scholarly journals Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016–2019

2022 ◽  
Vol 8 (1) ◽  
pp. 49
Author(s):  
Chi-Jung Wu ◽  
Cong-Tat Cia ◽  
Hsuan-Chen Wang ◽  
Chang-Wen Chen ◽  
Wei-Chieh Lin ◽  
...  

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016–2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup.

2019 ◽  
Vol 26 (6) ◽  
pp. 698-704 ◽  
Author(s):  
Li Yang ◽  
Hao Xu ◽  
Dian-Cai Zhang ◽  
Feng-Yuan Li ◽  
Wei-Zhi Wang ◽  
...  

Aims. We have established a procedure for uncut Roux-en-Y gastrojejunostomy after laparoscopic distal gastrectomy. This study aimed to evaluate the safety and technical feasibility of the procedure for patients with distal gastric cancer according to the short-term outcomes. Methods. Two hundred and twenty-eight consecutive patients who underwent a laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy from September 2014 to August 2018 were reviewed retrospectively. All the laparoscopic operations were performed successfully without conversion to open surgery. Results. The mean operative duration was 178.28 ± 32.82 minutes, the mean anastomotic process duration was 28.22 ± 7.50 minutes, the average blood loss was 48.97 ± 29.16 mL, and the overall number of lymph nodes harvested was 37.16 ± 11.47. The mean time of out-of-bed ambulation, anal exsufflation, liquid-diet intake, and duration of hospital stay were 41.99 ± 18.37 hours, 69.57 ± 23.17 hours, 5.06 ± 1.09 days, and 8.77 ± 2.42 days, respectively. Fifteen patients suffered postoperative complications, and the overall incidence rate was 6.58% (15/228). Seventeen patients experienced afferent recanalization, the mean time of which was 11 months after the operation. Conclusion. The laparoscopic uncut Roux-en-Y reconstruction is safe and technically feasible, and it has inspiring short-term outcomes for patients undergoing distal gastrectomy.


2007 ◽  
Vol 56 (4) ◽  
pp. 538-544 ◽  
Author(s):  
Tsonyo Dimitrov ◽  
Eded E. Udo ◽  
Ossama Albaksami ◽  
Shehab Al-Shehab ◽  
Abdal Kilani ◽  
...  

A retrospective analysis of 135 typhoid cases was conducted to review the clinical, epidemiological and microbiological characteristics of enteric fever cases diagnosed and treated at the Infectious Diseases Hospital, Kuwait, from 2002 to 2005. Diagnosis of patients was based on clinical features, serology and blood culture. The susceptibility testing of the isolates to ampicillin, chloramphenicol, trimethoprim–sulfamethoxazole, ceftriaxone, ciprofloxacin and nalidixic acid was performed by the disc diffusion method, and MICs of ceftriaxone and ciprofloxacin were determined by Etest. Of 135 typhoid fever patients, 108 (88 %) were treated with ceftriaxone and 27 (20 %) were treated with ciprofloxacin. The mean time for fever defervescence with ciprofloxacin therapy was 8 days and 6.3 days for those treated with ceftriaxone. Of the 135 Salmonella enterica serotypes Typhi and Paratyphi A isolated from patients, 50 (37 %) were multidrug resistant (MDR) and 94 (69.6 %) isolates of both serotypes were nalidixic acid resistant (NAR). Between 90 and 100 % of MDR and NAR strains had decreased susceptibility to ciprofloxacin (0.125–1 μg ml−1). Low-level resistance to ciprofloxacin (MIC 0.125−1 μg ml−1) was also detected in 13.8 and 33.3 % of nalidixic acid-susceptible isolates of S. Typhi and S. Paratyphi A, respectively. All isolates were susceptible to ceftriaxone. Two relapses occurred in the ciprofloxacin-treated group. MDR strains and strains resistant to ciprofloxacin and ceftriaxone are a major threat in the developing world. A situation is fast approaching where the emergence of highly resistant Salmonella isolates is quite likely. Proper steps must be taken to avoid a pandemic spread of MDR S. Typhi strains.


2020 ◽  
Vol 42 (3) ◽  
pp. 62-66
Author(s):  
Suresh Maharjan ◽  
Santosh Chhetri ◽  
Bikash Khatri ◽  
Nisha Sapkota ◽  
Mahesh R Sigdel

Introduction Post-transplant erythrocytosis (PTE) is defined as persistently elevated hemoglobin>17 g/dl and/or PCV>51% in kidney transplant recipients. The incidence of PTE varies from 5% to 17%, with occasional life‑threatening thromboembolic complications. We aimed to study the prevalence, risk factors and complications of PTE. MethodsWe conducted a retrospective single center study in 132 kidney transplant recipients who had undergone live donor kidney transplantation at Tribhuvan University Teaching Hospital, Nepal, between October 2017 and March 2019. Prior approval was obtained from Institutional Review Committee of Institute of Medicine. Patients with hemoglobin>17 g/dl were defined as PTE group, and others as non‑PTE group. The pattern of hemoglobin, serum creatinine, pre-transplant hemoglobin, native kidney disease, immunosuppression medications, rejection episodes, and new onset diabetes after transplantation were analyzed and compared between two groups. ResultsOut of the 132 kidney transplant recipients, PTE was diagnosed in 28 (21.2%) patients, out of which 27 patients (96.4%) were male and 1 (3.6%) were female with the mean time of onset at 7 months after transplantation. Patients with erythrocytosis had a relatively shorter duration of pre transplant dialysis (p=0.001). The mean pre transplant Hb and Hct in PTE group was 9.72g/dl and 30.35% whereas in non PTE group 10.02 g/dl and 31.31%. Thromboembolic and any other PTE related complications were not observed. Seventeen patients of PTE (60.7%) were treated with ACE Inhibitors and 11 (39.9%) patients did not require any treatment. ConclusionPost-transplant erythrocytosis was seen in nearly one fifth kidney transplant recipients at mean time of seven months post-transplantation; was more common in male with good graft function, and short duration of pre transplant dialysis. Response to ACE inhibitors was good.


1995 ◽  
Vol 83 (2) ◽  
pp. 215-217 ◽  
Author(s):  
Richard D. Penn ◽  
Michelle M. York ◽  
Judith A. Paice

✓ A prospective study of intrathecal catheter reliability was performed at Rush-Presbyterian-St. Luke's Medical Center. All 102 patients who had baclofen administered chronically for spasticity via an implanted drug pump were included. Sixty percent of the patients had no catheter complications; the remaining patients had one to five complications over their course of treatment. Survival analysis demonstrated a steady rate of malfunction up to 80 months, with the mean time to first failure recorded at 20 months. Kinks, holes, breaks, dislodgments, and disconnections were the most common complications. On the basis of their research the authors conclude that the thin-walled silastic catheter does not perform well and that larger, thick-walled catheters should be used.


2021 ◽  
pp. 089719002110271
Author(s):  
Sophia Pathan ◽  
Danine Sullinger ◽  
Laura J. Avino ◽  
Samuel E. Culli

Background: Timely medication administration is integral to patient care, and operational delays can challenge timely administration. Within an inpatient pharmacy of an academic medical center, intravenous medications were historically compounded on a patient-specific basis. In 2020, the pharmacy began batching frequently-utilized medications. This analysis explored the impact of compounded sterile batching on pharmacy and nursing services. Methods: This pre- and post-interventional study compared data from February through March 2020 with a seasonally matched period from 2019. The primary endpoint was difference in time to administration of urgent (STAT) medications. Secondary endpoints included timeframes for a pharmacy technician to prepare, a pharmacist to check, and a nurse to administer the medications, as well as reprinted labels and estimated waste. Results: On average, it took one hour and 43 minutes to administer a STAT medication in 2019 and one hour and 57 minutes in 2020 ( p = 0.122). It took about four hours to administer routine medications in 2019 and 2020 ( p = 0.488). The number of labels reprinted decreased from 616 in 2019 to 549 in 2020 ( p = 0.195), relating to decreased missing doses. The mean time to check and send a medication decreased from 2019 to 2020 for STAT orders ( p < 0.001), and there was no difference in wasted medications looking at all orders in this time. Conclusion: Anticipatory batching decreased time to prepare, check, and send medications, though there was no effect on waste or on time to administration. Future studies can examine the correlation between pharmacy operations and medication administration.


2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 262-262
Author(s):  
Ronak Patel ◽  
Victor Chiu ◽  
Darcy V. Spicer

262 Background: Delays in the initiation of chemotherapy for scheduled inpatient admissions cause excess lengths of stay and shift infusion start times to the evenings when hospital staffing is decreased. We sought to characterize delays in our admission process and assess the feasibility of using an admission checklist to shorten start times in a large academic safety-net hospital. Baseline data for scheduled chemotherapy admissions in July and August of 2017 (n = 25) showed a mean time to chemotherapy initiation of 14.6 hours and mean excess LOS was 0.7 midnights. Significant delays were identified in the time between ordering and resulting of pre-chemotherapy labs (average 2.6 hours), and the time required to obtain imaging to confirm peripheral-inserted central catheter (PICC) position (1.6 hours). Methods: We created a checklist of a standardized admission workflow for physicians, which included moving all pre-chemotherapy labs, pharmacy verification of chemotherapy regimen, and PICC imaging to the outpatient setting. We organized multiple staff in-services to introduce the admission workflow prior to implementation on May 1, 2018. We then performed a retrospective chart review of all scheduled inpatient chemotherapy admissions from May to August of 2018. Results: In the first 2 months after intervention, the mean time to chemotherapy initiation was 8.5 hrs, representing a 42% reduction. In the subsequent 2 months, the mean time to chemotherapy initiation was 11.6 hours, representing a 21% reduction from baseline. Mean excess LOS was 0.4 midnights and 0.5 midnights for those time periods, respectively. For the entire post-intervention group, 7 out of 26 patients obtained pre-chemotherapy labs in the outpatient setting. Conclusions: We observed an initial mean reduction of 6.1 hours in the time to start chemotherapy, as well as a reduction in mean excess length of stay with the introduction of a new admission workflow and admission checklist. We observed incomplete adoption of the checklist, and an increase in time to chemotherapy initiation after the first two months of implementation, suggesting that physician non-adherence represents a significant barrier to maintaining these reductions.


Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kavita Phatak ◽  
Kevin Makati ◽  
Marian Holland ◽  
Sara Baig ◽  
Michael H Kim ◽  
...  

Background: There are no upper age restrictions for ICD implantation, though guidelines state that placement should be reserved for those with expected survival of > 1 year. In octogenarians, competing comorbidities may limit the mortality benefit of ICDs. Methods: A retrospective cohort study was used to identify octogenarians who received ICD implantation and follow-up at Northwestern Memorial Hospital or Tufts New England Medical Center between 1990 and 2006. The primary endpoint was death within 1 year of implant. Results: The study identified 241 octogenarians. Mean age 83.3 ± 3.1 years, 79% male, 87% coronary disease and 35% implanted for primary prophylaxis. Mean EF 31 ± 13%, creatinine 1.49 ± 0.71 mg/dl, and mean survival was 3.9 ± 0.3 years. Death within 1 year of implant occurred in 32 (13.2%) patients. Univariate predictors of 1-year mortality included EF ≤ 20% and creatinine ≥ 1.5 mg/dl (p < 0.01 and 0.04, respectively). Cox proportional analysis demonstrated that EF ≤ 20% was the only independent predictor of death within 1 year of ICD implant [Hazard Ratio = 3.2 (95% CI 1.5– 6.5; p<0.002)] and was associated with a 48% 1-year mortality. Of these patients, 6 (19%) received appropriate ICD therapy prior to death; the mean time from therapy to death was 3 months. Conclusion: Octogenarians with EF ≤ 20% have a very high 1-year mortality despite ICD implantation. A minority of these patients will receive appropriate ICD therapy during this time. These results would be expected to have significant impact on the cost-effectiveness of ICDs and should be considered when evaluating device implantation in this population.


2019 ◽  
Vol 91 (6) ◽  
pp. 1-5
Author(s):  
Mateusz Jagielski ◽  
Marian Smoczyński ◽  
Krystian Adrych

Abstract: Introduction: The endoscopic treatment of walled-off pancreatic necrosis (WOPN) as well as other minimally invasive methods have been evolving since last years. The aim of this study is evaluation of efficiency and safety of endoscopic necrosectomy under fluoroscopy done during the transmural drainage in patients with symptomatic WOPN. Material and methods: The retrospective analysis 114 consecutive patients with symptomatic WOPN were treated endoscopically in our medical center between 2011 and 2016. Results: Endoscopic necrosectomy was performed under fluoroscopic guidance during transmural drainage in 24/114 (21,05%) patients.The mean amount of endoscopic procedures in each patient was 8,88 (3-27). The active drainage was continued averagely for 40,1 (11-96) days. The avarage number of necrosectomy procedures during continued drainage was 6,54 (1-24) per patient. Additional percutaneous drainage was applied in just two patients. The complications of endotherapy were present in 9/24 (37,5%) patients. The therapeutic success was reached in 23/24 (95,83%) patients. The mean time of observation was 35 [18-78] months. The recurrence of pancreatic fluid collection was stated in 4 patients during the observation time. The mean time between the end of endotherapy and recurrence of fluid collection was 19 [16-22] months. In three patients recurrent fluid collections were treated endoscopically and in one patient were treated surgically. Long-term success of endoscopic treatment of WOPN was reached in 22/24 (91,67%) patients. Conclusions: Endoscopic necrosectomy under fluoroscopic guidance during transmural drainage is successful and safe method of minimally invasive treatment in selected patients with walled-off pancreatic necrosis.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S245-S245
Author(s):  
Patricia Galindo-Lopez ◽  
Benjamin Valente-Acosta ◽  
Francisco Moreno-Sanchez ◽  
Luis Espinosa-Aguilar ◽  
Irma Hoyo-Ulloa ◽  
...  

Abstract Background COVID-19 has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in case series of critically ill patients. However, the criteria for CAPA diagnosis has been inconsistent among most of the reports. Mexico has been widely affected by SARS-CoV-2. We present a series of CAPA cases at a teaching hospital in Mexico City. Methods We performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from May 1st, 2020, to May 1st, 2021. Including only those with critical COVID-19 who required invasive mechanical ventilation (IMV). Patients with a diagnosis of CAPA were analyzed. We followed the 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika). Results Among the 230 admitted patients who required IMV, we identified 49 (21.3%) cases of CAPA, 46 probable CAPA and 3 proven CAPA. Nineteen (38%) of those died in the hospital. The mean age was 64.5 ± 12.6 years and 11 were female. Proven CAPA was diagnosed with culture in three cases (one A. niger, one A. terreus and one A. fumigatus). Probable CAPA was diagnosed by a positive serum GP in 27 (55.1%) patients and by a positive bronchoalveolar lavage (BAL) GP in 29 (59.2%) cases. Seven patients had both serum and BAL positive GP. Forty-six (93.9%) patients received corticosteroids, and 22 (49.9%) were treated with tocilizumab before CAPA diagnosis. All but one received isavuconazole as CAPA treatment. We detected 35 (71.4%) patients who had a bacterial co-infection. Eighteen of those died (51.4%) compared to only one dead in the subgroup without coinfections (7.1%). The mean time from hospital admission to CAPA diagnosis was 6.2 days (SD 7.1) among those who survived compared to 13.2 (SD 6.3) days in those who died p&lt; 0.01. Conclusion CAPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality when it occurs with other bacterial coinfections and when it is diagnosed late from admission. Disclosures All Authors: No reported disclosures


1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.


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