scholarly journals 1318. Clinical and Molecular Characteristics of Hypermucoviscous Klebsiella pneumoniae Causing Pneumonia in Korea

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S747-S748
Author(s):  
Ji Yeon Lee ◽  
Hyun Ah Kim ◽  
Miri Hyun
Keyword(s):  
Klebsiella Pneumoniae ◽  
Respiratory Infection ◽  
Biofilm Formation ◽  
Medical Center ◽  
Community Acquired Pneumonia ◽  
Molecular Characteristics ◽  
Microtiter Plate Assay ◽  
Group A ◽  
Group B ◽  
Underlying Diseases

Abstract Background Invasive Klebsiella pneumoniae (K. pneumoniae) was emerged in Asia, well-known for community-onset liver abscess. Healthcare-associated pneumonia caused by hypervirulent K. pneumoniae has been reported in recent studies. The purpose of this study was to evaluate the clinical and molecular characteristics of hypervirulent K. pneumoniae compared with classic K. pneumoniae in respiratory infection. Methods The study was performed on 163 K. pneumoniae isolates of respiratory infections collected from Keimyung University of Dongsan Medical Center from November 2013 to November 2015; group A, as classic K. pneumoniae and group B, as hypervirulent K. pneumoniae. Hypermucoviscous phenotype was confirmed with string test. Capsular serotypes, rmpA, magA, allS, mrkD, entB, kfu, and iutA were identified using specific primers by polymerase chain reaction. The biofilm mass was determined using the microtiter plate assay measured by optical density (OD, 570nm). Results A total 163 patients were analyzed, 100 (61.3%) of group A and 68 (38.7%) of group B. Community-acquired pneumonia was observed in 49.2% of group B and 18.0% of group A (p=0.001). Underlying diseases except chronic lung disease were more associated with group A. Mean age (72.6±11.7 vs. 68.8±12.5 years, p=0.051) and antimicrobial resistant rates were higher in group A. Mechanical ventilators (21.0% vs. 36.5%, p=0.030) was more associated with group B. Concordances of initial antibiotics (57.5% vs. 92.1%, p=0.001) were more observed in group B. Biofilm formation and infection related 30-day mortality showed no differences between the two groups. Conclusion Contrary to our expectations, hypervirulent K. pneumoniae was more associated with community-acquired pneumonia in this study. Compared to classic K. pneumoniae, hypervirulent K. pneumoniae showed more association with severe pneumonia and less association with underlying diseases. In respiratory infection, biofilm formation was not different according to hypermucoviscousity. Disclosures All Authors: No reported disclosures

scholarly journals Effect of Weight-Bearing in Conservative and Operative Management of Fractures of the Base of the Fifth Metatarsal Bone

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Jae-Yong Park ◽  
Hyong-Nyun Kim ◽  
Yoon-Suk Hyun ◽  
Jun-Sik Park ◽  
Hwan-Jin Kwon ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Weight Bearing ◽  
Operative Management ◽  
Foot And Ankle ◽  
Early Weight Bearing ◽  
Group A ◽  
Vas Scores ◽  
American Orthopaedic ◽  
Group B ◽  
Underlying Diseases

Background. There is no established principle regarding weight-bearing in conservative and operative management of fifth metatarsal base fractures. Methods. We reviewed 86 patients with acute fifth metatarsal base fractures. Conservatively treated late or early weight-bearing patients were assigned to Group A or C, respectively. Operatively treated late or early weight-bearing patients were assigned to Group B or D, respectively. Results were evaluated by clinical union, bone resorption, and the American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores. Results. All 4 groups had bone union at a mean of 6.9 weeks (range, 5.1–15.0). There were no differences between the groups in the AOFAS and VAS scores. In the early weight-bearing groups, there were fewer cases of bone resorption, and the bone unions periods were earlier. Conclusions. Early weight-bearing may help this patient population. Moreover, conservative treatment could be an option in patients with underlying diseases.

scholarly journals Interspecies Communication among Commensal and Pathogenic Streptococci

mBio ◽  
2013 ◽  
Vol 4 (4) ◽  
Author(s):  
Laura C. Cook ◽  
Breah LaSarre ◽  
Michael J. Federle
Keyword(s):  
Quorum Sensing ◽  
Biofilm Formation ◽  
Human Pathogens ◽  
Streptococcus Dysgalactiae ◽  
Interspecies Communication ◽  
Content Type ◽  
Streptococcal Species ◽  
Group A ◽  
Group B ◽  
Regulated Gene Expression

ABSTRACTQuorum sensing (QS) regulates diverse and coordinated behaviors in bacteria, including the production of virulence factors, biofilm formation, sporulation, and competence development. It is now established that some streptococci utilize Rgg-type proteins in concert with short hydrophobic peptides (SHPs) to mediate QS, and sequence analysis reveals that several streptococcal species contain highly homologous Rgg/SHP pairs. In group A streptococcus (GAS), two SHPs (SHP2 and SHP3 [SHP2/3]) were previously identified to be important in GAS biofilm formation. SHP2/3 are detected by two antagonistic regulators, Rgg2 and Rgg3, which control expression of theshpgenes. In group B streptococcus (GBS), RovS is a known virulence gene regulator and ortholog of Rgg2, whereas no apparent Rgg3 homolog exists. Adjacent torovSis a gene (shp1520) encoding a peptide nearly identical to SHP2. Using isogenic mutant strains and transcriptional reporters, we confirmed that RovS/SHP1520 comprise a QS circuit in GBS. More important, we performed experiments demonstrating that production and secretion of SHP1520 by GBS can modulate Rgg2/3-regulated gene expression in GAS intrans; likewise, SHP2/3 production by GAS can stimulate RovS-mediated gene regulation in GBS. An isolate ofStreptococcus dysgalactiaesubsp.equisimilisalso produced a secreted factor capable of simulating the QS circuits of both GAS and GBS, and sequencing confirms the presence of an orthologous Rgg2/SHP2 pair in this species as well. To our knowledge, this is the first documented case of bidirectional signaling between streptococcal species in coculture and suggests a role for orthologous Rgg/SHP systems in interspecies communication between important human pathogens.IMPORTANCEPathogenic streptococci, such as group A (GAS) and group B (GBS) streptococcus, are able to persist in the human body without causing disease but become pathogenic under certain conditions that are not fully characterized. Environmental cues and interspecies signaling between members of the human flora likely play an important role in the transition to a disease state. Since quorum-sensing (QS) peptides have been consistently shown to regulate virulence factor production in pathogenic species, the ability of bacteria to signal via these peptides may prove to be an important link between the carrier and pathogenic states. Here we provide evidence of a bidirectional QS system between GAS, GBS, andStreptococcus dysgalactiaesubsp.equisimilis, demonstrating the possibility of evolved communication systems between human pathogens.

The impact of pretreatment absolute lymphocyte count (pALC) and neutrophil-lymphocyte ratio (pNLR) on checkpoint inhibitors (CPIs) response rates in renal cell carcinoma (RCC) and bladder urothelial cancers (BC).

2020 ◽  
Vol 38 (5_suppl) ◽  
pp. 29-29
Author(s):  
Tonjeh Mary Stella Bah ◽  
David Sommerhalder ◽  
Philip A. Haddad
Keyword(s):  
Checkpoint Inhibitors ◽  
Medical Center ◽  
Response Rates ◽  
Neutrophil Lymphocyte Ratio ◽  
Essential Components ◽  
Group A ◽  
Group 2 ◽  
Group B ◽  
The Impact ◽  
Group 1

31 Background: CPIs have been established as essential components of cancer immunotherapy across multiple cancer types with proven clinical benefit, improved outcomes, and less toxicity. Studies in lung and head and neck cancers found that low ALC, a marker of immune exhaustion, was associated with poor response to CPIs and worse progression-free survival. We explored the effect of pALC and pNLR on CPI response rates in patients with RCC and BC. Methods: We retrospectively reviewed every RCC and BC patient that received CPIs at Overton Brooks VA Medical Center and LSUHSC-S between 2015 and 2019. Patients’ pALC and pNLR were calculated. The patients were divided according to pALC into 2 groups: Group A with pALC > 1000 and Group B with pALC < 1000. Similarly, using NLR’s established upper normal limit of 3, 2 groups were created: Group 1 with pNLR < 3 and Group 2 with pNLR > 3. Our primary outcome of interest was defined as the presence or absence of CPI response. Patients who attained stable disease, partial response, and complete response were categorized as responders. Those who progressed on CPIs were labeled as non-responders. The significance of the association between pALC and pNLR groups and the occurrence of any response was analyzed statistically. Results: Twenty patients (13 RCC, 7 BC) were treated with CPIs and had documented responses. Twelve patients had pALC > 1000 (Group A) whereas 8 patients had pALC < 1000 (Group B). Both groups were comparable with respect to age, sex, race, and types of CPIs. Group A had a significantly higher response rate (75% vs 25%, p = 0.027). As to pNLR, 10 patients had pNLR < 3 (Group 1) and another 10 patients had pNLR > 3 (Group 2). Patients with pNLR > 3 had worse response rates to CPIs compared to those with pNLR < 3 (30% vs 80%, p = 0.024). Conclusions: This is the first report from a real-world clinical setting to show a detrimental association between pALC < 1000 and pNLR > 3 and CPI response rates in a retrospective cohort of consecutive non-selected kidney and bladder cancer patients. This association and its clinical utility require further confirmation in a prospective larger cohort.

scholarly journals Defibrillation threshold of internal cardioversion prior to ablation predicts atrial fibrillation recurrence

2020 ◽  
Author(s):  
kohei sawasaki ◽  
Yasuya Inden ◽  
natsuko hosoya ◽  
masahiro muto ◽  
Toyoaki Murohara
Keyword(s):  
Atrial Fibrillation ◽  
Medical Center ◽  
Defibrillation Threshold ◽  
Ablation Procedure ◽  
Recurrence Rates ◽  
Internal Cardioversion ◽  
Group A ◽  
Group B ◽  
Recurrence Method ◽  
Af Recurrence

Background: Many studies have reported the predictors of atrial fibrillation (AF) recurrence after persistent AF (peAF) ablation. However, the correlation between the atrial defibrillation threshold (DFT) for internal cardioversion (IC) and AF recurrence rate is little-studied. We investigated the relationship between DFT prior to catheter ablation for peAF and the AF recurrence. Method and Results: From June 2016 to May 2019, we enrolled 82 consecutive patients (mean age 65.0 ± 12.4 years), including 45 patients with peAF and 37 with long-standing peAF, at Hamamatsu medical center. In order to assess the DFT, we performed IC with gradually increasing energy prior to radiofrequency application. Forty-nine and 33 patients showed DFT values less than or equal to 10 J (group A) and greater than 10 J or unsuccessful defibrillation (group B), respectively. During the mean follow-up duration of 20.5 ± 13.1 months, patients in group B showed significantly higher AF recurrence rates than those in group A after the ablation procedure (P = 0.017). Multivariate analysis revealed that the DFT was the only predictive factor for AF recurrence (OR=1.07; 95% CI: 1.00-1.13, P = 0.047). Conclusions: The DFT for IC was one of the strongest prognostic factors in the peAF ablation procedure.

scholarly journals Surgeons have hesitated early cholecystectomy because of cardiovascular comorbidities during adoption of guidelines

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Ichiro Onishi ◽  
Masato Kayahara ◽  
Takahisa Yamaguchi ◽  
Yukari Yamaguchi ◽  
Akihiko Morita ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Medical Center ◽  
Early Surgery ◽  
Early Cholecystectomy ◽  
Early Laparoscopic Cholecystectomy ◽  
Cardiovascular Comorbidities ◽  
Group A ◽  
Delayed Group ◽  
Group B ◽  
Early Operations

AbstractThe introduction of the guidelines has resulted in an increase of laparoscopic surgeries performed, but the rate of early surgery was still low. Here, the initial effect of the introduction of the guideline was confirmed in single center, and factors disturbing early cholecystectomy were analyzed. This study included 141 patients who were treated for acute cholecystitis from January 2010 to October 2014 at Kanazawa Medical Center. Each patient was assigned into a group according to when they received treatment. Patients in Group A were treated before the Tokyo Guidelines were introduced (n = 48 cases), those in Group B were treated after the introduction of the guidelines (93 cases). After the introduction of the guidelines, early laparoscopic cholecystectomy was significantly increased (P < 0.001), however, the rate of early operations was still 38.7% only. There are many cases with cardiovascular disease in delayed group, the prevalence had reached 50% as compared with early group of 24% (P < 0.01). Approximately 25% of patients continued antiplatelet or anticoagulant therapy. In the early days of guidelines introduction, the factor which most disturbed early surgery was the coexistence of cardiovascular disease. These contents could be described in the next revision of the guidelines.

scholarly journals Removal of Mechanical Ventilation During Veno-Venous ECMO May Improve Outcome of Patients with Acute Respiratory Failure Due to Adult Community-Acquired Pneumonia

2021 ◽  
Author(s):  
Lu-Lu Li ◽  
Cong-Ying Song ◽  
Mei Shao ◽  
An-Dong Shang ◽  
Lin-Lin Meng ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Survival Rate ◽  
Acute Respiratory Failure ◽  
Demographic Data ◽  
Community Acquired Pneumonia ◽  
Significant Independent Predictor ◽  
Group A ◽  
Group B ◽  
Ecmo Therapy

Abstract Background: As a life-saving therapy for patients with acute respiratory failure (ARF)Mechanical ventilation has catalyzed the development of modern emergency medicine and intensive care units.Another way to support respiratory or cardiac functions is extracorporeal membrane oxygenation (ECMO).Based on previous studies, the increased pre-ECMO time of mechanical ventilation is a significant independent predictor of the poorer outcome . Removal or maintaining of mechanical ventilation during ECMO is still debatable. Methods: We analyzed the clinical data of 23 patients veno-venous ECMO therapy with acute respiratory failure due to adult community-acquired pneumonia.They were divided into two groups: group A (removed of mechanical ventilation, n=10) and group B ( maintaining of mechanical ventilation,n=13).Demographic data, including gender, age, smoking habits were collected. General characteristics and Clinical characteristics of patients were also recorded, in order to discuss whether the retention or removal of trachea cannula and continued mechanical ventilation during ECMO can affect patients’ prognosis. Results: After analysis, patients in the Group B were older than the Group A (61.0 y [54.5-67.5] vs 39.0 y [24.0-61.8], P=0.021). The median APACHE Ⅱ score of 23 patients before ECMO therapy was 25.0 (IQR, 21.0-28.0), and the Group A had a lower initial APACHE Ⅱ score than the Group B (21.5 [20.8-24.3] vs 28.0 [24.0-29.0], P=0.005)(Table 1).The group A with a survival rate of 80% , and the group B presenting a survival rate of 23.1%.The difference in the survival rate between the two groups was statistically significant (P=0.012).No differences in other items were found between the two groups.Conclusions: The final results showed that the removing of mechanical ventilation during ECMO can improve the survival rate and prognosis in patients with ARF.

scholarly journals Comparison of biofilm formation and efflux pumps in ESBL and carbapenemase producing Klebsiella pneumoniae

2018 ◽  
Vol 12 (03) ◽  
pp. 156-163 ◽  
Author(s):  
Burak Yazgan ◽  
Ibrahim Türkel ◽  
Rıdvan Güçkan ◽  
Kılınç Kılınç ◽  
Tuba Yıldırım
Keyword(s):  
Klebsiella Pneumoniae ◽  
Biofilm Formation ◽  
Cell Communication ◽  
Opportunistic Pathogen ◽  
Efflux Pumps ◽  
Microtiter Plate ◽  
Virulence Determinants ◽  
Clinical Environment ◽  
Microtiter Plate Assay ◽  
Significant Difference

Introduction: Klebsiella pneumoniae is an opportunistic pathogen that causes a range of diseases. The appearance of extended-spectrum β-lactamase -and carbapenemase-producing strains, in addition to the biofilm-forming phenotype, is a major problem in the clinical environment. Methodology: A total of 33 clinical K. pneumoniae isolates were used in this study. Antimicrobial susceptibilities were assessed by a disc diffusion assay. Biofilm formation was determined by a microtiter plate assay, staining with 1% crystal violet and measuring  absorbance after destaining. Moreover, expression of acrA, kdeA, ketM, kpnEF, and kexD efflux associated genes  was measured by qRT-PCR. Results: Isolates displayed high resistance to β-lactams such as cefazolin, cefuroxime, ceftriaxone, cefepime, piperacillin-tazobactam, imipenem, and meropenem and decreased resistance to gentamicin, amikacin, ciprofloxacin, and levofloxacin. ESBL-producing isolates formed more biofilm than carbapenemase-producing isolates. The mRNA expression levels in KPC isolates for acrA (2-fold), kdeA (2.7-fold), ketM (2.2-fold), and kpnEF (3.4-fold) were significantly increased compared to ESBL-producing isolates. There was no significant difference in kexD expression level. Conclusions: Under the conditions used here ESBL-producing isolates formed more biofilm than KPC postive isolates; this was associated with virulence determinants which were also transferred by plasmids together with ESBLs enzymes. Moreover, the upregulation of acrA, kdeA, ketM, and kpnEF efflux pumps was seen in carbapenemase-producing isolates demonstrating that high expression of efflux pumps alone could not confer resistance but may act as a physiological determinant such as bacterial pathogenicity and virulence, and cell-to-cell communication for bacteria.

scholarly journals Evaluating the Efficacy and Trend of Sinus Surgery

2020 ◽  
Vol 24 (04) ◽  
pp. e407-e412
Author(s):  
Masa Petrovic ◽  
Arash Shamsian ◽  
Martin L. Hopp ◽  
Narine Vardanyan
Keyword(s):  
Medical Center ◽  
Preoperative Evaluation ◽  
Sinus Surgery ◽  
Surgical Results ◽  
Evaluation Time ◽  
Group A ◽  
Group B ◽  
Optimal Evaluation

Abstract Introduction From April 2009 to December 2016, 661 consecutive patients undergoing sinus surgery completed a quality of life (QOL) questionnaire (SNOT-22) preoperatively and at 3, 6, and 12 months postoperatively. Objective (1) To evaluate the long-term efficacy of sinus surgery using QOL instruments. (2) To determine the optimal evaluation time for surgical efficacy. (3) To determine if surgical results improve with yearly experience. Methods The prospective study patients were split into two groups: Group A, those who completed the initial preoperative evaluation and all postoperative evaluations, and Group B, who completed the preoperative questionnaire and at least one but not all of the postoperative questionnaires. Group A included 93 patients. Group B included 240 patients at 3 months, 180 at 6 months, and 121 at 12 months postoperatively. Results Group A efficacy reported at 3 months was 82.8%, 80.6% at 6 months, and 84.9% at 12 months postoperatively. Group B efficacy reported at 3 months was 71.3%, 78.3% at 6 months, and 84.3% at 12 months postoperatively. An 8-year trend analysis of year-to-year 12 months postoperative data illustrates a significant improvement with an analysis of variance (ANOVA) linear rate of 1.594 (p ≤0.12). Conclusion The 8-year trend at 12 months postoperatively shows a positive improvement in surgical results. Patients undergoing sinus surgery at tertiary medical center showed 84.9% improvement in sinus disease symptoms by 12 months postoperatively. Long-term improvement analysis showed no difference between 6 months postoperatively and 12 months, signifying 6 months as an effective evaluation for surgical efficacy.

scholarly journals Effects of varenicline therapy in combination with advanced behavioral support on smoking cessation and quality of life in inpatients with acute exacerbation of COPD, bronchial asthma, or community-acquired pneumonia: A prospective, open-label, preference-based, 52-week, follow-up trial

2017 ◽  
Vol 15 (2) ◽  
pp. 146-156 ◽  
Author(s):  
Alexios Politis ◽  
Vasileios Ioannidis ◽  
Konstantinos I Gourgoulianis ◽  
Zoe Daniil ◽  
Chrissi Hatzoglou
Keyword(s):  
Smoking Cessation ◽  
Community Acquired Pneumonia ◽  
Smoking Abstinence ◽  
Open Label ◽  
Behavioral Support ◽  
Asthma Attack ◽  
Group A ◽  
Group B ◽  
Exacerbation Of Copd

Quitting smoking is the most important element in the therapeutic management of chronic respiratory diseases. Combining pharmacotherapy with behavioral support increases smoking cessation success rates. In addition, hospitalized smokers have increased motivation to quit. We investigated the efficacy on smoking cessation, of varenicline in combination with behavioral support, in smokers hospitalized due to (a) acute exacerbation of chronic obstructive pulmonary disease (COPD), or (b) bronchial asthma attack, or (c) community-acquired pneumonia (CAP). The method used is prospective, open-label, preference-based, parallel group, 52-week trial. Patients chose the smoking cessation intervention they preferred: a standard regimen of varenicline combined with post-discharge advanced behavioral support (group A) or one private consultation session during hospitalization (group B). Follow-up phone calls were scheduled in weeks 1, 2, and 4 and months 3, 6, and 9. The final hospital visit was performed in week 52. Primary outcome was success rate defined as the percentage (%) of smoking abstinence at week 52 and secondary outcomes were (a) changes in quality of life (QoL) indicated by the scores on the Short Form 36 (SF36) questionnaire and (b) predictors of smoking abstinence investigated with multiple binary logistic regression. One hundred one patients were enrolled, 44 (43.6%) in group A and 57 (56.4%) in group B. Respective abstinence rates were 54.5% and 15.8% at week 12 and 52.3% and 14.0% at week 52. Scores on SF36 were statistically significantly increased in both groups. Predictors of smoking abstinence were varenicline (odds ratio (OR) 7.29; 95% confidence interval (CI) 2.15, 24.77; p = 0.001), age (OR 1.07; 95%CI 1.00, 1.15; p = 0.042), Fagerstrom score (OR 0.37; 95%CI 0.20, 0.68; p = 0.001), SF36 domains “vitality” (OR 1.12; 95%CI 1.04, 1.21; p = 0.003), and “social functioning” (OR 0.95; 95%CI 0.90, 1.00; p = 0.041). Varenicline in combination with behavioral support resulted in high abstinence rates inpatients hospitalized for exacerbation of COPD, asthma attack, or CAP, and improved QoL.

scholarly journals Efficacy of amoxicillin-clavulanic acid versus ceftriaxone in children hospitalized under 5 years of age with uncomplicated community acquired pneumonia.

2020 ◽  
Vol 27 (11) ◽  
pp. 2339-2344
Author(s):  
Huriya Abid ◽  
Wajiha Rizwan ◽  
Irfan Naeem ◽  
Aysha Mansoor Lodhi ◽  
Muhammad Nasir Rana
Keyword(s):  
Clavulanic Acid ◽  
Controlled Trial ◽  
Community Acquired Pneumonia ◽  
Duration Of Symptoms ◽  
Treatment Groups ◽  
Acid Versus ◽  
Group A ◽  
Amoxicillin Clavulanic Acid ◽  
Group B ◽  
Children Under 5

Objectives: Community acquired pneumonia (CAP) is considered to be the commonest reason for hospitalization among children. Pneumonia is the leading cause of mortality among children in Pakistan in children, causing 33% of all deaths in infants and 37% of all deaths in children 1 to 4 years. The aim of current study was to compare efficacy of amoxicillin-clavulanic acid versus ceftriaxone among children under 5 years of age, hospitalized having uncomplicated CAP. Study Design: Randomized Controlled trial (RCT). Setting: Department of Pediatric Medicine, The Children Hospital and Institute of Child Health, Lahore. Period: 01/01/2019 to 30/06/2019. Material & Methods: A total of 210 (105 in each group) children aged between 2 to 60 months, diagnosed having CAP were randomly allocated into either Group-A (received IV amoxicillin-clavulanic acid) or Group B (received IV ceftriaxone). Efficacy in terms of response of both treatment groups was noted after 5 days treatment. Results: Overall, mean age was noted as 14.68±15.7 months. Majority (n=131, 32.4%) were male and aged between 1 to 12 months (n=135, 64.3%). Mean duration of symptoms was noted as 3.60±1.69 days. Efficacy was significantly higher in children treated with ceftriaxone as compared to those treated with Amoxicillin/Clavulanic acid (96.2% vs. 76.2%; p<0.001). This difference was significant across all age, gender and duration of symptom groups (p<0.05). Conclusion: The efficacy was significantly higher in children treated with ceftriaxone as compared to Amoxicillin/Clavulanic acid.

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