Objectives
There is very limited evidence to support the common practice of preparative fasting prior to contrast-enhanced computerized tomography (CT). This study examined the effect of withholding ...fasting orders, prior to contrast-enhanced CT, on the incidence of aspiration pneumonitis and adverse gastrointestinal symptoms.
Methods
This randomized controlled trial enrolled hospitalized patients referred for non-emergency, contrast-enhanced CT scan to either at least 4 h of fasting or to an unrestricted consumption of liquids and solids up to the time of CT. The primary outcome was incidence of aspiration pneumonitis and the secondary outcomes were rates of adverse gastrointestinal symptoms (nausea and/or vomiting).
Results
After excluding participants with incomplete follow-up, a total of 1080 participants were assigned to the fasting group and 1011 were assigned to the non-fasting group. Aspiration pneumonitis was not identified in either group. The mean time of fasting in the fasting group was 8.4 ± 1.6 h. Rates of nausea and vomiting were not statistically different between the fasting group compared with the non-fasting group, 6.6% vs. 7.6% (
p
= 0.37) and 2.6% vs. 3.0% (
p
= 0.58), respectively. A subgroup analysis of patients who were required to drink oral contrast agent (
n
= 1257) showed that rates of nausea and vomiting were not statistically different between the fasting and non-fasting groups, 6.8% vs. 8.0% (
p
= 0.42) and 2.6% vs. 3.6% (
p
= 0.3), respectively.
Conclusions
Withholding fasting orders prior to contrast-enhanced CT was not associated with a greater risk of aspiration pneumonitis or a significant increase in rates of adverse gastrointestinal symptoms.
Trial registration
ClinicalTrials.gov
: NCT03533348
Key Points
• Is fasting necessary prior to contrast-enhanced computed tomography (CT)?
• In this randomized clinical study including 2091 participants referred to non-emergency contrast-enhanced CT scan, withholding preparative fasting was not associated with a greater risk of aspiration pneumonitis or clinically significant increase in rates of adverse gastrointestinal symptoms.
• Eating and drinking prior to contrast-enhanced CT can be allowed and are not associated with an increased risk of aspiration pneumonitis.
Vibrio vulnificus is the leading cause of seafood‐associated deaths worldwide. Despite the growing knowledge about the population structure of V. vulnificus, the evolutionary history and the ...ancestral relationships of strains isolated from various regions around the world have not been determined. Using the largest collection of sequence and isolate data of V. vulnificus to date, we applied ancestral character reconstruction to study the phylogeography of V. vulnificus. Multilocus sequence typing data from 10 housekeeping genes were used for the inference of ancestral states and reconstruction of the evolutionary history. The findings showed that the common ancestor of all V. vulnificus populations originated from East Asia, and later evolved into two main clusters that spread with time and eventually evolved into distinct populations in different parts of the world. While we found no meaningful insights concerning the evolution of V. vulnificus populations in the Middle East; however, we were able to reconstruct the ancestral scenarios of its evolution in East Asia, North America, and Western Europe.
Using a global collection of multilocus sequence typing data from Vibrio vulnificus spanning over 55 years, this study provides insights into the spatial and temporal dynamics of the species evolution. The common ancestor of all V. vulnificus populations originated in East Asia, and later evolved into two main clusters that spread with time and eventually evolved into distinct populations in North America and Western Europe.
Vibrio vulnificus is a waterborne pathogen that was responsible for an outbreak of severe soft-tissue infections among fish farmers and fish consumers in Israel. Several factors have been shown to be ...associated with virulence. However, the transcriptome profile of the pathogen during human infection has not been determined yet. We compared the transcriptome profile, using RNA sequencing, of a human-pathogenic strain harvested directly from tissue of a patient suffering from severe soft-tissue infection with necrotizing fasciitis, with the same strain and three other environmental strains grown in vitro. The five sequenced libraries were aligned to the reference genomes of V. vulnificus strains CMCP6 and YJ016. Approximately 47.8 to 62.3 million paired-end raw reads were generated from the five runs. Nearly 84 % of the genome was covered by reads from at least one of the five runs, suggesting that nearly 16 % of the genome is not transcribed or is transcribed at low levels. We identified 123 genes that were differentially expressed during the acute phase of infection. Sixty-three genes were mapped to the large chromosome, 47 genes mapped to the small chromosome and 13 genes mapped to the YJ016 plasmid. The 123 genes fell into a variety of functional categories including transcription, signal transduction, cell motility, carbohydrate metabolism, intracellular trafficking and cell envelope biogenesis. Among the genes differentially expressed during human infection we identified genes encoding bacterial toxin (RtxA1) and genes involved in flagellar components, Flp-coding region, GGDEF family protein, iron acquisition system and sialic acid metabolism.
Rapid progression of valvular stenosis in the setting of infective endocarditis is extremely rare. Here we describe a patient with Bartonella endocarditis on a bioprosthetic aortic valve that caused ...rapidly progressive aortic stenosis without regurgitation. At operation the bioprosthetic valve was severely fibrotic and calcified, with markedly thickened and distorted leaflets and circular partial detachment from the aortic ring. The patient underwent aortic root replacement with aortic bioprosthesis and aortic grafting with reimplantation of the coronary ostia.
Intra-operative tachycardia during noncardiac surgery has been associated with adverse postoperative outcomes. However, harm thresholds for tachycardia have not been uniformly defined. The definition ...of intra-operative tachycardia that best correlates with adverse postoperative outcomes remains unclear.
We aimed to identify the definition of intra-operative tachycardia during noncardiac surgery that is associated with the best predictive ability for adverse postoperative outcomes.
A single-centre retrospective cohort analysis.
Secondary care hospital, Afula, Israel.
Adults who underwent elective or nonelective noncardiac surgery during 2015 to 2019. Five intra-operative heart rate (HR) cut-off values and durations were applied with penalised logistic regression modelling for the outcome measures.
The primary outcome was all-cause 30-day mortality; the secondary outcome was myocardial ischaemia or infarction (MI) within 30 days after noncardiac surgery.
The derivation and validation datasets included 6490 and 4553 patients, respectively. Altogether, all-cause 30-day mortality and MI rates averaged 2.1% and 3.2%, respectively. Only two definitions of intra-operative tachycardia were significantly associated with the outcome measures: HR ≥ 100 bpm for ≥ 30 min and HR ≥ 120 bpm for ≥ 5 min. The C-statistics of the base models without tachycardia exposure for all-cause 30-day mortality and MI were 0.75 (95% confidence interval, CI, 0.74 to 0.78) and 0.73 (95% CI, 0.72 to 0.76), respectively. The addition of intra-operative tachycardia exposure to the base models significantly improved their predictive performance. The highest area under the curve (AUC) was achieved when tachycardia was defined as an intra-operative HR ≥ 100 bpm for at least 30 min: AUC 0.81 (95% CI, 0.80 to 0.84) and AUC 0.80 (95% CI, 0.79 to 0.82) for all-cause 30-day mortality and MI, respectively.
Intra-operative tachycardia, defined as an intra-operative HR ≥ 100 bpm for at least 30 min, was associated with the highest predictive power for adverse postoperative outcomes.
Summary
Aims
To determine the relationship between trends in admission serum albumin and long‐term mortality in medical patients with hospital readmission.
Materials and methods
We used a cohort of ...patients admitted to five departments of internal medicine during 3 years. Survival analysis was performed based on mean admission serum albumin levels and trends in albumin values from recurrent admissions.
Results
A total of 5396 patients had 16 640 admissions (readmission cohort), another 9422 patients were admitted only once (single admission cohort). Readmitted patients with low mean albumin were older, predominantly females and had higher comorbidity index than patients with normal mean albumin. The 6‐month all‐cause mortality rate of the normal and low mean albumin groups was 5.2% and 24.2%, respectively (P < 0.001). Survival analysis showed that patients with persistently normal albumin levels had the highest survival rates at 6 months (97.7%), compared with patients who had hypoalbuminemia at index admission but normalised their albumin levels in subsequent admissions (92%), patients with declining albumin trends (85.6%) and patients with persistently low albumin levels (68.9%) (P < 0.0001).
Conclusions
Serum albumin is strongly associated with long‐term mortality in readmitted medical patients. Persistent hypoalbuminemia during recurrent admissions is associated with increased risk of long‐term mortality.
Streptococcus pneumoniaeis the leading cause of community-acquired pneumonia. Levofloxacin is a fluoroquinolone used for treatment of severe community-acquired pneumonia. Here, we describe the draft ...genome sequences ofS. pneumoniaewith emerging resistance to levofloxacin, resulting in failure of treatment of pneumococcal pneumonia.
Prosthetic vascular graft infection (PVGI) is an infrequent and potentially fatal complication of abdominal aortic aneurysm surgery and occlusive vascular disease. The predictive value of blood ...cultures in accurately identifying the causative pathogen (or pathogens) has not been determined.
We studied the compatibility between results of blood and graft cultures obtained from patients suffering from late-onset (>4 months after surgery) infections of abdominal prosthetic vascular grafts.
Among 17 patients who suffered from late-onset abdominal PVGI, only in 3 patients (17.6%), the same microorganisms isolated from blood cultures were also identified by direct cultures from excised grafts or perigraft tissues. Three patients (17.6%) had negative blood cultures and the rest (n = 11; 64.7%) had different growth of microorganisms from the blood and graft cultures. Three patients were diagnosed with chronic Q fever vascular graft infection, all of whom had positive blood cultures. On the basis of graft cultures, Staphylococcus epidermidis and Escherichia coli were responsible for nearly 50% of cases.
The yield of blood cultures in late-onset abdominal PVGIs is low. Presence of microorganisms in blood cultures does not necessarily indicate a causal relationship with graft infection. An empirical broad-spectrum antimicrobial therapy is advised in all suspected cases until a definitive etiology has been made.
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