Fusarium species,Scedosporium species, and Lomentospora prolificans: A systematic review to inform the World Health Organization priority list of fungal pathogens.

Recognizing the growing global burden of fungal infections, the World Health Organization established a process to develop a priority list of fungal pathogens (FPPL). In this systematic review, we aimed to evaluate the epidemiology and impact of infections caused by Fusarium spp., Scedosporium spp., and Lomentospora prolificans to inform the first FPPL. PubMed and Web of Sciences databases were searched to identify studies published between January 1, 2011 and February 23, 2021, reporting on mortality, complications and sequelae, antifungal susceptibility, preventability, annual incidence, and trends. Overall, 20, 11, and 9 articles were included for Fusarium spp., Scedosporium spp., and L. prolificans, respectively. Mortality rates were high in those with invasive fusariosis, scedosporiosis, and lomentosporiosis (42.9%-66.7%, 42.4%-46.9%, and 50.0%-71.4%, respectively). Antifungal susceptibility data, based on small isolate numbers, showed high minimum inhibitory concentrations (MIC)/minimum effective concentrations for most currently available antifungal agents. The median/mode MIC for itraconazole and isavuconazole were ≥16 mg/l for all three pathogens. Based on limited data, these fungi are emerging. Invasive fusariosis increased from 0.08 cases/100 000 admissions to 0.22 cases/100 000 admissions over the time periods of 2000-2009 and 2010-2015, respectively, and in lung transplant recipients, Scedosporium spp. and L. prolificans were only detected from 2014 onwards. Global surveillance to better delineate antifungal susceptibility, risk factors, sequelae, and outcomes is required

Sex hormones and arrhythmia in myocardial ischemia

The mechanisms by which gender affects cardiac electrophysiological parameters and alters the predisposition to certain arrhythmias are not well understood, although differences in the expression and function of ion channels and in the activation of the autonomic nervous system may contribute. In their study Philp and coworkers address the issue of the effect of 17β-estradiol on ventricular vulnerability in a rat model of ischemia. Their data show that there is a dose-dependent antiarrhythmic activity of 17β-estradiol administration with suppression ventricular premature beats, ventricular tachycardia and ventricular fibrillation during ischemia. Furthermore they show a dose-dependent blockage of ICaL by 17β-estradiol which is again stronger in female than in male mice. They postulate that the shown gender-selective, concentration-dependent inhibition of ICaL is sufficient to account for the reduction in ischaemia-induced arrhythmia. With this data they have added important information on the influence of sex hormones on cardiac electrophysiology under pathophysiological conditions

[<SUP>18</SUP>F]FDG-PET-CT compared with CT for persistent or recurrent neutropenic fever in high-risk patients (PIPPIN): a multicentre, open-label, phase 3, randomised, controlled trial

BACKGROUND: Management of neutropenic fever in high-risk haematology patients is challenging; there are often few localising clinical features, and diagnostic tests have poor sensitivity and specificity. We aimed to compare how [18F]flurodeoxyglucose ([18F]FDG)-PET-CT scans and conventional CT scans affected the guidance of antimicrobial management and the outcomes of patients with persistent or recurrent neutropenic fever. METHODS: We did a multicentre, open-label, phase 3, randomised, controlled trial in two tertiary referral hospitals in Australia. We recruited adults aged 18 years or older who were receiving conditioning chemotherapy for haematopoietic stem-cell transplantation or chemotherapy for acute leukaemia and had persistent (>72 h) or recurrent (new fever beyond 72 h of initial onset interspersed with >48 h defervescence) neutropenic fever. Exclusion criteria were pregnancy, allergy to iodinated contrast, or estimated glomerular filtration rate of less than 30 mL/min. Patients were randomly assigned by computer-generated randomisation chart (1:1) to [18F]FDG-PET-CT or conventional CT. Masking was not possible because of the nature of the investigation. Scans were done within 3 days of random assignment. The primary endpoint was a composite of starting, stopping, or changing the spectrum (broadening or narrowing) of antimicrobial therapy-referred to here as antimicrobial rationalisation-within 96 h of the assigned scan, analysed per protocol. This trial is registered with clinicaltrials.gov, NCT03429387, and is complete. FINDINGS: Between Jan 8, 2018, and July 23, 2020, we assessed 316 patients for eligibility. 169 patients were excluded and 147 patients were randomly assigned to either [18F]FDG-PET-CT (n=73) or CT (n=74). Nine patients did not receive a scan per protocol, and two participants in each group were excluded for repeat entry into the study. 65 patients received [18F]FDG-PET-CT (38 [58%] male; 53 [82%] White) and 69 patients received CT (50 [72%] male; 58 [84%] White) per protocol. Median follow up was 6 months (IQR 6-6). Antimicrobial rationalisation occurred in 53 (82%) of 65 patients in the [18F]FDG-PET-CT group and 45 (65%) of 69 patients in the CT group (OR 2·36, 95% CI 1·06-5·24; p=0·033). The most frequent component of antimicrobial rationalisation was narrowing spectrum of therapy, in 28 (43%) of 65 patients in the [18F]FDG-PET-CT group compared with 17 (25%) of 69 patients in the CT group (OR 2·31, 95% CI 1·11-4·83; p=0·024). INTERPRETATION: [18F]FDG-PET-CT was associated with more frequent antimicrobial rationalisation than conventional CT. [18F]FDG-PET-CT can support decision making regarding antimicrobial cessation or de-escalation and should be considered in the management of patients with haematological diseases and persistent or recurrent high-risk neutropenic fever after chemotherapy or transplant conditioning. FUNDING: National Health and Medical Research Council Centre of Research Excellence (APP1116876), Melbourne Health foundation, Gilead Research Fellowship grants supported this study

Treinamento em natação com baixa intensidade não protege músculo esquelético contra lesões induzidas por exercício exaustivo em ratos

Enquanto o exercício aeróbico regular promove adaptações benéficas ao músculo esquelético, o exercício físico exaustivo induz lesões musculares. O objetivo deste estudo foi verificar se um programa de natação com baixa intensidade é capaz de proteger músculos esqueléticos contra lesões induzidas por exercício exaustivo. Ratos Wistar (peso: 376,50 ± 4,36g; idade: 90 dias) foram divididos aleatoriamente em quatro grupos: controle sedentário (CS); sedentário submetido a teste de exaustão (SE); treinado em natação (TN); treinado em natação submetido a teste de exaustão (TNE). Animais dos grupos TN e TNE foram submetidos a um programa de natação sem sobrecarga por 90 minutos/dia, cinco dias/semana, durante 17 semanas. Após este período, os grupos SE e TNE foram submetidos a um teste de exaustão em natação. Após eutanásia, fragmentos dos músculos sóleo e reto femoral foram coletados e submetidos à análise histológica e de proteínas de choque térmico (HSP70). Os resultados mostraram que o tempo até a exaustão foi maior no grupo TNE que no SE (125,0 ± 6,0 vs. 90,0 ± 8,5min, respectivamente, P < 0,05). Os níveis de lactato sanguíneo durante o teste e exaustão foram menores no grupo TNE que no SE (5,31 ± 0,22 vs. 8,76 ± 0,59mmol/L, respectivamente, P < 0,05). A frequência de fibras lesadas nos músculos foi maior nos grupos SE (sóleo: 34,86 ± 0,04; reto femoral: 37,57 ± 0,07) e TNE (sóleo: 41,57 ± 0,08; reto femoral: 39,57 ± 0,05), comparada aos grupos CS (sóleo: 13,88 ± 0,81; reto femoral: 16,75 ± 0,79) e TN (sóleo: 24,14 ± 0,06; reto femoral: 24,0 ± 0,05), respectivamente (P < 0,05). Não houve diferença significativa nos níveis de HSP70 dos músculos analisados entre os quatro grupos. Concluimos que apesar do treinamento em natação melhorar o desempenho dos animais no teste de exaustão, não promoveu proteção aos seus músculos esqueléticos contra as lesões induzidas pelo exercício exaustiv