The influence of carvedilol posology timing on clinically significant portal hypertension: insights from elastography measurements.

BACKGROUND AND AIMS: Carvedilol has emerged as the preferred ß-blocker for treating portal hypertension. However, there is still a debate in dosing regimen, with a potential lower bioavailability in once-daily regimens. The aim of this study is to assess the acute effects of carvedilol posology in patients with clinically significant portal hypertension (CSPH), as a surrogate marker of bioavailability. METHODS: In this experimental study, 34 patients with CSPH receiving carvedilol twice daily were asked to suppress the night dose of carvedilol, creating a standardized 24-hour dose interval. Spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) by transient elastography (TE) were performed, with the exact interval between the last carvedilol administration and TE measurements consistently maintained at 24 hours and compared with values prior and under treatment. RESULTS: Thirty-four patients were included, predominantly male (82.9%). SSM after suspending carvedilol for 24 hours [mean, 73.9kPa (SD, 17.0)] was significantly higher ( P < 0.001) than under treatment [mean, 56.3kPa (SD, 13.2)] and was not significantly different ( P = 0.908) from SSM prior to introduction of carvedilol [mean, 74.5kPa (SD, 12.4)]. Differences were also found in stratified analysis for carvedilol dosage, D'Amico classification stages, MELDNa scores, MELD3.0 scores, Child-Pugh class A and CSPH due to alcoholic cirrhosis. LSM after suspension was not significantly different from both under treatment and prior to treatment. CONCLUSION: The differences in SSM after skipping one dose of carvedilol show both the importance of strict adherence to the prescribed dosing regimen to achieve the expected therapeutic benefits and the impact of twice daily prescription in bioavailability throughout the day.

Fractionation of functional oligosaccharides produced from sugarcane straw using serial nanofiltration membranes and their influence on prebiotic potential.

Functional oligosaccharides are non-digestible by human gut enzymes and provide health benefits as fibers and prebiotics. The cello-oligosaccharides (COS) and xylooligosaccharides (XOS) are functional oligosaccharides obtained from xylan and cellulose, respectively, and are present in lignocellulosic material. The serial NF membranes process was performed to investigate the impact of the fractionation process on the prebiotic activity of oligosaccharides from xylan and cellulose. The NP030 (weight cut-off of 500-600 Da) and DK (weight cut-off of 150-300 Da) NF polymeric membranes were employed using defined operational conditions. The diafiltration (DF) was also investigated and it was determined that only a 1-time DF for NP030 was a more suitable strategy and improved the performance indices for short DP oligosaccharides. The short DP fractions obtained favored cell density for probiotic strains, which presented an increase on the optical density of up to 25 % after the fractionating process; enabling the use of short purified fractions in the food and pharmaceutical industry as a prebiotic ingredient.

Clinical validation of a multi-protein, serum-based assay for disease activity assessments in multiple sclerosis.

An 18-protein multiple sclerosis (MS) disease activity (DA) test was validated based on associations between algorithm scores and clinical/radiographic assessments (N = 614 serum samples; Train [n = 426; algorithm development] and Test [n = 188; evaluation] subsets). The multi-protein model was trained based on presence/absence of gadolinium-positive (Gd+) lesions and was also strongly associated with new/enlarging T2 lesions, and active versus stable disease (composite of radiographic and clinical evidence of DA) with improved performance (p < 0.05) compared to the neurofilament light single protein model. The odds of having ≥1 Gd+ lesions with a moderate/high DA score were 4.49 times that of a low DA score, and the odds of having ≥2 Gd+ lesions with a high DA score were 20.99 times that of a low/moderate DA score. The MSDA Test was clinically validated with improved performance compared to the top-performing single-protein model and can serve as a quantitative tool to enhance the care of MS patients.

Analytical validation of a multi-protein, serum-based assay for disease activity assessments in multiple sclerosis.

PURPOSE: To characterize and analytically validate the MSDA Test, a multi-protein, serum-based biomarker assay developed using Olink® PEA methodology. EXPERIMENTAL DESIGN: Two lots of the MSDA Test panel were manufactured and subjected to a comprehensive analytical characterization and validation protocol to detect biomarkers present in the serum of patients with multiple sclerosis (MS). Biomarker concentrations were incorporated into a final algorithm used for calculating four Disease Pathway scores (Immunomodulation, Neuroinflammation, Myelin Biology, and Neuroaxonal Integrity) and an overall Disease Activity score. RESULTS: Analytical characterization demonstrated that the multi-protein panel satisfied the criteria necessary for a fit-for-purpose validation considering the assay's intended clinical use. This panel met acceptability criteria for 18 biomarkers included in the final algorithm out of 21 biomarkers evaluated. VCAN was omitted based on factors outside of analytical validation; COL4A1 and GH were excluded based on imprecision and diurnal variability, respectively. Performance of the four Disease Pathway and overall Disease Activity scores met the established acceptability criteria. CONCLUSIONS AND CLINICAL RELEVANCE: Analytical validation of this multi-protein, serum-based assay is the first step in establishing its potential utility as a quantitative, minimally invasive, and scalable biomarker panel to enhance the standard of care for patients with MS.

An Improbable Thromboembolic Manifestation of COVID-19: A Case Report.

The coronavirus disease 2019 (COVID-19) disease is a multisystem disease and recent studies have shown an increase in reported thromboembolic complications as deep venous thrombosis, pulmonary embolism (PE), stroke, and less frequently mesenteric artery thrombosis. We present a case of a 75-year-old woman, COVID-19 positive with five days of evolution, who was admitted to the emergency room due to diffuse abdominal pain with several days of progression, along with diarrhea and biliary vomit. Abdominal computed tomography presented images of subtraction of the lumen of the upper mesenteric artery. With the reported clinical case the authors intend to clarify the importance of differential diagnosis in patients with a typical severe acute respiratory syndrome coronavirus 2 (SARS CoV2) infection presentation. The gastrointestinal symptoms of SARS CoV2 infection can mask a more severe condition, so a high index suspicion for abdominal thromboembolic events is required once this complication may threaten patient's life.

Not All Pulmonary Densifications Are COVID-19: A Case Report About Lemierre's Syndrome.

Lemierre's syndrome is a rare and a life-threatening disease characterized by anaerobic bacteraemia associated with thrombosis of the internal jugular vein. Odynophagia, otalgia, odontalgia, dyspnoea, cough and fever are the most frequent manifestations. We describe a case of a 37-year-old woman who was admitted to the emergency room due to fever, odynophagia, dyspnoea, myalgia, and pleuritic chest pain. She had hypoxaemia and increased systemic inflammatory markers. The chest CT showed parenchymal densification compatible with severe acute respiratory syndrome coronavirus infection, although all three polymerase chain reaction testing were negative. The neck CT showed occlusion of the left cervical internal jugular vein. She was treated with antibiotics and was discharged. With the reported clinical case the authors intend to clarify the importance of differential diagnosis and the diagnosis of other infectious respiratory conditions at the time of a global pandemic.

SIADH in the context of localised Herpes-Zoster infection.

Not required for Clinical Vignette.

Minimal change disease with maximum immunosuppression: successful treatment of steroid-dependent minimal change disease with rituximab.

Minimal change disease (MCD) is usually steroid sensitive, although in case of steroid dependent and multiple relapses we can struggle with different immunosuppressive agents, sometimes with no response. Rituximab has been emerging as an alternative therapeutic option.We describe a case of a young patient with MCD that had frequent relapses and steroid dependency, with no response to several immunosuppressive agents during 15 years of disease. He was kept under high-dose steroids and ciclosporin. He started treatment with rituximab (two administrations of 1 g 2 weeks apart, repeating after 6 months). The steroids dose was gradually reduced and the ciclosporin was stopped. During the entire 2 years follow-up period, he remained in remission and had no adverse events.This remarkable outcome reinforces the option of using rituximab in difficult cases, allowing the reduction of steroid burden and its adverse effects, which is of extreme importance, especially in young patients.

The moderating effect of gender on the relationship between coping and suicide risk in a Portuguese community sample of adults.

Background and aims(s): The study evaluated the contribution of coping strategies, based on the Toulousiane conceptualization of coping, to the prediction of suicide risk and tested the moderating effect of gender, controlling for depressive symptoms. METHOD: A two-time data collection design was used. A community sample of 195 adults (91 men and 104 women) ranging in age from 19 to 65 years and living in several Portuguese regions, mostly in Alentejo, participated in this research. RESULTS: Gender, depressive symptoms, control, and withdrawal and conversion significantly predicted suicide risk and gender interacted with control, withdrawal and conversion, and social distraction in the prediction of suicide risk. Coping predicted suicide risk only for women. CONCLUSIONS: Results have important implications for assessment and intervention with suicide at-risk individuals. In particular,the evaluation and development of coping skills is indicated as a goal for therapists having suicide at-risk women as clients.

Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: Contributions toward a more psychosocial approach to suicide risk.

Although suicidality is associated with mental illness in general and depression in particular, many depressed individuals do not attempt suicide and some individuals who attempt to or do die by suicide do not present depressive symptoms. This article aims to contribute to a more psychosocial approach to understanding suicide risk in nonclinical populations. In advocating a psychosocial perspective rather than a depression-focused approach, this article presents four diverse studies that demonstrate sampling and measurement invariance in findings across different populations and specific measures. Study 1 tests the mediation effects of 2 interpersonal variables, thwarted belongingness and perceived burdensomeness, in the association between depressive symptoms and recent suicidality. Studies 2 and 3 evaluate the contribution of hopelessness and psychache, beyond depressive symptoms, to suicidality. Study 4 tests the contribution of life events behind depressive symptoms, and other relevant sociodemographic and clinical variables, to the estimation of "future suicidality." Overall, results demonstrate that depressive symptoms do not directly predict suicidality in nonclinical individuals, but that other psychosocial variables mediate the association between depressive symptoms and suicidality or predict suicidality when statistically controlling for depressive symptoms. The article contributes to understanding some of the nonpsychopathological factors that potentially link depressive symptoms to suicide risk and that might themselves contribute to suicidality, even when controlling for depressive symptoms.

Gitelman syndrome.

Hypokalaemia is a common clinical disorder, the cause of which can usually be determined by the patient's clinical history. Gitelman syndrome is an inherited tubulopathy that must be considered in some settings of hypokalaemia. We present the case of a 60-year-old male patient referred to our nephrology department for persistent hypokalaemia. Clinical history was positive for symptoms of orthostatic hypotension and polyuria. There was no history of drugs consumption other than potassium supplements. Complementary evaluation revealed hypokalaemia (2.15 mmol/l), hypomagnesaemia (0.29 mmol/l), metabolic alkalosis (pH 7.535, bicarbonate 34.1 mmol/l), hypereninaemia (281.7 U/ml), increased chloride (160 mmol/l) and sodium (126 mmol/l) urinary excretion and reduced urinary calcium excretion (0.73 mmol/l). Renal function, remainder serum and urinary ionogram, and renal ultrasound were normal. A diagnosis of Gitelman syndrome was established. We reinforced oral supplementation with potassium chloride and magnesium sulfate. Serum potassium stabilised around 3 mmol/l. The aim of our article is to remind Gitelman syndrome in the differential diagnosis of persistent hypokalaemia.

Acute kidney injury by cantharidin poisoning following a silly bet on an ugly beetle.

Cantharidin is a poisonous substance secreted by blister beetles, including the 'Spanish fly'. Historically, cantharidin was used as an aphrodisiac, vesicant and abortifacient. Symptoms of poisoning include gastrointestinal and genitourinary mucosal irritation along with renal dysfunction. We present the case of a reckless 23-year-old soldier who accepted the challenge of eating a beetle (Berberomeloe majalis). Six hours later he was admitted to the emergency room with abdominal pain, dysuria, gross haematuria with clots, hypotension, fever and renal insufficiency. With intravenous fluid therapy, he recovered clinically. Laboratory parameters returned to normal within 1 week.

Avaliação da resiliência do cuidador de idosos com Alzheimer / Resilience evaluation of caregivers of elderly people with Alzheimer

Esta pesquisa observacional do tipo estudo de caso descritivo teve o objetivo de avaliar a resiliência de cuidadores de idosos demenciados com Alzheimer. Como instrumento, utilizou-se questionário para traçar o perfil do cuidador; protocolo bipolar para avaliar o estado subjetivo de fadiga; o SRQ - Self Report Questionnaire para avaliação do estresse; o inventário de Zarit para a sobrecarga e protocolo para a resiliência dos seis cuidadores que participaram do estudo. As variáveis quantitativas foram descritas em função de sua média e variância. Para as associações, utilizaram-se Correlação de Pearson e o Teste do Chi-Quadrado. O nível de significância adotado foi de p < 0,05. Os resultados indicaram que 83,3% dos cuidadores são femininos e 16,7%, masculinos; sendo quatro (66,7%) filhos e dois (33,3%) cônjuges. Observou-se que o estado de saúde de quatro cuidadores piorou, passando de um estado regular para ruim, em um período de cinco anos. Um (16,7%) cuidador dedica 20 horas do seu tempo ao cuidado e, para os demais (83,3%), a exigência é de 24 horas. Dos seis cuidadores, quatro demonstram probabilidade de desenvolver transtornos psiquiátricos e dois, não. E ainda, 66,7% dos cuidadores não apresentam sobrecarga, enquanto 33,3% acham-se com sobrecarga intensa. Embora alguns se mostrem fatigados e sobrecarregados, a maioria (83,3%) demonstra alta disposição à resiliência. Houve associação significativa entre resiliência e idade (p< 0,050), a qual expressa quanto maior a idade do cuidador maior a resiliência.

This observational study of the descriptive case study type aimed to evaluate the resilience of caregivers of demented elderly people with Alzheimer. A questionnaire was used to trace the profile of the caregivers; bipolar protocol to evaluate the fatigue subjective state; the SRQ - Self Report Questionnaire to evaluate the stress; the Zarit inventory to evaluate overload and protocol to evaluate resilience of the six caregivers who participated in this study. Quantitative variables were described as a function of their average and variance. For associations, the Pearson Correlation and the Chi-Square test were used. The significance level adopted was p < 0.05. Results indicated that 83.3% of caregivers were females and 16.7% males, four of which (66.7%) sons and two (33.3%), consorts. It was observed that the health status of four caregivers got worse, going from a regular to a bad state in a five-year period. One (16.7%) caregiver dedicated 20 hours of his time for caring, and for the others (83.3%) the requirement was of 24 hours. Two did not show any possibility of developing disturbances, while four showed possibilities of developing mental disturbances. 66.7% of the caregivers did not show overload, while 33.3% were under intense overload. Even though some demonstrated fatigue and overload, the majority (83.3%) presented a high disposition for resilience. There was significant association between resilience and age (p< 0.05), and this expressed that the older the caregiver the greater the resilience.

Relatos de experiências: (com) vivência com idosos que apresentam alzheimer / Experiences reports: living with elderly people who present alzheimer

Este artigo trata do relato de um projeto de extensão que apresentacomo objetivo oferecer aos idosos com Alzheimer atividadesfísicas, fisioterápicas e arteterapia. Oportunizam-se aos cuidadoresatividades de apoio psicossocial. O projeto acontece há um ano eos resultados mostram o quanto é importante para os idosos, emboraa maioria desses já esteja na segunda fase da doença, poisas atividades oferecidas colaboram para a sua socialização, paramanutenção da sua capacidade funcional e percepções de sentimentos,afetos e lembranças. Aos cuidadores serve como apoiopara o enfrentamento desse momento difícil e pesaroso das suasvidas. Neste trabalho relatam-se resultados da experiência somentecom os idosos que apresentam diagnóstico possível e provável deAlzheimer.(AU)

This article treats about the report of an extention Project that showsas a purpose to give to the elderly people physical, physiotherapyand art-therapy activities. It has been given pychosocial support tothe people who are responsible for taking care of them. The projecthas been happening for one year and the results show how much itis important to the elderly people, although most of them are alreadyin the second level of the illness, because the activities offered helpfor their socialization, for the maintenance of their functional capacitiesand feeling perceptions, affection and memories. To the peoplewho are taking care of the elderly, the project serves as a supportto face this difficult and hard moment of their lives. In this paper arereported the results and experiences only with the old people whoshow possible and probable Alzheimer diagnosis.

Processo de enfermagem aplicado a idosos com alzheimer que participamdo projeto estratégias de reabilitação / Nursing process applied to elderly with alzheimer’s who participate in the rehabilitation strategies project

Introdução: O aumento da população idosa em todo o mundo exige a capacitação de profissionais para o atendimento nesta área.Metodologia: Este é um estudo qualiquantitativo do tipo exploratório-descritivo realizado através da entrevista e exame físico feito nos idosos. Objetivos: O objetivo geral deste trabalho foi aplicar o processo de enfermagem nos idosos com alzheimer participantes do projeto da UNICRUZ. Os objetivos específicos foram: Realizara avaliação do estado de saúde atual destes idosos; Levantar os principais diagnósticos de enfermagem encontrados; Proporcionar aos sujeitos cuidados de enfermagem integral através da realiazação das prescrições de enfermagem. Resultados: Após a coleta de dados foram levantadas as informações em comum obtidas na entrevista e exame físico que apontam idade média dos sujeitos de 76 anos, 4 idosos têm o diagnóstico de alzheimer há 5 anos; 3 deles são hipertensos; 5 deles têm distúrbios do sono; 3 têm irmãos com alzheimer e todos têm falha de memória e limitação de amplitudede movivento. Dos diagnósticos de enfermagem, pode-se destacar - tensão do papel do cuidador e risco para o trauma. Dentre as principais prescrições de enfermagem estão - estimular cognição e memória, atividade física e participação social. Conclusão: Foi possível aplicar o processo de enfermagem nos idosos e com isso obter um maior conhecimento do estado de saúde deles, descrever os diagnósticos de enfermagem e levantar pontos de intervenção através da prescrição de enfermagem para promover cuidados como o estímulo à participação em grupos e encaminhamento ao odontólogo que poderão auxiliar no tratamento dos indivíduos e previnir complicações, oferecendo-os assistência e orientações de enfermagem e transdiciplinar.(AU)

Introduction: The aging population in the world requires the trainingof professionals providing care in this area. Methodology: This qualitative-quantitative study is of the exploratory-descriptive type conducted by interview and physical examination in the elderly Objectives: The aim of this work was to apply the nursing process in the elderly with Alzheimer's UNICRUZ project participants. The specific objectives were to perform the evaluation of current health status of elderly; Raise the main nursing diagnoses found; subjectproviding comprehensive nursing care through nursing realization prescriptions. Results: After data collection, it was raised together the information obtained in the interview and physical examination suggest that the average age of subjects 76 years, has four seniors diagnosed with Alzheimer's five years, three of them are hypertensive, five of them have disorders sleep, have three siblings with Alzheimer's and all have memory impairment and limitation of range of movivento. Of nursing diagnoses, can be ighlighted - the role of caregiver stress and risk for trauma. The main requirements are nursing - stimulate cognition and memory, physical activity and social participation. Conclusion: It was possible to apply the nursing process in the elderly and therefore gain a greater understanding of their health status, describing nursing diagnoses and raise points of intervention through the prescription of nursing care and to promote the stimulation of participation in groups and referral to a dentist that can help treat and prevent complications of individuals, offering them assistance and guidance to nursing and transdisciplinary.(AU)

Processo de enfermagem aplicado a idosos com alzheimer que participamdo projeto estratégias de reabilitação / Nursing process applied to elderly with alzheimer’s who participate in the rehabilitation strategies project

Introdução: O aumento da população idosa em todo o mundo exige a capacitação de profissionais para o atendimento nesta área.Metodologia: Este é um estudo qualiquantitativo do tipo exploratório-descritivo realizado através da entrevista e exame físico feito nos idosos. Objetivos: O objetivo geral deste trabalho foi aplicar o processo de enfermagem nos idosos com alzheimer participantes do projeto da UNICRUZ. Os objetivos específicos foram: Realizara avaliação do estado de saúde atual destes idosos; Levantar os principais diagnósticos de enfermagem encontrados; Proporcionar aos sujeitos cuidados de enfermagem integral através da realiazação das prescrições de enfermagem. Resultados: Após a coleta de dados foram levantadas as informações em comum obtidas na entrevista e exame físico que apontam idade média dos sujeitos de 76 anos, 4 idosos têm o diagnóstico de alzheimer há 5 anos; 3 deles são hipertensos; 5 deles têm distúrbios do sono; 3 têm irmãos com alzheimer e todos têm falha de memória e limitação de amplitudede movivento. Dos diagnósticos de enfermagem, pode-se destacar - tensão do papel do cuidador e risco para o trauma. Dentre as principais prescrições de enfermagem estão - estimular cognição e memória, atividade física e participação social. Conclusão: Foi possível aplicar o processo de enfermagem nos idosos e com isso obter um maior conhecimento do estado de saúde deles, descrever os diagnósticos de enfermagem e levantar pontos de intervenção através da prescrição de enfermagem para promover cuidados como o estímulo à participação em grupos e encaminhamento ao odontólogo que poderão auxiliar no tratamento dos indivíduos e previnir complicações, oferecendo-os assistência e orientações de enfermagem e transdiciplinar.

Introduction: The aging population in the world requires the trainingof professionals providing care in this area. Methodology: This qualitative-quantitative study is of the exploratory-descriptive type conducted by interview and physical examination in the elderly Objectives: The aim of this work was to apply the nursing process in the elderly with Alzheimer's UNICRUZ project participants. The specific objectives were to perform the evaluation of current health status of elderly; Raise the main nursing diagnoses found; subjectproviding comprehensive nursing care through nursing realization prescriptions. Results: After data collection, it was raised together the information obtained in the interview and physical examination suggest that the average age of subjects 76 years, has four seniors diagnosed with Alzheimer's five years, three of them are hypertensive, five of them have disorders sleep, have three siblings with Alzheimer's and all have memory impairment and limitation of range of movivento. Of nursing diagnoses, can be ighlighted - the role of caregiver stress and risk for trauma. The main requirements are nursing - stimulate cognition and memory, physical activity and social participation. Conclusion: It was possible to apply the nursing process in the elderly and therefore gain a greater understanding of their health status, describing nursing diagnoses and raise points of intervention through the prescription of nursing care and to promote the stimulation of participation in groups and referral to a dentist that can help treat and prevent complications of individuals, offering them assistance and guidance to nursing and transdisciplinary.

Relatos de experiências: (com) vivência com idosos que apresentam alzheimer / Experiences reports: living with elderly people who present alzheimer

Este artigo trata do relato de um projeto de extensão que apresentacomo objetivo oferecer aos idosos com Alzheimer atividadesfísicas, fisioterápicas e arteterapia. Oportunizam-se aos cuidadoresatividades de apoio psicossocial. O projeto acontece há um ano eos resultados mostram o quanto é importante para os idosos, emboraa maioria desses já esteja na segunda fase da doença, poisas atividades oferecidas colaboram para a sua socialização, paramanutenção da sua capacidade funcional e percepções de sentimentos,afetos e lembranças. Aos cuidadores serve como apoiopara o enfrentamento desse momento difícil e pesaroso das suasvidas. Neste trabalho relatam-se resultados da experiência somentecom os idosos que apresentam diagnóstico possível e provável deAlzheimer.

This article treats about the report of an extention Project that showsas a purpose to give to the elderly people physical, physiotherapyand art-therapy activities. It has been given pychosocial support tothe people who are responsible for taking care of them. The projecthas been happening for one year and the results show how much itis important to the elderly people, although most of them are alreadyin the second level of the illness, because the activities offered helpfor their socialization, for the maintenance of their functional capacitiesand feeling perceptions, affection and memories. To the peoplewho are taking care of the elderly, the project serves as a supportto face this difficult and hard moment of their lives. In this paper arereported the results and experiences only with the old people whoshow possible and probable Alzheimer diagnosis.

Early Diagnosis of Invasive Aspergillosis in Neutropenic Patients. Comparison between Serum Galactomannan and Polymerase Chain Reaction.

BACKGROUND: Invasive aspergillosis (IA) is a major cause of morbidity and mortality in profoundly neutropenic patients, so early diagnosis is mandatory. AIM: Consecutive patients with hematological malignancies undergoing intensive chemotherapy were screened for IA with two different methods which were compared. METHODS: From October 2000 to August 2003 we tested 1311 serum samples from 172 consecutive patients with a polymerase chain reaction assay and between April 2005 and April 2008 we tested 806 serum samples from 169 consecutive patients with a Galactomannan (GM) test. Bronchoalveolar (BAL) samples were obtained whenever the patient's condition allowed and tested with either method. RESULTS: The serum PCR assay had a sensitivity of 75.0% and a specificity of 91.9% and the serum GM assay had a sensitivity of 87.5% and a specificity of 93.1%, (P > 0.05). The presence of two or more consecutive positive serum samples was predictive of IA for both assays. BAL GM/PCR was positive in some patients without serum positivity and in patients with 2 or more positive serum GM/PCR. CONCLUSIONS: No significant differences between the 2 serum tests were found. The GM assay has the advantage of being standardized among several laboratories and is incorporated in the criteria established by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), however is much more expensive. BAL GM and PCR sampling aids in IA diagnosis but needs further validation studies to differentiate between colonization and true infection in cases where serum GM or PCR are negative.

Polymerase chain reaction screening for fungemia and/or invasive fungal infections in patients with hematologic malignancies.

INTRODUCTION: Invasive fungal infections (IFIs) are a life-threatening complication in patients with hematologic malignancies, mainly in acute leukemia patients, following chemotherapy. IFI incidence is increasing, and associated mortality remains high due to unreliable diagnosis. Antifungal drugs are often limited by inadequate antimicrobial spectrum and side effects. Thus, the detection of circulating fungal DNA has been advocated as a rapid, more sensitive diagnostic tool. PATIENTS AND METHODS: Between June 01 and January 03, weekly blood samples (1,311) were screened from 193 patients undergoing intensive myelosuppressive or immunosuppressive therapy. IFI cases were classified according to European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Fungal DNA was extracted from whole blood and amplified using polymerase chain reaction (PCR) published primers that bind to the conserved regions of the fungal 18S rRNA gene sequence. In our study, two or more consecutive positive samples were always associated with fungal disease. RESULTS: PCR screening predicted the development of IFI to be 17 days (median). This test had a specificity of 91.1% and a sensitivity of 75%. IFI incidence was 7.8%. DISCUSSION: Therefore, our results confirm the potential usefulness of PCR serial screening and the clinical applicability in everyday routine. PCR screening offers a noninvasive repeatable aid to the diagnosis of IFI.