A Retrospective Case Series of Concomitant Carbapenem and Valproic Acid Use: Are Best Practice Advisories Working?

2021 ◽  
pp. 089719002110633
Author(s):  
Andrew J. Fratoni ◽  
Jessica L. Colmerauer ◽  
Kristin E. Linder ◽  
David P. Nicolau ◽  
Joseph L. Kuti
Keyword(s):  
Valproic Acid ◽  
Best Practice ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Multidrug Resistant ◽  
Retrospective Case ◽  
Therapeutic Implications ◽  
Practice Advisory ◽  
Potential Alternative ◽  
Ct Data

Background: A Best Practice Advisory (BPA) warns clinicians of an interaction between carbapenems and valproic acid (VPA) that can cause significant declines in VPA levels leading to serious consequences for patients treated for seizure disorder and unknown implications for alternative indications. Objective: The goal of this study was to assess BPA efficacy in avoiding concomitant VPA/carbapenems, and to characterize use of these agents, clinical implications, and potential alternative therapeutic options. Methods: Retrospective chart review was performed on all patients over the course of 1 year who were concomitantly prescribed a carbapenem and VPA at Hartford Hospital, Hartford, CT. Data collected included: level of care, duration of concomitant therapy, indications, VPA levels during or surrounding overlap, documentation of the interaction, and therapeutic implications. Results: Carbapenems and VPA were administered to 591 and 625 patients, respectively; the BPA fired 126 times in 24 patients, and 15 patients were initiated on these agents concomitantly. Eight (53%) patients received VPA for seizures. The remaining seven (47%) received VPA for alternative indications. Eight of nine VPA levels were sub-therapeutic during carbapenem therapy and polypharmacy was administered in all patients receiving VPA for non-convulsive indications. Conclusion: Co-prescribing of these drugs was rare; however, the BPA was ineffective in 63% of instances. Reductions in VPA efficacy for any indication should be expected with concomitant carbapenem administration. Antibiotics other than carbapenems should be considered when coverage of multidrug resistant Gram-negative pathogens is required in patients whose VPA treatment cannot be interrupted or switched to a therapeutic alternative.

scholarly journals Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia

2015 ◽  
Vol 9 (12) ◽  
pp. 1323-1330 ◽  
Author(s):  
Basima Abdalla Almomani ◽  
Amanda McCullough ◽  
Rawan Gharaibeh ◽  
Shaher Samrah ◽  
Fatimah Mahasneh
Keyword(s):  
Critical Care ◽  
Acinetobacter Baumannii ◽  
Case Series ◽  
Positive Culture ◽  
Multidrug Resistant ◽  
Ventilator Associated Pneumonia ◽  
Retrospective Case ◽  
Critical Care Units ◽  
Susceptibility Data ◽  
Case Series Study

Introduction: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) is common in hospitals and impacts patient survival. We determined the incidence of MDR-AB VAP in critical care units and examined the predictors of 14-day mortality in these patients. Methodology: A retrospective case series study was conducted at a tertiary referral teaching hospital in north Jordan. A list of patients with a positive culture of A. baumannii between January 2007 and June 2013 was retrieved using computerized hospital databases. Medical records of all these patients were reviewed, and cases of VAP infected with MDR-AB were identified. Predictors of 14-day mortality were determined using multivariable logistic regression adjusted for possible confounders. Results: Out of 121 A. baumannii-VAP cases, 119 (98.3%) were caused by MDR-AB. The incidence rate of MDR-AB VAP was 1.59 cases per 100 critical care unit admissions. The mortality of A. baumannii-VAP cases in critical care units was 42% (50/119). Being prescribed two or more definitive antibiotics (prescribed based on susceptibility data) (OR = 0.075, 95% CI = 0.017–0.340, p = 0.001) and ipratropium/salbutamol during mechanical ventilation (OR = 0.140, 95% CI = 0.028–0.705, p = 0.017) were independently associated with lower hospital mortality. Conclusions: Our results suggest incidence of MDR-AB VAP in critical care units is high and that prescription of antibiotics based on antibiotic susceptibility and use of bronchodilators is associated with lower mortality in this population. Larger prospective studies are needed to explore whether these findings can be replicated in different clinical settings.

scholarly journals Pamidronate as first-line treatment of hypercalcemia in neonatal subcutaneous fat necrosis: A case series

2019 ◽  
Author(s):  
Alexander D Chesover ◽  
Jennifer Harrington ◽  
Farid H Mahmud
Keyword(s):  
Serum Calcium ◽  
Subcutaneous Fat ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Bisphosphonate Therapy ◽  
Fat Necrosis ◽  
First Line ◽  
Retrospective Case ◽  
Subcutaneous Fat Necrosis ◽  
Severe Hypercalcemia

Abstract Background Subcutaneous fat necrosis (SCFN) can be complicated by severe hypercalcemia, which is frequently asymptomatic. Nephrocalcinosis is associated with hypercalcemia and, in other clinical settings, has been linked to furosemide and glucocorticoid use. First-line bisphosphonate therapy treating hypercalcemia in neonatal SCFN is not well described. Objectives To describe the biochemical changes and risk of nephrocalcinosis in infants with hypercalcemia, secondary to neonatal SCFN, treated with initial pamidronate. Methods A retrospective chart review of five infants treated with initial pamidronate and without furosemide or glucocorticoids. Data were collected on the following: timing of presentation, therapeutic response, and presence of nephrocalcinosis. Results Hypercalcemia resolved after 2.8±1.7 days; this is compared to 7.6±2.8 days from previously reported cases utilising alternative therapies (P=0.012). There were no episodes of rebound hypercalcemia or hypocalcemia. Nephrocalcinosis was present in four of five cases. When including published cases, age at diagnosis was associated with presenting serum calcium (P=0.003) and nephrocalcinosis was associated with higher serum calcium (P=0.014) and time from SCFN to hypercalcemia diagnosis (P=0.002). Conclusions This retrospective case series demonstrates that first-line pamidronate treatment was effective and safe in the resolution of hypercalcemia. Nephrocalcinosis was observed, despite the avoidance of furosemide and glucocorticoid therapy, and associated with greater disease severity and duration of hypercalcemia.

Short- to Midterm Follow-up of Cemented Total Ankle Replacement Using the INBONE II: A Retrospective Chart Review

2020 ◽  
pp. 193864002091312
Author(s):  
Gregory C. Berlet ◽  
Roberto A. Brandão ◽  
Devon Consul ◽  
Pierce Ebaugh ◽  
Christopher F. Hyer
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Retrospective Case ◽  
Ankle Arthroplasty ◽  
Major Complications ◽  
End Stage ◽  
Complications Rate

Background: Total ankle arthroplasty is a viable option for the treatment of end stage ankle arthritis. The purpose of this study is to report on the mid-term results with a cemented total ankle prosthesis, the Inbone™ II implant over a 5 year period. Methods: A retrospective, single-center chart and radiographic review of all patients with end stage ankle arthritis treated with Inbone™ II TAR) as the primary index procedure from 12/1/2012 to 3/1/2017. Clinical data were evaluated at 3 month, 6 month, 1 year and subsequent intervals for the study period. Preoperative diagnosis, pertinent patient demographics adjunctive procedures, implant associated complications, subsequent surgeries, and revisions were recorded. Results: 121 total ankles met our inclusion criteria. Patients had an INBONE™ II TAR implant placed with bone cement with a minimum of a 12 months follow up. Average age was 62.88 (range, 32-87) years, average body mass index was 32.74 (range, 21.8-56.04) kg/m2 and average follow up was 28.51(range, 12-69) months. Using the COFAS complication classification there were 14 minor, 11 moderate, and 5 major complications. 6/121 (5.0%) revisions which included: polyethylene exchange, device explant/fusion, and antibiotic spacer in situ. No complications over the course of this study ended in amputation. Conclusion: Total Ankle Arthroplasty utilizing the cemented INBONE™ II yielded good midterm results with regards to minor, moderate, and major complications. Rate of revision 6/121 (5.0%) was within the reported range with only 5 patients converted to fusion during the study period resulting in a 95% survivability at mid-term follow up. Levels of Evidence: Level IV: Retrospective case series

The Role of Demineralized Allograft Subchondral Bone in the Treatment of Talar Cystic OCD Lesions That Have Failed Microfracture

2014 ◽  
Vol 7 (5) ◽  
pp. 377-386 ◽  
Author(s):  
Stephen A. Brigido ◽  
Nicole M. Protzman ◽  
Melissa M. Galli ◽  
Scott T. Bleazey
Keyword(s):  
Subchondral Bone ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Medial Malleolar Osteotomy ◽  
And Function ◽  
Bone Plug

Cystic talar shoulder defects are particularly challenging osteochondral lesions. A retrospective chart review was performed on 13 adults that previously failed microfracture, presented with medial cystic osteochondral lesions of the talus, and were treated with malleolar osteotomy and subchondral allograft reconstruction. The aim of the study was to evaluate the effect of a medial malleolar osteotomy and allograft subchondral bone plug on pain and function. We hypothesized that following surgery, pain and function would significantly improve. Compared with preoperative measures, pain (first step in the morning, during walking, at the end of the day) and function (descending the stairs, ascending the stairs, and ambulating up to 4 blocks) improved postoperatively at 6 and 12 months ( P ≤ .001). During each activity, pain improved postoperatively from 6 to 12 months ( P ≤ .006). Postoperatively, from 6 to 12 months, the level of disability improved while descending the stairs ( P = .004), and the level of disability experienced while ascending the stairs and ambulating up to 4 blocks was maintained ( P ≥ .02). Multiple regression analyses identified body mass index as a predictor of preoperative function ( R2 = .34, P = .04). No variables were identified as significant predictors of postoperative pain or function. With all osteotomies healing, no graft rejection, and a single deep venous thrombosis, allograft subchondral plugs appear to successfully treat osteochondral lesions of the talus with improvements in pain and function as well as an acceptable complication rate. Level of Evidence: Therapeutic, Level IV: Retrospective Case Series.

scholarly journals A Step towards Control of Multidrug Resistant Tuberculosis: Hospital Based Study from Nashik India

2016 ◽  
Vol 12 (2) ◽  
pp. 34-38
Author(s):  
SV Gosavi ◽  
M Patil ◽  
B Almale ◽  
S Dugad
Keyword(s):  
Case Series ◽  
Previous Treatment ◽  
Multidrug Resistant ◽  
Research Centre ◽  
Retrospective Case ◽  
College Hospital ◽  
Medical College ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Introduction: The Global TB report (2012), estimates 73,000 MDR TB patients living in India, among them only 1,660 cases were notified and 68.4% cases were put on treatment. Hence, this study was conducted with objective to assess the treatment outcome of multi drug resistant Tuberculosis patients enrolled in DOTS plus (Cat-VI) site.Methodology: It is a retrospective case series of MDR-TB cases conducted at Dr. Vasantrao Pawar Medical College, Hospital & Research Centre, Nashik (Maharashtra). Information was collected on age, gender, HIV status, previous treatment of TB, weight of patient, refused to take treatment for Cat IV. Outcome was recorded in terms of cure rate, rate of failure, defaulter, treatment completed, switch to Cat V and death.Results: Among the study subject, majority of study subjects were male (65%) and highest proportion (49%) of MDR-TB was in 25-44 years of age. Out of 353 patient 241 (68.4%) were still on Cat IV in which 35% patient’s on intensive phase and 65% put on continuation phase while 12.8%, 13.5%, 4%, 1.1%, 3.6% & 0.5% patient were found to be defaulted, died, refused to take treatment, treatment completed, transfer out & switch to Cat V, respectively.Conclusion: In the present study, the majority of study subjects (99.4%) were previously treated for TB, we identified number of operational challenges in the treatment of MDR-TB like rate of defaulter, refuse to take treatment & deaths among MDR-TB patient was high. There is need to study correlates of these factors in details also need of operational research to improve MDR-TB treatment in India is considered as priority.SAARC J TUBER LUNG DIS HIV/AIDS, 2015 XII (2), page: 34-38

Surgical Treatment for Stenosing Peroneal Tenosynovitis

2018 ◽  
Vol 40 (3) ◽  
pp. 282-286 ◽  
Author(s):  
Geoffrey I. Watson ◽  
Sydney C. Karnovsky ◽  
David S. Levine ◽  
Mark C. Drakos
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Tendon Sheath ◽  
Symptomatic Improvement ◽  
Peroneal Tendon ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
History Of ◽  
Diagnostic Injection

Background: Stenosing peroneal tenosynovitis (SPT) is an uncommon entity that is equally difficult to diagnose. We evaluated our outcomes with a local anesthetic diagnostic injection followed by surgical release of the sheath and calcaneal exostectomy. Methods: Eleven patients diagnosed with SPT underwent surgery between 2006 and 2014. Upon initial presentation, all patients reported a persistent history of pain along the ankle. Ultrasound-guided injections of anesthetics were administered into the peroneal tendon sheath to confirm the diagnosis. In patients with a confirmed diagnosis of SPT, we proceeded with surgical intervention with release of the peroneal tendon sheath and debridement of the calcaneal exostosis. Retrospective chart review was performed, and functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). FAOS results were collected pre- and postoperatively and were successfully obtained at 1 year or greater. Results: Of these patients, all showed significant improvements ( P < .05) in 4 of 5 categories of the FAOS (pain, daily activities, sports activities, and quality of life). Conclusion: We present a case series in which the peroneal tendon sheath was diagnostically injected with anesthetic to confirm a diagnosis of SPT. In each of these cases, symptomatic improvement was obtained following the injection. With the fact that many of these patients had advanced imaging denoting no significant tears, we believe that this diagnostic injection is paramount for the success of surgical outcome. Level of Evidence: Level IV, retrospective case series.

Osteochondral Lesions of the Talus: Predictors of Clinical Outcome

2011 ◽  
Vol 32 (11) ◽  
pp. 1045-1051 ◽  
Author(s):  
Daniel J. Cuttica ◽  
W. Bret Smith ◽  
Christopher F. Hyer ◽  
Terrence M. Philbin ◽  
Gregory C. Berlet
Keyword(s):  
Clinical Outcome ◽  
Treatment Plan ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence

Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm2. There were 20 lesions larger than 1.5 cm2 and 110 lesions smaller than 1.5 cm2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm2 and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions are often associated with inferior functional outcomes and may require a more extensive initial procedure. Level of Evidence: IV, Retrospective Case Series

Arthroscopic Treatment of Osteochondral Lesions of the Tibial Plafond

2012 ◽  
Vol 33 (8) ◽  
pp. 662-668 ◽  
Author(s):  
Daniel J. Cuttica ◽  
W. Bret Smith ◽  
Christopher F. Hyer ◽  
Terrence M. Philbin ◽  
Gregory C. Berlet
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Tibial Plafond ◽  
Average Patient ◽  
Poor Outcomes

Background: Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. The purpose of this study was to evaluate clinical outcomes following arthroscopic treatment of OLTPs. Methods: Retrospective chart review was performed on all patients treated arthroscopically for OLTPs. Treatment consisted of generalized synovectomy followed by curettage of the lesion and microfracture. If a cartilage cap was intact, antegrade drilling was performed. Cystic defects were treated with curettage of the cyst and filling of any defect with bone graft. Results: A total of 13 patients were included. Nine patients had isolated lesions, while four had lesions of the distal tibial plafond and talar dome. Average followup was 156 (range, 38 to 402 ± 117.9) weeks and average patient age was 32.9 (range, 14 to 50 ± 11.8) years. Eleven of 13 patients were available for followup modified AOFAS score. The average preoperative score was 35.2 (range, 24 to 49 ± 7.1). The average postoperative modified AOFAS score was 50.4 (range, 33 to 56 ± 7.6). There were four patients (30.8%) with a poor outcome. Conclusion: OLTPs can be challenging to treat. Arthroscopic treatment can lead to improved outcomes. However, the higher incidence of poor outcomes in our series may indicate less predictability in the treatment of OLTPs and that outcomes may not be equivalent to previous reported studies on OLTPs or osteochondral lesions of the talus. Level of Evidence: IV, Retrospective Case Series

An Investigation of Aspects of Design of Resin-Bonded Bridges in General Dental Practice and Hospital Services

2004 ◽  
Vol os11 (3) ◽  
pp. 87-89 ◽  
Author(s):  
Eleni Patsiatzi ◽  
Nick JA Grey
Keyword(s):  
Best Practice ◽  
Case Series ◽  
Retrospective Case ◽  
Fixed Design ◽  
Metal Framework ◽  
Case Series Study ◽  
Single Tooth ◽  
Dental Practitioners ◽  
Series Study

Purpose of study To assess the design of resin-bonded bridges (RBBs) by dentists, the quality of information provided to a dental laboratory, and aid identification of best practice. Design A retrospective case series study of slips for RBB construction, sent by hospital and general dental practitioners to a dental laboratory based in a postgraduate dental institute in Scotland, UK. Main findings 384 forms were reviewed. For single-tooth replacements, 40% of designs for upper anterior bridges and 46% for lower posterior bridges were fixed-fixed (F-F) when a cantilever design was a better option. Thirty-six (9.3%) of RBB designs involved double abutting. On the laboratory forms, fewer than five (1%) cases included instructions about the thickness of the metal framework and in 48% there was no reference to the extension of the metal framework. Principal conclusions For single-tooth replacements, a relatively high percentage of dentists prescribed a fixed-fixed design for RBBs, despite the evidence advocating the use of a cantilever design. A significant number of dentists used double abutments. The information provided to the laboratory for the construction of resin-bonded bridges was often insufficient.

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