Centrilobular zonal necrosis is a unique subtype of autoimmune hepatitis A cohort study

2020 ◽  
Author(s):  
Kaoru Ueda ◽  
Yoshio Aizawa ◽  
Chika Kinoshita ◽  
Tomohisa Nagano ◽  
Jinya Ishida ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Immunoglobulin G ◽  
Mixed Type ◽  
Antinuclear Antibodies ◽  
Medical Center ◽  
Acute Onset ◽  
Immunoglobulin M ◽  
University Hospital ◽  
Pure Type ◽  
Number Of Patients

Abstract BACKGROUND Centrilobular zonal necrosis (CZN) is advocated as a histological hallmark present in a small number of patients with autoimmune hepatitis (CZN-AIH). Moreover, CZN has been detected in the absence of significant interface hepatitis, one of the most important histological findings of AIH. The concept of CZN-AIH as a distinctive subtype of AIH remains controversial, due to the rarity of CZN-AIH and the ambiguous definition of CZN. To elucidate the clinicopathological and immunogenetic features of CZN-AIH, and to evaluate the significance of co-existent interface hepatitis in CZN-AIH. METHODS A total of 102 biopsy samples of AIH, obtained at The Jikei University Katsushika Medical Center and Jikei University Hospital, were reviewed. The 32 patients whose biopsies showed CZN were selected as the CZN-AIH group and the remaining 70 were grouped as the non-CZN-AIH controls. In the CZN-AIH group, interface hepatitis was histologically present in 37.5% (n=12; mixed-type) and absent in 62.5% (n=20; pure-type). Data on clinical, histopathologic and immunogenetic features were statistically compared between the CZN-AIH group and the non-CZH-AIH controls. Additionally, significance of interface hepatitis in CZN-AIH was determined by comparative analysis of the mixed-type and pure-type subgroups. RESULTS Cases of CZN-AIH were more frequently of acute-onset hepatitis (56.2% vs chronic: 32.9%, P=0.031), lower immunoglobulin G level (P<0.001), lower antinuclear antibodies titer (P<0.001), and lower AIH score (P<0.001). Compared to the non-CZN-AIH cases, the CZN-AIH cases also tended to lack the typical histological characteristics of AIH and of the immunogenetic disproportionate distribution of HLA-DR genotypes in AIH (increased HLA-DR4 and decreased HLA-DR9), and responded more favorably to first-line therapy (P=0.054). For the acute-onset CZN-AIH cases, the clinical and histological features were indistinguishable from the non-acute cases. In contrast, the acute-onset non-CZN-AIH cases were distinguishable from the non-acute cases by lower antinuclear antibodies titer, lower immunoglobulin G level, and less advanced histological stage. The presence of interface hepatitis generally did not influence the morbidity of CZN-AIH, except for comorbid autoimmune diseases, higher gamma-glutamyltranspeptidase level, and increased immunoglobulin M level. CONCLUSION CZN-AIH is clinicopathologically and immunogenetically distinguishable. CZN can characterize a distinct AIH subtype, regardless of onset-pattern or co-existent interface hepatitis.

Methicillin-ResistantStaphylococcus aureusOutbreak at a Veterans' Affairs Medical Center: Importance of Carriage of the Organism by Hospital Personnel

1990 ◽  
Vol 11 (6) ◽  
pp. 291-296 ◽  
Author(s):  
Annette C. Reboli ◽  
Joseph F. John ◽  
Christel G. Platt ◽  
J. Robert Cantey
Keyword(s):  
Infection Control ◽  
Healthcare Workers ◽  
Medical Center ◽  
Veterans Affairs ◽  
Control Measures ◽  
University Hospital ◽  
Contact Tracing ◽  
Hospital Personnel ◽  
Surgical Resident ◽  
Number Of Patients

AbstractThe reported prevalence of nasal carriage of methicillin-resistantStaphylococcus aureus (MRSA) by hospital personnel averages 2.5%. From August 1985 to September 1987, 155 patients at our Veterans' Affairs Medical Center (VAMC) were colonized or infected with MRSA. In December 1986, only two (2.1%) of 94 healthcare workers were identified as nasal carriers. Prompted by a sharp increase in the number of patients with MRSA in early 1987, contact tracing identified 450 employees, of whom 36 (8%) were nasal carriers. Thirty-five percent of surgical residents (7 of 20) were nasal carriers. Prior to being identified as a nasal carrier, one surgical resident was associated with the inter-hospital spread of the VAMC MRSA strain to the burn unit of the affiliated university hospital. Three family members of two employee carriers were also found to harbor the epidemic strain. All 36 carriers were decolonized with various antimicrobial combinations. Vigorous infection control measures were effective in controlling the epidemic. The frequency of MRSA carriage by hospital personnel at our medical center during the epidemic proved higher than previously appreciated. Thus, healthcare workers may comprise a sizable MRSA reservoir. During an MRSA epidemic, infection control should attempt to identify and decolonize this hospital reservoir, as these individuals can disseminate MRSA both within the hospital as well as into the community.

scholarly journals Effects of a trauma center on early mortality after trauma in a regional city in Japan: a population-based study

2019 ◽  
Vol 4 (1) ◽  
pp. e000291 ◽  
Author(s):  
Yuji Takahashi ◽  
Shuntaro Sato ◽  
Kazunori Yamashita ◽  
Naoya Matsumoto ◽  
Yoshihiro Nozaki ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Trauma Center ◽  
Medical Center ◽  
Early Mortality ◽  
University Hospital ◽  
Fiscal Year ◽  
Multivariate Logistic Regression Model ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Number Of Patients

BackgroundAlthough the effects of the trauma center(TC) were researched in several studies, there have been few studies on changes in the regional mortality due to the implementation of a TC. An emergency medical center (EMC) and TC were implemented at Nagasaki University Hospital (NUH) for the first time in the Nagasaki medical region of Japan in April 2010 and October 2011, respectively, and they have cooperated with each other in treating trauma patients. The purpose of this study was to investigate the effects on the early mortality at population level of a TC working in cooperation with an EMC.MethodsThis is a retrospective study using standardized regional data (ambulance service record) in Nagasaki medical region from April 2007 through March 2017. We included 19,045 trauma patients directly transported from the scene. The outcome measures were prognosis for one week. To examine the association between the implementation of the EMC and TC and mortality at a region, we fit adjusted logistic regression models.ResultsThe number of patients of each fiscal year increased from 1492 in 2007 to 2101 in 2016. The number of all patients transported to NUH decreased until 2009 to 70, but increased after implementation of the EMC and TC. Overall mortality of all patients in the region improved from 2.3% in 2007 to 1.0% in 2016.In multivariate logistic regression model, odds ratio of death was significantly smaller at 2013 and thereafter if the data from 2007 to 2011 was taken as reference.ConclusionsImplementation of the EMC and TC was associated with early mortality in trauma patients directly transported from the scene by ambulance. Our analysis suggested that the implementation of EMC and TC contributed to the improvement of the early mortality at a regional city with 500000 populations.Level of evidenceLevel III.

scholarly journals Placenta previa rates in relation to prior cesarean section deliveries, A 15-year single-center analysis

2020 ◽  
Author(s):  
Ahmad B. Alwazzan ◽  
abdullah Kafy ◽  
Samera F. AlBasri ◽  
Ahmed A. Mousa ◽  
Lujain K. Halawani ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Medical Center ◽  
Placenta Previa ◽  
Academic Medical Center ◽  
University Hospital ◽  
Positive Correlation ◽  
Academic Medical ◽  
Number Of Patients ◽  
King Abdulaziz University ◽  
Prior Cesarean Section

Abstract Background: To estimate the rate of placenta previa in relation to prior delivery via cesarean section (CS) during a 15-year period in an academic medical center, King Abdulaziz University Hospital (KAUH), in Jeddah, Saudi Arabia.Methods: In this retrospective study, we reviewed the medical records of all pregnant women who delivered at KAUH from January 2001 to December 2015. For each year, the research team recorded the total number of deliveries, as well as the number and percentage of CS deliveries and patients with placenta previa. The association between placenta previa and previous CS was assessed. Results: Out of the 62,701 deliveries at KAUH during the study period, 13,404 were CS deliveries, producing an overall CS rate of 21.4%. The total number of patients with placenta previa was 260, for a placenta previa rate of 4.14 cases/1,000 births. Of patients with placenta previa, 135 had a prior CS (60%), whereas 91 multigravida women had no previous CS (40%).There is positive correlation between number of CS and number of placenta pravia.Conclusion: In spite of, significant positive correlation between number of CS and number of placenta previa. The rate of placenta previa was not significantly different between patients with or without prior CS delivery. This suggests that factors other with previous CS could play role in the development of placenta previa especially in primgravida.

scholarly journals Acute-onset Autoimmune Hepatitis in a Patient with Selective Immunoglobulin M Deficiency

2019 ◽  
Vol 58 (15) ◽  
pp. 2185-2190
Author(s):  
Akitoshi Sano ◽  
Jun Inoue ◽  
Eiji Kakazu ◽  
Masashi Ninomiya ◽  
Tomoaki Iwata ◽  
...  
Keyword(s):  
Autoimmune Hepatitis ◽  
Acute Onset ◽  
Immunoglobulin M

The Causative Organisms of Bacterial Meningitis and their Antimicrobial Resistance Profiles in Iranian Children in 2011-2016

2020 ◽  
Vol 20 (2) ◽  
pp. 229-236
Author(s):  
Sepideh Keshavarz Valian ◽  
Shima Mahmoudi ◽  
Babak Pourakbari ◽  
Maryam Banar ◽  
Mohammad Taghi Haghi Ashtiani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Bacterial Meningitis ◽  
Medical Center ◽  
Blood Cultures ◽  
Gram Positive ◽  
Gram Negative ◽  
Number Of Patients ◽  
Resistance Patterns ◽  
Iranian Children ◽  
Surgery Department

Objective: The study aimed to describe the identity and antimicrobial resistance patterns of the causative agents of bacterial meningitis in children referred to Children’s Medical Center (CMC) Hospital, Tehran, Iran. Methods: This retrospective study was performed at CMC Hospital during a six-year period from 2011 to 2016. The microbiological information of the patients with a diagnosis of bacterial meningitis was collected and the following data were obtained: patients’ age, sex, hospital ward, the results of CSF and blood cultures, and antibiotic susceptibility profiles of isolated organisms. Results: A total of 118 patients with bacterial meningitis were admitted to CMC hospital. Sixty-two percent (n=73) of the patients were male. The median age of the patients was ten months (interquartile range [IQR]: 2 months-2 years) and the majority of them (n=92, 80%) were younger than two years of age. The highest number of patients (n=47, 40%) were admitted to the surgery department. Streptococcus epidermidis was the most frequent isolated bacterium (n=27/127, 21%), followed by Klebsiella pneumoniae (n=20/127, 16%), and Staphylococcus aureus (n=16/127, 12.5%). Blood culture was positive in 28% (n=33/118) of patients. Ampicillin-sulbactam and imipenem were the most effective antibiotics against Gram-negative bacteria isolated from CSF cultures. In the case of Gram-positive organisms, ampicillinsulbactam, vancomycin, and linezolid were the best choices. Imipenem was the most active drug against Gram-negative blood pathogens. Also, ampicillin and vancomycin had the best effect on Gram-positive bacteria isolated from blood cultures. Conclusion: Results of this study provide valuable information about the antibiotic resistance profiles of the etiologic agents of childhood meningitis, which can be used for prescription of more effective empirical therapies.

scholarly journals Patient Clothing as a Healing Environment: A Qualitative Interview Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5357
Author(s):  
Seon-Ju Kam ◽  
Young-Sun Yoo
Keyword(s):  
Emotional Response ◽  
Positive Emotions ◽  
Design Method ◽  
Medical Center ◽  
Emotional Responses ◽  
University Hospital ◽  
Hospital Environment ◽  
University Hospitals ◽  
Pattern Design ◽  
Qualitative Interview Study

Patients’ emotional responses to the hospital environment can be considered as important as medical technology and equipment. Therefore, this study investigated their experiences to determine whether the pattern using hospital identity (HI) elements, a widely used design method for patient clothing in university hospitals, can affect their emotional response and contribute to healing. It aimed to identify whether controlling the motif characteristics, arrangement, and spacing in this pattern design, and the direction between motifs, could be a method to design patient clothing for healing. To investigate patients’ emotional response and suggestions for patient clothing design, an interview-based qualitative approach was used. In-depth interviews were conducted with 12 patients discharged from Kyung Hee University Hospital Medical Center (KHUMC), Seoul. The interview questions consisted of two parts. One part featured questions about participants’ emotional responses to the medical environment and their latest patient clothing experience, and the other featured questions about their emotional response to, and suggestions for, the healing expression of pattern design using HI. The results confirmed that the motif characteristics, arrangement, and spacing, and the direction between motifs, influenced patients’ positive emotions and contributed to the healing effect. Therefore, when the HI elements of a medical institution are applied in the design of patient clothing with the characteristics of a healing design, patients perceive this as providing stability and comfort. The design of patient clothing becomes a medium that not only builds the brand image of medical institutions, but also enhances the quality of medical services centered on patient healing.

scholarly journals Couples’ experiences with expanded carrier screening: evaluation of a university hospital screening offer

2021 ◽  
Author(s):  
Ivy van Dijke ◽  
Phillis Lakeman ◽  
Naoual Sabiri ◽  
Hanna Rusticus ◽  
Cecile P. E. Ottenheim ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Center ◽  
Informed Choice ◽  
Carrier Screening ◽  
University Hospital ◽  
Structured Interviews ◽  
Expanded Carrier Screening ◽  
Post Test ◽  
Future Child ◽  
Clinically Significant

AbstractPreconception carrier screening offers couples the possibility to receive information about the risk of having a child with a recessive disorder. Since 2016, an expanded carrier screening (ECS) test for 50 severe autosomal recessive disorders has been available at Amsterdam Medical Center, a Dutch university hospital. This mixed-methods study evaluated the experiences of couples that participated in the carrier screening offer, including high-risk participants, as well as participants with a general population risk. All participants received genetic counselling, and pre- (n = 132) and post-test (n = 86) questionnaires and semi-structured interviews (n = 16) were administered. The most important reason to have ECS was to spare a future child a life with a severe disorder (47%). The majority of survey respondents made an informed decision (86%), as assessed by the Multidimensional Measure of Informed Choice. Among the 86 respondents, 27 individual carriers and no new carrier couples were identified. Turn-around time of the test results was considered too long and costs were perceived as too high. Overall, mean levels of anxiety were not clinically elevated. High-risk respondents (n = 89) and pregnant respondents (n = 13) experienced higher levels of anxiety before testing, which decreased after receiving the test result. Although not clinically significant, distress was on average higher for carriers compared to non-carriers (p < 0.0001). All respondents would opt for the test again, and 80.2% would recommend it to others. The results suggest that ECS should ideally be offered before pregnancy, to minimise anxiety. This study could inform current and future implementation initiatives of preconception ECS.

scholarly journals Impact of the COVID-19 pandemic and its related psychological effect on orthopedic surgeries conducted in different types of hospitals in Taiwan

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199607 ◽  
Author(s):  
Chia-Lung Shih ◽  
Peng-Ju Huang ◽  
Hsuan-Ti Huang ◽  
Chung-Hwan Chen ◽  
Tien-Ching Lee ◽  
...  
Keyword(s):  
Community Hospital ◽  
University Hospital ◽  
Total Knee Arthroplasties ◽  
Peak Period ◽  
Number Of Patients ◽  
Total Knee ◽  
Investigation Period ◽  
Orthopedic Diseases ◽  
The University ◽  
The Impact

Aim: Taiwan’s response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients’ fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients’ fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. Patients and Methods: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. Results: The COVID-19 pandemic led to a 22%–29% and 20%–26% reduction in outpatients, 22%–27% and 25%–37% reduction in admissions, and 26%–35% and 18%–34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. Conclusions: The reduction in orthopedic surgeries in Taiwan’s hospitals during COVID-19 could be attributed to patients’ fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%–30% of the operation volume.

scholarly journals A multicenter randomized trial to assess the efficacy of CONvalescent plasma therapy in patients with Invasive COVID-19 and acute respiratory failure treated with mechanical ventilation: the CONFIDENT trial protocol

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Benoît Misset ◽  
Eric Hoste ◽  
Anne-Françoise Donneau ◽  
David Grimaldi ◽  
Geert Meyfroidt ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Neutralizing Antibodies ◽  
Ethical Issues ◽  
High Titer ◽  
Passive Immunization ◽  
University Hospital ◽  
Optimal Time ◽  
Relative Reduction ◽  
Number Of Patients

Abstract Background The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory failure during the evolution of SARS-CoV-2 pneumonia. Methods We plan to include 500 adult patients, hospitalized in 16 Belgian intensive care units between September 2020 and 2022, diagnosed with SARS-CoV-2 pneumonia, under mechanical ventilation for less than 5 days and a clinical frailty scale less than 6. The study treatment will be compared to standard of care and allocated by randomization in a 1 to 1 ratio without blinding. The main endpoint will be mortality at day 28. We will perform an intention to treat analysis. The number of patients to include is based on an expected mortality rate at day 28 of 40 percent and an expected relative reduction with study intervention of 30 percent with α risk of 5 percent and β risk of 20 percent. Discussion This study will assess the efficacy of plasma in the population of mechanically ventilated patients. A stratification on the delay from mechanical ventilation and inclusion will allow to approach the optimal time use. Selecting convalescent plasmas with a high titer of neutralizing antibodies against SARS-CoV-2 will allow a homogeneous study treatment. The inclusion in the study is based on the consent of the patient or his/her legal representative, and the approval of the Investigational Review Board of the University hospital of Liège, Belgium. A data safety monitoring board (DSMB) has been implemented. Interim analyses have been planned at 100, 2002, 300 and 400 inclusions in order to decide whether the trail should be discontinued prematurely for ethical issues. We plan to publish our results in a peer-reviewed journal and to present them at national and international conferences. Funding and registration The trial is funded by the Belgian Health Care Knowledge Center KCE # COV201004 Trial registration Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476

Sign in / Sign up

Export Citation Format

Share Document