Perioperative infection prophylaxis and risk factor impact in colon surgery

Background: A prospective observational study was undertaken in 2,481 patients undergoing elective colon resection in 114 German centers to identify optimal drug and dosing modalities and risk factors for postoperative infection. Methods: Patients were pair matched using six risk factors and divided into 672 pairs (ceftriaxone vs, other cephalosporins, group A) and 400 pairs (ceftriaxone vs. penicillins, group B). End points were local and systemic postoperative infection and cost effectiveness. Results: Local infection rates were 6.0 versus 6.5% (group A) and 4.0 versus 10.5% (group B); systemic infection rates in groups A and B were 4.9 versus 6.3% and 3.3 versus 10.5%, respectively. Ceftriaxone was more effective than penicillins overall (6.8 vs. 17.8%, p < 0.001). Length of postoperative hospital stay was 16.2 versus 16.9 days (group A) and 15.8 versus 17.6 days (group B). Of the six risk factors, age and concomitant disease were significant for systemic infection, and blood loss, rectum resection and immunosuppressive therapy were significant for local infection. Penicillin was a risk factor compared to ceftriaxone (p < 0.0001). Ceftriaxone saved Q160.7 versus other cephalosporins and O416.2 versus penicillins. Conclusion: Clinical and microbiological efficacy are responsible for the cost effectiveness of ceftriaxone for perioperative prophylaxis in colorectal surgery. Copyright (C) 2000 S. Karger AG, Basel

COVID-19 Scenario Projections: The Emergence of Omicron in the US - January 2022

As of January 6, 2021, the highly-transmissible SARS-CoV-2 Omicron variant is driving the largest COVID-19 wave in the US to date. The numbers of new cases and hospitalizations continue to rise, straining healthcare systems around the country. On December 16, 2021, we posted projections for the emergence of the Omicron variant under 18 plausible scenarios [1]. At that time, many of Omicron's epidemiological characteristics were uncertain. Recent studies suggest that the Omicron variant is more transmissible, more immune evasive, and less severe than the Delta variant. In this report, we present updated scenario projections that reflect our current understanding of Omicron transmission and severity in the US. Using a stochastic compartmental model that tracks population-level immunity against the Delta and Omicron variants derived from infections, primary vaccines, and booster vaccines, we project COVID-19 cases, hospitalizations, and deaths over a six month period beginning on January 1, 2022 under eight different scenarios.Integrative Biolog

COVID-19 Scenario Projections: The Emergence of Omicron in the US

On November 24, 2021, South African scientists announced the rapid spread of a new SARS-CoV-2 variant. Within days, the WHO named the variant Omicron and classified it as a variant of concern (VOC). As of December 15, 2021, many of Omicron's epidemiological characteristics remain uncertain, including its intrinsic transmissibility, ability to evade vaccine-acquired and infection-acquired immunity, and severity. To support situational awareness and planning in the United States, we simulated the emergence and spread of Omicron in the US across a range of plausible scenarios. Using a stochastic compartmental model that tracks population-level immunity against the Delta and Omicron variants derived from infections, primary vaccines, and booster vaccines, we project COVID-19 cases, hospitalizations and deaths over a six month period beginning on December 1, 2021 under 18 different scenarios.Integrative Biolog

Omicron scenario projections for the Austin-Round Rock MSA

The ongoing COVID-19 surge is straining healthcare systems in the Austin-Round Rock Metropolitan area. As of January 21, 2022, COVID-19 hospital admissions have reached record numbers and the total number of COVID-19 patients in hospitals and ICUs continue to rise. To support response efforts and public risk awareness, we used a data-driven mathematical model to simulate the continued spread of the Omicron variant in the Austin-Round Rock MSA area from January 22, 2022 to June 21, 2022 under four plausible scenarios. Our projections suggest that the 7-day rolling average of reported new cases in the five-county MSA likely peaked on January 9, 2022 at a value 6,109.Integrative Biolog

Cryopyrin-Associated Periodic Fever Syndrome and the Nervous System

PURPOSE OF REVIEW: The purpose of this review is to highlight the molecular and clinical characteristics of the cryopyrin-associated periodic fever syndrome (CAPS) and its management. CAPS is an autosomal dominantly inherited autoinflammatory disorder associated with mutations in the NLRP3 gene, which ultimately lead to excessive production of interleukin-1β (IL-1β) and systemic inflammation. Typical systemic features include fever, urticarial rash and arthralgia, and ultimately amyloidosis. There are also multiple neurological manifestations including, but not restricted to, headache, sensorineural hearing loss, aseptic meningitis, myalgia and optic nerve involvement. RECENT FINDINGS: Since the recognition of CAPS as a single disease entity and discovery of the underlying causative gene, there has been a major breakthrough in terms of its treatment by pharmacological IL-1β inhibition. Highly targeted therapies against IL-1 have been shown to be remarkably effective in the treatment of CAPS and make early diagnosis of this condition crucial. It is hoped that starting pharmacological intervention in a timely manner will prove neuroprotective. There are three drugs licensed for treatment of CAPS; canakinumab, anakinra and rilonacept. The former two are widely used: canakinumab is a fully humanised anti-IL-1β monoclonal antibody administered as a subcutaneous injection once every 8 weeks starting at a dose of 150 mg in patients weighing more than 40 kg. Anakinra is a recombinant form of the IL-1 receptor antagonist and the adult daily dose is 100 mg subcutaneously. CAPS is a highly debilitating disorder characterised by unregulated IL-1β production driven by autosomal dominantly inherited mutations in the NLRP3 gene. Effective therapies targeted against IL-1 are now available and are vital to prevent long-term complications

White matter integrity correlates with cognition and disease severity in Fabry disease

Cerebral white matter pathology is a common CNS manifestation of Fabry disease, visualized as white matter hyperintensities on MRI in 42-81% of patients. Diffusion tensor imaging (DTI) MRI is a sensitive technique to quantify microstructural damage within the white matter with potential value as a disease biomarker. We evaluated the pattern of DTI abnormalities in Fabry disease, and their correlations with cognitive impairment, mood, anxiety, disease severity and plasma lyso-Gb3 levels in 31 patients with genetically proven Fabry disease and 19 age-matched healthy control subjects. We obtained average values of fractional anisotropy and mean diffusivity within the white matter and performed voxelwise analysis with tract-based spatial statistics. Using a standardized neuropsychological test battery, we assessed processing speed, executive function, anxiety, depression and disease severity. The mean age (% male) was 44.1 (45%) for patients with Fabry disease and 37.4 (53%) for the healthy control group. In patients with Fabry disease, compared to healthy controls the mean average white matter fractional anisotropy was lower in [0.423 (standard deviation, SD 0.023) versus 0.446 (SD 0.016), P = 0.002] while mean average white matter mean diffusivity was higher (749 × 10-6 mm2/s (SD 32 × 10-6) versus 720 × 10-6 mm2/s (SD 21 × 10-6), P = 0.004]. Voxelwise statistics showed that the diffusion abnormalities for both fractional anisotropy and mean diffusivity were anatomically widespread. A lesion probability map showed that white matter hyperintensities also had a wide anatomical distribution with a predilection for the posterior centrum semiovale. However, diffusion abnormalities in Fabry disease were not restricted to lesional tissue; compared to healthy controls, the normal appearing white matter in patients with Fabry disease had reduced fractional anisotropy [0.422 (SD 0.022) versus 0.443 (SD 0.017) P = 0.003] and increased mean diffusivity [747 × 10-6 mm2/s (SD 26 × 10-6) versus 723 × 10-6 mm2/s (SD 22 × 10-6), P = 0.008]. Within patients, average white matter fractional anisotropy and white matter lesion volume showed statistically significant correlations with Digit Symbol Coding Test score (r = 0.558, P = 0.001; and r = -0.633, P ≤ 0.001, respectively). Average white matter fractional anisotropy correlated with the overall Mainz Severity Score Index (r = -0.661, P ≤ 0.001), while average white matter mean diffusivity showed a strong correlation with plasma lyso-Gb3 levels (r = 0.559, P = 0.001). Our findings using DTI confirm widespread areas of microstructural white matter disruption in Fabry disease, extending beyond white matter hyperintensities seen on conventional MRI. Moreover, diffusion measures show strong correlations with cognition (processing speed), clinical disease severity and a putative plasma biomarker of disease activity, making them promising quantitative biomarkers for monitoring Fabry disease severity and progression