Development of Aspergillosis in a cohort of non-neutropenic, non-transplant patients colonised by Aspergillus spp.

BACKGROUND: A previous study explored factors discriminating colonization and true infection among non-transplant, non-neutropenic patients with repeated Aspergillus spp. isolation from lower respiratory samples. The present study explored the evolution of patients with Aspergillus colonization in that study to determine the percentage of cases progressing to aspergillosis and time to development. METHODS: Clinical records were retrospectively reviewed (for each patient from his end date in the past study) and data from all respiratory processes suffered by patients up to April 2015 were recorded. Comparisons of variables were performed between colonized patients that developed aspergillosis and those that did not. A Kaplan-Meier curve was used to describe time to development of aspergillosis in chronic obstructive pulmonary disease (COPD) patients for II-IV stages of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. RESULTS: Sixty seven colonized patients were followed, 12 of them (17.9%) developed aspergillosis. Diagnoses included six tracheobronchitis (4 invasive, 2 simple tracheobronchitis), four pulmonary disease (2 invasive pulmonary aspergillosis, 2 chronic pulmonary aspergillosis), one allergic bronchopulmonary aspergillosis and one pulmonary aspergilloma. Up to 47 (70.4%) of the study patients presented COPD. Among patients developing aspergillosis COPD was more frequent (100%) than among those that did not develop aspergillosis (35 out of 55; 63.6%) (p = 0.012), as well as GOLD IV patients were more frequent among COPD patients developing aspergillosis than among COPD patients that did not (50.0 vs. 26.1%, p = 0.046). Mean time to development of aspergillosis was 18.4 months (median: 8.5) with a wide range (1-58). Overtime, the percentage of patients developing aspergillosis was significantly higher among GOLD IV patients than among GOLD II-III patients (p = 0.032). CONCLUSIONS: The high percentage of cases progressing to aspergillosis among colonized patients, especially among those with COPD (25.5%), stresses the importance of colonization as risk factor, and creates awareness of the possible change from colonization to invasive disease in GOLD IV patients.

Antithrombin III Utilization in a Large Teaching Hospital.

In a retrospective study to assess the use of antithrombin concentrates, the authors judged the plasma-derived product (Thrombate III) to be more cost-effective than the recombinant human form (ATryn) for patients with hereditary antithrombin deficiency.

Hospital at home treatment with remdesivir for patients with COVID-19: real-life experience.

OBJECTIVES: Access and appropriateness of therapeutics for COVID-19 vary because of access or regulatory barriers, the severity of the disease, and for some therapies, the stage of the pandemic and circulating variants. Remdesivir has shown benefits in clinical recovery and is the treatment of choice for selected patients, both hospitalized and nonhospitalized, in main international guidelines. The use of remdesivir in alternatives to conventional hospitalization such as hospital at home (HaH) units remains incompletely explored. In this study, we aim to describe the real-life experience of outpatient remdesivir infusion for COVID-19 in a HaH unit. METHODS: We selected all the consecutive patients receiving remdesivir from a prospective cohort of 507 COVID-19 patients admitted at a HaH unit. Admission criteria included COVID-19 with a fraction of inspired oxygen requirement under 0.35 and respiratory rate under 22 rpm. Patients were daily assessed in person by a nurse and a physician. RESULTS: A total of 236 patients admitted at the HaH unit received remdesivir, 172 of whom were treated at home. Only 2% presented any adverse event related to the infusion, all of them mild. HaH saved 1416 day-beds, with only 5% of the patients requiring transfer back to the hospital. CONCLUSION: Remdesivir infusion in HaH units seems to be a safe and efficient alternative to conventional hospitalization for treating patients with nonsevere COVID-19.

Acute Colchicine-induced Neuromyopathy in a Patient Treated with Atorvastatin and Clarithromycin.

Neuromyopathy is a rare side effect of chronic colchicine therapy, especially without renal impairment. Drugs interacting with colchicine metabolism through CYP3A4 can accelerate accumulation and toxicity. We describe a case of an interaction between atorvastatin, clarithromycin and colchicine resulting in acute neuromyopathy. LEARNING POINTS: Colchicine has a narrow therapeutic window, and therefore, often produces side effects.Special caution should be adopted if patients with renal disease and concomitant medications are given colchicine.Before prescribing colchicine, the clinical history, including previous medications and conditions, should be carefully considered.

Implementing a pharmacy resident run transition of care service for heart failure patients: Effect on readmission rates.

OBJECTIVE: Heart failure (HF) is a leading cause of hospital readmissions adversely affecting resources and hospital reimbursements. The purpose of this study was to optimize medication therapy, provide patient education and facilitate discharge and follow-up through the creation of a pharmacy resident managed HF transition service with the intention of decreasing readmission rates. METHODS: A 6-month prospective, single center pilot study was conducted by a pharmacy resident to decrease readmission rates in patients with HF. Patients were identified through emergency department admission reports and direct requests from discharge nurses. The pharmacy resident provided patients with tailored medication and disease state counseling, ensured obtainment of discharge medications and performed follow up telephone calls for appointment reminders and further counseling. The primary outcome measured was readmission rate at 30 days. Secondary outcomes were number of patients requesting safety net medications, reason for readmission(s), and appointment compliance. RESULTS: Thirty patients were enrolled in the program. The 30-day heart failure readmission rate decreased from 28.1% to 16.6%. Eighty-eight percent of patients attended their follow up appointments. CONCLUSION: A reduction in readmission rate was achieved through this pharmacy resident-run HF transition service. The majority of patients attended follow-up visits and financial appointments after discharge.

Oxidative Nitration of Styrenes for the Recycling of Low-Concentrated Nitrogen Dioxide in Air.

The oxidative nitration of styrenes in ethyl acetate represents a metal-free, environmentally friendly, and sustainable technique to recover even low concentrations of NO2 in air. Favorable features are that the product mixture comprising nitroalcohols, nitroketones, and nitro nitrates simplifies at lower concentrations of NO2 . Experiments in a miniplant-type 10 L wet scrubber demonstrated that the recycling technique is well applicable on larger scales at which initial NO2 concentrations of >10 000 ppm were reliably reduced to less than 40 ppm.

A vulnerabilidade no/do analista / Vulnerability in/of the analyst

O interesse por analisar o tema da vulnerabilidade desde a perspectiva do analista surge da frequência com que, em cada um dos debates, o exame das intervenções do analista é ressaltado, colocando em reconsideração a neutralidade e a ética que as sustenta. Já não escandaliza que se postule um inconsciente não reprimido, mas nem sempre se questiona como ele se faz presente nas intervenções realizadas pelo analista, o que me levou a postular que, além de uma ética do desejo, seria necessário pensar em uma ética da criação de representações na análise. Esta é a linha de trabalho que se propõe aqui. Fazem-se precisões metapsicológicas com relação à hipótese de que o que demanda o analista a partir do heterogêneo o confronta com seus próprios limites, com seus aspectos mais vulneráveis, que são referidos ao mais além de seu capital representacional. Analisa-se o tema das identificações e da desmentida e se propõem possíveis vias de reelaboração do que se denomina o heterogêneo.

The interest in analyzing the topic of vulnerability from the analyst’s perspective arises from the frequent emphasis given, in debates, to the examination of the analyst’s interventions, that leads to a reconsideration of the neutrality and the ethics that support them. The postulate of an unrepressed unconscious no longer surprises, but it is not always questioned the way it presents itself in the analyst’s interventions, what made the author suggest that beyond a desire ethic, it is necessary to think about an ethic of the creation of representations in analysis. This is the working line proposed in this paper. Metapsychological accuracy are made in regard to the hypothesis that what demands the analyst from the heterogeneous confronts him with his own limits , with his most vulnerable aspects, which is considered to be beyond his own potential on representation. The paper analyzes issues of identification and of denial and proposes some ways to do the reworking through of the heterogeneous.

El interés por analizar el tema de la vulnerabilidad desde la perspectiva del analista surge de la frecuencia con que, en cada uno de los debates, el análisis de las intervenciones del analista se resalta poniendo en reconsideración la neutralidad y la ética que sustenta las mismas. Ya no escandaliza que se postule un inconsciente no reprimido, pero no siempre se plantea como se hace presente en las intervenciones que realiza el analista, lo que me llevó alguna vez a postular que, además de una ética del deseo, era necesario pensar en una ética de la creación de representaciones en el análisis y esta es la línea de trabajo que propongo en esta ocasión. Hago precisiones metapsicológicas con relación a la hipótesis que lo que demanda al analista desde lo heterogéneo lo enfrenta a sus propios límites, a sus aspectos más vulnerables que ubico en el más allá de su capital representacional. Analizo el tema de las identificaciones y la desmentida y propongo posibles vías de reelaboración de lo que se denomina lo heterogéneo.