scholarly journals Pasteurella Endocarditis: A Case Report and Statistical Analysis of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Randall S. Porter ◽  
Christine M. Hay
Keyword(s):  
Liver Disease ◽  
Statistical Analysis ◽  
Clinical Outcomes ◽  
Pasteurella Multocida ◽  
Small Sample Size ◽  
Significant Negative Correlation ◽  
Small Sample ◽  
Review Of The Literature ◽  
Aggressive Management ◽  
Animal Bites

Pasteurella is a genus of commensal bacteria of the oral cavity of several domesticated animals and a common cause of cellulitis after animal bites. Pasteurella has also been reported as a rare cause of endocarditis, with only 35 prior cases of definite Pasteurella endocarditis in the literature. Here, we present a case of Pasteurella multocida endocarditis treated successfully with surgery and antibiosis, as well as a review of the literature with statistical analysis of correlations between risk factors and clinical outcomes, as well as between treatment choices and clinical outcomes. Despite the small sample size, our analysis indicates a statistically significant correlation between comorbid liver disease and mortality, as well as a significant negative correlation between surgical treatment and mortality. This analysis implies a need for surgical management of endocarditis due to Pasteurella species and for more aggressive management of Pasteurella endocarditis in the setting of comorbid liver disease.

scholarly journals 1611. Evaluating Clinical Outcomes and Efficacy of Daptomycin in Combination with a Beta-Lactam for the Treatment of Vancomycin-Resistant Enterococcus (VRE) Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S799-S800
Author(s):  
Nerea Irusta ◽  
Ana Vega ◽  
Yoichiro Natori ◽  
Lilian M Abbo ◽  
Lilian M Abbo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Univariate Analysis ◽  
Small Sample ◽  
Significant Difference ◽  
Vancomycin Resistant ◽  
Secondary Outcomes ◽  
Related Mortality

Abstract Background In-vitro studies have shown synergistic bactericidal activity with daptomycin (DAP) plus β-lactam antimicrobials against vancomycin resistant enterococci (VRE). There is a paucity of data regarding clinical outcomes with this combination in VRE bloodstream infections (BSI). The purpose of this study was to assess the efficacy of DAP plus a β-lactam with in-vitro activity vs. other therapies for treatment of VRE BSI. Methods IRB-approved, single-center, retrospective study of patients with VRE BSI from 01/2018-09/2019. Patients were excluded if < 18 years old, pregnant, or incarcerated. The primary outcome was time-to-microbiological clearance. Secondary outcomes included infection-related mortality, 30-day all-cause mortality, and incidence of recurrent BSI within 30 days of index culture. Targeted DAP doses were ≥ 8mg/kg and based on MIC. Factors associated with significance for outcomes, via univariate analysis, were evaluated with multivariable logistic regression (MLR), removed in a backward-step approach. Results A total of 85 patients were included, 23 of which received DAP plus a β-lactam. The comparator arm included linezolid or DAP monotherapy. Patients with combination therapy had significantly higher Charlson Comorbidity Index (CCI) (p=0.013) and numerically higher Pitt Bacteremia scores (PBS) (p=0.087) (Table 1). There was no difference seen in the primary outcome (Table 2). Secondary outcomes are provided in Table 2. The presence of polymicrobial infection and higher PBS were significantly associated with infection-related mortality (p=0.008 and p=0.005, respectively) by MLR. A Mann Whitney U test indicated that presence of infection-related mortality was greater for patients with higher MICS (U=20.5, p=0.06). The presence of an underlying source may be related to recurrence of BSI (p=0.075). Table 1: Patient Characteristics Table 2. Primary and Secondary Outcomes Conclusion We did not find a significant difference in time-to-microbiological clearance, although patients treated with DAP and a β-lactam had higher CCI and PBS. These results are limited by retrospective design, small sample size, and potential selection bias. Prospective randomized studies are needed to further validate these findings. Disclosures All Authors: No reported disclosures

scholarly journals Statistical Analysis and Stochastic Modelling of Hydrological Extremes

Water ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1861 ◽  
Author(s):  
Hossein Tabari
Keyword(s):  
Statistical Analysis ◽  
Case Studies ◽  
Small Sample Size ◽  
Stochastic Modelling ◽  
Small Sample ◽  
Climate Conditions ◽  
Hydrological Extremes ◽  
Wide Range ◽  
Scale Models ◽  
Projected Changes

Analysis of hydrological extremes is challenging due to their rarity and small sample size and the interconnections between different types of extremes and gets further complicated by an untrustworthy representation of meso-scale processes involved in extreme events by coarse spatial and temporal scale models as well as biased or missing observations due to technical difficulties during extreme conditions. The special issue “Statistical Analysis and Stochastic Modelling of Hydrological Extremes”—motivated by the need to apply and develop innovative stochastic and statistical approaches to analyze hydrological extremes under current and future climate conditions —encompass 13 research papers. Case studies presented in the papers exploit a wide range of innovative techniques for hydrological extremes analyses. The papers focus on six topics: Historical changes in hydrological extremes, projected changes in hydrological extremes, downscaling of hydrological extremes, early warning and forecasting systems for drought and flood, interconnections of hydrological extremes and applicability of satellite data for hydrological studies. This Editorial provides an overview of the covered topics and reviews the case studies relevant for each topic.

scholarly journals Multi-model mapping of phonemic fluency

2021 ◽  
Author(s):  
Lisa Cipolotti ◽  
Tianbo Xu ◽  
Bronson Harry ◽  
Joe Mole ◽  
Grace Lakey ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Small Sample Size ◽  
Small Sample ◽  
Anterior Cingulate ◽  
Functional Region ◽  
Phonemic Fluency ◽  
Number Of Patients ◽  
Lesion Symptom Mapping ◽  
Subcortical Regions ◽  
Over Time

Abstract The voluntary generation of non-overlearned responses is usually assessed with phonemic fluency. Like most frontal tasks, it draws upon different complex processes and systems whose precise nature is still incompletely understood. Many claimed aspects regarding the pattern of phonemic fluency performance and its underlying anatomy remain controversial. Major limitations of past investigations include small sample size, scant analysis of phonemic output and methodologically insufficient lesion analyses approaches. We investigated a large number of patients with focal unilateral right or left frontal (n = 110) or posterior (n = 100) or subcortical (n = 65) lesions imaged with magnetic resonance or computed tomography and compared their performance on the number of overall responses, words produced over time, extremely infrequent/unknown words and inappropriate words generated. We also employed, for the first time parcel-based lesion symptom mapping, tract-wise statistical analysis as well as Bayesian multivariate analysis based on meta-analytically defined functional region of interest, including their interactions. We found that left frontal damage was associated with greater impairment than right frontal or posterior damage on overall fluency performance, suggesting that phonemic fluency shows specificity to frontal lesions. We also found that subcorticals, similar to frontals, performed significantly worse than posteriors on overall performance suggesting that subcortical regions are also involved. However, only frontal effects were found for words produced over time, extremely infrequent/unknown and inappropriate words. Parcel-based lesion symptom mapping analysis found that worse fluency performance was associated with damage to the posterior segment of the left frontal middle and superior gyrus, the left dorsal anterior cingulate gyrus and caudate nucleus. Tract-wise statistical analysis revealed that disconnections of left frontal tracts are critical. Bayesian multivariate models of lesions and disconnectome maps implicated left middle and inferior frontal and left dorsomedial frontal regions. Our study suggests that a set of well localised left frontal areas together with subcortical regions and several left frontal tracts are critical for word generation. We speculate that a left lateralized network exists. It involves medial, frontal regions supporting the process of energization, which sustains activation for the duration of the task and middle and inferior frontal regions concerned with selection, required due to the competition produced by associated stored words, respectively. The methodology adopted represents a promising and empirically robust approach in furthering our understanding of the neurocognitive architecture underpinning executive processes.

Association of N-acetyltransferase-2 Polymorphism with Antituberculosis Induced Hepatotoxicity: A meta-analysis

2021 ◽  
Vol 18 ◽  
Author(s):  
Nur Farhana Mohamed Noor ◽  
Teh Lay Kek ◽  
Mohd Arif Mohd Zim ◽  
Zamzurina Abu Bakar ◽  
Noor Izyani Zakaria ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
Inclusion Criteria ◽  
The World ◽  
Nat2 Polymorphism ◽  
Q Statistic ◽  
Quality Assessments ◽  
Review Manager

Background: N-acetyltransferase (NAT2) polymorphisms were reported to play important roles in antituberculosis-induced hepatotoxicity (ATDIH). However, the allelic types with increased risks for ATDIH were inconsistent as most studies are of a small sample size. Objective: The objective of the study was to conduct a meta-analysis to identify NAT2 alleles associated with increased risks of ATDIH. Methods: Studies reported on NAT2 polymorphism with the risk of ATDIH were searched systematically in PubMed, Scopus, and the World of Sciences. Studies were included if they fulfilled the inclusion criteria and excluded accordingly. Quality assessments were done using Newcastle-Ottawa Score. Statistical analysis was performed using Review Manager version 5.3. Cochrane Q-statistic test and I2 statistic were used to assess and quantify heterogeneity. Results: A total of 12 studies involving 580 cases and 3129 controls were included. NAT2 polymorphism was significantly associated with the risk of ATDIH with an odd ratio (OR) of 2.76 (1.86 – 4.10, 95% CI). Among the slow acetylators genotypes, NAT2*5/*7 carry the highest risk associated with ATDIH. Conclusion: NAT2 polymorphism was significantly associated with ATDIH.

scholarly journals 177. Clinical Outcomes of Daptomycin vs. Anti-Staphylococcal β-Lactams in Definitive Treatment of Methicillin-Susceptible Staphylococcus aureus (MSSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S111-S111
Author(s):  
Sydney Agnello ◽  
Shandra R Day ◽  
Lynn Wardlow ◽  
Erica E Reed ◽  
Jessica M Smith ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Small Sample ◽  
Definitive Treatment ◽  
Clinical Failure ◽  
Primary Indication ◽  
Definitive Therapy ◽  
All Cause Mortality ◽  
Related Mortality

Abstract Background The preferred management of patients with MSSA bacteremia includes definitive therapy with intravenous anti-staphylococcal β-lactam antibiotics. In β-lactam allergic or intolerant patients, daptomycin has been targeted as a viable alternative. The objective of this study was to assess clinical outcomes of daptomycin compared with nafcillin or cefazolin for the treatment of MSSA bacteremia. Methods This was a retrospective cohort study of patients hospitalized from November 1, 2011 to October 31, 2018 at The Ohio State University Wexner Medical Center with MSSA bacteremia. Patients treated with nafcillin, cefazolin or daptomycin were included with 1:1:1 random selection. The primary outcome was a composite of clinical failure, defined as a change in therapy due to persistent/worsening signs and symptoms, bacteremia recurrence or persistence, or inpatient infection-related mortality. Secondary endpoints included 30-day infection-related mortality, duration of bacteremia, 30-day all-cause mortality and adverse events (AEs) necessitating a change in therapy. Results Among patients with MSSA bacteremia, 162 received at least one dose of daptomycin. Of those, 29 received at least 14 days of daptomycin and/or received daptomycin as definitive therapy and thus were included in the analysis. There was no difference in the primary outcome of composite clinical failure comparing daptomycin vs. nafcillin/cefazolin (P = 0.71). In addition, no difference was observed in 30-day infection-related mortality (P = 0.51), duration of MSSA bacteremia (P = 0.9), or 30-day all-cause mortality (P = 0.64). A higher number of AEs necessitating change in therapy were seen in the daptomycin group (P = 0.0002), reflecting initial β-lactam intolerance. Conclusion No difference in clinical failure was identified in patients treated with daptomycin vs. nafcillin/cefazolin suggesting that daptomycin may serve as a non-inferior alternative for treatment of MSSA bacteremia. A higher number of AEs occurred in the daptomycin group indicating β-lactam intolerance as a primary indication for daptomycin therapy. Given the small sample size, subsequent studies are needed to further evaluate the use of daptomycin in the treatment of MSSA bacteremia. Disclosures All authors: No reported disclosures.

scholarly journals Preliminary Evidence Supports Modification of Retraction Technique to Prevent Needlestick Injuries

2016 ◽  
Vol 63 (4) ◽  
pp. 192-196 ◽  
Author(s):  
Bernadette Alvear Fa ◽  
Eve Cuny
Keyword(s):  
Statistical Analysis ◽  
Sample Size ◽  
Preliminary Data ◽  
Small Sample Size ◽  
Preliminary Evidence ◽  
Body Fluids ◽  
Small Sample ◽  
Needlestick Injuries ◽  
Nondominant Hand

A modified retraction technique was introduced into the DDS degree preclinical anesthesia course in 2011 with the goal of reducing needlestick exposure incidents. In numerous studies of dental exposures, injuries from dental anesthetic needles account for the highest proportion of all exposures. The purpose of this study was to assess the preliminary impact of a modified retraction technique on the incidence of blood and body fluids (BBF) exposure incidents associated with needles during injection. Data from evaluations of students from 2014 and 2015 were obtained and tracked to determine whether the modified retraction technique was “excellent,” “clinically acceptable,” or “clinically unacceptable.” Data were collected to determine if the patient perceived the modified retraction technique as “comfortable” or “correctable when addressed” to help improve student technique for future injections. Likewise, data from the blood-borne exposure database where all information related to BBF exposures is recorded were reviewed and the information separated by year and class. This study presents preliminary data only and because of the small sample size does not lend itself to validation by statistical analysis. However, the technique effectively removes the operator's hand from the field during injection, reducing the risk of accidental intraoral needlestick to the nondominant hand of the operator.

scholarly journals Clinical Outcomes of Single vs. Two-Strain Probiotic Prophylaxis for Prevention of Necrotizing Enterocolitis in Preterm Infants

2021 ◽  
Vol 9 ◽  
Author(s):  
Archana Priyadarshi ◽  
Gemma Lowe ◽  
Vishal Saddi ◽  
Amit Trivedi ◽  
Melissa Luig ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Pathogenic Bacteria ◽  
Competitive Inhibition ◽  
Small Sample Size ◽  
Bifidobacterium Bifidum ◽  
Small Sample ◽  
Single Strain ◽  
Microbial Invasion

Background: The administration of live microbiota (probiotic) via enteral route to preterm infants facilitates intestinal colonization with beneficial bacteria, resulting in competitive inhibition of the growth of pathogenic bacteria preventing gut microbiome dysbiosis. This dysbiosis is linked to the pathogenesis of necrotizing enterocolitis (NEC), an acquired multi-factorial intestinal disease characterized by microbial invasion of the gut mucosa, particularly affecting preterm infants. Probiotic prophylaxis reduces NEC; however, variations in strain-specific probiotic effects, differences in administration protocols, and synergistic interactions with the use of combination strains have all led to challenges in selecting the optimal probiotic for clinical use.Aim: To compare any differences in NEC rates, feeding outcomes, co-morbidities in preterm infants receiving single or two-strain probiotics over a 4-year period. The two-strain probiotic prophylaxis was sequentially switched over after 2 years to the single strain probiotic within this 4-year study period, in similar cohort of preterm infants.Methods: During two consecutive equal 2-year epochs, preterm infants (<32 weeks and or with birth weight <1,500 g) receiving two-strain (Lactobacillus acidophilus and Bifidobacterium bifidum) and single strain (Bifidobacterium breve M-16 V,) probiotic prophylaxis for prevention of NEC were included in this retrospective, observational study. The primary outcome included rates of NEC; secondary outcomes included prematurity related co-morbidities and feeding outcomes. Time to reach full enteral feeds was identified as the first day of introducing milk feeds at 150 ml/kg/day.Results: There were 180 preterm infants in the two-strain, 196 in the single strain group from the two equal consecutive 2-year epochs. There were no differences in the NEC rates, feeding outcomes, all-cause morbidities except for differences in rates of retinopathy of prematurity.Conclusion: In our intensive-care setting, clinical outcomes of single vs. two—strain probiotic prophylaxis for prevention of NEC were similar. Although our study demonstrates single strain probiotic may be equally effective than two-strain in the prevention of NEC, small sample size and low baseline incidence of NEC in our unit were not sufficiently powered to compare single vs. two-strain probiotic prophylaxis in preventing NEC. Further clustered randomized controlled trials are required to study the effects of single vs. multi-strain probiotic products for NEC prevention in preterm infants.

Abstract WP55: A Comparison of Outcomes in Patients Selected for Endovascular Stroke Treatment with and without the Aid of CT Perfusion Imaging

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gregory Ferenz ◽  
Raymond Reichwein
Keyword(s):  
Clinical Outcomes ◽  
Ct Perfusion ◽  
Small Sample Size ◽  
Medical Center ◽  
Outcome Data ◽  
Small Sample ◽  
Treatment Selection ◽  
Control Group ◽  
Stroke Treatment ◽  
Significant Difference

Background: Selection of patients for endovascular stroke treatment has traditionally been based on time since symptom onset. CT perfusion (CTP) imaging has raised the possibility of patient selection on objective measures other than time from stroke onset. However, previous studies have failed to show significant outcome improvement in patients selected for endovascular stroke treatment based on CTP, but have been limited by small sample size, lack of outcomes past time of discharge, or lack of control group. Objective: To determine if endovascular stroke treatment selection with the aid of CTP is associated with improved clinical outcomes at 90 days as compared to patients undergoing endovascular stroke treatment without the aid of CTP. Methods: This study retrospectively reviewed a prospectively collected database of all patients who underwent endovascular stroke treatment at Penn State Hershey Medical Center between 1/1/2009 and 12/31/2011. Patients with posterior circulation strokes and those enrolled in other treatment trials were excluded. Patients were divided into two groups based on whether they had undergone a CTP study prior to endovascular stroke treatment or not. The variables measured included age, sex, and NIHSS on admission. Outcome data measured from the patients 90 day post stroke follow up appointments included an NIHSS improvement by 4 or more, a modified Rankin Score (mRS) of 2 or less, and mortality. Results: Of 41 patients included in the study, there was no significant difference in outcomes at 90 days as measured by an improvement of NIHSS of 4 or more (p=0.106) or modified Rankin score of 0-2 (p=0.475). Table 1 summarizes the results. Conclusion: Endovascular stroke treatment selection with the use of CTP was not associated with improved clinical outcomes at 90 days as measured by NIHSS improvement of 4 or more or a mRS of 0-2.

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