Risk Factors and Outcomes of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study of USRDS Data

alexandrossfakianakis shared this article with you from Inoreader Risk Factors and Outcomes of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study of USRDS Data via Clinical Infectious Diseases Advance Access ABSTRACT Background Kidney transplant recipients are at increased risk for invasive aspergillosis (IA), a disease with poor outcomes and substantial economic burden. We aimed to determine risk factors for posttransplant IA by using a national database and to assess the association of IA with mortality and allograft failure. Methods Using the United States Renal Data System database, we performed a retrospective case-control study of patients who underwent kidney transplant from 1998 through 2017. To evaluate risk factors for IA, we performed conditional logistic regression analysis by comparing characteristics between IA-infected patients and their matched uninfected controls. We performed Cox regression analysis to evaluate the effects of IA on mortality and death-censored allograft failure. Results We matched 359 patients with IA to 1,436 uninfected controls (1:4). IA was diagnosed at a median of 22.5 months (IQR, 5.4-85.2 mo nths) after kidney transplant. Risk factors for IA were Black/African American race, duration of pretransplant hemodialysis, higher Elixhauser Comorbidity Index score, weight loss, chronic pulmonary disease, need for early posttransplant hemodialysis, and a history of cytomegalovirus infection. Receiving an allograft from a living donor was protective against IA. IA was a strong independent predictor of 1-year mortality (adjusted hazard ratio, 5.02 [95% CI, 3.58-7.04], P < .001). Additionally, IA was associated with 1-year allograft failure (adjusted hazard ratio, 3.37 [95% CI, 1.96-5.77], P < .001). Conclusions Our findings emphasize the importance of timely transplant to mitigate the risk of posttransplant IA. An individualized approach to disease prevention is essential to decrease mortality and allograft failure. View on Web

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Epidemiology of human parainfluenza virus type 3 (HPIV-3) and respiratory syncytial virus (RSV) infections in the time of COVID-19: findings from a household cohort

alexandrossfakianakis shared this article with you from Inoreader Epidemiology of human parainfluenza virus type 3 (HPIV-3) and respiratory syncytial virus (RSV) infections in the time of COVID-19: findings from a household cohort in Maryland via Clinical Infectious Diseases Advance Access Abstract Background During the COVID-19 pandemic, human parainfluenza type 3 (HPIV-3) and respiratory syncytial virus (RSV) circulation increased as non-pharmaceutical interventions were relaxed. Using data from 175 households (n = 690 members) followed between November 2020–October 2021, we characterizedHPIV-3 and RSV burden in children aged 0-4 years and infection patterns in their households. Methods Households with ≥1 child aged 0-4 years were enrolled and members collected weekly nasal swabs (NS) and additional swabs with COVID-like illness onset. We tested all NS from symptomatic episodes in children aged 0-4 years for HPIV-3, RSV, and SARS-CoV-2 by reverse-transcriptase polymerase chain reaction (RT-PCR). Among children with HPIV-3 or RSV infection, we tested all contemporaneous NS collected from household members. We compared incidence rates (IRs) of symptomatic infection with each virus among children aged 0-4 years dur ing epidemic periods, identified household primary infections as the earliest detected infection, and examined community exposures associated with primary infection. Results Overall, 41/175 (23.4%) households had individuals with HPIV-3 (n = 45) or RSV (n = 46) infections. Among children aged 0-4 years, IRs of symptomatic infection/1,000 person-weeks were 8.7[6.0, 12.2] for HPIV-3, 7.6[4.8, 11.4] for RSV, and 1.9[1.0, 3.5] for SARS-CoV-2. 35/36 primary HPIV-3 or RSV infections occurred in children aged 0-4 years. Children with childcare/preschool attendance had higher odds of primary infection (OR = 10.81, 95% CI: 3.14-37.23). Conclusion Among children aged 0-4 years in this cohort, IRs of symptomatic HPIV-3 and RSV infection were four-fold higher than for SARS-CoV-2 during epidemic periods. HPIV-3 and RSV were almost exclusively introduced into households by infants and preschool children. View on Web

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Physiopathology of peri‐implant diseases

alexandrossfakianakis shared this article with you from Inoreader Physiopathology of peri‐implant diseases via Clinical Implant Dentistry and Related Research Abstract Background Peri-implant health is characterized by the absence of clinical signs of soft tissue inflammation. Peri-implant diseases are initiated by the presence of bacterial biofilms and share a similar etiology as that involved in the onset of periodontal diseases. Purpose To summarize available evidence on the physiopathology of peri-implant diseases with emphasis on similarities and differences with periodontal diseases. Materials and Methods Evidence on the biologic mechanisms involved in the pathogenesis of peri-implant mucositis and peri-implantitis were explored in the recent scientific literature. Results Findings of studies in animals and in humans indicate that experimental peri-implant mucositis leads to a larger inflammatory connective tissue infiltrate and to a higher frequency of bleeding sites around implants compared with teeth. Tissue destruction at experimental peri-implantitis sites is more pronounced compared with that at experimental periodontitis sites. Although human periodontitis and peri-implantitis lesions share similarities with respect to etiology and clinical features, they represent distinct entities from a physiopathologic point of view. Conclusions Diagnosis of peri-implant health requires a clinical examination to confirm absence of peri-implant soft tissue inflammation. In order to make a correct diagnosis and select the appropriate therapeutic steps to manage peri-implant diseases, knowledge of their pathogenetic mechanisms is required. View on Web

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Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

alexandrossfakianakis shared this article with you from Inoreader Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss via The Laryngoscope We describe the results of exome sequencing for genetic diagnosis of hearing loss among a clinically heterogeneous cohort of 218 pediatric patients. We found a higher diagnostic rate for unilateral hearing loss than previously reported as well as a significant number of syndromic forms of hearing loss. Based on these results, we advocate for expanded access to genetic testing for phenotypically diverse hearing loss patients. Objectives Genetic testing is the standard-of-care for diagnostic evaluation of bilateral, symmetric, sensorineural hearing loss (HL). We sought to determine the efficacy of a comprehensive genetic testing method, exome sequencing (ES), in a heterogeneous pediatric patient population with bilateral symmetric, bilateral asymmetric, and unilateral HL. Methods Trio-based ES was performed for pediatric patients with confirmed HL including those with symmetric, asymmetric, and unilateral HL. Results ES was completed for 218 probands. A genetic cause was identified for 31.2% of probands (n = 68). The diagnostic rate was 40.7% for bilateral HL, 23.1% for asymmetric HL, and 18.3% for unilateral HL, with syndromic diagnoses made in 20.8%, 33.3%, and 54.5% of cases in each group, respectively. Secondary or incidental findings were identified in 10 families (5.52%). Conclusion ES is an effective method for genetic diagnosis for HL including phenotypically diverse patients and allows the identification of secondary findings, discovery of deafness-causing genes, and the potential for efficient data re-analysis. Level of Evidence Level IV Laryngoscope, 2022 View on Web

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Induced Paresis for Awake Laryngoscopy Procedures

alexandrossfakianakis shared this article with you from Inoreader Induced Paresis for Awake Laryngoscopy Procedures via The Laryngoscope This article describes an anesthetic technique that induces temporary adductor vocal fold paresis and dense sensory loss of the posterior glottis. This method allows for improved precision of treatment and patient tolerance during awake office-based laryngeal surgery. View on Web

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