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Houston, TX, United States

Murray K.O.,Baylor College of Medicine | Garcia M.N.,Baylor College of Medicine | Rahbar M.H.,University of Texas Health Science Center at Houston | Martinez D.,Harris County Public Health and Environmental Services | Rossmann S.,Gulf Coast Regional Blood Center
PLoS ONE | Year: 2014

In 2012, we witnessed a resurgence of West Nile virus (WNV) in the United States, with the largest outbreak of human cases reported since 2003. WNV is now endemic and will continue to produce epidemics over time, therefore defining the long-term consequences of WNV infection is critical. Over a period of eight years, we prospectively followed a cohort of 157 WNV-infected subjects in the Houston metropolitan area to observe recovery over time and define the long-term clinical outcomes. We used survival analysis techniques to determine percentage of recovery over time and the effects of demographic and co-morbid conditions on recovery. We found that 40% of study participants continued to experience symptoms related to their WNV infection up to 8 years later. Having a clinical presentation of encephalitis and being over age 50 were significantly associated with prolonged or poor recovery over time. Since the health and economic impact as a result of prolonged recovery, continued morbidity, and related disability is likely substantial in those infected with WNV, future research should be aimed at developing effective vaccines to prevent illness and novel therapeutics to minimize morbidity, mortality, and long-term complications from infection. © 2014 Murray et al.

Nolan M.S.,University of Houston | Zangeneh A.,University of Houston | Khuwaja S.A.,Office of Surveillance and Public Health Preparedness | Martinez D.,Office of Disease Control and Clinical Prevention | And 3 more authors.
Journal of Biomedicine and Biotechnology | Year: 2012

West Nile virus (WNV), a mosquito-borne virus, has clinically affected hundreds of residents in the Houston metropolitan area since its introduction in 2002. This study aimed to determine if living within close proximity to a water source increases ones odds of infection with WNV. We identified 356 eligible WNV-positive cases and 356 controls using a population proportionate to size model with US Census Bureau data. We found that living near slow moving water sources was statistically associated with increased odds for human infection, while living near moderate moving water systems was associated with decreased odds for human infection. Living near bayous lined with vegetation as opposed to concrete also showed increased risk of infection. The habitats of slow moving and vegetation lined water sources appear to favor the mosquito-human transmission cycle. These methods can be used by resource-limited health entities to identify high-risk areas for arboviral disease surveillance and efficient mosquito management initiatives. Copyright © 2012 Melissa S. Nolan et al.

Holcomb J.B.,University of Texas Health Science Center at Houston | Donathan D.P.,University of Texas Health Science Center at Houston | Cotton B.A.,University of Texas Health Science Center at Houston | Del Junco D.J.,University of Texas Health Science Center at Houston | And 9 more authors.
Prehospital Emergency Care | Year: 2015

Objective. Earlier use of plasma and red blood cells (RBCs) has been associated with improved survival in trauma patients with substantial hemorrhage. We hypothesized that prehospital transfusion (PHT) of thawed plasma and/or RBCs would result in improved patient coagulation status on admission and survival.Methods. Adult trauma patient records were reviewed for patient demographics, shock, coagulopathy, outcomes, and blood product utilization from September 2011 to April 2013. Patients arrived by either ground or two different helicopter companies. All patients transfused with blood products (either pre- or in-hospital) were included in the study. One helicopter system (LifeFlight, LF) had thawed plasma and RBCs while the other air (OA) and ground transport systems used only crystalloid resuscitation. Patients receiving PHT were compared with all other patients meeting entry criteria to the study cohort. All comparisons were adjusted in multilevel regression models.Results. A total of 8,536 adult trauma patients were admitted during the 20-month study period, of which 1,677 met inclusion criteria. They represented the most severely injured patients (ISS = 24 and mortality = 26%). There were 792 patients transported by ground, 716 by LF, and 169 on OA. Of the LF patients, 137 (19%) received prehospital transfusion. There were 942 units (244 RBCs and 698 plasma) placed on LF helicopters, with 1.9% wastage. PHT was associated with improved acid-base status on hospital admission, decreased use of blood products over 24 hours, a reduction in the risk of death in the sickest patients over the first 6 hours after admission, and negligible blood products wastage. In this small single-center pilot study, there were no differences in 24-hour (odds ratio 0.57, p = 0.117) or 30-day mortality (odds ratio 0.71, p = 0.441) between LF and OA.Conclusions. Prehospital plasma and RBC transfusion was associated with improved early outcomes, negligible blood products wastage, but not an overall survival advantage. Similar to the data published from the ongoing war, improved early outcomes are associated with placing blood products prehospital, allowing earlier infusion of life-saving products to critically injured patients.

Garcia M.N.,Baylor College of Medicine | Aguilar D.,Baylor College of Medicine | Gorchakov R.,Baylor College of Medicine | Rossmann S.N.,Gulf Coast Regional Blood Center | And 5 more authors.
American Journal of Tropical Medicine and Hygiene | Year: 2015

Autochthonous transmission of Trypanosoma cruzi in the United States is rarely reported. Here, we describe five newly identified patients with autochthonously acquired infections from a small pilot study of positive blood donors in southeast Texas. Case-patients 1-4 were possibly infected near their residences, which were all in the same region ∼100 miles west of Houston. Case-patient 5 was a young male with considerable exposure from routine outdoor and camping activities associated with a youth civic organization. Only one of the five autochthonous case-patients received anti-parasitic treatment. Our findings suggest an unrecognized risk of human vector-borne transmission in southeast Texas. Education of physicians and public health officials is crucial for identifying the true disease burden and source of infection in Texas. Copyright © 2015 by The American Society of Tropical Medicine and Hygiene.

Nobles J.R.,Gulf Coast Regional Blood Center
Immunohematology / American Red Cross | Year: 2013

Routine adsorption procedures to remove autoantibodies from patients' serum often require many hours to perform. This time-consuming process can create significant delays that affect patient care. This study modified the current adsorption method to reduce total adsorption time to 1 hour. A ratio of one part serum to three parts red blood cells (RBCs; 1:3 method) was maintained for all samples. The one part serum was split into three tubes. Each of these three aliquots of serum was mixed with one full part RBCs, creating three adsorbing tubes. All tubes were incubated for 1 hour with periodic mixing. Adsorbed serum from the three tubes was harvested, combined, and tested for reactivity. Fifty-eight samples were evaluated using both the current method and the 1:3 method. Forty-eight (83%) samples successfully adsorbed using both methods. Twenty (34.5%) samples contained underlying alloantibodies. The 1:3 method demonstrated the same antibody specificities and strengths in all 20 samples. Eight samples failed to adsorb by either method. The 1:3 method found previously undetected alloantibodies in three samples. Two samples successfully autoadsorbed but failed to alloadsorb by either method. The 1:3 method proved to be efficient and effective for quick removal of autoantibodies while allowing for the detection of underlying alloantibodies.

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