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Transplantation Proceedings May 2024Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that, in immunocompromised patients, can progress to respiratory failure and death. Since...
Pneumocystis jirovecii Pneumonia in a Liver Transplant Recipient With an Adverse Reaction to Trimethoprim/Sulfamethoxazole Treated With a Sulfonamide Desensitization Protocol: Case Report.
BACKGROUND
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that, in immunocompromised patients, can progress to respiratory failure and death. Since trimethoprim/sulfamethoxazole (TMP/SMX) chemoprophylaxis has become a standard management, the prognosis has improved. However, there are patients with a history of TMP/SMX intolerance who cannot receive chemoprophylaxis.
BACKGROUND
We report on a 53-year-old male liver recipient treated with a standard triple immunosuppressive regimen in whom TMP/SMX was waived because of a history of allergy manifested as a generalized rash with edema more than 30 years ago. At transplantation, the immunologic risk was assessed as low, and liver graft function was normal. In the third month after engraftment, he developed dyspnea at rest required constant passive oxygen therapy. Ceftriaxone, azithromycin, and clindamycin were implemented. Mycophenolate acid was stopped, and tacrolimus was reduced. High-resolution computed tomography revealed interstitial pneumonia. Pneumocystis jirovecii pneumoniae was diagnosed from bronchoalveolar lavage. Instead of TMP/SMX, pentamidine and caspofungin were also used for PJP, with no improvement. After 3 weeks, the patient deteriorated. Because of his life-threatening condition, TMP/SMX was introduced in the sulfonamide desensitization protocol, including hydrocortisone and clemastinum. Within 4 days, the patient stabilized with no signs of TMP/SMX intolerance. Pneumonia subsided within a month, and TMP/SMX was prescribed lifelong.
CONCLUSIONS
Prophylaxis for PJP with TMP/SMX still remains an important issue in transplant recipients. Adverse reaction to TMP/SMX in the past is not always a contraindication to reintroducing prophylaxis. The decision of prophylaxis avoidance should be analyzed carefully; in uncertain cases, a sulfonamide desensitization protocol should be considered.
Topics: Humans; Male; Middle Aged; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination; Liver Transplantation; Pneumocystis carinii; Sulfonamides; Desensitization, Immunologic; Immunocompromised Host; Immunosuppressive Agents
PubMed: 38760300
DOI: 10.1016/j.transproceed.2024.03.022 -
Scientific Reports May 2024Transforming growth factor-β (TGF-β) signaling plays a significant role in multiple biological processes, including inflammation, immunity, and cell death. However,...
Transforming growth factor-β (TGF-β) signaling plays a significant role in multiple biological processes, including inflammation, immunity, and cell death. However, its specific impact on the cochlea remains unclear. In this study, we aimed to investigate the effects of TGF-β signaling suppression on auditory function and cochlear pathology in mice with kanamycin-induced ototoxicity. Kanamycin and furosemide (KM-FS) were systemically administered to 8-week-old C57/BL6 mice, followed by immediate topical application of a TGF-β receptor inhibitor (TGF-βRI) onto the round window membrane. Results showed significant TGF-β receptor upregulation in spiral ganglion neurons (SGNs) after KM-FA ototoxicity, whereas expression levels in the TGF-βRI treated group remained unchanged. Interestingly, despite no significant change in cochlear TGF-β expression after KM-FS ototoxicity, TGF-βRI treatment resulted in a significant decrease in TGF-β signaling. Regarding auditory function, TGF-βRI treatment offered no therapeutic effects on hearing thresholds and hair cell survival following KM-FS ototoxicity. However, SGN loss and macrophage infiltration were significantly increased with TGF-βRI treatment. These results imply that inhibition of TGF-β signaling after KM-FS ototoxicity promotes cochlear inflammation and SGN degeneration.
Topics: Animals; Kanamycin; Signal Transduction; Ototoxicity; Transforming Growth Factor beta; Mice; Spiral Ganglion; Mice, Inbred C57BL; Cochlea; Hair Cells, Auditory; Furosemide; Male
PubMed: 38740884
DOI: 10.1038/s41598-024-61630-1 -
Physiological Reports May 2024The pathophysiology behind sodium retention in heart failure with preserved ejection fraction (HFpEF) remains poorly understood. We hypothesized that patients with HFpEF...
The pathophysiology behind sodium retention in heart failure with preserved ejection fraction (HFpEF) remains poorly understood. We hypothesized that patients with HFpEF have impaired natriuresis and diuresis in response to volume expansion and diuretic challenge, which is associated with renal hypo-responsiveness to endogenous natriuretic peptides. Nine HFpEF patients and five controls received saline infusion (0.25 mL/kg/min for 60 min) followed by intravenous furosemide (20 mg or home dose) 2 h after the infusion. Blood and urine samples were collected at baseline, 2 h after saline infusion, and 2 h after furosemide administration; urinary volumes were recorded. The urinary cyclic guanosine monophosphate (ucGMP)/plasma B-type NP (BNP) ratio was calculated as a measure of renal response to endogenous BNP. Wilcoxon rank-sum test was used to compare the groups. Compared to controls, HFpEF patients had reduced urine output (2480 vs.3541 mL; p = 0.028), lower urinary sodium excretion over 2 h after saline infusion (the percentage of infused sodium excreted 12% vs. 47%; p = 0.003), and a lower baseline ucGMP/plasma BNP ratio (0.7 vs. 7.3 (pmol/mL)/(mg/dL)/(pg/mL); p = 0.014). Patients with HFpEF had impaired natriuretic response to intravenous saline and furosemide administration and lower baseline ucGMP/plasma BNP ratios indicating renal hypo-responsiveness to NPs.
Topics: Humans; Heart Failure; Male; Female; Aged; Pilot Projects; Stroke Volume; Furosemide; Sodium; Natriuretic Peptide, Brain; Kidney; Middle Aged; Natriuresis; Diuretics; Cyclic GMP; Aged, 80 and over
PubMed: 38740564
DOI: 10.14814/phy2.16033 -
Jornal Brasileiro de Nefrologia 2024
Topics: Humans; Sulfadiazine; Toxoplasmosis, Cerebral; Male; HIV Infections; HIV-1; Crystallization; Renal Insufficiency; Adult; Crystalluria
PubMed: 38739000
DOI: 10.1590/2175-8239-JBN-2023-0151en -
Chemosphere Jul 2024The effective removal of micropollutants by water treatment technologies remains a significant challenge. Herein, we develop a CoFe layered double hydroxide (CoFeLDH)...
The effective removal of micropollutants by water treatment technologies remains a significant challenge. Herein, we develop a CoFe layered double hydroxide (CoFeLDH) catalytic membrane for peroxymonosulfate (PMS) activation to achieve efficient micropollutant removal with improved mass transfer rate and reaction kinetics. This study found that the CoFeLDH membrane/PMS system achieved an impressive above 98% degradation of the probe chemical ranitidine at 0.1 mM of PMS including five more micropollutants (Sulfamethoxazole, Ciprofloxacin, Carbamazepine, Acetaminophen and Bisphenol A) at satisfactory level (above 80%). Moreover, significant improvements in water flux and antifouling properties were observed, marking the membrane as a specific advancement in the removal of membrane fouling in water purification technology. The membrane demonstrated consistent degradation efficiency for several micropollutants and across a range of pH (4-9) as well as different anionic environments, thereby showing it suitability for scale-up application. The key role of reactive species such as SO, and O - radicals in the degradation process was elucidated. This is followed by the confirmation of the occurrence of redox cycling between Co and Fe, and the presence of CoOH that promotes PMS activation. Over the ten cycles, the membrane could be operated with a flux recovery of up to 99.8% and maintained efficient performance over 24 h continuous operation. Finally, the efficiency in degrading micropollutants, coupled with reduced metal leaching, makes the CoFeLDH membrane as a promising technology for application in water treatment.
Topics: Water Purification; Water Pollutants, Chemical; Membranes, Artificial; Hydroxides; Phenols; Peroxides; Benzhydryl Compounds; Carbamazepine; Ranitidine; Acetaminophen; Sulfamethoxazole; Ciprofloxacin; Catalysis; Cobalt; Oxidation-Reduction
PubMed: 38735495
DOI: 10.1016/j.chemosphere.2024.142318 -
Scientific Reports May 2024Cisplatin (CDDP)-induced nephrotoxicity is a common dose-limiting toxicity, and diuretics are often administered to prevent nephrotoxicity. However, the efficacy and... (Observational Study)
Observational Study Comparative Study
Cisplatin (CDDP)-induced nephrotoxicity is a common dose-limiting toxicity, and diuretics are often administered to prevent nephrotoxicity. However, the efficacy and optimal administration of diuretics in preventing CDDP-induced nephrotoxicity remain to be established. This study aimed to evaluate the efficacy of combining furosemide and mannitol to prevent CDDP-induced nephrotoxicity. This was a post-hoc analysis of pooled data from a multicenter, retrospective, observational study, including 396 patients who received one or two diuretics for CDDP-based chemotherapy, compared using propensity score matching. Multivariate logistic regression analyses were used to identify risk factors for nephrotoxicity. There was no significant difference in the incidence of nephrotoxicity between the two groups (22.2% vs. 28.3%, P = 0.416). Hypertension, CDDP dose ≥ 75 mg/m, and no magnesium supplementation were identified as risk factors for nephrotoxicity, whereas the use of diuretics was not found to be a risk factor. The combination of furosemide and mannitol showed no advantage over a single diuretic in preventing CDDP-induced nephrotoxicity. The renal function of patients receiving CDDP-based chemotherapy (≥ 75 mg/m) and that of those with hypertension should be carefully monitored. Magnesium supplementation is important for these patients.
Topics: Furosemide; Cisplatin; Humans; Mannitol; Male; Female; Diuretics; Middle Aged; Retrospective Studies; Aged; Risk Factors; Kidney Diseases; Drug Therapy, Combination; Antineoplastic Agents; Adult
PubMed: 38714773
DOI: 10.1038/s41598-024-61245-6 -
Bioresources and Bioprocessing May 2024In this work, a beneficial approach for efficient depolymerization of lignin and controllable product distribution is provided. Lignin, an abundant aromatic biopolymer,...
In this work, a beneficial approach for efficient depolymerization of lignin and controllable product distribution is provided. Lignin, an abundant aromatic biopolymer, has the potential to produce various biofuels and chemical adsorption agents and is expected to benefit the future circular economy. Microwave-ultrasonic (MW/US) assisted efficient depolymerization of lignin affords some aromatic materials used in manufacturing the starting material to be investigated. Some nano organometallic surfactants (NOMS) based on Ni, Cu, Co, Fe, and Mn besides 2-hydroxynaphth-sulphanilamide are synthesized to enhance oil recovery (EOR). In this work, the assessment of the NOMS's efficiency was improving the heavy oil recovery via the study of the dynamic interfacial tension (IFT), contact angle, and chemical flooding scenarios. The NOMS-Ni exhibited the maximum reduction of viscosity and yield values. Dropping the viscosity to 819.9, 659.89, and 499.9 Pa s from blank crude oil viscosity of 9978.8, 8005.6, and 5008.6 Pa s respectively at temperatures of 40, 60, and 80 °C was investigated. The reduction of τ values was obtained also by OMS-Ni. The minimum IFT was recorded against the Ni derivatives (0.1 × 10 mN m). The complete wettability alteration was achieved with the NOMS-Ni surfactant (ɵ The flooding test has been steered in 3 sets using the sand-packed model as a porous media at surfactant concentrations (1, 1.5, 2 and 2.5%) at 50 °C and 499 psi as injection pressure. The best value (ORs) formed for NOMS-Ni were 62, 81, 85.2, and 89% respectively as compared with other NOMS-M at the same concentrations. The mechanism of alternating wettability was described in the text. The rheology of the used heavy crude oil was investigated under temperatures of 40, 60, and 80 °C.
PubMed: 38709379
DOI: 10.1186/s40643-024-00761-9 -
Ecotoxicology and Environmental Safety Jun 2024The combined pollution of microplastics (MPs) and sulfamethoxazole (SMZ) often occurs in aquatic ecosystems, posing a serious threat to animal and human health. However,...
The combined pollution of microplastics (MPs) and sulfamethoxazole (SMZ) often occurs in aquatic ecosystems, posing a serious threat to animal and human health. However, little is known about the liver damage caused by the single or co-exposure of MPs and SMZ, and its specific mechanisms are still poorly understood. In this study, we investigated the effects of co-exposure to 20 μm or 80 nm MPs and SMZ in both larval and adult zebrafish models. Firstly, we observed a significant decrease in the number of hepatocytes and the liver damage in larval zebrafish worsened following co-exposure to SMZ and MPs. Additionally, the number of macrophages and neutrophils decreased, while the expression of inflammatory cytokines and antioxidant enzyme activities increased after co-exposure in larval zebrafish. Transcriptome analysis revealed significant changes in gene expression in the co-exposed groups, particularly in processes related to oxidation-reduction, inflammatory response, and the MAPK signaling pathway in the liver of adult zebrafish. Co-exposure of SMZ and MPs also promoted hepatocyte apoptosis and inhibited proliferation levels, which was associated with the translocation of Nrf2 from the cytoplasm to the nucleus and an increase in protein levels of Nrf2 and NF-kB p65 in the adult zebrafish. Furthermore, our pharmacological experiments demonstrated that inhibiting ROS and blocking the MAPK signaling pathway partially rescued the liver injury induced by co-exposure both in larval and adult zebrafish. In conclusion, our findings suggest that co-exposure to SMZ and MPs induces hepatic dysfunction through the ROS-mediated MAPK signaling pathway in zebrafish. This information provides novel insights into the potential environmental risk of MPs and hazardous pollutants co-existence in aquatic ecosystems.
Topics: Animals; Zebrafish; Sulfamethoxazole; Microplastics; Water Pollutants, Chemical; Reactive Oxygen Species; MAP Kinase Signaling System; Liver; Chemical and Drug Induced Liver Injury; Larva; Apoptosis; Hepatocytes
PubMed: 38703406
DOI: 10.1016/j.ecoenv.2024.116415 -
The American Journal of Case Reports May 2024BACKGROUND Histoplasmosis is typically associated with immunocompromised individuals, but cases in immunocompetent patients are rare. Primary cutaneous histoplasmosis...
BACKGROUND Histoplasmosis is typically associated with immunocompromised individuals, but cases in immunocompetent patients are rare. Primary cutaneous histoplasmosis (PCH) is a challenging diagnosis due to its clinical polymorphism and can mimic other infectious and non-infectious diseases. Previous cases of PCH have been reported in immunocompetent patients with underlying medical conditions or trauma history. So far there have been no reports of PCH after platelet-rich plasma (PRP) application due to inadequate hygiene measures in an immunocompetent host. CASE REPORT This case report presents a rare occurrence of PCH following a cosmetic procedure (PRP injection) in an immunocompetent patient. The patient developed nodule-like lesions at the application sites, which progressed to ulceration with purulent discharge. Initially, atypical mycobacterial infection was suspected, and empirical antibiotic therapy was initiated. Complementary tests were performed, ruling out immunosuppression and systemic pathogens. The patient showed complete resolution of the lesions after one month of atypical treatment with trimethoprim-sulfamethoxazole (TMP/SMX). Pathological examination confirmed the diagnosis of PCH with intracytoplasmic inclusions of Histoplasma sp. CONCLUSIONS This case highlights the importance of considering histoplasmosis as a diagnostic possibility, especially in hyperendemic areas like Venezuela. Direct inoculation of Histoplasma sp. after aesthetic procedures without proper hygiene measures can lead to pathological lesions, even in immunocompetent individuals. TMP/SMX can be considered as an alternative treatment option in the absence of the first-line medication. Further exploration of this treatment approach may benefit patients with similar clinical conditions or when ideal treatment options are unavailable.
Topics: Humans; Histoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Platelet-Rich Plasma; Female; Cosmetic Techniques; Dermatomycoses; Immunocompetence; Adult
PubMed: 38702880
DOI: 10.12659/AJCR.942660