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Wang Q, Schwartz D. RECURRENT APHTHOUS STOMATITIS AND ORAL CANDIDIASIS DUE TO STAT1 MUTATION. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wang Q, Schwartz D. HYMENOPTERA VENOM SKIN TESTING: ADOPTING AN ACCELERATED TEST METHOD. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Miller M, McMurray J, Mikita C, Schwartz D. RETROSPECTIVE REVIEW OF ORAL FOOD CHALLENGE OUTCOMES IN A MILITARY MEDICAL CENTER. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Macomb C, Schwartz D. P029 MOLD ALLERGEN IMMUNOTHERAPY: PRESCRIBING PATTERNS ACROSS A LARGE HEALTH CARE SYSTEM OVER A 20-YEAR PERIOD. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bashkin O, Davidovitch N, Asna N, Schwartz D, Dopelt K. Individual and organizational perceptions of hospital workers during COVID-19: the link with burnout. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The COVID-19 crisis poses challenges to healthcare systems and their employees. Medical staff are at the front of the battle against COVID-19. They must cope with a crisis accompanied by personal health and occupational ramifications and ongoing job stressors, which may lead to adverse mental health symptoms and may affect the quality of medical care provided to patients. This study evaluated health workers' perceptions and concerns about the COVID-19 crisis and its management in an Israeli hospital.
Methods
At the end of the pandemic's first wave in Israel, 547 healthcare workers responded to an online survey, which inquired about COVID-19 concerns at the individual and family level, perceptions at the national and organizational level, perceptions of the way the crisis was managed, self-assessment of coping with the crisis and burnout, and demographics.
Results
Findings showed that healthcare workers expressed deep concerns for family members and apprehension at a national level. Respondents noted that they were coping well with the crisis while expressing negative perceptions of how the crisis was managed. The regression model showed that concerns for family members, perceptions at the system level, working directly with COVID-19 patients, and having negative perceptions towards the crisis management at the national level, were associated with burnout.
Conclusions
The findings of this study deepen our understanding of issues that require systemic attention to strengthen mental resilience among hospital staff. Several actions are recommended to improve healthcare systems' ability to continue fighting the virus and confront future health crises:
Further examination and monitoring of healthcare workers' concerns and job stressors. Providing psychosocial support plans for frontline workers to ensure their safety and health and prevent burnout. Strengthening supportive organizational culture.
Key messages
Healthcare workers express deep concerns and perceptions associated with burnout. Health services management needs a good understanding of workers' concerns and develop strategies to address them.
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Affiliation(s)
- O Bashkin
- Public Health, Ashkelon Academic College, Ashkelon, Israel
| | - N Davidovitch
- Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - N Asna
- Oncology Institute, Ziv Medical Center, Safed, Israel
| | - D Schwartz
- Risk Management Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - K Dopelt
- Public Health, Ashkelon Academic College, Ashkelon, Israel
- Health Systems Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Lin J, Li S, Pezzi T, Mohamed A, Fuller C, Chen A, Minsky B, Schwartz D, Hernandez B, Chun S. CP01.06 Veterans Affairs Insurance Disparities for Metastatic Lung Cancer in the Hawaiian Islands. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Barajas RF, Schwartz D, McConnell HL, Kersch CN, Li X, Hamilton BE, Starkey J, Pettersson DR, Nickerson JP, Pollock JM, Fu RF, Horvath A, Szidonya L, Varallyay CG, Jaboin JJ, Raslan AM, Dogan A, Cetas JS, Ciporen J, Han SJ, Ambady P, Muldoon LL, Woltjer R, Rooney WD, Neuwelt EA. Distinguishing Extravascular from Intravascular Ferumoxytol Pools within the Brain: Proof of Concept in Patients with Treated Glioblastoma. AJNR Am J Neuroradiol 2020; 41:1193-1200. [PMID: 32527840 DOI: 10.3174/ajnr.a6600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma-associated macrophages are a major constituent of the immune response to therapy and are known to engulf the iron-based MR imaging contrast agent, ferumoxytol. Current ferumoxytol MR imaging techniques for localizing macrophages are confounded by contaminating intravascular signal. The aim of this study was to assess the utility of a newly developed MR imaging technique, segregation and extravascular localization of ferumoxytol imaging, for differentiating extravascular-from-intravascular ferumoxytol contrast signal at a delayed 24-hour imaging time point. MATERIALS AND METHODS Twenty-three patients with suspected post-chemoradiotherapy glioblastoma progression underwent ferumoxytol-enhanced SWI. Segregation and extravascular localization of ferumoxytol imaging maps were generated as the voxelwise difference of the delayed (24 hours) from the early (immediately after administration) time point SWI maps. Continuous segregation and extravascular localization of ferumoxytol imaging map values were separated into positive and negative components. Image-guided biologic correlation was performed. RESULTS Negative segregation and extravascular localization of ferumoxytol imaging values correlated with early and delayed time point SWI values, demonstrating that intravascular signal detected in the early time point persists into the delayed time point. Positive segregation and extravascular localization of ferumoxytol imaging values correlated only with delayed time point SWI values, suggesting successful detection of the newly developed extravascular signal. CONCLUSIONS Segregation and extravascular localization of ferumoxytol MR imaging improves on current techniques by eliminating intrinsic tissue and intravascular ferumoxytol signal and may inform glioblastoma outcomes by serving as a more specific metric of macrophage content compared with uncorrected T1 and SWI techniques.
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Affiliation(s)
- R F Barajas
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
- Knight Cancer Institute Translational Oncology Research Program (R.F.B. Jr)
| | - D Schwartz
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - H L McConnell
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - C N Kersch
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - X Li
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - B E Hamilton
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J Starkey
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - D R Pettersson
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J P Nickerson
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - J M Pollock
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
| | - R F Fu
- Medical Informatics and Clinical Epidemiology (R.F.F.)
| | - A Horvath
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - L Szidonya
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
- Department of Diagnostic Radiology (L.S.), Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - C G Varallyay
- From the Departments of Radiology (R.F.B. Jr, D.S., B.E.H., J.S., D.R.P., J.P.N., J.M.P., L.S., C.G.V.)
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | | | - A M Raslan
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - A Dogan
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - J S Cetas
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - J Ciporen
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - S J Han
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
| | - P Ambady
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | - L L Muldoon
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
| | | | - W D Rooney
- Advanced Imaging Research Center (R.F.B. Jr, D.S., X.L., A.H., W.D.R.)
| | - E A Neuwelt
- Departments of Neurology (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.)
- Neurological Surgery (A.M.R., A.D., J.S.C., J.C., S.J.H., E.A.N.)
- Blood-Brain Barrier Program (H.L.M., C.N.K., L.S., C.G.V., P.A., L.L.M., E.A.N.), Oregon Health & Science University, Portland, Oregon
- Portland Veterans Affairs Medical Center (E.A.N.), Portland, Oregon
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Duong MD, Schwartz D, Wang S, Broder AR, Goilav B. FRI0164 BANFF INFLAMMATORY INDICES MAY BE SUPERIOR TO THE NIH SCORING IN PREDICTING CKD PROGRESSION IN LUPUS NEPHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Chronic kidney disease/end stage renal disease (CKD/ESRD) from lupus nephritis (LN) is a major cause of morbidity and mortality. Advanced tubulointerstitial disease (TID) in LN is a better predicor of renal outcome than glomerular lesions. The current NIH classification is heavily weighted towards glomerular lesions and only provides a semiqualitative assessment of TID. In contrast, Banff classification of renal allograft pathology provides 6 reproducible scores for TID (inflammation, fibrosis, atrophy). Banff scoring may better predict CKD/ESRD in LN than NIH scoresObjectives:We compared Banff grading vs. NIH scoring as predictors of CKD progression at 5 years, defined as a decline in estimated glomerular filtration rate (eGFR) ≥30%, a strong risk factor for ESRD and mortalityMethods:We included patients with LN class III, IV, V on the index biopsy Jan 2005 and Dec 2018. H&E/PAS stained slides were reviewed and scored by an experienced pathologist. Six TID Banff scores (0/1 vs. 2/3), NIH activity/chronicity (AI/CI) and NIH interstitial fibrosis/tubular atrophy (IF/TA), tubulointerstitial inflammation (TII) scores (none/mild vs. moderate/severe) were evaluated as predictors of CKD progression using survival analysesResults:Of the 125 patients, 46 had CKD progression and 20 subsequently developed ESRD. There were no differences between progressors and non-progressors in terms of baseline demographic, clinical data, LN class (Tab 1). Banff ti score (total inflammation) was associated with CKD progression in bivariate and time-dependent analyses. However, NIH TII score and corresponding Banff i score were not predictive (Tab 2, Fig 1). Overall NIH AI and CI were not predictive of CKD progression. Moderate/severe NIH IF/TA was associated with CKD progression as was Banff ci (interstitial fibrosis) score (Tab 2, Fig 2). Banff score for atrophy was not predictive. In a subset of 92 patients with baseline eGFR≥60ml/min/1.73m2only Banff ti score (but not i score or NIH TII, IF/TA) was predictive of CKD progression (Fig 1)Table 1.Baseline data in patients with/without CKD progressionProgressors1n=46Non-progressorsn=79pn (%) or median (IQR)Female36 (78)69 (87)0.18Age (years)26 (20-41)29 (21-43)0.53<18 years7 (15)13 (16)0.86Race0.82 White4 (9)4 (5) Black18 (39)35 (44) Asian1 (2)1 (1) Unknown23 (50)39 (50)Diabetes5 (11)3 (4)0.12Hypertension33 (72)55 (70)0.8eGFR ml/min/1.73m296.1 (56.6-117.8)88.9 (47-117)0.51C3 mg/dL71 (52-88)67.5 (43-94)0.58C4 mg/dL12.65 (9-23)12 (7-20)0.48Anti-ds DNA titer IU108.7(36.6-194.9)151.3(39.2-200)0.57Total SLEDAI11 (8-16)12 (8-16)0.47Renal SLEDAI8 (4-12)8 (4-12)0.9LNProliferative GN2: III, IV18 (39)30 (38)0.15Nonproliferative GN: V9 (20)27 (34)Mixed GN: V and III/IV19 (41)22 (28)1Progressors: LN patients with eGFR decline ≥30% within 5 years.2GN: glomerulonephritisTable 2.NIH and Banff scores with/without progressorsProgressorsn=46Non-progressorsn=79pn (%) or median (IQR)NIHOverall AI1 (0-4)1 (0-3)0.61AI ≥ 111 (2)3 (3.8)0.62Overall CI3 (0-5)2 (0-3)0.33CI ≥ 324 (52)28 (35.4)0.07Moderate/severe TII7 (15.2)4 (5)0.05Moderate/severe IF/TA16 (35)15 (19)0.049BanffTubulitis: t00Interstitial inflammation: i 2/33 (6.5)5 (6.3)0.9Total inflammation: ti 2/316 (34.8)12 (15.2)0.01Tubular atrophy: ct 2/316 (34.8)16 (20.3)0.07Interstitial fibrosis: ci 2/317 (37)15 (19)0.03Inflammation in area of interstitial fibrosis and/or tubular atrophy: i-IFTA 2/3n=26*18 (69)n=51*25 (49)0.09* Biopsy number is smaller due to inability to apply score to biopsies without areas of fibrosis/tubular atrophyConclusion:Banff inflammation scores may be superior predictors of CKD/ESRD progression at 5 years, compared to the currently used NIH classification. Detection of inflammation by Banff scores may allow earlier interventions to prevent ESRDDisclosure of Interests:None declared
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Nakase-Richardson R, Dismuke-Greer C, Jeanne H, Drashser-Phillips L, Schwartz D, Calero K, Bogner J, Whyte J, Almeida E, Ketchum J, Magalang U. 1177 Cost Effectiveness Of Diagnostic Approaches To Sleep Apnea Evaluation During Inpatient Rehabilitation For Moderate To Severe TBI. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent work has highlighted prevalent obstructive sleep apnea (OSA) after traumatic brain injury (TBI) when patients are vulnerable to disruption of neural repair. The recently completed clinical trial comparing screening and diagnostic tools for OSA during inpatient rehabilitation provided the opportunity to conduct economic modeling of phased approaches using actual trial findings to address one perspective (the payor) on the value of phased testing.
Methods
A cost-effectiveness analysis of four phased approaches to OSA diagnosis including initial utilization of portable sleep monitoring [HSAT] regardless of pre-test probability, determination of pre-test probability using two prediction models [STOPBANG, MAPI], and initial assessment using Level 1 polysomnography was conducted. The analyses were modeled assuming all participants were considered high risk thus a negative screen or portable diagnostic test would result in a participant being referred for Level 1 polysomnography. The cost aversion used in analyses were derived from a recent white paper on the economic modeling of untreated OSA. Trial data from 214 participants were used in analyses (mean age 44 [SD 18], 82% male, 75% white, with primarily motor-vehicle related injury [44%] and falls [33%] with a sample mean emergency department Glasgow Coma Scale of 8 (SD 5).
Results
At AHI ≥15 (33.6%), the prediction models (STOPBANG [-$5,291], MAPI [-$5,262]) resulted in greater cost savings and effectiveness relative to the HSAT approach (-$5,210) and initial use of Level 1 PSG (-$5,011). Sensitivity analyses at AHI ≥5 (70.1%) revealed the initial use of HSAT (-$6,322.85) relative to the prediction models (MAPI [-$6,249.71], STOPBANG [-$6,237) and initial assessment with Level 1 PSG (-$5,977) resulted in greater savings and cost effectiveness.
Conclusion
The high rates of sleep apnea after TBI highlight the importance of accurate diagnosis and treatment of this comorbid disorder. However, financial and practical barriers exist to obtaining an earlier diagnosis during inpatient rehabilitation hospitalization. Diagnostic cost savings are demonstrated across all phased approaches and OSA severity levels with the most cost-effective approach varying by incidence of OSA.
Support
PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).
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Affiliation(s)
| | | | - H Jeanne
- University of Washington, Seattle, WA
| | | | - D Schwartz
- James A. Haley Veterans Hospital, Tampa, FL
| | - K Calero
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - J Bogner
- Departrment of PMR, Ohio State University, Columbus, OH
| | - J Whyte
- Moss Rehabilitation Research Institute, Philadelphia, PA
| | - E Almeida
- Craig Hospital Department of Research, Denver, CO
| | - J Ketchum
- Craig Hospital Department of Research, Denver, CO
| | - U Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine and Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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Drasher-Phillips L, Schwartz D, Ketchum J, O’Connor D, Calero K, Diaz-Sein C, Wharton L, Almeida E, Dahdah M, Bell K, Nakase-Richardson R. 1136 Polysomnography Is Feasible During Inpatient TBI Rehabilitation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
A recent meta-analytic report highlighted that obstructive sleep apnea was 12 times more prevalent in TBI (mixed severity) than in community-based samples. Recent studies highlight prevalent obstructive sleep apnea during acute inpatient rehabilitation which is a time of critical neural repair. Acute sleep disturbances are associated with therapy cooperation due to effects on daytime sleepiness and are associated with key rehabilitation outcomes. Given the high rates of OSA and risk for negative morbidity, this analysis sought to examine the feasibility of administering polysomnography (PSG) with EEG to diagnose sleep apnea during inpatient rehabilitation in persons with moderate to severe TBI.
Methods
This is a secondary analysis from a prospective diagnostic comparative effectiveness clinical trial (NCT03033901) that took place at six NIDILRR and one VA TBI Model System Centers. Participants were included if they met the TBI Model System case definition and slept at least 2 hours per night prior to PSG. PSG was conducted following AASM procedures in the participant’s hospital bed on the inpatient rehabilitation unit. Studies were scored by RPSGT staff and interpreted by a board certified sleep medicine physician at a centralized sleep scoring center in Tampa, FL.
Results
Of 896 potential TBI participants, 449 met initial eligibility and 345 consented for further screening; a final sample of 263 (76%) completed PSG during hospitalization. Primary reasons for not completing PSG included early discharge or medical instability (n=59) and last-minute withdrawal of consent for PSG (n=23). Of the 263 participants who completed PSG, 3 were excluded from analysis due to technical issues and 12 were excluded as the total sleep time (TST) was less than 120 minutes. Of the 248, 85.5% of the PSGs were rated as interpretable/scoreable by RPSGT and sleep physicians.
Conclusion
For a majority of participants, polysomnography is feasible during inpatient rehabilitation. Participants with shorter lengths of stay, medical instability, prolonged agitation may require polysomnography follow-up after discharge.
Support
Supported by PCORI (CER-1511-33005), VA TBIMS, DVBIC with subcontract from GDIT/GDHS (W91YTZ-13-C-0015, HT0014-19-C-0004), and NIDILRR (90DPTB00070, 90DPTB00130100, 90DPTB0008, 90DPT8000402, 90DPTB0001).
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Affiliation(s)
| | - D Schwartz
- James A. Haley Veterans’ Hospital, Tampa, FL
| | | | - D O’Connor
- James A. Haley Veterans’ Hospital, Tampa, FL
| | - K Calero
- James A. Haley Veterans’ Hospital, Tampa, FL
- Department of Internal Medicine, Morasani College of Medicine, University of South Florida, Tampa, FL
| | - C Diaz-Sein
- James A. Haley Veterans’ Hospital, Tampa, FL
| | - L Wharton
- James A. Haley Veterans’ Hospital, Tampa, FL
| | | | - M Dahdah
- Baylor Scott & White Medical Center, Plano, TX
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX
| | - K Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | - R Nakase-Richardson
- James A. Haley Veterans’ Hospital, Tampa, FL
- Department of Internal Medicine, Morasani College of Medicine, University of South Florida, Tampa, FL
- Defense and Veterans Brain Injury Center, Tampa, FL
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Richardson R, Schwartz D, Drasher-Phillips L, Ketchum J, Calero K, Dahdah M, Monden K, Bell K, Hoffman J, Magalang U, Bogner J, Whyte J, Zeitzer J. 0606 Comparative Effectiveness of Sleep Apnea Screening Tools During Inpatient Rehabilitation for Moderate to Severe TBI. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent studies highlight prevalent obstructive sleep apnea after moderate to severe TBI during a time of critical neural repair. The purpose of this study is to determine the diagnostic sensitivity, specificity and comparative effectiveness of traditional sleep apnea screening tools in TBI neurorehabilitation admissions.
Methods
This is a prospective diagnostic comparative effectiveness trial of sleep apnea screening tools (STOPBANG, Berlin, MAPI [Multi-Apnea Prediction Index]) relative Level 1 polysomnography at six TBI Model System Inpatient Rehabilitation Centers. Between 05/2017 and 02/2019, 449 of 896 screened were eligible for the trial with 345 consented (77% consented). Additional screening left 263 eligible for and completing polysomnography with final analyses completed on 248. The primary outcome was the Area Under the Curve (AUC) of screening tools relative to total apnea hypopnea index ≥15 (AHI, moderate to severe apnea) measured at a median of 47 days post-TBI (IQR 29-47).
Results
Participants were primarily young to middle age (AGE IQR 28,40,59), male (81%), white (74%), and had primarily severe TBI (IQR GCS 3,6,14). A subset (26%) had a history of military service. Results revealed that the Berlin high risk score (ROC-AUC=0.63) was inferior to the MAPI (ROC-AUC = 0.7802) (p=.0211, CI: 0.0181, 0.2233) and STOPBANG (ROCAUC = 0.7852) (p=.0006, CI: 0.0629, 0.2302); both of which had comparable AUC (p=.7245, CI: -0.0472, 0.0678). Findings were similar for AHI≥30 (severe apnea); however, no differences across scales was observed at AHI>5. The pattern was similar across TBI severity subgroups except for delirium or post-traumatic amnesia status wherein the MAPI outperformed the Berlin and STOPBANG. Youden’s Index to determine risk yielded lower sensitivities but higher specificities relative to non-TBI samples.
Conclusion
This study is the first to provide clinicians with data to support a choice for which sleep apnea screening tools are more effective during inpatient rehabilitation for moderate to severe TBI (STOPBANG, MAPI vs Berlin) to help reduce comorbidity and possibly improve neurologic outcome.
Support
PCORI (CER-1511-33005), GDHS (W91YTZ-13-C-0015; HT0014-19-C-0004)) for DVBIC, NIDILRR (NSDC Grant # 90DPTB00070, #90DP0084, 90DPTB0013-01-00, 90DPTB0008, 90DPT80004-02).
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Affiliation(s)
| | - D Schwartz
- Medicine Service, James A. Haley Veterans’ Hospital, Tampa, FL
| | | | - J Ketchum
- Research Department, Craig Hospital, Denver, CO
| | - K Calero
- Medicine Service, James A. Haley Veterans’ Hospital, Tampa, FL
| | - M Dahdah
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX; Baylor Scott & White Medical Center, Dallas, TX
| | | | - K Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX
| | - J Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - U Magalang
- Division of Pulmonary, Critical Care, and Sleep Medicine and Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - J Bogner
- Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH
| | - J Whyte
- Moss Rehabilitation Research Institute, Albert Einstein Healthcare Network, Philadelphia, PA
| | - J Zeitzer
- Psychiatry and Behavioral Service, Stanford University, Palo Alto, CA
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12
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Manetta I, Almeida A, Schwartz D, Meira e Cruz M. 1272 Control of Sleep-Associated Respiratory Distress with a Mandibular Advancement Oral Appliance in an Unusual Case of a Patient with a Mild Rather Persistent Nocturnal Baseline Hypoventilation/Hypoxia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Normal respiratory function is crucial for adequate sleep. Sleep Related Breathing Disorders, namely Obstructive Sleep Apnea (OSA) are frequent conditions among a large spectrum of obstructive events in the upper airway which are often linked to significant sleep related oxyhemoglobin dessaturation levels compared to those observed in baseline PSG-oximetry recorded. On the other hand, low baseline oxygen saturation (LBOS) is commonly linked to symptomatic cardiorespiratory disturbances which may adversely impact respiratory outcomes either awake or during sleep. Therefore it is relevant to be aware of the baseline ventilatory status in order to optimize the therapeutic care.
Report of Case
We present an unusual case of a patient with moderate OSA which was successfully controlled with a Mandibular Advancement Oral Appliance (OAm). Despite the control with the OAm, the patient still maintained a nocturnal pattern of hypoventilation/hypoxia. The 53 yo female patient with normal weight/height ratio (BMI=25,2) complaining of non restorative sleep, tiredness, impaired memory, excessive diurnal sleepiness (Epworth Sleepiness Scale - ESS=10 and bruxism with a PSG diagnosis of moderate OSA (BaselineO2Sat=94%; IAH=17,4 ev/h; ODI=32,9 ev/h; T90=34,7% of TST) was referred for treatment with a OAm. A PM Type 1 positioner was inserted and titrated until 12 mm of advancement (80% of maximal measured protrusion). Within 6 months follow up and after clinical titration, there was a clear symptomatic and objective improvement with resolution of all major complaints including sleepiness (ESS=5). Titration PSG showed a normalization in all parameters (IAH=1,4 ev/h;ODI=4 ev/h;T90=0,1% of TST). Baseline O2 Sat however remained low (93%) in the titration PSG even though no symptoms or signs of a disorder existed even after discounting for Ph related metabolic changes (normal levels of HCO3)
Conclusion
This is an interesting case of an unusual patient who presented with a LBOS level in the diagnostic PSG. Despite the therapeutic success of the OAm in controlling the sleep related respiratory condition, measured by all otherwise normalized PSG based sleep and respiratory parameters, maintained a LBOS in the titration PSG without any signs or symptoms of disease.
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Affiliation(s)
- I Manetta
- Pontifical Catholic University of Campinas, Campinas, BRAZIL
| | - A Almeida
- School of Medical Science, Campinas State University, Campinas, BRAZIL
| | | | - M Meira e Cruz
- Sleep Unit, Cardiovascular Center of University of Lisbon, Lisbon School of Medicine, Lisbon, PORTUGAL
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13
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Schwartz D, Peyrin-Biroulet L, Lasch K, Adsul S, Danese S. P476 Efficacy and safety of 2 vedolizumab IV regimens in patients with perianal fistulising Crohn’s disease: results of the ENTERPRISE study. J Crohns Colitis 2020. [DOI: 10.1093/ecco-jcc/jjz203.605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Abstract
Background
Perianal fistulae occurring with Crohn’s disease (CD) are a challenge to treat. Vedolizumab (VDZ) is a gut-selective, monoclonal α 4β7 integrin antibody approved to treat patients (patients) with moderately to severely active CD. Here we report results from ENTERPRISE (NCT02630966; EudraCT 2015-000852-12), a randomised, double-blind, phase 4 trial to evaluate 2 VDZ IV dosing regimens in patients with fistulising CD.
Methods
Patients with moderately to severely active CD and 1–3 draining perianal fistulae received either VDZ 300 mg IV at Weeks (Week) 0, 2, 6, 14, and 22 (VDZ), or the same regimen plus an additional VDZ dose at Wk10 (VDZ+Wk10). The primary endpoint was the proportion of patients with a ≥50% reduction from baseline (BL) in the number of draining fistulae (absence of draining despite gentle finger compression) at Wk30. Secondary endpoints were the proportion of patients with a ≥50% reduction from BL in the number of draining fistulae at Wk22 and Wk30, and the proportion of patients with 100% fistulae closure at Wk30. Patients with missing data at study visits were counted as non-responders. Perianal disease activity index (PDAI), perianal pain score, Van Assche score, gadolinium contrast enhancement by pelvic MRI, and safety were assessed. Study enrolment closed early due to slow recruitment; thus, all analyses are descriptive.
Results
Of the 32 patients with post-BL assessment of fistulae healing (full analysis set, FAS), 28 had ≥1 draining fistula at BL (modified FAS). Median CD duration was 8.5 years (VDZ [n = 14]: 11.2 years; VDZ+ Week 10 [n = 14]: 6.1 years). In each arm, 11 patients (78.6%) had prior anti-tumour necrosis factor therapy at BL; concomitant corticosteroid use was 21.4% (VDZ) and 14.3% (VDZ+ Week 10), and concomitant immunosuppressant use was 28.6% (VDZ) and 21.4% (VDZ+ Week 10). At Wk30, 53.6% of all patients achieved ≥50% decrease in the number of draining fistulae (VDZ: 64.3%; VDZ+ Week 10: 42.9%; Figure 1). The proportion of patients with fistulae response increased rapidly and remained high through Week 30 (Figure 2); 46.4% of patients (VDZ: 57.1%; VDZ+Week 10: 35.7%) achieved ≥50% decrease in the number of draining fistulae at both Weeks 22 and 30. Closure of all fistulae draining at BL was observed at Week 30 in 42.9% of patients (VDZ: 50.0%; VDZ+ Week 10: 35.7%). In the FAS, mean (SD) PDAI scores changed from BL to Weeks 30–4.1 (3.3) and perianal pain scores changed –2.2 (2.7) (table). At Wk30, mean (SD) Van Assche scores and contrast enhancement scores changed –1.1 (3.1) and –9.5 (69.4) from screening, respectively. No new safety signals were observed.
Conclusion
Over half of CD patients treated with VDZ had reductions of ≥50% in the number of draining perianal fistulae. Clinically relevant reductions in draining fistulae were seen as early as Wk2 and maintained through Wk30.
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Affiliation(s)
- D Schwartz
- Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, USA
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Nancy, France
| | - K Lasch
- Medical Affairs, Takeda Pharmaceuticals USA, Deerfield, USA
| | - S Adsul
- Takeda Pharmaceuticals International AG, Chief Medical Office- Global Medical Affairs, Zurich, Switzerland
| | - S Danese
- Department of Gastrointestinal Immunopathology, Humanitas University, Milan, Italy
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14
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Abstract
A 3-year-old, male intact, pet inland bearded dragon (Pogona vitticeps) presented with a history of diarrhea, progressive inappetence and weight loss. A palpable cranial celomic mass was identified on physical examination and confirmed to be hepatic in origin by celomic ultrasonography. Hematologic and biochemical abnormalities were mild and consistent with inflammation, regenerative anemia, and hepatocellular injury. Fine needle aspiration of the liver masses was suggestive of amoebiasis and the patient was humanely euthanized. PCR and Sanger DNA sequencing of liver aspirates were supportive of Entamoeba infection, although definitive speciation was not possible. Pathogenic amoebiasis due to infection by E. invadens has been reported in a wide range of reptiles and is an important cause of morbidity and mortality in these species.
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Affiliation(s)
- Diana Schwartz
- Kansas State University, College of Veterinary Medicine, Department of Diagnostic Medicine/Pathobiology, Manhattan, Kansas, USA
| | - Ibne Ali
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shantanu Roy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Pohlman
- Kansas State University, College of Veterinary Medicine, Department of Diagnostic Medicine/Pathobiology, Manhattan, Kansas, USA
| | - Brandy Kastl
- Kansas State University, College of Veterinary Medicine, Department of Diagnostic Medicine/Pathobiology, Manhattan, Kansas, USA
| | - David Eshar
- Kansas State University, College of Veterinary Medicine, Department of Clinical Sciences, Manhattan, Kansas, USA
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15
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Schwartz D, Guzman DSM, Beaufrere H, Ammersbach M, Paul-Murphy J, Tully TN, Christopher MM. Morphologic and quantitative evaluation of bone marrow aspirates from Hispaniolan Amazon parrots (Amazona ventralis). Vet Clin Pathol 2019; 48:645-651. [PMID: 31701548 DOI: 10.1111/vcp.12799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/01/2019] [Accepted: 04/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bone marrow aspirate assessments provide valuable information about hematopoietic status and hematologic disease. Hematopoietic cell differentials and morphologies have been anecdotally described in psittacines, but quantitative studies are lacking. OBJECTIVES We aimed to determine differential cell counts and calculate granulocyte:erythroid (G:E) ratios in bone marrow aspirates from Hispaniolan Amazon parrots and report representative morphologies of the hematopoietic cells. METHODS Bone marrow aspirates were collected from 32 clinically healthy, captive, parrots. Peripheral blood was obtained for CBCs. Bone marrow differential cell counts (%) were determined by counting 500 cells on modified Wright's-stained smears. G:E ratios were calculated. Representative images of hematopoietic cells at all stages of development were taken. RESULTS Of the 32 parrots sampled, 17 bone marrow samples were of sufficient cellularity and quality for evaluation. Erythroid cells comprised 68.9 ± 8.6% (total ± SD) of the hematopoietic cells and consisted primarily of early- and late-stage polychromatophilic rubricytes (43.6 ± 2.1% of total erythroid cells). Granulocytic cells comprised 28.1 ± 3.8% of the hematopoietic cells and consisted primarily of mature and band heterophils (11.9 ± 5.2% and 6.5 ± 3.4%, respectively, of total granulocytic cells). A unique morphologic finding in avian progranulocytes was the presence of multiple different granules. The G:E ratio was 0.4 ± 0.2 (median 0.4, range 0.1-0.9). Thrombocyte lineage cells could not be reliably identified and were not counted. CBC results were largely within expected limits. CONCLUSIONS The low G:E ratios observed could be normal in this species; however, these ratios could be affected by factors related to sampling and cell identification. These findings will be a valuable resource for the diagnostic evaluation of clinical bone marrow samples from Hispaniolan Amazon parrots and could serve as a general reference for psittacine bone marrow evaluation.
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Affiliation(s)
- Diana Schwartz
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - David Sanchez-Migallon Guzman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Hugues Beaufrere
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | | | - Joanne Paul-Murphy
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
| | - Thomas N Tully
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Mary M Christopher
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA
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16
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Chun S, Pezzi T, Schwartz D, Pisters K, Mohamed A, Welsh J, Chang J, Liao Z, Gandhi S, Byers L, Minsky B, Hahn S, Fuller C. PD01.20 Medicaid Outcome Inequalities in Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Halperin L, Liew J, Kong D, Levin A, Krahn A, Schwartz D, Laksman Z. ANTICOAGULATION FOR PATIENTS WITH ATRIAL FIBRILLATION AND END STAGE RENAL FAILURE ON DIALYSIS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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18
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Oakes VJ, Yabsley MJ, Schwartz D, LeRoith T, Bissett C, Broaddus C, Schlater JL, Todd SM, Boes KM, Brookhart M, Lahmers KK. Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA. Emerg Infect Dis 2019; 25:1653-1659. [PMID: 31237835 PMCID: PMC6711211 DOI: 10.3201/eid2509.190088] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Theileria orientalis Ikeda genotype is a parasite that causes a disease in cattle that results in major economic issues in Asia, New Zealand, and Australia. The parasite is transmitted by Haemaphysalis longicornis ticks, which have recently been reported in numerous states throughout the eastern United States. Concurrently, cattle in Virginia showed clinical signs consistent with a hemoprotozoan infection. We used amplicons specific for the major piroplasm surface protein and small subunit rDNA of piroplasms to test blood samples from the cattle by PCR. Bidirectional Sanger sequencing showed sequences with 100% identity with T. orientalis Ikeda genotype 2 sequences. We detected the parasite in 3 unrelated herds and from various animals sampled at 2 time points. Although other benign T. orientalis genotypes are endemic to the United States, detection of T. orientalis Ikeda genotype might represent a risk for the cattle industry in Virginia.
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19
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Huckins GL, Eshar D, Schwartz D, Morton M, Herrin BH, Cerezo A, Yabsley MJ, Schneider SM. Trypanosoma cruzi infection in a zoo-housed red panda in Kansas. J Vet Diagn Invest 2019; 31:752-755. [PMID: 31342874 DOI: 10.1177/1040638719865926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 9-y-old, zoo-housed, male red panda (Ailurus fulgens) became progressively lethargic and inappetent over a 1-wk period. Physical examination was unremarkable. A complete blood count showed mild normocytic, normochromic, non-regenerative anemia with the presence of trypomastigote organisms, consistent with a Trypanosoma sp. The organism was confirmed later as Trypanosoma cruzi lineage TcI via PCR and genome sequencing. The panda was initially treated supportively; however, its clinical status within 24 h from presentation deteriorated, and euthanasia was elected. Autopsy showed severe systemic T. cruzi infection with the presence of amastigotes in the heart, brain, peripheral nerves, skeletal muscles, tongue, liver, and testes. We used genome sequencing and serology in identifying the agent.
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Affiliation(s)
- Gail L Huckins
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
| | - David Eshar
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
| | - Diana Schwartz
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
| | - Mark Morton
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
| | - Brian H Herrin
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
| | - Argine Cerezo
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
| | - Michael J Yabsley
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
| | - Sarah M Schneider
- Departments of Clinical Sciences (Huckins, Eshar), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Diagnostic Medicine/Pathobiology (Schwartz, Morton, Herrin, Cerezo, Schneider), College of Veterinary of Medicine, Kansas State University, Manhattan, KS.,Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA (Yabsley)
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20
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Lellouche J, Schwartz D, Elmalech N, Ben Dalak MA, Temkin E, Paul M, Geffen Y, Yahav D, Eliakim-Raz N, Durante-Mangoni E, Iossa D, Bernardo M, Daikos GL, Skiada A, Pantazatou A, Antoniadou A, Mouton JW, Carmeli Y. Combining VITEK ® 2 with colistin agar dilution screening assist timely reporting of colistin susceptibility. Clin Microbiol Infect 2018; 25:711-716. [PMID: 30291971 DOI: 10.1016/j.cmi.2018.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The rise in carbapenem resistance among Gram-negative bacteria has renewed interest in colistin. Recently, the EUCAST-CLSI Polymyxin Breakpoints Working Group declared that broth microdilution (BMD) is the only valid method for colistin susceptibility testing. BMD is not easily incorporated into the routine work of clinical laboratories, and usually this test is incorporated serially, resulting in delayed susceptibility reporting. We tested a strategy of combining VITEK® 2 with a 2 μg/mL colistin agar dilution (VITEK® 2/AD) screening plate to improve performance and time to reporting of colistin susceptibility. METHODS Colistin susceptibility for 364 clinical isolates was determined by VITEK® 2/AD and compared with the reference standard BMD according to the ISO 20776-1:2007 and CLSI guidelines. The EUCAST colistin susceptibility breakpoint of ≤2 μg/mL was used. Escherichia coli NCTC 13846 served as quality control strain. Agreement, very major error (VME) and major error rates were determined using ISO 20776-2:2007. RESULTS The VME rate for VITEK® 2 alone was 30.6% (15/49, 95% CI 18.3-45.4%), and was reduced to 10.2% (5/49, 95% CI 3.4-22.2%) using the VITEK® 2/AD combined testing. The combined testing had categorical agreement with BMD of 97% (354/364, 95% CI 95.0-98.7%), and a major error (ME) rate of 1.6% (5/315, 95% CI 0.5-3.7%). Using the combined testing, even against challenging strains, 349 (95.8%, 95% CI 93.3-97.7%) colistin susceptibility results could be reported, and only 15 isolates required further analysis by BMD. DISCUSSION Our method is simple to apply and allows rapid reporting of colistin susceptibility.
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Affiliation(s)
- J Lellouche
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel.
| | - D Schwartz
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - N Elmalech
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - M A Ben Dalak
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - E Temkin
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel
| | - M Paul
- Institute of Infectious Diseases, Rambam Health Care Campus, Israel; Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Y Geffen
- Clinical Microbiology Laboratory, Rambam Health Care Campus, Haifa, Israel
| | - D Yahav
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - N Eliakim-Raz
- Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel; Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - E Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - D Iossa
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - M Bernardo
- Department of Precision Medicine, University of Campania 'L Vanvitelli' and AORN dei Colli-Monaldi Hospital, Napoli, Italy
| | - G L Daikos
- First Department of Medicine, Laikon General Hospital, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - A Skiada
- First Department of Medicine, Laikon General Hospital, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - A Pantazatou
- National and Kapodistrian University of Athens, Athens, Greece; Clinical Microbiology Laboratory, Laikon General Hospital, Greece
| | - A Antoniadou
- National and Kapodistrian University of Athens, Athens, Greece; Fourth Department of Medicine, Attikon University General Hospital, Athens, Greece
| | - J W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Y Carmeli
- Molecular Epidemiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; National Laboratory for Antibiotic Resistance and Investigation of Outbreaks in Medical Institutions, National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel
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21
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Svetitsky S, Baruch R, Schwartz IF, Schwartz D, Nakache R, Goykhman Y, Katz P, Grupper A. Long-Term Effects of Pregnancy on Renal Graft Function in Women After Kidney Transplantation Compared With Matched Controls. Transplant Proc 2018; 50:1461-1465. [PMID: 29880371 DOI: 10.1016/j.transproceed.2018.02.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND An important benefit associated with kidney transplantation in women of child-bearing age is increased fertility. We retrospectively evaluated the maternal and fetal complications and evolution of graft function associated with 22 pregnancies post-kidney and kidney-pancreas transplantation, compared with controls without pregnancy post-transplantation, who were matched for gender, year of transplantation, type of donor, age at transplantation, number of transplants, type of transplant (kidney vs kidney-pancreas), and cause of native kidney failure, as well as for renal parameters including serum creatinine and urine protein excretion 1 year before delivery. RESULTS The mean age at time of transplantation was 22.32 (range, 19.45-33.1) years. The mean interval between transplantation and delivery was 75.7 (range, 34-147.8) months. Main maternal complications were pre-eclampsia in 27.3%. The main fetal complications included delayed intrauterine growth (18.2%), preterm deliveries (89.4%), and one death at 3 days postdelivery. The mean serum creatinine level pre-pregnancy was 1.17 (range, 0.7-3.1) mg/dL. Graft failure was higher in the pregnancy group (6 vs 3) but did not differ statistically from the control group, and was associated with creatinine pre-pregnancy (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.15-3.45; P = .04), age at transplantation (1.13 [1.03-1.21]; P = .032), and time of follow-up (2.14 [1.27-2.98]; P = .026). Delta serum creatinine was not different in both groups: 1.05 ± 0.51 versus 0.99 ± 0.92 mg/dL, study versus control group, respectively (P = .17). CONCLUSION Pregnancy after kidney transplantation is associated with serious maternal and fetal complications. We did not observe a significantly increased risk of graft loss or reduced graft function in comparison with recipients with similar clinical characteristics.
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Affiliation(s)
- S Svetitsky
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Baruch
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I F Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - D Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Nakache
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Goykhman
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Katz
- Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Grupper
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Organ Transplantation Unit, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Eshar D, Gardhouse SM, Schwartz D, Beaufrere H. Reference Intervals for Plasma Biochemical Variables by Point-of-Care Testing in Captive Black-tailed Prairie Dogs (Cynomys ludovicianus). J Am Assoc Lab Anim Sci 2018; 57. [PMID: 30208991 PMCID: PMC6241388 DOI: 10.30802/aalas-jaalas-18-000021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/08/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
Black-tailed prairie dogs (Cynomys ludovicianus) are kept in zoological collections, maintained as companion pets, and aretested in field and laboratory settings. Biochemical analysis for routine health and research purposes can be performed byusing point-of-care (POC) testing; however, analyzer- and species-specific reference intervals need to be determined. In this prospective study, 50 captive-raised sexually intact prairie dogs (16 females, 34 males) underwent plasma biochemical analysisby using a veterinary POC biochemical analyzer. We used a manufacturer-predetermined profile of 14 analytes: albumin, ALP,ALT, amylase, BUN, calcium, creatinine, glucose, potassium, sodium, phosphorus, total bilirubin, total protein and globulin.A subset of 17 samples was tested concurrently for the same 14 analytes by using a reference laboratory analyzer, and wedetermined RI for the POC analyzer for these 14 biochemical analytes. Sex had a significant effect on albumin and creatininevalues, which were higher in females than males, and on ALT, which was lower in females. In addition, age had an effect on9 plasma analytes: juvenile animals had higher plasma concentrations of albumin, ALP, ALT, BUN, and glucose than adultanimals, whereas adults had higher concentrations of creatinine, sodium, total protein, and globulins. Only calcium and BUNhad acceptable analytical agreement between the POC and reference analyzers. The reference intervals determined in this study can aid clinicians and researchers performing POC plasma biochemical analysis in prairie dogs, providing that they consider potential analyzer-, sex-, and age-related effects.
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Affiliation(s)
- David Eshar
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas
| | - Sara M Gardhouse
- Health Sciences Center, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Diana Schwartz
- The Department of Diagnostic Medicine–Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas; and
| | - Hugues Beaufrere
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
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Ricketti P, Schwartz D, Calero K, Anderson W, Diaz-Sein C, Rechkemmer M, Bell K, Dahdad M, Nakase-Richardson R. 1031 A Multicenter Study Examining Two Scoring Algorithms for Diagnosis of Obstructive Sleep Apnea (OSA) in an Acute Neurorehabilitation Population with Traumatic Brain Injury (TBI). Sleep 2018. [DOI: 10.1093/sleep/zsy061.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Ricketti
- University of South Florida Morsani College of Medicine, Tampa, FL
- Section of Sleep Medicine, Department of Internal Medicine, Tampa, FL
| | - D Schwartz
- University of South Florida Morsani College of Medicine, Tampa, FL
- Section of Sleep Medicine, Department of Internal Medicine, Tampa, FL
| | - K Calero
- University of South Florida Morsani College of Medicine, Tampa, FL
- Section of Sleep Medicine, Department of Internal Medicine, Tampa, FL
| | - W Anderson
- University of South Florida Morsani College of Medicine, Tampa, FL
- Section of Sleep Medicine, Department of Internal Medicine, Tampa, FL
| | - C Diaz-Sein
- Section of Sleep Medicine, Department of Internal Medicine, Tampa, FL
| | - M Rechkemmer
- Center for Innovation on Disability and Rehabilitation Research, Tampa, FL
| | - K Bell
- North Texas Traumatic Brain Injury Model System, Dallas, TX
- University of Texas Southwestern Medical Center, Dallas, TX
| | - M Dahdad
- North Texas Traumatic Brain Injury Model System, Dallas, TX
- Baylor Institute for Rehabilitation Institute, Dallas, TX, Dallas, TX
- Baylor Scott & White Medical Center - Plano, United States of America, Dallas, TX
| | - R Nakase-Richardson
- University of South Florida Morsani College of Medicine, Tampa, FL
- Center for Innovation on Disability and Rehabilitation Research, Tampa, FL
- Mental Health and Behavioral Sciences, Tampa, FL
- Defense and Veterans Brain Injury Center, James A. Haley Veterans Affairs Medical Center, Tampa, FL, Tampa, FL
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Jaberi A, Schwartz D, Marticorena R, Dacouris N, Prabhudesai V, Mcfarlane P, Donnelly S. Risk Factors for the Development of Cephalic Arch Stenosis. J Vasc Access 2018. [DOI: 10.1177/112972980700800412] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The creation of a vascular access is necessary in hemodialysis patients, including those with marginal vessels. Upper arm fistulae are attractive due to the ease of creation and of achieving high access flow rates. Cephalic arch stenosis (CAS) can lead to failure of upper arm fistulae and is increasingly identified. We hypothesized that CAS is promoted by high blood flow rates, brachiocephalic fistulae, and an angle of cephalic vein insertion approaching 90 degrees. Methods All patients requiring a fistulogram between January 2004 and May 2006 had surveillance fluoroscopy of the central veins. Demographic, clinical and laboratory parameters were collected and the angle of the cephalic vein insertion measured by 3 blinded independent observers. Results Fifty-eight patients had fistulograms and CAS was detected in 18 subjects. Significant differences between the CAS and non-CAS groups were brachiocephalic fistula site (p=0.046), access flow (mL/min) (p=0.012), and absence of diabetes (p=0.03). Univariate predictors of CAS include access flow (per 100 mL/min) (p=0.042), platelet count (p=0.031) and calcium-phosphate product (p=0.026). The relationship of brachiocephalic site and CAS was confounded by access flow [(per 100 mL/min)*brachiocephalic fistula site (p=0.016)] and fistula age [brachiocephalic fistula site*fistula age (p=0.017)]. In multivariate analysis, renovascular disease, calcium-phosphate product, platelet count and access flow (per 100 mL/min)*brachiocephalic fistula predicted CAS (p<0.001, Negelkerke's R-Square= 0.55). The angle of insertion of the cephalic vein was not predictive for CAS. Conclusions CAS may be a long-term consequence of high blood flow rates. The interaction of access flow and brachiocephalic fistula supports the hypothesis that high flow through a brachiocephalic fistula promotes CAS. The multiple factors influencing cephalic arch remodeling require further research.
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Affiliation(s)
- A. Jaberi
- Department of Medicine, St. Michael's Hospital Toronto - Canada
| | - D. Schwartz
- Department of Medicine, St. Michael's Hospital Toronto - Canada
- University of Toronto, Toronto - Canada
| | - R. Marticorena
- Department of Medicine, St. Michael's Hospital Toronto - Canada
| | - N. Dacouris
- Department of Medicine, St. Michael's Hospital Toronto - Canada
| | - V. Prabhudesai
- Department of Medicine, St. Michael's Hospital Toronto - Canada
- University of Toronto, Toronto - Canada
| | - P. Mcfarlane
- Department of Medicine, St. Michael's Hospital Toronto - Canada
- University of Toronto, Toronto - Canada
| | - S. Donnelly
- Department of Medicine, St. Michael's Hospital Toronto - Canada
- University of Toronto, Toronto - Canada
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Schwartz D, Pusterla N, Jacobsen S, Christopher MM. Analytical validation of a new point-of-care assay for serum amyloid A in horses. Equine Vet J 2018; 50:678-683. [PMID: 29344980 DOI: 10.1111/evj.12807] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Serum amyloid A (SAA) is a major acute phase protein in horses. A new point-of-care (POC) test for SAA (Stablelab) is available, but studies evaluating its analytical accuracy are lacking. OBJECTIVES To evaluate the analytical performance of the SAA POC test by 1) determining linearity and precision, 2) comparing results in whole blood with those in serum or plasma, and 3) comparing POC results with those obtained using a previously validated turbidimetric immunoassay (TIA). STUDY DESIGN Assay validation. METHODS Analytical validation of the POC test was done in accordance with American Society of Veterinary Clinical Pathology guidelines using residual equine serum/plasma and whole blood samples from the Clinical Pathology Laboratory at the University of California-Davis. A TIA was used as the reference method. We also evaluated the effect of haematocrit (HCT). RESULTS The POC test was linear for SAA concentrations of up to at least 1000 μg/mL (r = 0.991). Intra-assay CVs were 13, 18 and 15% at high (782 μg/mL), intermediate (116 μg/mL) and low (64 μg/mL) concentrations. Inter-assay (inter-batch) CVs were 45, 14 and 15% at high (1372 μg/mL), intermediate (140 μg/mL) and low (56 μg/mL) concentrations. SAA results in whole blood were significantly lower than those in serum/plasma (P = 0.0002), but were positively correlated (r = 0.908) and not affected by HCT (P = 0.261); proportional negative bias was observed in samples with SAA>500 μg/mL. The difference between methods exceeded the 95% confidence interval of the combined imprecision of both methods (15%). MAIN LIMITATIONS Analytical validation could not be performed in whole blood, the sample most likely to be used stall side. CONCLUSION The POC test has acceptable accuracy and precision in equine serum/plasma with SAA concentrations of up to at least 1000 μg/mL. Low inter-batch precision at high concentrations may affect serial measurements, and the use of the same test batch and sample type (serum/plasma or whole blood) is recommended. Comparison of results between the POC test and the TIA is not recommended.
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Affiliation(s)
- D Schwartz
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, USA
| | - N Pusterla
- Department of Medicine and Epidemiology, University of California, Davis, California, USA
| | - S Jacobsen
- Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
| | - M M Christopher
- Department of Pathology, Microbiology and Immunology, University of California, Davis, California, USA
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Niedringhaus KD, Fenton HMA, Cleveland CA, Anderson AN, Schwartz D, Alex CE, Rogers KH, Mete A, Yabsley MJ. Case Series: Virulent hemosporidiosis infections in juvenile great horned owls (Bubo virginianus) from Louisiana and California, USA. Vet Parasitol Reg Stud Reports 2018; 12:49-54. [PMID: 31014809 DOI: 10.1016/j.vprsr.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/17/2022]
Abstract
A total of eight juvenile great horned owls (Bubo virginianus) were found lethargic and on the ground in spring 2015, 2016, and 2017, including one fledgling from Louisiana, USA and seven nestlings from California, USA. One bird survived to release after rehabilitation; seven birds died or were euthanized due to poor prognosis and were necropsied. Necropsy findings were similar and included general pallor of all tissues, particularly the subcutis and lungs, and enlarged liver and spleen. Histopathology revealed multi-organ necrosis, abundant meronts containing merozoites, and intracytoplasmic pigmented haemosporidian parasites in blood cells in one bird. Leucocytozoon lineages lSTOCC16 and BUVIR06 were identified by polymerase chain reaction and genetic sequencing. The systemic Leucocytozoon infections were likely associated with morbidity and mortality in these owls. A second parasite, Haemoproteus lineage hSTVAR01, was also identified in an owl from Louisiana. This is the first identification of Leucocytozoon lineages that have been associated with mortality in young great horned owls.
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Affiliation(s)
- Kevin D Niedringhaus
- Southeastern Cooperative Wildlife Disease Study, 589 D.W. Brooks Drive, Wildlife Health Building, College of Veterinary Medicine, The University of Georgia, Athens, GA 30602, USA.
| | - Heather M A Fenton
- Southeastern Cooperative Wildlife Disease Study, 589 D.W. Brooks Drive, Wildlife Health Building, College of Veterinary Medicine, The University of Georgia, Athens, GA 30602, USA.
| | - Christopher A Cleveland
- Southeastern Cooperative Wildlife Disease Study, 589 D.W. Brooks Drive, Wildlife Health Building, College of Veterinary Medicine, The University of Georgia, Athens, GA 30602, USA.
| | - A Nikki Anderson
- Louisiana Department of Wildlife and Fisheries, 2000 Quail Dr., Baton Rouge, LA 70808, USA.
| | - Diana Schwartz
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California - Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Charles E Alex
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California - Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Krysta H Rogers
- Wildlife Investigations Laboratory, California Department of Fish and Wildlife, 1701 Nimbus Road, Suite D, Rancho Cordova, CA 95670, USA.
| | - Aslι Mete
- California Animal Health and Food Safety Laboratory, University of California - Davis, 620 W. Health Sciences Drive, Davis, CA 95616-5270, USA.
| | - Michael J Yabsley
- Southeastern Cooperative Wildlife Disease Study, 589 D.W. Brooks Drive, Wildlife Health Building, College of Veterinary Medicine, The University of Georgia, Athens, GA 30602, USA; Warnell School of Forestry and Natural Resources, 180 E Green Street, University of Georgia, Athens, GA 30602, USA.
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Sheth N, Osborn V, Lee A, Schwartz D, Schreiber D. Association of Nadir PSA >0.5ng/Ml after Dose Escalated External Beam Radiation With Prostate Cancer-Specific Endpoints. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Osborn V, Givi B, Roden D, Katsoulakis E, Sheth N, Lederman A, Schwartz D, Schreiber D. Patterns of Care and Outcomes of Adjuvant Therapy for High Risk Head and Neck Cancer After Surgery. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Osborn V, Lee A, Garay E, Becker D, Safdieh J, Schwartz D, Schreiber D. Impact of Delay Between Surgery and Chemoradiation Initiation in Patients with Glioblastoma. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Garay E, Lederman A, Osborn V, Schwartz D, Schreiber D. Atypical and Malignant Meningiomas: Patterns of Care in Use of Adjuvant Radiation. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee A, Becker D, Osborn V, Lederman A, Schwartz D, Schreiber D. The Utilization of MGMT Methylation Testing in United States Hospitals for Glioblastoma and Its Impact on Prognosis. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Guillon J, Attal Y, Colliot O, La Corte V, Dubois B, Schwartz D, Chavez M, De Vico Fallani F. Loss of brain inter-frequency hubs in Alzheimer's disease. Sci Rep 2017; 7:10879. [PMID: 28883408 PMCID: PMC5589939 DOI: 10.1038/s41598-017-07846-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/29/2017] [Indexed: 01/05/2023] Open
Abstract
Alzheimer's disease (AD) causes alterations of brain network structure and function. The latter consists of connectivity changes between oscillatory processes at different frequency channels. We proposed a multi-layer network approach to analyze multiple-frequency brain networks inferred from magnetoencephalographic recordings during resting-states in AD subjects and age-matched controls. Main results showed that brain networks tend to facilitate information propagation across different frequencies, as measured by the multi-participation coefficient (MPC). However, regional connectivity in AD subjects was abnormally distributed across frequency bands as compared to controls, causing significant decreases of MPC. This effect was mainly localized in association areas and in the cingulate cortex, which acted, in the healthy group, as a true inter-frequency hub. MPC values significantly correlated with memory impairment of AD subjects, as measured by the total recall score. Most predictive regions belonged to components of the default-mode network that are typically affected by atrophy, metabolism disruption and amyloid-β deposition. We evaluated the diagnostic power of the MPC and we showed that it led to increased classification accuracy (78.39%) and sensitivity (91.11%). These findings shed new light on the brain functional alterations underlying AD and provide analytical tools for identifying multi-frequency neural mechanisms of brain diseases.
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Affiliation(s)
- J Guillon
- Inria Paris, Aramis project-team, 75013, Paris, France
- CNRS UMR-7225, Sorbonne Universites, UPMC Univ Paris 06, Inserm U-1127, Institut du cerveau et la moelle (ICM), Hopital Pitie-Salpetriere, 75013, Paris, France
| | - Y Attal
- MyBrain Technologies, Paris, France
| | - O Colliot
- Inria Paris, Aramis project-team, 75013, Paris, France
- CNRS UMR-7225, Sorbonne Universites, UPMC Univ Paris 06, Inserm U-1127, Institut du cerveau et la moelle (ICM), Hopital Pitie-Salpetriere, 75013, Paris, France
| | - V La Corte
- Institute of Psychology, University Paris Descartes, Sorbonne Paris Cite, France
- INSERM UMR 894, Center of Psychiatry and Neurosciences, Memory and Cognition Laboratory, Paris, France
| | - B Dubois
- Department of Neurology, Institut de la Memoire et de la Maladie dAlzheimer - IM2A, Paris, France
| | - D Schwartz
- CNRS UMR-7225, Sorbonne Universites, UPMC Univ Paris 06, Inserm U-1127, Institut du cerveau et la moelle (ICM), Hopital Pitie-Salpetriere, 75013, Paris, France
| | - M Chavez
- CNRS UMR-7225, Sorbonne Universites, UPMC Univ Paris 06, Inserm U-1127, Institut du cerveau et la moelle (ICM), Hopital Pitie-Salpetriere, 75013, Paris, France
| | - F De Vico Fallani
- Inria Paris, Aramis project-team, 75013, Paris, France.
- CNRS UMR-7225, Sorbonne Universites, UPMC Univ Paris 06, Inserm U-1127, Institut du cerveau et la moelle (ICM), Hopital Pitie-Salpetriere, 75013, Paris, France.
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Elhanan E, Boaz M, Schwartz I, Schwartz D, Chernin G, Soetendorp H, Gal Oz A, Agbaria A, Weinstein T. A randomized, controlled clinical trial to evaluate the immunogenicity of a PreS/S hepatitis B vaccine Sci-B-Vac™, as compared to Engerix B ®, among vaccine naïve and vaccine non-responder dialysis patients. Clin Exp Nephrol 2017; 22:151-158. [PMID: 28456864 DOI: 10.1007/s10157-017-1416-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dialysis patients have a suboptimal response to hepatitis B (HBV) vaccination. This study aimed to compare the immunogenicity of two vaccines: the third-generation Sci-B-Vac™ vs. the second-generation Engerix B®. The cohort included two groups of dialysis patients: naïve and previously vaccinated non-responders. Primary endpoints were antibody titers ≥10 IU/L at 3 and 7 month post-vaccination. Secondary objectives were seroprotection rates in vaccine-naïve patients and in previously vaccinated non-responders. METHODS Eighty-six patients were assigned to vaccine (Sci-B-Vac™ or Engerix B®) using computer-generated randomization, stratified by age, gender, diabetes, and previous HBV vaccination. Sci-B-Vac™ was administered in three doses, 10 μg, at 0, 1, and 6 months in naïve patients; or 20 μg in previously vaccinated non-responders. Engerix B® included four doses, 40 μg at 0, 1, 2, and 6 months. RESULTS Each group had 43 patients. Seroconversion was 69.8% with Engerix B® vs. 73.2% with Sci-B-Vac™. Antibody titers at 7 months were higher with Sci-B-Vac™ (266.4 ± 383.9, median 53.4) than with Engerix® (193.2 ± 328.9, median 19). However, these differences were not significant, perhaps due to a suboptimal sample size. CONCLUSIONS This study suggests comparable immunogenicity for both vaccines. Thus, we cannot reject the null hypothesis that there is no difference in seroconversion by vaccine type. It is noteworthy that naïve patients were vaccinated with a standard dose of Sci-B-Vac™, while Engerix B® was administered at a double dose. Similarly, although mean antibody titer levels in the Sci-B-Vac™ group were higher than in the Engerix® group, this difference did not reach significance. Consequently, a future clinical trial should recruit a larger cohort of patients, using a standard double-dose protocol in both groups.
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Affiliation(s)
- E Elhanan
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - M Boaz
- Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel
- Ariel University, Ariel, Israel
| | - I Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - D Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - G Chernin
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - H Soetendorp
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Gal Oz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Agbaria
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - T Weinstein
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel.
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Nakase-Richardson R, Healey E, Silva M, Schwartz D, Modarres M, Brown R, Lim M. 0599 SLEEP APNEA SEVERITY IS ASSOCIATED WITH MOTOR RECOVERY AND PROCESSING SPEED IN ACUTE TBI REHABILITATION ADMISSIONS: A VA TBI MODEL SYSTEM STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kumar J, Dillane C, Plamenac J, Schwartz D. The Mortality of Cardiogenic Shock in Patients Admitted with Acute Decompensated Systolic Heart Failure. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Alakailly X, Schwartz D, Alwanni N, Demko C, Altay M, Kilinc Y, Baur D, Quereshy F. Patient-centered quality of life measures after alloplastic temporomandibular joint replacement surgery. Int J Oral Maxillofac Surg 2017; 46:204-207. [DOI: 10.1016/j.ijom.2016.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/31/2016] [Accepted: 11/03/2016] [Indexed: 11/25/2022]
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Nutman A, Lerner A, Schwartz D, Carmeli Y. Evaluation of carriage and environmental contamination by carbapenem-resistant Acinetobacter baumannii. Clin Microbiol Infect 2016; 22:949.e5-949.e7. [DOI: 10.1016/j.cmi.2016.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/14/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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Weiner J, Schwartz D, Shao M, Osborn V, Schreiber D. Stereotactic Body Radiation Therapy to the Prostate: Patterns of Care in the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Osborn V, Schwartz D, Shao M, Lee A, Wong A, Schreiber D. Patterns of Care of Intensity Modulated Radiation Therapy Usage in Postoperative Management of Uterine Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wong A, Schwartz D, Rineer J, Safdieh J, Osborn V, Schreiber D. The Impact of Thoracic Radiation Therapy Timing and Fractionation on Survival in Nonmetastatic Small Cell Lung Carcinoma Using the National Cancer Data Base. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wong A, Schwartz D, Osborn V, Safdieh J, Weiner J, Schreiber D. Adjuvant Radiation With Hormonal Therapy Is Associated With Improved Survival for Men With Pathologically Involved Lymph Nodes Following Radical Surgery for Prostate Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Safdieh J, Schwartz D, Osborn V, Wong A, Weiner J, Schreiber D. Utilization of Prostate Brachytherapy for Low-Risk Prostate Cancer: Is the Decline Overstated? Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Grindler N, Yang I, Rajendiran K, Kannan K, Polotsky A, Schwartz D, Powell T, Jansson T. The effect of the endocrine disrupting chemical DEHP on the ovarian and adipose transcriptome. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nutman A, Fisher Even-Tsur S, Shapiro G, Braun T, Schwartz D, Carmeli Y. Time to Detection with BacT/Alert FA Plus Compared to BacT/Alert FA Blood Culture Media. Eur J Clin Microbiol Infect Dis 2016; 35:1469-73. [PMID: 27272123 DOI: 10.1007/s10096-016-2686-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
Rapid identification of the causative pathogen in patients with bacteremia allows adjustment of antibiotic therapy and improves patient outcomes. We compared in vitro and real-life time to detection (TTD) of two blood culture media, BacT/Alert FA (FA) and BacT/Alert FA Plus (FA Plus), for the nine most common species of bacterial pathogens recovered from blood samples. Experimental data from simulated cultures was compared with microbiology records of TTD for both culture media with growth of the species of interest in clinical blood cultures. In the experimental conditions, median TTD was 3.8 hours (23.9 %) shorter using FA Plus media. The magnitude of reduction differed between species. Similarly, in real life data, FA Plus had shorter TTD than FA media; however, the difference between culture media was smaller, and median TTD was only 1 hour (8.5 %) less. We found shorter TTD with BacT/Alert FA Plus culture media, both experimentally and in real-life conditions and unrelated to antibiotic neutralization, highlighting the importance of appropriate blood culture media selection.
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Affiliation(s)
- A Nutman
- Division of Epidemiology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 64239, Israel.
| | - S Fisher Even-Tsur
- Division of Epidemiology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 64239, Israel
| | - G Shapiro
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - T Braun
- Division of Epidemiology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 64239, Israel
| | - D Schwartz
- Division of Epidemiology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 64239, Israel
| | - Y Carmeli
- Division of Epidemiology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, 64239, Israel
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Mao W, Liu C, Zhong H, Rozario T, Lu W, Gu X, Yan Y, Jia X, Sumer B, Schwartz D. SU-C-202-05: Pilot Study of Online Treatment Evaluation and Adaptive Re-Planning for Laryngeal SBRT. Med Phys 2016. [DOI: 10.1118/1.4955573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Jovanovic B, Khan H, Mowrey W, Izmirly P, Schwartz D, Buyon J, Putterman C, Goilav B, Broder A. THU0317 Tubuloinsterstial Damage Is An Independent Predictor of End Stage Renal Disease in Lupus Nephritis Patients with Mild To Moderate Renal Impairment. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zhao B, Maquilan G, Anders M, Jiang S, Schwartz D. SU-F-J-18: Feasibility of Open Mask Immobilization with Optical Imaging Guidance (OIG) for H&N Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4955926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Malhotra R, Hoyo C, Østbye T, Hughes G, Schwartz D, Tsolekile L, Zulu J, Puoane T. Determinants of obesity in an urban township of South Africa. South African Journal of Clinical Nutrition 2016. [DOI: 10.1080/16070658.2008.11734173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Grisaru-Soen G, Savyon M, Sadot E, Schechner V, Sivan Y, Schwartz D, Tarabeia J, Amitai Z, Yoabov I, Carmeli Y. Congenital tuberculosis and management of exposure in neonatal and pediatric intensive care units. Int J Tuberc Lung Dis 2016; 18:1062-5. [PMID: 25189553 DOI: 10.5588/ijtld.14.0160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING This report describes the management and outcome of neonatal intensive care unit (NICU) and paediatric ICU (PICU) exposure to a 26-day-old premature infant with congenital tuberculosis (TB). DESIGN The infant's mother underwent chest X-ray (CXR) and sputum culture. Contacts of the infant were identified. Tuberculin skin tests (TSTs) were performed on 97 infants and children, 156 NICU and PICU visitors and 115 health care workers. RESULTS The mother's sputum culture was positive for Mycobacterium tuberculosis. No TST conversion occurred in the exposed NICU infants. All neonates received prophylactic isoniazid (INH). One exposed child in the PICU had TST conversion with normal CXR and completed 9 months of INH without developing active disease; 22 (14%) PICU and NICU visitors and 3 NICU personnel had TST conversion without evidence of disease. CONCLUSIONS The sequence of events described here demonstrates the difficulty in diagnosis and management of TB in this age group. Transmission of TB in NICU and PICUs is unusual but can occur, and calls for a systematic approach to investigation of the exposed infants, family members and health care providers.
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Affiliation(s)
- G Grisaru-Soen
- Pediatric Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - M Savyon
- Tel Aviv Health District, Ministry of Health, Tel Aviv, Israel
| | - E Sadot
- Department of Pediatric Intensive Care, Dana-Dwek Children's Hospital, Israel
| | - V Schechner
- Division of Epidemiology and Preventive Medicine, Israel
| | - Y Sivan
- Department of Pediatric Intensive Care, Dana-Dwek Children's Hospital, Israel
| | - D Schwartz
- Microbiology Laboratory, Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Faculty of Nursing, Yezreel Valley College, Yezreel Valley, Israel
| | - J Tarabeia
- Division of Epidemiology and Preventive Medicine, Israel
| | - Z Amitai
- Tel Aviv Health District, Ministry of Health, Tel Aviv, Israel
| | - I Yoabov
- Tel Aviv Health District, Ministry of Health, Tel Aviv, Israel
| | - Y Carmeli
- Department of Pediatric Intensive Care, Dana-Dwek Children's Hospital, Israel
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Dillane C, Bove A, Cohen H, Bashir R, O’Murchu B, O’Neill B, Gomez-Abraham J, Shiose A, Schwartz D, Dries D, Punnoose L, Toyoda Y, Alvarez R, Hamad E. A Shock Team Improves Survival in Cardiogenic Shock by Decreasing Time to Intervention. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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