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1.
Medicina (Kaunas) ; 56(11)2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33138045

RESUMO

BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae urinary antigen (u-Ag) testing has recently gained attention in the early diagnosis of severe and critical acute respiratory syndrome coronavirus-2/pneumococcal co-infection. The aim of this study is to assess the effectiveness of Streptococcus pneumoniae u-Ag testing in coronavirus disease 2019 (COVID-19) patients, in order to assess whether pneumococcal co-infection is associated with different mortality rate and hospital stay in these patients. MATERIALS AND METHODS: Charts, protocols, mortality, and hospitalization data of a consecutive series of COVID-19 patients admitted to a tertiary hospital in northern Italy during COVID-19 outbreak were retrospectively reviewed. All patients underwent Streptococcus pneumoniae u-Ag testing to detect an underlying pneumococcal co-infection. Covid19+/u-Ag+ and Covid19+/u-Ag- patients were compared in terms of overall survival and length of hospital stay using chi-square test and survival analysis. RESULTS: Out of 575 patients with documented pneumonia, 13% screened positive for the u-Ag test. All u-Ag+ patients underwent treatment with Ceftriaxone and Azithromycin or Levofloxacin. Lopinavir/Ritonavir or Darunavir/Cobicistat were added in 44 patients, and hydroxychloroquine and low-molecular-weight heparin (LMWH) in 47 and 33 patients, respectively. All u-Ag+ patients were hospitalized. Mortality was 15.4% and 25.9% in u-Ag+ and u-Ag- patients, respectively (p = 0.09). Survival analysis showed a better prognosis, albeit not significant, in u-Ag+ patients. Median hospital stay did not differ among groups (10 vs. 9 days, p = 0.71). CONCLUSIONS: The routine use of Streptococcus pneumoniae u-Ag testing helped to better target antibiotic therapy with a final trend of reduction in mortality of u-Ag+ COVID-19 patients having a concomitant pneumococcal infection. Randomized trials on larger cohorts are necessary in order to draw definitive conclusion.


Assuntos
Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Coinfecção/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Mortalidade Hospitalar , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Antígenos de Bactérias/urina , Azitromicina/uso terapêutico , Betacoronavirus , Ceftriaxona/uso terapêutico , Cobicistat/uso terapêutico , Coinfecção/urina , Infecções por Coronavirus/complicações , Estudos Transversais , Darunavir/uso terapêutico , Combinação de Medicamentos , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Levofloxacino/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Pandemias , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/urina , Pneumonia Viral/complicações , Estudos Retrospectivos , Ritonavir/uso terapêutico , Streptococcus pneumoniae/imunologia
2.
BMC Infect Dis ; 20(1): 809, 2020 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-33153450

RESUMO

BACKGROUND: Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is an emerging global health threat. Surveillance of AMR in N. gonorrhoeae in the Western Pacific Region is important, as resistant strains have typically emerged from this region. There are sparse data regarding antibiotic susceptibility of N. gonorrhoeae from Vietnam. This study aimed to provide updated data on antibiotic susceptibilities in N. gonorrhoeae isolates from Hanoi, Vietnam. METHODS: From 2017 to 2019, 409 N. gonorrhoeae clinical isolates were collected at the National Hospital for Venereology and Dermatology in Hanoi, Vietnam. Antibiotic susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) protocol. The zone diameters of inhibition were recorded and interpreted according to standard CLSI criteria, except for azithromycin, due to the absence of CLSI interpretation. Categorical variables were analyzed by Chi-square and Fisher's exact tests. Linear regression was used to evaluate zones of inhibition by year. RESULTS: Among the 409 isolates, no isolates were susceptible to penicillin, 98.3% were resistant to ciprofloxacin, and all isolates were susceptible to spectinomycin. There were 122/407 (30.0%) isolates resistant to azithromycin and there was an association between resistance and year (p <  0.01), ranging from 15.3% of isolates in 2017 to 46.7% of the isolates in 2018. Resistance to cefixime was found in 13/406 (3.2%) of isolates and there was no association by year (p = 0.30). Resistance to ceftriaxone occurred in 3/408 (0.7%) of isolates. Linear regression indicated the zone of inhibition diameters decreased by 0.83 mm each year for ceftriaxone (95% CI: - 1.3, - 0.4; p <  0.01) and decreased by 0.83 mm each year (95% CI: - 1.33, - 0.33; p <  0.01) for azithromycin; the association was not significant for cefixime (p = 0.07). CONCLUSIONS: We found decreasing susceptibility of N. gonorrhoeae to ceftriaxone and azithromycin, as well as a high prevalence of resistance to azithromycin, among isolates in Hanoi, Vietnam from 2017 to 2019. The trends of decreasing susceptibility to first-line treatments are concerning and highlight the urgency of addressing antimicrobial resistance in N. gonorrhoeae. Expanded surveillance efforts within the Western Pacific Region are critical to monitoring trends and informing treatment guidelines.


Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/efeitos dos fármacos , Adolescente , Adulto , Idoso , Feminino , Gonorreia/epidemiologia , Gonorreia/microbiologia , Humanos , Laboratórios , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neisseria gonorrhoeae/isolamento & purificação , Vietnã/epidemiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(41): e22476, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031278

RESUMO

RATIONALE: Sciatica is usually caused by lumbar spine disease; the incidence of sciatica from extra-spinal causes is noted to be only about 0.09%. PATIENT CONCERNS: We report a case of a 92-year-old man who came to the neurologist outpatient department due to left buttock pain and numbness that radiated to the left lower leg in the recent 6 months and progressed rapidly over 10 days. DIAGNOSIS: We arranged magnetic resonance imaging for lumbar nerve lesion. Magnetic resonance imaging showed a common iliac artery mycotic aneurysm, at about 6.3 cm in diameter, which compressed the psoas muscle, nerve plexus, and vein. INTERVENTIONS: We used a left-side iliac bifurcation stent graft of 12 mm in diameter for aneurysm repair. An internal iliac artery with a stent graft of 10 mm x 5 cm. An abdomen aortic aneurysm stent was inserted, 1 cm beneath the right renal artery from the right side femoral artery. OUTCOMES: After endovascular repair and 4 weeks of antibiotic treatment, he could walk again, and no sciatica was noted. We repeated computed tomography 5 months after the operation and noted that the size of the iliac artery aneurysm decreased without stent graft migration or extravasation. Our patient recovered from sciatic and left leg weakness; above all, he could walk again. LESSONS: We suggest practitioners check for common iliac artery aneurysms in the diagnosis of symptoms mimicking spinal cord origin sciatica, especially in elder patients.


Assuntos
Aneurisma Ilíaco/complicações , Aneurisma Ilíaco/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Ciática/etiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Progressão da Doença , Humanos , Aneurisma Ilíaco/microbiologia , Aneurisma Ilíaco/cirurgia , Imagem por Ressonância Magnética , Masculino , Stents
4.
BMC Infect Dis ; 20(1): 654, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894070

RESUMO

BACKGROUND: Brucellosis is a zoonotic disease caused by brucella. It has been an increasing trend in recent years (Wang H, Xu WM, Zhu KJ, Zhu SJ, Zhang HF, Wang J, Yang Y, Shao FY, Jiang NM, Tao ZY, Jin HY, Tang Y, Huo LL, Dong F, Li ZJ, Ding H, Liu ZG, Emerg Microbes Infect 9:889-99, 2020). Brucellosis is capable to invade multiple systems throughout the body, lacking in typical clinical manifestations, and easily misdiagnosed and mistreated. CASE PRESENTATION: We report a case of a male, 5-year-and-11-month old child without relevant medical history, who was admitted to hospital for 20 days of fever. When admitted to the hospital, we found that he was enervated, irritable and sleepy, accompanied with red eyes phenomenon. After anti-infection treatment with meropenem, no improvement observed. Lumbar puncture revealed normal CSF protein, normal cells, and negative culture. Later, doppler echocardiography suggested coronary aneurysms, and incomplete Kawasaki Disease with coronary aneurysms was proposed. The next day, brucellosis agglutination test was positive. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid suggested B.melitensis, which was confirmed again by blood culture. The child was finally diagnosed as brucellosis with meningocephalitis, coronary aneurysm and keratitis. According to our preliminary research and review, such case has never been reported in detail before. After diagnosis confirmation, the child was treated with rifampicin, compound sulfamethoxazole, and ceftriaxone for cocktail anti-infection therapy. Aspirin and dipyridamole were also applied for anticoagulant therapy. After medical treatment, body temperature of the child has reached normal level, eye symptoms alleviated, and mental condition gradually turned normal. Re-examination of the doppler echocardiographic indicated that the coronary aneurysm was aggravated, so warfarin was added for amplification of anticoagulation treatment. At present, 3 months of follow-up, the coronary artery dilatation gradually assuaged, and the condition is continued to alleviate. CONCLUSION: Brucellosis can invade nervous system, coronary artery, and cornea. Brucellosis lacks specific signs for clinical diagnosis. The traditional agglutination test and the new mNGS are convenient and effective, which can provide the reference for clinical diagnosis.


Assuntos
Brucella melitensis/isolamento & purificação , Brucelose/complicações , Brucelose/diagnóstico , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico , Ceratite/complicações , Ceratite/diagnóstico , Meningoencefalite/complicações , Meningoencefalite/diagnóstico , Testes de Aglutinação , Animais , Anti-Infecciosos/uso terapêutico , Anticoagulantes/uso terapêutico , Brucelose/tratamento farmacológico , Ceftriaxona/uso terapêutico , Pré-Escolar , Erros de Diagnóstico , Febre/tratamento farmacológico , Humanos , Ceratite/tratamento farmacológico , Masculino , Meningoencefalite/tratamento farmacológico , Rifampina/uso terapêutico , Sulfametoxazol/uso terapêutico , Resultado do Tratamento , Zoonoses/diagnóstico , Zoonoses/tratamento farmacológico
6.
BMJ Case Rep ; 13(8)2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843469

RESUMO

Bacterial co-infection in the ongoing pandemic of COVID-19 is associated with poor outcomes but remains little understood. A 22-year-old woman presented with a 3-week history of fever, headache, neck stiffness, rigours and confusion. She was noted to have a purpuric rash over her hands and feet. Cerebrospinal fluid bacterial PCR was positive for Neisseria meningitidis A concurrent nasopharyngeal RT-PCR was positive for SARS-CoV-2, the causative virus of COVID-19. She was treated with antibiotics for bacterial meningitis and made a complete recovery. Bacterial infection from nasopharyngeal organisms has followed previous pandemic viral upper respiratory illnesses and the risk of bacterial co-infection in COVID-19 remains unclear. Research characterising COVID-19 should specify the frequency, species and outcome of bacterial co-infection. Management of bacterial co-infection in COVID-19 presents major challenges for antimicrobial stewardship and clinical management. Judicious use of local antibiotic guidelines and early liaison with infection specialists is key.


Assuntos
Coinfecção , Infecções por Coronavirus/complicações , Meningite Meningocócica/complicações , Pneumonia Viral/complicações , Antibacterianos/uso terapêutico , Betacoronavirus , Ceftriaxona/uso terapêutico , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Meningite Meningocócica/tratamento farmacológico , Pandemias , Pneumonia Viral/diagnóstico , Fatores de Risco , Adulto Jovem
7.
J Med Life ; 13(2): 151-155, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32742506

RESUMO

Thalassemia represents a heterogeneous group of inherited diseases characterized by the lack or reduced production of hemoglobin ß-chains. Many patients with thalassemia require splenectomy. What should be considered in the evaluation and management of candidates for splenectomy is to cover vaccination against infections such as pneumococci and the implementation of antibiotic prophylaxis. This study aimed to investigate the effect of the antibiotic type on the outcome of acute post-splenectomy infection in patients with thalassemia. This investigation is a retrospective cohort study. One hundred fifty medical records of hemoglobinopathy patients who underwent splenectomy were collected from the Ali-Asghar Hospital, Tehran, Iran. SPSS v. 20 and SAS v. 1.9 were used to analyze the data. A total of 150 patients that were vaccinated against post-splenectomy infections and were under antibiotic prophylaxis underwent splenectomy. The most commonly prescribed drugs were ceftriaxone or cefotaxime (132 cases, 88%), followed by ceftriaxone plus clindamycin (5.3%), ceftriaxone plus amikacin (3.3%), clindamycin (1.3%), vancomycin plus amikacin (0.7%), and others (1.3%). In terms of treatment outcomes, 143 cases (95.3%) were treated with the same antibiotics, and 4 (2.7%) experienced a changed antibiotic regimen with vancomycin. The results show that perceptions of treatment for fever in splenectomized children need to be changed, and most of them do not require hospitalization and initiation of broad-spectrum antibiotics such as vancomycin for initially refractory cases, and can only be treated with daily intravenous ceftriaxone.


Assuntos
Antibacterianos/uso terapêutico , Febre/tratamento farmacológico , Esplenectomia , Adolescente , Adulto , Amicacina/administração & dosagem , Amicacina/uso terapêutico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Irã (Geográfico) , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
PLoS One ; 15(8): e0237011, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745091

RESUMO

Enterococcus faecalis infective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen.


Assuntos
Ampicilina/uso terapêutico , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Endocardite/tratamento farmacológico , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/patogenicidade , Feminino , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
9.
Medicina (Kaunas) ; 56(7)2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32708858

RESUMO

The evolving pandemic of Coronavirus Disease 2019 has posed a substantial health risk worldwide. However, there is a paucity of data regarding the clinical course and the therapeutic management of patients with chronic kidney disease and COVID-19 infection. To date, most evidence has come from renal transplantation, with about 45 patients reported thus far, and the current data from the ERA-EDTA (ERACODA) registry for transplanted patients and patients on Renal Replacement Therapy (RRT); as for those with glomerular diseases, data are lacking. Herein, we report the case of a 62-year-old patient with severe membranoproliferative glomerulonephritis who had been receiving a high burden of immunosuppression until four months before the COVID-19 infection. He developed severe disease with acute respiratory failure requiring mechanical ventilation. After treatment with hydroxychloroquine and azithromycin, despite his low chances, he gradually recovered and survived. To the best of our knowledge, this is one of the few reported patients with glomerulonephritis who had COVID-19 Besides our single case with glomerulonephritis early during the disease outbreak, the very low prevalence of COVID-19 infection in the country's transplant recipients (0.038%) and dialysis patients (0.24%) reflects the impact of the rapid implementation of social distancing rules as well as of preventive measures for disease control in the hospitals and dialysis units in our country.


Assuntos
Infecções por Coronavirus/complicações , Crioglobulinemia/complicações , Glomerulonefrite Membranoproliferativa/complicações , Pneumonia Viral/complicações , Insuficiência Respiratória/etiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus , Ceftriaxona/uso terapêutico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/terapia , Creatinina/metabolismo , Crioglobulinemia/imunologia , Ciclofosfamida , Inibidores Enzimáticos/uso terapêutico , Glomerulonefrite Membranoproliferativa/tratamento farmacológico , Glomerulonefrite Membranoproliferativa/imunologia , Glomerulonefrite Membranoproliferativa/metabolismo , Glucocorticoides/uso terapêutico , Grécia , Humanos , Hidroxicloroquina/uso terapêutico , Hospedeiro Imunocomprometido , Fatores Imunológicos/uso terapêutico , Falência Renal Crônica/terapia , Transplante de Rim , Leucemia Linfocítica Crônica de Células B/complicações , Leucemia Linfocítica Crônica de Células B/imunologia , Pulmão/diagnóstico por imagem , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Pneumonia Viral/terapia , Diálise Renal , Respiração Artificial , Insuficiência Respiratória/terapia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rituximab/uso terapêutico , Tomografia Computadorizada por Raios X
10.
BMC Infect Dis ; 20(1): 514, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32677988

RESUMO

BACKGROUND: Worldwide, an increase in antimicrobial resistance (AMR) of Neisseria gonorrhoeae has been observed. Until now, no protocol for an external quality assessment (EQA) has been available for Germany. The German gonococcal resistance network (GORENET) performed an EQA of primary laboratories in Germany in order to assess quality of antibiotic susceptibility testing, to gain information about laboratory procedures and to assess the impact of these procedures on test results. METHODS: Laboratories assessed drug susceptibility to cefixime, ceftriaxone, azithromycin, penicillin and ciprofloxacin for five N. gonorrhoeae strains, using their standard laboratory protocols. Minimal inhibitory concentrations (MICs) were compared to World Health Organisation (WHO) consensus results (or, if not available, reference laboratory results), while deviation by +/- one doubling dilution was accepted. Data on laboratory procedures were collected via a standardised questionnaire. Generalized linear models and conditional inference trees (CTREE) were used to assess relationships between laboratory procedures and testing outcomes. RESULTS: Twenty-one primary laboratories participated in the EQA in June 2018. 96% of ciprofloxacin MICs were reported within accepted deviations, as well as 88% for cefixime, 85% for ceftriaxone, 79% for penicillin and 70% for azithromycin. The use of interpretation standards and general laboratory procedures like agar base, incubation settings or the use of control strains strongly differed between laboratories. In statistical analysis, incubation time of cultures < 24 h was associated with correct measurements. Additionally, a 5% CO2 concentration was associated with correct results regarding azithromycin compared to 3%. CTREE analysis showed that incubation time, humidity and CO2 concentration had the greatest influence on the average deviation from consensus results. CONCLUSIONS: In conclusion, we report the development of a protocol for N. gonorrhoeae antimicrobial susceptibility testing in Germany. While testing results were in accordance with the expected consensus results in 70-96%, depending on the antibiotic agent, laboratory methodology was heterogeneous and may significantly affect the testing quality. We therefore recommend the development of a standard operating procedure (SOP) for N. gonorrhoeae susceptibility testing in Germany.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Gonorreia/tratamento farmacológico , Laboratórios/normas , Ensaio de Proficiência Laboratorial , Neisseria gonorrhoeae/efeitos dos fármacos , Antibacterianos/farmacologia , Azitromicina/farmacologia , Azitromicina/uso terapêutico , Cefixima/farmacologia , Cefixima/uso terapêutico , Ceftriaxona/farmacologia , Ceftriaxona/uso terapêutico , Ciprofloxacino/farmacologia , Ciprofloxacino/uso terapêutico , Alemanha , Gonorreia/microbiologia , Humanos , Ensaio de Proficiência Laboratorial/métodos , Testes de Sensibilidade Microbiana , Penicilinas/farmacologia , Penicilinas/uso terapêutico , Controle de Qualidade , Padrões de Referência , Inquéritos e Questionários
11.
BMC Infect Dis ; 20(1): 505, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660552

RESUMO

BACKGROUND: Meningococcal meningitis (MM) is a life-threatening disease associated with approximately 10% case fatality rates and neurological sequelae in 10-20% of the cases. Recently, we have shown that the matrix metalloproteinase (MMP) inhibitor BB-94 reduced brain injury in a mouse model of MM. The present study aimed to assess whether doxycycline (DOX), a tetracycline that showed a neuroprotective effect as adjuvant therapy in experimental pneumococcal meningitis (PM), would also exert a beneficial effect when given as adjunctive therapy to ceftriaxone (CRO) in experimental MM. METHODS: BALB/c mice were infected by the intracisternal route with a group C Neisseria meningitidis strain. Eighteen h post infection (hpi), animals were randomised for treatment with CRO [100 mg/kg subcutaneously (s.c.)], CRO plus DOX (30 mg/kg s.c.) or saline (control s.c.). Antibiotic treatment was repeated 24 and 40 hpi. Mouse survival and clinical signs, bacterial counts in cerebella, brain damage, MMP-9 and cyto/chemokine levels were assessed 48 hpi. RESULTS: Analysis of bacterial load in cerebella indicated that CRO and CRO + DOX were equally effective at controlling meningococcal replication. No differences in survival were observed between mice treated with CRO (94.4%) or CRO + DOX (95.5%), (p > 0.05). Treatment with CRO + DOX significantly diminished both the number of cerebral hemorrhages (p = 0.029) and the amount of MMP-9 in the brain (p = 0.046) compared to untreated controls, but not to CRO-treated animals (p > 0.05). Levels of inflammatory markers in the brain of mice that received CRO or CRO + DOX were not significantly different (p > 0.05). Overall, there were no significant differences in the parameters assessed between the groups treated with CRO alone or CRO + DOX. CONCLUSIONS: Treatment with CRO + DOX showed similar bactericidal activity to CRO in vivo, suggesting no antagonist effect of DOX on CRO. Combined therapy significantly improved mouse survival and disease severity compared to untreated animals, but addition of DOX to CRO did not offer significant benefits over CRO monotherapy. In contrast to experimental PM, DOX has no adjunctive activity in experimental MM.


Assuntos
Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Doxiciclina/uso terapêutico , Meningite Meningocócica/tratamento farmacológico , Neisseria meningitidis Sorogrupo C , Animais , Antibacterianos/administração & dosagem , Carga Bacteriana/efeitos dos fármacos , Ceftriaxona/administração & dosagem , Hemorragia Cerebral/tratamento farmacológico , Quimiocinas/análise , Quimiocinas/metabolismo , Modelos Animais de Doenças , Doxiciclina/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Metaloproteinase 9 da Matriz/análise , Metaloproteinase 9 da Matriz/metabolismo , Meningite Meningocócica/mortalidade , Camundongos , Camundongos Endogâmicos BALB C , Distribuição Aleatória , Resultado do Tratamento
12.
BMJ Case Rep ; 13(7)2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32675129

RESUMO

The clinical implications of COVID-19 in pregnancy remain unknown. While preliminary reports demonstrate that pregnant patients have a similar symptomatic presentation to the general population, the appropriate management and timing of delivery in these patients is still unclear, as pregnancy may impose additional risk factors and impede recovery in gravid patients. In this brief report, we present a case of COVID-19 in a pregnant patient with severe respiratory compromise, whose clinical status significantly improved after caesarean delivery. We also address the potential benefits of experimental therapy, including tocilizumab, a monoclonal antibody that targets interleukin-6 receptors.


Assuntos
Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus , Cesárea , Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Progressão da Doença , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Pandemias , Período Pós-Parto , Gravidez , Resultado do Tratamento
14.
Brasília; s.n; 22 jul.2020.
Não convencional em Português | LILACS | ID: biblio-1117681

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 20 artigos e 10 protocolos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Ribavirina/uso terapêutico , Avaliação da Tecnologia Biomédica , Ceftriaxona/uso terapêutico , Dexametasona/uso terapêutico , Metilprednisolona/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Estudos Transversais , Estudos de Coortes , Corticosteroides/uso terapêutico , Azitromicina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Ritonavir/uso terapêutico , Oseltamivir/uso terapêutico , Lopinavir/uso terapêutico , Interferon beta-1a/uso terapêutico , Rituximab/uso terapêutico , Amiodarona/uso terapêutico , Hidroxicloroquina/uso terapêutico , Medicina Tradicional Chinesa/instrumentação , Antibacterianos/uso terapêutico
15.
Cir. pediátr ; 33(3): 149-152, jul. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193559

RESUMO

INTRODUCCIÓN: La ceftriaxona es un antibiótico de amplio espectro frecuentemente utilizado en pediatría. La pseudolitiasis vesicular es un efecto adverso bien conocido que se presenta en un 15 a 57% de los casos. En cambio, la litiasis renal es extremadamente infrecuente, con muy pocas publicaciones al respecto. CASO CLÍNICO: Se presenta el caso de un paciente de 9 años que, durante tratamiento con ceftriaxona por una apendicitis aguda complicada, desarrolla pseudolitiasis vesicular y urinaria. Durante la misma internación el paciente presenta una pancreatitis leve y una ureterohidro-nefrosis bilateral, con insuficiencia renal aguda, como complicaciones de las pseudolitiasis. COMENTARIOS: La sospecha de la formación de litiasis renal y/o vesicular asociada al uso de ceftriaxona es fundamental para un diagnóstico temprano y prevención de complicaciones como las reportadas en este paciente, siendo fundamental la suspensión precoz del fármaco como inicio del tratamiento


INTRODUCTION: Ceftriaxone is a wide-spectrum antibiotic frequently used in pediatrics. Biliary pseudolithiasis is a well-known side-effect occurring in 15-57% of cases. However, nephrolithiasis is extremely infrequent, with very few related publications. CASE REPORT: We present the case of a 9-year-old patient with ceftriaxone-treated complicated acute appendicitis who developed biliary pseudolithiasis and nephrolithiasis. During hospitalization, the patient presented with pseudolithiasis complications such as mild pancreatitis and bilateral ureterohydronephrosis with acute renal failure. REMARKS: Suspecting ceftriaxone-associated biliary pseudolithiasis and/or nephrolithiasis is key to achieve an early diagnosis and prevent complications such as those reported in this patient. Early discontinuation is essential as an initial treatment measure


Assuntos
Humanos , Masculino , Criança , Nefrolitíase/induzido quimicamente , Ceftriaxona/efeitos adversos , Antibacterianos/efeitos adversos , Cálculos Renais/induzido quimicamente , Cálculos Biliares/induzido quimicamente , Nefrolitíase/prevenção & controle , Ceftriaxona/uso terapêutico , Nefrolitíase/diagnóstico por imagem , Radiografia Abdominal
16.
Brasília; s.n; 7 jul. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1117630

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 17 artigos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Esteroides/uso terapêutico , Avaliação da Tecnologia Biomédica , Vitamina D/uso terapêutico , Varfarina/uso terapêutico , Ivermectina/uso terapêutico , Ceftriaxona/uso terapêutico , Cloroquina/uso terapêutico , Metotrexato/uso terapêutico , Corticosteroides/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Oseltamivir/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Lopinavir/uso terapêutico , Infliximab/uso terapêutico , Leflunomida/uso terapêutico , Amoxicilina/uso terapêutico , Hidroxicloroquina/uso terapêutico , Ácido Micofenólico/uso terapêutico
17.
Life Sci ; 258: 118119, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32682915

RESUMO

Ceftriaxone (CTX) is a third-generation cephalosporin antibiotic that has broad-spectrum antimicrobial activity. This agent also has anti-inflammatory and antioxidant characteristics. In the current study, the effects of CTX against hepatorenal damages in a D-galactose (DGL) induced aging model were investigated. We used twenty-eight male mice which equally and randomly were separated into four groups as follows: Control, DGL group (treated with 500 mg/kg/day DGL orally for six weeks), DGL + CTX group (treated with 500 mg/kg/day DGL orally plus 200 mg/kg/day CTX intraperitoneally for six weeks), and CTX group (treated with 200 mg/kg/day CTX intraperitoneally for six weeks). The liver and kidney function indices such as serum creatinine, blood urine nitrogen, alanine aminotransferase, and aspartate aminotransferase were measured. Also, levels of malondialdehyde, catalase, and glutathione peroxidase in hepatic and renal tissues were evaluated. Moreover, the expression profiles of interleukin 1 beta and tumor necrosis factor alpha were assessed. The liver and kidney tissues were assessed for histopathological lesions. The results showed that aging induced by DGL leads to abnormalities in functional indices of the liver and kidneys. DGL also induced significant oxidative stress and inflammation, as well as histopathological lesions, in these organs. CTX improved functional indices, as well as the parameters of oxidative stress and inflammation, compared with the DGL-treated animals. These results were also confirmed by histological evaluations of the liver and kidneys. These data provide evidence for the therapeutic value of CTX in clinical practice for mitigating the hepatorenal damages of aging.


Assuntos
Envelhecimento/patologia , Ceftriaxona/uso terapêutico , Síndrome Hepatorrenal/tratamento farmacológico , Animais , Ceftriaxona/farmacologia , Galactose , Inflamação/patologia , Rim/efeitos dos fármacos , Rim/patologia , Fígado/efeitos dos fármacos , Fígado/patologia , Masculino , Camundongos , Oxirredução , Estresse Oxidativo/efeitos dos fármacos
18.
Niger J Clin Pract ; 23(6): 883-886, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32525127

RESUMO

A complicated case of female genital mutilation (FGM) type 2b done in late-pregnancy is presented and the interplay of Yoruba and Kwale culture, in this case, is discussed. A Yoruba who grew up among Kwales/Urhobos had FGM at 38 weeks and 4 days gestation (to assure vaginal delivery) and presented with vulvar hematoma, septicemia, obstructed labor, and a distressed fetus. 5 days after FGM procedure, she had an emergency cesarean section (EmCS), repair of FGM site and baby was admitted in special care. There was the obvious synergy of the Yoruba culture of FGM in infancy and Kwale/Urhobo culture of FGM in pregnancy. The patient and her fetus/baby almost became mortalities but for prompt intervention. The role of sociocultural factors in the practice of FGM is recommended to be further investigated as FGM even in educated women and at the dangerous stage of term pregnancy is still prevalent.


Assuntos
Cesárea , Circuncisão Feminina/efeitos adversos , Hematoma/cirurgia , Complicações do Trabalho de Parto/etiologia , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Drenagem , Tratamento de Emergência , Feminino , Gentamicinas/uso terapêutico , Hematoma/reabilitação , Humanos , Metronidazol/uso terapêutico , Gravidez , Resultado da Gravidez , Sepse/tratamento farmacológico , Sepse/microbiologia , Toxoide Tetânico , Resultado do Tratamento , Doenças da Vulva/tratamento farmacológico , Doenças da Vulva/etiologia , Adulto Jovem
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