scholarly journals Treating Critically Ill Patients Experiencing SARS-CoV-2 Severe Infection with Ig-M and Ig-A Enriched Ig-G Infusion

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 930
Author(s):  
Alberto Corona ◽  
Giuseppe Richini ◽  
Sara Simoncini ◽  
Marta Zangrandi ◽  
Monica Biasini ◽  
...  
Keyword(s):  
Immunoglobulin G ◽  
Standard Therapy ◽  
Severe Infection ◽  
Treated Group ◽  
Simplified Acute Physiology Score ◽  
Retrospective Case ◽  
Baseline Characteristics ◽  
Time Of Admission ◽  
Ig G ◽  
Control Study

SARS-CoV-2 in patients who need intensive care unit (ICU) is associated with a mortality rate ranging from 10 to 40–45%, with an increase in morbidity and mortality in presence of sepsis. We hypothesized that IgM and IgA enriched immunoglobulin G may support the sepsis-related phase improving patient outcome. We conducted a retrospective case–control study on 47 consecutive patients admitted to our ICU. At the time of admission, patients received anticoagulants (heparin sodium) together with the standard supportive treatment. We decided to add IgM and IgA enriched immunoglobulin G to the standard therapy. Patients receiving IgM and IgA enriched immunoglobulin G were compared with patients with similar baseline characteristics and treatment, receiving only standard therapy. The mortality resulted significantly higher in patients treated with standard therapy only (56.5 vs. 37.5%, p < 0.01) and, at day 7, the probability of dying was 3 times higher in this group. Variable life adjustment display (VLAD) was 2.4 and -2.2 (in terms of lives saved in relation with those expected and derived from Simplified Acute Physiology Score II) in the treated and not treated group, respectively. The treatment based on IgM and IgA enriched immunoglobulin G infusion seems to give an advantage on survival in SARS-CoV-2 severe infection.

scholarly journals Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256368
Author(s):  
Roshan Acharya ◽  
Aakash Patel ◽  
Evan Schultz ◽  
Michael Bourgeois ◽  
Natalie Kandinata ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Mechanical Ventilation ◽  
Severe Sepsis ◽  
Case Control Study ◽  
Case Control ◽  
Retrospective Case ◽  
Fluid Bolus ◽  
Baseline Characteristics ◽  
Control Study

Background The use of ≥30 mL/Kg fluid bolus in congestive heart failure (CHF) patients presenting with severe sepsis or septic shock remained controversial due to the paucity of data. Methods The retrospective case-control study included 671 adult patients who presented to the emergency department of a tertiary care hospital from January 01, 2017 to December 31, 2019 with severe sepsis or septic shock. Patients were categorized into the CHF group and the non-CHF group. The primary outcome was to evaluate the compliance with ≥30 mL/Kg fluid bolus within 6 hours of presentation. The comparison of baseline characteristics and secondary outcomes were done between the groups who received ≥30 mL/Kg fluid bolus. For the subgroup analysis of the CHF group, it was divided based on if they received ≥30 mL/Kg fluid bolus or not, and comparison was done for baseline characteristics and secondary outcomes. Univariate and multivariable analyses were performed to explore the differences between the groups for in-hospital mortality and mechanical ventilation. Results The use of ≥30 mL/Kg fluid bolus was low in both the CHF and non-CHF groups [39% vs. 66% (p<0.05)]. Mortality was higher in the CHF group [33% vs 18% (p<0.05)]. Multivariable analysis revealed that the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 12% [OR 0.88, 95% CI 0.82–0.95 (p<0.05)]. The use of ≥30 mL/Kg fluid bolus did not increase the odds of mechanical ventilation [OR 0.99, 95% CI 0.93–1.05 (p = 0.78)]. In subgroup analysis, the use of ≥30 mL/Kg fluid bolus decreased the chances of mortality by 5% [OR 0.95, 95% CI 0.90–0.99, (p<0.05)] and did not increase the odds of mechanical ventilation. The presence of the low ejection fraction did not influence the chance of getting fluid bolus. Conclusion The use of ≥30 mL/Kg fluid bolus seems to confer protection against in-hospital mortality and is not associated with increased chances of mechanical ventilation in heart failure patients presenting with severe sepsis or septic shock.

Abstract P530: Safety of Intravenous Cangrelor in Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Hisham Salahuddin ◽  
Giana Dawod ◽  
Syed F Zaidi ◽  
Mouhammad A Jumaa
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Functional Outcomes ◽  
Retrospective Case ◽  
Severe Stenosis ◽  
Anterior Circulation ◽  
Safety And Efficacy ◽  
Baseline Characteristics ◽  
Control Study

Introduction: Mechanical Thrombectomy often requires immediate antiplatelet therapy when emergent stenting is needed. Intravenous cangrelor (CGR) is a potent reversible intravenous antiplatelet with a fast onset, a short half-life, and predictable pharmacokinetics. We sought to evaluate the safety and efficacy of this drug in MT patients. Methods: We performed a retrospective case control study at a CSC between 3/2016 and 4/2020. Patients who received intravenous CGR within 6 hours of admission (between 10/2019 - 4/2020) were compared with patients with anterior circulation tandem MCA occlusions who required stenting and oral antiplatelet therapy (between 3/16 - 10/19), prior to the availability of CGR at our facility. Results: We identified 35 patients, 12 of whom received IV CGR and 23 received acute oral antiplatelets for tandem occlusions. Average age of the cohort was 68.5 ± 13.4. Baseline characteristics including co-morbidities, rate of IV tPA, and time metrics were similar between the two groups. In the CGR group, nine patients had tandem anterior circulation occlusions, two had basilar occlusions, and one patient had an MCA occlusion secondary to severe stenosis. Eleven of the twelve patients in the CGR group required acute stenting. Intravenous CGR was used for an average of 20.2 hours after which patients were transitioned to aspirin and ticagrelor (33%) or clopidogrel (67%). Successful recanalization was achieved in all patients who received IV-CGR and in 95.7% of the tandem group. Final infarct volumes were comparable between the CGR and tandem cohorts (7.1 vs 15.5 ml; p=0.75). There were two cases of asymptomatic hemorrhage in both the CGR group and the tandem cohort, and one case of symptomatic ICH in the tandem cohort. Final functional outcomes (83.3% vs 60.9%; p=0.259) and mortality at three months (13% vs. 17%; p=1) were similar between the two groups. Conclusions: IV CGR is a promising medication for patients with acute ischemic stroke who require an immediate antiplatelet effect and is comparable in safety and efficacy to oral antiplatelets in the acute period of ischemic stroke. Larger prospective studies on the efficacy and safety of CGR in neurointervention are warranted.

scholarly journals 2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S782-S782 ◽  
Author(s):  
Raymond K C Fong ◽  
Stephen G Donoghue ◽  
Humaira Shafi ◽  
Seow Yen Tan ◽  
Wee Boon Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Impairment ◽  
Univariate Analysis ◽  
Outpatient Setting ◽  
Retrospective Case ◽  
Neurotoxic Effects ◽  
Gram Negative Bacteremia ◽  
History Of ◽  
Baseline Characteristics ◽  
Control Study

Abstract Background Numerous reports have emerged about the neurotoxic effects of ertapenem. A recent study supports carbapenem use for the treatment of extended spectrum β-lactamase (ESBL)- producing Gram-negative bacteremia. This will likely bolster the use of ertapenem as it is a convenient choice to complete antibiotic treatment in an outpatient setting. This study aims to review the incidence of neurotoxicity with ertapenem and the risk factors associated with it. Methods A retrospective nested cohort study was conducted in Changi General Hospital in Singapore from January 2015 to Decemeber 2016. All patients who received at least 24 hours of ertapenem were identified. Those who exhibited ertapenem-associated neurotoxic effects were selected as cases while those who did not were included in the pool of controls and randomly selected at a 1:3 ratio. Results A total of 544 patients were treated with ertapenem in our hospital during this 2-year period. Twenty-five patients (incidence 4.6%) developed neurotoxic manifestations and 75 patients were included as controls. Acute confusion was the commonest reaction (n = 19, 76%) followed by hallucinations (n = 8, 32%) and seizures (n = 5, 20%). Baseline characteristics were similar in both groups; the median age of the cases was 79 years (IQR 71–83 years) and 14 (56%) were males. The median duration of ertapenem use before neurotoxicity occurred was 7 days (IQR 5–11days). The median Naranjo ADR probability score for cases was 7 (range 5 to 7) which suggests a probable relationship. Univariate analysis showed that renal impairment (with CrCl< 60 mL/minute) (OR 3.31, 95% CI 1.03–10.64), a history of a vulnerable brain (including stroke and epilepsy etc)(OR 2.61 95% CI 1.03–6.61) increased the risk of neurotoxicity. Neurotoxicity was also significantly associated with longer hospitalization (median 21 days, p = 0.03). Conclusion Our study suggests that renal impairment or a history of vulnerable brain may increase the risk for ertapenem-associated neurotoxicity. Hence, caution should be exercised when ertapenem is used to treat these individuals. Future prospective studies to further evaluate risk and to derive a prediction scoring system may help to reduce the incidence of neurotoxic adverse events with ertapenem use. Disclosures All authors: No reported disclosures.

scholarly journals Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study

2018 ◽  
Vol 29 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Shoichi Haimoto ◽  
Ralph T. Schär ◽  
Yusuke Nishimura ◽  
Masahito Hara ◽  
Toshihiko Wakabayashi ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Spinal Fusion ◽  
Case Control Study ◽  
Posterior Spinal Fusion ◽  
Study Groups ◽  
Treated Group ◽  
Untreated Group ◽  
Retrospective Case ◽  
Vancomycin Powder ◽  
Control Study

OBJECTIVERecent studies have demonstrated the efficacy of subfascial intrawound application of vancomycin powder in spine surgery in reducing the rate of surgical site infections (SSIs). However, to date no study has evaluated the efficacy and safety of suprafascial application of vancomycin powder in spine surgery. The purpose of this study was to quantify the rate of SSIs after open instrumented posterior spinal fusion with and without application of suprafascial vancomycin powder and to evaluate the rate of vancomycin powder–related local adverse effects.METHODSThe authors conducted a single-center retrospective case-control study of adult patients undergoing open instrumented posterior fusion of the cervical, thoracic, or lumbar spine performed by a single surgeon from January 2010 through December 2016. In March 2013, routine application of 1 g of suprafascial vancomycin powder was started for all cases in addition to standard systemic antibiotic prophylaxis. Baseline demographics and operative data as well as the SSI rates were compared between the study groups. The incidence of vancomycin powder–related adverse effects was analyzed.RESULTSA total of 515 patients (268 in the untreated group and 247 in the treated group) were included in the study. The mean age was significantly higher in the treated group than in the untreated group (58.4 vs 54.4 years, p < 0.01). Operative variables were similar between the study groups. Patients receiving vancomycin powder had a significantly lower infection rate (5.6% in the untreated group vs 0% in the treated group, p < 0.001). No vancomycin powder–related adverse effects were identified in the treated group.CONCLUSIONSRoutine application of suprafascial intrawound vancomycin powder in addition to systemic antibiotic prophylaxis is an easy-to-use, safe, and effective strategy for preventing SSIs after instrumented posterior spinal fusion. Suprafascial application of vancomycin powder could be a valuable alternative to previously reported subfascial distribution, minimizing the risk of local adverse drug reactions.

Assessment of Craniofacial Morphology in Mouth Breathing Children. A retrospective case-control study

2019 ◽  
Vol 70 (10) ◽  
pp. 3649-3653
Author(s):  
David Angelescu ◽  
Teodora Angelescu ◽  
Meda Romana Simu ◽  
Alexandrina Muntean ◽  
Anca Stefania Mesaros ◽  
...  
Keyword(s):  
Case Control Study ◽  
Case Control ◽  
Craniofacial Morphology ◽  
Respiratory Pattern ◽  
Control Group ◽  
Upper Lip ◽  
Retrospective Case ◽  
Oral Breathing ◽  
Facial Height ◽  
Control Study

The aim of this retrospective case-control study is to determine a possible correlation between breathing mode and craniofacial morphology. The study was carried out in the Department of Pedodontics,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. The sample comprised 80 patients, age between 6 and 13 years, which were divided in two groups based on respiratory pattern: control group composed of 38 nasal breathing children and case group composed of 42 oral breathing children. Three quantitative craniofacial parameters were measured from the frontal and lateral photos: facial index, lower facial height ratio and upper lip ratio. The statistical analysis showed a significant higher facial index (p=0.006*) and an increase lower facial height (p=0.033*) for the oral breathers group. No differences in facial morphology were found between genders and age groups, when comparing the data between the same type of respiratory pattern children. Spearman�s rho Correlation show a significant positive correlation (p=0.002*) between facial index and lower facial height and a significant negative correlation between facial index and upper lip (p=0,005*). Long faces children are more likely to develop oral breathing in certain conditions, which subsequently have a negative effect on increasing the lower facial height by altering the postural behavior of mandible and tongue.

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