Archive for February 24, 2013

Biomarkers in community-acquired pneumonia: A state-of-the-art review.

Clinics (Sao Paulo). 2012 Nov;67(11):1321-5.

Seligman R, Ramos-Lima LF, Oliveira Vdo A, Sanvicente C, Pacheco EF, Dalla Rosa K.

Source

Departamento de Medicina Interna, Hospital de ClÃ-nicas de Porto Alegre (HCPA), Faculdade de Medicina, Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Abstract

Community-acquired pneumonia (CAP) exhibits mortality rates, between 20% and 50% in severe cases. Biomarkers are useful tools for searching for antibiotic therapy modifications and for CAP diagnosis, prognosis and follow-up treatment. This non-systematic state-of-the-art review presents the biological and clinical features of biomarkers in CAP patients, including procalcitonin, C-reactive protein, copeptin, pro-ANP (atrial natriuretic peptide), adrenomedullin, cortisol and D-dimers.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488993/pdf/cln-67-11-1321.pdf

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February 24, 2013 at 9:06 pm

Treatment of liver hydatidosis: how to treat an asymptomatic carrier?

World J Gastroenterol. 2010 Sep 7;16(33):4123-9.

Frider B, Larrieu E.

Bernardo Frider, Department of Medicine-Hepatology, Argerich Hospital, University of Buenos Aires, Maimonides University, Salguero 2601, 1425 Buenos Aires, Argentina

Edmundo Larrieu, Department of Zoonosis, Ministry of Health of Rio Negro Province, Laprida 240, 8500 Viedma, Argentina; University of La Pampa, Calle 5 y 116, 6360 General Pico, Argentina

Abstract

Liver hydatidosis is the most common clinical presentation of cystic echinococcosis (CE). Ultrasonographic mass surveys have demonstrated the true prevalence, including the asymptomatic characteristic of the majority of cases, providing new insight into the natural history of the disease. This raises the question of whether to treat or not to treat these patients, due to the high and unsuspected prevalence of CE. The high rate of liver/lung frequencies of cyst localization, the autopsy findings, and the involution of cysts demonstrated in long time follow-up of asymptomatic carriers contribute to this discussion. The decision to treat an asymptomatic patient by surgery, albendazole, or puncture aspiration injection and re-aspiration or to wait and watch, is based on conflicting reports in the literature, the lack of complications in untreated patients over time, and the spontaneous disappearance and involution of cysts. All these points contribute to difficulties of individual clinical decisions. The patients should be informed of the reasons and the risks of watchful/waiting without treatment, the possibility of complications, and the risks of the other options. As more information on the natural history of liver hydatidosis is acquired, selection of the best treatment will be come easier. Without this knowledge it would be very difficult to establish definitive rules of treatment. At present, it is possible to manage these patients over time and to wait for the best moment for treatment. Follow-up studies must be conducted to achieve this objective.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2932914/pdf/WJG-16-4123.pdf

February 24, 2013 at 9:03 pm

Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis.

Bull World Health Organ. 1996;74(3):231-42.

Abstract

Summarized in this article are recent experiences in the treatment of human cystic echinococcosis (CE) and alveolar echinococcosis (AE) of the liver caused by the metacestode stages of Echinococcus granulosus and E. multilocularis, respectively. For CE, surgery remains the first choice for treatment with the potential to remove totally the parasite and completely cure the patient. However, chemotherapy with benzimidazole compounds (albendazole or mebendazole) and the recently developed PAIR procedure (puncture-aspiration-injection-re-aspiration) with concomitant chemotherapy offer further options for treatment of CE cases. Chemotherapy is not yet satisfactory: cure can be expected in about 30% of patients and improvement in 30-50%, after 12 months’ follow-up. AE is generally a severe disease, with over 90% mortality in untreated patients. Radical surgery is recommended in all operable cases but has to be followed by chemotherapy for at least 2 years. Inoperable cases and patients who have undergone nonradical resection or liver transplantation require continuous chemotherapy for many years. Long-term chemotherapy may significantly prolong survival, even for inoperable patients with severe AE. Liver transplantation may be indicated as a life-saving measure for patients with severe liver dysfunction, but is associated with a relatively high risk of proliferation of intraoperatively undetected parasite remnants. Details of indications, contraindications, treatment schedules and other aspects are discussed.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486920/pdf/bullwho00401-0005.pdf

February 24, 2013 at 9:02 pm


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