Deleted Journal, Journal Year: 2023, Volume and Issue: 1(3), P. 277 - 278

Published: July 1, 2023

Short intravenous amphotericin B followed by oral posaconazole using a simple, stratified treatment approach for diabetes or COVID-19-associated rhino-orbito-cerebral mucormycosis: A prospective cohort studyThe objective of this single-center study[1] was to evaluate the efficacy and safety short-course (IV) sustained release tablets mucormycosis (ROCM). It included adult patients with mucormycosis, who were into short antifungal group (SHIFT), i.e., those having disease limited sinus, bone, eye, meninges but no brain involvement, long (LIFT), parenchymal involvement internal carotid artery invasion. The SHIFT received 7–14 days IV therapy LIFT 15–28 therapy. Both groups underwent surgical debridement, had good glycemic control, step-down sustained-release tablets.The primary outcome study success (disease stabilization, survival, adverse events) at week 14. enrolled 251 total patients, 203 in 45 group. Two hundred forty-nine relevant debridement. deoxycholate used 138 (55%) lipid emulsion 75 (30%), liposomal 35 (14%), 3. overall rate 3 months 88%, 93% group, 62% all-cause mortality 12%, 6% versus 37% as expected. factors associated poor diabetic ketoacidosis presentation, stroke, involvement.Among 235 (94%) experienced least one event B, 25% developed CLABSI.Comment:This helps clarify ambiguity surrounding duration ROCM. shorter can be given without reduce inpatient stay, CLABSI, drug toxicity, increasing rate. This also found that produced less renal toxicity showed clinical efficacy, cost-friendly viable option more toxic expensive B. More studies same are needed strengthening recommendations about protocols.Effectiveness adjunctive high-dose infliximab improve disability-free survival among severe central nervous system tuberculosis: matched retrospective studyThis study[2] conducted assess effectiveness (CNS) tuberculosis (TB). compared along steroids optimal anti-tuberculous (ATT), i.e. Cohort A, only standard care (SOC), not infliximab, Primary 6 months.The considered were, worsening despite ATT steroids: Refractory symptomatic tuberculomas Recurrent on steroid tapering Optochiasmatic TB visual deficits Recent onset arachnoiditis paraparesis. higher dose 10 mg/kg monthly doses.Cohort 30 whom 73.3% microbiologically confirmed 90% disseminated TB. median between start SOC consideration months. 86.6% disability (mRS score 4–5). 60 (1:2).The 25 (88.3%) improved marked neurological improvement after first itself. Radiological noted 19 (73%), stable 5 (19%) 2 worsening. Infliximab likelihood successful outcome, lower severity, reduced trend group.Comment:Tumor necrosis factor alpha (TNF-α) is important formation maintenance tuberculous granulomas, making (a TNF-α inhibitor) unique strategy managing inflammatory lesions cases CNS causing deficits. has excellent penetration presence neuroinflammation carefully selected worsened steroids. article supports responses previous literature being biased selective reporting, which often case singular reports. However, since relatively small number control arm (Cohort B) functional status. In addition, many referred late facility, precluding earlier treatment, would affect outcomes well. Larger trials different dosing rigorous long-term follow-up reactivation help secure firm place TB.Clinical management NAAT-positive/toxin-negative Clostridioidesdifficile infection: systematic review meta-analysisThe meta-analysis[3] tested positive clostridiodes difficile infections (CDI) through nucleic acid amplification tests (NAAT) Toxin, NAAT, NAAT+/Toxin− did not. Twenty-six observational comprising 12,737 included. meta-analysis 30-day significantly NAAT+/Toxin+ recurrence (19.8%) (11%). On comparing although 60-day rates (11.6% vs. 7%), untreated (12.7%) treated (5%). concluded there may benefit from treating patients.Comment:NAATs commonly diagnose CDI, they cannot differentiate colonization actual disease. Toxin assays other hand have sensitivity standalone test diagnosis CDI. To increase accuracy, two-stage NAAT toxin immunoassay (Toxin) been proposed. analysis shown raises question whether add any value protocol if treat every NAAT+ patient. estimating risk, recurrence. limitation it hence subject confounding well immortal-time bias. well-planned randomized controlled trial testing strategies determine cost-benefit. Financial support sponsorship Nil. Conflicts interest There conflicts interest.

Language: Английский