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Galveston, TX, United States

Singal A.K.,University of Alabama at Birmingham | Singal A.K.,Mayo Medical School | Salameh H.,UTMB | Kamath P.S.,Mayo Medical School
Alimentary Pharmacology and Therapeutics | Year: 2014

Background Data on bacterial infections in hospitalised patients in the US with cirrhosis are derived largely from single centre data. Countrywide data in this population are lacking. Aim To assess prevalence of infections among hospitalised patients in the US and examine their impact on in-hospital mortality and health care resources utilisation. Methods Nationwide Inpatient Sample (1998-2007) was queried for hospitalisations with cirrhosis and examined for infections including spontaneous bacterial peritonitis (SBP), urinary tract infection (UTI), skin and soft tissue infections, pneumonia and Clostridium difficile infections (CDI). In-hospital mortality, length of stay (LOS) and total charges were analysed. Results Of 742 391 admissions with cirrhosis, 168 654 (23%) had discharge diagnosis of any infection. Between 1998 and 2007, there was a trend towards increasing prevalence of infections (21-25%). Higher rates of infection were associated with ascites (22-25%) and renal insufficiency (RI) (38-43%). Infection with RI increased from 13% in 1998 to 27% in 2007. UTI was the most common infection (9-12%) followed by subcutaneous tissue infections (5-6%) and SBP (2-3%, around 12% in patients with ascites). Infection rate was similar among teaching and nonteaching hospitals with CDI and SBP being more common in teaching hospitals. In-hospital mortality was about 5%, over fivefold higher in infected cirrhotics, and associated with higher LOS and charges. Sepsis (38-42%), pneumonia (23-30%), SBP (16-23%) and CDI (11-16%) contributed most to in-hospital mortality. Conclusions The prevalence of infections among hospitalised patients with cirrhosis in the US is increasing and is associated with in-hospital mortality, renal insufficiency and costs. © 2014 John Wiley & Sons Ltd.


Lewis Z.H.,University of Texas Medical Branch | Lyons E.J.,University of Texas Medical Branch | Jarvis J.M.,University of Texas Medical Branch | Baillargeon J.,UTMB
BMC Public Health | Year: 2015

Background: Obesity is a growing global health concern that may lead to cardiovascular disease, type II diabetes, and cancer. Several systematic reviews have shown that technology is successful in combating obesity through increased physical activity, but there is no known review on interventions that use an electronic activity monitor system (EAMS). EAMSs are defined as a wearable device that objectively measures lifestyle physical activity and can provide feedback, beyond the display of basic activity count information, via the monitor display or through a partnering application to elicit continual self-monitoring of activity behavior. These devices improve upon standard pedometers because they have the ability to provide visual feedback on activity progression, verbal encouragement, and social comparison. This systematic review aimed to synthesize the efficacy and feasibility results of EAMSs within published physical activity interventions. Methods: Electronic databases and journal references were searched for relevant articles. Data sources included CINAHL, Cochrane CENTRAL, Medline Ovid, PsycINFO, and clinicaltrials.gov. Out of the 1,574 retrieved, 11 articles met the inclusion criteria. These articles were reviewed for quality and content based on a risk of bias tool and intervention components. Results: Most articles were determined to be of medium quality while two were of low quality, and one of high quality. Significant pre-post improvements in the EAMS group were found in five of nine studies for physical activity and in four of five studies for weight. One found a significant increase in physical activity and two studies found significant weight loss in the intervention group compared with the comparator group. The EAMS interventions appear to be feasible with most studies reporting continual wear of the device during waking hours and a higher retention rate of participants in the EAMS groups. Conclusion: These studies provide preliminary evidence suggesting that EAMS can increase physical activity and decrease weight significantly, but their efficacy compared to other interventions has not yet been demonstrated. More high-quality randomized controlled trials are needed to evaluate the overall effect of EAMS, examine which EAMS features are most effective, and determine which populations are most receptive to an EAMS. © 2015 Lewis et al.


Hmoud B.,UTMB | Singal A.K.,UAB | Kamath P.S.,Mayo Medical School
Journal of Clinical and Experimental Hepatology | Year: 2014

Mesenteric vein thrombosis is increasingly recognized as a cause of mesenteric ischemia. Acute thrombosis commonly presents with abdominal pain and chronic type with features of portal hypertension. Contrast enhanced CT scan of abdomen is quite accurate for diagnosing and differentiating two types of mesenteric venous thrombosis. Prothrombotic state, hematological malignancy, and local abdominal inflammatory conditions are common predisposing conditions. Over the last decade, JAK-2 (janus kinase 2) mutation has emerged as an accurate biomarker for diagnosis of myeloproliferative neoplasm, an important cause for mesenteric venous thrombosis. Anticoagulation is the treatment of choice for acute mesenteric venous thrombosis. Thrombolysis using systemic or transcatheter route is another option. Patients with peritoneal signs or refractory to initial measures require surgical exploration. Increasing recognition of mesenteric venous thrombosis and use of anticoagulation for treatment has resulted in reduction in the need for surgery with improvement in survival. © 2014 INASL.


Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of mediastinal lymph nodes (LNs) has emerged as a valuable minimally invasive tool for staging. The objective of this study was to determine the accuracy of EUS-FNA of mediastinal LNs in patients with known or suspected non-small cell lung cancer (NSCLC) or with mediastinal LNs of unknown etiology and review its clinical impact. A review was performed on 107 consecutive patients. If malignant cells were identified by EUS-FNA, the result was accepted as a true positive. When cytology was non-malignant, results were compared with the final surgical pathology. Of 79 patients with known or suspected lung cancer who had mediastinal LNs, 69 patients underwent EUS-FNA. Thirty-two received a definitive diagnosis with EUS-FNA and did not undergo further workup, while 37 patients had benign (33) or non-diagnostic FNAs (4); 26 patients further underwent surgical staging. Sensitivity, specificity, and accuracy for EUS-FNA of mediastinal LNs in patients with known or suspected lung cancer was 82.35%, 100%, and 90% respectively. The negative predictive value was 80% and the positive predictive value was 100%. There were 20 patients with suspicious mediastinal LNs of uncertain etiology, with a definitive diagnosis being made using EGD/EUS-FNA in 95%. Our data supports the use of EUS-FNA in the work-up of enlarged mediastinal LNs on cross sectional imaging, thus avoiding more invasive mediastinal sampling procedures and potentially futile surgery.


Aedes aegypti mosquitoes are seen at the Laboratory of Entomology and Ecology of the Dengue Branch of the U.S. Centers for Disease Control and Prevention in San Juan, March 6, 2016. REUTERS/Alvin Baez More CHICAGO (Reuters) - U.S. scientists have identified a genetically modified strain of mice that develop Zika, an important tool needed for testing vaccines and medicines to treat the virus that is rapidly spreading across the Americas and the Caribbean. Early tests on the mice show the virus growing in the testes, offering clues about how a virus typically spread by mosquito bites can be transmitted sexually. "We are going to do experiments to see if we can produce sexual transmission" in these mice, said Scott Weaver, a virologist at the University of Texas Medical Branch in Galveston who worked on the study published on Monday in the American Journal of Tropical Medicine and Hygiene. Weaver said the Zika mouse model will provide a critical tool to allow companies and scientists to test vaccines and antiviral drugs against Zika, which has been linked with thousands of cases of microcephaly, a rare birth defect marked by unusually small head size and possible developmental problems. Zika has not been proven to cause microcephaly, but strong evidence connecting Zika infections with microcephaly cases in Brazil prompted the World Health Organization to declare Zika a global health emergency on Feb. 1. Normally, creating this kind of mouse model would take several months. But the urgency of the Zika outbreak called for rapid response, and the team put together the results in just three weeks, said Shannan Rossi, a UTMB virologist who led the study. Normally, mice do not become sick from a Zika infection. The team tested the virus on several genetically altered mice that had weakened immune systems. The young mice quickly succumbed to the virus, becoming lethargic, losing weight and typically dying six days later. Testing on the mice showed virus particles in many major organs, including high concentrations in the spleen, brain and testes. While Weaver says there are limits to what mouse models can tell about human infections, they may at least provide some early clues that could be followed up in non-human primates, a more costly animal model that is a better predictor of human disease. "The mouse will mainly be used to do the very earliest testing of vaccines or drugs where the mechanism of disease doesn't have to be a perfect model to what happens in humans," Weaver said. Brazil has confirmed more than 900 microcephaly cases and considers most related to Zika infections in the mothers. It is investigating nearly 4,300 additional suspected cases of microcephaly.

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