scholarly journals Investigating the Unfavored Factors That Interfere MALDI-TOF Based AI in Predicting Antibiotic Resistance

2022 ◽  
Author(s):  
Hsin-Yao Wang ◽  
Yu-Hsin Liu ◽  
Yi-Ju Tseng ◽  
Chia-Ru Chung ◽  
Ting-Wei Lin ◽  
...  
Keyword(s):  
Medical Center ◽  
Demographic Data ◽  
Predictive Performance ◽  
Correct Prediction ◽  
Grey Zone ◽  
Maldi Tof ◽  
Predictive Probability ◽  
Antibiotic Susceptibility Test ◽  
Rapid Prediction ◽  
Wrong Prediction

Combining Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) spectra data and artificial intelligence (AI) has been introduced for rapid prediction on antibiotic susceptibility test (AST) of S. aureus. Based on the AI predictive probability, the cases with probabilities between low and high cut-offs are defined as “grey zone”. We aimed to investigate the underlying reasons of unconfident (grey zone) or wrong predictive AST. A total 479 S. aureus isolates were collected, analyzed by MALDI-TOF, and AST prediction, standard AST were obtained in a tertiary medical center. The predictions were categorized into the correct prediction group, wrong prediction group, and grey zone group. We analyzed the association between the predictive results and the demographic data, spectral data, and strain types. For MRSA, larger cefoxitin zone size was found in the wrong prediction group. MLST of the MRSA isolates in the grey zone group revealed that uncommon strain types composed 80%. Amid MSSA isolates in the grey zone group, the majority (60%) was composed of over 10 different strain types. In predicting AST based on MALDI-TOF AI, uncommon strains and high diversity would contribute to suboptimal predictive performance.

Demographic and Clinical Characteristics Associated With Adherence to Guideline-Based Polysomnography in Children With Down Syndrome

2020 ◽  
pp. 019459982095483
Author(s):  
Philip D. Knollman ◽  
Christine H. Heubi ◽  
Susan Wiley ◽  
David F. Smith ◽  
Sally R. Shott ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Down Syndrome ◽  
Clinical Characteristics ◽  
Medical Center ◽  
Demographic Data ◽  
Children With Down Syndrome ◽  
Medical Need ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
History Of

Objectives To compare the demographic and clinical characteristics of children with Down syndrome who did and did not receive polysomnography to evaluate for obstructive sleep apnea after publication of the American Academy of Pediatrics’ guidelines recommending universal screening by age 4 years. Study Design Retrospective cohort study. Setting Single tertiary pediatric hospital. Methods Review was conducted of children with Down syndrome born between 2007 and 2012. Children who obtained polysomnography were compared with children who did not, regarding demographic data, socioeconomic status, and comorbidities. Results We included 460 children with Down syndrome; 273 (59.3%) received at least 1 polysomnogram, with a median age of 3.6 years (range, 0.1-8.9 years). There was no difference in the distribution of sex, insurance status, or socioeconomic status between children who received polysomnography and those who did not. There was a significant difference in race distribution ( P = .0004) and distance from home to the medical center ( P < .0001) between groups. Among multiple medical comorbidities, only children with a history of hypothyroidism ( P = .003) or pulmonary aspiration ( P = .01) were significantly more likely to have obtained polysomnography. Conclusions Overall, 60% of children with Down syndrome obtained a polysomnogram. There was no difference between groups by payer status or socioeconomic status. A significant difference in race distribution was noted. Proximity to the medical center and increased medical need appear to be associated with increased likelihood of obtaining a polysomnogram. This study illustrates the need for improvement initiatives to increase the proportion of patients receiving guideline-based screening.

Prophylactic Antibiotic Reduces the Risk of Peritonitis after Invasive Gynecologic Procedures

2019 ◽  
Vol 39 (4) ◽  
pp. 356-361
Author(s):  
Pei-Yi Fan ◽  
Ming-Jen Chan ◽  
Sheng-Hsuan Lin ◽  
Hsin-Hsu Wu ◽  
Ming-Yang Chang ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Medical Center ◽  
Demographic Data ◽  
Group B Streptococcus ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Streptococcus Group ◽  
Prophylactic Antibiotic Treatment ◽  
Group B ◽  
Invasive Techniques

BackgroundPeritonitis is a serious complication after invasive procedures in patients undergoing peritoneal dialysis (PD). Most studies that have investigated peritonitis following invasive gynecologic procedures enrolled small patient populations. This study focuses on the clinical presentation, outcomes, and effects of prophylactic antibiotic use before invasive techniques.MethodsA retrospective study was conducted on patients who underwent invasive gynecologic procedures between 2005 and 2015 in a tertiary medical center. Eligible patients were identified and enrolled and their demographic data were collected. The use of prophylactic antibiotics and the outcomes of peritonitis were recorded.ResultsTwenty-six gynecologic procedures were performed on 18 PD patients. Seven episodes of peritonitis occurred in 6 patients after invasive gynecologic procedures. Eleven procedures were preceded by prophylactic antibiotic treatment (6 oral cefadroxil, 1 oral cefuroxime, 1 oral clindamycin, 1 intravenous [IV] ceftriaxone, 1 IV ceftazidime, and 1 IV cefazolin). The pathogens were diverse (group B Streptococcus, group D Streptococcus, E. coli, and Enterococcus). All episodes of peritonitis were successfully treated using intraperitoneal antibiotics without recurrence, technique failure, or mortality. The odds ratio of peritonitis in the non-prophylaxis group was 20.29 (95% confidence interval 1.01 – 406.35, p = 0.0103).ConclusionThe use of prophylactic antibiotic treatment considerably reduced the risk of peritonitis after invasive gynecologic procedures.

scholarly journals Giant Cell Tumour of Bone with Late Presentation: Review of Treatment and Outcome

2002 ◽  
Vol 10 (2) ◽  
pp. 120-128 ◽  
Author(s):  
ES Ng ◽  
A Saw ◽  
S Sengupta ◽  
AR Nazarina ◽  
M Path
Keyword(s):  
Giant Cell ◽  
Clinical Outcomes ◽  
Giant Cell Tumour ◽  
Medical Center ◽  
Demographic Data ◽  
Good Alternative ◽  
Late Presentation ◽  
Wide Excision ◽  
Cell Tumour ◽  
The University

Purpose. To review cases of giant cell tumour of bone or osteoclastoma managed at the University Malaya Medical Center, University of Malaya, Kuala Lumpur, from January 1990 to December 1999. Methods. Medical records of all patients with musculoskeletal tumours were reviewed. Demographic data, clinical presentation, surgical management, and clinical outcomes were reviewed retrospectively. Results. Most of the 31 patients who were treated for giant cell tumour of bone presented late on the basis of the duration of their symptoms and radiological features. Five of the patients had been referred for local recurrences. 26 patients were treated for primary tumours: 18 needed wide excision, 7 curettage, and one amputation. The joint could not be preserved and arthrodesis was performed for 11 patients. Three (12%) of the 26 patients had local recurrence during a mean follow-up of 60 months, including one (6%) who had recurrence after wide excision and 2 (29%) after curettage. Pulmonary metastasis was noted in 4 cases, 2 of which were confirmed histologically. Conclusion. Even in an advanced stage of disease, good clinical outcomes can be achieved with adequate excision and appropriate reconstruction. For lesions around the knee, autologous rotational grafting is a good alternative method of reconstruction.

scholarly journals Nasopharyngeal Lymphoma: A 22-Year Review of 35 Cases

2019 ◽  
Vol 8 (10) ◽  
pp. 1604 ◽  
Author(s):  
Hsueh ◽  
Yang ◽  
Gau ◽  
Kuan ◽  
Ho ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Medical Center ◽  
Demographic Data ◽  
B Cell Lymphoma ◽  
Neck Mass ◽  
Treatment Modalities ◽  
Primary Malignancy ◽  
Barr Virus ◽  
Mantle Cell ◽  
Epstein Barr

Nasopharyngeal (NP) lymphoma is a rare primary malignancy of the head and neck and represents a minority of malignancies originating from the nasopharynx. For this reason, there are limited data regarding epidemiologic and treatment outcomes. This is a retrospective review of patients diagnosed with NP lymphoma from 1995 to 2017 at a tertiary medical center. The patients’ demographic data, clinical presentations, treatment modalities, Epstein–Barr virus (EBV)-encoded small RNA (EBER) staining, and outcomes were investigated. We considered a total of 35 patients, including 20 males and 15 females, diagnosed with NP lymphoma. The age ranged from 17 to 88 years (mean = 59.6). The common presentations were nasal obstruction, epistaxis, and neck mass. In our study, the most common pathological diagnosis of NP lymphoma was diffuse large B cell lymphoma (DLBCL) (n = 17), followed by NK/T cell lymphoma (NKTCL) (n = 9). Other pathologic diagnoses included extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALToma), small lymphocytic lymphoma, mantle cell lymphoma. There were 13 cases showing EBER positivity, including 7 cases of NKTCL, 5 cases of DLBCL, and 1 case of post-transplant lymphoproliferative disorder (PTLD). Most patients received chemotherapy alone, while some patients received both chemotherapy and radiotherapy. Seven patients had local recurrence, and fewer than half of the patients (n = 16) were alive at the time of the study (mean follow-up duration: 54.4 months). The five-year overall survival was 50.4%. NP lymphoma is very rare, and the most common pathologic type is DLBCL. EBER positivity is found in both NKTCL and DLBCL. Identifying more effective therapeutic agents is extremely important to improve patients’ survival.

scholarly journals Antimicrobial Susceptibility Patterns and Wild-Type MIC Distributions of Anaerobic Bacteria at a German University Hospital: A Five-Year Retrospective Study (2015–2019)

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 823
Author(s):  
Mohamed Tarek Badr ◽  
Benjamin Blümel ◽  
Sandra Baumgartner ◽  
Johanna M. A. Komp ◽  
Georg Häcker
Keyword(s):  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Medical Center ◽  
Demographic Data ◽  
Anaerobic Bacteria ◽  
Empirical Therapy ◽  
Antimicrobial Susceptibility Testing ◽  
University Hospital ◽  
Comprehensive Overview ◽  
Susceptibility Patterns

Local antimicrobial susceptibility surveys are crucial for optimal empirical therapy guidelines and for aiding in antibiotic stewardship and treatment decisions. For many laboratories, a comprehensive overview of local antimicrobial susceptibility patterns of anaerobic bacteria is still lacking due to the long incubation time and effort involved. The present study investigates the antimicrobial susceptibility patterns and related clinical and demographic data of 2856 clinical isolates of anaerobic bacteria that were submitted for analysis to the Institute for Medical Microbiology and Hygiene of the Freiburg University Medical Center (a tertiary university medical center in Southern Germany) between 2015 and 2019. Antimicrobial susceptibility testing has been carried out according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guideline. Minimum inhibitory concentration (MIC)50 and MIC90 for penicillin, metronidazole, moxifloxacin, and clindamycin were established for Gram-positive anaerobes and for ampicillin-sulbactam, meropenem, metronidazole, moxifloxacin, and clindamycin for Gram-negative anaerobes. The distribution of MIC-values for various antibiotics against anaerobic bacteria was also established, especially for those having no specific breakpoints according to EUCAST guidelines. Most clinically relevant anaerobic bacteria originated from general surgery, neurological, and orthopedic wards. A high proportion of isolates were resistant to moxifloxacin and clindamycin indicating the importance of their susceptibility testing before administration. Based on our study metronidazole and other β-lactam/β-lactamase inhibitor combinations such as ampicillin-sulbactam remain suitable for empirical treatment of infections with anaerobic bacteria.

scholarly journals Patients with chronic pain: evaluating depression and their quality of life in a single center study in Greece

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Ekaterini Rapti ◽  
Dimitrios Damigos ◽  
Paraskevi Apostolara ◽  
Vasiliki Roka ◽  
Chara Tzavara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Chronic Pain ◽  
Regression Analysis ◽  
Short Form ◽  
Medical Center ◽  
Demographic Data ◽  
Greek Language ◽  
Common Location

Abstract Background Chronic pain constitutes one of the most common reasons for seeking health care services and may even lead to disability. Chronic pain has been associated with depression and deterioration of the quality of life. The aim of our study is to outline the burden of chronic pain in the context of a primary health care (PHC) setting in Greece and to investigate its association with depression and quality of life. Methods A cross-sectional study was conducted from September 2016 to November 2016. The subjects of the study comprised 200 individuals who visited the regional medical center of Ag. Theodoroi, Greece. The collected data were from a representative sample of 200 adults and included demographic data, social and medical history, presence and characteristics of chronic pain and questions from three questionnaires for the assessment of pain (BPI- short form), the investigation of depression (PHQ-9) and the evaluation of the quality of life (EuroQ-5D) validated in Greek language. Multiple regression analysis was used in order to find associated factors with quality of life, depression and chronic pain. Results A percentage of 56.8% of the participants, the majority of whom (62%) were women, reported chronic pain. Among individuals with pain, lower back area was the most common location. Based on the given questionnaire, depression was detected in 22. 5% of the participants who claimed chronic pain. Regression analyses revealed that women and respondents with chronic mental disorders like depression and anxiety had significantly higher scores on the pain scale and suffered pain which had a greater impact on their daily activities. According to regression analysis decreased quality of life was expressed by women, as well as participants with a chronic mental disorder. A significant reverse correlation emerged between the quality of life, depression and pain scales. Conclusion Chronic pain, as it has been studied within this PHC setting, is a common health care problem. Individuals who had experienced chronic pain and depression had a lower health-related quality of life.

Modified Craniocervical Approach for Resection of the Styloid Process in Patients with Eagle's Syndrome

2019 ◽  
Author(s):  
Felipe Constanzo ◽  
Ricardo Ramina ◽  
Mauricio Coelho Neto
Keyword(s):  
Facial Nerve ◽  
Medical Center ◽  
Demographic Data ◽  
Styloid Process ◽  
Jugular Foramen ◽  
Eagle’S Syndrome ◽  
Transcervical Approach ◽  
Marginal Mandibular Branch ◽  
Mean Size ◽  
Mandibular Branch

Abstract Objectives Surgical treatment of Eagle's syndrome remains the mainstay of treatment. Palsy of the marginal mandibular branch of the facial nerve is the most significant complication encountered in transcervical resections, due to direct compression during the approach. We proposed a modification of the craniocervical approach to the jugular foramen to resect the styloid process avoiding the marginal mandibular branch and subsequent palsy. Design Preset study is a single-center retrospective cohort study. Setting The research was conducted at a tertiary medical center. Participants From November 2008 to October 2018, 12 patients with Eagle's syndrome underwent treatment using our modified approach. Main Outcome Measures Demographic data, type of Eagle's syndrome, symptomatic side, size of the styloid process, clinical outcomes, and complications were analyzed. Results Mean size of the styloid processes was of 3.34 cm on the operated side (2.3–4.7 cm) and 2.98 cm on the other (2–4.2 cm). Intraoperative facial nerve irritation occurred in one case. Resection of the entire styloid process was achieved in all cases. Eight cases experienced complete improvement, three cases had a partial response, and one case failed to improve. There were no cases of recurrence. Two patients presented transient postoperative auricular paresthesia. There were no cases of mandibular branch palsy, nor any other complications in our series. Conclusions Our modified transcervical approach is effective in avoiding the marginal mandibular branch of the facial nerve, avoiding postoperative palsy.

scholarly journals Risk factors and outcomes for multidrug-resistant Gram-negative bacilli bacteremia

2017 ◽  
Vol 5 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Swati Patolia ◽  
Getahun Abate ◽  
Nirav Patel ◽  
Setu Patolia ◽  
Sharon Frey
Keyword(s):  
Risk Factors ◽  
Urinary Catheter ◽  
Medical Center ◽  
Demographic Data ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Solid Organ ◽  
Gram Negative ◽  
Source Of Infection

Background: The incidence of multidrug-resistant (MDR) organisms is increasing along with mortality. Identifying risk factors for the development of MDR Gram-negative bacilli (GNB) bacteremia could greatly impact patient care and management. Methods: Data from the electronic health record of patients with GNB over 13-month period were collected at a single university medical center. Baseline demographic data, risk factor, microbiological data, recurrence of bacteremia, and mortality were recorded. Results: A total of 177 patients were included in the analysis. MDR GNB occurred in 46 patients (26%). The mortality rate in the MDR group was 34.8% compared to 13.7% in non-MDR group ( p = 0.002). In multivariate analysis, diabetes mellitus [DM; odds ratio (OR): 2.8, 95% confidence interval (CI): 1–4.88], previous antibiotic use (OR: 2.93, 95% CI: 1.25–6.87), and urinary catheter as a source of infection (OR 5.96, 95% CI: 1.78–19.94) were significant risk factors for the development of MDR GNB. In addition, end-stage liver disease (OR: 3.64, 95% CI: 1.07–12.3), solid organ malignancy (OR: 3.64, 95% CI: 1.25–10.56), intra-abdominal source of infection (OR: 3.66, 95% CI: 1.14–11.73), inappropriate empiric antibiotics (OR 7.59, 95% CI: 1.68–34.34) and urinary catheter as a source of infection (OR 5.68, 95% CI: 1.37–23.5) were significant factors for mortality in patients with MDR GNB. Conclusion: Our study provides important information about the risk factors for the development of MDR GNB bacteremia and helps prognosticate patient with MDR GNB.

Calcium and magnesium infusions for prevention of oxaliplatin-induced peripheral neuropathy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 387-387
Author(s):  
M. Bupathi ◽  
G. Mahmud ◽  
J. Kovar ◽  
E. Wang ◽  
T. E. O'Brien
Keyword(s):  
Peripheral Neuropathy ◽  
Cumulative Dose ◽  
Medical Center ◽  
Demographic Data ◽  
Performance Status ◽  
Safety Net ◽  
Control Group ◽  
Minority Population ◽  
Tumor Type ◽  
Safety Net Hospital

387 Background: Oxaliplatin plays an important role in chemotherapy regimens for colorectal and other GI malignancies. Debilitating peripheral neuropathy (PN) often develops with use of this drug. One study (Grothey A et al, ASCO 2009, abst #4025) has shown that pre- and post-oxaliplatin infusions with calcium (Ca) and magnesium (Mg) may reduce this toxicity. To confirm this in an unselected indigent minority population, a retrospective review was performed comparing development of PN in oxaliplatin exposed patients treated with or without Ca/Mg. Methods: Records of patients who received oxaliplatin from 1/2008 to 12/2009 at MetroHealth Medical Center, a large safety net hospital in Cleveland, OH, were reviewed. 47 patients received Ca/Mg + oxaliplatin and 46 oxaliplatin alone. Data collected included age, race, gender, insurance status, performance status, tumor type, stage, concomitant diseases (DM and EtOH), number of cycles and cumulative dose of oxaliplatin. PN was determined using the Common Terminology Criteria of Adverse Events (CTCAE) version 3.0. Patients were followed 6 months after completion of oxaliplatin. Results: Demographic data was similar between the two groups. Colorectal cancer compromised 77% of the treatment group and 85% of control group. Patients who received Ca/Mg had significantly less PN in all three grades (1-3) compared with the control group (grade 1 89.4% vs. 71.7%, grade II 10.6% vs. 19.6%, grade 3 0% vs. 8.7%, respectively). The cumulative dose of oxaliplatin did not differ between the two groups (Ca/Mg median 1,143 range 260-2,169; control median 1,425 range 137-2,635). The combined total grades 2 and 3 in both the treatment and control (10.6% vs. 28.3%, p = 0.038) favored use of Ca/Mg. Conclusions: This small, retrospective study confirms that Ca/Mg infusions reduce the incidence of clinically significant (grade 2/3) PN in pts receiving oxaliplatin. No significant financial relationships to disclose.

Cervical Laminoplasty as a Management Option for Patients With Cervical Spondylotic Myelopathy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Anthony L. Petraglia ◽  
Vasisht Srinivasan ◽  
Michelle Coriddi ◽  
M. Gordon Whitbeck ◽  
James T. Maxwell ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Medical Center ◽  
Demographic Data ◽  
Adult Population ◽  
Postoperative Outcome ◽  
Outcome Data ◽  
Consecutive Series ◽  
Cervical Laminoplasty ◽  
Presenting Symptoms

Abstract BACKGROUND Cervical spondylotic myelopathy (CSM) is one of the leading causes of spinal cord dysfunction in the adult population. Laminoplasty is an effective decompressive procedure for the treatment of CSM. OBJECTIVE We present our experience with 40 patients who underwent cervical laminoplasty using titanium miniplates for CSM. METHODS We performed a retrospective review of the medical records of a consecutive series of patients with CSM treated with laminoplasty at the University of Rochester Medical Center or Rochester General Hospital. We documented patient demographic data, presenting symptoms, and postoperative outcome. Data are also presented regarding the general cost of constructs for a hypothetical 3-level fusion. RESULTS Forty patients underwent cervical laminoplasty; all were available for follow-up. The mean number of levels was 4. All patients were myelopathic, and 17 (42.5%) had signs of radiculopathy preoperatively. Preoperatively, 62.5% of patients had a Nurick grade of 2 or worse. The average follow-up was 31.3 months. The median length of stay was 48 hours. On clinical evaluation, 36 of 40 patients demonstrated an improvement in their myelopathic symptoms; 4 were unchanged. Postoperative kyphosis did not develop in any patients. CONCLUSION The management of CSM for each of its etiologies remains controversial. As demonstrated in our series, laminoplasty is a cost-effective, decompressive procedure for the treatment of CSM, providing a less destabilizing alternative to laminectomy while preserving mobility. Cervical laminoplasty should be considered in the management of multilevel spondylosis because of its ease of exposure, ability to decompress, effective preservation of motion, maintenance of spinal stability, and overall cost.

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