Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive
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The prognosis of HIV-infected patients has dramatically improved since the advent of HAART. The immune recovery associated with HAART may result in immuno-pathological reactions and clinical deterioration when HAART is initiated in patients with tuberculosis (TB). This phenomenon is defined as immune reconstitution inflammatory syndrome (IRIS). In this review, we summarise the epidemiology, clinical presentations and management of TB-associated IRIS.
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Abdominal sepsis carries a high morbidity and mortality. Intra-abdominal infectious complications are one of the most common infectious etiologies seen in critically ill patients. Approximately 30% of patients admitted to an ICU with intra-abdominal infection succumb to their illness, and when peritonitis arises as a complication of a previous surgical procedure, or recurs during ICU admission, mortality rates exceed 50%. ⋯ For diagnosis of intra-abdominal conditions using CT scanning it is optimal if patients receive both oral and intravenous contrast. An exception to the use of CT scanning is evaluation of suspected biliary pathology, which is best imaged by ultrasound. It will identify cholecystitis with or without calculus and may show changes in the gallbladder or common bile duct associated with biliary obstruction.
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The influenza pandemic of 1918-1919, so-called Spanish influenza, spread to almost all nations worldwide. This outbreak is thought to have killed 25 million people, although some have claimed that the epidemic resulted in as many as 40 million deaths. This pandemic was a particularly dramatic event, because it occurred at the end of World War I, when both armies and the civilian population, in nations involved in the war, were exhausted. ⋯ In Bologna the impact of the epidemic, albeit important in comparison to other situations, was not particularly dramatic. No special preventive measures were adopted, with the exception of isolating seriously ill patients in a former school converted by the military authorities into a hospital. Family doctors worked together actively with the city's medical authorities when the epidemiological survey was carried out.
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Both medical doctors and humanitarian operators engaged in health relief or development missions abroad, are called to respect the general principles of international law, that is to say, customary law that is legally compulsory for the International Community and rules deriving from Treaties and International Conventions. Humanitarian operators have to observe also the rules and regulations of the hosting country. They have to respect all rules applying to their humanitarian action and they have to take responsibility towards beneficiaries and donors alike.
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The progressive emergence of antimicrobial-resistant Gram-positive cocci especially in the setting of surgery and intensive care, recommends particular attention in making sound therapeutic choices to overcome both microbial resistances and haemato-encephalic barriers to effective local drug penetration. As in other Western countries, the occurrence of methicillin-resistant Staphylococcus aureus is particularly high also in Italy, especially when high-risk patients and/or settings are involved. ⋯ Recent findings have focused on the possible role of linezolid, an oxazolidinone antibiotic, as a suitable candidate for the treatment of severe brain infection (abscesses) and post-neurosurgical infection, where treatment options and efficacy are significantly limited by the low glycopeptide transfer and the spread of glycopeptide-resistant bacterial strains. Three representative case reports (two brain abscesses and one post-surgical meningitis) are presented and discussed in light of the current literature: in all these cases, salvage linezolid treatment proved resolutory.