1
|
Mathew D, Kim J, Kosuru BP, Devagudi D, Sherif A, Shrestha U, Bedi P. Mortality and bleeding associated with the management of sub-massive pulmonary embolism: a systematic review and Bayesian network meta-analysis. Sci Rep 2023; 13:7169. [PMID: 37137999 PMCID: PMC10156731 DOI: 10.1038/s41598-023-34348-9] [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] [Received: 09/29/2022] [Accepted: 04/27/2023] [Indexed: 05/05/2023] Open
Abstract
Current guidelines recommend anticoagulation (AC) for low and intermediate-risk pulmonary embolism (PE) and systemic thrombolysis (tPA) for high risk (massive) PE. How these treatment options compare with other modalities of treatment such as catheter directed thrombolysis (CDT), ultrasound assisted catheter thrombolysis (USAT), and administering lower dose of thrombolytics (LDT) is unclear. There is no study that has compared all these treatment options. We conducted a systematic review and Bayesian network meta-analysis of randomized controlled trials in patients with submassive (intermediate risk) PE. Fourteen randomized controlled trials were included, comprising 2132 patients. On Bayesian network meta-analysis, a significant decrease in mortality was noted in tPA versus AC. There was no significant difference between USAT versus CDT. For risk of major bleeding, there was no significant difference in relative risk of major bleeding between tPA versus AC and USAT versus CDT. tPA was found to have a significantly higher risk of minor bleeding and a lower risk of recurrent PE compared to AC. Systemic thrombolysis is associated with a significant reduction in mortality and recurrent PE compared to anticoagulation but an increased risk of minor bleeding. There was no difference in risk of major bleeding. Our study also shows that while the newer modalities of treatment for pulmonary embolism are promising, there is lack of data to comment on the purported advantages.
Collapse
Affiliation(s)
- Don Mathew
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
- Department of Internal Medicine, UPMC East, 2775 Mosside Blvd, Monroeville, PA, 15146, USA.
| | - Jay Kim
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Bhanu Prasad Kosuru
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Deepthi Devagudi
- Department of Internal Medicine, West Anaheim Medical Center, Anaheim, CA, USA
| | - Akil Sherif
- Department of Cardiology, St Vincent Hospital, Worcester, MA, USA
| | - Utsav Shrestha
- Department of Pulmonary and Critical Care Medicine, West Virginia University, Morgantown, WV, USA
| | - Prabhjot Bedi
- Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| |
Collapse
|
2
|
Xiao L, Chiang J, Castro-Codesal M, Kolski H, Bedi P, Al Amrani F, Gonorazky HD, Amin R. Respiratory characteristics in children with spinal muscular atrophy type 1 receiving nusinersen. Pediatr Pulmonol 2023; 58:161-170. [PMID: 36193036 DOI: 10.1002/ppul.26173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Spinal muscular atrophy type 1 (SMA1) is a neuromuscular disorder with a natural history of chronic respiratory failure and death during infancy without ventilation. Recently, disease-modifying therapies such as nusinersen have improved disease trajectory. However, objective data on the trajectory of polysomnography outcomes, the relationship between motor scores and respiratory parameters, respiratory technology dependence and healthcare utilization in children with SMA1 remain to be elucidated. METHODS This was a retrospective observational study of children with SMA1 receiving nusinersen between October 2016 and February 2021 at two tertiary care hospitals in Canada. Baseline polysomnography data, motor scores, respiratory technology, and unanticipated healthcare utilization were examined. RESULTS Eleven children (five females, two SMN2 copies each) were included. Median (interquartile range [IQR]) age at diagnosis was 3.6 (2.8-5.0) months and age at diagnostic polysomnogram following nusinersen initiation was 9.4 (5.3-14.0) months. Nusinersen was initiated at a median (IQR) age of 5.4 (3.4-7.6) months and 8/11 children had respiratory symptoms at that time. Diagnostic polysomnography data showed a median (IQR) central apnea-hypopnea index (AHI) of 4.1 (1.8-10.0) and obstructive AHI of 2.2 (0-8.0) events/h. We observed an inverse relationship between motor scores and central apnea-hypopnea indices. All children required ventilatory support at the end of the study period. CONCLUSION This study showed abnormal polysomnography parameters and need for ventilation despite nusinersen suggesting ongoing need for regular monitoring with polysomnography. Understanding the respiratory disease trajectory of children undergoing treatment with nusinersen will inform decision-making regarding optimal timing of ventilatory support initiation.
Collapse
Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jackie Chiang
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Maria Castro-Codesal
- Division of Respiratory Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Hanna Kolski
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Division of Neurology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Prabhjot Bedi
- Division of Respiratory Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Fatema Al Amrani
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Pediatric Neurology Unit, Child Health Department, Sultan Qaboos University Hospital, Seeb, Oman.,Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hernan D Gonorazky
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
3
|
Singh T, Bedi P, Bumrah K, Gandhi D, Arora T, Verma N, Schleicher M, Rai MP, Garg R, Verma B, Sanaka MR. Fecal Microbiota Transplantation and Medical Therapy for Clostridium difficile Infection : Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol 2022; 56:881-888. [PMID: 34516460 DOI: 10.1097/mcg.0000000000001610] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022]
Abstract
GOALS The aim was to assess the effectiveness of fecal microbiota transplantation (FMT) against medical therapy (MT). BACKGROUND FMT has shown good outcomes in the treatment of Clostridium difficile infection (CDI). We aimed to conduct a systematic review and meta-analysis to compare the effectiveness of FMT versus MT for CDI. STUDY We performed a comprehensive search to identify randomized controlled trials comparing FMT against MT in patients with CDI. Outcomes of interest were clinical cure as determined by the resolution of diarrhea and/or negative C. difficile testing. Primary CDI is defined as the first episode of CDI confirmed endoscopically or by laboratory analysis. Recurrent C. difficile infection (RCDI) is defined as laboratory or endoscopically confirmed episode of CDI after at least 1 course of approved antibiotic regimen. RESULTS A total of 7 studies with 238 patients were included in meta-analysis. Compared with MT, FMT did not have a statistically significant difference for clinical cure of combined primary and RCDI after first session [risk ratio (RR): 1.52, 95% confidence interval (CI): 0.90, 2.58; P =0.12; I2 =77%] and multiple sessions of FMT (RR: 1.68; CI: 0.96, 2.94; P =0.07; I2 =82%). On subgroup analysis, FMT has statistically higher rate of response than MT (RR: 2.41; CI: 1.20, 4.83; I2 =78%) for RCDI. However, for primary CDI there is no statistically significant difference between FMT and MT (RR: 1.00; CI: 0.72, 1.39; I2 =0%). CONCLUSION As per our analysis, FMT should not be utilized for every patient with CDI. It is more effective in RCDI, but the results were not significant in patients with primary CDI.
Collapse
Affiliation(s)
| | | | | | - Darshan Gandhi
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tanureet Arora
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Nikita Verma
- Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | | | - Manoj P Rai
- Department of Medicine, Asante Rogue Regional Medical Center, Medford, OR
| | | | | | | |
Collapse
|
4
|
Mathew D, Hasin F, Bumrah K, Kosuru B, Singh V, Bedi P. Impact of cannabis use in patients with implantable cardiac defibrillators admitted with acute heart failure: a national perspective. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2655] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cannabis is the most popular recreational drug in the United States but knowledge about its health implications remain limited. Cannabis use has been linked to acute myocardial infarction and congestive heart failure. The effect of cannabis use in acute decompensated heart failure in patients with Implantable Cardiac Defibrillators (ICDs) is not known.
Objective
In this study, we sought to explore the impact of cannabis use in patients with Implantable Cardiac Defibrillators (ICDs) admitted with acute decompensated heart failure.
Methods
We queried the 2019 National Inpatient Sample (NIS) database for all patients aged ≥18 with ICD devices admitted with acute heart failure. Patients were stratified into two groups based on Cannabis use. We excluded patients with opioid, amphetamine, psychostimulants, cocaine, sedative, and hallucinogen abuse disorders to eliminate the effect of polysubstance use.
Results
Of the 174,295 hospitalization events for acute decompensated heart failure with ICDs, 1824 were noted to have diagnosis of cannabis use (CU). Patients with CU were younger (mean age 52.4y vs 68.5y) and mostly male (81.1% vs 18.9%). CU group had lower prevalence rates for anemia, atrial fibrillation, coronary artery disease, diabetes, cirrhosis, chronic kidney disease and hypothyroidism. They had higher rates of alcoholism, tobacco use and depression. The primary outcome studied was inpatient mortality. Secondary outcomes include cardiac arrest, myocardial infarction, cardiogenic shock, ventricular tachycardia, ventricular fibrillation, stroke, respiratory failure, pleural effusion, acute kidney injury, length of stay (LoS) and hospital charges. Patients in CU group were noted to have decreased length of stay (reduction in adjusted mean LoS: 2.14 days, P=0.000), mortality (adjusted OR: 0.14, P=0.006) and respiratory failure (adjusted OR: 0.53, P=0.009).
Conclusion
Among patients with implantable cardiac defibrillator admitted for acute decompensated heart failure, cannabis users were younger and mostly male. These patients were noted to have decreased length of stay, inpatient mortality, and respiratory failure.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- D Mathew
- Upmc University of Pittsburgh Medical Center , Pittsburgh , United States of America
| | - F Hasin
- Upmc University of Pittsburgh Medical Center , Pittsburgh , United States of America
| | - K Bumrah
- Upmc University of Pittsburgh Medical Center , Pittsburgh , United States of America
| | - B Kosuru
- Upmc University of Pittsburgh Medical Center , Pittsburgh , United States of America
| | - V Singh
- Upmc University of Pittsburgh Medical Center , Pittsburgh , United States of America
| | - P Bedi
- Upmc University of Pittsburgh Medical Center , Pittsburgh , United States of America
| |
Collapse
|
5
|
Bedi P, Hasbun G, Castro-Codesal M. 570 Comparing NIV Adherence in Early versus Advanced Stage Sleep Disordered Breathing for Children with Neuromuscular Disease. Sleep 2021. [DOI: 10.1093/sleep/zsab072.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Children with neuromuscular disease (NMD) typically develop progressive sleep disordered breathing (SDB), including obstructive sleep apnea (OSA), nocturnal hypoxemia and/or hypoventilation, due to loss of upper airway muscle tone and weakness of respiratory muscles. Commonly, the SDB initially presents during rapid eye movement (REM) sleep, as this stage is associated with physiological muscle atonia, but then progresses to non-REM (NREM) sleep and ultimately daytime respiratory insufficiency. Non-invasive ventilation (NIV) is currently the treatment of choice for children with NMD and SDB. However, the use of NIV in REM-related SDB is less demonstrated and adequate therapy adherence is unclear. The aim of this study is to determine differences in NIV adherence in children with early (REM) versus advanced (non-REM) SDB.
Methods
Children (0–18 years) diagnosed with NMD and using NIV for the past 10 years were included. Demographic, clinical, technology-related, and sleep study data were collected from medical charts and polysomnography reports. Adherence data (mean hours of NIV use and % days NIV was used >4hrs) were collected from NIV machine downloads. Children were categorized into two groups based on based on their apnea-hypopnea index (AHI) ratio between REM and NREM sleep. Children with REM-SDB were defined as a REM/NREM AHI ratio of ≥ 2. Children with NREM-SDB were defined as a REM/NREM AHI ratio < 2.
Results
A total of 14 children (9 REM-SDB and 5 NREM-SDB) were included in the analysis. Both groups were comparable with respect to demographic, clinical, and technology-related characteristics. A total of 24 adherence reports were available for the cohort (16 REM-SDB and 8 NREM-SDB). The mean hours of NIV use per night was comparable between the REM-SDB and NREM-SDB groups (9.2±1.3hrs vs. 9.0±0.4hrs respectively), but the percent days NIV was used >4hrs was higher in the NREM-SDB group (68.7±9.6 vs. 93.0±2.7, p=0.03).
Conclusion
NIV adherence was high for children with both REM-SDB and NREM-SDB. While hours of NIV use were comparable between both groups, suggesting good NIV tolerance through the night, children with REM-SDB had a lower percentage of days with NIV use >4hr, suggesting less willingness to use the therapy.
Support (if any):
Collapse
|
6
|
Bedi P, Rai MP, Bumrah K, Singh VK, Arora TK, Singh T. Pattern and burden of opioid-related hospitalizations in the USA from 2016 to 2018. Br J Clin Pharmacol 2021; 87:4366-4374. [PMID: 33856070 DOI: 10.1111/bcp.14857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/28/2021] [Accepted: 04/06/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS The current opioid crisis in the USA is a formidable challenge for the healthcare system, and the general population. Our objective is to characterize the burden of opioid-related disorders in an inpatient setting in the USA for the years 2016, 2017 and 2018 using the National Inpatient Sample (NIS). METHODS A cross-sectional analysis of the NIS was performed to identify and analyse hospitalizations with an opioid-related diagnosis in 2016, 2017 and 2018. Descriptive statistics and regression models were utilized to define the demographics of the population of interest and measure the outcomes. RESULTS We identified 962 900 discharges with opioid-related diagnosis in 2016, 982 710 in 2017 and 942 110 in 2018. The majority were age <60 years, were found in residents of low-income zip codes and covered by Medicaid. The adjusted mean total hospitalization cost trended up from $12 828 (95% confidence interval [CI] 12 547-13 108) in 2016, to $13164.9 (95% CI 12 872.47-13 457.34) in 2017 and then to $13 626.65 (95% CI 13 325.95-13 927.34) in 2018. The adjusted mortality was highest in 2016; 2.26% (95% CI 2.16-2.35) and it trended down to 1.97% (95% CI 1.88-2.05) in 2017, and to 1.89% (95% CI 1.81-1.98) in 2018. CONCLUSIONS Opioid-related disorders cause a significant number of hospitalizations in the USA. A large proportion of these patients are age <60 years, have lower household income, and are covered by Medicaid. Programmes directed towards this specific group can help reduce the overall burden of hospitalizations.
Collapse
Affiliation(s)
- Prabhjot Bedi
- Department of Hospital Medicine UPMC East, Pittsburgh, PA, USA
| | - Manoj P Rai
- Department of Hospital Medicine, Asante Rogue Regional Medical Center, Medford, OR, USA
| | | | - Vikas K Singh
- Department of Hospital Medicine UPMC East, Pittsburgh, PA, USA
| | - Tanureet K Arora
- Department of Endocrinology, University Hospitals, Cleveland, OH, USA
| | - Tanveer Singh
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
7
|
Singh T, Bedi P, Bumrah K, Singh J, Rai M, Seelam S. Updates in Treatment of Recurrent Clostridium difficile Infection. J Clin Med Res 2019; 11:465-471. [PMID: 31236163 PMCID: PMC6575119 DOI: 10.14740/jocmr3854] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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] [Received: 05/01/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022] Open
Abstract
Recurrent Clostridium difficile infection (CDI) is a perpetual problem that leads to increased economic burden, higher healthcare cost, and significant morbidity and mortality. Its treatment remains a challenge. While various treatment approaches have been attempted with different levels of success, robust data establishing the superiority of one approach over the others is lacking. In this article, we review the current evidence pertaining to conventional pharmacological treatment as well as fecal microbiota transplantation (FMT) as a novel, rapidly emerging treatment modality for recurrent CDI.
Collapse
Affiliation(s)
- Tanveer Singh
- Department of Hospital Medicine, Rochester General Hospital, Rochester, NY 14621, USA
| | - Prabhjot Bedi
- Department of Medicine, UPMC East, Monroeville, PA 15146, USA
| | | | - Jeevandeep Singh
- Department of Medicine, Montefiore Medical Center-Wakefield, Bronx, NY 10466, USA
| | - Manoj Rai
- Department of Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Susmitha Seelam
- Department of Medicine, UPMC East, Monroeville, PA 15146, USA
| |
Collapse
|
8
|
Mchayleh W, Bedi P, Sehgal R, Solh M. Chimeric Antigen Receptor T-Cells: The Future is Now. J Clin Med 2019; 8:jcm8020207. [PMID: 30736426 PMCID: PMC6406995 DOI: 10.3390/jcm8020207] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 12/27/2022] Open
Abstract
The immune system acting via cancer immune-surveillance is considered a potential target for improving outcomes among some malignancies. The ability to harness immune cells, engineer them and educate them to target cancer cells has changed the paradigm for treating non-Hodgkin’s lymphomas (NHL) and acute lymphoblastic leukemia (ALL). Chimeric antigen receptor (CAR) T-cell therapy has shown remarkable anti-tumor activity against refractory B cell malignancies. Ongoing research aims to expand the scope of this adoptive cell therapy, understanding mechanisms of resistance and reducing toxicity. In this review, we will discuss the current scope of CAR T-cell therapy and ongoing future applications.
Collapse
Affiliation(s)
- Wassim Mchayleh
- Department of Medicine, Northside Hospital Cancer Institute, Atlanta, GA 30342, USA.
| | - Prabhjot Bedi
- Department of Medicine, University of Pittsburgh Center East, Monroeville, PA 15146, USA.
| | - Rajesh Sehgal
- Department of Medicine, University of Pittsburgh Center East, Monroeville, PA 15146, USA.
| | - Melhem Solh
- Department of Medicine, Northside Hospital Cancer Institute, Atlanta, GA 30342, USA.
- Blood and Marrow Transplant, Acute Leukemia and Immunotherapy Program, Northside Hospital, Atlanta, GA 30342, USA.
| |
Collapse
|
9
|
Singh T, Arora TK, Bedi P, Kashinath S. Paroxysmal Sympathetic Hyperactivity after Cardiac Arrest in a Young Male. Cureus 2018; 10:e3028. [PMID: 30254817 PMCID: PMC6150751 DOI: 10.7759/cureus.3028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Paroxysmal sympathetic hyperactivity (PSH) is a syndrome of an increased sympathetic drive after brain injury. PSH has been previously referred with multiple different names. It is seen most commonly after a traumatic brain injury, but rarely it has been reported after infections, brain malignancies, and brain injury after cardiac arrest. We present a case of a young male who developed PSH after cardiac arrest and will discuss clinical features and various management options.
Collapse
|
10
|
Castro Codesal ML, Dehaan K, Featherstone R, Bedi P, Martinez Carrasco C, Katz SL, Chan EY, Bendiak GN, Almeida F, Olmstead D, Young R, Waters K, Sullivan C, Hartlin L, MacLean JE. 0886 LONG-TERM NON-INVASIVE VENTILATION THERAPIES IN CHILDREN: A SCOPING REVIEW. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
11
|
Bedi P, McHugh B, Davidson DJ, Rossi AG, Hill AT. S106 Peripheral blood neutrophils are primed and activated in bronchiectasis and are attenuated by the pro-resolving mediator lipoxin a4. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
Velu PP, Bedi P, Turnbull K, Hill AT. Risk factors for requiring intravenous antibiotic therapy in hospital and 30-day readmission for exacerbations of bronchiectasis. QJM 2016; 109:723-729. [PMID: 27081209 DOI: 10.1093/qjmed/hcw057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/02/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The safety and efficacy of domiciliary intravenous (IV) antibiotic therapy compared to inpatient hospital treatment for exacerbations of bronchiectasis has been established. Factors that determine the setting for IV antibiotic therapy need to be characterized further. AIM We aimed to identify factors at presentation that were associated with the requirement for IV antibiotic therapy delivered in hospital and 30-day readmission. DESIGN Retrospective cohort study of all IV antibiotic courses administered to patients with bronchiectasis by a specialist respiratory unit over a 2-year period. METHODS We assessed demographic data, treatment outcomes, morbidity, mortality, and 30-day readmission rates. Multiple linear regression analysis was performed to identify factors associated with inpatient IV antibiotics and 30-day readmission. RESULTS One hundred six patients received 243 courses of IV antibiotic therapy in 2 years. Sixty-six cases (27.2%) were managed in hospital, 28 cases (11.5%) required initial admission prior to early supported discharge to complete IV antibiotics at home and 149 cases (61.3%) received domiciliary IV antibiotics. Bronchiectasis Severity Index (P < 0.0001) and emergency presentation with an exacerbation (P < 0.0001) were independent factors associated with the requirement for inpatient IV antibiotic therapy. There were no differences between mortality (P = 0.06) and morbidity (P = 0.1) between groups. Thirty-day readmission following early supported discharge was higher compared to inpatient or domiciliary therapy (P=0.0004). CONCLUSION A higher Bronchiectasis Severity Index and emergency presentation with an exacerbation are independently associated with the need for IV antibiotics delivered in hospital. We could not identify any factors that predicted 30-day readmission in a multi-variable model.
Collapse
Affiliation(s)
- P P Velu
- From the Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little Frances Crescent, Edinburgh EH16 4SA, UK
| | - P Bedi
- MRC Centre for Inflammation Research, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| | - K Turnbull
- From the Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little Frances Crescent, Edinburgh EH16 4SA, UK
| | - A T Hill
- From the Department of Respiratory Medicine, Royal Infirmary of Edinburgh, 51 Little Frances Crescent, Edinburgh EH16 4SA, UK
- MRC Centre for Inflammation Research, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
| |
Collapse
|
13
|
Palani Velu P, Bedi P, Turnbull K, Hill AT. P204 Risk Factors for Requiring Intravenous Antibiotic Therapy Delivered in Hospital for Exacerbations of Bronchiectasis: Abstract P204 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
14
|
|
15
|
Bedi P, Kaur H, Gupta B, Talreja J, Sood M. A Website Recommender System Based on an Analysis of the User's Access Log. Journal of Intelligent Systems 2009. [DOI: 10.1515/jisys.2009.18.4.333] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
16
|
Kar P, Bedi P, Berry N, Chakravorty A, Gupta RK, Saha R, Das BC. Hepatitis G virus (HGV) infection in voluntary and commercial blood donors in India. Diagn Microbiol Infect Dis 2000; 38:7-10. [PMID: 11025177 DOI: 10.1016/s0732-8893(00)00168-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prevalence of hepatitis G virus (HGV) has been determined in commercial as well as voluntary blood donors from India by detecting viral RNA genome using reverse transcription polymerase chain reaction (RT-PCR) assay. 45 professional blood donors from private blood banks and 50 healthy controls who opted for voluntary blood donation were recruited for the study. Both the groups were also screened serologically for HBV and HCV infection. The prevalence of HGV in the general population in India was found to be 4% but significantly a higher frequency (46.6%; p<0.001) of HGV was observed in commercial blood donors.
Collapse
Affiliation(s)
- P Kar
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
| | | | | | | | | | | | | |
Collapse
|
17
|
Bedi P, Chaudhury RR. Oxytocin levels in the plasma of women with an intrauterine device. Indian J Med Res 1968; 56:1391-7. [PMID: 5703359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|
18
|
Perkash A, Bedi P, Chaudhury RR. Screening for bleeding tendency in patients with bleeding after insertion of an intrauterine device. Am J Obstet Gynecol 1968; 101:766-9. [PMID: 5660972 DOI: 10.1016/0002-9378(68)90028-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
19
|
Bedi P, Devi PK, Chaudhury RR. Preliminary report of a trial of a long acting antihistaminic, buclizine hydrochloride in patients with bleeding after insertion of an intrauterine device. Indian J Med Res 1968; 56:884. [PMID: 4386522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|