scholarly journals Associated Factors of Acute Chest Syndrome in Children with Sickle Cell Disease in French Guiana

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Narcisse Elenga ◽  
Emma Cuadro ◽  
Élise Martin ◽  
Nicole Cohen-Addad ◽  
Thierry Basset

A matched case-control study was performed in order to identify some associated factors for ACS or to confirm the published data. Controls were children hospitalized during the same period for pain crisis who did not develop an ACS during hospitalization. Between January 2006 and October 2010, there were 24 episodes of ACS distributed among 19 patients (8 girls and 11 boys). The median age was 7.5 years (range: 3 to 17 years) for the cases and 7 years (range: 3–18 years) for the controls. Four cases and 11 controls were treated with hydroxyurea (HU). In 75% of the cases, the ACS had arisen 24–72 hours following admission. The independent factors associated with ACS were average Hb rate <8 g/dL (OR = 4.96, 95% CI = 1.29–27.34, andP=0.04), annual number of hospitalizations >3 (OR = 5.44, 95% CI = 3.59–8.21, andP=0.003), average length of hospitalization >7 days (OR = 3.69, 95% CI = 3.59–8.21, andP=0.003), and a pathological transthoracic echocardiography (TTE) (OR = 13.77, 95% CI = 2.07–91.46, andP=0.003). Although the retrospective design and small sample size are weaknesses of the present study, these results are consistent with those of previous studies and allowed identifying associated factors such as a pathological TTE.

2016 ◽  
Vol 145 (1) ◽  
pp. 23-29 ◽  
Author(s):  
B. SAID ◽  
K. D. HALSBY ◽  
C. M. O'CONNOR ◽  
J. FRANCIS ◽  
K. HEWITT ◽  
...  

SUMMARYOver 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.


2021 ◽  
Vol 2020 ◽  
Author(s):  
Vladimir Zaichick

Introduction: The prostate gland is subject to various disorders. The etiology and pathogenesis of these diseases remain not well understood. Moreover, despite technological advancements, the differential diagnosis of prostate disorders has become progressively more complex and controversial. It was suggested that the nickel (Ni) level in prostatic tissue plays an important role in prostatic carcinogenesis and its measurement may be useful as a cancer biomarker. These suggestions promoted more detailed studies of the Ni content in the prostatic tissue of healthy subjects. Materials and methods: The present study evaluated by systematic analysis the published data for Ni content analyzed in prostatic tissue of “normal” glands. This evaluation reviewed 1889 studies, all of which were published in the years from 1921 to 2020 and were located by searching the databases Scopus, PubMed, MEDLINE, ELSEVIER-EMBASE, Cochrane Library, and the Web of Science. The articles were analyzed and “Median of Means” and “Range of Means” were used to examine heterogeneity of the measured Ni content in prostates of apparently healthy men. Results: The objective analysis was performed on data from the 20 studies, which included 743 subjects. It was found that the range of means of prostatic Ni content reported in the literature for “normal” gland varies widely from 0.030 mg/kg to 4.50 mg/kg with median of means 0.625 mg/kg on a wet mass basis. Conclusion: Because of small sample size and high data heterogeneity, we recommend other primary studies be performed.


Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2667-2667 ◽  
Author(s):  
Carlton Dampier ◽  
Wally R. Smith ◽  
Carrie Wager ◽  
Margaret Bell ◽  
James R. Eckman ◽  
...  

Abstract Abstract 2667 Background: Acute pain is the leading cause of hospitalization in both children and adults with sickle cell disease (SCD). Opioid analgesics are used for pain relief, but are associated with significant adverse effects that are bothersome to patients and may predispose to serious sickle-related pulmonary events. Evidence is limited for the most effective opioid administration strategy that maximizes analgesia and minimizes adverse effects. Patient Controlled Analgesia (PCA) has the potential advantage to allow a patient to optimize pain control without dependence on healthcare providers for administration. PCA generally consists of an opioid given by constant infusion with additional demand doses as needed; the proper dosing for each is largely unknown, particularly at high opioid doses. The SCDCRN conducted a multi-center phase III clinical trial comparing two alternative opioid PCA dosing strategies (HDLI-higher demand dose with low constant infusion or LDHI- lower demand dose and higher constant infusion). The required sample size for the trial was 278 subjects. Patients and Methods: SCD patients ≥ age 10 years hospitalized for significant pain (baseline pain VAS ≥ 4.5/10) who had received < 12 hours of previous analgesic therapy and provided informed consent were eligible; patients with renal/hepatic dysfunction, who received large amounts of oral opioids prior to admission, or who had evidence of acute chest syndrome were excluded. Investigators used standardized opioid dosing tables for morphine or hydromorphone, and for participants weighing ±50 kg. Opioid-related symptoms were assessed with a validated daily questionnaire; multimodal assessments of pain, physical function, and sleep were conducted by an assessor blinded to treatment assignment/dose level; because of safety concerns, individuals responsible for making dosing decisions were not blinded. The assigned PCA strategy was continued until patients were transitioned to oral analgesics. An intention to treat analysis was planned for the time to a significant (2.5 cm) improvement in average daily 10 cm pain VAS. Secondary endpoints included total opioid usage and frequency of opioid-related symptoms. Results: From January 1, 2010 to June 8, 2010, a total of 1050 patients age ≥ 10 years were hospitalized for pain; 216 were ineligible, 796 were missed for logistic/staffing issues at sites, and 38 subjects completed randomization prior to trial closure (due to inadequate time to complete enrollment prior to Network termination in March 2011). Average age of enrolled subjects was 23.9 ± 12.2 years (range 10–52 years), and 53% were female. The HDLI arm had 50% morphine and 40% pediatric subjects (10-17 years); the LDHI arm had 44% morphine and 50% pediatric subjects. Four subjects were withdrawn (1 parent permission withdrawal, 2 inadvertent withdrawals by PI, 1 ineligible). Baseline VAS was high (mean 7.5 cm HDLI, and 7.7 cm LDHI). A reduction in pain intensity during PCA treatment was observed in both treatment arms (mean difference from baseline ± SEM: 2.7 ±1.5 cm HDLI vs 2.8 ±2.0 cm LDHI; time to significant improvement 22.0 ±3.0 hours HDLI vs 22.1 ±3.8 hours LDHI), with 75% of the HDLI subjects and 79% of the LHDI experiencing a significant improvement in pain. Average length of hospitalization was 143.7 ±94.2 hours HDLI vs 102.4 ±42.6 hours LDHI. The reliability or significance of any similarities or differences noted in this descriptive analysis is limited by the small sample size. Opioid utilization in the two treatment arms is currently being analyzed. Opioid-related symptoms were well managed and similar in both treatment arms (mean daily opioid symptom severity score (1-4): 0.9 ± 0.6 HDLI vs 0.8 ± 0.6 LDHI). Four episodes of serious hypoxia, likely relate to exacerbation of pulmonary hypertension, developed in adult subjects during the study (2 HDLI, 2 LDHI). Conclusions: The premature closure of the study limits potential conclusions regarding safety and efficacy, or superiority of either treatment regimen. The data gathered will help resolve potential design issues related to the complexity of running an inpatient opiod PCA trial and help guide modification of subject selection and enrollment, optimization of opioid dosing and monitoring, and endpoint assessments. Given the clinical priority of adequate pain management and the challenges of opioid PCA therapy, completion of this trial is imperative. Supported by NHLBI. Disclosures: Dampier: Anthera Pharmaceuticals Inc:; Glycomimetics Inc:. Telen: GlycoMimetics: Consultancy, clinical trial sponsorship.


2020 ◽  
Vol 41 (S1) ◽  
pp. s445-s446
Author(s):  
Megan DiGiorgio ◽  
Lori Moore ◽  
Greg Robbins ◽  
Albert Parker ◽  
James Arbogast

Background: Hand hygiene (HH) has long been a focus in the prevention of healthcare-associated infections. The limitations of direct observation, including small sample size (often 20–100 observations per month) and the Hawthorne effect, have cast doubt on the accuracy of reported compliance rates. As a result, hospitals are exploring the use of automated HH monitoring systems (AHHMS) to overcome the limitations of direct observation and to provide a more robust and realistic estimation of HH behaviors. Methods: Data analyzed in this study were captured utilizing a group-based AHHMS installed in a number of North American hospitals. Emergency departments, overflow units, and units with <1 year of data were excluded from the study. The final analysis included data from 58 inpatient units in 10 hospitals. Alcohol-based hand rub and soap dispenses HH events (HHEs) and room entries and exits (HH opportunities (HHOs) were used to calculate unit-level compliance rates. Statistical analysis was performed on the annual number of dispenses and opportunities using a mixed effects Poisson regression with random effects for facility, unit, and year, and fixed effects for unit type. Interactions were not included in the model based on interaction plots and significance tests. Poisson assumptions were verified with Pearson residual plots. Results: Over the study period, 222.7 million HHOs and 99 million HHEs were captured in the data set. There were an average of 18.7 beds per unit. The average number of HHOs per unit per day was 3,528, and the average number of HHEs per unit per day was 1,572. The overall median compliance rate was 35.2 (95% CI, 31.5%–39.3%). Unit-to-unit comparisons revealed some significant differences: compliance rates for medical-surgical units were 12.6% higher than for intensive care units (P < .0001). Conclusions: This is the largest HH data set ever reported. The results illustrate the magnitude of HHOs captured (3,528 per unit per day) by an AHHMS compared to that possible through direct observation. It has been previously suggested that direct observation samples between 0.5% to 1.7% of all HHOs. In healthcare, it is unprecedented for a patient safety activity that occurs as frequently as HH to not be accurately monitored and reported, especially with HH compliance as low as it is in this multiyear, multicenter study. Furthermore, hospitals relying on direct observation alone are likely insufficiently allocating and deploying valuable resources for improvement efforts based on the scant information obtained. AHHMSs have the potential to introduce a new era in HH improvement.Funding: GOJO Industries, Inc., provided support for this study.Disclosures: Lori D. Moore and James W. Arbogast report salary from GOJO.


2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S95-S96
Author(s):  
Kathleen Singer ◽  
Jalen Harvey ◽  
Elizabeth Dale

Abstract Introduction The Boston Criteria and the Abbreviated Burn Severity Index (ABSI) are two widely accepted models for predicting mortality in burn patients. We aimed to elucidate whether these models are able to accurately predict risk of mortality in patients who sustain burns while smoking on home oxygen given their overall clinical fragility. Methods We conducted a retrospective chart review of 48 patients admitted to our burn center from November 2013 to September 2017 who sustained a burn while smoking on home oxygen. Yearlong mortality was the primary outcome of the investigation; secondary outcomes included discharge to facility, length of stay, and need for tracheostomy. We then calculated the expected mortality rate for each patient based on Boston Criteria and ABSI, respectively, and compared the mortality rate observed in our cohort. Results Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p &lt; 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p &lt; 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Conclusions Patients whose burns are attributable to smoking on home oxygen may have an increased risk of mortality than prognostication models, such as the Boston Criteria and ABSI, may suggest. This bears significant clinical impact, particularly regarding family and provider decision-making in pursuing aggressive management. Applicability of Research to Practice This data indicates that these injuries are direr than expected, which may have significant impact on family and provider decision-making.


2019 ◽  
Vol 8 (9) ◽  
pp. 1310-1317 ◽  
Author(s):  
Ana P Estrada-Flórez ◽  
Mabel E Bohórquez ◽  
Alejandro Vélez ◽  
Carlos S Duque ◽  
Jorge H Donado ◽  
...  

Papillary thyroid cancer (PTC) is the second most commonly diagnosed malignancy in U.S. Latinas and in Colombian women. Studies in non-Latinos indicate that BRAF and TERT mutations are PTC prognostic markers. This study aimed to determine the prevalence and clinical associations of BRAF and TERT mutations in PTC Latino patients from Colombia. We analyzed mutations of BRAF (V600E) and TERT promoter (C228T, C250T) in tumor DNA from 141 patients (75 with classical variant PTC, CVPTC; 66 with follicular variant PTC, FVPTC) recruited through a multi-center study. Associations between mutations and clinical variables were evaluated with Fisher exact tests. Survival was evaluated with Kaplan–Meier plots. Double-mutant tumors (BRAF+/TERT+, n = 14 patients) were more common in CVPTC (P = 0.02). Relative to patients without mutations (n = 48), double mutations were more common in patients with large tumors (P = 0.03), lymph node metastasis (P = 0.01), extra-thyroid extension (P = 0.03), and advanced stage (P = 6.0 × 10−5). In older patients, TERT mutations were more frequent (mean age 51 years vs 45 years for wild type TERT, P = 0.04) and survival was lower (HR = 1.20; P = 0.017); however, given the small sample size, the decrease in survival was not statically significant between genotypes. Comparisons with published data in US whites revealed that Colombian patients had a higher prevalence of severe pathological features and of double-mutant tumors (10 vs 6%, P = 0.001). Mutations in both oncogenes show prognostic associations in Latinos from Colombia. Our study is important to advance Latino PTC precision medicine and replicates previous prognostic associations between BRAF and TERT in this population.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19566-19566
Author(s):  
A. Panju ◽  
D. Kelvin ◽  
M. D. Minden ◽  
S. M. Alibhai

19566 Background: Fatigue is the most common and disabling symptom affecting patients with AML; effective prevention or treatment measures have yet to be found. Cytokines, biological markers of inflammation, may represent a major cause of fatigue, but published data are limited. Methods: Patients age 50 or older with AML were recruited between May and September 2006. All patients were fluent in English, within one year of diagnosis, and free of any other active malignancy. Fatigue was measured using the Functional Assessment of Cancer Therapy (FACT) Fatigue subscale, a single-item global fatigue scale, and the European Organization for the Research and Treatment of Cancer (EORTC) QLQ-C30. Blood was simultaneously drawn for quantitative measurement of a panel of 13 cytokines. Repeat measurements were done 4–6 weeks later. Correlational analysis was used to examine relationships between individual cytokines and fatigue scores. Changes in fatigue scores between time points were correlated with changes in cytokine levels. Results: 34 patients (23 men; 11 women) were enrolled (mean age 67 y; range 52–84). 27% had not started chemotherapy or were receiving best supportive care, while the rest were undergoing active chemotherapy. At baseline, a weak correlation (r=0.332, p=0.059) was seen with interleukin (IL)-6 and at least one fatigue measure. No correlations (r<0.30) were observed with any of the other cytokines (interferon (IFN)-?, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, MiG, and tumor necrosis factor-a) and any fatigue measure. Follow-up data were available for 29 patients. A statistically significant correlation with fatigue was seen with IL-2 (r=0.407, p=0.032), and clinically-important correlations that did not achieve conventional statistical significance were seen with IFN-? (r=0.331, p=0.085), IL-5 (r=0.344, p=0.073), and IL-10 (r=0.326, p=0.091). Conclusions: Based on these data, the most promising cytokine-fatigue relationship was noted with IL-2. However, IFN-?, IL-5, IL-6, and IL-10 also showed potentially important relationships with fatigue. Given our small sample size and patient enrolment at differing time points during their treatment course, further controlled studies are warranted. No significant financial relationships to disclose.


2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16140-e16140
Author(s):  
C. J. Pezaro ◽  
G. C. Toner ◽  
R. Hicks

e16140 Background: We retrospectively evaluated our single institution experience using FDG-PET as part of initial assessment of stage I/II NSGCT. Previous studies by de Wit et al and the TE22 trial concluded that there was a very limited role for PET staging in NSGCT. Despite these results, PET continues to be utilised in our center. Methods: With local ethics approval, the PET center database at Peter MacCallum Cancer Centre (PMCC) was used to identify a series of 26 patients with NSGCT who underwent FDG-PET as part of staging investigations between 1998 and 2008. Demographic and clinical information was collected using electronic and paper medical records. Histological samples were reviewed if additional information was required. Results: Lymphovascular invasion (LVI) was present in 10 (38%) of orchiectomy specimens. 15 patients had stage I disease on both CT and PET. PET upstaged 7 patients from stage I to stage II disease, and all upstaged patients received systemic chemotherapy (3 cycles BEP). 1 patient with stage I disease on PET and CT received adjuvant chemotherapy (2 cycles EP). 3 patients with LVI and stage 1 disease on CT and PET underwent surveillance. With median follow-up of 33 months (range 1–94), all patients were alive without disease recurrence, although 1 patient was treated for a second primary NSGCT. Conclusions: Using PET images, we were able to identify patients with low volume metastatic disease and achieve 100% relapse-free survival rates. Despite the small sample size, these results are promising and are better than expected based on published data. This might be explained by the quality of the PET imaging, including attenuation correction and combined CT/PET for enhanced sensitivity interpreting retroperitoneal disease. Further evaluation of PET is warranted, particularly in patients with equivocal CTs or with the high-risk feature of LVI. [Table: see text] No significant financial relationships to disclose.


2016 ◽  
Vol 13 (1) ◽  
pp. 67-75 ◽  
Author(s):  
Gillian Z. Heller ◽  
Maurizio Manuguerra ◽  
Roberta Chow

AbstractBackground and aimsThe Visual Analogue Scale (VAS) is a popular tool for the measurement of pain. A variety of statistical methods are employed for its analysis as an outcome measure, not all of them optimal or appropriate. An issue which has attracted much discussion in the literature is whether VAS is at a ratio or ordinal level of measurement. This decision has an influence on the appropriate method of analysis. The aim of this article is to provide an overview of current practice in the analysis of VAS scores, to propose a method of analysis which avoids the shortcomings of more traditional approaches, and to provide best practice recommendations for the analysis of VAS scores.MethodsWe report on the current usage of statistical methods, which fall broadly into two categories: those that assume a probability distribution for VAS, and those that do not. We give an overview of these methods, and propose continuous ordinal regression, an extension of current ordinal regression methodology, which is appropriate for VAS at an ordinal level of measurement. We demonstrate the analysis of a published data set using a variety of methods, and use simulation to compare the power of the various methods to detect treatment differences, in differing pain situations.ResultsWe demonstrate that continuous ordinal regression provides the most powerful statistical analysis under a variety of conditions.Conclusions and Implications We recommend that in the situation in which no covariates besides treatment group are included in the analysis, distribution-free methods (Wilcoxon, Mann–Whitney) be used, as their power is indistinguishable from that of the proposed method. In the situation in which there are covariates which affect VAS, the proposed method is optimal. However, in this case, if the VAS scores are not concentrated around either extreme of the scale, normal-distribution methods (t-test, linear regression) are almost as powerful, and are recommended as a pragmatic choice. In the case of small sample size and VAS skewed to either extreme of the scale, the proposed method has vastly superior power to other methods.


Author(s):  
ZAICHICK V

The prostate gland is subject to various disorders. The etiology and pathogenesis of these diseases remain not well understood. Moreover, despite technological advancements, the differential diagnosis of prostate disorders has become progressively more complex and controversial. It was suggested that the chromium (Cr) level in prostatic tissue plays an important role in prostatic carcinogenesis and its measurement may be useful as a cancer biomarker. These suggestions promoted more detailed studies of the Cr content in the prostatic tissue of healthy subjects. The present study evaluated by systematic analysis the published data for Cr content analyzed in prostatic tissue of “normal” glands. This evaluation reviewed 1958 studies, all of which were published in the years from 1921 to 2020 and were located by searching the databases PubMed, Scopus, ELSEVIER-EMBASE, Cochrane Library, and the Web of Science. The articles were analyzed and “Median of Means” and “Range of Means” were used to examine heterogeneity of the measured Cr content in prostates of apparently healthy men. The objective analysis was performed on data from the 28 studies, which included 1282 subjects. It was found that the range of means of prostatic Cr content reported in the literature for “normal” gland varies widely from 0.009 mg/kg to 0.34 mg/kg with median of means 0.095 mg/kg on a wet mass basis. The level of intra-prostatic metal does not depend on age and androgen status. Finally, because of small sample size and high data heterogeneity, we recommend other primary studies be performed.


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