by the gold standard of diagnostics (biopsy or else)The calculator validation study was carried out at the Military Medical Academy in Belgrade during a two-year period (2015–2016). Results For all tested diagnoses, the calculator demonstrated a highly significant difference between the area under the receiver-operator curves’ values and the value of 0.5 (p < 0.001), and high level of sensitivity (more than 90%, except for the model for chronic hepatitis) as well as relatively high specificity (more than 75%) were noted, indicating good ability of the calculator to detect etiology of liver damageConclusion New calculators showed satisfactory sensitivity and specificity for revealing major liver damage etiologies

Antimicrobial treatment of Erysipelatoclostridium ramosum invasive infections: a systematic review

The aim of this systematic review was to determine the causal role of Erysipelatoclostridium ramosum in specific invasive infections in humans, and to assess the clinical outcome of antibiotic therapy used to treat them. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with a systemic inflammatory response syndrome (SIRS) due to E. ramosum isolated from body fluids or tissues in which it is not normally present. Only reports identifying E. ramosum as the only microorganism isolated from a patient with SIRS were included. This systematic review included 15 studies reporting 19 individual cases in which E. ramosum caused invasive infections in various tissues, mainly in immunocompromised patients. E. ramosum was most often isolated by blood cultures and identified by specific biochemical tests. Severe infections caused by E. ramosum were in most cases effectively treated with antibiotics, except in two patients, one of whom died. More than one isolate of E. ramosum exhibited 100% susceptibility to metronidazole, amoxicillin/clavulanate and piperacillin/tazobactam. On the other hand, individual resistance of this bacterium to penicillin, ciprofloxacin, clindamycin, imipenem and ertapenem was reported. This systematic review confirmed the clinical relevance of E. ramosum as a cause of a number of severe infections mainly in immunocompromised inpatients. Metronidazole and meropenem appear to be the antibiotics of choice that should be used in combination or as monotherapy to treat E. ramosum infections, depending on the type and severity of the infection

Factors associated with early treatment failure in adult hospitalized patients with community-acquired pneumonia

© 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved. Background/Aim. Early treatment failure (ETF) in patients hospitalized for community-acquired pneumonia (CAP) is associated with prolonged hospitalization, increased risk of mortality and high treatment costs. The aim of this study was to analyze the relative importance of factors influencing ETF in hospitalized adult patients with CAP that are still insufficiently explored. Methods. A retrospective casecontrol study was carried out on a sample of 126 adult patients treated for serious CAP at the Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia, during the 5-year period (2007-2011). The cases (n = 63) were consecutive patients with ETF, observed within the three days upon the admission to hospital, while the control group consisted of the equal number of randomly selected patients without such an outcome. The association between potential risk/protective factors and ETF was estimated using logistic regression analysis. Results. The coexistence of gastrointestinal disorders [adjusted odds ratio (OR) 18.83, 95% confidence interval (CI) 1.15-309.04], higher CURB-65 (C - confusion; U - urea 7 mmol/L; R - respiratory rate ≥ 30 breaths/min; B - systolic blood pressure < 90 mmHg or diastolic blood pressure ≤ 60 mmHg; 65 - age ≥ 65 years) score on admission (adjusted OR 2.57, 95%CI 1.05-6.25), initial use of nonsteroidal anti-inflammatory drugs (NSAIDs) in hospital (adjusted OR 38.19, 95%CI 3.61-404.51) and previous outpatient use of inhaled corticosteroids (adjusted OR 22.41, 95%CI 1.03-489.06) were found to be significant risk factors for ETF. On the other hand, older age and use of antibiotics before the hospitalization were associated with a significantly lower chance of experiencing ETF, reducing the odds for 98% and almost 90%, respectively. Conclusion. The avoidance of the routine in-hospital use of NSAIDs as well as the outpatient use of appropriate antibiotics may be beneficial for patients hospitalized for CAP in terms of reducing the risk of ETF. The CURB-65 score could be a better predictor of ETF than Pneumonia Severity Index. Further prospective studies are required to confirm these findings

Antimicrobial treatment of erysipelatoclostridium ramosum invasive infections: A systematic review

The aim of this systematic review was to determine the causal role of Erysipelatoclostridium ramosum in specific invasive infections in humans, and to assess the clinical outcome of antibiotic therapy used to treat them. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with a systemic inflammatory response syndrome (SIRS) due to E. ramosum isolated from body fluids or tissues in which it is not normally present. Only reports identifying E. ramosum as the only microorganism isolated from a patient with SIRS were included. This systematic review included 15 studies reporting 19 individual cases in which E. ramosum caused invasive infections in various tissues, mainly in immunocompromised patients. E. ramosum was most often isolated by blood cultures and identified by specific biochemical tests. Severe infections caused by E. ramosum were in most cases effectively treated with antibiotics, except in two patients, one of whom died. More than one isolate of E. ramosum exhibited 100% susceptibility to metronidazole, amoxicillin/clavulanate and piperacillin/tazobactam. On the other hand, individual resistance of this bacterium to penicillin, ciprofloxacin, clindamycin, imipenem and ertapenem was reported. This systematic review confirmed the clinical relevance of E. ramosum as a cause of a number of severe infections mainly in immunocompromised inpatients. Metronidazole and meropenem appear to be the antibiotics of choice that should be used in combination or as monotherapy to treat E. ramosum infections, depending on the type and severity of the infection

Antimicrobial treatment of corynebacterium striatum invasive infections: A systematic review

The aim of this study was to establish an evidence-based guideline for the antibiotic treatment of Corynebacterium striatum infections. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with systemic inflammatory response syndrome, harboring C. striatum isolated from body fluids or tissues in which it is not normally present. C. striatum had to be identified as the only causative agent of the invasive infection, and its isolation from blood, body fluids or tissues had to be confirmed by one of the more advanced diagnostic methods (biochemical methods, mass spectrometry and/or gene sequencing). This systematic review included 42 studies that analyzed 85 individual cases with various invasive infections caused by C. striatum. More than one isolate of C. striatum exhibited 100% susceptibility to vancomycin, linezolid, teicoplanin, piperacillin-tazobactam, amoxicillin-clavulanate and cefuroxime. On the other hand, some strains of this bacterium showed a high degree of resistance to fluoroquinolones, to the majority majority of β-lactams, aminoglycosides, macrolides, lincosamides and cotrimoxazole. Despite the antibiotic treatment, fatal outcomes were reported in almost 20% of the patients included in this study. Gene sequencing methods should be the gold standard for the identification of C. striatum, while MALDI-TOF and the Vitek system can be used as alternative methods. Vancomycin should be used as the antibiotic of choice for the treatment of C. striatum infections, in monotherapy or in combination with piperacillin-tazobactam. Alternatively, linezolid, teicoplanin or daptomycin may be used in severe infections, while amoxicillin-clavulanate may be used to treat mild infections caused by C. striatum

Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit

© 2019 Dejan Z. Aleksic et al. Background: Clinically relevant potential drug-drug interactions are considered preventable adverse drug reactions. Objective: The aim of this study was to ascertain the frequency of potential drug-drug interactions in acute ischemic stroke patients and to explore factors associated with occurrence of potentially contraindicated drug-drug interactions. Methods: This observational retrospective cohort and nested case-control study was carried out among patients treated for acute ischemic stroke at the Neurological Intensive Care Unit in the Clinical Centre Kragujevac, Serbia. The potentially drug-drug interactions for each day of hospitalization were identified using Micromedex® software. Based on the existence or absence of potentially contraindicated drug-drug interactions, the participants were divided into a group of cases (n=111) and the control group (n=444). Results: A total of 696 patients were analysed. All patients had a minimum of one potential drug-drug interaction during hospitalization. The most common drugs involved in potential drug-drug interactions were aspirin (8.02%), diclofenac (7.49%) and warfarin (7.14%). The number of medications prescribed for simultaneous use during hospitalisation and the use of antipsychotics in therapy significantly increased the likelihood of potentially contraindicated drug-drug interactions after adjustment by means of logistic regression for 1.2 and 3 times, respectively. Conclusions: This study suggests that patients with acute ischemic stroke are frequently exposed to potential drug-drug interactions. It is essential to identify potentially drug-drug interactions in these patients as early as possible in order to prevent adverse drug reactions and ensure safe recovery. Besides, full attention should be paid when adding each new medication in therapy, particularly when a neurologist decides to prescribe antipsychotics, such as risperidone

Hyperprolactinemia: Diagnosis and treatment principles

Prolactin (PRL) is a peptide hormone that consists of 198 aminoacids and synthesizes in lactotrophs which present about 20 % of cells in hypophysis. The levels of prolactin can be increased due to physical and psychological stress, temperature, increased physical activity, general anesthesia, acute coronary syndrome and meals. The secretion of prolactin is under tonic inhibitory control by hypothalamic dopamine. Prolactinomas are benign pituitary tumors of lactotrophs in adenohypophysis, with unknown etiology. Clinical symptoms and signs of hyperprolactinemia in women include amenorrhea, infertility, and galactorrhea, and decreased libido and visual impairment in men. Dopamine agonists decrease tumor mass in the majority of patients and are used as the primary therapy. The therapy should be initiated at a low dose, which should be increased slowly to minimize side effects, such as gastrointestinal symptoms and orthostatic hypotension. Pituitary function should be tested in patients with micro and macroadenomas until normalizing PRL level and recovering hypogonadism. Repeat MR of hypophysis and visual field testing are mandatory when tumors are adjacent to the optic chiasm. Dopamine agonists are not approved for use during pregnancy and should be discontinued once pregnancy occurs. A normal serum prolactin level is the goal in treating hyperprolactinemia, decreasing galactorrhea and symptoms of hypogonadism, as well as reduction of tumor mass. Dopamine agonists are recommended for first-line therapy and typically decrease both prolactin levels and tumor mass, thereby relieving symptoms