113 Invasive fungal infections among pediatric patients with hematologic malignancies at KFSH&RC/KFCCC&R

Objectives: To define the magnitude of the problem, study factors associated with increased risk of invasive fungal, infections (IFI) and outcome.Methods: From June 1998 to March 2003, all, radiological, studies of patients with hematologic/ oncologic disorders were evaluated for inclusion. AII, cases of invasive fungal, infection were reviewed. The criteria for inclusion were obvious lesion suggestive of fungal, infection shown on radiological, studies, and fungal, infections were classified as proven , probable\u27, possible or insufficient evidence according to a prior definitions.Results: A total, of 1615 patient charts were reviewed. The underlying diagnoses include ALL 410, SCT 293, AML 133, non-malignant hematology 288, NHL/solid tumors 491. 152 (9%) had evidence of fungal, infection (55 [36%] \u27definite = proven/probable\u27, 97 [64%] \u27possible\u27). Biopsy was performed in 94 cases and the findings included budding yeast in 10 patients, septated hyphae in 19, and hyphae with no specifications in 12 patients. Delays in performing diagnostic procedures possibly resulted in the lower incidence of \u27definite\u27 IFI (36% vs 64% \u27possible ). The overall, incidence of fungal, infection was 9%, being highest for AML (39%), followed by ALL (17%). The majority of IFI developed during or immediately after induction (42% of IFI in AML and 53% of IFI in ALL), which can be a target for intervention. The infections included disseminated fungal, infection (36%), CDC (11%), pulmonary fungal, infection (43%) and aspergillosis (9.5%) including pulmonary, Para nasal, sinuses, skin and disseminated. IFI was radiologically diagnosed during neutropenia in 123 patients (81%). Ten patients died due to fungal, infection (7%), 75 (49%) were cured, 26 (17%) were alive with fungal, infection, and 39 patients (26%) died due to primary disease seemingly unrelated to fungal, infection. Mortality due to IFI in this study is less than what is reported in the literature and could be a result of our practice of early intervention. The average LOS for IFI was 56 days compared with the usual. 12 days, which can add to the increased cost.Conclusions: Invasive fungal, infection is becoming a serious problem. Furthermore, acute invasive fungal, infection is associated with a much higher mortality. Early diagnosis with prompt antifungal, therapy, or even with surgical, intervention, might be warranted to save patients\u27 lives

Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study

Introduction Specialist centres have been developed to deliver high-quality Hepatology care. However, there is geographical inequity in accessing these centres in the United Kingdom (UK). We aimed to assess the impact of these centres on decompensated cirrhosis patient outcomes and understand which patients transfer to specialist centres. Methods A UK multicentred retrospective observational study was performed including emergency admissions for patients with decompensated cirrhosis in November 2019. Admissions were grouped by specialist/non-specialist centre designation, National Health Service region and whether a transfer to a more specialist centre occurred or not. Univariable and multivariable comparisons were made. Results 1224 admissions (1168 patients) from 104 acute hospitals were included in this analysis. Patients at specialist centres were more likely to be managed by a Consultant Gastroenterologist/Hepatologist on a Gastroenterology/Hepatology ward. Only 24 patients were transferred to a more specialist centre. These patients were more likely to be admitted for gastrointestinal bleeding and were not using alcohol. Specialist centres eliminated regional variations in mortality which were present at non-specialist centres. Low specialist Consultant staffing numbers impacted mortality at non-specialist centres (aOR 2.15 (95% CI 1.18 to 4.07)) but not at specialist centres. Hospitals within areas of high prevalence of deprivation were more likely to have lower specialist Consultant staffing numbers. Conclusions Specialist Hepatology centres improve patient care and standardise outcomes for patients with decompensated cirrhosis. There is a need to support service development and care delivery at non-specialist centres. Formal referral pathways are required to ensure all patients receive access to specialist interventions

Structure and macroscopic tackiness of ultra-thin pressure sensitive adhesive films

Ultrathin layers of the statistical copolymer P(nBA-stat-MA) with a majority of n-butyl acrylate (nBA) and a minority of methyl acrylate (MA) are characterized with respect to the film morphology and the mechanical response in a probe tack test. The probed copolymer can be regarded as a model system of a pressure sensitive adhesive (PSA). The films are prepared by spin-coating which enables an easy thickness control via the polymer concentration of the solution. The film thickness is determined with x-ray reflectivity (XRR) and white light interferometry (WLI). Grazing incidence small angle x-ray scattering (GISAXS) provides detailed and statistically significant information about the film morphology. Two types of lateral structures are identified and no strong correlation of these structures with the PSA film thickness is observed. In contrast, prominent parameters of the probe tack test, such as the stress maximum and the tack energy, exhibit an exponential dependence on the film thickness