RESUMO
BACKGROUND: Levonadifloxacin (intravenous) and alalevonadifloxacin (oral prodrug) are novel antibiotics based on benzoquinolizine subclass of fluoroquinolone, licensed for clinical use in India in 2019. The active moiety, levonadifloxacin, is a broad-spectrum antibiotic with a high potency against methicillin-resistant Staphylococcus. aureus, multi-drug resistant pneumococci and anaerobes. OBJECTIVE: This review, for the first time, critically analyses the antimicrobial susceptibility testing methods, Clinical Laboratory & Standards Institute (CLSI)-quality control of susceptibility testing and breakpoints of levonadifloxacin. Further, the genesis, discovery and developmental aspects as well as therapeutic profile of levonadifloxacin and alalevonadifloxacin are briefly described. CONTENTS: In order to aid the scientific and clinician communities with a single comprehensive overview on all the key aspects of levonadifloxacin and alalevonadifloxacin, the present article covers the reference MIC and disk diffusion methods for levonadifloxacin susceptibility testing that were approved by CLSI and the reference ranges for quality control strains published in the CLSI M100 document. The breakpoints of levonadifloxacin were derived in concordance to US FDA, European Committee on Antibiotic Susceptibility Testing (EUCAST) and CLSI approaches. Further, the article provides a brief account of challenges encountered during the discovery stages of levonadifloxacin and alalevonadifloxacin, activity spectrum and safety benefits accruing from structural novelty-linked mechanism of action. Further, the review also covers in vitro and in vivo activities, registrational clinical studies and patient-friendly features of levonadifloxacin/alalevonadifloxacin. Cumulatively, levonadifloxacin has a potential to offer a long awaited new standard-of-care treatment for the resistant Gram-positive bacterial infections.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Quinolonas , Humanos , Laboratórios Clínicos , Antibacterianos , Controle de Qualidade , Testes de Sensibilidade MicrobianaRESUMO
Excessive bleeding post coronary artery bypass surgery (CABG) remains a major source of morbidity and mortality. Approaching this bleeding with a resternotomy, while necessary in the vast majority of cases, is associated with an increased incidence of infections and sternal wound complications. A thoracoscopic approach in select patients with a pleural based collection is described.
Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Hemorragia Pós-Operatória/cirurgia , Toracoscópios , Gravação em Vídeo/instrumentação , Idoso , Doença das Coronárias/diagnóstico por imagem , Desenho de Equipamento , Feminino , Humanos , Hemorragia Pós-Operatória/diagnóstico por imagem , Radiografia , ReoperaçãoRESUMO
Between January 1, 1990, and March 20, 1994, 56 patients had a homograft valve device placed in the aortic position. The mean age at operation was 53.3 years (range 5-77 years). Diagnosis included dominant aortic stenosis in 27 patients (48.2%) and aortic incompetence in 29 (51.8%). Thirteen patients (23.2%) had subacute bacterial endocarditis. Forty-three aortic homografts and 13 pulmonary homografts were placed. Concomitant procedures were performed in 12 patients (21.8%). The hospital mortality was 7.3% (four patients). On follow-up, three pulmonary valves have failed, two between 1 and 5 weeks post implantation. At reoperation a linear cusp fracture was found in all with no evidence of infection. All remaining patients have no, trivial, or mild, aortic regurgitation on echo and remain well. Pulmonary and aortic valves were compared for failure, P = 0.02 suggesting a significant difference between valve substitutes. In conclusion we advise caution in using pulmonary allografts in the aortic position.
Assuntos
Valva Aórtica/cirurgia , Valva Pulmonar/transplante , Adolescente , Adulto , Idoso , Valva Aórtica/transplante , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Criança , Pré-Escolar , Ecocardiografia , Endocardite Bacteriana Subaguda/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Taxa de Sobrevida , Transplante Homólogo , Resultado do TratamentoRESUMO
A 12-year-old child with tricuspid atresia and acquired hypoplasia of the left pulmonary artery was successfully treated with unilateral Fontan operation. Angiography at age 2 months had shown a normal left pulmonary artery, and a modified Potts shunt was performed. An emergency central shunt was required a year later. Reinvestigation 5 years after the initial operation revealed severe hypoplasia of the left pulmonary artery.