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Pavan R, Husain S. Role of Echinocandins as Antifungal Prophylaxis Agents in Lung Transplant Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Khan B, Husain S, Binnie M, Chow C, Martinu T, Chaparro C, Keshavjee S, Singer L, Tikkanen J. Impact of Prolonging CMV Prophylaxis in High Risk (CMV D+/R-) Lung Transplant Recipients. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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AlDabbagh MA, Gitman MR, Kumar D, Humar A, Rotstein C, Husain S. The Role of Antiviral Prophylaxis for the Prevention of Epstein-Barr Virus-Associated Posttransplant Lymphoproliferative Disease in Solid Organ Transplant Recipients: A Systematic Review. Am J Transplant 2017; 17:770-781. [PMID: 27545492 DOI: 10.1111/ajt.14020] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 01/25/2023]
Abstract
The role of antiviral prophylaxis for the prevention of posttransplant lymphoproliferative disease (PTLD) remains controversial for solid organ transplantation (SOT) recipients who are seronegative for Epstein-Barr virus (EBV) but who received organs from seropositive donors. We performed a systematic review and meta-analysis to address this issue. Two independent assessors extracted data from studies after determining patient eligibility and completing quality assessments. Overall, 31 studies were identified and included in the quantitative synthesis. Nine studies were included in the direct comparisons (total 2366 participants), and 22 were included in the indirect analysis. There was no significant difference in the rate of EBV-associated PTLD in SOT recipients among those who received prophylaxis (acyclovir, valacyclovir, ganciclovir, valganciclovir) compared with those who did not receive prophylaxis (nine studies; risk ratio 0.95, 95% confidence interval 0.58-1.54). No significant differences were noted across all types of organ transplants, age groups, or antiviral use as prophylaxis or preemptive therapy. There was no significant heterogeneity in the effect of antiviral prophylaxis on the incidence of PTLD. In conclusion, the use of antiviral prophylaxis in high-risk EBV-naive patients has no effect on the incidence of PTLD in SOT recipients.
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Husain S. Poor association between neonatal morbidity and long-term outcome. BJOG 2017; 124:1079. [PMID: 28158938 DOI: 10.1111/1471-0528.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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55
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Abdelwarith A, Alsaleh K, Abdelaziz N, Ali A, Elsamany S, Rasmy A, Elfarargy O, Husain S, Rikabi A. A multicenter study of the impact of body mass index (BMI) on the incidence of pathologic complete response (pCR) among Saudi patients with locally advanced breast cancer (LABC) post neoadjuvant chemotherapy (NCth). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bhimji A, Singer L, Kumar D, Humar A, Pavan R, Zhang H, Rotstein C, Keshavjee S, Mazzulli T, Husain S. Feasibility of Detecting Fungal DNA in Exhaled Breath Condensate by the Luminex Multiplex xTAG Fungal PCR Assay in Lung transplant Recipients: A Pilot Study. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hamandi B, Fegbeutel C, Silveira F, Verschuuren E, Ussetti P, Chin-Hong P, Sole A, Holmes-Liew C, Billaud E, Grossi P, Manuel O, Levine D, Barbers R, Hadjiliadis D, Singer L, Husain S. Universal Versus Culture-Directed Pre-Emptive Treatment (CDPET) among Lung Transplant Recipients: A Propensity-Score Matched Analysis. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nakajima D, Cypel M, Bonato R, Machuca TN, Iskender I, Hashimoto K, Linacre V, Chen M, Coutinho R, Azad S, Martinu T, Waddell TK, Hwang DM, Husain S, Liu M, Keshavjee S. Ex Vivo Perfusion Treatment of Infection in Human Donor Lungs. Am J Transplant 2016; 16:1229-37. [PMID: 26730551 DOI: 10.1111/ajt.13562] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/17/2015] [Accepted: 10/04/2015] [Indexed: 01/25/2023]
Abstract
Ex vivo lung perfusion (EVLP) is a platform to treat infected donor lungs with antibiotic therapy before lung transplantation. Human donor lungs that were rejected for transplantation because of clinical concern regarding infection were randomly assigned to two groups. In the antibiotic group (n = 8), lungs underwent EVLP for 12 h with high-dose antibiotics (ciprofloxacin 400 mg or azithromycin 500 mg, vancomycin 15 mg/kg, and meropenem 2 g). In the control group (n = 7), lungs underwent EVLP for 12 h without antibiotics. A quantitative decrease in bacterial counts in bronchoalveolar lavage (BAL) was found in all antibiotic-treated cases but in only two control cases. Perfusate endotoxin levels at 12 h were significantly lower in the antibiotic group compared with the control group. EVLP with broad-spectrum antibiotic therapy significantly improved pulmonary oxygenation and compliance and reduced pulmonary vascular resistance. Perfusate endotoxin levels at 12 h were strongly correlated with levels of perfusates tumor necrosis factor α, IL-1β and macrophage inflammatory proteins 1α and 1β at 12 h. In conclusion, EVLP treatment of infected donor lungs with broad-spectrum antibiotics significantly reduced BAL bacterial counts and endotoxin levels and improved donor lung function.
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Husain S, Lyons B, Hanson K, Whorton A. MEDICAL CONTROL FOR EMTS. King County, Wash., program offers safety net for patients, EMTs and the EMS system. JEMS : A JOURNAL OF EMERGENCY MEDICAL SERVICES 2016; 41:34-36. [PMID: 27008728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Beg MU, Al-Jandal N, Al-Subiai S, Karam Q, Husain S, Butt SA, Ali A, Al-Hasan E, Al-Dufaileej S, Al-Husaini M. Metallothionein, oxidative stress and trace metals in gills and liver of demersal and pelagic fish species from Kuwaits' marine area. MARINE POLLUTION BULLETIN 2015; 100:662-672. [PMID: 26231068 DOI: 10.1016/j.marpolbul.2015.07.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 07/02/2015] [Accepted: 07/25/2015] [Indexed: 06/04/2023]
Abstract
Two fish species yellowfin seabream (Acanthopagrus latus) and tonguesole (Cynoglossus arel) were collected from two locations in Kuwait's territorial waters in non-reproductive periods and used as bio-indicator organism for the assessment of metals in the marine environment. Species variation in fish was observed; seabream contained high metal content and metallothionein in liver and gill tissues compared to tonguesole, especially from Kuwait Bay area. Oxidative injury was registered in the gills of both species, but in tonguesole liver was also involved. Consequently, antioxidant enzyme catalase was elevated in tonguesole enabling bottom dwelling fish to combat oxidative assault. The study provided information about the current status of metals in marine sediment and levels of metals accumulated in representative species along with oxidative damage in exposed tissues and the range of biomarker protein metallothionein and enzymes of antioxidant defence mechanism enhancing our understanding about the biological response to the existing marine environment in Kuwait.
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Kudenchuk PJ, Stuart R, Husain S, Fahrenbruch C, Eisenberg M. Treatment and outcome of out-of-hospital cardiac arrest in outpatient health care facilities. Resuscitation 2015; 97:97-102. [PMID: 26476198 DOI: 10.1016/j.resuscitation.2015.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022]
Abstract
AIM We evaluated the frequency and effectiveness of basic and advanced life support (ALS) interventions by medical professionals when out-of-hospital cardiac arrest (OHCA) occurred in ambulatory healthcare clinics before emergency medical services (EMS) arrival. METHODS Non-traumatic OHCAs in adults were systematically characterized over a 15 year period by their occurrence in clinics, at home, or in non-medical public locations, and outcomes compared between matched cohorts from each group. RESULTS Among 7784 patients, 6098 OHCA occurred at home, 1612 in non-medical public locations and 74 in clinics. Compared to non-medical public locations, clinic patients with OHCA were older, more often women and more frequently shocked; clinic arrests were more often witnessed, less likely to be of cardiac cause and to occur before EMS arrival. Compared to home, more clinic arrests were witnessed, occurred after EMS arrival, had bystander CPR, shockable rhythms and were defibrillated. When OHCA occurred before EMS arrival, 51 of 56 clinic patients (91%) received CPR, a defibrillator applied to 23 (41%), 17 (30%) were shocked, 4 (7%) intubated, and 7 (13%) received intravenous medications from facility personnel. Of these, only pre-EMS defibrillator use was associated with improved outcome. Among matched patients, OHCA survival was higher in clinics than at home (42% vs 26%, p=0.029), but comparable to other public locations. CONCLUSIONS Survival from OHCA in clinics was comparable to non-medical public locations, and higher than at home. Alongside CPR, use of defibrillators was associated with improved survival and worth prioritizing over other interventions before EMS arrival regardless of OHCA location.
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Al-Mogairen SM, Al Sheikh A, Husain S, Al Arfaj AS, Al Swat K, Hamdani M, Hefnawy M, Al Mohimed B, Al Hammad AW, Adam M, Gad El Rab MO, Sheikh SA, Meo SA. Effect of exposure to silica in inducing autoimmune hepatitis: an experimental animal-controlled study. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2015; 19:3881-3885. [PMID: 26531274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this experimental study is to investigate the effect of subcutaneous and oral sodium silicate in inducing the autoimmune hepatitis. MATERIALS AND METHODS Twelve Brown Norway rats were studied, six rats were challenged with Sodium Silicate and the rest were challenged with normal saline as a control group. At 14th week post-sodium silicate or normal saline exposure, the rats were sacrificed. Histopathological studies were conducted in six positive autoantibodies responding silicate group rats and then compared with an equal number of negative autoantibodies responding control rats. RESULTS The liver findings from sodium silicate group of animals showed a histopathological reaction in 3/6 (50%) compared with 0/6 of the corresponding control saline group (p = 0.09). However, the absolute differences in the percentage between the two groups was 50%, the subcutaneous sodium silicate sub-group showed hepatic tissue response close to being statistically significant level (p = 0.05). CONCLUSIONS After correlating the results with autoantibodies including serum antinuclear antibodies and anti ribo-nucleoprotein response of the same rats, it is concluded that sodium silicate play a role in inducing the autoimmune hepatitis in a genetically susceptible rat model.
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Akseer N, Kamali M, Husain S, Mirza M, Bakhache N, Bhutta ZA. Strategies to avert preventable mortality among mothers and children in the Eastern Mediterranean Region: new initiatives, new hope. EASTERN MEDITERRANEAN HEALTH JOURNAL 2015; 21:361-73. [PMID: 26343127 DOI: 10.26719/2015.21.5.361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We conducted an assessment of maternal, newborn and child health and progress towards achieving Millennium Development Goals (MDG) 4 and 5 in the Eastern Mediterranean Region (EMR). We provide recommendations for scaling up and sustaining gains post-2015. Data were obtained from global data repositories. We constructed time trends from 1990 to 2013 and evaluated inequities across the Region. Under-5, neonatal and maternal mortality rates decreased 46%, 35%, and 50% respectively from 1990 to 2013. Pneumonia and diarrhoea accounted for 50% of all post-neonatal deaths; pregnancy- and delivery-related complications were the leading causes of neonatal and maternal deaths. Coverage of maternal, newborn and child health interventions is suboptimal, and poverty, food insecurity and conflict are pervasive across the Region. The EMR has made progress but is unlikely to attain MDG 4 and 5 targets. To sustain and further accelerate gains, the Region must reduce inequities and scale up implementation of recommendations made by the independent Expert Review Group.
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Lisboa LF, Egli A, Fairbanks J, O'Shea D, Manuel O, Husain S, Kumar D, Humar A. CCL8 and the Immune Control of Cytomegalovirus in Organ Transplant Recipients. Am J Transplant 2015; 15:1882-92. [PMID: 25764912 DOI: 10.1111/ajt.13207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/03/2014] [Accepted: 12/24/2014] [Indexed: 02/06/2023]
Abstract
Monitoring of cytomegalovirus cell-mediated immunity is a promising tool for the refinement of preventative and therapeutic strategies posttransplantation. Typically, the interferon-γ response to T cell stimulation is measured. We evaluated a broad range of cytokine and chemokines to better characterize the ex vivo host-response to CMV peptide stimulation. In a cohort of CMV viremic organ transplant recipients, chemokine expression-specifically CCL8 (AUC 0.849 95% CI 0.721-0.978; p = 0.003) and CXCL10 (AUC 0.841, 95% CI 0.707-0.974; p = 0.004)-was associated with control of viral replication. In a second cohort of transplant recipients at high-risk for CMV, the presence of a polymorphism in the CCL8 promoter conferred an increased risk of viral replication after discontinuation of antiviral prophylaxis (logrank hazard ratio 3.6; 95% CI 2.077-51.88). Using cell-sorting experiments, we determined that the primary cell type producing CCL8 in response to CMV peptide stimulation was the monocyte fraction. Finally, in vitro experiments using standard immunosuppressive agents demonstrated a dose-dependent reduction in CCL8 production. Chemokines appear to be important elements of the cell-mediated response to CMV infection posttransplant, as here suggested for CCL8, and translation of this knowledge may allow for the tailoring and improvement of preventative strategies.
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Taggar A, Martell K, Sia M, Angyalfi S, Husain S. OC-0132: Biochemical failure in low and intermediate risk prostate cancer patients after LDR Brachytherapy appear similar. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nakajima D, Cypel M, Bonato R, Machuca T, Iskender I, Linacre V, Chen M, Waddell T, Martinu T, Liu M, Husain S, Keshavjee S. Correlation Between Bacterial Count and Levels of Endotoxin and Inflammatory Mediators During Ex Vivo Treatment of Infection in Human Donor Lungs. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kabbani D, Kozlowski H, Chaparro C, Singer L, Rotstein C, Keshavjee S, Husain S. Lung Transplant Recipients (LTRs) With Granulomas in the Explanted Lungs: Assessment of Outcomes Related to Non-Tuberculous Mycobacteria. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Martell K, Sia M, Angyalfi S, Husain S. PO-1043: Parameters predicting for PSA response rates at one year post low dose rate intraoperative prostate brachytherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mumtaz K, Faisal N, Husain S, Morillo A, Renner EL, Shah PS. Universal prophylaxis or preemptive strategy for cytomegalovirus disease after liver transplantation: a systematic review and meta-analysis. Am J Transplant 2015; 15:472-81. [PMID: 25522141 DOI: 10.1111/ajt.13044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/24/2014] [Accepted: 09/28/2014] [Indexed: 02/06/2023]
Abstract
We systematically reviewed and meta-analyze the efficacy of universal prophylaxis (UP) and preemptive (PE) strategies (using ganciclovir or valganciclovir) in preventing cytomegalovirus (CMV) disease (CMD) among liver transplant recipients (LTRs). We performed an electronic search of MEDLINE, EMBASE and the Cochrane Database till December 2013. Studies that assessed UP or PE for preventing CMD in LTRs were included. The risk of bias was assessed using the Newcastle-Ottawa scale. The primary outcome was CMD, secondary outcomes being acute cellular rejection (ACR), graft loss (GL) and mortality. Due to the heterogeneity of comparative studies, an indirect comparison was performed. Pooled incidence rates with 95% confidence interval (CI) are calculated for each outcome using a random-effects model. Thirty-two studies involving 2456 LTRs were included. The majority of the studies were of low risk of bias. Irrespective of donor/recipient CMV sero-status, CMD was 10% with UP (95% CI: 6-14; I(2) = 87%; 16 studies, n = 1581) and 7% with PE (95% CI: 3-10; I(2) = 84%; 16 studies, n = 875) (mean difference 2.6; 95% CI: -3.25 to 8.45, p = 0.34). Likewise, ACR and mortality were similar with the two strategies. However, GL was significantly lower in the UP group, regardless of donor/recipient sero-status. In indirect comparison, the incidence of CMD, ACR and mortality in LTRs were similar with two strategies. Trials comparing the two strategies directly are needed.
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Shalhoub S, Luong ML, Howard SJ, Richardson S, Singer LG, Chaparro C, Keshavjee S, Akinlolu Y, Rotstein C, Mazzulli T, Husain S. Rate of cyp51A mutation in Aspergillus fumigatus among lung transplant recipients with targeted prophylaxis. J Antimicrob Chemother 2015; 70:1064-7. [PMID: 25604745 DOI: 10.1093/jac/dku528] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The most common mechanism of azole (itraconazole and voriconazole) resistance in Aspergillus fumigatus is a mutation at the cyp51A locus. The aim of our study was to determine the rate of cyp51A mutations in lung transplant recipients (LTR) undergoing targeted antifungal prophylaxis with 12 weeks of voriconazole. METHODS We conducted a prospective study that included 22 LTR with A. fumigatus between October 2008 and November 2011. Of those, 10 LTR were colonized with A. fumigatus and 12 had invasive pulmonary aspergillosis. RESULTS Four patients were found to have A. fumigatus isolates with a cyp51A mutation, two had colonization and two had invasive pulmonary aspergillosis. The remaining 18 LTR had WT cyp51A A. fumigatus isolates. All A. fumigatus isolates (except one due to mixed growth) were tested for antifungal susceptibility. A total of nine LTR were exposed to azoles prior to A. fumigatus isolation for a median duration of 249 (IQR 99-524) days. Azole exposure preceded the isolation of two mutant isolates and seven WT isolates. None of the cyp51A mutant isolates conferred phenotypic resistance to azoles. CONCLUSIONS Targeted antifungal prophylaxis in LTR did not lead to cyp51A resistance mutations in this cohort. Data on larger cohorts who receive universal antifungal prophylaxis are needed.
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Liu D, Meyer T, Usmani N, Kay I, Husain S, Angyalfi S, Sloboda R. Poster - Thur Eve - 77: Implanted Brachythearpy Seed Movement due to Transrectal Ultrasound Probe-Induced Prostate Deformation. Med Phys 2014. [DOI: 10.1118/1.4894938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Watt E, Long K, Husain S, Meyer T. Sci-Fri PM: Topics - 02: Evaluation of Dosimetric Variations in Partial Breast Seed Implant (PBSI) due to Patient Arm Position (Up vs. Down). Med Phys 2014. [DOI: 10.1118/1.4894948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Fernandez-Ruiz M, Kumar D, Husain S, Lilly L, Renner E, Mazzulli T, Moussa G, Humar A. Utility of a Monitoring Strategy for Human Herpesviruses 6 and 7 Viremia in Liver Transplant Recipients: A Randomized Clinical Trial. Transplantation 2014. [DOI: 10.1097/00007890-201407151-02645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu D, Meyer T, Usmani N, Kay I, Husain S, Angyalfi S, Sloboda R. WE-A-17A-11: Implanted Brachytherapy Seed Movement Due to Transrectal Ultrasound Probe-Induced Prostate Deformation. Med Phys 2014. [DOI: 10.1118/1.4889381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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75
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Katchman E, Marquez M, Bazerbachi F, Grant D, Cattral M, Low CY, Renner E, Humar A, Selzner M, Ghanekar A, Rotstein C, Husain S. A comparative study of the use of selective digestive decontamination prophylaxis in living-donor liver transplant recipients. Transpl Infect Dis 2014; 16:539-47. [PMID: 24862338 DOI: 10.1111/tid.12235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 08/28/2013] [Accepted: 02/05/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Bacterial infections are major causes of early morbidity and mortality after liver transplantation. Selective digestive decontamination (SDD) can be used pre-operatively for living-donor liver transplant (LD-LT), but its role in this setting remains controversial. METHODS To evaluate this strategy, we retrospectively analyzed a cohort of consecutive LD-LTs performed in our center from March 2007 to February 2011 and compared the incidence and nature of early infectious complications, length of intensive care unit stay and hospitalization, antibiotic use, and emergence of resistant bacteria in patients with or without SDD prophylaxis. RESULTS Of 148 LD-LTs in the study period, 111 received SDD prophylaxis while 37 did not. In a multivariate model, the independent factors associated with an increased risk of early post-transplant infections were length of postoperative mechanical ventilation (for every additional day odds ratio [OR] = 2.37, 95% confidence interval [CI] 1.4-4.0; P = 0.002), and choledochojejunostomy (OR = 4.5, 95% CI 1.95-10.5; P < 0.001). Use of SDD did not affect the rate or distribution of infectious complications, duration of hospitalization, antibiotic use, or acquisition of resistant bacteria (OR = 3.52, 95% CI 0.43-15.17; P = 0.376). CONCLUSION In conclusion, the use of SDD prophylaxis in LD-LT was not beneficial and should be avoided, as it offers no advantage and could potentiate the emergence of multidrug-resistant organisms.
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