Browsing by Author "Vedanta Institute of Medical Sciences"
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Publication Metadata only Clinicians’ challenges in managing patients with invasive fungal diseases in seven Asian countries: An Asia Fungal Working Group (AFWG) Survey(2020-01-01) Ban Hock Tan; Arunaloke Chakrabarti; Atul Patel; Mitzi Marie M. Chua; Pei Lun Sun; Zhengyin Liu; Porpon Rotjanapan; Ruoyu Li; Retno Wahyuningsih; Methee Chayakulkeeree; Yee Chun Chen; Peking University First Hospital; Universitas Kristen Indonesia; National Taiwan University Hospital; Chang Gung University; Singapore General Hospital; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University; National Health Research Institutes Taiwan; Peking Union Medical College Hospital; Postgraduate Institute of Medical Education & Research, Chandigarh; Vedanta Institute of Medical Sciences; Cebu Institute of Medicine© 2020 The Authors Background: Invasive fungal diseases (IFD) are a serious threat, but physicians in Asia lack access to many advanced diagnostics in mycology. It is likely that they face other impediments in the management of IFD. A gap analysis was performed to understand the challenges Asian physicians faced in medical mycology. Methods: The Asia Fungal Working Group (AFWG) conducted a web-based survey on management practices for IFD among clinicians in China, India, Indonesia, Philippines, Singapore, Taiwan and Thailand. Findings: Among 292 respondents, 51.7% were infectious disease (ID) specialists. Only 37% of respondents had received formal training in medical mycology. They handled only around 2–4 proven cases of each fungal infection monthly, with invasive candidiasis the most common. For laboratory support, the majority had access to direct microscopy (96%) and histopathology (87%), but galactomannan and azole levels were available to 60% and 25% of respondents, respectively. The majority (84%) used clinical parameters for treatment response monitoring, and 77% followed the Infectious Diseases Society of America guidelines. The majority (84%) did not use the services of an ID physician. Where febrile neutropenia was concerned, 74% of respondents used the empirical approach. Only 30% had an antifungal stewardship program in their hospital. Eighty percent could not use preferred antifungals because of cost. Interpretation: The survey identified inadequacies in medical mycology training, non-culture diagnostics, access to antifungal drugs, and local guidelines as the major gaps in the management of IFDs in Asian countries. These gaps are targets for improvement.Publication Metadata only Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium(2019-12-01) Oliver A. Cornely; Ana Alastruey-Izquierdo; Dorothee Arenz; Sharon C.A. Chen; Eric Dannaoui; Bruno Hochhegger; Martin Hoenigl; Henrik E. Jensen; Katrien Lagrou; Russell E. Lewis; Sibylle C. Mellinghoff; Mervyn Mer; Zoi D. Pana; Danila Seidel; Donald C. Sheppard; Roger Wahba; Murat Akova; Alexandre Alanio; Abdullah M.S. Al-Hatmi; Sevtap Arikan-Akdagli; Hamid Badali; Ronen Ben-Ami; Alexandro Bonifaz; Stéphane Bretagne; Elio Castagnola; Methee Chayakulkeeree; Arnaldo L. Colombo; Dora E. Corzo-León; Lubos Drgona; Andreas H. Groll; Jesus Guinea; Claus Peter Heussel; Ashraf S. Ibrahim; Souha S. Kanj; Nikolay Klimko; Michaela Lackner; Frederic Lamoth; Fanny Lanternier; Cornelia Lass-Floerl; Dong Gun Lee; Thomas Lehrnbecher; Badre E. Lmimouni; Mihai Mares; Georg Maschmeyer; Jacques F. Meis; Joseph Meletiadis; C. Orla Morrissey; Marcio Nucci; Rita Oladele; Livio Pagano; Alessandro Pasqualotto; Atul Patel; Zdenek Racil; Malcolm Richardson; Emmanuel Roilides; Markus Ruhnke; Seyedmojtaba Seyedmousavi; Neeraj Sidharthan; Nina Singh; János Sinko; Anna Skiada; Monica Slavin; Rajeev Soman; Brad Spellberg; William Steinbach; Ban Hock Tan; Andrew J. Ullmann; Jörg J. Vehreschild; Maria J.G.T. Vehreschild; Thomas J. Walsh; P. Lewis White; Nathan P. Wiederhold; Theoklis Zaoutis; Arunaloke Chakrabarti; Manchester University NHS Foundation Trust; Duke University Medical Center; Public Health Wales; Universidade Federal de Ciencias da Saúde de Porto Alegre; Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore; Ministry of Health Oman; American University of Beirut Medical Center; Szent Laszlo Hospital; Hospital General Universitario Gregorio Marañon; Cancer Research Institute of Slovak Academy of Sciences; Peter Maccallum Cancer Centre; Universitätsklinikum Würzburg; Erasmus MC; KU Leuven– University Hospital Leuven; Hopital Europeen Georges-Pompidou; Københavns Universitet; University of California, San Diego; The Children's Hospital of Philadelphia; University of Southern California; Universite Paris Descartes; National and Kapodistrian University of Athens; Nijmegen Interdenominational Hospital Canisius-Wilhelmina; Alma Mater Studiorum Università di Bologna; Universidad Complutense de Madrid; University of Melbourne; Centro Nacional de Microbiologia; The University of Sydney; Université Paris-Sud; University of Cologne; University of Lagos College of Medicine; Lukas-Krankenhaus; Centre Hospitalier Universitaire Vaudois; P.D. Hinduja National Hospital and Medical Research Centre; Monash University; Mohammed V University in Rabat; University of Texas Health Science Center at San Antonio; New York Presbyterian Hospital; Singapore General Hospital; North-Western State Medical University named after I.I. Mechnikov; Mazandaran University of Medical Sciences; Klinikum Ernst von Bergmann; National Institute of Allergy and Infectious Diseases; University of Witwatersrand; Harbor-UCLA Medical Center; IRCCS Istituto Giannina Gaslini - Ospedale Pediatrico; University of Aberdeen; Pontificia Universidade Catolica do Rio Grande do Sul; Hospital General de Mexico; Aristotle University of Thessaloniki; Universidade Federal de Sao Paulo; University of Pittsburgh Medical Center; Hacettepe University, Faculty of Medicine; Faculty of Medicine, Siriraj Hospital, Mahidol University; Tel Aviv Sourasky Medical Center; Uniklinik Köln; Medizinische Universitat Innsbruck; Amrita Institute of Medical Sciences India; Goethe-Universität Frankfurt am Main; Universitätsklinikum Münster; Medizinische Universität Graz; Tel Aviv University, Sackler Faculty of Medicine; University of Manchester; Hippokration General Hospital; Hospital General "Dr. Manuel Gea González"; Universitätsklinikum Heidelberg; The Catholic University of Korea; McGill University; Institute of Hematology and Blood Transfusion; Postgraduate Institute of Medical Education & Research, Chandigarh; Universidade Federal do Rio de Janeiro; Center of Expertise in Microbiology; Westerdijk Fungal Biodiversity Institute; German Center for Infection Research (DZIF), Partner Site Bonn-Cologne; Ion Ionescu de la Brad University; Vedanta Institute of Medical Sciences© 2019 Elsevier Ltd Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the “One World One Guideline” initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
