Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune dysfunctions.Clinically can occur as an acute life-threatening disease,with lung,brai...Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune dysfunctions.Clinically can occur as an acute life-threatening disease,with lung,brain and skin being commonly affected.The infection was classically diagnosed in HIV infected persons,organ transplanted recipients and long term corticosteroid treated patients.Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario.Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings.We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals.Eleven cases of nocardiosis associated with anti-tumor necrosis factor(TNF) prescription(9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease(IBD),4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients,lung disease in 4 patients,hepatic in one and disseminated disease in 3 patients.From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine.In conclusion,nocardiosis requires high levels of clinical suspicion and experience of laboratory staff,in order to establish a timely diagnosis and by doing so avoid worst outcomes.Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential.The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.展开更多
BACKGROUND The impact caused by the coronavirus disease 2019(COVID-19)on the Portuguese population has been addressed in areas such as clinical manifestations,frequent comorbidities,and alterations in consumption habi...BACKGROUND The impact caused by the coronavirus disease 2019(COVID-19)on the Portuguese population has been addressed in areas such as clinical manifestations,frequent comorbidities,and alterations in consumption habits.However,comorbidities like liver conditions and changes concerning the Portuguese population's access to healthcare-related services have received less attention.AIM To(1)Review the impact of COVID-19 on the healthcare system;(2)examine the relationship between liver diseases and COVID-19 in infected individuals;and(3)investigate the situation in the Portuguese population concerning these topics.METHODS For our purposes,we conducted a literature review using specific keywords.RESULTS COVID-19 is frequently associated with liver damage.However,liver injury in COVID-19 individuals is a multifactor-mediated effect.Therefore,it remains unclear whether changes in liver laboratory tests are associated with a worse prognosis in Portuguese individuals with COVID-19.CONCLUSION COVID-19 has impacted healthcare systems in Portugal and other countries;the combination of COVID-19 with liver injury is common.Previous liver damage may represent a risk factor that worsens the prognosis in individuals with COVID-19.展开更多
Background:The efficacy and safety of opicapone,a once-daily catechol-O-methyltransferase inhibitor,have been established in two large randomized,placebo-controlled,multinational pivotal trials.Still,clinical evidence...Background:The efficacy and safety of opicapone,a once-daily catechol-O-methyltransferase inhibitor,have been established in two large randomized,placebo-controlled,multinational pivotal trials.Still,clinical evidence from routine practice is needed to complement the data from the pivotal trials.Methods:OPTIPARK(NCT02847442)was a prospective,open-label,single-arm trial conducted in Germany and the UK under clinical practice conditions.Patients with Parkinson’s disease and motor fluctuations were treated with opicapone 50 mg for 3(Germany)or 6(UK)months in addition to their current levodopa and other antiparkinsonian treatments.The primary endpoint was the Clinician’s Global Impression of Change(CGI-C)after 3 months.Secondary assessments included Patient Global Impressions of Change(PGI-C),the Unified Parkinson’s Disease Rating Scale(UPDRS),Parkinson’s Disease Questionnaire(PDQ-8),and the Non-Motor Symptoms Scale(NMSS).Safety assessments included evaluation of treatment-emergent adverse events(TEAEs)and serious adverse events(SAEs).Results:Of the 506 patients enrolled,495(97.8%)took at least one dose of opicapone.Of these,393(79.4%)patients completed 3 months of treatment.Overall,71.3 and 76.9%of patients experienced any improvement on CGI-C and PGI-C after 3 months,respectively(full analysis set).At 6 months,for UK subgroup only(n=95),85.3%of patients were judged by investigators as improved since commencing treatment.UPDRS scores at 3 months showed statistically significant improvements in activities of daily living during OFF(mean±SD change from baseline:?3.0±4.6,p<0.0001)and motor scores during ON(?4.6±8.1,p<0.0001).The mean±SD improvements of?3.4±12.8 points for PDQ-8 and-6.8±19.7 points for NMSS were statistically significant versus baseline(both p<0.0001).Most of TEAEs(94.8%of events)were of mild or moderate intensity.TEAEs considered to be at least possibly related to opicapone were reported for 45.1%of patients,with dyskinesia(11.5%)and dry mouth(6.5%)being the most frequently reported.Serious TEAEs considered at least possibly related to opicapone were reported for 1.4%of patients.Conclusions:Opicapone 50 mg was effective and generally well-tolerated in PD patients with motor fluctuations treated in clinical practice.展开更多
Background: Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are ...Background: Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients’survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality. The aim of this work is to check the suitability of procalcitonin (PCT) to fulfill these goals in a large sample of septic burn patients. Methods: One hundred and one patients, with 15% or more of total body surface area (TBSA) burned, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), in Portugal were included in the sample. All patients had a diagnosis of sepsis, according to the American Burn Association (ABA) criteria. The sample was factored by survival (68 survivors and 33 non-survivors). The maximum value of PCT in each day was used for statistical analysis. Data were summarized by location measures (mean, median, minimum, maximum, quartiles) and dispersion measures (standard error and range measures). Statistical analysis was performed with SPSS?23.0 IBM? for Windows?. Results: There were statistically significant differences between PCT levels of patients from the survivor and non-survivor groups during the first and the last weeks of hospitalization as well as during the first week after sepsis suspicion, being slightly higher during this period. During the first 7 days of antimicrobial therapy, PCT was always higher in the non-survivor, still without reaching statistical significance, but when the analysis was extended till the 15th day, PCT increased significantly, rapidly, and steadily, denouncing therapy failure. Conclusion: Despite being not an ideal biomarker, PCT proved to have good prognostic power in septic burn patients, paralleling the evolution of the infectious process and reflecting the efficacy of antimicrobial therapy, and the inclusion of its serial dosing may be advised to reinforce antimicrobial stewardship programs at burn units;meanwhile, more accurate approaches are not available.展开更多
文摘Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune dysfunctions.Clinically can occur as an acute life-threatening disease,with lung,brain and skin being commonly affected.The infection was classically diagnosed in HIV infected persons,organ transplanted recipients and long term corticosteroid treated patients.Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario.Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings.We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals.Eleven cases of nocardiosis associated with anti-tumor necrosis factor(TNF) prescription(9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease(IBD),4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients,lung disease in 4 patients,hepatic in one and disseminated disease in 3 patients.From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine.In conclusion,nocardiosis requires high levels of clinical suspicion and experience of laboratory staff,in order to establish a timely diagnosis and by doing so avoid worst outcomes.Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential.The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.
文摘BACKGROUND The impact caused by the coronavirus disease 2019(COVID-19)on the Portuguese population has been addressed in areas such as clinical manifestations,frequent comorbidities,and alterations in consumption habits.However,comorbidities like liver conditions and changes concerning the Portuguese population's access to healthcare-related services have received less attention.AIM To(1)Review the impact of COVID-19 on the healthcare system;(2)examine the relationship between liver diseases and COVID-19 in infected individuals;and(3)investigate the situation in the Portuguese population concerning these topics.METHODS For our purposes,we conducted a literature review using specific keywords.RESULTS COVID-19 is frequently associated with liver damage.However,liver injury in COVID-19 individuals is a multifactor-mediated effect.Therefore,it remains unclear whether changes in liver laboratory tests are associated with a worse prognosis in Portuguese individuals with COVID-19.CONCLUSION COVID-19 has impacted healthcare systems in Portugal and other countries;the combination of COVID-19 with liver injury is common.Previous liver damage may represent a risk factor that worsens the prognosis in individuals with COVID-19.
基金The study was funded by BIALThree authors(JFR,DM and PSS)were employed by the funder and participated in the study design,data collection,data management,and data analysis+1 种基金The funder of the study had no other role in data interpretation or in the decision to submit the manuscript for publicationBIAL also supported reporting of study results by procuring medical writing support.
文摘Background:The efficacy and safety of opicapone,a once-daily catechol-O-methyltransferase inhibitor,have been established in two large randomized,placebo-controlled,multinational pivotal trials.Still,clinical evidence from routine practice is needed to complement the data from the pivotal trials.Methods:OPTIPARK(NCT02847442)was a prospective,open-label,single-arm trial conducted in Germany and the UK under clinical practice conditions.Patients with Parkinson’s disease and motor fluctuations were treated with opicapone 50 mg for 3(Germany)or 6(UK)months in addition to their current levodopa and other antiparkinsonian treatments.The primary endpoint was the Clinician’s Global Impression of Change(CGI-C)after 3 months.Secondary assessments included Patient Global Impressions of Change(PGI-C),the Unified Parkinson’s Disease Rating Scale(UPDRS),Parkinson’s Disease Questionnaire(PDQ-8),and the Non-Motor Symptoms Scale(NMSS).Safety assessments included evaluation of treatment-emergent adverse events(TEAEs)and serious adverse events(SAEs).Results:Of the 506 patients enrolled,495(97.8%)took at least one dose of opicapone.Of these,393(79.4%)patients completed 3 months of treatment.Overall,71.3 and 76.9%of patients experienced any improvement on CGI-C and PGI-C after 3 months,respectively(full analysis set).At 6 months,for UK subgroup only(n=95),85.3%of patients were judged by investigators as improved since commencing treatment.UPDRS scores at 3 months showed statistically significant improvements in activities of daily living during OFF(mean±SD change from baseline:?3.0±4.6,p<0.0001)and motor scores during ON(?4.6±8.1,p<0.0001).The mean±SD improvements of?3.4±12.8 points for PDQ-8 and-6.8±19.7 points for NMSS were statistically significant versus baseline(both p<0.0001).Most of TEAEs(94.8%of events)were of mild or moderate intensity.TEAEs considered to be at least possibly related to opicapone were reported for 45.1%of patients,with dyskinesia(11.5%)and dry mouth(6.5%)being the most frequently reported.Serious TEAEs considered at least possibly related to opicapone were reported for 1.4%of patients.Conclusions:Opicapone 50 mg was effective and generally well-tolerated in PD patients with motor fluctuations treated in clinical practice.
文摘Background: Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients’survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality. The aim of this work is to check the suitability of procalcitonin (PCT) to fulfill these goals in a large sample of septic burn patients. Methods: One hundred and one patients, with 15% or more of total body surface area (TBSA) burned, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), in Portugal were included in the sample. All patients had a diagnosis of sepsis, according to the American Burn Association (ABA) criteria. The sample was factored by survival (68 survivors and 33 non-survivors). The maximum value of PCT in each day was used for statistical analysis. Data were summarized by location measures (mean, median, minimum, maximum, quartiles) and dispersion measures (standard error and range measures). Statistical analysis was performed with SPSS?23.0 IBM? for Windows?. Results: There were statistically significant differences between PCT levels of patients from the survivor and non-survivor groups during the first and the last weeks of hospitalization as well as during the first week after sepsis suspicion, being slightly higher during this period. During the first 7 days of antimicrobial therapy, PCT was always higher in the non-survivor, still without reaching statistical significance, but when the analysis was extended till the 15th day, PCT increased significantly, rapidly, and steadily, denouncing therapy failure. Conclusion: Despite being not an ideal biomarker, PCT proved to have good prognostic power in septic burn patients, paralleling the evolution of the infectious process and reflecting the efficacy of antimicrobial therapy, and the inclusion of its serial dosing may be advised to reinforce antimicrobial stewardship programs at burn units;meanwhile, more accurate approaches are not available.
