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Organ Procurement & Transplantation Network policy requires post-transplant screening of recipients of organs from donors at increased risk for transmission of HIV, hepatitis B virus, and hepatitis C virus. Available data suggest that follow-up testing of recipients is not routinely conducted. Data on increased risk donors and recipients of their organs from 2008 to 2012 were retrospectively collected from 6 transplant centers after IRB approval. Descriptive statistics were performed. About 363 (60%) recipients were screened for transmission of HIV, HBV, and/or HCV at some time point; 257 (70.8%) within 90 days of transplant. The type of test used to screen for infection was variable with many recipients (25%-43%) screened with serology alone. Our results reveal that post-transplant screening for HIV, HBV, and HCV in recipients of increased risk donor organs did not universally occur and testing methods were variable.
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Infecciones por VIH/transmisión , Hepatitis B/transmisión , Hepatitis C/transmisión , Tamizaje Masivo , Donantes de Tejidos , Receptores de Trasplantes/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Infecciones por VIH/prevención & control , Hepatitis B/prevención & control , Hepatitis C/prevención & control , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Trasplante de Órganos/efectos adversos , Trasplante de Órganos/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Obtención de Tejidos y Órganos , Adulto JovenRESUMEN
Characteristics of cirrhosis-associated cryptococcosis first diagnosed after death are not fully known. In a multicenter study, data generated as standard of care was systematically collected in 113 consecutive patients with cirrhosis and cryptococcosis followed for 80 patient-years. The diagnosis of cryptococcosis was first established after death in 15.9% (18/113) of the patients. Compared to cases diagnosed while alive, these patients had higher MELD score (33 vs. 22, P = .029) and higher rate of cryptococcemia (75.0% vs. 41.9%, P = .027). Cases diagnosed after death, in comparison to those diagnosed during life were more likely to present with shock (OR 3.42, 95% CI 1.18-9.90, P = .023), require mechanical ventilation at admission (OR 8.5, 95% CI 2.74-26.38, P = .001), less likely to undergo testing for serum cryptococcal antigen (OR 0.07, 95% CI 0.02-0.21, P < .001) and have positive antigen when the test was performed (OR 0.07, 95% CI 0.01-0.60, P = .016). In a subset of cirrhotic patients with advanced liver disease cryptococcosis was first recognized after death. These patients had the characteristics of presenting with fulminant fungemia, were less likely to have positive serum cryptococcal antigen and posed a diagnostic challenge for care providers.
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Criptococosis/patología , Fungemia/patología , Cirrosis Hepática/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la EnfermedadRESUMEN
Introduction: COPD is a progressive lung disease that adds significant economic burden to the healthcare system in the United States. Digital platforms integrated into clinical workflows have demonstrated success in improving patient outcomes in COPD, but few studies have explored the impact of an integrated digital and clinical approach on drivers of direct healthcare costs (COPD-related prescriptions, emergency department (ED) visits and hospitalizations) in a real-world setting. Methods: We conducted a six-month retrospective matched control analysis to assess the impact of a digital quality improvement (QI) program delivered by clinical pharmacists on healthcare resource utilization among people living with COPD. Results: Compared to matched controls at six months, participants in the digital QI program had a nearly two-third relative reduction in COPD-related ED visits and hospitalizations (p=0.044), as well as a 47% reduction in all-cause ED visits and hospitalizations (p=0.059). Participants in the digital QI program also had higher rates of COPD-related prescription fills for antibiotics and oral corticosteroids, as well as a greater number of non-acute care visits compared to matched controls. Conclusion: Digital health platforms integrated into a virtual clinical pharmacist workflow can help reduce costly COPD-related emergency department visits and hospitalizations. Care models integrating digital platforms may also offer a scalable approach to managing COPD and should be explored in different clinical settings.
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Ceftolozane/tazobactam is a combination intravenous antibiotic with potentially important activity against drug-resistant Gram-negative organisms. Ceftolozane/tazobactam's in vitro activity was evaluated in 30 samples collected from 23 adult cystic fibrosis patients with extended and pan-resistant Pseudomonas aeruginosa in 2015. Testing results demonstrated that 30% of the isolates were susceptible,13% were intermediate, and 57% were resistant. This suggests that ceftolozane/tazobactam may be a useful antibiotic in carefully selected, multidrug-resistant Pseudomonas isolates.
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Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Fibrosis Quística/microbiología , Ácido Penicilánico/análogos & derivados , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/efectos de los fármacos , Adulto , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana/métodos , Ácido Penicilánico/uso terapéutico , Esputo/microbiología , TazobactamRESUMEN
We conducted this study to determine the risk of transmission of Q fever to health care workers (HCWs) during perioperative exposure to Coxiella burnetii-infected thoracic endovascular aneurysm stent graft. Pre-operative and 6-week post-operative phase I and II IgG Q fever antibody titers were determined in 14 staff members of an operation room. The room had a negative pressure and all the members of the surgical team wore either a fitted N-95 mask or a powered purified air respirator. Phase I and II IgG antibody titers were <1:16 for 11 of the 14 studied HCWs; 2 HCWs did not follow up at 6 weeks and 1 had a pre-exposure phase II IgG titer of 1:128 with no change 6 weeks later. We concluded that risk of transmission of C. burnetii in the operating room from infected patient to HCWs who wore appropriate personal protective equipment is low.
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Coxiella burnetii/aislamiento & purificación , Cuerpo Médico de Hospitales , Exposición Profesional , Periodo Perioperatorio , Fiebre Q/transmisión , Stents/microbiología , Aneurisma/cirugía , Humanos , Fiebre Q/cirugía , TexasRESUMEN
Epstein-Barr virus (EBV) is a gamma herpesvirus associated with diseases ranging from asymptomatic viremia to post-transplant malignancies in kidney transplant recipients. EBV specifically is associated with post-transplantation lymphoproliferative disorder (PTLD), in kidney transplant recipients, with increased risk in EBV seronegative patients with EBV seropositive donors on intensified immunosuppression. The diagnosis of PTLD relies on clinical suspicion plus tissue biopsy with polymerase chain reaction (PCR) testing of blood currently used for risk determination in high-risk recipients. Therapeutic strategies for PTLD include reduction of immunosuppression, chemotherapy and rituximab, and consideration of sirolimus-based immunosuppression. Antivirals such as ganciclovir are used to prevent reactivation of cytomegalovirus and other herpes viruses but are not onco-therapeutic. Radiation therapy or surgery is indicated for bulky, disseminated or recalcitrant disease. Prognosis varies depending on the type of malignancy identified and stage of disease.
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Infecciones por Virus de Epstein-Barr/epidemiología , Rechazo de Injerto/virología , Herpesvirus Humano 4/aislamiento & purificación , Fallo Renal Crónico/cirugía , Trasplante de Riñón/efectos adversos , Viremia/epidemiología , Aloinjertos , Comorbilidad , Selección de Donante , Infecciones por Virus de Epstein-Barr/diagnóstico , Femenino , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión/métodos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/virología , Trasplante de Riñón/métodos , Masculino , Prevención Primaria/métodos , Pronóstico , Medición de Riesgo , Estudios Seroepidemiológicos , Donantes de Tejidos , Viremia/diagnóstico , Viremia/cirugíaRESUMEN
Epstein-Barr virus (EBV) and human herpesvirus-8 (HHV-8) are γ herpesviruses associated with post-transplant malignancies in kidney transplant recipients. EBV is associated with post-transplantation lymphoproliferative disorder (PTLD), with increased risk in EBV-seronegative patients on intensified immunosuppression. Human herpesvirus-8 is associated with Kaposi's sarcoma (KS), with an increased risk in certain patient populations. Diagnosis of PTLD and KS relies on tissue biopsy. The mainstay of therapy for both PTLD and Kaposi's sarcoma is a reduction of immunosuppression, and in the case of PTLD, consideration of rituximab. Chemotherapy, radiation therapy, or surgery is provided for disseminated or recalcitrant disease. The prognoses vary depending on the type of malignancy identified and stage of disease.
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Infecciones por Virus de Epstein-Barr/inducido químicamente , Rechazo de Injerto/prevención & control , Inmunosupresores/efectos adversos , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Trastornos Linfoproliferativos/inducido químicamente , Sarcoma de Kaposi/inducido químicamente , Antineoplásicos/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Infecciones por Virus de Epstein-Barr/diagnóstico , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Infecciones por Herpesviridae/inducido químicamente , Infecciones por Herpesviridae/diagnóstico , Infecciones por Herpesviridae/terapia , Infecciones por Herpesviridae/virología , Herpesvirus Humano 4 , Herpesvirus Humano 8 , Humanos , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/terapia , Trastornos Linfoproliferativos/virología , Radioterapia , Rituximab/uso terapéutico , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/terapia , Sarcoma de Kaposi/virología , Procedimientos Quirúrgicos OperativosRESUMEN
BACKGROUND: The outcomes and optimal management of cirrhotic patients who develop cryptococcosis before transplantation are not fully known. METHODS: We conducted a multicenter study involving consecutive patients with cirrhosis and cryptococcosis between January 2000 and March 2014. Data collected were generated as standard of care. RESULTS: In all, 112 patients were followed until death or up to 9 years. Disseminated disease and fungemia were present in 76.8% (86/112) and 90-day mortality was 57.1% (64/112). Of the 39 patients listed for transplant, 20.5% (8) underwent liver transplantation, including 2 with active but unrecognized disease before transplantation. Median duration of pretransplant antifungal therapy and posttransplant therapy was 43 days (interquartile range, 8-130 days) and 272 days (interquartile range, 180-630 days), respectively. Transplantation was associated with lower mortality (P = 0.002). None of the transplant recipients developed disease progression during the median follow-up of 3.5 years with a survival rate of 87.5%. CONCLUSIONS: Cryptococcosis in patients with cirrhosis has grave prognosis. Our findings suggest that transplantation after recent cryptococcal disease may not be a categorical exclusion and may be cautiously undertaken in liver transplant candidates who are otherwise deemed clinically stable.
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Criptococosis/complicaciones , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Trasplante de Hígado , Antifúngicos/uso terapéutico , Progresión de la Enfermedad , Femenino , Fluconazol/uso terapéutico , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Receptores de Trasplantes , Resultado del TratamientoRESUMEN
In 2012, Texas has reported the highest number of West Nile virus (WNV) cases in the United States to the Centers for Disease Control and Prevention. In this report, we conducted a retrospective chart review of 57 patients with WNV disease and analyzed the clinical features of these patients. Our results revealed that 25 (44%) patients were diagnosed with West Nile fever and 32 (56%) with West Nile neuroinvasive disease (WNND). The median age for patients with WNND was 54.5 years, and those with encephalitis were more likely to be >60 years old. Pre-existing conditions such as hypertension and diabetes were more frequent in patients with WNND. Testing both serum and cerebrospinal fluid (CSF) for antibodies diagnosed more cases of WNND than just testing serum or CSF alone. The increasing number of WNV cases during this epidemic highlights the need to increase efforts to control mosquito populations and educate the general public.