24 results

Inhaled liposomal ciprofloxacin in patients with noncystic fibrosis bronchiectasis and chronic lung infection with Pseudomonas aeruginosa ( orbit-3 e orbit-4): tow phase 3, randomized controlled trials

Patients with non-cystic fibrosis bronchiectasis and lung infection due to Pseudomonas aeruginosa experience frequent infection exacerbations, decreased in quality of life, and increased in mortality. Orbit-3 and ORBIT-4 were randomized double blind, placebo controlled trials that applied liposomal ciprofloxacin or placebo inhalation to their study population. Results were not remarkable, however, patients treated with inhaled ciprofloxacin had less frequent pulmonary exacerbations than those treated with placebo. Hawoth CS, Bilton D, Chalmers JD, Davis AM, Forehlich J, Gonda I, et al. […]

Strain-specific antibody therapy prevents cytomegalovirus reactivation after transplantation

Cytomegalovirus infection and its reactivation is frequent after solid organs and hematopoietic stem cell transplantation, and this infection can cause significant impact on transplantation outcomes. In mouse experimental models and in hematopoietic stem cells, an infusion in the presence of strain-specific anti-cytomegolovirus, was protective. There is the need for antibodies specific for the strain that was presented. Commercial immunoglobulin infusions were tried in bone marrow transplantation and solid organ transplantation as prophylactic or therapeutic measures against cytomegalovirus, but trials did […]

We need to develop new antibiotics

Progressing of antibiotic resistance in bacteria erodes our therapeutic resources. Some infections are caused by bacteria that have only one or no therapeutic options. New antibacterial agents should be developed, but economic considerations conspire against investing in this market. Antibiotics are used, at most, two weeks for serious infections, and there is a tendency of lesser time use. Infection control wants exactly that: to control new antibiotic use to delay resistance, so the market for those new drugs is restricted. […]

HIV viral load and transmissibility of HIV infection: undetectable means non transmissible

Many evidences exist on undetectable HIV viral load – which means less than 200 genomic copies/ml signifies that a patient will not transmit infection to other person. This small. but powerful review article, insists that all persons with HIV should adhere to treatment and have their viral load controlled, as a measure of public health. If such measurable is done, as widely as possible, we can stop HIV epidemic. Eisinger RW, Dieffenbach CW, Fauci AS. HIV viral load and transmissibility […]

Change from intravenous to oral antibiotics is possible, even in cases of endocarditis or bone and joint infections

A study from Denmark by Iversen and colleagues that included 400 patients with left side endocarditis compared two groups. Their sample was composed by randomized patients who used the usual regimen of intravenous antibiotics for longer periods versus those who changed intravenous antibiotics to oral antibiotics after 10 days.(1) There was no inferiority and curiously side effects of the antibiotics were the same in both groups. Ho-Kwong and his team studied a larger group including 1,554 patients who were also […]

Acute infection and myocardial infarction

The risk of myocardial infarction after infection is well known, and for inpatients with pneumococcal pneumonia, it is 7 to 8%. This risk is higher at the onset of infection, is proportional to severity of pneumonia, and persists for at least 5 weeks. The risk declines slowly after this period but persists for several years. The explanation for this fact is complex.  Some individuals may suffer from type 2 infarction, when there are atherosclerosis and plaques in coronary arteries, but […]

Hard to treat multi-resistant gram negative bacteremia

First line antibiotics for gram negative bacteremia were defined as simultaneous to all carbapenems, all other beta lactams and all fluoroquinolones. In a sample including 173 American hospitals and 45,011 patients with gram negative bacteremia, a total of 471 (1%) had what the authors called difficult-to-treat resistance in gram negative bacteremia; 79 % of those patients received parentheral aminoglicosides, polymixin B or tigeciline. Mortality among them was 43.3 % higher than in simple carbapenem resistance. This difficult- to-treat gram negative bacteremia […]

The future of Medicine in the time of artificial intelligence

A report published in The Lancet, Chilamkurthy et al report impressive results using deep learning to interpret critical findings on head CT scans. The sensitivity of the algorithms using artificial intelligence was compared to radiologists’ interpretation; specificity was a little – not much – less precise. It could be – and in the future will be – cheaper, faster and almost equivalent. There are not – yet – clinical trials in real life comparing artificial intelligence with human interpretation. But […]

Armadillos as vectors of Hansen’s disease

Zoonotic transmission of Mycobacterium leprae to humans by 9 banded armadillos was reported in the Southern United States of America, mainly in Texas, Louisiana and Florida. Armadillos’ meat are consumed in some areas of Brazil, including Para state.  This consumption includes a kind of ceviche using raw liver of armadillos. Researchers detected in the study genetic material of Mycobacterium leprae by PCR in 10 of the 16 animals included, in addition antibodies to a Mycobacterium leprae specific antigen, phenolic glycolipid, was […]

Isolation time of patients with tuberculosis

One of the difficulties of managing tuberculosis in hospitalized patients is the maintenance of isolation time. The golden standard diagnostic test is culture negative for Mycobacterium tuberculosis. AFB stain can still be positive with non-viable bacteria, leading to more isolation time than necessary. The morphological characteristics of bacilli are useful: broken bacteria with gaps in staining are probable dead bacteria, but this information is rarely used to define the isolation time. The Chaisson LH et al study, done at Zuckerberg […]

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