Growth hormone as concomitant treatment in severe fibromyalgia associated with low IGF-1 serum levels. A pilot study

<p>Abstract</p> <p>Background</p> <p>There is evidence of functional growth hormone (GH) deficiency, expressed by means of low insulin-like growth factor 1 (IGF-1) serum levels, in a subset of fibromyalgia patients. The efficacy of GH versus placebo has been previously suggested in this population. We investigated the efficacy and safety of low dose GH as an adjunct to standard therapy in the treatment of severe, prolonged and well-treated fibromyalgia patients with low IGF-1 levels.</p> <p>Methods</p> <p>Twenty-four patients were enrolled in a randomized, open-label, best available care-controlled study. Patients were randomly assigned to receive either 0.0125 mg/kg/d of GH subcutaneously (titrated depending on IGF-1) added to standard therapy or standard therapy alone during one year. The number of tender points, the Fibromyalgia Impact Questionnaire (FIQ) and the EuroQol 5D (EQ-5D), including a Quality of Life visual analogic scale (EQ-VAS) were assessed at different time-points.</p> <p>Results</p> <p>At the end of the study, the GH group showed a 60% reduction in the mean number of tender points (pairs) compared to the control group (p < 0.05; 3.25 ± 0.8 <it>vs</it>. 8.25 ± 0.9). Similar improvements were observed in FIQ score (p < 0.05) and EQ-VAS scale (p < 0.001). There was a prompt response to GH administration, with most patients showing improvement within the first months in most of the outcomes. The concomitant administration of GH and standard therapy was well tolerated, and no patients discontinued the study due to adverse events.</p> <p>Conclusion</p> <p>The present findings indicate the advantage of adding a daily GH dose to the standard therapy in a subset of severe fibromyalgia patients with low IGF-1 serum levels.</p> <p>Trial Registration</p> <p>NCT00497562 (ClinicalTrials.gov).</p

Auswirkungen der COVID-19-Pandemie auf nosokomiale Blutstrominfektionen durch multiresistente Bakterien und auf den Antibiotikaverbrauch in einem Krankenhaus der Tertiärversorgung

We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.Es wurden die Veränderungen in der Epidemiologie nosokomialer Blutstrominfektionen (BSI) durch multiresistente Bakterien und die Antibiotika-Verbrauchsraten während der COVID-19 Pandemie in einem mit an COVID-19 Erkrankten belegten Krankenhaus und der Onkologischen Klinik auf demselben Universitätsgelände ohne Belegung mit COVID-19 Patienten untersucht. Im Pandemiekrankenhaus wurde ein signifikanter Anstieg der Infektionsdichte (IDR) von BSI, verursacht durch Carbapenem-resistente Acinetobacter baumannii (CRAB) und Ampicillin-resistente Enterococcus faecium (ARE), festgestellt, während Carbapenem-resistente Klebsiella pneumoniae BSI in der nicht-pandemischen Onkologischen Klinik erhöht waren. Die Pulsfeld-Gel-Elektrophorese zeigte einen polyklonalen Ausbruch von CRAB auf den COVID-19-Intensivstationen. Der Antibiotikaverbrauch war bei fast allen Antibiotika erhöht, am stärksten bei Meropenem in beiden Krankenhäusern. Erhöhte IDRs von CRAB und ARE BSIs sowie ein erhöhter Verbrauch von Breitspektrum-Antibiotika unterstreichen die Bedeutung einer multimodalen Strategie zur Infektionsprävention in Kombination mit einem aktiven Antibiotic-Stewardship-Programm