Loop-mediated isothermal DNA amplification (LAMP) are currently used as standalone diagnostic test for C. difficile infection (CDI). We assessed the diagnostic accuracy of LAMP for the diagnosis of CDI. We searched 5 databases to identify studies that compared LAMP with culture cytotoxicity neutralization assay or anaerobic toxigenic culture (TC) of C. difficile. We used the random-effects model to calculate pooled sensitivities, specificities, diagnostic odds ratios and their 95% confidence intervals (CIs). The search of the databases yielded 16 studies (6,979 samples) that met inclusion criteria. When TC was used as the gold standard (6,572 samples), bivariate analysis yielded a mean sensitivity of 0.95 (95%CI, 0.93-0.97; I2 = 67.4) and a mean specificity of 0.99 (95%CI, 0.96-1.00; I2 = 97.0). LAMP is a useful diagnostic tool with high sensitivity and specificity for detecting CDI. The results should however be interpreted only in the presence of clinical suspicion and symptoms of CDI.
Authors: Lloyd, Aaron; Pasupuleti, Vinay; Thota, Priyaleela; Pant, Chaitanya; Rolston, David D.K; Hernandez, Adrian V.; Benites Zapata, Vicente A.; Fraser, Thomas G.; Donskey, Curtis J.; Deshpande, Abhishek
Source: Diagn Microbiol Infect Dis
URL: http://hdl.handle.net/10757/345286
Background: Obstructive sleep apnea (OSA) is associated
with increased mortality, for which impaired functional capacity
(IFC) has been established as a surrogate. We sought to assess
whether IFC is associated with increased mortality in patients
with OSA and whether IFC is predictive of increased mortality
after accounting for coronary artery disease.
Methods: Patients with OSA who underwent both polysomnography
testing and exercise stress echocardiogram were selected. Records
were reviewed retrospectively for demographics, comorbidities,
stress echocardiographic parameters, and polysomnography data.
Univariable and multivariable logistic regression analysis was used to
evaluate the association between IFC and overall mortality. We then
evaluated the variables associated with IFC in the overall population
and in the subgroup with normal Duke treadmill score (DTS).
Results: In our cohort, 404 (26%) patients had IFC. The best
predictors of IFC were female sex, history of smoking, ejection
fraction less than 55, increased body mass index, presence of
comorbidities, abnormal exercise echocardiogram, abnormal
heart rate recovery, and abnormal DTS. Compared with those
without IFC, patients with IFC were 5.1 times more likely to die
(odds ratio [OR], 5.1; 95% confidence interval [CI], 2.5–10.5; P ,
0.0001) by univariate analysis and 2.7 times more likely to die (OR,
2.7; 95% CI, 1.2–6.1; P = 0.02) by multivariate analysis, when
accounting for heart rate recovery, DTS, and sleep apnea severity.
Among those without coronary artery disease, patients with IFC
were at significantly increased risk of mortality (OR, 4.3; 95%
CI, 1.35–13.79; P = 0.0088) compared with those with preserved
functional capacity.
Conclusions: In our OSA population, IFC was a strong predictor
of increased mortality. Among those with normal DTS, IFC
identified a cohort at increased risk of mortality.
Authors: Nisar, Shiraz A.; Muppidi, Raghunandan; Duggal, Sumit; Hernandez, Adrian V.; Kalahasti, Vidyasagar; Jaber, Wael; Minai, Omar A.
Source: The American Thoracic Society
URL: http://hdl.handle.net/10757/337271
Hypertension is common in deep brain stimulator (DBS) placement predisposing to intracranial
hemorrhage. This retrospective review evaluates factors predicting incremental antihypertensive use
intraoperatively. Medical records of Parkinson’s disease (PD) patients undergoing DBS procedure
between 2008–2011 were reviewed after Institutional Review Board approval. Anesthesia medication,
preoperative levodopa dose, age, preoperative use of antihypertensive medications, diabetes mellitus,
anxiety, motor part of the Unified Parkinson’s Disease Rating Scale score and PD duration were collected.
Univariate and multivariate analysis was done between each patient characteristic and the number of
antihypertensive boluses. From the 136 patients included 60 were hypertensive, of whom 32 were on
angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), told to hold
on the morning of surgery. Antihypertensive medications were given to 130 patients intraoperatively.
Age (relative risk [RR] 1.01; 95% confidence interval [CI] 1.00–1.02; p = 0.005), high Joint National
Committee (JNC) class (p < 0.0001), diabetes mellitus (RR 1.4; 95%CI 1.2–17; p < 0.0001) and duration
of PD >10 years (RR 1.2; 95%CI 1.1–1.3; p = 0.001) were independent predictors for antihypertensive
use. No difference was noted in the mean dose of levodopa (p = 0.1) and levodopa equivalent dose
(p = 0.4) between the low (I/II) and high severity (III/IV) JNC groups. Addition of dexmedetomidine to
propofol did not influence antihypertensive boluses required (p = 0.38). Intraoperative hypertension
during DBS surgery is associated with higher age group, hypertensive, diabetic patients and longer
duration of PD. Withholding ACEI or ARB is an independent predictor of hypertension requiring more
aggressive therapy. Levodopa withdrawal and choice of anesthetic agent is not associated with higher
intraoperative antihypertensive medications.
Authors: Rajan, Shobana; Deogaonkar, Milind; Kaw, Roop; Nada, Eman MS; Hernandez, Adrian V.; Ebrahim, Zeyd; Avitsian, Rafi
Source: Journal of Clinical Neuroscience
URL: http://hdl.handle.net/10757/336286
El presente artículo expone la problemática de los animales en peligro de extinción desde la perspectiva del Law & Economics. Así, en lugar de abogar por mecanismos legales orientados hacia la protección estatal de los animales (entendidos como una suerte de patrimonio de la humanidad), el autor sustenta las razones por las cuales se debería someter a los animales en peligro de extinción a un régimen de propiedad privada mediante el cual se generen incentivos para el cuidado de los mismos y para la productividad.; This paper presents the issue of endangered species from a Law & Economic's perspective. In this way, instead of defending the creation of legal mechanisms oriented to public protection of animals (seen as a heritage of humanity), the author maintains the reasons why animals should be considered under a private property regime that provides incentives for their care and for productivity.
Autores: Rodríguez García, Gustavo
Fuente: Ius et Praxis
URL: http://hdl.handle.net/10757/324708
In a systematic review and random effects meta-analysis, we evaluated whether obesity is
associated with postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery.
Eighteen observational studies that excluded patients with preoperative AF were selected until
December 2011 (n=36,147). Obese patients had a modest higher risk of POAF in comparison to
non-obese (OR 1.12, 95%CI 1.04-1.21, p=0.002). The association between obesity and POAF did
not vary substantially by type of cardiac surgery, study design or year of publication. POAF was
significantly associated with higher risk of stroke, respiratory failure, and operative mortality.
Authors: Hernandez, Adrian V.; Kaw, Roop; Pasupuleti, Vinay; Bina, Pouya; P. A. Ioannidis, John; Bueno, Hector; Boersma, Eric;Gillinov, Marc
Source: The Annals of Thoracic Surgery
URL: http://hdl.handle.net/10757/322422
