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Journal of Fungi (Basel, Switzerland) Jan 2021is a frequent cause of fungal bloodstream infections, especially in critically ill neonates or immunocompromised patients. Due to the formation of biofilms, the use of...
is a frequent cause of fungal bloodstream infections, especially in critically ill neonates or immunocompromised patients. Due to the formation of biofilms, the use of indwelling catheters and other medical devices increases the risk of infection and complicates treatment, as cells embedded in biofilms display reduced drug susceptibility. Therefore, biofilm formation may be a significant clinical parameter, guiding downstream therapeutic choices. Here, we phenotypically characterized 120 selected isolates out of a prospective collection of 215 clinical isolates, determining biofilm formation, major emerging colony morphotype, and antifungal drug susceptibility of the isolates and their biofilms. In our isolate set, increased biofilm formation capacity was independent of body site of isolation and not predictable using standard or modified European Committee on Antimicrobial Susceptibility Testing (EUCAST) drug susceptibility testing protocols. In contrast, biofilm formation was strongly correlated with the appearance of non-smooth colony morphotypes and invasiveness into agar plates. Our data suggest that the observation of non-smooth colony morphotypes in cultures of may help as an indicator to consider the initiation of anti-biofilm-active therapy, such as the switch from azole- to echinocandin- or polyene-based strategies, especially in case of infections by potent biofilm-forming strains.
PubMed: 33430377
DOI: 10.3390/jof7010033 -
JAMA Jan 2021Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known. (Comparative Study)
Comparative Study Randomized Controlled Trial
IMPORTANCE
Antibiotics are an effective and safe alternative to appendectomy for managing uncomplicated acute appendicitis, but the optimal antibiotic regimen is not known.
OBJECTIVE
To compare oral antibiotics with combined intravenous followed by oral antibiotics in the management of computed tomography-confirmed uncomplicated acute appendicitis.
DESIGN, SETTING, AND PARTICIPANTS
The Appendicitis Acuta (APPAC) II multicenter, open-label, noninferiority randomized clinical trial was conducted from April 2017 until November 2018 in 9 Finnish hospitals. A total of 599 patients aged 18 to 60 years with computed tomography-confirmed uncomplicated acute appendicitis were enrolled in the trial. The last date of follow-up was November 29, 2019.
INTERVENTIONS
Patients randomized to receive oral monotherapy (n = 295) received oral moxifloxacin (400 mg/d) for 7 days. Patients randomized to receive intravenous antibiotics followed by oral antibiotics (n = 288) received intravenous ertapenem (1 g/d) for 2 days followed by oral levofloxacin (500 mg/d) and metronidazole (500 mg 3 times/d) for 5 days.
MAIN OUTCOMES AND MEASURES
The primary end point was treatment success (≥65%) for both groups, defined as discharge from hospital without surgery and no recurrent appendicitis during 1-year follow-up, and to determine whether oral antibiotics alone were noninferior to intravenous and oral antibiotics, with a margin of 6% for difference.
RESULTS
Among 599 patients who were randomized (mean [SD] age, 36 [12] years; 263 [44%] women), 581 (99.7%) were available for the 1-year follow-up. The treatment success rate at 1 year was 70.2% (1-sided 95% CI, 65.8% to ∞) for patients treated with oral antibiotics and 73.8% (1-sided 95% CI, 69.5% to ∞) for patients treated with intravenous followed by oral antibiotics. The difference was -3.6% ([1-sided 95% CI, -9.7% to ∞]; P = .26 for noninferiority), with the confidence limit exceeding the noninferiority margin.
CONCLUSION AND RELEVANCE
Among adults with uncomplicated acute appendicitis, treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups, but failed to demonstrate noninferiority for treatment success of oral antibiotics compared with intravenous followed by oral antibiotics.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03236961; EudraCT Identifier: 2015-003633-10.
Topics: Acute Disease; Administration, Intravenous; Administration, Oral; Adult; Anti-Bacterial Agents; Appendectomy; Appendicitis; Drug Therapy, Combination; Ertapenem; Female; Follow-Up Studies; Humans; Levofloxacin; Male; Metronidazole; Middle Aged; Moxifloxacin; Tomography, X-Ray Computed; Young Adult
PubMed: 33427870
DOI: 10.1001/jama.2020.23525 -
JAMA Surgery Feb 2021Diverticulitis has a tendency to recur and affect quality of life. (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparing Laparoscopic Elective Sigmoid Resection With Conservative Treatment in Improving Quality of Life of Patients With Diverticulitis: The Laparoscopic Elective Sigmoid Resection Following Diverticulitis (LASER) Randomized Clinical Trial.
IMPORTANCE
Diverticulitis has a tendency to recur and affect quality of life.
OBJECTIVE
To assess whether sigmoid resection is superior to conservative treatment in improving quality of life of patients with recurrent, complicated, or persistent painful diverticulitis.
DESIGN, SETTING, AND PARTICIPANTS
This open-label randomized clinical trial assessed for eligibility 128 patients with recurrent, complicated, or persistent painful diverticulitis in 6 Finnish hospitals from September 29, 2014, to October 10, 2018. Exclusion criteria included age younger than 18 years or older than 75 years; lack of (virtual) colonoscopy or sigmoidoscopy data within 2 years, or presence of cancer, contraindication to laparoscopy, or fistula. Outcomes were assessed using intention-to-treat analysis. A prespecified interim analysis was undertaken when 66 patients had been randomized and their 6-month follow-up was assessable. Data were analyzed from June 2018 to May 2020.
INTERVENTIONS
Laparoscopic sigmoid resection or conservative treatment.
MAIN OUTCOMES AND MEASURES
The primary outcome was difference in Gastrointestinal Quality of Life Index (GIQLI) score between randomization and 6 months.
RESULTS
Of 128 patients assessed for eligibility, 90 were randomized (28 male [31%]; mean [SD] age, 54.11 [11.9] years; 62 female [69%]; mean [SD] age, 57.13 [7.6] years). A total of 72 patients were included in analyses for the primary outcome (37 in the surgery group and 35 in the conservative treatment group), and 85 were included in analyses for clinical outcomes (41 in the surgery group and 44 in the conservative treatment group). The difference between GIQLI score at randomization and 6 months was a mean of 11.96 points higher in the surgery group than in the conservative treatment group (mean [SD] of 11.76 [15.89] points vs -0.2 [19.07] points; difference, 11.96; 95% CI, 3.72-20.19; P = .005). Four patients (10%) in the surgery group and no patients in the conservative treatment group experienced major complications (Clavien-Dindo grade III or higher). There were 2 patients (5%) in the surgery group and 12 patients (31%) in the conservative treatment group who had new episodes of diverticulitis within 6 months.
CONCLUSIONS AND RELEVANCE
In this randomized clinical trial, elective laparoscopic sigmoid resection improved quality of life in patients with recurrent, complicated, or persistent painful diverticulitis but carried a 10% risk of major complications.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02174926.
Topics: Aged; Colon, Sigmoid; Conservative Treatment; Diverticulitis, Colonic; Elective Surgical Procedures; Female; Finland; Humans; Laparoscopy; Male; Middle Aged; Quality of Life
PubMed: 33206182
DOI: 10.1001/jamasurg.2020.5151 -
International Journal of Radiation... Mar 2021We report long-term outcomes of phase 2 trial on patients with invasive breast cancer treated with accelerated partial-breast irradiation (APBI) using tomotherapy after...
PURPOSE
We report long-term outcomes of phase 2 trial on patients with invasive breast cancer treated with accelerated partial-breast irradiation (APBI) using tomotherapy after breast conservative surgery.
METHODS AND MATERIALS
From December 2010 to December 2018, we treated 338 women with APBI-tomotherapy: 38.5 Gy in 10 once-daily fractions. Patients selected were age ≥50 years old, with ≤3 cm in size unifocal tumor and at least 2 mm of clear margins. Disease outcomes were analyzed by clinicopathologic characteristics, molecular phenotypes, and American Society for Radiation Oncology (ASTRO) 2017 updated consensus groupings.
RESULTS
The median age was 65 years (range, 50-86). The invasive ductal (87.5%) and the luminal A-like molecular phenotype (70%) were the most common tumors. Overall 242 patients (71.6%) were considered "suitable" for enrollment in APBI according to the eligibility criteria of the ASTRO-2017 consensus statement. With a median follow-up of 76 months (range, 17-113), 2 patients (0.6%) had an invasive ipsilateral breast tumor recurrence (IBTR), and 2 patients (0.6%) had an axillary ipsilateral failure. The rate of local control in terms of free of IBTR was 99.4% and locoregional control (no recurrence in ipsilateral breast as well as in regional nodes) was 98.8%. Progression-free survival was 98.4% and 92% at 5 and 10 years, respectively. Acute and late skin toxicity, graded according to the Common Terminology Criteria for Adverse Events, were 7.7% (G1) and 0.6% (G2) and 4.4% (G1) and 1.1% (G2), respectively. There were no grade 3/4 toxicities, however. Very few patients (2%) or physicians (2%) assessed cosmetic outcome as fair or poor at the 2-year follow-up.
CONCLUSIONS
This phase 2 trial on APBI-tomotherapy shows excellent long-term results. Once-daily fractionation schedule was well tolerated with a low rate of adverse events and worse cosmetic outcome. In this series, even among those deemed cautionary or unsuitable for APBI by ASTRO criteria, we demonstrated a low rate of IBTR.
Topics: Aged; Aged, 80 and over; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Lobular; Consensus; Dose Fractionation, Radiation; Esthetics; Female; Humans; Kaplan-Meier Estimate; Margins of Excision; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Progression-Free Survival; Radiotherapy; Radiotherapy, Intensity-Modulated; Time Factors; Treatment Outcome
PubMed: 33098960
DOI: 10.1016/j.ijrobp.2020.10.009 -
Journal of Medical Internet Research Oct 2020Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are...
Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing.
BACKGROUND
Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19.
OBJECTIVE
Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease.
METHODS
We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases.
RESULTS
A total of 10,504 patients with a clinical or polymerase chain reaction-confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature <39 degrees Celsius (or >39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care.
CONCLUSIONS
Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admission.
Topics: Adult; Aged; Betacoronavirus; COVID-19; Coronavirus Infections; Electronic Health Records; Emergency Service, Hospital; Female; Hospitalization; Humans; Intensive Care Units; Machine Learning; Male; Middle Aged; Natural Language Processing; Pandemics; Pneumonia, Viral; Prognosis; Retrospective Studies; SARS-CoV-2; Spain; Treatment Outcome
PubMed: 33090964
DOI: 10.2196/21801 -
Breast (Edinburgh, Scotland) Dec 2020Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed... (Comparative Study)
Comparative Study
BACKGROUND
Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants.
METHODS
A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants.
RESULTS
Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0-3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4-16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1-15.7) and 15.8% (95% CI: 4.1-15.7) [p = 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR = 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR = 0.3, p = 0.003).
CONCLUSIONS
After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto- Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).
Topics: Adult; Breast Implantation; Breast Implants; Breast Neoplasms; Female; Humans; Implant Capsular Contracture; Incidence; Mastectomy; Middle Aged; Polyurethanes; Prosthesis Design; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 33010626
DOI: 10.1016/j.breast.2020.09.009 -
Journal of Clinical and Translational... Jul 2020Radiosurgery is employed for the treatment of brain metastases. The aim of this study is to evaluate the efficacy and tolerability of single-dose radiosurgery (SRS)...
BACKGROUND
Radiosurgery is employed for the treatment of brain metastases. The aim of this study is to evaluate the efficacy and tolerability of single-dose radiosurgery (SRS) compared to hypofractionated stereotactic radiotherapy (hFSRT).
MATERIALS AND METHODS
Between 2004 and 2018, we analyzed treatments of 97 patients with 135 brain metastases. Fifty-six patients were treated with SRS, and 41 patients were treated with hFSRT. Median dose was 16 Gy (12-20 Gy) for the SRS group and 30 Gy in 5-6 fractions for the hFSRT group. hFSRT was used for larger lesions and lesions located near critical structures. Kaplan-Meier curves were constructed for overall survival (OS) and local control (LC).
RESULTS
Median age was 64 years (range, 32-89 years). Median survival was 10 months (1-68 months). With a median follow-up of 10 months, no significant differences in OS between groups were found (=0.21). LC for all patients was 67%. Local progression-free survival (LPFS) at 6 months and 1 year was 71% and 60% for the SRS group, respectively, and 80% and 69% for the hFSRT group, respectively (=0.93). Although hFSRT was used for larger lesions and lesions in adverse locations, LPFS was not inferior compared to lesions treated with SRS. We observed acute toxicity grade 1-2 in 25 patients (25.8%). Late complications were observed in 11 patients (11.3%). Acute and late toxicity was similar in the SRS- and hFSRT-treated patients (=0.63 and =0.11, respectively). Brain recurrence occurred in 37.5% and 14.6% in the hFSRT and SRS group, respectively (=0.06).
CONCLUSIONS
Since patients treated with hFSRT exhibited similar survival and LPFS rates without differences in toxicity compared to those treated with SRS, hFSRT can be beneficial, particularly for patients with brain metastases.
RELEVANCE FOR PATIENTS
Hypofractionated schemes in stereotactic radiosurgery offers treatment alternatives to patients with large lesions or lesions near critical structures.
PubMed: 32875136
DOI: No ID Found -
Antimicrobial Agents and Chemotherapy Sep 2020Although remains the major etiological agent of invasive candidiasis, and other emerging species of are increasingly isolated. This species is the second most...
Although remains the major etiological agent of invasive candidiasis, and other emerging species of are increasingly isolated. This species is the second most prevalent cause of candidiasis in many regions of the world. However, clinical isolates of and can be misidentified and are underdiagnosed due to phenotypic traits shared with Little is known about the two cryptic species. Therefore, pathogenesis studies are needed to understand their virulence traits and their susceptibility to antifungal drugs. The susceptibility of to different species makes this nematode an excellent model for assessing host-fungus interactions. We evaluated the usefulness of as a nonconventional host model to analyze the virulence of , , and The three species caused candidiasis, and the highest virulence of was confirmed. Furthermore, we determined the efficacy of current antifungal drugs against the infection caused by these species in the model. Amphotericin B and azoles showed the highest activity against and infections, while echinocandins were more active for treating those caused by proved to be a useful model system for assessing the pathogenicity of these closely related species.
Topics: Animals; Antifungal Agents; Caenorhabditis elegans; Candida; Candida glabrata; Microbial Sensitivity Tests; Saccharomycetales; Virulence
PubMed: 32718968
DOI: 10.1128/AAC.00824-20 -
Polymers Mar 2020The design of new materials with antimicrobial properties has emerged in response to the need for preventing and controlling the growth of pathogenic microorganisms...
The design of new materials with antimicrobial properties has emerged in response to the need for preventing and controlling the growth of pathogenic microorganisms without the use of antibiotics. In this study, partially reduced graphene oxide decorated with silver nanoparticles (GO-AgNPs) was incorporated as a reinforcing filler with antibacterial properties to poly(vinyl alcohol) (PVA) for preparation of poly(vinyl alcohol)/graphene oxide-silver nanoparticles nanocomposites (PVA/GO-AgNPs). AgNPs, spherical in shape and with an average size of 3.1 nm, were uniformly anchored on the partially reduced GO surface. PVA/GO-AgNPs nanocomposites showed exfoliated structures with improved thermal stability, tensile properties and water resistance compared to neat PVA. The glass transition and crystallization temperatures of the polymer matrix increased with the incorporation of the hybrid. The nanocomposites displayed antibacterial activity against and in a filler content- and time-dependent manner. showed higher susceptibility to PVA/GO-AgNPs films than Inhibitory activity was higher when bacterial cells were in contact with nanocomposite films than when in contact with leachates coming out of the films. GO-AgNPs based PVA nanocomposites could find application as wound dressings for wound healing and infection prevention.
PubMed: 32214025
DOI: 10.3390/polym12030723 -
Nanomaterials (Basel, Switzerland) Feb 2020Drug resistance of pathogenic microorganisms has become a global public health problem, which has prompted the development of new materials with antimicrobial...
Drug resistance of pathogenic microorganisms has become a global public health problem, which has prompted the development of new materials with antimicrobial properties. In this context, antimicrobial nanohybrids are an alternative due to their synergistic properties. In this study, we used an environmentally friendly one-step approach to synthesize graphene oxide (GO) decorated with silver nanoparticles (GO-AgNPs). By this process, spherical AgNPs of average size less than 4 nm homogeneously distributed on the surface of the partially reduced GO can be generated in the absence of any stabilizing agent, only with ascorbic acid (L-AA) as a reducing agent and AgNO as a metal precursor. The size of the AgNPs can be controlled by the AgNO concentration and temperature. Smaller AgNPs are obtained at lower concentrations of the silver precursor and lower temperatures. The antimicrobial properties of nanohybrids against Gram-negative bacteria and , Gram-positive , and the yeast were found to be concentration- and time-dependent. and showed the highest susceptibility to GO-AgNPs. These nanohybrids can be used as nanofillers in polymer nanocomposites to develop materials with antimicrobial activity for applications in different areas, and another potential application could be cancer therapeutic agents.
PubMed: 32098083
DOI: 10.3390/nano10020376