Cerebral phaeohyphomycosis is an infrequent infectious condition associated with a high mortality rate. The authors describe a very rare case that occurred in an immunocompetent 18-year-old man who developed severe meningoencephalitis and arachnoiditis caused by Alternaria alternata, which were diagnosed in the context of difficult-to-treat hydrocephalus. Etiological diagnosis was made based on fungal culture and histopathologic examination. Empirical treatment consisted of an early aggressive antifungal combination therapy consisting of intravenous liposomal amphotericin B (5 mg/kg per day) and voriconazole (4 mg/kg every 12 h), which initially induced a favorable response. Following the fungus identification, the choice for the combination of posaconazole (400 mg every 12 h) plus flucytosine (4000 mg/day) proved to be effective in the suppression of the signs and symptoms of this uncommon cerebral mycosis. At a 12-month follow-up visit no recurrence had occurred and posaconazole was then stopped.
Case report he found IE in 0.6% of the patients (3). Sun et al, in a retrospective study between 1986-2008, found an incidence of 0.07% (9 in 13,352 patients) (4). IE generally involves the extraperitoneal portion of the round ligament, but it may be found in inguinal lymph nodes, subcutaneous adipose tissue or in the wall of sacs of inguinal or femoral hernias (5). Due to its rarity, the correct diagnosis of IE poses a challenge as it can mimic the whole range of inguinal pathology and be often misdiagnosed as inguinal hernia, lymphadenopathy, abscess, lymphoma, lipoma, hematoma or subcutaneous cyst (1, 2, 5). Therefore, the real prevalence of IE is probably underreported. IE pathogenesis is not yet completely understood. There are several possible theories: 1) implantation of endometrial tissue by transtubal regurgitation during the menstrual cycle; 2) via hematological or lymphatic spread of endometrial cells; 3) congenital hormonal activation of embryonal cells from the Müllerian duct; 4) metaplasia of mesothelial cells and direct extension from the pelvis along the round ligament (1). The reason why the right side is much more affected remains unclear, but it can be due to: asymmetrical lymphatic drainage in favor of the right inguinal and femoral region; protection of the left inguinal canal by the sigmoid colon; endometrial cells remaining on the right side for a longer period due to clockwise flow of intraperitoneal fluid (2, 4, 6).
Background Iron deficiency anaemia (IDA) is a common condition. The pharmacy intravenous iron protocol (100 mg/5 ml iron sucrose vials) includes assessment of patient analytical data, dose calculation, schedule and information about iron administration intended to prevent adverse reactions. Purpose To assess the use of intravenous iron in hospitalised patients being treated by the pharmacy protocol. Materials and Methods An eight-month retrospective, observational study (January to August 2012). Hospitalized patients treated with pharmacist-managed intravenous iron were selected. Demography, main diagnosis, comorbidities, basic data, dosage suggestions and haemoglobin and haematocrit values were collected from electronic clinical files and pharmacotherapeutic profiles. ResultsA total of 35 patients (19 male) were included. Mean age was 75.9 years (range 43–94). 9 (25.7%) patients were admitted for surgery and 26 (74.3%) for a variety of medical conditions. 20 patients (57.1%) were treated without complete investigation of the anaemia. The most frequent intravenous iron dosage was 200 mg 3x week. 27 (77.1%) patients had increased haemoglobin and haematocrit values after an average of 10.3 days (range 3–20) of intravenous iron replacement treatment. The mean increase in haemoglobin concentration was 2.5 g/dl (range 0.2–6.6). Only 9 patients (25.7%) achieved the haemoglobin target during admission. The majority of patients were discharge before achieving the target haemoglobin. No adverse reactions were reported to the pharmacist. Conclusions As stated in the literature, a large proportion of patients in our study were not confirmed to be iron deficient. Pharmacist should advise physicians about the importance of a complete IDA study before starting this therapy. The information about iron administration and a test dose in the pharmacy protocol seem to be useful in preventing adverse reactions. No conflict of interest.
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