Delayed isolation of smear-positive pulmonary tuberculosis patients in a Japanese acute care hospital
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Active pulmonary tuberculosis (TB) is associated with intra-hospital spread of the disease. Expeditious diagnosis and isolation are critical for infection control. However, factors that lead to delayed isolation of smear-positive pulmonary TB patients, especially among the elderly, have not been reported. The purpose of this study is to investigate factors associated with delay in the isolation of smear-positive TB patients. All patients with smear-positive pulmonary TB admitted between January 2008 and December 2016 were included. The setting was a Japanese acute care teaching hospital. Following univariate analysis, significant factors in the model were analyzed using the multivariate Cox proportional hazard model. Sixty-nine patients with mean age of 81 years were included. The median day to the isolation of pulmonary TB was 1 day with interquartile range, 1–4 days. On univariate analysis, the time to isolation was significantly delayed in male patients (p = 0.009), in patient who had prior treatment with newer quinolone antibiotics (p = 0.027), in patients who did not have chronic cough (p = 0.023), in patients who did not have appetite loss (p = 0.037), and in patients with non-cavitary lesion (p = 0.005), lesion located other than in the upper zone (p = 0.015), and non-disseminated lesion on the chest radiograph (p = 0.028). On multivariate analysis, the time to isolation was significantly delayed in male patients (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.25 to 0.89; P = 0.02), in patients who did not have chronic chough (HR, 0.52; 95% CI, 0.28 to 0.95; P = 0.033), and in patients with non-cavitary lesion on the chest radiograph (HR, 0.46; 95% CI, 0.23 to 0.92; P = 0.028). In acute care hospitals of an aging society, prompt diagnosis and isolation of TB patients are important for the protection of other patients and healthcare providers. Delay in isolation is associated with male gender, absence of chronic cough, and presence of non-cavitary lesions on the chest radiograph.Keywords:
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Heart rate-adjusted ST-segment depression (ST/HR) analysis improves the diagnostic accuracy of exercise testing, but its prognostic value has not been evaluated in unselected populations. We prospectively used comparative exercise-recovery ST/HR analysis to predict outcome in a consecutive cohort of outpatients referred for exercise testing.The stress-recovery index, defined as the difference between ST/HR areas during exercise and recovery,was derived in 1163 patients (median age, 60 years; interquartile range, 54-65 years). All-cause mortality and the combination of death or nonfatal myocardial infarction were target end points. The individual effect of clinical and exercise-testing data on outcome was evaluated by Cox regression analysis using separate models for each group of variables. Model validation was performed using bootstrap methods adjusted by the degree of optimism in estimates. Survival analysis was performed with the product-limit Kaplan-Meier method.During a 33-month follow-up, 48 deaths and 72 nonfatal myocardial infarctions occurred. After adjusting for confounding variables, hypertension (hazard ratio, 1.80; 95% confidence interval, 1.26-2.59), ST/HR index (hazard ratio, 1.32; 95% confidence interval, 1.04-1.66; for interquartile difference), and stress-recovery index (hazard ratio, 0.75; 95% confidence interval, 0.65-0.86; for interquartile difference) were predictive of death or nonfatal myocardial infarction, whereas hypertension (hazard ratio, 3.67; 95% confidence interval, 2.00-6.73) and stress-recovery index (hazard ratio, 0.55; 95% confidence interval, 0.48-0.63; for interquartile difference) were predictive of all-cause mortality. In addition, stress-recovery index increased the prognostic power of the model on top of clinical and exercise-testing variables and provided significant discrimination for survival.Combined evaluation of ST/HR analysis during exercise and recovery improves the prognostic capacity of standard exercise electrocardiography.
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Maximum oxygen consumption (peak VO2) <50% predicted on exercise testing is a class I indication for heart transplant (HT) listing in children. This recommendation is based on exercise data in adults. We assessed the association of peak VO2<50% predicted during HT evaluation with freedom from death or deterioration in children.We analyzed all children who underwent exercise testing during HT evaluation at our center between 2002 and 2011. Patients with peak VO2<50% predicted were compared with those with peak VO2 ≥ 50% predicted for the composite outcome of death before HT, initiation of mechanical circulatory support, and HT at highest urgency status, using time-to-event analyses. There were 50 children in the study (median age, 15 years; interquartile range, 13-17 years; 24 girls; 18 with palliated single ventricle). Overall, 24 children reached the composite end point. Peak VO2<50% predicted was associated with outcome in children with biventricular circulation (hazard ratio, 4.7; 95% confidence interval, 1.8-12.3; P<0.001) but not in those with a palliated single ventricle (hazard ratio, 1.3; 95% confidence interval, 0.1-12.0; P=0.80). Similarly, VE/VCO2 slope ≥ 34 was associated with outcome in children with biventricular circulation (hazard ratio, 2.7; 95% confidence interval, 1.1-7.1; P<0.001) but not in children with a palliated single ventricle.Exercise testing during HT evaluation in children with biventricular circulation identified those at higher risk of death or deterioration in this small study. Larger studies are needed to assess the role of exercise testing during HT evaluation in children with a palliated single ventricle.
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The aim of the present meta-analysis and systematic review was to explore the association between the expression of miR-34a and prognosis in solid tumor.PubMed, Google Scholar, Web of Science and NCBI databases were used to search studies to evaluate the effect of miR-34a expression on clinical outcomes, including overall survival (OS), recurrence-free survival (RFS), disease-free survival (DFS), progression-free survival (PFS) and event-free survival (EFS) in solid tumor. The pooled random effect models were performed to calculate pooled hazard ratio (HR), 95% confidence interval (CI) to assess the association.Twenty-three eligible studies with 4030 patients were included in this meta-analysis. It was confirmed that increased expression of miR-34a was in relevant with better DFS/RFS/PFS/EFS, which was identified with both univariate and multivariate models (univariate model: HR = 0.62, 95% CI: 0.42-0.92, P = 0.019; multivariate model: HR = 0.55, 95% CI: 0.34-0.88, P = 0.013). Furthermore, in the analysis of relationship between miR-34a and DFS/RFS/PFS/EFS, the results remained similar when excluding the studies contributed to the heterogeneity (univariate analysis: HR = 0.57, 95% CI: 0.46-0.70, P < 0.001; multivariate analysis: HR = 0.57, 95% CI: 0.43-0.75, P < 0.001). With univariate analysis, it was also demonstrated that miR-34a overexpression might be positively associated with a favorable OS in solid tumor (HR = 0.73, 95% CI: 0.54-1.00, P = 0.005) with considering an obvious heterogeneity.Our current study supports the notion that miR-34a may be a potential biomarker to predict OS and RFS/PFS/DFS/EFS in solid tumor.
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Abstract Background Determining prognostic factors for the probability of tracheostomy decannulation is key to an adequate therapeutic plan. Methods A retrospective cohort study of 160 paediatric patients undergoing tracheostomy was conducted. Associations between different parameters and eventual tracheostomy decannulation were assessed. Results Mean follow-up duration was 27.8 months (interquartile range = 25.5–30.2 months). Median age at tracheostomy was 6.96 months (interquartile range = 3.37–29.42 months), with median tracheostomy maintenance of 14.5 months (interquartile range = 3.7–21.5 months). The overall tracheostomy decannulation rate was 22.5 per cent. Factors associated with a higher probability of tracheostomy decannulation included age at tracheostomy (hazard ratio = 1.11, 95 per cent confidence interval = 1.03–1.18) and post-intubation laryngitis as an indication for tracheostomy (hazard ratio = 2.25, 95 per cent confidence interval = 1.09–4.62). Neurological (hazard ratio = 0.30, 95 per cent confidence interval = 0.12–0.80) and pulmonary (hazard ratio = 0.41, 95 per cent confidence interval = 0.18–0.91) co-morbidities were negatively associated with tracheostomy decannulation. The probability of tracheostomy decannulation decreased significantly with increasing numbers of co-morbidities ( p < 0.001). Conclusion Age, post-intubation laryngitis, and number and type of co-morbidities influence tracheostomy decannulation rate in the paediatric population.
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Aim This study aimed to assess the association between physical frailty and clinical outcomes among older patients hospitalized for pneumonia. Methods This study examined 852 consecutive patients hospitalized for pneumonia between October 2018 and September 2020. Patients who were <65 years old, scheduled for admission, did not receive inpatient rehabilitation, or died during admission were excluded. A short physical performance battery (SPPB) test was performed by physical therapists upon discharge. The primary outcome measure was a composite endpoint of readmission or mortality due to any cause within 6 months of discharge. Results In total, 521 patients (median age, 80 years; interquartile range, 74–86 years) were included in the analyses, and were divided into the following two groups: robust group with SPPB scores >9 ( n = 150), and physical frailty group with SPPB scores ≤9 ( n = 371). Of these, 346 (66.4%) patients were men; and the median SPPB score was 6 (interquartile range, 1–10). During the median follow‐up period of 53 days (interquartile range, 4–180 days), 92 (17.6%) patients were readmitted and 25 (4.8%) patients died. Patients with physical frailty were at an increased risk for the primary endpoint (hazard ratio, 2.21; 95% confidence interval, 1.44–3.41; P < 0.001); the risk remained significant after adjusting for multiple variables (adjusted hazard ratio, 1.70; 95% confidence interval, 1.05–2.74; P = 0.028). Conclusions Among older patients with pneumonia, physical frailty status at discharge was an independent risk factor for readmission and mortality within 6 months after initial discharge. Geriatr Gerontol Int 2021; 21: 926–931 .
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Objectives Our aim was to evaluate the predictors of biochemical recurrence after Retzius‐sparing robot‐assisted radical prostatectomy. Methods The study cohort consisted of 359 consecutive non‐metastatic prostate cancer patients who underwent Retzius‐sparing robot‐assisted radical prostatectomy between November 2012 and January 2016. According to the National Comprehensive Cancer Network prostate cancer risk classification, 164 patients (45.7%) had high‐ or very high‐risk prostate cancer. No patient received adjuvant therapy until documented biochemical recurrence. Biochemical recurrence‐free survival was estimated using the Kaplan–Meier method. Univariable and multivariable Cox proportional hazards regression models were used to determine variables predictive of biochemical recurrence. Results The median follow‐up period was 26 months (interquartile range 19–38 months). The overall biochemical recurrence rate was 14.8%, and the median time to biochemical recurrence was 11 months (interquartile range 6–22 months). The 3‐year biochemical recurrence‐free survival probability was 71.2%, 72.1%, 88.7%, 82.3% and 95.7% in very high‐, high‐, intermediate‐, low‐ and very low‐risk prostate cancer, respectively (log–rank, P < 0.001). On multivariable analysis, preoperative prostate‐specific antigen (hazard ratio 1.03, 95% confidence interval 1.02–1.04; P < 0.0001), percentage of maximum core involvement on biopsy (hazard ratio 1.02, 95% confidence interval 1.01–1.03; P = 0.029) and clinical stage ≥T3a (hazard ratio 2.12, 95% confidence interval 1.02–4.39; P = 0.043) were predictors of biochemical recurrence, whereas pathological Gleason score ≥8 (hazard ratio 5.63, 95% confidence interval 1.62–19.61; P = 0.007) and pathological tumor volume (hazard ratio 1.08, 95% confidence interval 1.04–1.20; P < 0.001) were the main pathological predictors of biochemical recurrence. Conclusions Retzius‐sparing robot‐assisted radical prostatectomy confers effective biochemical recurrence control at the mid‐term follow‐up period. Preoperative prostate‐specific antigen, advanced clinical stage and higher Gleason score were important predictors of biochemical recurrence after Retzius‐sparing robot‐assisted radical prostatectomy. Long‐term oncological safety still needs to be established.
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