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Rhee Y, Hayden MK, Schoeny M, Baker AW, Baker MA, Gohil S, Rhee C, Talati NJ, Warren DK, Welbel S, Lolans K, Bahadori B, Bell PB, Bravo H, Dangana T, Fukuda C, Bach TH, Nelson A, Simms AT, Tolomeo P, Wolf R, Yelin R, Lin MY. Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study. Infect Control Hosp Epidemiol 2023; 44:1375-1380. [PMID: 37700540 PMCID: PMC10859163 DOI: 10.1017/ice.2023.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs). DESIGN A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods). SETTING The study was conducted across 7 geographically diverse ICUs with routine CHG bathing. PARTICIPANTS Adult patients in the medical ICU. METHODS CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations. RESULTS We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001). CONCLUSIONS Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
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Affiliation(s)
- Yoona Rhee
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Mary K. Hayden
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Michael Schoeny
- Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Arthur W. Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Meghan A. Baker
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Shruti Gohil
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Chanu Rhee
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Naasha J. Talati
- Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Sharon Welbel
- Division of Infectious Diseases, Cook County Health, Chicago, Illinois
| | - Karen Lolans
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Bardia Bahadori
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Pamela B. Bell
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Heilen Bravo
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Thelma Dangana
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Christine Fukuda
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Tracey Habrock Bach
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Alicia Nelson
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Andrew T. Simms
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Pam Tolomeo
- Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Wolf
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Rachel Yelin
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Michael Y. Lin
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
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Munns CF, Yoo HW, Jalaludin MY, Vasanwala RF, Chandran M, Rhee Y, But WM, Kong AP, Su PH, Numbenjapon N, Namba N, Imanishi Y, Clifton‐Bligh R, Luo X, Xia W. Asia‐Pacific
Consensus Recommendations on
X‐Linked
Hypophosphatemia: Diagnosis, Multidisciplinary Management, and Transition from Pediatric to Adult Care. JBMR Plus 2023. [DOI: 10.1002/jbm4.10744] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Kim KJ, Hong N, Lee S, Shin S, Rhee Y. Exploratory use of romosozumab for osteoporosis in a patient with Hajdu-Cheney syndrome: a case report. Osteoporos Int 2023; 34:1005-1009. [PMID: 36622389 DOI: 10.1007/s00198-023-06668-z] [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: 07/20/2022] [Accepted: 12/30/2022] [Indexed: 01/10/2023]
Abstract
Hajdu-Cheney syndrome (HCS) is an inherited skeletal disorder caused by mutations in the Notch homolog protein 2 gene (NOTCH2). Treatment of this rare disease is challenging because there are no established guidelines worldwide. Previous case reports using bisphosphonates, denosumab, or teriparatide suggested that curative treatment for HCS did not exist yet in terms of preventing the disease progression. Therefore, the efficacy of romosozumab for osteoporosis in patients with HCS needs to be evaluated. Herein, we report the case of a 43-year-old woman who had progressive acro-osteolysis and repeated fractures since the age of 29 years. Next-generation sequencing confirmed HCS with a mutation at nucleotide 6758G>A, leading to Trp2253Ter replacement in NOTCH2. Romosozumab treatment was initiated because she had already received bisphosphonate for more than 10 years at other hospitals. After 1 year of romosozumab treatment, the bone mineral density (BMD) increased by 10.2%, 6.3%, and 1.3%, with Z scores of -2.9, -1.6, and -1.2 at the lumbar spine, femoral neck, and total hip, respectively. In addition, C-telopeptide was suppressed by 26.4% (0.121 to 0.089 ng/mL), and procollagen type I N-terminal propeptide increased by 18.7% (25.2 to 29.9 ng/mL). This was the first report of romosozumab treatment in patient with osteoporosis and HCS in Korea. One year of romosozumab treatment provided substantial gains in BMD with maintaining the last acro-osteolytic status without deteriorating, representing a possible treatment option for HCS.
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Affiliation(s)
- K J Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - N Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - S Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, 26426, Republic of Korea
| | - S Shin
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Y Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Parker K, Honrath K, Rhee Y. Fruit and Vegetable Intakes Are Up, But Not Significantly, In College-Aged Young Adults During The COVID-19 Pandemic. J Acad Nutr Diet 2022. [PMCID: PMC9385434 DOI: 10.1016/j.jand.2022.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Houfek A, Garden-Robinson J, Hilliard E, Rhee Y, Stastny S, Belury MA, Cawthon PM, McGrath R. Older American Women May Especially Benefit from Distributing and Consuming Protein for Decreasing Odds of Functional Limitations. J Nutr Health Aging 2022; 26:1025-1032. [PMID: 36437771 DOI: 10.1007/s12603-022-1857-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Protein is a key macronutrient for preserving physical function, but the role of protein intake on functional status may differ in men and women. We sought to examine the associations of daily protein intake and distribution on functional limitations in older American men and women. DESIGN Cross-sectional. SETTING Population-based survey. PARTICIPANTS The analytic sample included 3,976 men and 4,081 women aged ≥60-years from the 2007-2016 waves of the National Health and Nutrition Examination Survey. MEASUREMENTS Participants reported their ability to perform basic activities of daily living, instrumental activities of daily living, leisure and social activities, lower extremity mobility activities, and general physical tasks. Those reporting difficulty or an inability in completing such functional tasks were considered as having a functional limitation. Protein intake was determined with dietary recalls and participants revealed functional limitations. Protein recommendations of ≥0.80, ≥1.00, and ≥1.50 g/kg/day were used. Based on these cut-points, we also investigated distribution of protein across 4 eating occasions at ≥0.20, ≥0.25, and ≥0.38 g/kg/meal, respectively. RESULTS Older women meeting each recommendation had decreased odds for functional limitations: 0.55 (95% confidence interval (CI): 0.40-0.75) for ≥0.80 g/kg/day, 0.75 (CI: 0.58-0.97) for ≥1.00 g/kg/day, and 0.72 (CI: 0.55-0.94) for ≥1.5 g/kg/day. No significant associations were observed in older men. Further, older women with protein consumption ≥0.20 g/kg/meal had decreased odds for functional limitations: 0.24 (CI: 0.10-0.61) for 1 occasion, 0.20 (CI: 0.08-0.49) for 2 occasions, 0.16 (CI: 0.07-0.40) for 3 occasions, and 0.12 (CI: 0.04-0.32) for 4 occasions. A similar trend was observed for intake ≥0.25 g/kg/meal: 0.31 (CI: 0.16-0.62) for 2 occasions, 0.30 (CI: 0.14-0.61) for 3 occasions, and 0.31 (CI: 0.12-0.78) for 4 occasions. Women with 1 and 2 eating occasions at ≥0.38 g/kg/meal of protein had 0.66 (CI: 0.48-0.91) and 0.54 (CI: 0.37-0.79) decreased odds for functional limitations, respectively. CONCLUSION Trials that are powered to detect the effects of protein on functional status in women will help to establish causality.
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Affiliation(s)
- A Houfek
- Ryan McGrath, Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108-6050 Phone: 701-231-7474, Fax: 701-231-8872,
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Popovich KJ, Green SJ, Okamoto K, Rhee Y, Hayden MK, Schoeny M, Snitkin ES, Weinstein RA. MRSA Transmission in Intensive Care Units: Genomic Analysis of Patients, Their Environments, and Healthcare Workers. Clin Infect Dis 2021; 72:1879-1887. [PMID: 32505135 PMCID: PMC8315036 DOI: 10.1093/cid/ciaa731] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA)-and now USA300 MRSA-is a significant intensive care unit (ICU) pathogen; healthcare worker (HCW) contamination may lead to patient cross-transmission. METHODS From September 2015 to February 2016, to study the spread of MRSA, we enrolled HCWs in 4 adult ICUs caring for patients on MRSA contact precautions. Samples were collected from patient body sites and high-touch surfaces in patient rooms. HCW hands, gloves, and personal protective equipment were sampled pre/post-patient encounter. Whole genome sequencing (WGS) was used to compare isolates from patients, HCWs, and environment. RESULTS There were 413 MRSA isolates sequenced (38% USA300, 52% USA100) from 66 patient encounters. Six of 66 HCWs were contaminated with MRSA prior to room entry. Isolates from a single patient encounter were typically either USA100 or USA300; in 8 (12%) encounters both USA300 and USA100 were isolated. WGS demonstrated that isolates from patients, HCWs, and environment often were genetically similar, although there was substantial between-encounter diversity. Strikingly, there were 5 USA100 and 1 USA300 clusters that contained similar strains (<22 single-nucleotide variants [SNVs], with most <10 SNVs) within the cluster despite coming from different encounters, suggesting intra- and inter-ICU spread of strains, that is, 4 of these genomic clusters were from encounters in the same ICU; 5 of 6 clusters occurred within 1 week. CONCLUSIONS We demonstrated frequent spread of MRSA USA300 and USA100 strains among patients, environment, and HCWs. WGS identified possible spread within and even between ICUs. Future analysis with detailed contact tracing in conjunction with genomic data may further elucidate pathways of MRSA spread and points for intervention.
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Affiliation(s)
- Kyle J Popovich
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Stefan J Green
- Genome Research Core, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoona Rhee
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Mary K Hayden
- Division of Infectious Disease, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Schoeny
- Community, Systems, and Mental Health Nursing Rush University Medical Center, Chicago, Illinois, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology and Division of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert A Weinstein
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
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Santos CAQ, Rhee Y, Hollinger EF, Olaitan OK, Schadde E, Peev V, Saltzberg SN, Hertl M. Comparative incidence and outcomes of COVID-19 in kidney or kidney-pancreas transplant recipients versus kidney or kidney-pancreas waitlisted patients: A single-center study. Clin Transplant 2021; 35:e14362. [PMID: 33998716 PMCID: PMC8209946 DOI: 10.1111/ctr.14362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 epidemiologic studies comparing immunosuppressed and immunocompetent patients may provide insight into the impact of immunosuppressants on outcomes. METHODS In this retrospective cohort study, we assembled kidney or kidney-pancreas transplant recipients who underwent transplant from January 1, 2010, to June 30, 2020, and kidney or kidney-pancreas waitlisted patients who were ever on the waitlist from January 1, 2019, to June 30, 2020. We identified laboratory-confirmed COVID-19 until January 31, 2021, and tracked its outcomes by leveraging informatics infrastructure developed for an outcomes research network. RESULTS COVID-19 was identified in 62 of 887 kidney or kidney-pancreas transplant recipients and 20 of 434 kidney or kidney-pancreas waitlisted patients (7.0% vs. 4.6%, p = .092). Of these patients with COVID-19, hospitalization occurred in 48 of 62 transplant recipients and 8 of 20 waitlisted patients (77% vs. 40%, p = .002); intensive care unit admission occurred in 18 of 62 transplant recipients and 2 of 20 waitlisted patients (29% vs. 10%, p = .085); and 7 transplant recipients were mechanically ventilated and died, whereas no waitlisted patients were mechanically ventilated or died (11% vs. 0%, p = .116). CONCLUSIONS Our study provides single-center data and an informatics approach that can be used to inform the design of multicenter studies.
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Affiliation(s)
- Carlos A Q Santos
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Yoona Rhee
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Edward F Hollinger
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Oyedolamu K Olaitan
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Erik Schadde
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vasil Peev
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Samuel N Saltzberg
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Martin Hertl
- Division of Abdominal Transplantation, Department of Surgery, Rush University Medical Center, Chicago, IL, USA
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Jung YW, Hong N, Kim CO, Kim HC, Youm Y, Choi JY, Rhee Y. The diagnostic value of phase angle, an integrative bioelectrical marker, for identifying individuals with dysmobility syndrome: the Korean Urban-Rural Elderly study. Osteoporos Int 2021; 32:939-949. [PMID: 33128075 DOI: 10.1007/s00198-020-05708-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/12/2020] [Accepted: 10/20/2020] [Indexed: 12/25/2022]
Abstract
UNLABELLED Low phase angle, a non-invasive bioimpedance marker, is associated with elevated odds of dysmobility syndrome and its components. Phase angle (estimated cutoffs: < 4.8° in men; < 4.5° in women) can be used to detect dysmobility syndrome in community-dwelling older adults as a simple, integrative screening tool. INTRODUCTION Dysmobility syndrome uses a score-based approach to predict fracture risk that incorporates the concepts of osteoporosis, sarcopenia, and obesity. Low phase angle (PhA), a simple, non-invasive bioelectrical impedance marker, was associated with low lean mass, high fat mass, and poor muscle function. We aimed to investigate the association between PhA and dysmobility syndrome, with the exploration of the diagnostic cutoffs. METHODS In a community-dwelling Korean older adult cohort, dysmobility syndrome was defined as the presence of ≥ 3 of the following components: osteoporosis, low lean mass, falls in the preceding year, low grip strength, high fat mass, and poor timed up and go performance. RESULTS Among the 1825 participants (mean age 71.6, women 66.7%), subjects were classified into sex-stratified PhA tertiles. The prevalence of dysmobility syndrome increased from the highest PhA tertile group to the lowest (15.50 to 2.45% in men; 33.41 to 12.25% in women, P for trend < 0.001). The mean PhA values decreased as the dysmobility score increased (5.33° to 4.65° in men; 4.76° to 4.39° in women, P for trend < 0.001). Low PhA (cutoff: < 4.8° in men; < 4.5° in women) was associated with twofold elevated odds of dysmobility syndrome after adjusting for age, sex, and conventional risk factors. Low PhA improved the identification of individuals with dysmobility syndrome when added to the conventional risk model (area under the curve, 0.73 to 0.75, P = 0.002). CONCLUSION Low PhA was associated with dysmobility syndrome and its components, independent of age, sex, body mass index, nutritional status, and inflammation.
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Affiliation(s)
- Y W Jung
- Division of Endocrinology, Endocrine Research Institute, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - N Hong
- Division of Endocrinology, Endocrine Research Institute, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - C O Kim
- Division of Geriatrics, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - H C Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Y Youm
- Department of Sociology, Yonsei University, Seoul, Korea
| | - J -Y Choi
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Y Rhee
- Division of Endocrinology, Endocrine Research Institute, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
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Hong N, Siglinsky E, Krueger D, White R, Kim CO, Kim HC, Yeom Y, Binkley N, Rhee Y, Buehring B. Defining an international cut-off of two-legged countermovement jump power for sarcopenia and dysmobility syndrome. Osteoporos Int 2021; 32:483-493. [PMID: 32894301 PMCID: PMC7929946 DOI: 10.1007/s00198-020-05591-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/10/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED We aimed to establish jump power cut-offs for the composite outcome of either sarcopenia (EWGSOP2) or dysmobility syndrome using Asian and Caucasian cohorts. Estimated cut-offs were sex specific (women: < 19.0 W/kg; men: < 23.8 W/kg) but not ethnicity specific. Jump power has potential to be used in definitions of poor musculoskeletal health. PURPOSE Weight-corrected jump power measured during a countermovement jump may be a useful tool to identify individuals with poor musculoskeletal health, but no cut-off values exist. We aimed to establish jump power cut-offs for detecting individuals with either sarcopenia or dysmobility syndrome. METHODS Age- and sex-matched community-dwelling older adults from two cohorts (University of Wisconsin-Madison [UW], Korean Urban Rural Elderly cohort [KURE], 1:2) were analyzed. Jump power cut-offs for the composite outcome of either sarcopenia defined by EWGSOP2 or dysmobility syndrome were determined. RESULTS The UW (n = 95) and KURE (n = 190) cohorts were similar in age (mean 75 years) and sex distribution (68% women). Jump power was similar between KURE and UW women (19.7 vs. 18.6 W/kg, p = 0.096) and slightly higher in KURE than UW in men (26.9 vs. 24.8 W/kg, p = 0.050). In UW and KURE, the prevalence of sarcopenia (7.4% in both), dysmobility syndrome (31.6% and 27.9%), or composite of either sarcopenia or dysmobility syndrome (32.6% and 28.4%) were comparable. Low jump power cut-offs for the composite outcome differed by sex but not by ethnicity (< 19.0 W/kg in women; < 23.8 W/kg in men). Low jump power was associated with elevated odds of sarcopenia (adjusted odds ratio [aOR] 4.07), dysmobility syndrome (aOR 4.32), or the composite of sarcopenia or dysmobility syndrome (aOR 4.67, p < 0.01 for all) independent of age, sex, height, and ethnicity. CONCLUSION Sex-specific jump power cut-offs were found to detect the presence of either sarcopenia or dysmobility syndrome in older adults independent of Asian or Caucasian ethnicity.
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Affiliation(s)
- N Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - E Siglinsky
- Osteoporosis Clinical Research Program, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA
- UT Southwestern Medical Center, University of Texas Southwestern, Dallas, TX, USA
| | - D Krueger
- Osteoporosis Clinical Research Program, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA
| | - R White
- Osteoporosis Clinical Research Program, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA
| | - C O Kim
- Division of Geriatrics, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - H C Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Y Yeom
- Department of Sociology, Yonsei University College of Social Sciences, Seoul, Korea
| | - N Binkley
- Osteoporosis Clinical Research Program, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA
| | - Y Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - B Buehring
- Osteoporosis Clinical Research Program, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Suite 100, Madison, WI, 53705, USA.
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany.
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Sansom S, Lin MY, Schoeny M, Fukuda C, Bassis C, Shimasaki T, Dangana TE, Moore NM, Yelin R, Liu S, Young VB, Rhee Y, Tabith L, Sheng J, Cisneros EC, Murray J, Chang K, Lolans K, Ariston M, Rotunno W, Ramos H, Li H, Aboushaala K, Iwai N, Hayden MK. 919. Understanding Intermittent Detection of Multidrug-Resistant Organisms (MDROs) in Rectally Colonized Patients. Open Forum Infect Dis 2020. [PMCID: PMC7777592 DOI: 10.1093/ofid/ofaa439.1107] [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: 12/05/2022] Open
Abstract
Background MDRO detection in colonized patients may be intermittent for reasons that are incompletely understood. We examined temporal patterns of gut MDRO colonization after initial MDRO detection by rectal swab screening, and determined the relationship of culture positivity to the relative abundance of corresponding MDRO operational taxonomic units (OTUs) identified by 16S rRNA gene sequence analysis. Methods Rectal or fecal swabs were collected daily from MICU patients 1/11/2017-1/11/2018. First MICU admissions with ≥2 swabs and MICU stays ≥3 days were studied. Samples were cultured for vancomycin-resistant enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE) and P. aeruginosa (CRPA), and extended-spectrum β-lactamase-producing (ESBL) Enterobacteriaceae by selective media. Resistance mechanisms were confirmed by phenotypic methods and/or PCR. Limit of detection was similar for different MDROs (24-52 CFU/sample). OTU categories corresponding to MDRO species were identified by taxonomy and BLAST. Multilevel regression models estimated the association between MDRO detection and relative abundance of the corresponding OTU. Results 796 unique patients with 3519 swabs were studied. Median (IQR) age was 64 (51-74) years, MICU length of stay was 5 (3-8) days, and number of samples-per-patient was 3 (2-5). Following initial MDRO detection, the probability of subsequent detection varied by MDRO type, and was highest for VRE and lowest for CRPA [Figure 1]. Within each sample, we found a significant association between MDRO detection and relative abundance of the corresponding OTU [Table 1]. In contrast, relative OTU abundance in the first sample with MDRO detection was not predictive of odds of future MDRO detection (p >0.05 for all comparisons). Carriage of >1 MDRO did not affect the odds of MDRO detection in later samples. Figure 1. Probability of Subsequent MDRO Detection after First Positive Varies by MDRO Type ![]()
Table 1. Higher Mean Corresponding OTU Relative Abundance Within Each Sample is Associated with MDRO Detection ![]()
Conclusion MDRO culture positivity in rectally colonized patients was correlated with relative abundance of the corresponding OTU in the same sample. Serial detection of different MDRO types was variable, possibly due to distinct microbial community dynamics of different MDRO types. Intermittent failure to detect MDROs could result in misattribution of MDRO acquisition, resulting in inappropriate investigation or intervention. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Sophia Liu
- University of Michigan-Ann Arbor, Ann Arbor, Michigan
| | | | - Yoona Rhee
- Rush University Medical Center, Berwyn, IL
| | | | | | | | | | - Kyle Chang
- Rush University Medical Center, Berwyn, IL
| | | | | | | | | | - Haiying Li
- Rush University Medical Center, Berwyn, IL
| | | | - Naomi Iwai
- Rush University Medical Center, Berwyn, IL
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Evenocheck A, Rhee Y, Hall C. Do Health Promoting Compounds of Flaxseed Attenuate Weight Gain Via Modulation of Obesity Gene Expression? Plant Foods Hum Nutr 2020; 75:441-445. [PMID: 32440756 DOI: 10.1007/s11130-020-00825-z] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Diet-induced obesity (DIO) has been shown to increase DNA methyltransferases (DNMTs) expression and DNMTs binding at obesity-associated genes. Natural compounds have the potential to reverse obesity-associated gene expression via the regulation of DNA methylation. The objective of this study was to determine the effect of health promoting compounds of flaxseed on DNMTs and obesity-associated gene expression and weight gain. Sixty C57BL/6J male mice were randomly assigned into one of the following diet groups and fed for eight weeks: 45% kcal fat; 45% kcal fat+10% whole flaxseed; 45% kcal fat+6% defatted flaxseed; 45% kcal fat+4% flaxseed oil; and 16% kcal fat. DNMT1, DNMT3a, DNMT3b, leptin, and peroxisome proliferator-activated receptor (PPAR)-α expressions in adipose and muscle tissues were determined by real-time PCR. The health promoting compounds of flaxseed affected selected gene expression and attenuated weight gain. Further research is needed to identify the specific mechanisms modulating leptin or PPAR-α expression during DIO development.
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Affiliation(s)
- A Evenocheck
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Y Rhee
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA.
| | - C Hall
- Department of Dairy and Food Science, South Dakota State University, Brookings, SD, USA
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Rhee Y, Chan EL, Eswaran SL, Aloman C, Hertl M, Santos CA. Fatal COVID-19 in a Patient with End-Stage Liver Disease Wait-Listed for Liver Transplantation: An Evidence-Based Review of COVID-19 Screening Modalities Prior to Transplant. Clin Liver Dis (Hoboken) 2020; 15:246-250. [PMID: 32617159 PMCID: PMC7326630 DOI: 10.1002/cld.990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Yoona Rhee
- Department of Internal MedicineDivision of Infectious DiseasesRush University Medical CenterChicagoIL
| | - Edie L. Chan
- Department of SurgeryDivision of Abdominal TransplantationRush University Medical CenterChicagoIL
| | - Sheila L. Eswaran
- Department of Internal MedicineSection of HepatologyRush University Medical CenterChicagoIL
| | - Costica Aloman
- Department of Internal MedicineSection of HepatologyRush University Medical CenterChicagoIL
| | - Martin Hertl
- Department of SurgeryDivision of Abdominal TransplantationRush University Medical CenterChicagoIL
| | - Carlos A.Q. Santos
- Department of Internal MedicineDivision of Infectious DiseasesRush University Medical CenterChicagoIL
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Rhee Y, Sha BE, Santos CA. Optimizing Vaccination in Adult Patients With Liver Disease and Liver Transplantation. Clin Liver Dis (Hoboken) 2020; 15:63-68. [PMID: 32226617 PMCID: PMC7098669 DOI: 10.1002/cld.898] [Citation(s) in RCA: 8] [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: 08/04/2019] [Accepted: 11/02/2019] [Indexed: 02/04/2023] Open
Abstract
http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-reading-rhee a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-2-interview-rhee an interview with the author.
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Affiliation(s)
- Yoona Rhee
- Division of Infectious DiseasesDepartment of Internal MedicineRush University Medical CenterChicagoIL
| | - Beverly E. Sha
- Division of Infectious DiseasesDepartment of Internal MedicineRush University Medical CenterChicagoIL
| | - Carlos A.Q. Santos
- Division of Infectious DiseasesDepartment of Internal MedicineRush University Medical CenterChicagoIL
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Santos CAQ, Rhee Y, Czapka MT, Kazi AS, Proia LA. Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients. J Clin Med 2020; 9:jcm9030865. [PMID: 32245201 PMCID: PMC7141503 DOI: 10.3390/jcm9030865] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Hematopoietic stem cell transplant recipients are at increased risk of infection and immune dysregulation due to reception of cytotoxic chemotherapy; development of graft versus host disease, which necessitates treatment with immunosuppressive medications; and placement of invasive catheters. The prevention and management of infections in these vulnerable hosts is of utmost importance and a key “safety net” in stem cell transplantation. In this review, we provide updates on the prevention and management of CMV infection; invasive fungal infections; bacterial infections; Clostridium difficile infection; and EBV, HHV-6, adenovirus and BK infections. We discuss novel drugs, such as letermovir, isavuconazole, meropenem-vaborbactam and bezlotoxumab; weigh the pros and cons of using fluoroquinolone prophylaxis during neutropenia after stem cell transplantation; and provide updates on important viral infections after hematopoietic stem cell transplant (HSCT). Optimizing the prevention and management of infectious diseases by using the best available evidence will contribute to better outcomes for stem cell transplant recipients, and provide the best possible “safety net” for these immunocompromised hosts.
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Rhee Y, Hayden MK, Simms AT, Yelin RD, Lolans K, Bell PB, Schoeny M, Baker AW, Baker MA, Gohil SK, Rhee C, Talati NJ, Warren DK, Welbel SF, Dangana TE, Majalca T, Bravo H, Cass C, Nelson A, Tolomeo PC, Wolf R, Lin MY. 572. Relationship Between Chlorhexidine Gluconate (CHG) Skin Concentrations and Microbial Skin Colonization among Medical Intensive Care Unit (MICU) Patients. Open Forum Infect Dis 2019. [PMCID: PMC6811213 DOI: 10.1093/ofid/ofz360.641] [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: 11/19/2022] Open
Abstract
Background CHG bathing is used to suppress patients’ microbial skin colonization, in order to prevent infections and transmission of multidrug-resistant organisms. Prior work has suggested that microbial growth is inhibited when CHG skin concentrations exceed threshold levels. Methods We conducted 6 single-day surveys from January 2018 to February 2019 in 7 academic hospital MICUs with established CHG patient bathing. Adult patients were eligible to have skin swabbed from adjacent 25 cm2 areas on the neck, axilla, and inguinal region for culture and CHG concentration determination. CHG skin concentrations were measured by a semi-quantitative colorimetric assay. Selective media were used to isolate targeted microorganisms (Table 1). Species were confirmed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry; antibiotic susceptibility was determined by MicroScan (Beckman Coulter). We modeled the relationship between CHG skin concentrations (log2-transformed) and microorganism recovery (yes/no as primary outcome) using multilevel models controlling for clustering of body sites within patients and within ICUs, assessing slope and threshold effects. Results We enrolled 736/759 (97%) patients and sampled 2176 skin sites. Gram-positive bacteria were detected most frequently (Table 1). The adjusted odds of identifying gram-positive organisms decreased linearly as CHG skin levels increased (Figure 1a), without evidence of a threshold effect. We also found significant negative linear slopes without evidence of threshold effects for other pathogens tested (Table 2; Figure 1), with the exception of gram-negative bacteria and vancomycin-resistant enterococci. When modeling quantitative culture results (colony-forming units) for gram-positive organisms as a continuous outcome variable, a similar relationship was found. Conclusion Higher concentrations of CHG were associated with less frequent recovery of gram-positive bacteria and Candida species on the skin of MICU patients who were bathed routinely with CHG. For microbial inhibition, we did not identify a threshold concentration of CHG on the skin; rather, increasing CHG skin concentrations led to additional gains in inhibition. For infection prevention, aiming for high CHG skin levels may be beneficial. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Karen Lolans
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Arthur W Baker
- Duke University School of Medicine; Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | | | - Shruti K Gohil
- University of California, Irvine School of Medicine, Irvine, California
| | - Chanu Rhee
- Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - David K Warren
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | - Heilen Bravo
- Rush University Medical Center, Chicago, Illinois
| | - Candice Cass
- Washington University School of Medicine, St. Louis, Missouri
| | - Alicia Nelson
- Duke University Medical Center, Durham, North Carolina
| | - Pam C Tolomeo
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Wolf
- Harvard Pilgrim Healthcare and Harvard Medical School, Brigham and Women’s Hospital, Brighton, Massachusetts
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Rhee Y, Hayden MK, Simms AT, Yelin RD, Lolans K, Bell PB, Schoeny M, Baker AW, Baker MA, Gohil SK, Rhee C, Talati N, Warren DK, Welbel SF, Dangana TE, Majalca T, Bravo H, Cass C, Nelson A, Tolomeo PC, Wolf R, Lin MY. 895. Impact of Measurement and Results Feedback of Chlorhexidine Gluconate (CHG) Skin Concentrations in Medical Intensive Care Unit (MICU) Patients Receiving CHG Bathing. Open Forum Infect Dis 2019. [PMCID: PMC6809081 DOI: 10.1093/ofid/ofz359.054] [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
Background Higher CHG skin levels may be needed to adequately control infection and transmission of pathogens in the ICU. We assessed whether measurement and feedback of patient CHG skin concentrations could improve CHG bathing quality and identified factors associated with higher CHG skin concentrations. Methods We conducted 6 one-day surveys from January 2018 to February 2019 in 7 academic hospital MICUs with established daily CHG bathing. Adults admitted >1 day were assessed for CHG skin levels with a semi-quantitative colorimetric assay using swabbed 25 cm2 areas of anterior neck, axilla, and inguinal skin. Prior to survey 4, results from the first 3 surveys (baseline) were reported to ICU leadership and front-line staff to retrain and reeducate on bathing technique. Feedback of results from prior surveys also occurred before surveys 5 and 6. For statistical analysis, mixed-effects models accounted for clustering of CHG measurements within patients and ICUs. We categorized CHG product type as “cloth” for no-rinse 2% CHG-impregnated cloth and “liquid” for 4% CHG liquid or foam. Results In total, 681 of 704 (97%) patients were enrolled. Three ICUs used CHG cloth, 3 ICUs used CHG liquid, and 1 ICU switched from liquid to cloth after the second survey. Median CHG skin concentrations were higher in both the baseline and feedback period for institutions using CHG cloth, as compared with liquid (table). Across all time points, axillary and inguinal regions had higher skin CHG concentrations than the neck (median 39.1, 78.1, 19.5 µg/mL, respectively, P < 0.001). After controlling for age, mechanical ventilation, presence of a central venous catheter, body site, and hours since last CHG bath, institutions that used CHG cloth had a 3-fold increase in adjusted CHG skin concentrations in the feedback period compared with the baseline period (P = 0.001, Figure). There was no significant change in CHG skin concentrations from baseline to feedback period for institutions that used liquid CHG. Conclusion CHG skin concentrations on MICU patients receiving daily CHG bathing varied by body site and CHG product type. The use of CHG cloth was associated with higher CHG skin levels, compared with CHG liquid. For ICUs using CHG cloth, feedback of CHG skin concentration results to ICU staff improved CHG bathing quality. ![]()
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Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
- Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Karen Lolans
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Arthur W Baker
- Duke University School of Medicine, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | | | - Shruti K Gohil
- School of Medicine, University of California at Irvine, Irvine, California
| | - Chanu Rhee
- Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - David K Warren
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | - Heilen Bravo
- Rush University Medical Center, Chicago, Illinois
| | - Candice Cass
- Washington University School of Medicine, St. Louis, Missouri
| | - Alicia Nelson
- Duke University Medical Center, Durham, North Carolina
| | | | - Robert Wolf
- Harvard Pilgrim Healthcare and Harvard Medical School, Brigham and Women’s Hospital, Brighton, Massachusetts
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Bassis C, Seekatz A, Dangana TE, Shimasaki T, Yelin RD, Schoeny M, Rhee Y, Ariston M, Lolans K, Cornejo Cisneros E, Aboushaala K, Thabit L, Murray J, Sheng J, Ollison S, Bell PB, Fogg L, Weinstein RA, Lin MY, Young VB, Hayden MK. 2849. Gut Microbiota Differences at the Time of Medical Intensive Care Unit (MICU) Admission Are Associated with Acquisition of Multi-drug-Resistant Organisms (MDROs) Among Patients Not Already Colonized with an MDRO. Open Forum Infect Dis 2019. [PMCID: PMC6808848 DOI: 10.1093/ofid/ofz359.154] [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: 11/30/2022] Open
Abstract
Background Among hospitalized patients, underlying variation in gut microbiota may confer differential risk for gut MDRO acquisition. Methods Rectal swab samples were collected from patients ≤2 days of MICU admission and then daily in the 27-bed MICU of an acute care hospital in Chicago, IL over 1 year. Patients were screened for MDRO colonization by selective culture (see Figure 1 for MDRO types); those with ≥2 swabs and MICU stays ≥3 days were studied. Bacterial 16S rRNA gene amplicon sequences were used for microbiota analysis. Medical records were reviewed. Results In preliminary analysis, 2,480 samples were collected from 627 patients who acquired 170 MDROs (Figure 1). Debilitation, co-morbidities, and certain medical devices were associated with MDRO acquisition, though admission MDRO status was not (table). While no interactions were detected between admission MDRO status and clinical predictors of MDRO acquisition, there were significant differences in gut microbiota composition at the time of MICU admission between patients colonized with an MDRO on admission and those not colonized (P < 0.001, using analysis of molecular variance (AMOVA) on distances). Therefore, we stratified our analysis by admission MDRO colonization status. For patients MDRO-colonized at admission, there were no significant differences in microbiota of patients who later did or did not acquire a new MDRO (AMOVA P-value = 0.32). For patients not MDRO-colonized on admission, there was a significant difference in microbiota of patients who later acquired an MDRO and those who did not (AMOVA P-value: 0.026). Differentially abundant operational taxonomic units (OTUs, based on 3% sequence difference) included OTUs classified as Anaerococcus and as other Clostridiales (higher in patients who remained uncolonized) and as Enterococcus (higher in patients who acquired an MDRO) (Figure 2). Diversity was also higher in patients who remained uncolonized (Wilcoxon test P-value: 0.035) (Figure 3). Conclusion Among patients not already colonized with an MDRO on admission, we identified gut microbiota differences associated with MDRO acquisition that could help explain patient-level variation in MDRO colonization resistance. ![]()
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Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
| | | | | | | | | | | | - Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
| | | | - Karen Lolans
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - John Murray
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Louis Fogg
- Rush University Medical Center, Chicago, Illinois
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Shimasaki T, Seekatz A, Bassis C, Rhee Y, Yelin RD, Fogg L, Dangana T, Cisneros EC, Weinstein RA, Okamoto K, Lolans K, Schoeny M, Lin MY, Moore NM, Young VB, Hayden MK. Increased Relative Abundance of Klebsiella pneumoniae Carbapenemase-producing Klebsiella pneumoniae Within the Gut Microbiota Is Associated With Risk of Bloodstream Infection in Long-term Acute Care Hospital Patients. Clin Infect Dis 2019; 68:2053-2059. [PMID: 30239622 PMCID: PMC6541703 DOI: 10.1093/cid/ciy796] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/10/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An association between increased relative abundance of specific bacterial taxa in the intestinal microbiota and bacteremia has been reported in some high-risk patient populations. METHODS We collected weekly rectal swab samples from patients at 1 long-term acute care hospital (LTACH) in Chicago from May 2015 to May 2016. Samples positive for Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) by polymerase chain reaction and culture underwent 16S rRNA gene sequence analysis; relative abundance of the operational taxonomic unit containing KPC-Kp was determined. Receiver operator characteristic (ROC) curves were constructed using results from the sample with highest relative abundance of KPC-Kp from each patient admission, excluding samples collected after KPC-Kp bacteremia. Cox regression analysis was performed to evaluate risk factors associated with time to achieve KPC-Kp relative abundance thresholds calculated by ROC curve analysis. RESULTS We collected 2319 samples from 562 admissions (506 patients); KPC-Kp colonization was detected in 255 (45.4%) admissions and KPC-Kp bacteremia in 11 (4.3%). A relative abundance cutoff of 22% predicted KPC-Kp bacteremia with sensitivity 73%, specificity 72%, and relative risk 4.2 (P = .01). In a multivariable Cox regression model adjusted for age, Charlson comorbidity index, and medical devices, carbapenem receipt was associated with achieving the 22% relative abundance threshold (P = .044). CONCLUSION Carbapenem receipt was associated with increased hazard for high relative abundance of KPC-Kp in the gut microbiota. Increased relative abundance of KPC-Kp was associated with KPC-Kp bacteremia. Whether bacteremia arose directly from bacterial translocation or indirectly from skin contamination followed by bloodstream invasion remains to be determined.
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Affiliation(s)
- Teppei Shimasaki
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Anna Seekatz
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
| | - Christine Bassis
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
| | - Yoona Rhee
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Rachel D Yelin
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Thelma Dangana
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Enrique Cornejo Cisneros
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
- Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Robert A Weinstein
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Koh Okamoto
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
- University of Tokyo Hospital, Japan
| | - Karen Lolans
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Michael Schoeny
- Department of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Michael Y Lin
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Nicholas M Moore
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Vincent B Young
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
| | - Mary K Hayden
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
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Shimasaki T, Rhee Y, Yelin RD, Ariston M, Ollison S, Fogg L, Dangana T, Cisneros EC, Weinstein RA, Lolans K, Schoeny M, Lin MY, Moore NM, Hayden MK. 1764. The Gut: A Veiled Reservoir for Multidrug-resistant Organisms (MDROs) Below the Tip of the Iceberg. Open Forum Infect Dis 2018. [PMCID: PMC6252510 DOI: 10.1093/ofid/ofy209.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Clinical culture results are sometimes used to estimate the burden of multidrug-resistant organisms (MDROs) in hospitals. The association between positive clinical culture results and prevalence of MDROs in the gut is incompletely understood. Methods Rectal swab or stool samples were collected daily from adult medical intensive care unit (MICU) patients and cultured for target MDROs using selective media between January 2017 and January 2018 at Rush University Medical Center, a 676-bed tertiary-care center in Chicago. Resistance mechanisms were confirmed by phenotypic methods and/or polymerase chain reaction. Clinical culture results during MICU stay were extracted from the hospital information system. Target MDROs included vancomycin-resistant Enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB). Patients with either a study or clinical culture positive for a target MDRO were analyzed. Results We collected 5,086 study samples from 1,661 unique admissions (1,419 patients) and included here data from 413 unique admissions (397 patients) with completed microbiologic analysis. Median (IQR) patient age was 65 (51–75) years and length of MICU stay was 3 (3–4) days. A total of 156 (37.8%) patients had a target MDRO detected from a study sample at any point; 57 (36.5%) patients had >1 MDRO detected. Overall prevalence of these MDROs was found to be 22.5% VRE, 6.5% CRE, 19.8% ESBL, 4.4% CRPA, and 0.7% CRAB. New MDRO acquisition was observed in 58 (14.6%) patients (figure). Once a target MDRO was detected in a study sample, 82.2% of subsequent study samples were positive for that MDRO. Only 13 (5.8%) patients had a positive clinical culture for any target MDRO during their MICU stay (table). Conclusion Clinical cultures capture only the tip of the resistance iceberg and alone are insufficient to guide MDRO-targeted prevention strategies. Universal infection prevention measures are an alternative that may be preferred in settings where overall prevalence of MDROs is moderate or high and patients may be colonized with >1 MDRO. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Teppei Shimasaki
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Yoona Rhee
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Rachel D Yelin
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Michelle Ariston
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Stefanie Ollison
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Thelma Dangana
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | | | - Robert A Weinstein
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Karen Lolans
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Michael Schoeny
- Department of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Michael Y Lin
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Nicholas M Moore
- Medical Laboratory Science, Rush University Medical Center, Chicago, Illinois
| | - Mary K Hayden
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
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Hong H, Rhee Y, Kim H, Lee Y, Song Y, Cho C. Optimal fermenting condition for the production of immuno-stimulating polysaccharides in Korean traditional rice wine. N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.1022] [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: 11/25/2022]
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Seekatz AM, Bassis CM, Fogg L, Moore NM, Rhee Y, Lolans K, Weinstein RA, Lin MY, Young VB, Hayden MK. Gut Microbiota and Clinical Features Distinguish Colonization With Klebsiella pneumoniae Carbapenemase-Producing Klebsiella pneumoniae at the Time of Admission to a Long-term Acute Care Hospital. Open Forum Infect Dis 2018; 5:ofy190. [PMID: 30151415 PMCID: PMC6101546 DOI: 10.1093/ofid/ofy190] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/27/2018] [Indexed: 12/29/2022] Open
Abstract
Background Identification of gut microbiota features associated with antibiotic-resistant bacterial colonization may reveal new infection prevention targets. Methods We conducted a matched, case–control study of long-term acute care hospital (LTACH) patients to identify gut microbiota and clinical features associated with colonization by Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-Kp), an urgent antibiotic resistance threat. Fecal or rectal swab specimens were collected and tested for KPC-Kp; 16S rRNA gene-based sequencing was performed. Comparisons were made between cases and controls in calibration and validation subsamples using microbiota similarity indices, logistic regression, and unit-weighted predictive models. Results Case (n = 32) and control (n = 99) patients had distinct fecal microbiota communities, but neither microbiota diversity nor inherent clustering into community types distinguished case and control specimens. Comparison of differentially abundant operational taxonomic units (OTUs) revealed 1 OTU associated with case status in both calibration (n = 51) and validation (n = 80) subsamples that matched the canonical KPC-Kp strain ST258. Permutation analysis using the presence or absence of OTUs and hierarchical logistic regression identified 2 OTUs (belonging to genus Desulfovibrio and family Ruminococcaceae) associated with KPC-Kp colonization. Among clinical variables, the presence of a decubitus ulcer alone was independently and consistently associated with case status. Combining the presence of the OTUs Desulfovibrio and Ruminococcaceae with decubitus ulcer increased the likelihood of KPC-Kp colonization to >38% in a unit-weighted predictive model. Conclusions We identified microbiota and clinical features that distinguished KPC-Kp gut colonization in LTACH patients, a population particularly susceptible to KPC-Kp infection. These features may warrant further investigation as markers of risk for KPC-Kp colonization.
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Affiliation(s)
- Anna M Seekatz
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Christine M Bassis
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Louis Fogg
- Department of Nursing, Rush College of Nursing, Chicago, Illinois
| | | | - Yoona Rhee
- Division of Infectious Diseases, Department of Internal Medicine, Rush Medical College, Chicago, Illinois
| | | | - Robert A Weinstein
- Division of Infectious Diseases, Department of Internal Medicine, Rush Medical College, Chicago, Illinois.,Cook County Health and Hospitals System, Chicago, Illinois
| | - Michael Y Lin
- Division of Infectious Diseases, Department of Internal Medicine, Rush Medical College, Chicago, Illinois
| | - Vincent B Young
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mary K Hayden
- Department of Pathology.,Division of Infectious Diseases, Department of Internal Medicine, Rush Medical College, Chicago, Illinois
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Kim SW, Hong N, Rhee Y, Choi YC, Shin HY, Kim SM. Clinical and laboratory features of patients with osteomalacia initially presenting with neurological manifestations. Osteoporos Int 2018; 29:1617-1626. [PMID: 29623355 DOI: 10.1007/s00198-018-4501-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED Patients with osteomalacia often visit the neurology department with conditions mimicking other myopathies. We analyzed clinical features of osteomalacia patients who visited the neurology department. These patients frequently presented with hypocalcemia, hypovitaminosis D, and pain with less severe weakness. Osteomalacia should be considered when patients present with pain and weakness. INTRODUCTION Osteomalacia is a disease of bone metabolism; however, some patients with osteomalacia initially visit the neurology department. As these patients often complain of weakness and gait disturbance, osteomalacia can be confused with other myopathies. We analyzed the clinical features of patients with osteomalacia who visited the neurology department. METHODS We retrospectively reviewed the medical records. Osteomalacia was diagnosed based on symptoms, laboratory features, and imaging results. We compared the characteristics of patients with osteomalacia who visited the neurology department with (1) those who did not visit the neurology department and (2) patients with idiopathic inflammatory myopathy. RESULTS Eighteen patients with osteomalacia visited the neurology department (NR group). The common etiologies in the NR group included tumors or antiepileptic medication, whereas antiviral medication was the most common in patients who did not visit the neurology department (non-NR group). The NR group showed lower serum calcium (p = 0.004) and 25-hydroxyvitamin D (p = 0.006) levels than the non-NR group. When compared with patients with inflammatory myopathy, both groups showed proximal dominant weakness. However, pain was more common in osteomalacia than in myopathy (p = 0.008), and patients with osteomalacia showed brisk deep tendon reflex more often (p = 0.017). Serum calcium (p = 0.003) and phosphate (p < 0.001) levels were lower in osteomalacia than in myopathy. CONCLUSIONS It was not uncommon for patients with osteomalacia to visit the neurology department. The clinical presentation of these patients can be more complex owing the superimposed neurological disease and accompanying hypocalcemia. Osteomalacia should be considered when patients present with pain and weakness.
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Affiliation(s)
- S W Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - N Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Y Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Y-C Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - H Y Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S M Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
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23
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Choi E, Cho H, Park B, Park S, Choi K, Rhee Y. Socioeconomic inequalities in breast and thyroid cancer screening in Korea: A nationwide cross-sectional study. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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24
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Hodgson HA, Sim T, Gonzalez H, Aziz M, Rhee Y, Lewis PO, Jhobalia N, Shields B, Wang SK. Successful Treatment of Cerebral Toxoplasmosis Using Pyrimethamine Oral Solution Compounded From Inexpensive Bulk Powder. Open Forum Infect Dis 2018; 5:ofy055. [PMID: 29693038 PMCID: PMC5906922 DOI: 10.1093/ofid/ofy055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/16/2018] [Indexed: 11/17/2022] Open
Abstract
A price increase of pyrimethamine tablets in the United States has made the life-saving drug difficult to acquire for hospitalized patients who need it most. We report the successful use of a pyrimethamine oral suspension compounded from an economical bulk powder in a patient with acute toxoplasmic encephalitis.
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Affiliation(s)
- Hayley A Hodgson
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois.,Department of Pharmacy, Department of Internal Medicine, Chicago, Illinois
| | - Taeyong Sim
- Division of Infectious Diseases, Department of Internal Medicine, Chicago, Illinois
| | - Hemil Gonzalez
- Division of Infectious Diseases, Department of Internal Medicine, Chicago, Illinois
| | - Mariam Aziz
- Division of Infectious Diseases, Department of Internal Medicine, Chicago, Illinois
| | - Yoona Rhee
- Division of Infectious Diseases, Department of Internal Medicine, Chicago, Illinois
| | - Paul O Lewis
- Department of Pharmacy, Johnson City Medical Center, Johnson City, Tennessee
| | - Neel Jhobalia
- Rush Specialty Drug Solutions, Rush University Medical Center, Chicago, Illinois
| | - Beth Shields
- Department of Pharmacy, Department of Internal Medicine, Chicago, Illinois
| | - Sheila K Wang
- Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois.,Department of Pharmacy, Department of Internal Medicine, Chicago, Illinois
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Abstract
Although osteoradionecrosis (ORN) is a serious complication of craniofacial radiotherapy, the current management methods remain suboptimal. Teriparatide (TPTD), a recombinant human parathyroid hormone (1-34), has shown beneficial effects on osseous regeneration in medication-related osteonecrosis of the jaw or periodontitis. However, TPTD therapy in irradiated bones has not been indicated yet because of the theoretical risk of osteosarcoma seen in rat models. Hence, we first report here two patients with tongue cancer with late-emerging ORN who were successfully treated with TPTD for 4-6 months with serum calcium and vitamin D supplementation. In contrast to the usual progress of ORN, the bone defect regenerated well and bone turnover markers including serum C-terminal telopeptide of type 1 collagen and osteocalcin were restored with TPTD therapy. Our experience might suggest that TPTD therapy with careful monitoring can provide an effective treatment option for patients with ORN in select refractory cases, with the benefits outweighing the potential risks.
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Affiliation(s)
- Y H Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Korea
| | - N Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Y Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - I-H Cha
- Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Korea.
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26
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Seekatz A, Bassis CM, Lolans K, Yelin RD, Moore NM, Okamoto K, Rhee Y, Bell P, Dangana T, Sidimirova G, Weinstein RA, Fogg L, Lin MY, Young VB, Hayden MK. Longitudinal Comparison of the Microbiota During Klebsiella pneumoniae Carbapenemase-Producing Klebsiella pneumoniae (KPC-Kp) Acquisition in Long-Term Acute Care Hospital (LTACH) patients. Open Forum Infect Dis 2017. [PMCID: PMC5632161 DOI: 10.1093/ofid/ofx162.115] [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: 11/13/2022] Open
Abstract
Background Colonization with KPC-Kp precedes infection and represents a potential target for intervention. To identify microbial signatures associated with KPC-Kp acquisition, we conducted a prospective, longitudinal study of the fecal microbiota in LTACH patients at risk of acquiring KPC-Kp. Methods We collected admission and weekly rectal swab samples from patients admitted to one LTACH from May 2015 to May 2016. Patients were screened for KPC-Kp by PCR at each sampling time. KPC acquisition was confirmed by culture of KPC-Kp. To assess changes in the microbiota related to acquisition, we sequenced the 16S rRNA gene (V4 region) from collected rectal swabs. Diversity, intra-individual changes, and the relative abundance of the operational taxonomic unit (OTU) that contains KPC-Kp were compared in patients who were KPC-Kp negative upon admission and who had at least one additional swab sample collected. Results 318 patients (1247 samples) were eligible for analysis; 3.7 samples (mean) were collected per patient. Sixty-two patients (19.5%) acquired KPC-Kp (cases) and 256 patients remained negative for all carbapenem-resistant Enterobacteriaceae throughout their stay (controls). Median length of stay before KPC-Kp detection was 14.5 days. At time of KPC-Kp acquisition, levels of an Enterobacteriaceae OTU increased significantly compared with pre-acquisition samples and to samples from control patients (Wilcoxon test, P < 0.0001). Similarly, we observed a decrease in total diversity of the fecal microbiota at time of acquisition in cases (P < 0.01). Compared with controls, cases exhibited decreased intra-individual fecal microbiota similarity immediately prior to acquisition of KPC-Kp (P < 0.01). Comparison of microbial features at time of admission using random forest revealed a higher abundance of Enterococcus and Escherichia OTUs in controls vs cases. Conclusion We observed intra-individual changes in the fecal microbiota of case patients prior to acquisition of KPC-Kp. Compared with patients who did not acquire KPC-Kp, cases exhibited significant changes in microbiota diversity and increased abundance of potential KPC-Kp at acquisition. Our results suggest that shifts in the microbiota may precede colonization by KPC-Kp. Disclosures N. M. Moore, Cepheid: Research Contractor, Funded and provided reagents for associated research projects; R. A. Weinstein, OpGen: Receipt of donated laboratory services for project, Research support; CLorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; M. Y. Lin, Sage, Inc.: receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; OpGen, Inc.: receipt of in-kind laboratory services, Conducting studies in healthcare facilities that are receiving contributed product; M. K. Hayden, OpGen, Inc.: Receipt of donated laboratory services for project, Research support; Clorox: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Molnlycke: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product; Sage Products: Receipt of contributed product, Conducting studies in healthcare facilities that are receiving contributed product.
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Affiliation(s)
- Anna Seekatz
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Christine M Bassis
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Karen Lolans
- Rush University Medical Center, Chicago, Illinois
| | | | - Nicholas M Moore
- Medical Laboratory Science, Rush University Medical Center, Chicago, Illinois
| | - Koh Okamoto
- Infectious Disease, University of Tokyo Hospital, Tokyo, Japan
| | - Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
| | - Pamela Bell
- Rush University Medical Center, Chicago, Illinois
| | | | | | | | - Louis Fogg
- Rush University Medical Center, Chicago, Illinois
| | | | - Vincent B Young
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mary K Hayden
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
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27
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Kim H, Baek KH, Lee SY, Ahn SH, Lee SH, Koh JM, Rhee Y, Kim CH, Kim DY, Kang MI, Kim BJ, Min YK. Association of circulating dipeptidyl-peptidase 4 levels with osteoporotic fracture in postmenopausal women. Osteoporos Int 2017; 28:1099-1108. [PMID: 27866216 DOI: 10.1007/s00198-016-3839-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/10/2016] [Indexed: 01/15/2023]
Abstract
UNLABELLED Postmenopausal women with osteoporotic fracture (OF) had higher plasma dipeptidyl-peptidase 4 (DPP4) levels than those without. Furthermore, higher plasma DPP4 levels were significantly associated with higher bone turnover and a higher prevalence of OF. These results indicated that DPP4 may be associated with OF by mediating bone turnover rate. INTRODUCTION Evidence indicates that dipeptidyl-peptidase 4 (DPP4) plays a distinct role in bone metabolism. However, there has been no report on the association, if any, between circulating DPP4 levels and osteoporosis-related phenotypes, including osteoporotic fracture (OF). Therefore, we performed a case-control study to investigate these associations in postmenopausal women. METHODS This study was conducted in multiple centers in Korea. We enrolled 178 cases with OF and 178 age- and body mass index-matched controls. OF was assessed by an interviewer-assisted questionnaire and lateral thoracolumbar radiographs. Bone turnover markers (BTMs), bone mineral density (BMD), and plasma DPP4 levels were obtained in all subjects. RESULTS After adjustment for potential confounders, subjects with OF had significantly higher DPP4 levels than those without (P = 0.021). Higher DPP4 levels were significantly positively associated with higher levels of all BTMs, but not with BMD at all measured sites. The differences in DPP4 levels according to OF status disappeared after an additional adjustment for each BTM, but not after adjustment for any BMD values. BTMs explained approximately half of the relationship between DPP4 and OF. The risk of OF was 3.80-fold (95% confidence interval = 1.53-9.42) higher in subjects in the highest DPP4 quartile than in those in the lowest quartile after adjustment for potential confounders, including femoral neck BMD. CONCLUSIONS DPP4 may be associated with OF by at least partly mediating the bone turnover rate. Circulating DPP4 levels may be a potential biomarker that could increase the predictive power of current fracture risk assessment models.
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Affiliation(s)
- H Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - K H Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, 137-701, South Korea
| | - S-Y Lee
- Asan Institute for Life Science, Seoul, 138-736, South Korea
| | - S H Ahn
- Department of Endocrinology, Inha University School of Medicine, Incheon, 402-751, South Korea
| | - S H Lee
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - J-M Koh
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Y Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, 120-752, South Korea
| | - C H Kim
- Department of Internal Medicine, Sejong General Hospital, Bucheon, 422-711, South Korea
| | - D-Y Kim
- Department of Nuclear Medicine, Kyunghee University School of Medicine, Seoul, 130-872, South Korea
| | - M-I Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, 137-701, South Korea
| | - B-J Kim
- Division of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Y-K Min
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
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28
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Yang JG, Hwang KH, Kil EJ, Park J, Cho S, Lee YG, Auh CK, Rhee Y, Lee S. PVX-tolerant potato development using a nucleic acid-hydrolyzing recombinant antibody. Acta Virol 2017; 61:105-115. [PMID: 28161965 DOI: 10.4149/av_2017_01_105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
3D8 scFv, a catalytic recombinant antibody developed in the MRL mouse, exhibits nucleic acid-hydrolyzing activity. Previous studies have demonstrated that tobacco plants harboring 3D8 scFv antibodies showed broad-spectrum resistance to infection by both DNA and RNA viruses. In this study, potatoes were transformed with the 3D8 scFv gene and screened by potato virus X (PVX) challenge. Starting with the T0 and T1 potato lines, PVX-tolerant T1 potatoes were identified in the field and characterized by ELISA and RT-PCR analysis. T2 potatoes were propagated for T3 generation and additional virus challenges in the field, and 44% of the 3D8 scFv T3 transgenic potatoes grown in GMO fields were found to be tolerant to PVX infection. Tubers from PVX-tolerant T3 lines were 60% bigger and 24% heavier, compared with tubers from PVX-susceptible transgenic lines and wild-type potatoes. Three-step virus challenge experiments and molecular characterization techniques were used for plants grown in growth chambers or fields to identify 3D8 scFv-transgenic, PVX-tolerant potatoes. These studies also revealed that the viral tolerance enabled by 3D8 scFv persisted during asexual propagation.
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29
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Okamoto K, Rhee Y, Schoeny M, Lolans K, Cheng J, Reddy S, Salazar E, Warpinski G, Carr M, Mcilroy G, Mangan P, Weinstein RA, Hayden MK, Popovich K. Impact of Doffing Errors on Healthcare Worker Self-Contamination When Caring for Patients on Contact Precautions. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Koh Okamoto
- Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
| | - Yoona Rhee
- Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
| | | | - Karen Lolans
- Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
| | - Jennifer Cheng
- Infectious Disease, Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
| | - Shivani Reddy
- Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
| | - Efrain Salazar
- Rush University,, College of Health Sciences, chicago, IL
- CDC, Atlanta, GA
| | | | - Melanie Carr
- Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
| | - Grace Mcilroy
- Rush University Medical Center, chicago, IL
- CDC, Atlanta, GA
| | | | | | - Mary K. Hayden
- Internal Medicine (Infectious Diseases) and Pathology, Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
| | - Kyle Popovich
- Rush University Medical Center, Chicago, IL
- CDC, Atlanta, GA
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Seekatz A, Bassis CM, Lolans K, Okamoto K, Moore NM, Rhee Y, Bardowski L, Bell P, Salazar E, Dangana T, Sidimirova G, Weinstein RA, Fogg L, Lin MY, Young VB, Hayden MK. Fecal Microbiota Dynamics During Klebsiella pneumoniae carbapenemase (KPC) Acquisition in Long-Term Acute Care Hospital (LTACH) Patients. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna Seekatz
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Christine M. Bassis
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Karen Lolans
- Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Koh Okamoto
- University of Tokyo Hospital, Tokyo, Japan
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Nicholas M. Moore
- Medical Laboratory Science, Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Laura Bardowski
- Section of Infectious Disease, Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Pamela Bell
- Pathology, Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Efrain Salazar
- Rush University, College of Health Sciences, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Thelma Dangana
- Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Galina Sidimirova
- Infection Control, Rush Oak Park Hospital, Oak Park, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Louis Fogg
- Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Michael Y. Lin
- Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Vincent B. Young
- Internal Medicine-Infectious Diseases, University of Michigan, Ann Arbor, Michigan
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
| | - Mary K. Hayden
- Internal Medicine (Infectious Diseases) and Pathology, Rush University Medical Center, Chicago, Illinois
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
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Bassis CM, Seekatz A, Fogg L, Lolans K, Moore NM, Okamoto K, Rhee Y, Bardowski L, Bell P, Salazar E, Dangana T, Sidimirova G, Weinstein RA, Lin MY, Young VB, Hayden MK. Gut Microbiota and Clinical Predictors of Carbapenem-Resistant Enterobacteriaceae (CRE) Carriage Among Patients at the Time of Admission to a Long-term Acute Care Hospital (LTACH). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christine M. Bassis
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anna Seekatz
- Internal Medicine/Infectious Diseases, University of Michigan, Ann Arbor, Michigan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Louis Fogg
- Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen Lolans
- Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicholas M. Moore
- Medical Laboratory Science, Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Koh Okamoto
- University of Tokyo Hospital, Tokyo, Japan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Bardowski
- Section of Infectious Disease, Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Bell
- Pathology, Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Efrain Salazar
- Rush University, College of Health Sciences, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thelma Dangana
- Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Galina Sidimirova
- Infection Control, Rush Oak Park Hospital, Oak Park, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert A. Weinstein
- Cook County Health and Hospitals System, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Y. Lin
- Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vincent B. Young
- Internal Medicine-Infectious Diseases, University of Michigan, Ann Arbor, Michigan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary K. Hayden
- Internal Medicine (Infectious Diseases) and Pathology, Rush University Medical Center, Chicago, Illinois
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Popovich KJ, Green S, Okamoto K, Rhee Y, Hayden MK, Weinstein RA. Genomic Epidemiology of USA300 Methicillin-Resistant Staphylococcus aureus in Intensive Care Units (ICUs) Using Whole-Genome Sequencing (WGS). Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw194.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center, Chicago, Illinois
- Stroger Hospital of Cook County, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
| | - Stefan Green
- University of Illinois at Chicago, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
| | - Koh Okamoto
- Rush University Medical Center, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
| | - Yoona Rhee
- Rush University Medical Center, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
| | - Mary K. Hayden
- Rush University Medical Center, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois
- Stroger Hospital of Cook County, Chicago, Illinois
- Rush University Medical Center, Chicago, Illinois
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Okamoto K, Lin MY, Haverkate M, Lolans K, Moore NM, Weiner S, Lyles RD, Blom D, Rhee Y, Kemble S, Fogg L, Hines DW, Weinstein RA, Hayden MK. Risk Factors for Acquisition of Rectal Colonization With KPC-Producing Enterobacteriaceae (KPC) Among Long-Term Acute Care Hospital (LTACH) Patients. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.123] [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: 11/14/2022] Open
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Seo D, Rhee Y. Osteitis fibrosa cystica in primary hyperparathyroidism. QJM 2015; 108:991. [PMID: 26261355 DOI: 10.1093/qjmed/hcv144] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Seo
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Y Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Cohen J, Pivodic L, Miccinesi G, Onwuteaka-Philipsen BD, Naylor WA, Wilson DM, Loucka M, Csikos A, Pardon K, Van den Block L, Ruiz-Ramos M, Cardenas-Turanzas M, Rhee Y, Aubry R, Hunt K, Teno J, Houttekier D, Deliens L. International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data. Br J Cancer 2015; 113:1397-404. [PMID: 26325102 PMCID: PMC4815784 DOI: 10.1038/bjc.2015.312] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [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] [Received: 03/17/2015] [Revised: 07/08/2015] [Accepted: 08/10/2015] [Indexed: 11/16/2022] Open
Abstract
Background: Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries. Methods: Cross-sectional study using death certificate data for all deaths from cancer (ICD-10 codes C00-C97) in 2008 in Belgium, Canada, Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (2010), USA (2007) and Wales (N=1 355 910). Multivariable logistic regression analyses evaluated factors associated with home death within countries and differences across countries. Results: Between 12% (South Korea) and 57% (Mexico) of cancer deaths occurred at home; between 26% (Netherlands, New Zealand) and 87% (South Korea) occurred in hospital. The large between-country differences in home or hospital deaths were partly explained by differences in availability of hospital- and long-term care beds and general practitioners. Haematologic rather than solid cancer (odds ratios (ORs) 1.29–3.17) and being married rather than divorced (ORs 1.17–2.54) were most consistently associated with home death across countries. Conclusions: A large country variation in the place of death can partly be explained by countries' healthcare resources. Country-specific choices regarding the organisation of end-of-life cancer care likely explain an additional part. These findings indicate the further challenge to evaluate how different specific policies can influence place of death patterns.
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Affiliation(s)
- J Cohen
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - L Pivodic
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - G Miccinesi
- ISPO Cancer Prevention and Research Institute, Clinical Epidemiology Unit, Via Oblate 2, Pal 28/A, 50142 Florence, Italy
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - W A Naylor
- Hospice Waikato, 334 Cobham Drive, Hillcrest, Hamilton 3216, New Zealand
| | - D M Wilson
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada
| | - M Loucka
- Center for Palliative Care, Michelska 1/7, Prague 140 00, Czech Republic
| | - A Csikos
- University of Pécs Medical School, 48-as tér 1, 7622 Pécs, Hungary
| | - K Pardon
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - L Van den Block
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - M Ruiz-Ramos
- Information and Evaluation Service, Regional Ministry of Health in Andalusia, Av. Innovación, s/n - Edificio Arenas 1, 41071 Seville, Spain
| | - M Cardenas-Turanzas
- Department of General Internal Medicine, MD Anderson Cancer Center, The University of Texas, Houston, 515 Holcombe Blvd, Houston, TX 77030, USA
| | - Y Rhee
- Department of Health Science, Dongduk Women's University, 23-1 Hawolgok-dong, Seongbuk-gu, Seoul, South Korea
| | - R Aubry
- French National Observatory on End-of-Life Care, 35 Rue du Plateau, 75952 Paris CEDEX 19, France
| | - K Hunt
- Faculty of Health Sciences, University of Southampton, 104 Burgess Road, Southampton SO17 1BJ, Hampshire, UK
| | - J Teno
- Cambia Palliative Care Center of Excellence, University of Washington Division of Geriatric Medicine, Box 359765, 401 Broadway, Suite 5123.11 Seattle, WA 98122, USA
| | - D Houttekier
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - L Deliens
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, Building 6K12E, 9000 Ghent, Belgium
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Youn JC, Lee SJ, Lee HS, Oh J, Hong N, Park S, Lee SH, Choi D, Rhee Y, Kang SM. Exercise capacity independently predicts bone mineral density and proximal femoral geometry in patients with acute decompensated heart failure. Osteoporos Int 2015; 26:2121-9. [PMID: 25963233 DOI: 10.1007/s00198-015-3112-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 12/02/2014] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Heart failure is associated with increased risk of osteoporosis. We evaluated the prevalence and predictors of osteoporosis in hospitalized patients with ADHF using quantitative computed tomography. Osteoporosis and vertebral fracture are prevalent in patients with ADHF and exercise capacity independently predicts bone mass and femoral bone geometry. INTRODUCTION Heart failure is associated with reduced bone mass and increased risk of osteoporotic fractures. However, the prevalence and predictors of osteoporosis in hospitalized patients with acute decompensated heart failure (ADHF) are not well understood. METHODS Sixty-five patients (15 postmenopausal females and 50 males) with ADHF were prospectively and consecutively enrolled. After stabilization of heart failure symptoms, quantitative computed tomography for bone mineral density (BMD) and femoral geometry as well as biochemical, echocardiographic, and cardiopulmonary exercise tests were performed. RESULTS Fifteen postmenopausal female showed a high prevalence of osteoporosis (40%) and vertebral fracture (53%). Among 50 male patients, 12% had osteoporosis and 32% had osteopenia, while vertebral fracture was found in 12%. Lumbar volumetric BMD (vBMD) was significantly lower in ischemic patients than non-ischemic patients (107.9 ± 47.5 vs. 145.4 ± 40.9 mg/cm(3), p = 0.005) in male. Exercise capacity, indicated by peak oxygen consumption (VO2), was significantly associated with lumbar vBMD (r = 0.576, p < 0.001) and total hip areal BMD (aBMD) (r = 0.512, p = 0.001) and cortical thickness of the femur neck (r = 0.544, p = 0.001). When controlled for age, body mass index, N-terminal proBrain natriuretic protein (NT-proBNP), etiology of heart failure, hemoglobin, and thigh circumference, multivariate regression analysis revealed peak VO2 independently predicted lumbar vBMD (β = 0.448, p = 0.031), total hip aBMD (β = 0.547, p = 0.021), and cortical thickness of the femur neck (β = 0.590, p = 0.011). CONCLUSION In male patients with ADHF, osteoporosis and vertebral fracture are prevalent, and exercise capacity independently predicts bone mass and geometry. Given that heart failure patients with reduced exercise capacity carry a substantial increased risk of fracture, proper osteoporosis evaluation is important in these patients.
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Affiliation(s)
- J-C Youn
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
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Hwang S, Choi HS, Kim KM, Rhee Y, Lim SK. Associations between serum 25-hydroxyvitamin D and bone mineral density and proximal femur geometry in Koreans: the Korean National Health and Nutrition Examination Survey (KNHANES) 2008-2009. Osteoporos Int 2015; 26:163-71. [PMID: 25262060 DOI: 10.1007/s00198-014-2877-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 03/11/2014] [Accepted: 08/26/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED The association between 25-hydroxyvitamin D (25(OH)D) levels and bone mineral density (BMD) and proximal femur bone geometry was examined in the Korean population. A positive relationship between skeletal health and 25(OH)D levels was observed. However, there were no significant differences in skeletal health between the groups with 25(OH)D level of 50-75 nmol/L and greater than 75 nmol/L. INTRODUCTION Vitamin D plays an important role in calcium and phosphate homeostasis and normal mineralization of bone. However, the optimal level of vitamin D for skeletal health has not been clearly established. We analyzed the associations between serum 25(OH)D and BMD and proximal femur bone geometry and determined the optimal 25(OH)D level. METHODS This was a cross-sectional study of 10,062 participants (20-95 years, 4,455 men, 5,607 women) in the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) conducted from 2008 to 2009. Participants were divided into groups according to 25(OH)D level (<25, 25-50, 50-75, and ≥75 nmol/L). BMD and proximal femur geometric indices were measured. RESULTS The group with 25(OH)D levels of 50-75 nmol/L had greater bone density values, with the exception of the lumbar spine, and also had greater femur neck cortical thickness, cross-sectional area, and cross-sectional moment of inertia, as well as a lesser buckling ratio than the groups with 25(OH)D level of 25-50 nmol/L and less than 25 nmol/L. However, there were no significant differences in BMD and proximal femur geometry properties between the groups with 50-75 nmol/L and greater than 75 nmol/L of 25(OH)D. CONCLUSION The skeletal outcomes, including BMD and proximal femur geometric indices observed in this study, suggest that serum 25(OH)D levels of 50 to <75 nmol/L are optimal for skeletal health.
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Affiliation(s)
- S Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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Rhee Y. Factors Associated with Relocating to Nursing Homes Among Community-Dwelling Older Persons with Dementia. Value Health 2014; 17:A722. [PMID: 27202564 DOI: 10.1016/j.jval.2014.08.027] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Y Rhee
- Dongduk Women's University, Seoul, South Korea
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Kim JE, Lee YH, Huh JH, Kang DR, Rhee Y, Lim SK. Early-stage chronic kidney disease, insulin resistance, and osteoporosis as risk factors of sarcopenia in aged population: the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2008-2009. Osteoporos Int 2014; 25:2189-98. [PMID: 24846317 DOI: 10.1007/s00198-014-2745-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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] [Received: 12/10/2013] [Accepted: 05/07/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Sarcopenia means the progressive loss of skeletal muscle mass and strength with aging. In this study, we found that insulin resistance, chronic kidney disease stage 3, and osteoporosis at the femur neck were closely associated with sarcopenia in elderly men. These conditions modified to slow down the progression of sarcopenia. INTRODUCTION Sarcopenia is known to have multiple contributing factors; however, its modifiable risk factors have not yet been determined. The aim of this study was to identify the most influential and modifiable risk factors for sarcopenia in elderly. METHODS This was a population-based, cross-sectional study using data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV), 2008-2009. This study included 940 men and 1,324 women aged 65 years and older who completed a body composition analysis using dual-energy X-ray absorptiometry. Sarcopenia was defined as an appendicular skeletal muscle mass divided by height(2) of less than 1 standard deviation below the sex-specific mean for a younger reference group. RESULTS Using univariate analysis, age, body mass index (BMI), homeostasis model assessment for insulin resistance (HOMA-IR), limitations in daily activities, regular exercise, high-risk drinking, family income, osteoporosis, daily energy, and protein intake were associated with sarcopenia in men; age, BMI, limitations in daily activities, regular exercise, occupation, osteoporosis at the total hip, and daily energy intake were associated with sarcopenia in women. In the multivariate logistic regression analysis, HOMA-IR ≥2.5 (odds ratio [OR] for sarcopenia, 2.27; 95 % confidence interval [CI], 1.21-4.25), chronic kidney disease stage 3 (OR, 3.13; 95 % CI, 1.14-8.61), and osteoporosis at the femur neck (OR, 6.83; 95 % CI, 1.08-43.41) were identified as risk factors for sarcopenia in men. CONCLUSIONS Insulin resistance, chronic kidney disease, and osteoporosis at the femur neck should be modified to prevent the acceleration of skeletal muscle loss in elderly men.
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Affiliation(s)
- J E Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea,
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Brunt A, Rhee Y, Fisk P, Caldarone M. Dietary Intake Trends of Sodium, Potassium, Magnesium and Calcium over 12 Years. J Acad Nutr Diet 2014. [DOI: 10.1016/j.jand.2014.06.156] [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: 10/24/2022]
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41
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Rhee Y, Popovich KJ. Community-associated methicillin-resistant Staphylococcus aureus and HIV. Future Virol 2014. [DOI: 10.2217/fvl.14.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Yoona Rhee
- Rush University Medical Center, Section of Infectious Diseases, 600 South Paulina St. Suite 143, Chicago, IL 60612, USA
| | - Kyle J Popovich
- Rush University Medical Center, Section of Infectious Diseases, 600 South Paulina St. Suite 143, Chicago, IL 60612, USA
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Kim KM, Park W, Oh SY, Kim HJ, Nam W, Lim SK, Rhee Y, Cha IH. Distinctive role of 6-month teriparatide treatment on intractable bisphosphonate-related osteonecrosis of the jaw. Osteoporos Int 2014; 25:1625-32. [PMID: 24554340 DOI: 10.1007/s00198-014-2622-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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] [Received: 09/11/2013] [Accepted: 01/09/2014] [Indexed: 12/21/2022]
Abstract
UNLABELLED The administration of teriparatide (TPTD) in conjunction with periodontal care could provide faster and more favorable clinical outcomes in previously refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) cases compared to conventional dental care, combination of surgery and antimicrobial treatment. We also found that underlying vitamin D levels might influence the response to TPTD treatment. INTRODUCTION Treatment of BRONJ is quite challenging and there are no standard treatment modalities. In this retrospective, longitudinal study, we examined whether additional TPTD administration could be beneficial for the resolution of BRONJ lesions compared to conservative management, such as antimicrobial treatment with or without surgery, and also studied the factors influencing the response to TPTD. METHODS Twenty-four cases of intractable BRONJ were included: 15 subjects were assigned to the TPTD group and the other 9 subjects, who refused TPTD administration, were assigned to the non-TPTD group. All subjects in both groups continued calcium and vitamin D supplementation and the TPTD group additionally received a daily subcutaneous injection of 20 μg TPTD for 6 months. RESULTS While 60.0% of the non-TPTD group showed one stage of improvement in BRONJ, 40.0% of the group did not show any improvement in disease status. In the TPTD group, 62.5% of the treated subjects showed one stage of improvement and the other 37.5% demonstrated a marked improvement, including two stages of improvement or complete healing, and there was not a single case that did not improve. The clinical improvement of BRONJ was statistically better in the TPTD group after the 6-month treatment (p < 0.05). Moreover, patients with higher baseline serum 25(OH)D levels showed better clinical therapeutic outcomes with TPTD. CONCLUSIONS We observed the beneficial effects of TPTD on BRONJ, and subjects with optimal serum vitamin D concentrations seemed to reap the maximum therapeutic effects of TPTD. A prospective, randomized, controlled trial should be needed to further evaluate the therapeutic efficacy of TPTD in the resolution of BRONJ.
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Affiliation(s)
- K M Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Rhee Y, Aroutcheva A, Hota B, Weinstein RA, Popovich K. 274Evolving Epidemiology of Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu052.140] [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: 11/12/2022] Open
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Rhee Y, Heaton T, Keegan C, Ahmad A. Citrullinemia type I and hypertrophic pyloric stenosis in a 1-month old male infant. Clin Pract 2013; 3:e2. [PMID: 24765495 PMCID: PMC3981224 DOI: 10.4081/cp.2013.e2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/06/2012] [Indexed: 11/29/2022] Open
Abstract
Citrullinemia type I (CTLN1) is an inherited urea cycle disorder, now included in most newborn screening panels in the US and Europe. Due to argininosuccinate synthetase deficiency, CTLN1 can lead to recurrent hyperammonemic crisis that may result in permanent neurologic sequelae. Vomiting in patients with urea cycle disorders may either be the result or cause of acute hyperammonemia, particularly if due to an illness that leads to catabolism. Therefore, age-appropriate common etiologies of vomiting must be considered when evaluating these patients. We present a 1-month old male infant with CTLN1 who had a 1-week history of vomiting and was discovered to have hypertrophic pyloric stenosis. This is the first documented case of an infant with CTLN1 who was later diagnosed with hypertrophic pyloric stenosis, and only the second case of concomitant disease.
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Affiliation(s)
- Yoona Rhee
- Department of Internal Medicine and Pediatrics & Communicable Diseases
| | - Todd Heaton
- Division of Pediatric Surgery, Department of Surgery
| | - Catherine Keegan
- Division of Pediatric Genetics, Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor , MI, USA
| | - Ayesha Ahmad
- Division of Pediatric Genetics, Department of Pediatrics & Communicable Diseases, University of Michigan, Ann Arbor , MI, USA
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Kim KM, Brown JK, Kim KJ, Choi HS, Kim HN, Rhee Y, Lim SK. Differences in femoral neck geometry associated with age and ethnicity. Osteoporos Int 2011; 22:2165-74. [PMID: 20976592 DOI: 10.1007/s00198-010-1459-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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: 04/06/2010] [Accepted: 08/31/2010] [Indexed: 11/27/2022]
Abstract
SUMMARY We studied femoral geometry in relation to age and ethnicity in a cross-sectional study. Age-associated cortical thinning showed the most pronounced effect, and Koreans studied here had thicker cortices and lower buckling ratios than those reported for other races. Cortical thickness may thus be a major determinant of hip fracture risk. INTRODUCTION The rate of hip fracture varies by age and ethnicity. The geometric properties of the femur influence femoral strength and fragility, but differences in femoral geometry according to age and ethnicity are poorly understood. To explain the high prevalence of hip fractures in the elderly and the relatively low hip fracture rate in Asian populations, we studied age-related changes and ethnic differences in femoral geometry. METHODS We recruited 214 peri- or postmenopausal women aged 46 to 85 years (mean age, 60.6 years). Their proximal femoral bone mineral densities (BMD) were measured by quantitative computed tomography and further analyzed geometric properties. RESULTS We observed large declines in trabecular volumetric bone mineral density associated with aging (33.03% less than the reference value in the oldest group, respectively). Cortical thickness decreased remarkably with age as well, and only 53.94% of the baseline value remained in the oldest group. As a result, the cortical buckling ratio increased geometrically and reached 239.14% of the reference value in the oldest group. In comparisons with other ethnic groups, Korean subjects had thicker cortices than their American, European, and African counterparts. CONCLUSIONS In this cross-sectional study, cortical thickness showed a pronounced age-associated decrease, and the cortical buckling ratio showed a strong age-associated increase. This may in part explain the higher rates of hip fractures in the elderly. When compared with other races, Asians had thicker cortical bone and lower buckling ratios, which may partially explain the lower prevalence of hip fractures in Asians.
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Affiliation(s)
- K M Kim
- Division of Endocrinology, Department of Internal Medicine, and Institute of Endocrine Research, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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Kim SH, Choi HS, Rhee Y, Kim KJ, Lim SK. Prevalent vertebral fractures predict subsequent radiographic vertebral fractures in postmenopausal Korean women receiving antiresorptive agent. Osteoporos Int 2011; 22:781-7. [PMID: 20533028 DOI: 10.1007/s00198-010-1298-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 12/06/2009] [Accepted: 03/30/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED The relationship between prevalent vertebral fractures and new vertebral fractures in Korean women has not been previously studied. We found that prevalent vertebral fracture is a strong risk factor for subsequent radiographic vertebral fracture, independent of age and spine bone mineral density (BMD) in postmenopausal Korean women receiving antiresorptive agents. INTRODUCTION The presence of prevalent vertebral fractures increases the risk of subsequent vertebral fractures. This observational study examined whether prevalent vertebral fractures influenced future incident vertebral fracture in postmenopausal women receiving antiresorptive treatment. METHODS Using the medical records, we retrospectively assessed 1,200 postmenopausal women who had visited the osteoporosis clinic. Among them, we selected patients whose BMD was measured at least once a year for 3 years. We excluded patients whose lateral spine X-ray film at baseline or follow-up period was missing, which is the key assessment. In the end, we analyzed 666 postmenopausal women. The mean duration of follow-up period was 3.2 years. RESULTS The majority of patients (83%) received bisphosphonates or raloxifene during the mean duration of 3.2 years. Fifty-five of the 666 women had new incident radiographic vertebral fractures during the follow-up period. Prevalent vertebral fractures were associated with a five-fold increased risk (odd ratio 5.7, 95% CI 3.09-10.74) of incident vertebral fractures after adjusting for age. These associations remained significant after the adjustment for multiple confounding factors (odd ratio 4.4, 95% CI 1.97-9.75). The risk of incident vertebral fracture increased with the number of prevalent vertebral fractures at baseline: 3.4 (95% CI 1.54-7.70) for those with a single fracture and 7.4 (95% CI 3.10-17.54) for those with two or more after adjustment for age and spine BMD. CONCLUSIONS We confirmed that prevalent vertebral fracture is a strong risk factor for new vertebral fractures, independent of age and spine BMD in postmenopausal Korean women receiving antiresorptive agents.
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Affiliation(s)
- S H Kim
- Division of Endocrinology, Department of Internal Medicine, Kwandong University College of Medicine, Myongji Hospital, Goyang, South Korea
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Hong JW, Nam W, Cha IH, Chung SW, Choi HS, Kim KM, Kim KJ, Rhee Y, Lim SK. Oral bisphosphonate-related osteonecrosis of the jaw: the first report in Asia. Osteoporos Int 2010; 21:847-53. [PMID: 19633881 DOI: 10.1007/s00198-009-1024-9] [Citation(s) in RCA: 47] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious side effect of bisphosphonate therapy. The incidence of BRONJ is known to be low among patients treated with oral bisphosphonates. We investigated the prevalence, demographics, clinical manifestations, and treatment outcome of 24 patients with oral BRONJ in Asian populations. INTRODUCTION The long-term safety of oral bisphosphonates is clinically important considering the rare but potentially serious complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ) versus the effect of reducing and preventing osteoporotic fracture. The incidence of BRONJ is known to be low among patients treated with oral bisphosphonates around the world. However, the prevalence in those taking oral bisphosphonates for osteoporosis in Asian populations is unknown. Moreover, a recent article, showing that the majority of reported patients who received alendronate were Asian American, raised concern about the prevalence of oral BRONJ in Asian populations. The objective of this study was to investigate the estimated prevalence, clinical characteristics, and treatment outcome of oral BRONJ in Asian populations. METHODS From October 2005 to December 2008, a retrospective review of medical charts identified 24 patients receiving oral bisphosphonates diagnosed as BRONJ at the Department of Oral and Maxillofacial Surgery, Yonsei University Dental Hospital, Seoul, South Korea. RESULTS The estimated prevalence of oral BRONJ was 0.05-0.07%. The average oral bisphosphonate treatment duration was 43.1 months (range, 5-120 months). Treatment with oral antibiotics and/or surgery including sequestrectomy or alveolectomy showed relatively favorable results. CONCLUSIONS The prevalence of oral BRONJ in Korea is similar to that reported previously in Western populations. We suggest that recognition of BRONJ and appropriate management pre- and post-dental surgery might reduce the frequency of BRONJ among patients receiving oral bisphosphonates.
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Affiliation(s)
- J W Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Noh H, Rhee Y. P1046 Epithelioid throphoblastic tumor of paracervix and parametrium. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rhee Y, Belmonte F, Weiner SJ. An Urban School Based Comparative Study of Experiences and Perceptions Differentiating Public Health Insurance Eligible Immigrant Families with and without Coverage for their Children. J Immigr Minor Health 2009; 11:222-8. [DOI: 10.1007/s10903-008-9132-8] [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] [Received: 08/18/2007] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
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