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1.
Background
Comparative studies have demonstrated that asthma education to pediatric patients decreases average hospital usage and that allergy specialists provide stronger asthma education and more improved outcomes.Objective
To evaluate the real-world benefits of allergy subspecialty involvement outside inpatient consultation and the impediments for patients in establishing allergy subspecialty care.Methods
The study population was composed mostly of minority children 0 to 18 years old seen at a large university-affiliated stand-alone children's hospital who had a hospital discharge diagnosis of asthma from 2009 to 2013. The retrospective portion of the study compared all variables pertaining to asthma, teaching, and discharge reconciliation for the following subgroups: patients recommended to allergy and immunology (AI) follow-up who adhered to the appointment (adherent), patients recommended to AI follow-up who did not adhere (nonadherent), and patients not recommended to AI follow-up (non-referred). In the phone interview portion of the study, the nonadherent patients were contacted to identify barriers to AI follow-up.Results
Of the referred sample, the adherent group had significantly fewer visits to the pediatric intensive care unit, days in the pediatric intensive care unit, and days in the hospital. Providing more specific hospital discharge instructions increased AI follow-up and hospital teaching given on the baseline admission decreased hospital visits. Phone interviews showed that nonadherent patients most commonly missed follow-up because the parents believed it unnecessary because their child showed acute improvement or from advice from their primary care physician.Conclusion
These results showed improvement in outcomes for patients who attended AI follow-up and specifically identified key barriers that could be addressed in a standardized form to prevent nonadherence in the future. 相似文献2.
Peng-Hao Chang Tsui-Ping Liu Po-Yen Huang Shu-Yu Lin Jung-Fu Lin Chun-Fu Yeh Shih-Cheng Chang Ting-Shu Wu Jang-Jih Lu 《Journal of microbiology, immunology, and infection》2018,51(6):847-855
Background/purpose
We reported an outbreak of Staphylococcus haemolyticus (SH) infection in a group of young patients (mean age 21.6) simultaneously hospitalized due to a mass-burn incident. This study analyzed the clinical features of these patients and the microbiological characteristics of the outbreak.Methods
All 50 patients hospitalized for burns were enrolled, and their clinical differences were analyzed based on culture results. A drug sensitivity test and pulsed-field gel electrophoresis (PFGE) were conducted to analyze the microbiological difference between SH isolates from the mass-burn casualty patients (the study group) and SH isolates from other patients hospitalized during the same period (the control group) with the intention of identifying the strain of SH outbreak.Results
Patients with isolated SH (N = 36) had a significantly higher disease severity (higher revised Baux score, APACHE II score, and concurrent bacteremia rate), and a significantly poorer clinical outcome (longer ICU and hospital stay, and longer MV usage). Significant differences in the phenotype (antibiotics drug sensitivity test) and genotype (PFGE typing) were observed between the study and control groups. The dominant PFGE type C identified among the study group was related to poorer outcomes in a subgroup analysis.Conclusion
A dominant PFGE type of SH infection was found in these mass-burn casualty patients. Pathogenesis or virulence factors may have contributed to our results. Further study of isolated SH should be conducted. 相似文献3.
I-Ling Chen Chen-Hsiang Lee Li-Hsiang Su Yu-Chin Lily Wang Jien-Wei Liu 《Journal of microbiology, immunology, and infection》2018,51(1):55-63
Background/purpose
The long-term effects of antimicrobial-stewardship programs in the intensive care units (ICUs) have not been adequately examined. We evaluated the impact of an online comprehensive antimicrobial stewardship program (OCASP) on the outcomes of patients in 200-bed medical/surgical ICUs over the course of 11 years.Methods
We analyzed the records of adult patients admitted to ICUs during the 5 years before (n = 27,499) and the 6 years after (n = 33,834) implementation of an OCASP. Antimicrobial consumption, expenditures, duration of treatment, incidence of healthcare-associated infections (HAIs), prevalence of HAIs caused by antimicrobial-resistant strains, and crude or sepsis-related mortality of patients were analyzed. Segmented regression analyses of interrupted time series were used to assess the significance of changes in antimicrobial use.Results
Compared to the patients in the pre-OCASP period, the patients in the post-OCASP period were older, had greater disease severity, longer ICU stays, and were more likely to receive antimicrobials, but had lower antimicrobial expenditures and crude and sepsis-related mortality. The trend of overall antimicrobial use [slope of defined daily dose/1000 patient-days vs. time) increased significantly before OCASP implementation (p < 0.001), but decreased significantly after implementation (p < 0.01). The administration duration of all classes of antibiotics were significantly shorter (p < 0.001) and the incidences of HAIs were significantly lower (p < 0.001) after implementation. However, there was an increase in the proportion of HAIs caused by carbapenem-resistant Acinetobacter baumannii relative to all A. baumannii infections.Conclusion
Implementation of an OCASP in the ICUs reduced antimicrobial consumption and expenditures, but did not compromise healthcare quality. 相似文献4.
Background
Congenital disorders of glycosylation (CDG) are a group of rare metabolic diseases due to impaired lipid and protein glycosylation. It comprises a characteristic high frequency of intellectual disability (ID) and a wide range of clinical phenotypes.Objective
To identify the underlying diagnosis in two families each with two siblings with variable level of ID through trio whole exome sequencing.Methods
Both the families were recruited to the Deciphering Developmental Disorders (DDD) study to identify the aetiology for their ID. Further work-up included isoelectric focusing (IEF) of serum transferrin done to add evidence to the molecular diagnosis.Results
These patients were found to have three novel variants in MAN1B1 inherited from their healthy parents. Serum transferrin IEF showed a type 2 pattern.Discussion
MAN1B1 variants were initially described in association with non-syndromic ID; subsequent literature suggested that variants in MAN1B1 resulted in a CDG-type II syndrome. However, there remains a paucity of literature on detailed clinical phenotyping and it still remains a rare form of CDG. The present patients showed the phenotype previously reported in MAN1B1-CDG: a characteristic facial dysmorphism, hypotonia, truncal obesity and in some, behavioural problems.Conclusions
In unexplained ID, serum transferrin should be included in the first-line screening. With advances in genomic medicine, it is important to diagnose CDG as this has implications for management and recurrence risk counselling. 相似文献5.
Bogusław Buszewski Viorica Railean-Plugaru Paweł Pomastowski Katarzyna Rafińska Malgorzata Szultka-Mlynska Patrycja Golinska Magdalena Wypij Dariusz Laskowski Hanna Dahm 《Journal of microbiology, immunology, and infection》2018,51(1):45-54
Background/Purpose
In this study, an acidophilic actinobacteria strain was used as a novel reducing agent for a single-step synthesis of nanostructure silver particles. We used a Streptacidiphilus durhamensis HGG16n isolate for efficient synthesis of bioactive silver nanoparticles [bio(AgNPs)] in an inexpensive, eco-friendly, and nontoxic manner. The obtained bio(AgNPs) exhibited unique physicochemical and biochemical properties.Methods
Structural, morphological, and optical properties of the synthesized biocolloids were characterized by spectroscopy, dynamic light scattering, and electron microscopy approaches. The antimicrobial activity was evaluated using the well- and disc-diffusion methods.Results
The obtained crystalline structure and stable biosynthesized silver nanoparticles ranged in size from 8 nm to 48 nm and were mostly spherical in shape. Antimicrobial assays of the silver nanoparticles against pathogenic bacteria showed the highest antimicrobial activity against Pseudomonas aeruginosa, Staphylococcus aureus, and Proteus mirabilis, followed by Escherichia coli, Klebsiella pneumoniae, and Bacillus subtilis. Moreover, the synergistic effect of bio(AgNPs) with various commercially available antibiotics was also evaluated.Conclusion
These results provide insight into the development of new antimicrobial agents along with synergistic enhancement of the antibacterial mechanism against clinical bacteria. 相似文献6.
Public Attitudes and Knowledge About Youth Sports Participation and Concussion Risk in an Urban Area
Eleanor Taranto Michael Fishman Katherine Garvey Meryl Perlman Holly J. Benjamin Lainie Friedman Ross 《Journal of the National Medical Association》2018,110(6):635-643
Background
Every year, millions of children in the United States participate in youth full-contact sports, which carry concussion risks—the long-term sequelae of which are not well understood. We examined the attitudes and knowledge of adults in Chicago about youth sports participation, concussion risk, and whether physicians should counsel against youth participation in full-contact sports.Methods
An anonymous paper survey featuring 13 attitudinal, 13 demographic, and 9 knowledge questions was distributed to a convenience sample of adults ≥18 years in hospital waiting areas and four Chicago parks. Participants were asked to hypothetically consider themselves the parent of a 10-year-old child regarding attitudes towards full-contact sports participation.Results
Between June 13 and July 27, 2016, 1091 partial or complete valid surveys were collected. Almost half (46%) of respondents would not allow a hypothetical 10-year-old son to play tackle football. The majority (74%) of respondents agreed that it was appropriate for physicians to counsel against youth participation in full-contact sports. Respondents obtained information about concussions from, on average, 2–3 sources, although only 34% received information from physicians. Respondents demonstrated a high concussion knowledge level (average: 6.75 of 9 questions). However, only 39% of respondents correctly answered that the following statement was false: “After a mild concussion, there are usually visible changes on medical imaging”.Conclusions
Overall, respondents are well-informed about concussions. They are divided about the participation of youth in full-contact sports and are amenable to physician counseling against youth participation in full-contact sports. 相似文献7.
Joshua A. Lawson Luan M. Chu Donna C. Rennie Louise Hagel Chandima P. Karunanayake Punam Pahwa James A. Dosman 《Annals of allergy, asthma & immunology》2017,118(3):304-310
Background
Because of time and cost constraints, objective classification of atopic and nonatopic asthma has been limited in large epidemiologic studies. However, as we try to better understand exposure-outcome associations and ensure appropriate treatment of asthma, it is important to focus on phenotype-defined asthma classification.Objective
To compare atopic and nonatopic asthma in rural children with regard to risk factors and clinical outcomes.Methods
We conducted a cross-sectional study in rural Saskatchewan, Canada, in 2011. Parents of 6- to 14-year-old children completed a health and exposure survey. Skin prick tests were completed in a subsample of 529 children. Asthma was based physician diagnosis. Asthma status was defined as no asthma, nonatopic asthma, and atopic asthma.Results
Asthma prevalence was 14.7% of which 32.1% of cases were atopic. After adjustment, early respiratory illness and a family history of asthma were predictors of childhood asthma, regardless of atopic status (P < .05). Being overweight and having a dog in the home were associated with an increased risk of nonatopic asthma (P < .05). A mother with a history of smoking increased the risk of atopic asthma (P = .01). Compared with those with nonatopic asthma, in the past 12 months, children with atopic asthma were more likely to report a sneezy, runny, or blocked nose or have shortness of breath (odds ratio >2), whereas those with nonatopic asthma were more likely to have parents who missed work (odd ratio >3). Those with nonatopic asthma had significantly lower forced expiratory volume in 1 second compared w2ith those with atopic asthma.Conclusion
Exposures may contribute differentially to atopic and nonatopic asthma and result in differential clinical presentation or burden. The study of these characteristics is important for etiologic understanding and management decisions. 相似文献8.
Sarah M. Reilly Megan Wilson Crowley Pamela Harold Deborah Hemphill Laurene Tumiel Berhalter 《Journal of the National Medical Association》2018,110(5):448-454
Background/Purpose
African American women are diagnosed with breast cancer at later stages and have higher mortality rates than white women. The Patient Voices Network (PVN), a community group whose vision is “a community of educated and involved patients working hand in hand with physicians in making decisions about their own health care,” conceived of and implemented a walk to raise awareness of breast cancer and link women to screening resources in a low-income, urban communityObjectives
To describe the planning and implementation of the Concerned About You: Breast Cancer Awareness Walk & Wellness Event and its impact on an academic community partnership.Methods
A narrative approach was used. Meeting minutes and event planning notes were reviewed. Community participation rates and participant satisfaction were tracked using registration records and a survey administered at the event.Results
328 community members registered and 194 attended. Responses to a satisfaction survey indicated community buy-in and interest in future events. Two women were screened at the event and 78 were screened at a follow-up opportunity at their primary care practices. The process was driven by participatory guidelines and laid the foundation for future activities.Conclusions
Community input addressed the need for screening mammography in an underserved community. The partnership approach featured complementary strengths of both patients and University staff, fostered skill building and co-learning, and ultimately strengthened our partnership. A partnered approach may be effective in engaging hard-to-reach populations to address health disparities. 相似文献9.
Jerónimo Carnés Víctor Iraola Seong H. Cho Robert E. Esch 《Annals of allergy, asthma & immunology》2017,118(3):249-256
Objective
To provide physicians, researchers, and other interested health care professionals with information about how mite source materials and allergen extracts are manufactured, including the critical process parameters that can affect the final composition of allergenic extracts available for clinical use.Data Sources
A PubMed search was performed using focused keywords combined with relevant regulatory documents and industry guidelines.Study Selections
The information obtained through literature and specialized books was evaluated and combined with the personal expertise and experience of the authors.Results
Dermatophagoides farinae and Dermatophagoides pteronyssinus are the primary species responsible for allergen sensitizations and allergy symptoms in genetically predisposed individuals. Storage mites belonging to the families Glycyphagidae, Echimyopodidae, and Acaridae can also be relevant sources of indoor mite allergens. The cultivation and purification processes used to produce mite raw materials play a critical role in the final composition of mite allergen extracts. Mite extract standardization in the United States is based on total allergenic activity with respect to a single national standard, whereas in Europe consistency is ensured by in-house standards and international references. Because of the limitation of allergen avoidance and pharmacotherapy for patients with severe allergic rhinitis and asthma, house dust mite subcutaneous immunotherapy or sublingual immunotherapy can be an invaluable treatment option for them.Conclusion
Differences in manufacturing processes and extract standardization approaches may lead to differences in extract quality and potency. Physicians should be aware of these potential sources of mite extract variability. Use of well-standardized house dust mite extracts would be critical for success in the diagnosis and treatment of house dust mite allergy. 相似文献10.
Vanitha Sampath Dana Tupa Michelle Toft Graham Talal A. Chatila Jonathan M. Spergel Kari C. Nadeau 《Annals of allergy, asthma & immunology》2017,118(1):21-27
Objective
To review our current understanding of immunotherapy, the immune mechanisms underlying food allergy, and the methodological advances that are furthering our understanding of the role of immune cells and other molecules in mediating food allergies.Data Sources
Literature searches were performed using the following combination of terms: allergy, immunotherapy, food, and mechanisms. Data from randomized clinical studies using state-of-the-art mechanistic tools were prioritized.Study Selections
Articles were selected based on their relevance to food allergy.Results
Current standard of care for food allergies is avoidance of allergenic foods and the use of epinephrine in case of severe reaction during unintentional ingestion. During the last few decades, great strides have been made in understanding the cellular and molecular mechanisms underlying food allergy, and this information is spearheading the development of exciting new treatments.Conclusion
Immunotherapy protocols are effective in desensitizing individuals to specific allergens; however, recurrence of allergic sensitization is common after discontinuation of therapy. Interestingly, in a subset of individuals, immunotherapy is protective against allergens even after discontinuation of immunotherapy. Whether this protection is permanent is currently unknown because of inadequate long-term follow-up data. Research on understanding the underlying mechanisms may assist in modifying protocols to improve outcome and enable sustained unresponsiveness, rather than a temporary relief against food allergies. The cellular changes brought about by immunotherapy are still a black box, but major strides in our understanding are being made at an exciting pace. 相似文献11.
Physicians' experience and opinion on contraindications to allergen immunotherapy: The CONSIT survey
Pablo Rodríguez del Rio Constantinos Pitsios Marina Tsoumani Oliver Pfaar Giannis Paraskevopoulos Radoslaw Gawlik Erkka Valovirta Desirée Larenas-Linnemann Pascal Demoly Moises A. Calderón 《Annals of allergy, asthma & immunology》2017,118(5):621-628.e1
Background
Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy but several contraindications limit its use.Objective
To collect the outcome of using AIT in theoretically contraindicated situations in real patients in the Contraindications to Specific ImmunoTherapy (CONSIT) survey.Methods
The CONSIT is an electronic European Academy of Allergy and Clinical Immunology survey conducted to gather the safety outcomes of patients undergoing subcutaneous, sublingual, or venom AIT and the opinions of physicians on each of 17 selected conditions: children younger than 5 years; starting AIT during pregnancy; controlled severe asthma; arrhythmias; coronary disease; cancer; autoimmune disease; bone marrow and solid organ transplantation; human immunodeficiency virus and acquired immunodeficiency syndrome; previous anaphylaxis during AIT; use of β-blockers, angiotensin-converting inhibitors, cyclosporine, and methotrexate; and inability to communicate. Safety using AIT was reported in a 3-point scale: 1, “no problems”; 2, “minor problems” (requiring only dose modifications); and 3, “major problems” (AIT not tolerated). Each physician was asked about the degree of contraindication that each condition should have: no contraindication (score 1), relative contraindication (score 2), or absolute contraindication (score 3).Results
Five hundred twenty physicians (75% Europeans, 89% allergists) reported on approximately 45,000 patients undergoing AIT with any of these conditions. Major problems were infrequent, occurring more frequently in patients with asthma (9.9%) and with previous anaphylaxis from AIT (9.5%). Regarding opinions, experienced physicians scored a significantly lower mean for all conditions than non-experienced physicians for all routes.Conclusion
Major problems were infrequent and experienced physicians were less likely to be restrictive in the use of AIT. 相似文献12.
Pooja H. Mehta Jay Chhablani Jiangxia Wang Catherine B. Meyerle 《Journal of the National Medical Association》2018,110(3):297-302
Objective
To evaluate the frequency of central serous chorioretinopathy (CSC) in African Americans/blacks within an academic center in a predominantly African American city, as the current belief is that CSC is rare in this population.Methods
A retrospective review of all patients' charts diagnosed with CSC at Wilmer Eye Institute/Johns Hopkins University from August 2009–August 2015 was conducted via an electronic health record search (EPIC). The charts were categorized by self-reported race and gender. The diagnosis was confirmed by multiple physician consensus through chart and imaging review. Fluorescein angiograms were classified as single versus multiple point leakage. OCTs were evaluated for subfoveal thickness, location of fluid, presence or absence of pigment epithelial detachment. Color photos were categorized as to the extent of retinal pigment epithelial changes.Results
Of the 590 charts identified via EPIC as CSC patients, 407 were confirmed as CSC through chart and imaging review. 45 patients (11.1%) were African Americans and 298 patients (73.2%) were Caucasians. Of all patients seen during the study period, 0.09% of African Americans at Wilmer had CSC and 0.18% of Caucasians had CSC. While three fold more Caucasians were seen during the study period as compared to African Americans, this study's prevalence rate in African Americans/blacks at Wilmer Eye Institute was half of that in Caucasian/whites.Conclusions
CSC has been reported as exceedingly rare in African Americans, but our study suggests that CSC may be underestimated in this population. A large nationally representative population based study is needed to determine true racial prevalence to ensure that the diagnosis of CSC is not overlooked in African Americans. 相似文献13.
Rashmi Prava Mohanty Mark Alan Buchheim Estelle Levetin 《Annals of allergy, asthma & immunology》2017,118(2):204-211.e2
Background
Pollen monitoring is a common and vital tool in the field of allergy, creating awareness in pollen sensitive individuals. Traditionally, pollen monitoring has been based on conventional microscopic counting techniques that are labor intensive and limited in the identification to the genus or family level. Molecular techniques provide an alternative approach that is less labor intensive and enable identification of any species by its genetic fingerprint.Objective
To use quantitative polymerase chain reaction (qPCR) to evaluate pollen concentrations in air samples.Methods
Juniperus pollen was selected as our model because of the importance of this pollen in the southcentral United States. We analyzed 105 air samples collected with a Burkard spore trap from 2013 to 2015 using species-specific primers and probes. To evaluate the feasibility of a molecular approach, we used duplicate air samples that allowed us to compare results from classical identification based on light microscopy with our qPCR results.Results
Pollen concentrations from the qPCR data were significantly correlated with concentrations determined through light microscopy (R = 0.902, P < .001). We also confirmed an overlap in the pollination seasons between Juniperus ashei and Juniperus pinchotii and between J ashei and Juniperus virginiana.Conclusion
We found that this method correctly identified different Juniperus species present in mixed air samples in the southcentral United States, an accomplishment that cannot be achieved using microscopic identification. We conclude that the qPCR method is more accurate and sensitive than current pollen monitoring techniques and, therefore, has the potential to be used in various pollen monitoring stations. 相似文献14.
Peng Li Miao Ge Congxia Wang Jinwei He Shaofang Yang Jing Jing Dezhi Wei 《Journal of the National Medical Association》2018,110(4):334-342
Objectives
This study aims to explore the spatial characteristics of the alpha-fetoprotein (AFP) reference value in healthy Chinese adults, and its relationship to geographical location.Methods
A total of 9396 AFP reference values were collected from patients in 96 administrative units. A correlation analysis and support vector machine (SVM) were employed to extract dependent geographical factors and predict the reference values in the entire country, respectively. A geostatistics analysis was developed to reveal the spatial characteristics of the value.Results
Under the long-term influence of geographical environment, AFP reference values show spatial autocorrelation and regional variation. The values are higher in western and northern areas than in eastern and southern areas of China.Conclusions
The AFP reference values show regional differences, and this difference should be considered in clinical practice. 相似文献15.
Leila Katoozian Nahid Tahan Maryam Zoghi Babak Bakhshayesh 《Journal of the National Medical Association》2018,110(6):547-552
Background
Spasticity is one of the most important causes of disability after stroke. In spite of high incidence of spasticity, little is known about the relationship between the occurrence and the development of spasticity. This study aimed to determine risk-factors of post stroke spasticity.Methods
This was an observational study of 149 persons with first ever stroke. The following parameters were assessed: Stroke severity, Spasticity, Disability and Joint contracture.Results
Prevalence of spasticity was between 17–25% during the first 3 months after stroke. The onset of spasticity was 13.79% and 4.16% at 1 and 3 months after stroke respectively. The prevalence of spasticity in the upper extremity was significantly more than lower extremity at 1 month. Spasticity was significantly more severe in the upper extremity than lower extremity. In patients with hemorrhagic stroke Odds ratios of spasticity was 2.5 times more than persons with ischemic stroke (P = 0.0210. The Odds ratios of severe spasticity at 1 and 3 months were 1.66 and 1.75 times more than the first week (P = 0.024, P = 0.042 respectively).Conclusions
Post stroke spasticity is more common in persons with hemorrhagic stroke, severe paresis and lower functional abilities. The most incidence of spasticity happens in the first month after stroke. 相似文献16.
Yen-Chih Chen Ming-Yen Hsiao Yi-Chian Wang Chih-Pin Fu Tyng-Guey Wang 《中华民国医用超音波学会杂志》2017,25(2):90-95
Background
Timely and adequate laryngeal elevation along with hyoid bone movement is an essential component of the swallowing movement under normal physiological conditions. The purpose of this study was to verify the reproducibility of using ultrasonography to evaluate hyoid bone displacement during swallowing through the assessment of inter- and intrarater reliability and examine its accuracy by comparing the results with videofluoroscopic swallowing study (VFSS).Methods
A self-designed water balloon was fixed to the transducer, which provided good contact between the transducer and the submental skin. Ten participants with dysphagia were recruited. The measurements of hyoid bone displacement using ultrasonography were performed by two of the authors. All the participants underwent ultrasonographic examinations and VFSS within 24 hours.Results
The intrarater intraclass correlation coefficient (ICC) of the two examiners was 0.996 and 0.959, respectively (p < 0.01); the interrater ICC between the two examiners was 0.892 (p < 0.05). ICCs between VFSS and ultrasonography for two researchers were 0.815 and 0.916 (p < 0.01).Conclusion
Submental ultrasonography is a reliable and accurate method for assessing the hyoid bone movement. 相似文献17.
Wan-Lin Tsai Chih-Hsin Hung Hui-An Chen Jiun-Ling Wang I-Fei Huang Yee-Hsuan Chiou Yao-Shen Chen Susan Shin-Jung Lee Wan-Yu Hung Ming-Fang Cheng 《Journal of microbiology, immunology, and infection》2018,51(6):723-731
Background/Purpose
The prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is increasing worldwide. This study investigated the clinical features and bacteriology of pediatric patients with ESBL-producing E. coli bacteremia and compared their characteristics with those of adult patients.Methods
Clinical and laboratory data from all of the 41 patients aged ≤18 years diagnosed with E. coli bacteremia were collected over 5 years. Patients aged >18 years diagnosed with E. coli bacteremia, matched 1:1 for calendar time, were enrolled as the adult group. All E. coli isolates were tested for their blaCTX-M group and sequence type 131 (ST131). A novel seven-single nucleotide polymorphism-based clonotyping test was applied to detect the septatypes of each isolate.Results
In the adult group, patients with ESBL-producing E. coli bacteremia had more previous hospitalizations and antimicrobial agent use than did those with non-ESBL-producing E. coli bacteremia, but these differences were not found in pediatric group. In the pediatric group, the proportion of isolates producing CTX-M group 9 was higher than that in the adult group (85.7% vs. 42.9%; p < 0.05). Among both groups, there were more E. coli ST131 in ESBL isolates in than there were non-ESBL isolates. The distribution of septatypes was more homogenous in ESBL-producing E. coli among the pediatric patients than among the adult patients.Conclusion
ST131 was the major clone causing E. coli bacteremia in both pediatric and adult populations. The pediatric population demonstrated a higher number of isolates producing CTX-M group 9 with more homogenous septatypes compared with the adult population. 相似文献18.
Faith A. Birnbaum 《Journal of the National Medical Association》2018,110(5):473-479
Purpose
The purpose of this review is to describe the demographics (age, gender, race and iris color) of subjects enrolled in clinical trials supportive of approved New Molecular Entities (NMEs) in ophthalmology over the last 10 years (2006–2016).Methods
Publicly available data on Drugs@FDA were reviewed for all 9 approved NMEs, including biologics, from 2006 to 2016.Results
All NMEs have publicly available data on the race, gender and age of clinical trial participants. Women and white subjects comprise a majority of clinical trial participants (68% and 92%, respectively). FDA analyses on all 9 NMEs did not find any differences across age, gender, race, or iris color subgroups. 相似文献19.
Charles F. Schuler James L. Baldwin Alan P. Baptist 《Annals of allergy, asthma & immunology》2017,118(3):333-338.e1
Background
The frequency with which patients with aspirin-exacerbated respiratory disease (AERD) react to 325 mg of aspirin during aspirin desensitization, or fail to react at all, is not fully known.Objective
To determine the rate and type of reaction at 325 mg of aspirin during desensitization.Methods
A retrospective study of 104 patients who underwent aspirin desensitization from 2010 to 2016 was performed. A standard desensitization protocol (starting at 20–40 mg, progressing through 325 mg, and extinguishing reactions by dose repetition) was used. Reactions were defined by upper respiratory tract symptoms, lower respiratory tract symptoms, and/or forced expiratory volume in 1 second decrease of 15% or greater. Patients who did and did not react were compared by logistic regression.Results
Eighty-four patients reacted (81%) and 20 did not (19%). Seventy-seven patients who had a provoking reaction at 162 mg of aspirin or less subsequently extinguished their reactions before they reached a dose of 325 mg and had no problems at that dose; one subsequent 325-mg reaction occurred during a protocol violation. One initial provoking reaction to 325 mg occurred. Both 325-mg reactions were mild, and neither met the forced expiratory volume in 1 second criterion for a clinically meaningful change. The remaining 5 patients could not complete the protocol because of persistent reactions or social reasons. Reactors were more likely to have had asthma for more than 10 years than nonreactors (odds ratio, 3.2; 95% confidence interval, 1.0–10.3; P = .05).Conclusion
During aspirin desensitization for AERD, provoking reactions at the 325-mg dose are rare (1%) and mild. Patients who react at 162 mg or less and extinguish their reactions may be able to administer the 325-mg dose at home. 相似文献20.
Che Yusfarina Che Yusop Irfan Mohamad Wan Mohd Zahiruddin Wan Mohammad Baharudin Abdullah 《Journal of the National Medical Association》2017,109(3):215-220