23 research outputs found
Emerg Infect Dis
No full textAlthough Lyme disease has been endemic to parts of the Lower Hudson Valley of New York, United States, for >2 decades, babesiosis has emerged there only since 2001. The number of Lower Hudson Valley residents in whom babesiosis was diagnosed increased 20-fold, from 6 to 119 cases per year during 2001-2008, compared with an 481.6-fold increase for the rest of New York. During 2002-2009, a total of 19 patients with babesiosis were hospitalized on 22 occasions at the regional tertiary care center. Concurrent conditions included advanced age, malignancies, splenectomy, and AIDS. Two patients acquired the infection from blood transfusions and 1 from perinatal exposure, rather than from a tick bite. One patient died. Clinicians should consider babesiosis in persons with fever and hemolytic anemia who have had tick exposure or have received blood products
Supporting_Information_File.xlsx
No full textData on plasma TMAO and outcomes of baseline fasting plasma glucose, HOMA-IR, visit 2 fasting plasma glucose and Hba1
ENDOSCOPIC ULTRASOUND IN THE MANAGEMENT OF PEDIATRIC PATIENTS WITH SUSPECTED CHOLEDOCHOLITHIASIS
No full textBackground: Gallbladder disease in the pediatric population has been steadily increasing in the U.S. The management of choledocholithiasis is Endoscopic Retrograde Cholangiopancreatography (ERCP) which might necessitate a laparoscopic cholecystectomy for stones in the gallbladder. However, ERCP is associated with the risk of post ERCP pancreatitis. Endoscopic Ultrasound (EUS) is a minimally invasive procedure, yielding high-quality images of the digestive and biliary tract. With regards to gallstones, EUS can detect stones lodged in the biliary tract, all the way to the duodenal papilla. However, limited literature exists on the use of EUS in children with suspected choledocholithiasis with no studies exploring the number of ERCP that were averted. Aim: The primary aim of this project is to evaluate the safety and clinical outcomes of EUS in pediatric patients with suspected choledocholithiasis. The secondary aim of this project is to evaluate how many ERCP procedures were averted by performing an EUS. Methods: The data for this project was obtained from an IRB-approved registry among pediatric patients in whom EUS was indicated and pediatric gastroenterology consultation was sought. Results: A total of 67 EUS procedures were performed on pediatric patients presenting with suspected choledocholithiasis over 1.5 years by a stand-alone pediatric gastroenterologist trained in EUS. There were a total of 9 ERCPs (13.4%) that were averted by doing a EUS. The most common symptoms reported were abdominal pain, vomiting. Six patients had a past medical history of sickle cell disease. Five patients presented with persisting abdominal pain post cholecystectomy which warranted further exploration with EUS and ERCP for evaluation of stone in the common bile duct. 32(47.8%) had a BMI- Obese (≥95 percentile),11 of 63 patients experienced symptoms along with elevated lipase levels suggestive of gallstone pancreatitis. A direct bilirubin of 0.8 mg/dl or more and a common bile duct diameter (CBD) of 6.6 mm or more has a greater probability of stone in the CBD. Prior to EUS, imaging for suspected choledocholithiasis included USG abdomen and magnetic resonance cholangiopancreatography performed in 50 and 19 patients respectively. Of the 19 patients who underwent MRCP, 5 (26.3 %) had findings that were not concordant with EUS. No complications were reported following EUS. Firth’s logistic regression was employed to determine any significant differences between the ERCP averted group and the group that underwent ERCP following EUS. No significant differences were observed between the two groups. Discussion & Conclusion: This preliminary data demonstrates that EUS can be safely performed in pediatric patients with symptoms suggestive of choledocholithiasis to visualize the biliary tract and assess the need for ERCP
Plasma Trimethylamine-N-oxide and impaired glucose regulation: Results from The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS)
No full textA Collaborative Approach Intended to Reduce the Duration of Short Term Urinary Catheters in Adult Patients at a Tertiary Care Medical Center Also Significantly Reduced the Duration of Hospitalization
No full textBACKGROUND: Urinary tract infections are the leading cause of nosocomial infections in the United States. The major contributing factor is the placement of indwelling urinary catheters. METHODS: Following a chart review of adult patients hospitalized at a tertiary care medical center who required the use of a short-term (≤ 2 weeks) indwelling urinary catheter, a collaborative effort was initiated by an Infectious Diseases physician to develop protocols focused on the clinical service involved for the expeditious removal of short-term indwelling urinary catheters. The protocols relied in part on the standards of practice by pertinent medical/surgical subspecialty societies. Usage of urinary catheters and duration of hospitalization following implementation of the protocols was assessed. RESULTS: Based on a multivariate analysis controlling for demographic variables, comorbidities, medical vs surgical service, and indication for the urinary catheterization, the median duration of catheterization was significantly reduced from 6.7 days to 3.6 days after the protocols were initiated (P \u3c .001), and the median duration of hospitalization was significantly reduced from 9.5 days to 5.9 days (P \u3c .001). No patient had to have the urinary catheter reinserted. CONCLUSIONS: Development of collaborative protocols for the removal of short-term indwelling urinary catheters significantly reduced both the duration of catheterization and the duration of hospitalization
Plasma Trimethylamine-N-oxide and impaired glucose regulation: Results from The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS)
No full textTrimethylamine-N-oxide (TMAO)–a gut-microbiota metabolite–is a biomarker of cardiometabolic risk. No studies have investigated TMAO as an early biomarker of longitudinal glucose increase or prevalent impaired glucose regulation. In a longitudinal cohort study, 300 diabetes-free men and women (77%) aged 20–55 years (mean = 34±10) were enrolled at baseline and re-examined at 2-years to investigate the association between TMAO and biomarkers of diabetes risk. Plasma TMAO was measured using Ultra Performance Liquid Chromatography-Mass Spectrometry. After an overnight fast, FPG was measured longitudinally, HbA1C and insulin were measured only at baseline. Insulin resistance was defined using HOMA-IR. Multivariable generalized linear models regressed; i) FPG change (year 2 minus baseline) on baseline TMAO tertiles; and ii) HOMA-IR and HbA1c on TMAO tertiles. Multivariable relative risk regressions modeled prevalent prediabetes across TMAO tertiles. Mean values of 2-year longitudinal FPG±SE across tertiles of TMAO were 86.6±0.9, 86.7±0.9, 86.4±0.9 (p = 0.98). Trends were null for FPG, HbA1c, HOMA-IR, cross-sectionally. The prevalence ratio of prediabetes among participants in 2nd and 3rd TMAO tertiles (vs. the 1st) were 1.94 [95%CI 1.09–3.48] and 1.41 [95%CI: 0.76–2.61]. TMAO levels are associated with increased prevalence of prediabetes in a nonlinear fashion but not with insulin resistance or longitudinal FPG change.</div
Babesiosis in Lower Hudson Valley, New York, USA
No full textAlthough Lyme disease has been endemic to parts of the Lower Hudson Valley of New York, United States, for >2 decades, babesiosis has emerged there only since 2001. The number of Lower Hudson Valley residents in whom babesiosis was diagnosed increased 20-fold, from 6 to 119 cases per year during 2001–2008, compared with an ≈1.6-fold increase for the rest of New York. During 2002–2009, a total of 19 patients with babesiosis were hospitalized on 22 occasions at the regional tertiary care center. Concurrent conditions included advanced age, malignancies, splenectomy, and AIDS. Two patients acquired the infection from blood transfusions and 1 from perinatal exposure, rather than from a tick bite. One patient died. Clinicians should consider babesiosis in persons with fever and hemolytic anemia who have had tick exposure or have received blood products
Interaction between membrane and protein properties on flux decline during sterile microfiltration
No full textDepartment Head: Stuart A. Tobet.Includes bibliographical references (pages 63-66).Microfiltration is widely used in industry to filter out particulate matter that contaminates or slows down the performance of the membrane. In the biopharmaceutical industry in particular, bacteria, microorganisms and viruses are filtered out using sterile microfiltration. Numerous studies have been conducted to further the understanding of flux decline due to protein fouling. Many times the operating conditions, the type of membrane and type of protein all interact to have an effect on protein fouling and flux decline. Normal-flow microfiltration experiments were conducted using uncoated polytetrafluoroethylene (PTFE) and polyvinylidene fluoride (PVDF) membranes, and PTFE and PVDF membranes coated with polyvinyl alcohol (PVA). Feed streams consisted of lysozyme, β-lactoglobulin and ovalbumin. The pH values of the solution were set at the isoelectric point of each of the proteins (11.0, 5.8, and 4.7 respectively). The experiments were operated with a feed pressure of 2 or 10 psi. Each of the proteins was tested at 0.1 and 2 g/L with uncoated PTFE. No flux decline was seen using 0.1 g/L, so 2 g/L was focused on for PVA coated PTFE, PVA coated PVDF and uncoated PVDF membranes. Protein fouling of the membrane was investigated by determining the variation of permeate flux versus filtrate volume and by analysis of Attenuated Total Reflection-Fourier Transform Infrared (ATR-FTIR) spectra and Field Emission Scanning Electron Microscopy (FESEM) images of unfouled membranes and membranes after microfiltration. Results indicate that the greatest amount of fouling occurs with ovalbumin. The order of most to least fouling was found to be ovalbumin> β-lactoglobulin>lysozyme. Fouling was more severe at the higher protein concentration (2 g/L) and feed pressure (10 psi) and seen only when filtering the solution through uncoated and PVA coated PTFE. Flux decline under these conditions was analyzed using classical pore blockage models. In general, flux decline was found to be caused by complete pore blocking. In the case of ovalbumin filtered through PVA coated PTFE, the flux decline was first caused by pore blockage and then later transitioned to cake filtration. The proteins which showed significant fouling conditions were looked at more closely by pre-filtering the protein solution. The goal of pre-filtration was to decrease any protein aggregates present in solution. This pre-filtration step was conducted with 0.2, 0.45 and 1 μm diameter pore sizes. The flux decline when pre-filtering the feed solution with 1 μm pores was equivalent to the filtration experiments without pre-filtration. The only significant decrease in flux was present when pre-filtering with the 1μm pores. Additional experiments were conducted using hemoglobin (Hb) at 2 g/L and 10 psi operating conditions. Previous literature had shown that using 1 μm pre-filtration, there was severe flux decline for uncoated and PVA coated PTFE. To follow up on these experiments, Hb was pre-filtered using 0.2 and 0.45 μm pre-filtration membranes and then filtered through uncoated and PVA coated PTFE. These experiments resulted in no flux decline. The Hb experiments verified the results from the ovalbumin and β-lactoglobulin experiments. All together, these results indicate that there is an interaction among membrane properties, protein properties, operating conditions and pre-filtration characteristics that determine whether fouling occurs and to what extent
Mean fasting plasma glucose, HbA1c, HOMA-IR across TMAO Tertiles: Cross-sectional results from ORIGINS) 2011–2015.
No full textMean fasting plasma glucose, HbA1c, HOMA-IR across TMAO Tertiles: Cross-sectional results from ORIGINS) 2011–2015.</p
Participant characteristics overall and by TMAO Tertiles: (ORIGINS) 2011–2015.
No full textParticipant characteristics overall and by TMAO Tertiles: (ORIGINS) 2011–2015.</p
