Influence of Concomitant Polypharmacy on Docetaxel-induced Febrile Neutropenia

2021 ◽  
Vol 1 (3) ◽  
pp. 135-141
Author(s):  
KATSUYA MAKIHARA ◽  
YUKA SHIMEDA ◽  
TOMOKAZU MATSUMURA
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Febrile Neutropenia ◽  
Confidence Interval ◽  
Cytochromes P450 ◽  
Cyp3a4 Activity ◽  
Factors Associated ◽  
Cyp3a4 Inhibitors ◽  
Concomitant Medications ◽  
Main Factor

Background/Aim: Docetaxel (DTX) is metabolized by liver cytochromes P450 (CYP) 3A4 (CYP3A4) and 3A5 (CYP3A5) CYP3A4 activity is considered the main factor affecting the effectiveness in DTX clearance. We, therefore, explored the association between DTX-induced febrile neutropenia (FN) and concomitant polypharmacy involving CYP3A4 inhibitors in cancer patients. Patients and Methods: Among patients who received docetaxel, we compared the number of concomitant medications between patients with and without FN, and risk factors associated with FN were identified. Results: The total number of concomitant CYP3A4 inhibitors and substrates used was significantly higher in patients with FN [mean: 2.1 (95% confidence interval (CI)=1.5-2.9)] than in those without FN [mean: 1.4 (95% CI=1.0-1.8)] (p=0.01). The only risk factor for FN was the use of ≥2 concomitant CYP3A4 inhibitors and substrates in total (OR=4.82, 95% CI=1.77-14.1; p=0.002). Conclusion: Polypharmacy involving CYP3A4 inhibitors and substrates increases the risk of DTX-induced FN.

Risk Factors for Withdrawal of Life-Sustaining Treatment in Severe Traumatic Brain Injury

2020 ◽  
Vol 86 (1) ◽  
pp. 8-14
Author(s):  
Sahil Gambhir ◽  
Areg Grigorian ◽  
Divya Ramakrishnan ◽  
Catherine M. Kuza ◽  
Brian Sheehan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Risk Factor ◽  
Brain Injury ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Independent Risk Factor ◽  
Factors Associated ◽  
Severe Tbi ◽  
Life Sustaining Treatment

Studies demonstrate a significant variation in decision-making regarding withdrawal of life-sustaining treatment (WLST) practices for patients with severe traumatic brain injury (TBI). We investigated risk factors associated with WLST in severe TBI. We hypothesized age ≥65 years would be an independent risk factor. In addition, we compared survivors with patients who died in hospital after WLST to identify potential factors associated with in-hospital mortality. The Trauma Quality Improvement Program (2010–2016) was queried for patients with severe TBI of the head. Patients were compared by age (age < 65 and age ≥ 65 years) and survival after WLST (survivors versus non-survivors) at hospitalization discharge. A multivariable logistic regression model was used for analysis. From 1,403,466 trauma admissions, 328,588 (23.4%) patients had severe TBI. Age ≥ 65 years was associated with increased WLST (odds ratio: 1.76, confidence interval: 1.59–1.94, P < 0.001), whereas nonwhite race was associated with decreased WLST (odds ratio: 0.60, confidence interval: 0.55–0.65, P < 0.001). Compared with non-survivors of WLST, survivors were older (74 vs 61 years, P < 0.001) and more likely to have comorbidities such as hypertension (57% vs 38.5%, P < 0.001). Age ≥ 65 years was an independent risk factor for WLST, and nonwhite race was associated with decreased WLST. Patients surviving until discharge after WLST decision were older (≥74 years) and had multiple comorbidities.

scholarly journals 798. Metronidazole Exposure Prior to Clostridiodes difficile Infection (CDI) is a Risk Factor for Severe C. difficile Disease in Cancer Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S442-S443
Author(s):  
Denise Marie A Francisco ◽  
Liangliang Zhang ◽  
Ying Jiang ◽  
Adilene Olvera ◽  
Eduardo Yepez Guevara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cancer Patients ◽  
Research Study ◽  
Research Support ◽  
Factors Associated ◽  
Patients With Cancer ◽  
Study Investigator ◽  
Severity Levels ◽  
Permutation Analysis

Abstract Background Antibiotic use is a risk factor for CDI. Few studies have correlated use of prior antibiotics with CDI severity in cancer patients. This study identified clinical and microbiology risk factors associated with severe CDI in patients with cancer. We hypothesized that previous antibiotic exposure and microbiome composition at time of CDI presentation, are risk factors for severe disease in cancer patients. Methods This non-interventional, prospective, single-center cohort study examined patients with cancer who had their first episode or first recurrence of CDI between Oct 27, 2016 and Jul 1, 2019. C. difficile was identified using nucleic acid amplification testing. Multivariate analysis was used to determine significant clinical risk factors for severe CDI as defined in the 2018 IDSA/SHEA guidelines. Alpha, and beta diversities were calculated to measure the average species diversity and the overall microbial composition. Differential abundance analysis and progressive permutation analysis were used to single out the significant microbial features that differed across CDI severity levels. Results Patient (n=200) demographics show mean age of 60 yrs., 53% female, majority White (76%) and non-Hispanic (85%). Prior 90 day metronidazole use (Odds Ratio OR 4.68 [1.47-14.91] p0.009) was a significant risk factor for severe CDI. Other factors included Horn’s Index &gt; 2 (OR 7.75 [1.05-57.35] p0.045), Leukocytosis (OR 1.29 [1.16-1.43] p&lt; 0.001), Neutropenia (OR 6.01 [1.34-26.89] p0.019) and Serum Creatinine &gt;0.95 mg/dL (OR 25.30 [8.08-79.17] p&lt; 0.001). Overall, there were no significant differences in alpha and beta diversity between severity levels. However, when identifying individual microbial features, the high presence of Bacteroides uniformis, Ruminococceae, Citrobacter koseri and Salmonella were associated with protection from severe CDI (p&lt; 0.05). Table 1 - Results of multivariate logistic regression analysis of factors associated with severe CDI Figure 1. Microbiome features identified by progressive permutation analysis as seen in a volcano plot. Conclusion A number of risk factors for severe CDI were identified among this population, including prior 90 day metronidazole use. Also, increased relative abundance of Bacteroides uniformis, Ruminococceae, Citrobacter koseri and Salmonella were linked to protection from severe CDI. Reducing metronidazole use in patients with cancer may help prevent subsequent severe CDI. Disclosures Adilene Olvera, MPH MLS (ASCP), MERK (Grant/Research Support, Scientific Research Study Investigator) Kevin W. Garey, PharmD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator) Ryan J. Dillon, MSc, Merck & Co., Inc., (Employee) Engels N. Obi, PhD, Merck & Co. (Employee)

Prevalence and Risk Factors for Salmonella and Campylobacter spp. Carcass Contamination in Turkeys Slaughtered in Quebec, Canada

2007 ◽  
Vol 70 (6) ◽  
pp. 1350-1359 ◽  
Author(s):  
JULIE ARSENAULT ◽  
ANN LETELLIER ◽  
SYLVAIN QUESSY ◽  
JEAN-PIERRE MORIN ◽  
MARTINE BOULIANNE
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Confidence Interval ◽  
Regression Models ◽  
Meteorological Data ◽  
Low Wind Speed ◽  
Potential Risk Factors ◽  
Estimate Prevalence ◽  
Carcass Contamination ◽  
Campylobacter Spp

An observational study was conducted to estimate prevalence and risk factors for carcass contamination by Salmonella and Campylobacter spp. in 60 lots of turkey slaughtered over 10 months in the province of Quebec, Canada. Carcass contamination was evaluated by the carcass rinse technique for about 30 birds per lot. Exposure to potential risk factors was evaluated with questionnaires, meteorological data, and cecal cultures. Multivariable binomial negative regression models were used for risk factor analysis. Prevalence of Salmonella-positive carcasses was 31.2% (95% confidence interval, 22.8 to 39.5%). Variables positively associated (P ≤ 0.05) with the proportion of lot-positive carcasses were ≥0.5% of carcass condemnation due to various pathologies, cecal samples positive for Salmonella, low wind speed during transportation, closure of lateral curtains of truck during transportation, and slaughtering on a weekday other than Monday. When only Salmonella-positive cecal culture lots were considered, the proportion of carcasses positive for Salmonella was significantly higher in lots exposed to a &gt;5°C outside temperature variation during transportation, slaughtered on a weekday other than Monday, and in which ≥4% of carcasses had visible contamination. Prevalence of Campylobacter-positive carcasses was 36.9% (95% confidence interval, 27.6 to 46.3%). The proportion of positive carcasses was significantly higher in lots with Campylobacter-positive cecal cultures and lots undergoing ≥2 h of transit to slaughterhouse. For lots with Campylobacter-positive cecal cultures, variables significantly associated with an increased incidence of carcass contamination were ≥4% of carcasses with visible contamination, crating for ≥8 h before slaughtering, and no antimicrobials used during rearing.

scholarly journals Comparison of the Contamination Rate and Risk Factor Profile of Blood Culture Done in Emergency Department and MHDU/MICUs

2021 ◽  
pp. 1-8
Author(s):  
Dr. Pankaj Kumar Singh
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Blood Culture ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Contamination Rate ◽  
Medical Illness ◽  
Inclusion Criteria ◽  
Factors Associated

Aims and objectives: To determine the risk factors of blood culture contamination done in ED and those done in the MHDU/MICU among patients admitted with medical illness. Material and Methods: This is a two months’ prospective observational study comparing blood culture contamination rate and risk factors associated with contamination between ED and MICU/MHDU. A total of 998 patients were included in the study who underwent blood culture in ED and MICU/MHDU. 570 in ED and 428 in MICU/MHDU were included after meeting exclusion and inclusion criteria. Results: Blood culture growths were higher in ED (19%). Most common growth was CoNS (4%). The overall contamination rate in this study was (4.8%) The contamination rate was lower in ED (4.4%) when compared to MICU/MHDU (5.4%).

#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S15-S16
Author(s):  
Miguel A Minero ◽  
Asia Castro ◽  
Martha Avilés-Robles
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Febrile Neutropenia ◽  
Pediatric Oncology ◽  
Pediatric Patients ◽  
Bloodstream Infections ◽  
Oncology Patients ◽  
Factors Associated ◽  
Patients With Cancer ◽  
The Impact

Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.

scholarly journals Body Weight at Birth: The Only Risk Factor Associated with Contralateral Clavicular Fracture in Patients with Congenital Muscular Torticollis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Zeeihn Lee ◽  
Joo Young Cho ◽  
Byung Joo Lee ◽  
Jong Min Kim ◽  
Donghwi Park
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Risk Factor ◽  
The Body ◽  
Youden Index ◽  
Clavicular Fracture ◽  
Congenital Muscular Torticollis ◽  
Factors Associated ◽  
Significant Difference ◽  
Muscular Torticollis

Abstract To date and to the best of our knowledge, there have been limited studies on the risk factor of clavicle fracture combined with congenital muscular torticollis (CMT), despite it being the most common fracture in newborns. So, the aim of this study was to investigate the risk factors associated with clavicular fracture combined with CMT, and its effect on prognosis. In this study, a total of 134 infants with CMT were included. The risk factors associated with clavicular fracture combined with CMT were analyzed. To analyze the correlation between the clinical parameters and the clavicular fracture in patients with CMT, demographic data, such as body weight at birth, maternal age, gender, gestational age, delivery method, sternocleidomastoid (SCM) thickness of ipsilateral side, its ratio between the ipsilateral and contralateral side, and the first visitation date after birth were evaluated. In the results of this study, the clavicular fracture was found in 15 of 134 patients with CMT (19%). In multivariate logistic analysis, the body weight at birth was the only significant parameter for predicting clavicular fracture in patients with CMT (p-value < 0.05). However, there was no significant difference of treatment duration between CMT infants with or without clavicular fracture. In infants with CMT, the area under the ROC curve of the body weight at birth for predicting clavicular fracture was 0.659 (95% CI, 0.564–0.745.; p < 0.05). The optimal cut-off value obtained from the maximum Youden index J was 3470 g (sensitivity: 57.14%, specificity: 75.76%), and the odd ratio of clavicular fracture in patients with CMT increased by 1.244 times for every 100 g of body weight at birth. In conclusion, birth weight appears to be a clinical predictor of clavicular fracture in infants with CMT. More studies and discussions are needed on whether any screening should be recommended for detecting the concurrent clavicular fracture in subjects with CMT.

scholarly journals Frequency and Determinant Factors for Calcification in Neurocysticercosis

2020 ◽  
Author(s):  
Javier A Bustos ◽  
Gianfranco Arroyo ◽  
Robert H Gilman ◽  
Percy Soto-Becerra ◽  
Isidro Gonzales ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Antibody Response ◽  
Human Brain ◽  
Risk Ratio ◽  
Factors Associated ◽  
Patient Level ◽  
Increased Risk ◽  
Acquired Epilepsy ◽  
Antiparasitic Treatment

Abstract Background Neurocysticercosis is a major cause of acquired epilepsy. Larval cysts in the human brain eventually resolve and either disappear or leave a calcification that is associated with seizures. In this study, we assessed the proportion of calcification in parenchymal neurocysticercosis and risk factors associated with calcification. Methods Data for 220 patients with parenchymal NCC from 3 trials of antiparasitic treatment were assessed to determine what proportion of the cysts that resolved 6 months after treatment ended up in a residual calcification at 1 year. Also, we evaluated the risk factors associated with calcification. Results The overall proportion of calcification was 38% (188/497 cysts, from 147 patients). Predictors for calcification at the cyst level were cysts larger than 14 mm (risk ratio [RR], 1.34; 95% confidence interval [CI], 1.02–1.75) and cysts with edema at baseline (RR, 1.39; 95% CI, 1.05–1.85). At the patient level, having had more than 24 months with seizures (RR, 1.25; 95% CI, 1.08–1.46), mild antibody response (RR, 1.14; 95% CI, 1.002–1.27), increased dose albendazole regime (RR, 1.26; 95% CI, 1.14–1.39), lower doses of dexamethasone (RR, 1.36; 95% CI, 1.02–1.81), not receiving early antiparasitic retreatment (RR, 1.45; 95% CI, 1.08–1.93), or complete cure (RR, 1.48; 95% CI, 1.29–1.71) were associated with a increased risk of calcification. Conclusions Approximately 38% of parenchymal cysts calcify after antiparasitic treatment. Some factors associated with calcification are modifiable and may be considered to decrease or avoid calcification, potentially decreasing the risk for seizure relapses.

Dyslipidemia in northeastern China

Open Medicine ◽  
2011 ◽  
Vol 6 (2) ◽  
pp. 220-226 ◽  
Author(s):  
Xiao Shi ◽  
Qinglong Jin ◽  
Yulin Hu ◽  
Xiumei Chi ◽  
Yanhang Gao ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Coronary Artery ◽  
Binary Logistic Regression ◽  
Northeastern China ◽  
Major Risk Factor ◽  
Coronary Artery Diseases ◽  
Factors Associated

AbstractDyslipidemia, is a major risk factor for premature coronary artery disease. Our aim was to estimate the prevalence of dyslipidemia (blood lipid abnormalities) and other risk factors associated with coronary artery diseases among an adult population in northeastern China. Throughout the months of September and October of 2007,a population-based cross-sectional study was conducted and a total of 3,815 individuals were included. Total cholesterol (TC), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), and triglycerides (TG) were measured. A binary logistic regression analysis was conducted to determine risk factors associated with dyslipidemia. The prevalence of hypercholesterolemia, high LDL-C, low HDL-C, and hypertriglyceridemia were 17.3%, 27.8%, 11.66% and 29.85%, respectively. The prevalence of hypertension, central obesity, alcoholic liver disease (ALD), non-ALD, diabetes and metabolic syndrome was higher in serum lipid abnormality groups than in the non-dyslipidemia group (p < 0.001). In a binary logistic regression, hyperlipidemia was positively correlated with age, male, hypertension, high body mass index, etc. There were negative correlations with being female and the level of education a subject had attained. Dyslipidemia is a major risk factor for premature coronary artery diseases and an important public health issue in the northeastern part of China. Dyslipidemia is more frequent than expected based on previous studies. To control dyslipidemia, routine evaluations in clinics and community centers are needed, as well as effective public health education.

scholarly journals Quantitative Measures of Physical Risk Factors Associated with Work-Related Musculoskeletal Disorders of the Elbow: A Systematic Review

2019 ◽  
Vol 16 (1) ◽  
pp. 130 ◽  
Author(s):  
David H. Seidel ◽  
Dirk M. Ditchen ◽  
Ulrike M. Hoehne-Hückstädt ◽  
Monika A. Rieger ◽  
Benjamin Steinhilber
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Musculoskeletal Disorders ◽  
Well Being ◽  
Special Focus ◽  
Factors Associated ◽  
Work Related ◽  
Work Related Musculoskeletal Disorders ◽  
Physical Risk ◽  
Physical Risk Factors

Background: Work-related musculoskeletal disorders at the elbow are a common health problem, which highly impacts workers’ well-being and performance. Besides existing qualitative information, there is a clear lack of quantitative information of physical risk factors associated with specific disorders at the elbow (SDEs). Objective: To provide evidence-based quantitative measures of physical risk factors associated with SDEs. Methods: Studies were searched from 2007 to 2017 in Medline, EMBASE, and Cochrane Work. The identified risk factors were grouped in main- and sub-categories of exposure using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework for rating evidence. Results: 133 different risk-factor specifications were identified in 10/524 articles and were grouped into 5 main- and 16 sub-categories of exposure. The risk factors were significantly associated with lateral epicondylitis, medial epicondylitis, or ulnar neuropathy. Significant risk factors such as wrist angular velocity (5°/s, with increasing prevalence ratio of 0.10%/(°/s), or forearm supination (≥45° and ≥5% of time combined with forceful lifting) were found. Conclusions: This review delivers a categorization of work-related physical risk-factor specifications for SDEs with a special focus on quantitative measures, ranked for evidence. These results may build the base for developing risk assessment methods and prospective preventive measures.

scholarly journals Risk Factors for Pressure Ulcers at the Ala of Nose in Oral Surgery

2017 ◽  
Vol 64 (2) ◽  
pp. 104-105 ◽  
Author(s):  
Masanori Tsukamoto ◽  
Miwa Kobayashi ◽  
Takeshi Yokoyama
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Pressure Ulcers ◽  
Oral Surgery ◽  
Male Gender ◽  
Quality Review ◽  
Nasal Tube

A quality review revealed pressure ulcers at the ala of nose in 16 cases (2.2%) over 3 years. We therefore retrospectively investigated the risk factors for alar pressure ulcers from nasal tubes. Male gender was the highest risk factor (odds ratio = 9.1411; 95% confidence interval = 1.680–170.58), and the second highest risk factor was duration of anesthesia (odds ratio = 1.0048/min of anesthesia; 95% confidence interval = 1.0034–1.0065). Male gender and duration of anesthesia appear to be risk factors for nasal tube pressure ulcers at the ala of nose in patients.

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