#45: Phenotypic heterogeneity among isolates of Candida albicans from specific anatomical niches in VLBW premature infants

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S14-S14
Author(s):  
Kacie C Rytlewski ◽  
Melanie Wellington ◽  
Damian Krysan
Keyword(s):  
Risk Factors ◽  
Vertical Transmission ◽  
Premature Infants ◽  
Reference Strain ◽  
Phenotypic Heterogeneity ◽  
Clinical Isolates ◽  
High Morbidity ◽  
Significant Heterogeneity ◽  
Filamentous Form ◽  
Vlbw Infants

Abstract Background Disseminated candidiasis is associated with high morbidity and mortality among very low birth weight (VLBW) infants. Research about C. albicans traits which lead to colonization versus invasive disease is lacking. Ability to grow in a filamentous form is a known virulence trait of C. albicans. Nevertheless, significant heterogeneity in filamentous growth in C. albicans clinical isolates has been documented (Hirakawa et. al). However, the clinical isolates investigated were obtained from varied tissue niches from hosts with differing risk factors, which could account for the variation in filamentation. A collection of C. albicans isolates prospectively collected from VLBW infants and their mothers demonstrated vertical transmission of C. albicans from mother to infant (Bliss et. al). We used the infants’ isolates from this collection to investigate filamentation amongst isolates obtained from the same tissue niche and host type. Methods The standard C. albicans reference strain in the field, SC5314 was chosen for a positive control as it demonstrates strong filamentation and high virulence. A strain lacking Efg1, a regulatory transcription factor that promotes filamentation, produces hypofilamentous colonies and was used as the negative control. Reference strains and the clinical isolates were grown on two types of stimulation media at 37 C for 7 days after which filamentation was scored. Results Filamentation development varied widely among isolates. Of the strains which were acquired through vertical transmission, 5 of 11 strains showed strong filamentation, 5 of 11 had an intermediate phenotype, and 1 did not display any filamentation. Three strains were acquired through horizontal transmission (RO10, RO54, and RO56). Of these, one showed strong filamentation whereas the other two failed to form filaments. None of the neonatal isolates showed colony wrinkling, a prominent phenotype in the reference strain SC5314. Strain RO61, an isolate associated with candidemia showed strong filamentation. In contrast, strain RO39, which was associated with dermatitis, was non-filamentous. Conclusions We observed phenotypic heterogeneity with respect to filament development among clinical isolates obtained from the same niche (rectal) in similar hosts (VLBW premature infants). This is consistent with the variation seen in Hirakawa et al and indicates that phenotypic variation is not a function of host risk factors nor clinical niche. Filamentation was not required for vertical transmission. No conclusions can be drawn based on this observation with only 2 strains, but it is interesting to note that the isolate which caused candidemia and death of the patient was highly filamentous whereas the isolate that caused dermatitis was not. Further investigation of these strains, including genomic sequencing and additional phenotypic evaluations, will explore the underlying factors leading to transmission and virulence of C. albicans in VLBW premature infants.

Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

2015 ◽  
Vol 18 (1) ◽  
pp. 006
Author(s):  
Hasan Reyhanoglu ◽  
Kaan Ozcan ◽  
Murat Erturk ◽  
Fatih İslamoglu ◽  
İsa Durmaz
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Significant Risk ◽  
High Morbidity ◽  
Factors Associated

<strong>Objective:</strong> We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery.<br /><strong>Methods:</strong> One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group <br />(C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated.<br /><strong>Results:</strong> Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while <br />26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P &lt; .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively.<br /><strong>Conclusion:</strong> Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.<br /><br />

Incidence of depression and its influencing factors in 387 patients with asthma from Xinjiang, China

2020 ◽  
Vol 41 (2) ◽  
pp. e45-e53 ◽  
Author(s):  
Dilinuer Wufuer ◽  
Haidiya Aierken ◽  
Yan Fang ◽  
Mihereguli Simayi ◽  
Kelibiena Tuerxun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Depression Scale ◽  
High Morbidity ◽  
Hamilton Depression Scale ◽  
Multiple Factors ◽  
Asthma Symptoms ◽  
Depression Status ◽  
Treatment Of Depression ◽  
Quality Life

Background: Our study aimed to investigate the incidence of depression in 387 patients with asthma. Methods: The Zung self-rating depression scale and the Hamilton depression scale were used to evaluate the depression status in patients with asthma. Results: Results of logistic regression analysis indicated that, severity of asthma symptoms, taking medicine, frequency of asthma onset, and lack of education were the major risk factors for depression in patients with asthma. Conclusion: Depression is a complication with high morbidity in patients with asthma. It largely affects disease control of asthma and the quality life in patients. Multiple factors are relevant for depression in the patient with asthma. This study provided a comprehensive horizon for clinical management and treatment of depression in patients with asthma.

Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries

2019 ◽  
Vol 17 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Abdulla Shehab ◽  
Khalid F. AlHabib ◽  
Akshaya S. Bhagavathula ◽  
Ahmad Hersi ◽  
Hussam Alfaleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Quality Of Care ◽  
Middle East ◽  
Clinical Presentation ◽  
Middle Eastern ◽  
High Morbidity ◽  
Inhospital Mortality ◽  
Acute Stemi

Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

scholarly journals The ‘wave sign’ in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options

2020 ◽  
Author(s):  
Jason Derry Onggo ◽  
James Randolph Onggo ◽  
Mithun Nambiar ◽  
Andrew Duong ◽  
Olufemi R Ayeni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Protective Factor ◽  
Treatment Options ◽  
Arthroscopic Surgery ◽  
Classification Systems ◽  
Diagnostic Methods ◽  
Suture Repair ◽  
Significant Heterogeneity ◽  
Epidemiological Factors

ABSTRACT This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle &gt;65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P&lt;0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P&lt;0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P&lt;0.05), 12-months (MD=22.0, P&lt;0.05) and 28-months (MD=17.5, P&lt;0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.

scholarly journals Low Maternal Immunoglobulin G Avidity and Single Parity as Adverse Implications of Human Cytomegalovirus Vertical Transmission in Pregnant Women with Immunoglobulin M Positivity

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 866
Author(s):  
Masatoki Kaneko ◽  
Junsuke Muraoka ◽  
Kazumi Kusumoto ◽  
Toshio Minematsu
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Human Cytomegalovirus ◽  
Multiple Logistic Regression Analysis ◽  
Clinical Signs ◽  
Immunoglobulin M ◽  
Igg Antibody ◽  
Neurological Sequelae ◽  
Previous Pregnancy

Human cytomegalovirus (CMV) is the leading cause of neurological sequelae in infants. Understanding the risk factors of primary CMV infection is crucial in establishing preventive strategies. Thus, we conducted a retrospective cohort study to identify risk factors of vertical transmission among pregnant women with immunoglobulin (Ig) M positivity. The study included 456 pregnant women with IgM positivity. Information on age, parity, occupation, clinical signs, IgM levels, and IgG avidity index (AI) was collected. The women were divided into infected and non-infected groups. The two groups showed significant differences in IgM level, IgG AI, number of women with low IgG AI, clinical signs, and number of pregnant women with single parity. In the multiple logistic regression analysis, pregnant women with single parity and low IgG AI were independent predictors. Among 40 women who tested negative for IgG antibody in their previous pregnancy, 20 showed low IgG AI in their current pregnancy. Among the 20 women, 4 had vertical transmission. These results provide better understanding of the risk factors of vertical transmission in pregnant women with IgM positivity.

scholarly journals Elimination of Intravenous Di-2-Ethylhexyl Phthalate Exposure Abrogates Most Neonatal Hypertension in Premature Infants with Bronchopulmonary Dysplasia

Toxics ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 75
Author(s):  
Randall Jenkins ◽  
Katia Farnbach ◽  
Sandra Iragorri
Keyword(s):  
Risk Factors ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Chi Square ◽  
Neonatal Hypertension ◽  
Vlbw Infants ◽  
Chi Square Analysis ◽  
Ethylhexyl Phthalate ◽  
Current Report

(1) Background: The incidence of hypertension in very low birthweight (VLBW) infants in a single neonatal intensive care unit (NICU) dropped markedly during a 2-year period when the IV fluid (IVF) in both the antenatal unit and the NICU temporarily changed to a di-2-ethylhexyl phthalate (DEHP)-free formulation. The objective of the current report is to document this observation and demonstrate the changes in incidence of hypertension were not associated with the variation in risk factors for hypertension; (2) Methods: The charts of all VLBW infants born in a single NICU during a 7-year span were reviewed. This time includes 32 months of baseline, 20 months of DEHP-free IVF, 20 months of IVF DEHP re-exposure, and two 4-month washout intervals. The group of interest was limited to VLBW infants with bronchopulmonary dysplasia (BPD). Chi-square analysis was used to compare incidence of hypertension among periods. Vermont Oxford NICU Registry data were examined for variation in maternal and neonatal risk factors for hypertension; Results: Incidence of hypertension in VLBW infants with BPD decreased from 7.7% (baseline) to 1.4% when IVF was DEHP-free, rising back to 10.1% when DEHP-containing IVF returned to use. Risk factors for neonatal hypertension were stable across the 3 study periods in the NICU’s group of VLBW infants; (3) Conclusions: Serendipitous removal of IVF containing DEHP resulted in near elimination of hypertension in one NICU—an effect entirely reversed after the same brand of DEHP-containing IVF returned to clinical use. These results suggest that DEHP exposure from IVF plays a major role in neonatal hypertension.

Effects of neurodevelopmental risk factors on brainstem maturation in premature infants

2021 ◽  
Author(s):  
Borenstein-Levin Liron ◽  
Taha Roaya ◽  
Riskin Arieh ◽  
Hafner Hava ◽  
Cohen-Vaizer Mauricio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Premature Infants

A Prospective Study of Free Bilirubin and Other Risk Factors in the Development of Kernicterus in Premature Infants

PEDIATRICS ◽  
1982 ◽  
Vol 69 (3) ◽  
pp. 260-266 ◽  
Author(s):  
Dorothy A. Ritter ◽  
John D. Kenny ◽  
H. James Norton ◽  
Arnold J. Rudolph
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Blood Brain Barrier ◽  
Premature Infants ◽  
Total Bilirubin ◽  
Total Bilirubin Level ◽  
Maximum Level ◽  
Clinical Applicability ◽  
Low Levels ◽  
A Prospective Study

To assess the value of free bilirubin (FB) measurements in predicting kernicterus (KI) in sick premature infants, 91 newborns weighing less than 1,500 gm at birth were observed during the first week of life with twice daily FB and total bilirubin determinations. Autopsies were performed on 30 of the 53 infants who died. Seven had KI and 23 did not. There were no differences between infants with and without KI in the maximum FB level (KI 18.2 ± 4.5 [SEM] nm/liter, no KI 11.1 ± 0.9 nm/liter, P not significant) or the total bilirubin level (KI 7.3 ± 1.3 mg/100 ml, no KI 6.1 ± 0.5 mg/100 ml, P not significant). In fact, three kernicteric infants had very low maximum FB levels (&lt;10 nm/liter). These three infants had prolonged episodes of acidosis, hypoxemia, or hypothermia during the 24 hours preceding their maximum level of FB. Although elevated levels of FB may be predictive of KI in some infants, other factors may make the blood-brain barrier more permeable to low levels of FB. This may limit the clinical applicability of FB measurements.

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