Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.998
Filtrar
1.
J Wound Ostomy Continence Nurs ; 48(6): 573-577, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34781315

RESUMO

BACKGROUND: Mycobacterium wolinskyi is a rare, fast-growing, painful bacterium causing soft tissue infections. Sparse case reports focus on long-term intravenous antibiotic therapy and surgical interventions. We searched the literature and found almost no discussion about treatment from a nursing and wound care perspective. CASE: Ms P, a 30-year-old Arabic female patient, underwent cosmetic surgery in Iraq including liposuction, abdominoplasty, and herniorrhaphy. One month postoperatively, she presented with an infection identified as M. wolinskyi resulting in multiple hospital admissions. Ms P received treatment with long-term antibiotic therapy and underwent multiple surgical debridements with extensive wound care management. CONCLUSION: Mycobacterium wolinskyi is an exceedingly rare bacterium not typically seen in the clinical setting and requires prolonged and aggressive treatment. It is painful and fast-growing, as evidenced by multiple abscess formations and tissue necrosis in this case. Daily assessments and wound management using a collaborative approach were important to promote optimal healing.


Assuntos
Mycobacteriaceae , Infecções dos Tecidos Moles , Cirurgia Plástica , Abdome , Adulto , Feminino , Humanos , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/terapia
2.
MMWR Morb Mortal Wkly Rep ; 70(42): 1472-1477, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34673748

RESUMO

During December 2018-February 2019, a multistate investigation identified 101 patients with vaccination-associated adverse events among an estimated 940 persons in Kentucky, Indiana, and Ohio who had received influenza; hepatitis A; pneumococcal; or tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines at the workplace during September 11-November 28, 2018. These vaccines had been administered by staff members of a third-party health care company contracted by 24 businesses. Company A provided multiple vaccine types during workplace vaccination events across 54 locations in these adjoining states. Injection-site wound isolates from patients yielded Mycobacterium porcinum, a nontuberculous mycobacteria (NTM) species in the Mycobacterium fortuitum group; subtyping using pulsed-field gel electrophoresis of all 28 available isolates identified two closely related clusters. Site visits to company A and interviews with staff members identified inadequate hand hygiene, improper vaccine storage and handling, lack of appropriate medical record documentation, and lack of reporting to the Vaccine Adverse Event Reporting System (VAERS). Vaccination-associated adverse events can be prevented by training health care workers responsible for handling or administering vaccines in safe vaccine handling, administration, and storage practices, timely reporting of any suspected vaccination-associated adverse events to VAERS, and notifying public health authorities of any adverse event clusters.


Assuntos
Mycobacteriaceae/isolamento & purificação , Dermatopatias Bacterianas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Vacinação/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Indiana/epidemiologia , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Ohio/epidemiologia , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Adulto Jovem
3.
BMC Infect Dis ; 21(1): 1046, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627195

RESUMO

BACKGROUND: Necrotizing soft-tissue infection (NSTI) is a severe and fast-progressing bacterial infection. Prognostic biomarkers may provide valuable information in treatment guidance and decision-making, but none have provided sufficient robustness to have a clinical impact. YKL-40 may reflect the ongoing pathological inflammatory processes more accurately than traditional biomarkers as it is secreted by the activated immune cells, but its prognostic yields in NSTI remains unknown. For this purpose, we investigated the association between plasma YKL-40 and 30-day mortality in patients with NSTI, and assessed its value as a marker of disease severity. METHODS: We determined plasma YKL-40 levels in patients with NSTI (n = 161) and age-sex matched controls (n = 65) upon admission and at day 1, 2 and 3. RESULTS: Baseline plasma YKL-40 was 1191 ng/mL in patients with NSTI compared with 40 ng/mL in controls (p < 0.001). YKL-40 was found to be significantly higher in patients with septic shock (1942 vs. 720 ng/mL, p < 0.001), and in patients receiving renal-replacement therapy (2382 vs. 1041 ng/mL, p < 0.001). YKL-40 correlated with Simplified Acute Physiology Score II (Rho 0.33, p < 0.001). Baseline YKL-40 above 1840 ng/mL was associated with increased risk of 30-day mortality in age-sex-comorbidity adjusted analysis (OR 3.77, 95% CI; 1.59-9.24, p = 0.003), but after further adjustment for Simplified Acute Physiology Score II no association was found between YKL-40 and early mortality. CONCLUSION: High plasma YKL-40 to be associated with disease severity, renal-replacement therapy and risk of death in patients with NSTI. However, YKL-40 is not an independent predictor of 30-day mortality.


Assuntos
Choque Séptico , Infecções dos Tecidos Moles , Biomarcadores , Proteína 1 Semelhante à Quitinase-3 , Humanos , Índice de Gravidade de Doença
4.
Int J Mycobacteriol ; 10(3): 217-227, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34494559

RESUMO

Nontuberculous mycobacteria (NTM), considered as mere contaminants, are off late, being reported as potential pathogens through various studies. The infections due to NTM range from pulmonary to extra pulmonary including skin and soft-tissue infections, traumatic and surgical wound infections, and catheter and implant-associated infections. Although extrapulmonary infections are extensively explored, pulmonary infections are scarcely reported due to their misdiagnosis as tuberculosis caused by M. tuberculosis (MTB). Appropriate detection methods are essential in order to facilitate the differential diagnosis of NTM from MTB infections. We aimed to collate the data available on NTM diagnosis and its epidemiology in India in this review. While diagnosis of MTB itself is more challenging in India, for appropriate treatment of NTM, special training and attention is needed for differential diagnosis of the former from latter. Currently, in India, in addition to the available techniques for identification of NTM, line probe assay (Hains life sciences) is proving to be a promising tool for the detection of NTM (common mycobacteria/additional species kit) and their antimicrobial resistance (Genotype NTM-DR VER 1.0). In future, with the price of sequencing steadily coming down, with proper monitoring, whole-genome sequencing could be the test of choice to predict the species, drug resistance, outbreaks in hospitals, and transmission dynamics.


Assuntos
Infecções por Mycobacterium não Tuberculosas , Mycobacterium tuberculosis , Infecções dos Tecidos Moles , Tuberculose , Humanos , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Micobactérias não Tuberculosas/genética
5.
Microsurgery ; 41(7): 637-644, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34473372

RESUMO

BACKGROUND: Management of cranial defects following failed cranioplasty due to titanium mesh exposure and infection is challenging. The purpose of this report is to describe a modified technique using a free myocutaneous flap transfer for primary soft tissue reconstruction, and titanium mesh reinsertion for cranioplasty revision. METHODS: Nineteen patients with titanium mesh exposure and infection following cranioplasty were treated from January 2012 to January 2019. The average patient age was 41.89 years and the average size of the cranial defect was 7.74 × 13.92 cm. The reasons for craniotomy were craniocerebral trauma (n = 17), cerebrovascular disease (n = 1), and brain tumor (n = 1). The mean duration between implant exposure and current procedure was 7.16 months. Implant was removed and a free myocutaneous flap was designed to cover both scalp and cranium defects. After a mean duration of 12.32 months, implants were re-inserted in a vascularized pocket at the second stage by elevating a plane between the previously transferred fascia layer and muscle layer. RESULTS: The average sizes of the muscle flaps and skin paddles were 7.74 × 13.92 cm and 4.97 × 8.97 cm. The average size of the implants was 8.24 × 14.42 cm. All flaps survived completely with no complication. After an average follow-up of 48.16 months there were no cranioplasty failures. Functional coverage of craniectomy defect sites with normalized head contour was achieved. CONCLUSIONS: The use of free myocutaneous flap and implant reinsertion achieved durable cranial and scalp defect reconstruction and aesthetic outcomes. The myocutaneous flap increases blood supply to the scalp, which may reduce the chances of infection and implant re-exposure.


Assuntos
Retalho Miocutâneo , Procedimentos Cirúrgicos Reconstrutivos , Infecções dos Tecidos Moles , Adulto , Humanos , Complicações Pós-Operatórias , Crânio/cirurgia , Telas Cirúrgicas/efeitos adversos , Titânio
6.
Antimicrob Agents Chemother ; 65(11): e0065821, 2021 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-34491807

RESUMO

Biofilm has recently been highlighted as a complicating feature of necrotizing soft tissue infections (NSTI) caused by Streptococcus pyogenes (i.e., group A Streptococcus [GAS]) contributing to a persistence of bacteria in tissue despite prolonged antibiotic therapy. Here, we assessed the standard treatment of benzylpenicillin and clindamycin with or without rifampin in a tissue-like setting. Antibiotic efficacy was evaluated by CFU determination in a human organotypic skin model infected for 24 or 48 h with GAS strains isolated from NSTI patients. Antibiotic effect was also evaluated by microcalorimetric metabolic assessment in in vitro infections of cellular monolayers providing continuous measurements over time. Adjunctive rifampin resulted in enhanced antibiotic efficacy of bacterial clearance in an organotypic skin tissue model, 97.5% versus 93.9% (P = 0.006). Through microcalorimetric measurements, adjunctive rifampin resulted in decreased metabolic activity and extended lag phase for all clinical GAS strains tested (P < 0.05). In addition, a case report is presented of adjunctive rifampin treatment in an NSTI case with persistent GAS tissue infection. The findings of this study demonstrate that adjunctive rifampin enhances clearance of GAS biofilm in an in vitro tissue infection model.


Assuntos
Infecções dos Tecidos Moles , Infecções Estreptocócicas , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Humanos , Rifampina/farmacologia , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes
7.
Rozhl Chir ; 100(7): 325-329, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34465108

RESUMO

Skin abscess is one of the most common infections of skin and soft tissues. Incision and drainage under local anesthesia is the mainstay of treatment. Although previous small-scale studies failed to show a benefit of antibiotics in patients with simple abscesses, the use of antibiotic therapy is still encountered in the treatment of uncomplicated skin abscesses in our practice. The purpose of our study was to evaluate existing data assessing the effect of adjuvant antibiotic therapy on abscess management. Although as indicated by two recent multicenter studies, antibiotics may provide a positive effect in the management, it is important to consider the risk of resistance associated with antibiotic overuse and to approach each case individually.


Assuntos
Abscesso , Infecções dos Tecidos Moles , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Terapia Combinada , Drenagem , Humanos
10.
BMJ Open ; 11(8): e049924, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373309

RESUMO

INTRODUCTION: Injecting-related bacterial and fungal infections are a common complication among people who inject drugs (PWID), associated with significant morbidity and mortality. Invasive infections, including infective endocarditis, appear to be increasing in incidence. To date, preventive efforts have focused on modifying individual-level risk behaviours (eg, hand-washing and skin-cleaning) without much success in reducing the population-level impact of these infections. Learning from successes in HIV prevention, there may be great value in looking beyond individual-level risk behaviours to the social determinants of health. Specifically, the risk environment conceptual framework identifies how social, physical, economic and political environmental factors facilitate and constrain individual behaviour, and therefore influence health outcomes. Understanding the social and structural determinants of injecting-related bacterial and fungal infections could help to identify new targets for prevention efforts in the face of increasing incidence of severe disease. METHODS AND ANALYSIS: This is a protocol for a systematic review. We will review studies of PWID and investigate associations between risk factors (both individual-level and social/structural-level) and the incidence of hospitalisation or death due to injecting-related bacterial infections (skin and soft-tissue infections, bacteraemia, infective endocarditis, osteomyelitis, septic arthritis, epidural abscess and others). We will include quantitative, qualitative and mixed methods studies. Using directed content analysis, we will code risk factors for these infection-related outcomes according to their contributions to the risk environment in type (social, physical, economic or political) and level (microenvironmental or macroenvironmental). We will also code and present risk factors at each stage in the process of drug acquisition, preparation, injection, superficial infection care, severe infection care or hospitalisation, and outcomes after infection or hospital discharge. ETHICS AND DISSEMINATION: As an analysis of the published literature, no ethics approval is required. The findings will inform a research agenda to develop and implement social/structural interventions aimed at reducing the burden of disease. PROSPERO REGISTRATION NUMBER: CRD42021231411.


Assuntos
Doenças Transmissíveis , Infecções por HIV , Micoses , Preparações Farmacêuticas , Infecções dos Tecidos Moles , Abuso de Substâncias por Via Intravenosa , Humanos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Revisões Sistemáticas como Assunto
12.
Br J Radiol ; 94(1126): 20210236, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34233485

RESUMO

The epitrochlear lymph nodes (ELN) are rarely examined clinically and are difficult to identify radiologically in healthy patients. They are, therefore, generally under appreciated as a source of significant pathology. Despite this, enlargement of an ELN is almost always secondary to a pathological process, the differential for which is relatively narrow. The following pictorial review illustrates the spectrum of infectious, inflammatory and malignant conditions affecting the ELN, some of which are quite specific to this location. We also emphasise the importance of distinguishing enlarged ELNs from benign and malignant non-nodal soft tissue masses, which can have very similar clinical presentation and imaging appearances.


Assuntos
Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Infecções dos Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Infecções dos Tecidos Moles/patologia , Neoplasias de Tecidos Moles/patologia
13.
J Clin Invest ; 131(14)2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34263738

RESUMO

BACKGROUNDNecrotizing soft-tissue infections (NSTIs) are rapidly progressing infections frequently complicated by septic shock and associated with high mortality. Early diagnosis is critical for patient outcome, but challenging due to vague initial symptoms. Here, we identified predictive biomarkers for NSTI clinical phenotypes and outcomes using a prospective multicenter NSTI patient cohort.METHODSLuminex multiplex assays were used to assess 36 soluble factors in plasma from NSTI patients with positive microbiological cultures (n = 251 and n = 60 in the discovery and validation cohorts, respectively). Control groups for comparative analyses included surgical controls (n = 20), non-NSTI controls (i.e., suspected NSTI with no necrosis detected upon exploratory surgery, n = 20), and sepsis patients (n = 24).RESULTSThrombomodulin was identified as a unique biomarker for detection of NSTI (AUC, 0.95). A distinct profile discriminating mono- (type II) versus polymicrobial (type I) NSTI types was identified based on differential expression of IL-2, IL-10, IL-22, CXCL10, Fas-ligand, and MMP9 (AUC >0.7). While each NSTI type displayed a distinct array of biomarkers predicting septic shock, granulocyte CSF (G-CSF), S100A8, and IL-6 were shared by both types (AUC >0.78). Finally, differential connectivity analysis revealed distinctive networks associated with specific clinical phenotypes.CONCLUSIONSThis study identifies predictive biomarkers for NSTI clinical phenotypes of potential value for diagnostic, prognostic, and therapeutic approaches in NSTIs.TRIAL REGISTRATIONClinicalTrials.gov NCT01790698.FUNDINGCenter for Innovative Medicine (CIMED); Region Stockholm; Swedish Research Council; European Union; Vinnova; Innovation Fund Denmark; Research Council of Norway; Netherlands Organisation for Health Research and Development; DLR Federal Ministry of Education and Research; and Swedish Children's Cancer Foundation.


Assuntos
Infecções dos Tecidos Moles , Adulto , Idoso , Biomarcadores/sangue , Citocinas/sangue , Intervalo Livre de Doença , Proteína Ligante Fas/sangue , Feminino , Fator Estimulador de Colônias de Granulócitos/sangue , Humanos , Masculino , Metaloproteinase 9 da Matriz/sangue , Pessoa de Meia-Idade , Necrose , Estudos Prospectivos , Infecções dos Tecidos Moles/sangue , Infecções dos Tecidos Moles/mortalidade , Taxa de Sobrevida , Trombomodulina/sangue
14.
Infect Dis Now ; 51(6): 540-546, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34198001

RESUMO

OBJECTIVE: We aimed to report a community outbreak of an uncommon methicillin-resistant Staphylococcus aureus (MRSA) originating in a maternity ward. PATIENTS AND METHODS: Cases were defined by epidemiological, clinical, and microbiological investigations. Microbiological investigations included phenotypic analysis, molecular typing, and whole-genome sequencing. To control the outbreak, we applied both national recommendations to prevent in-hospital transmission and the French High Council for Public Health guidelines on the management of community-acquired MRSA infections. RESULTS: Between March and July 2016, seven patients with MRSA infections were identified: six skin and soft tissue infections and one pulmonary infection, including six microbiologically confirmed infections. Infections occurred in community settings, but a link with the same maternity ward was found for all patients. All MRSA strains had a t690 spa type, were tetracycline-resistant, and produced Panton-Valentine leukocidin. All isolates belonged to the sequence type 88 (ST88). CONCLUSION: This outbreak highlights the largely underestimated risk of healthcare-associated infections in maternity wards. Healthcare workers should be aware of the importance of standard hygiene precautions and use of alcohol-based hand sanitizers for neonates and mothers.


Assuntos
Infecções Comunitárias Adquiridas , Staphylococcus aureus Resistente à Meticilina , Infecções dos Tecidos Moles , Infecções Estafilocócicas , Infecções Comunitárias Adquiridas/epidemiologia , Feminino , Hospitais , Humanos , Recém-Nascido , Staphylococcus aureus Resistente à Meticilina/genética , Gravidez , Infecções Estafilocócicas/tratamento farmacológico
15.
Am J Trop Med Hyg ; 105(3): 596-599, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34280133

RESUMO

This retrospective and single-center study in Reunion Island (Indian Ocean) assessed frequency, mortality, causative pathogens of severe necrotizing skin, and necrotizing skin and soft tissue infections (NSSTIs) admitted in intensive care unit (ICU). Sixty-seven consecutive patients were included from January 2012 to December 2018. Necrotizing skin and soft tissue infection represented 1.06% of total ICU admissions. We estimate the incidence of NSSTI requiring ICU at 1.21/100,000 person/years in Reunion Island. Twenty (30%) patients were receiving nonsteroidal anti-inflammatory drugs (NSAIDs) prior to admission in ICU and 40 (60%) were diagnosed patients with diabetes. Sites of infection were the lower limb in 52 (78%) patients, upper limb in 4 (6%), and perineum in 10 (15%). The surgical treatment was debridement for 40 patients, whereas 11 patients required an amputation. The most commonly isolated microorganisms were Streptococci (42%) and Gram-negative bacteria (22%).The mortality rate was 25.4%. NSAIDs did not influence mortality when interrupted upon admission to ICU.


Assuntos
Fasciite Necrosante/epidemiologia , Choque Séptico/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Infecções Estreptocócicas/epidemiologia , Idoso , Amputação , Anti-Inflamatórios não Esteroides/uso terapêutico , Arterite/epidemiologia , Comorbidade , Desbridamento , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Fasciite Necrosante/mortalidade , Fasciite Necrosante/terapia , Feminino , Hidratação , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Negativas/terapia , Mortalidade Hospitalar , Humanos , Hipertensão/epidemiologia , Hipoglicemiantes/uso terapêutico , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Necrose , Insuficiência Renal Crônica/epidemiologia , Terapia de Substituição Renal , Respiração Artificial , Estudos Retrospectivos , Reunião/epidemiologia , Fatores de Risco , Choque Séptico/mortalidade , Choque Séptico/terapia , Dermatopatias Infecciosas , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/terapia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Infecções Estreptocócicas/mortalidade , Infecções Estreptocócicas/terapia , Streptococcus , Streptococcus pyogenes , Vasoconstritores/uso terapêutico
16.
J Oral Maxillofac Surg ; 79(11): 2280-2284, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34245702

RESUMO

PURPOSE: Many dental infections that otherwise could be treated in-office are directly referred to emergency departments (ED) outside of normal business hours. This study sought to determine if odontogenic infections presenting to EDs were less severe on the weekends. MATERIALS AND METHODS: This was a retrospective cohort study of the 2014 Nationwide Emergency Department Sample. All patients with the primary diagnosis of an oral soft tissue infection were included in the study sample. The primary study predictor was day of presentation. The study outcome was inpatient admission from the ED. A multivariate regression model was created for ED admission rate to identify independent predictors. RESULTS: A total of 6,560 records were included in the final sample. Overall, 34.8% of encounters occurred on the weekend, and these patients were more likely to have private insurance and reside in higher income locations. The unadjusted ED admission rate (9.4 vs 13.4%, P < .01) was lower for patients evaluated on the weekend. The multiple regression model confirmed that weekend presentation was associated with a significantly lower odds of admission (OR = 0.69, P < .01). CONCLUSIONS: Weekend odontogenic infections were less severe than those presenting on the weekdays. Off-hour dental emergencies remain a potential source of ED waste and should be scrutinized in any reforms seeking to reduce unnecessary emergency room encounters.


Assuntos
Serviço Hospitalar de Emergência , Infecções dos Tecidos Moles , Mortalidade Hospitalar , Hospitalização , Humanos , Admissão do Paciente , Encaminhamento e Consulta , Estudos Retrospectivos
17.
Sci Rep ; 11(1): 14566, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34267298

RESUMO

Combining traditional medicine with nanotechnology therefore opens the door to innovative strategies for treating skin and soft tissue infections (SSTIs) and also contributes to the fight against the rise of antimicrobial resistance. Acanthospermum australe (Loefl.) Kuntze is a medicinal plant used by indigenous peoples in northeastern Argentina to treat SSTIs. Spherical and stable silver nanoparticles (AgNPs) of 14 ± 2 nm were synthesized from the aqueous extract of A. australe and silver nitrate. The antimicrobial activity against main species causing SSTIs and cytotoxicity on peripheral blood mononuclear cells of AgNP solution and its synthesis components were evaluated. Compared to its synthesis components, AgNP solution showed greater antimicrobial activity and lower cytotoxicity. The antimicrobial activity of AgNPs was due to the silver and not to the metabolites of the aqueous extract present on the surface of the nanoparticles. The plant extract played an important role in the formation of stable AgNPs and acted as a modulator of cytotoxic and immune responses.


Assuntos
Anti-Infecciosos/farmacologia , Nanopartículas Metálicas/química , Prata/química , Dermatopatias Infecciosas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Anti-Infecciosos/síntese química , Antioxidantes/química , Antioxidantes/farmacologia , Asteraceae/química , Flavonoides/análise , Química Verde , Humanos , Leucócitos Mononucleares/efeitos dos fármacos , Nanopartículas Metálicas/uso terapêutico , Testes de Sensibilidade Microbiana , Fenóis/análise , Extratos Vegetais/química
18.
Int J Dermatol ; 60(11): 1429-1434, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34080684

RESUMO

BACKGROUND: Biological therapies are widely used for moderate to severe chronic plaque psoriasis owing to their high efficacy and safety profile. However, skin and soft tissue infections (SSTIs) have been reported in association with biological treatment in psoriasis. METHODS: We report a case of necrotizing fasciitis in an 18-year-old psoriasis patient with a history of severe combined immunodeficiency treated with secukinumab and conducted a systematic literature review of SSTIs associated with biological therapy for psoriasis. The literature review related to biological therapies for psoriasis between the years 1990 and 2020: Medline (PubMed), Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched for psoriasis, biological treatment, and skin and soft tissue infections. RESULTS: Over 1,300 titles were found, 24 of which met the inclusion criteria for our study: nine retrospective studies, nine randomized controlled trials, and six prospective studies. The data covered 10 biological treatments. More than 40,000 patients receiving biological treatment were included, and nearly 1,000 cases of SSTIs were documented. CONCLUSIONS: We present the available records regarding SSTIs among chronic plaque psoriasis patients given biological treatment. Most reported SSTIs were related to psoriasis patients treated with TNF-α inhibitors. In view of the presented data, biological treatment appears to be a safe mode of therapy for this aspect of psoriasis.


Assuntos
Psoríase , Infecções dos Tecidos Moles , Adolescente , Terapia Biológica/efeitos adversos , Humanos , Estudos Prospectivos , Psoríase/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos
19.
J Trauma Acute Care Surg ; 91(1): 241-246, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34144567

RESUMO

BACKGROUND: During the coronavirus disease 2019 pandemic, New York instituted a statewide stay-at-home mandate to lower viral transmission. While public health guidelines advised continued provision of timely care for patients, disruption of safety-net health care and public fear have been proposed to be related to indirect deaths because of delays in presentation. We hypothesized that admissions for emergency general surgery (EGS) diagnoses would decrease during the pandemic and that mortality for these patients would increase. METHODS: A multicenter observational study comparing EGS admissions from January to May 2020 to 2018 and 2019 across 11 NYC hospitals in the largest public health care system in the United States was performed. Emergency general surgery diagnoses were defined using International Classification Diseases, Tenth Revision, codes and grouped into seven common diagnosis categories: appendicitis, cholecystitis, small/large bowel, peptic ulcer disease, groin hernia, ventral hernia, and necrotizing soft tissue infection. Baseline demographics were compared including age, race/ethnicity, and payor status. Outcomes included coronavirus disease (COVID) status and mortality. RESULTS: A total of 1,376 patients were admitted for EGS diagnoses from January to May 2020, a decrease compared with both 2018 (1,789) and 2019 (1,668) (p < 0.0001). This drop was most notable after the stay-at-home mandate (March 22, 2020; week 12). From March to May 2020, 3.3%, 19.2%, and 6.0% of EGS admissions were incidentally COVID positive, respectively. Mortality increased in March to May 2020 compared with 2019 (2.2% vs. 0.7%); this difference was statistically significant between April 2020 and April 2019 (4.1% vs. 0.9%, p = 0.045). CONCLUSION: Supporting our hypothesis, the coronavirus disease 2019 pandemic and subsequent stay-at-home mandate resulted in decreased EGS admissions between March and May 2020 compared with prior years. During this time, there was also a statistically significant increase in mortality, which peaked at the height of COVID infection rates in our population. LEVEL OF EVIDENCE: Epidemiological, level IV.


Assuntos
COVID-19/prevenção & controle , Emergências/epidemiologia , Mortalidade Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , Doença Aguda/mortalidade , Doença Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Apendicite/mortalidade , Apendicite/cirurgia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Colecistite/diagnóstico , Colecistite/mortalidade , Colecistite/cirurgia , Serviço Hospitalar de Emergência , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/mortalidade , Hérnia Inguinal/cirurgia , Hérnia Ventral/diagnóstico , Hérnia Ventral/mortalidade , Hérnia Ventral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/mortalidade , Necrose/cirurgia , New York/epidemiologia , Pandemias/prevenção & controle , Admissão do Paciente/tendências , Úlcera Péptica/diagnóstico , Úlcera Péptica/mortalidade , Úlcera Péptica/cirurgia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Tempo para o Tratamento/tendências , Adulto Jovem
20.
Sci Rep ; 11(1): 12542, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34131202

RESUMO

Dose-response models (DRMs) are used to predict the probability of microbial infection when a person is exposed to a given number of pathogens. In this study, we propose a new DRM for Staphylococcus aureus (SA), which causes skin and soft-tissue infections. The current approach to SA dose-response is only partially mechanistic and assumes that individual bacteria do not interact with each other. Our proposed two-compartment (2C) model assumes that bacteria that have not adjusted to the host environment decay. After adjusting to the host, they exhibit logistic/cooperative growth, eventually causing disease. The transition between the adjusted and un-adjusted states is a stochastic process, which the 2C DRM explicitly models to predict response probabilities. By fitting the 2C model to SA pathogenesis data, we show that cooperation between individual SA bacteria is sufficient (and, within the scope of the 2C model, necessary) to characterize the dose-response. This is a departure from the classical single-hit theory of dose-response, where complete independence is assumed between individual pathogens. From a quantitative microbial risk assessment standpoint, the mechanistic basis of the 2C DRM enables transparent modeling of dose-response of antibiotic-resistant SA that has not been possible before. It also enables the modeling of scenarios having multiple/non-instantaneous exposures, with minimal assumptions.


Assuntos
Infecções Bacterianas/microbiologia , Hormese/genética , Infecções Cutâneas Estafilocócicas/microbiologia , Staphylococcus aureus/patogenicidade , Infecções Bacterianas/patologia , Interações Hospedeiro-Patógeno/genética , Humanos , Modelos Teóricos , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/patologia , Infecções Cutâneas Estafilocócicas/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...