Introduction Newly developed Doppler techniques enable the sampling of slow vascular flows and the extrapolation of spectral parameters in distal arterioles. The aim of this study was to investigate the role of spectral analysis performed by means of ultra‐high frequency ultrasound (US) in the evaluation of the peripheral vascular bed of systemic sclerosis (SSc) patients. Methods Both hands of 33 patients affected by diffuse cutaneous SSc and 34 volunteers were evaluated with a US machine equipped with 33‐9 MHz and 18‐5 MHz transducers. Proximal resistive index and the peak systolic velocity (pRI and pPSV, respectively), were calculated at the level of the second interdigital artery. The distal resistive index (dRI) was calculated at the level of a nailfold arteriole of the third finger. All SSc patients had been previously divided into 4 subgroups according to their nailfold videocapillaroscopic (NVC) patterns following accepted criteria. Results SSc patients showed a significantly slower systolic velocity at the level of the second interdigital artery (pPSV [SD] = 8.38 [3] cm/s vs pPSV [SD] = 11.14 [4.5] cm/s; P = .005) and a higher dRI (dRI [SD] = 0.65 (0.14) vs dRI [SD] = 0.57 [0.11); P = .0115). No differences were found between the pRI values measured in the SSc patients and those of the controls (pRI [SD] = 0.76 [0.11] vs pRI [SD] = 0.73 [0.12]; P = .359]. The subgroup analysis did not show any significant difference when pPSV, pRI and dRI were compared among NVC morphological patterns. Conclusion High‐resolution Doppler analysis of digital distal arterioles may disclose subtle abnormalities in the downstream microvasculature of SSc patients that could be missed when the examination is performed at a more proximal level and/or using lower Doppler frequencies.

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Background To compare the clinical outcomes of patients receiving short course (SC) or prolonged course (PC) of antifungal therapy for uncomplicated Candida bloodstream infections (BSI). Methods All episodes of uncomplicated Candida BSI from 1 September 2018 to 31 August 2020 were reviewed. We compared the primary (all cause 90-day mortality) and secondary study endpoints (1-year recurrent Candida BSI and all-cause 1-year-mortality) among patients who underwent SC (5-11 days) or PC (12-24 days) therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results A total of 114 patients with uncomplicated Candida BSI were included: 35 (30.7%) were classified into the SC-group [median of 9 days (IQR 7-11 days)] and 79 (69.3%) into the PC-group [median of 14 days (IQR 14-16 days)]. Patients in SC-group compared to PC-group had a higher rate of hospitalization in the surgical ward (40.0% vs 19.0%, p = 0.02), or septic shock at the time of Candida BSI onset (11.4% vs 1.3%; p = 0.03). The risk of 90 day-mortality was not different between SC and PC groups [n = 8 (22.9%) vs 17 (21.5%), respectively; IPTW-adjusted sHR = 0.67; 95% CI = 0.31-1.47, P = 0.20]. The risk for recurrent Candida BSI within 1 year of completing therapy (IPTW-adjusted sHR = 1.07; 95% CI = 0.20-5.80, p = 0.94) or for all cause 1-year mortality (IPTW-adjusted HR = 0.72; 95% CI = 0.35-1.50, p = 0.38) did not differ between groups. Conclusions Short or prolonged course of antifungal therapy do not affect mortality and BSI recurrence in patients with uncomplicated candidemia.

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