ABSTRACT
Candida wangnamkhiaoensis is a species clustered under the Hyphopichia clade has not ever been isolated from any clinical specimens. To the best of our knowledge, this is the first report of C. wangnamkhiaoensis associated with fungaemia in immunocompromised paediatric patient. The isolate was assigned a strain name as UZ1679/14, in which the identification was confirmed by a polymerase chain reaction-sequencing of the internal transcribed spacer (ITS) and large subunit (LSU) regions of the rRNA gene. Antifungal susceptibility pattern showed that the isolate was sensitive to anidulafungin, caspofungin, fluconazole and voriconazole. The patient clinically improved after the antifungal treatment with caspofungin.
Subject(s)
Candida/isolation & purification , Candidemia/microbiology , Immunocompromised Host , Anidulafungin , Antifungal Agents/pharmacology , Candida/classification , Candida/genetics , Candida/ultrastructure , Candidemia/drug therapy , Candidemia/immunology , Caspofungin , Child, Preschool , DNA, Ribosomal Spacer , Echinocandins/pharmacology , Echinocandins/therapeutic use , Fluconazole/pharmacology , Humans , Hyphae/isolation & purification , Hyphae/ultrastructure , Lipopeptides/pharmacology , Lipopeptides/therapeutic use , Male , Phylogeny , Polymerase Chain Reaction , Sequence Alignment , Voriconazole/pharmacologyABSTRACT
BACKGROUND: Some patients continue to have significant heart failure symptoms despite optimal medical therapy. METHODS: We describe a first-in-human experience with an implantable non-blood-contacting extra-ascending aortic counterpulsation heart assist system (C-Pulse) in 5 end-stage heart failure patients, aged 54 to 73 years. RESULTS: All patients improved by 1 NYHA class and improvements in invasive hemodynamics were documented in 3 patients. Three of 5 patients (60%) had infectious complications. Two patients were explanted at 5 and 7 weeks, respectively, as a result of mediastinal infection related to the implant procedure. One patient was successfully transplanted at 1 month and 1 remained hemodynamically improved on the device at 6 months but suffered infective complications. The device and protocol have been modified as a result of this pilot study with a further multicenter safety study underway. CONCLUSIONS: Although feasibility of this device is suggested by this pilot study, safety and efficacy will need to be examined in a larger cohort with longer follow-up.
Subject(s)
Counterpulsation/instrumentation , Heart Failure/surgery , Heart-Assist Devices , Prosthesis Implantation/methods , Aged , Feasibility Studies , Female , Follow-Up Studies , Hemodynamics , Humans , Male , Mediastinal Diseases/microbiology , Middle Aged , Pilot Projects , Prosthesis Implantation/adverse effects , Treatment OutcomeABSTRACT
Extra-aortic counterpulsation for the management of chronic heart failure is a novel approach. We report the use of an extra-aortic implantable counterpulsation pump in the management of a 73-year-old patient with severe heart failure refractory to medical therapy. The implantable counterpulsation pump prolonged his life and greatly improved its quality. The patient lived almost 7 months after the implantation of the device and died of septic complications secondary to gas line infection.
Subject(s)
Counterpulsation/instrumentation , Heart Failure/surgery , Heart-Assist Devices , Prosthesis Implantation/methods , Abscess/diagnosis , Aged , Aortography , Chronic Disease , Echocardiography , Follow-Up Studies , Heart Failure/diagnosis , Humans , Male , Myocardial Infarction/complications , Palliative Care , Postoperative Complications/diagnosis , Prosthesis Design , Pseudomonas Infections/diagnosis , Quality of Life , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Disease management programs in which drugs are prescribed by dietitians or nurses have been shown to improve the coronary risk factor profile in patients with coronary heart disease. However, those disease management programs in which drugs are not prescribed by allied health professionals have not improved coronary risk factor status. The objective of the Coaching patients On Achieving Cardiovascular Health (COACH) study was to determine whether dietitians or nurses who did not prescribe medications could coach patients with coronary heart disease to work with their physicians to achieve the target levels for their total cholesterol (TC) and other risk factors. METHODS: Multicenter randomized controlled trial in which 792 patients from 6 university teaching hospitals underwent a stratified randomization by cardiac diagnosis within each hospital: 398 were assigned to usual care plus The COACH Program and 394 to usual care alone. Patients in The COACH Program group received regular personal coaching via telephone and mailings to achieve the target levels for their particular coronary risk factors. There was one coach per hospital. The primary outcome was the change in TC (DeltaTC) from baseline (in hospital) to 6 months after randomization. Secondary outcomes included measurement of a wide range of physical, nutritional, and psychological factors. The analysis was performed by intention to treat. RESULTS: The COACH Program achieved a significantly greater DeltaTC than usual care alone: the mean DeltaTC was 21 mg/dL (0.54 mmol/L) (95% confidence interval [CI], 16-25 mg/dL [0.42-0.65 mmol/L]) in The COACH Program vs 7 mg/dL (0.18 mmol/L) (95% CI, 3-11 mg/dL [0.07-0.29 mmol/L]) in the usual care group (P<.0001). Thus, the reduction in TC from baseline to 6 months after randomization was 14 mg/dL (0.36 mmol/L) (95% CI, 8-20 mg/dL [0.20-0.52 mmol/L]) greater in The COACH Program group than in the usual care group. Coaching produced substantial improvements in most of the other coronary risk factors and in patient quality of life. CONCLUSIONS: Coaching, delivered as The COACH Program, is a highly effective strategy in reducing TC and many other coronary risk factors in patients with coronary heart disease. Coaching has potential effectiveness in the whole area of chronic disease management.
