Background
The novel coronavirus has become a global threat and healthcare concern. The manifestations of COVID‐19 pneumonia in transplant patients are not well understood and may have more severe ...symptoms, longer duration, and a worse prognosis than in immunocompetent populations.
Aims
This study proposed to evaluate the clinical characteristics of COVID‐19 pneumonia in kidney transplant recipients.
Patients/Methods
Clinical records, laboratory results, radiological characteristics, and clinical outcome of 24 kidney transplant patients with COVID‐19 pneumonia were evaluated from March 20, 2020, to May 20, 2020.
Results
The most common symptom was shortness of breath (70.8%), followed by fever (62.5%) and cough (45.8%). Five patients had leukopenia, and only one patient had leukocytosis, while 75% of the patients had a white blood cell (WBC) count in the normal range, and 79% of recipients developed lymphopenia. All of the patients had an elevated concentration of C‐reactive protein and an increase in blood urea levels. Chest CT images of 23 patients (95.8%) showed typical findings of patchy ground‐glass shadows in the lungs. Of the 24 patients, 12 were admitted to ICU (invasive care unit), and ten of 24 patients (41.6%) died, and 14 patients were discharged after complete recovery.
Conclusion
It seems that COVID‐19 is more severe in transplant patients and has poorer outcomes. Multiple underlying diseases, low O2 saturation, and multilobar view in chest CT scan may be of prognostic value. However, many SARS‐CoV‐2 demonstrations are similar to those of the general population.
Drug-induced liver injury is an acute or chronic liver damage in response to drugs, herbals, and any chemical compound.
In the present work, liver failure following the use of tofacitinib was ...reported. The patient was an 18-year-old iranian woman without any history of underlying disease. She complained of alopecia areata, and tofacitinib was administered for disease management. Following adherence to tofacitinib medication, partial recovery was obtained. At the time of hospitalization, the patient had a stable condition and only anorexia, jaundice, and elevation of liver enzymes were reported. During hospitalization, liver injury progressed and liver transplantation was suggested. After drug-induced liver injury diagnosis, the use of the drug was discontinued and the patient underwent supportive treatment. The patient recovered without any severe sequelae.
Tofacitinib is a Janus kinase inhibitor that is useful in the treatment of disorders such as rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis. Until now, the severe side effect of this drug has not been reported and in most cases it is used as a last resort, but here we report a rare side effect of this drug.
The The impact of a hospital antimicrobial stewardship was determined on antimicrobial-resistant, Clostridioides difficile rates and the amount of antimicrobial consumed in cancer patients.The ...intervention effects of antimicrobial stewardship (ASP) plans in 2017-2018 and 2018-2019 were respectively evaluated among hematology/oncology and bone marrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (meropenem and vancomycin) consumption gr-year, the number of positive Clostridioides difficile infection and multidrug-resistant positive cases in blood cultures.
The number of MDR cases in the periods of 2017-2018 and 2018-2019 were 145 and 75, respectively (p = 0.011). A significant reduction in all positive blood cultures from 2017-2018 to 2018-2019 was found (p = 0.001). 574 patients admitted to our hospital in these periods of 2017- 2018 and 2018- 2019were assessed for MPM and VMN use. The amounts of MPM prescriptions in 2018-2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms, and CDI can highly promote patients' health and decreasing medical costs and long-term defects for patients.
Infections is yet one of the life-threatening complications of the hematopoietic stem cell transplantation (HSCT). The myeloablative and immunosuppressive conditioning regimens, which are ...administered before HSCT, dampen the defense capacity of the recipients' immune systems. In this condition, opportunistic infections, especially viral infections such as cytomegalovirus (CMV) can be reactivated and cause morbidity and mortality in HSCT patients. Here, we aimed to find out any possible relationship between types of conditioning regimen and CMV reactivation in allogeneic HSCT patients.
We retrospectively analyzed the data of 145 CMV-seropositive cases out of total 201 allo-HSCT patients, including age, gender, underlying disease, conditioning regimen, prophylaxis regimen and occurrence of acute graft-versus-host disease (aGVHD) to evaluate their roles in CMV reactivation.
Our result showed that conditioning regimen containing Busulfan and Fludarabine (P=0.003) or Cyclophospha-mide (P=0.02) significantly decrease the early CMV reactivation. Patients who developed aGVHD (P=0.003) and those who received anti-thymocyte globulin (ATG) as prophylaxis regimen (P=0.002), had 1.84 and 2.63 times higher risks of CMV reactivation, respectively.
Our findings suggest the conditioning regimen, aGVHD and ATG as influencing factors for early CMV reactivation post-HSCT which should be considered in the future studies.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Case reports of CAPA emerged. In most of the reports, the predominant species is Aspergillus fumigatus. Uncommon species are less reported. Due to poor clinical outcome with Aspergillus terreus, the ...increasing reports with this agent require attention.
Case reports of CAPA emerged. In most of the reports, the predominant species is Aspergillus fumigatus. Uncommon species are less reported. Due to poor clinical outcome with Aspergillus terreus, the increasing reports with this agent require attention.
Background: Chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD regimen) cannot cure all patients with Hodgkin lymphoma. In this study, we evaluated the efficacy and adverse ...effect of a new regimen consist irinotecan, cisplatin, and dexamethasone (ICD) in relapsed and refractory Hodgkin lymphoma as the second to fifth line of treatment.
Materials and Methods: We performed a retrospective study in 26 relapsed or refractory patients with Hodgkin lymphoma receiving at least the first-line chemotherapy regimen (ABVD) and (ICD) as salvage therapy in Thaleghany Hospital from 2012 to 2018. This regimen consisted of irinotecan 65mg/m2 D1, D8, cisplatin 30mg/m2 D1, D8, and dexamethasone 40mg D1, 2, 8, and 9 was administered every 3 weeks for 6 cycles. Treatment was discontinued in cases of disease progression or severe toxicity. Response to treatment was evaluated after two cycles. Patients with complete and partial remission were candidate high dose chemotherapy and autologous stem cell transplantation. Twenty-four patients were enrolled in the study. The mean age of 22 patients was 31.5 (19-67) years. Seven patients (29.1%) were in the first recurrence, and 17 (70.8%) were in the second or subsequent recurrence.
Results: According to this study, three patients (12.5%) had complete response, 13 (45%) had partial response, four (16.6%) had stable disease, and four (16.6%) had progressive disease. Nine patients (37.5%) received high-dose chemotherapy and autologous stem cell support after ICD regimen. None of the cycles of chemotherapy were delayed due to treatment-related adverse event. Overall survival after six months in all patients was 91%, and mortality rate was 8.3% at the end of the study.
Conclusion: The goal of salvage chemotherapy in relapsed or refractory Hodgkin Lymphoma is achieving CR or PR preparation patients for stabilization with BMT. Thus, we recommend ICD as one of the most effective protocols with overall response rate of 66% in this population.
Recurrences of COVID‐19 infection may occur in immunocompromised patients. Reinfection or reactivation of COVID‐19 virus is a challenging issue in these patients.
Recurrences of COVID‐19 infection ...may occur in immunocompromised patients. Reinfection or reactivation of COVID‐19 virus is a challenging issue in these patients.
Oropharyngeal candidiasis (OPC) is a fungal infection of the oral cavity caused by the members of
complex. Although
, as a part of the complex, is considered to be mostly responsible for the ...development of vulvovaginal candidiasis, it may be associated with a wider clinical spectrum.
This report described two cases diagnosed with oral candidiasis during the receipt of treatment for malignancies. Conventional and molecular tests were performed on the samples collected from the patients' oral cavities. The test results revealed
as the causative agent of oral candidiasis. Furthermore, in vitro antifungal susceptibility test indicated the full susceptibility of all
isolates to caspofungin. However, the data were also suggestive of the resistance against fluconazole and amphotericin B. Caspofungin was used as the main antifungal agent for the treatment of oral candidiasis, resulting in the improvement of thrush in patients. The resistance of
to fluconazole and amphotericin B suggests the necessity of performing in vitro susceptibility testing on the isolates for the selection of appropriate antifungal agents.
As the findings indicated, the achievement of knowledge regarding
as an emerging non-albicans Candida species and its antifungal susceptibility profile is crucial to select antifungal prophylaxis and empirical therapy for oral candidiasis in cancer patients undergoing chemotherapy.
non.
species is an opportunistic mold that causes disseminated infections in immunocompromised patients. Given the high mortality rate of this infection, it is important to make a definite diagnosis when ...encountering suspected cases.
Herein, we presented a 35-year-old man diagnosed with acute myeloid leukemia with a prolonged febrile neutropenic period and ecthyma gangrenosum-like lesions, along with fungemia and disseminated fusariosis. The patient died despite receiving combination therapy, perhaps due to the nonrecovery of neutrophil.
Ecthyma gangrenosum-like lesions due to disseminated fusariosis might be easily misdiagnosed. Consequently, more attention should be paid to the cutaneous lesions in immunocompromised patients.
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