scholarly journals Long-term Outcomes of Patients With Fungal Infections Associated With Contaminated Methylprednisolone Injections

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Anurag N Malani ◽  
Carol A Kauffman ◽  
Robert Latham ◽  
Sheree Peglow ◽  
Christopher S Ledtke ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Fungal Infections ◽  
The United States ◽  
Long Term Outcomes ◽  
Radiographic Findings ◽  
Osteoarticular Infection ◽  
Osteoarticular Infections ◽  
Exserohilum Rostratum ◽  
Health Care Associated Infection

Abstract Background The largest health care–associated infection outbreak in the United States occurred during 2012–2013. Following injection of contaminated methylprednisolone, 753 patients developed infection with a dematiaceous mold, Exserohilum rostratum. The long-term outcomes of these infections have not been described. Methods This retrospective cohort study of 440 of a total of 753 patients with proven or probable Exserohilum infection evaluated clinical and radiographic findings, antifungal therapy and associated adverse effects, and outcomes at 6 weeks, 3, 6, 9, and 12 months after diagnosis. Patients were grouped into 4 disease categories: meningitis with/without stroke, spinal or paraspinal infections, meningitis/stroke plus spinal/paraspinal infections, and osteoarticular infections. Results Among the 440 patients, 223 (51%) had spinal/paraspinal infection, 82 (19%) meningitis/stroke, 123 (28%) both, and 12 (3%) osteoarticular infection. Of 82 patients with meningitis/stroke, 18 (22%) died; among those surviving, 87% were cured at 12 months. Only 7 (3%) of 223 patients with spinal/paraspinal infection died, but at 12 months, 68% had persistent or worsening pain and only 47% were cured. For the 123 patients with both meningitis/stroke and spinal/paraspinal infection, 10 (8%) died, pain persisted in 72%, and 52% were cured at 12 months. Only 37% of those with osteoarticular infection were cured at 12 months. Adverse events from antifungal therapy were noted at 6 weeks in 71% of patients on voriconazole and 81% on amphotericin B. Conclusions Fungal infections related to contaminated methylprednisolone injections culminated in death in 8% of patients. Persistent pain and disability were seen at 12 months in most patients with spinal/paraspinal infections.

Traumatic Brain Injury: A Trauma Surgeon's Perspective

2012 ◽  
Vol 22 (3) ◽  
pp. 82-89
Author(s):  
Oscar D. Guillamondegui
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multidisciplinary Approach ◽  
Trauma Team ◽  
The United States ◽  
Long Term Outcomes ◽  
Term Care ◽  
Injured Brain ◽  
The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

scholarly journals Deep brain stimulation treatment in dystonia: a bibliometric analysis

2020 ◽  
Vol 78 (9) ◽  
pp. 586-592
Author(s):  
Clarice LISTIK ◽  
Eduardo LISTIK ◽  
Rubens Gisbert CURY ◽  
Egberto Reis BARBOSA ◽  
Manoel Jacobsen TEIXEIRA ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Bibliometric Analysis ◽  
Brain Stimulation ◽  
The United States ◽  
Scientific Journals ◽  
Long Term Outcomes ◽  
Generalized Dystonia ◽  
Research Domain ◽  
Deep Brain

ABSTRACT Background: Dystonia is a heterogeneous disorder that, when refractory to medical treatment, may have a favorable response to deep brain stimulation (DBS). A practical way to have an overview of a research domain is through a bibliometric analysis, as it makes it more accessible for researchers and others outside the field to have an idea of its directions and needs. Objective: To analyze the 100 most cited articles in the use of DBS for dystonia treatment in the last 30 years. Methods: The research protocol was performed in June 2019 in Elsevier’s Scopus database, by retrieving the most cited articles regarding DBS in dystonia. We analyzed authors, year of publication, country, affiliation, and targets of DBS. Results: Articles are mainly published in Movement Disorders (19%), Journal of Neurosurgery (9%), and Neurology (9%). European countries offer significant contributions (57% of our sample). France (192.5 citations/paper) and Germany (144.1 citations/paper) have the highest citation rates of all countries. The United States contributes with 31% of the articles, with 129.8 citations/paper. The publications are focused on General outcomes (46%), followed by Long-term outcomes (12.5%), and Complications (11%), and the leading type of dystonia researched is idiopathic or inherited, isolated, segmental or generalized dystonia, with 27% of articles and 204.3 citations/paper. Conclusions: DBS in dystonia research is mainly published in a handful of scientific journals and focused on the outcomes of the surgery in idiopathic or inherited, isolated, segmental or generalized dystonia, and with globus pallidus internus as the main DBS target.

Food Insecurity and Mortality in American Adults: Results From the NHANES-Linked Mortality Study

2020 ◽  
pp. 152483992094592 ◽  
Author(s):  
Srikanta Banerjee ◽  
Tim Radak ◽  
Jagdish Khubchandani ◽  
Patrick Dunn
Keyword(s):  
Health Risk ◽  
Food Insecurity ◽  
Public Health Problem ◽  
The United States ◽  
Mortality Data ◽  
Long Term Outcomes ◽  
Interdisciplinary Approaches ◽  
The Impact

Food insecurity is a significant public health problem in the United States leading to substantial social, economic, and health care–related burdens. While studies continue to estimate the prevalence of food insecurity, the long-term outcomes are not extensively explored. The purpose of this study was to assess the impact of food insecurity on mortality. We analyzed data on adults (≥ 20 years) from the 1999–2010 National Health and Nutrition Examination Survey, with mortality data obtained through 2015. Among the total study participants (n = 25,247), 17.6% reported food insecurity. Food-insecure individuals were more likely to be younger in age, minorities, poorer, with lesser education, obese, smokers, and with diabetes compared to food-secure counterparts. During a 10.2-year follow-up, among the food insecure, 821 individuals died (11%). The hazard ratio (HR) for mortality among the food insecure compared with the food secure, with adjustment for age and gender only, was 1.58; 95% confidence interval [CI: 1.25, 2.01]. The adjusted HRs for all-cause mortality, HR = 1.46, CI [1.23, 1.72], p < .001, and cardiovascular mortality, HR = 1.75, CI [1.19, 2.57], p < .01, were statistically significantly higher among food-insecure individuals, after adjustment for multiple demographic and health risk factors. Individuals who are food-insecure have a significantly higher probability of death from any cause or cardiovascular disease in long-term follow-up. Comprehensive and interdisciplinary approaches to reducing food insecurity–related disparities and health risks should be implemented. Including food insecurity in health risk assessments and addressing food insecurity as a determinant of long-term outcomes may contribute to lower premature death rates.

A Scoping Review on the Long-Term Outcomes in Persons with Adult-Acquired Burn Injuries

2019 ◽  
Vol 41 (3) ◽  
pp. 472-502
Author(s):  
Stephanie R Cimino ◽  
Jorge N Rios ◽  
Matthew Godleski ◽  
Sander L Hitzig
Keyword(s):  
Community Participation ◽  
Scoping Review ◽  
The United States ◽  
Community Dwelling ◽  
Burn Injuries ◽  
Computer Assisted ◽  
Long Term Outcomes ◽  
Burn Survivors ◽  
The Impact

Abstract Adult-acquired burn injuries are a life-altering event that can lead to debilitating functional or psychological impairments. With advancements in health care resulting in decreased mortality rates, survivors of burn injuries can expect to live longer. This warrants a shift in focus to better understand what happens to adults once they are discharged from the hospital into the community. Therefore, the purpose of this scoping review was to map the literature regarding the long-term outcomes of community-dwelling adult-acquired burn survivors. A computer-assisted literature search was conducted on literature from January 1, 2000 to August 31, 2018 utilizing four large databases (MEDLINE, EMBASE, CINHAL, and PsycINFO). Articles were included if they had a minimum of five individuals with a burn injury as a result of an accidental injury who were at least 18 years of age at the time of injury. Fifty-four articles were found suitable for inclusion in this review. The majority of studies were conducted in the United States and were longitudinal in design. Four themes were apparent from the articles: postburn complications, psychosocial outcomes, quality of life, and community participation. Data are lacking with respect to outcomes more than 5 years postburn as well as qualitative research. Furthermore, more literature is needed to understand the impact of postburn complications, coping strategies, and posttraumatic growth as well as barriers to community participation. Overall, there is an emerging body of literature that describes the long-term outcomes of adult-acquired burn survivors up to 5 years postburn.

scholarly journals Salmonella entericaSerotype Choleraesuis Infection of the Knee and Femur in a Nonbacteremic Diabetic Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Alexander M. Sy ◽  
Jagbir Sandhu ◽  
Theodore Lenox
Keyword(s):  
United States ◽  
Septic Arthritis ◽  
Diabetic Patient ◽  
Salmonella Enterica ◽  
The United States ◽  
Joint Fluid ◽  
Highly Pathogenic ◽  
Osteoarticular Infection ◽  
Osteoarticular Infections ◽  
Intestinal Involvement

Osteoarticular infections caused bySalmonellaare rare. The rates of osteomyelitis and septic arthritis due toSalmonellaare estimated to be less than 1% and 0.1%-0.2%, respectively (Kato et al., 2012).Salmonella entericaserotype Choleraesuis is anontyphoidal Salmonella, highly pathogenic in humans, usually causing septicemic disease with little or no intestinal involvement. Serotype Choleraesuis accounts for a small percentage of published studies ofSalmonellainfections in the United States. It is not commonly reported in joint fluid and bones in contrast to serotype Enteritidis and Typhi, where a considerable number of cases have been published. Chen et al. in Taiwan found that 21% of bacteremic patients with this infection subsequently develop focal infections such as septic arthritis, pneumonia, peritonitis, and cutaneous abscess (Chen et al., 1999, Chiu et al., 2004). In contrast, our patient presented with localized osteoarticular infection withSalmonella enterica serotype Cholerasuis, but without evidence of bacteremia.

Invasive healthcare-associated (HA) environmental fungal infections (EFI) in pediatric oncology (ONC) patients (PTS) are an ever-present risk

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19631-19631
Author(s):  
J. Cox ◽  
P. Metcalf ◽  
J. Seigel ◽  
N. Winick
Keyword(s):  
Antifungal Therapy ◽  
Fungal Infections ◽  
Weather Conditions ◽  
Antifungal Prophylaxis ◽  
Cell Transplant ◽  
Risk Patients ◽  
New Construction ◽  
Healthcare Associated ◽  
N95 Respirators

19631 To reduce the risk of HA EFI, our ICUs, onc inpatient and stem cell transplant (SCT) units are centrally HEPA filtered and portable HEPA filters are used in each onc outpatient clinic room. Anticipating demolition and then construction of a new, adjacent hospital tower, infection control (IC) verified (Feb 2006) that all windows were completely sealed, provided valet parking remote to the construction and N95 respirators to be worn in all areas except the HEPA filtered locations for immunosuppressed pts to reduce exposure to construction dust; a known risk factor for HA EFI. Eleven new cases of possible HA EFI were diagnosed in 2006: 3 part of a Jan-Feb cluster related to a new construction elevator and malfunction of a door to the outside and 8 clustered July-Oct after demolition and construction began in April. This compares with only 4 cases in 2005. The primary diagnoses in 2006 were AML (6), ALL (4), and hemophagocytic lymphohistiocytosis (1) versus AML (2) and SCT (2) in 2005. Pts with AML and SCT received antifungal prophylaxis or were receiving antifungal therapy at the time of EFI diagnosis. Different isolates were identified including Aspergillus (numerous species), Scedosporium, Fusarium, and Rhizopus; sites of infection included paranasal sinuses (5), pulmonary (6), skin (2) and GI tract (1). 3 of 11 pts died; all required long term antifungal therapy, and most required altered chemotherapy. 4 of 8 pts in the Jul-Oct cluster had been in rooms later found to have faulty window caulking caused by severe weather conditions in Mar 2006. Our data suggest that despite implementation of measures to prevent HA EFI, new sources of outside air and construction dust likely led to an increase in HA EFI. The absence of HA EFI in SCT pts in 2006 may be attributed to the positive pressurization of the SCT unit, location of the unit facing away from the construction site and the antifungal prophylaxis used. The variety of fungi also support outside air as a source. After the faulty caulking was identified and repaired, no further HA EFI occurred; a case-control study is underway to identify important risk factors. Vigilance for potential new sources of contaminated air is required on units with high risk patients. No significant financial relationships to disclose.

scholarly journals National Trends and Long-term Outcomes of Liver Transplant for Alcohol-Associated Liver Disease in the United States

2019 ◽  
Vol 179 (3) ◽  
pp. 340 ◽  
Author(s):  
Brian P. Lee ◽  
Eric Vittinghoff ◽  
Jennifer L. Dodge ◽  
Giuseppe Cullaro ◽  
Norah A. Terrault
Keyword(s):  
United States ◽  
Liver Disease ◽  
Liver Transplant ◽  
The United States ◽  
Long Term Outcomes ◽  
National Trends

scholarly journals Transgastric-Assisted Endoscopic Fundoplication

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Konstantinos Spaniolas ◽  
Richard I. Rothstein ◽  
Thadeus L. Trus
Keyword(s):  
Potential Role ◽  
Symptomatic Relief ◽  
The United States ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Endoluminal Therapy ◽  
Laparoscopic Instruments ◽  
Recurrent Gerd ◽  
Endoscopic Fundoplication

Gastroesophageal reflux disease (GERD) is a common entity in the United States. Surgical fundoplication can be performed safely with well-established long-term results. In selected patients with GERD, endoluminal therapy has a potential role. We report on a patient with recurrent GERD after two prior fundoplications who wished to pursue endoscopic treatment. The presence of a gastrostomy tube allowed for the performance of a transgastric-assisted endoluminal fundoplication using the EndoCinch (TM) device and standard pediatric laparoscopic instruments. Symptomatic relief of GERD with EndoCinch (TM) is common but the long-term outcomes are limited. Nevertheless, the EndoCinch (TM) device remains a method for endoscopic suturing in certain settings. In patients with gastrostomy access, the use of laparoscopic instruments may further enable the performance of advanced endoscopic therapies.

Daily Life Positive Events Predict Well-Being Among Depressed Adults 10 Years Later

2021 ◽  
pp. 216770262095696
Author(s):  
Vanessa Panaite ◽  
Andrew R. Devendorf ◽  
Todd B. Kashdan ◽  
Jonathan Rottenberg
Keyword(s):  
Psychological Functioning ◽  
Daily Life ◽  
Well Being ◽  
The United States ◽  
Positive Interactions ◽  
Long Term Outcomes ◽  
Positive Events ◽  
Social Time ◽  
Midlife Development

Relatively little is known about the links between the events and emotions experienced in daily life and long-term outcomes among people diagnosed with depression. Using daily diary data from the Midlife Development in the United States, we examined how positive daily life events and emotions influence long-term (10 years later) depression severity and well-being. Participants met criteria for major depressive disorder ( n = 121) or reported no depression ( n = 839) over the past 12 months. Participants reported positive events, socializing activities, and negative affect (NA) and positive affect (PA) for 8 consecutive days. Relative to nondepressed adults, depressed adults reported fewer positive events (fewer positive interactions, spending less time with others), lower PA, and higher NA. Among initially depressed adults, higher baseline well-being was related to higher daily PA, lower NA, and fewer days with less reported social time; higher daily PA and positive interactions predicted higher well-being 10 years later ( N = 77). Variations in day-to-day events and emotions among people with depression may presage psychological functioning years later.

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