Portal Hypertension Related to Schistosomiasis Treated with a Transjugular Intrahepatic Portosystemic Shunt

Hepatosplenic schistosomiasis represents the most common form of chronic intestinal schistosomiasis. Liver periportal fibrosis, leading to portal hypertension, is the major cause of disease morbidity and mortality, due to massive bleeding of esophageal or gastric varices.

Could molecular assessment of calcium metabolism be a useful tool to early screen patients at risk for pre-eclampsia complicated pregnancy? Proposal and rationale.

Abstract One of the most frequent causes of maternal and perinatal morbidity is represented by hypertensive disorders during pregnancy. Women at high risk must be subjected to a more intensive antenatal surveillance and prophylactic treatments. Many genetic risk factors, clinical features and biomarkers have been proposed but none of these seems able to prevent pre-eclampsia onset. English literature review of manuscripts focused on calcium intake and hypertensive disorders during pregnancy was performed. We performed a critical analysis of evidences about maternal calcium metabolism pattern in pregnancy analyzing all possible bias affecting studies. Calcium supplementation seems to give beneficial effects on women with low calcium intake. Some evidence reported that calcium supplementation may drastically reduce the percentage of pre-eclampsia onset consequently improving the neonatal outcome. Starting from this evidence, it is intuitive that investigations on maternal calcium metabolism pattern in first trimester of pregnancy could represent a low cost, large scale tool to screen pregnant women and to identify those at increased risk of pre-eclampsia onset. We propose a biochemical screening of maternal calcium metabolism pattern in first trimester of pregnancy to discriminate patients who potentially may benefit from calcium supplementation. In a second step we propose to randomly allocate the sub-cohort of patients with calcium metabolism disorders in a treatment group (calcium supplementation) or in a control group (placebo) to define if calcium supplementation may represent a dietary mean to reduce pre-eclampsia onset and to improve pregnancy outcome

Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis

Importance: Meropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes. Objective: To determine whether continuous administration of meropenem reduces a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis. Design, setting, and participants: A double-blind, randomized clinical trial enrolling critically ill patients with sepsis or septic shock who had been prescribed meropenem by their treating clinicians at 31 intensive care units of 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia). Patients were enrolled between June 5, 2018, and August 9, 2022, and the final 90-day follow-up was completed in November 2022. Interventions: Patients were randomized to receive an equal dose of the antibiotic meropenem by either continuous administration (n = 303) or intermittent administration (n = 304). Main outcomes and measures: The primary outcome was a composite of all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. There were 4 secondary outcomes, including days alive and free from antibiotics at day 28, days alive and free from the intensive care unit at day 28, and all-cause mortality at day 90. Seizures, allergic reactions, and mortality were recorded as adverse events. Results: All 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients). Conclusions and relevance: In critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. Trial registration: ClinicalTrials.gov Identifier: NCT03452839

Sero-epidemiological survey of Neospora caninum infection in dogs in north-eastern Italy

Risk factors associated with Neospora caninum seroprevalence in north-eastern Italy in healthy dogs were assessed. Antibodies to N. caninum were found in 10.9% of 707 kennel and owned dogs by a commercial competitive ELISA (VMRD(R) Inc.). All dogs were negative for Leishmania infantum by indirect fluorescent antibody test indicating no cross reactivity or association between the two protozoa in this area. Seroprevalence association with breed and age of dogs and other factors are discussed

Validation of a commercially available cELISA test for canine neosporosis against an indirect fluorescent antibody test (IFAT)

A commercially available competitive enzyme-linked immunosorbent assay (cELISA, VMRD (R)) was validated for the detection of Neospora caninum antibodies in the serum of dogs, using as a reference test an indirect fluorescent antibody test (IFAT, Fuller (R)). A partial verification approach Was used. A total of 618 dogs were screened with cELISA and a subset of positive and negative sera (n = 237) were then tested with IFAT. Naive relative sensitivity (SE,) and naive relative specificity (SPnv) of cELISA were calculated and then corrected (SEcorr SPcorr) for studies with partial validation. Results showed a SEnv of 72% and a SPnv of 89.3%; corrected estimates showed a SEcorr of 47% and a SPcorr of 96%. ROC analysis showed that the cutoff recommended by the Manufacturer (30%) corresponded to the highest naive sensitivity (72%) combined with a good naive specificity (90%) of cELISA. Corrected estimates of SE and SP for partial verification method revealed that SE of the cELISA is lower and SP is higher than naive estimates. The results Suggest to use this test for confirmation of a clinical suspicion of neosporosis, and to use some techniques for adjustment of misclassification in prevalence and risk-factor studies