Lipolytic Response to Metabolic Stress in Critically Ill Patients SAMUEL KLEIN, EDWARD J. PETERS, ROBERT SHAW, ROBERT WOLFE Departments of Internal Medicine, Preventive Medicine and Community Health, Surgery, and Anesthesiology, The University of Texas Medical Branch and The Shriners Burns Institute Galveston, TX

The University of Texas Medical Branch in Galveston is offering a Ph.D. program in Preventive Medicine and Community Health with a concentration in Sociomedical Sciences. The program is designed to provide students with the opportunity for careers in research and teaching in the rapidly growing fields of social and behavioral health sciences and preventive medicine. Emphases include the promotion of health, determinants of illness, the delivery of health services, and the recovery process. Faculty members have backgrounds in medical sociology, anthropology, psychology, gerontology, epidemiology, biometry, demography, pediatrics, family medicine, behavioral medicine, psychiatry, health education, program evaluation, and family therapy. Program facilities are located in a complex of medical, nursing, allied health and graduate schools, with opportunities for community and clinical research.

Download Full-text

44. Antibiotic Class-Based Distribution and Analysis of Reported Beta-Lactam Allergies amongst Hospitalized Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.089 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S45-S45

Author(s):

Joseph Patrik Hornak ◽

David Reynoso

Keyword(s):

Bacterial Infections ◽

Drug Resistant ◽

Beta Lactam ◽

Resistance Development ◽

Texas Medical ◽

University Of Texas ◽

Icd 10 ◽

Mrsa Infection ◽

The University ◽

Alternative Antibiotic

Abstract Background Reported β-lactam allergy (BLA) is very common, yet less than 10% of these patients exhibit true hypersensitivity. When faced with reported BLAs, physicians often choose alternative antibiotics which can be associated with C. difficile infection, drug-resistance development, poorer outcomes, & increased costs. Effective identification of these patients is necessary for subsequent, appropriate BLA “de-labeling.” Here, we conducted a single-center analysis of alternative antibiotic utilization amongst patients reporting BLA and compare the frequency of drug-resistant infections and C. difficile infection in allergic & non-allergic patients. Methods This is a retrospective review of adult patients hospitalized at The University of Texas Medical Branch from 1/1/2015 to 12/31/2019. Pooled electronic medical records were filtered by antibiotic orders and reported allergies to penicillins or cephalosporins. Patients with drug-resistant and/or C. difficile infection (CDI) were identified by ICD-10 codes. Microsoft Excel & MedCalc were used for statistical calculations. Results Data were available for 118,326 patients and 9.3% (11,982) reported a BLA, with the highest rates seen in those receiving aztreonam (85.9%, 530/617) & clindamycin (33.7%, 3949/11718). Amongst patients reporting BLA, high ratios-of-consumption (relative to all patients receiving antibiotics) were seen with aztreonam (7.0), clindamycin (2.7), cephalosporin/β-lactamase inhibitors (2.4), & daptomycin (2.1). Compared to the non-BLA population, BLA patients more frequently experienced MRSA infection (3.0% vs 1.5%, OR 1.99, 95% CI 1.79–2.23, p< 0.0001), β-lactam resistance (1.2% vs 0.6%, OR 2.07, 95% CI 1.72–2.49, p< 0.0001), and CDI (1.2% vs 0.7%, OR 1.85, 95% CI 1.54–2.23, p< 0.0001). Conclusion Our measured BLA rate matches approximate expectations near 10%. Moreover, these patients experienced significantly higher frequencies of drug-resistant bacterial infections and CDI. Targeted inpatient penicillin allergy testing stands to be particularly effective in those patients receiving disproportionately utilized alternative agents (e.g. aztreonam, clindamycin, daptomycin). β-lactam allergy “de-labeling” in these patients is likely a valuable antimicrobial stewardship target. Disclosures All Authors: No reported disclosures

Download Full-text

Severe liver dysfunction complicating course of COVID-19 in the critically ill: multifactorial cause or direct viral effect?

Annals of Intensive Care ◽

10.1186/s13613-021-00835-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kevin Roedl ◽

Dominik Jarczak ◽

Andreas Drolz ◽

Dominic Wichmann ◽

Olaf Boenisch ◽

...

Keyword(s):

Critically Ill ◽

Liver Dysfunction ◽

Critically Ill Patients ◽

Severity Of Illness ◽

University Hospital ◽

Severe Liver ◽

Saps Ii ◽

Severe Liver Dysfunction ◽

Global Threat ◽

The University

Abstract Background SARS-CoV-2 caused a pandemic and global threat for human health. Presence of liver injury was commonly reported in patients with coronavirus disease 2019 (COVID-19). However, reports on severe liver dysfunction (SLD) in critically ill with COVID-19 are lacking. We evaluated the occurrence, clinical characteristics and outcome of SLD in critically ill patients with COVID-19. Methods Clinical course and laboratory was analyzed from all patients with confirmed COVID-19 admitted to ICU of the university hospital. SLD was defined as: bilirubin ≥ 2 mg/dl or elevation of aminotransferase levels (> 20-fold ULN). Results 72 critically ill patients were identified, 22 (31%) patients developed SLD. Presenting characteristics including age, gender, comorbidities as well as clinical presentation regarding COVID-19 overlapped substantially in both groups. Patients with SLD had more severe respiratory failure (paO2/FiO2: 82 (58–114) vs. 117 (83–155); p < 0.05). Thus, required more frequently mechanical ventilation (95% vs. 64%; p < 0.01), rescue therapies (ECMO) (27% vs. 12%; p = 0.106), vasopressor (95% vs. 72%; p < 0.05) and renal replacement therapy (86% vs. 30%; p < 0.001). Severity of illness was significantly higher (SAPS II: 48 (39–52) vs. 40 (32–45); p < 0.01). Patients with SLD and without presented viremic during ICU stay in 68% and 34%, respectively (p = 0.002). Occurrence of SLD was independently associated with presence of viremia [OR 6.359; 95% CI 1.336–30.253; p < 0.05] and severity of illness (SAPS II) [OR 1.078; 95% CI 1.004–1.157; p < 0.05]. Mortality was high in patients with SLD compared to other patients (68% vs. 16%, p < 0.001). After adjustment for confounders, SLD was independently associated with mortality [HR3.347; 95% CI 1.401–7.999; p < 0.01]. Conclusion One-third of critically ill patients with COVID-19 suffer from SLD, which is associated with high mortality. Occurrence of viremia and severity of illness seem to contribute to occurrence of SLD and underline the multifactorial cause.

Download Full-text

The University of Texas Medical School at Houston

Academic Medicine ◽

10.1097/acm.0b013e3181ea9910 ◽

2010 ◽

Vol 85 ◽

pp. S563-S566

Author(s):

Patricia M. Butler ◽

Allison R. Ownby

Keyword(s):

Medical School ◽

Texas Medical ◽

University Of Texas ◽

Texas Medical School ◽

The University

Download Full-text

Interventional radiology case conference: the University of Texas Medical Branch. Percutaneous management of pyogenic spondylodiskitis.

American Journal of Roentgenology ◽

10.2214/ajr.170.6.9609179 ◽

1998 ◽

Vol 170 (6) ◽

pp. 1587-1592 ◽

Cited By ~ 20

Author(s):

A M Borowski ◽

W N Crow ◽

A G Hadjipavlou ◽

G Chaljub ◽

J Mader ◽

...

Keyword(s):

Interventional Radiology ◽

Case Conference ◽

Texas Medical ◽

University Of Texas ◽

The University

Download Full-text

Neoglottic Reconstruction following Total Laryngectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948008900609 ◽

1980 ◽

Vol 89 (6) ◽

pp. 534-537 ◽

Cited By ~ 34

Author(s):

Bruce Leipzig

Keyword(s):

Total Laryngectomy ◽

Operative Procedure ◽

Careful Study ◽

Texas Medical ◽

University Of Texas ◽

Major Complications ◽

Number Of Patients ◽

Constant Feature ◽

Gag Reflex ◽

The University

The purpose of this paper is to analyze the problems and complications which have resulted from neoglottic reconstruction at the University of Texas Medical Branch in Galveston. It has been performed as a primary procedure at the time of laryngectomy on 50 patients. Over 40 % of these patients have required a second operative procedure to control major complications of their neoglottis. Aspiration is a nearly constant feature of the procedure, and a significant number of patients do not tolerate it well. Radiation therapy does not appear to increase the number of problems, but the complications are more severe when they do occur, and they are more difficult to control. The indications for surgical neoglottic reconstruction cannot be extended beyond those tumors which are within the confines of the larynx without an increased incidence of major complications. Other relative contraindications to this surgery are poor patient pulmonary reserve, reflux esophageal incompetence, and a “hyperactive” gag reflex. Nine patients with prior treatment which included a total laryngectomy underwent secondary neoglottic reconstruction. In our experience, all have had significant aspiration. About one half of these patients developed speech. The procedure of neoglottic reconstruction must be reviewed critically prior to popular introduction into the surgical armamentarium. A plea for careful study by a small number of experienced surgeons is now in order.

Download Full-text

PREDICTIVE DEMI-SPAN EQUATIONS FOR ESTIMATION OF STATURE IN AGED MEXICAN AMERICANS

Journal of Frailty & Aging ◽

10.14283/jfa.2012.19 ◽

2012 ◽

pp. 1-5

Author(s):

C. SIORDIA ◽

L.J. PANAS ◽

K. MARKIDES

Keyword(s):

Mexican Americans ◽

Cross Sectional Study ◽

Community Dwelling ◽

Sectional Study ◽

Cross Sectional ◽

Texas Medical ◽

University Of Texas ◽

Data Files ◽

The University ◽

Study Setting

Objectives: To develop demi-span height predictive equations for older Mexican Americans. Design: Cross-sectional study. Setting: Data files housed by the Sociomedical Division in the department of Community Health and Preventive Medicine at the University of Texas Medical Branch in Galveston, Texas. Participants: 1,078 (700 females, 378 males) Southwest U.S.A. community-dwelling older Mexican Americans, aged 80-102 years. Measurements: Demi-span, height, weight, BMI, demi-span equivalent height (DSEH), DSEH derived BMI (DS-BMI). Bland and Altman agreement analysis on: height and DSEH; BMI and DS-BMI. Paired t-test comparing derived and actual measures by single-age units and sex. Results: DSEH with Bassey equations (DSEHBassey) are significantly different than actual measures. DSEHBassey derived BMIs (DSBasseyBMIs) are significantly different than BMIs computed from actual measures. DSEH with Mexican equations (DSEHMexican) are not significantly different than real measures. DSEHMexican derived BMIs (DSMexicanBMIs) are not significantly different than real measures. Conclusions: These findings provide evidence that both DSEHBassey and DSBasseyBMIs estimates are significantly different from measured height and BMI. Both DSEHMexican and DSMexicanBMIs estimates are shown to produce similar height and BMI estimates to those obtained from real measures.

Download Full-text

Neoglottic Reconstruction after Total Laryngectomy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947808700206 ◽

1978 ◽

Vol 87 (2) ◽

pp. 180-184 ◽

Cited By ~ 1

Author(s):

Ceri M. Griffiths ◽

J. Thom Love

Keyword(s):

Success Rate ◽

Total Laryngectomy ◽

Preliminary Report ◽

Speech Therapy ◽

Texas Medical ◽

University Of Texas ◽

Second Stage ◽

The University

This paper is a preliminary report on neoglottic reconstruction of the larynx after total laryngectomy following the techniques described by Staffieri. Also included are general observations on the criteria for selecting candidates for this procedure. At the University of Texas Medical Branch in Galveston, this procedure has been attempted on eight candidates. Reconstruction was accomplished in six, of whom five achieved satisfactory speech, providing an 80% success rate. One of the five did not like the quality of his voice and refused to use it. The sixth produced speech with difficulty and is still undergoing speech therapy. One patient died from recurrence before a second stage could be carried out, and another patient did not have sufficient tissue for neoglottic reconstruction after total laryngectomy. Three patients developed salivary fistulas at the drain site, but all closed spontaneously with the application of pressure. From this data, one may conclude that this technique offers much potential and warrants further study.

Download Full-text