scholarly journals Detection of metabolic disorders in high-risk patients: a pilot study in Salvador, Bahia

1997 ◽  
Vol 55 (2) ◽  
pp. 209-212 ◽  
Author(s):  
Maria Betânia Pereira ◽  
Gildásio Carvalho da Conceição ◽  
Janice C. Coelho ◽  
Moacir Wajner ◽  
Roberto Giugliani
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Clinical Symptoms ◽  
Total Sample ◽  
University Hospital ◽  
Inborn Errors ◽  
High Risk Patients ◽  
Number Of Patients ◽  
Screening Protocol ◽  
Risk Patients

The purpose of this pilot-study was to evaluate the applicability of a screening protocol for the detection of inborn errors of metabolism (IEM) in high-risk patients. The protocol was applied in 65 patients referred to the Medical Genetics Laboratory of the University Hospital Professor Edgard Santos due to the suspicion of an IEM. Eight of these patients (12.3%) displayed an abnormal result in the screening protocol. These patients, along with 22 who displayed normal results in the screening protocol but who presented clinical symptoms or signs suggestive of an IEM not detectable by the tests applied, were selected for a further diagnostic investigation. In 5 of these 30 patients (7.7% of the total sample) it was possible to establish the diagnosis of an specific IEM. The results indicate that the designed screening protocol was sucessfully applied, allowing the detection of affected patients in a frequency comparable to that observed in larger studies performed elsewhere. The continuation of this study and the enlargement of the sample will help to delineate the profile of IEM in northeast of Brazil and will allow the identification of a significative number of patients and families, who could benefit from the therapeutic and preventive measures available for these diseases.

Prophylactic placement of an inferior vena cava filter in high-risk patients undergoing spinal reconstruction

2004 ◽  
Vol 17 (4) ◽  
pp. 1-6 ◽  
Author(s):  
Michael K. Rosner ◽  
Timothy R. Kuklo ◽  
Rabih Tawk ◽  
Ross Moquin ◽  
Stephen L. Ondra
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Matched Cohort ◽  
Filter Placement ◽  
High Risk Patients ◽  
Ivc Filters ◽  
Risk Patients

Object The purpose of this study was to evaluate the safety and efficacy of prophylactic inferior vena cava (IVC) filter placement in high-risk patients who undergo major spine reconstruction. Methods In the pilot study, 22 patients undergoing major spine reconstruction received prophylactic IVC filters. These patients were prospectively followed to evaluate complications related to the filter, the rate of deep venous thrombosis (DVT) formation, and the rate of pulmonary embolism (PE). These data were compared with those obtained in a retrospective review for PE in a matched cohort treated at the same institution. At a second institution the treatment guidelines were implemented in 17 patients undergoing complex spine surgery with the same follow-up criteria. In the pilot study, no patient experienced PE (0%), whereas two had DVT (9%). Bilateral DVT developed postoperatively in one patient (associated morbidity rate 4.5%), who required thrombolytic therapy. One patient died of unrelated surgical complications. The PE rate in the matched cohort at the same institution was 12%. At the second institution, no patient had PE, and no complications were noted. Conclusions In this patient population, prophylactic IVC filter placement appears to decrease the PE rate substantially, from 12 to 0%. The placement of IVC filters appears to be a safe and efficacious intervention for prevention of PE in high-risk patients.

scholarly journals Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: a pilot study

2010 ◽  
Vol 11 (6) ◽  
pp. 554-556 ◽  
Author(s):  
F. Guarracino ◽  
L. Cabrini ◽  
R. Baldassarri ◽  
C. Cariello ◽  
R. D. Covello ◽  
...  
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Transoesophageal Echocardiography ◽  
Invasive Ventilation ◽  
High Risk Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Risk Patients

scholarly journals Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital

2020 ◽  
Author(s):  
Li Yan ◽  
Jide Sun ◽  
Xiuyu Xu ◽  
Shifeng Huang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
University Hospital ◽  
Health Concern ◽  
Urinary System ◽  
Fecal Samples ◽  
High Risk Patients ◽  
Risk Patients ◽  
Independent Risk Factors ◽  
Rectal Colonization

Abstract Background: Nosocomial infections caused by carbapenemase-producing Enterobacterieceae (CPE) constitute a major global health concern and are associated with increased morbidity and mortality. Rectal colonization with CPE is a risk factor for bacterial translocation leading to subsequent endogenous CPE infections. This prospective observational study was aimed to investigate the prevalence and epidemiology of rectal colonization of CPE, the carbapenemase genotypes, and to identify the independent risk factors for the acquisition of CPE colonization in high-risk patients from ICU and HSCT wards in a university hospital in China. Methods: In a prospective cohort study, 150 fecal samples from rectal swabs were consecutively obtained for inpatients from the ICU and HSCT wards from November 2018 to May 2019, and screening test for CPE was conducted by using home-made trypsin soybean broth (TSB) selective media and MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and carbapenemase genes were characterized by both the GeneXpert Carba-R and PCR for blaKPC, blaNDM, blaIMP, blaVIM and blaOXA. In order to further investigate the risk factors and clinical outcomes of CPE colonization, a prospective case-control study was also performed.Results: 26 suspected CPE strains, including 17 Klebsiella pneumoniae, 6 Escherichia coli, 1 Citrobacter freundii, 1 Enterobacter Kobe, and 1 Raoultella ornithinolytica, were identified in 25 non-duplicated fecal samples from 25 patients, with a carriage rate of 16.67% (25/150). Through GeneXpert Carba-R and subsequent PCR and sequencing, all the suspected CPE isolates were identified to be positive for the carbapenemase genes, of which 17 were blaKPC-carriers, and another 9 were blaNDM-producers. Multivariate analysis indicated that urinary system diseases, operation of bronchoscopy, and combined use of antibiotics were independent risk factors for acquiring CPE colonization in high-risk patients from the ICU and HSCT wards. Conclusions: This study revealed a high prevalence of rectal CPE colonization in high-risk patients from ICU and HSCT wards, and a predominant colonization of the KPC-producing K. pneumoniae strains. Stricter infection control measures are urgently needed to limit the dissemination of CPE strains, especially in patients who were afflicted by urinary system diseases, have underwent bronchoscopy, and were previously exposed to combined antibiotic use.

scholarly journals Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Li Yan ◽  
Jide Sun ◽  
Xiuyu Xu ◽  
Shifeng Huang
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
University Hospital ◽  
Health Concern ◽  
Urinary System ◽  
High Risk Patients ◽  
Broth Microdilution Method ◽  
Risk Patients ◽  
Independent Risk Factors ◽  
Rectal Colonization

Abstract Background Nosocomial carbapenemase-producing Enterobacterieceae (CPE) infections constitute a major global health concern and are associated with increased morbidity and mortality. Rectal colonization with CPE is a risk factor for bacterial translocation leading to subsequent endogenous CPE infections. This prospective observational study was aimed to investigate the prevalence and epidemiology of rectal colonization of CPE, the carbapenemase genotypes, and to identify the independent risk factors for the acquisition of CPE colonization in high-risk patients from ICU and HSCT wards in a university hospital in China. Methods In a prospective cohort study, 150 fecal samples from rectal swabs were consecutively obtained for inpatients from the intensive care unit (ICU) and hematopoietic stem cell transplantation (HSCT) wards from November 2018 to May 2019, and screening test for CPE was conducted by using prepared in-house trypsin soybean broth (TSB) selective media and MacConkey agar. Antimicrobial susceptibility was determined by the broth microdilution method and carbapenemase genes were characterized by both the GeneXpert Carba-R and PCR for blaKPC, blaNDM, blaIMP, blaVIM and blaOXA. Multi-locus sequence typing (MLST) was employed to characterize the genetic relationships among the carbapenemase-producing K. Pneumonia (CPKP) isolates. In order to further investigate the risk factors and clinical outcomes of CPE colonization, a prospective case-control study was also performed. Results Twenty-six suspected CPE strains, including 17 Klebsiella pneumoniae, 6 Escherichia coli, 1 Citrobacter freundii, 1 Enterobacter Kobe, and 1 Raoultella ornithinolytica, were identified in 25 non-duplicated rectal swab samples from 25 patients, with a carriage rate of 16.67% (25/150). Through GeneXpert Carba-R and subsequent PCR and sequencing, all the suspected CPE isolates were identified to be positive for the carbapenemase genes, of which 17 were blaKPC-carriers, and another 9 were blaNDM-producers. MLST designated all the CPKP isolates to be ST11 clone. Multivariate analysis indicated that urinary system diseases, operation of bronchoscopy, and combined use of antibiotics were independent risk factors for acquiring CPE colonization in high-risk patients from the ICU and HSCT wards. Conclusions This study revealed a high prevalence of rectal CPE colonization in high-risk patients from ICU and HSCT wards, and a predominant colonization of the KPC-producing K. pneumoniae clone ST11. Stricter infection control measures are urgently needed to limit the dissemination of CPE strains, especially in patients who were afflicted by urinary system diseases, have underwent bronchoscopy, and were previously exposed to combined antibiotic use.

scholarly journals POSU: A pilot study looking into the feasibility, safety and efficacy of a post-operative surgical unit for high-risk patients

2019 ◽  
pp. 175114371989279
Author(s):  
Matthew Baldwin ◽  
Bruce McCormick ◽  
Mark Foale ◽  
Martha Belete ◽  
Connie Chen ◽  
...  
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Safety And Efficacy ◽  
High Risk Patients ◽  
Risk Patients ◽  
Surgical Unit

Good Response to Decitabine in an Elderly Patient with MDS (Refractory Anemia with Excess Blasts RAEB-2) after Failure of Azacitidine.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4597-4597
Author(s):  
Ashraf R. Aziz
Keyword(s):  
High Risk ◽  
Objective Response ◽  
Risk Groups ◽  
Iron Chelator ◽  
Multicenter Trial ◽  
Refractory Anemia ◽  
High Risk Patients ◽  
Normal Limits ◽  
Number Of Patients ◽  
Risk Patients

Decitabine, A pyrimidine nucleoside analog of cytidine, 5-aza-2′-deoxycytidine strongly inhibits DNA methylation, is capable of inducing cell differentiation, In a phase II multicenter trial of 66 patients with MDS (median age 68 years, range: 38 to 84), DAC was given in a dose of 15 mg/m2 IV over 4 hours every eight hours for three consecutive days; cycles were repeated every six weeks. The overall response rate was 25, 48, and 64 percent for those in the intermediate-I, intermediate-II, and high IPSS risk groups, respectively. The median survival time from the start of treatment for the IPSS high risk patients was 1.2 years, considerably longer than the expected survival of 0.3 to 0.5 years for high risk patients treated with supportive care alone. Response to Decitabine after failure of Azaitadine was mentioned only in one abstract presented in the American society of hematology meeting 2006 in 22 patients. We present a case of an 83 y/o gentleman with RAEB-2 with IPSS of 1 Intermediate I with normal cytogenetics, trilineage pancytopenia, was heavily transfusion dependent with both red cells and platelets on a weekly bases. The patient was treated initially with Revlamide for 3 months, followed by Azacitadine for total of 4 cycles, along with Exjade as an iron chelator without any objective response or reduction in his transfusion requirement. The patient eventually was switched to Decitabine 20 mg SC daily for 5 days every 28 days. The patient started to have a response after the 4 th cycle with prolongation of his transfusion intervals. After the 5 th cycle the patient did not need transfusions with platelets within normal limits. Since there is paucity of data regarding the response to these new agents, our case may be added to the small number of patients that was presented to try to create a data pool that helps clinicians to manage this difficult disease.

Screening for Thyroid Dysfunction in 1st Trimester of Pregnancy

2016 ◽  
Vol 8 (2) ◽  
pp. 154-156
Author(s):  
Bharath Ramji ◽  
Kavitha Karthikeyan ◽  
Prabha Swaminathan ◽  
Amrita Priscilla Nalini ◽  
Annie Thatheus
Keyword(s):  
High Risk ◽  
Thyroid Dysfunction ◽  
Strong Association ◽  
Thyroid Stimulating Hormone ◽  
Low Risk ◽  
Routine Screening ◽  
High Risk Patients ◽  
Number Of Patients ◽  
Risk Patients ◽  
In Pregnancy

ABSTRACT This study was done to find the prevalence of newly diagnosed thyroid dysfunction in early pregnancy in patients attending the antenatal clinic and to emphasize the need for routine screening for thyroid dysfunction in pregnancy. Free thyroxine (FT4) and thyroid stimulating hormone (TSH) levels were measured and cut-off levels set at FT4 0.86—1.86 ng/dl, TSH 0.1—2.5 mIU/l in 1st trimester, TSH 0.1—3 mIU/l in 2nd and 3rd trimesters. A total of 956 pregnant women were screened in 1st trimester after excluding patients with known thyroid dysfunction. About 13.2% were diagnosed as hypothyroid and 1.6% as hyperthyroid. Incidence in high-risk patients was 21.7% and in low-risk was 10.4%. High-risk factors have a strong association for hypothyroidism (p < 0.001). Screening only high-risk patients will miss a significant number of patients seen positive in the low-risk group. Hence, it is essential to do routine screening for thyroid dysfunction in pregnancy. How to cite this article Karthikeyan K, Swaminatan P, Nalini AP, Ramji B, Thatheus A. Screening for Thyroid Dysfunction in 1st Trimester of Pregnancy. J South Asian Feder Obst Gynae 2016;8(2):154-156.

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