scholarly journals 1181. Spectrum and Risk Factors of Early Onset versus Late Onset Neonatal Candidemia from Pakistan

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S615-S616
Author(s):  
Salima Rattani ◽  
Kauser Jabeen ◽  
Joveria Farooqi ◽  
Ali Shabbir Hussain
Keyword(s):  
Risk Factors ◽  
Vaginal Delivery ◽  
Early Onset ◽  
Candida Species ◽  
Late Onset ◽  
Clinical Information ◽  
Ethical Review ◽  
High Morbidity ◽  
Male Patients ◽  
Candida Sepsis

Abstract Background Candidemia leads to high morbidity and mortality especially in premature neonates from developing countries. We studied the spectrum and risk factors of candidemia in neonates with early onset disease (EOD) or late onset disease (LOD) which has not been extensively investigated in Pakistan. We also determined whether vaginal delivery is associated with candidemia in neonates with EOD. Methods A case control study was conducted at the Aga Khan University, Karachi, Pakistan. Cases (neonates with EOD) and controls (neonates with LOD) were identified from laboratory database for year 2014-2018, and for 2019 data was collected prospectively from laboratory during routine reporting of cultures at which time clinical information was gathered from the patient’s physician/guardian. Study was conducted after obtaining exemption from the ethical review committee. Results A total of 669 neonates with IC were identified, out of these 162 neonates had EOD while 507 had LOD. Chart 1 shows the year wise distribution and frequency of different C. species. Mean age of neonates with EOD and LOD was 1.7 and 12.2 days respectively. LOD in neonates was more likely to occur in male patients (COR 2.5, 95% CI 0.6-9.9) was and associated with use of carbapenems (COR 5.1, 95% CI 1.4-17.8). However, LOD had no correlation with non-C. albicans Candida sepsis (COR 0.6, 95% CI 0.1-6.3) as causative agent. EOD was more likely in patients delivered via vaginal delivery (COR 11.3, 95% CI 2.6-48.5). Chart 1: Year wise distribution of Candida species in neonates with candidemia from 2014-2019 Conclusion The trends for isolation of C. species in neonates showed a trend with C. tropicalis being more common C. species during the recent years. With the infrequent isolation of C. glabrata and C. krusei among other Candida species in this study, fluconazole may be considered a good empiric choice for neonates with suspected fungal sepsis. Disclosures All Authors: No reported disclosures

NEONATAL SEPSIS AND IDENTIFICATION OF RISK FACTORS: STUDY IN AVBRH HOSPITAL SAWANGI

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pramod P. Singhavi
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Signs And Symptoms ◽  
Premature Rupture ◽  
Maternal Risk ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Meconium Stained Amniotic Fluid

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

scholarly journals Differences in Clinical and Dietary Characteristics, Serum Adipokine Levels, and Metabolomic Profiles between Early- and Late-Onset Gout

Metabolites ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 399
Author(s):  
Young Sun Suh ◽  
Hae Sook Noh ◽  
Hyun-Jin Kim ◽  
Yun-Hong Cheon ◽  
Mingyo Kim ◽  
...  
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Clinical Information ◽  
Plasminogen Activator Inhibitor ◽  
Ultra Performance Liquid Chromatography ◽  
Plasminogen Activator Inhibitor 1 ◽  
Baseline Serum ◽  
Onset Group ◽  
Early Onset Group ◽  
Pai 1

This study aimed to identify differences in clinical and dietary characteristics, serum adipokine levels, and metabolomic profiles between early- and late-onset gout. Eighty-three men with gout were divided into an early-onset group (n = 38, aged < 40 years) and a late-onset group (n = 45, aged ≥ 40 years). Dietary and clinical information was obtained at baseline. Serum adipokines, including adiponectin, resistin, leptin, and plasminogen activator inhibitor-1 (PAI-1), were quantified by a Luminex multiplex immunoassay. Metabolite expression levels in plasma were measured in 22 representative samples using metabolomics analysis based on ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry. Average body mass index, rate of consumption of sugar-sweetened beverages, and serum uric acid levels were significantly higher in the early-onset group (p < 0.05), as was the PAI-I concentration (105.01 ± 42.45 ng/mL vs. 83.76 ± 31.16 ng/mL, p = 0.013). Changes in levels of metabolites mostly involved those related to lipid metabolism. In the early-onset group, acylcarnitine analog and propylparaben levels were downregulated and negatively correlated with the PAI-1 concentration whereas LPC (22:6) and LPC (18:0) levels were upregulated and positively correlated with the PAI-1 concentration. Dietary and clinical features, serum adipokine concentrations, and metabolites differed according to whether the gout is early-onset or late-onset. The mechanisms of gout may differ between these groups and require different treatment approaches.

Post-thymectomy myasthenia gravis: a case report and systematic review of literature

2021 ◽  
Vol 14 (12) ◽  
pp. e246005
Author(s):  
Louise Gurowich ◽  
Gabriel Yiin ◽  
Adam Maxwell ◽  
Alexandra Rice
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Myasthenia Gravis ◽  
Early Onset ◽  
Late Onset ◽  
High Morbidity ◽  
Review Of Literature ◽  
Prompt Treatment ◽  
Autoimmune Condition ◽  
Anti Acetylcholine

Myasthenia gravis (MG) is an autoimmune condition affecting the neuromuscular junction characterised by weakness and fatiguability, carrying a high morbidity if treatment is delayed. A clear association with thymoma has led to management with thymectomy as a common practice, but MG presenting post-thymectomy has rarely been reported. We present a case of an 82- year-old woman developing fatigue, ptosis and dysarthria 3 months after thymectomy. After a clinical diagnosis of MG was made, she responded well to prompt treatment with prednisolone and pyridostigmine. Her anti-acetylcholine receptor antibody (anti-AChR) subsequently came back positive. Our systematic review reveals that post-thymectomy MG can be categorised as early-onset or late-onset form with differing aetiology, and demonstrated correlation between preoperative anti-AChR titres and post-thymectomy MG. The postulated mechanisms for post-thymectomy MG centre around long-lasting peripheral autoantibodies. Clinicians should actively look for MG symptoms in thymoma patients and measure anti-AChR preoperatively to aid prognostication.

scholarly journals Maternofetal outcomes in early versus late onset pre-eclampsia: a comparative study

2019 ◽  
Vol 8 (2) ◽  
pp. 548
Author(s):  
Poornima Shankar ◽  
Kavitha Karthikeyan ◽  
Amrita Priscilla Nalini ◽  
Sindhura M. ◽  
Gowtham Kim
Keyword(s):  
Risk Factors ◽  
Gestational Age ◽  
Early Onset ◽  
Age Of Onset ◽  
Late Onset ◽  
Fetal Outcomes ◽  
Chi Square ◽  
Onset Type ◽  
Significant Difference ◽  
Early Onset Preeclampsia

Background: Preeclampsia is being increasingly recognized as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset disease occurring at 34 or more weeks of gestation. Early-onset and late-onset pre-eclampsia are found to have different implications for the mother and neonate. The aim of this study is to compare the risk factors, maternal and fetal outcomes in early (<34 weeks) versus late (≥34weeks) onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Chettinad Academy of Research and Education over a period of three years (From January 2014 to December 2016) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on risk factors, maternal and fetal outcomes were collected and analyzed using Chi Square and Fisher’s test and compared.Results: The overall preeclampsia rate was 6.3%. Early onset and late onset were 34.6% and 65.3% respectively and the rate increased with increasing gestational age.35.3% of patients with late onset preeclampsia and 55.6% patients of early onset type required more than one drug which is a statistically significant difference. Proteinuria more than 3gm/l/day was significantly more in late onset preeclampsia than in early onset preeclampsia. 55.5% of patients with early onset pre-eclampsia required MgSO4 when compared to 17.4%. There was no statistically significant difference in the rate of caesarean section (61.1% vs 73.5%). Altered coagulation profile was significantly more in early onset preeclampsia (11.1%). The incidence of oligohydramnios, SGA and low APGAR at 5 minutes of birth were significantly high in early onset pre-eclampsia when compared to late onset type.Conclusions: Patients with early onset pre-eclampsia are found to have significantly higher rates of specific maternal and fetal morbidity when compared to the late onset type.

Risk Factors for Ventilator-associated Pneumonia by Pseudomonas aeruginosa  in Presence of Recent Antibiotic Exposure

2006 ◽  
Vol 105 (4) ◽  
pp. 709-714 ◽  
Author(s):  
Jordi Rello ◽  
Camilla Allegri ◽  
Alejandro Rodriguez ◽  
Loreto Vidaur ◽  
Gonzalo Sirgo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Relative Risk ◽  
Confidence Interval ◽  
Early Onset ◽  
Late Onset ◽  
Interquartile Range ◽  
Ventilator Associated Pneumonia ◽  
Antibiotic Exposure ◽  
Retrospective Case

Background To facilitate the decision-making process for therapy and prevention of ventilator-associated pneumonia (VAP) in patients undergoing recent antibiotic exposure, this study investigated whether the development of VAP episodes caused by Pseudomonas aeruginosa or other pathogens are related to different risk factors, thereby distinguishing two risk population for this serious complication. Methods A 5-year retrospective case-control observational study was conducted. Cases of VAP caused by P. aeruginosa were compared with those caused by other pathogens. Univariate and multivariate analysis was performed using SPSS 11.0 software (SPSS Inc., Chicago, IL). Results Two groups were identified: P. aeruginosa (group P) was isolated in 58 (63.7%) episodes, and 33 episodes served as controls (group C), after a median of 12 days (interquartile range, 4-28 days) and 9 days (interquartile range, 3-12.5 days) of mechanical ventilation, respectively. P. aeruginosa was identified in 34.7% of episodes with early-onset pneumonia and in 73.5% with late-onset pneumonia. In a logistic regression analysis, P. aeruginosa was independently associated with duration of stay of 5 days or longer (relative risk = 3.59; 95% confidence interval, 1.04-12.35) and absence of coma (relative risk = 8.36; 95% confidence interval, 2.68-26.09). Risk for pathogens different from P. aeruginosa (group C) in early-onset pneumonia associated with coma was estimated to be 87.5%. Conclusions Risk factors in episodes under recent antibiotic treatment caused by P. aeruginosa or other microorganism are not the same, a fact that could have implications for preventive and therapeutic approaches for this infection.

Early Onset versus Late Onset Peripherally Inserted Central Venous Catheter Infections: An Analysis of Risk Factors and Microbiology

2013 ◽  
Vol 34 (9) ◽  
pp. 980-983 ◽  
Author(s):  
Paul Chittick ◽  
Sobia Azhar ◽  
Kalyani Movva ◽  
Paula Keller ◽  
Judith A. Boura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Early Onset ◽  
Late Onset ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Catheter Infections ◽  
Central Catheters

The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared patients with early- and late-onset PICC bloodstream infections at our institution and found significant differences in microbiologic etiologies.

scholarly journals 1280Natural history, developmental trajectories, and determinants of eczema from infancy to 26 years of age

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Ali Ziyab ◽  
Nandini Mukherjee ◽  
Hasan Arshad ◽  
Wilfried Karmaus
Keyword(s):  
Risk Factors ◽  
Early Onset ◽  
Late Onset ◽  
Developmental Trajectories ◽  
Early Adulthood ◽  
Clinical Criteria ◽  
Adjusted Risk ◽  
Disease Patterns ◽  
Males And Females ◽  
Semiparametric Mixture Models

Abstract Background Eczema is a common inflammatory skin disease with varying developmental trajectories/patterns. This study sought to investigate eczema development from infancy to early adulthood by identifying distinct developmental trajectories that describe disease patterns over time and evaluate the role of early life risk factors. Methods The Isle of Wight Birth Cohort (n = 1456) was prospectively assessed at birth, 1, 2, 4, 10, 18, and 26 years. At each assessment, eczema was ascertained based on established clinical criteria. Developmental trajectories of eczema between 1-or-2 and 26 years were identified separately for males and females by applying semiparametric mixture models. Associations were assessed by applying a modified Poisson regression to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results In both males and females, the following eczema trajectories were identified: unaffected/transient (77.7% vs. 73.0%), mid-onset late-resolving (7.8% vs. 4.4%), late-onset (5.2% vs. 9.5%), and early-onset persistent (9.3% vs. 5.4%). In females, an additional trajectory was identified: early-onset early-resolving (7.7%). Among males, filaggrin gene (FLG) variants (aRR = 2.45, 95% CI: 1.34-4.46) and paternal eczema (2.66, 1.39-5.08) were associated with the early-onset persistent trajectory. Among females, maternal eczema (2.84, 1.42-5.70) and high birthweight (2.25, 1.08-4.69) were associated with the early-onset persistent trajectory. Conclusions Four and five trajectories represented eczema development among males and females, respectively, with different predisposing risk factors. Key messages Males and females may experience a different course of eczema and also sex-specific risk factors.

scholarly journals Differences in risk factors for early-onset and late-onset biliary complications in liver transplant patients

2015 ◽  
Vol 35 (5) ◽  
pp. 201
Author(s):  
Teng-Wei Chen ◽  
Hsiu-Lung Fan ◽  
An-Chieh Feng ◽  
Meng-Hsing Ho ◽  
Shih-Ming Kuo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplant ◽  
Early Onset ◽  
Late Onset ◽  
Biliary Complications ◽  
Transplant Patients
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