Immunosuppression: Evolution in Practice and Trends, 1994–2004

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73911/1/j.1600-6143.2006.01270.x.pd

Acute Kidney Injury in Pediatric Treated with Vancomycin and Piperacillin-Tazobactam in Tertiary Care Hospital

Background. Vancomycin and piperacillin-tazobactam (PTZ) are commonly used as empirical therapy for patients with health care associated infections. Vancomycin has been recognized as a nephrotoxic agent and in a few cases in the literature PTZ has been associated with interstitial nephritis nevertheless; the combination of these agents has routinely been used for many years. However, there have been some observational studies that showed high rates of acute kidney injury (AKI) in patients receiving vancomycin and PTZ concomitant treatment compared to patients receiving vancomycin alone. The incidence of AKI in adult patients receiving vancomycin and PTZ concomitant treatment was reported in these studies to be relatively high. Similar studies in pediatric patients are lacking. Method. We conducted a single center retrospective chart review of 248 pediatric patients receiving one of the following treatments: vancomycin alone 36 patients, vancomycin/PTZ 62 patients, vancomycin/ceftazidime 99 patients, and vancomycin/ceftriaxone 51 patients. Result. Our results showed a low incidence of AKI in patients on vancomycin/PTZ concomitant treatment where overall incidence was only (4.8%) three cases and only one of them (2.0%) in a patient receiving the vancomycin/ceftriaxone concomitant treatment. No cases of AKI present in patients receiving vancomycin with ceftazidime or vancomycin alone. There were no statistically significant differences between the four treatment groups in terms of AKI incidence, vancomycin trough, and use of nephrotoxins. Conclusion. Overall, the incidence of AKI was low in our study sample with no statistically significant increased risk when PTZ was used in combination with vancomycin in a pediatric population. However, further investigation with an equal larger sample size is needed to confirm our findings

Immunosuppression: evolution in practice and trends, 1993–2003

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73471/1/j.1600-6135.2005.00833.x.pd

Quality of Life and Stress Level Among Health Professions Students

Purpose: Numerous studies have shown that students of health professions report higher perceived stress and lower quality of life (QOL) levels than those in other disciplines. The purpose of this cross-sectional survey study is to assess variations in students’ QOL and perceived stress levels by demographic and college-related factors. Methods: The World Health Organization QOL (WHOQOL) – BREF and Perceived Stress Scale (PSS-14) were used to assess QOL and stress levels among students at King Saud Bin Abdul-Aziz University for Health Sciences (KSAU-HS), Riyadh, during December 2015–June 2016. The WHOQOL-BREF comprises four broad QOL domains: physical health, psychological health, social relationships and environment. A total score from responses to the 14 questions in the PSS was computed. Univariate statistical analyses were performed using the Chi-square/Fisher's exact test or the t-test/Mann-Whitney U test, as appropriate. Linear regression models were used to examine the independent effect of numerous demographic and college-related factors on QOL and PSS. Results: A total of 479 students completed the questionnaire, representing a response rate of 95%. Fifty nine percent of the respondents were females. Then vast majority of respondents were single (96%) and reported a household income of SAR 10,000 or higher (82%). The distribution of college enrollment was as follows: Medicine 37%, Applied Medical Sciences 18%, Nursing 16%, Dentistry 13% and Pharmacy 14%. Scores in a number of QOL domains were significantly different by gender, household income, college, academic level and smoking status. Scores in all four QOL domains were negatively correlated with PSS, indicating that better QOL is strongly and highly significantly related to lower perceived stress levels with correlations ranging from −0.27 to −0.58 (p < 0.001). PSS scores were independently and significantly associated with QOL scores in the physical and psychological health domains. Conclusions: Most students that participated in this study appeared to acknowledge challenges in various aspects of their QOL which have been shown to be associated with their perceived stress. Further studies are needed to evaluate the effect of implementing educational and counseling programs to improve QOL and reduce stress levels among health sciences students

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline