Real-World Application of a Procalcitonin Monitoring Protocol in a Pediatric Intensive Care Unit.

OBJECTIVE: Procalcitonin (PCT) is a biomarker used as an indicator for inflammation and bacterial infections. In October 2018, our PICU implemented a PCT monitoring protocol incorporating cutoffs established in previous studies to help guide antibiotic decision-making in patients undergoing sepsis evaluation. The study objective was to evaluate adherence to the protocol with regard to PCT monitoring and antibiotic use. METHODS: This retrospective review included PICU patients with systemic inflammatory response syndrome ages > 1 month to 18 years with at least 1 PCT level and blood culture obtained during the 9 months following protocol implementation. Patients were excluded if they received < 48 hours of antibiotic therapy, were neutropenic, or had antibiotics initiated at another hospital. Patients were evaluated for protocol adherence, defined as antibiotic continuation or discontinuation per protocol guidance without excess PCT monitoring. Descriptive statistics were employed. RESULTS: Out of 100 patients evaluated, 50 patients were included. Full adherence was observed in 17 patients (34%). Reasons for non-adherence were excess PCT monitoring (54.5%), antibiotic continuation (30.3%), or both (15.2%). Of patients who were non-adherent due to antibiotic continuation, 61.5% had a positive respiratory viral panel (RVP). A total of 49 excess PCT levels were drawn, resulting in an additional $2,000 in health care costs and $15,000 in patient charges. CONCLUSIONS: Overall, the impact of our PCT monitoring protocol was difficult to evaluate due to non-adherence, but it highlights potential areas of focus for improving PCT monitoring and antimicrobial stewardship, such as inclusion of RVP results.

Resistance Training during Chemotherapy with Doxorubicin.

Previous research has shown that resistance training (RT) before doxorubicin (DOX) treatment attenuates the decline in muscle dysfunction; however, the effect of RT during DOX treatment is less known. PURPOSE: Investigate the effects of RT before and during a 4-wk course of incremental DOX treatment on skeletal muscle function. METHODS: Male, Sprague-Dawley rats (N = 36) were randomly assigned to the following groups: sedentary+saline (SED + SAL), sedentary+DOX (SED + DOX), RT + SAL, or RT + DOX. The RT protocol utilized a raised cage model, which provided progressive hindlimb loading throughout the 14-wk study, whereas SED animals were kept in normal housing. Starting at week 10, DOX-treated animals received 3 mg·kg DOX weekly for 4 wk (12 mg·kg cumulative); whereas SAL-treated groups received 0.9% NaCl as a placebo. Grip strength was recorded at 0, 10, 12, and 14 wk. Ex vivo muscle function was performed on excised soleus (SOL) and extensor digitorum longus (EDL) from the right hind limb 5 d after the last injection and were analyzed for expression of creatine kinase (CK) and creatine transporters. RESULTS: SED + DOX-treated animals had significantly lower EDL mass compared with SED + SAL- and RT + DOX-treated animals. Grip strength, EDL maximal force, and EDL force development were significantly lower in SED + DOX-treated animals compared with RT + SAL and SED + SAL. No significant differences in EDL function were found between RT + DOX and RT + SAL animals. DOX treatment reduced expression of CK in the SOL, which abated with RT. CONCLUSIONS: Low-intensity RT may attenuate the decline in skeletal muscle function during incremental DOX treatment.

Development of polymer-membrane based electrodes for suramin.

The development of a polymer membrane-based electrode to measure the anionic drug suramin in buffered saline and biological samples is described. A large non-equilibrium, steady state EMF response is observed toward suramin, and judicious choice of the polymer membrane components allows for adjustment of the dynamic range of the electrode. The optimized membrane for use in the toxic suramin range consists of 25 wt% tridodecylmethyl ammonium chloride, 55 wt% bis-2-ethylhexyl sebacate, and 20 wt% Pellethane. Although this electrode can be used to directly quantify suramin in human plasma, determination of suramin that is not affected by the background concentration of small anions is best achieved by simple potentiometric titrations with polycationic protamine monitored with a protamine-sensitive electrode.

Benzene exposure and non-Hodgkin lymphoma: a meta-analysis of epidemiologic studies.

OBJECTIVE: To conduct a meta-analysis of studies of benzene exposure and non-Hodgkin lymphoma (NHL). METHODS: A total of 8 cohort and 14 case-control studies were analyzed. RESULTS: Meta-analysis of any benzene exposure resulted in a summary relative risk estimate (SRRE) of 1.02 (95% CI: 0.94 to 1.12). The SRRE changed minimally when only data representing the highest level of benzene exposure were analyzed after an a priori data extraction protocol, using cumulative exposure as the optimum metric (SRRE = 1.08, 95% CI: 0.93 to 1.24). Meta-analysis of five studies that reported results for 60 or more ppm-years of cumulative exposure yielded an SRRE of 1.08 (95% CI: 0.36 to 3.24). Similarly, an SRRE of 1.04 (95% CI: 0.96 to 1.12) for each 25 ppm-year increment of benzene exposure was observed. CONCLUSIONS: The results from this meta-analysis are not supportive of an independent association between benzene exposure and NHL.

HIV, the clustering of sexually transmitted infections, and sex risk among African American women who use drugs.

UNLABELLED: African American women have high rates of most sexually transmitted infections (STIs), including HIV. STIs have been associated with increased HIV transmission risk. METHODS: Two hundred twenty-eight black women who used drugs completed a structured questionnaire in a central Brooklyn, NY-based research center between March 2003 and August 2005. Women were screened for HIV, herpes simplex virus-2, syphilis, gonorrhea, chlamydia, and trichomoniasis. This analysis determined if STIs cluster within individuals and if clustering and sex practices or partnerships differ by HIV status. RESULTS: Thirty-eight (17%) women tested HIV seropositive and STI prevalence was herpes simplex virus-2 (79%), trichomoniasis (37%), chlamydia (11%), and gonorrhea (2%). Few women knew themselves to be infected with STIs other than HIV. Excluding HIV, the mean number of STIs per woman was 1.3 (SD 0.7). HIV-infected women were significantly more likely than uninfected women to have multiple positive screens (1.6 vs. 1.2, P = 0.002). Women reported having both lower and higher risk sex partners. HIV-infected women were 2 times more likely than uninfected woman to report current sex work (P = 0.05), the only difference in sex risk. In a linear regression model, crack cocaine use was uniquely associated with multiple positive STI screens, excluding HIV (P = 0.002). CONCLUSIONS: Several STIs, including HIV, seem to be endemic among black women who use drugs in this community. In addition to the known geographical clustering of HIV and STIs, STIs were also found to cluster at the individual level. Multiply STI infected individuals may unknowingly, but efficiently, contribute to high STI and HIV rates.

Therapeutic radiation for lymphoma: risk of malignant mesothelioma.

BACKGROUND: Ionizing radiation has been used since the 1950s to treat a variety of cancers. Cancer patients who are treated with radiotherapy have shown increased risks for a variety of second malignancies, including mesothelioma, in several recent reports. The only existing study of Hodgkin lymphoma (HL) and subsequent mesothelioma had a short observation period. METHODS: The authors used Surveillance, Epidemiology, and End Results data over a 30-year period to identify patients with HL and non-Hodgkin lymphoma (NHL) who also were diagnosed with mesothelioma. Standardized incidence ratios (SIR) and absolute excess risks were calculated by sex and treatment modality for both types of lymphoma. RESULTS: Twenty-six patients were identified who had mesothelioma as second primaries based on 21,881 diagnoses of HL and 101,001 diagnoses of NHL. There was a statistically significant increase in mesothelioma (4 diagnoses; SIR, 6.59; 95% confidence interval [95% CI], 1.79-16.87) among men with HL who received radiation, but no women survivors were identified who had a diagnosis of mesothelioma. For NHL survivors, there was a nonsignificant excess of mesothelioma among men (SIR, 1.91; 95% CI, 0.77-3.93) and women (SIR, 3.75; 95% CI, 0.77-10.95) who had received radiation treatment. There were no increases among patients who were unirradiated. CONCLUSIONS: Mesothelioma rates for patients who had received radiotherapy were increased for survivors of HL and NHL. No increases were observed among the unirradiated. These findings and the existing body of supporting studies confirmed that radiotherapy is a cause of mesothelioma.

Sexual diversity among black men who have sex with men in an inner-city community.

Dramatic increases in HIV-incidence rates have been documented for Black men who have sex with men (MSM). Moreover, MSM has become a more visible HIV-transmission route in the Black community, in part due to public interest in the "down low" (i.e., "straight" men who also have sex with men). Interviews were conducted with 21 Black MSM in central Brooklyn, New York City, in efforts to understand the diversity of MSM experience in a low income, high HIV-prevalence community. Two thirds of the men identified as either heterosexual (43%) or bisexual (24%) and 15 (71%) MSM reported recent sex with women. Conformity to masculine social role expectations made it difficult to identify sex partners in the community; therefore, men relied on private sex clubs and the Internet. The findings suggest that stigma surrounding both HIV and homosexuality may effectively insure that nonheterosexual preferences and practices remain hidden in the Black community. A focus on sexual orientation and bisexuality has obscured the issue of race in the HIV/AIDS epidemic among Black MSM. In the long term, public health promotion and HIV prevention will require greater tolerance and acceptance of sexual diversity in the Black community.