scholarly journals Increasing Incidence of Blastomycosis Infection in Vermont

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S84-S85 ◽  
Author(s):  
Porntip Kiatsimkul
Keyword(s):  
Medical Center ◽  
The United States ◽  
Common Disease ◽  
Invasive Infection ◽  
Fungal Culture ◽  
Disseminated Infection ◽  
South Central ◽  
Urine Antigen ◽  
Number Of Patients ◽  
Disseminated Disease

Abstract Background Blastomycosis is an invasive infection caused by the ubiquitous fungus Blastomyces. The clinical presentation ranges from limited cutanenous infections to pneumonia and disseminated disease. Endemic areas in the United States include: midwestern, south-central, and southeastern states; yearly incidence is <0.3 cases per 100,000. Diagnosis is based on recovery of the organism on fungal culture. A urine antigen test is available for the detection of blastomycosis which has a sensitivity of 92.9% and specificity of 79.3%. Anecdotally, an increasing number of patients are presenting to the University of Vermont Medical Center (UVMMC) with disseminated blastomycosis – an area in which the fungus is rare. We hoped to determine the incidence of blastomycosis in Vermont over a 10-year period and examine the sensitivity of the urine antigen in our patient population. Methods After IRB approval, medical record numbers of all patients who had BD-glucan, blastomyces urine antigen, culture, or pathology positive for blastomyces during a 10-year period (2006–2016) were obtained. Chart review completed for all patients with diagnosis of blastomycosis. Data collected on demographic characteristics: zip code, comorbidities, site of infection, HIV, BD-glucan, blastomyces urine antigen, fungal culture, and treatment duration. Results Forty-one blastomycosis cases were found; 39 cases in Vermont residents. The incidence rate Vermont was 0.7 cases per 100,000. Mean age was 49 years, 60% of patients were male. Most patients had pulmonary (37%) or disseminated infection (37%). 17% of patients had localized cutaneous disease, bone and joint infection (7%) or CNS disease (2%). Urine antigen was positive in 78% overall, and in 90% with disseminated infection. Three deaths, none attributed to blastomycosis. Conclusion Vermont appears to have a higher incidence than what has been reported in the US overall. This increase may have to do with better reporting and testing rather than a true increase in disease. Most common disease presentation was localized pulmonary or disseminated disease. Urine antigen sensitivity ranged from 78% (overall) to 90% (disseminated disease). This appears consistent with what has been reported in other studies, but is lower than the overall reported sensitivity. Disclosures All authors: No reported disclosures.

scholarly journals Setting Up and Expanding a Home Dialysis Program: Is There a Recipe for Success?

Kidney360 ◽  
2020 ◽  
Vol 1 (6) ◽  
pp. 569-579 ◽  
Author(s):  
Masood Ahmad ◽  
Eric L. Wallace ◽  
Gaurav Jain
Keyword(s):  
Medical Center ◽  
Clinical Care ◽  
Academic Medical Center ◽  
The United States ◽  
Absolute Number ◽  
Team Approach ◽  
Home Dialysis ◽  
Education Of Patients ◽  
Number Of Patients ◽  
Experienced Nurse

Home dialysis modalities remain significantly underused in the United States despite similar overall survival in the modalities, and recent incentives to expand these modalities. Although the absolute number of patients using home modalities has grown, the proportion compared to in-center hemodialysis (ICHD) continues to remain quite low. Well known barriers to home dialysis utilization exist, and an organized and team-based approach is required to overcome these barriers. Herein, we describe our efforts at growing our home dialysis program at a large academic medical center, with the proportion of home dialysis patients growing from 12% to 21% over the past 9 years. We prioritized individualized education for patients and better training for physicians, with the help of existing resources, aimed at better utilization of home modalities; an example includes dedicated dialysis education classes taught twice monthly by an experienced nurse practitioner, as well as the utilization of the dialysis educator from a dialysis provider for inpatient education of patients with CKD. The nephrology fellowship curriculum was restructured with emphasis on home modalities, and participation in annual home dialysis conferences has been encouraged. For timely placement and troubleshooting of access for dialysis, we followed a complementary team approach using surgeons and interventional radiologists and nephrologists, driven by a standardized protocol developed at UAB, and comanaged by our access coordinators. A team-based approach, with emphasis on staff engagement and leadership opportunities for dialysis nurses as well as collaborative efforts from a team of clinical nephrologists and the dialysis provider helped maintain efficiency, kindle growth, and provide consistently high-quality clinical care in the home program. Lastly, efforts at reducing burden of disease such as decreased number of monthly visits as well as using innovative strategies, such as telenephrology and assisted PD and HHD, were instrumental in reducing attrition.

scholarly journals Impact of COVID-19 Pandemic on Ambulatory and Operating Room Rhinology Practice in the US

2020 ◽  
pp. 194589242096196
Author(s):  
P Papagiannopoulos ◽  
A Ganti ◽  
YJ Kim ◽  
RA Raad ◽  
EC Kuan ◽  
...  
Keyword(s):  
Medical Center ◽  
Point Of Care ◽  
The United States ◽  
Further Education ◽  
The Novel ◽  
Web Based ◽  
Number Of Patients ◽  
The Us ◽  
Novel Coronavirus ◽  
The Impact

Introduction The pandemic caused by the novel coronavirus virus has altered all facets of clinical practice in the United States. The goal of this study is to better understand the impact of COVID-19 on rhinologic ambulatory and operative practice. Methods A 27-item survey to assess these objectives was created and approved by the Division of Rhinology faculty at Rush University Medical Center in April 2020. The survey was then distributed to rhinologists in a web based format via www.surveymonkey.com from April 10 through April 23, 2020. Results A total of 277 U.S based rhinologists responded to the survey (23.04%). The most common practice types were single specialty private (44.9%) and academic (24.6%). 90.2% practice in a state under a shelter in place order. Comparing pre-COVID baseline to during-COVID, there was statistically significant reduction in the number of patients of seen daily in clinic ( p < 0.001). The number of nasal endoscopies in the office and surgical procedures fell dramatically. Overall, 5 respondent rhinologists have been infected with COVID-19 and 27 have been furloughed. Conclusion COVID-19 has drastically affected rhinologic practice. There is a dramatic reduction of in person care in the office setting and surgical management of sinonasal and skull base disease. Enhanced PPE is being used in only half of potentially aerosolizing procedures which represents an area of further education. Novel approaches such as use of virtual encounters and point of care testing should be considered as options to facilitate care.

Old Patients and Uremia: Rates of Acceptance to and Withdrawal from Dialysis

1987 ◽  
Vol 10 (3) ◽  
pp. 166-172 ◽  
Author(s):  
D.G. Husebye ◽  
C.M. Kjellstrand
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Age Groups ◽  
The United States ◽  
Living Situation ◽  
Term Survival ◽  
Old Patients ◽  
Hennepin County ◽  
Number Of Patients ◽  
Patients At Risk

We studied the entry of elderly uremic patients to chronic dialysis in the U.S. in 1979. We also reviewed long-term survival, causes of death, and risk factors for death in old patients on dialysis at one center for the period 1966 to 1983. A comparison of the number of patients at risk with the number entering dialysis in the United States in 1979 indicates that 80% of the patients aged 25-45 years, 30% of patients over the age of 65 years, and 6% of those over the age of 75 years entered dialysis during that period. Of 239 patients over the age of 70 years followed at the Regional Kidney Disease Program at Hennepin County Medical Center in Minneapolis, the seven-year cumulative survival was 17%. In this program withdrawal from dialysis was the commonest cause of death, accounting for 40% of all deaths. Age groups over 75 years, sex, time period, duration of dialysis, eight pre-existing degenerative diseases, living situation, family support, and site and type of dialysis were not risk factors for termination of dialysis, but living in a nursing home was. When compared to the young, total deaths and deaths from discontinuation were much higher, and this decision was made earlier. Half of the patients who died because dialysis was discontinued were competent and decided for themselves; the other half were incompetent and families and physicians made the decision. Thus, old patients do not live as long, and they withdraw from dialysis more frequently than the young. Qualitatively, though, the decisions to stop dialysis are no different from those decisions made by or for younger patients.

scholarly journals Review of Treatment Regimens for Mucormycosis in a Las Vegas County Hospital Between 2013 and 2017

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S87-S87
Author(s):  
Angela Villamagna ◽  
Ian Adrian Frani ◽  
Kimberly D Leuthner ◽  
Shadaba Asad
Keyword(s):  
Combination Therapy ◽  
Treatment Regimen ◽  
Initial Treatment ◽  
Las Vegas ◽  
Fungal Infections ◽  
Medical Center ◽  
The United States ◽  
Treatment Regimens ◽  
Non Hodgkin Lymphoma ◽  
Disseminated Disease

Abstract Background Mucormycosis (MC) is a group of invasive fungal infections with a mortality rate approaching 100% in disseminated disease. The incidence of MC is low, with one study estimating 500 cases/year in the United States, making optimal treatment difficult to identify. Liposomal amphotericin B (L-ampho), along with aggressive surgical intervention, is the first-line treatment for MC. Isavuconazole (ISA) and posaconazole (POSA) are newer azoles used as salvage therapy in patients not improving with L-ampho. Limited data are available about the use of L-ampho in combination with ISA or POSA as an initial treatment regimen, but aggressive treatment empirically may increase favorable outcomes. Methods We performed a retrospective review of patients diagnosed with MC from 2013 to2017 at University Medical Center of Southern Nevada in Las Vegas, Nevada. Data collected included patient demographics, comorbidities, and predisposing risk factors as well as treatment regimens. Patients were evaluated for outcome after treatment therapy with monotherapy (L-ampho, POSA or ISA) or combination therapy (L-ampho with ISA). Results From 2013 to 2017, seven cases of MC were identified – five rhinocerebral (RC), one cutaneous (CT), and 1onepulmonary (PM). The most common risk factor was uncontrolled diabetes (5/7), followed by HIV (2/7) and non-Hodgkin lymphoma (1/7). Fifty-seven percent of patients received monotherapy and 43% received combination therapy (L-ampho/ISA). All the patients receiving combination therapy had RC. Seventy-one percent of patients survived to discharge regardless of treatment regimen. One hundred percent of combination therapy patients survived to discharge, whereas 50% of monotherapy patients survived to discharge. The two mortalities were patients with PM and CT MC. Conclusion MC is a rare infection with high mortality. For this reason, we are using ISA in combination with L-ampho as initial treatment to improve clinical outcomes. With our limited experience, combination therapy showed better rates of survival to discharge, without increasing adverse events. Our data suggest the use of combination therapy may improve outcomes in MC, but a larger sample of patients treated with initial combination therapy is required to strengthen conclusions about patient outcomes. Disclosures All authors: No reported disclosures.

Gonococcal endocarditis: A rare manifestation of a common disease in the COVID-19 era

2021 ◽  
pp. 095646242110174
Author(s):  
Meredith Kavalier ◽  
Amy Fiedler ◽  
Andrew Urban
Keyword(s):  
United States ◽  
Heart Failure ◽  
Healthcare Providers ◽  
The United States ◽  
Blood Cultures ◽  
Common Disease ◽  
Test Kit ◽  
Rare Manifestation ◽  
Rrna Sequencing ◽  
Disseminated Disease

Gonococcal infections have been increasing worldwide and in the United States. Rarely, Neisseria gonorrhoeae can cause disseminated disease, including endocarditis. We present a case of gonococcal endocarditis, confirmed by blood cultures and 16S rRNA sequencing on excised valvular tissue. Prior to presentation with heart failure, our patient was asymptomatic. Most gonococcal infections are diagnosed through routine screening of individuals at risk. During the COVID-19 pandemic, healthcare contact for nonurgent complaints has decreased, and test kit shortage has been a factor. With increased incidence and decreased opportunities for screening, healthcare providers should be aware of rising gonococcal infections, as well as potential complications.

Local Histories/Global Designs

2012 ◽  
Author(s):  
Walter D. Mignolo
Keyword(s):  
Social Sciences ◽  
Central America ◽  
Postcolonial Studies ◽  
The United States ◽  
Philosophy Of History ◽  
South Central ◽  
The Social ◽  
The Caribbean ◽  
Border Thinking ◽  
East West

This book is an extended argument about the “coloniality” of power. In a shrinking world where sharp dichotomies, such as East/West and developing/developed, blur and shift, this book points to the inadequacy of current practices in the social sciences and area studies. It explores the crucial notion of “colonial difference” in the study of the modern colonial world and traces the emergence of an epistemic shift, which the book calls “border thinking.” Further, the book expands the horizons of those debates already under way in postcolonial studies of Asia and Africa by dwelling on the genealogy of thoughts of South/Central America, the Caribbean, and Latino/as in the United States. The book's concept of “border gnosis,” or sensing and knowing by dwelling in imperial/colonial borderlands, counters the tendency of occidentalist perspectives to manage, and thus limit, understanding. A new preface discusses this book as a dialogue with Hegel's Philosophy of History.

Electronic cigarettes: How confident and effective are allergists, pulmonologists, and primary care physicians in their practice behavior?

2020 ◽  
Vol 41 (3) ◽  
pp. 192-197
Author(s):  
Sherry S. Zhou ◽  
Alan P. Baptist
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Electronic Cigarettes ◽  
The United States ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Knowledge And Beliefs ◽  
Tobacco Cigarette ◽  
Number Of Patients ◽  
Personal Use

Background: There has been a striking increase in electronic cigarette (EC) use in the United States. The beliefs and practices toward ECs among physicians are unknown. Objective: The purpose of this study was to investigate EC practice patterns among allergists, pulmonologists, and primary care physicians. Methods: An anonymous survey was sent to physicians. The survey contained 32 questions and addressed issues related to demographics, cessation counseling behaviors, personal use, and knowledge and beliefs about ECs. Statistical analysis was performed by using analysis of variance, the Pearson χ2 test, Fisher exact test, and logistic regression. Results: A total of 291 physicians completed the survey (222 primary care physicians, 33 pulmonologists, and 36 allergists) for a response rate of 46%. The allergists asked about tobacco cigarette use as frequently as did the pulmonologists and more than the primary care physicians (p < 0.001), but they rarely asked about EC use. The pulmonologists scored highest on self-reported knowledge on ECs, although all the groups answered <40% of the questions correctly. The allergists did not feel as comfortable about providing EC cessation counseling as did the pulmonologists and primary care physicians (p < 0.001). All three groups were equally unlikely to recommend ECs as a cessation tool for tobacco cigarette users. Conclusion: Allergists lacked knowledge and confidence in providing education and cessation counseling for EC users. As the number of patients who use these products continues to increase, there is an urgent need for all physicians to be comfortable and knowledgeable with counseling about ECs.

The Causative Organisms of Bacterial Meningitis and their Antimicrobial Resistance Profiles in Iranian Children in 2011-2016

2020 ◽  
Vol 20 (2) ◽  
pp. 229-236
Author(s):  
Sepideh Keshavarz Valian ◽  
Shima Mahmoudi ◽  
Babak Pourakbari ◽  
Maryam Banar ◽  
Mohammad Taghi Haghi Ashtiani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Bacterial Meningitis ◽  
Medical Center ◽  
Blood Cultures ◽  
Gram Positive ◽  
Gram Negative ◽  
Number Of Patients ◽  
Resistance Patterns ◽  
Iranian Children ◽  
Surgery Department

Objective: The study aimed to describe the identity and antimicrobial resistance patterns of the causative agents of bacterial meningitis in children referred to Children’s Medical Center (CMC) Hospital, Tehran, Iran. Methods: This retrospective study was performed at CMC Hospital during a six-year period from 2011 to 2016. The microbiological information of the patients with a diagnosis of bacterial meningitis was collected and the following data were obtained: patients’ age, sex, hospital ward, the results of CSF and blood cultures, and antibiotic susceptibility profiles of isolated organisms. Results: A total of 118 patients with bacterial meningitis were admitted to CMC hospital. Sixty-two percent (n=73) of the patients were male. The median age of the patients was ten months (interquartile range [IQR]: 2 months-2 years) and the majority of them (n=92, 80%) were younger than two years of age. The highest number of patients (n=47, 40%) were admitted to the surgery department. Streptococcus epidermidis was the most frequent isolated bacterium (n=27/127, 21%), followed by Klebsiella pneumoniae (n=20/127, 16%), and Staphylococcus aureus (n=16/127, 12.5%). Blood culture was positive in 28% (n=33/118) of patients. Ampicillin-sulbactam and imipenem were the most effective antibiotics against Gram-negative bacteria isolated from CSF cultures. In the case of Gram-positive organisms, ampicillinsulbactam, vancomycin, and linezolid were the best choices. Imipenem was the most active drug against Gram-negative blood pathogens. Also, ampicillin and vancomycin had the best effect on Gram-positive bacteria isolated from blood cultures. Conclusion: Results of this study provide valuable information about the antibiotic resistance profiles of the etiologic agents of childhood meningitis, which can be used for prescription of more effective empirical therapies.

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