Lessons From a Diabetes Clinic: Achieving Glycemic Goals and Clinical Use of Antidiabetic Agents in Patients With Type 2 Diabetes.

The proportion of patients with type 2 diabetes who achieve their glycemic goals remains low. We examined medical records and A1C results from patient visits to our referral diabetes center between 21 March to 20 July 2018. After stratifying patients into four groups-monotherapy, dual therapy, triple therapy, or insulin therapy-we found that the target A1C of ≤7.0% was achieved by 86% of patients and that A1C was uniformly low across the treatment categories. Our individualized approach, which included high use of glucagon-like peptide-1 receptor agonists and low use of sulfonylureas, may have contributed to these results.

Disseminated Bartonella henselae disease mimicking Langerhans' cell histiocytosis.

Bartonella henselae, the causative agent of cat-scratch disease, has been recognized to be responsible for a broad range of clinical syndromes. We report the case of a patient with disseminated B. henselae infection mimicking Langerhans cell histiocytosis at presentation and its successful management with neurosurgery, prolonged antibacterial therapy, and observation.

Bing-Neel Syndrome: Real-Life Experience in Personalized Diagnostic Approach and Treatment.

The involvement of the central nervous system (CNS) in Waldenström's Macroglobulinemia (WM) is a rare extramedullary manifestation of the disease known as Bing-Neel syndrome (BNS). To expand our understanding of this disease manifestation, we conducted a retrospective analysis of the incidence of BNS in 86 consecutive patients with WM [70% male, median age 65 years (range 33-86)] seen in our center during a 30-year period. Six patients (7%) from this group were diagnosed with BNS. The median period of time between WM diagnosis and BNS diagnosis was 6.8 years (range 2.3-15). They demonstrated a range of neurological deficits, including transient expressive aphasia, impaired vision, resting hand tremor, foot drop, and headache. Between the onset of symptoms and the diagnosis of BNS, the median time interval was 12.5 months (range 1-30). The diagnosis was made not on the basis of neurological symptoms or radiological evidence, but on the basis of the presence of WM cells in cerebrospinal fluid (CSF). Intrathecal chemotherapy with methotrexate, cytarabine, and dexamethasone (IT MTX, ARA-C, DEX) was used as front-line treatment, followed by intensive immunochemotherapy with rituximab, high-dose MTX, and ARA-C (R-Hi MTX/ARA-C) in three patients who were fit enough to receive this type of cytotoxic regimen, and rituximab plus bendamustine (R-Benda) in two patients who simultaneously required treatment for WM. Ibrutinib was administered to five patients (three as consolidation and two for initial treatment). All patients responded to front-line treatment, with four (67%) achieving partial response (PR) and two (33%) achieving complete response (CR). This study provides insight into the clinical presentation, diagnostic and treatment options, as well as the outcome of patients who have BNS.

Real world data on light chain cardiac amyloidosis: Still a delayed diagnosis.

Cardiac amyloidosis (CA) represents a myocardial disorder developed by fibril deposition of a heterogeneous group of misfolding proteins. Despite being rare, a high clinical index of suspicion and novel advanced diagnostic methods seem to facilitate its early recognition. Currently nine types of cardiac amyloidosis have been described with AL and ATTR being the most common. Light chain amyloidosis (AL) is a life-threatening disease, resulting from clonal plasma cells that produce amyloidogenic light chain fragments causing organ damage including the heart. Morbidity and mortality of these patients is strongly associated with the severity of cardiac involvement. Thus, early and precise diagnosis is crucial for prompt treatment initiation. In this study, we retrospectively analyzed data of 36 consecutive patients who were diagnosed with AL amyloidosis and treated in our center over the past 15 years. Heart involvement was present in 33 (92%) of them while 76% had severe cardiac disease as of stage IIIa and IIIb, according to the Mayo2004/European staging system. Almost one third of these patients experienced an early death occurring the first five months of diagnosis. To capture everyday clinical practice, we provide details on clinical presentation, diagnostic challenges, and outcome of these patients.

Candida lusitaniae Breakthrough Fungemia in an Immuno-Compromised Adolescent: Case Report and Review of the Literature.

Candida lusitaniae is a rare cause of candidemia that is known for its unique capability to rapidly acquire resistance to amphotericin B. We report the case of an adolescent with grade IV graft-vs.-host disease after hematopoietic cell transplantation who developed catheter-associated C. lusitaniae candidemia while on therapeutic doses of liposomal amphotericin B. We review the epidemiology of C. lusitaniae bloodstream infections in adult and pediatric patients, the development of resistance, and its role in breakthrough candidemia. Appropriate species identification, in vitro susceptibility testing, and source control are pivotal to optimal management of C. lusitaniae candidemia. Initial antifungal therapy may consist of an echinocandin and be guided by in vitro susceptibility and clinical response.

A rare pulmonary pathology complicated with an unusual condition.

Differential diagnosis should never be limited to the obvious diagnoses http://ow.ly/ybTM30obh6H.

Invasive Aspergillosis in Children: Update on Current Guidelines.

Invasive aspergillosis (IA) is an important cause of infectious morbidity and mortality in immunocompromised paediatric patients. Despite improvements in diagnosis, prevention, and treatment, IA is still associated with high mortality rates. To address this issue, several international societies and organisations have proposed guidelines for the management of IA in the paediatric population. In this article, we review current recommendations of the Infectious Diseases Society of America, the European Conference on Infection in Leukaemia and the European Society of Clinical Microbiology and Infectious Diseases for the management and prevention of IA in children.

Invasive candidiasis and candidemia in pediatric and neonatal patients: A review of current guidelines.

Several international and national guidelines have been proposed for the treatment and prevention of invasive candidiasis/candidemia (IC/C) in both neonatal and pediatric patients. This article is a review of the current guidelines, recommendations, and expert panel consensus of a number of associations and conferences on the prevention and management of IC and candidemia in both pediatric and neonatal patients. The investigated resources included the Infectious Diseases Society of America, the European Conference on Infection in Leukaemia, the European Society of Clinical Microbiology and Infectious Diseases, the German Speaking Mycological Society/Paul-Ehrlich Society for Chemotherapy, as well as the Canadian, Middle Eastern, and Australian guidelines. Echinocandins and liposomal amphotericin B (L-AmB) are the first-line agents in the treatment of IC and candidemia both for immunocompetent and immunocompromised pediatric patients. The recommendations suggested to keep patients under sterile conditions for at least 14 days after blood cultures as the prompt initiation of antifungal treatment. Guidelines addressing the neonates recommended to use L-AmB, deoxycholate AmB (D-AmB), and fluconazole based on three main principles of no previous exposure to azoles, the prompt initiation of antifungal treatment, and control of predisposing underlying conditions. Despite minor differences among the investigated guidelines, general treatment recommendations suggest the prompt initiation of antifungal treatment and control of all predisposing underlying conditions.

Streptococcus thoraltensis Bacteremia: First Described Case as a Fever of Unknown Origin in Human.

Streptococcus thoraltensis has mainly been reported to cause infections in animals. Its clinical significance as a human pathogen has not yet been fully elucidated and needs further investigation. We describe here a case of bacteremia attributed to S. thoraltensis in a 55-year-old female patient admitted to our department due to fever of unknown origin. To the best of our knowledge, this is the first reported case of S. thoraltensis bacteremia in a human and the first reported case of S. thoraltensis as a cause of fever of unknown origin in human.