Comparative Study on the Effect of Cidofovir Treatment for Severe Adenovirus Pneumonia

Background: Adenovirus infection can cause severe pneumonia even in immunocompetent adults. However, there is limited data on the benefits of cidofovir treatment in severe adenovirus pneumonia. The objective of this study was to evaluate the association of cidofovir treatment with clinical improvement in immunocompetent adult patients with severe adenovirus pneumonia. Methods: We evaluated 22 male patients who admitted to intensive care unit (ICU) with severe adenovirus pneumonia between January 2014 and December 2019. The patients were divided into 2 groups, patients treated with cidofovir or not. Clinical outcomes including time to defervescence and stopping of oxygen supplement, length of stay in ICU and hospital, and the need for mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) were compared between the 2 groups. Results: Among 22 patients, 13 patients (59%) were treated with cidofovir and 9 (41%) were not. The difference in mean time (95% confidence interval [CI]) to defervescence and stopping of oxygen supplement between cidofovir group and no cidofovir group was 2.1 (−5.7 to 10.0) and 1.0 (−14.9 to 16.8) days, respectively. The difference in mean length of stay (95% CI) in ICU and hospital between the 2 groups was 0.2 (−7.1 to 7.5) and −0.4 (−18.3 to 17.5) days, respectively. The differences in proportion of patients requiring MV and ECMO between the 2 groups was 28.2 (−17.4 to 73.8) % and −10.3 (−52.2 to 31.7) %, respectively. Conclusions: The treatment with cidofovir for severe adenovirus pneumonia in immunocompetent patients did not improve clinical outcomes. Further studies with larger samples with prospective design are warranted.

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Impact of Convalescent Plasma Transfusion (CCP) In Patients With Previous Circulating Neutralizing Antibodies (nAb) to COVID-19

10.1101/2020.12.08.20246173 ◽

2020 ◽

Author(s):

Ana Paula H Yokoyama ◽

Silvano Wendel ◽

Carolina Bonet-Bub ◽

Roberta M Fachini ◽

Ana Paula F Dametto ◽

...

Keyword(s):

Mechanical Ventilation ◽

Length Of Stay ◽

Clinical Outcomes ◽

Clinical Improvement ◽

Neutralizing Antibodies ◽

Disease Onset ◽

Severe Pneumonia ◽

Current Evidence ◽

Icu Length Of Stay ◽

Medical Centers

AbstractINTRODUCTIONCOVID-19 convalescent plasma (CCP) transfusion has emerged in the past months as an alternative approach to treat pneumonia cases of SARS-CoV-2. Current evidence regarding characteristics of the plasma product, the titer of neutralizing antibodies (nAbs) in the transfused units, time to onset of intervention, and impact of nAbs produced by the patient are limited and heterogeneous.MATERIAL AND METHODSWe describe the preliminary results of 104 patients with severe pneumonia due to SARS-CoV-2 transfused with CCP at three medical centers in Brazil. All enrolled patients were transfused with doses between 200 mL through 600mL of ABO compatible CCP on days 0-2 after enrolment. Clinical parameters were monitored and nAbs titration was performed using the cytopathic effect-based virus neutralization test with SARS-CoV-2 (GenBank MT126808.1).RESULTSForty-one patients achieved clinical improvement on day 14, and multivariable logistic regression showed that nAbs T (from CCP units transfused) (p= 0.001), nAbs P0 (on day of enrolment) (p=0.009) and use of other supportive therapies (p<0.001) were associated with higher odds for this clinical improvement. Considering ICU length of stay (LOS) and length of mechanical ventilation, in our analysis, nAbs P0 were associated with a significant reduction in ICU LOS (p=0.018) and duration of mechanical ventilation (p<0.001). Administration of CCP after 10 days of symptom onset was associated with increases in ICU length of stay (p<0.001).DISCUSSION/CONCLUSIONDespite the study limitations, our data have shown an association between patients’ previously acquired nAbs and clinical outcomes. The potential value of timely administration of CCP transfusion before day 10 of disease onset was demonstrated and nAbsP0, but not nAbsT, were associated with ICU LOS, and duration of mechanical ventilation on the improvement of clinical outcomes was also demonstrated. In conclusion, we consider these data are useful parameters to guide future CPP transfusion strategies to COVID-19.

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Evaluation of Risk Factors for Exacerbations in Children with Adenoviral Pneumonia

BioMed Research International ◽

10.1155/2020/4878635 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Na Xu ◽

Peng Chen ◽

Ying Wang

Keyword(s):

Risk Factors ◽

Disease Severity ◽

Clinical Manifestations ◽

Severe Pneumonia ◽

Clinical Implications ◽

Laboratory Findings ◽

Severe Group ◽

Adenovirus Pneumonia ◽

The Difference ◽

D Dimer

Purpose. The aim of this work was to analyze clinical features and laboratory findings of children with adenovirus pneumonia and guide clinical diagnosis, treatment, and assessment of disease severity. Material and Methods. Retrospective analysis of clinical data of 285 children with adenoviral pneumonia who were hospitalized in Wuhan Children’s Hospital from December 2018 to October 2019. According to the assessment criteria for severe pneumonia, it was divided into the severe group (92 cases) and the nonsevere group (193 cases). Collected clinical manifestations, complications, and laboratory test indicators in two groups of children and conducted all statistical analyses. Results. The risk of fever and wheezing was significantly higher in the severe group than in the nonsevere group. The difference was statistically significant (P<0.05). The risk of complications in the severe group was significantly higher than that in the nonsevere group. The difference was statistically significant (P<0.05). The levels of AST, LDH-L, PCT, ferritin, and D-dimer in the severe group were significantly higher than those in the nonsevere group. The difference was statistically significant (P<0.05). Conclusion. Children with severe adenovirus pneumonia have severe clinical manifestations and many complications. AST, LDH-L, PCT, ferritin, and D-dimer levels have important clinical implications for assessing disease severity.

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39 Managing Burn Wounds with Silvadene

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.043 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S29-S30

Author(s):

Tomer Lagziel ◽

Louis J Born ◽

Luis H Quiroga ◽

Eliana Duraes ◽

Pragna N Shetty ◽

...

Keyword(s):

Length Of Stay ◽

Wound Infection ◽

Standard Of Care ◽

Infection Rates ◽

Average Amount ◽

Once Daily ◽

Preliminary Results ◽

The Difference ◽

Dressing Change ◽

Hospital Acquired

Abstract Introduction Topical delivery of antibacterial agents is typically incorporated and is an essential component of burn wound therapy. The goal is to prevent infection and promote the healing process. Poorly treated wounds can result in scarring or severely in sepsis and multi-organ dysfunction. Topical SSD cream has been the gold-standard for initial local care in partial thickness or full thickness burns. Due to immediate burst release of the drug into the exposed areas, application is relatively frequent (usually twice daily). However, it remains unknown whether twice-daily SSD dressings are superior to once-daily. Methods We maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once-daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after. The main outcomes recorded are wound infection rates, hospital-acquire complications (non-wound related), pain scores, daily narcotic requirements, average amount of SSD used, and length-of-stay. Results Preliminary results of the 75 pre-change-of-practice and 75 post-change-of-practice patients showed slightly better outcomes in the post-change group. Wound-infection rates were the same for both groups (pre=5.33%, post=5.33%), average daily pain-levels for the pre-change group were slightly higher but the difference was negligible and not statistically significant (pre=5.76, post=5.69). The pre-change group had a higher average daily narcotic dosage (pre=6.81mg, post=6.38mg), hospital-acquired complication rates were higher pre-change (pre=10.67%, post=6.67%), and length-of-stay was longer in the pre-change group (pre=10.81, post=9.25). The average amount of SSD jars used per patient was higher as well (pre=6.30, post=2.85). Statistical analysis of the distribution of burn type, age, and burn depth showed no discrepancy and a generalized decreased length-of-stay with once-daily SSD dressing change. Conclusions Preliminary results show that once-daily dressing changes of SSD in burn wounds have no negative impact on wound outcomes. However, it is associated with a decreased length-of-stay, decreased pain levels, and less hospital-acquired complications. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. In addition, less hospital-acquired complications result in better patient recovery. Since the difference in wound outcomes is negligible and statistically insignificant, changing the standard-of-care to once-daily could prove beneficial.

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Medical Comorbidity in Psychiatric Inpatients: Relation to Clinical Outcomes and Hospital Length of Stay

Psychosomatics ◽

10.1176/appi.psy.43.1.24 ◽

2002 ◽

Vol 43 (1) ◽

pp. 24-30 ◽

Cited By ~ 85

Author(s):

Constantine G. Lyketsos ◽

Gary Dunn ◽

Michael J. Kaminsky ◽

William R. Breakey

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Psychiatric Inpatients ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Medical Comorbidity

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Influence of Sex on Outcomes After Thoracic Endovascular Repair for Type B Aortic Dissection

Angiology ◽

10.1177/0003319720987956 ◽

2021 ◽

pp. 000331972098795

Author(s):

Songyuan Luo ◽

Yi Zhu ◽

Enmin Xie ◽

Huanyu Ding ◽

Fan Yang ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Outcomes ◽

Cox Regression ◽

Type B ◽

Type B Aortic Dissection ◽

Landing Zone ◽

End Point ◽

Male Patients ◽

Long Term Mortality

We aimed to investigate whether sex differences influence the clinical outcomes of patients who undergo thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We retrospectively analyzed a prospectively maintained single-center cohort of patients with TBAD who underwent TEVAR between January 2010 and June 2017. We evaluated the in-hospital and long-term mortality and composite end point. Of the 913 patients, 793 (86.8%) were male and 120 (13.1%) were female. Compared to male patients, the female patients were older, more likely to have diabetes mellitus, but less likely to smoke or have hypertension. The proximal landing zone in 0 and 1 was higher in male patients ( P = .023), who were more likely to require an aortic arch bypass. Endoleak, delirium, and ICU stay after stent-graft implantation were also more frequent in men. Sex factor was not associated with in-hospital or long-term mortality or the composite end point in the multivariable regression analyses and Cox regression model. The mean estimated survival time was similar between males and females (2462.9 ± 141.2 vs 2804.1 ± 117.4 days, P = .167) in the propensity score–matched cohort. Despite distinct characteristics between sex, there was no sex-related difference in long-term clinical outcomes after TEVAR for TBAD.

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Identification and Characterization of Unique Subgroups of Chronic Pain Individuals with Dispositional Personality Traits

Pain Research and Management ◽

10.1155/2016/5187631 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

S. Mehta ◽

D. Rice ◽

A. McIntyre ◽

H. Getty ◽

M. Speechley ◽

...

Keyword(s):

Chronic Pain ◽

Personality Traits ◽

Clinical Outcomes ◽

High Risk Group ◽

Comprehensive Treatment ◽

Cluster Membership ◽

Significant Difference ◽

Secondary Objective ◽

The Difference ◽

And Coping

Objective.The current study attempted to identify and characterize distinct CP subgroups based on their level of dispositional personality traits. The secondary objective was to compare the difference among the subgroups in mood, coping, and disability.Methods.Individuals with chronic pain were assessed for demographic, psychosocial, and personality measures. A two-step cluster analysis was conducted in order to identify distinct subgroups of patients based on their level of personality traits. Differences in clinical outcomes were compared using the multivariate analysis of variance based on cluster membership.Results.In 229 participants, three clusters were formed. No significant difference was seen among the clusters on patient demographic factors including age, sex, relationship status, duration of pain, and pain intensity. Those with high levels of dispositional personality traits had greater levels of mood impairment compared to the other two groups (p<0.05). Significant difference in disability was seen between the subgroups.Conclusions.The study identified a high risk group of CP individuals whose level of personality traits significantly correlated with impaired mood and coping. Use of pharmacological treatment alone may not be successful in improving clinical outcomes among these individuals. Instead, a more comprehensive treatment involving psychological treatments may be important in managing the personality traits that interfere with recovery.

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1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1657 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S739-S739

Author(s):

Jessica Snawerdt ◽

Derek N Bremmer ◽

Dustin R Carr ◽

Thomas L Walsh ◽

Tamara Trienski ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Community Acquired Pneumonia ◽

Sputum Culture ◽

Post Intervention ◽

Significant Difference ◽

Educational Campaign ◽

The Difference ◽

Hospital Acquired ◽

Culture Acquisition

Abstract Background The 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol. Methods This was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay. Results A total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups. Conclusion An educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results. Disclosures All Authors: No reported disclosures

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Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001378 ◽

2018 ◽

Vol 19 (1) ◽

pp. 23-31 ◽

Cited By ~ 6

Author(s):

Claire L. Cigarroa ◽

Sarah J. van den Bosch ◽

Xiaoqi Tang ◽

Kimberlee Gauvreau ◽

Christopher W. Baird ◽

...

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Dead Space ◽

Icu Admission ◽

Cavopulmonary Anastomosis ◽

Bidirectional Cavopulmonary Anastomosis

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Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter

Journal of Clinical Medicine ◽

10.3390/jcm10091802 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1802

Author(s):

Grzegorz Meder ◽

Paweł Żuchowski ◽

Wojciech Skura ◽

Violetta Palacz-Duda ◽

Milena Świtońska ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Statistical Significance ◽

Stent Retriever ◽

Single Center Experience ◽

Significant Difference ◽

First Pass ◽

Need To Evaluate ◽

The Difference

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters. Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. The primary endpoint was the frequency of perfect reperfusion defined as grade 3 of the modified Thrombolysis in Cerebral Infarction scale (mTICI) after the first pass. The secondary endpoints were the procedure success, defined as mTICI grades 2b-3; time of the procedure; clinical outcome, measured by 90 days’ modified Rankin Scale (mRS) score; Δ NIHSS, defined as the difference between National Institutes of Health Stroke Scale (NIHSS) score at patients’ admission and discharge; and the total number of device passes. Results: Out of the 70 patients included, 33 were treated with SO and 37 with CA. In both groups, a total number of 42 patients received intravenous recombined tissue plasminogen activator (iv-rTPA: 20 patients (60.6%) in the SO group and 22 patients (59.5%) in the CA group (p = 1.000). There was a significant difference between the groups regarding first-pass success rate, with 46% in the CA group and 18% in the SO group, (OR 3.83, 95% CI 1.28 to 11.44, p = 0.016). Complete procedure success tended to be more frequent in the CA group than in the SO group—94.6% vs. 84.8% (OR 3.13, 95% CI 0.56 to 17.34, p = 0.193)—and CA tended to require a lower number of passes than SO (mean 1.76 vs. 2.09 passes per procedure, p = 0.114), yet these differences did not reach statistical significance. Mean duration of the procedure was significantly shorter in the CA group than in the SO group (49 min vs. 64 min, p = 0.017). There was a significant difference in clinical outcomes, with higher Δ NIHSS (9.3 in the CA group vs. 6.7 in the SO group, p = 0.025) after the procedure and 90-day mRS (median 2 in the CA group vs. 4 in the SO group, p = 0.031). Conclusions: Combining stent retrievers with aspiration catheters may offer a beneficial effect on angiographic results and clinical outcomes in stroke patients undergoing endovascular treatment.

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Implementing Potentially Better Practices to Improve Neonatal Outcomes After Reducing Postnatal Dexamethasone Use in Infants Born Between 501 and 1250 Grams

PEDIATRICS ◽

10.1542/peds.111.se1.e534 ◽

2003 ◽

Vol 111 (Supplement_E1) ◽

pp. e534-e541

Author(s):

Joseph W. Kaempf ◽

Betty Campbell ◽

Ronald S. Sklar ◽

Cindy Arduza ◽

Robert Gallegos ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Mortality Rate ◽

Length Of Stay ◽

Clinical Outcomes ◽

Airway Pressure ◽

Neonatal Intensive Care ◽

Positive Airway Pressure ◽

Late Onset ◽

Late Onset Sepsis

Objective. The purpose of this article is to describe how a neonatal intensive care unit (NICU) was able to reduce substantially the use of postnatal dexamethasone in infants born between 501 and 1250 g while at the same time implementing a group of potentially petter practices (PBPs) in an attempt to decrease the incidence and severity of chronic lung disease (CLD). Methods. This study was both a retrospective chart review and an ongoing multicenter evidence-based investigation associated with the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative (NIC/Q 2000). The NICU specifically made the reduction of CLD and dexamethasone use a priority and thus formulated a list of PBPs that could improve clinical outcomes across 3 time periods: era 1, standard NICU care that antedated the quality improvement project; era 2, gradual implementation of the PBPs; and era 3, full implementation of the PBPs. All infants who had a birth weight between 501 and 1250 g and were admitted to the NICU during the 3 study eras were included (era 1, n = 134; era 2, n = 73; era 3, n = 83). As part of the NIC/Q 2000 process, the NICU implemented 3 primary PBPs to improve clinical outcomes related to pulmonary disease: 1) gentle, low tidal volume resuscitation and ventilation, permissive hypercarbia, increased use of nasal continuous positive airway pressure; 2) decreased use of postnatal dexamethasone; and 3) vitamin A administration. The total dexamethasone use, the incidence of CLD, and the mortality rate were the primary outcomes of interest. Secondary outcomes included the severity of CLD, total ventilator and nasal continuous positive airway pressure days, grades 3 and 4 intracranial hemorrhage, periventricular leukomalacia, stages 3 and 4 retinopathy of prematurity, necrotizing enterocolitis, pneumothorax, length of stay, late-onset sepsis, and pneumonia. Results. The percentage of infants who received dexamethasone during their NICU admission decreased from 49% in era 1 to 22% in era 3. Of those who received dexamethasone, the median number of days of exposure dropped from 23.0 in era 1 to 6.5 in era 3. The median total NICU exposure to dexamethasone in infants who received at least 1 dose declined from 3.5 mg/kg in era 1 to 0.9 mg/kg in era 3. The overall amount of dexamethasone administered per total patient population decreased 85% from era 1 to era 3. CLD was seen in 22% of infants in era 1 and 28% in era 3, a nonsignificant increase. The severity of CLD did not significantly change across the 3 eras, neither did the mortality rate. We observed a significant reduction in the use of mechanical ventilation as well as a decline in the incidence of late-onset sepsis and pneumonia, with no other significant change in morbidities or length of stay. Conclusions. Postnatal dexamethasone use in premature infants born between 501 and 1250 g can be sharply curtailed without a significant worsening in a broad range of clinical outcomes. Although a modest, nonsignificant trend was observed toward a greater number of infants needing supplemental oxygen at 36 weeks’ postmenstrual age, the severity of CLD did not increase, the mortality rate did not rise, length of stay did not increase, and other benefits such as decreased use of mechanical ventilation and fewer episodes of nosocomial infection were documented.

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