scholarly journals Current routines for antibiotic prophylaxis prior to transrectal prostate biopsy: a national survey to all urology clinics in Sweden

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 58 ◽  
Author(s):  
Johan Styrke ◽  
Sven Resare ◽  
Karl-Johan Lundström ◽  
Patrick Masaba ◽  
Christofer Lagerros ◽  
...  
Keyword(s):  
Single Dose ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Prostate Biopsy ◽  
High Risk Patient ◽  
Guideline Recommendation ◽  
Risk Of Infection ◽  
Urine Dipstick ◽  
Number Of Patients ◽  
Increased Risk

Background: The risk of infection after transrectal ultrasound (TRUS)-guided prostate biopsies is increasing. The aim of the study was to assess the use of antibiotic prophylaxis for prostate biopsy in Sweden. Methods: All public and private urology clinics reporting to the National Prostate Cancer Register of Sweden received a survey on TRUS-biopsy prophylaxis. Results: Of the 84 clinics surveyed, 76 replied (90%). If no risk factors for infection were present, a single dose of ciprofloxacin 750 mg was used by 50 clinics (66%). Multiple doses of ciprofloxacin 500 or 750 mg (n=14; 18%) or a single dose of trimethoprim-sulfamethoxazole 160/800 mg (n=7; 9%) were other common prophylaxes. Most clinics gave the prophylaxes immediately before the biopsy (n=41; 54%). Urine dipstick was used by 30 clinics (39%) and rectal enema by six (8%). In patients with high risk of infection, the survey mirrors a large variety of regiments used. Conclusions: The preference to use a single dose of ciprofloxacin 750 mg is in accordance with the Swedish national guidelines for patients with a low risk of infection. Better compliance to the guideline recommendation to use a urine dipstick would probably increase the number of patients classified as having an increased risk of infection. Being classified as a high-risk patient should lead to an extended duration of antibiotic prophylaxis, however, the variety of regimens used in the high-risk group reflects an inability to treat these patients in a standardized fashion and also highlights a need for more clear-cut guidelines. Pre-biopsy identification of high-risk patients is an important issue to tackle for the urologic clinics in order to reduce the number of infections.

PALB2 mutations in Brazilian patients from North-Northeast regions.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13670-e13670
Author(s):  
Thamara Ferreira ◽  
Thais Ferreira Bomfim-Palma ◽  
Isabelle Joyce de Lima Silva-Fernandes ◽  
Gabriela Espirito Santo Felix ◽  
Inacelli Queiroz De Souza Caires ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Male Breast Cancer ◽  
Clinical Management ◽  
Susceptibility Gene ◽  
High Risk Patient ◽  
Male Breast ◽  
The North ◽  
Number Of Patients ◽  
Increased Risk

e13670 Background: Loss-of-function mutations in PALB2 gene are associated with increased risk for breast cancer and possibly pancreatic, ovarian, male breast, prostate, colorectal as others cancers. In Brazil it has been estimated that up to 1,516 new cases of hereditary breast cancer for 2020 in the North and Northeast regions. Analysis of susceptibility gene mutations helps identify precisely the high-risk patient and their families, whom need specific and personalized clinical management as high-risk individuals. Methods: Twenty-six patients with pathogenic mutations in PALB2 gene identify by next-generation sequencing from states of Bahia (11), Ceará (9), Pernambuco (5) and Rondônia (1) in the North and Northeast regions were analyzed. Results: Most of the patients analyzed had only breast cancer (80%), including two cases of male breast cancer (9,5%); the others were isolated cases of endometrial cancer (4%), breast and pancreas cancers (4%), breast and lung cancers (4%), only ovarian cancer (4%) and ovarian and breast cancers (4%). Most cancers were stage II or III (65%). Family history of cancer was observed in 22/26 (84%); the most common tumors were breast, prostate, pancreas and thyroid. The founder mutations were more frequent in exons: 4 (58%) and 12 (15%). Eleven variants were found as follow: c.1240C > T (19%); c.3256delC (15%); c.1671_1674delTATT (11.5%); c.355delC (11.5%); NC_000016.9:g.(?_23632673)_(23652488_?)del (11,5%). The greatest variety of mutations was found in the state of Bahia, probably due to the greater number of patients included (42%). Conclusions: These data suggest that changes in clinical management of PALB2 patients are needed since the phenotype observed exhibited pattern of hereditary tumors, including male breast cancer. Besides that, PALB2 gene should be included in painel gene analysis in patients from the North and Northeast of Brazil because its high frequency of pathogenic variants.

scholarly journals Estimating the burden of hyperkalaemia in the UK in high-risk patient populations

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P McEwan ◽  
L Hoskin ◽  
K Badora ◽  
D Sugrue ◽  
G James ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Patient Outcomes ◽  
Real World ◽  
High Risk Patient ◽  
Incidence Rates ◽  
Funding Source ◽  
Eligible Population ◽  
Increased Risk ◽  
The Uk

Abstract Background Patients with chronic kidney disease (CKD), heart failure (HF), resistant hypertension (RHTN) and diabetes are at an increased risk of hyperkalaemia (HK) which can be potentially life-threatening, as a result of cardiac arrhythmias, cardiac arrest leading to sudden death. In these patients, renin-angiotensin-aldosterone system inhibitors (RAASi), are used to manage several cardiovascular and renal conditions, and are associated with an increased risk of HK. Assessing the burden of HK in real-world clinical practice may concentrate relevant care on those patients most in need, potentially improving patient outcomes and efficiency of the healthcare system. Purpose To assess the burden of HK in a real-world population of UK patients with at least one of: RHTN, Type I or II diabetes, CKD stage 3+, dialysis, HF, or in receipt of a prescription for RAASi. Methods Primary and secondary care data for this retrospective study were obtained from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES). Eligible patients were identified using READ codes defining the relevant diagnosis, receipt of indication-specific medication, or, in the case of CKD, an estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73m2 within the study period (01 January 2008 to 30 June 2018) or in the five-year lookback period (2003–2007). The index date was defined as 01 January 2008 or first diagnosis of an eligible condition or RAASi prescription, whichever occurred latest. HK was defined as K+ ≥5.0 mmol/L; thresholds of ≥5.5 mmol/L and ≥6.0 mmol/L were explored as sensitivity analyses. Incidence rates of HK were calculated with 95% confidence intervals (CI). Results The total eligible population across all cohorts was 931,460 patients. RHTN was the most prevalent comorbidity (n=317,135; 34.0%) and dialysis the least prevalent (n=4,415; 0.5%). The majority of the eligible population were prescribed RAASi during follow-up (n=754,523; 81.0%). At a K+ threshold of ≥5.0 mmol/L, the dialysis cohort had the highest rate of HK (501.0 events per 1,000 patient-years), followed by HF (490.9), CKD (410.9), diabetes (355.0), RHTN (261.4) and the RAASi cohort (211.2) (Figure 1). This pattern was still observed at alternative threshold definitions of HK. Conclusion This large real-world study of UK patients demonstrates the burden of hyperkalaemia in high-risk patient populations from the UK. There is a need for effective prevention and treatment of HK, particularly in patients with CKD, dialysis or HF where increased incidence rates are observed which in turn will improve patient outcomes and healthcare resource usage. Figure 1. Rates of HK by condition Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

scholarly journals Hepatitis C Transmission after Prostate Biopsy

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Karim Ferhi ◽  
Morgan Rouprêt ◽  
Pierre Mozer ◽  
Guillaume Ploussard ◽  
Alain Haertig ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antibiotic Prophylaxis ◽  
Prostate Biopsy ◽  
Viral Transmission ◽  
Risk Of Infection ◽  
Ultrasound Probe ◽  
Transrectal Prostate Biopsy ◽  
A Current

Prostate biopsy is a current and well-codified procedure; antibiotic prophylaxis and rectal enema limit the risk of infection. To date, there has been no reported viral transmission between patients due to a contaminated ultrasound probe. In this study, we report the case of a patient who contracted the hepatitis C virus after transrectal prostate biopsy as part of an individual screening for prostate cancer.

Perioperative management of the high-risk surgical patient: cardiac surgery

2017 ◽  
Author(s):  
Marco Ranucci ◽  
Serenella Castelvecchio ◽  
Andrea Ballotta
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
High Risk Patient ◽  
Advanced Age ◽  
Bleeding Complications ◽  
Surgical Patient ◽  
Number Of Patients

During the last decade, as a result of continually improving surgical strategy and the technology which supports it (e.g. anaesthesia), cardiac surgery is offered to patients with advanced age and those with increasingly complex co-existing conditions that were previously considered to be contraindications. In addition, an increasing number of patients have previously undergone angioplasty, thereby delaying their initial coronary artery bypass graft surgery to a more advanced age. In general, candidates for cardiac surgery may now be not only older than in the past, but also more likely to have health problems such as hypertension and diabetes. Risk stratification may help to identify ‘the’ high-risk patient: ‘pre-warned is pre-armed’. In high-risk cardiac surgery patients, the surgical treatment options and perioperative care must be tailored to each patient, in order to optimize the benefits and minimize the risk of detrimental effects. The preoperative anticoagulation practice is an important aspect, balancing the risk between ischaemic and bleeding complications. New antiplatelet agents and oral anticoagulants have been recently delivered, and their role in patients scheduled for heart surgery is an additional important issue.

Vaccination Induced Immunity to the Hepatitis B Virus among High-Risk Groups in Glasgow 1993–2001: Evaluating the Effectiveness of the United Kingdom's Selective Immunisation Policy

2008 ◽  
Vol 53 (4) ◽  
pp. 13-17 ◽  
Author(s):  
KM Roy ◽  
DJ Goldberg ◽  
K Wilson ◽  
SO Cameron
Keyword(s):  
High Risk ◽  
Hepatitis B ◽  
Drug Users ◽  
Close Contact ◽  
Risk Groups ◽  
Hbv Infection ◽  
Risk Of Infection ◽  
Selective Approach ◽  
Hiv Test ◽  
Increased Risk

Background and Aims The United Kingdom has adopted a selective approach to the control of hepatitis B (HBV), vaccinating those at increased risk of infection through lifestyle, occupation or other factors such as close contact with a case or carrier. This paper sought to assess the effectiveness of the targeted HBV vaccination programme, by determining the level of immunity and exposure to HBV infection among three high risk groups (injecting drug users (IDUs), men who have sex with men (MSM) and heterosexuals attending genitourinary medicine clinics) at three time points between 1993–2001 in Glasgow, Scotland. Methods Residual sera from i) IDUs having a named HIV test and ii) MSM and heterosexual men and women attending GUM clinics and undergoing routine syphilis serology testing, were tested anonymously for HBV infection. Results The overall prevalence of HBV infection remained at a low level in all three risk groups. IDUs continue to be the group at greatest risk of infection. Discussion Despite the implementation of new initiatives targeting high-risk groups, vaccination levels remain low in the populations studied.

Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population

2004 ◽  
Vol 8 (5) ◽  
pp. 303-309 ◽  
Author(s):  
Anatoli Freiman ◽  
John Yu ◽  
Antoine Loutfi ◽  
Beatrice Wang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Groups ◽  
High Risk Population ◽  
Awareness Campaigns ◽  
Number Of Patients ◽  
Increased Risk ◽  
Patients At Risk ◽  
And Behavior ◽  
Attitudes And Behavior

Background: Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. Objectives: The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Methods: Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. Results: The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. Conclusions: The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.

scholarly journals A theory on SARS-CoV-2 susceptibility: 
low sensitivity of tlr7-signalling as a mechanistic explanation for the increased risk of obese and elderly COVID-19 patients

2020 ◽  
Author(s):  
Ludwig Englmeier
Keyword(s):  
High Risk ◽  
Virus Infection ◽  
High Risk Patient ◽  
Mechanistic Explanation ◽  
Risk Patient ◽  
Increased Risk ◽  
Patient Groups ◽  
Innate Antiviral Response ◽  
Low Sensitivity ◽  
Lower Expression

I hypothesize that high-risk patient groups for developing severe Covid-19 have in common that there is a chronic, low-level activation of tlr7 by intrinsic substrates prior to virus infection. This leads to acquired desensitization of tlr7-signalling and, more generally, to a state of tlr-tolerance. Upon SARS-CoV-2 infection the induced activation of tlr7-signalling in high-risk patient groups can be expected to be weaker and delayed and consequently these patients will show a weaker or delayed initial innate antiviral response immediately after infection. In men, this is then exacerbated further by the naturally lower expression level of tlr7. The implications for therapy and prophylaxis are discussed.

scholarly journals Study of Neuroimaging in Patients with Refractory Eclampsia

2013 ◽  
Vol 5 (1) ◽  
pp. 4-7
Author(s):  
Mithil M Patil
Keyword(s):  
Developing Countries ◽  
Sinus Thrombosis ◽  
High Risk Patient ◽  
Radiation Hazard ◽  
List Type ◽  
Ct Scanner ◽  
Pathological Conditions ◽  
Number Of Patients ◽  
Increased Risk ◽  
Prospective Study Design

ABSTRACT Need Despite availability of intensive care units and improved antenatal care some women still die from eclampsia. Eclampsia is associated with increased risk of maternal death from 1.8% in developing countries to 14% in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk patient for development of cerebrovascular thrombosis/ischemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various CNS pathological conditions amenable to the medical treatment. Aim and objectives To study the neurological changes in patients with eclampsia and to delineate the pathophysiology in patients with refractory eclampsia. Materials and methods Prospective study design where 30 patients were included in the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and antihypertensives. The patients who are refractory to the treatment, such as having recurrent convulsions despite on MgSO4 were selected for neuroimaging with CT scan. neuroimaging is done with Phillips Tomoscan CT scanner where slices of 10 mm thickness were taken through the entire brain in the transaxial plane. Abdomen shielding is done with lead shield to prevent radiation hazard. Results Sr. Findings Number of patients Percentage 1 Cerebral edema 20 Mild to moderate 17 56 Severe 3 10 2 Hypertensive encephalopathy 5 16 3 Posterior reversible encephalopathy syndrome 11 36 4 Cerebral infarction 4 13 5 Cortical venous sinus thrombosis 2 16 6 Tuberculomas 2 6 7 Meningitis 1 3 8 Hydrocephalus 1 3 9 Normal 4 13 Conclusion Eclampsia patients who were refactory to the treatment with MgSO4 and antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuroimaging in this patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which has surely improved patients condition and have reduced morbidity. How to cite this article Patil MM. Study of Neuroimaging in Patients with Refractory Eclampsia. J South Asian Feder Obst Gynae 2013;5(1):4-7.

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