Staphylococcus aureus Carrier Types are not Evidence of Population Heterogeneity

alexandrossfakianakis shared this article with you from Inoreader Staphylococcus aureus Carrier Types are not Evidence of Population Heterogeneity via American Journal of Epidemiology - Advance Access Abstract Asymptomatic colonization by Staphylococcus aureus is a precursor for infection, so identifying the mode and source of transmission which leads to colonization could help target interventions. Longitudinal studies have shown that some people are persistently colonized for years, while others seem to carry S. aureus for weeks or less, and conventional wisdom attributes this disparity to an underlying risk factor in the persistently colonized. We analyze published data with mathematical models of acquisition and carriage to compare this hypothesis with alternatives. The null model assumes a homogeneous population and still produces highly variable colonization durations (mean of 1.94 years, 5th percentile 0.1 years, 95th percentile 5.8 years). Simulations show that this inherent variability, combined with censoring in longitudinal cohort studies, i s sufficient to produce the appearance of "persistent carriers," "intermittent carriers," and "noncarriers" in data. Our estimates for colonization duration exhibit sensitivity to the assumption that false positives can occur despite being rare, but our model-based approach simultaneously estimates specificity and sensitivity along with epidemiological parameters. Our results show it is plausible that S. aureus colonizes people indiscriminately, and improved understanding of the types of exposures which result in colonization is essential. View on Web

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Cardiovascular outcomes after tixagevimab and cilgavimab use for pre-exposure prophylaxis against COVID-19: a population-based propensity-matched cohort study

alexandrossfakianakis shared this article with you from Inoreader Cardiovascular outcomes after tixagevimab and cilgavimab use for pre-exposure prophylaxis against COVID-19: a population-based propensity-matched cohort study via Clinical Infectious Diseases Advance Access Abstract Tixagevimab and cilgavimab treatment was associated with higher rates of cardiovascular events in a post-hoc analysis of a phase 3 trial. In this large population-based propensity-matched study, we found no increased risk of cardiovascular events up to 90 days after tixagevimab and cilgavimab administration, including in patients with pre-existing cardiovascular disease. View on Web

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Chickenpox and multiple sclerosis: A Mendelian randomization study

alexandrossfakianakis shared this article with you from Inoreader Chickenpox and multiple sclerosis: A Mendelian randomization study via Journal of Medical Virology Abstract Background Observational studies have suggested a suspected association between varicella-zoster virus (VZV) infection and multiple sclerosis (MS), but the connection has remained unclear. The aim of the present study is to evaluate the causal relationship between chickenpox which is caused by VZV infection and MS. Methods We performed a two‑sample Mendelian randomization analysis to investigate the association of chickenpox with MS using summary statistics from genome‑wide association studies (GWAS). The GWAS summary statistics data for chickenpox was from the 23andMe cohort including 107,769 cases and 15,982 controls. A large summary of statistical data from the International Multiple Sclerosis Genetics Consortium (IMSGC) was used as the outcome GWAS data set, including 14,802 MS cases and 26,703 controls. Results We found evidence of a significant association between genetically predicted chickenpox and risk of MS (odds ratio [OR] = 35.27 , 95% confidence interval [CI] = 22.97–54.17, P = 1.46E-59). Conclusions Our findings provided evidence indicating a causal effect of chickenpox on MS. Further elucidations of this association and underlying mechanisms are needed for identifying feasible interventions to promote MS prevention. This article is protected by copyright. All rights reserved. View on Web

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Cervical Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome: Technical Description and Results of Seven Cases

alexandrossfakianakis shared this article with you from Inoreader Cervical Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome: Technical Description and Results of Seven Cases via Pain Practice Abstract Introduction Complex regional pain syndrome (CRPS) is characterized by nociplastic pain with alterations in sympathetic function. Neuromodulation could be a useful alternative therapy option. Dorsal root ganglion (DRG) stimulation has demonstrated better results than conventional spinal cord stimulation (SCS) for patients with CRPS in lower limbs. Methods We report a case series of seven patients treated with cervical DRG stimulation for CRPS of the hand that required neuromodulation for pain relief, after no response with other analgesic techniques (medication and interventional). We report retrospective data collection of seven consecutive patients with a one year follow up. Results Seven patients were trialed, and six were implanted with a permanent pulse generator after achieving more than 50% pain relief during two to seven days of trial phase. The average pain relief (rated on a standard 100 mm visual analog scale) after one year of treatment was 64.3% ± 16.6. No major complications were observed during a one year follow up. Discussion The results for cervical DRG stimulation are similar to other DRG stimulation studies for the treatment of refractory CRPS at lower levels. The cervical DRG implant technique guided with C-arm fluoroscopy and under conscious sedation could be a safe and effective option for relieving pain of the upper limbs CRPS. Monitoring neural status is required for cervical DRG stimulation either with a responder awake patient or with intraoperative neural monitoring in non-responder patients. View on Web

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Correlation between asparaginase enzyme activity levels and coagulation parameters during childhood acute lymphoblastic leukemia treatment

alexandrossfakianakis shared this article with you from Inoreader Correlation between asparaginase enzyme activity levels and coagulation parameters during childhood acute lymphoblastic leukemia treatment via Pediatric Blood & Cancer Abstract Thromboembolism is a serious toxicity in the treatment of acute lymphoblastic leukemia (ALL), but little is known about the correlation between asparaginase enzyme activity (ASA) levels and coagulation parameters. We included 65 non-high risk ALL patients, aged 1–17 years. Coagulation parameters and corresponding ASA levels were measured during asparaginase treatment. We found ASA to be negatively correlated with antithrombin and fibrinogen up to ASA levels of 250 IU/L, after which these parameters reached a plateau and did not decrease further with further increase of ASA. Patients with silent inactivation of asparaginase had normal coagulation parameters. View on Web

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Approach to Lymphedema Management

alexandrossfakianakis shared this article with you from Inoreader Approach to Lymphedema Management via Seminars in Plastic Surgery Semin Plast Surg DOI: 10.1055/s-0042-1758691 Millions of people worldwide suffer from lymphedema. In developed nations, lymphedema most commonly stems secondarily from oncologic treatment, but may also result from trauma. More recently, lymphedema has been identified in patients after gender-affirmation phalloplasty reconstruction. Regardless of the etiology, the underlying pathophysiology involves blockage of lymphatic flow, resulting in lymph stasis, thus triggering a casca de of inflammation culminating in fibrosis and adipose deposition. Recent technical advances led to the refinement of physiologic and reductive surgeries—including lymphovenous anastomosis and free functional lymphatic transfer, which collectively encompass a variety of flap procedures including lymph node transfer, lymph channel transfer, and lymphatic system transfer. This article provides a summary of our approach in the assessment and management of the lymphedema patient, including detailed intraoperative photography and imaging, in addition to advanced technical considerations in physiologic reconstruction. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on Web

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Black and White Patients with Staphylococcus aureus Bacteremia have Similar Outcomes but Different Risk Factors

alexandrossfakianakis shared this article with you from Inoreader Black and White Patients with Staphylococcus aureus Bacteremia have Similar Outcomes but Different Risk Factors via Clinical Infectious Diseases Advance Access Abstract BACKGROUND Staphylococcus aureus bacteremia (SAB) disproportionately affects Black patients. The reasons for this disparity are unclear. METHODS We evaluated a prospectively ascertained cohort of patients with SAB from 1995 to 2020. Clinical characteristics, bacterial genotypes, and outcome were compared among Black and White patients with SAB. Multivariable logistic regression models were used to determine factor s independently associated with the outcomes. RESULTS Among 3068 patients with SAB, 1107 (36%) were Black. Black patients were younger (Median: 56 years vs. 63 years; p < 0.001), had higher rates of diabetes (47.5% vs. 34.5%; p < 0.001), hemodialysis dependence (40.0% vs. 7.3%; p < 0.001), and HIV (6.4% vs. 0.6%; p < 0.001). Black patients had higher rates of methicillin-resistant S. aureus (49.3% vs 44.9%; p = 0.020), including the USA300 hypervirulent clone (11.5% vs. 8.4%; p = 0.007). White patients had higher rates of corticosteroid use (22.4% vs. 15.8%; p < 0.0001), and surgery in the preceding 30 days (28.1% vs. 18.7%; p < 0.001). Although median Acute Physiology Score (APS) at the time of initial SAB diagnosis was significantly higher in Black patients (Median APS 9, Interquartile Range [IQR] 5-14; vs. Median APS 7, IQR: 4-12; p < 0.001), race was not associated with 90-d ay mortality (risk ratio (RR): 1.02; 95% CI: 0.93–1.12, and rates of metastatic infection were lower among Black patients (37.2% vs. 41.3% White; p = 0.029). CONCLUSIONS Despite differences in Black patients' higher APS on presentation and more risk factors, including a 5 times higher risk of hemodialysis dependence, 90-day mortality among Black and White patients with SAB was similar. View on Web

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