No abstract

No abstract

No abstract

No abstract

Our small pilot study suggests that lopinavir/ritonavir once daily may be a suitable regimen for antiretroviral-naive children. However, due to the high interindividual variability and low concentrations in some patients, therapeutic drug monitoring may be necessary to ensure that concentrations are adequate to inhibit viral replication. A formal clinical study of lopinavir/ritonavir once daily in treatment-naive children is warranted.

SummaryAcinetobacter baumannii is a Gram-negative coccobacillus causing serious nosocomial infections. The recent emergence of strains of bacteria, which are resistant to common antibiotics, has made the treatment of these infections increasingly complex. We report the case of a young patient affected by AIDS, who suffered brain toxoplasmosis and sepsis due to multidrug-resistant A baumannii . This bacterial infection was successfully treated with colistin and tigecycline. In addition, we review recent literature on this topic, from the year 2000 to date. showed a left pleural effusion. Epstein-Barr virus and cytomegalovirus infection was ruled out on the basis of a molecular test (PCR). BMJ Case ReportsBrain CT documented coarse, hypodense and inhomogeneous area, probably due to toxoplasmosis, localised in the left basal ganglia. Other hypodense areas of variable size were diffused bilaterally in all brain parenchyma. Electroencephalogram showed diffuse depressed brain activity, without epileptiform abnormalities.After the onset of suprapubic pain, an abdominal ultrasound scan was performed, which visualised fl uid collection (37×34×66 mm) of probable infectious origin above the bladder located in the point of insertion of the ventricular-peritoneal shunt.The most likely cause of the clinical status of the patient was a meningitis secondary to neurosurgery, which was complicated by the contamination of the shunt with consequent formation of a peritoneal abscess and sepsis. Indeed, ventriculo-peritoneal catheter culture, cerebrospinal fl uid (CSF) examination and peritoneal swab culture revealed the presence of multidrug-resistant (MDR) A baumannii . The bacteria were identifi ed by morphology, Gram stain and reactions with automated instrument Vitek 2 (BioMerieux, Inc.100 Rodolphe Street, Durham, NC 27712).Full in vitro antibiotic susceptibility was exclusively present for colistin (minimum inhibitor concentration (MIC) 1.5 mg/l) and tigecycline (MIC 0.5 mg/l) with a partial susceptibility to amikacin, tobramycin and levofl oxacin. TREATMENTAt the beginning, antibiotic treatment with meropenem and piperacillin/tazobactam was started.Successively, vancomycin was added to the treatment, following the discovery of the fl uid collection above the bladder.Since culture results detected the presence of MDR A baumannii , the patient was treated with a combined therapy based on the association of colistin (150 000 UI/kg/ day divided in three doses) and tigecycline (3 mg/kg/day divided in two doses) for 4 weeks and then continued with tigecycline alone for another 4 weeks. Therapy was well tolerated. At the same time, highly active antiretroviral therapy treatment led an increase of CD4 cells (126 cells/ ml -5.1%). OUTCOME AND FOLLOW-UPThe patient's general clinical conditions rapidly improved and there was a reduction of the infl ammation markers, with a complete disappearance of fever after 1 week of therapy. After 2 weeks of therapy, CSF testing gave a negative result. Successive chest x-ray showed gradual improvemen...

HIV-infected children and adolescents present high prevalence of thrombophilic abnormalities. The multivariate model confirmed that high viral replication is independently associated with decrease of protein S and increase of D-dimer, suggesting the advantage of suppressive therapy on coagulation homeostasis and the opportunity of an active control of cardiovascular risk factors starting at a younger age.

Background and purpose: The aim of our study was to elaborate a suitable model on bladder late toxicity in prostate cancer (PC) patients treated by radiotherapy with volumetric technique. Materials and methods: PC patients treated between September 2010 and April 2017 were included in the analysis. An observational study was performed collecting late toxicity data of any grade, according to RTOG and CTCAE 4.03 scales, cumulative dose volumes histograms were exported for each patient. Vdose, the value of dose to a specific volume of organ at risk (OAR), impact was analyzed through the Mann–Whitney rank-sum test. Logistic regression was used as the final model. The model performance was estimated by taking 1000 samples with replacement from the original dataset and calculating the AUC average. In addition, the calibration plot (Hosmer–Lemeshow goodness-of-fit test) was used to evaluate the performance of internal validation. RStudio Software version 3.3.1 and an in house developed software package “Moddicom” were used. Results: Data from 175 patients were collected. The median follow-up was 39 months (min–max 3.00–113.00). We performed Mann–Whitney rank-sum test with continuity correction in the subset of patients with late bladder toxicity grade ≥ 2: a statistically significant p-value with a Vdose of 51.43 Gy by applying a logistic regression model (coefficient 4.3, p value 0.025) for the prediction of the development of late G ≥ 2 GU toxicity was observed. The performance for the model’s internal validation was evaluated, with an AUC equal to 0.626. Accuracy was estimated through the elaboration of a calibration plot. Conclusions: Our preliminary results could help to optimize treatment planning procedures and customize treatments.