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Castillo, P., and R. M. Jiménez-Díaz. "First Report of Meloidogyne incognita Infecting Spinach in Southern Spain." Plant Disease 87, no. 7 (July 2003): 874. http://dx.doi.org/10.1094/pdis.2003.87.7.874c.
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Severe plant yellowing and decline were recently observed in two commercial fields of spinach (Spinacia oleracea cv. Polka) in Encinarejo (Córdoba), southern Spain. Disease surveys revealed severe infections of main and feeder roots and a large soil population of the southern root-knot nematode Meloidogyne incognita. The nematode population was extracted and quantified from soil and root samples according to Barker (1) and identified by female perineal pattern, phenotype esterases, and host-differential test (3,4). M. incognita was found in 100% of soil samples and 85.7% of root samples with nematode population densities ranging from 44 to 378 eggs and second-stage juveniles (J2s) per 100 cm3 of soil and 162 to 725 eggs and J2s per 5 g of fresh roots. Infected roots showed large, regular galls on root tips and also along the main root axis and secondary feeder roots. Galling of root tips prevents further root growth into deeper soil layers and induced proliferation of secondary roots. The severe infections in roots of spinach suggest that parasitism of spinach roots by the nematode must contribute to stunting, yellowing, and decline of spinach as previously reported (2). To our knowledge, this is the first report of M. incognita infecting spinach in Spain. References: (1) K. R. Barker. Nematode extraction and bioassays. Page 19 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker, C. C. Carter, and J. N. Sasser, eds. North Carolina State University Graphics, Raleigh, 1985. (2) J. C. Correll et al. Plant Dis. 78:653, 1994. (3) P. R. Esbenshade and A. C. Triantaphyllou. J. Nematol. 22:10, 1990. (4) K. M. Hartman and J. N. Sasser. Identification of Meloidogyne species on the basis of differential host test and perineal pattern. Page 69 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker, C. C. Carter, and J. N. Sasser, eds. North Carolina State University Graphics, Raleigh, 1985.
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Narang, S., S. K. Raju, and R. Kumar. "ABC analysis of anti cancer drugs in a tertiary care Employees’ State Insurance Corporation Hospital in Delhi." International Journal Of Community Medicine And Public Health 5, no. 5 (April 24, 2018): 2081. http://dx.doi.org/10.18203/2394-6040.ijcmph20181727.
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Background: Material management is co-ordinated activities comprising of planning, acquiring, storing and controlling the supply of various items for optimal use. Effective inventory management can bring about a substantial decrease in expenditure. ABC analysis categorizes all items based on their annual drug expenditure into three categories A, B and C for better control by different level managers.Methods: ABC analysis for anticancer drugs was done in ESIC Hospital, Basaidarapur which is a tertiary care hospital of ESI Corporation in Delhi. Total number of drugs analysed were 98 with total annual expenditure of Rupees 5.77 crores approximately.Results: 12.2% (n=12), 16.3% (n=16) and 71.4% (n=70) items were found to be in A, B and C categories respectively.Conclusions: ABC analysis identified the drugs which need more strict control by top level management. Inventory control techniques should be an integral part of any hospital store.
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Espárrago, G., and I. Blanco. "First Report of the Cyst Nematode (Globodera tabacum) Complex on Flue-Cured Tobacco in Spain." Plant Disease 86, no. 12 (December 2002): 1402. http://dx.doi.org/10.1094/pdis.2002.86.12.1402c.
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The Globodera tabacum complex infects tobacco (Nicotiana tabacum L.) fields in the United States. In August 2001, plants of flue-cured tobacco cv. K326 from a field of the La Vera Region of Spain displayed a premature wilting and yellowing of foliage, but the roots looked healthy. In the laboratory under the microscope, nematode cysts were observed on the roots. At harvest in September 2001, soil and root samples were collected to identify the nematode and to quantify the population in the soil. Identification of the nematode was based on morphological characteristics of second-stage juveniles collected from cysts and perineal patterns of cysts recovered from the roots (2). Cysts were collected from roots, and second-stage juveniles were extracted from crushed cysts. The nematode population was extracted from the soil and quantified as described by Barker (1). The nematode population was identified as Globodera tabacum. Soil density of the nematode was 5,307 cysts per liter of soil, 64,286 eggs per liter of soil, and 16,071 second-stage juveniles per liter of soil. To our knowledge, this is the first report of G. tabacum complex in Spain. References: (1) K. R. Barker. Nematode extraction and bioassays. Page 19 in: An Advanced Treatise on Meloidogyne. Vol II, Methodology. K. R. Barker, C. C. Carter, and J. N. Sasser, eds. North Carolina State University Graphics, Raleigh, 1985. (2) R. H. Mulvey and A. Morgan Golden, J. Nematol. 15:1, 1983.
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d'Errico, G., A. Crescenzi, and S. Landi. "First Report of the Southern Root-Knot Nematode Meloidogyne incognita on the Invasive Weed Araujia sericifera in Italy." Plant Disease 98, no. 11 (November 2014): 1593. http://dx.doi.org/10.1094/pdis-06-14-0584-pdn.
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Moth plant, Araujia sericifera, is native to South America and was exported to many other countries as an ornamental plant. However, it is now considered an invasive, perennial, noxious weed in Italy. Because of the ability of this plant to spread rapidly and invade natural ecosystems, A. sericifera has been included on the Alert list by the European and Mediterranean Plant Protection Organization (EPPO). In September 2013, numerous plants of A. sericifera with chlorotic leaves and large root-galls were observed in agricultural fields, gardens, and uncultivated locations in Nocera Inferiore, Salerno Province, Italy. Ten samples were collected from a vegetable farm (40°45′40.8″ N, 14°38′18.4″ E) and nematodes were extracted from soil and root samples using standard procedures (1). Meloidogyne sp. was found in all soil and root samples, with nematode population densities ranging from 420 to 1,270 eggs and J2s/10 cm3 of soil and 84 to 2,200 eggs and J2s/5 g of fresh roots. The morphological identification of the nematode was based on characterization of second-stage juveniles (J2s), males, eggs, and females (2). Measurements of J2s (n = 30) include: mean body length (L) = 403 ± 3.7 μm; L/maximum body width = 27.5 ± 0.3; L/esophageal length = 6.2 ± 0.1; stylet length = 12.8 ± 0.1 μm; L/tail length = 9.5 ± 0.1; tail length = 42.5 ± 0.3 μm. Males (n = 10): L = 1,491 ± 0.04 μm; L/maximum body width = 44.4 ± 0.8; L/esophageal length = 16.1 ± 0.3; stylet length = 22.1 ± 0.7 μm; spicules length = 30.1 ± 0.8 μm. Eggs (n = 30): length = 96.6 ± 1 μm; width = 45.1 ± 0.5 μm; length/width ratio = 2.1. Females (n = 20): L = 909.5 ± 38.4 μm; body width = 588.3 ± 19.3 μm; stylet length = 17.0 ± 0.2 μm. Perineal patterns of females had a high dorsal arch with wavy striae bending toward the lateral lines and the absence of distinct lateral line incisures. All measurements conformed to the description of Meloidogyne incognita (Kofoid & White, 1919) Chitwood 1949. DNA was extracted from five individual adult females from each sample and morphological identification was confirmed by a sequence-characterized amplified region (SCAR)-PCR technique using species-specific primers. The amplified product obtained was 1.2 kb in length, demonstrating proper amplification of the species-specific, length variant SCAR marker (3). Weeds are known to serve as hosts for nematodes in the absence of crop plants and to affect the success of nematode management programs. Meloidogyne spp. have been reported to survive and even thrive on weeds; among them, M. incognita is considered the most economically important agricultural nematode pest worldwide as it causes severe yield losses on many hosts. Thus, the invasive plant A. sericifera can be a potential reservoir for M. incognita in Italy and elsewhere. To our knowledge, this is the first report of M. incognita parasitizing A. sericifera. References: (1) K. R. Barker. Page 19 in: An Advanced Treatise on Meloidogyne. Vol. II, Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh, 1985. (2) J. D. Eisenback et al. A Guide to the Four Most Common Species of Root-Knot Nematodes (Meloidogyne spp.), with a Pictorial Key. North Carolina State University, Raleigh, 1981. (3) C. Zijlstra et al. Nematology 2:847, 2000.
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Naranjo, José Martín Alanís, Eduardo Federico Hammeken Larrondo, and María Guadalupe Silva Arroyo. "Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State Associated With COVID 19." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A372—A373. http://dx.doi.org/10.1210/jendso/bvab048.758.
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Abstract Background: Cases of patients with combined DKA and HHS associated to COVID-19 are scarce but showed Hispanics patients tended to be associated with higher mortality. Clinical Case: A 51-year-old Mexican man with past medical history of T2DM presented to our hospital with 1-week history of fever, dyspnea, polydipsia, and nausea. Initial vital signs were notable for fever (axillary temperature 39°C) and low oxygen saturation (90% on room air). His examination was notable for a BMI of 31.2 kg/m2. Blood tests showed hyperglycemia (663 mg/dl, n 70–100 mg/dL), hypernatremia (146 mEq/L, n 135–145 mEq/L), hyperchloremia (113 mEq/L, n 95–110 mEq/L), elevated C-Reactive Protein [CRP] (18.7 mg/dl, n < 0.7 mg/dl), elevated lactate dehydrogenase [LDH] (672 U/L, n 100–170 U/L), high D-dimer (3420 ng/ml, n <400 ng/ml), elevated WBC count (13,200 cell/mm3, n 4600–10200 cells/mm3), high neutrophil count (11300 cells/mm3, n 2000–6900 cells/mm3) and low lymphocyte count (200 cells/mm3, n 600–3400 cells/mm3). Arterial blood gas analysis showed metabolic acidosis (pH 7.2 [n 7.35–7.45], bicarbonate 8mmol/L [22–28 mmol/L], anion gap 23.5 [8–16]) with ketones (100 mg/dl, n <5 mg/dl) in the urine analysis. Calculated serum osmolarity resulted of 328 mOsm/kg (n 278–305 mOsm/kg). Electrocardiogram showed no alterations. Chest X-ray revealed bilateral ground-glass opacities with bilateral infiltrates. Blood and urine cultures were negative. The patient tested positive for SARS-CoV-2. Intravenous fluids, insulin infusion with ceftriaxone i.v. (2 g daily) and clarithromycin p.o. (1 g daily) were initiated but did not result in clinical improvement, continuing with fever, hyperglycemia, metabolic acidosis and worsening of respiratory status. At first day of hospitalization, he presented acute respiratory distress syndrome and was intubated and sedated. He developed multi-organ failure and expired after 3 days of mechanical ventilation. Conclusion: DM is a predisposing factor leading to severe COVID-19 disease. Patient showed similar features reported in cases who died of combined DKA and HHS associated with COVID-19: male, Hispanic, poor blood glucose control, mechanical ventilation, elevated CRP with high LDH and D-dimer. In this patient, obesity was an additional feature that led to severe COVID- 19. Reference: Hoe Chan K, Thimmareddygari D, Ramahi A, Atallah L, Baranetsky NG, Slim J (2020) Clinical characteristics and outcome in patients with combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID-19: a retrospective, hospital-based observational case series. Diabetes Res Clin Pract 166:108279
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Tangel, Virginia E., Briana Lui, Dima El Halawani Aladdin, Kane O. Pryor, and Robert S. White. "Validity of comorbidity adjustment scores in estimating in-hospital mortality in individual subgroups of race/ethnicity." Journal of Comparative Effectiveness Research 10, no. 10 (July 2021): 823–29. http://dx.doi.org/10.2217/cer-2020-0222.
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Aim: To examine the validity of race/ethnicity-specific comorbidity adjustment scores in estimating in-hospital mortality. Materials & methods: Using 2007–2014 data from the State Inpatient Databases (SID), we compared the performance of derived race/ethnicity-specific composite scores to the existing scores and binary Elixhauser comorbidity measures at estimating in-hospital mortality. Results: In the overall validation sample (N = 9,564,277), our index (c = 0.80; 95% CI: 0.79–0.80) discriminated better than the van Walraven score (c = 0.79; 95% CI: 0.79–0.79), SID 29 (c = 0.78; 95% CI: 0.78–0.79) and SID 30 (c = 0.78; 95% CI: 0.78–0.78), but was not superior to the binary indicators (c = 0.80; 95% CI: 0.80–0.80). Similar findings were observed in individual populations of White and Black patients. All models showed weak calibration. Conclusion: Race/ethnicity-specific indexes discriminated slightly better than existing composite measures at modeling in-hospital mortality in individual subgroups of race/ethnicity.
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Machado, A. C. Z., O. F. Dorigo, A. Boss, and P. Tironi. "First Report of Meloidogyne javanica Parasitizing Duboisia sp. in Paraná State, Brazil." Plant Disease 98, no. 12 (December 2014): 1745. http://dx.doi.org/10.1094/pdis-06-14-0649-pdn.
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Duboisia sp. is a small tree belonging to the family Solanaceae originating from the rainforest areas of the eastern coast of Australia. Dried leaves are used for the extraction of pharmaceutical alkaloids, making this a commercially viable crop. The root-knot nematode Meloidogyne incognita has been reported parasitizing Duboisia myoporoides (5); however, no information of other root-knot nematode species associated with this plant was found. Duboisia sp. is cultivated at Solana Farm, near Arapongas (23°25′08″ S, 51°25′26″ W), Paraná State, Brazil. During the renovation of a production field in this municipality, galled roots were observed on plants and samples were submitted to the Nematology Laboratory at Instituto Agronômico do Paraná, IAPAR, on December 2013. Plants did not exhibit any above-ground symptoms. The specimens were identified through perineal patterns and esterase phenotypes of 20 adult females extracted from dissected roots (2,3) and morphometrics of 10 second-stage juveniles extracted from roots using the blender-sieving method (1). Morphological characteristics were consistent with those described for M. javanica (4). Females had rounded perineal patterns with low, trapezoid shape dorsal arch, striae smooth interrupted by a pair of incisures on both sides, corresponding to lateral fields, clearly demarcated from striae by more or less parallel lines, tail whorl often distinct (4). The juvenile mean body length was 459.9 ± 28.7 μm and tail length averaged 51.6 ± 5.1 μm, with 10 to 16 μm long hyaline region and finely rounded tail tip (4). Results from the esterase electrophoresis were typical of M. javanica (2) with the J3 (Rm = 1.0, 1.3, and 1.4) phenotype being obtained. To our knowledge, this is the first report of M. javanica on Duboisia sp. in Brazil. This finding has great importance for Brazilian production since this nematode may damage plants, reduce yields, and control of this nematode on Duboisia sp. is difficult (5). Additional work is necessary in order to elucidate the losses caused by M. javanica on Duboisia sp. References: (1) J. I. Bonetti and S. Ferraz. Fitopatol. Bras. 6:533, 1981. (2) P. R. Esbenshade and A. C. Triantaphyllou. J. Nematol. 22:10, 1990. (3) K. M. Hartman and J. N. Sasser. Page 115 in: An Advanced Treatise on Meloidogyne. Volume II Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh, 1985. (4) D. J. Hunt and Z. A. Handoo. Page 55 in: Root-Knot Nematodes. R. N. Perry et al., eds. CABI International, Wallingford, UK, 2010. (5) A. M. Mello et al. Nematol. Bras. 22(2):12, 1998.
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de Araújo Filho, J. V., A. C. Z. Machado, R. S. C. A. de Faria, and L. E. A. Camargo. "Root-Knot Disease Caused by Meloidogyne arenaria and M. javanica in Teak in São Paulo State, Brazil." Plant Disease 96, no. 1 (January 2012): 151. http://dx.doi.org/10.1094/pdis-05-11-0442.
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Teak (Tectona grandis Linn. F.) is one of the most important forest crops in Brazil, occupying areas in different regions, such as Goiás, Mato Grosso, Paraná, and São Paulo states. Teak wood is used for many purposes such as shipbuilding, rolling and plywood, firewood, and charcoal. In May 2011, teak symptomatic feeder root samples, exhibiting inconspicuous, small galls, were collected in the municipality of Piracicaba, São Paulo State, Brazil (22°41′46.90″S, 47°38′36.84″W). Specimens were identified through perineal patterns and esterase phenotypes of 20 adult females (1,2). Perineal patterns and esterase phenotypes were consistent with those described for Meloidogyne arenaria (Neal, 1889) Chitwood, 1949 and M. javanica (Treub, 1885) Chitwood, 1949. Perineal patterns of M. arenaria showed a low dorsal arch, compressed dorsolaterally, with lateral field marked by some forked and broken striae; no punctate markings between anus and tail terminus were observed. Perineal patterns of M. javanica were rounded, with low dorsal arch, striae smooth, lateral field distinct, clearly demarcated from striae by parallel lines. From the esterase electrophoresis we obtained A2 (Rm:1.2;1.3) and J3 (Rm:1.0;1.25;1.4) phenotypes, typical from M. arenaria and M. javanica, respectively. To our knowledge, this is the first report of M. arenaria parasitizing teak roots in Brazil and elsewhere (new host) and the first report of M. javanica infecting teak in the State of São Paulo. Previously, M. javanica was reported to be infecting teak-growing areas in the State of Mato Grosso (3). This finding has a great importance, not only by the inclusion of these parasites in teak pathological scenario, but also for predicting possible damage in plant species used in teak-based intercropping systems. References: (1) P. R. Esbenshade and A. C. Triantaphyllou. J. Nematol. 22:10, 1990. (2) K. M. Hartman and J. N. Sasser. 1985. Page 115 in: An Advanced Treatise on Meloidogyne. Volume II, Methodology. K. R. Barker et al., eds. North Carolina State University Graphics, Raleigh,1985. (3) R. A. Silva et al. Nematol. Bras. 27:261, 2003.
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Lemiech-Mirowska, Ewelina, Michał Michałkiewicz, Aleksandra Sierocka, Ewelina Gaszyńska, and Michał Marczak. "The Hospital Environment as a Potential Source for Clostridioides difficile Transmission Based on Spore Detection Surveys Conducted at Paediatric Oncology and Gastroenterology Units." International Journal of Environmental Research and Public Health 20, no. 2 (January 15, 2023): 1590. http://dx.doi.org/10.3390/ijerph20021590.
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Clostridioides difficile is an anaerobic, Gram-positive bacterium widely present in the hospital environment due to its ability to generate spores. The transfer of spores to patients through the hands of medical personnel is one of the most frequent paths of C. difficile transmission. In paediatric patients burdened with a serious primary illness requiring long-term hospitalisation and antibiotic therapy, C. difficile may be a significant risk factor for antibiotic-associated diarrhoea. The goal of the study was to assess the state of hospital environments as a potential source of C. difficile spores and to establish the share of hyperepidemic strains at the two paediatric units. The survey for C. difficile was conducted with a C. diff Banana BrothTM medium, used to detect spores and to recover vegetative forms of the bacteria. Environmental samples (n = 86) and swabs from the clothing of medical personnel (n = 14) were collected at two units of a paediatric hospital, where the cases of antibiotic-associated diarrhoea with a C. difficile aetiology constitute a significant clinical problem. In 17 samples, a change in the broth’s colour was observed, indicating the presence of spores. Out of seven samples, C. difficile strains were cultured. The pathogenic isolates of C. difficile were obtained from swabs collected from elements of beds, a toilet, a door handle and a doctor’s uniform. In our study, we indicated points of increased risk of pathogen transmission, which could constitute a source of infection. The clothing of medical personnel may be a dangerous carrier of pathogenic spores. Periodical surveys of hospital environments with the use of specialist microbiological mediums successfully indicate the direction of corrective actions to be undertaken by the medical facility in order to increase patient safety.
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Reese, Sara, Bryan Knepper, Amber Miller, and Heather Young. "1155. Excessive Movement, Unnecessary Contamination: Clostridium difficile Patients in the Hospital." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S347—S348. http://dx.doi.org/10.1093/ofid/ofy210.988.
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Abstract Background The environmental contamination of Clostridium difficile in acute care hospital rooms is associated with increased risk of infection for subsequent patients. Patients that stay in a room following a patient with a C. difficile infection (CDI) have an increased risk of CDI compared with patients whose previous resident did not have CDI. The objective of this study was characterize the room movement of CDI patients in a Level 1 Trauma Medical Center. Methods A patient with CDI was defined as an inpatient with a positive C. difficile test through rapid serology, C. difficile polymerase chain reaction (PCR) or multiplex-stool PCR from March 2017 to March 2018. Patients were classified as either community-onset (CO, positive test <4 days after admission) or hospital-onset (HO, positive test ≥4 days after admission). Additionally, the number of rooms each CDI patient resided in during one admission following a positive C. difficile test was determined and the proportion of patients who stayed in one to two rooms or at least three rooms per visit was calculated. Results There were a total of 244 CDI patients identified (172: CO, 72: HO) between March 2017 and March 2018. The mean time from admission to positive test was 12.4 hours post-admission for CO-CDI patients and 251.1 hours for HO-CDI patients. Almost 40% of HO-CDI patients (36.1%, n = 72) stayed in at least three rooms during their hospital admission compared with <30% of CO-CDI patients (28.4%, n = 172). Conclusion The current state of room movement with CDI patients is suboptimal, resulting in increased infection risk for subsequent patients. A multi-faceted intervention to address this problem is essential to achieve an optimal goal of 1–2 rooms per hospital stay for a CDI patient. Quality improvement projects include (1) notification of patient movement to nursing leadership, (2) alerts to nursing supervisors of potential CDI patients before room transfer, and (3) earlier diagnosis of community-onset C. difficile. Disclosures All authors: No reported disclosures.
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Tyrala, Eileen, Michael H. Goodstein, Erich Batra, Barbara Kelly, Judy Bannon, and Ted Bell. "Post-Partum Skin-to-Skin Care and Infant Safety: Results of a State-Wide Hospital Survey." Global Pediatric Health 8 (January 2021): 2333794X2198954. http://dx.doi.org/10.1177/2333794x21989549.
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Objectives. Survey current experience with Skin to Skin care (SSC) in Pennsylvania Maternity Centers. Study Design. The nursing director of each Maternity Center in PA (n = 95) was sent an on-line confidential survey querying SSC practices. Responses were compared by delivery size, location, and nature of affiliation. Statistics analyzed by chi-square and student t-test. Results. Of these 64/95 MCs (67%) responded. All allowed SSC after vaginal deliveries, 55% after C-section, 73% mother’s room. Monitoring included delivery room nurse (94%) with support from other providers (61%), family members (37%), and electronic monitoring (5%). If SSC occurred in mother’s room all reported family education on safe practices. 40% were aware of adverse SSC events, including falls and suffocation. About 80% educated staff about infant safety during SSC. Conclusions. Gaps in education and supervision during SSC were identified. Additional education and standardization of best practices are needed to reduce risks from falls and suffocation during SSC.
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Bridges, R., D. Smedley, M. Hall, and J. Powell. "C-66 Limited Access to Pediatric Neuropsychological Evaluations for Non-English Speakers." Archives of Clinical Neuropsychology 34, no. 6 (July 25, 2019): 1095. http://dx.doi.org/10.1093/arclin/acz034.228.
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Abstract Objective The aim of this empirical study was to examine the accessibility of pediatric neuropsychological evaluations in the state of Arizona for non-English speaking children. To date, there is very limited research that analyzes the accessibility of neuropsychological evaluations. Diversity variables, such as primary language, can negatively impact assessment scores (Norbury & Sparks, 2013), leaving diverse individuals at risk of misdiagnosis when an assessment is not conducted in one’s primary language, nor normed on similar individuals (Mindt et al., 2008). The Center for Immigration Studies (2017) found 28% of school-age children in Arizona speak a foreign language, warranting a need for culturally-appropriate evaluations. Method Arizona pediatric neuropsychologists in non-hospital settings were identified via electronic resources: AzNS, AAPdN, AzPA, CSN, and AACN provider lists; LinkedIn; Google search. Participants met criteria for inclusion if “pediatric neuropsychological” evaluations were provided by a neuropsychologist on staff. “Pediatrics” is defined as 0-17. Neuropsychologists were contacted directly via phone for survey participation; verbal informed consent was obtained. Results Seventeen pediatric neuropsychologists were found in the state of Arizona, and 52.9% consented to participate in the survey (n = 9). All participants (100%, n = 9) stated they provide evaluations in English only, and refer-out for non-English evaluations. Conclusions There is a severe disparity in the access to care with respect to availability of culturally-appropriate evaluations in Arizona: a state with a large population of non-English speakers. The current study adds to the limited literature in this area, and sets the stage for continued professional advocacy efforts. Goals for future national research is critically discussed.
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Pulis, Randy P., Beatrice M. Wu, Norman M. Kneteman, and Thomas A. Churchill. "Conservation of phosphorylation state of cardiac phosphofructokinase during in vitro hypothermic hypoxia." American Journal of Physiology-Heart and Circulatory Physiology 279, no. 5 (November 1, 2000): H2151—H2158. http://dx.doi.org/10.1152/ajpheart.2000.279.5.h2151.
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We investigated the metabolic effects of buffering agents α-amino-4-imidazole-propionic acid (Histidine), N,N-bis(2-hydroxyethyl)glycine (bicine), N,N-bis(2-hydroxyethyl)-2-aminoethanesulfonic acid (BES) on anaerobic energy production (via glycolysis) and conservation of key regulatory enzyme activity, and phosphofructokinase (PFK) throughout prolonged hypothermic hypoxia in porcine hearts. Hearts from 35 to 40 kg pigs were flushed with one of the following five solutions: St. Thomas' Hospital solution (STHS); modified University of Wisconsin (UW) solution; and three solutions containing modified UW plus 90 mM of histidine, bicine, or BES. The hearts were then stored at 4°C for 10 h. After 10 h of hypothermic hypoxia, lactate values were 6.7–12.9 μmol/g higher than control; this reflected an increase in anaerobic end product of 35–67%. The consequences of enhanced anaerobic metabolism were higher ATP, total adenylate, Energy Charge, and ATP/ADP ratios in most of the buffered groups after 4–10 h cold storage; effectiveness of the buffers employed correlated with buffering capacity (BES proved to be the most effective). PFK remained activated throughout most of the 10-h period in hearts stored with buffers and did not undergo the rapid inactivation experienced by hearts stored in STHS. Conservation of PFK integrity with buffering agents was not related to a pH-mediated event; changes in kinetic parameters suggested that this protection was due to an irreversible posttranslational modification, specifically a dephosphorylation event.
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Shigemi, Daisuke, Kazuho Nakanishi, Miwa Miyazaki, Yoshie Shibata, and Shunji Suzuki. "The Effect of the Gelatinous Lactulose for Postoperative Bowel Movement in the Patients Undergoing Cesarean Section." International Scholarly Research Notices 2014 (October 29, 2014): 1–4. http://dx.doi.org/10.1155/2014/752862.
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Lactulose is a non-digestible disaccharide formed from fructose and galactose. The objective of this study was to assess the effect of lactulose on gastrointestinal function after cesarean section. One hundred patients who underwent cesarean section at the Japanese Red Cross Katsushika Maternity Hospital were enrolled in this study. They were divided into 2 groups by randomization: (1) an L group that was treated with gelatinous lactulose (N = 48) and (2) a control group (C group) that did not receive gelatinous lactulose (N = 52). The interval between cesarean section and first postoperative flatus, defecation, and walking; appearance of symptoms of ileus; use of other medicines for stimulating bowel movement; properties and state of feces; and duration of postoperative hospital stay were compared between the two groups. The two groups did not show a significant difference in postoperative outcomes, except for the incidence of loose or watery stools (50% in the L group and 26.9% in the C group, P=0.03). This study could not demonstrate the apparent effectiveness of lactulose in improving bowel function after cesarean section. Therefore, a routine use of gelatinous lactulose after surgery may negatively impact the patients undergoing cesarean section.
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Machado, A. C. Z., O. F. Dorigo, and D. Mattei. "First Report of the Root Knot Nematode, Meloidogyne inornata, on Common Bean in Paraná State, Brazil." Plant Disease 97, no. 3 (March 2013): 431. http://dx.doi.org/10.1094/pdis-09-12-0832-pdn.
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Common bean (Phaseolus vulgaris F.) is one of the most important crops in Paraná State, which is responsible for almost 10% of the Brazilian production (4). Root knot nematodes, Meloidogyne spp., are common parasites of this crop worldwide, but damage caused by Meloidogyne inornata has not been reported. During a survey of nematode species present on common bean fields in Paraná State, Brazil, galled root samples of cultivars Tuiuiú and Eldorado were submitted, in June 2012, in the Nematology Laboratory from IAPAR, collected in the municipalities of Araucária (25°35′34″S, 49°24′36″W) and Santana do Itararé (23°45′18″S, 49°37′44″W). Plants did not exhibit any above-ground symptoms. The specimens were identified through perineal patterns and esterase phenotypes of 20 adult females extracted from dissected roots (2,3). The population densities observed in the samples were 140 and 700 J2 and eggs per gram of roots, respectively, for both samples. Characteristics were consistent with those described for M. inornata. For example, perineal patterns of M. inornata showed a high dorsal arch, with smooth to wavy striae, similar to those of M. incognita; but no punctate markings between anus and tail terminus were observed. However, from the esterase electrophoresis we obtained the I3 (Rm = 0.83, 1.15, and 1.32) phenotype, typical of M. inornata, a species-specific phenotype used to differentiate this species from M. incognita (1). Moreover, the excretory pore of adult females was located 32.1 (± 5.4) μm from the anterior end, consistent with the M. inornata description (25 to 53 μm) (1). To the best of our knowledge, this is the first report of M. inornata parasitizing common bean roots. This finding has great importance for Brazilian agriculture, since this nematode may damage common bean plants and become an additional problem for this crop. Additional work is necessary in order to elucidate the losses caused by M. inornata on common bean. References: (1) R. M. D. G. Carneiro et al. Nematology 10:123, 2008. (2) P. R. Esbenshade and A. C. Triantaphyllou J. Nematol. 22:10, 1990. (3) K. M. Hartman and J. N. Sasser. Page 115 in: An Advanced Treatise on Meloidogyne, Volume II Methodology. K. R. Barker et al., eds. Raleigh: North Carolina State University Graphics, 1985. (4) MAPA. Feijão, Ministério da Agricultura, Brasil. Retrieved from http://www.agricultura.gov.br/vegetal/culturas/feijao September 05, 2012.
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Kochhann, Renata, Ana Luiza Camozzato, Cláudia Godinho, Maria Otília Cerveiro, Letícia M. K. Forster, and Márcia Lorena Fagundes Chaves. "Cognitive complaints compared to performance on a mental state screening test in elderly outpatients." Dementia & Neuropsychologia 2, no. 1 (March 2008): 46–51. http://dx.doi.org/10.1590/s1980-57642009dn20100010.
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Abstract Memory and other cognitive complaints are common in the elderly population. However, the clinical meaning of these complaints remains controversial. Objectives: The goal of this study was to investigate the association between cognitive complaints and performance on a mental state screening test in elderly patients attended for the first time at the Neurogeriatric and Dementia (NGA) Outpatient Clinic within a major University hospital. Methods: Two hundred patients referred to the NGA Clinic during 2005, 2006 and 2007 first semesters participated in the study. The variables of interest were: (a) source of and reason for referral; (b) whether or not they had previously been evaluated with the screening test (Mini Mental State Exam - MMSE) by their physicians before referral to our specialized clinic; (c) cognitive complaints; and (d) performance on the screening test (MMSE) at the NGA Clinic. Results: The main reason for referral to the NGA clinic was cognitive complaints 63% (N=126), where only 5% (N=10) of the referred patients had been previously evaluated by the cognitive screening test (MMSE or equivalent). Of the 135 patients who presented cognitive complaints during the first appointment, 52 (38%) presented MMSE scores below the education-adjusted cut-off. No association between cognitive complaint and performance on the MMSE during the first evaluation at the NGA Clinic was observed (c²=3.04, p=0.1). Conclusions: Although cognitive complaints among elders should not be disregarded, the mental state screening evaluation is crucial for the detection of clinically significant cognitive impairment.
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Paetzold, Maira Gabriela, Ligiane De Lourdes Silva, and Márcia Regina Simões. "Métodos de rastreamento da ansiedade e depressão em estudantes universitários: revisão integrativa." Saúde Coletiva (Barueri) 11, no. 60 (January 5, 2021): 4686–95. http://dx.doi.org/10.36489/saudecoletiva.2021v11i60p4686-4695.
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Objetivo: A presente pesquisa teve como objetivo realizar uma revisão integrativa da literatura de instrumentos utilizados no rastreamento de depressão, ansiedade e misto (ambos) em amostras de estudantes de graduação. Método: a pesquisa ocorreu na base de dados PubMed, de 2009 até 2019. Resultados: Inicialmente foram encontrados 895 artigos, dos quais 345 foram incluídos após a leitura dos títulos e resumos; destes, 316 foram recuperados e posteriormente 176 foram excluídos após a leitura na íntegra, totalizando 140 artigos. Conclusão: Os instrumentos mais utilizados foram: a) Ansiedade: Beck Anxiety Inventory (BAI) (n=19) e State-Trait Anxiety Inventory (STAI) (n=17); b) Depressão: Beck Depression Inventory (BDI) (n=35); e c) Misto: Depression, Anxiety and Stress Scale (DASS-21) (n=40) e Hospital Anxiety and Depression Scale (HADS) (n=19). O curso mais avaliado foi Medicina e os países com mais produções de artigos foram China (n=24) e Estados Unidos (n=20). O Brasil publicou apenas 7 artigos.
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Manorenj, Sandhya, and Sudhaker Barla. "Cerebral sinus venous thrombosis." International Journal of Research in Medical Sciences 5, no. 1 (December 19, 2016): 177. http://dx.doi.org/10.18203/2320-6012.ijrms20164544.
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Background: Intracranial Sino venous occlusive disease is an infrequent condition and accounts only 0.5-1% of all strokes. Objective of the study was to know the prevalence, pattern and risk factors involved in patients of cerebral sinus venous thrombosis (CSVT).Methods: Hospital databases were searched retrospectively and patients diagnosed with CSVT from December 2014 to February 2016 were identified. Data on clinical presentation, risk factor, cerebral sinus involved, hospital stay and outcome were analyzed.Results: Fifteen patients (3.4%) were identified as CSVT out of a total acute stroke case of 430. Mean age of patients was 31 years and 11 (73.3%) were males. The presenting symptoms included headache (n=14), altered sensorium (n=1) and seizures (n=5); signs included hemi paresis (n=4), papilledema (n=8) and bilateral VI nerve palsy (n=3). Majority had aseptic CSVT (n=14), and one patient had septic CSVT associated with tuberculous meningitis (TBM). Radiological findings included brain parenchyma involvement (n=8), subdural hematoma (SDH) (n=1), subarachnoid haemorrhage (SAH) (n=1) and normal brain parenchyma (n=5). Multiple cerebral sinuses were involved in seven patients. Most common site of CSVT was observed in sigmoid sinus. Risk factors included hyperhomocystenemia (n=3), protein S deficiency (n=8), protein C deficiency (n=6) and antithrombin III deficiency (n=3) as primary hypercoagulable state. ANA positive was observed in one patient and four had history of alcohol use. All fifteen patients received low molecular weight heparin (LMWH) for 1 week along with bridging oral anticoagulant. None of the patients required intrasinus thrombolysis and decompression surgery. Average hospital stay was 9 days. All had modified Rankin scale (MRS) ≤ 2 at 6 months follow up.Conclusions: Prevalence of CSVT is higher than that reported from Asian studies. Younger age and male predominance was observed. Protein S deficiency was the major risk factor for CSVT.
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Villamagna, Angela, Rebecca Pierce, Dat Tran, Roza Tammer, Lisa Iguchi, Alexia Zhang, and Christopher Pfeiffer. "Has UTI and Clostridioides difficile Testing and Treatment Stewardship Diffused Into Oregon Hospitals? A Survey of the Current State." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s243—s244. http://dx.doi.org/10.1017/ice.2020.800.
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Background: Urinary tract infection (UTI) and Clostridioides difficile infection (CDI) both pose significant diagnostic challenges. Excess testing has implications for hospital-associated infection surveillance and may also lead to overtreatment and associated patient risk. Accurate diagnosis requires stewardship efforts to ensure that the correct patients are tested appropriately. In coordination with clinicians and microbiology labs, hospital infection prevention departments can aid diagnostic stewardship efforts by creating policies for order indications and proper test collection methods and by developing electronic medical record (EMR) support for diagnostic and treatment algorithms. The prevalence of these practices in Oregon, however, is unknown. Methods: We deployed a web-based survey to infection preventionists at all 61 acute-care hospitals in Oregon in January 2019. Responses were collected through April 2019, and a subset of applicable questions were analyzed. Results: Of 61 acute-care hospitals, 58 (95%) responded. A response from a single long-term acute-care hospital was excluded. For urinary tract infections (UTIs), a minority of hospitals reported having policies requiring annual sterile urine collection training for registered nurses (n = 7, 12%), annual observation of the RN sterile urine collection procedure (n = 1, 2%), or use of boric acid containers for urine collection (n = 10, 17%). UTI testing and treatment algorithms embedded in the electronic medical record (EMR) were more common (Fig. 1). Regarding urine culture reflex policies, 39 facilities (68%) reported reflexing abnormal urinalyses to culture only if ordered, whereas 14 respondents (25%) reported automatically reflexed all abnormal urinalyses to culture. For Clostridioides difficile infection (CDI), respondents reported using a variety of methods to discourage inappropriate testing (Fig. 2). Although almost all facilities (n = 53, 93%) reported having a policy to reject formed stool, less than half (n = 27, 47%) reported having a policy to reject stool in patients receiving laxatives. Furthermore, 74% of respondents (n = 42) had a published testing algorithm, more than twice the 18 (32%) hospitals that reported having a comparable UTI algorithm. Conclusions: Infection prevention departments in Oregon acute-care hospitals utilize a variety of tools to contribute to diagnostic and treatment stewardship for UTI and CDI. Our survey revealed many opportunities for improvement in UTI and C. difficile testing and treatment stewardship in Oregon hospitals. For example, although most hospitals reject formed stool for CDI testing, policies for other diagnosis and treatment stewardship techniques were much less commonly employed. Future work will compare the results of this survey to a set of similar questions on a statewide microbiology laboratory survey, assess best practices, and form consensus recommendations on stewardship practices for the state.Funding: NoneDisclosures: None
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ANWER, SHAHNAZ, MUHAMMAD YOUNIS KHAN, and SHEIKH ATIQ-UR REHMAN. "RISK FACTORS;." Professional Medical Journal 16, no. 04 (December 10, 2009): 518–25. http://dx.doi.org/10.29309/tpmj/2009.16.04.2730.
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O b j e c t i v e : To determine the risk factors associated with hepatitis B and C carriers versus healthy pregnant women. Materiala n d M e t h o d s : It was a single center based, cross sectional comparative study, conducted at Gynae ward II, B-V hospital Bahawalpur. Durationof study was from March to August 2008.100 patients were enrolled in the two groups, 50 HbsAg/Anti HCV positive women (cases) to comparewith 50 healthy women (controls) match for parity. The data were recorded on a proforma. R e s u l t s : 100 pregnant women were enrolled. Sixtyeight (68.0%) were aged 25 years or less with a mean age ± S.D of 24.62 ± 3.40. Ten (20%) women had HBV and 40(80%) were HCV positive.The risk factors were compared between the two groups by uni-variate and multivariate analysis which showed that history of dental treatment,blood transfusion, surgery, parenteral treatment and jaundice were significant risk factors for hepatitis B and C carrier status. C o n c l u s i o n :There appears to be a strong co-relation of history of blood transfusion and dental treatment with HbsAg/ Anti HCV carrier state in pregnantwomen. The anti HCV seropositivity was appreciably high (80%) as compared to HbsAg (20%) in carrier pregnant women.
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Polozova, E. I., N. N. Sorokina, E. V. Puzanova, and A. A. Seskina. "The role of metabolic disorders in the progression of renal dysfunction in patients with metabolic syndrome and arterial hypertension." Medical Council, no. 6 (April 28, 2019): 170–75. http://dx.doi.org/10.21518/2079-701x-2019-6-170-175.
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The clinical study enrolled 120 patients, who were hospitalized to the Therapeutic Department of Republican Clinical Hospital No. 5 of Saransk. The patients were divided into 2 groups: Group I (n = 60) included patients with metabolic syndrome; Group II (n = 60) included patients with arterial hypertension. The paper presents data on the assessment of the functional state of kidneys in the analysed groups, defines the role of metabolic disorders in the progression of renal dysfunction in patients with metabolic syndrome and arterial hypertension. It is noted that more pronounced functional changes in the kidneys (microalbuminuria, increased cystatin C levels, decreased glomerular filtration rate) are detected in patients with arterial hypertension and metabolic syndrome, as compared with patients without metabolic disorders. Cystatin C and microalbuminuria have been shown to be one of the earliest markers of kidney damage in hypertension, especially in combination with metabolic disorders. Cystatin C and microalbuminuria level is significantly higher in patients with arterial hypertension and metabolic syndrome, as compared with patients with arterial hypertension, who have no metabolic disorders. Significant correlations were found between cystatin C, microalbuminuria levels and lipid and carbohydrate metabolism in patients with arterial hypertension in combination with metabolic disorders.
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Sturgeon, Jonathan P., Michaela A. Mayhew, Janet Campbell, and Fenella M. Willis. "Automated Erythrocytapheresis in Sickle Cell Disease: Impact On Hospital Admission Rate and Iron Loading." Blood 114, no. 22 (November 20, 2009): 1522. http://dx.doi.org/10.1182/blood.v114.22.1522.1522.
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Abstract Abstract 1522 Poster Board I-545 INTRODUCTION Red cell exchange in sickle cell disease (SCD) reduces the risk of life threatening complications including acute chest syndrome, and thromboembolic stroke. Reduction in Hb S to less than 30% reduces overall blood viscosity and improves tissue oxygenation. With treatment being life-long, concerns over iron loading, patient compliance, blood-bourne infections, and cost could temper its effectiveness. METHODS/SUBJECTS A retrospective study of 74 patients with SCD (mean age 37.5, range 19-73) on automated red cell exchange (mean 21.3 exchanges, range 1-74) was carried out for the period September 1995 to January 2009. Primary end points included the effect of consistency of exchange on hospital admission rate and the relationship between steady state haemoglobin (Hb) and serum ferritin (iron loading). The impact of the consistency of exchange was assessed by dividing the patients into 4 groups. A: Regular exchanges at least every 8 weeks. B: Regular exchanges with occasional short breaks. C: 3 or fewer exchanges per year. D: 4 or fewer exchanges in total. Average hospital admission data per year pre- and post- exchange transfusion programme were calculated. Patients were excluded if no exchanges or hospital admissions had happened in the last 4 years. To assess the relationship between ferritin and steady state Hb, the pre-treatment ferritin, latest ferritin, and steady state Hb were recorded. Patients were excluded if they were on iron chelation. Target post-procedure Hb was 10-11g/dL in all patients, with Hb S % <15%. RESULTS The 74 subjects received a total of 1578 exchange procedures, with a median of 8.00 units per exchange (range 5-10.5). Median time on erythrocytopheresis was 2.60 years (range 0.0 – 13.0 years). The mean steady state Hb was 10.0g/dL (SD 1.24). Hospital admission data was available for 67/74 (91%) patients. This included 25 in group A, 11 in group B, 5 in group C and 26 in group D. Fourteen patients in group D were excluded due to no record of admissions or exchanges in the last 4 years. In group A, there was a significant reduction in average hospital admission days per year, from 34.8 days/year (range 0-365, SD 71.4) to 7.60 days/year [range 0-34, SD 9.87 (p<0.005)]. In group B and group C, there was a non-significant reduction in average admission days per year from 38.1 days/year (range 1-124, SD 40.98) to 34.1 days/year [range 0-163, SD 55.14 (p=0.53)] and 45.3 days/year (range 0-75, SD 29.8) to 30.4 days/year [range 4-68, SD 24.48 (p=0.08)] respectively. In group D, there was a non-significant increase in admissions from 11.64 days/year (range 0-43, SD 15.33) to 42.26 days/year [range 3-190, SD 65.75 (p=0.161)]. A slight increase in mean serum ferritin levels was seen post initiation of an exchange transfusion program (pre 2523μg/L (range 11-15990, SD 3198) to post 2659μg/L [range 21-14229, SD 3229 (p=0.10)]. The data from one patient were excluded from analysis because the patient was on iron chelation. There was a strong negative correlation between serum ferritin levels and the patient's steady state Hb (r= -0.73, see graph A). The line of best fit went through no net ferritin change at the Hb level of 10.5g/dL, the midpoint of the target Hb range. This suggests that the ‘top-up’ of patients with a low pre-exchange Hb with extra donor red blood cells (carried out automatically by the exchange machine to get the patient's Hb up to the post-exchange target level) is also increasing the patient's iron loading. CONCLUSIONS Reduction in hospital admissions for sickle cell patients on erythrocytopheresis is dependent on a good patient consistency and compliance with treatment schedules. A statistically significant reduction in the average hospital admission days per year is lost when erythrocytapheresis exchanges are further than 8 weeks apart. Iron loading on exchange transfusion correlates to the patient's steady-state Hb, with patients achieving a baseline Hb of less than the target level (10g/dL) increasing their iron load. Graph A Graph demonstrating the correlation between the steady state Hb and the change in ferritin levels (n=33) Graph A. Graph demonstrating the correlation between the steady state Hb and the change in ferritin levels (n=33) Disclosures No relevant conflicts of interest to declare.
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Watanabe, Yumi, Kaori Kitamura, Kazutoshi Nakamura, Kazuhiro Sanpei, Minako Wakasugi, Akio Yokoseki, Osamu Onodera, et al. "Elevated C-Reactive Protein Is Associated with Cognitive Decline in Outpatients of a General Hospital: The Project in Sado for Total Health (PROST)." Dementia and Geriatric Cognitive Disorders Extra 6, no. 1 (January 19, 2016): 10–19. http://dx.doi.org/10.1159/000442585.
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Background/Aims: We aimed to determine whether the concentration of serum C-reactive protein (CRP) is associated with cognitive function in an adult Japanese population. Methods: Participants of this cross-sectional study were from a subgroup of the Project in Sado for Total Health (PROST; n = 454; mean age, 70.5 years). The cognitive state was evaluated using the Mini-Mental State Examination (MMSE), and those with an MMSE score <24 were considered ‘cognitively declined'. Concentrations of serum high-sensitivity CRP were measured. Multiple logistic regression analysis was used to calculate odds ratios (ORs) for cognitive decline, adjusting for the covariates of age, sex, BMI, disease history, and APOE allele. Results: Of the 454 participants, 94 (20.7%) were cognitively declined. Relative to the lowest (first) quartile of CRP concentration, adjusted ORs were 1.29 (95% CI 0.61-2.75) for the second, 1.78 (95% CI 0.82-3.86) for the third, and 3.05 (95% CI 1.45-6.42) for the highest (fourth) quartiles (p for trend = 0.018). When data were stratified by sex, the association between CRP concentration and cognitive decline was observed only in women. Conclusion: Our findings suggest an association between higher CRP concentration and lower cognitive function. Chronic inflammation may affect cognitive function in adults, in particular women.
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Mokhnacheva, Т. Е., Y. Y. Monogarova, Zh L. Varakina, and А. V. Kudryavtsev. "Implementation of SCORE calculator into the medical information system of the primary care." Manager Zdravoochranenia, no. 5 (June 1, 2022): 58–67. http://dx.doi.org/10.37690/1811-0185-2022-5-58-67.
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In the Russian Federation, disease prevention in primary care is a priority area of medical care for the adult population. An automated assessment of the risk of death from cardiovascular disease can be an auxiliary preventive tool if integrated intoa medical information system. P u r p o s e o f t h e s t u d y – to substantiate the automation of the process of assessing the risk of death from cardiovascular diseases over the next 10 years using the SCORE scale at the level of a city hospital. M a t e r i a l s a n d m e t h o d s . The study was carried outat the State Budgetary Medical Institution of Arkhangelsk region “Arkhangelsk City Clinical Hospital № 7”. The completeness and quality of electronic patient records were assessed. The SCORE calculator was integrated into the examination protocol for primary care physicians. The effects of the innovation on the completeness and quality of electronic patient records were assessed. R e s u l t s a n d d i s c u s s i o n . Among the served population aged 40 to 79 years, any information on risk factors for cardiovascular diseases was reflected in 28,7% of electronic patient records. Data on all variables used to assess the risk on the SCORE scale (gender, age, systolic blood pressure, smoking, cholesterol level) were present for 20,8% of the patients. The introduction of the SCORE automated calculator into the examination protocol of a general practitioner and a cardiologist made it possibleto increase the completeness of data on cardiovascular disease risk factors used for the risk assessment on the SCORE scale to 97,4%. C o n c l u s i o n s . The introduction of the SCORE automated calculator has significantly increased the completeness of data on the main risk factors for cardiovascular diseases in patients’ electronic patient records. The innovation makes it possible to reduce labor costs forestimatingthe risks, allowsmore effective identification of persons subject to dispensary observation.
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Kozyro, I. A., А. V. Sukalo, and О. A. Kondratenko. "THE STATE OF THE CARDIOVASCULAR SYSTEM IN CHILDREN OF KIDNEY TRANSPLANT RECIPIENTS." Medical Journal, no. 3(77) (2021): 65–70. http://dx.doi.org/10.51922/1818-426x.2021.3.65.
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Damage of the cardiovascular system (cardiovascular disease, CVD) is the main cause of reduced life expectancy in children with chronic kidney disease (CKD). In the development of damage of the heart and blood vessels, both traditional factors and caused by impaired renal function, which appear already in the early stages of kidney disease, play a role. Purpose of the study: assessment of markers of the structure, function and metabolism of the heart and study of their changes in children, kidney transplant recipients. Materials and methods. 54 children, a kidney transplant recipients (Tx), who were under observation and treatment at the National Center for Pediatric Nephrology and Renal Replacement Therapy, Minsk 2nd Children's City Clinical Hospital, aged 3 to 17 years, were included in the study. The analysis of the data of the Tx group and conditionally divided subgroups: 1) with glomerular disease leading to the end stage of CKD (ESRD), n = 26; 2) with non-glomerular pathology, n = 27, in one patient the cause of ESRD was not specified. The control group consisted of healthy children from cardiology department without kidney pathology (n = 86). Results. Anamnestic, clinical, laboratory, immunological (serum concentration of T- and B-lymphocyte activation markers (RANTES and BAFF), proinflammatory (caspase 1, IL1fi and TNFa), vascular (VEGF) and tissue (TGF1p) growth factors), metabolic status (adyponectin, leptin, obestatin, vitamin D 25(OH)D), cardiospecific molecules (highly sensitive C-reactive protein (hsCRP), proBNP, transferrin, TSAT index), instrumental changes. Conclusion. Changes in the cardiovascular system in Tx are ambiguous. On the one hand, there is a significant improvement in the geometry of the myocardium and arterial hypertension, on the other hand, the atherogenic direction of metabolic changes and biochemical markers of CVD remains.
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DOTEVALL, Annika, Johannes HULTHE, Annika ROSENGREN, Olov WIKLUND, and Lars WILHELMSEN. "Autoantibodies against oxidized low-density lipoprotein and C-reactive protein are associated with diabetes and myocardial infarction in women." Clinical Science 101, no. 5 (October 3, 2001): 523–31. http://dx.doi.org/10.1042/cs1010523.
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Women with diabetes mellitus are at high risk of myocardial infarction (MI), and it is well recognized that smoking, hypertension, hyperlipidaemia and the diabetic state itself do not fully explain this increased risk. During the last decade, growing evidence has accumulated that the immune system, with oxidized low-density lipoprotein (LDL) as a key antigen, plays an important role in the development of atherosclerosis. The aim of the present study was to explore the association between the immune response, as measured by antibody titres to malondialdehyde-treated LDL (MDA-LDL) and levels of C-reactive protein (CRP; a marker of inflammation), and diabetes mellitus and MI in women. Women (35-64 years) with diabetes (n = 18) and non-diabetic women (n = 46) who had been treated in hospital for MI were compared with diabetic women without MI (n = 35) and healthy controls (n = 70). Blood samples were collected after an overnight fast. CRP was determined with a highly sensitive immuno-enzymometric assay. IgM and IgG antibodies against MDA-LDL were analysed with a solid-phase ELISA technique. Women with diabetes but without previous MI were more similar to women with previous MI (both with and without diabetes) than to the healthy controls. Compared with healthy women, the women with diabetes and/or MI had higher IgG (P < 0.05) and lower IgM (P = 0.006) antibody titres against oxidized LDL and higher CRP levels (P < 0.001), associations that were independent of other cardiovascular risk factors. These findings might indicate a differentiated immune response against modified LDL, more pronounced inflammation and a more aggressive atherosclerotic process in women with diabetes.
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Rock, Clare, Rebecca Perlmutter, David Blythe, Jacqueline Bork, Kimberly Claeys, Sara E. Cosgrove, Kate Dzintars, et al. "Impact of Statewide Prevention and Reduction of Clostridioides difficile (SPARC), a Maryland public health–academic collaborative: an evaluation of a quality improvement intervention." BMJ Quality & Safety 31, no. 2 (December 9, 2021): 153–62. http://dx.doi.org/10.1136/bmjqs-2021-014014.
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To evaluate changes in Clostridioides difficile incidence rates for Maryland hospitals that participated in the Statewide Prevention and Reduction of C. difficile (SPARC) collaborative. Pre-post, difference-in-difference analysis of non-randomised intervention using four quarters of preintervention and six quarters of postintervention National Healthcare Safety Network data for SPARC hospitals (April 2017 to March 2020) and 10 quarters for control hospitals (October 2017 to March 2020). Mixed-effects negative binomial models were used to assess changes over time. Process evaluation using hospital intervention implementation plans, assessments and interviews with staff at eight SPARC hospitals. Maryland, USA. All Maryland acute care hospitals; 12 intervention and 36 control hospitals. Participation in SPARC, a public health–academic collaborative made available to Maryland hospitals, with staggered enrolment between June 2018 and August 2019. Hospitals with higher C. difficile rates were recruited via email and phone. SPARC included assessments, feedback reports and ongoing technical assistance. Primary outcomes were C. difficile incidence rate measured as the quarterly number of C. difficile infections per 10 000 patient-days (outcome measure) and SPARC intervention hospitals’ experiences participating in the collaborative (process measures). SPARC invited 13 hospitals to participate in the intervention, with 92% (n=12) participating. The 36 hospitals that did not participate served as control hospitals. SPARC hospitals were associated with 45% greater C. difficile reduction as compared with control hospitals (incidence rate ratio=0.55, 95% CI 0.35 to 0.88, p=0.012). Key SPARC activities, including access to trusted external experts, technical assistance, multidisciplinary collaboration, an accountability structure, peer-to-peer learning opportunities and educational resources, were associated with hospitals reporting positive experiences with SPARC. SPARC intervention hospitals experienced 45% greater reduction in C. difficile rates than control hospitals. A public health–academic collaborative might help reduce C. difficile and other hospital-acquired infections in individual hospitals and at state or regional levels.
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Evdakov, V. A., M. N. Banteva, E. M. Manoshkina, and Y. Y. Melnikov. "Efficiency indicators of the round-the-clock hospital beds of the oncologic profile in the Russian Federation." Manager Zdravoochranenia, no. 10 (2020): 12–18. http://dx.doi.org/10.37690/1811-0185-2020-10-12-18.
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The steady growth trend of oncological diseases in Russia in recent years requires a response from the health care system: development of prevention aimed at early detection of diseases; improvement of methods of diagnostics and treatment of oncopathology; improving the quality and effectiveness of medical care. A i m : to identify trends in changes of the neoplasms incidence and performance indicators of oncological beds for round-the-clock stay of the state health care system in the Russian Federation, federal districts and regions of the Russian Federation in dynamics for 2010–2019. M a t e r i a l s a n d m e t h o d s . Using the data of federal statistical observation (forms NoNo. 12, 30) by the method of descriptive statistics, the main indicators of the neoplasms incidence in the population are analyzed, as well as the work of round-the-clock oncological beds in the Russian Federation, federal districts and regions of the Russian Federation in dynamics for 2010–2019. R e s u l t s . On the background of an increase in the neoplasms incidence in the population (by 24.9%), including malignant (1.5 times), for the period 2010–2019 in the Russian Federation increased: the absolute number of oncology beds of round-the-clock stay from 30,970 to 36,186 (+ 16.8%), the provision with these beds from 2.17 to 2.47 per 10,000 population (+ 13.8%), hospitalization rate from 6.1 to 9.6 per 1000 population (+ 57.4%), and decreased: the average length of stay in an oncological bed (from 12.1 days to 8.4 – by 30.6%), as well as the average bed occupancy per year (from 345 to 330 days – by 4.3%). The extreme values of the indicators of the hospitalization rate for round-the-clock oncological beds in the regions of the Russian Federation in 2019 differ 12.8 times, the provision of these beds – 9.2 times, the average bed occupancy per year – 1.5 times, the average length of stay in a bed – 2.4 times. Mortality in oncological hospital beds increased from 0.76% in 2010 to 0.95% in 2019 (by 25%). C o n c l u s i o n . The 24-hour oncological bed capacity, against the background of the growth of oncological morbidity, has naturally increased, but at the same time it is characterized by an extreme disproportionality of development in the Federal Districts and the regions of the Russian Federation. Optimization of the bed fund should be carried out based on the objective needs of a particular region, taking into account its characteristics and with the simultaneous development of alternative medical services.
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Dalton, Jarrod E., Laurent G. Glance, Edward J. Mascha, John Ehrlinger, Nassib Chamoun, and Daniel I. Sessler. "Impact of Present-on-admission Indicators on Risk-adjusted Hospital Mortality Measurement." Anesthesiology 118, no. 6 (June 1, 2013): 1298–306. http://dx.doi.org/10.1097/aln.0b013e31828e12b3.
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Abstract Background: Benchmarking performance across hospitals requires proper adjustment for differences in baseline patient and procedural risk. Recently, a Risk Stratification Index was developed from Medicare data, which used all diagnosis and procedure codes associated with each stay, but did not distinguish present-on-admission (POA) diagnoses from hospital-acquired diagnoses. We sought to (1) develop and validate a risk index for in-hospital mortality using only POA diagnoses, principal procedures, and secondary procedures occurring before the date of the principal procedure (POARisk) and (2) compare hospital performance metrics obtained using the POARisk model with those obtained using a similarly derived model which ignored the timing of diagnoses and procedures (AllCodeRisk). Methods: We used the 2004–2009 California State Inpatient Database to develop, calibrate, and prospectively test our models (n = 24 million). Elastic net logistic regression was used to estimate the two risk indices. Agreement in hospital performance under the two respective risk models was assessed by comparing observed-to-expected mortality ratios; acceptable agreement was predefined as the AllCodeRisk-based observed-to-expected ratio within ±20% of the POARisk-based observed-to-expected ratio for more than 95% of hospitals. Results: After recalibration, goodness of fit (i.e., model calibration) within the 2009 data was excellent for both models. C-statistics were 0.958 and 0.981, respectively, for the POARisk and AllCodeRisk models. The AllCodeRisk-based observed-to-expected ratio was within ±20% of the POARisk-based observed-to-expected ratio for 89% of hospitals, which was slightly lower than the predefined limit of agreement. Conclusion: Consideration of POA coding meaningfully improved hospital performance measurement. The POARisk model should be used for risk adjustment when POA data are available.
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Anyanwu, Chinwe F., Wolie A. Obianime, Iyeopu M. Siminialayi, and Eric O. Aigbogun. "Evaluating the effects of Moringa oleifera on atherogenic lipoprotein indices of HIV infected Nigerian adults on tenofovir-based antiretroviral regimen." International Journal of Basic & Clinical Pharmacology 8, no. 6 (May 23, 2019): 1312. http://dx.doi.org/10.18203/2319-2003.ijbcp20192195.
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Background: The administration of tenofovir (TDF) based (tenofovir/ lamivudine/efavirenz) antiretroviral regimen for the management of HIV has remained a concern to both clinicians and patients, thus necessitating the need for suitable supplement for the management of ART induced metabolic abnormalities. The study evaluated the effects of Moringa supplementation on the atherogenic lipoprotein indices of HIV patients on TDF-based regimen at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.Methods: The study was designed as a time dependent investigation structured into 3 visits, visit 1 (cross sectional, baseline), visit 2 (4 weeks after administration) and visit 3 (12 weeks post administration). Subjects recruited (140) into this study comprised of two groups, TDF-M (n=56, administered Moringa Supplement) and TDF-NM (n=84, no supplement).Results: At baseline, more than 50% of the patients had at least one abnormal atherogenic lipoprotein indices (Log (TC/HDL-C) = 85.7%, TC/HDL-C=58.5% and LDL-C/HDL-C=51.4%), although at lower limits. At the end of 12 weeks of Moringa supplement administration, the results showed subjects in the TDF-M group who were at risk of CVD had fallen to 20%, indicating a dramatic (40.4%) decrease, while the prevalence of TDF-NM subject at risk of CVD rose to 53.6% (χ2=26.67, P <0.001). HIV patients on TDF-based regime, who were at risk of CVD had elevated triglycerides and low-density lipoprotein cholesterols which inversely affected the levels of high-density lipoprotein and negatively impacting the atherogenic indices.Conclusions: Moringa oleifera supplementation may be helpful in ameliorating the metabolic abnormalities associated with HIV patients on TDF-based regimen.
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Hiebert, Elizabeth C., David L. Panciera, Katie M. Boes, and Lara Bartl. "Platelet function in cats with hyperthyroidism." Journal of Feline Medicine and Surgery 22, no. 12 (May 21, 2020): 1214–18. http://dx.doi.org/10.1177/1098612x20920585.
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Objectives Cats with hyperthyroidism have been reported to develop thromboembolism, with and without echocardiographic abnormalities consistent with hyperthyroidism. The objective of this study was to compare platelet function in cats with hyperthyroidism with euthyroid age-matched cats. We hypothesized that cats with hyperthyroidism have shortened collagen and adenosine diphosphate (C-ADP) closure times as measured with the platelet function analyzer (PFA-100) in comparison with healthy, age-matched controls. Methods Sixteen hyperthyroid and nine euthyroid healthy cats >7 years of age were recruited from the hospital population. Platelet function, measured using the C-ADP closure times by the PFA-100, and platelet count were measured in healthy euthyroid cats and cats with hyperthyroidism. Results Mean ± SD closure times were not significantly different between control (66.3 ± 9.6 s) and hyperthyroid cats (65.9 ± 11.5 s; P = 0.75). The mean ± SD closure times of hyperthyroid cats that either were untreated or received methimazole for ⩽3 weeks (n = 6; mean 68.5 ± 15.4 s) was not different than that of cats treated for >3 weeks (n = 10; mean 64.3 ± 8.9 s; P = 0.57). The mean automated platelet count was higher in the hyperthyroid group than in the control group ( P = 0.023). Conclusions and relevance Platelet function, as measured by closure time under high shear conditions using C-ADP as an agonist, was not affected by hyperthyroidism in this group of cats. Further research is needed to determine if a hypercoagulable state exists in hyperthyroid cats and the potential roles platelets and von Willebrand factor may have.
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Luu, Dai Chu Nguyen, Xiaobai Li, Julia Ojcius, Peter Muscarella, Edwin Christopher Ellison, Lavina Malhotra, Mark Bloomston, and Tanios S. Bekaii-Saab. "Retrospective analysis of treatment effects and prognostic factors associated with overall survival in patients with resected adenocarcinoma of the pancreas." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 359. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.359.
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359 Background: The role of adjuvant chemotherapy in pancreas cancer has been well established. The role of radiation therapy however remains controversial. The ESPAC-1 study showed a possible deleterious effect for radiation on survival of patients with resected pancreas cancer, although the study was limited by lack of compliance and quality control. Methods: We performed a retrospective analysis of patients who underwent curative resection of their cancer of the pancreas over the last 2 decades at the Ohio State University. 333 patients with adenocarcinoma of the pancreas were identified from our database and 148 subjects were found with complete treatment information available. Thirty patients had no treatment after resection. Log-rank test was used to compare the overall survival (OS) of two groups of patients: treated with chemotherapy (C, N=68) or fluoropyrimidine-based chemoradiation (CRT, N=50). Demographics of the CT and CRT groups were balanced. Patient characteristics including age, sex, tumor size, tumor location, tumor grade, nodal status, margins (R0 vs. R1) and number of hospitalizations within a six-month period of discharge from the hospital after surgery were compared across all groups. The effect of these variables on OS was assessed using log-rank test. Results: The mOS for C (21.5 months, 95% CI; 13.5, 24.6) and CRT (16.8 months, 95% CI; 13.9, 23.1) were similar. There was no statistically significant difference observed for C vs. CRT (p>0.8). Out of all the characteristic variables tested (N= 148), only the presence of at least one positive lymph node vs. none had a statistically significant negative effect on survival (mOS of 12.20 months vs. 23.10 months; p=0.0053). Conclusions: In patients with resected adenocarcinoma of the pancreas, the addition of radiation does not seem to add benefit. The presence of positive lymph nodes is an adverse prognostic factor on overall survival.
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Helissey, Carole, Clémentine Riviere, Charles Parnot, Claire Duverger, Selma Becheriat, Perrine Vuagnat, Antoine Schernberg, et al. "Early patient-reported outcomes are a promising predictive factor of cancer progress and outcome in older patients: The EPROFECY study." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 12045. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.12045.
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12045 Background: Contrary to commonly-held beliefs, older patients (OPs, aged 70 or more) in oncology are compliant with the use of a telemonitoring digital platform. Such a tool allows the medical team to gain detailed knowledge of the tolerance profile of patients, and help monitor and maintain their quality of life, which is a particularly important goal for older patients. The EPROFECY study assesses the predictive power of the patient health status in the first month of treatment, evaluated with the digital telemonitoring platform Cureety, on survival. Methods: This prospective study was conducted at the Military Hospital Bégin on OPs. Patients were allowed to respond to a symptomatology questionnaire based on CTCAE v.5.0, personalized to their pathology and treatment. An algorithm evaluated the patient status based on reported adverse events: correct (A), compromised (B), to be monitored (C) and critical state (D). For A/B (good health status), the patient received therapeutic advice to help manage each of the reported adverse events. For C/D (poor health status), the patient was invited to call the hospital. To assess the early tolerance of patience to their treatments, we determined the health status in the 1st month after initiation of treatment, which was classified as “Good health” (GH, majority of A/B reports) or “Poor health” (PH, majority of C/D reports). The primary endpoint was to assess if the first-month tolerance is a predictive factor of progression free-survival (PFS). The secondary endpoint was to assess if the first-month tolerance is a predictive factor of overall survival (OS). Results: Sixty-one patients were enrolled between July 1st, 2020 and September 30th, 2021. The median age was 78.0 years (range 70.0 – 99.0), with 81% presenting a metastatic stage, and the most represented cancer being prostate cancer. The median follow-up was 8.2 months. Overall, 2299 ePRO were completed, 89% (n= 2036) corresponding to a "correct" or a "compromised" state and only 11% (n=263) corresponding to a state "to be monitored" or "critical". Based on the first month of questionnaires, 62% of the patients were classified in the GH group, and 38% in the PH group. The PFS ratio at 6 months was 64.6 % in GH vs 23.4 % in PH (HR = 0.1980, 95% CI = 0.04431–0.8845, p = 0.0339). The OS ratio at 6 months was 100% in GH versus 95.5 % in PH (HR: 0.69, 95 % CI = 0.06 – 8.29, p = 0.77). Conclusions: This is the first study that assesses the use of PRO-based tolerance as a predictive factor of treatment response in older individuals. We demonstrated here a significant 80% reduction in the risk of progression in OPs that exhibited a good first-month tolerance. This suggests that e-PRO follow-up might be an effective predictor of response and a tool to treatment plan.
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Helissey, Carole, Clémentine Riviere, Charles Parnot, Claire Duverger, Selma Becheriat, Perrine Vuagnat, Antoine Schernberg, et al. "Early patient-reported outcomes are a promising predictive factor of cancer progress and outcome in older patients: The EPROFECY study." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 12045. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.12045.
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12045 Background: Contrary to commonly-held beliefs, older patients (OPs, aged 70 or more) in oncology are compliant with the use of a telemonitoring digital platform. Such a tool allows the medical team to gain detailed knowledge of the tolerance profile of patients, and help monitor and maintain their quality of life, which is a particularly important goal for older patients. The EPROFECY study assesses the predictive power of the patient health status in the first month of treatment, evaluated with the digital telemonitoring platform Cureety, on survival. Methods: This prospective study was conducted at the Military Hospital Bégin on OPs. Patients were allowed to respond to a symptomatology questionnaire based on CTCAE v.5.0, personalized to their pathology and treatment. An algorithm evaluated the patient status based on reported adverse events: correct (A), compromised (B), to be monitored (C) and critical state (D). For A/B (good health status), the patient received therapeutic advice to help manage each of the reported adverse events. For C/D (poor health status), the patient was invited to call the hospital. To assess the early tolerance of patience to their treatments, we determined the health status in the 1st month after initiation of treatment, which was classified as “Good health” (GH, majority of A/B reports) or “Poor health” (PH, majority of C/D reports). The primary endpoint was to assess if the first-month tolerance is a predictive factor of progression free-survival (PFS). The secondary endpoint was to assess if the first-month tolerance is a predictive factor of overall survival (OS). Results: Sixty-one patients were enrolled between July 1st, 2020 and September 30th, 2021. The median age was 78.0 years (range 70.0 – 99.0), with 81% presenting a metastatic stage, and the most represented cancer being prostate cancer. The median follow-up was 8.2 months. Overall, 2299 ePRO were completed, 89% (n= 2036) corresponding to a "correct" or a "compromised" state and only 11% (n=263) corresponding to a state "to be monitored" or "critical". Based on the first month of questionnaires, 62% of the patients were classified in the GH group, and 38% in the PH group. The PFS ratio at 6 months was 64.6 % in GH vs 23.4 % in PH (HR = 0.1980, 95% CI = 0.04431–0.8845, p = 0.0339). The OS ratio at 6 months was 100% in GH versus 95.5 % in PH (HR: 0.69, 95 % CI = 0.06 – 8.29, p = 0.77). Conclusions: This is the first study that assesses the use of PRO-based tolerance as a predictive factor of treatment response in older individuals. We demonstrated here a significant 80% reduction in the risk of progression in OPs that exhibited a good first-month tolerance. This suggests that e-PRO follow-up might be an effective predictor of response and a tool to treatment plan.
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Grand, Johannes, Gisela Lilja, Jesper Kjaergaard, John Bro-Jeppesen, Hans Friberg, Michael Wanscher, Tobias Cronberg, Niklas Nielsen, and Christian Hassager. "Arterial blood pressure during targeted temperature management after out-of-hospital cardiac arrest and association with brain injury and long-term cognitive function." European Heart Journal: Acute Cardiovascular Care 9, no. 4_suppl (June 27, 2019): S122—S130. http://dx.doi.org/10.1177/2048872619860804.
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Objectives: During targeted temperature management after out-of-hospital cardiac arrest infusion of vasoactive drugs is often needed to ensure cerebral perfusion pressure. This study investigated mean arterial pressure after out-of-hospital cardiac arrest and the association with brain injury and long-term cognitive function. Methods: Post-hoc analysis of patients surviving at least 48 hours in the biobank substudy of the targeted temperature management trial with available blood pressure data. Patients were stratified in three groups according to mean arterial pressure during targeted temperature management (4–28 hours after admission; <70 mmHg, 70–80 mmHg, >80 mmHg). A biomarker of brain injury, neuron-specific enolase, was measured and impaired cognitive function was defined as a mini-mental state examination score below 27 in 6-month survivors. Results: Of the 657 patients included in the present analysis, 154 (23%) had mean arterial pressure less than 70 mmHg, 288 (44%) had mean arterial pressure between 70 and 80 mmHg and 215 (33%) had mean arterial pressure greater than 80 mmHg. There were no statistically significant differences in survival ( P=0.35) or neuron-specific enolase levels ( P=0.12) between the groups. The level of target temperature did not statistically significantly interact with mean arterial pressure regarding neuron-specific enolase ( Pinteraction_MAP*TTM=0.58). In the subgroup of survivors with impaired cognitive function ( n=132) (35%) mean arterial pressure during targeted temperature management was significantly higher ( Pgroup=0.03). Conclusions: In a large cohort of comatose out-of-hospital cardiac arrest patients, low mean arterial pressure during targeted temperature management was not associated with higher neuron-specific enolase regardless of the level of target temperature (33°C or 36°C for 24 hours). In survivors with impaired cognitive function, mean arterial pressure during targeted temperature management was significantly higher.
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Zivkovic, Zorica, and Slavica Golubovic. "Tongue mobility in patients with cerebral palsy." Vojnosanitetski pregled 69, no. 6 (2012): 488–91. http://dx.doi.org/10.2298/vsp1206488z.
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Background/Aim. In children with cerebral palsy speech is a big problem. Speech of these children is more or less understandable, depending on the degree of reduced mobility of articulatory organs. Reduced mobility is affected by inability to control facial grimacing and poor muscle strength when performing targeted movements. The aim of this study was to determine the mobility of tongue in patients with cerebral palsy. Methods. The study included a sample of 34 children - patients with cerebral palsy who had been treated in the Special Hospital for the Cerebral Palsy and Developmental Neurology in Belgrade. The patients were divided according to the determined diagnosis into two groups: Quadriparesis spastica (n = 11) and Morbus Little (n = 16). The children, aged 8-12 years, had preserved intelectual abilities, and all of them had preserved hearing. The study was conducted during the period from January to September 2009. The functional state of articulatory organs in both groups was tested by the C-test that examines the anatomic structure and mobility of the articulatory organs. Results. Our research showed that both groups of the patients had impaired functional state of the tongue - the most mobile articulatory organ. Also, the research showed that the functional state of the tongue was worse in children diagnosed with Quadriparesis spastica. A statistically significant correlation between the diagnosis and the functional state of the tongue, the tongue test performance and the retention of the tongue in a given position was found (r = 0.594, p < 0.005; r = 0.816, p < 0.01 and r = 0.738, p < 0.001, respectively). Conclusion. A large percentage of children with cerebral palsy were not able to establish control over the position of articulatory organs, especially the tongue, and its retention in a given position, all of which affect the quality of speech.
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KHAN, SADIA, ASMA TANVEER USMANI, and NAILA IFTIKHAR. "MATERNAL MORTALITY." Professional Medical Journal 16, no. 03 (September 10, 2009): 445–553. http://dx.doi.org/10.29309/tpmj/2009.16.03.2880.
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Objective: The women residing in a developing country have 200 times greater risk of suffering from pregnancy and childbirthrelated mortality compared with the women of a developed country. To investigate relevant causes and the determinants of maternal mortalitythrough conducting scientific clinical studies. Methodologies: We conducted a prospective study of maternal deaths in the obstetrics andgynaecology unit of RGH for one year. Period: January 2007 to December 2007. We investigated the socio-demographic variables - includingage, parity, socio-economic status and literacy - along with the social behavior towards the antenatal. We designed standardized data collectingforms to collect data from the confidential hospital notes of the patients. The collected medical data of the patients proved useful in analyzingthe underlying causes and the risk factors behind direct and indirect maternal mortalities. Results: In our unit, we have recorded 28 maternaldeaths during the study period. 24 (86%) deaths are due to the direct causes and 4 (14%) are due to the indirect causes. The leading directcauses are hemorrhage 9 (37.5%), eclampsia 7 (29%), septicemia 5 (21%) and anaesthesia complications 2 (8%). Similarly, the distributionof indirect causes is: blood transfusion reactions 2 (50 %), hepatic failure 2 (50 %), Consequently, crude maternal mortality rate can beextrapolated at 645 per 100,000 maternities and maternal mortality ratio at 659 per 100,000 live births. The socio demographics of the deadmothers are: 16 (57%) patients in the age group of 25-35 years, 13 (52%) are multiparas (G2-G4) and 10 (36%) are grandmulti para i.e. G5and above. Moreover, 13 (46%) of them expired at term. The majority of them is illiterate and belongs to lower socio-economic group. 14 (42%)mothers have not received antenatal care and just 4 (15%) of them have received antenatal care from RGH or other hospital. 23 (92%) patientshave been suffering from anemia and we received 15 (54%) of them in a critical state with the hospital stay of less than 12 hours. C o n c l u s i o n :In our study hemorrhage and hypertensive disorders of pregnancy are the leading causes of maternal deaths. We argue that most of thesematernal deaths could have been possibly avoided by periodic interventions during the pregnancy, child birth and the postpartum period.
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Demirbilek, Huseyin, Ved Bhushan Arya, Mehmet Nuri Ozbek, Jayne A. L. Houghton, Riza Taner Baran, Melek Akar, Selahattin Tekes, et al. "Clinical characteristics and molecular genetic analysis of 22 patients with neonatal diabetes from the South-Eastern region of Turkey: predominance of non-KATP channel mutations." European Journal of Endocrinology 172, no. 6 (June 2015): 697–705. http://dx.doi.org/10.1530/eje-14-0852.
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BackgroundNeonatal diabetes mellitus (NDM) is a rare form of monogenic diabetes and usually presents in the first 6 months of life. We aimed to describe the clinical characteristics and molecular genetics of a large Turkish cohort of NDM patients from a single centre and estimate an annual incidence rate of NDM in South-Eastern Anatolian region of Turkey.Design and methodsNDM patients presenting to Diyarbakir Children State Hospital between 2010 and 2013, and patients under follow-up with presumed type 1 diabetes mellitus, with onset before 6 months of age were recruited. Molecular genetic analysis was performed.ResultsTwenty-two patients (59% males) were diagnosed with NDM (TNDM-5; PNDM-17). Molecular genetic analysis identified a mutation in 20 (95%) patients who had undergone a mutation analysis. In transient neonatal diabetes (TNDM) patients, the genetic cause included chromosome 6q24 abnormalities (n=3),ABCC8(n=1) and homozygousINS(n=1). In permanent neonatal diabetes (PNDM) patients, homozygousGCK(n=6),EIF2AK3(n=3),PTF1A(n=3), andINS(n=1) and heterozygousKCNJ11(n=2) mutations were identified. Pancreatic exocrine dysfunction was observed in patients with mutations in the distalPTF1Aenhancer. Both patients with aKCNJ11mutation responded to oral sulphonylurea. A variable phenotype was associated with the homozygous c.-331C>AINSmutation, which was identified in both a PNDM and TNDM patient. The annual incidence of PNDM in South-East Anatolian region of Turkey was one in 48 000 live births.ConclusionsHomozygous mutations inGCK,EIF2AK3and the distal enhancer region ofPTF1Awere the commonest causes of NDM in our cohort. The high rate of detection of a mutation likely reflects the contribution of new genetic techniques (targeted next-generation sequencing) and increased consanguinity within our cohort.
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Anderson, Alex Kojo, Evan Johnson, Nicole Motoyasu, and Whitney E. Bignell. "Awareness of Breastfeeding Laws and Provisions of Students and Employees of Institutions of Higher Learning in Georgia." Journal of Human Lactation 35, no. 2 (December 3, 2018): 323–39. http://dx.doi.org/10.1177/0890334418801536.
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Background: Over the past 2 decades, southern states in the United States have recorded the lowest breastfeeding rates. It is not known whether awareness of breastfeeding laws and provision of resources play any role in their breastfeeding practices. Research aims: The aims were (a) to describe awareness of breastfeeding laws and provisions by students and employees of institutions of higher learning in the state of Georgia, (b) to describe awareness by race and ethnicity, and (c) to determine factors associated with awareness of breastfeeding laws and provisions among students and employees within Georgia institutions of higher learning. Methods: A cross-sectional online survey of students ( n = 1,923) and employees ( n = 1,311) associated with five institutions within the University System of Georgia ( N = 3,271) was completed. Convenience sampling was used. Data were collected through Qualtrics. Chi-square test was used to examine differences between groups, while logistic regression was used to examine associations. Results: Participants included 33.3% undergraduate, 26.2% graduate students, 24.6% staff, 14.2% faculty, and 1.7% administrators. Over two thirds were female and white. Almost one third reported having a child or children. Awareness of breastfeeding laws and provisions was very low among respondents, with 26.6 and 9.6% aware of federal and state provisions, respectively. While less than 10% were familiar with the Baby Friendly Hospital Initiative program, 52.6% reported their institution provides a supportive environment for breastfeeding. Being a student and being a minority were negatively associated with awareness of laws and provisions that support breastfeeding. Conclusion: The need for focused efforts on increasing awareness of legislative and institutional provisions and support for breastfeeding exists.
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Mokrini, F., L. Waeyenberge, N. Viaene, and M. Moens. "First Report of the Cereal Cyst Nematode Heterodera latipons on Wheat in Morocco." Plant Disease 96, no. 5 (May 2012): 774. http://dx.doi.org/10.1094/pdis-11-11-0999-pdn.
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From May to June 2011, during a survey of the wheat-growing areas in Meknes in the Saïs Region of Morocco, several cyst nematode populations were detected. Sampling was performed 1 month before wheat (Triticum durum) harvest, in fields showing patches of stunted plants. Plants were growing poorly, had chlorotic lower leaves, and a reduced numbers of ears. Root systems were short and had a bushy appearance because of increased secondary root production. No cysts were visible on the roots, but were found in the soil. Cysts were collected from soil on 200-μm sieves by the modified Cobb decanting and sieving method (1) and identified by morphology and internal transcribed spacer (ITS)-rDNA sequencing. All isolates were identified as Heterodera avenae except the isolate from Aïn Jemâa. From the latter, key morphological features from cysts and second-stage juveniles (J2) were determined. The cysts (n = 10) had the following characteristics: bifenestrate vulval cone, body length without neck 590 μm (551 to 632 μm), body width 393 μm (310 to 490 μm), neck length 75 μm (65 to 90 μm), fenestra length 64 μm (60 to 72 μm) and width 21 μm (18 to 25 μm), underbridge length 96 μm (85 to 115 μm), vulval slit length 8 μm (7 to 9 μm), vulva bridge width 27 μm (24 to 33 μm), and bullae absent. The J2s (n = 10) had the following characteristics: body length 445 μm (412 to 472 μm), body width 19 μm (19 to 21 μm), stylet length 24 μm (23 to 25 μm), four lateral lines, tail length 50 μm (46 to 54 μm), and hyaline terminal tail 28 μm (24 to 31 μm). Values of the morphological characters were within the range of H. latipons reported by Handoo (3). The bifenestrate cysts with a strong underbridge and no bullae and J2 with a tail length greater than 40 μm, a stylet longer than 15 μm, and four incisures in the lateral field were typical for H. latipons. To confirm the identification, molecular observations were made. DNA was extracted from three juveniles from three different cysts separately (4). The ITS-rDNA region was amplified using the primers 5′-CGT AAC AAG GTA GCT GTA G-3′ and 5′-TCC TCC GCT AAA TGA TAT G-3′ as described by Ferris et al. (2). This resulted in a 1,040-bp DNA fragment. The PCR-products were purified and sequenced (Macrogen, Inc., Seoul, Korea). All sequences obtained (GenBank Accession Nos. per cyst: JQ319035, JQ319036, and JQ319037) were compared with sequences available from the GenBank database ( www.ncbi.nlm.nih.gov ), including several species of Heterodera. This comparison revealed a sequence similarity of 97 to 99% with H. latipons and 89% or lower with any other species of Heterodera. Morphological and molecular identification demonstrated that the population of cyst nematodes from a wheat field in Aïn Jemâa, Morocco was H. latipons. In the patches with poor growing plants, 65 cysts per 100 cm3 soil were found. To our knowledge, this detection represents a new record of H. latipons. Since the nematode can cause considerable damage to wheat, one of the main cereals produced in Morocco, care should be taken to prevent the spread to other regions. References: (1) K. R. Barker. Page 19 in: An Advanced Treatise on Meloidogyne. Vol II. Methodology. C. C. Carter and J. N. Sasser, eds. North Carolina State University Graphics, Raleigh, 1985. (2) V. R. Ferris et al. Fundam. Appl. Nematol. 16:177, 1993. (3) Z. A. Handoo. J. Nematol. 34:250, 2002. (4) M. Holterman et al. Mol. Biol. Evol. 23:1792, 2006.
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Naqash, Abdul Rafeh, Dwight Hall Owen, Biagio Ricciuti, Yukihiro Toi, Rita Chiari, Nitika Sharma, Sandip H. Patel, et al. "Immune pneumonitis-related treatment discontinuations and outcomes in metastatic non-small cell lung cancer treated with nivolumab: A pooled analysis from a multi-institutional international collaboration." Journal of Clinical Oncology 37, no. 8_suppl (March 10, 2019): 118. http://dx.doi.org/10.1200/jco.2019.37.8_suppl.118.
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118 Background: Immune-related adverse events (irAEs) due to immune-checkpoint inhibitors (ICI) can lead to significant morbidity. Immune pneumonitis (IP) constitutes one of the common irAEs in non-small cell lung cancer (NSCLC) with a reported incidence of 3-5%. However outside of clinical trials there is a paucity of data regarding incidence/outcomes of IP in nivolumab (N) treated metastatic-NSCLC (m-NSCLC). Methods: We retrospectively pooled data of 381 m-NSCLC patients (pts) from four cohorts treated with N within different treatment time periods: East Carolina University, USA: 4/2015- 2/2018; Ohio State University, USA: 6/2013-6/2016; University of Perugia, Italy: 10/2013-9/2017, and Sendai Kousei Hospital, Japan: 1/2016-1/2018. IP identification was based on clinical diagnosis of treating team. Grade (G) was based on Common Terminology Criteria for Adverse Events (CTCAE v 4.03). Time to immune pneumonitis (TTIP) was the time from starting N to diagnosis of IP. Results: The rate of IP was 13.1% (n=50) with 68% of IP presenting as the index irAE. Median TTIP was 9.75 weeks (range: 0.25-73.7) with G1 (24.0%), G2 (36.0%), G3 (36.0%), G4 (4.0%). 57.9% of IP ≥G2 had TTIP ≤ 3 months (m). For all-G (IP), 22.0% pts had stopped N before IP either due to non-IP irAEs or progression. Excluding these, treatment discontinuations (d/c) attributed to IP ≥ G2 were 66.6%. IP ≥G2 had higher treatment d/c when TTIP was ≤ 3m vs. > 3m (51.8% vs. 14.8%; P=0.09). Median overall survival (OS) by log rank test for pts with any grade IP vs. no IP was not statistically significant (13.7 vs. 7.5m; P =0.14). IP ≥G2 occurring at > 3m had longer median OS vs. IP ≥G2 occurring in ≤3m (16.7 vs. 3.6m, P=0.008), which was not significant at a 3m landmark analysis when accounting for time on N (P= 0.31). Conclusions: Our real-world multi-institutional data shows a higher incidence of IP in m-NSCLC. We also see a trend for frequent ICI d/c in IP ≥ G2 occurring within 3 months that may ultimately influence OS per our landmark analysis. Thus aggressive and early symptom management specifically directed at allowing reinitiation of ICI after IP needs to be considered.
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Dexter, Franklin. "Observational Study of the Distribution and Diversity of Interventional Pain Procedures Among Hospitals in the State of Iowa." Pain Physician 3, no. 22;3 (May 11, 2019): E157—E170. http://dx.doi.org/10.36076/ppj/2019.22.e157.
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Background: Critical access hospitals represent 61% of hospitals in the rural United States, and 68% of hospitals in Iowa. The role of small hospitals, such as critical access hospitals, in providing interventional chronic pain procedures is unknown. Objectives: We evaluated whether: a) the diversity of interventional pain procedures offered by hospitals is related to their size and is attributable principally to lumbosacral epidural injections; b) critical access hospitals contribute substantively to the count and diversity of pain procedures; and c) whether most interventional pain procedures performed at hospitals’ facilities are performed by relatively few proceduralists or by the cumulative activity of many clinicians. Study Design: This research involved an observational cohort design with a sample size of n = 283,940 interventional pain procedures. Setting: Data were collected from hospital-owned facilities in the state of Iowa from July 2012 through September 2017. Methods: The diversity of types of interventional pain procedures performed statewide was quantified in terms of the relative proportions of procedures at each hospital using the Herfindahl index. Bilinear weighted least squares regression quantified the relationship between the inverse of the Herfindahl and the percentage of procedures that were lumbar or caudal epidural. Kendall tau concordances quantified the relationship between counts of interventional pain procedures and hospital size. Using a blinded version of the National Provider Identifier of the clinician with primary responsibility for performing the principal procedure of the ambulatory visit, we calculated the percentage shares of interventional pain procedures performed by the 1% and 5% of proceduralists who performed the most procedures. Results: The diversity of types of procedures substantively differentiated among hospitals. Heterogeneity among hospitals in the proportion of procedures that were lumbar or caudal epidural injections substantively contributed to the heterogeneity among hospitals (P < .001). Hospitals performing more procedures tended to have greater diversity of types of procedures (P < .001). However, the strength of the concordance was small (Kendall τb = 0.332), showing substantial heterogeneity among hospitals. The 82 critical access hospitals statewide cumulatively accounted for 23.9% of interventional pain procedures. The critical access hospitals’ procedures were mostly (67.7%) lumbar or caudal epidural injections (P < .001), greater than the 48.9% of the other 41 hospitals (P < .001). Procedures were concentrated among proceduralists. The 1.0% of the proceduralists performing the most procedures performed 64.8% of procedures. The 5.0% of proceduralists performing the most procedures performed 87.7% of procedures. Limitations: The data are procedures were performed in hospital-owned facilities of Iowa. Conclusions: Although busier pain programs, based on procedures per week, generally performed more types of procedures, the variability was so large that the number of procedures a pain program performs per week cannot validly be used to infer the diversity of the hospital’s pain medicine practice. Hospitals with pain medicine programs that lack diversity in the types of procedures performed may provide limited options for patients and be susceptible to changes in payment for individual procedures. Relatively few proceduralists performed the vast majority of the procedures. Key words: Critical access hospitals, Herfindahl, interventional pain procedures, managerial epidemiology, pain medicine, state outpatient procedure database, lumbar epidural
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White, Jennell, Xiufeng Gao, Ke Liu, Michael U. Callaghan, and Patrick C. Hines. "A Longitudinal Study to Identify and Assess Adhesion Indices during Vaso-Occlusive Crises in Adults and Adolescents with Sickle Cell Disease." Blood 132, Supplement 1 (November 29, 2018): 1097. http://dx.doi.org/10.1182/blood-2018-99-120311.
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Abstract Sickle cell disease (SCD) is characterized by frequent and unpredictable vaso-occlusive complications (VOCs); however, there are no objective measures for VOC as a clinical endpoint. Vaso-occlusion results from processes that reduce blood flow in the microvasculature, including red cell stickiness and erythrocyte sickling. These processes lead to pain, chronic organ damage, and decreased life expectancy. The decision to seek medical contact varies amongst patients. When VOCs are managed at home valuable information remains unknown. We designed a longitudinal, observational study to capture adhesion data at home and in a hospital setting. The objective of this study was to determine whether a standardized, flow-based adhesion bioassay is capable of identifying VOCs occurring in SCD patients with varying degrees of medical contact. SCD patients (n=33) were evaluated over a 6-month period. Blood samples were collected every 3 weeks; when patients report a VOC corresponding blood samples are collected and steady state samples are resumed. During 6 months of evaluation, longitudinal measures of pain and clinical laboratory and biomarker samples from SCD patients (+/- hydroxyurea therapy) in steady state to VOC were studied. Blood samples were collected in sodium citrate from SCD subjects at steady state and during VOCs. Blood samples were perfused through VCAM-1-coated microchannels at standard physiologic flow conditions (1dyne/cm2, 1.67Hz). An adhesion index was established by quantifying adherent cells within a standard viewing area (cells/mm2), and could be obtained within 6-9 min. Adhesion indices varied from sample-to-sample at baseline (n=289; mean = 355 ± 235; median = 297 cells/mm2) and during VOC (n=59, mean=416±233, median=390). Repeated measures of adhesion over 6 months reveals significant intra-patient associations with C-reactive protein (CRP, n=335, r=0.16; p=0.006), lactose dehydrogenase (LDH, n=336, r=0.12; p=0.032), white blood cells (WBC, n=341, r=0.13; p=0.019), and reticulocyte percent (n=336, r=0.37, p<0.0001). The results also show significant inter-patient (n=35) correlations with CRP (r=0.34, p=0.047), fetal hemoglobin (HbF, r=-0.61, p=0.0001), reticulocyte percent (r=0.63, p<0.0001), reticulocyte (r=0.77, p<0.0001), and uric acid (r=0.37, p=0.028). At-home VOC adhesion indices (n=33; mean=482±255) were significantly higher than both ER-based VOC (n=8; mean=322± 153; p=0.031) and hospital-based VOC (n=18, mean=336±182; p=0.018) adhesion indices. The difference between at home VOC adhesion indices and baseline adhesion indices approached significance (482 ± 255 vs 355 ± 235, p=0.088). This study represents the largest longitudinal study of adhesion indices using a standardized clinical assay. These data confirm the normal range and longitudinal variability of SCD adhesion indices at baseline and during VOC. Adhesion increased during patient-reported VOCs in a subpopulation of individuals with SCD, suggesting there may be a subphenotype who are more predisposed to adhesion-mediated VOCs. At-home VOCs are likely higher because ER-VOC indices are influenced by fluid boluses, blood transfusions, or anti-inflammatory therapy. Further studies are underway to determine if a clinical adhesion index can effectively monitor response to SCD-modifying therapies and prospectively predict disease progression. Disclosures White: functional fluidics: Equity Ownership. Gao:Functional Fluidics: Equity Ownership. Liu:Functional Fluidics: Equity Ownership. Callaghan:Bioverativ: Honoraria; Alnylam Pharmaceuticals: Equity Ownership; Bayer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Octapharma: Honoraria; Sancilio Pharmaceuticals Company: Employment; Novo Nordisk: Employment, Membership on an entity's Board of Directors or advisory committees; Shire: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Hema Pharmaceuticals: Honoraria; Grifols: Honoraria; Pfizer: Employment, Honoraria, Research Funding; Roche/Genentech: Employment, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Employment; Global Blood Therepeutics: Employment. Hines:functional fluidics: Equity Ownership.
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Zheng, Weiyang, Xue Liang, Liyan Shui, Bingjue Ye, Guohua Lou, Yanning Liu, and Min Zheng. "Serum Procalcitonin Correlates with Renal Function in Hepatitis B Virus-Related Acute-on-Chronic Liver Failure." Cellular Physiology and Biochemistry 50, no. 5 (2018): 1794–803. http://dx.doi.org/10.1159/000494820.
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Background/Aims: To investigate the relationship between elevated serum procalcitonin (PCT) and renal function in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: HBV-ACLF patients (n = 201) presenting to the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University, from January 2013 to November 2016 were categorized into three groups according to serum PCT levels: (i) normal group (n = 74) had PCT of ≤ 0.5 ng/mL; (ii) elevated group (n = 85) had PCT in the range 0.5–1.0 ng/mL; and (iii) highly elevated group (n = 42) had PCT of > 1.0 ng/mL. Thirty-five cases received standard care after admission. Serum PCT levels and renal function were determined during a two-week follow-up. Results: Significant increases in serum creatinine (Cr) were recorded in male and female patients in the elevated group and highly elevated group compared with the normal group (P < 0.05). In addition, serum Cr levels in male and female patients were significantly higher in the highly elevated group than in the elevated group (P < 0.05). The glomerular filtration rate (GFR) was significantly lower in the highly elevated group (P < 0.05) and this group had the highest risk of altered Cr (45.9% in males; 80% in females) and abnormal GFR (37.5%). Serum PCT levels correlated significantly with all renal function parameters including homocysteine (Hcy), GFR, Cr, blood urea nitrogen, uric acid, and cystatin C at baseline and during treatment. Univariate and multivariate analyses indicated that serum PCT was a strong predictor of renal dysfunction. Conclusion: Serum PCT is closely related to renal dysfunction in HBV-ACLF.
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Oral, Arsinur. "Defibrotide: Seamless Phase I/II Dose Escalation Trial (ICSRI DF#1) to Stratify the Polypharmacology of a Cell Modulator to the Polypharmacology of Multi Organ Failure: Part I, Clinical Design, and Therapeutic Results." Blood 112, no. 11 (November 16, 2008): 4316. http://dx.doi.org/10.1182/blood.v112.11.4316.4316.
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Abstract VOD/sinusoidal obstruction syndrome (SOS) is a lethal multiorgan dysfunction syndrome (MODS) caused by multifactorial/polypharmacological damage, inclusive of inflammatory cytokines, to the endothelial cell (EC), hepatocytes, and sinusoids. The final pathology has the component of thrombotic microangiopathy (TM), with its universal marker of upregulated plasminogen activator inhibitor-1(PAI-1). Prior Art reported on the vast polypharmacology of DF in ex-vivo systems inclusive of but not restrickted to cell adhesion molecules, immune cells (NK ), cytokines (TNF-Alpha, neuroendocrine molecules (ET1) as a dose dependent event. Thus far, there has been no dose system defined that would translate the dose-reponsivenes of its polypharmacology to in vivo systems, i.e. patient care-to the bed-side. We hypothesized: DF by virtue of being a cell modulator, may reflect the cell’s own polypharmacology during the repair event. Therefore its in-vivo polypharmacology, analogous to that of the cell, may be specific to the type, intensity and duration of the state of injury. DF may upregulate the cell’s repair event, without side effects, if the daily dose and duration of therapy are guided by the intensity and duration of the respective injury marker(s). Protocol ICSRI DF#1: Primary Objective: Complete remission at the clinical and molecular level for all injury markers universally recognized as representatives of respective clinical syndromes. Secondary Objective: To run a panel of laboratory, clinical and molecular markers at each dose escalation of 30mg/kg/day every 3 days and to continue upregulation of daily dose and duration of therapy till all of the respective marker(s) plateau in intensity and then stabilize at a state of normalcy, respectively. Experimental Plan: Trial Phase: Seamless Phase I/II: Patients are controls in themselves. Patient population: Open label, MODS patients otherwise untreatable by present standard of care or experimental protocols. Therapy: DF as single therapeutic agent. 3 Dose Ranges: Empiric doses: 25 mg/kg/day × 2 weeks Marker Directed Escalating Daily Dose (MDD): 40mg/kg/d, escalated by 30mg/kg/d every 3 days till plateau in the laboratory or molecular marker(s) MDD-CR continued till clinical and molecular CR Collection of 32 marker Master Panel (MP) at each dose escalation for ICSRI DF#2 Scientific Protocol. Regulatory Format: USA and Turkey FDA Compassionate Use, 14 patients (Presbyterian University Hospital, USA) and 3 patients (Haseki Federal Infectious Disease Hospital, Turkey) treated respectively. Results: Results: Key injury markers for EC diseases: TNF-Alpha, PAI-1; vWag; ET-1; AA-plt aggregation. A) Empiric doses: n. of pts = 6; dose range =30–40mg/kg/d; n. of assays = 1,363; Rx length = 28 d; CR = 0; No Response (NR) = 4 pts; Diagnosis (Dx) Hemolytic Uremic Syndrome (HUS = 3 pts; Hypercoagulable State = 1 pt; Partial response (PR) = 1 pt; Dx:HUS B) MDD escalating doses: n. of. pts = 6; Dose Range = 30–300mg/kg/d; n. of assays = 5,080; Rx length per pt. = 3–24 d; duration of trial = 21 m; PR =2 (MODS); CR = 2 (HUS/MODS); CR = 1 (FV Leiden, concurrent GI bleed; CNS thrombosis, ekstremity inflammatory DVT); C-1) MDD-CR-EC Diseases: n. of pts = 2; dose range=30–275mg/kg/d; dose escalation= 30mg/kg/d every 3 d; n. of assays = 120; RX length per pt= 28d; duration of trial=2 m. CR=1 (HUS); CR=1 (MODS/Antiphospholipid Antibody Synd); C-2) MDD-CR-MODS Viral/fungal/protozoal Infection/HIV: n. pts-3; dose range=150–275 mg/kg/d; n. assays=682; Rx length per pt= 34–136 d; duration of trial=18m. CR=2, duration 34–136 days; (HIV cryptococcal diarrhea, polyarthralgia; waste synd; refractory necrotic Candida/Herpes I/II anal and labial; cardiogenic shock); CR= 136 d. (Kaposi’s sarcoma, isolated, intraoral). Conclusion: Stratifying the daily optimal dose and the total duration of DF therapy in VOD may escalate the clinical CR beyond the present 36 %, and may incorporate into the responses patients with higher degree lesions. Stratification of the dose may incorporate the polypharmacology of DF beyond the final thrombotic phase of the lesion. ICSRI-DF#2 reports the universal injury markers and their respective dose ranges, as well as insight into an all-encompassing mechanism of efficacy of DF
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Ishida, Tomo, Tomoki Makino, Koji Tanaka, Makoto Yamasaki, Yasuhiro Miyazaki, Tsuyoshi Takahashi, Yukinori Kurokawa, Kiyokazu Nakajima, Masaki Mori, and Yuichiro Doki. "PS02.202: CLINICAL SIGNIFICANCE OF MEASUREMENT OF SKELETAL MUSCLE VOLUME AND SERUM NUTRITIONAL MARKERS IN ESOPHAGEAL CANCER PATIENTS." Diseases of the Esophagus 31, Supplement_1 (September 1, 2018): 179. http://dx.doi.org/10.1093/dote/doy089.ps02.202.
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Abstract Background Some studies reported the association of muscle mass or nutritional state with development of postoperative morbidity. However, it remains unknown whether body composition or nutritional state influences upon clinical outcome in esophageal cancer (EC) patients undergoing surgery following neoadjuvant chemotherapy (NAC). Methods A total of 100 EC patients who undergone NAC followed by curative surgical resection in our hospital from 2011 to 2013 was analyzed. The cross-sectional area of psoas was measured by computed tomography at third lumbar vertebra and the Psoas Muscle Index [PMI: total psoas area at L3/(height × height)] was calculated. Pre- and post-NAC PMI in addition to prognostic nutritional index (PNI), modified Glasgow prognostic scale (mGPS), and neutrophil/lymphocyte ratio (N/L) as an inflammation or nutrition marker were evaluated in terms of their association with development of NAC adverse event, postoperative complications and long-term survival. Results The PMI significantly decreased during chemotherapy from 705.5 to 682.7 cm2/m2 (P = 0.0008). Pre-NAC PMI (low vs high group, cutoff: 6.36cm2/m2 for male, 3.92cm2/m2 for female) was significantly associated with serum albumin (3.5 vs 3.8g/dl P = 0.0064) and body mass index (19.6 vs 22.2kg/m2P < 0.001), and clinical response to NAC (response rate 66.7 vs 87.1% P = 0.02). Post-NAC PMI, meanwhile, correlated with development of postoperative pneumonia [Clavien-Dindo (C-D) classification grade > II] (35.0 vs 8.3% P = 0.0009) and expectoration disorder of sputum (C-D classification grade > III) (28.6 vs 10.5% P = 0.027) while neither pre- or post PMI were predictive of patient survival. Regarding serum nutritional markers, pre-NAC PNI and mGPS correlated with NAC-induced neutropenia [low vs high PNI (cutoff: 40): 100 vs 87% P = 0.019] and diarrhea (mGPS 0/1 vs 2: 27.4 vs 80.0% P = 0.017) while post-NAC mGPS (mGPS 0 vs 1/2) was predictive of development of postoperative pneumonia (11.5 vs 30.8%, P = 0.018) and expectoration disorder of sputum (10.7 vs 27.8%, P = 0.037), respectively. Notably, post-NAC mGPS (mGPS 0 vs 1/2: 76.4 vs 65.4%, P = 0.039) and N/L (N/L ≥ 2.5 vs < 2.5: 43.5 vs 82.1% P = 0.006) showed the significant association with 2-year overall survival. Conclusion Pre- and post-NAC PMI in addition to serum inflammation/nutrition markers might be clinically useful in predicting outcome of multidisciplinary treatments for EC patients. Disclosure All authors have declared no conflicts of interest.
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Abdelwahab, Salih, Abdelsalam MA Nail, and GadAllah Osman Modawe. "The Association between CRP Levels with Comorbidities, Species, and Complications of Severe Malaria." AL-Kindy College Medical Journal 18, no. 3 (December 31, 2022): 207–12. http://dx.doi.org/10.47723/kcmj.v18i3.867.
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Background: Malaria remains a leading cause of mortality in sub-Saharan Africa (including Sudan). C-reactive protein (CRP) is useful as a marker of severity in malaria. African studies have shown that serum CRP levels correlate with parasite burden and complications in malaria, especially falciparum. However, there are no data on CRP levels in Sudanese malaria patients. This study aims to evaluate the association between CRP levels with comorbidities, species, and complications of severe malaria Subjects and Methods: A cross-sectional study enrolled 65 severe malaria patients at Khartoum state hospitals during the period from April to June2021. Manifestations of severe malaria were defined according to WHO criteria. Data regarding demographics, presenting symptoms & signs, laboratory investigations, complications, length of hospital stay and outcomes were collected. CRP was classified as elevated when the measured level was >10 mg/l. Results: Among 65 patients, 33(50.8%) were females and 32(49.2%) were males, and mean age was 48±21 years. The main manifestation of severe malaria diagnosis criteria was anemia in 26(40%) patients. Most of the patients had density 1+ (n=53; 81.5%) and were infected by P. falciparum (n=61; 93.8%). The overall case fatality rate for malaria was 8% (n=15 patients). The mean of CRP was 72±57 mg/L and 84% (n=55) of patients had elevated levels above 10 mg/L (ranged from 10-100 mg/L in 52%, and above 100 mg/L in 32%). The elevated CRP levels were significantly DM (P= 0.048), high malaria parasite density in blood film (P= 0.001), P. falciparum (P= 0.33), presence of complications (P= 0.001) and death (P= 0.003) Conclusion: Elevated CRP levels were found in a considerable proportion of severe malaria patients. CRP is an effective biomarker in assessing malaria severity and poor prognosis in term of complications development and mortality.
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Marqueen, Kathryn E., Nikhil Waingankar, John Sfakianos, Reza Mehrazin, Scot Anthony Niglio, François Audenet, Rachel Jia, Madhu Mazumdar, Bart Ferket, and Matt D. Galsky. "Identifying high surgical risk in muscle-invasive bladder cancer (MIBC) patients undergoing radical cystectomy (RC)." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 460. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.460.
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460 Background: Although RC is the standard treatment for MIBC, it is associated with non-negligible morbidity and mortality. Given the advanced age and prevalence of comorbidities in MIBC patients, many are suboptimal RC candidates. We sought to develop a prediction rule for determining high surgical risk using routinely available pre-surgical variables. Methods: We identified N=8,634 patients with MIBC (cT2-T4aN0M0) who underwent RC, without perioperative chemotherapy, within the National Cancer Database (2003-2012). Using multi-state modeling, we calculated time spent in 3 health states: hospitalized, discharged and death over 90 days post-RC. Predictors were selected in a stepwise manner. Cross validation was performed leaving one of 6 geographic regions out to assess model performance. Time spent in each state was weighted by utility (0=death, 1=full health) to determine 90d quality-adjusted survival (QAS) as a composite of morbidity and mortality. Results: Median age: 69y (IQR 62-78), mean length of stay: 10±12d, and 90d mortality: 654/8,634 (7.6%). Increasing age, cT stage, Charlson comorbidity index (CCI) and lower hospital RC volume were associated with greater 90d mortality (Table). C-statistics of 0.57-0.73 and calibration slopes of 0.54-1.37 (1=perfect) were sufficient across the regions. Our model predicted 25% of patients had a 90d mortality >10%; observed 90d mortality in this group was 14.0% (95% CI 12.5-15.5). Mean QAS was 63d (range 43-68). Conclusions: We developed a multi-state model to identify high post-RC risk that may ultimately help to identify patients for ‘prehabilitation’ strategies and/or inform standard definitions of ‘cystectomy ineligibility’ for clinical trials. [Table: see text]
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Radenkova-Saeva, J., and H. Naydenov. "Clinical Case of Toxic Epidermal Necrolysis." Acta Medica Bulgarica 44, no. 1 (May 1, 2017): 42–45. http://dx.doi.org/10.1515/amb-2017-0007.
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Abstract Toxic epidermal necrolysis or Lyell’s syndrome is a severe life-threatening adverse drug reaction with a high mortality rate. The drugs most commonly involved are: antibiotics; anticonvulsants; antiretroviral drugs; nonsteroidal anti-inflammatory drugs, allopurinol. Case report: A 68-year-old female, presented with complaints of fever and extensive rashes on the skin of the face, the neck and the trunk, severe itching of the skin, ulcerations and erythema of the conjunctiva and the oral cavity and difficulty in swallowing. She has a period of two or three days of general discomfort and fatigue, rash, fever up to 38°C, sore throat, arthralgia, myalgia, loss of appetite and have been treated with antipyretics, antibiotic – ampicillin, antihistamines, vitamins. Her state worsened during the next 3 days, therefore she was hospitalized in the Toxicology clinic of University Hospital “N. I. Pirogov”. Multiple maculopapular and bullous eruptions, plaques were present all over the body, blisters that cover a substantial portion of the body. The entire skin covering the body surface was denuded and peeled off with minor manipulation – the Nikolsky’s sign. Intraorally, multiple oral ulcers of the buccal mucosa, tongue, palate, labial mucosa, and soft palate were seen. Hemorrhagic erosions were also seen on both the upper and lower lips. Conjunctivitis and ulceration of genitalia were also noted. The lesions got slowly better with serum therapy, fluid and electrolyte replacement, systemic corticosteroids, antihistamines, antibiotic, vitamins, H2 blockers, topical care of mucosal changes. Evolution was satisfactory with epidermization and the patient was discharged from the hospital after 1 month.
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Pah, Bucuras, Buleu, Tudor, Iurciuc, Velimirovici, Streian, Badalica-Petrescu, Christodorescu, and Dragan. "The Importance of DS-14 and HADS Questionnaires in Quantifying Psychological Stress in Type 2 Diabetes Mellitus." Medicina 55, no. 9 (September 5, 2019): 569. http://dx.doi.org/10.3390/medicina55090569.
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Background and Objectives: The comorbid association between type 2 diabetes mellitus (T2DM) and a psychological profile characterized by depression and/or anxiety has been reported to increase the risk of coronary heart disease (CAD), the most striking macrovascular complication of diabetes. The purpose of the present study was to quantify anxiety, depression and the presence of type D personality, and to correlate the scores obtained with cardiovascular risk factors and disease severity in diabetic patients. Materials and methods: The retrospective study included 169 clinically stable diabetic patients divided into two groups: group 1 without macrovascular complications (n = 107) and group 2 with CAD, stroke and/or peripheral vascular disease (n = 62). A biochemical analysis and an assessment of psychic stress by applying the Hospital Anxiety and Depression Scale (HADS)and the Type D scale (DS-14) to determine anxiety, depression and D personality scores were done in all patients. Statistical analysis was made using SPSSv17 and Microsoft Excel, non-parametric Kruskal–Wallis and Mann–Whitney tests. Results: Following application of the HAD questionnaire for the entire group (n = 169), anxiety was present in 105 patients (62.2%), and depression in 96 patients (56.8%). Group 2 showed significantly higher anxiety scores compared to group 1 (p = 0.014), while depression scores were not significantly different. Per entire group, analysis of DS-14 scores revealed social inhibition (SI) present in 56 patients (33%) and negative affectivity (NA) in 105 patients (62%). TheDS-14 SI score was significantly higher in group 2 compared to group 1 (p = 0.036). Type D personality, resulting from scores above 10 in both DS-14 parameter categories, was present in 51 patients of the study group (30%). There was a direct and significant correlation (r = 0.133, p = 0.025) between the Hospital Anxiety and Depression Scale-Anxiety (HAD-A) score and the LDL-c values. Conclusions: The results of this study demonstrated that more than a half of patients with diabetes had anxiety and/or depression and one third had Type D personality, sustaining that monitoring of emotional state and depression should be included in the therapeutic plan of these patients. New treatment strategies are needed to improve the well-being of diabetic patients with psychological comorbidities.