RESUMEN
BACKGROUND: The number of terbinafine-resistant Trichophyton indotineae is increasing in recent years while the treatment is still a matter to discuss. OBJECTIVES: To explore the best therapeutic approach, we present real-world treatment of T. indotineae infection by analysing publicly available data. METHODS: We have reviewed all published articles, mainly including case reports and case series, on the drug-resistant T. mentagrophytes complex by using the key search terms to search the databases. RESULTS: We enrolled 25 articles from 14 countries, including 203 times of treatment information for 113 patients. The cure rate of itraconazole 200 mg per day at the fourth, eighth and the twelfth week were 27.27%, 48.48% and 54.55%, respectively, which was significantly higher than terbinafine 250 mg per day (8.77%, 24.56% and 28.07%) and even 500 mg/d terbinafine. Griseofulvin 500-1000 mg for 2-6 months may be effective while fluconazole had no record of successful treatment. Voriconazole and ravuconazole had potential therapeutic efficacy. Topical therapy alone showed limited therapeutic efficacy, but the combination with oral antifungals can be alternative. CONCLUSION: Oral itraconazole 200 mg per day for 4-8 weeks was the most effective treatment out of these commonly used antifungal drugs, and can be prior selection.
Asunto(s)
Itraconazol , Naftalenos , Tiña , Humanos , Itraconazol/farmacología , Terbinafina/uso terapéutico , Terbinafina/farmacología , Estudios Retrospectivos , Naftalenos/farmacología , Antifúngicos/farmacología , Trichophyton , Griseofulvina/farmacología , Pruebas de Sensibilidad MicrobianaRESUMEN
BACKGROUND: The purpose of this study was to evaluate the efficacy of denosumab or zoledronic acid (ZA) using symptomatic skeletal events (SSEs) as the primary endpoint in Asian postmenopausal women with oestrogen-receptor-positive advanced breast cancer. METHODS: Asian postmenopausal women with oestrogen-receptor-positive advanced breast cancer receiving subcutaneous denosumab 120 mg Q4W, or intravenous ZA 4 mg Q4W until the primary analysis cut-off date were retrospectively analysed in the Hong Kong Practice-Based Cancer Research Center(HKCRC) from March 2011 to March 2013. The time to first on-study SSE that was assessed either clinically or through routine radiographic scans was the primary endpoint. RESULTS: 242 patients received denosumab or ZA treatment (n = 120, mean age of 64.9 years (SD 3.01) and n = 122, 65.4 years (3.44), respectively). The median times to first on-study SSE were 14.7 months (12.9-45.6) and 11.7 months (9.9-45.6) for denosumab and ZA, respectively (hazard ratio, HR 0.44, 95% CI 0.71-2.95; p = 0·0002). Compared with the ZA group, denosumab-treated patients had a significantly delayed time to first SSE (HR 0.65 [95% CI 0.29-1.45], p < 0.0001). An increased incidence of SSE was found in the 16-month follow-up with rates of 2.1 and 10.7% for denosumab and ZA, respectively (P = 0.033). The difference persisted with time with rates of 8.3 and 17.2% at the final follow-up, respectively (P < 0.05). CONCLUSION: In postmenopausal women aged ≥60 years with oestrogen-receptor-positive advanced breast cancer, denosumab significantly reduced the risk of developing SSEs compared with ZA. The findings of this pilot trial justify a larger study to determine whether the result is more generally applicable to a broader population.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Resorción Ósea/prevención & control , Neoplasias de la Mama/terapia , Denosumab/uso terapéutico , Ácido Zoledrónico/uso terapéutico , Anciano , Antineoplásicos Hormonales/efectos adversos , Pueblo Asiatico , Densidad Ósea/efectos de los fármacos , Densidad Ósea/efectos de la radiación , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/etiología , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/patología , Quimioterapia Adyuvante/efectos adversos , Femenino , Estudios de Seguimiento , Hong Kong/epidemiología , Humanos , Incidencia , Mastectomía , Persona de Mediana Edad , Posmenopausia , Radioterapia Adyuvante/efectos adversos , Receptores de Estrógenos/metabolismo , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Paeoniflorin (PF), a Chinese herbal medicine, has been widely used in clinical practice in China because of its dual immunoregulatory effects. A previous study found that PF inhibited the biofilm formation of Candida albicans (C. albicans) in vitro; however, whether PF plays an antifungal role in vivo is still unexplored. In this study, we sought to examine the effect of PF alone or in combination with an antifungal agent, fluconazole (FCZ), using a mouse model of systemic candidiasis. The results showed that the survival time of mice treated with PF alone or PFâ¯+â¯FCZ decreased compared with the Infected alone and FCZ treated groups, respectively (8.20⯱â¯1.75 vs 10.40⯱â¯2.50â¯days, Pâ¯<â¯0.05; 24.60⯱â¯6.55 vs 29.00⯱â¯3.16â¯days, Pâ¯<â¯0.05). The fungal burden in the kidney of mice increased in the PF alone and PFâ¯+â¯FCZ treated groups compared with the Infected alone or FCZ treated group. Furthermore, it was found that the PF and PFâ¯+â¯FCZ treated groups showed significantly decreased levels of serum interferon gamma (IFN-γ), interleukin (IL)-17, and IL-22, and an increased level of serum IL-4; PF had no effect on the production of tumor necrosis factor alpha (TNF-α). PF alone or in combination with FCZ decreased the proliferation of Th1 (IFN-γ+CD4+) and Th17 cells (IL-17+CD4+) and increased the expression of Th2 cells (IL-4+CD4+). These results suggested that PF treatment could be detrimental to the host response to systemic C. albicans infection in mice. Thus, caution might be required for clinical use of PF in patients with fungal infection.
Asunto(s)
Candidiasis/inmunología , Glucósidos/farmacología , Monoterpenos/farmacología , Células TH1/efectos de los fármacos , Células Th17/efectos de los fármacos , Animales , Candida albicans , Candidiasis/sangre , Candidiasis/microbiología , Candidiasis/patología , Citocinas/sangre , Modelos Animales de Enfermedad , Riñón/efectos de los fármacos , Riñón/microbiología , Riñón/patología , Hígado/efectos de los fármacos , Hígado/patología , Ratones Endogámicos BALB C , Bazo/anatomía & histología , Bazo/efectos de los fármacos , Células TH1/inmunología , Células Th17/inmunologíaRESUMEN
Objective This study was performed to evaluate the efficacy of rivaroxaban versus nadroparin for preventing deep venous thrombosis (DVT) in elderly patients with osteoporosis undergoing initial total hip arthroplasty (THA) for femoral neck fractures. Methods Prospectively maintained databases were reviewed to retrospectively compare elderly patients with osteoporosis who underwent initial THA for femoral neck fractures from 2007 to 2015. The patients received peroral rivaroxaban at 10 mg/day for 2 weeks or subcutaneous injections of nadroparin at 0.3 mL/day for 2 weeks until the primary analysis cut-off date. The time to first on-study DVT was the primary endpoint. Results In total, 399 patients were included (rivaroxaban group: n=200; mean age, 70.20 ± 9.16 years and nadroparin group: n = 199; mean age, 69.90 ± 8.87 years), with a mean 3-year follow-up. The time to first on-study DVT was significantly longer in the rivaroxaban than nadroparin group (12 and 5 days, respectively). The incidence of DVT within the 2-week follow-up was significantly higher in the nadroparin than rivaroxaban group (6.8% and 19.7%, respectively), but this difference was no longer present at the final follow-up. Conclusion Rivaroxaban was associated with a significant reduction in the occurrence of first on-study DVT compared with nadroparin.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Fracturas del Cuello Femoral/cirugía , Nadroparina/uso terapéutico , Rivaroxabán/uso terapéutico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Anciano , Coagulación Sanguínea , Demografía , Femenino , Fracturas del Cuello Femoral/sangre , Humanos , Masculino , Osteoporosis/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Trombosis de la Vena/sangreRESUMEN
Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. We report a case of chromoblastomycosis in a pulmonary tuberculosis patient without known history of trauma. The lesions were initially diagnosed as sporotrichosis and skin tuberculosis. Histopathology of scales and skin biopsy specimen revealed sclerotic bodies, the hallmark of chromoblastomycosis. The causative organism was identified as Fonsecaea monophora by rDNA ITS sequencing. The lesions recovered markedly after two month treatment with oral terbinafine 250 mg daily according to drug sensitive test in vitro in combination with local thermotherapy.