Macrolides are often used to treat group A streptococcus (GAS) infections, but their resistance rates reached high proportions worldwide. The aim of the present study was to give an update on the ...characteristics and contemporary prevalence of macrolide-resistant pharyngeal GAS in Central Italy. A total of 592 isolates causing pharyngitis in children were collected in the period 2012–2013. Clonality was assessed by
emm
typing and pulsed-field gel electrophoresis (PFGE) for all macrolide-resistant strains and for selected susceptible isolates. Genetic determinants of resistance were screened by polymerase chain reaction (PCR). Forty-four GAS were erythromycin-resistant (7.4 %). Among them, 52.3 % and 50 % were clindamycin- and tetracycline-resistant, respectively.
erm
(B)-positive isolates (52.3 %) expressed the constitutive cMLS
B
phenotype.
mef
(A) and its associated M phenotype were recorded in 40.9 % of the cases. The remaining
erm
(A)-positive isolates expressed the iMLS
B
phenotype. Seventeen tetracycline-resistant isolates carried
tet
(M) and five isolates carried
tet
(O). Twenty-five
emm
types were found among all strains, with the predominance of
emm
types 12, 89, 1, and 4. Eleven
emm
types and 12 PFGE clusters characterized macrolide-resistant strains, with almost two-thirds belonging to
emm
12,
emm
4, and
emm
11. Macrolide-susceptible and -resistant
emm
types 12, 89, 11, and 4 shared related PFGE profiles. There was a dramatic decline in macrolide resistance in Central Italy among pharyngeal GAS isolates in 2012–2013 when compared to previous studies from the same region (
p
< 0.05), although macrolide consumption remained stable over the past 15 years. We observed a decrease in the proportion of macrolide-resistant strains within
emm
types commonly associated with macrolide resistance in the past, namely
emm
12, 1, and 89.
Purpose Background: To describe the efficacy of intra‐arterial chemotherapy combined with intravitreal chemotherapy for the treatment of advanced stage retinoblastoma
Methods The Authors report the ...medical records of four patients who presented with unilateral retinoblastoma, (Reese‐Ellsworth stage Vb/ group D of ABC Classification in the affected eye). They underwent clinical and ophthalmoscopic evaluation and MRI to exclude local and CNS dissemination. All 4 patients received 2 cycles (six infusions) of intrarterial chemotherapy (4‐5 mg of melphalan/0.3‐0.4 mg of topotecan), and from 7 up to 9 melphalan injections into the vitreous (10‐30μg in 0.05 mL).
Results Successful control of tumor masses and vitreous seeds was achieved in all cases at long‐term (> 6 months) follow‐up. Tumor control was 100% in all cases. Complications included: posterior lens opacities, acute ischemic papillitis, transient hypotonia, vitreous hemorrhage. There were no cases of orbital tumor recurrence or metastasis (follow‐up range, 6 – 12 months).
Conclusion Sequential intra‐arterial chemotherapy and intravitreal melphalan for advanced retinoblastoma allowed to provide retinal and vitreous seed control
Purpose Iridociliary tumors are usually uncommon in childhood. Our aim is to describe cases of juvenile xanthogranuloma, iris tuberculoma and medulloepithelioma in young patients and to differentiate ...them from other similar lesions
Methods Retrospective cases study. Four patients ( two girls and two boys) were referred at the Referral Center for Retinoblastoma of the University of Siena. They underwent all the ophthalmological examination including standard procedures, MRI of the orbits, CT, UBM, immunological and molecular analysis. In three cases organ‐preserving operations were performed.
Results Two tumors were histologically identified as medulloepitheliomae. Two tumor‐like lesions were determined as juvenile xanthogranuloma and iris tuberculous granuloma. In the last case, antituberculous therapy was performed
Conclusion Iridociliary tumors and pseudotumors are rather rare in childhood. Nevertheless, they should be taken in consideration in differential diagnosis with other pediatric intraocular tumors, particularly retinoblastoma, ciliary body adenoma and adenocarcinoma. An executive checkup including pathology, immunohistochemistry and immunology is to be performed.
Purpose to describe retinoblastoma massive anterior chamber involvement after treatment with intra‐arterial chemotherapy. This condition represents an extremely poor prognostic sign for ocular ...preservation in patients with retinoblastoma. Therefore, anterior chamber retinoblastoma should be considered an absolute indication for enucleation.
Methods Ultrasound biomicroscopy (UBM) was used to document tumour pseudohypopion, cells in the aqueous humor, implanted clusters of cells on the corneal endothelium, iris nodules and lens capsule deposits.
Results The UBM data were compared with the histopathologic analysis after enucleation and revealed a significant concordance.
Conclusion UBM may represent an important diagnostic tool in retinoblastoma, particularly when the decision about enucleation of the eye, must be made in the absence of histopathologic data.
Esthesioneuroblastoma is a rare tumour arising from the olfactory epithelium of the nasal vault which frequently invades the cranial base and orbit. Esthesioneuroblastoma has a bimodal age ...distribution between 11 and 20 years and between 51 and 60 years. Esthesioneuroblastoma accounts for approximately 1-5% of intranasal cancers. The case is reported of a 79-year-old female patient with a Kadish stage C tumour with a one-year history of headache, nasal obstruction, anosmia, rhinorrhoea and epistaxis. Aim of this study is to analyse the natural history, treatment and prognosis of this tumour, based on a review of the literature.
The aim of this study was to evaluate the survival of patients with "glioblastoma multiforme", to analyse the prognostic factors influencing the survival rate and to review recent results in the ...literature.
Seventy five patients underwent radiation treatment between May 1998 and April 2003. Among the factors under investigation we ascertained that sex, chemotherapy, conformal treatment, surgery, and the choice of the irradiation area (whole brain or only the involved field) did not influence the survival in a statistically significant manner.
Whereas age and total dose were the 95% statistically significant variables. Hazard ratio of patients older than 58 years compared to younger patients was 1.69. The death risk was 69% in older than younger patients. A greater irradiation dose improved the survival with an increase of the median survival days. The total dose lower than 6000 cGy caused an increase of 81.8% in the death risk. The median survival from the diagnosis to the death was 14.7 months (446 days) and 1-, 2- and 3- year survival rate was 69.3%, 38.4%, and 14.7% respectively.
The current medical literature and our experience attests that the use of temozolomide improves the survival of these patients.
To update the EULAR recommendations for the use of imaging modalities in primary large vessel vasculitis (LVV).
A systematic literature review update was performed to retrieve new evidence on ...ultrasound, MRI, CT and
F-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis, monitoring and outcome prediction in LVV. The task force consisted of 24 physicians, health professionals and patients from 14 countries. The recommendations were updated based on evidence and expert opinion, iterating until voting indicated consensus. The level of agreement was determined by anonymous votes.
Three overarching principles and eight recommendations were agreed. Compared to the 2018 version, ultrasound is now recommended as first-line imaging test in all patients with suspected giant cell arteritis, and axillary arteries should be included in the standard examination. As an alternative to ultrasound, cranial and extracranial arteries can be examined by FDG-PET or MRI. For Takayasu arteritis, MRI is the preferred imaging modality; FDG-PET, CT or ultrasound are alternatives. Although imaging is not routinely recommended for follow-up, ultrasound, FDG-PET or MRI may be used for assessing vessel abnormalities in LVV patients with suspected relapse, particularly when laboratory markers of inflammation are unreliable. MR-angiography, CT-angiography or ultrasound may be used for long-term monitoring of structural damage, particularly at sites of preceding vascular inflammation.
The 2023 EULAR recommendations provide up-to-date guidance for the role of imaging in the diagnosis and assessment of patients with LVV.
The aim of the study was i) to assess the spectrum of changes over 24 months in ambulant boys affected by Duchenne muscular dystrophy, ii) to establish the difference between the first and the second ...year results and iii) to identify possible early markers of loss of ambulation.
One hundred and thirteen patients (age range 4.1-17, mean 8.2) fulfilled the inclusion criteria, 67 of the 113 were on daily and 40 on intermittent steroids, while 6 were not on steroids. All were assessed using the 6 Minute Walk Test (6MWT), the North Star Ambulatory Assessment (NSAA) and timed test.
On the 6MWT there was an average overall decline of -22.7 (SD 81.0) in the first year and of -64.7 (SD 123.1) in the second year. On the NSAA the average overall decline was of -1.86 (SD 4.21) in the first year and of -2.98 (SD 5.19) in the second year. Fourteen children lost ambulation, one in the first year and the other 13 in the second year of the study. A distance of at least 330 meters on the 6MWT, or a NSAA score of 18 at baseline reduced significantly the risk of losing ambulation within 2 years.
These results can be of help at the time of using inclusion criteria for a study in ambulant patients in order to minimize the risk of patients who may lose ambulation within the time of the trial.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
High throughput sequencing is discovering many likely causative genetic variants in individuals with cerebral palsy. Some investigators have suggested that this changes the clinical diagnosis of ...cerebral palsy and that these individuals should be removed from this diagnostic category. Cerebral palsy is a neurodevelopmental disorder diagnosed on clinical signs, not etiology. All nonprogressive permanent disorders of movement and posture attributed to disturbances that occurred in the developing fetal and infant brain can be described as “cerebral palsy.” This definition of cerebral palsy should not be changed, whatever the cause. Reasons include stability, utility and accuracy of cerebral palsy registers, direct access to services, financial and social support specifically offered to families with cerebral palsy, and community understanding of the clinical diagnosis. Other neurodevelopmental disorders, for example, epilepsy, have not changed the diagnosis when genomic causes are found. The clinical diagnosis of cerebral palsy should remain, should prompt appropriate genetic studies and can subsequently be subclassified by etiology.
PDF
