scholarly journals An unexpectedly high occurrence of aciclovir-induced neuropsychiatric symptoms in patients treated for herpesvirus CNS infection: a prospective observational study

2019 ◽  
Vol 74 (12) ◽  
pp. 3565-3572 ◽  
Author(s):  
Johan Lindström ◽  
Anders Helldén ◽  
Jan Lycke ◽  
Anna Grahn ◽  
Marie Studahl
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Medical Records ◽  
Regression Models ◽  
Prospective Observational Study ◽  
Neuropsychiatric Symptoms ◽  
Cns Infection ◽  
Albumin Ratio ◽  
Number Of Patients ◽  
The Impact

Abstract Background Aciclovir is effective in herpesvirus infections of the CNS. Aciclovir-induced neuropsychiatric symptoms (AINS) have been reported and are associated with high CSF concentrations of aciclovir metabolite 9-carboxymethoxymethylguanine (CMMG). Risk factors except for renal failure have not been explored, and disruption of the blood–brain barrier (BBB) in acute CNS infection may be of interest. Objectives To investigate the impact of risk factors on aciclovir and CMMG concentrations, and to relate the results to AINS. Methods We investigated 21 consecutively included, consenting patients treated with aciclovir or valaciclovir for herpesvirus CNS infection. Regression models were constructed to study the impact of risk factors including BBB disruption, as measured with CSF:serum albumin ratio, on CSF aciclovir and CMMG concentrations. Medical records were assessed retrospectively to identify patients with AINS. Results Increased CSF:serum albumin ratio, as well as decreased renal function and high aciclovir doses, was associated with increased aciclovir and CMMG concentrations in the CSF. We identified five patients with new neuropsychiatric symptoms; four of those were considered to have AINS and had increased CSF CMMG concentrations. Only one patient without suspicion of AINS had an increased CSF CMMG concentration. Conclusions In patients with herpesvirus CNS infections, BBB disruption is associated with increasing aciclovir and CMMG CSF concentrations. We also found an unexpectedly high number of patients with AINS. Evaluation of CSF:serum albumin ratios, renal function and CSF concentrations of aciclovir and CMMG may all contribute to the optimization of aciclovir dosing and avoidance of AINS.

Indication to postoperative radiotherapy for oral cavity squamous cell carcinoma: what’s new in the Depth of Infiltration (DOI) era?

2021 ◽  
Author(s):  
Daniela Alterio ◽  
Rita De Berardinis ◽  
Matteo Augugliaro ◽  
Pasqualina D’Urso ◽  
Stefania Volpe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Oral Cavity ◽  
Squamous Cell ◽  
Tnm Classification ◽  
Postoperative Radiotherapy ◽  
Tnm Staging ◽  
Stage Migration ◽  
Number Of Patients ◽  
The Impact ◽  
Depth Of Infiltration

Objectives: The last edition of the American Joint Committee on Cancer (AJCC eighth) has introduced the depth of infiltration (DOI) as a new prognostic parameter in oral cavity squamous cell carcinomas (OCSCCs). Aim of this study is to analyze the impact of stage migration on the indication to postoperative radiotherapy (PORT). Methods: OCSCCs treated at two Institutions between 2014 and 2019 were retrieved. Per the AJCC eighth, only pT3 primarily OCSCCs were considered; availability of the pathologic specimen was a further inclusion criterion. Risk factors considered for PORT were: pT3-pT4, nodal involvement, positive/close surgical margins, perineural and lymph vascular invasion. Results: One-hundred forty-nine patients staged as pT3 AJCC eighth were included. A four-fold increase in the number of patients staged as pT3 from the seventh to the eighth AJCC was found. Stage migration to pT3 was equally due to the downstaging from former pT4 (38%) and upstaging of former pT1-pT2 (35%). Considering the former pT1-pT2 53 patients, 13 (25%) had no risk factors for PORT other than DOI. Among 25 cases with former pT1-pT2 and negative lymph nodes no additional risk factors were found in 11 (44%). Conclusion: Ninety percent of patients had at least one risk factor besides DOI and would have received PORT also according to the AJCC seventh; notably, of former pT1-pT2N0, half of them have been upstaged to pT3 in the current TNM classification. The role of PORT in this cohort of patients has not been clarified yet. Advances in knowledge: Other-than-DOI risk factors leading to PORT indication are highly prevalent in OCSSC patients classified as pT3 per the latest AJCC TNM staging system and should therefore be considered for a comprehensive oncological assessment.

The Effect of Hospital Resource Unavailability and Ambulance Diversions on the EMS System

1994 ◽  
Vol 9 (3) ◽  
pp. 172-176 ◽  
Author(s):  
Keith W. Neely ◽  
Robert L. Norton ◽  
Gary P. Young
Keyword(s):  
Prospective Observational Study ◽  
Trauma System ◽  
Base Station ◽  
Computed Tomography Scan ◽  
Hospital Resource ◽  
Multilinear Regression ◽  
Number Of Patients ◽  
The Impact ◽  
Tomography Scan ◽  
Intended Destination

AbstractHypotheses:1) There is no increase in transport or scene time of diverted patients and no increase in distances traveled; 2) hospital resource shortages bear no relationship to the number of patients diverted; and 3) paramedics are able to match their patient correctly with the resources available at a given hospital.Methods:This was a five-month, prospective, observational study in an urban area with a population of 600,000 comparing all 9-1-1 ambulance diversions against a randomly selected sample of 5% of all other 9-1-1 originated patients. All patient diversions that originated from the 9-1-1 center are included in the study.Results:Hospitals identify their diversion status on a community-wide computer system monitored at the 9-1-1 center and base station. Accepted categories include: 1) diversion of all patients through the 9-1-1 center from the emergency department (ED); 2) trauma system patients (T); 3) psychiatric secure beds (PSB); 4) general acute ward beds (AW); 5) critical care (CC); 6) computed tomography scan (CT); 7) labor and delivery (LD); and 8) pediatric beds (PEDS). Data were abstracted from 481 patients' records. A total of 111 were diverted from their intended destination. Transport times were longer and diverted patients traveled further (p <.002). Hospitals showing ED and LD diversion categories were more likely to have patients diverted away (r2 = .895, multilinear regression, p <.001). Of the 111 patients, 21 (19%) were diverted because of CC unavailability. Six of these (28%) were inappropriate because they did not fit the CC definition.Conclusions:In this system, hospital diversions increase transport times and distances traveled. Diversion of patients correlated strongly to unavailability of specific categories. Paramedics make errors in determining appropriate CC diversions. Systems reviewing their diversion problems need to assess the impact of longer out-of-hospital times and of certain diversion categories, and to clarify definitions.

Early Transient Hypoglycemia and Test Performance in At-Risk Newborns

2021 ◽  
Author(s):  
Nahed O. ElHassan ◽  
Eric W. Schaefer ◽  
Basilia Gonzalez ◽  
Thomas Nienaber ◽  
Luc P. Brion ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Academic Performance ◽  
Glucose Concentration ◽  
Achievement Tests ◽  
Large For Gestational Age ◽  
Study Cohort ◽  
Perinatal Factors ◽  
Number Of Patients ◽  
The Impact

Objective This study aimed to evaluate if early (within the first 3 hours after birth) transient neonatal hypoglycemia (TNH) is associated with poor academic performance in infants at-risk for hypoglycemia. Study Design This was a retrospective cohort study of at risk-infants (late preterm infants, small and large for gestational age infants, and infants of diabetic mothers [IDMs]) who were born in 1998 and 1999 at the University of Arkansas for Medical Sciences and had ≥1 recorded glucose concentration. The outcome measure was proficiency on 4th grade literacy and mathematics achievement tests. Three glucose concentration cutoffs for defining hypoglycemia (<35, <40, and <45 mg/dL) were investigated. Logistic regression models were developed to examine the association between early TNH and achievement test proficiency based on perinatal factors. Results Among 726 infants, 472 had one, 233 had two, and 21 had three risk factor(s). Early TNH (glucose concentration <35, <40, and <45 mg/dL) was observed in 6.3, 11.6, and 20.5% of the study cohort, respectively. Irrespective of the cutoff used, the frequency of early TNH (number of patients with early TNH in a risk category divided by the total number of patients in that category) was significantly greater among infants with multiple risk factors. After controlling for perinatal factors, early TNH (cutoffs <35 and <40 mg/dL) was significantly associated with decreased probability of proficiency in literacy but not mathematics. Despite that early TNH was more common in IDMs and infants with three risk factors, the category or number of risk factors did not impact academic proficiency. Conclusion Early TNH (<35 and <40 mg/dL) was associated with lower adjusted probability of proficiency on 4th grade literacy achievement tests in at-risk infants. The impact of early TNH on academic performance was similar irrespective of category or number of risk factors. Key Points

EXAMINING THE IMPACT OF CARDIOVASCULAR RISK FACTORS ON NEUROPSYCHIATRIC SYMPTOMS IN THE PACT-MD STUDY

2019 ◽  
Vol 27 (3) ◽  
pp. S202-S203
Author(s):  
Ines Kortebi ◽  
Wael Karameh ◽  
Sanjeev Kumar ◽  
Damien Gallagher ◽  
Angela Golas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Neuropsychiatric Symptoms ◽  
The Impact

scholarly journals Post-treatment heterogeneity of cardio-metabolic risk in acromegalic patients: The Impacts of GH and IGF-1

2020 ◽  
Author(s):  
Mahshid Heydari ◽  
Nahid Hashemi Madani ◽  
Zahra Emami ◽  
Alireza Khajavi ◽  
Mohammad Ghorbani ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multivariate Analysis ◽  
Regression Models ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Metabolic Abnormalities ◽  
Logistic Regression Models ◽  
The Impact ◽  
Prevalence Of Diabetes Mellitus

Abstract Background: Metabolic abnormalities are frequently seen in patients with acromegaly. However, it is not clear to what extent GH /IGF-1 contribute to the development of these abnormalities. This study aimed to explore the impact of GH/IGF-1 on different aspects of metabolic abnormalities in patients with acromegaly. Methods: This retrospective, registry-based study conducted on 102 patients with acromegaly. Prevalence of diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DLP) at the time of diagnosis has been explored. Moreover, the impact of GH/IGF-1 on these cardio-metabolic risk factors at 3-12 months after surgery has been investigated using linear and logistic regression models.Results: At the time of diagnosis, the prevalence of cardio-metabolic risk factors was 79.17 % for DLP, 29.41% for DM, and 15% for HTN. Furthermore, each 1 ng/ml increase in the level of GH was significantly associated with 2 mg/dl increase in the level of FBS, 0.54 mmHg increase in the level of SBP, and 0.88 mmHg increase in the level of DBP. Upon multivariate analysis GH, but not IGF-1, significantly increased the odds of DM (OR; 1.17, 95% CI; 1.02-1.35, p= 0.025). Conclusions: Our findings showed at early postoperative stage, GH is significantly associated with the levels of FBS, SBP, and DBP. Moreover, GH, but not IGF-1, appears as a predictive factor for the presence of DM. However, neither GH nor IGF-1 could predict the presence of HTN, or DLP in this study.

scholarly journals Prevalence and Risk Factors For Retinopathy of Prematurity Among Infants in Minilk-II Hospital, Addis Ababa, Ethiopia: A Retrospective Cross-Sectional Study, 2020.

2021 ◽  
Author(s):  
Emebet Berhane Woldemariam ◽  
Hana Endale Aliyou ◽  
Yosef Tsige Redi
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Retinopathy Of Prematurity ◽  
Medical Records ◽  
Oxygen Therapy ◽  
Maternal Education ◽  
Cross Sectional ◽  
Childhood Blindness ◽  
Zone Ii ◽  
The Impact

Abstract Background: Retinopathy of prematurity (ROP) is defined as a vaso-proliferative retinal disorder that leads to childhood blindness; and persists as the main cause of preventable childhood blindness. The impact of ROP in developing countries is heavier as term infants can develop ROP because of inadequate awareness of the disease development and the risk factors. Hence, the aim of the study is assessing the prevalence and risk factors for retinopathy of prematurity in the specific study area.Methodology: An institutional based cross-sectional retrospective study was conducted on 301 samples of the pediatrics out-patient eye clinic medical records, at Minilik II referral hospital, from March to April 2020. Study subjects were selected using systematic random sampling method. Data was collected from medical records of all infants visiting the hospital for eye problems from January 2018 to December 2019, using a structured check list. The collected data was entered and cleaned using Epi data 6.4.2.0 and then exported & analyzed using SPSS version 25. Bivariate and multivariate analysis was computed to distinguish the statistically significant factors. Result: The prevalence of ROP among infants in this study showed 39(13%). Of these, more than half (56.4%) were Zone II + Stage 1, followed by Zone II + stage-2, and Stage-5; 12.8% and 10.2% respectively. Birth weight, oxygen therapy and sepsis were the factors significantly associated with ROP [AOR= 39.28; 95% CI: 3.204- 481.658], [AOR= 5.317; 95% CI:1.009- 28.019] and [AOR=9.805; 95% CI:1.592- 60.388] respectively. Conclusions: the prevalence of ROP in the current study is (13%). Birth weight, oxygen therapy and sepsis were the determinant risk factors for development of ROP. Regular ANC, and maternal education may be important to reduce the risk of low-birth weight, and sepsis that results in long-term oxygen therapy leading to childhood blindness.

Improvement In Renal Function In Newly Diagnosed Myeloma Improves Survival, but Still Remains Inferior to Those with Normal Renal Function

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2970-2970 ◽  
Author(s):  
Shaji Kumar ◽  
Angela Dispenzieri ◽  
Martha Lacy ◽  
Suzanne R. Hayman ◽  
Francis Buadi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Renal Function ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Research Funding ◽  
Negative Impact ◽  
Newly Diagnosed ◽  
Number Of Patients ◽  
The Impact

Abstract Abstract 2970 Background: Over a quarter of patients (pts) with symptomatic multiple myeloma (MM) have some degree of renal insufficiency at the time of diagnosis. Multiple studies show that presence of renal failure is strong predictor of inferior overall survival in MM. With effective therapy, renal function improves in a considerable number of patients. It is not clear if the return of renal function to normal levels will improve their outcome to that expected for patients without renal dysfunction. Methods: We evaluated 1478 patients with newly diagnosed myeloma seen at Mayo Clinic within 90 days of diagnosis, between January 1999 and January 2009. We examined these patients for improvement in renal function and identified the lowest serum creatinine obtained during the disease course. The outcomes were analyzed with respect to the renal function improvements. Results: The median age at diagnosis was 64 years (range; 22–93) and 50% were male. The median estimated follow up for the entire cohort was 53 months, with 781 patients alive at the time of analysis with a median follow of 3 years. The serum creatinine was over 1.5 mg/dL at diagnosis in 333 (22.5%) pts and over 2.5 mg/dL in 148 (10%) pts. The median overall survival for the 333 patients was 37 mos (95% CI; 28, 40) compared to 56 mos (95% CI; 51, 63) for those < 1.5 mg/dL; P < 0.001. Among the 333 pts with baseline Cr > 1.5 mg/dl, any improvement in Cr was seen in 263 (79%) including an improvement of at least 0.5 mg/dL in 208 (62%) pts. Among the 263 pts with any improvement, the median time to lowest Cr was 4 months (range; 1–13). The median survival of the group of patients with Cr <= 1.5 mg/dl, over 1.5 mg/dL at diagnosis but improved to <= 1.5 mg/dL, or remained >1.5 mg/dL were 56., 40 and 27 mos respectively; P < 0.001, Figure). We then examined the impact of renal function improvement in the group of patients where the baseline Cr was >2.5 mg/dL. The median OS for the 42 (out of 148 pts with Cr > 2.5 at diagnosis) who had improved to <=1.5 mg/dL was 40 mos compared to 56 mos for those with a Cr <= 1.5 mg/dL at diagnosis and 27.4 mos for the 106 pts whose Cr did not decrease to <= 1.5 mg/dL; P < 0.001. Conclusion: The results of this study point toward improved outcome among patients with renal dysfunction in whom renal function improves. However, it shows that this improvement in renal function does not necessarily improve survival to that observed for the patients with a comparable level of serum creatinine at diagnosis. While early treatment of asymptomatic myeloma has been shown to have little impact on overall survival, a strategy of waiting for serious features of target organ damage to appear before initiation of treatment may have a negative impact on survival in some patients, especially patients with high light chain production who have a higher predilection for renal insufficiency. Disclosures: Kumar: Celgene: Consultancy, Research Funding; Millennium: Research Funding; Merck: Consultancy, Research Funding; Novartis: Research Funding; Genzyme: Consultancy, Research Funding; Cephalon: Research Funding. Off Label Use: Lenalidomide for treatment of newly diagnosed myeloma. Dispenzieri:Celgene: Honoraria, Research Funding; Binding Site: Honoraria. Lacy:Celgene: Research Funding.

Melphalan 200 Mg/m2 in Patients with Renal Impairment Is Associated with Increased Short Term Toxicity but Improved Response and Longer Treatment-Free Survival

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1998-1998 ◽  
Author(s):  
Karen Sweiss ◽  
Katie Culos ◽  
Seema Patel ◽  
Annie L. Oh ◽  
Damiano Rondelli ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Impairment ◽  
Creatinine Clearance ◽  
Normal Renal Function ◽  
Disease Risk ◽  
Short Term ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Number Of Patients ◽  
The Impact

Abstract Renal impairment (RI) is a common complication of multiple myeloma (MM) and is reported in up to 40 percent of patients. There is limited data on the outcomes of melphalan 200 mg/m2 (MEL200) and autologous stem cell transplantation (ASCT) in patients with serum creatinine > 2 g/dL since they have been excluded from most studies. Therefore we retrospectively evaluated the impact of RI on outcome of patients with MM treated with MEL200 and ASCT at our institution. One hundred and forty nine consecutive patients who received MEL200 and ASCT between 2000 and 2011 were included in the analysis. Forty-six patients had a CrCl< 60 ml/min and 103 had a CrCl ≥ 60 ml/min. Baseline characteristics were similar between the two groups including measures of disease risk and treatment history. Median creatinine clearance was 50 ml/min (20-59) in the RI cohort and 83 ml/min (60-128) in the normal renal function cohort. Patients with a CrCl < 60 ml/min experienced a longer median time to neutrophil (10 vs. 9 days, p=0.008) and platelet (12 vs. 10 days p<0.001) engraftment despite a similarmean dose of infused CD34+ cells between the two groups. The median duration of hospitalization was significantly longer in patients with RI (16 (11-47) versus 14 (12-36) days, p=0.02). More patients in the CrCl < 60 ml/min group experienced diarrhea, required the use of anti-motility agents, required total parenteral nutrition administration, and developed infection, as compared to the CrCl >60 ml/min group. Response was measured using the International Myeloma Working Group criteria and was assessed immediately prior to transplant and again between 90 to 180 days after transplant. Although there was an increase in the number of patients achieving CR in both groups, this was found to be significant only in the CrCl<60 group (p=0.02). In addition, the overall response rate increased in the CrCl<60ml/min group. No difference in overall survival was seen between the two groups. Median treatment free survival was 37 months in the RI group and 17 months in normal renal function group (p=0.0025). A multivariate cox regression analysis revealed that creatinine clearance <60 ml/min (HR 3.5, p=0.0004) and prior proteasome inhibitor therapy (HR 2.441, p=0.025) were factors that predicted longer treatment free survival. Number of prior therapies (HR 0.7, p=0.03) predicted for a shorter treatment free survival. This represents one of the largest analyses of outcomes of MEL200 in MM patients with RI. We report that although short-term toxicity is increased in the RI group, long-term outcomes may be superior to those patients without renal impairment. We propose that this may be due to greater melphalan exposure in patients with RI. Based on these findings, we would consider MEL200 safe and effective in select patients with creatinine clearance between 30 and 60 ml/min. Disclosures No relevant conflicts of interest to declare.

scholarly journals Pharyngoesophageal Suturing Technique May Decrease the Incidence of Pharyngocutaneous Fistula following Total Laryngectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Mahmut Deniz ◽  
Zafer Ciftci ◽  
Erdogan Gultekin
Keyword(s):  
Risk Factors ◽  
Medical Records ◽  
Total Laryngectomy ◽  
Pharyngocutaneous Fistula ◽  
Continuous Suture ◽  
Main Risk Factor ◽  
Significant Difference ◽  
Suturing Technique ◽  
Life Threatening ◽  
The Impact

Objectives. A pharyngocutaneous fistula (PCF) following total laryngectomy is associated with increased morbidity and severe life threatening complications. We aimed to review our experience with the PCF following total laryngectomy and determine the impact of previously reported risk factors on the development of PCF in our patients.Methods. The medical records of 20 patients who had a total laryngectomy operation were retrospectively analyzed. The association between the proposed risk factors and the incidence of the PCF was investigated.Results. Comparison of the suture techniques used for the closure of the pharynx (either continuous Cushing type or interrupted) yielded that primary interrupted sutures had a significantly higher incidence of PCF formation(p<0.05). Although it was not statistically significant, diabetes mellitus was also associated with increased PCF formation(p>0.05). No significant difference was observed between the PCF and non-PCF groups in terms of other proposed risk factors(p>0.05).  Conclusions. The main risk factor associated with PCF was found to be the type of pharyngeal closure technique. A vertical closure with a Cushing type continuous suture may be more successful than interrupted sutures in preventing a PCF.

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