Necessity Of Prophylaxis Research Articles

Post-discharge Thromboembolic Events in COVID-19 Patients: A Review on the Necessity for Prophylaxis.

Coronavirus disease 2019 (COVID-19) affects the respiratory system of patients and is characterized by pneumonia with hypoxemia. Hospitalized patients and particularly those admitted to intensive care unit (ICU) may encounter a cascade of coagulopathies, which may lead to macrovessel thrombotic events such as pulmonary embolism (PE), deep vein thrombosis (DVT), or arterial thromboembolism (ATE). These events can result in serious life-threatening diseases including cerebrovascular stroke and myocardial infarction. Despite all available information about the incidence, prevention, and treatment of venous thromboembolism (VTE) among hospitalized patients, few data are available on the incidence of both symptomatic and subclinical VTE after discharge. Therefore, there is no precise suggestion or guideline for prophylaxis against VTE in post-discharge period, and some controversies exist over the current guidelines. In the present study, we aimed to review and summarize available literature upon incidence, prevention, diagnosis, and therapeutic approaches for VTE in COVID-19 patients. Also, the pathogenic mechanisms of VTE in infected individuals with COVID-19 were discussed.

Pneumocystis Jirovecii Infection in Autologous Hematopoietic Stem Cell Transplant Recipients

BackgroundInfections remain a common cause of morbidity and mortality following hematopoietic stem cell transplant (HSCT). Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection that can occur in HSCT patients, although the association is best demonstrated in allogeneic HSCT, occurring less commonly in autologous HSCT. However, reports on PJP incidence, timing of infection, and outcomes among autologous HSCT cohorts are limited. Furthermore, while current guidelines recommend 3-6 months of prophylaxis against PJP following autologous HSCT, the optimal duration and even necessity of prophylaxis is not well established.Patients and MethodsWe performed a retrospective analysis of all consecutive patients who had autologous HSCT at the University of Michigan Blood and Marrow Transplantation program over a 20-year period from 1/1/2000 through 12/31/2019. The cohort consisted of a total of 2082 patients, 1221 male (58.6%), with median age 56 (range 10 months - 77 years, 91.2% ≥ 18 years). Records were searched for use of PJP prophylaxis over 6-month and 2-year follow-up periods post-HCT to determine rates of prophylaxis and choice of agent. Cases of polymerase-chain reaction (PCR)-confirmed PJP occurring within two years of HSCT were identified. The timing, clinical and laboratory features at diagnosis, use of concurrent immunosuppression, treatment, and outcomes were determined.ResultsOf the 2082 patients undergoing autologous HCT, 704 patients (33.8%) received PJP prophylaxis in the first 6 months following transplant. Prophylaxis rates varied over time, ranging from 14.6% to 80.0% when calculated by year of transplant (Figure 1). Trimethoprim-sulfamethoxazole (TMP-SMX) was the most used prophylaxis agent (70.3%), followed by inhaled pentamidine (31.8%), with intravenous pentamidine (8.1%), dapsone (7.1%), and atovaquone (2.6%) being used less frequently.There were 9 cases of PJP identified in our cohort, with an incidence of 0.43%. There were 6 males, with median age of 50 (range 34 - 69). Cases occurred a median of 126 days following HSCT (range 65 - 496), with 4 cases occurring after 6 months. None of the patients were on PJP prophylaxis at the time of diagnosis, and only 2 patients had received prophylaxis at any point after transplant. In 8 of 9 cases, patients were receiving concurrent pharmacologic immunosuppression in the form of steroids or maintenance brentuximab (Table 1).All patients presented with symptoms compatible with PJP, most often with fevers, dyspnea, and cough. Diagnosis was made by PCR from bronchoalveolar lavage specimen in 8 cases, and from sputum sample in 1 case. All patients were lymphopenic at the time of diagnosis, with median absolute lymphocyte count of 400 cells/µL (range 200 - 1100). Patients were most often treated with TMP-SMX. Three patients required transfer to the intensive care unit and 2 were intubated. Ultimately, 2 patients died from PJP infection; the remaining 7 recovered (Table 2).ConclusionOur analysis reveals that among a large cohort, incidence of PJP following autologous HSCT is low. This was the case even with relatively modest rates of PJP prophylaxis in the first 6 months following transplant. Most cases of PJP occurred in patients receiving additional immunosuppression and often occurred late following transplant. [Display omitted] DisclosuresPianko: Karyopharm: Honoraria.

Toxoplasma gondii IgG Seroprevalence in Patients with HIV/AIDS.

Toxoplasmosis is a common opportunistic infection in patients with HIV/AIDS and may cause life-threatening clinical courses, such as encephalitis and pneumonia. Patients admitted between January 2006 and August 2017 with anti-HIV positivity confirmed by Western blotting were included in the study. Demographic data, CD4+ T-lymphocyte counts, and Toxoplasma gondii IgG/IgM levels were retrospectively obtained from patient records. T. gondii IgM positivity was not detected in patients, whereas T. gondii IgG positivity was detected in 267 (43.5%) patients. The T. gondii IgG positivity rate was 37.6% in men who had sex with men (MSM) and 48.4% in heterosexual patients. Furthermore, 42.6% of MSM and 21% of heterosexual patients were university graduates, of which T. gondii IgG positivity was detected in only 33.6% of MSM patients and 42.3% of heterosexual patients. In our study, high seronegativity was remarkable in MSM patients, particularly those who were highly educated, thus emphasizing the importance of prevention of primary infection in seronegative patients; necessity of prophylaxis in appropriate patients due to encephalitis, which has a high mortality rate and almost always develops after a latent infection; and necessity of screening for toxoplasmosis seropositivity at the time of diagnosis.

A Cross-sectional study to look at the determinants of poor adherence to secondary penicillin prophylaxis for rheumatic heart disease at a tertiary care center in South India

Background: Rheumatic heart disease (RHD) continues to create havoc in the developing countries even decades after its discovery. It is entirely preventable through primordial, primary, and secondary level intervention. Secondary prevention is a reasonable treatment option in patients in India, but it suffers due to poor adherence which remains the main impediment to its implementation. The aim is to study the compliance with benzathine penicillin as secondary prophylaxis in RHD patients and to establish the patient-related factors for adherence and reasons for missing of doses. Materials and Methods: This is a cross-sectional study of RHD patients presenting to our institute. The demographic data, clinical history, and details of penicillin prophylaxis were noted. The patient was labeled as compliant or noncompliant depending on frequency and duration of prophylaxis as prescribed. Potential factors between the two groups have been analyzed by univariate and binary logistic regression. Results: The study cohort of 500 patients consisted of 261 compliant and 239 noncompliant patients. Average age of presentation was 29 ± 13 years with females outnumbering the males. Noncompliance with secondary prophylaxis was more prevalent among male (P = 0.003), low socioeconomic class (P = 0.0009), uneducated (P = 0.000018), and the rural population (P = 0.025) while those with previous history of rheumatic fever (RF) were found to be more compliant (P = 0.04). Recurrences of RF were more common in those not on regular prophylaxis (P = 0.011). The most common reason cited for noncompliance was the absence of proper counseling followed by a sense of well-being, injection site pain and financial constraints. Conclusion: Compliance with secondary penicillin prophylaxis is essential to ensure eradication of RHD. Education about the importance and necessity of prophylaxis would improve compliance. A close patient and health personnel relationship is important in improving adherence to secondary prophylaxis.

Adherence to Prophylaxis in Adolescents and Young Adults with Severe Haemophilia: A Quantitative Study with Patients.

Introductionhaemophilia is an inherited bleeding disorder caused by a deficiency in one of the blood coagulation factors. For people affected by severe haemophilia, the deficiency can cause spontaneous internal bleeding. Most young people with severe haemophilia in the UK follow a preventative treatment regimen (prophylaxis) consisting of several intravenous injections of factor concentrate each week. There is good evidence that prophylaxis reduces bleeds whilst also improving quality of life. However, levels of adherence among young people with haemophilia reported in the existing literature vary widely and are predominately based on estimations made by healthcare professionals and parents. Additionally, drivers of (non)adherence among young people specifically have not been evidenced.Aimto assess self-reported adherence among young people with haemophilia, provide evidence of psychosocial predictors of adherence, and to establish the associations between non-adherence and number of bleeds and hospital visits.Methods91 participants were recruited during outpatient appointments in 13 haemophilia centres across England and Wales, and invited to complete a questionnaire assessing self-reported adherence (VERITAS-Pro), Haemophilia-related pain and impact of pain, Illness Perceptions, Beliefs about Medications, Self-efficacy, Outcome expectations, Positive and Negative Affect, and Social support. Number of hospital visits and bleeds during the previous six months were collected from medical files.ResultsOf 78 participants with complete data, just 18% had scores indicating non-adherence. Psychosocial predictors differed between intentional (skipping) and un-intentional (forgetting) non-adherence. Overall, however, better adherence was reported where participants perceived the need for prophylaxis was greater than their concern over taking it as well as having a positive expectancy of its effectiveness, good social support and a stronger emotional reaction to having haemophilia.ConclusionThe findings indicate that adherence is generally good, and that assessing illness and treatment beliefs, social support and outcome expectations may play a valuable role in identifying which individuals are at risk of non-adherence. Interventions aimed at improving adherence should particularly consider improving social support, reducing patients’ concerns about prophylaxis, increasing their belief in the necessity of prophylaxis, and increasing positive outcome expectations.

A105: Late Cardiac Assessment in Children Who Were Diagnosed With Post Streptococcal Reactive Arthritis—A Long Term Study

Background/Purpose:In different from rheumatic fever (RF), the association of post streptococcal reactive arthritis (PSRA) and carditis is controversial. Currently the American Heart Association recommends anti‐streptococcal prophylaxis for PSRA for one year, repeat echocardiogram and discontinuation of prophylaxis if normal (level 2, C evidence).Aim—To examine whether there is late cardiac involvement in a cohort of children with PSRA.Methods:Children with defined PSRA who were followed at the pediatric rheumatology units in Meir and Kaplan hospitals had echocardiography, done by pediatric cardiologists, at least 1 year following diagnosis.Results:146 PSRA patients fulfilled the study criteria. Of these, 69 had undergone echocardiography 1–6.9 years from diagnosis. All had normal major parameters. 20 patients had minimal findings: 5 (7.2%) mild mitral insufficiency; 12 (17.4%) minimal mitral insufficiency; 2 (2.9%) mild tricuspid insufficiency and one patient (1.4%) had very mild aortic insufficiency. All were consistent as non significant findings. Of the 77 patients who did not complete echocardiography, 31 were randomly excluded from the study, 26 refused to undergo echocardiography, and 20 were lost to followup, all were asymptomatic according to their medical record or telephone questionnaire. There were no statistically significant differences between the group that had completed echocardiography to the group that had not.Conclusion:No late cardiac involvement was found in our pediatric PSRA patients. Therefore, different approaches to antibiotic prophylaxis for PSRA and RF are probably justified. A prospective, double blind placebo controlled study is needed to definitively assess the necessity of prophylaxis in PSRA.

Isolated bacteria from subcutaneous abscesses in infested goats with Przhevalskiana species

Przhevalskiana is a Diptera from the Oestridae family; its larvae are a major cause of subcutaneous myiasis in goats in many European and Asian countries. In addition to reducing animal production, the main economic losses due to this myiasis are perforation of the goats' skin and its subsequent decrease in the value. Involvement of secondary bacterial agents following penetration of larvae into the skin and formation of subcutaneous abscesses that can result in death of the animals has been little investigated. Therefore, a decision was made to assess the necessity of prophylaxis and the adoption of a more specific treatment by isolation and recognition of the bacterial agents and fly species involved in the formation of this type of abscess. Of the 434 inspected goats, 57 goats (13.13%) were infested with larvae of this fly. Additionally, 11 subcutaneous abscesses were diagnosed in infested goats and 22 larvae were isolated from these abscesses. Parasitological studies revealed that 18 larvae belonged to Przhevalskiana crossii (81.81%) and the remaining four larvae belonged to Przhevalskiana silenus (18.18%). Following bacteriological examinations, five species were isolated from the subcutaneous abscesses produced by Przhevalskiana larvae: Staphylococcus epidermidis from six abscesses, Escherichia coli from four abscesses, Staphylococcus aureus from two abscesses, Streptococcus pyogenes from two abscesses, and Klebsiella pneumoniae from one abscess.

Treatment and Accommodation for the Psycho-neuroses

The advantage and desirability of early treatment in all forms of mental disorder are now generally accepted. The treatment of general paralysis of the insane by malaria, of schizophrenia by shock therapy and of the neuroses by psychotherapy covers a wide range of different methods, yet no one would hesitate to stress the importance of starting the treatment in each case as early as possible. Nor must the necessity of prophylaxis be forgotten, with the consequent importance of child guidance.

The Necessity for Prophylaxis and Radiology in the Practice of Orthodontia

The Necessity for Prophylaxis and Radiology in the Practice of Orthodontia