Short-Course Versus Long-Course Colistin for Treatment of Carbapenem-Resistant A.baumannii in Cancer Patient

Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly reported nosocomial infections in cancer patients and could be fatal because of suboptimal immune defenses in these patients. We aimed to compare clinical response, microbiological response, nephrotoxicity, and 30-day mortality between cancer patients who received short (<14 days) and long (≥14 days) courses of colistin for treatment of CRAB infection. A retrospective cohort study was conducted in cancer patients with CRAB infection who received short or long courses of colistin between 2015 to 2017 at Chiang Mai University Hospital (CMUH). A total of 128 patients met the inclusion criteria. The results of this study show that patients who received long course of colistin therapy had a higher rate of clinical response; adjusted odds ratio (OR) was 3.16 times in patients receiving long-course colistin therapy (95%CI, 1.37–7.28; p value = 0.007). Microbiological response in patients with long course was 4.65 times (adjusted OR) higher than short course therapy (95%CI, 1.72–12.54; p value = 0.002). Moreover, there was no significant difference in nephrotoxicity (adjusted OR, 0.91, 95%CI, 0.39–2.11; p value = 0.826) between the two durations of therapy. Thirty-day mortality in the long-course therapy group was 0.11 times (adjusted OR) compared to the short-course therapy group (95%CI, 0.03–0.38; p value = 0.001). Propensity score analyses also demonstrated similar results. In conclusion, cancer patients who received a long course of colistin therapy presented greater clinical and microbiological responses and lower 30-day mortality but similar nephrotoxicity as compared with those who a received short course. Therefore, a long course of colistin therapy should be considered for management of CRAB infection in cancer patients.

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A Comparison of Colistin versus Colistin Plus Meropenem for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients: A Propensity Score-Matched Analysis

Antibiotics ◽

10.3390/antibiotics9100647 ◽

2020 ◽

Vol 9 (10) ◽

pp. 647

Author(s):

Wasan Katip ◽

Suriyon Uitrakul ◽

Peninnah Oberdorfer

Keyword(s):

Propensity Score ◽

Acinetobacter Baumannii ◽

Critically Ill ◽

Critically Ill Patients ◽

University Hospital ◽

Apache Ii Score ◽

Nosocomial Pathogen ◽

Chiang Mai ◽

Carbapenem Resistant ◽

Significant Difference

Carbapenem-resistant Acinetobacter baumannii (CRAB), an important nosocomial pathogen, occurs particularly in the intensive care unit (ICU). Thus, the aim of this study was to compare the efficacy and safety of documented treatment with colistin monotherapy versus colistin plus meropenem in critically ill patients with CRAB infections at Chiang Mai University Hospital (CMUH). We conducted a retrospective cohort study of critically ill patients with CRAB infections in an ICU from 2015 to 2017, who received colistin monotherapy versus colistin plus meropenem. After propensity score matching, an adjusted odds ratio (aOR) of a 30-day mortality rate in patients who received colistin plus meropenem was 0.43 compared to those who received colistin monotherapy (95% CI, 0.23–0.82, p = 0.01). aORs of clinical response and microbiological response were also higher in patients who received colistin plus meropenem (1.81, 95% CI 1.01–3.26, p = 0.048 and 2.08, 95% CI 1.11–3.91, p = 0.023, respectively). There was no significant difference in nephrotoxicity (aOR, 0.76, 95% CI, 0.43–1.36, p = 0.363) between colistin monotherapy and colistin plus meropenem. In conclusion, the addition of meropenem to colistin caused a reduction in 30-day mortality, higher clinical and microbiological responses, and did not increase nephrotoxicity compared to colistin monotherapy. Furthermore, 30-day mortality was significantly related with age, receiving vasopressor, having malignancy, and the APACHE II score.

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Clinical Efficacy and Nephrotoxicity of Colistin Alone versus Colistin Plus Vancomycin in Critically Ill Patients Infected with Carbapenem-Resistant Acinetobacter baumannii: A Propensity Score-Matched Analysis

Pharmaceutics ◽

10.3390/pharmaceutics13020162 ◽

2021 ◽

Vol 13 (2) ◽

pp. 162

Author(s):

Wasan Katip ◽

Peninnah Oberdorfer

Keyword(s):

Propensity Score ◽

Acinetobacter Baumannii ◽

Clinical Response ◽

Critically Ill ◽

Critically Ill Patients ◽

University Hospital ◽

Efficacy And Safety ◽

Inclusion Criteria ◽

Chiang Mai ◽

Carbapenem Resistant

Acinetobacter baumannii has emerged as a significant concern worldwide. The mortality rate of carbapenem-resistant A. baumannii (CRAB) is increasing, especially in the intensive care unit (ICU). Thus, the objective of this study is to compare the efficacy and safety of colistin plus vancomycin for the treatment of critically ill patients with CRAB in Chiang Mai University Hospital. We conducted a retrospective cohort study of critically ill patients in the ICU with CRAB infection who received colistin alone or colistin-vancomycin combination therapy at Chiang Mai University Hospital. A total of 365 critically ill patients met the inclusion criteria. The results in this study showed that after propensity score matching, colistin plus vancomycin showed no significant differences in the 30-day mortality compared to colistin alone. Likewise, for colistin plus vancomycin, compared with colistin therapy alone, there were no significant differences in the clinical response, microbiological response and nephrotoxicity. In conclusion, colistin plus vancomycin was no significant differences in 30-day mortality, clinical response, microbiological response compared to colistin alone for infections due to CRAB. The nephrotoxicity rates were similar for both groups, so colistin combination with vancomycin was not necessary for the management of infection caused by CRAB.

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Violence and depression among pregnant women in Egypt

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03932-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hanan M. Ghoneim ◽

Mohamed Elprince ◽

Tamer Yehia M. Ali ◽

Waleed F. Gharieb ◽

Amal A. Ahmed

Keyword(s):

Intimate Partner Violence ◽

Sexual Violence ◽

Partner Violence ◽

Strong Association ◽

Depression Scale ◽

Intimate Partner ◽

University Hospital ◽

P Value ◽

Significant Difference ◽

History Of

Abstract Background Depression is a serious mental health disorder that might affect women in the childbearing period. Incidences increase during pregnancy as well as after delivery. Its association with intimate partner violence (defined as physical, sexual, or psychological harm by a current or former partner) has been reported in many countries. Data about this sensitive issue are lacking in Egypt. The aim of the study was to determine the relation between intimate partner violence and depression during pregnancy. Methods This was a case control study conducted at the outpatient clinics in Suez Canal University hospital, from January 2019 to March 2020. The study included two groups, the study group included women exposed to violence during the current pregnancy and a control one included women with no history of violence. Both groups were recruited according to the predetermined inclusion criteria (women aged 18-45 years, continuous marital relationship, no history of depression in current or previous pregnancies, and singleton pregnancy). Women were asked to complete the Arabic validated NorVold Domestic Abuse Questionnaire (measuring four types of abuse: emotional, physical, sexual, and violence in the health care system, the last one being excluded). Depression was evaluated using the Arabic validated form of the Edinburgh Postnatal Depression Scale (comprises 10 questions that represent patients’ feelings in the last 7 days). The main outcome measure was to assess the association between intimate partner violence and depression. Results We recruited 158 women in each group. Both groups were matched in their demographic characters. Although emotional violence was reported prominently among women exposed to IPV 87.9% (139/158), it was not significantly reported in depressed women (P value 0.084). Physical and sexual violence were significantly reported among depressed women (P value 0.022 and 0.001, respectively). There was a significant difference between women exposed to violence and those who were not exposed to violence in the total depression scores (13.63 ± 5.47 and 10.65 ± 5.44, respectively with a p value < 0.001). Emotional (p value < 0.001) and sexual violence (mild and severe with p value of 0.026 and 0.002 respectively) had significant roles as risk factors for depression during pregnancy in single regression and after control of other confounders. Conclusion There was a strong association between intimate partner violence and depression during pregnancy.

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Comparison of Human Thymus Gland between Young and Old Age

10.53350/pjmhs211561907 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1907-1909

Author(s):

Faiza Mehboob ◽

Ponum Mirani ◽

M. Kamran Ameer ◽

Khurram Shabeer ◽

Muhammad Ali Qamar ◽

...

Keyword(s):

Connective Tissue ◽

Old Age ◽

Age Groups ◽

Young Age ◽

University Hospital ◽

P Value ◽

Old Patients ◽

Human Thymus ◽

Group I ◽

Significant Difference

Aim: Study was conducted to examine the different parameters of human thymus glands of young and old patients and compare the findings between both age groups. Study Design: Comparative/observational study Place and Study: Study was conducted at Anatomy department of Nishtar Medical University Hospital, Multan for duration of six months from 15th January 2020 to 15th July 2020. Methods: Total 54 specimens of human thymus of 54 patients were enrolled in this study. All specimens were divided in to two groups I and II, Group I contains 27 patients with ages <30 years and group II with 27 patients having ages 45 to 60 years. All specimens were fixed in 10% formalin solution and then processed for paraffin embedding. Compare the different parameters such as thickness of interlobular connective tissue and thymic capsule, length and number of Hassal’s corpuscles between both groups. Data was analyzed by SPSS 24.0. Results: In group I 12 (44.44%) patients were ages <15 years and 15 (55.56%) patients were ages >15 years. In group 13 (48.15%) and 14 (51.85%) patients were ages <50 years and >50 years. There was a significant difference observed between both groups regarding thickness of interlobular connective tissue and thymic capsule, quantity and length of Hassal’s corpuscles with p-value <0.05. Conclusion: It is to be concluded that patients with young age had significantly less thickness of thymic capsule and interlobular connective tissue with more in number and decreasing size of Hassal’s corpuscles as compared to old age patients. Keywords: Human Thymus Glands, Young Age, Old Age

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The Effect of the Covid-19 Free Operation Path Protocol on the Incidence of Lung Complications in Postoperative Elective Patients at dr. Moewardi Hospital Surakarta

BioScientia Medicina ◽

10.32539/bsm.v5i11.369 ◽

2021 ◽

Vol 5 (11) ◽

pp. 1030-1036

Author(s):

Galih Aktama ◽

Henky Agung Nugroho ◽

Muhammad David Perdana Putra

Keyword(s):

Cancer Patients ◽

Elective Surgery ◽

Pulmonary Complications ◽

P Value ◽

Chi Square ◽

Elective Surgical Procedures ◽

Significant Difference ◽

Before And After ◽

Chi Square Test ◽

Elective Patients

The pandemic that began in late 2019, COVID-19, affects all patients, including cancer patients. Patients with cancer that continues to spread and there is no other effective alternative treatment must undergo surgery so that cancer does not get worse. Given this problem, many health care centers have developed a protocol system in the form of a COVID-19-free surgical route. This study is a retrospective cohort study comparing the incidence of pulmonary complications in patients undergoing elective cancer surgery at dr. Moewardi Surakarta before and during the COVID-19 pandemic. The study sample was adult patients aged ≥ 18 years which underwent elective surgical procedures with the aim of curative cancer starting before COVID-19 (March 2019-February 2020) until the time the COVID-19 pandemic emerged (March 2020 - February 2021). The data obtained were 768 patients. Of these patients, 384 were classified as having a COVID19-free operation route during the pandemic, and 384 others underwent elective surgery in the pre-pandemic period. Based on the Chi-Square test, a p-value of 0.850 was obtained (P>0.05) which shows that there is significant difference between cases of pulmonary complications in surgical patients before and after the pandemic who were carried out through the COVID-19-free protocol route. In conclusion, there is no significant change in effect of the covid-19 free operation path protocol on the incidence of lung complications in postoperative elective patients at dr. Moewardi Hospital Surakarta, although this patented and mandatory protocol can reduce cancer patients’ morbidity and mortality who undergoing elective surgery during a pandemic.

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Prevalence of Hepatitis C Virus in the Population of Albania for the Period 2007-2010

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2014.094 ◽

2014 ◽

Vol 2 (3) ◽

pp. 525-528 ◽

Cited By ~ 1

Author(s):

Hysaj Vila Brunilda ◽

Shundi Lila ◽

Abazaj Erjona ◽

Bino Silva ◽

Rexha Tefta

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Age Groups ◽

Viral Disease ◽

Hcv Infection ◽

University Hospital ◽

P Value ◽

Hcv Rna ◽

Significant Difference ◽

Males And Females

BACKGROUND: Hepatitis C is a blood-borne, infectious, viral disease that is caused by a hepatotropic virus called Hepatitis C virus (HCV).AIM: The aim of this study is to determine the prevalence of active HCV infection (HCV–RNA) in the cases that were anti-HCV positive.MATERIAL AND METHODS: Plasma of 301 high-risk for HCV infection consecutive from University Hospital Centre “Mother Theresa” Tirana-Albania, during January 2007 to December 2010 was included in this study. To identify the presence of HCV RNA, the samples were examined by Cobas Amplicor HCV test (qualitative method).RESULTS: From 301 samples analyzed in total, 214 of them resulted positive for the presence of HCV-RNA's, corresponding to a prevalence of 71.1%, with 95% CI interval [65.8 - 75.9] for value of χ2 = 52.7 p value <0.0001. Divide by the sex 56% were males and 44% females, with statistically significant difference between them for value χ2 =4306 p value=0.0380. Among the age groups the highest prevalence was observed in the age groups > 25 years with a significant difference with other age groups for p value <0.001.CONCLUSION: Among tested samples, 71.1 % were confirmed to be positive for HCV –RNA infections. The prevalence of male was highest compared to female. For males and females infected the prevalence was highest in the age group of > 25 years.

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149. Short vs. Long Course of Antibiotics for Uncomplicated Gram-Negative Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.224 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S101-S102

Author(s):

James Go ◽

Sarah Cotner ◽

Donna R Burgess ◽

David Burgess ◽

Katie Wallace ◽

...

Keyword(s):

Bloodstream Infections ◽

Data Bank ◽

The United States ◽

Duration Of Treatment ◽

Gram Negative ◽

Short Course ◽

Days Of Therapy ◽

Significant Difference ◽

Gram Negative Bacteremia ◽

Long Course

Abstract Background Bloodstream infections (BSI) continue to be a major cause of morbidity and mortality in the United States; thus, the correct choice of antibiotics for an appropriate duration is imperative. However, there are limited recommendations on adequate duration of treatment of bacteremia caused by Gram-negative organisms. Therefore, treating an infection for an adequate duration to prevent complications while preventing adverse effects from unnecessary antibiotic exposure remains a balancing act. This study aims to compare clinical outcomes between patients treated with a short (7–10 days) vs. long (11–20 days) course of antibiotics for uncomplicated gram-negative bacteremia. Methods This single-center retrospective cohort study evaluated adult patients admitted between January 2007 to October 2018 with a blood culture positive for gram-negative bacteria. Data came from the University of Kentucky Microbiological Laboratory and Center for Clinical and Translational Science (CCTS) Data Bank. Patients included must have received appropriate antibiotics for at least 7 days. Appropriate antibiotics were defined as those to which the organism is susceptible with day one of therapy as the first day of appropriate antibiotic therapy. Patients were excluded if they were treated with aminoglycoside monotherapy, had polymicrobial bacteremia, or if treated for longer than 20 days of therapy. Results A total of 466 patients were identified (208 in the short-course group and 258 in the long course group). Gender and ethnicity were similar across both groups. The patients in the long course group had more ICU admissions compared with the short-course group (52.7% vs. 43.3%, P = 0.0426), tended to be older (57 ± 16.7 vs. 53 ± 15.9 years, P = 0.0119), had a higher Charlson Comorbidity Index (5.7 ± 3.6 vs. 4.6 ± 3.6, P = 0.0009) and remained admitted to the hospital longer (23.2 ± 25.6 vs. 15.8 ± 17.5 days, P = 0.0002). However, patients treated with a long course had no difference in 30-day mortality compared with the short-course group (3.9% vs. 3.4%, P = 0.7701). Conclusion Patients with an uncomplicated gram-negative BSI treated with a short course (7–10 days) of antibiotics do not appear to have a significant difference in 30-day mortality compared with those patients treated with a long course (11–20 days). Disclosures All authors: No reported disclosures.

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Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1107 ◽

2020 ◽

pp. 1-9

Author(s):

Ali Faisal Saleem ◽

Huma Faiz Halepota ◽

Hasaan Omar ◽

Areeba Zain ◽

Muhammad Arif Mateen Khan

Keyword(s):

Abdominal Surgery ◽

Surgical Site Infection ◽

Tertiary Care ◽

Stable Condition ◽

University Hospital ◽

P Value ◽

Care Hospital ◽

Site Infection ◽

Significant Difference ◽

Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...

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Effect of body mass index (BMI) on outcomes after surgical resection and adjuvant therapy for pancreatic cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.185 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 185-185

Author(s):

M. R. Khawaja ◽

N. Zyromski ◽

M. Yu ◽

H. R. Cardenes ◽

C. M. Schmidt ◽

...

Keyword(s):

Pancreatic Cancer ◽

Adjuvant Therapy ◽

Cancer Patients ◽

Surgical Resection ◽

Survival Rates ◽

Disease Free Survival ◽

University Hospital ◽

Rank Test ◽

Kaplan Meier ◽

Significant Difference

185 Background: Obesity is one of the factors commonly associated with pancreatic cancer risk, but its prognostic role for survival is debatable. This study aimed to determine the role of BMI in treatment outcomes of pancreatic cancer patients (pts) undergoing surgical resection followed by adjuvant therapy. Methods: We retrospectively reviewed 165 consecutive pts with pancreatic cancer undergoing pancreaticoduodenectomy at Indiana University Hospital between 2004 and 2008. Fifty-three pts who received adjuvant treatment [gemcitabine alone (C-group): n=19; gemcitabine + radiotherapy (CRT-group): n=34] at our institution were included in the analysis. The Kaplan-Meier method was used to estimate the disease-free survival (DFS) and overall survival (OS); log-rank test was used to compare these outcomes between BMI groups (normal 18.5-24.99 kg/m2 vs. overweight/obese ≥ 25 kg/m2). Results: The sample comprised 53 pts (28 males; median age 62 yrs) with a median follow-up of 18.6 months (mos). Thirty pts (56.6%) had their BMIs recorded before the date of surgery, and 23 pts prior to starting adjuvant therapy. Two (3.8%) pts were underweight, 21 (39.6%) had a normal BMI and 30 (56.6%) were overweight/obese. There was no statistically significant difference in the median DFS of obese/overweight and normal BMI pts irrespective of adjuvant therapy (C or CRT) (14.47 vs. 11.80 mos; p= 0.111). Obese/overweight pts had a better median OS [25.2 vs. 14.6 mos; p=0.045 overall (25.7 vs. 16.9 mos; p= 0.143 for the CRT-group and 17.3 vs. 13.4 mos; p= 0.050 for the C-group)], 1-year survival [96.7% vs. 61.9%; p < 0.0001 overall (95% vs. 64.3%; p= 0.001 for the CRT-group, and 90% vs. 57.1%; p=0.016 with C)], and 2-year survival [52.6% vs. 25.4%; p < 0.0001 overall (60.0% vs. 30.0%; p=0.0001 for the CRT-group and 37.5% vs. 14.3%; p=0.0002 for the C-group)] than patients with normal BMI. Conclusions: In our experience, overweight/obese pts undergoing surgery followed by adjuvant therapy have better survival rates than patients with normal BMI. [Table: see text] No significant financial relationships to disclose.

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Long-course targeted therapy with bevacizumab to predict better survival in patients with advanced colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14704 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14704-e14704

Author(s):

Yanhong Deng ◽

Yuting Tang ◽

Jian Xiao ◽

Jiayu Ling ◽

Yue Cai ◽

...

Keyword(s):

Colorectal Cancer ◽

Targeted Therapy ◽

Standard Treatment ◽

Advanced Colorectal Cancer ◽

P Value ◽

First Line ◽

The Third ◽

Short Course ◽

Negative Effect ◽

Long Course

e14704 Background: Bevacizumab has been the standard treatment in first-line treatment of advanced colorectal cancer. This study explored whether the short-course and long-course use of bevacizumab could influence overall survival (OS). Methods: A total of 74 patients with advanced colorectal cancer who had received at least one cycle of bevacizumab-based regimens were included. The primary endpoint was OS defined as from the date of first diagnosis of advanced colorectal cancer to death. Results: The P value among the median OS of initiating bevacizumab in first-line group (n = 47), in the second-line group (n = 18), and the third-or more-line group (n = 9) was not reached statistically significance(P = 0.349). In the first-line initiating bevacizumab group, the irinotecan arm showed a trend of better activity than the oxaliplatin arm, but the significance was not reached(P = 0.128). For patients in the first-line initiating bevacizumab group who had received at least four courses of bevacizumab (n = 36), the median PFS and OS was 11 m and 29m respectively and for those receiving less than four courses of bevacizumab (n = 10), it was 3.9 m (P = 0.005) and 13m (P=0.003) respectively. Conclusions: The delayed use of bevacizumab has no negative effect on the OS of patients with advanced colorectal cancer. Long-Course targeted therapy with bevacizumab favors better survival in patients with advanced colorectal cancer.

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