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Kapoor H, Bi C, Kroll MH, Salm AE, Dominguez EA. Burden and frequency of viral testing of kidney and non-kidney transplant recipients. Microbiol Spectr 2024:e0357523. [PMID: 38709030 DOI: 10.1128/spectrum.03575-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 10/06/2023] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Transplant patients are at risk of infections due to long-term immunosuppression contributing to morbidity and mortality in this population. Post-transplant testing guidelines were established to monitor and guide therapeutic interventions in transplant recipients. We hypothesize that there are gaps in adherence to the recommended frequency of laboratory testing in post-transplant patients. We analyzed national reference laboratory data to compare viral post-transplant infection (PTI) testing frequency with their respective published guidelines to understand patient uptake and compliance. We evaluated the ordering patterns, positivity rates, and frequency of molecular infectious disease tests (MIDTs). We included 345 patients with International Classification of Diseases (ICD)-10 codes for transplant (Z940-Z942, Z944, Z9481, Z9483, Z9484) with at least two tests (within 7 days) in January 2019 and at least one test in December 2020 to find patients in the post-transplant period. We analyzed two cohorts: kidney transplant recipients (KTRs; 40%) and non-KTR (60%) then followed them longitudinally for the study period. In KTR cohort, high-to-low proportion of ordered MIDT was blood BK virus (bBKV) followed by cytomegalovirus (CMV); in non-KTR cohort, CMV was followed by Epstein-Barr virus (EBV). KTR cohort positivity was highest for urine BK virus (uBKV; 58%) followed by EBV (46%), bBKV (40%), and CMV (31%). Non-KTR cohort positivity was highest for uBKV (64%), EBV (51%), CMV (30%), bBKV (8%), and adenovirus (7%). All patients were tested at progressively longer intervals from the date of the first post-transplant ICD-10-coded test. More than 40% of the KTR cohort were tested less frequently for EBV and bBKV, and more than 20% of the non-KTR cohort were tested for EBV less frequently than published guidelines 4 months after transplant. Despite regular testing, the results of MIDT testing for KTR and non-KTR patients in the post-transplant period are not aligned with published guidelines.IMPORTANCEGuidance for post-transplant infectious disease testing is established, however, for certain infections it allows for clinician discretion. This leads to transplant center policies developing their own testing/surveillance strategies based on their specific transplant patient population (kidney, stem cell, etc.). The Organ Procurement and Transplant Network (OPTN) has developed a strategic plan to improve and standardize the transplant process in the US to improve outcomes of living donors and recipients. Publishing national reference lab data on the testing frequency and its alignment with the recommended guidelines for post-transplant infectious diseases can inform patient uptake and compliance for these strategic OPTN efforts.
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Affiliation(s)
- Hema Kapoor
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus, New Jersey, USA
| | - Caixia Bi
- Medical Informatics, Biostatistics and Outcomes Research Group, Quest Diagnostics, Secaucus, New Jersey, USA
| | - Martin H Kroll
- Analytics and Statistical Applications, Quest Diagnostics, Secaucus, New Jersey, USA
| | - Ann E Salm
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus, New Jersey, USA
| | - Edward A Dominguez
- Organ Transplant Infectious Disease, Methodist Transplant Specialists, Dallas, Texas, USA
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Kroll MH, Bi C, Salm AE, Szymanski J, Goldstein DY, Wolgast LR, Rosenblatt G, Fox AS, Kapoor H. Risk Estimation of Severe COVID-19 Based on Initial Biomarker Assessment Across Racial and Ethnic Groups. Arch Pathol Lab Med 2023; 147:1109-1118. [PMID: 37338199 DOI: 10.5858/arpa.2023-0039-sa] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Accepted: 06/14/2023] [Indexed: 06/21/2023]
Abstract
CONTEXT.— Disease courses in COVID-19 patients vary widely. Prediction of disease severity on initial diagnosis would aid appropriate therapy, but few studies include data from initial diagnosis. OBJECTIVE.— To develop predictive models of COVID-19 severity based on demographic, clinical, and laboratory data collected at initial patient contact after diagnosis of COVID-19. DESIGN.— We studied demographic data and clinical laboratory biomarkers at time of diagnosis, using backward logistic regression modeling to determine severe and mild outcomes. We used deidentified data from 14 147 patients who were diagnosed with COVID-19 by polymerase chain reaction SARS-CoV-2 testing at Montefiore Health System, from March 2020 to September 2021. We generated models predicting severe disease (death or more than 90 hospital days) versus mild disease (alive and fewer than 2 hospital days), starting with 58 variables, by backward stepwise logistic regression. RESULTS.— Of the 14 147 patients, including Whites, Blacks, and Hispanics, 2546 (18%) patients had severe outcomes and 3395 (24%) had mild outcomes. The final number of patients per model varied from 445 to 755 because not all patients had all available variables. Four models (inclusive, receiver operating characteristic, specific, and sensitive) were identified as proficient in predicting patient outcomes. The parameters that remained in all models were age, albumin, diastolic blood pressure, ferritin, lactic dehydrogenase, socioeconomic status, procalcitonin, B-type natriuretic peptide, and platelet count. CONCLUSIONS.— These findings suggest that the biomarkers found within the specific and sensitive models would be most useful to health care providers on their initial severity evaluation of COVID-19.
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Affiliation(s)
- Martin H Kroll
- From the Department of Medical Operations and Quality (Kroll), Quest Diagnostics, Secaucus, New Jersey
| | - Caixia Bi
- Department of Corporate Medical (Bi), Quest Diagnostics, Secaucus, New Jersey
| | - Ann E Salm
- Department of Infectious Diseases/Immunology (Salm, Kapoor), Quest Diagnostics, Secaucus, New Jersey
| | - James Szymanski
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - D Yitzchak Goldstein
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - Lucia R Wolgast
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - Gregory Rosenblatt
- The Department of Pathology, Albert Einstein College of Medicine, Bronx, New York (Rosenblatt). Kapoor is currently located at HK Healthcare Consultant LLC in Davie, Florida
| | - Amy S Fox
- Department of Pathology, Montefiore Medical Center, Bronx, New York (Szymanski, Goldstein, Wolgast, Fox)
| | - Hema Kapoor
- Department of Infectious Diseases/Immunology (Salm, Kapoor), Quest Diagnostics, Secaucus, New Jersey
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Wedemeyer H, Leus M, Battersby TR, Glenn J, Gordien E, Kamili S, Kapoor H, Kessler HH, Lenz O, Lütgehetmann M, Mixson-Hayden T, Simon CO, Thomson M, Westman G, Miller V, Terrault N, Lampertico P. HDV RNA assays: Performance characteristics, clinical utility, and challenges. Hepatology 2023:01515467-990000000-00551. [PMID: 37640384 DOI: 10.1097/hep.0000000000000584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 08/31/2023]
Abstract
Coinfection with HBV and HDV results in hepatitis D, the most severe form of chronic viral hepatitis, frequently leading to liver decompensation and HCC. Pegylated interferon alpha, the only treatment option for chronic hepatitis D for many years, has limited efficacy. New treatments are in advanced clinical development, with one recent approval. Diagnosis and antiviral treatment response monitoring are based on detection and quantification of HDV RNA. However, the development of reliable HDV RNA assays is challenged by viral heterogeneity (at least 8 different genotypes and several subgenotypes), intrahost viral diversity, rapid viral evolution, and distinct secondary structure features of HDV RNA. Different RNA extraction methodologies, primer/probe design for nucleic acid tests, lack of automation, and overall dearth of standardization across testing laboratories contribute to substantial variability in performance characteristics of research-based and commercial HDV RNA assays. A World Health Organization (WHO) standard for HDV RNA, available for about 10 years, has been used by many laboratories to determine the limit of detection of their assays and facilitates comparisons of RNA levels across study centers. Here we review challenges for robust pan genotype HDV RNA quantification, discuss particular clinical needs and the importance of reliable HDV RNA quantification in the context of drug development and patient monitoring. We summarize distinct technical features and performance characteristics of available HDV RNA assays. Finally, we provide considerations for the use of HDV RNA assays in the context of drug development and patient monitoring.
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Affiliation(s)
- Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
- Excellence Cluster RESIST, Hannover Medical School, Hannover, Germany
- D-SOLVE: EU-funded Network on Individualized Management of Hepatitis D
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
| | - Mitchell Leus
- Forum for Collaborative Research, School of Public Health, University of California, Berkeley, Washington DC Campus, Washington, District of Columbia, USA
| | | | - Jeffrey Glenn
- Departments of Medicine (Division of Gastroenterology and Hepatology) and Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, USA
| | - Emmanuel Gordien
- Laboratoire de microbiologie clinique, Centre National de Référence pour les virus des hépatites B, C et Delta, Hôpital Avicenne Assistance Publique - Hôpitaux de Paris, Bobigny, France
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hema Kapoor
- Ex Quest Diagnostics, HK Healthcare Consultant LLC, Secaucus, New Jersey, USA
| | - Harald H Kessler
- Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz, Austria
| | - Oliver Lenz
- Clinical Microbiology and Immunology, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Marc Lütgehetmann
- Institute for Microbiology, Virology and Hygiene, University Medical Center Hamburg Eppendorf (UKE), Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg, Lübeck, Kiel, Germany
| | - Tonya Mixson-Hayden
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christian O Simon
- Clinical Development and Medical Affairs, Roche Diagnostics Solutions, Rotkreuz, Switzerland
| | - Michael Thomson
- Division of Antivirals, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gabriel Westman
- Swedish Medical Products Agency, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Veronica Miller
- Forum for Collaborative Research, School of Public Health, University of California, Berkeley, Washington DC Campus, Washington, District of Columbia, USA
| | - Norah Terrault
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan, Milan, Italy
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Martin SS, Niles JK, Kaufman HW, Awan Z, Elgaddar O, Choi R, Ahn S, Verma R, Nagarajan M, Don-Wauchope A, Gurgel Castelo MHC, Hirose CK, James D, Truman D, Todorovska M, Momirovska A, Pivovarníková H, Rákociová M, Louzao-Gudin P, Batu J, El Banna N, Kapoor H. Lipid distributions in the Global Diagnostics Network across five continents. Eur Heart J 2023; 44:2305-2318. [PMID: 37392135 PMCID: PMC10314323 DOI: 10.1093/eurheartj/ehad371] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/07/2023] [Accepted: 05/24/2023] [Indexed: 07/03/2023] Open
Abstract
AIMS Lipids are central in the development of cardiovascular disease, and the present study aimed to characterize variation in lipid profiles across different countries to improve understanding of cardiovascular risk and opportunities for risk-reducing interventions. METHODS AND RESULTS This first collaborative report of the Global Diagnostics Network (GDN) evaluated lipid distributions from nine laboratory organizations providing clinical laboratory testing in 17 countries on five continents. This cross-sectional study assessed aggregated lipid results from patients aged 20-89 years, tested at GDN laboratories, from 2018 through 2020. In addition to mean levels, the World Health Organization total cholesterol risk target (<5.00 mmol/L, <193 mg/dL) and proportions in guideline-based low-density lipoprotein cholesterol (LDL-C) categories were assessed. This study of 461 888 753 lipid results found wide variation by country/region, sex, and age. In most countries, total cholesterol and LDL-C peaked at 50-59 years in females and 40-49 years in males. Sex- and age-group adjusted mean total cholesterol levels ranged from 4.58 mmol/L (177.1 mg/dL) in the Republic of Korea to 5.40 mmol/L (208.8 mg/dL) in Austria. Mean total cholesterol levels exceeded the World Health Organization target in Japan, Australia, North Macedonia, Switzerland, Germany, Slovakia, and Austria. Considering LDL-C categories, North Macedonia had the highest proportions of LDL-C results >4.91 mmol/L (>190 mg/dL) for both females (9.9%) and males (8.7%). LDL-C levels <1.55 mmol/L (<60 mg/dL) were most common among females in Canada (10.7%) and males in the UK (17.3%). CONCLUSION With nearly a half billion lipid results, this study sheds light on the worldwide variability in lipid levels, which may reflect inter-country differences in genetics, lipid testing, lifestyle habits, and pharmacologic treatment. Despite variability, elevated atherogenic lipid levels are a common global problem, and these results can help inform national policies and health system approaches to mitigate lipid-mediated risk of cardiovascular disease.
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Affiliation(s)
- Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Carnegie 591, Baltimore, MD 21287, USA
| | | | | | - Zuhier Awan
- King Abdulaziz University, Jeddah, Saudi Arabia
- Al Borg Diagnostics, Jeddah, Saudi Arabia
| | - Ola Elgaddar
- Al Borg Diagnostics, Jeddah, Saudi Arabia
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Rihwa Choi
- GC Labs, Yongin, Republic of Korea
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | | | - Andrew Don-Wauchope
- McMaster University, Hamilton, Ontario, Canada
- LifeLabs Inc., Toronto, Ontario, Canada
| | | | | | - David James
- SYNLAB, Southwest Pathology Service, London, UK
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Menza TW, Zlot A, Gonzalez-Pena Y, Capizzi J, Bush L, Humphrey S, Kapoor H, Moore R, Garai J. The ongoing impact of COVID-19 on testing for and diagnoses of HIV and bacterial sexually transmitted infections in Oregon. Sex Transm Dis 2023:00007435-990000000-00197. [PMID: 37074311 DOI: 10.1097/olq.0000000000001817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted HIV and sexually transmitted infection (STI) testing accessibility. We sought to assess the longer-term impacts of COVID-19 on HIV and STI testing and diagnosis in Oregon. METHODS First, we examined HIV, Neisseria gonorrhoeae (NG)/Chlamydia trachomatis (CT), and syphilis tests conducted at the Oregon State Public Health Laboratory (public sector) and a large commercial laboratory (private sector) and HIV, NG, CT, and primary and secondary (P&S) syphilis diagnoses in Oregon from 1/1/2019-12/31/2021. We compared monthly testing and diagnosis rates in five pre-specified time periods: pre-COVID-19 (1/2019-2/2020), stay-at-home order (3/2020-5/2020), reopening (6/2020-12/2020), vaccine availability (1/2021-6/2021), and Delta/early Omicron spread (7/2021-12/2021). Second, we calculated the number of HIV and STI diagnoses per test in the public and private sectors. Finally, we used seasonal autoregressive integrated moving average (SARIMA) models to predict expected HIV and STI diagnoses for comparison to those observed. RESULTS Both public and private sector HIV and bacterial STI testing fell to nadirs in April 2020 with incomplete recovery to 2019 levels by the close of 2021. Compared to pre-COVID-19, public sector and private sector testing was significantly lower in all subsequent time periods. Compared to pre-COVID-19, P&S syphilis cases were 52%, 75%, and 124% greater in the reopening, vaccine availability, and Delta/early Omicron periods, respectively. From 3/2020-12/2021, we observed an excess of P&S syphilis cases (+37.1%; 95%CI: 22.2%, 52.1%) and a deficit in CT cases (-10.7%; 95%CI: -15.4%, -6.0%). CONCLUSIONS By 12/2021, HIV/STI testing had not recovered to pre-COVID-19 levels and HIV/STI continue to be underdiagnosed. Despite decreased testing, P&S syphilis cases have increased substantially.
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Affiliation(s)
| | - Amy Zlot
- From the Oregon Health Authority Public Health Division, Portland, Oregon, USA
| | | | - Jeff Capizzi
- From the Oregon Health Authority Public Health Division, Portland, Oregon, USA
| | - Lea Bush
- From the Oregon Health Authority Public Health Division, Portland, Oregon, USA
| | - Sarah Humphrey
- From the Oregon Health Authority Public Health Division, Portland, Oregon, USA
| | | | | | - Jillian Garai
- From the Oregon Health Authority Public Health Division, Portland, Oregon, USA
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Wong RJ, Kaufman HW, Niles JK, Kapoor H, Gish RG. Simplifying Treatment Criteria in Chronic Hepatitis B: Reducing Barriers to Elimination. Clin Infect Dis 2023; 76:e791-e800. [PMID: 35594550 DOI: 10.1093/cid/ciac385] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 02/17/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early, sustained hepatitis B virus (HBV) DNA suppression reduces long-term risks of hepatocellular carcinoma. Chronic hepatitis B (CHB) treatment criteria are complex. Simplifying criteria will improve timely linkage to therapy. We evaluated treatment eligibility patterns among US patients with CHB and propose stepwise simplification of CHB treatment criteria. METHODS Using 2016-2020 Quest Diagnostics data, we evaluated treatment eligibility among patients with CHB (2 positive HBV tests [HBV surface antigen, HBV e antigen, or HBV DNA] ≥6 months apart) using American Association for the Study of Liver Disease (AASLD), European Association for Study of the Liver (EASL), Asian Pacific Association for Study of the Liver (APASL), and Asian American Treatment Algorithm (AATA) criteria. RESULTS Among 84 916 patients with CHB, 6.7%, 6.2%, 5.8%, and 16.4% met AASLD, EASL, APASL, and AATA criteria, respectively. Among treatment-ineligible patients with CHB, proportion with significant fibrosis (aspartate aminotransferase platelet ratio index >0.5) were 10.4%, 10.4%, 10.8%, and 7.7% based on AASLD, EASL, APASL, and AATA, respectively. In the proposed treatment simplification, the proportion of patients with CHB eligible for therapy increased from 10.3% for step 1 (HBV DNA >20 000 IU/mL, elevated alanine aminotransferase [ALT] level) to 14.1% for step 2 (HBV >2000 IU/mL, elevated ALT level), 33.5% for step 3 (HBV DNA >2000 IU/mL, any ALT level), and 87.2% for step 4 (detectable HBV DNA, any ALT level). CONCLUSIONS A large proportion of patients with CHB not meeting established treatment criteria have significant fibrosis. Simplifying criteria to treat all patients with detectable HBV DNA will reduce complexity and heterogeneity in assessing treatment eligibility, improving treatment rates and progress toward HBV elimination.
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Affiliation(s)
- Robert J Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
| | | | | | - Hema Kapoor
- Quest Diagnostics, Secaucus, New Jersey, USA
| | - Robert G Gish
- Hepatitis B Foundation, Doylestown, Pennsylvania, USA
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Fenelon HT, Rabinowitz PM, Salm A, Kapoor H, Hawes SE, Radcliff J. 1757. Regional distribution of Escherichia coli antibiotic resistance among outpatients in Washington state, 2013-2019. Open Forum Infect Dis 2022. [PMCID: PMC9752696 DOI: 10.1093/ofid/ofac492.1387] [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: 12/23/2022] Open
Abstract
Background Escherichia coli is the predominant pathogen of urinary tract infections in the United States. Understanding regional patterns of uropathogenic E. coli antimicrobial resistance (AMR) may help further the practice of antibiotic stewardship through the creation of region-specific antibiograms. In this study, we analyzed regional patterns of uropathogenic E. coli AMR among outpatients in Washington state. Methods Deidentified results from antibiotic susceptibility tests performed by Quest Diagnostics on Washington state outpatient isolates from 2013 through 2019 were analyzed. Only the first E. coli isolate from each patient was included in the analyses. We conducted separate relative risk regressions with robust standard errors for five antibiotics (ampicillin [AMP], ciprofloxacin [CIP], ceftriaxone [CRO], gentamicin [GEN], and trimethoprim/sulfamethoxazole), classified as “susceptible” or “non-susceptible.” The state is divided into nine Public Health Emergency Preparedness Regions (PHEPRs), which served as the exposures for the analysis, with adjustment for sex, year of isolate collection, and age group (0-18, 19-50, > 50). Results We included 40,865 isolates in the study (93% female, mean age 47 years). Compared to the Central PHEPR (containing Seattle), most other regions had significantly lower adjusted relative risks (aRR) of AMR; no regions had significantly higher aRR of resistance for any of the five antibiotics. Differences in resistance between Central and other regions varied by antibiotic. Regional AMR differences were largest for CRO (low aRRs compared to Central) and smallest for AMP. Other patterns observed include a lower aRR of AMR for females compared to males for AMP, CIP, CRO, and GEN; higher aRR of AMR for CRO for recent years (2015-2019) compared to 2013; and higher AMR with age for CIP and CRO. Conclusion Given the differences in resistance across Washington’s PHEPRs, antibiograms should be tailored to provide the most regionally accurate information to prescribers. The emergent situation surrounding AMR calls for more specific outpatient antibiograms to enable healthcare providers to improve health outcomes and mitigate emerging resistance to antibiotics among outpatients. Disclosures Ann Salm, PhD, Quest Diagnostics Inc.: Employed and own stock in Quest Diagnostics Inc.|Quest Diagnostics Inc.: Stocks/Bonds Hema Kapoor, MD, D(ABMM), Quest Diagnsotics: Stocks/Bonds Stephen E. Hawes, PhD, InBios International: Advisor/Consultant Jeff Radcliff, B.S., Quest Diagnostics: Employee|Quest Diagnostics: Stocks/Bonds.
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Affiliation(s)
| | | | - Ann Salm
- Quest Diagnostics, Secaucus, New Jersey
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Frisbie L, Weissman SJ, Kapoor H, D’Angeli M, Salm A, Radcliff J, Rabinowitz P. Outpatient Antibiotic Resistance Patterns of Escherichia coli Urinary Isolates Differ by Specialty Type. Microbiol Spectr 2022; 10:e0237321. [PMID: 35727039 PMCID: PMC9431218 DOI: 10.1128/spectrum.02373-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Antibiotic-resistant E. coli infections represent a major cause of morbidity and mortality and pose a challenge to antibiotic stewardship. We analyzed a large outpatient data set of E. coli urinary isolates to determine whether resistance patterns vary between types of outpatient practices. Using deidentified data from a clinical reference laboratory over 5 years and logistic regression, we examined the association of antibiotic resistance with outpatient practice type, controlling for testing year, patient sex, and patient age. The odds of antibiotic resistance were significantly higher in urology/nephrology practices for ampicillin (odds ratio [OR] 1.36; 95% CI, 1.10 to 1.69), ciprofloxacin (OR 2.29; 95% CI, 1.77 to 2.94), trimethoprim-sulfamethoxazole (OR 1.52; 95% CI, 1.18 to 1.94), and gentamicin (OR 1.72; 95% CI, 1.16 to 2.46). Odds of resistance were also higher for ciprofloxacin in oncology practices (OR 1.54; 95% CI, 1.08 to 2.15) and "all other specialties" (OR 1.33; 95% CI, 1.13 to 1.56). In contrast, specimens from obstetrics and gynecology practices had lower odds of having resistance to ampicillin (OR 0.90; 95% CI, 0.82 to 0.99) and trimethoprim-sulfa (OR 0.83; 95% CI, 0.73 to 0.93) but higher odds of having resistance to nitrofurantoin (OR 1.33; 95% CI, 1.03 to 1.70). Other findings included lower odds of having resistance to trimethoprim-sulfa in pediatric practices (OR 0.78; 95% CI, 0.64 to 0.94) and lower odds of having resistance to gentamicin in isolates from internal medicine practices (OR 0.66; 95% CI, 0.51 to 0.84) (all P < 0.05). IMPORTANCE Patterns of antibiotic resistance in E. coli urinary isolates can vary between outpatient specialties. The use of clinical data to create practice and specialty-specific antibiograms in outpatient settings may improve antibiotic stewardship.
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Affiliation(s)
- Lauren Frisbie
- Department of Environmental and Occupational Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle, Washington, USA
| | - Scott J. Weissman
- Infectious Diseases Department, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Hema Kapoor
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus, New Jersey, USA
| | - Marisa D’Angeli
- Washington State Department of Health, Shoreline, Washington, USA
| | - Ann Salm
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus, New Jersey, USA
| | - Jeff Radcliff
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus, New Jersey, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle, Washington, USA
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Vingino AR, Rabinowitz P, Kapoor H, Ramirez V, Salm A. 177. User Preferences for Visualization of Antibiogram Data in Clinical Practice for Empiric Prescription of Antibiotics. Open Forum Infect Dis 2021. [PMCID: PMC8644035 DOI: 10.1093/ofid/ofab466.379] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Antibiograms are widely used to present antibiotic susceptibility data, but user preferences for data visualization have received little attention. We report on a qualitative research study designed to gauge preferences for presenting antibiotic resistance data, with the goals of improving speed and effectiveness of prescribing empiric antibiotics in out-patient practices to meaningfully influence antibiotic stewardship programs. Methods Criteria for online focus groups included having the ability to prescribe antibiotics, practice in Washington state, and familiarity with antibiogram usage. A preliminary survey (Fig. 1) was sent to selected participants to understand their role in healthcare and their current attitudes towards antibiograms. During focus groups, we presented examples of 3 antibiograms: standard (Fig. 2A), color-coded for % susceptible (Fig. 2B), and color-coded for change in % susceptible from 2013 to 2016 (Fig. 2C). Figure 1. Preliminary Survey via RedCap ![]()
A preliminary survey via RedCap was sent all focus group participants to capture current attitudes towards antibiograms and antibiotic resistance data. Figure 2. Presented antibiograms for focus group discussions using Quest Data. (A) Standard antibiogram for displaying % susceptibility. (B) Antibiogram color-coded for % susceptibility. (C) Antibiogram color-coded for change in % susceptibility, comparing 2013 data to 2016 data. ![]()
Results Focus groups were held between October 2020 and March 2021. Participants were 44 years of age on average, with 6-23 years of experience in primary care and/or infectious disease practice. Eight of nine participants took the preliminary survey. The survey revealed that 5 (63%) participants used antibiograms in their practice. Most participants (7; 88%) preferred an online format to print out antibiogram tables. Discourse analysis from focus groups (n=3) revealed common themes regarding Figures 2A-C as examples of antibiograms. Key ideas included discussion of the data source and content, arrangement of the table, usability during clinical days, and efforts for antibiotic stewardship related to antibiogram use. All focus group participants (n=9) favored the feature of color-coding cells and found the data in the Fig. 2B user friendly. Consensus across all groups was that antibiogram tables would not be useful for daily practice. Clinicians would rather receive simplified therapy suggestions either in the patient laboratory report or in the electronic health system. Conclusion Antibiograms can be useful for visualization of empirical data but can become a more useful tool if they can be interpreted and simplified for guiding empiric prescribing in daily out-patient practice. Disclosures Hema Kapoor, MD; D(ABMM), Quest Diagnostics (Employee, I am an employee of Quest Diagnostics and receive its stock as part of my employment.) Ann Salm, M (ASCP), MSc, PhD, Quest Diagnostics (Employee, I am an employee of Quest Diagnostics and receive its stock as part of my employment.)
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Affiliation(s)
| | | | | | - Vickie Ramirez
- University of Washington - Center for One Health Research, Seattle, Washington
| | - Ann Salm
- Quest Diagnostics, Incorporated, Secaucus, New Jersey
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Bi C, Clark RB, Master R, Kapoor H, Kroll MH, Salm AE, Meyer WA. Retrospective Performance Analyses of over Two Million U.S. QuantiFERON Blood Sample Results. Microbiol Spectr 2021; 9:e0009621. [PMID: 34319139 PMCID: PMC8552680 DOI: 10.1128/spectrum.00096-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
Both the QuantiFERON-TB Gold Plus (QFT-Plus) and the QuantiFERON-TB Gold In-Tube (QFT-GIT) tests are interferon gamma (IFN-γ) release assays (IGRAs) intended to detect in vitro cell-mediated immune responses to Mycobacterium tuberculosis antigens. In this study, we retrospectively analyzed performance data for both the QFT-GIT and QFT-Plus test systems from over 2 million samples. QFT-Plus and QFT-GIT testing was performed as specified in the respective package inserts at 23 Quest Diagnostics sites. Blood specimens were collected from individuals in all 50 states from November 2018 through December 2019. Retrospective analyses compared the proportion of positive, indeterminate, and conversion/reversion results. The overall proportion of QFT-positive results was 7% for both the QFT-Plus and QFT-GIT. The proportion of positive results was highest for QFT-GIT (7.5%) followed by the heparin 1-tube QFT-Plus (7.2%); a lower proportion of positives was observed with the 4-tube (all four QFT tubes were used in blood collection) QFT-Plus (6.0%). The proportions of indeterminate results for the 1-tube (heparin-only tube collection) and 4-tube QFT-Plus methods were less than 1% and 4%, respectively. This study indicates a higher proportion of positive results for M. tuberculosis than data from other studies. Additionally, the proportion of indeterminate QFT results were markedly lower when the sample was transported in one lithium-heparin tube instead of direct inoculation into 4 QFT-Plus tubes at the site of blood collection. IMPORTANCE In this study, we retrospectively analyzed results from both the QFT-GIT and QFT-Plus test systems from over 2 million blood specimens. The variables analyzed were (i) QFT positivity rates among various U.S. populations, (ii) indeterminate rates among various types of blood draws and how often an indeterminate result was resolved within 30 days after the initial draw, and (iii) the association of TB1 and TB2 antigen tubes with IGRA reversion and conversion events from serial QFT testing. This is, to our knowledge, the largest QFT study representing patients from an extensive geographic coverage across the United States and U.S. territories.
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Affiliation(s)
- Caixia Bi
- Quest Diagnostics, Secaucus, New Jersey, USA
| | | | | | - Hema Kapoor
- Quest Diagnostics, Secaucus, New Jersey, USA
| | | | - Ann E. Salm
- Quest Diagnostics, Secaucus, New Jersey, USA
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11
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Frisbie L, Weissman SJ, Kapoor H, D'Angeli M, Salm A, Radcliff J, Rabinowitz P. Antimicrobial Resistance Patterns of Urinary Escherichia coli Among Outpatients in Washington State, 2013-2017: Associations with Age and Sex. Clin Infect Dis 2021; 73:1066-1074. [PMID: 33768228 DOI: 10.1093/cid/ciab250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Management of acute, uncomplicated cystitis in outpatients benefits from knowledge of drug resistance patterns in the population. However, antibiograms are often not available for the outpatient setting, and the role of host factors such as sex and age in assessing the likelihood of resistance are not well understood. We investigated whether antibiotic resistance patterns of outpatient urinary Escherichia coli (EC) isolates vary by age group and sex in a large database of antibiotic susceptibility test (AST) results from Washington State. METHODS We retrospectively analyzed AST data for outpatient urinary EC isolates in Washington State tested at a clinical reference laboratory from 2013 - 2017. In logistic regression models stratified by sex, we tested the associations of antibiotic resistance with patient age. RESULTS We found females >50 years had greater odds than females younger than 19 for resistance to amoxicillin-clavulanate (odds ratio [OR], 1.43; 95% CI, 1.22-1.69), ciprofloxacin (OR, 3.04; 95% CI, 2.48-3.74), ceftriaxone (OR, 2.58; 95% CI, 1.77-3.92), and gentamicin (OR, 1.62; 95% CI, 1.27-2.08) (all p<0.001). Compared to males younger than 19, males >50 years had greater odds of resistance to ciprofloxacin (OR, 2.59; 95% CI, 1.18-5.69) and lower odds of resistance to amoxicillin-clavulanate (OR, 0.56; 95% CI, 0.34-0.96) (all p<0.05). CONCLUSION These findings demonstrate that age and sex are associated with variability in antibiotic resistance patterns in the outpatient setting. Availability of outpatient antibiotic resistance data based on sex and age may be useful to inform empiric prescribing for outpatient UTIs and to support antibiotic stewardship efforts.
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Affiliation(s)
- Lauren Frisbie
- Department of Environmental and Occupational Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle WA, USA
| | - Scott J Weissman
- Infectious Diseases Department, Seattle Children's Hospital, Seattle WA, USA
| | - Hema Kapoor
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus NJ, USA
| | | | - Ann Salm
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus NJ, USA
| | - Jeff Radcliff
- Infectious Diseases/Immunology, Quest Diagnostics, Secaucus NJ, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle WA, USA
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Cockerill FR, Wohlgemuth JG, Radcliff J, Sabol CE, Kapoor H, Dlott JS, Marlowe EM, Clarke NJ. Evolution of Specimen Self-Collection in the COVID-19 Era: Implications for Population Health Management of Infectious Disease. Popul Health Manag 2021; 24:S26-S34. [PMID: 33544647 PMCID: PMC7875129 DOI: 10.1089/pop.2020.0296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Laboratory testing is an important component in the diagnosis of respiratory tract infections such as with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, specimen collection not only risks exposure of health care workers and other patients to infection, but also necessitates use of personal protective equipment that may be in short supply during periods of heightened disease activity. Self-collection of nasal or oropharyngeal swabs offers an alternative to address these drawbacks. Although studies in the past decade have demonstrated the utility of this approach for respiratory infections, it has not been widely adopted in routine clinical practice. The rapid spread of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has focused attention on the need for safe, convenient, timely, and scalable methods for collecting upper respiratory specimens for testing. The goals of this article are to highlight the literature regarding self-collected nasal or oropharyngeal specimens for respiratory pathogen testing; discuss the role of self-collection in helping prevent the spread of the COVID-19 disease from infected patients and facilitating a shift toward “virtual” medicine or telemedicine; and describe the current and future state of self-collection for infectious agents, and the impacts these approaches can have on population health management and disease diagnosis and prevention.
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Affiliation(s)
| | | | | | | | - Hema Kapoor
- Quest Diagnostics, Secaucus, New Jersey, USA
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13
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Frisbie L, Weissman S, Kapoor H, D’Angeli MA, Salm A, Rabinowitz PM. 182. increasing Odds of Resistance for Subsequent Urinary e. Coli Isolates. Open Forum Infect Dis 2020. [PMCID: PMC7777799 DOI: 10.1093/ofid/ofaa439.492] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Annual cumulative antibiograms are routinely used by clinicians to guide selection of empirical antibiotic therapies. CLSI guidelines recommend that these antibiograms to analyze data yearly, include only final, verified results, include bacterial species with > 30 isolates and to include only the first isolate for each species/patient instance per analysis period. Handling multiple isolates from individual patients in cumulative antibiograms is a controversial topic within the antimicrobial stewardship community. Current practice favors removing subsequent isolates, thereby discarding data reflecting impact of selective antibiotic pressure on resistance patterns in recurring urinary tract infection (UTI). In this study we analyzed a five-year data set of deidentified outpatient antibiotic results from a commercial laboratory to determine whether there were significant differences in resistance patterns between first and subsequent isolates from the same patient. Methods The 5-year antibiotic susceptibility data was restricted to urinary Escherichia coli (EC) isolates. Patient occurrence(s) of urinary EC were categorized by frequency: 1st occurrence, 2nd occurrence, 3rd occurrence, and 4th or greater occurrence. A logistic regression analysis using a binary outcome for resistance and independent variable of patient isolate occurrence was run for amoxicillin-clavulanate, ampicillin, ceftriaxone, ciprofloxacin, gentamicin, levofloxacin, nitrofurantoin, and trimethoprim-sulfa. Results From a logistic regression analysis, we estimate that for each occurrence in the data, an isolate’s odds of resistance were higher for every increase in a patient’s number of occurrences in the data for all antibiotics reported with p values < 0.0001. Table 1: Odds ratios (OR) of resistance for each subsequent urinary EC isolate occurrence over 5 years ![]()
Conclusion Our findings suggest that individuals with higher numbers of urinary EC occurrences have more resistant EC than the first EC occurrence, with effects that vary by antibiotic class. Although traditional antibiograms include only the first occurrence of urinary EC from a single patient, this approach may underestimate levels of reservoir resistance in a community. Such an underestimation likely impacts efficacy of empiric therapeutic choice, healthcare outcomes, and cost. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | | | - Ann Salm
- Quest Diagnostics, Incorporated, Secaucus, New Jersey
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Clark RB, Master RN, Kapoor H, Bi C, Kroll MH, Salm A, Meyer WB. 665. Lower Indeterminate Rates and Resolution by Retesting Using a Single Lithium-Heparin Tube Blood Collection Method for the QuantiFERON®-TB Gold Plus (QFT®-Plus). Open Forum Infect Dis 2020. [PMCID: PMC7777913 DOI: 10.1093/ofid/ofaa439.858] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The QuantiFERON-TB Gold Plus (QFT-Plus) test is an assay for detecting a cell-mediated immune response to M. tuberculosis (MTB). The assay measures the in vitro quantitative IFN-γ responses to MTB or control antigens in an incubated blood sample. There are 2 options for QFT-Plus blood collection. One option is a lithium-heparin transport tube with sample aliquots subsequently transferred to 4 QFT-Plus Blood Collection Tubes (1-tube QFT-Plus); the 2nd option is to directly collect the blood sample in 4 QFT-Plus collection tubes (4-tube QFT-Plus). In this study, we compared the indeterminate (IND) rates by the 2 blood collection methods to assess which method was superior. Methods For both blood collection methods, QFT-Plus ELISA testing was performed at various Quest Diagnostics sites as specified in the assay’s package insert. A retrospective data analysis of results for the above 2 blood processing methods was conducted. Also, we evaluated the rates of IND results in follow up blood collections. Statistical analyses were performed by the proportion test. Results In 2019, the IND result rate for greater than an 1.8 million 1-tube QFT-Plus draws was less than 1% whereas, the IND result rate for 0.3 million 4-tube draws was 4% This difference was significant. The overall MTB positive rate was 7% for the 1-tube method and 6% for the 4-tube method. Within a one-month interval following an initial blood collection event, 464 patients with an original IND result had a 2nd blood sample collected and tested. Only 35% of the 2nd blood collection events produced an IND result, with 52% of the 2nd sample results reporting as negative and 13% were positive. Conclusion This study found that the 1-tube QFT-Plus collection method reduces the IND rates by 4-fold compared to the observed rate in the 4-tube process. Additionally, two thirds of patients with an initial IND result resolved to either a positive or a negative result when retested within 1 month. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | - Caixia Bi
- Quest Diagnostics, Secaucus, New Jersey
| | | | - Ann Salm
- Quest Diagnostics, Incorporated, Secaucus, New Jersey
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Frisbie L, Weissman S, Kapoor H, A. D’Angeli M, Salm A, Rabinowitz P. 1450. Risk Factors for Antibiotic Resistance of Escherichia coli Urinary Isolates in Outpatients. Open Forum Infect Dis 2019. [PMCID: PMC6810087 DOI: 10.1093/ofid/ofz360.1314] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Antibiotic-resistant E. coli infections represent a major cause of morbidity and mortality, and pose a challenge to antibiotic stewardship. Patient age has been suggested as a key determinant of resistance patterns in studies based in the United States and Europe, although local antibiotic use patterns may affect this relationship. We analyzed results from clinical antibiotic susceptibility tests performed at a large reference laboratory to further examine the association of age with E. coli urinary tract resistance patterns in WA State.
Methods
We analyzed 5 years of E. coli antibiotic susceptibility data for outpatient urinary tract infections in WA State from a national clinical reference laboratory. We included only the first isolate recorded for each patient and calculated crude rates of resistance to antibiotics for the age groups of 50 years. In a multivariate logistic model, we tested the effect of patient age, year of antimicrobial susceptibility test submission, and sex on antibiotic resistance.
Results
Univariate analyses indicated that resistance rates differed significantly across patient age groups for ciprofloxacin and nitrofurantoin. Among females, resistance rates also differed significantly across patients age groups for amoxicillin-clavulanate and gentamicin. Logistic regression using data from male patients found the odds of resistance to be significantly greater in older individuals for ciprofloxacin (OR 2.59) and lower in older individuals for amoxicillin-clavulanate (OR 0.56). For females, logistic regression found the odds of resistance to be significantly greater for older individuals for amoxicillin-clavulanate (OR 1.43), ciprofloxacin (OR 3.04), ceftriaxone (OR 2.58), nitrofurantoin (OR 2.20), and gentamicin (OR 1.62).
Conclusion
In WA State, the distribution of antibiotic resistance in E. coli urinary isolates varies with age, sex and the antibiotic of interest. Greater and more timely use of databases of susceptibility testing of clinical isolates from outpatient settings can allow for the creation of age-specific antibiograms to guide and improve stewardship.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Ann Salm
- Quest Diagnostics, Incorporated, Secaucus, New Jersey
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Frisbie L, Weissman S, Kapoor H, D’Angeli MA, Salm A, Rabinowitz P. 1602. Antibiotic Resistance Patterns of Clinical Escherichia coli Urinary Isolates by Outpatient Practice Type. Open Forum Infect Dis 2019. [PMCID: PMC6810670 DOI: 10.1093/ofid/ofz360.1466] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Antibiotic-resistant E. coli (EC) infections represent a major cause of morbidity and mortality, and pose a challenge to antibiotic stewardship. At present, clinicians in outpatient facilities may not have access to local antibiogram data to guide stewardship. Additionally, antibiotic resistance may vary between types of outpatient practices. Methods Using the database of a major clinical reference lab, this study analyzed several years of antibiotic susceptibility results for outpatient urinary EC isolates from Washington State. We compared rates of resistance to antibiotics between different types of outpatient practices, categorized using a modification of published ambulatory practice categories. Logistic regression was used to examine the association of outpatient practice type with antibiotic resistance, controlling year, sex, and age. Results After adjusting for year, sex, and age, logistic regression found significantly higher odds of resistance in urology compared with the reference groups of general family practice for ampicillin (OR 1.35), ciprofloxacin (OR 2.27), trimethoprim-sulfa (OR 1.51) and gentamicin (OR 1.73). We also saw increased odds of resistance to ciprofloxacin in patients from an oncology clinic (OR 1.56) as well as patients from “All other specialties” (OR 1.37). A lower odds of resistance was found in OBGYN clinics for ampicillin (OR 0.86), trimethoprim-sulfa (0.81) while a greater odds or resistance in OBGYN clinics was found for nitrofurantoin (OR 1.36). Conclusion Antibiotic resistance in EC urinary isolates can vary across types of outpatient practices according to clinical practice type. This may reflect differences in patient morbidity and/or differences in antibiotic stewardship practices and deserves further investigation. Patients with recurrent cases of resistant UTIs are generally referred to a urologist, and this was reflected in our data as there a higher odds of resistance was found in urology clinics. Similarly, we found higher odds of resistance into nitrofurantoin, a commonly prescribed antibiotic for UTIs in pregnant women, in OBGYN clinics that may reflect prescribing practices. Use of clinical data to create facility and specialty-specific antibiograms in outpatient settings may enable improved and “precise” antibiotic stewardship. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Ann Salm
- Quest Diagnostics, Secaucus, New Jersey
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Kapoor H, Aqil M, Imam SS, Sultana Y, Ali A. Formulation of amlodipine nano lipid carrier: Formulation design, physicochemical and transdermal absorption investigation. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2018.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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18
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Kapoor H, Jayavarapu R, Han Q, Raissi D. 3:00 PM Abstract No. 171 Microwave ablation of primary and secondary liver malignancies: patient-specific predictors of success. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.193] [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: 10/17/2022] Open
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Daley CL, Reves RR, Beard MA, Boyle J, Clark RB, Beebe JL, Catanzaro A, Chen L, Desmond E, Dorman SE, Hudson TW, Lardizabal AA, Kapoor H, Marder DC, Miranda C, Narita M, Reichman L, Schwab D, Seaworth BJ, Terpeluk P, Thanassi W, Kawamura LM. A Summary of Meeting Proceedings on Addressing Variability around the Cut Point in Serial Interferon-γ Release Assay Testing. Infect Control Hosp Epidemiol 2015; 34:625-30. [DOI: 10.1086/670635] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
On June 13, 2012, a group of key stakeholders, leaders, and national experts on tuberculosis (TB), occupational health, and laboratory science met in Atlanta, Georgia, to focus national discussion on the higher than expected positive results occurring among low-risk, unexposed healthcare workers undergoing serial testing with interferon-γ release assays (IGRAs). The objectives of the meeting were to present the latest clinical and operational research findings on the topic, to discuss evaluation and treatment algorithms that are emerging in the absence of national guidance, and to develop a consensus on the action steps needed to assist programs and physicians in the interpretation of serial testing IGRA results. This report summarizes its proceedings.
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Kapoor H, Gupta E, Sood A. Chronic pelvic ischemia: etiology, pathogenesis, clinical presentation and management. MINERVA UROL NEFROL 2014:R19Y9999N00A140003. [PMID: 24939050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Overactive Bladder (OAB) and Bladder Pain Syndrome (BPS) although common, are vaguely defined and difficult to diagnose and manage etiologies of storage--type lower urinary tract symptoms (LUTS). The lack of optimal management options is a direct consequence of deficient understanding of the pathophysiologic mechanisms underlying these conditions. These conditions are especially prevalent in females, and cumulative contemporary epidemiological, clinical and laboratory evidence implicates ischemia as one of the key players in the pathophysiologic foundation of both these disorders. Taken together they make up 'the' diagnostic as well as therapeutic black--hole in urologic practice. Much akin to chronic ischemic heart disease, chronic ischemia--reperfusion has been shown to cause degenerative changes at cellular and sub--cellular level in the bladder mucosa, smooth muscle fibers, and vesical neural and microvascular structures leading to a hypersensitive, hyperactive bladder initially, which with time invariably progresses into a failed, fibrotic and pressurized bladder. Diagnosis and management of these diseases are currently symptom focused and remains a source of much frustration. Consideration of role of ischemia connotates hope and could lead to a paradigm shift in the management of these patients with a completely new therapeutic armamentarium attacking the pathology itself.
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Affiliation(s)
- H Kapoor
- Department of Surgery, Maulana Azad Medical College, New Delhi, IN -
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21
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Kapoor H, Gupta E, Sood A. Chronic pelvic ischemia: etiology, pathogenesis, clinical presentation and management. MINERVA UROL NEFROL 2014; 66:127-137. [PMID: 24988204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Overactive bladder (OAB) and bladder pain syndrome (BPS) although common, are vaguely defined and difficult to diagnose and manage etiologies of storage-type lower urinary tract symptoms (LUTS). The lack of optimal management options is a direct consequence of deficient understanding of the pathophysiologic mechanisms underlying these conditions. These conditions are especially prevalent in females, and cumulative contemporary epidemiological, clinical and laboratory evidence implicates ischemia as one of the key players in the pathophysiologic foundation of both these disorders. Taken together they make up "the" diagnostic as well as therapeutic black-hole in urologic practice. Much akin to chronic ischemic heart disease, chronic ischemia-reperfusion has been shown to cause degenerative changes at cellular and subcellular level in the bladder mucosa, smooth muscle fibers, and vesical neural and microvascular structures leading to a hypersensitive, hyperactive bladder initially, which with time invariably progresses into a failed, fibrotic and pressurized bladder. Diagnosis and management of these diseases are currently symptom focused and remains a source of much frustration. Consideration of role of ischemia connotates hope and could lead to a paradigm shift in the management of these patients with a completely new therapeutic armamentarium attacking the pathology itself. The aim of the current review is to provide a clinical thought perspective on the etiology/pathophysiology of chronic pelvic ischemia and its role as a precursor to the aforementioned conditions, and shed some light upon the potential management strategies to consider.
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Affiliation(s)
- H Kapoor
- Department of Surgery, Maulana Azad Medical College, New Delhi, India -
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22
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Chander A, Kapoor H, Thomas S. Comparison of the efficacy and safety of bimatoprost (0.03 %) and travoprost (0.004 %) in patients with primary open angle glaucoma. Nepal J Ophthalmol 2013; 5:75-80. [DOI: 10.3126/nepjoph.v5i1.7831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To compare the efficacy and safety of bimatoprost (0.03 %) and travoprost (0.004 %) in patients with primary open angle glaucoma (POAG). Subjects and methods: Patients with POAG were randomized to receive either bimatoprost or travoprost once daily. Detailed ocular examination was done and intraocular pressure (IOP) was measured at 9.00 am, 1.00 pm and 4.00 pm at the baseline and at 1, 2, 4, 6 and 12 weeks of therapy. Results: A total of 31 patients were analysed. The patients were randomly divided into two groups (Bimatoprost group = 16; Travoprost group = 15). Both the groups had a statistically significant reduction from the baseline IOP at all follow up visits at 9.00 am, 1.00 pm and 4.00 pm. The mean IOP decreased from a baseline of 25 ± 2.32 mm Hg to 15.93 ± 1.79 mm Hg after 12 weeks in the bimatoprost group (p < 0.001), and from 24.2 ± 1.60 mm Hg to 16.53 ± 1.56 mm Hg in the travoprost group (p < 0.001). A better mean reduction of IOP was obtained with bimatoprost than with travoprost at the end of the study at 12 weeks (p = 0.03). Mild ocular redness was the commonest side effect in both the groups but was not significant in either group. Conclusion: Both drugs lowered IOP effectively but bimatoprost showed a greater reduction in the mean IOP than did travoprost at 12 weeks and both are safe for ocular use. Nepal J Ophthalmol 2013; 5(9):75-80 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7831
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Chopra R, Kapoor H, Chopra A. Ocular myocysticercosis: Favorable outcomes with early diagnosis and appropriate therapy. Nepal J Ophthalmol 2012; 4:315-8. [DOI: 10.3126/nepjoph.v4i2.6551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Ocular myocysticercosis is rare and a high index of suspicion is required for its diagnosis. Objective: To describe clinical characteristics and treatment outcome of ocular myocysticercosis. Cases: We describe a series of three patients who had different clinical presentations of ocular myocysticerocosis namely diplopia, restricted ocular motility and subconjunctival cyst. The treatment with oral albendazole and prednisolone was effective in all three cases. Conclusion: Favorable outcomes can be achieved with a high index of suspicion, early diagnosis and treatment with oral albendazole and prednisolone in patients with ocular myocysticercosis.DOI: http://dx.doi.org/10.3126/nepjoph.v4i2.6551 Nepal J Ophthalmol 2012; 4 (2): 315-318
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Abstract
Endoscopic Retrograde Cholangiopancreatography is used for both diagnostic and therapeutic purposes. It is relatively more complex than routine endoscopies and requires adequate patient sedation. Furthermore the patients often have co-morbidities. This article provides an overview of various anaesthetic drugs and the type of anaesthesiological support.
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Affiliation(s)
- H Kapoor
- Department of Anaesthesiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.
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25
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Abstract
Aims and Objectives: The aim of the study was to establish the prevalence of enuresis in school children and to determine contributing factors along with treatment methods used in these children. Materials and Methods: The parents of 1473 children aged between 6-10 years completed a self-administered semi-structured questionnaire. Socio-demographic profiles, enuresis data, medical and psychiatric disorders and family stressors were collected. The data was analyzed and the results presented. Results: The response rate was 89.22%. The overall prevalence of enuresis was 7.61%. Enuresis was more common in boys. A positive family history of enuresis was seen in 28.57% children; 14.29% of the children had daytime wetting as well. Only 24.11% of the parents had taken their child to a doctor for the problem. Family stressors, significant birth history and lower socioeconomic status was present to a larger extent in the enuretic group. Scholastic backwardness was also an important factor in this group. Conclusions: This study reports on the prevalence of enuresis in school-going children and stresses on the need for parental education and awareness about this problem.
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De Sousa AA, De Sousa J, Kapoor H. An open randomized trial comparing disulfiram and topiramate in the treatment of alcohol dependence. J Subst Abuse Treat 2007; 34:460-3. [PMID: 17629442 DOI: 10.1016/j.jsat.2007.05.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [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: 04/04/2007] [Revised: 05/03/2007] [Accepted: 05/22/2007] [Indexed: 11/29/2022]
Abstract
This study compared the efficacy of disulfiram (DSF) and topiramate (TPM) for preventing alcoholic relapse in an open study of routine clinical practice in India. One hundred alcohol-dependent men with family members who agreed to encourage medical compliance and to accompany them for follow-up were randomly allocated to 9 months of treatment with DSF or TPM. Weekly psychotherapy was also provided. There was no blinding of conditions for the psychiatrist, patient, or family members. Supervision and support of the family member were used in the maintenance of compliance among the patients. Alcohol consumption, craving, and adverse events were recorded weekly for 3 months and then biweekly. Serum gamma glutamyl transferase was measured at the start and at the end of the study. At the end of the trial, 92 patients were still in contact. Relapse occurred at a mean of 133 days for DSF as compared with 79 days for TPM. At 9 months, 90% of DSF patients, as compared with 56% of TPM patients, remained abstinent. TPM-treated patients did show less craving than DSF patients did. Further comparisons between these drugs in different treatment settings and patient populations are warranted.
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Guerin S, Collins C, Kapoor H, McClean I, Collins D. Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med 2007; 17:37-43. [PMID: 17266702 DOI: 10.1111/j.1365-3148.2006.00698.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this study was to identify the clinical factors associated with the need for peri-operative blood transfusion in non-anaemic patients undergoing hip or knee arthroplasty. We prospectively evaluated 162 consecutive patients who underwent total hip or knee arthroplasty. Analysis was performed to establish the relationship between all independent variables and the need for postoperative transfusion. Univariate analysis revealed a significant relationship between the need for postoperative blood transfusion and the pre-operative haemoglobin levels (P= 0.001), weight (P= 0.019) and age (P= 0.018). Multivariate analysis identified a significant relationship only between the need for transfusion and the pre-operative haemoglobin level (P= 0.0001). The pre-operative haemoglobin level of the patient was the only variable to independently predict the need for blood transfusion after primary hip or knee arthroplasty.
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Affiliation(s)
- S Guerin
- Department of Orthopaedic Surgery, St Mary's Orthopaedic Hospital, Cork, Ireland.
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Grover SS, Sharma M, Chattopadhya D, Kapoor H, Pasha ST, Singh G. Phenotypic and genotypic detection of ESBL mediated cephalosporin resistance in Klebsiella pneumoniae: Emergence of high resistance against cefepime, the fourth generation cephalosporin. J Infect 2006; 53:279-88. [PMID: 16488476 DOI: 10.1016/j.jinf.2005.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Cephalosporins belonging to second and third generation are commonly used in India for the treatment of Klebsiella pneumoniae. Report on resistance among K. pneumoniae strains to second and third generation cephalosporins are on rise in this country, which has been attributed to emergence of strains expressing extended-spectrum beta-lactamases (ESBLs). The aim of this study was to evaluate the in vitro susceptibility of K. pneumoniae to broad-spectrum cephalosporins particularly to cefepime, a recently introduced fourth generation cephalosporin in relation to ESBL production. METHODS This study has been carried out in two phases among K. pneumoniae strains isolated between October 2001 and September 2002 (phase I, before marketing of cefepime in India) and between August 2003 and July 2004 (phase II, after marketing of cefepime in India). Minimum Inhibitory Concentration (MIC) was determined by a commercial strip containing gradient of antimicrobials (Strip E-test). Detection for ESBL production was carried out by DDST, E-test ESBL and PCR. RESULTS Antimicrobial resistance profile of K. pneumoniae strains to five cephalosporins as analyzed by WHONET 5 identified 15 different resistance profiles among the 108 phase I isolates, ranging from resistance to none (19.44%) to all the five cephalosporin (8.33%) and eight different resistance profiles among the 99 phase II isolates, ranging from resistance to none (9.1%) to all the five cephalosporins (36.4%). Among the 108 phase I isolates a total of 71 (65.72%) and out of 99 phase II isolates, a total of 87 (88.0%) could be identified as ESBL producers. Among the isolates, regardless of the phase of the isolation, those characterized by production of ESBL showed overall higher frequency of resistance to cephalosporins (range 19.7-85.9% and 51.7-100% in phase I and phase II, respectively) compared to those for ESBL non-producers (range 0-13.5% and 0-25% in phase I and phase II, respectively). Ten randomly selected isolates from the most common resistance phenotypes probably belonged to a single strain as evident by MIC patterns, genotypic characterization and resistance profile to non-cephalosporin group of antimicrobials thereby pointing out the possibility of an outbreak. CONCLUSIONS PCR may be regarded as a reliable method for detection of ESBL since in addition to the strains that could be identified as ESBL producers by DDST and E-test ESBL; PCR could demonstrate ESBL production among additional 32 strains (15 in phase I and 17 in phase II). Continued uses of cephalosporin group appear to be a potential risk factor for emergence of ESBL producing K. pneumoniae strains. In addition, as noted in the present study, the rise of resistance to cefepime that has been introduced recently in this country for therapeutic use could be of concern.
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Affiliation(s)
- S S Grover
- Department of Biochemistry-Biotechnology, National Institute of Communicable Diseases, 22-Shamnath Marg, New Delhi-110054, India
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Abstract
We summarize the first reported case of acquired lymphocytic choriomeningitis virus (LCMV) infection in Michigan to be investigated by public health authorities and provide evidence of the focal nature of LCMV infection in domestic rodents. Results of serologic and virologic testing in rodents contrasted, and negative serologic test results should be confirmed by tissue testing.
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Affiliation(s)
- Erik S Foster
- Communicable Disease Division, Michigan Department of Community Health, 201 Townsend Street, Lansing, MI 48913, USA.
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Muerhoff AS, Dawson GJ, Dille B, Gutierrez R, Leary TP, Gupta MC, Kyrk CR, Kapoor H, Clark P, Schochetman G, Desai SM. Enzyme-linked immunosorbent assays using recombinant envelope protein expressed in COS-1 and Drosophila S2 cells for detection of West Nile virus immunoglobulin M in serum or cerebrospinal fluid. Clin Diagn Lab Immunol 2005; 11:651-7. [PMID: 15242936 PMCID: PMC440607 DOI: 10.1128/cdli.11.4.651-657.2004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Humans infected with West Nile virus (WNV) develop immunoglobulin M (IgM) antibodies soon after infection. The microtiter-based assays for WNV IgM antibody detection used by most state public health and reference laboratories utilize WNV antigen isolated from infected Vero cells or recombinant envelope protein produced in COS-1 cells. Recombinant antigen produced in COS-1 cells was used to develop a WNV IgM capture enzyme immunoassay (EIA). A supplementary EIA using WNV envelope protein expressed in Drosophila melanogaster S2 cells was also developed. Both assays detected WNV IgM in the sera of experimentally infected rhesus monkeys within approximately 10 days postinfection. Human sera previously tested for WNV IgM at a state public health laboratory (SPHL) were evaluated using both EIAs. Among the sera from 20 individuals with laboratory-confirmed WNV infection (i.e., IgM-positive cerebrospinal fluid [CSF]) that were categorized as equivocal for WNV IgM at the SPHL, 19 were IgM positive and one was negative by the new EIAs. Of the 19 IgM-positive patients, 15 were diagnosed with meningitis or encephalitis; the IgM-negative patient was not diagnosed with neurological disease. There was 100% agreement between the EIAs for the detection of WNV IgM. CSF samples from 21 individuals tested equivocal for WNV IgM at the SPHL; all 21 were positive in both bead assays, and 16 of these patients were diagnosed with neurological disease. These findings demonstrate that the new EIAs accurately identify WNV infection in individuals with confirmed WNV encephalitis and that they exhibit enhanced sensitivity over that of the microtiter assay format.
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Affiliation(s)
- A Scott Muerhoff
- Infectious Diseases Research and Development, Abbott Diagnostics, Abbott Laboratories, Abbott Park, Illinois 60064-6015, USA.
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Kapoor H, Signs K, Somsel P, Downes FP, Clark PA, Massey JP. Persistence of West Nile Virus (WNV) IgM antibodies in cerebrospinal fluid from patients with CNS disease. J Clin Virol 2004; 31:289-91. [PMID: 15494271 DOI: 10.1016/j.jcv.2004.05.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [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] [Revised: 05/24/2004] [Accepted: 05/28/2004] [Indexed: 11/23/2022]
Abstract
The Michigan Department of Community Health (MDCH) reported 644 laboratory positive human cases of West Nile Virus (WNV) in the 2002 outbreak in the US, of which 559 cases presented with either meningitis or encephalitis. The first line test utilized for diagnosis of WNV infection was the immunoglobulin M (IgM)-capture enzyme-linked immunosorbent assay (MAC-ELISA). We continued testing for WNV even during winter months of the year 2002-2003 due to the awareness of other modes of WNV transmission (blood transfusion, organ transplantation, transplacental, breast milk, and occupational) as well as concern for people traveling to endemic areas. As a result of year-round testing for WNV infections during 2002-2003, we detected WNV IgM-specific antibodies in cerebrospinal fluid (CSF) specimens from three patients persisting for 110, 141, and 199 days post acute phase infection in patients with central nervous system (CNS) disease. This is a new observation and there is no published data on the persistence of WNV IgM antibodies in CSF specimens beyond 47 days. Thus, it is important to note that the presence of WNV IgM class antibodies may not always reflect acute phase infection with this virus.
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Affiliation(s)
- Hema Kapoor
- Bureau of Laboratory, Michigan Department of Community Health (MDCH), 3350 N MLK Blvd, Lansing, MI 48909, USA.
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Pealer LN, Marfin AA, Petersen LR, Lanciotti RS, Page PL, Stramer SL, Stobierski MG, Signs K, Newman B, Kapoor H, Goodman JL, Chamberland ME. Transmission of West Nile virus through blood transfusion in the United States in 2002. N Engl J Med 2003; 349:1236-45. [PMID: 14500806 DOI: 10.1056/nejmoa030969] [Citation(s) in RCA: 411] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND During the 2002 West Nile virus epidemic in the United States, patients were identified whose West Nile virus illness was temporally associated with the receipt of transfused blood and blood components. METHODS Patients with laboratory evidence of recent West Nile virus infection within four weeks after receipt of a blood component from a donor with viremia were considered to have a confirmed transfusion-related infection. We interviewed the donors of these components, asking them whether they had had symptoms compatible with the presence of a viral illness before or after their donation; blood specimens retained from the time of donation and collected at follow-up were tested for West Nile virus. RESULTS Twenty-three patients were confirmed to have acquired West Nile virus through transfused leukoreduced and nonleukoreduced red cells, platelets, or fresh-frozen plasma. Of the 23 recipients, 10 (43 percent) were immunocompromised owing to transplantation or cancer and 8 (35 percent) were at least 70 years of age. Immunocompromised recipients tended to have longer incubation periods than nonimmunocompromised recipients and infected persons in mosquito-borne community outbreaks. Sixteen donors with evidence of viremia at donation were linked to the 23 infected recipients; of these donors, 9 reported viral symptoms before or after donation, 5 were asymptomatic, and 2 were lost to follow-up. Fever, new rash, and painful eyes were independently associated with being an implicated donor with viremia rather than a donor without viremia. All 16 donors were negative for West Nile virus-specific IgM antibody at donation. CONCLUSIONS Transfused red cells, platelets, and fresh-frozen plasma can transmit West Nile virus. Screening of potential donors with the use of nucleic acid-based assays for West Nile virus may reduce this risk.
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Affiliation(s)
- Lisa N Pealer
- Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Narwal S, Balasubrahmanyam A, Sadhna P, Kapoor H, Lodha ML. A systemic resistance inducing antiviral protein with N-glycosidase activity from Bougainvillea xbuttiana leaves. Indian J Exp Biol 2001; 39:600-3. [PMID: 12562026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
An antiviral protein from Bougainvillea xbuttiana leaves induced systemic resistance in host plants N. glutinosa and Cyamopsis tetragonoloba against TMV and SRV, respectively which was reversed by actinomycin D, when applied immediately or shortly after antiviral protein treatment. When the inhibitor was applied to the host plant leaves post inoculation, it was effective if applied upto 4 h after virus infection. It also delayed the expression of symptoms in systemic hosts of TMV. The inhibitor showed characteristic N-glycosidase activity on 25S rRNA of tobacco ribosomes, suggesting that it could also be interfering with virus multiplication through ribosome-inactivation process.
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Affiliation(s)
- S Narwal
- Division of Biochemistry, Indian Agricultural Research Institute, New Delhi 110 012, India
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Sengupta S, Deodhar L, Kapoor H, Badrinath S, Menon SS. Spectrum of antibiogram against pathogens related to respiratory tract infections with a special reference to ceftibuten: a multicentric study. J Indian Med Assoc 2000; 98:196-7. [PMID: 11016192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
In a multicentric study at several leading hospitals of this country, microbiological assessment was carried out in 500 specimens from patients suffering from respiratory tract infections (RTIs; both upper and lower) for a period of 6 months from January, 1999 to June, 1999. The antibiotic sensitivity study was done in 201 isolates from 500 different specimens of throat swab, postpharyngeal swab, sinusitis drainage fluid, sputum, broncho-alveolar lavage (BL), etc. Ceftibuten, an orally active third generation cephalosporin showed encouraging results when compared with seven other selected antibiotics used for RTI. The majority of the patients with acute or chronic RTIs showed an excellent in vitro response to ceftibuten in the analysis of the isolates. Seventy to ninety per cent of the isolated respiratory pathogens were found to be sensitive to ceftibuten in vitro; which offers a promising alternative to other antibiotics included in this study.
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Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury 2000; 31:75-9. [PMID: 10748808 DOI: 10.1016/s0020-1383(99)00207-7] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. In this study 90 adult cases of acute displaced intra-articular fractures of the lower end of the radius were classified according to Frykman's and AO classifications after obtaining radiographs in antero-posterior and lateral planes. These were randomly treated by one of three methods: (1) closed reduction and plaster immobilisation, (2) external fixation and (3) open reduction and internal fixation, and were followed for an average of 4 yr. In the final functional assessment (Sarmiento) the results were (1) plaster 43% good and excellent, 50% fair and 7% poor, (2) external fixator 80% good and excellent, 20% fair and poor results, (3) open reduction and internal fixation 63% good and excellent, 26% fair, 11% poor. We recommend that displaced severely comminuted intra-articular fractures should be treated with an external fixator.
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Abstract
AIM To evaluate the results of cataract surgery performed in a rural Indian eye camp. METHOD The pre- and postoperative visual acuities and surgical complications were recorded prospectively in 6383 eyes undergoing cataract extraction for age related cataract in rural eye camps held in northern India in 1993-4. The best visual acuity and cause of poor outcome were recorded on 3908 eyes seen at 6 weeks' follow up. RESULTS Of 6383 operated eyes 94.8% had a visual acuity of less than 3/60 preoperatively, and 41% of the procedures were performed on patients who were bilaterally blind (less than 3/60 better eye). At discharge with standard aphakic spherical spectacles, 11.3% of eyes had an acuity of less than 6/60 (poor outcome), and 25.9% had an acuity of 6/18 or better. At 6 weeks' follow up 3908 eyes were examined (61.2%), of which, with best correction, 4.3% had poor outcome (acuity of less than 6/60) and 79.9% obtained 6/18 or better. Pre-existing eye pathology was responsible for poor outcome in 3.0% of eyes and surgical complications in 1.3% of eyes, of which corneal decompensation was the major cause (0.5%). In 237 eyes which received an intraocular lens implantation (IOL) in the camp, the visual acuity at discharge was 6/18 or better in 44.5% of eyes improving to 87.9% in the 157 eyes which were seen at 6 weeks' follow up. Poor outcome (less than 6/60) was seen in 5.7% of the eyes with an IOL at discharge improving to 1.9% at follow up. CONCLUSION This evaluation suggests that it is possible to obtain acceptable results from cataract extraction with experienced ophthalmologists in well conducted Indian eye camps. Better correction of aphakia at discharge from the camp would improve the immediate visual results, which is important as a significant number of patients do not return for follow up. The use of posterior chamber IOLs in the eye camp by experienced ophthalmologists, appeared to give satisfactory results, although further evaluation with a larger series of cases and more surgeons is required before it can be recommended.
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Affiliation(s)
- H Kapoor
- Christian Medical College and Hospital, Ludhiana, Punjab, India
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37
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Kapoor H, Aggarwal P. Resistance to Quinolones in Pathogens Causing Urinary Tract Infections. J Urol 1999. [DOI: 10.1016/s0022-5347(01)62190-6] [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: 10/25/2022]
Affiliation(s)
- H. Kapoor
- Department of Microbiology, Safdarjang Hospital, New Delhi, India
| | - P. Aggarwal
- Department of Microbiology, Safdarjang Hospital, New Delhi, India
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Chaudhry R, Chandel D, Mehta G, Kapoor H, Pang T. Molecular characterization of drug sensitive and drug resistant strains of Salmonella typhi. Med J Indones 1998. [DOI: 10.13181/mji.v7isupp1.1100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kapoor H, Murlidhar S, Jais M, Thakur R, Aggarwal P. Evaluation of efficacy of Dettol-H in hospital use. J Commun Dis 1998; 30:167-70. [PMID: 10093423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
A study was conducted at Safdarjang Hospital, New Delhi, to elucidate the bactericidal effect of a new disinfectant having benzalkonium chloride (40%) + disodium edetate (1.5%) and commercially available as Dettol-H, in comparison with that of a disinfectant already in-use in this hospital and having chlorhexidine gluconate (7.5%) + cetrimide (15%) + isopropyl alcohol (commercially available as Alpilon). The modified Capacity test of Kelsey-Sykes and In-use test of Kelsey-Maurer were carried out using control strains and random gram positive and gram negative bacterial isolates from clinical specimens. The two disinfectant solutions were analysed at three dilutions viz. weak, recommended and strong. From the study it could be inferred that both Dettol-H and Alpilon were equally effective in recommended and strong dilutions against the organisms tested. Weak dilutions were not effective in both and hence Dettol-H and Alpilon are effective only if used in prescribed concentrations.
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Affiliation(s)
- H Kapoor
- Department of Microbiology, Safdarjang Hospital, New Delhi
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40
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Yeung PK, Little R, Jiang Y, Buckley SJ, Pollak PT, Kapoor H, Veldhuyzen van Zanten SJ. A simple high performance liquid chromatography assay for simultaneous determination of omeprazole and metronidazole in human plasma and gastric fluid. J Pharm Biomed Anal 1998; 17:1393-8. [PMID: 9800658 DOI: 10.1016/s0731-7085(98)00020-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Antibiotics which are actively secreted into gastric fluid may be more efficacious in the eradication of Helicobacter pylori in peptic ulcer disease. Other agents used in the treatment of this disease such as omeprazole or other anti-secretory agents may alter the secretion and/or distribution characteristics of antibiotics. In order to test the applicability of these concepts to metronidazole, a sensitive and specific high performance liquid chromatography (HPLC) assay was developed to quantitate omeprazole in plasma, and metronidazole in plasma and gastric fluid. The HPLC system consisted of a multi-phase column combining anion exchange and reversed phase separation (OmniPac Pax-500, Dionex), and a variable wavelength UV detector set at 254 nm. The mobile phase was a mixture of 0.1 M sodium phosphate buffer:methanol:acetonitrile (60:20:20) with final pH adjusted to approximately 7.0. Metronidazole and omeprazole were extracted by adsorption onto a C2-bonded silica gel solid phase extraction column, and eluted with methanol. The extract was dried, reconstituted in a solution of acetyl salicylic acid (ASA), and then injected into the HPLC system. Under these conditions, metronidazole, omeprazole and ASA were well separated and recoveries in plasma were greater than 80%. Omeprazole could not be measured in gastric fluid because of rapid decomposition. Using 0.3 ml of sample, the assay sensitivity was less than 0.1 microgram ml-1 and linear up to 10 micrograms ml-1. Both intra- and inter-assay CV were greater than 15%. It was applied successfully in determining metronidazole concentrations in clinical samples of plasma and gastric fluid.
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Affiliation(s)
- P K Yeung
- Pharmacokinetics and Metabolism Laboratory, College of Pharmacy, Dalhousie University, Halifax, N.S., Canada
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Thong KL, Nair S, Chaudhry R, Seth P, Kapil A, Kumar D, Kapoor H, Puthucheary S, Pang T. Molecular analysis of Salmonella paratyphi A from an outbreak in New Delhi, India. Emerg Infect Dis 1998; 4:507-8. [PMID: 9716989 PMCID: PMC2640298 DOI: 10.3201/eid0403.980348] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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42
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Kapoor H, Aggarwal P. Resistance to quinolones in pathogens causing urinary tract infections. J Commun Dis 1997; 29:263-7. [PMID: 9465532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
157 bacterial isolates from cases with urinary tract infections (UTI) were studied for their susceptibility to some of the available quinolones as compared to other commonly used antimicrobial agents in UTI. Resistance to nalidixic acid was observed in 62.4% of isolates whereas for pefloxacin, norfloxacin, ciprofloxacin and lomifloxacin it was 54.7%, 52.5%, 51.5% and 50.3% respectively. Aminoglycosides and third generation cephalosporins showed resistance in fewer isolates. Gentamicin resistance was observed in 21% and corresponding figure for amikacin, cefotaxime and ceftriaxone was 7%, 8.9% and 12.1% respectively. Nitrofurantoin showed resistance in 36.3% of isolates and 48% isolates were resistant to cephalexin. The minimum inhibitory concentration (MIC) of quinolones was more than 64 mcg/ml which is > 8 times in resistant strains as compared to sensitive isolates.
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Affiliation(s)
- H Kapoor
- Department of Microbiology, Safdarjang Hospital, New Delhi
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43
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Sarin YK, Kapoor H. Bardet-Biedl syndrome. Indian Pediatr 1997; 34:539-40. [PMID: 9357211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Y K Sarin
- Department of Surgery, Christian Medical College, Ludhiana
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Veldhuyzen van Zanten SJ, Pollak PT, Kapoor H, Yeung PK. Effect of omeprazole on movement of intravenously administered metronidazole into gastric juice and its significance in treatment of Helicobacter pylori. Dig Dis Sci 1996; 41:1845-52. [PMID: 8794805 DOI: 10.1007/bf02088756] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Four healthy, Helicobacter-negative volunteers were studied to determine the effect of omeprazole on the movement of metronidazole across the gastric mucosa into the gastric lumen. Each received a 500-mg intravenous infusion of metronidazole and repeated serum, and gastric juice samples were obtained concomitantly over an 8-hr study via indwelling intravenous catheter and nasogastric tube. The same protocol was repeated following one week of oral omeprazole 20 mg twice daily. Metronidazole concentrations were measured by high-performance liquid chromatography. The results demonstrated that: metronidazole moves rapidly from serum into gastric juice; omeprazole causes a marked reduction in total metronidazole concentrations in gastric juice, completely accounted for by pH-related shifts in the proportion of ionized metronidazole, but does not alter concentrations of nonionized metronidazole, which remain above the MIC level against H. pylori; and even under conditions where no pH-related drug trapping occurs (pH > 4), concentrations of metronidazole were higher in gastric juice than in serum during most of the study, indicating that a special transport mechanism may be operational. The practical implication of this effect of omeprazole in combination therapy with metronidazole remains to be established.
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Affiliation(s)
- S J Veldhuyzen van Zanten
- Division of Gastroenterology, Faculty of Medicine, Dalhousie University, Victoria General Hospital, Halifax, Nova Scotia, Canada
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Peterson RT, Kapoor H. Hospital portrayal of seniors in newspaper advertisements: a content analysis. J Hosp Mark 1994; 10:91-102. [PMID: 10156187 DOI: 10.1300/j043v10n01_08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this inquiry was to analyze: (a) the extent to which hospitals employed senior citizens as models in their advertisements, (b) the roles of these models and their active-passive status, and (c) the degree to which the advertisements portrayed seniors in a positive or negative status. Content analysis was employed to assess these issues. Hypotheses about the portrayal of senior citizens by hospitals were tested by examining advertisements in newspapers. The analysis provided some findings which should be of value to researchers and practitioners in the health care industry.
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Affiliation(s)
- R T Peterson
- Department of Marketing, New Mexico State University, Las Cruces 88003, USA
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Affiliation(s)
- S Gupta
- Department of Medicine Unit-II, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Malhotra AK, Singh B, Minocha SK, Kapoor H. Drug resistant typhoid fever (DRT). J Assoc Physicians India 1992; 40:416-7. [PMID: 1452575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Haldane JH, Kapoor H, Morris J. Severe eosinophilia associated with a malignant islet cell tumour. CMAJ 1989; 140:1061, 1063. [PMID: 2539897 PMCID: PMC1268980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- J H Haldane
- Department of Medicine, Victoria General Hospital, Halifax NS
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Gohil P, Kapoor H, Ma D, Pekerar MC, McIlrath TJ, Ginter ML. Soft x-ray lithography using radiation from laser-produced plasmas. Appl Opt 1985; 24:2024. [PMID: 18223832 DOI: 10.1364/ao.24.002024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Kapoor H. Separation and gravimetric determination of cerium and lanthanum with N-m-tolyl-m-nitrobenzohydroxamic acid. Talanta 1975; 22:193-6. [DOI: 10.1016/0039-9140(75)80165-2] [Citation(s) in RCA: 5] [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] [Received: 01/16/1974] [Revised: 08/01/1974] [Accepted: 08/29/1974] [Indexed: 10/17/2022]
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