Archive for February, 2013

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.


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.


February 24, 2013 at 9:02 pm

In vitro activity and microbiological efficacy of tedizolid (TR-700) against Gram-positive clinical isolates from a phase 2 study of oral tedizolid phosphate (TR-701) in patients with complicated skin and skin structure infections.

Antimicrob Agents Chemother. 2012 Sep;56(9):4608-13.

Prokocimer P, Bien P, Deanda C, Pillar CM, Bartizal K.


Trius Therapeutics, Inc., San Diego, California, USA.


Tedizolid (TR-700, formerly torezolid) is the active moiety of the prodrug tedizolid phosphate (TR-701), a next-generation oxazolidinone, with high potency against Gram-positive species, including methicillin-resistant Staphylococcus aureus (MRSA). A recently completed randomized, double-blind phase 2 trial evaluated 200, 300, or 400 mg of oral tedizolid phosphate once daily for 5 to 7 days in patients with complicated skin and skin structure infections. This report examines the in vitro activity of tedizolid and Zyvox (linezolid) against Gram-positive pathogens isolated at baseline and describes the microbiological and clinical efficacy of tedizolid. Of 196 isolates tested, 81.6% were S. aureus, and of these, 76% were MRSA. The MIC(50) and MIC(90) of tedizolid against both methicillin-susceptible S. aureus (MSSA) and MRSA were 0.25 μg/ml, compared with a MIC(50) of 1 μg/ml and MIC(90) of 2 μg/ml for linezolid. For coagulase-negative staphylococci (n = 7), viridans group streptococci (n = 15), and beta-hemolytic streptococci (n = 3), the MICs ranged from 0.03 to 0.25 μg/ml for tedizolid and from 0.12 to 1 μg/ml for linezolid. The microbiological eradication rates at the test-of-cure visit (7 to 14 days posttreatment) in the microbiologically evaluable population (n = 133) were similar in all treatment groups, with overall eradication rates of 97.7% for all pathogens, 97.9% for MRSA, and 95.7% for MSSA. The clinical cure rates for MRSA and MSSA infections were 96.9% and 95.7%, respectively, across all dose groups. This study confirms the potent in vitro activity of tedizolid against pathogenic Gram-positive cocci, including MRSA, and its 4-fold-greater potency in comparison with linezolid. All dosages of tedizolid phosphate showed excellent microbiological and clinical efficacy against MRSA and MSSA.




February 22, 2013 at 8:43 am

Lesions in the Oral Cavity

N Engl J of Medic Feb.21, 2013 V.368


Jose Narciso Rosa Assunção, D.D.S., Ms.C., and Gustavo Davi Rabelo, D.D.S., Ph.D.

University of São Paulo, São Paulo, Brazil

A 59-year-old man presented with multiple painful ulcers in the oral cavity that had developed over the course of a week. He also noted difficulty swallowing and speaking. Physical examination revealed …





February 22, 2013 at 8:42 am

Pott’s Disease of the Thoracic Spine

N Engl J of Medic Feb.21, 2013 V.368 P.756


Soraya Jodra, M.D., and Carlos Alvarez, M.D.

University Hospital 12 de Octubre, Madrid, Spain

A 20-year-old man who was originally from Bangladesh presented to our clinic with a 6-month history of anorexia and weight loss. The physical examination was remarkable for a temperature of 39°C. Chest radiography showed a mass that appeared to be located in the posterior mediastinum (Panel A, white arrows). Computed tomography (CT) of the chest showed a paravertebral mass of soft tissue surrounding the vertebra (Panel B, white arrows), with destruction of vertebral bodies (black arrow). The mass extended from ..



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February 22, 2013 at 8:40 am

Yellow Fever Outbreak in Sudan

N Engl J of Medic Feb.21, 2013 V.368 P.689-691


Lewis Markoff, M.D

From the Laboratory of Vector-borne Virus Diseases, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, MD.

On November 16, 2012, the Weekly Epidemiological Record of the World Health Organization (WHO) reported that an outbreak of yellow fever was under way in Sudan. By the end of November, the disease had been detected in 26 localities in Sudan’s Darfur region, with 459 suspected cases and 116 related deaths. As of January 16, the Centers for Disease Control and Prevention (CDC) confirmed that 849 cases and 171 deaths had been reported….



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February 22, 2013 at 8:38 am

When to Start ART in Africa — An Urgent Research Priority

N Engl J of Medic Feb.21, 2013


Kevin M. De Cock, M.D., D.T.M.&H., and Wafaa M. El-Sadr, M.D., M.P.H.

From the Centers for Disease Control and Prevention, Atlanta (K.M.D.C.); and ICAP, Columbia University Mailman School of Public Health, New York (W.M.E.-S.).

The history of the HIV–AIDS epidemic was profoundly altered by the introduction of antiretroviral therapy (ART). More than 8 million people in low-income and middle-income countries have received lifesaving ART over the past decade, yet in 2011 an estimated 34 million people were living with HIV infection, 6.8 million were eligible for treatment but lacked access to ART, 2.5 million became newly infected, and 1.7 million died of HIV-related disease….


February 22, 2013 at 8:37 am

Updating the HIV-Testing Guidelines — A Modest Change with Major Consequences

N Engl J of Medic Feb.21, 2013


Erika G. Martin, Ph.D., M.P.H., and Bruce R. Schackman, Ph.D.

From Rockefeller College of Public Affairs and Policy and the Nelson A. Rockefeller Institute of Government, University at Albany–State University of New York, Albany (E.G.M.); and the Division of Health Policy, Department of Public Health, Weill Cornell Medical College, New York (B.R.S.).

The U.S. Preventive Services Task Force (USPSTF) recently released a draft statement assigning a grade A recommendation to screening for human immunodeficiency virus (HIV) in the general population 15 to 65 years of age. The proposed guidelines cite an updated systematic evidence review of the benefits and potential harms of HIV screening. Since the previous evidence review was published in 2005, new studies have shown that antiretroviral therapy can reduce transmission by HIV-infected persons and that earlier initiation of such therapy can reduce morbidity and mortality and improve quality of life…


February 22, 2013 at 8:36 am

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