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emboli or from vegetations at the time of valve replacement Valve destruction (usually aortic or mitral) is common, and surgical therapy is necessary in addition to a prolonged course of amphotericin therapy, given in a dosage of 05 1 mg/kg/d intravenously, usually to a total dose of 1 15 g intravenously It is important to note that non-albicans species of Candida now account for over 50% of clinical bloodstream isolates and are often resistant to imidazole antibiotics such as fluconazole The widespread use of these agents for prophylaxis in immunocompromised patients can lead to the emergence of pathogens such as Candida krusei Azole-resistant C albicans has increased in frequency in immunocompromised patients, particularly in patients with late-stage AIDS receiving long-term suppressive fluconazole In all forms of invasive candidiasis, an important element of therapy is reversal of the underlying predisposing factor when possible In high-risk patients undergoing induction chemotherapy, bone marrow transplantation, or liver transplantation, prophylaxis with antifungal agents has been shown to prevent invasive fungal infections although the effect on mortality and the preferred agent remain debated

This risk category assignment occurs in the same place as the customer credit limit, which is the Customer Credit Management Screen, as seen in Figure 10-8 That is, it is assigned to the customer by Finance as described earlier Refer to transaction code [FD32]

Kulberg BJ et al Voriconazole versus a regimen of amphotericin B followed by fluconazole for candidaemia in non-neutropenic patients: a randomised non-inferiority trial Lancet 2005 Oct 22 28;366(9495):1435 42 [PMID: 16243088] Pappas PG Invasive candidiasis Infect Dis Clin North Am 2006 Sep;20(3):485 506 [PMID: 16984866] Spellberg BJ et al Current treatment strategies for disseminated candidiasis Clin Infect Dis 2006 Jan 15;42(2):244 51 [PMID: 16355336]

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1 Maturity-onset diabetes of the young (MODY) This subgroup is a relatively rare monogenic disorder characterized by non insulin-dependent diabetes with autosomal dominant inheritance and an age at onset of 25 years or younger Patients are nonobese, and their hyperglycemia is due to impaired glucose-induced secretion of insulin Six types of MODY have been described Except for MODY 2, in which a glucokinase gene is defective, all other types involve mutations of a nuclear transcription factor that regulates islet gene expression MODY 2 is quite mild, associated with only slight fasting hyperglycemia and few if any microvascular diabetic complications It generally responds well to hygienic measures or low doses of oral hypoglycemic agents MODY 3 the most common form accounts for two-thirds of all MODY cases The clinical course is similar to that of idiopathic type 2 diabetes in terms of microangiopathy and failure to respond to oral agents with time 2 Diabetes due to mutant insulins This is a very rare subtype of nonobese type 2 diabetes, with no more than ten families having been described Since affected individuals were heterozygous and possessed one normal insulin gene, diabetes was mild, did not appear until middle age, and showed autosomal dominant genetic transmission There is generally no evidence of clinical insulin resistance, and these patients respond well to standard therapy

3 Diabetes due to mutant insulin receptors Defects in one of their insulin receptor genes have been found in more than 40 people with diabetes, and most have extreme insulin resistance associated with acanthosis nigricans In very rare instances when both insulin receptor genes are abnormal, newborns present with a leprechaun-like phenotype and seldom live through infancy 4 Diabetes mellitus associated with a mutation of mitochondrial DNA Since sperm do not contain mitochondria, only the mother transmits mitochondrial genes to her offspring Diabetes due to a mutation of mitochondrial DNA that impairs the transfer of leucine or lysine into mitochondrial proteins has been described Most patients have a mild form of diabetes that responds to oral hypoglycemic agents; some have a nonimmune form of type 1 diabetes Two-thirds of patients with this subtype of diabetes have a hearing loss, and a smaller proportion (15%) had a syndrome of myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) 5 Wolfram s syndrome Wolfram s syndrome is an autosomal recessive neurodegenerative disorder first evident in childhood It consists of diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, hence the acronym DIDMOAD It is due to mutations in a gene named WFS1, which encodes a 1003 KDa transmembrane protein localized in the endoplasmic reticulum The function of the protein is not known The diabetes mellitus, which is nonimmune and not linked to specific HLA antigens, usually presents in the first decade together with the optic atrophy Cranial diabetes insipidus and sensorineural deafness develop during the second decade in 60 75% of patients Ureterohydronephrosis, neurogenic bladder, cerebellar ataxia, peripheral neuropathy, and psychiatric illness develop later in many patients

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