Association between the severity of newly diagnosed obstructive sleep apnea and subclinical carotid atherosclerosis in patients without overt cardiovascular disease

OBJECTIVE

Obstructive Sleep Apnea (OSA) has been associated with both subclinical and accelerated atherosclerosis; however, it still remains unknown whether this association is unique or is mediated by the higher burden of co-existing cardio-metabolic disorders frequently seen in patients with OSA.

PATIENTS AND METHODS

A total of 40 subjects without clinically diagnosed cardiovascular disease (CVD) referred for polysomnography test were included in the study. Subjects with apnea/hypopnea index (AHI > 15/h) were classified as moderate/severe OSA. Subclinical changes in carotid atherosclerosis were assessed using mean carotid intima-media thickness (cIMT) and presence of atheromatic plaques on both carotid arteries. The measurement was performed using B-mode ultrasonogram. Framingham risk score was used in the approximation of cardiovascular risk.

RESULTS

The mean age of our cohort was 56.8 years, 70% (n = 28) of whom were males. Moderate/severe OSA was diagnosed in 21 subjects. Both groups were well matched in terms of clinical and demographic characteristics, and cardiovascular risk profile, as shown in their respective Framingham risk scores (10.4 ± 6.6 vs. 11.8 ± 8.8, p = NS). Patients with moderate/severe OSA had a higher mean AHI, 3% oxygen desaturation index, and lower minimum nocturnal oxygen saturation than controls. No significant differences were detected in terms of C-reactive protein levels. The two groups had similar cIMT (0.66 ± 0.17 vs. 0.75 ± 0.20 p = 0.33) and presence of atheromatic plaque (50% vs. 45%, p = 1.00).

CONCLUSIONS

Our study suggests that among patients with similar cardiovascular risk profile and free of overt CVD, the severity of newly diagnosed OSA was not correlated with increased inflammation or subclinical carotid atherosclerosis.

Asthmatic bronchitis for 2 years: A case report

Longstanding asthmatic bronchitis, without evidence of underlying disease, occurring in middle-aged patients, is usually attributed to chronic obstructive pulmonary disease and is treated appropriately.

We report a case of 2-year asthmatic bronchitis with recurrent attacks of wheezing, in a 60-year-old patient. He had three repeated hospitalizations, in different institutions, where he was treated for exacerbations of chronic bronchitis complicated by lower respiratory tract infections. During his final hospitalization, a tracheal hamartoma was found and removed, releasing him from his symptoms.

β-Blocker Use and Risk of Recurrence in Patients with Early Breast Cancer

AIM

We evaluated whether the concurrent β-blocker use in early breast cancer patients influenced the outcome in terms of preventing tumor recurrence after adjuvant chemotherapy.

METHODS

We retrospectively reviewed the medical records of 610 patients with breast cancer. Thereafter, we compared overall disease-free survival (DFS) between β-blocker users and nonusers.

RESULTS

Those not receiving β-blockers had a relatively longer mean DFS (10.8 vs. 9.7 years), although the difference did not reach statistical significance (p = 0.651). When the survival analysis was adjusted for age, tumor stage, hormone receptor status and HER2 status, the results remained unaltered, suggesting that β-blocker use did not significantly improve overall DFS (HR, 0.849; 95% CI, 0.537-1.343; p = 0.485).

CONCLUSION

Our findings failed to confirm previous results indicating a potential antitumor effect of β-blockers.

Evaluation of a Bone Marrow Dysmyelopoiesis Immunophenotypic Index for the Diagnosis and Prognosis of Myelodysplastic Syndromes

BACKGROUND

Myelodysplastic Syndromes (MDS) are a group of clonal hematopoietic stem cell disorders with significant heterogeneity in their clinical presentation and the prognosis of the patients. Several attempts have been made to incorporate flow cytometry (FC) findings into the diagnostic and/or prognostic criteria of dysplasia, but bone marrow (BM) aspirate morphology evaluation remains the gold-standard for diagnosis. The purpose of this study was to provide a diagnostic tool for MDS that relies on BM immunophenotyping and objectifies the interpretation of FC analysis and to validate its capacity to discriminate MDS from other causes of cytopenias.

METHODS

To that purpose, a mathematical formula was developed which incorporates granulocytic maturation markers and the percentage of selected myeloid populations and translates them into a single parameter that quantifies the maturation and differentiation defects of BM granulocytes, named Dysmyelopoiesis Index (DMI). Bone marrow samples from 84 MDS patients and 47 non-MDS cytopenic patients were analyzed with FC and DMI was calculated for every patient.

RESULTS

DMI detected clonal dysplasia with 84.5% sensitivity and 93.6% specificity, identified as MDS 77.2% of low grade patients and revealed multilineage dysplasia for a number of RA and RARS cases. It discriminated prognostic subgroups of MDS patients (P< .005) and negatively correlated with IPSS (r= - .472, P= .000), WPSS (r= - .481, P= .000) and IPSS-R (r= -.395, P= .000).

CONCLUSIONS

DMI represents an accurate quantification of dysmyelopoiesis and an effective stand-alone diagnostic test for MDS, facilitating FC analysis and daily clinical practice.

Drug-induced cardiotoxicity due to aminophylline treatment: a case report

BACKGROUND

Aminophylline, a theophylline compound that contains ethylenediamine, has untoward side effects on many organ systems.

OBJECTIVE

The goal of this case report was to illustrate the occurrence of acute adverse events (ie, chest discomfort and myocardial enzyme elevation) that may be associated with aminophylline treatment.

METHODS

To uncover previous studies/reports on this subject, a literature search (1950-2003) was conducted on MEDLINE, UpToDate, and Doctor's Guide, using the search terms aminophylline toxicity, theophylline toxokinetics, pharmacotoxic myocardial injury, hypersensitivity myocarditis, and diagnosis of myocardial infarction with biomarkers of cardiac injury. A 76-year-old, obese, female patient was admitted to University Hospital (Rion, Greece) for an acute exacerbation of chronic bronchitis. Beginning on day 0 of hospitalization, the patient was treated with aminophylline 750 mg IV, given in a 24hour constant infusion, for persistent wheezing. We monitored the patient's condition using electrocardiography, echocardiography, and blood chemistry analysis.

RESULTS

While undergoing aminophylline treatment, the patient developed vague chest discomfort and myocardial enzyme elevation due to aminophylline-induced cardiotoxicity. Mild wheezing was still present on physical examination on day 2 of hospitalization. The serum creatine kinase (CK) level was slightly increased. On day 6 of hospitalization, the patient's symptoms worsened, with mild epigastric discomfort, tachycardia, fatigue, and tightness in the chest. Blood gas analysis revealed mild hypoxia and hypocapnia. Pulmonary perfusion scan showed a low risk for pulmonary thromboembolism, as indicated by the absence of segmental perfusion defects. Blood chemistry analysis showed increased serum CK (×2.5) and CK isoenzyme (CK-MB) fraction (×8.6) levels. Echocardiography on day 7 showed a slight hypertrophy of the septum, with normal dimensions of the ventricles and a 70% ejection fraction. Aminophylline treatment was permanently discontinued, and the patient's signs and symptoms promptly improved.

CONCLUSIONS

In the case presented here, the exclusion of usual causes of increased serum CK and CK-MB fraction levels, together with the increased serum aminophylline concentration and, most importantly, the rapid alleviation of symptoms and normalization of myocardial enzymes in absolute temporal relationship to the discontinuation of the drug, suggested that aminophylline treatment might be associated with elevated levels of myocardial enzymes. (Curr Ther Res Clin Exp. 2003;64:379-386).

Epidemiology of Hantavirus infections in humans: a comprehensive, global overview

Hantaviruses comprise an emerging global threat for public health, affecting about 30,000 humans annually. Infection may lead to Hantavirus pulmonary syndrome (HPS) in the Americas and hemorrhagic fever with renal syndrome (HFRS) in the Europe and Asia. Humans are spillover hosts, acquiring infection primarily through the inhalation of aerosolized excreta from infected rodents and insectivores. Risk factors for infection include involvement in outdoor activities, such as rural- and forest-related activities, peridomestic rodent presence, exposure to potentially infected dust and outdoor military training; prolonged, intimate contact with infected individuals promotes transmission of Andes virus, the only Hantavirus known to be transmitted from human-to-human. The total number of Hantavirus case reports is generally on the rise, as is the number of affected countries. Knowledge of the geographical distribution, regional incidence and associated risk factors of the disease are crucial for clinicians to suspect and diagnose infected individuals early on. Climatic, ecological and environmental changes are related to fluctuations in rodent populations, and subsequently to human epidemics. Thus, prevention may be enhanced by host-reservoir control and human exposure prophylaxis interventions, which likely have led to a dramatic reduction of human cases in China over the past decades; vaccination may also play a role in the future.

Angiogenesis as a therapeutic target in breast cancer

Current evidence indicates that angiogenesis plays an important role in the pathogenesis of several malignancies, including breast cancer. Bevacizumab is a monoclonal antibody that targets the vascular endothelial growth factor (VEGF). Recent clinical data have demonstrated that the addition of bevacizumab to first-line chemotherapy improves the progression-free survival of patients with advanced breast cancer. This review presents an update on the role of bevacizumab, as well as other anti-angiogenic agents in the management of patients with breast carcinoma.

Pathogens and chronic or long-term neurologic disorders

Infections of the central nervous system may provoke glial and autoimmune responses but a definitive linkage between these infections and the pathogenesis of chronic neurologic disorders is still elusive. There are controversial reports implicating infectious agents in the pathogenetic mechanisms of chronic or long-term neurologic disorders, such as multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, Alzheimer's disease and autistic spectrum disorders, but the specific role of bacterial or viral infections in the pathogenesis of these medical entities has not been fully elucidated. Up till now, the evidence is distant from definite, but certain cases may be attributed to infections in the millieu of multiple toxic events such as trauma, nutritional deficits, immune dysregulation and excitotoxicity in genetically vulnerable indiniduals. There is an ongoing debate concering the direct involvement of various infectious agents in the neurodegenerative and neurobehavioral diseases pathogenesis and/or their contribution to the deterioration of the disease or co-morbidity in these patients. These patients are exceptionally difficult to be treated by using single therapeutic modalities, because their disese is multifocal and treatment is aimed to control signs and symptoms rather than the true causes of the disease and its progressive course. Furthermore, even if these causative links were indetifiable, our therapeutic interventions would come too late due to the irreversible damages at the time of the initiation of treatment. Our aim is to comprehensively review all available data suggesting that infections could be common antecedent events of progressive neurologic degenerative or behavioural diseases.

Targeted therapies for advanced non-small cell lung cancer

The incorporation of targeted agents has considerably improved the management of patients with advanced non-small cell lung cancer (NSCLC) over the last years. The main targets include the epidermal growth factor receptor (EGFR) and the vascular endothelial growth factor (VEGF). Currently available agents with established role in NSCLC include the anti-EGFR tyrosine-kinase inhibitors (TKIs) erlotinib/gefitinib and the anti-VEGF monoclonal antibody bevacizumab. Moreover, several other agents targeting critical pathways in lung carcinogenesis are currently under preclinical or clinical evaluation. This review presents an update on the role of targeted agents in advanced NSCLC. In addition, we present the main clinical studies investigating the activity of these agents in NSCLC and we provide recent data with respect to future therapeutic strategies.

Dealing with the substance abuse epidemic and infective endocarditis: clinical, immunologic and pathogenetic aspects

Although infective endocarditis (IE) is not the most frequent infection seen in intravenous (IV) drug abusers (IVDAs), health care providers should always regard it as a possible diagnosis in this population. Many researchers have tried to elucidate the clinical, epidemiologic, immunologic and pathogenetic aspects of this entity. Right-sided endocarditis accounts for almost 10% of all IE episodes and has been most commonly interrelated with IV use of illicit substances. On the other hand, recent reports have proposed that left-sided valve participation is seen more often now than in the past. While, our progress in medicine, new diagnostic criteria and especially modern imaging techniques have broadened our ability to recognize IE, there are still some gray areas regarding right-sided IE. Our aim is to comprehensively review the clinical features and complications and also the possible pathogenetic and immunologic mechanisms implicated in IE patients who are injecting illicit substances.

Drug-induced thromboembolic events in patients with malignancy

Patients with malignancies are often in a hypercoagulable status. The pathogenetic mechanisms of thrombotic events in malignancy are multifaceted and consist of release or expression of procoagulants by cancer cells, but also appearance of procoagulant action by normal host cells. Most importantly, current therapeutic modalities for cancer such as high dose chemotherapy and surgery represent a significant additional risk for serious or even fatal thromboembolic events. There is a wide spectrum of clinical manifestations of these events which encompass Trousseau's syndrome, deep venous thrombosis, marantic endocarditis, disseminated intravascular coagulation, thrombotic microangiopathy and arterial thrombosis. Cancer chemotherapy is most commonly associated with deep vein thrombosis but intracranial sinus vein thromboses and thrombotic microangiopathy may also occur. Our purpose is to review the relevant literature linked to the effect of chemotherapy and other cancer-related interventions on thromboembolic incidents.

Unusual manifestations of brucellosis: a retrospective case series in a tertiary care Greek university hospital

Brucellosis remains a diagnostic puzzle. We retrospectively studied the case notes of 105 patients with brucellosis who were admitted in the Department of Internal Medicine of the University of Patras Hospital, a tertiary care institution serving an extended rural area in western Greece, from 2003 to 2006. Five unusual causes of brucellosis were identified: hepatic, epidural and thyroid abscesses, intrahepatic cholestatic liver disease and pancytopenia. Virtually every human organ and system can be involved in brucellosis, which highlights the need to include brucellosis in the differential diagnosis, especially in endemic areas.

Injecting illicit substances epidemic and infective endocarditis

Infective endocarditis (IE) is not the most frequent infection acquainted in intravenous drug abusers (IVDAs). On the other hand, all physicians should keep a high index of suspicion and always consider this possibility when they are dealing with an infectious process in this special population group. Since Sir William Osler, at the turn of the previous century, first described IE, there have been tremendous alterations in the very nature of this serious and possibly fatal disease. Right-sided endocarditis accounts for almost 10% of all IE episodes and has been correlated most commonly with injection of illicit drugs. However, recent reports have proposed that left-sided valves' participation is seen more often now than in the past. Although, the advances in medicine and especially modern imaging techniques have expanded our capacity to identify IE, there are still some gray areas in our ability to fully comprehend right-sided IE. Hussey et al. [1] were the first to distinguish IE as a distinct impediment of IV narcotics abuse in 1950. Although, many reports have been published since then arguing about the aspects of this medical entity, we will try here to comprehensively review the epidemiology and predisposing factors, clinical features and complications, diagnosis, treatment and prognosis of this disease, emphasizing on those distinctive or exclusive features seen in IE patients who are injecting illicit substances.

Prosthetic valve endocarditis: diagnostic approach and treatment options

Prosthetic valve endocarditis (PVE) is a grave medical entity with potentially fatal end results. The disease encompasses a rather small but, in the same time, vital part of IE incidents that is probable to be augmented in future years. PVE occurs in 1-4% of valve recipients during the first year following valve replacement, and in approximately 1 % per year afterwards. The type of prosthetic valve (mechanical versus bioprosthetic) seems not having an impact on the rate of development of IE and it is comparable in both groups (0.8 cases per year of follow-up). The pathogenetic mechanisms, pathogens implicated, clinical features and diagnostic approach of PVE will be reviewed here, along with the antibacterial and potential surgical treatment and prevention of the disease.

Prevalence of anti-HAV antibodies in multitransfused patients with beta-thalassemia

AIM: To detect the prevalence of anti-HAV IgG antibodies in adult multitransfused beta-thalassemic patients.

METHODS: We studied 182 adult beta-thalassemic patients and 209 controls matched for age and sex from the same geographic area, at the same time. Anti-HAV IgG antibodies, viral markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were evaluated.

RESULTS: Anti-HAV IgG antibodies were detected more frequently in thalassemic patients (133/182; 73.1%) than in healthy controls (38/209; 18.2%, P < 0.0005). When we retrospectively evaluated the prevalence of anti-HAV IgG antibodies in 176/182 (96.7%) thalassemic patients, whose medical history was available for the previous ten years, it was found that 83 (47.2%) of them were continuously anti-HAV IgG positive, 16 (9.1%) acquired anti-HAV IgG antibody during the previous ten years, 49 (27.8%) presented anti-HAV positivity intermittently and 28 (15.9%) were anti-HAV negative continuously.

CONCLUSION: Multitransfused adult beta-thalassemic patients present higher frequency of anti-HAV IgG antibodies than normal population of the same geographic area. This difference is difficult to explain, but it can be attributed to the higher vulnerability of thalassemics to HAV infection and to passive transfer of anti-HAV antibodies by blood transfusions.

Brain metastasis in renal cell cancer responding to sunitinib

Sunitinib (SU011248; Sutent) is a new small molecule that inhibits members of the split-kinase domain family of receptor tyrosine kinases (RTKs), with established antitumor activity in renal cancer. In the current report, we describe a patient with a solitary brain metastasis from renal cell carcinoma who achieved partial response of the cerebral lesion following treatment with sunitinib. To the best of our knowledge, this is the first report of sunitinib activity in brain metastases from kidney cancer. A limited number of publications support the hypothesis that small tyrosine kinase inhibitors may cross the blood-brain barrier. Although the role of sunitinib in advanced renal carcinoma has been evaluated through prospective trials, the efficacy of the drug in patients with brain metastases has not been explored, since patients with cerebral lesions were excluded in those studies. Thus, we believe that accumulating evidence from personal experience or limited reports could be useful. Moreover, in our case, sunitinib was found to be safe, leading to considerable shrinkage of the brain metastasis without any serious adverse events or central nervous system toxicities. We consider this observation to be important, given the absence of data regarding the activity of the drug in this particular clinical setting.

Endocarditis due to Salmonella enterica subsp. arizonae in a patient with sickle cell disease: a case report and review of the literature

Human cases due to Salmonella enterica subsp. arizonae are especially rare, but it may affect immunocompromised patients and infants. We present a case of endocarditis in a patient with sickle cell disease and a review of earlier cases caused by this rare human pathogen. The patient was successfully treated with ceftriaxone and ciprofloxacin. There are only few cases of salmonella endocarditis reported in the last six decades and it is the first case of Salmonella enterica subsp. arizonae endocarditis in the literature to the best of our knowledge.

Serum adiponectin in chronic hepatitis C and B

Adiponectin possesses anti-inflammatory, insulin-sensitizing and anti-atherosclerotic properties. The aim of this study was to assess the levels of serum adiponectin in patients with chronic viral hepatitis C and B and correlate them with parameters exploring insulin resistance and indices of chronic liver disease. Seventy-two patients with chronic hepatitis C virus (HCV) infection and 73 patients with chronic hepatitis B virus (HBV) infection, matched for age and sex, were studied. All individuals were examined for serum concentrations of adiponectin, insulin, C-peptide and homeostasis model assessment for insulin resistance (HOMA-IR). Viral parameters and liver histology were also evaluated. Serum adiponectin levels were significantly higher in HCV compared with HBV-infected patients. Correlation analysis in the whole group demonstrated that serum adiponectin was positively correlated with aspartate aminotransferase, alkaline phosphatase, globulins, high-density lipoprotein cholesterol and staging score, while it was negatively correlated with body mass index, insulin, C-peptide and HOMA-IR. Logistic regression analysis identified type of infection (HCV vs HBV), alcohol consumption more than 25 g daily, serum total globulin and low C-peptide as significant predictive variables associated with high adiponectin levels. Higher levels of serum adiponectin in HCV compared with HBV patients could have a role in the slower disease progression of chronic HCV infection. In addition, alcohol intake more than 25 g daily seems to be a significant predictor for hyperadiponectinaemia in patients with chronic viral hepatitis C or B. Finally, in this study, a clear positive association between adiponectin and hepatic necroinflammation or staging score was not found.

Catastrophic antiphospholipid syndrome presented with severe hypertension, adult respiratory distress syndrome and unilateral adrenal haemorrhagic infarction

We are reporting a case of catastrophic antiphospholipid syndrome (CAPS) in an adult female manifested with severe hypertension followed by adrenal haemorrhagic infarction and adult respiratory distress syndrome. Adrenal involvement appears to be exceedingly high in CAPS and adult respiratory distress syndrome (ARDS) is the prevailing pulmonary manifestation in this condition, compared with these impediments in patients with simple antiphospholipid syndrome (APS). Even though the above manifestations are well recognized, their combination as an initial presentation of CAPS is uncommon.

Hepatitis caused by the herbal remedy Teucrium polium L

Herbal remedies have become increasingly popular throughout the globe as a result of disappointment with conventional medicines and also of the alleged belief that herbal preparations are basically harmless. On the other hand, their effects can be exceedingly potent or even lethal if used improperly. Drugs and other chemicals account for less than 5% of cases of jaundice or acute hepatitis and smaller number of cases of chronic liver disease. Drug reactions can mimic any hepatobiliary disease, posing a diagnostic challenge for physicians and pathologists. Hepatotoxicity generally occurs after approximately 2 months of ingestion and consists of a non-specific hepatitis, which usually runs a benign course. Typical features include anorexia, nausea, abdominal pain, and jaundice associated with a marked elevation in serum aminotransferases. We present a case of acute hepatitis in a 70-year-old farmer, using Teucrium polium (golden germander) as hypoglycaemic aid. The patient presented only with jaundice, after 1 month's consumption of large quantities of this herb in a tea form.

Serum lipid pattern in chronic hepatitis C: histological and virological correlations

Lipoproteins are closely connected to the process of hepatitis C virus (HCV) infection. The aim of this study was to evaluate the lipaemic profile in patients with chronic HCV infection, and to identify any association between serum lipid levels and viral load, HCV genotype or liver histology. Total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG) were measured in the sera of 155 patients with chronic HCV infection and 138 normal subjects, matched for age and sex. Viral parameters and liver histology were evaluated in HCV-infected patients. Serum TC (P < 0.0005), HDL-C (P < 0.0005) and LDL-C (P < 0.0005) were lower in chronic hepatitis C patients compared with controls. Grading score was positively correlated with TC and LDL-C. Patients with HCV genotype 3a had significantly lower levels of TC, HDL-C, LDL-C, higher viral load and higher frequency of hepatic steatosis than those with other genotypes. Logistic regression analysis identified genotype 3a (OR, 6.96; 95% CI, 2.17-22.32, P = 0.0011) as the only significant predictive variable associated with low serum cholesterol concentration. HCV infection is associated with clinically significant lower cholesterol levels (TC, LDL and HDL) when compared with those of normal subjects. This finding is more pronounced in patients infected with HCV genotype 3a. Further studies are necessary to define the pathophysiology of the relationship between lipid metabolism and HCV infection.

Prosthetic Valve Endocarditis Caused by Acinetobacter lwoffi

We are reporting a case of recurrent prosthetic-valve endocarditis (PVE) caused by an unusual pathogen. The patient suffered 2 consecutive relapses of Acinetobacter lwoffi bacteremia, although he had completed a full course of treatment with antibiotics to which the microorganism was susceptible. He was finally successfully operated with replacement of the infected aortic valve. Acinetobacter spp are relatively low-grade but potentially virulent pathogens, and endocarditis caused by these species can be fulminant, accompanied by septic complications, and fatal. Although some patients with relapsed PVE may respond to a second course of antibiotics and medical treatment rather than early valve replacement is suggested in A lwoffi PVE, combined antibiotic treatment and early surgical intervention may be considered as the first option in these patients. There are only a few cases of Acinetobacter endocarditis in the literature, and it is the first case reported in Greece to our knowledge.

A rooster's revenge: hepatic abscess caused by a chicken bone

We present the case of a liver abscess caused by a swallowed chicken bone in an elderly man successfully treated with laparotomy. This report illustrates the difficulties of obtaining a preoperative diagnosis. The prolonged time course of the illness, the lack of history of the ingestion of a foreign body, the relatively non-specific symptoms and signs and the non-specific results obtained by conventional radiography resulted in a delayed recognition of this possibly fatal disease. This rare condition should be kept in mind when dealing with cases of hepatic abscess or even septic shock of unknown origin.

Acute transverse myelitis due to Coxsackie virus

The case of a young adult male, who after a short upper respiratory illness presented with fever and alarming progressive neurological deficits, is reported. The diagnostic puzzle and the difficulty in establishing a diagnosis are reported. Acute transverse myelitis is a rare clinical manifestation of Coxsackie virus infection, and very few cases of transverse myelitis caused by serotype B have been reported in the English literature. This is a case report of an unusual acute transverse myelitis caused by Coxsackie B2 infection.

Comparative effects of ciprofloxacin and ceftazidime on cytokine production in patients with severe sepsis caused by gram-negative bacteria

In the present study the effect of ciprofloxacin versus ceftazidime on concentrations of pro- and anti-inflammatory cytokines in the sera of patients with severe sepsis was evaluated. The study included 58 previously healthy patients suffering from severe sepsis caused by gram-negative bacteria, treated with either ciprofloxacin or ceftazidime after thorough clinical and microbiological evaluation and followed up for clinical outcome. Levels of the proinflammatory cytokines tumor necrosis factor alpha (TNF-alpha), interleukin-1b (IL-1b), IL-6, and IL-8 and of the anti-inflammatory cytokine IL-10, as well as of IL-1 receptor antagonist and soluble TNF receptors I and II, in serum were measured at baseline and 24 and 48 h after the first antimicrobial dose. Mean SAPS-II scores, development of septic shock, and mortality rates were similar in the two groups (43.2 +/- 9.2, 21.4%, and 14.3% in the ceftazidime group versus 49.8 +/- 11.3, 20%, and 13.3% in the ciprofloxacin group). Serum TNF-alpha and IL-6 levels at 24 and 48 h were significantly lower in the ciprofloxacin group, while the IL-10/TNF-alpha ratio was significantly higher, than those for the ceftazidime group. Among patients with high baseline TNF-alpha levels, there were significant increases in the IL-10/TNF-alpha ratio at both 24 and 48 h over that at admission for the ciprofloxacin group, while no differences were noted in the ceftazidime group. These results indicate that ciprofloxacin may have an immunomodulatory effect on septic patients by attenuating the proinflammatory response, while there is no evidence that differences in the cytokines measured have any impact on the final outcome.

Five-day moxifloxacin therapy compared with 7-day co-amoxiclav therapy for the treatment of acute exacerbation of chronic bronchitis

In this randomized, non-blinded study, the efficacy and safety of a 5-day course of moxifloxacin (one 400 mg tablet daily) was compared with that of co-amoxiclav (one 625 mg tablet every 8h) for 7 days, for the treatment of acute exacerbations of chronic bronchitis (AECB). A total of 162 patients with clear signs of an acute exacerbation of chronic bronchitis were enrolled. Of these, 153 could be studied. Seventy-nine patients were randomized in the moxifloxacin arm and 74 in the co-amoxiclav arm of the study. The primary efficacy parameter was clinical response at 14 days in the evaluable population. A clinical success was classified as resolution or improvement of symptoms. Variables used to assess clinical response included wheeze, cough, dyspnoea, sputum volume, rales and ronchi. The success rate in the moxifloxacin group was 88.6% (70 of 79) and that for co-amoxiclav group was 89.2% (66 of 74). At follow-up (28-35 days post-treatment), the continued clinical cure rates were 90.0% (63 of 70) for moxifloxacin and 89.4% (59 of 66) for co-amoxiclav. No significant differences were detected between the two groups. A total of 78 pathogenic bacteria were isolated from the sputum samples of the patients, with Moraxella catarrhalis, Haemophilus influenzae and Streptococcus pneumoniae being the most frequently isolated pathogens. The eradication rate at 14 days in the valid patients was similar for both groups, 90.9% (20 of 22) for the moxifloxacin group and 90.0% (18 of 20) for the co-amoxiclav group. Both drugs were well tolerated with no differences in the drug-related adverse effects or the patients withdrawing because of an adverse event. These results and the good spectrum of antibacterial activity make moxifloxacin a promising and also safe alternative for the empirical treatment of AECB.

Asthmatic bronchitis for 2 years. A case report

Longstanding asthmatic bronchitis, without evidence of underlying disease, occurring in middle-aged patients, is usually attributed to chronic obstructive pulmonary disease and is treated appropriately. We report a case of 2-year asthmatic bronchitis with recurrent attacks of wheezing, in a 60-year-old patient. He had three repeated hospitalizations, in different institutions, where he was treated for exacerbations of chronic bronchitis complicated by lower respiratory tract infections. During his final hospitalization, a tracheal hamartoma was found and removed, releasing him from his symptoms.

Results of a prospective, randomized, double blind comparison of the efficacy and the safety of sequential ciprofloxacin (intravenous/oral)+metronidazole (intravenous/oral) with ceftriaxone (intravenous)+metronidazole (intravenous/oral) for the treatment of intra-abdominal infections

The efficacy and the safety of sequential intravenous/oral (i.v./p.o.) ciprofloxacin (CIPX) plus i.v./p.o. metronidazole (MTR) was compared with i.v. ceftriaxone (CTRX) plus i.v./p.o. MTR in the treatment of complicated intra-abdominal infections. One hundred and forty two patients received study medications. Of these, 135 could be studied. Sixty-nine patients were randomized in the CIPX arm of the study and 66 in the CTRX arm. In the CIPX group 58 patients were switched to oral treatment and 11 patients remained in the intravenous arm. In the CTRX group 57 patients switched to oral MTR continuing i.v. CTRX and 9 patients remained in the i.v. branch. Success rates at the end of treatment in patients who switched to oral were 100% in both the CIPX group and the CTRX group. For validated patients continuing on oral, the success rates at the end of treatment were 63.6 and 33.3% in the CIPX and CTRX groups respectively. Overall success rates at the end of treatment and follow-up in all patients were 94.2% in the CIPX group and 89.4% in the CTRX group. Overall success rates at the end of treatment in patients with proven bacterial infection were 92.9% in the CIPX group and 88.3% in the CTRX group. Duration of hospitalization (days) for studied patients was 22.7+/-8.2 in the CIPX and 19.6+/-14.5 in the CTRX group. There was no statistical difference between the CIPX and CTRX groups in both the intent to treat and in the modified intent to treat populations. Conversion to oral therapy with CIPX/MTR was as effective as continued intravenous therapy with CTRX and oral MTR in those patients able to tolerate oral feeding.

Repeated point prevalence survey of nosocomial infections in a Greek university hospital

Two point prevalence surveys of nosocomial infections (NIs) were carried out in a Greek University hospital on an annual basis in 1998 and 1999. The overall prevalence of NIs was 9.5% and 9.1% in the first and second study, respectively. The average length of stay of patients in the hospital (ALOS) was 7.7 and 9.6 days in these two studies, respectively. Of the 97 NIs detected, the most frequent were lower respiratory tract infections (36%). Urinary tract infections, bloodstream infections, surgical site infections, and gastrointestinal infections were found in 25.8%, 19.6%, 7.2% and 4.1% of patients, respectively. The prevalence of antibiotic usage was 55.6% in 1998 and 54.1% in 1999. Empiric antibiotic therapy prevailed over prophylactic and rational therapies. These percentages are higher than those reported from other countries, emphasizing the need for rational antibiotic usage to decrease pharmacy expenses and discourage the development of resistant microorganisms. A nationwide network of surveillance of NIs in Greece is now being developed using these experiences.