Opioid use prior to admission for chemotherapy induced febrile neutropenia is associated with increased documented infection, sepsis, and death.

PURPOSE: Cancer patients on chemotherapy are at risk for developing febrile neutropenia and infections. Opioids have been associated with immune suppression and risk of infection. We aimed to investigate opioid use associated with infections and death among cancer patients admitted with febrile neutropenia. METHODS: A total of 481 patients admitted for chemotherapy-induced febrile neutropenia were reviewed. There were 274 patients with opioid prescriptions (OP) within 10 days of hospitalization and 207 patients without opioid prescriptions (NOP) for >1 year of hospitalization. The primary outcomes were microbiologically and clinically documented infection as defined by the International Immunocompromised Host Society (IHS), sepsis by clinician, systemic inflammatory response syndrome (SIRS) criteria, and sequential organ failure assessment (SOFA) score. RESULTS: Documented infection occurred in 192 (70%) of patients with opioids compared to 99 (48%) with non-opioids, p < 0.001. Similar results were observed in sepsis by SOFA score with 173 (63%) opioids versus 92 (44%) non-opioids, p < 0.001, and sepsis by SIRS with 225 (82%) and 115 (56%) respectively, p < 0.001. Multivariable analysis showed opioid use has an increased adjusted odds of documented infection by 7.13 fold (95% CI 3.97-12.78), Sepsis by SOFA by 2.39 fold (95% CI 1.33-4.29), and Sepsis by SIRS by 1.87 fold (95% CI 1.13-3.10). Multivariable analysis for death/hospice showed that opioids had 2.30 fold (95% CI 1.16-4.57) increase in adjusted odds of death/hospice within 30 days of discharge. CONCLUSION: The data supports that patients with prior opioid use is associated with increased odds for infection, sepsis and death than non-opioid users admitted with febrile neutropenia.

Standardizing electrocardiographic and arterial pressure parameters in creole horses of the Bogotá Savannah / Estandarización de parámetros electrocardiográficos y presión arterial en caballos criollos de la Sabana de Bogotá

ABSTRACT Background: Cardiovascular parameters may vary between breeds and physiological stages, hindering the cardiovascular evaluation in horses. Objective: Standardize electrocardiographic (ECG) and arterial pressure (AP) parameters in creole horses from the Bogota Savannah. Methods: 100 male and female horses were evaluated, divided into four groups (n=25 each) according to age: group 1 (G1), between 6 months and 1 year old; group 2 (G2), between 1 and 4 years old; group 3 (G3), between 4 and 10 years old; and group 4 (G4), over 10 years old. Bipolar, unipolar and precordial leads in ECG, as well as systolic AP (SAP), mean AP (MAP), and diastolic AP (DAP) were evaluated in all groups. Results: 99 animals showed sinus rhythm, among which one female from G2 and one from G4 exhibited left fascicles anterior block; a female from G3 had sinus arrhythmia and one female from G2 evidenced 3 premature ventricular complexes. The presence of a unique and positive P wave, a QRS complex of the QR type and a biphasic T wave, were the most common in all groups. A significant decrease in the cardiac axis was observed in G1 when compared to the other groups. The G1 group showed a significant increase in heart rate, SAP, MAP and DAP values. Conclusions: Taking into account the environmental conditions and how the investigation was developed, it is possible to conclude that creole horses from the Bogotá Savannah differ in their cardiovascular parameters in relation to age.

RESUMEN Antecedentes: Los parámetros cardiovasculares en los caballos pueden variar entre razas y etapas fisiológicas, lo que dificulta la evaluación cardiaca. Objetivo: Estandarizar parámetros electrocardiográficos (ECG) y de presión arterial (PA) en caballos criollos de la Sabana de Bogotá. Métodos: Fueron estudiados 100 caballos entre machos y hembras divididos en cuatro grupos de acuerdo con su edad (n=25): grupo 1 (G1), entre 6 meses y 1 año de edad; grupo 2 (G2), entre 1 y 4 años; grupo 3 (G3), entre 4 y 10 años, y grupo 4 (G4), mayores de 10 años. Se evaluaron derivaciones bipolares, unipolares y precordiales en ECG, así como en PA Sistólica (PAS), PA Media (PAM), y PA Diastólica (PAD) en todos los grupos. Resultados: 99 animales mostraron ritmo sinusal, entre los cuales se observó bloqueo anterior del fascículo izquierdo en una hembra del G2 y en una del G4; a su vez, una hembra del G3 presentó arritmia sinusal y en una del G2 se evidenciaron tres complejos ventriculares prematuros. La presencia de una onda P única y positiva, complejo QRS tipo QR y onda T bifásica fueron los más observados en todos los grupos. Una disminución significativa del eje cardiaco se observó en el G1 cuando se comparó con los demás grupos; además, el G1 presentó aumento significativo en valores de frecuencia cardiaca, PAS, PAM y PAD. Conclusiones: Teniendo en cuenta las condiciones del medio y la forma en que la investigación se ejecutó, es posible concluir que los parámetros cardiovasculares de caballos criollos de la Sabana de Bogotá difieren con relación a su edad.

Challenges of hepatitis C treatment in Native Americans in two North Dakota medical facilities.

INTRODUCTION: The prevalence of chronic liver disease (CLD) in the Aboriginal North American population is disproportionately higher than that of the non-indigenous population. Hepatitis C virus (HCV) is the second leading cause of CLD in American Indians or Alaska Natives (AIANs). This study described the experience of two teaching community medical centers in North Dakota in treating HCV infection among AIANs and compared treatment outcomes to a cohort of Caucasian patients. METHODS: The retrospective study described the characteristics and proportion of AIAN patients with HCV who received treatment. Documented reasons for not receiving treatment were analyzed. For those AIAN patients treated for HCV infection, responses to treatment, including rapid, early and sustained virological responses (SVRs), were compared with those of Caucasians. RESULTS: Only 22 (18%) of 124 AIANs with HCV infection received treatment. Common reasons for not receiving treatment include lack of access to specialists, concomitant or decompensated liver disease, alcohol and drug abuse and cost. There were no significant differences in the baseline characteristics and key predictors of SVR in AIANs compared to Caucasian controls. CONCLUSIONS: Most AIAN patients with HCV infection do not receive treatment despite comparable treatment response rates to Caucasians. Further population-based studies, addressing access to specialized hepatitis C treatment and public health concerns are warranted, as it is crucial to treat chronic HCV infection to decrease the burden of disease in the AIAN community.

Asymptomatic carriage of toxigenic Clostridium difficile by hospitalized patients.

Asymptomatic carriage of Clostridium difficile is common in hospitals, but the risk for transmission by carriers is unclear. In this point prevalence culture survey of asymptomatic hospitalized patients, 18 of 149 (12%) were carriers of toxigenic C. difficile. By comparison with C. difficile infection (CDI) patients, the prevalence of skin and/or environmental contamination was significantly lower in asymptomatic carriers (3/18, 17% versus 5/6, 83%; P = 0.007), but carriers outnumbered CDI patients in the hospital by a factor of 3 to 1. These data suggest that asymptomatic carriers have the potential to contribute to C. difficile transmission in hospitals.

Field evaluation of malaria rapid diagnostic tests for the diagnosis of P. falciparum and non-P. falciparum infections.

The objective of this study was to evaluate various malaria rapid diagnostic tests as a tool in the detection of P. falciparum and non-P. falciparum infections in field conditions. Four field surveys were conducted in malaria-endemic areas of Palawan and Davao del Norte, Philippines to validate the various rapid diagnostic tests, namely Diamed OptiMAL 48 (DiaMed AG, Switzerland), ParaHIT f (Span Diagnostics, India), Orchid OptiMAL, and Paracheck Pf (both from Orchid Biomedical Systems, India). The results of the various rapid diagnostic tests were compared to those of microscopy. Sensitivity, specificity and detection rates according to the level of parasitemia were used as parameters to describe the performance of the various rapid diagnostic tests in the field. Practical and operational assessments were also done. The results of the study show that the sensitivity and detection rates were generally lower than previously reported, with sensitivities ranging from 4.8% to 20.6%, except for Diamed OptiMAL 48, which had sensitivities of 78.8% to 96.8%, and detection rates of 50.0% to 96.8%. The rest had detection rates ranging from 0.0% to 50.0%. All the specificities ranged from 18.2% to 100.0%. Improper conditions at the time of manufacturing, storage, transport, and utilization may affect the validity of the results. Rapid diagnostic tests for malaria provide practical means of detecting malarial infections, especially in endemic areas. However, issues regarding variability in performance must to be addressed before they can be used as mainstream diagnostic tools.

Clinical and microbiological changes associated with the use of combined antimicrobial therapies to treat "refractory" periodontitis.

BACKGROUND: The present investigation examined clinical and microbial changes after a combined aggressive antimicrobial therapy in subjects identified as "refractory" to conventional periodontal therapy. METHOD: Fourteen subjects were identified as "refractory" based on full-mouth mean attachment loss and/or >3 sites with attachment loss > or =3 mm following scaling and root planing (SRP), periodontal surgery and systemic antibiotics. After baseline monitoring, subjects received SRP, locally delivered tetracycline at pockets > or =4 mm, systemically administered amoxicillin (500 mg, t.i.d. for 14 days)+metronidazole (250 mg, t.i.d. for 14 days) and professional removal of supragingival plaque weekly for 3 months. Subjects were monitored clinically every 3 months post-therapy for 2 years. Subgingival plaque samples were taken at the same time points from the mesial aspect of each tooth and the levels of 40 subgingival taxa were determined using checkerboard DNA-DNA hybridization. Mean levels of each species were averaged within a subject at each visit. Significance of changes in clinical and microbiological parameters over time were evaluated using the Friedman or Wilcoxon signed ranks test. RESULTS: On average, subjects showed significant improvements in all clinical parameters after therapy. Mean (+/-SEM) full-mouth pocket depth reduction was 0.83+/-0.13 mm and mean attachment level "gain" was 0.44+/-0.12 at 24 months. Clinical improvement was accompanied by major reductions in multiple subgingival species during the first 3 months of active therapy that were maintained for most species to the last monitoring visit. Reductions occurred for three Actinomyces species, "orange complex" species including Campylobacter showae, Eubacterium nodatum, three Fusobacterium nucleatum subspecies, Peptostreptococcus micros, Prevotella intermedia as well as the "Streptococcus milleri" group, Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedus. Subjects differed in their response to therapy; six modest response subjects exhibited less attachment level gain and were characterized by reductions in the microbiota from baseline to 3 months, but re-growth of many species thereafter. CONCLUSIONS: The combined antibacterial therapy was successful in controlling disease progression in 14 "refractory" periodontitis subjects for 2 years.

Treatment of periodontitis by local administration of minocycline microspheres: a controlled trial.

BACKGROUND: Periodontitis is an inflammatory condition of tooth-supporting tissues that is usually treated by mechanical removal of plaque and microorganisms that adhere to teeth. This treatment, known as scaling and root planing, is not optimally effective. Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes such as probing depth reduction. This article reports on the efficacy and safety of locally administered microencapsulated minocycline. METHODS: Seven hundred forty-eight (748) patients with moderate to advanced periodontitis were enrolled in a multi-center trial and randomized to 1 of 3 treatment arms: 1) scaling and root planing (SRP) alone; 2) SRP plus vehicle; or 3) SRP plus minocycline microspheres. The primary outcome measure was probing depth reduction at 9 months. Clinical assessments were performed at baseline and 1, 3, 6, and 9 months. RESULTS: Minocycline microspheres plus scaling and root planing provided substantially more probing depth reduction than either SRP alone or SRP plus vehicle. The difference reached statistical significance after the first month and was maintained throughout the trial. The improved outcome was observed to be independent of patients' smoking status, age, gender, or baseline disease level. There was no difference in the incidence of adverse effects among treatment groups. CONCLUSIONS: Scaling and root planing plus minocycline microspheres is more effective than scaling and root planing alone in reducing probing depths in periodontitis patients.