22 results on '"Lardo S"'
Search Results
2. Post-prescription audit plus beta-d-glucan assessment decrease echinocandin use in people with suspected invasive candidiasis
- Author
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Murri, Rita, Lardo, S., De Luca, Alessio, Posteraro, Brunella, Torelli, Riccardo, De Angelis, Giulia, Giovannenze, Francesca, Taccari, Francesco, Pavan, L., Parroni, L., Sanguinetti, Maurizio, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), De Luca A., Posteraro B. (ORCID:0000-0002-1663-7546), Torelli R., De Angelis G. (ORCID:0000-0002-7087-7399), Giovannenze F., Taccari F., Sanguinetti M. (ORCID:0000-0002-9780-7059), Fantoni M. (ORCID:0000-0001-6913-8460), Murri, Rita, Lardo, S., De Luca, Alessio, Posteraro, Brunella, Torelli, Riccardo, De Angelis, Giulia, Giovannenze, Francesca, Taccari, Francesco, Pavan, L., Parroni, L., Sanguinetti, Maurizio, Fantoni, Massimo, Murri R. (ORCID:0000-0003-4263-7854), De Luca A., Posteraro B. (ORCID:0000-0002-1663-7546), Torelli R., De Angelis G. (ORCID:0000-0002-7087-7399), Giovannenze F., Taccari F., Sanguinetti M. (ORCID:0000-0002-9780-7059), and Fantoni M. (ORCID:0000-0001-6913-8460)
- Abstract
Background and Objectives: Overtreatment with antifungal drugs is often observed. Antifungal stewardship (AFS) focuses on optimizing the treatment for invasive fungal diseases. The objective of the present study was to evaluate the utility of a post-prescription audit plus beta-D-glucan (BDG) assessment on reducing echinocandin use in persons with suspected invasive candidiasis. Materials and Methods: This is a prospective, pre-post quasi-experimental study of people starting echinocandins for suspected invasive candidiasis. The intervention of the study included review of each echinocandin prescription and discontinuation of treatment if a very low probability of fungal disease or a negative BDG value were found. Pre-intervention data were compared with the intervention phase. The primary outcome of the study was the duration of echinocandin therapy. Secondary outcomes were length of hospital stay and mortality. Results: Ninety-two echinocan-din prescriptions were reviewed, 49 (53.3%) in the pre-intervention phase and 43 (46.7%) in the intervention phase. Discontinuation of antifungal therapy was possible in 21 of the 43 patients in the intervention phase (48.8%). The duration of echinocandin therapy was 7.4 (SD 4.7) in the pre-intervention phase, 4.1 days (SD 2.9) in persons undergoing the intervention, and 8.6 (SD 7.3) in persons in whom the intervention was not feasible (p at ANOVA = 0.016). Length of stay and mortality did not differ between pre-intervention and intervention phases. Conclusions: An intervention based on pre-prescription restriction and post-prescription audit when combined with BDG measurement is effective in optimizing antifungal therapy by significantly reducing excessive treatment duration.
- Published
- 2021
3. Association of initial intracellular signalling pathway and cytokine level with early mortality in severe sepsis patients
- Author
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Lie, KC, Widodo, D, Lardo, S, Eppy, and Sinto, R
- Published
- 2014
- Full Text
- View/download PDF
4. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia
- Author
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Perez-Nadales, E., Gutierrez-Gutierrez, B., Natera, A. M., Abdala, E., Reina Magalhaes, M., Mularoni, A., Monaco, F., Camera Pierrotti, L., Pinheiro Freire, M., Iyer, R. N., Mehta Steinke, S., Grazia Calvi, E., Tumbarello, M., Falcone, M., Fernandez-Ruiz, M., Costa-Mateo, J. M., Rana, M. M., Mara Varejao Strabelli, T., Paul, M., Carmen Farinas, M., Clemente, W. T., Roilides, E., Munoz, P., Dewispelaere, L., Loeches, B., Lowman, W., Hock Tan, B., Escudero-Sanchez, R., Bodro, M., Antonio Grossi, P., Soldani, F., Gunseren, F., Nestorova, N., Pascual, A., Martinez-Martinez, L., Aguado, J., Rodriguez-Bano, J., Torre-Cisneros, J., Wan Song, A. T., Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., Jota de Paula, F., Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I., Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. V., Bar-Sinai, N., Koppel, F., Arnaiz de las Revillas Almajano, F., Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I., Minero, M. V., Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, B. M., van Delden, C., Manuel, O., Arslan, H., Kocak Tufan, Z., Kazak, E., David, M., Lease, E., Cornaglia, G., Akova, M., European Commission, Ministerio de Ciencia, Innovación y Universidades (España), Instituto de Salud Carlos III, and Universidad de Cantabria
- Subjects
medicine.medical_specialty ,Combination therapy ,infectious disease ,030230 surgery ,Settore MED/17 - MALATTIE INFETTIVE ,Logistic regression ,clinical research/practice ,03 medical and health sciences ,0302 clinical medicine ,infection and infectious agents - bacterial ,Internal medicine ,medicine ,Immunology and Allergy ,Pharmacology (medical) ,organ transplantation in general ,Infection and infectious agents - bacterial ,Transplantation ,Infectious disease ,Receiver operating characteristic ,business.industry ,Hazard ratio ,Confidence interval ,Organ transplantation in general ,antibiotic drug resistance ,Cohort ,Clinical research/practice ,Antibiotic drug resistance ,business ,Cohort study - Abstract
Treatment of carbapenemase‐producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase‐producing Enterobacterales bloodstream infections. A multinational, retrospective (2004‐2016) cohort study (INCREMENT‐SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30‐day all‐cause mortality. The INCREMENT‐SOT‐CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT‐CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT‐CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76‐0.88) and classified patients into 3 strata: 0‐7 (low mortality), 8‐11 (high mortality), and 12‐17 (very‐high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very‐high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13‐7.06, P = .03) and high (HR 9.93, 95% CI 2.08‐47.40, P = .004) mortality risk strata. A score‐based algorithm is provided for therapy guidance., This work was supported by Plan Nacional de I+D+i 2013‐2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0008; RD16/0016/0001, RD16/0016/0002, RD16/0016/00010] ‐ co‐financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014‐2020; ESCMID Study Group for Infections in Compromised Hosts [ESGICH grant to JMA]; Sociedad Andaluza de Trasplante de Órgano Sólido [SATOT grant to LMM]; ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS); and ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS).
- Published
- 2020
5. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia
- Author
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Perez-Nadales E, Gutierrez-Gutierrez B, Natera A, Abdala E, Magalhaes M, Mularoni A, Monaco F, Pierrotti L, Freire M, Iyer R, Steinke S, Calvi E, Tumbarello M, Falcone M, Fernandez-Ruiz M, Costa-Mateo J, Rana M, Strabelli T, Paul M, Farinas M, Clemente W, Roilides E, Munoz P, Dewispelaere L, Loeches B, Lowman W, Tan B, Escudero-Sanchez R, Bodro M, Grossi P, Soldani F, Gunseren F, Nestorova N, Pascual A, Martinez-Martinez L, Aguado J, Rodriguez-Bano J, Torre-Cisneros J, Song A, Andraus W, D'Albuquerque L, David-Neto E, de Paula F, Rossi F, Ostrander D, Avery R, Rizzi M, Losito A, Raffaelli F, Del Giacomo P, Tiseo G, Lora-Tamayo J, San-Juan R, Gracia-Ahufinger I, Caston J, Ruiz Y, Altman D, Campos S, Bar-Sinai N, Koppel F, Almajano F, Rico C, Martinez M, Mourao P, Neves F, Ferreira J, Pyrpasopoulou A, Iosifidis E, Romiopoulos I, Minero M, Sanchez-Carrillo C, Lardo S, Coussement J, Dodemont M, Jiayun K, Martin-Davila P, Fortun J, Almela M, Moreno A, Linares L, Gasperina D, Balsamo M, Rovelli C, Concia E, Chiesi S, Salerno D, Ogunc D, Pilmis B, Seminari E, Carratala J, Dominguez A, Cordero E, Lepe J, Montejo M, de Lucas E, Eriksson B, van Delden C, Manuel O, Arslan H, Tufan Z, Kazak E, David M, Lease E, Cornaglia G, Akova M, REIPI INCREMENT-SOT Investigators, Swiss Transplant Cohort Study, and ESGARS-ESCMID Study Grp Antimicrob
- Subjects
infection and infectious agents - bacterial ,clinical research ,infectious disease ,antibiotic drug resistance ,organ transplantation in general ,practice - Abstract
Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
- Published
- 2020
6. Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales : The impact of cytomegalovirus disease and lymphopenia
- Author
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Perez-Nadales, Elena, Gutierrez-Gutierrez, Belen, Natera, Alejandra M., Abdala, Edson, Magalhaes, Maira Reina, Mularoni, Alessandra, Monaco, Francesco, Pierrotti, Ligia Camera, Freire, Maristela Pinheiro, Iyer, Ranganathan N., Steinke, Seema Mehta, Calvi, Elisa Grazia, Tumbarello, Mario, Falcone, Marco, Fernandez-Ruiz, Mario, Maria Costa-Mateo, Jose, Rana, Meenakshi M., Varejao Strabelli, Tania Mara, Paul, Mical, Carmen Farinas, Maria, Clemente, Wanessa Trindade, Roilides, Emmanuel, Munoz, Patricia, Dewispelaere, Laurent, Loeches, Belen, Lowman, Warren, Tan, Ban Hock, Escudero-Sanchez, Rosa, Bodro, Marta, Grossi, Paolo Antonio, Soldani, Fabio, Gunseren, Filiz, Nestorova, Nina, Pascual, Alvaro, Martinez-Martinez, Luis, Maria Aguado, Jose, Rodriguez-Bano, Jesus, Torre-Cisneros, Julian, Song, A. T. Wan, Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., de Paula, F. Jota, Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I, Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. , V, Bar-Sinai, N., Koppel, F., de las Revillas Almajano, F. Arnaiz, Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I, Minero, M. , V, Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, Britt-Marie, van Delden, C., Manuel, O., Arslan, H., Tufan, Z. Kocak, Kazak, E., David, M., Lease, E., Cornaglia, G., Akova, M., Perez-Nadales, Elena, Gutierrez-Gutierrez, Belen, Natera, Alejandra M., Abdala, Edson, Magalhaes, Maira Reina, Mularoni, Alessandra, Monaco, Francesco, Pierrotti, Ligia Camera, Freire, Maristela Pinheiro, Iyer, Ranganathan N., Steinke, Seema Mehta, Calvi, Elisa Grazia, Tumbarello, Mario, Falcone, Marco, Fernandez-Ruiz, Mario, Maria Costa-Mateo, Jose, Rana, Meenakshi M., Varejao Strabelli, Tania Mara, Paul, Mical, Carmen Farinas, Maria, Clemente, Wanessa Trindade, Roilides, Emmanuel, Munoz, Patricia, Dewispelaere, Laurent, Loeches, Belen, Lowman, Warren, Tan, Ban Hock, Escudero-Sanchez, Rosa, Bodro, Marta, Grossi, Paolo Antonio, Soldani, Fabio, Gunseren, Filiz, Nestorova, Nina, Pascual, Alvaro, Martinez-Martinez, Luis, Maria Aguado, Jose, Rodriguez-Bano, Jesus, Torre-Cisneros, Julian, Song, A. T. Wan, Andraus, W., Carneiro D'Albuquerque, L. A., David-Neto, E., de Paula, F. Jota, Rossi, F., Ostrander, D., Avery, R., Rizzi, M., Losito, A. R., Raffaelli, F., Del Giacomo, P., Tiseo, G., Lora-Tamayo, J., San-Juan, R., Gracia-Ahufinger, I, Caston, J., Ruiz, Y. A., Altman, D. R., Campos, S. , V, Bar-Sinai, N., Koppel, F., de las Revillas Almajano, F. Arnaiz, Gonzalez Rico, C., Fernandez Martinez, M., Mourao, P. H. O., Neves, F. A., Ferreira, J., Pyrpasopoulou, A., Iosifidis, E., Romiopoulos, I, Minero, M. , V, Sanchez-Carrillo, C., Lardo, S., Coussement, J., Dodemont, M., Jiayun, K., Martin-Davila, P., Fortun, J., Almela, M., Moreno, A., Linares, L., Gasperina, D. D., Balsamo, M. L., Rovelli, C., Concia, E., Chiesi, S., Salerno, D. N., Ogunc, D., Pilmis, B., Seminari, E. M., Carratala, J., Dominguez, A., Cordero, E., Lepe, J. A., Montejo, M., Merino de Lucas, E., Eriksson, Britt-Marie, van Delden, C., Manuel, O., Arslan, H., Tufan, Z. Kocak, Kazak, E., David, M., Lease, E., Cornaglia, G., and Akova, M.
- Abstract
Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
- Published
- 2020
- Full Text
- View/download PDF
7. Procalcitonin is useful in driving the choice of early antibiotic treatment in patients with bloodstream infections
- Author
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Murri, R., Mastrorosa, I., Taccari, F., Baroni, S., Giovannenze, F., Palazzolo, C., Lardo, S., Scoppettuolo, G., Ventura, G., Cauda, R., and Massimo FANTONI
- Subjects
Aged, 80 and over ,Male ,bloodstream infections ,Candidiasis ,Bacteremia ,Middle Aged ,Settore MED/17 - MALATTIE INFETTIVE ,Drug Administration Schedule ,Cohort Studies ,Anti-Infective Agents ,ROC Curve ,Humans ,Female ,Gram-Negative Bacterial Infections ,Procalcitonin ,Biomarkers ,Gram-Positive Bacterial Infections ,Aged ,Retrospective Studies - Abstract
To evaluate whether PCT levels could be used to distinguish among different bacterial and fungal etiologies in patients with documented bloodstream infection (BSI).Monocentric retrospective cohort study on patients admitted to the Fondazione Policlinico Gemelli Hospital between December 2012 and November 2015 with BSI. Those who had undergone PCT determination within 48 hours of when the first positive blood culture was sampled were included in the study.Four hundred and one patients were included in the study. Both the 24h and 48h PCT values were significantly higher in patients with Gram-negative (GN) BSI than in those with Gram-positive (GP) or candida BSI (p at ANOVA = 0.003). A PCT value of1 ng/ml was found in 31.5% of patients with GN BSI. Less than 7% of people with candida BSI had PCT level of1 ng/ml. At multivariable regression analysis, GN BSI, septic shock, and plasma creatinine were significantly correlated with PCT values.PCT may be of value in distinguishing GN BSI from GP, and fungal BSI and PCT values of1 ng/ml could be used to prevent unnecessary antifungal treatment.
- Published
- 2018
8. Two Cases of Nosocomial Infection Protesic Valve Endocarditis Caused by Pseudomonas aeruginosa
- Author
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Lardo S, Glieca F, Raffaelli F, and Damiano F
- Subjects
Aortic valve ,medicine.medical_specialty ,Pseudomonas aeruginosa ,business.industry ,Incidence (epidemiology) ,medicine.disease ,medicine.disease_cause ,Cardiac surgery ,Surgery ,medicine.anatomical_structure ,Mitral valve ,cardiovascular system ,medicine ,Endocarditis ,Presentation (obstetrics) ,business - Abstract
Recently, changes have been observed in the occurrence and clinical presentation of Pseudomonas endocarditis, with increasing incidence of nosocomial infections and involvement of the aortic and mitral valves. Two cases of patients who had suffered cardiac surgery in the recent past, successfully treated for pseudomonal endocarditis, are presented here.
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- 2018
- Full Text
- View/download PDF
9. Update on Peripherically Inserted Central Catheters in Patients with HIV in a tertiary hospital
- Author
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Lardo S, Dolcetti L, and Scoppettuolo G
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medicine.medical_specialty ,business.industry ,Medical record ,Retrospective cohort study ,medicine.disease ,Omics ,Peripherally inserted central catheter ,Catheter ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,medicine ,Infection control ,Complication ,business - Abstract
Literature on patients with HIV and Peripherally Inserted Central Catheter “PICC“ published on MEDLINE database in English and Spanish have thoroughly been studied, revised and updated. We reviewed the medical records of all Human Immunodeficiency Virus (HIV) infected patients with Peripherally Inserted Central Catheter “PICC” implanted from 2010 to 2016. In view of changes over the past in the intravenous management of patients with AIDS and infectious disease, we performed at Policlinico Gemelli Hospital a retrospective study of the last six years, in which we had reviewed all HIV infected patients with PICCs. Retrospectively we have evaluated the clinical severity of patients enrolled using Charlson-Deyo comorbidity score. Our hospital has 1500 beds. There are two departments of infectious diseases for a total of 40 beds. There is an outpatient service where HIV patients are followed and a Day Hospital where chemotherapy is administered. All HIV- infected patients who had PICC were identified about the occurrence of one of the following events: catheter related complication, catheter requiring removal in all cases, or death. All statistical procedures were performed using the SPSS software package (SPSS Inc. Version 15.0, Chicago).
- Published
- 2018
- Full Text
- View/download PDF
10. A 72-h intervention for improvement of the rate of optimal antibiotic therapy in patients with bloodstream infections.
- Author
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Murri, R., Taccari, F., Spanu, T., D’Inzeo, T., Mastrorosa, I., Giovannenze, F., Scoppettuolo, G., Ventura, G., Palazzolo, C., Camici, M., Lardo, S., Fiori, B., Sanguinetti, M., Cauda, R., and Fantoni, M.
- Subjects
ANTIBIOTICS ,INFECTION treatment ,ANTI-infective agents ,BLOOD diseases ,THERAPEUTICS research - Abstract
Antimicrobial stewardship programs are implemented to optimize the use of antibiotics and control the spread of antibiotic resistance. Many antimicrobial stewardship interventions have demonstrated significant efficacy in reducing unnecessary prescriptions of antibiotics, the duration of antimicrobial therapy, and mortality. We evaluated the benefits of a combination of rapid diagnostic tests and an active re-evaluation of antibiotic therapy 72 h after the onset of bloodstream infection (BSI). All patients with BSI from November 2015 to November 2016 in a 1100-bed university hospital in Rome, where an Infectious Disease Consultancy Unit (Unità di Consulenza Infettivologica, UDCI) is available, were re-evaluated at the bedside 72 h after starting antimicrobial therapy and compared to two pre-intervention periods: the UDCI was called by the ward physician for patients with BSI and the UDCI was called directly by the microbiologist immediately after a pathogen was isolated from blood cultures. Recommendations for antibiotic de-escalation or discontinuation significantly increased (54%) from the two pre-intervention periods (32% and 27.2%, p < 0.0001). Appropriate escalation also significantly increased (22.5%) from the pre-intervention periods (8.1% and 8.2%, p < 0.0001). The total duration of antibiotic therapy decreased with intervention (from 21.9 days [standard deviation, SD 15.4] in period 1 to 19.3 days [SD 13.3] in period 2 to 17.7 days in period 3 [SD 11.5]; p = 0.002) and the length of stay was significantly shorter (from 29.7 days [SD 29.3] in period 1 to 26.8 days [SD 24.7] in period 2 to 24.2 days in period 3 [SD 20.7]; p = 0.04) than in the two pre-intervention periods. Mortality was similar among the study periods (31 patients died in period 1 (15.7%), 39 (16.7%) in period 2, and 48 (15.3%) in period 3; p = 0.90). Rapid diagnostic tests and 72 h re-evaluation of empirical therapy for BSI significantly correlated with an improved rate of optimal antibiotic therapy and decreased duration of antibiotic therapy and length of stay. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
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11. Malaria and co-infection among traveller in a refferal hospital: a case series
- Author
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Habib, H., primary and Lardo, S., additional
- Published
- 2012
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12. Testing the Monetary Model for Exchange Rate Determination in South Africa: Evidence from 101 Years of Data
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Riané de Bruyn, Rangan Gupta, and Lardo Stander
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Economics as a science ,HB71-74 - Abstract
Evidence in favor of the monetary model of exchange rate determination for the South African Rand is, at best, mixed. A co-integrating relationship between the nominal exchange rate and monetary fundamentals forms the basis of the monetary model. With the econometric literature suggesting that the span of the data, not the frequency, determines the power of the co-integration tests and the studies on South Africa primarily using short-span data from the post-Bretton Woods era, we decided to test the long-run monetary model of exchange rate determination for the South African Rand relative to the US Dollar using annual data from 1910 – 2010. The results provide some support for the monetary model in that long-run co-integration is found between the nominal exchange rate and the output and money supply deviations. However, the theoretical restrictions required by the monetary model are rejected. A vector error-correction model identifies both the nominal exchange rate and the monetary fundamentals as the channel for the adjustment process of deviations from the long-run equilibrium exchange rate. A subsequent comparison of nominal exchange rate forecasts based on the monetary model with those of the random walk model suggests that the forecasting performance of the monetary model is superior.
- Published
- 2013
- Full Text
- View/download PDF
13. H3.3K122A results in a neomorphic phenotype in mouse embryonic stem cells.
- Author
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Patty B, Jordan C, Lardo S, Troy K, and Hainer S
- Abstract
The histone variant H3.3 acts in coordination with histone posttranslational modifications and other chromatin features to facilitate appropriate transcription. Canonical histone H3 and histone variant H3.3 are post-translationally modified with the genomic distribution of these marks denoting different features and with more recent evidence suggesting that these modifications may influence transcription. While the majority of posttranslational modifications occur on histone tails, there are defined modifications within the globular domain, such as acetylation of H3K122/H3.3K122. To understand the function of the residue H3.3K122 in transcriptional regulation, we attempted to generate H3.3K122A mouse embryonic stem (mES) cells but were unsuccessful. Through multi-omic profiling of mutant cell lines harboring two or three of four H3.3 targeted alleles, we have uncovered that H3.3K122A is neomorphic and results in lethality. This is surprising as prior studies demonstrate H3.3-null mES cells are viable and pluripotent, albeit with reduced differentiation capacity. Together, these studies have uncovered a novel dependence of a globular domain residue of H3.3 for viability and broadened our understanding of how histone variants contribute to transcription regulation and pluripotency in mES cells., Competing Interests: Competing interests Authors declare that they have no competing interests.
- Published
- 2024
- Full Text
- View/download PDF
14. Tafenoquine co-administered with dihydroartemisinin-piperaquine for the radical cure of Plasmodium vivax malaria (INSPECTOR): a randomised, placebo-controlled, efficacy and safety study.
- Author
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Sutanto I, Soebandrio A, Ekawati LL, Chand K, Noviyanti R, Satyagraha AW, Subekti D, Santy YW, Crenna-Darusallam C, Instiaty I, Budiman W, Prasetya CB, Lardo S, Elyazar I, Duparc S, Cedar E, Rolfe K, Fernando D, Berni A, Jones S, Kleim JP, Fletcher K, Sharma H, Martin A, Taylor M, Goyal N, Green JA, Tan LK, and Baird JK
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- Humans, Primaquine therapeutic use, Drug Therapy, Combination, Chloroquine therapeutic use, Plasmodium vivax, Malaria, Vivax drug therapy, Malaria, Vivax prevention & control, Antimalarials, Quinolines therapeutic use, Artemisinins adverse effects, Malaria drug therapy
- Abstract
Background: Tafenoquine, co-administered with chloroquine, is approved for the radical cure (prevention of relapse) of Plasmodium vivax malaria. In areas of chloroquine resistance, artemisinin-based combination therapies are used to treat malaria. This study aimed to evaluate tafenoquine plus the artemisinin-based combination therapy dihydroartemisinin-piperaquine for the radical cure of P vivax malaria., Methods: In this double-blind, double-dummy, parallel group study, glucose-6-phosphate dehydrogenase-normal Indonesian soldiers with microscopically confirmed P vivax malaria were randomly assigned by means of a computer-generated randomisation schedule (1:1:1) to dihydroartemisinin-piperaquine alone, dihydroartemisinin-piperaquine plus a masked single 300-mg dose of tafenoquine, or dihydroartemisinin-piperaquine plus 14 days of primaquine (15 mg). The primary endpoint was 6-month relapse-free efficacy following tafenoquine plus dihydroartemisinin-piperaquine versus dihydroartemisinin-piperaquine alone in all randomly assigned patients who received at least one dose of masked treatment and had microscopically confirmed P vivax at baseline (microbiological intention-to-treat population). Safety was a secondary outcome and the safety population comprised all patients who received at least one dose of masked medication. This study is registered with ClinicalTrials.gov, NCT02802501 and is completed., Findings: Between April 8, 2018, and Feb 4, 2019, of 164 patients screened for eligibility, 150 were randomly assigned (50 per treatment group). 6-month Kaplan-Meier relapse-free efficacy (microbiological intention to treat) was 11% (95% CI 4-22) in patients treated with dihydroartemisinin-piperaquine alone versus 21% (11-34) in patients treated with tafenoquine plus dihydroartemisinin-piperaquine (hazard ratio 0·44; 95% CI [0·29-0·69]) and 52% (37-65) in the primaquine plus dihydroartemisinin-piperaquine group. Adverse events over the first 28 days were reported in 27 (54%) of 50 patients treated with dihydroartemisinin-piperaquine alone, 29 (58%) of 50 patients treated with tafenoquine plus dihydroartemisinin-piperaquine, and 22 (44%) of 50 patients treated with primaquine plus dihydroartemisinin-piperaquine. Serious adverse events were reported in one (2%) of 50, two (4%) of 50, and two (4%) of 50 of patients, respectively., Interpretation: Although tafenoquine plus dihydroartemisinin-piperaquine was statistically superior to dihydroartemisinin-piperaquine alone for the radical cure of P vivax malaria, the benefit was not clinically meaningful. This contrasts with previous studies in which tafenoquine plus chloroquine was clinically superior to chloroquine alone for radical cure of P vivax malaria., Funding: ExxonMobil, Bill & Melinda Gates Foundation, Newcrest Mining, UK Government all through Medicines for Malaria Venture; and GSK., Translation: For the Indonesian translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests IS reports grants or contracts from Menzies School of Health Research, Darwin and the National Health and Medical Research Council, and funding from Medicines for Malaria Venture (MMV) and GSK. AS, KC, RN, DS, YWS, II, WB, CBP, and SL report that they or their institutions received funding from MMV to do the study and editorial support from GSK for this publication. LLE and AWS report institutional funding from Menzies School of Health Research, MMV, and GSK. CC-D reports institutional funding from MMV, GSK, and the Chan Zuckerberg Initiative. IE reports institutional funding from MMV, GSK, WHO, SPARK (University of Melbourne), and honoraria from the Indonesian Ministry of Health. SD is an employee of MMV; his institution received funding from ExxonMobil, the Bill & Melinda Gates Foundation (grant number INV-007155/19-BMGF-006), Newcrest Mining, and the UK Government to fund the INSPECTOR study. EC is a former independent contractor at GSK and holds shares in the company. EC developed the first draft of the manuscript and provided editorial services as an independent medical writer funded by GSK. KR, DF, AB, SJ, KF, HS, AM, MT, and LKT are employees of GSK and hold shares in the company. J-PK, NG, and JAG are former employees of GSK and hold shares in GSK. JKB reports institutional research funding from MMV, GSK, the Wellcome Trust, the Gates Foundation, FIND, Sanaria, UKAid, University of Oxford, US Centers for Disease Control and Prevention, and the Chinese Center for Disease Control; travel and speaking fees from the Belgian Society of Tropical Medicine, the International Conference of Tropical Medicine and Malariology, and Singapore Malaria Group Conference; and participation on the US National Health Institute Data Safety Monitoring Board., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2023
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15. Post-Prescription Audit Plus Beta-D-Glucan Assessment Decrease Echinocandin Use in People with Suspected Invasive Candidiasis.
- Author
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Murri R, Lardo S, De Luca A, Posteraro B, Torelli R, De Angelis G, Giovannenze F, Taccari F, Pavan L, Parroni L, Sanguinetti M, and Fantoni M
- Subjects
- Antifungal Agents therapeutic use, Glucans, Humans, Prescriptions, Prospective Studies, Candidiasis, Invasive diagnosis, Candidiasis, Invasive drug therapy, Echinocandins therapeutic use
- Abstract
Background and Objectives: Overtreatment with antifungal drugs is often observed. Antifungal stewardship (AFS) focuses on optimizing the treatment for invasive fungal diseases. The objective of the present study was to evaluate the utility of a post-prescription audit plus beta-D-glucan (BDG) assessment on reducing echinocandin use in persons with suspected invasive candidiasis. Materials and Methods: This is a prospective, pre-post quasi-experimental study of people starting echinocandins for suspected invasive candidiasis. The intervention of the study included review of each echinocandin prescription and discontinuation of treatment if a very low probability of fungal disease or a negative BDG value were found. Pre-intervention data were compared with the intervention phase. The primary outcome of the study was the duration of echinocandin therapy. Secondary outcomes were length of hospital stay and mortality. Results: Ninety-two echinocandin prescriptions were reviewed, 49 (53.3%) in the pre-intervention phase and 43 (46.7%) in the intervention phase. Discontinuation of antifungal therapy was possible in 21 of the 43 patients in the intervention phase (48.8%). The duration of echinocandin therapy was 7.4 (SD 4.7) in the pre-intervention phase, 4.1 days (SD 2.9) in persons undergoing the intervention, and 8.6 (SD 7.3) in persons in whom the intervention was not feasible ( p at ANOVA = 0.016). Length of stay and mortality did not differ between pre-intervention and intervention phases. Conclusions: An intervention based on pre-prescription restriction and post-prescription audit when combined with BDG measurement is effective in optimizing antifungal therapy by significantly reducing excessive treatment duration.
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- 2021
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16. A Randomized, Double-Blind, Multicenter Clinical Study Comparing the Efficacy and Safety of a Drug Combination of Lopinavir/Ritonavir-Azithromycin, Lopinavir/Ritonavir-Doxycycline, and Azithromycin-Hydroxychloroquine for Patients Diagnosed with Mild to Moderate COVID-19 Infections.
- Author
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Purwati, Budiono, Rachman BE, Yulistiani, Miatmoko A, Nasronudin, Lardo S, Purnama YI, Laely M, Rochmad I, Ismail T, Wulandari S, Setyawan D, Rosyid AN, Setiawan HW, Wulaningrum PA, Asmarawati TP, Marfiani E, Yuniati SK, Fuadi MR, Endraswari PD, Purwaningsih, Hendrianto E, Karsari D, Dinaryanti A, Ertanti N, Ihsan IS, Purnama DS, and Indrayani Y
- Abstract
Background: At the present time, COVID-19 vaccines are at the testing stage, and an effective treatment for COVID-19 incorporating appropriate safety measures remains the most significant obstacle to be overcome. A strategic countermeasure is, therefore, urgently required., Aim: This study aims to evaluate the efficacy and safety of a combination of lopinavir/ritonavir-azithromycin, lopinavir/ritonavir-doxycycline, and azithromycin-hydroxychloroquine used to treat patients with mild to moderate COVID-19 infections. Setting and Design . This study was conducted at four different clinical study sites in Indonesia. The subjects gave informed consent for their participation and were confirmed as being COVID-19-positive by means of an RT-PCR test. The present study constituted a randomized, double-blind, and multicenter clinical study of patients diagnosed with mild to moderate COVID-19 infection., Materials and Methods: Six treatment groups participated in this study: a Control group administered with a 500 mg dose of azithromycin; Group A which received a 200/50 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; Group B treated with a 200/50 mg dose of lopinavir/ritonavir and 200 mg of doxycycline; Group C administered with 200 mg of hydroxychloroquine and 500 mg of azithromycin; Group D which received a 400/100 mg dose of lopinavir/ritonavir and 500 mg of azithromycin; and Group E treated with a 400/100 mg dose of lopinavir/ritonavir and 200 mg of doxycycline., Results: 754 subjects participated in this study: 694 patients (92.4%) who presented mild symptoms and 57 patients (7.6%) classified as suffering from a moderate case of COVID-19. On the third day after treatment, 91.7%-99.2% of the subjects in Groups A-E were confirmed negative by a PCR swab test compared to 26.9% in the Control group. Observation of all groups which experienced a significant decrease in virus load between day 1 and day 7 was undertaken. Other markers, such as CRP and IL-6, were significantly lower in all treatment groups ( p < 0.05 and p < 0.0001) than in the Control group. Furthermore, IL-10 and TNF- α levels were significantly elevated in all treatment groups ( p < 0.0001). The administration of azithromycin to the Control group increased CRP and IL-6 levels, while reduced IL-10 and TNF- α on day 7 ( p < 0.0001) compared with day 1. Decreases in ALT and AST levels were observed in all groups ( p < 0.0001). There was an increase in creatinine in the serum level of the Control, C, D, and E groups ( p < 0.05), whereas the BUN level was elevated in all groups ( p < 0.0001)., Conclusions: The study findings suggest that the administration of lopinavir/ritonavir-doxycycline, lopinavir/ritonavir-azithromycin, and azithromycin-hydroxychloroquine as a dual drug combination produced a significantly rapid PCR conversion rate to negative in three-day treatment of mild to moderate COVID-19 cases. Further studies should involve observation of older patients with severe clinical symptoms in order to collate significant amounts of demographic data., Competing Interests: The authors declare no conflicts of interest regarding this work., (Copyright © 2021 Purwati et al.)
- Published
- 2021
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17. Transformation of infectious diseases and the Indonesian national military health research collaboration in supporting national health security.
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Lardo S
- Abstract
Transformation of infectious diseases is a dynamic movement of the spread of disease that is largerly determined by the ability to understand geomedical maps, disease transmission and impacts on national security. Disease transformation is an order of infection that can be life threatening in a clinical perspective an outbreak at the community level. The involvement of the Indonesian National Military ( Tentara Nasional Indonesia , TNI) in the transformation of infected diseases is a network that needs to be strengthened, considering that its role is very important to maintain health security as a gate for national security. Strength in dealing with the extraordinary event of infection requires on going collaboration, competence, networking and integration., (©Copyright: the Author(s).)
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- 2020
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18. Adult-onset Still's Disease as a Differential Diagnosis in Prolonged Fever: Diagnosis and Treatment Experience.
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Widjaja FF, Martina D, Lardo S, and Wibowo SAK
- Subjects
- Administration, Intravenous, Adult, Diagnosis, Differential, Humans, Male, Methylprednisolone administration & dosage, Radiography, Still's Disease, Adult-Onset drug therapy, Fever etiology, Still's Disease, Adult-Onset complications, Still's Disease, Adult-Onset diagnosis
- Abstract
Adult onset Still's disease is a rare systemic disease that may involve many organs and may mimick many disease such as infection, autoimmune disease, and also malignancy. The diagnostic approach and treatment strategies have not been well established due to its rarity; however, there are some diagnostic criteria that may help. We present a case of 36-year old man who experienced high prolonged fever which firstly thought as infection. He also had unilateral wrist and knee joint pain and maculopapular rash. Laboratory examination showed high leukocytes count with elevated polymorphonuclear neutrophil count, high platelet count, high ferritin level, and negative results of many infection markers (typhoid antibody, procalcitonin, malaria test, blood culture, urine culture, IgM pneumonia, ASTO, syphilis test, antiHIV, HBsAg, antiHCV, etc). Chest X-ray, joint X-ray, ultrasonography, and echocardiography showed normal result. The patient was then diagnosed with Adult-onset Still's disease and received intravenous methylprednisolone and the fever was disappeared in 3 days. Six months later the arthralgia appeared again, methotrexate was administered and the pain was then relieved.
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- 2019
19. Plasmodium ovale Infection After One Year Mefloquine Prophylaxis in A Young Indonesian Soldier: A Case Report.
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Liwang F, Ratih DM, and Lardo S
- Subjects
- Artemisinins therapeutic use, Chemoprevention, Congo epidemiology, Drug Therapy, Combination, Humans, Indonesia, Malaria prevention & control, Male, Military Personnel, Primaquine therapeutic use, Young Adult, Antimalarials therapeutic use, Malaria diagnosis, Malaria drug therapy, Mefloquine therapeutic use, Plasmodium ovale isolation & purification
- Abstract
Malaria chemoprevention using mefloquine has become the WHO standard regimen for military personnel who stay in the endemic area for an extended period of time. We reported a case of Plasmodium ovale infection in a young Indonesian Soldier following one year mefloquine prophylaxis 250 mg weekly. Typical fever and chills were experienced two weeks after returning from one year duty in Congo, West-Central Africa. The diagnosis of ovale malaria was made by peripheral blood smear, and 35/250 parasites in small microscopic view was found. Then, he recovered after dihydroartemisin and primaquine combination therapy. This was an unusual case of long-term prophylaxis failure since mefloquine has been recognized as the agent for malaria prevention, even multi-drug-resistance Plasmodium. Dormant stage of Plasmodium ovale, quinoline-resistance potential, and the efficacy of mefloquine itself are discussed as the cause of that phenomenon.
- Published
- 2019
20. The Autoimmune Mechanism in Dengue Hemorrhagic Fever.
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Lardo S, Soesatyo MH, Juffrie J, and Umniyati SR
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- Cytokines immunology, Dengue Virus, Humans, Immunity, Cellular, Severe Dengue virology, Viral Vaccines, Autoimmunity, Severe Dengue immunology
- Abstract
The immune response of dengue fever/dengue hemorrhagic fever is a series of immunopathogenesis processes starting from viral infection to the target on monocytes and macrophages. It may consequently cause a cascade of viremia in the circulation that stimulates the afferent, efferent, and effector mechanism by the interaction of the humoral and complement system. The cascade results in inflammatory substance that will affect capillary permeability and activate coagulation factors leading to further effects on endothelial level. The mechanism involving pathogenesis of DHF/DSS is still vague. So far, a theory of heterologous infection has been developed, which explains that on second infection, there is subneutralization that induce viral replication. The autoimmune mechanism development leads to the better understanding of DHF. It also explains the autoimmune response of the viral infection, which consists of molecular mimicry, bystander activation and viral persistence. The development of the autoimmune pathomechanism is related to the role of autoantibody and endothelial dysfunction that may have role in worsening DHF.
- Published
- 2018
21. Concurrent infections of dengue viruses serotype 2 and 3 in patient with severe dengue from Jakarta, Indonesia.
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Lardo S, Utami Y, Yohan B, Tarigan SM, Santoso WD, Nainggolan L, and Sasmono RT
- Abstract
Objective: To describe the clinical manifestation of patient with severe dengue, to identify the serotypes and genotypes of dengue viruses (DENV) which concurrently infecting the patient, and to explore the possible relationship of severe dengue with the concurrent infection of DENV., Methods: Dengue diagnosis was performed using NS1 antigen detection and IgG/IgM ELISA. Standard clinical and laboratory examinations were performed to obtain the clinical and hematological data. DENV concurrent infections were detected and confirmed using RT-PCR and DENV Envelope gene sequencing. Phylogenetic analyses were performed to determine the genotypes of the viruses., Results: The patient was classified as having severe dengue characterized by severe plasma leakage, hemorrhage, and organ damage involving lung, liver, and kidney. Concurrent infection of DENV serotype 2 and 3 was observed. The infecting DENV-2 virus was grouped into Cosmopolitan genotype while DENV-3 virus was classified into Genotype I. Both viruses were closely related to isolates that were endemic in Jakarta. Viremia measurement was conducted and revealed a significantly higher virus titer of DENV-3 compared to DENV-2., Conclusions: The occurrence of multi-serotype DENV infections was presented in a patient with severe clinical manifestation in Indonesia. The hyperendemicity of dengue in Indonesia may contribute to the DENV concurrent infections cases and may underlie the severity of the disease., (Copyright © 2016 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.)
- Published
- 2016
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22. Septic Pulmonary Embolism Following Appendectomy Surgery.
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Lardo S, Ariane A, and Chen K
- Subjects
- Adult, Appendicitis surgery, Female, Humans, Pulmonary Embolism diagnostic imaging, Radiography, Appendectomy adverse effects, Escherichia coli, Escherichia coli Infections complications, Pulmonary Embolism microbiology, Surgical Wound Infection microbiology
- Abstract
Septic Pulmonary embolism is a rare condition where there were numerous pulmonary infarcts resulting from blood clot emboli that also contains microorganism. This disorder is insidious onset, Its clinical features usually unspecific and the diagnosis usually difficult to establish. A 43 old woman who underwent an appendicitis surgery, reentered the hospital at the sixth day after surgery presented with fever, pain at the surgical site, progressive severe dyspnea and chest tightness. From the physical examination finding there were tachycardia, tachypneu, wet rough basal rhonki on the right rear and tenderness at right lower region of the abdomen. The thorax-abdomen CT scan result was pleuropneumonial with minimal effusion in the right side. A CT angiography scan of the chest and abdomen showed intralumen emboli in medial lobe segmen of right pulmonary artery, right pleuropneumonia with segmental lession in segmen 10 right lobe and inflammation process along right lateral wall of the abdomen. Laboratory results that also supported diagnosis were D dimer 3442 ng/mL and culture result from surgical site pus showed E. Coli ESBL (+). Base on these findings, this case was established as a septic pulmonary embolism.
- Published
- 2015
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