The safety and efficacy of high versus low vancomycin trough levels in the treatment of patients with infections caused by methicillin-resistant Staphylococcus aureus: a meta-analysis

Additional file 1. Supplementary data

Measurement of the Aortic Diameter in the Asymptomatic Thai Population in Siriraj Hospital: Assessment with Multidetector CT

Objective: The purpose of this study was to determine normal reference values of intra-thoracic and abdominal aortic diameters of asymptomatic Thai adults obtained by multidetector computed tomography. Secondary end points were evaluation of relationships between aortic diameters and patients’ demographic data or potential risk factors of cardiovascular disease. Methods: Three hundred and ten Thai adults in Siriraj Hospital who had no any signs or symptoms of cardio- vascular disease that examined with computed tomography (CT) of chest and whole abdomen were investigated in this study. Aortic diameters were measured at eight predefined intra-thoracic and abdominal levels on CT images, including ascending aorta, proximal transverse aortic arch, distal transverse aortic arch, aortic isthmus, thoracoabdominal junction, celiac axis, suprarenal aorta and aortic bifurcation. Analysis of data was performed with regard to patients’ demographic data (age, sex, weight, and height) and three potential risk factors of cardio- vascular disease (hypertension, dyslipidemia and diabetes mellitus). Furthermore, we also recorded the co-morbid non-cardiovascular underlying diseases which were classified into seven groups, including tumors (malignant and benign tumors), infectious diseases, inflammatory diseases, autoimmune diseases, degenerative diseases, psychiatric diseases and others. Results: Aortic diameters were 3.14±0.40 cm. at the ascending aorta, 2.88 ± 0.34 cm. at proximal transverse aortic arch, 2.65±0.30 cm. at distal transverse aortic arch, 2.46 ± 0.31cm. at aortic isthmus, 2.10± 0.27 cm. at thoracoab- dominal junction, 1.99 ± 0.26 cm. at celiac axis, 1.81 ±0.25 cm. at suprarenal aorta, and 1.47±0.21 cm. at aortic bifurcation. Overall aortic diameters tend to continuously significantly decrease aortic diameters from proximal to distal direction from ascending aorta to aortic bifurcation. Men had slightly more enlarged aortic diameters in all eight predefined levels than women with statistical significance (p<0.05). Increasing age is an independent and the most influential predictor of increasing size of aortic diameter in all aortic levels. Furthermore, age was classified into three age groups; 18-50 years, 51-70 years and 71-94 years. There were significant differences of aortic diameter in all aortic levels, except two age groups which are 51-70 years and 71-90 years when considered at celiac trunk and aortic bifurcation levels. Aortic diameters increased as weight increased at only one aortic level which was aortic bifurcation, with statistical significance (p<0.001). Weight was an independent influential predictor of aortic diameter in various levels, which were 5-46 percentages of influent degree. All aortic diameters were not increased with underlying hypertension, dyslipidemia and diabetes mellitus. Conclusion: This study delineates normal intra-thoracic and abdominal aortic diameters, including relationships with age and sex in asymptomatic Thai adults

Determinants of continuing mental health service use among older persons diagnosed with depressive disorders in general hospitals: latent class analysis and GEE

Abstract Background Prevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders. Methods We employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data. Results The continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003). Conclusions The findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment

The Correlation of Aortic Neck Angle and Length in Abdominal Aortic Aneurysm with Severe Neck Angulation for Prediction of Intraoperative Neck Complications and Postoperative Outcomes after Endovascular Aneurysm Repair

Objectives: Endovascular aneurysm repair (EVAR) in a hostile neck has been associated with adverse outcomes. We aimed to determine the association of infrarenal aortic neck angle and length and establish an optimal cutoff value to predict intraoperative neck complications and postoperative outcomes. Methods: This was a retrospective review of patients with an intact infrarenal abdominal aortic aneurysm (AAA) with severe neck angulation (>60 degrees) who underwent EVAR from October 2010 to October 2018. Demographic data, aneurysm morphology, and operative details were collected. The ratio of neck angle and length was calculated as the optimal cutoff value of the aortic neck angle-length index. The patients were categorized into two distinct groups using latent profile analysis, a statistical technique employed to identify concealed subgroups within a larger population by examining a predetermined set of variables. Intraoperative neck complications, adjunct neck procedures, and early and late outcomes were compared. Results: 115 patients were included. Group 1 (G1) had 95 patients with an aortic neck angle-length index ≤ 4.8, and Group 2 (G2) had 20 patients with an aortic neck angle-length index > 4.8. Demographic data and aneurysm morphology were not significantly different between groups except for neck length (p p = 0.005). Adjunctive neck procedures were more common in G2 (18.9% vs. 60%, p p = 0.785). The 5-year overall survival rate was not statistically different (59.9% G1 vs. 69.2% G2, p = 0.891). Conclusions: Patients with an aortic neck angle-length index > 4.8 are at greater risk of intraoperative neck complications and adjunctive neck procedures than patients with an aortic neck angle-length index ≤ 4.8. The 5-year proximal neck re-intervention-free rate and the 5-year survival rate were not statistically different. Based on our findings, this study suggests that the aortic neck angle-length index is a reliable predictor of intraoperative neck complications during EVAR in AAA with severe neck angulation

Demographics and clinical characteristics of patients with extensively drug-resistant <i>Pseudomonas aeruginosa</i> (XDR-PA) and non-XDR-PA infection.

<p>Demographics and clinical characteristics of patients with extensively drug-resistant <i>Pseudomonas aeruginosa</i> (XDR-PA) and non-XDR-PA infection.</p

Independent predictors of mortality attributable to infection.

<p>Independent predictors of mortality attributable to infection.</p

Treatment, and clinical and microbiological outcomes, of patients with <i>Pseudomonas aeruginosa</i> infections.

<p>Treatment, and clinical and microbiological outcomes, of patients with <i>Pseudomonas aeruginosa</i> infections.</p

Clinical outcome and laboratory markers for predicting disease activity in patients with disseminated opportunistic infections associated with anti-interferon-γ autoantibodies.

BackgroundClinical courses and treatment outcomes are largely unknown in patients with adult-onset immunodeficiency associated with anti-interferon-gamma autoantibodies due to the fact that it was recently recognized and anti-IFN-γ auto-Abs detection is not widely available.Methods and findingsNon-HIV-infected adult patients with detectable anti-IFN-γ auto-Abs diagnosed and followed at Siriraj Hospital, Bangkok, Thailand during January 2013 to November 2016 were prospectively studied. At each follow-up visit, patients were classified as stable or active disease according to symptoms and signs, and all proven OIs were recorded. Laboratory parameters, including erythrocyte sedimentation rate, C-reactive protein, and anti-IFN-γ auto-Abs level, were compared between active and stable disease episodes. We identified 80 patients with this clinical syndrome and followed them up during study period. Seventy-nine patients developed overall 194 proven opportunistic infections. Mycobacterium abscessus (34.5%) and Salmonella spp. (23.2%) were the two most common pathogens identified among these patients. Sixty-three patients were followed for a median of 2.7 years (range 0.6-4.8 years). Eleven (17.5%) patients achieved the drug-free remission period for at least 9 months. Four patients died. Anti-IFN-γ auto-Abs concentration was significantly lower at baseline and decreased over time in the drug-free remission group compared to another group (p = 0.001). C-reactive protein, erythrocyte sedimentation rate and white cell count were found to be useful biomarkers for determining disease activity during follow-up.ConclusionsReinfection or relapse of OIs is common despite long-term antimicrobial treatment in patients with anti-IFN-γ auto-Abs. Treatment to modify anti-IFN-γ auto-Abs production may improve long-term outcomes in this patient population

Epidemiology and risk factors of extensively drug-resistant <i>Pseudomonas aeruginosa</i> infections

<div><p>Background</p><p>The incidence of nosocomial infections from extensively drug-resistant <i>Pseudomonas aeruginosa</i> (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality.</p><p>Methods</p><p>We retrospectively studied a cohort of adult, hospitalized patients with <i>P</i>. <i>aeruginosa</i> (PA) infections between April and December 2014.</p><p>Results</p><p>Of the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12.5%) to multidrug resistant <i>Pseudomonas aeruginosa</i> (MDR-PA), and 167 (65.5%) to non-MDR PA. Receiving total parenteral nutrition (adjusted OR [aOR] 6.21; 95% CI 1.05–36.70), prior carbapenem use (aOR 4.88; 95% CI 2.36–10.08), and prior fluoroquinolone use (aOR 3.38; 95% CI 1.44–7.97) were independently associated with the XDR-PA infections. All XDR-PA remained susceptible to colistin. Factors associated with mortality attributable to the infections were the presence of sepsis/septic shock (aOR 11.60; 95% CI 4.66–28.82), admission to a medical department (aOR 4.67; 95% CI 1.81–12.06), receiving a central venous catheter (aOR 3.78; 95% CI 1.50–9.57), and XDR-PA infection (aOR 2.73; 95% CI 1.05–7.08).</p><p>Conclusion</p><p>The prevalence of XDR-PA infections represented almost a quarter of <i>Pseudomonas aeruginosa</i> hospital-acquired infections and rendered a higher mortality. The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected.</p></div