Screening of Strongyloides stercoralis Infection in High-Risk Patients in Khuzestan Province, Southwestern Iran

Abstract Background: Strongyloidiasis, one of the neglected tropical diseases (NTDs), can be fatal in immunocompromised patients. Available data on Strongyloides stercoralis infection in high-risk patients in Iran; however, is limited. The aim of the present study was to determine the prevalence of S. stercoralis infection and associated risk factors among high-risk patients, as well as to evaluate the accuracy of the diagnostic tests used in the diagnose of S. stercoralis infection. Methods: This cross-sectional study was performed during 2019 to 2020 among 300 high-risk patients in Khuzestan Province, southwestern Iran. Patients with autoimmune diseases, uncontrolled diabetes, HIV/AIDS, cancer, organ transplant, hematologic malignancy, asthma and chronic obstructive pulmonary disease (COPD) were examined using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test. Culture-positive samples were confirmed by PCR amplification and sequencing of the nuclear 18S rDNA (SSU) hypervariable region (HVRIV) of the parasite.Results: The prevalence of S. stercoralis infection was 1%, 1.3%, 2%, 2.7%, and 8.7% using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test, respectively. All culture-positive samples were confirmed by SSU-PCR. According to the results, the most sensitive test was ELISA, with 100% sensitivity, followed by Baermann funnel technique with sensitivity of 75%. Direct smear examination, formalin-ether concentration technique, and Baermann funnel technique had the highest PPV (100%), while ELISA test had the highest NPV (100%). Eosinophilia significantly was observed in patients whose culture test were positive (7/8; p= 0.001). Of these, 5 patients had a history of asthma and COPD. In the present study, the majority of the positive cases by the agar plate culture had a history of prolonged exposure to soil, history of asthma and COPD, and were over the ages of 60. In two cases, S. stercoralis larva was observed 6 months and 8 months after treatment with albendazole.Conclusions: Given that the ELISA test had the highest NPV, screening of all high-risk patients for S. stercoralis infection in endemic areas is recommended prior to starting corticosteroid therapy with ELISA test. Ivermectin should be available to the strongyloidiasis patients in the endemic areas.

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Screening of Strongyloides stercoralis infection in high-risk patients in Khuzestan Province, Southwestern Iran

Parasites & Vectors ◽

10.1186/s13071-020-04549-6 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Alireza Ashiri ◽

Abdollah Rafiei ◽

Molouk Beiromvand ◽

Abdollah Khanzadeh ◽

Arash Alghasi

Keyword(s):

High Risk ◽

Agar Plate ◽

Elisa Test ◽

Direct Smear ◽

High Risk Patients ◽

Smear Examination ◽

Risk Patients ◽

Funnel Technique ◽

Endemic Areas ◽

Baermann Funnel

Abstract Background Strongyloidiasis, one of the neglected tropical diseases (NTDs), can be fatal in immunocompromised patients. Available data on Strongyloides stercoralis infection in high-risk patients in Iran are limited. The aim of the present study was to determine the prevalence of S. stercoralis infection and associated risk factors among high-risk patients as well as to evaluate the sensitivity of the diagnostic tests used in the diagnose of S. stercoralis infection. Methods This cross-sectional study was performed from 2019 to 2020 among 300 high-risk patients in Khuzestan Province, southwestern Iran. Patients with autoimmune diseases, uncontrolled diabetes, HIV/AIDS, cancer, organ transplant, hematological malignancy, asthma and chronic obstructive pulmonary disease (COPD) were examined using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test. Since agar plate culture was considered the reference diagnostic test, culture-positive samples were confirmed by PCR amplification and the sequencing of the nuclear 18S rDNA (SSU) hypervariable region (HVRIV) of the parasite. Results The prevalence of S. stercoralis infection was 1%, 1.3%, 2%, 2.7%, and 8.7% using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test, respectively. All culture-positive samples were confirmed by SSU-PCR. According to the results, the most sensitive test was ELISA, with 100% sensitivity, followed by the Baermann funnel technique with the sensitivity of 75%. Direct smear examination, formalin-ether concentration technique, and Baermann funnel technique had the highest PPV (100%) while the ELISA test had the highest NPV (100%). Significant eosinophilia was observed in the patients whose culture test was positive (7/8; P < 0.05). In the present study, the majority of the positive cases by the agar plate culture had a history of prolonged exposure to soil and of asthma and COPD and were > 60 years old. Conclusions Given that the ELISA test had the highest NPV, the screening of all high-risk patients for S. stercoralis infection in endemic areas is recommended prior to starting corticosteroid therapy with the ELISA test. The results indicate the importance of paying attention to patients with unknown eosinophilia in endemic areas. Ivermectin should be available to strongyloidiasis patients in the endemic areas.

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Natural History of Thoraco-abdominal Aneurysm in High-Risk Patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.01.064 ◽

2010 ◽

Vol 51 (3) ◽

pp. 785

Author(s):

P.A. Hansen ◽

J.M.J. Richards ◽

A.L. Tambyraja ◽

L.R. Khan ◽

R.T.A. Chalmers

Keyword(s):

High Risk ◽

Natural History ◽

Abdominal Aneurysm ◽

High Risk Patients ◽

Risk Patients ◽

History Of

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Re-operation within 30 days of radical cystectomy: Identifying high-risk patients and complications using ACS-NSQIP database

Canadian Urological Association Journal ◽

10.5489/cuaj.6490 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Rashid K. Sayyid ◽

Diana Magee ◽

Amanda E. Hird ◽

Benjamin T. Harper ◽

Eric Webb ◽

...

Keyword(s):

Risk Factors ◽

Bladder Cancer ◽

African American ◽

High Risk ◽

Radical Cystectomy ◽

High Risk Patients ◽

Metastatic Bladder Cancer ◽

Risk Patients ◽

History Of ◽

African American Race

Introduction: Radical cystectomy (RC) is a highly morbid procedure, with 30-day complication rates approaching 31%. Our objective was to determine risk factors for re-operation within 30 days following a RC for non-metastatic bladder cancer. Methods: We included all patients who underwent a RC for non-metastatic bladder cancer using The American College of Surgeons National Surgical Quality Improvement Program database between January 1, 2007 and December 31, 2014. Logistic regression analyses were used to evaluate predictors of re-operation. Results: A total of 2608 patients were included; 5.8% of patients underwent re-operation within 30 days. On multivariable analysis, increasing body mass index (BMI) (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07), African-American race (vs. Caucasian OR 2.29; 95% CI 1.21–4.34), and history of chronic obstructive pulmonary disease (COPD) (OR 2.33; 95% CI 1.45–3.74) were significant predictors of re-operation within 30 days of RC. Urinary diversion type (ileal conduit vs. continent) and history of chemotherapy or radiotherapy within 30 days prior to RC were not. Patients who underwent re-operation within this timeframe had a significantly higher mortality rate (4.0% vs. 1.6%) and were more likely to experience cardiac (7.2% vs. 1.9%), pulmonary (23.0% vs. 3.0%), neurological (2.0% vs. 0.49%), and venous thromboembolic events (10.5% vs. 5.4%), as well as infectious complications (64.5% vs. 24.1%) with a significantly longer hospital length of stay (16.5 vs. 7.0 days). Conclusions: Recognizing increasing BMI, COPD, and African-American race as risk factors for re-operation within 30 days of RC will allow urologists to preoperatively identify such high-risk patients and prompt them to adopt more aggressive approaches to minimize postoperative surgical complications.

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Hepatitis C Virus Screening of High-Risk Patients in a Canadian Emergency Department

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2020/5258289 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Kelsey Ragan ◽

Anjali Pandya ◽

Tristan Holotnak ◽

Katrina Koger ◽

Neil Collins ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

High Risk ◽

Drug Use ◽

Hcv Rna ◽

High Risk Patients ◽

Risk Patients ◽

History Of ◽

Hcv Screening

Background. Approximately 0.7% of the Canadian population is infected with hepatitis C virus (HCV), and many individuals are unaware of their infection. Our objectives were to utilize an emergency department (ED) based point-of-care (POC) HCV screening test to describe our local population and estimate the proportion of high-risk patients in our population with undiagnosed HCV. Methods. A convenience sample of medically stable patients (≥18 years) presenting to a community ED in Calgary, AB, between April and July 2018 underwent rapid clinical screening for HCV risk factors, including history of injection drug use, healthcare in endemic countries, and other recognized criteria. High-risk patients were offered POC HCV testing. Antibody-positive patients underwent HCV-RNA testing and were linked to hepatology care. The primary outcome was the proportion of new HCV diagnoses in the high-risk population. Results. Of the 999 patients screened by survey, 247 patients (24.7%) were high-risk and eligible for testing. Of these, 123 (49.8%) were from HCV-endemic countries, while 63 (25.5%) and 31 (12.6%) patients endorsed a history of incarceration and intravenous drug use (IVDU), respectively. A total of 144 (58.3%) eligible patients agreed to testing. Of these, 6 patients were POC-positive (4.2%, CI 0.9–7.4%); all 6 had antibodies detected on confirmatory lab testing and 4 had detectable HCV-RNA viral loads in follow-up. Notably, 103 (41.7%) patients declined POC testing. Interpretation. Among 144 high-risk patients who agreed to testing, the rate of undiagnosed HCV infection was 4.2%, and the rate of undiagnosed HCV infection with detectable viral load was 2.8%. Many patients with high-risk clinical criteria refused POC testing. It is unknown if tested and untested groups have the same disease prevalence. This study shows that ED HCV screening is feasible and that a small number of previously undiagnosed patients can be identified and linked to potentially life-changing care.

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Philadelphia-Negative Classical Myeloproliferative Neoplasms: Critical Concepts and Management Recommendations From European LeukemiaNet

Journal of Clinical Oncology ◽

10.1200/jco.2010.31.8436 ◽

2011 ◽

Vol 29 (6) ◽

pp. 761-770 ◽

Cited By ~ 476

Author(s):

Tiziano Barbui ◽

Giovanni Barosi ◽

Gunnar Birgegard ◽

Francisco Cervantes ◽

Guido Finazzi ◽

...

Keyword(s):

High Risk ◽

Myeloproliferative Neoplasms ◽

Primary Myelofibrosis ◽

International Prognostic Scoring System ◽

High Risk Patients ◽

Thrombosis Risk ◽

Risk Patients ◽

History Of ◽

Management Recommendations ◽

Monitoring Response

We present a review of critical concepts and produce recommendations on the management of Philadelphia-negative classical myeloproliferative neoplasms, including monitoring, response definition, first- and second-line therapy, and therapy for special issues. Key questions were selected according the criterion of clinical relevance. Statements were produced using a Delphi process, and two consensus conferences involving a panel of 21 experts appointed by the European LeukemiaNet (ELN) were convened. Patients with polycythemia vera (PV) and essential thrombocythemia (ET) should be defined as high risk if age is greater than 60 years or there is a history of previous thrombosis. Risk stratification in primary myelofibrosis (PMF) should start with the International Prognostic Scoring System (IPSS) for newly diagnosed patients and dynamic IPSS for patients being seen during their disease course, with the addition of cytogenetics evaluation and transfusion status. High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. Monitoring response in PV and ET should use the ELN clinicohematologic criteria. Corticosteroids, androgens, erythropoiesis-stimulating agents, and immunomodulators are recommended to treat anemia of PMF, whereas hydroxyurea is the first-line treatment of PMF-associated splenomegaly. Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequent RBC transfusions. The risk of allogeneic stem-cell transplantation–related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years.

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The Risk of Stroke Using CHA2 DS2 -VASc Score in Hemodialysis Patients at a Tertiary Hospital in Riyadh, Saudi Arabia

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.04.07.01 ◽

2019 ◽

Vol 4 (7) ◽

Keyword(s):

Risk Factors ◽

High Risk ◽

Stroke Risk ◽

Hemodialysis Patients ◽

Low Risk ◽

High Risk Patients ◽

Stroke Risk Factors ◽

Increased Risk ◽

Risk Patients ◽

History Of

Introduction: Patients undergoing hemodialysis are at increased risk of stroke. However, less known about the impact of some of the stroke risk factors, and the value of stroke risk scores in determining the risk in those patients. Our main goal. To assess the risk factors for stroke in hemodialysis patients and the use of the new CHA2DS2-VASc score for stroke assessment. Methods: Single center, retrospective cohort study of 336 patients undergoing hemodialysis from June 24, 2018, to September 6, 2018, was recruited. Baseline demographics, clinical, and laboratory data were collected. We calculated the CHA2 DS2 -VASc score for stroke assessment in all patients and categorized them into high, moderate and low risk patients according to CHA2 DS2 - VASc score and subcategorized them to two groups atrial fibrillation (AFib) and Non- Atrial fibrillation (Non AFib) patients. Results: 336 patients were included in our study; the majority of patients were at high risk with a CHA2 DS2 -VASc Score mean of 2.9± 1.5, although history of stroke was observed only in 15 patients (4.46%). According to CHA2 DS2 - VASc score, 280 patients were at high risk, 172 (51.19%) were high-risk patients on treatment (anticoagulant or antiplatelet) and 108(32.14%) patients were high risk patients not on treatment 48 were at moderate risk (14.28%) and 8 were at low risk (2.38 %). Patients were divided into subgroups as non-AFib and AFib. In non-AFib patients 320 (95.23%), high-risk patients 103 (32.18%) were not treated; high-risk patients with treatment are 162 (50.62%), moderate patients were 47 (14.68%), 8(2.5%) was in low risk. AFib patients were 16 with a mean CHA2 DS2 -VASc score of 4.4±1.1. Patients with AFib were all at high risk except 1 was at moderate risk (6.25%). There were 11 (68.75%) patients on treatment and 5 (31.25%) patients not on treatment. The risk factors for stroke that were statistically significant in increasing score risk for all patients were: age > 65 (95% CI, -2.04– -1.29; p = 0.000), being female (95% CI, -1.36– -0.68; p = 0.000) hypertension (95% CI, -2.59– -1.37; p = 0.000), diabetes (95% CI, -2.10– -1.50; p = 0.000), CVD (95% CI, -2.07– -1.24; p=0.000), history of stroke or TIA (95% CI, -3.70– -2.03; p = 0.000), CHF or LVEF (95% CI, -2.28– - 0.91; p = 0.000). Conclusions: The risk of stroke in hemodialysis patients is significant according to the use of CHA2 DS2 -VASc score in Non-AFib hemodialysis patients shows supportive evidence of increased risk of stroke in those patients, which suggest the importance of close monitoring of patients with stroke risk factors by the nephrologist and the stroke team which will lead to the initiation of early prophylaxis in those patients.

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291 Ticagrelor monotherapy after percutaneous coronary intervention in high-risk patients with prior myocardial infarction: a prespecified twilight substudy

European Heart Journal Supplements ◽

10.1093/eurheartj/suab140.015 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Mauro Chiarito ◽

Davide Cao ◽

Usman Baber ◽

Carlo Pivato ◽

Carlo Briguori ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

High Risk ◽

Coronary Intervention ◽

Bleeding Events ◽

High Risk Patients ◽

Percutaneous Coronary ◽

Risk Patients ◽

History Of ◽

The Impact

Abstract Aims Patients with history of myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI) remain at risk of recurrent ischaemic events. The optimal antithrombotic strategy for this cohort remains debated. Methods and results In this prespecified analysis of the TWILIGHT trial, we evaluated the impact of prior MI on treatment effect of ticagrelor monotherapy vs. ticagrelor plus aspirin in patients undergoing PCI with at least one clinical and one angiographic high-risk feature and free from adverse events at 3 months after the index PCI. The primary endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5, the key secondary endpoint was the composite of all-cause death, MI, or stroke, both at 12 months after randomization. 1937 (29.7%) patients with and 4595 (70.3%) without prior MI were randomized to ticagrelor and placebo or ticagrelor and aspirin. Patients with prior MI had increased rates of death, MI or stroke (5.7 vs. 3.2%, P < 0.001) but similar BARC 2–5 bleeding (5.0 vs. 5.5%, P = 0.677). Ticagrelor monotherapy reduced the risk of BARC 2–5 bleeding in patients with [3.4% vs. 6.7%; hazard ratio (HR): 0.50; 95% confidence interval (CI): 0.33–0.76] and without prior MI [4.2% vs. 7.0%; HR: 0.58; 95% CI: 0.45–0.76; pinteraction = 0.54). Rates of the key secondary ischaemic outcome were similar between treatment groups irrespective of history of MI (prior MI: 6.0% vs. 5.5%; HR: 1.09; 95% CI: 0.75–1.58; no prior MI: 3.1% vs. 3.3%; HR: 0.92; 95% CI: 0.67–1.28; pinteraction = 0.52). Conclusions Ticagrelor monotherapy is associated with significantly lower risk of bleeding events as compared to ticagrelor plus aspirin without any compromise in ischaemic prevention among high-risk patients with history of MI undergoing PCI.

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Comments regarding ‘Natural History of Thoraco-abdominal Aneurysm in High-Risk Patients’

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2009.12.026 ◽

2010 ◽

Vol 39 (3) ◽

pp. 271-272 ◽

Cited By ~ 1

Author(s):

G. Melissano ◽

R. Chiesa

Keyword(s):

High Risk ◽

Natural History ◽

Abdominal Aneurysm ◽

High Risk Patients ◽

Risk Patients ◽

History Of

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Are patients with high-risk polycythemia vera (PV) receiving cytoreductive medications? A retrospective analysis of real-world data.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18031 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18031-e18031

Author(s):

Dilan Paranagama ◽

Jingbo Yu ◽

Philomena Colucci ◽

Kristin Evans ◽

Machaon Bonafede ◽

...

Keyword(s):

High Risk ◽

Current Treatment ◽

Treatment Recommendations ◽

Low Risk ◽

Myelogenous Leukemia ◽

Real World Data ◽

High Risk Patients ◽

Risk Patients ◽

Acute Myelogenous ◽

History Of

e18031 Background: Risk-adapted therapy in PV is aimed at preventing thrombotic events (TE). Under current treatment recommendations (including European LeukemiaNet), high-risk patients (age ≥ 60 y and/or history of TE) should be managed with cytoreductive medications in addition to phlebotomy and low-dose aspirin. The objective of this study was to describe cytoreductive medication usage in patients with high-risk PV. Methods: Retrospective claims from the Truven Health MarketScan Database were analyzed. Inclusion criteria were ≥ 2 non-diagnostic claims for PV >30 days apart, age ≥ 18 y, continuous enrollment during pre-index (1/1/2012–12/31/2012), and continuous enrollment through or death during the study period (1/1/2013–12/31/2014). Patients with claims for myelodysplastic syndrome, myelofibrosis, acute myelogenous leukemia, or secondary polycythemia were excluded. Descriptive statistics were used. Results: The study included 2856 patients. Mean (SD) age was 62.5 (13.5) y, 65.9% of patients were male, and 63.8% were high-risk. Comorbid conditions of interest were reported more frequently in high-risk patients than low-risk patients: hypertension (65.0% vs 43.1%), diabetes (21.7% vs 10.1%), and congestive heart failure (6.6% vs 0.6%). In low- and high-risk patients, the most commonly used cytoreductive medications were hydroxyurea (93.6%), anagrelide (7.6%), and interferon (2.4%). Low-risk patients received cytoreductive medications less often than high-risk patients (Table). However, only 42% of the high-risk patients received treatment with a cytoreductive medication by the end of the study. Conclusions: Despite higher cardiovascular risk and treatment recommendations, less than half of the high-risk PV patients received cytoreductive medications. Furthermore, less than a third of younger patients with a prior TE received cytoreductive medications. [Table: see text]

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