Background and Purpose-Evidence is accumulating regarding the prognostic influence of hyperglycemia in patients with acute ischemic stroke. However, the level associated with poor outcome is unknown. Our objectives were to establish the capillary glucose threshold with the highest predictive accuracy of poor outcome and to evaluate its hypothetical value in influencing functional outcome by adjusting for other well-known prognostic factors in acute stroke. Methods-The authors conducted a multicenter, prospective, and observational cohort study of 476 patients with ischemic stroke within less than 24 hours from stroke onset. Capillary finger-prick glucose and stroke severity were determined on admission and 3 times a day during the first 48 hours. Poor outcome (modified Rankin Scale Ͼ2) was evaluated at 3 months. Results-The receiver operating characteristic curves showed the predictive value of maximum capillary glucose at any time within the first 48 hours with an area under the curve of 0.656 (95% CI, 0.592 to 0.720; PϽ0.01) and pointed to 155 mg/dL as the optimal cutoff level for poor outcome at 3 months (53% sensitivity; 73% specificity). This point was associated with a 2.7-fold increase (95% CI, 1.42 to 5.24) in the odds of poor outcome after adjustment for age, diabetes, capillary glucose on admission, infarct volume, and baseline stroke severity and with a 3-fold increase in the risk of death at 3 months (hazard ratio, 3.80; 95% CI, 1.79 to 8.10). Conclusions-Hyperglycemia Ն155 mg/dL at any time within the first 48 hours from stroke onset, and not only the isolated value of admission glycemia, is associated with poor outcome independently of stroke severity, infarct volume, diabetes, or age. (Stroke. 2009;40:562-568.)
BackgroundGene expression profiling may improve prognostic accuracy in patients with early breast cancer. Our objective was to demonstrate that it is possible to develop a simple molecular signature to predict distant relapse.MethodsWe included 153 patients with stage I-II hormonal receptor-positive breast cancer. RNA was isolated from formalin-fixed paraffin-embedded samples and qRT-PCR amplification of 83 genes was performed with gene expression assays. The genes we analyzed were those included in the 70-Gene Signature, the Recurrence Score and the Two-Gene Index. The association among gene expression, clinical variables and distant metastasis-free survival was analyzed using Cox regression models.ResultsAn 8-gene prognostic score was defined. Distant metastasis-free survival at 5 years was 97% for patients defined as low-risk by the prognostic score versus 60% for patients defined as high-risk. The 8-gene score remained a significant factor in multivariate analysis and its performance was similar to that of two validated gene profiles: the 70-Gene Signature and the Recurrence Score. The validity of the signature was verified in independent cohorts obtained from the GEO database.ConclusionsThis study identifies a simple gene expression score that complements histopathological prognostic factors in breast cancer, and can be determined in paraffin-embedded samples.
The prevalence of hypertension using ambulatory blood pressure monitoring in HIV-infected patients was 15%. Because isolated office hypertension occurs in 39% of HIV-infected patients with office hypertension, ambulatory blood pressure monitoring could be useful to confirm the diagnosis of hypertension. Hypertension is strongly associated with family history of hypertension, male gender, age, and number of antiretroviral regimens.
Cancer survivors in this study encountered some problems in returning to work, mainly linked to the sequelae of their disease and its treatment, rather than to discrimination by employers or colleagues. Prediction of working outcomes is possible to recommend interventions.
Background
As vaginal flucytosine is not commercially available, it is necessary to prepare this formulation in the Pharmacy Department.
Purpose
To describe the preparation of flucytosine 15.5% (FLUCY15.5), and flucytosine 17% + amphotericin 3% (FLUAM) creams for vaginal use and their efficacy in the treatment of Candida glabrata and Candida tropicalis.
Materials and methods
FLUCY15.5 was prepared as follows: Twenty-eight 500 mg capsules of flucytosine (Ancotil) were opened into a mortar and the contents crushed. The powder was mixed with glycerine to form a paste. Cold Cream was added up to 90 g. It was blended until smooth.
The procedure for preparing FLUAM was: Thirty-one 500 mg capsules of flucytosine were opened into a mortar and the contents crushed. Then 2.7 g of amphotericin B powder were added and mixed with glycerine to create a paste. Acuagel was added to a total weight of 90 g. It was blended until smooth. An expiry date of 14 days was given, although according to the Spanish Pharmacopoeia the stability of these formulations is 3 months. Vaginal applicators were used to apply the cream intravaginally.
Results
A 36-year-old woman with vulvovaginitis (positive culture for C. glabrata resistant to itraconazole and sensitive to amphotericin B, flucytosine, fluconazole and voriconazole in January 2009), was treated with oral and intravenous fluconazole, vaginal ketoconazole, intravenous voriconazole and vaginal boric acid. However, in February 2009 the culture was still positive. The physician prescribed 5 g/day vaginal FLUCY 15.5 for 14 days. For preparation details see materials and methods. After this treatment, the culture became negative (April 2009). Unfortunately, in March 2010, the patient again developed pain and vaginal itching. Culture of vaginal discharge was positive for C. tropicalis. The physician prescribed 5 g/day vaginal FLUAM and oral fluconazole 50 mg/day for 14 days. It was prepared as indicated above. After this treatment, the culture was negative (April 2010).
Conclusions
Local treatment with flucytosine and amphotericin B was effective against vaginal infections caused by non-albicans Candida species.
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