Abstract. Combined treatment with caspofungin and trimethoprim/sulfamethoxazole (TMP/SMZ) as salvage therapy in non-HIV positive patients with severe pneumocystis pneumonia (PCP) yields poor outcomes. It remains unknown whether the use of this combination strategy as a first-line therapy would improve patient outcomes. The present study aimed to assess the efficacy of caspofungin combined with TMP/SMZ as a first-line therapy in non-HIV positive patients with severe PCP. A retrospective cohort study was conducted between March 2016 and February 2017. Patient clinical characteristics and outcomes were compared between two groups receiving first-line and second-line therapy respectively. In addition, similar cases from previous studies were assessed. A total of 14 patients were included in the present study (mean age, 58.79±14.41 years); including 9 patients receiving caspofungin and TMP/SMZ as a first-line therapy and 5 that received it as a second-line therapy. The overall positive response rate was 71.43% (10/14), with 88.89 (8/9) and 40.00% (2/5) in the first-line and second-line therapy groups, respectively (P=0.095). The positive response rates of patients requiring invasive mechanical ventilation differed significantly between the first-line (5/6, 83.33%) and the second-line (0/3, 0%) therapy groups (P=0.048). All-cause hospital mortality was 42.86% (6/14), with mortality rates of 33.33 (3/9) and 60.00% (3/5) in the first-line and second-line therapy groups, respectively (P=0.580). Combined with previously reported cases (n=27), the positive response rate was significantly greater in the first-line therapy group (11/12, 91.67%) than in the second-line therapy group (8/15, 53.33%, P= 0.043). No significant differences were in all-cause mortality rates between the two groups (25.00 vs. 46.67%, P=0.424) were identified, despite the fact that all-course mortality in the first-line therapy group was ~50% that of the second-line therapy group. Therefore, the results of the present study indicate that combined caspofungin and TMP/SMZ as first-line therapy may be a promising and effective strategy to treat non-HIV positive patients with severe PCP, particularly for those requiring invasive mechanical ventilation.
Objective The aim of this study was to investigate the clinical significance of serum homocysteine (Hcy) as a biomarker for early diagnosis of diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) patients. Methods Fifty-five T2DM patients with DN and 51 T2DM patients without DN were prospectively recruited from January 2016 to May 2020 in our hospital. The serum Hcy was tested by electrochemiluminescence assay in DN and T2DM groups and compared. The diagnostic efficacy of serum Hcy as a biomarker for early diagnosis of DN was evaluated by calculating the diagnostic sensitivity, specificity and area under the ROC curve (AUC). Results The serum levels of Hcy were 15.49 ± 5.40 and 9.23 ± 3.15 μmol/L for DN and T2DM patients, respectively, with statistical difference (t = 7.21, P < 0.001). In the DN group, the serum Hcy levels for patients with hyperfiltration, intermittent proteinuria, microalbuminuria, macroalbuminuria and uremic were 10.99 ± 2.57, 13.90 ± 2.86, 15.38 ± 4.77, 18.98 ± 4.36 and 23.31 ± 5.22 μmol/L, respectively, which indicated that serum Hcy levels in DN were higher than those of T2DM patients and correlated with patient’s renal damage. Using the serum Hcy level as the reference, the diagnostic sensitivity, specificity and AUC were 84.31 (71.41–92.98)%, 74.55 (61.00–85.33)% and 0.85 (0.78–0.92)%, respectively, with the cutoff value of 12.08 between DN and T2DM. The serum Hcy also had relatively good differential diagnostic efficacy between different DN stages with high sensitivity, specificity and AUC. Conclusion Serum Hcy was obviously elevated in DN compared to T2MD and correlated with the renal damage severity, which can be applied as a potential serological marker for early diagnosis of DN.
ObjectivesTo investigate the dynamic changes of serum neopterin and its significance as biomarker in prediction the prognosis of patients with acute pancreatitis.Methods54 cases with confirmed diagnosis of acute pancreatitis were included in the present work. Of the included 54 cases, 21 were mild acute pancreatitis and other 33 were server diseases. For the 33 severe cases, nine were finally dead and 24 were survived. The serological neopterin level of the 54 acute pancreatitis was continuously examined at the time point of days 0 (diagnosis), 1 (24 h after diagnosis), 2, 4, 8 and 14 by the enzyme linked immunosorbent assay (ELISA). The severity or death risk of the acute pancreatitis patients was predicted by the serological neopterin.ResultsThe serological neopterin was gradually increasing from days 0 to 8, but descending at day 14 in mild and survival groups. For days 8 and 14, the serological levels of neopterin in severe group were higher than those of mild group with statistical difference (p<0.05). The serum neopterin was statistical different in the time point of day 8 and day 14 between death and survival groups (p<0.05). For day 8, the serological neopterin as biomarker for death prediction sensitivity and specificity were 88.89% (95% CI: 51.75–99.72%) and 83.33% (95% CI: 62.62–95.26%) respectively with the AUC of 0.95 (95% CI: 0.88–1.00). For day 14, the death prediction sensitivity and specificity were 77.78% (33.99–97.19%) and 95.83% (78.88–99.89%) respectively with the AUC of 0.94 (95%CI:0.87–1.00).ConclusionsSerological neopterin level was elevated with the development of the pancreatitis. Continuously monitoring the serum neopterin may helpful for prediction death risk of acute pancreatitis. In the later phase of disease beginning on day 8, neopterin levels may be used for risk assessment and possibly change of therapy regiment.
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