bluuebunny/crossref_metadata_2025 huggingface dataset:
772. Effect of Selective Digestive Decontamination Using Oral Colistin on HAI Rates and All-Cause Mortality Among Cardiovascular Surgery Patients - A Single Centre Experience from India
Authors: R Sneha , Wilson Arun , Warrier Anup R , Prakash Shilpa , Elizabeth Reima , Nair Suresh
Published: December 2021

Background

Hospital acquired infections affect the morbidity and mortality of ICU patients considerably. Selective digestive decontamination (SDD) is defined as the prophylactic application of topical, non-absorbable antimicrobials in the oropharynx and stomach, with the goal of eradicating potentially pathogenic microorganisms but preserving the protective anaerobic microbiota. SDD has been applied in trials among critically ill patients and found to be effective in reducing HAI.

Methods

This cohort study was conducted in our cardiothoracic vascular surgery ICU of a tertiary care hospital, where patients were given oral colistin syrup (100mg 6th hourly for 5 days) in the immediate post op during the intervention period. We compared the clinical and microbiological outcomes of patients before (5 months, pre-intervention arm) and after (5 months, intervention arm) the implementation of SDD (Oral colistin syrup).

Results

A total of 78 patients were included in the interventional arm with a mean age of 58.7 years whereas the pre-interventional group consisted of 94 study participants with a median age of 57.5 years. 11 out of 94 had positive respiratory sample culture (11.7%) in the preintervention group which mandated antibiotic therapy for HAP compared to one culture positive in the interventional period (OR 0.0980, 95% CI: 0.0124 to 0.777 and P=0.0279). One patient had blood stream infection in the pre-intervention period compared to none in the intervention phase. All-cause mortality in the pre-interventional group was 7.44% (7 in 94) vs 1.28% (1 in 78) in the interventional group (OR 0.1614, 95% CI: 0.0194 to 1.3416, P= 0.0914). Adverse events (nausea, vomiting & loose stools) were observed in a total of 24 study patients, but necessitated withdrawal of regimen only in nine patients.

Conclusion

An SDD regimen of Colistin alone in Cardiac Surgery patients resulted in statistically significant reduction in incidence of Hospital Acquired Pneumonia, along with a reduction in all-cause mortality (though not statistically significant).

Disclosures

All Authors: No reported disclosures
779. COVID-19 Pandemic and Catheter-associated Urinary Tract Infection Trends
Authors: Suleyman Geehan , Kassab Rita , Gudipati Smitha , Mayur Ramesh , Brar Indira
Published: December 2021

Background

It has been postulated that the COVID-19 pandemic would increase the overall catheter-associated urinary tract infections (CAUTI) risk in part due to higher acuity, increased indwelling urinary catheter (IUC) utilization, longer length of stay, changes in infection prevention practices due to staffing shortages. However, reported data are limited. The goal of this study was to evaluate the impact of the COVID-19 pandemic on our CAUTI rates.

Methods

This was a retrospective cross-sectional study comparing CAUTI rate per 1,000 indwelling urinary catheter (IUC) days, urine culture (UC) utilization rate per 1,000 IUC days, IUC utilization rate per 1,000 patient days, Standardized Infection Ratio (SIR) and Standardized Utilization Ratio (SUR) in the pre-COVID-19 period from January 1, 2019 to December 31, 2019 to the COVID-19 period from April 1, 2020 to March 31, 2021 at an 877-bed tertiary care hospital in Detroit, Michigan. CAUTI, UC utilization and IUC utilization rate were extracted from the electronic medical record (Epic™ Bugsy). SIR and SUR data were extracted from National Healthcare Safety Network (NHSN).

Results

The average CAUTI rate per 1,000 IUC days decreased from 0.99 pre-COVID-19 to 0.64 during COVID-19, yielding a 35% reduction. The UC order rate per 1,000 IUC days decreased from 19.19 to 18.83 with only 2% reduction. However, IUC utilization rate increased by 55% from 0.184 to 0.286. The SIR decreased from 0.483 to 0.337 with a 30% reduction, although this was not statistically significant ((P-value 0.283). The overall SUR decreased significantly from 0.806 to 0.762 (P-value < 0.001). Figure 2 is a control chart of the CAUTI rate from July 2019 to April 2021.

Figure 1. CAUTI, indwelling urinary catheter and urine culture utilization rates pre-and during COVID-19 pandemic.

Figure 2. CAUTI control chart pre-and during COVID-19 pandemic.

Conclusion

Although the IUC utilization increased during the COVID-19 pandemic, CAUTI rate, SIR and SUR decreased and UC orders remained unchanged. Thus, the pandemic did not have a negative impact on our CAUTI rates.

Disclosures

All Authors: No reported disclosures
786. Facility Reported vs. CLSI MIC Breakpoint Comparison of Carbapenem Non-susceptible (Carb-NS) Pseudomonas aeruginosa (PSA) From 2016-2019: A Multicenter Evaluation
Authors: Gupta Vikas , Yu Kalvin , Pogue Jason M , Weeks Janet , Clancy Cornelius J
Published: December 2021

Background

CLSI lowered Pseudomonas aeruginosa (PSA) Carbapenem (Carb) interpretive breakpoint minimum inhibitory concentrations (MICs) in 2012. It often takes several years for commercial test manufacturers and microbiology labs to incorporate revised breakpoints. We compare facility-reported rates of Carb-NS PSA to the 2012 CLSI MIC breakpoints, using a large nationwide database for isolates tested in 2016-2020 at United States (US) facilities.

Table. Imipenem (IPM)/meropenem (MEM)/doripenem (DOR) interpretation (evaluable isolates) results for PSA.

Methods

All adults with a positive non-contaminant PSA culture (first isolate per 30-day period from blood, respiratory, urine, skin/wound, intra-abdominal, or other) in ambulatory and inpatient settings from 298 US hospitals from Q1 2016-Q4 2020 were evaluated (BD Insights Research Database, Becton, Dickinson & Company). Facility-reported Carb-non susceptible (NS) was defined as lab information system feed designations of susceptible (S), intermediate (I) or resistant (R) to imipenem (IPM), meropenem (MEM) and/or doripenem (DOR) per commercial panels. Where available, MICs were interpreted using CLSI 2012 Carb breakpoints (µg/ml) of ≤2 (S), 4 (I), ≥8 (R) for IPM/MEM/DOR. For evaluable PSA isolates we compared susceptibility results as reported by the facility to those using CLSI MIC breakpoints.

Results

Overall, 86.9% (255,844/294,426) of non-duplicate PSA isolates with facility-reported IPM/MEM/DOR susceptibility interpretations also had interpretable MIC results. S rates were 84.9% and 83.3% as reported by facilities and determined by CLSI criteria, respectively (Table). Facilities under-reported Carb-NS by 9.8%, using CLSI criteria as the standard (10.4% and 7.7% of R and I isolates, respectively, were missed by facility reporting).

Conclusion

Systematic application of CLSI breakpoints in 2016-20 would have had minimal impact on PSA S rates in the US. However, facility reporting failed to identify ~10% of Carb-NS isolates. The clinical implications of this observation are unknown. Facilities should know their local epidemiology, decide if under-reporting might be an issue, and assess if there is any impact on their patients.

Disclosures

Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder) Kalvin Yu, MD, BD (Employee) Jason M Pogue, PharmD, BCPS, BCIDP, Merck (Consultant)QPex (Consultant)Shionogi (Consultant)Utility Therapeutics (Consultant)VenatoRX (Consultant) Janet Weeks, PhD, Becton, Dickinson and Company (Employee) Cornelius J. Clancy, MD, Merck (Grant/Research Support)
789. Susceptibility of Phenotypic Subsets of Pseudomonas aeruginosa Isolates to Cefiderocol and Comparator Agents from SIDERO-WT 2014-2019
Authors: Nguyen Sean , Fam David , Sahm Daniel F , Hackel Meredith , Echols Roger , Yamano Yoshinori
Published: December 2021

Background

Multidrug-resistant (MDR) phenotypes are frequently observed among P. aeruginosa (PsA) isolated from hospitalized patients. This study describes the in vitro activities of cefiderocol (CFDC) and comparator agents against various non-susceptible (NS) phenotypic subsets of MDR PsA isolates from the SIDERO-WT multi-national surveillance program.

Methods

Clinical PsA isolates were collected from North America (NA) and Europe in 2014-2019 and tested for susceptibility at a central laboratory. MICs (μg/ml) were determined for CFDC, ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), colistin, cefepime, meropenem (MEM), and ciprofloxacin by broth microdilution according to CLSI guidelines. Aztreonam-avibactam (avibactam fixed concentration of 4 µg/ml) and imipenem/relebactam (I/R) were only tested during SIDERO-WT Year 5 (i.e. 2019). Susceptibility was interpreted according to current FDA and 2021 CLSI breakpoints.

Results

The different phenotypic subsets and susceptibility of tested compounds are shown in the table. Among 7700 PsA isolates, 47.7% and 23% were from respiratory and gastrointestinal sources of infection. CFDC inhibited 97.5% and 99.9% of all PsA at its FDA-S and CLSI-S MIC breakpoint of ≤1 and ≤4, respectively. CFDC had the lowest MIC90 of all tested agents and >99% S at an MIC ≤4 for all phenotypic subsets. At a MIC ≤1, CFDC displayed high susceptibility rates against all subsets including ≥88% S against CZA-NS, C/T-NS, I/R-NS, and MEM+I/R-NS isolates. Against MDR subsets, comparator agents consistently demonstrated lower activity than CFDC; 88% of MEM+C/T-NS and MEM+CZA-NS isolates had a CFDC MIC≤1 while 15.6% and 20.3% were S to I/R, respectively. 86% of MEM+CZA+C/T-NS and 80.4% CZA+C/T+I/R-NS isolates were S to CFDC. CFDC inhibited 98.1% and 99.4% of PsA isolates from NA (n = 3548) at a MIC of ≤1 and ≤4, respectively. In NA isolates that were MEM+C/T-NS; 85.7% of PsA isolates had a MIC ≤1 to CFDC and 33.3% and 28.6% were S to CZA and I/R, respectively.

MEM: Meropenem; NS: Non-susceptible; CZA: Ceftazidime/avibactam; C/T: Ceftolozane/tazobactam; I/R: Imipenem/relebactam

Conclusion

CFDC demonstrated potent in vitro activity against a variety of phenotypic subsets of MDR P. aeruginosa isolates as compared to agents that are commonly used to treat MDR PsA infections including strains NS to other agents. These data support the use of CFDC as an important treatment option for MDR PsA.

Disclosures

Sean Nguyen, PharmD, Shionogi Inc (Employee) David Fam, PharmD, Shionogi (Employee) Daniel F. Sahm, PhD, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Meredith Hackel, PhD MPH, IHMA (Employee)Pfizer, Inc. (Independent Contractor) Roger Echols, MD, Shionogi (Consultant) Yoshinori Yamano, PhD, Shionogi (Employee)
802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021
Authors: Kim Janice J , Turner Nancy E , Holman Emily , Lefrak Linda , Youssef Fady A , Richardson Patrizia , Mukhopadhyay Rituparna , Crandall John , Su Henry , Epson Erin
Published: December 2021

Background

Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices.

Methods

A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq.

Results

Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2).

Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021

Figure 2. Phylogenetic Tree Corynebacterium striatum Isolates

Conclusion

A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients.

Disclosures

All Authors: No reported disclosures
Immunotherapy in non-small cell lung cancer: rationale, recent advances and future perspectives
Authors: Luo Wenxin , Wang Zhoufeng , Zhang Ting , Yang Lan , Xian Jinghong , Li Yalun , Li Weimin
Published: December 2021

Lung cancer, with non-small cell lung cancer (NSCLC) being the major type, is the second most common malignancy and the leading cause of cancer-related death globally. Immunotherapy, represented by immune checkpoint inhibitors (ICIs), has been one of the greatest advances in recent years for the treatment of solid tumors including NSCLC. However, not all NSCLC patients experience an effective response to immunotherapy with the established selection criteria of programmed death ligand 1 (PD-L1) and tumor mutational burden (TMB). Furthermore, a considerable proportion of patients experience unconventional responses, including pseudoprogression or hyperprogressive disease (HPD), immune-related toxicities, and primary or acquired resistance during the immunotherapy process. To better understand the immune response in NSCLC and provide reference for clinical decision-making, we herein review the rationale and recent advances in using immunotherapy to treat NSCLC. Moreover, we discuss the current challenges and future strategies of this approach to improve its efficacy and safety in treating NSCLC.
CALCULATION OF THE DOSE CONVERSION COEFFICIENTS FOR CHINESE EYE LENS UNDER PHOTON EXPOSURE
Authors: Teng Zhongbin , Song Mingzhe , Liu Senlin , Wei Kexin , Liu Yuntao
Published: December 2021

In this work, the conversion coefficients from air kerma to the eye lens dose were calculated for photon exposures using the detailed eye and head Monte-Carlo (MC) model with the Chinese adult parameters. To verify the MC model and the simulation method, the conversion coefficients from fluence to the eye lens dose for mono-energy electrons (0.7–12 MeV) were calculated and compared with other studies. Then the conversion coefficients from air kerma to the doses in the entire lens and in the sensitive volume were calculated, respectively, for mono-energy photons (0.01–50 MeV) at different incidence angles (0–90°, in step of 15°). A small difference was found between the calculated conversion coefficient and the ICRP recommended value. The difference could be mainly due to the difference in their geometry characteristic of the eye and head models. In addition, the uncertainty analysis of the calculated conversion coefficients was performed in detail. The calculated dose conversion coefficient of the eye lens can be used to evaluate the eye lens dose for Chinese occupational staffs in external photon fields. And it can be used to determine the personal absorbed dose in the eye lens Dp lens in photon reference radiation fields.
Between Online Autonomy and Local Constraints: Spaces of Roman Catholic Women’s Activity in Poland
Authors: Szwed Anna
Published: December 2021

The analysis presented in this article shows how a hybrid community combining online and offline activity generates a semi-autonomous space of women's activity, neither fully independent of the religious institution, nor entirely controlled by it. Based on results obtained over 15 months of qualitative research conducted in the Captivating (Urzekająca), conservative community of Roman Catholic women in Poland, I show that digital environments are conducive to building a community of women, a creative approach to practices, renegotiating power relations, and building a sense of agency among women, while also recognizing the authority of the Church as an institution. At the same time, I argue that relative autonomy in practising religion online is limited by the pressures experienced by women in the offline space as a result of the nature of the local Church. The article discusses the question of the relations between the online and offline space, as well as the role of the broader context for understanding conservative women's practice of religion.
Effect of protein source and nonroughage NDF content in finishing diets of feedlot cattle fed free-choice hay on growth performance and carcass characteristics
Authors: Pittaluga Alejandro M , Clark Chris , Relling Alejandro E
Published: December 2021

One-hundred twenty crossbreed steers (initial body weight (BW) 566 ± 42 kg) were used to evaluate the interaction of protein source (PS) and nonroughage NDF content (NRFC) in finishing diets of feedlot cattle fed free-choice hay on performance and carcass characteristics. Steers were stratified by BW and randomly assigned to 8 pens (2 × 2 factorial) and fed for 104 ± 10 d. Four dietary treatments were investigated: (1) distillers’ dry grains with solubles (DDGS) and a low NRFC (DLF), (2) DDGS and a high NRFC (DHF), (3) soybean meal (SBM) and a low NRFC (SLF), (4) SBM and a high NRFC (SHF). Free-choice grass hay and concentrates were offered in a different bunk. Data were analyzed as a randomized complete block design. Do to the confounded effect of PS and protein intake, a linear regression was used to evaluate the effect of protein intake in growth performance. For gain to feed ratio (G:F) an interaction tended to occur (P = 0.10) between PS and NRFC. Steers on the DHF treatment had a lower G:F compared with SLF and SHF. Feeding SBM increased (P = 0.05) final BW, tended to increase (P = 0.06) average daily gain (ADG), and decreased (P = 0.05) hay intake (HI) compared with steers fed DDGS. There was a positive association (P ˂ 0.01) of crude protein intake with ADG and FBW. Dietary NRFC did not change (P ≥ 0.3) final BW, ADG, DMI, and HI. Protein source did not affect (P ≥ 0.16) hot carcass weight (HCW), longissimus muscle (LM) area, dressing, 12th rib fat thickness, or marbling score (MS). No differences were detected between NRFC for dressing, HCW, LM area, or MS (P ≥ 0.18); but diets with greater NRFC decreased (P = 0.03) the 12th rib fat thickness. Steers in the SHF treatment presented the lesser kidney-pelvic-heart fat compared with the remaining treatments (PS × NRFC interaction, P = 0.04). Soybean meal inclusion/increase in protein intake improved growth performance of feedlot steers compared with DDGS, despite protein intake meet the protein requirement. Increasing the NRFC did not affect growth or HI but decreased feed efficiency of steers fed DDGS.
Relationship between mask wearing, testing, and vaccine willingness among Los Angeles County adults during the peak of the COVID-19 pandemic
Authors: Lam Chun Nok , Kaplan Cameron , Saluja Sonali
Published: December 2021

Background

Mask wearing mitigates the spread of COVID-19; however, many individuals have not adopted the protective behavior.

Purpose

We examine mask wearing behavior during the height of the pandemic in Los Angeles County, and its association with COVID-19 testing and willingness to get vaccinated.

Methods

We conducted a cross-sectional survey using representative sampling between December 2020 and January 2021, through an online platform targeting Los Angeles County residents. Survey items include demographic characteristics, health conditions, access to health care, mask wearing, COVID-19 testing, exposure risk factors, and willingness to receive COVID-19 vaccine. We performed logistic regression models to examine factors associated with always mask wearing.

Results

Of the analytic sample (n = 1,984), 75.3% reported always wearing a face mask when leaving home. Being a female, Asian or African American, or non-Republican resident, or having higher education, having poor or fair health, having a regular doctor, knowing someone hospitalized for COVID-19, and being willing to receive the COVID-19 vaccine were associated with always wearing a mask. Residents who were younger, had a highest risk health condition, and had ≥2 COVID-19 tests had lower odds of always mask wearing.

Conclusion

Mask wearing guidelines are easing; however, as vaccination rates plateau and new virus variants emerge, mask wearing remains an important tool to protect vulnerable populations. Encouraging protective measures among younger adults, those with less education, republicans, men, and White residents—groups that are least likely to be vaccinated or wear a mask—may be critical to reducing transmission.
A low aldosterone/renin ratio and high soluble ACE2 associate with COVID-19 severity
Authors: Akin Sakir , Schriek Paula , van Nieuwkoop Cees , Neuman Rugina I. , Meynaar Iwan , van Helden Erik J. , Bouazzaoui Hassan El , Baak Remon , Veuger Marjan , Mairuhu Ronne A.T.A. , van den Berg Lettie , van Driel Vincent , Visser Loes E. , de Jonge Evert , Garrelds Ingrid M. , Duynstee Johannes F.A.B. , van Rooden Jan Kees , Ludikhuize Jeroen , Verdonk Koen , Caliskan Kadir , Jansen Tim , van Schaik Ron H.N. , Danser A.H. Jan
Published: December 2021

Background:

The severity of COVID-19 after SARS-CoV-2 infection is unpredictable. Angiotensin-converting enzyme-2 (ACE2) is the receptor responsible for coronavirus binding, while subsequent cell entry relies on priming by the serine protease TMPRSS2 (transmembrane protease, serine 2). Although renin-angiotensin-aldosterone-system (RAAS) blockers have been suggested to upregulate ACE2, their use in COVID-19 patients is now considered well tolerated. The aim of our study was to investigate parameters that determine COVID-19 severity, focusing on RAAS-components and variation in the genes encoding for ACE2 and TMPRSS2.

Methods:

Adult patients hospitalized due to SARS-CoV-2 infection between May 2020 and October 2020 in the Haga Teaching Hospital were included, and soluble ACE2 (sACE2), renin, aldosterone (in heparin plasma) and polymorphisms in the ACE2 and TMPRSS2 genes (in DNA obtained from EDTA blood) were determined.

Measurements and main results:

Out of the 188 patients who were included, 60 were defined as severe COVID-19 (ICU and/or death). These patients more often used antidiabetic drugs, were older, had higher renin and sACE2 levels, lower aldosterone levels and a lower aldosterone/renin ratio. In addition, they displayed the TMPRSS2-rs2070788 AA genotype less frequently. No ACE2 polymorphism-related differences were observed. Multivariate regression analysis revealed independent significance for age, sACE2, the aldosterone/renin ratio, and the TMPRSS2 rs2070788 non-AA genotype as predictors of COVID-19 severity, together yielding a C-index of 0.79. Findings were independent of the use of RAAS blockers.

Conclusion:

High sACE2, a low aldosterone/renin ratio and having the TMPRSS2 rs2070788 non-AA genotype are novel independent determinants that may help to predict COVID-19 disease severity.

Trial registration:

retrospectively registered.
GUNN's DOTS AS INDICATORS OF RENAL FUNCTION, FINDINGS FROM THE TONGREN HEALTH CARE STUDY
Authors: Xue Can Can , Gao Li Qin , Cui Jing , Zhang Chun , Chen Dong Ning , Wang Ya Xing , Jonas Jost B.
Published: December 2021

Purpose:

To investigate the prevalence of Gunn's dots (GDs) and associated systemic factors in adult Chinese.

Methods:

A cross-sectional study enrolling participants older than 45 years from a community-based study. Gunn's dots were evaluated using fundus photography, and associated systemic factors were analyzed. Patients with any retinal or optic neuropathy were excluded.

Results:

The study included 4,118 participants (mean age: 58.3 ± 9.9 years; male: 1,699/41.3%). Gunn's dots were found in 931 participants, with a prevalence of 22.6 ± 0.8% (95% confidence interval [CI]: 21.3–23.9). Systemic factors associated with a higher GD prevalence were younger age (odds ratio [OR]: 0.92; 95% CI: 0.91–0.93; P < 0.001), higher estimated glomerular filtration rate (eGFR) (OR: 1.01; 95% CI: 1.001–1.02; P = 0.022), and higher serum concentration of triglycerides (OR: 1.08; 95% CI: 1.004–1.16; P = 0.040). The GD prevalence was 3.5 (OR = 3.46; 95% CI: 1.06–11.35) and 4.4 (OR = 4.37; 95% CI: 1.27–15.09) times greater for participants with an eGFR of ≥90 mL/minute/1.73 m2 and an eGFR of ≥100 mL/minute/1.73 m2, respectively, as compared with participants with an eGFR of <60 mL/minute/1.73 m2.

Conclusion:

The GD prevalence (mean: 22.6%) was associated with younger age, higher eGFR, and higher serum triglyceride concentrations. The presence of GDs may serve as indicators of healthy renal function.
RELATIONSHIP BETWEEN CHOROIDAL FINDINGS AND GROWTH FACTORS, CYTOKINES, AND OTHER INFLAMMATORY MEDIATORS AFTER INTRAVITREAL RANIBIZUMAB INJECTION IN PATIENTS WITH MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSION
Authors: Noma Hidetaka , Yasuda Kanako , Mimura Tatsuya , Shimura Masahiko
Published: December 2021

Purpose:

To examine possible associations between subfoveal choroidal thickness (SCT), choroidal blood flow, aqueous flare value, and aqueous humor levels of multiple growth factors, cytokines, and other inflammatory mediators in patients with branch retinal vein occlusion and macular edema who received antivascular endothelial growth factor (anti-VEGF) therapy.

Methods:

We recruited 65 patients with macular edema due to branch retinal vein occlusion who received intravitreal ranibizumab injection and measured aqueous levels of eight factors by the suspension array method. Furthermore, we evaluated choroidal blood flows by laser speckle flowgraphy and quantified them as the mean blur rate and measured aqueous flare values using a laser flare meter and SCT and central macular thickness by optical coherence tomography.

Results:

At 1 month after intravitreal ranibizumab injection, central macular thickness was significantly improved and SCT, choroidal mean blur rate, and aqueous flare value were significantly decreased. SCT was significantly correlated with vascular endothelial growth factor and placental growth factor, and the change in both SCT and central macular thickness was significantly correlated with the change in aqueous flare value. However, only SCT was significantly negatively correlated with the aqueous flare value.

Conclusion:

Growth factors seem to play a role in SCT. In macular edema with branch retinal vein occlusion, antivascular endothelial growth factor agents may decrease SCT by reducing inflammation.
Acute Hydrops After Bowman Layer Transplantation for Keratoconus May Indicate that Descemet Membrane Rupture Is Secondary to Hydrops
Authors: Musayeva Aytan , Santander-García Diana , Quilendrino Ruth , Parker Jack , van Dijk Korine , Henrat Carole , Dapena Isabel , Binder Perry S. , Melles Gerrit R.J.
Published: December 2021

Purpose:

The aim of this study was to review the postoperative course and imaging features of 7 eyes that presented with corneal hydrops after Bowman layer (BL) transplantation was performed for advanced keratoconus to determine the potential mechanisms of hydrops formation.

Methods:

A retrospective analysis was performed of 7 eyes of 5 patients with advanced keratoconus that underwent midstromal BL transplantation at 2 tertiary referral centers and developed acute corneal hydrops on average 64 (±30) months (range 14–104 months) postoperatively. Corneal tomography and anterior segment optical coherence tomography (AS-OCT) images were reviewed to document the postoperative and posthydrops course.

Results:

For all eyes, the post-BL transplantation course was uneventful until hydrops development. Despite stable postoperative topographies in 5 of 7 eyes, eyes developed hydrops with typical hypodense areas on AS-OCT that were limited to the stromal layers posterior to the BL graft. With AS-OCT (6/7 eyes), 2 eyes showed a break in Descemet membrane, whereas Descemet membrane was intact across the cornea in 2 eyes; in 2 eyes, the images were inconclusive. All patients admitted to continued eye rubbing, and all but 1 had a clinically significant allergy and/or atopic constitution. Most eyes (5/7) showed a relatively quick (visual) recovery within 1 to 4 months after hydrops.

Conclusions:

Hydrops formation in keratoconic corneas after midstromal BL transplantation may indicate that a break in Descemet membrane is secondary to hydrops development (and not vice versa). With a midstromal BL graft in situ limiting hydrops dimensions, resolution of the hydrops seemed relatively quick with recovery to prehydrops visual acuity in most eyes.
Rescue Technique to Solve Postoperative Refractory Double Anterior Chamber in Deep Anterior Lamellar Keratoplasty
Authors: Hayashi Takahiko , Siebelmann Sebastian
Published: December 2021

Purpose:

The purpose of this study was to describe a simple rescue technique to solve postoperative double anterior chamber refractory to rebubbling in deep anterior lamellar keratoplasty (DALK).

Methods:

This study analyzed consecutive patients who underwent DALK between June 2014 and March 2018 and required a postoperative reattachment of Descemet membrane because of macroperforation-led persistent double chambers. The technique entails placing anchoring sutures to attach Descemet membrane to the donor's posterior stroma. Anchoring sutures were removed within 1 month of surgery. The postoperative best spectacle–corrected visual acuity (BSCVA) [converted to logarithm of the minimum angle of resolution (logMAR) units], endothelial cell density (cells/mm2), graft survival, postoperative complications, and corneal astigmatism (diopters) were evaluated.

Results:

Five eyes from 5 patients were included in this study [5 women, 63.6 ± 6.0 yrs (32–80 yrs); mean follow-up duration, 72.0 ± 23.3 mo (30–100 mo)] (mean ± SD). The grafts survived successfully in all patients without primary or secondary graft failure. The best spectacle–corrected visual acuity improved from 1.26 ± 0.66 logMAR preoperatively to 0.25 ± 0.15 logMAR postoperatively (n = 5, P = 0.042). The endothelial cell density was 1468 ± 810 cells/mm2 at the last visit.

Conclusions:

Macroperforation of Descemet membrane during DALK with incomplete removal of the stroma can lead to persistent double anterior chamber. This complication could be solved by the technique devised by this study.
New views on three-dimensional imaging technologies for glaucoma: an overview
Authors: Guzman Aparicio Maria A. , Chen Teresa C.
Published: December 2021

Purpose of review

To summarize the literature on three-dimensional (3D) technological advances in ophthalmology, the quantitative methods associated with this, and their improved ability to help detect glaucoma disease progression.

Recent findings

Improvements in measuring glaucomatous structural changes are the result of dual innovations in optical coherence tomography (OCT) imaging technology and in associated quantitative software.

Compared with two-dimensional (2D) OCT parameters, newer 3D parameters provide more data and fewer artifacts.
Antimicrobial Susceptibility Profiles Among Neonatal Early-onset Sepsis Pathogens
Authors: Flannery Dustin D. , Puopolo Karen M. , Hansen Nellie I. , Gerber Jeffrey S. , Sánchez Pablo J. , Stoll Barbara J.
Published: December 2021

Background:

Empiric administration of ampicillin and gentamicin is recommended for newborns at risk of early-onset sepsis (EOS). There are limited data on antimicrobial susceptibility of all EOS pathogens.

Methods:

Retrospective review of antimicrobial susceptibility data from a prospective EOS surveillance study of infants born ≥22 weeks’ gestation and cared for in Neonatal Research Network centers April 2015–March 2017. Nonsusceptible was defined as intermediate or resistant on final result.

Results:

We identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data were available for 189/239 (79.1%) isolates. Among 81 Gram-positive isolates with ampicillin and gentamicin susceptibility data, all were susceptible in vitro to either ampicillin or gentamicin. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 72/94 (76.6%) isolates were nonsusceptible to ampicillin, 8/94 (8.5%) were nonsusceptible to gentamicin, and 7/96 (7.3%) isolates were nonsusceptible to both. Five percent or less of tested Gram-negative isolates were nonsusceptible to each of third or fourth generation cephalosporins, piperacillin-tazobactam, and carbapenems. Overall, we estimated that 8% of EOS cases were caused by isolates nonsusceptible to both ampicillin and gentamicin; these were most likely to occur among preterm, very-low birth weight infants.

Conclusions:

The vast majority of contemporary EOS pathogens are susceptible to the combination of ampicillin and gentamicin. Clinicians may consider the addition of broader-spectrum therapy among newborns at highest risk of EOS, but we caution that neither the substitution nor the addition of 1 single antimicrobial agent is likely to provide adequate empiric therapy in all cases.
Kikuchi Disease in Children
Authors: Abdu Ahmed , Pajkrt Dasja , Bijker Else M.
Published: December 2021

Background:

Kikuchi disease (KD) is a rare and generally benign condition of uncertain etiology that presents with nonspecific symptoms including fever and cervical lymphadenopathy. Clinical presentations can vary. Here, we present an atypical case of KD in a 10-year-old girl, as well as an updated literature review of the clinical presentation, laboratory features and management of KD in children.

Methods:

Studies (published up until February 2020) were identified through searches of PubMed using the following search items: Kikuchi-Fujimoto disease or histiocytic necrotizing lymphadenitis or Kikuchi disease. Our primary search resulted in 1117 publications. A total of 34 publications with a total of 670 patients were included in the final analysis.

Results:

All children present with lymphadenopathy. Almost all (96.3%) have cervical lymphadenopathy. Fever is recorded in the majority of children (77.1%). Analysis of laboratory features found that the majority of children have leukopenia (56.0%) and a raised erythrocyte sedimentation rate (56.0%). Over 30% have a raised C-reactive protein and anemia. Other features such as leukocytosis, thrombocytopenia and antinuclear antibodies positivity are less common. KD is mostly self-limiting, but steroids, hydroxychloroquine and intravenous immunoglobulin are used in protracted courses. Their efficacy has yet to be established in clinical trials.

Conclusions:

The presentation of KD is variable, and there is no specific set of symptoms or laboratory features that reliably establishes the diagnosis. Thus, histopathology is crucial. Definitive evaluation and establishment of effective treatments will require future prospective research studies for a more comprehensive description of the clinical course and effects of treatment. Given the rarity of the disease, this will have to be performed in collaborative consortia.
The Suboptimal Pediatric HIV Viral Load Cascade
Authors: Muhairwe Josephine A. , Brown Jennifer A. , Motaboli Lipontso , Nsakala Bienvenu L. , Lerotholi Malebanye , Amstutz Alain , Klimkait Thomas , Glass Tracy R. , Labhardt Niklaus D.
Published: December 2021

Background:

Children living with HIV and taking antiretroviral therapy (ART) are a priority group for routine viral load (VL) monitoring. As per Lesotho guidelines, a VL ≥1000 copies/mL (“unsuppressed”) should trigger adherence counseling and a follow-up VL; 2 consecutive unsuppressed VLs (“virologic failure”) qualify for switching to second-line ART, with some exceptions. Here, we describe the pediatric VL cascade in Lesotho.

Methods:

In a prospective open cohort study comprising routine VL results from 22 clinics in Lesotho, we assessed outcomes along the VL cascade for children who had at least 1 VL test from January 2016 through June 2020. Data were censored on February 10, 2021.

Results:

In total, 1215 children received 5443 VL tests. The median age was 10 years (interquartile range 7–13) and 627/1215 (52%) were female; 362/1215 (30%) had at least 1 unsuppressed VL. A follow-up VL was available for 325/362 (90%), although only for 159/362 (44%) within 6 months of the first unsuppressed VL. Of those with a follow-up VL, 172/329 (53%) had virologic failure and 123/329 (37%) qualified for switching to second-line ART. Of these, 55/123 (45%) were ever switched, although only 9/123 (7%) were switched within 12 weeks of the follow-up VL. Delays were more pronounced in rural facilities. Overall, 100/362 (28%) children with an unsuppressed VL received a timely follow-up VL and, if required, a timely regimen switch.

Conclusions:

Despite access to VL monitoring, clinical management was suboptimal. HIV programs should prioritize timely clinical action to maximize the benefits of VL monitoring.
Comparison of clinical outcomes of LASIK, Trans-PRK, and SMILE for correction of myopia
Authors: Chang Jin-Yu , Lin Pei-Yu , Hsu Chih-Chien , Liu Catherine Jui-Ling
Published: December 2021

Transepithelial photorefractive keratectomy (Trans-PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) are three mainstay refractive surgeries worldwide. The applicability, efficacy, safety, and predictability of these different techniques are quite similar. Trans-PRK has the strongest biostability, earliest return to normal corneal sensitivity but the longest recovery time, most uncomfortable postoperative experience, and possibility of corneal haze. LASIK possesses the fastest visual rehabilitation but the slowest corneal nerve reinnervation, and flap displacement is possibly lifelong. SMILE incurs no flap-related complications and has intermediate vision recovery time and biomechanics compared with Trans-PRK and LASIK. However, it lacks the cyclotorsion-compensation system, eye-tracking system, and customized treatment profile for high astigmatism or irregular corneal surface. This review aims to introduce the mechanisms, pros, and cons of these three types of refractive surgery. With full understanding, practitioners could advise patients on the most suitable treatment of choice.
Risk of Breast Cancer With Prolactin Elevating Antipsychotic Drugs
Authors: Rahman Tahir , Sahrmann John M. , Olsen Margaret A. , Nickel Katelin B. , Miller J. Phillip , Ma Cynthia , Grucza Richard A.
Published: December 2021

Purpose/Background

Antipsychotic drugs are well established to alter circulating prolactin levels by blocking dopamine D2 receptors in the pituitary. Prolactin activates many genes important in the development of breast cancer. Prior studies have found an association with antipsychotic use and risk of breast cancer.

Methods/Procedures

The IBM MarketScan Commercial and Medicaid Databases were used to establish a large, observational cohort of women taking antipsychotics drugs compared with anticonvulsants or lithium. A new user design was used that required 12 months of insurance enrollment before the first antipsychotic or anticonvulsant/lithium prescription. Invasive breast cancer was identified using diagnostic codes. Multivariable Cox proportional hazards models were used to evaluate the risk of breast cancer with antipsychotic drug exposure controlling for age and other risk factors.

Findings/Results

A total of 914 cases (0.16%) of invasive breast cancer were identified among 540,737 women. Exposure to all antipsychotics was independently associated with a 35% increased risk of breast cancer (aHR [adjusted hazard ratio], 1.35; 95% confidence interval, 1.14–1.61). Category 1 drugs (high prolactin) were associated with a 62% increased risk (aHR, 1.62; 95% CI, 1.30–2.03), category 2 drugs a 54% increased risk (aHR, 1.54; 95% CI, 1.19–1.99), and category 3 drugs were not associated with breast cancer risk.

Implications/Conclusions

In the largest study of antipsychotics taken by US women, a higher risk between antipsychotic drug use and increased risk for breast cancer was observed, with a differential higher association with antipsychotic categories that elevate prolactin. Our study confirms other recent observational studies of increased breast cancer risk with antipsychotics that elevate prolactin.
A Randomized Clinical Trial on the Impact of Individually Targeted Computerized Cognitive Training on Quality of Life Indicators in Adults With HIV-Associated Neurocognitive Disorder in the Southeastern United States
Authors: Vance David E. , Pope Caitlin N. , Fazeli Pariya L. , Azuero Andres , Frank Jennifer S. , Wadley Virginia G. , Raper James L. , Byun Jun Y. , Ball Karlene K.
Published: December 2021

HIV-associated neurocognitive disorder (HAND) is experienced by 30% to 50% of people living with HIV (PLWH), potentially affecting their quality of life (QoL). In the Training on Purpose Study, we investigated whether targeted cognitive training can improve QoL in PLWH with HAND. Using a two-group experimental design, we randomized 109 adults with HAND to either (a) the Individualized-Targeted Cognitive Training group or (b) a no-contact control group. Those in the training group were assigned 10 hr of cognitive training per two selected cognitive domains (20 hr total) for which impairment was observed. Overall, two patterns emerged. First, significant improvements in measures of everyday cognitive complaints, depression, and mental health were consistently observed after the completion of many cognitive training protocols. Second, immediate and delayed spatial learning and memory training resulted in more significant indicators of QoL improvements compared with the other cognitive domain trainings. The findings suggest that some types of cognitive training may have advantages over others in improving aspects of QoL.
Coronavirus disease 2019 in patients with chronic immune thrombocytopenia on thrombopoietin receptor agonists: new perspectives and old challenges
Authors: Pantic Nikola , Suvajdzic-Vukovic Nada , Virijevic Marijana , Pravdic Zlatko , Sabljic Nikica , Adzic-Vukicevic Tatjana , Mitrovic Mirjana
Published: December 2021

There are limited data on the impact of severe acute respiratory syndrome corona virus 2 infection in patients previously diagnosed with primary immune thrombocytopenia (ITP) on thrombopoietin receptor agonist therapy (TPO-RA). Seven chronic ITP patients who had contracted COVID-19 and had been treated with TPO-RA are included in the study. Demographic, ITP treatment and comorbidities data were collected retrospectively from patients’ medical records. Data regarding clinical course of COVID-19 were collected prospectively. During the infection, all patients had platelet count higher than average, and platelet count peak was mainly observed on day 7. For that reason, therapy modification was required. However, platelet count increment was transient in most ITP patients. One patient developed pulmonary embolism despite the use of therapeutic dose of anticoagulants. One patient died of respiratory failure whereas another developed rebound thrombocytopenia after the infection and consequential intracerebral hemorrhage. Careful platelet count monitoring and therapy management are needed in chronic ITP patients on TPO-RAs with COVID-19.
Anticoagulation Management and Outcomes in Patients With Covid-19 With Propensity Score Matching: A Multicenter Retrospective Cohort Study
Authors: Kaur Jasmeet , deLongpre Jennifer , Koehler Tracy , Laclair Heather , Bowen Monica , Khine Justin , Khosrodad Nadia , Jena Nihar , Dixit Priyadarshini , Yadav Sumeet , Mogulla Swathi M. , Coakley Rob , Sule Anupam , Krishnamoorthy Geetha
Published: December 2021

Background:

Therapeutic doses of anticoagulation have been administered to patients with coronavirus-19 disease (Covid-19) without thromboembolism, although there is a lack of robust evidence supporting this practice.

Study Question:

To compare outcomes between patients admitted to the hospital for Covid-19 who received full-dose anticoagulation purely for the indication of Covid-19 and patients who received prophylactic doses of anticoagulation.

Study Design:

This is a multicenter retrospective cohort study, including 7 community hospitals in Michigan. Patients were >18 years of age, confirmed positive for Covid-19 by polymerase chain reaction, and admitted to the hospital between March 10 and May 3, 2020. Exposed group: Patients receiving therapeutic dose anticoagulation for Covid-19 for any duration excluding clinically evident venous thromboembolism, atrial fibrillation, and myocardial infarction; control group: Patients receiving prophylactic anticoagulation. Propensity score matching was used to adjust for the nonrandomized nature of the study.

Measures and Outcomes:

The primary endpoint: 30-day in-hospital mortality. Secondary endpoints: intubation, length of hospital stay, and readmissions in survivors.

Results:

A total of 115 exposed and 115 control patients were analyzed. Rates of 30-day in-hospital mortality were similar (exposed: 33.0% vs. control: 28.7%). Controlling for institution, there was no significant association between treatment and 30-day in-hospital mortality (hazard ratio: 0.63; 95% confidence interval: 0.37–1.06). Survivors had statistically similar length of hospital stay and readmission rates.

Conclusions:

We found no difference in mortality in patients with Covid-19 without clinically evident venous thromboembolism, atrial fibrillation, and myocardial infarction who received therapeutic versus prophylactic doses of anticoagulation.
Emerging concepts in sinonasal tumor research
Authors: Lopez Diana C. , Wadley Andrew E. , London Nyall R.
Published: December 2021

Purpose of review

Sinonasal malignancies are rare and understudied, often diagnosed at late stages, and may behave aggressively. This review explores investigative diagnostic, therapeutic, and scientific advances specific to sinonasal undifferentiated carcinoma (SNUC), intestinal-type adenocarcinoma (ITAC), and olfactory neuroblastoma (ONB).

Recent findings

A number of studies have recently contributed more robust knowledge of the genetic and molecular landscapes of SNUC, ITAC, and ONB. These analyses have identified SMARCB1 and IDH2 mutations in SNUC, potentially allowing for the tumor's subdivision. Recent studies have also defined a role for induction chemotherapy in SNUC. Somatic mutations for ITAC have been identified and may be potentially targetable with FDA approved therapies. Studies defining the tumor microenvironment for ITAC and ONB have introduced the possibility of immune checkpoint inhibition for these tumor types.

Studies reviewed here detail promising results of the most current and novel characterization of SNUC, ITAC, and ONB genetic and molecular landscapes, which have informed ongoing therapeutic discovery. With continued multi-institutional efforts, the field of sinonasal tumor research will achieve higher disease control and improved treatment outcomes for patients afflicted with these rare cancers.