Fungal urinary tract infection in outpatient practice: approaches to diagnosis and treatment

Introduction. In recent years, the role of fungal infection in inpatient and outpatient patients has been increasing. At the same time, there are currently no recommendations on the duration of treatment of outpatient patients with fungal urinary tract infection (UTI). Aim of the study. Optimization of methods of diagnosis and treatment of outpatient patients with fungal UTI.Materials and methods. To detect fungi in urine, the E. Koneman et al. (1997) method was improved. 56 patients with fungal UTI were examined. The efficacy of fluconazole in the treatment of fungal UTI was studied in 53 patients.Results. Candida albicans was detected in 37% of cases of fungal UTI in outpatient patients. Risk factors for fungal UTI in outpatient patients include: antibacterial therapy, infravesical obstruction, type 2 diabetes mellitus and the presence of urinary drainage. The microbiological efficacy of fluconazole therapy for 7, 10 and 14 days was 83.0%, 94.3% and 96.2%, respectively. The growth of fungi in the urine a month after treatment was absent in 86.7% of patients. In outpatient patients with fungal UTI without type 2 diabetes mellitus, the efficacy of fluconazole at a dose of 150 mg per day for 7 days was 94.9%. In patients with type 2 diabetes mellitus after 7 days of therapy, the efficacy was 50.0%.Conclusions. The most common causative agent of fungal UTI in outpatient patients is Candida albicans. To detect fungi in urine, samples should be seeded on selective media, while increasing the seeding volume to 0.1 ml and extending the incubation time to 96 hours. Fluconazole is a highly effective treatment for fungal UTI at a dose of 150 mg per day for 7 days, however, in patients with diabetes mellitus, therapy should last at least 10 days.

Normalization of the epidermal barrier as a method of pathogenetic therapy of Atopic Dermatitis in children

Background. A key link in the pathogenesis of atopic dermatitis is a violation of the barrier function of the skin. Artificial skin moisturizing with emollients is the basis of palliative therapy for the disease. Aims. The purpose of the study was to assess the effectiveness and tolerability of the cosmetic product Admera. Materials and methods. The article presents the results of an open non-comparative prospective observational study of the efficacy and safety of Admera cream in pediatric patients with mild to moderate atopic dermatitis, conducted at the Pierre Wolkenstein Clinic for Skin Diseases in June-August 2020. Results. The study included 35 patients aged 4 to 17 years. The study included 35 patients aged 4 to 17 years inclusive. The clinical study demonstrated a statistically significant decrease in the Severity scoring of atopic dermatitis (SCORAD) index total score. The average value of this indicator decreased by 33% from the value 36.2 12.3 at the screening visit to 24.2 11.4 at the visit 3 (p 0.001). Assessment of the dynamics of the Eczema area and severity index (EASI) index showed a significant decrease in the total score of the indicator after 14 and 28 days of therapy relative to the baseline (p 0.001). The cosmetic product studied was well tolerated by patients. During the present study, 3 adverse events were reported in 2 patients. According to expert opinion, the recorded undesirable phenomena were not associated with the application of the studied cosmetic product. Reported adverse events were gastrointestinal disorders and included cases of diarrhea, abdominal pain and at the end of the study completely Conclusions. Evaluation of the results of the study showed high efficacy and safety of the study drug as a moisturizing agent: four-week therapy leads to a decrease in the severity of Atopic dermatitis manifestations, a decrease in the intensity of pruritus, an increase in the level of skin hydration in the T-zone and on the patient's body.

The effectiveness of combined topical product with fluocortolone pivalate and lidocaine for hemorrhoids: results of a multicenter observational study

AIM: to assess the changes in hemorrhoids symptoms and satisfaction with treatment against the background of treatment with a combined topical product Relief® Pro.PATIENTS AND METHODS: multicenter prospective non-interventional cohort study was done in 13 clinical centers in Russia. The study included patients aged 18 to 65 years with acute hemorrhoids of stages 1–2 treated with the combined product Relief® Pro (rectal suppositories, cream or a combination thereof). The follow-up period was up to 14 days (in the case of 2 visits to the clinical center after receiving the initial data). The analysis was performed on the basis of data obtained at Visit 2 (5–7 days of therapy) and Visit 3 (10–14 days of therapy) vs the initial data (Visit 1). Following criteria were used: the severity of hemorrhoid symptoms on the Sodergren scale, the severity of hemorrhoid symptoms (pain, bleeding, itching, edema, the presence of discharge, a feeling of discomfort), the size of the largest hemorrhoid node, the satisfaction of the doctor and the patient with treatment, assessment of the patient’s adherence to recommendations for lifestyle changes and treatment, evaluation of the use of the drug Relief® were evaluated as endpoints About the treatment process and patient preferences regarding the dosage form of the prescribed drug. In addition, adverse events were evaluated.RESULTS: the study included 1000 patients aged 18 to 65 years (men — 54.5%, women — 45.5%) Patients had grade 1 acute hemorrhoids (330 patients), grade 2 acute hemorrhoids (345 patients) and exacerbation of chronic hemorrhoids (325 patients). The drug Relief® Pro rectal cream was used by 333 patients; suppositories — 383 patients; joint therapy with both dosage forms — 284 patients. During follow-up (visits 2 and 3), positive dynamics was observed in patients — a decrease in the severity of hemorrhoid symptoms both during objective examination and according to patient questionnaires. So, according to the patients’ estimates, the use of Relief® Pro, regardless of the form, led to a decrease in the severity or disappearance of the main symptoms of hemorrhoids — bleeding, itching, edema, the presence of discharge, discomfort already by Visit 2 and in almost all patients by the end of observation. A similar change of the symptoms due the digital examination: by day 5–7, the severity of edema and bleeding in the perianal region, bleeding decreased. About 96% of patients and about 97% of doctors were satisfied with the treatment. Application of both forms of Relief® The ABM was characterized by good tolerability: there were no adverse events associated, according to the researcher, with the studied drug.CONCLUSIONS: combined topical product Relief® Pro is effective for hemorrhoids.

Fatal Tumour Lysis Syndrome Induced by Brigatinib in a Lung Adenocarcinoma Patient Treated With Sequential ALK Inhibitors: A Case Report

Tumour lysis syndrome (TLS) represents a group of fatal metabolic derangements resulting from the rapid breakdown of tumour cells. TLS typically occurs soon after the administration of chemotherapy in haematologic malignancies but is rarely observed in solid tumours. Here, we report a case of brigatinib-induced TLS after treatment with sequential anaplastic lymphoma kinase (ALK) inhibitors in a patient with advanced ALK-rearranged lung adenocarcinoma. The patient was treated sequentially with crizotinib, alectinib, and ensartinib. High-throughput molecular profiling after disease progression indicated that brigatinib may overcome ALK resistance mutations, so the patient was administered brigatinib as the fourth-line treatment. After 22 days of therapy, he developed oliguria, fever, and progressive dyspnoea. Clinical manifestations and laboratory findings met the diagnostic criteria for TLS. The significant decrease in the abundance of ALK mutations in plasma indicated a therapeutic response at the molecular level. Consequently, the diagnosis of brigatinib-induced TLS was established. To the best of our knowledge, this is the first case of TLS induced by sequential targeted therapy in non-small cell lung cancer. With the extensive application of sequential therapy with more potent next-generation targeted therapeutic drugs, special attention should be given to this rare but severe complication.

Assessing Nephrotoxicity Associated With Different Vancomycin Dosing Modalities in Obese Patients at a Community Hospital

Background: Vancomycin requires therapeutic drug monitoring (TDM) based on its pharmacokinetic properties, and guidelines have shifted to analyzing area under the curve over 24 hours (AUC24) rather than trough concentrations due to nephrotoxicity concerns and correlation to efficacy. Obesity is an established risk factor for vancomycin-induced nephrotoxicity due to increased drug exposure based on dosing calculations and volume of distribution estimation. The aim of this study is to assess the relationship between AUC-based versus trough-based dosing and nephrotoxicity among obese patients receiving vancomycin. Methods: This research project was conducted as a retrospective, observational, single-centered study which included obese adults who received at least 48 hours of vancomycin. The electronic medical record provided data for patients with vancomycin pharmacokinetic consults either evaluated with trough-only or AUC-based dosing. The primary objective was to compare the development of nephrotoxicity after vancomycin initiation, while secondary objectives included vancomycin loading dose exposure, total daily dose of vancomycin, and whether target TDM was attained. Nominal data were evaluated utilizing the chi-square test and continuous data using the independent samples t-test or Mann-Whitney test. The a priori level of significance was .05. Data analysis was performed using Microsoft Excel and SAS statistical software. Results: Two hundred fifty-four patients were included in the primary analysis. Four patients in the AUC cohort (6.3%) developed nephrotoxicity compared to 32 (17.4%) in the trough cohort ( P = .035). Both cohorts received a median of 4 days of therapy; however, the median loading dose per actual body weight in the AUC cohort was 20 mg/kg as compared to 16 mg/kg in the trough cohort. Of the 130 patients with available TDM in the trough cohort, 97 (74.6%) did not meet target attainment as compared to 15 of the 57 in the AUC cohort (26.3%) ( P < .001). Conclusions: AUC dosing was associated with a statistically significant reduction in AKI occurrence despite overall higher loading dose exposure as compared to the trough cohort. Though maintenance dose exposure was similar between both cohorts, patients in the AUC cohort maintained therapeutic concentrations at a higher percentage than the trough cohort.

Evaluation of the Efficacy and Safety of a Compound of Micronized Flavonoids in Combination With Vitamin C and Extracts of Centella asiatica, Vaccinium myrtillus, and Vitis vinifera for the Reduction of Hemorrhoidal Symptoms in Patients With Grade II and III Hemorrhoidal Disease: A Retrospective Real-Life Study

Background and Aim: Several evidences have shown how, in hemorrhoidal disease, phlebotonic flavonoid agents such as quercetin reduce capillary permeability by increasing vascular walls resistance, how rutin and vitamin C have antioxidant properties, and that Centella asiatica has reparative properties towards the connective tissue. A retrospective study was designed in order to evaluate the efficacy and safety of a compound consisting of micronized flavonoids in combination with vitamin C and extracts of C. asiatica, Vaccinium myrtillus, and Vitis vinifera for grade II and III hemorrhoidal disease.Patients and Methods: Data of 49 patients, over 18, who were following a free diet regimen, not on therapy with other anti-hemorrhoid agents, treated with a compound consisting of 450 mg of micronized diosmin, 300 mg of C. asiatica, 270 mg of micronized hesperidin, 200 mg of V. vinifera, 160 mg of vitamin C, 160 mg of V. myrtillus, 140 mg of micronized quercetin, and 130 mg of micronized rutin (1 sachet or 2 tablets a day) for 7 days were collected. Hemorrhoid grade according to Goligher’s scale together with anorectal symptoms (edema, prolapse, itching, thrombosis, burning, pain, tenesmus, and bleeding) both before treatment (T0) and after 7 days of therapy (T7) were collected. Primary outcomes were the reduction of at least one degree of hemorrhoids according to Goligher’s scale assessed by proctological examination and compound safety. The secondary outcome was the reduction of anorectal symptoms assessed by questionnaires administered to patients.Results: Forty-four patients (89.8%) presented a reduction in hemorrhoidal grade of at least one grade (p &lt; 0.001). No adverse events with the use of the compound were noted. A significant reduction was observed in all anorectal symptoms evaluated (p &lt; 0.05). No predictors of response to the compound were identified among the clinical and demographic variables collected.Conclusion: The compound analyzed was effective and safe for patients with grade II and III hemorrhoidal disease according to Goligher’s scale.

Impact and Sustainability of Antibiotic Stewardship on Antibiotic Prescribing in Visceral Surgery

Background: Antibiotic stewardship (AS) ward rounds are a core element in clinical care for surgical patients. Therefore, we aimed to analyze the impact of surgical AS ward rounds on antibiotic prescribing, and the sustainability of the effect after the AS interventions are no longer provided. Methods: On four wards of the department of visceral surgery, we conducted two independent retrospective prescribing analyses (P1, P2) over three months each. During the study periods, the level of AS intervention differed for two of the four wards (ward rounds/no ward rounds). Results: AS ward rounds were associated with a decrease in overall antibiotic consumption (91.1 days of therapy (DOT)/100 patient days (PD) (P1), 70.4 DOT/100PD (P2)), and improved de-escalation rates of antibiotic therapy (W1/2: 25.7% (P1), 40.0% (P2), p = 0.030; W3: 15.4 (P1), 24.2 (P2), p = 0.081). On the ward where AS measures were no longer provided, overall antibiotic usage remained stable (71.3 DOT/100PD (P1), 74.4 DOT/100PD (P2)), showing the sustainability of AS measures. However, the application of last-resort compounds increased from 6.4 DOT/100PD to 12.1 DOT/100PD (oxazolidinones) and from 10.8 DOT/100PD to 13.2 DOT/100PD (carbapenems). Conclusions: Antibiotic consumption can be reduced without negatively affecting patient outcomes. However, achieving lasting positive changes in antibiotic prescribing habits remains a challenge.

Antibiotic prescribing patterns among patients admitted to an academic teaching hospital for COVID-19 during the first wave of the pandemic in Toronto: A retrospective, controlled study

Background: Empirical antibiotics are not recommended for coronavirus disease 2019 (COVID-19). Methods: In this retrospective study, patients admitted to Toronto General Hospital’s general internal medicine from the emergency department for COVID-19 between March 1 and August 31, 2020 were compared with those admitted for community-acquired pneumonia (CAP) in 2020 and 2019 in the same months. The primary outcome was antibiotics use pattern: prevalence and concordance with COVID-19 or CAP guidelines. The secondary outcome was antibiotic consumption in days of therapy (DOT)/100 patient-days. We extracted data from electronic medical records. We used logistic regression to model the association between disease and receipt of antibiotics, linear regression to compare DOT. Results: The COVID-19, CAP 2020, and CAP 2019 groups had 67, 73, and 120 patients, respectively. Median age was 71 years; 58.5% were male. Prevalence of antibiotic use was 70.2%, 97.3%, and 90.8% for COVID-19, CAP 2020, and CAP 2019, respectively. Compared with CAP 2019, the adjusted odds ratio (aOR) for receiving antibiotics was 0.23 (95% CI 0.10 to 0.53, p = 0.001) and 3.42 (95% CI 0.73 to 15.95, p = 0.117) for COVID-19 and CAP 2020, respectively. Among patients receiving antibiotics within 48 hours of admission, compared with CAP 2019, the aOR for guideline-concordant combination regimens was 2.28 (95% CI 1.08 to 4.83, p = 0.031) for COVID-19 and 1.06 (95% CI 0.55 to 2.05, p = 0.856) for CAP-2020. Difference in mean DOT/100 patient-days was –24.29 ( p = 0.009) comparing COVID-19 with CAP 2019, and +28.56 ( p = 0.003) comparing CAP 2020 with CAP 2019. Conclusions: There are opportunities for antimicrobial stewardship to address unnecessary antibiotic use.

EFFECT OF THE ANTIVIRAL DRUG KAGOCEL® ON THE LEVELS OF MATRIX METALLOPROTEINASES MMP-8 AND MMP-9 AND THEIR TISSUE INHIBITORS TIMP-1 AND TIMP-2 IN INDUCED SPUTUM IN THE COMBINED TREATMENT OF COMMUNITY-ACQUIRED VIRAL-BACTERIAL PNEUMONIA

The effect of the antiviral drug Kagocel on the levels of metalloproteinases MMP-8 and MMP-9 and their tissue inhibitors TIMP-1 and TIMP-2 in induced sputum in the treatment of community-acquired viral-bacterial pneumonia was analyzed. 60 adult patients with a confirmed diagnosis of community-acquired pneumonia and viral-bacterial etiology were included in the follow-up research work. Materials and methods. All patients were randomly divided into 2 groups: 1 group (comparison group) included 30 patients receiving Ceftriaxone monotherapy; in the 2nd group (main) - 30 people who were prescribed Ceftriaxone and the antiviral drug Kagocel as etiotropic treatment. Both groups were comparable in terms of gender, age and time of admission to the hospital. Results. During hospitalization, patients in both groups had elevated levels of MMP-8, MMP-9, TIMP-1 and TIMP-2 in induced sputum compared to the reference values. By 7 days of inpatient treatment, the level of MMP-8 continued to be significantly higher than the reference values ​​in both groups, and in patients of the 2nd group there was a decrease compared to baseline values, and in patients in the 1st group at the same time. The activity of MMP-9 during hospitalization was also high in patients of both groups compared with the level of these enzymes in healthy people. By the 7th day of therapy various indicators' changes were recorded. The level of MMP-9 in patients of the 1st group increased, and in patients of the 2nd group - on the contrary - decreased. The level of TIMP-1 decreased in patients of the 1st group below the control value, and in patients of the 2nd group - reached the reference values. The level of TIMP-2 decreased in both groups and reached the level of control values. Conclusion. Inclusion in the standard antibacterial regimen of community-acquired viral-bacterial pneumonia of the antiviral drug Kagocel reduces the level of MMR-9 and reduces the severity of the imbalance in the MMP and TIMP system by 7 days of therapy, which leads to a faster clinical recovery of patients.