727. Outcomes of Antibiotic Use in Ischemic Colitis

Abstract Background Ischemic colitis (IC) is caused by inadequate blood flow to the colon. Most cases resolve with conservative management. Isolated right-sided colitis, peritonitis, shock, and vascular risk factors are predictors of severe disease which can be life-threatening and require surgery. Current guidelines recommend antibiotics for moderate/severe disease. This is based on results from animal models and concern for gut translocation of bacteria; there have been no comparative studies in humans. This study aims to evaluate whether there is benefit to antibiotic use in non-severe IC. Methods This is a single-center retrospective cohort study of adult patients hospitalized with IC from 2015-2018. Inclusion in the study required endoscopic, radiologic, operative, or histologic evidence of ischemic colitis. Patients were divided into mild/moderate and severe IC cohorts as per 2014 American College of Gastroenterology Guidelines. Primary outcomes were length of stay (LOS) and any adverse event, which is defined as a composite measure of pre-specified secondary outcomes including mortality, need for surgery, 1-year relapse, and bacteremia. Results Of 191 patients enrolled in the study, 130 had mild/moderate IC and 61 had severe IC. In mild/moderate IC groups there was no significant difference in total adverse events, although use of antibiotics was associated with a significant increase in LOS (Table 1). In the severe IC groups there was no significant difference in any primary outcomes, but mortality was lower at 3 and 6 months among patients who did not receive antibiotics. Table 1 Conclusion Antibiotics did not improve outcomes in mild/moderate IC, suggesting that conservative management may be sufficient in this group. Antibiotic use was associated with increased LOS in mild/moderate IC and with increased mortality in severe IC; it is not clear whether these associations are true antibiotic-mediated adverse effects or whether they simply reflect a tendency to use antibiotics more frequently in patients who are more unstable. Future prospective research is needed to establish clear guidelines for antibiotic indications, agent selection, and optimal treatment duration. Disclosures All Authors: No reported disclosures

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Synergistic Effect of Coadministration of Haemophilus influenzae and Neisseria meningitidis Vaccines on Immune Responses to Meningitis in Mouse Model

10.20944/preprints201701.0010.v1 ◽

2017 ◽

Author(s):

Randa H. Ali ◽

Nourtan F. Abdeltawab ◽

Osama A. Hady ◽

Magdy A. Amin

Keyword(s):

Synergistic Effect ◽

Immune Responses ◽

Severe Disease ◽

Immunization Schedule ◽

Haemophilus Influenza ◽

Neisseria Meningitides ◽

Significant Difference ◽

Causative Agents ◽

Life Threatening ◽

Antibody Titers

Meningitis is a severe disease associated with death in children under five with highest rates of infections under age of one. Vaccines for Neisseria meningitides and Haemophilus influenza are used to prevent the main causative agents of meningitis. Administration of H. influenzae type b (Hib) vaccine is recommended at 2, 4 and 6 months with a booster dose at 18 months. N. meningitidis has two commercially available vaccines, the pure polysaccharide is recommended at 24 months meanwhile the protein-conjugated vaccines at 12 months. We sought in this study to examine if coadministering the vaccines for the two main meningitis causing bacteria might be synergistic as a preliminary step towards the possibility of shuffling immunization schedule. So, we coadministered Hib vaccine with commercially available vaccines either quadrate (ACWY) polysaccharide meningococcal (Men) or conjugated meningococcal (Nim) vaccines in Balb/C mice (n = 6/group) and compared to each vaccine administered separately and controls. Thirty-five days post immunization, we measured specific antibodies titers. Hib vaccine increased Men antibody titers significantly for serotypes Y and W. When Hib vaccine was coadministrated with Nim, antibody titer for Y, W and A significantly increased. For serotype C, there was no significant difference in antibody titers among immunized groups. As for effect of meningococcal vaccines on Hib, Men significantly increased Hib antibody titers while Nim had no effect. Collectively, our data suggested that coadministration of Hib and Men or Nim vaccines was safe and had synergistic effect on immune responses elicited to both vaccines. Further studies are needed before immunization schedule modifications. Such immunization schedule recommendation should provide better protection against this life-threatening disease in young children.

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Is perioperative antibiotic necessary in straightforward implant placement procedures?

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00282 ◽

2020 ◽

Author(s):

Elçin Bedeloğlu ◽

Mustafa Yalçın ◽

Cenker Zeki Koyuncuoğlu

Keyword(s):

Clavulanic Acid ◽

Dental Implant ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Implant Failure ◽

Control Group ◽

Implant Placement ◽

Significant Difference ◽

Amoxicillin Clavulanic Acid ◽

Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p >0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p <0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

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Renal Phosphate Handling in Antiretroviral-naïve HIV-infected Patients

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666200707115259 ◽

2020 ◽

Vol 20 ◽

Author(s):

Tewogbade Adeoye Adedeji ◽

Simeon Adelani. Adebisi ◽

Nife Olamide Adedeji ◽

Olusola Akanni Jeje ◽

Rotimi Samuel Owolabi

Keyword(s):

Hiv Infection ◽

Plasma Phosphate ◽

Cross Sectional ◽

Phosphate Retention ◽

Significant Difference ◽

Immunodeficiency Virus ◽

Life Threatening ◽

Moderate Chronic Kidney Disease ◽

One Year ◽

Sectional Analysis

Background: Human immunodeficiency virus (HIV) infection impairs renal function, thereby affecting renal phosphate metabolism. Objectives: We prospectively estimated the prevalence of phosphate abnormalities (mild, moderate to life-threatening hypophosphataemia, and hyperphosphataemia) before initiating antiretroviral therapy (ART). Methods: A cross-sectional analysis was performed on 170 consecutive newly diagnosed ART-naïve, HIV-infected patients attending our HIV/AIDS clinics over a period of one year. Fifty (50) screened HIV-negative blood donors were used for comparison (controls). Blood and urine were collected simultaneously for phosphate and creatinine assay to estimate fractional phosphate excretion (FEPi %) and glomerular filtration rate (eGFR). Results: eGFR showed significant difference between patients’ and controls’ medians (47.89ml/min/1.73m2 versus 60ml/min/1.73m2, p <0.001); which denotes a moderate chronic kidney disease in the patients. Of the 170 patients, 78 (45.9%) had normal plasma phosphate (0.6-1.4 mmol/L); 85 (50%) had hyperphosphataemia. Grades 1, 2 and 3 hypophosphataemia was observed in 3 (1.8%), 3 (1.8%), and 1(0.5%) patient(s) respectively. None had grade 4 hypophosphataemia. Overall, the patients had significantly higher median of plasma phosphate than the controls, 1.4 mmol/L (IQR: 1.0 – 2.2) versus 1.1 mmol/L (IQR: 0.3 – 1.6), p <0.001, implying hyperphosphataemia in the patients; significantly lower median urine phosphate than the controls, 1.5 mmol/L (IQR: 0.7 -2.1) versus 8.4 mmol/L (IQR: 3.4 – 16), p <0.001), justifying the hyperphosphataemia is from phosphate retention; but a non-significantly lower median FEPi% than the controls, 0.96 % (IQR: 0.3 -2.2) versus 1.4% (IQR: 1.2 -1.6), p > 0.05. Predictors of FEPi% were age (Odds ratio, OR 0.9, p = 0.009); weight (OR 2.0, p < 0.001); CD4+ cells count predicted urine phosphate among males (p = 0.029). Conclusion: HIV infection likely induces renal insufficiency with reduced renal phosphate clearance. Thus, hyperphosphataemia is highly prevalent, and there is mild to moderate hypophosphataemia but its life-threatening form (grade 4) is rare among ART-naïve HIV patients.

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The Initial Course of IL1β, IL-6, IL-8, IL-10, IL-12, IFN-γ and TNF-α with Regard to Severity Grade in Acute Pancreatitis

Biomolecules ◽

10.3390/biom11040591 ◽

2021 ◽

Vol 11 (4) ◽

pp. 591

Author(s):

Hanna Sternby ◽

Hannes Hartman ◽

Henrik Thorlacius ◽

Sara Regnér

Keyword(s):

Acute Pancreatitis ◽

Roc Analysis ◽

Paired Comparison ◽

Severe Disease ◽

Temporal Development ◽

Predictive Capacity ◽

Mean Values ◽

Tnf Α ◽

Significant Difference ◽

Ifn Γ

Clinical reports on early immune dysregulation in acute pancreatitis (AP) are scarce. Herein we investigate the initial temporal development of selected biomarkers. Blood samples were taken at 0–24 and 25–48 h after onsets of AP were acquired. Mean values and temporal intermediate difference (delta-values) of IL-1β, IL-6, IL-8, IL-10, IL-12, IFN-γ and TNF-α were calculated. Differences between severity groups, predictive capacity of the biomarkers and association with severe disease were analyzed. Paired comparison of samples (n = 115) taken at 0–24 and 25–48 h after onsets of AP showed a change over time for IL-1β, IL-6, IL-8 and IL-10 (p < 0.05) and a significant difference between severity groups after 24 h. In ROC-analysis an IL-6 cut-off level of 196.6 pg/mL could differentiate severe AP (sensitivity 81.9, specificity 91.3). The delta-values of IL-1β and IL-6 were significantly associated with severe outcomes (odds ratios 1.085 and 1.002, respectively). Data of this work demonstrate a distinct change in IL-1β, IL-8, IL-10 and IL-6 over the first 48 h after onset of AP. The temporal development of biomarkers can assist in the early stratification of the disease. Herein IL-1β and IL-6 were associated with severe disease, however the prognostic capacity of investigated biomarkers is low.

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Characteristics, Treatment, and Outcomes of Patients With Severe or Life-threatening COVID-19 at a Military Treatment Facility—A Descriptive Cohort Study

Military Medicine ◽

10.1093/milmed/usab055 ◽

2021 ◽

Author(s):

Brian P Elliott ◽

Gregory M Buchek ◽

Matthew T Koroscil

Keyword(s):

Severe Disease ◽

Ambient Air ◽

Active Duty ◽

Urban Setting ◽

Arterial Oxygen ◽

Treatment Facility ◽

Blood Oxygen Saturation ◽

Life Threatening ◽

Military Treatment Facility ◽

Active Duty Personnel

ABSTRACT Introduction The treatment of severe and life-threatening COVID-19 is a rapidly evolving practice. The purpose of our study was to describe the characteristics and outcomes of patients with severe or life-threatening COVID-19 who present to a Military Treatment Facility (MTF) with an emphasis on addressing institutional adaptations to rapidly changing medical evidence. Materials and Methods A single-center retrospective study conducted on a prospectively maintained cohort. The MTF is a 52-bed hospital within an urban setting. Patients were included in the cohort if they had laboratory-confirmed severe or life-threatening COVID-19 with positive SARS-CoV-2 reverse transcription polymerase chain reaction. Severe disease was defined as dyspnea, respiratory frequency ≥30/min, blood oxygen saturation ≤93% on ambient air, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, or lung infiltrates involving >50% of lung fields within 24-48 hours. Life-threatening COVID-19 was defined as respiratory failure, septic shock, or multiple organ dysfunction. The cohort included patients admitted from June 1 through November 13. Data were collected retrospectively via chart review by a resident physician. Results In total, our MTF saw 14 cases of severe or life-threatening COVID-19 from June 1 to November 13. Patients had a median age of 70.5 years, with 7% being active duty personnel, 21% dependents, and 71% retired military members. The median time to dexamethasone, remdesivir, and convalescent plasma administration was 4.7, 6.3, and 11.2 hours, respectively. The 28-day in-hospital mortality was 0%. Conclusions Patients who present to an MTF with severe or life-threatening COVID-19 are largely retirees, with only a small fraction comprising active duty personnel. The institution of order sets and early consultation can help facilitate prompt patient care for COVID-19.

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Patient Related Outcome Measures (PROMs) in Morton’s Neuroma: Conservative vs. Surgical Management at One-Year Follow-Up

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00021 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0002

Author(s):

Alastair Faulkner ◽

Alistair Mayne ◽

Fraser Harrold

Keyword(s):

Outcome Measures ◽

Surgical Management ◽

Conservative Management ◽

Morton’S Neuroma ◽

Significant Difference ◽

Morton's Neuroma ◽

One Year ◽

Patient Related Outcome ◽

Eq Vas

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

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Chemical manipulation of Leptosphaeria maculans (blackleg disease) pseudothecial development and timing of ascospore discharge from canola (Brassica napus) residues

Australian Journal of Agricultural Research ◽

10.1071/ar03056 ◽

2003 ◽

Vol 54 (9) ◽

pp. 837 ◽

Cited By ~ 16

Author(s):

A. D. Wherrett ◽

K. Sivasithamparam ◽

M. J. Barbetti

Keyword(s):

Developmental Stages ◽

Severe Disease ◽

Leptosphaeria Maculans ◽

Potential Method ◽

Chemical Treatments ◽

Ascospore Discharge ◽

Significant Difference ◽

Significant Efficacy ◽

Early Seedling ◽

Disease Pressure

A study was carried out to establish key developmental stages of Leptosphaeria maculans on canola residues leading up to ascospore discharge and how these stages could be affected by chemicals. The residues were dipped in a range of chemicals, including fungicides, herbicides, and surfactants, to determine possible manipulative effects of the chemicals on the development of the fungus including ascospore discharge. Treated residues were placed in the field during the growing season. Ascospore discharge was found to be closely related to pseudothecial maturity and density. There was no significant difference between pseudothecial maturation on the crown component compared with the stem component. A high correlation between rainfall and pseudothecial density suggested that rainfall was a good complimentary indicator for timing of ascospore discharge. These results may provide the canola industry with a potential method of monitoring pseudothecial development for estimating disease hazards. This would allow manipulation of sowing times so as to minimise or avoid heavy ascospore showers coinciding with the early seedling phase. Twenty chemical treatments showed significant efficacy in decreasing ascospore numbers early in the season, most often by delaying the development of the pseudothecia on the residues. Two scenarios were formulated giving growers the potential to manipulate pseudothecial development and/or ascospore discharge. Firstly, a number of chemicals, such as fluquinconazole, technical grade flutriafol, and gluphosinate-ammonium, were able to delay pseudothecial development and subsequent ascospore discharge was decreased by 100%, 99%, and 96%, respectively. This scenario gives growers the potential to minimise synchronisation of ascospore discharge with early crop establishment. Secondly, a situation where pseudothecial development is not delayed, but number of ascospores discharged is reduced (e.g. ziram by 45%) would only be effective if the reduction resulted in a less severe disease epidemic. There is significant potential for development of commercial chemical treatments of residues to reduce disease pressure on seedlings.

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Effect of COVID-19 outbreak on emergency department attendances in an Italian academic hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.207 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Poletto ◽

G Perri ◽

F Malacarne ◽

B Bianchet ◽

A Doimo ◽

...

Keyword(s):

Emergency Department ◽

Initial Phase ◽

Mainland China ◽

Hospital Setting ◽

Academic Hospital ◽

Significant Difference ◽

Before And After ◽

Life Threatening ◽

The Mean ◽

Critical Patients

Abstract Background Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was discovered during the 2019 outbreak in Mainland China and the first cases were reported in Italy on February 21, 2020. This study evaluates the emergency department (ED) attendances of an academic hospital in northern Italy before and after media reported the news of the first infected patients in Italy. Methods Adult attendances in ED in February 2020 were analysed dividing the period into 4 weeks (days 1-7, 8-14, 15-21, 22-28) compared with the same periods in 2019. The visits were analysed separately according to the Italian colour code of triage: white (non-critical), green (low-critical), yellow (medium critical), red (life-threatening). The mean weekly number of attendances was compared with t-test. Results February 2020 total ED attendances compared with February 2019 were 4865 vs 5029 (-3.3%), of which white codes were 834 vs 762 (+9.4%), green 2450 vs 2580 (-5.0%), yellow 1427 vs 1536 (-7.1%), red 154 vs 151 (+2.0%). February 2020 weekly mean ED attendances compared with February 2019 had statistically significant difference only in the fourth week (days 22-28) for green codes (75 vs 92, p = 0.007) and yellow codes (41 vs 52, p = 0.047), not for white (27 vs 26, p = 0.760) and red codes (5 vs 5, p = 0.817). The first three weeks of February 2020 compared with 2019 showed no statistically significant difference in weekly mean ED attendances. Conclusions There was a significant reduction of green and yellow codes attendances at ED in the fourth week of February 2020, corresponding to the initial phase of Italian COVID-19 outbreak. The fear of contracting SARS-CoV-2 by attending the ED probably acted as a significant deterrent in visits, especially for low and medium critical patients. Additional data are required to better understand the phenomenon, including the behaviour of non-critical attendances. Key messages A reduction of green and yellow codes attendances was reported during initial phase of COVID-19 outbreak in an Italian academic hospital. Fear of contracting COVID-19 infection in a hospital setting could impact on emergency department attendances.

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Caesarean Section in Eclampsia and its Outcome in Bangladesh

KYAMC Journal ◽

10.3329/kyamcj.v6i1.32787 ◽

2017 ◽

Vol 6 (1) ◽

pp. 583-586

Author(s):

MA Mazid ◽

Shahida Akter

Keyword(s):

Heart Failure ◽

Pulmonary Embolism ◽

Caesarean Section ◽

Conservative Management ◽

Causes Of Death ◽

Post Partum ◽

Economic Status ◽

Treatment Options ◽

Age Difference ◽

Significant Difference

This prospective study was carried out on a total number of 58 eclamptic subjects during the period of July 2010 to June 2012 where 38 were undergone caesarean section (LUCS - Lower Uterine Caesarean Section) and 20 received conservative management. Mean (±SD) Age of the subjects who undergone Caesarean Section and conservative management (NVD) were 23.67±8.63 and 23.45±9.31 years respectively. Significant mean age difference was also present between these two groups. In 38 subjects of LUCS 34 subjects were recovered and rest 4 cases were died. Possible causes of death were due to heart failure and post partum pulmonary embolism. Among these 20 subjects who were treated conservatively 14 were recovered and 6 subjects were died. Causes of death in these groups were pulmonary embolism, Septic pneumonia, and HELLP syndrome. Significant difference was found between these two treatment options. It was observed that socio-demographic, economic status and BMI had significant effects on management outcome.KYAMC Journal Vol. 6, No.-1, Jul 2015, Page 583-586

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Apoptosis as a Mechanism for Keratinocyte Death in Canine Toxic Epidermal Necrolysis

Veterinary Pathology ◽

10.1177/0300985816666609 ◽

2016 ◽

Vol 54 (2) ◽

pp. 249-253 ◽

Cited By ~ 3

Author(s):

F. Banovic ◽

S. Dunston ◽

K. E. Linder ◽

P. Rakich ◽

T. Olivry

Keyword(s):

Cell Death ◽

Toxic Epidermal Necrolysis ◽

Caspase 3 ◽

Skin Lesions ◽

Terminal Deoxynucleotidyl Transferase ◽

Epidermal Keratinocytes ◽

Biopsy Specimens ◽

Significant Difference ◽

Keratinocyte Cell ◽

Life Threatening

In humans and dogs, toxic epidermal necrolysis (TEN) is a life-threatening dermatosis characterized by sudden epidermal death resulting in extensive skin detachment. There is little information on the pathogenesis of keratinocyte cell death in canine TEN. We studied the occurrence of apoptosis in skin lesions of dogs with TEN to determine if apoptosis contributes to the pathogenesis of this disease. Immunostaining with antibodies to activated caspase-3 and the terminal deoxynucleotidyl-transferase (TdT)–mediated deoxyuridine triphosphate (dUTP) nick-end labeling technique revealed positive apoptotic keratinocytes in basal and suprabasal epidermal compartments in 17 biopsy specimens collected from 3 dogs with TEN and 16 from 3 dogs with erythema multiforme (EM). There was no significant difference in the number of positively stained epidermal cells between TEN and EM. These results suggest that apoptosis of epidermal keratinocytes and lymphocytic satellitosis represent one of the early steps in the pathogenesis of canine TEN, as in the human disease counterpart.

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