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Background: The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence.
Methods: This study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon.
Results: Forty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n = 38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study.
Conclusions: This first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon.
Trial Registration: ClinicalTrials.gov Identifier: NCT00725777
Objectives: Multidrug-resistant organisms (MDRO) are considered an emerging threat worldwide. Data covering the clinical impact of MDRO colonization in patients with solid malignancies, however, is widely missing. We sought to determine the impact of MDRO colonization in patients who have been diagnosed with Non-small cell lung cancer (NSCLC) who are at known high-risk for invasive infections.
Materials and methods: Patients who were screened for MDRO colonization within a 90-day period after NSCLC diagnosis of all stages were included in this single-center retrospective study.
Results: Two hundred and ninety-five patients were included of whom 24 patients (8.1%) were screened positive for MDRO colonization (MDROpos) at first diagnosis. Enterobacterales were by far the most frequent MDRO detected with a proportion of 79.2% (19/24). MDRO colonization was present across all disease stages and more present in patients with concomitant diabetes mellitus. Median overall survival was significantly inferior in the MDROpos study group with a median OS of 7.8 months (95% CI, 0.0–19.9 months) compared to a median OS of 23.9 months (95% CI, 17.6–30.1 months) in the MDROneg group in univariate (p = 0.036) and multivariate analysis (P = 0.02). Exploratory analyses suggest a higher rate of non-cancer-related-mortality in MDROpos patients compared to MDROneg patients (p = 0.002) with an increased rate of fatal infections in MDROpos patients (p = 0.0002).
Conclusions: MDRO colonization is an independent risk factor for inferior OS in patients diagnosed with NSCLC due to a higher rate of fatal infections. Empirical antibiotic treatment approaches should cover formerly detected MDR commensals in cases of (suspected) invasive infections.
Tetraphenyl-p-benzoquinone, according to its single crystal structure, shows some steric congestion: its quinone ring is distorted by 7° to a chair conformation, and its phenyl substituents are twisted around their CC axes between 46° and 72°. The half-wave reduction potentials of -0.57 and -1.25 V in acetonitrile confirm negligible π interaction of the phenyl substituents. Addition of alkalimetal tetraphenylborate salts lowers the second reduction potential due to contact ion formation, which can be confirmed by UV/VIS spectra recorded under aprotic conditions. Extensive ESR/ENDOR investigations prove the formation of the following species in THF solution: Tetraphenyl-p-benzosemiquinone radical anion contact ion pairs [M·⊖ Me⊕solv]' (Me⊕: Li⊕, Na⊕, Rb⊕, Cs⊕) and contact triple ion radical cations both with identical cations [M·⊖ (Me⊕solv)2]·⊕ (Me⊕: Li⊕, Na⊕, Cs⊕) and different cations [M·⊖ (Li⊕solv)(Me⊕solv)]·⊕ (Me⊕: Na⊕, Cs⊕). Addition of crown ethers can lead to external solvation of the Me⊕ counter cations, whereas cryptands form internal solvation complexes. The radical anion of 2,6-diphenyl-p-benzosemiquinone adds cations at its phenyl-free molecular half. The radical anion salt [tetraphenyl-p-benzosemiquinone·⊖ (Na⊕(tetrahydropyrane) 2)] could be crystallized and its structure determined at 200 K. In agreement with the Hirota sign rules for contact radicals in solution, the Na⊕ ion is found 62 pm above the π plane and 29° outside the axis of the CO bound, which is elongated due to one-electron reduction by 5 pm to 127 pm.
The following mixed-stack donor/acceptor complexes {D···A}∞ have been crystallized and their structures determined: {hexamethylbenzene···3,5-dicyano-1-nitrobenzene hexamethylbenzene···3,5-dinitro-1-cyanobenzene}∞, {pyrene···3,5-dinitro-1-cyanobenzene}∞, {anthracene···(3,5-dinitro-1-cyanobenzene)2}∞, {N,N-dimethylanilin···3,5-dinitro- 1-cyanobenzene}∞ and { 1-3-phenylenediamine···3,5-dinitro-1-cyanobenzene}∞. Their lattice packing consists of parallel layers, which contain either donors and acceptors as for hexamethylbenzene and pyrene or composite ones as in the 1:2 complex of anthracene with each one of the acceptors above and below its peripheral rings. The isostructural hexamethylbenzene complexes exhibit almost identical packing coefficients as well as a hexagonal coplanar arrangement of the C6(CH3)6 donors. Weak intermolecular van der Waals interactions are also observed between antiparallel cyano substituents. The interplanar n distances range between 334 and 353 pm, i. e. around 340 pm of two van der Waals n radii. In none of the complexes, however, significant structural changes in either the donor or the acceptor components due to the complex formation are observed. In both the crystals as well as in solution, the donor/acceptor complexes exhibit colours between yellow and red; their long-wavelength charge transfer absorption maxima, therefore, correspond to a lowering in excitation energy of only up to 1 eV relative to that of the components. The different charge transfer in the ground and the CT excited states is also discussed referring to other data such as vertical first ionization energies or interplanar distances {D···A}, as well as to results from semiempirical calculations based on the crystal structure data determined and including approximate configuration interaction.