Showing papers by "Detroit Receiving Hospital published in 2008"
TL;DR: In this study of patients with symptomatic HF and anemia, treatment with darbepoetin alfa was not associated with significant clinical benefits and a nonsignificant trend was observed toward a lower risk of all-cause mortality or first HF hospitalization in darb EpiAlfa–treated patients compared with placebo.
Abstract: Background— Substantial evidence suggests that anemia is an independent risk factor for worse outcomes in patients with heart failure (HF). The Study of Anemia in Heart Failure Trial (STAMINA-HeFT) is the largest multicenter, randomized, double-blind, placebo-controlled trial to date evaluating the effect of treating anemia in HF. Methods and Results— Patients (N=319) with symptomatic HF, left ventricular ejection fraction ≤40%, and hemoglobin ≥9.0 g/dL and ≤12.5 g/dL were randomized (double-blind) to placebo (N=157) or darbepoetin alfa (N=162) subcutaneously every 2 weeks for 1 year (target hemoglobin, 14.0±1.0 g/dL). The primary end point was change from baseline to week 27 in treadmill exercise time. Secondary end points were change from baseline in New York Heart Association class and quality of life at week 27. An additional prespecified efficacy analysis included the time to death by any cause or first HF-related hospitalization by 1 year. At baseline, the median (interquartile range) hemoglobin was...
279 citations
TL;DR: The percentage of hVISA-positive strains appeared to increase as a function of the vancomycin MIC, and surveillance of h VISA strains is warranted based on the association of vancomYcin treatment failure in patients with hVisa.
Abstract: We screened for heteroresistant, vancomycin-intermediate Staphylococcus aureus (hVISA) among clinical isolates of methicillin-resistant S. aureus collected from three hospitals (two urban teaching hospitals and one community hospital) in the Detroit metropolitan area over a 22-year period. The Macro Etest method was used to screen all available isolates. Confirmation of hVISA-positive screens were confirmed by population-area under the concentration-time curve (AUC) analysis. A total of 1,499 isolates revealed hVISA/VISA rates of 2.2/0.4% (n = 225; 1986 to 1993), 7.6/2.3% (n = 356; 1994 to 2002), and 8.3/0.3% (n = 917; 2003 to 2007). Population-AUC analysis confirmed 92.6% of the hVISA-positive strains determined by the Macro Etest method. For the isolates with known sources (1,208), the predominant source of hVISA was blood (60%), followed by lung (21%), skin and wound infections (14%), abscess (1%), and other (4%). The percentage of hVISA-positive strains appeared to increase as a function of the vancomycin MIC. Staphylococcal cassette chromosome mec (SCCmec) typing revealed that the majority (56.9%) of the hVISA strains were SCCmec type II and 39.4% were type IV; the majority of these strains were collected from 2000 to 2007. Our data indicate that the prevalence of hVISA may be increasing. Based on the association of vancomycin treatment failure in patients with hVISA, surveillance of hVISA strains is warranted.
147 citations
TL;DR: The results suggest that high-dose daptomycin therapy and combination therapy may be reasonable treatment options for susceptible isolates; however, more investigations are needed to confirm the variability of these regimens with nonsusceptible isolates.
Abstract: The need to investigate novel dosing regimens and combinations is essential in combating poor treatment outcomes for Staphylococcus aureus bacteremia and endocarditis. We evaluated the impact of simulated standard- and high-dose daptomycin in combination with gentamicin or rifampin against daptomycin-susceptible and nonsusceptible matched strains of S. aureus. These strains were collected from the daptomycin bacteremia and endocarditis clinical trial and consisted of three susceptible strains (MIC, 0.25 mg/liter) and four nonsusceptible isolates (MICs, 2 to 4 mg/liter). Daptomycin regimens of 6 and 10 mg/kg of body weight daily alone and in combination with gentamicin at 5 mg/kg daily or rifampin at 300 mg every 8 h were evaluated using an in vitro model with simulated endocardial vegetations over 96 h. Rapid bactericidal activity, identified by time to 99.9% kill, was displayed in all regimens with the daptomycin-susceptible strains. Concentration-dependent activity was noted by more-rapid killing with the 10-mg/kg/day dose. The addition of gentamicin improved activity in the majority of susceptible isolates. Daptomycin 6-mg/kg/day monotherapy displayed bactericidal activity for only one of the nonsusceptible isolates and for only two isolates with increased doses of 10 mg/kg/day. Combination regimens demonstrated improvement with some but not all nonsusceptible isolates. Three isolates developed a reduction in daptomycin susceptibility with 6-mg/kg/day monotherapy, but this was suppressed with both combination therapy and high-dose daptomycin. These results suggest that high-dose daptomycin therapy and combination therapy may be reasonable treatment options for susceptible isolates; however, more investigations are needed to confirm the variability of these regimens with nonsusceptible isolates.
96 citations
TL;DR: It is suggested that reduced daptomycin susceptibility can be a strain-specific and unstable event and further evaluation of the susceptibility relationship between d aptomycin and vancomycin is necessary to understand the factors involved and their clinical significance.
Abstract: Recently, the emergence of reduced susceptibility to daptomycin has been linked to the reduced vancomycin susceptibility that occurs after vancomycin exposure in Staphylococcus aureus in vivo and in vitro. This study evaluated this propensity in clinical isolates of S. aureus using an in vitro pharmacokinetic/pharmacodynamic model with simulated endocardial vegetations over 8 days. Five clinical isolates (four methicillin-resistant S. aureus isolates and one methicillin-susceptible S. aureus [MSSA] isolate), all of which were reported to have become nonsusceptible to daptomycin, were evaluated. The following regimens were evaluated: vancomycin 1 g every 12 h for 4 days followed by daptomycin 6 mg/kg of body weight daily for 4 days and daptomycin 6 mg/kg daily for 8 days. If nonsusceptibility was detected, the following regimens were evaluated: no treatment for 4 days followed by daptomycin 6 mg/kg daily for 4 days, vancomycin 1 g every 12 h for 4 days followed by daptomycin 10 mg/kg daily for 4 days, and daptomycin 10 mg/kg daily for 8 days. The emergence of daptomycin nonsusceptibility (12- to 16-fold MIC increase) was detected only with the MSSA isolate with daptomycin 6 mg/kg daily for 4 days after vancomycin exposure. However, the bactericidal activity of daptomycin was maintained and the MIC increases of these isolates, which had no mprF or yycG mutations, were unstable to serial passage on antibiotic-free agar. Subsequent regimens did not demonstrate nonsusceptibility to daptomycin. These findings suggest that reduced daptomycin susceptibility can be a strain-specific and unstable event. Further evaluation of the susceptibility relationship between daptomycin and vancomycin is necessary to understand the factors involved and their clinical significance.
87 citations
TL;DR: Low-income African American patients have experienced unequal and discriminatory treatment, which can result in a cultural mistrust of providers; yet, providers in this study were able to engender high trust and satisfaction among these respondents, suggesting the high levels of trust in the NMC may offer a promising solution to the health disparities of African Americans.
Abstract: PURPOSE: To examine correlates of low-income African Americans' level of trust in healthcare providers. Specific aims were to (a) describe the levels and correlations of trust, mistrust, and satisfaction; (b) compare trust scores by provider type (nurse practitioner [NP] and medical doctor) and clinic type (nurse-managed clinic [NMC] and joint-managed clinic [JMC]); and (c) examine the relationship of patient and provider demographic factors (e.g., race concordance) with trust in the provider.
DATA SOURCES: This descriptive cross-sectional study was conducted with 145 low-income African Americans (51% women, 49% men; mean age = 49.4 years). All participants were enrolled in a larger study that examined the effect of psychosocial variables on hypertension outcomes. Participants completed three questionnaires: Trust in Provider Scale, Cultural Mistrust Inventory, and the Michigan Academic Consortium Patient Satisfaction tool. Chart audits were performed to collect clinical data.
CONCLUSIONS: Trust and satisfaction were moderately high, M = 3.9 (0.56), M = 4.1 (0.57), respectively, on the 5-point scales, and cultural mistrust was in the moderate range, M = 3.9 (0.79), on a 7-point scale. No significant differences in mistrust, t(142) =-1.43, p = .155, or satisfaction, t(142) = 0.716, p = .475, were noted by provider type. Trust was significantly higher for patients seen by NPs, t(142) = 2.57, p = .011. Additionally, patients seen in the NMC reported significantly higher levels of trust than those seen in the JMC, t(143) = 3.62, p < .001. Race concordance between provider and patient did not change these findings.
IMPLICATIONS FOR PRACTICE: Low-income African American patients have experienced unequal and discriminatory treatment, which can result in a cultural mistrust of providers; yet, providers in this study were able to engender high trust and satisfaction among these respondents. Still, the sociocultural effects of race concordance require further exploration to better understand the impact on trust in the patient-provider relationship. Finally, the high levels of trust in the NMC may offer a promising solution to the health disparities of African Americans; yet, more research is needed.
55 citations
TL;DR: The use of combined techniques, including surgical unburying, scrotoplasty, escutcheonectomy, and split-thickness skin grafts fixed with dilute fibrin glue, appears to be a useful approach to repair this unique condition.
55 citations
TL;DR: In time-kill analysis, ceftobiprole was bactericidal at all concentrations tested and potential for synergy with tobramycin was found.
Abstract: We evaluated the activity of ceftobiprole against 100 community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and 100 hospital-associated MRSA (HA-MRSA) isolates. Eight isolates were evaluated by time-kill studies for kill rate and potential for synergy with tobramycin. Ceftobiprole MIC50 and MIC90 values were 1 and 2 g/ml, respectively, against CA-MRSA and HA-MRSA. In time-kill analysis, ceftobiprole was bactericidal at all concentrations tested.
53 citations
TL;DR: Telavancin appears to be a promising agent for the treatment of serious infections caused by gram‐positive pathogens, including drug‐resistant pathogens, according to phase II and III studies for complicated skin and skin structure infections.
Abstract: Telavancin is a once-daily lipoglycopeptide antibiotic structurally derived from vancomycin. It has broad-spectrum activity against gram-positive bacteria, including strains with reduced susceptibility to vancomycin. Telavancin's multifunctional mechanism of action, including inhibition of peptidoglycan synthesis and disruption of membrane potential, account for this enhanced activity as well as rapid bactericidal properties. In vitro activity has been demonstrated against a wide range of gram-positive pathogens such as multidrug-resistant Streptococcus pneumoniae, as well as methicillin-resistant, glycopeptide-intermediate, and vancomycin-resistant Staphylococcus aureus. The agent also displays activity against many gram-positive anaerobic organisms. Predictable linear pharmacokinetics have been demonstrated over a wide range of doses, with the most common adverse effects being taste disturbance and nausea. Clinical experience with telavancin in phase II and III studies for complicated skin and skin structure infections has shown it to have similar efficacy and tolerability compared with vancomycin and antistaphylococcal penicillins, and recently telavancin received an approvable letter from the United States Food and Drug Administration for this indication. Telavancin appears to be a promising agent for the treatment of serious infections caused by gram-positive pathogens, including drug-resistant pathogens. Further clinical experience will clarify its role in therapy.
51 citations
TL;DR: The use of restraints and hyperthermia is associated with increased odds of death for patients with DT, and this study highlights the need for further research into modifiable factors influencing mortality from DT.
Abstract: Objectives: The objectives were to identify factors that may help predict mortality for patients with delirium tremens (DT).
Methods: The authors conducted a 1:1 gender- and age-matched case–control study of patients hospitalized for DT. Using McNemar chi-square tests and conditional logistic regression (CLR), risk factors for death, including demographics, location of diagnosis, vital sign derangements, treatment methods, and comorbid conditions, were evaluated. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.
Results: Thirty-five patients with DT died between January 2000 and June 2006. The majority (31; 88.6%) were male with a mean (±standard deviation [SD]) age of 51.7 (±7.6) years. Hyperthermia in the first 24 hours of DT diagnosis (OR = 10.0, 95% CI = 2.3 to 42.7), persistent tachycardia (OR = 24.0, 95% CI = 3.3 to 177.4), and use of restraints (OR = 7.50, 95% CI = 1.7 to 32.8) were associated with increased mortality by univariate analysis, while an emergency department (ED) diagnosis of DT (OR = 0.18, 95% CI = 0.05 to 0.6) and use of clonidine (OR = 0.10, 95% CI = 0.01 to 0.78) were associated with decreased mortality. In the CLR model, restraint use and hyperthermia were the only variables that remained significant (OR = 5.8, 95% CI = 1.0 to 32.2; and OR = 6.1, 95% CI = 1.2 to 30.4, respectively).
Conclusions: The use of restraints and hyperthermia is associated with increased odds of death for patients with DT. This study highlights the need for further research into modifiable factors influencing mortality from DT.
50 citations
TL;DR: Urethral dilation is still common despite the fact that true female urethral stricture is an uncommon entity, likely secondary to the persistence of the mostly discarded practice of dilating the unstricturedFemale urethra for a wide variety of complaints despite the lack of data suggesting that it improves lower urinary tract symptoms.
48 citations
TL;DR: The extent of protein binding was lower than expected, particularly for daptomycin and telavancin, which suggests these drugs may be more active than predicted based on unbound drug concentrations alone.
TL;DR: Overall, daptomycin achieved rapid and effective kill against both MRSA and hVISA while vancomycin displayed slow and minimal kill againstMRSA and minimal-to-no activity againsthVISA, regardless of high dose exposure.
Abstract: Objectives: Glycopeptides have historically been the drugs of choice for the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, the continued selective pressure has led to the emergence of non-susceptible strains including heterogeneously vancomycin-intermediate S. aureus (hVISA). Infections with hVISA have been associated with poor outcomes including vancomycin treatment failures. The objective of this study was to evaluate vancomycin and daptomycin against vancomycin-susceptible MRSA and hVISA in a pharmacokinetic/pharmacodynamic (PK/PD) model with simulated endocardial vegetations. Methods: Six clinical isolates obtained from patients at the Detroit Medical Center were used: MRSA 494, MRSA 67, hVISA R1720, hVISS R2295, hVISA R3640 and hVISA R1629. All heteroresistant strains were confirmed by a population analysis profile ratio, with Mu3 as a control strain. Vancomycin regimens of 1 g every 12 h and 2 g every 12 h and daptomycin regimens of 6, 10 and 12 mg/kg daily were utilized in a PK/PD model over 72 h. Results: Against MRSA isolates, vancomycin displayed minimal activity and minimal-to-no activity against hVISA. In general, the use of high dose vancomycin over standard dose vancomycin did not improve activity except against one of six isolates (MRSA 494). Daptomycin was bactericidal against both MRSA and hVISA isolates, although the rate of kill was slower against hVISA. Conclusions: Overall, daptomycin achieved rapid and effective kill against both MRSA and hVISA while vancomycin displayed slow and minimal kill against MRSA and minimal-to-no activity against hVISA, regardless of high dose exposure.
TL;DR: Although it is primarily used for dermatophyte infections, terbinafine has broad in vitro activity against a variety of non-dermatophyte fungal pathogens, including Candida spp.
Abstract: Terbinafine is the only systemic allylamine antifungal currently available. Its mechanism of action is unique and sets it apart from other agents. Although it is primarily used for dermatophyte infections, such as onychomycosis and tinea pedis, terbinafine has broad in vitro activity against a variety of non-dermatophyte fungal pathogens, including Candida spp. and many molds. In addition, synergistic activity is noted with other antifungals, notably triazoles. Multiple case reports exist of its use for unusual and refractory fungal infections, but no systematic review is available. We review the current literature with regard to in vitro data and clinical experience with terbinafine in the treatment of rare and refractory mycoses.
TL;DR: Gingival fibromatosis, a rare but often familial condition, is described in two siblings, associated with mental retardation, epilepsy and hypertrichosis, and in one child a maxillary giant‐cell tumour was found and excised.
Abstract: SUMMARY
Gingival fibromatosis, a rare but often familial condition, is described in two siblings, associated with mental retardation, epilepsy and hypertrichosis. In one child a maxillary giant-cell tumour was found and excised. It is important to distinguish idiopathic gingival fibromatosis from phenytoin-induced gingival hypertrophy.
RESUME
Fibromatose gingivale familiale idiopathique associee a un retard mental, une epilepsie et une hypertrichose La fibromatose gingivale, une affection rare et souvent familiale, est decrite chez deux enfants de meme fratrie, en association avec un retard mental, une epilepsie et une hypertrichose. Chez l'un des enfants, une tumeur maxillaire a cellules geantcs fut depistee et excisee. II est important de distinguer la fibromatose gingivale idiopathique de l'hypertrophie gingivale liee au traitement par phenytoine.
ZUSAMMENFASSUNG
Idiopathische, familiare Gingivafibromatose mit geistiger Retardierung, Epilepsie und Hypertrichose Die Gingivafibromatose, eine seltene, aber haufig familiar auftretende Erkrankung, wird bei zwei Geschwistern in Verbindung mit geistiger Retardierung, Epilepsie und Hypertrichose beschrieben. Bei einem Kind wurde ein maxillarer Riesenzelltumor gefunden und exzidiert. Es ist wichtig, die idiopathische Gingivafibromatose von der Phenytoin bedingten Gingivahypertrophie zu unterscheiden.
RESUMEN
Fibromatosis gingival familiar idiopdtica asociada a retraso mental, epilepsia e hipertricosis Se describe en dos ninos una gingivitis fibromatosa, alteracion rara pero a menudo familiar, asociada a retraso mental, epilepsia e hipertricosis. En un nino se hallo y extirpo un tumor maxilar de celulas gigantes. Es importante distinguir la fibromatosis gingival idiopatica de la hipertrofia gingival debida a la fenitoina.
TL;DR: Patients undergoing hypospadias surgery should receive lifelong follow-up protocol to detect latent urethral strictures, and may eventually require salvage treatment such as a perineal urethrostomy.
Abstract: Background. Adult patients with urethral stricture after childhood hypospadias surgeries are infrequently discussed in the literature. We report our experience in treating such patients. Materials and Methods. A retrospective chart review was performed. From 2002 through 2007, nine consecutive adult patients who had current urethral stricture and had undergone childhood hypospadias surgeries were included. All adult urethral strictures were managed by a single surgeon. Results. Mean patient age was 38.9 years old. The lag time of urethral stricture presentation ranged from 25 to 57 years after primary hypospadias surgery, with an average of 36 years. Stricture length ranged from 1 to 17 cm (mean: 10.3 cm). Open graft-based urethroplasties were performed in 4/9 cases. Salvage perineal urethrostomy was performed in 2/9 cases. Another 3 cases chose to undergo repeat urethrotomy or dilatations—none of these patients was cured by such treatment. Complications included one urethrostomy stenosis and one urinary tract infection. Conclusion. Urethral stricture may occur decades after initial hypospadias surgery. It can be the most severe form of anterior urethral stricture, and may eventually require salvage treatment such as a perineal urethrostomy. Patients undergoing hypospadias surgery should receive lifelong follow-up protocol to detect latent urethral strictures.
TL;DR: The American Burn Association, in conjunction with the American College of Chest Physicians, should address this issue and develop guidelines for physicians who order home oxygen therapy and for state departments of public health who should regulate the companies that deliver home oxygen.
Abstract: Patients who continue to smoke while on home oxygen therapy endanger themselves, family members, neighbors, and firefighters and create an expense to society for their medical care. This phenomenon was studied in our burn center. Fourteen patients were identified prospectively during the last 2 years. All were smoking while on nasal oxygen. The 14 patients (10 males) were 45 to 87 years of age. All suffered facial burns. Only one patient had a significant burn (30% TBSA, 20% 3rd degree), but all suffered from an exacerbation of chronic obstructive pulmonary disease. Two patients gave a history of stage IV lung cancer and four patients had newly found squamous cell cancer seen on bronchoscopy. All six patients with lung cancer and one with severe chronic obstructive pulmonary disease died. Of the seven survivors, only one patient quit smoking. Total charges were $2,861,526 and total costs were $938,311. All patients had Medicare or Medicaid on admission. Hospital loss ($432,561) was incurred in those patients admitted more than 4 days whereas a profit ($33,285) was realized in patients admitted less than 4 days. These deaths and financial loss could be reduced by better testing and more precise guidelines as to which patients can safely receive home oxygen. Patients can have their saliva tested for the nicotine breakdown product of cotinine; the test takes 10 minutes. The American Burn Association, in conjunction with the American College of Chest Physicians, should address this issue and develop guidelines for physicians who order home oxygen therapy and for state departments of public health who should regulate the companies that deliver home oxygen.
TL;DR: It is concluded that collagen-blended chitosan nerve guides enhanced motor and sensory nerve recovery assayed through gait and behavioral testing compared to unblended nerve guides.
Abstract: The objective of this work was to use a functional gait analysis technique to evaluate sciatic nerve repair through tissue-engineered nerve guides in a rodent animal model. The nerve guides were fabricated by blending collagen with chitosan material and evaluated over a 12-week period for motor and sensory nerve recovery assessed by gait analysis and behavioral testing. Gastrocnemius muscle weight measurements were obtained at the end of each experimental time point and correlated to motor nerve recovery. Functional gait analysis studied both the stance and swing phase angle formations during a normal gait cycle. During the stance phase, functional results revealed that blended nerve guides promoted increased motor nerve recovery than unblended chitosan nerve guides. Similar results were obtained from behavioral tests, indicating that blended nerve guides created increased sensitivity to applied stimulus compared to unblended nerve guides. Muscle strength also correlated with functional recovery and was s...
TL;DR: Agr function did not determine teicoplanin resistance proclivity and is consistent with the previously described higher mutation rate in S. aureus to teicountin.
Abstract: Objectives: The accessory gene regulator (agr) has been identified as playing a role in the expression of reduced glycopeptide susceptibility in Staphylococcus aureus. Previous studies indicate that strains with agr dysfunctional group II polymorphism have a higher propensity for reduced vancomycin activity. We investigated this relationship in agr groups I‐IV using another glycopeptide, teicoplanin, in an in vitro pharmacodynamic model. Methods: Teicoplanin doses ranging from 1.88 to 30 mg/kg daily (fAUC/MIC 26.1‐380.7) were simulated and evaluated for activity and the development of reduced susceptibility over 72 h.
TL;DR: This study shows that sIgA downregulates the measured determinants of neutrophil inflammatory potential, which is the principal defense against potential pathogens at mucosal surfaces.
Abstract: Background: Gut ischemia may prime neutrophils to produce an exaggerated inflammatory response when challenged with bacterial pathogens. Secretory immunoglobulin A (sIgA) is the first line of defense against potential pathogens, but may also exert its anti-inflammatory effects on potentially destructive neutrophil functions. We hypothesized that sIgA would blunt the gut-mediated priming events that lead to neutrophil hypersensitivity to bacterial challenge. Methods: Confluent Caco 2 cell monolayers were grown in a two-chamber culture system under normoxic or hypoxic conditions for 90 minutes followed by a 90-minute reoxygenation period. sIgA was placed in apical chamber media in experimental groups before reoxygenation period. Supernatants were then collected and incubated with neutrophils. Lipopolysaccharide was then used to activate neutrophils. Measurements of CDllb expression, elastase and superoxide anion production, and chemotaxis were undertaken. Results: Polymorphonuclear neutrophils (PMNs) treated with Caco 2 cells undergoing hypox-reoxygenation followed by activation with lipopolysaccharide show a dramatic increase in inflammatory potential when compared with naive neutrophils (n = 4, *p < 0.001). The addition of sIgA in this same group before the activation step showed a blunting of the inflammatory response, but never to the level of naive PMN. Conclusions: sIgA is the principal defense against potential pathogens at mucosal surfaces. Additional protective activity may be found in its ability to downregulate gut-mediated neutrophil priming. Although more work needs to be performed examining the role of sIgA in the pathogenesis of sepsis, this study shows that sIgA downregulates the measured determinants of neutrophil inflammatory potential.
TL;DR: Pantoprazole is not being prescribed appropriately for stress ulcer prophylaxis in the patient population, and even in patients appropriately receiving pantoprazoles the majority were prescribed an incorrect dose.
Abstract: Background
In recent years there has been a rapid increase in the use of proton pump inhibitors. Our institution has recently had several shortages of IV pantoprazole, each lasting 7–10 days. The purpose of our study was to evaluate in-patient usage of IV pantoprazole. We hypothesized that hospitalized patients with upper gastrointestinal bleeding (GIB) or risk for stress ulcers inappropriately received IV pantoprazole based on current literature.