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vrijdag 26 januari 2018

The Lancet: [Articles] Cerebral tryptophan metabolism and outcome of tuberculous meningitis: an observational cohort ...

[Articles] Cerebral tryptophan metabolism and outcome of tuberculous meningitis: an observational cohort study
Cerebral tryptophan metabolism, which is known to affect Mycobacterium tuberculosis growth and CNS inflammation, is important for the outcome of tuberculous meningitis. CSF tryptophan concentrations in tuberculous meningitis are under strong genetic influence, probably contributing to the variable outcomes of tuberculous meningitis. Interventions targeting tryptophan metabolism could improve outcomes of tuberculous meningitis.
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[Comment] Could omics unlock the secret of surviving tuberculous meningitis?
Despite devastating mortality among patients with tuberculosis meningitis, little progress has been made in understanding the pathophysiology of this disease since the landmark autopsy studies of Rich and McCordick in the 1930s.1 Even with treatment, two-thirds of patients die or are left with severe neurological deficits, including cognitive impairment, epilepsy, and paralysis.2 In The Lancet Infectious Diseases, Arjan van Laarhoven and colleagues3 present an elegant systems biology (or multi-omics) approach designed to elucidate the underlying mechanisms that cause these dire outcomes and ultimately aiming to identify new approaches to therapeutics.
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[Comment] Antibiotic strategies in critical care: back to square one?
The worth of antibiotics to human health is without bound, but antimicrobial resistance poses a serious threat to this treasured resource.1 Reduction of the selection pressure on pathogens through the rational use of antimicrobials, and discernment of which antibiotic treatment strategies achieve this goal, are now international priorities. Antibiotic stewardship encompasses different evidence-based measures to improve the appropriate use of antibiotics by promoting selection of optimal drug regimens, including dosing, duration of therapy, and route of administration.
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[Articles] The effects of antibiotic cycling and mixing on antibiotic resistance in intensive care units: a cluster-randomised crossover trial
Antibiotic cycling does not reduce the prevalence of carriage of antibiotic-resistant, Gram-negative bacteria in patients admitted to the ICU.
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[Comment] Use of data to drive pneumococcal conjugate vaccine policy
In The Lancet Infectious Diseases, Shamez Ladhani and colleagues1 describe changes in invasive pneumococcal disease in the UK over a 17-year period, during which two pneumococcal conjugate vaccines (PCVs) were introduced for infants: the seven-valent vaccine (PCV7) in 2006, and the 13-valent vaccine (PCV13) in 2010.1 The authors estimate that 38 366 invasive pneumococcal disease cases were prevented in England and Wales during the decade of PCV use. Although disease incidence declined by the largest percentage in the vaccine target age group (from 49·00 cases per 100 000 population in 2000–06 to 13·90 per 100 000 in 2016/17), most cases were prevented among adults who were not eligible to receive the vaccine.
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