Rhodococcus equi is a well-recognized pathogen in veterinary medicine that can also affect immuno-compromised human subjects. The most common clinical features in humans include necrotizing pneumonia ...with subacute pulmonary disease, progressive cough, chest pain and fever. We report a case of a 49-year-old kidney transplant patient who developed a Rhodococcus equi infection characterized by multiple abscesses of the soft tissues and muscles without any respiratory manifestation. Combining specific antibiotic therapy and surgical management of the abscesses without immunosuppression discontinuation led to a complete recovery of both patient and graft.
With the rise of remote working, business communication platforms such as Microsoft Teams have become indispensable tools deeply ingrained in the workflow of every employee. However, their increasing ...importance have made the identification and analysis of covert channels a critical concern for both individuals and organizations. In fact, covert channels can be utilized to facilitate unauthorized data transfers or enable malicious activities, thereby compromising confidentiality and system integrity. Unfortunately, traditional detection methods for covert channels may face challenges in detecting covert channels in such cloud-based platforms, as the complexities introduced may not be adequately addressed. Despite the importance of the issue, a comprehensive analysis of covert channels in business communication platforms has been lacking. In fact, to the best of the our knowledge, this Master’s thesis represents the first endeavor in identifying and analysing covert channels within Microsoft Teams. To address this problem, an in-depth literature review was conducted to identify existing research and techniques related to covert channels, their detection and their countermeasures. A thorough analysis of Microsoft Teams was then carried out and a threat scenario was selected. Through extensive experimentation and analysis, three covert channels were then identified, exploited and compared based on bandwidth, robustness and efficiency. This thesis sheds light on the diversity of covert channels in Microsoft Teams, providing valuable insights on their functioning and characteristics. The insights gained from this work pave the way for future research on effective detection systems for covert channels in cloud-based environments, fostering a proactive approach towards securing digital business communication.
Med ökningen av distansarbete har företagskommunikationsplattformar som Microsoft Teams blivit oumbärliga verktyg som är djupt rotade i arbetsflödet för varje anställd. Deras ökande betydelse har dock gjort identifiering och analys av dolda kanaler till ett kritiskt problem för både individer och organisationer. I själva verket kan dolda kanaler användas för att underlätta obehöriga dataöverföringar eller möjliggöra skadliga aktiviteter, vilket äventyrar sekretess och systemintegritet. Tyvärr kan traditionella detekteringsmetoder för dolda kanaler möta utmaningar när det gäller att upptäcka dolda kanaler i sådana molnbaserade plattformar, eftersom komplexiteten som introduceras kanske inte hanteras på ett adekvat sätt. Trots frågans betydelse har det saknats en omfattande analys av dolda kanaler i plattformar för affärskommunikation. Såvitt vi vet är denna masteruppsats det första försöket att identifiera och analysera dolda kanaler inom Microsoft Teams. För att ta itu med detta problem genomfördes en djupgående litteraturgenomgång för att identifiera befintlig forskning och tekniker relaterade till dolda kanaler, deras upptäckt och deras motåtgärder. Därefter gjordes en grundlig analys av Microsoft Teams och ett hotscenario valdes ut. Genom omfattande experiment och analys identifierades, utnyttjades och jämfördes sedan tre dolda kanaler baserat på bandbredd, robusthet och effektivitet. Denna avhandling belyser mångfalden av dolda kanaler i Microsoft Teams och ger värdefulla insikter om deras funktion och egenskaper. Insikterna från detta arbete banar väg för framtida forskning om effektiva detekteringssystem för hemliga kanaler i molnbaserade miljöer, vilket främjar en proaktiv strategi för att säkra digital affärskommunikation.
Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections in solid organ transplant recipients are associated with high morbidity and mortality. We report a case of a fatal donor-derived CR-KP ...infection in a combined kidney-pancreas transplant. Given the short interval of time between donor hospitalization and organ procurement, information concerning the donor CR-KP positivity arrived only 72 hours after transplant. Based on this experience, we believe that knowledge of the donor’s CR-KP status should be mandatory before procurement and, if positive, pancreas donation should be contraindicated.
Background
Carbapenem‐resistant Klebsiella pneumoniae (CR‐KP) infections in solid organ transplant patients are progressively increasing and are associated with worse outcomes, although potential ...risk factors and therapeutic strategies are still not well defined.
Methods
We conducted a retrospective matched‐pair analysis in which we compared 26 recipients CR‐KP‐positive after kidney transplantation (KT) with 52 CR‐KP‐negative patients transplanted in the same period, during a CR‐KP outbreak that occurred in our hospital. Twenty‐one patients (80%) received a combined antibiotic treatment. At the end of the follow‐up, of the 26 CR‐KP infected patients, 11 (42.3%) experienced at least one episode of re‐infection, 9 (34.6%) remained colonized, and 6 (23.0%) had a symptomatic infection. Two of the 11 patients with re‐infection died, while 9 were colonized at the end of the study.
Results
A significantly better patient (P = .043) and graft (P < .001) survival was observed in CR‐KP‐negative patients. Univariate analysis identified the following variables as potential risk factors associated with CR‐KP infection after KT: lower body mass index (P = .020); higher creatinine levels at post‐transplant days 7 (P = .009), 15 (P = .026), and 30 (P = .019); longer hospital stay (P = .007); longer cold ischemia time (P = .004); delayed graft function (P = .020); and higher Clavien‐Dindo score (P = .006).
Conclusion
The study confirmed that a CR‐KP positivity may affect the outcome of a kidney transplant population. In severe CR‐KP infections with sepsis, a combined antibiotic treatment seems to be advisable.
Abstract
Background
Carbapenem‐resistant
K
lebsiella pneumoniae
(
CR
‐
KP
) infections in solid organ transplant patients are progressively increasing and are associated with worse outcomes, although ...potential risk factors and therapeutic strategies are still not well defined.
Methods
We conducted a retrospective matched‐pair analysis in which we compared 26 recipients
CR
‐
KP
‐positive after kidney transplantation (
KT
) with 52
CR
‐
KP
‐negative patients transplanted in the same period, during a
CR
‐
KP
outbreak that occurred in our hospital. Twenty‐one patients (80%) received a combined antibiotic treatment. At the end of the follow‐up, of the 26
CR
‐
KP
infected patients, 11 (42.3%) experienced at least one episode of re‐infection, 9 (34.6%) remained colonized, and 6 (23.0%) had a symptomatic infection. Two of the 11 patients with re‐infection died, while 9 were colonized at the end of the study.
Results
A significantly better patient (
P
= .043) and graft (
P
< .001) survival was observed in
CR
‐
KP
‐negative patients. Univariate analysis identified the following variables as potential risk factors associated with
CR
‐
KP
infection after
KT
: lower body mass index (
P
= .020); higher creatinine levels at post‐transplant days 7 (
P
= .009), 15 (
P
= .026), and 30 (
P
= .019); longer hospital stay (
P
= .007); longer cold ischemia time (
P
= .004); delayed graft function (
P
= .020); and higher Clavien‐Dindo score (
P
= .006).
Conclusion
The study confirmed that a
CR
‐
KP
positivity may affect the outcome of a kidney transplant population. In severe
CR
‐
KP
infections with sepsis, a combined antibiotic treatment seems to be advisable.
Renal transplantectomy is still a frequent procedure for a transplant surgeon. Nevertheless, it is constantly marred by complications, first of all bleeding. In fact, the local circumstances after ...the operation and the general health state of the uremic patients lead to a high incidence of this complication. To avoid this, we adopt a particular technique for renal extracapsular transplantectomy, performing three running sutures between the two faces of the renal capsule. This prevents the formation of the hematoma which is the basis of the continuous bleeding and following infection. We collected a series of nine patients who underwent transplantectomy in which we used this technique. No complications were noted.
Summary
Delayed graft function (DGF) is a frequent complication of kidney transplantation (KT) that may affect both short‐ and long‐term graft outcome. It has been reported that pretransplantation ...peritoneal dialysis was correlated with a better recovery of graft function than hemodialysis in adult kidney recipients. However, the effect of pretransplantation dialysis mode (PDM) seemed to be unclear on the early outcome of KT in pediatric recipients. In this study, the potential impact of PDM on early graft function was evaluated in 174 pediatric patients who underwent KT by using cadaveric donors. The primary outcome parameter was the time to reach a serum creatinine (SCr) level 50% of the pretransplantation value T1/2(SCr), while DGF was defined as a T1/2(SCr) >3 days after KT (n = 40). By stratifying kidney recipients for normal function graft or DGF, this latter group showed a significantly higher body weight (BW) on the day of KT (P = 0.014), body surface area (BSA) (P = 0.005), warm ischemia time (WIT) (P = 0.022), early SCr on the day 1 after KT (P < 0.001), and T1/2(SCr) (P < 0.001), whereas lower urine volume (UV) collected in the first 24 h after KT (P < 0.001) and fluid load (P < 0.001) occurred. Univariate exponential correlation that was carried out between T1/2(SCr) and all the other variables had shown a better value than the linear correlation for BW (R2 = 0.28 vs. R2 = 0.04), BSA (R2 = 0.29 vs. R2 = 0.03), and SCr (R2 = 0.51 vs. R2 = 0.28). In a multivariate regression analysis performed by entering T1/2(SCr) as dependent variable and following a forward stepwise method, cold ischemia time (CIT) (P = 0.027) but not PDM (P = 0.195) reached significance. In a Cox regression analysis carried out with T1/2(SCr) as dependent variable, neither CIT nor PDM gained significance. This study suggests that PDM does not affect early graft function in pediatric kidney recipients.
The serum levels of sHLA-I have been determined in 16 patients following liver transplantation. sHLA-I levels did not show remarkable variations in six patients without evidence of transplant-related ...complications. sHLA-I levels strongly increased in 10 patients undergoing acute rejection episodes. In these patients, an average 20% daily increase of sHLA-I levels was detected on the 6 days preceding and on the 2 days following the rejection episode. A fast decrease of sHLA-I levels was observed in seven patients following treatment of acute rejection with anti-CD3 mAb. The serum level of sHLA-I antigens positively correlated with ALT serum level and inversely correlated with PT. The determination of sHLA-I in serum may therefore be proposed as a useful marker in the monitoring of patients following liver transplantation. The increase of sHLA-I antigens may predict the onset of acute rejection whereas their decrease may be related to a good response of acute rejection to immunosuppressive treatment.
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