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Yang J, Li J, Zhang L, Shen Z, Xiao Y, Zhang G, Chen M, Chen F, Liu L, Wang Y, Chen L, Wang X, Zhang L, Wang L, Wang Z, Wang J, Li M, Ren L. Highly diverse sputum microbiota correlates with the disease severity in patients with community-acquired pneumonia: a longitudinal cohort study. Respir Res 2024; 25:223. [PMID: 38811936 PMCID: PMC11137881 DOI: 10.1186/s12931-024-02821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a common and serious condition that can be caused by a variety of pathogens. However, much remains unknown about how these pathogens interact with the lower respiratory commensals, and whether any correlation exists between the dysbiosis of the lower respiratory microbiota and disease severity and prognosis. METHODS We conducted a retrospective cohort study to investigate the composition and dynamics of sputum microbiota in patients diagnosed with CAP. In total, 917 sputum specimens were collected consecutively from 350 CAP inpatients enrolled in six hospitals following admission. The V3-V4 region of the 16 S rRNA gene was then sequenced. RESULTS The sputum microbiota in 71% of the samples were predominately composed of respiratory commensals. Conversely, 15% of the samples demonstrated dominance by five opportunistic pathogens. Additionally, 5% of the samples exhibited sterility, resembling the composition of negative controls. Compared to non-severe CAP patients, severe cases exhibited a more disrupted sputum microbiota, characterized by the highly dominant presence of potential pathogens, greater deviation from a healthy state, more significant alterations during hospitalization, and sparser bacterial interactions. The sputum microbiota on admission demonstrated a moderate prediction of disease severity (AUC = 0.74). Furthermore, different pathogenic infections were associated with specific microbiota alterations. Acinetobacter and Pseudomonas were more abundant in influenza A infections, with Acinetobacter was also enriched in Klebsiella pneumoniae infections. CONCLUSION Collectively, our study demonstrated that pneumonia may not consistently correlate with severe dysbiosis of the respiratory microbiota. Instead, the degree of microbiota dysbiosis was correlated with disease severity in CAP patients.
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Affiliation(s)
- Jing Yang
- Beijing Institute of Genomics, Chinese Academy of Sciences, China National Center for Bioinformation, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Changping Laboratory, Beijing, 102206, China
| | - Jinman Li
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Linfeng Zhang
- Beijing Institute of Genomics, Chinese Academy of Sciences, China National Center for Bioinformation, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Zijie Shen
- Beijing Institute of Genomics, Chinese Academy of Sciences, China National Center for Bioinformation, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yan Xiao
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Respiratory Health and Multimorbidity, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Guoliang Zhang
- Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Mingwei Chen
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Fuhui Chen
- The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Ying Wang
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Lan Chen
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xinming Wang
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Li Zhang
- Beijing Institute of Genomics, Chinese Academy of Sciences, China National Center for Bioinformation, Beijing, 100101, China
| | - Lu Wang
- Beijing Institute of Genomics, Chinese Academy of Sciences, China National Center for Bioinformation, Beijing, 100101, China
| | - Zhang Wang
- Institute of Ecological Sciences, South China Normal University, Guangzhou, 510631, China
| | - Jianwei Wang
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Mingkun Li
- Beijing Institute of Genomics, Chinese Academy of Sciences, China National Center for Bioinformation, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Lili Ren
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, National Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Fujiwara S, Akaishi R, Yokosawa T, Suzuki H, Hoshida T. Coagulopathy Induced by Antibiotics Usage and Bowel Obstruction With Colon Cancer: Report of a Rare Case. Cureus 2024; 16:e52865. [PMID: 38406074 PMCID: PMC10889475 DOI: 10.7759/cureus.52865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
This case report presents a rare occurrence of coagulopathy induced by antibiotics in a woman in her 90s with chronic bowel obstruction and massive colon cancer. The patient developed vitamin K deficiency-related coagulopathy following antibiotic administration, resulting in bleeding complications. Despite initial consideration of disseminated intravascular coagulation, further investigations revealed antibiotic-induced vitamin K deficiency. Prompt discontinuation of antibiotics and IV vitamin K2 administration led to the resolution of coagulopathy. The case emphasizes the importance of cautious antibiotic use in patients with chronic bowel obstruction and prolonged fasting. The protein induced by vitamin K absence-II (PIVKA-II) proved valuable in diagnosing vitamin K deficiency. The learning points include the potential for coagulopathy with antibiotics in prolonged bowel obstruction and the utility of PIVKA-II in assessing vitamin K deficiency. Healthcare providers should exercise caution when administering antibiotics in similar clinical scenarios.
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Affiliation(s)
- Sho Fujiwara
- Surgery, Iwate Prefectural Ofunato Hospital, Ofunato, JPN
- Surgery, Columbia University Irving Medical Center, New York, USA
| | | | - Tomoki Yokosawa
- Emergency and Critical Care, Iwate Prefectural Ofunato Hospital, Ofunato, JPN
| | - Hiroshi Suzuki
- Surgery, Iwate Prefectural Ofunato Hospital, Ofunato, JPN
| | - Toru Hoshida
- Surgery, Iwate Prefectural Ofunato Hospital, Ofunato, JPN
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Liu L, Chen CH, Rong SW, Lin SZ, Cai NL, Ao D. Antenatal steroid as an independent risk factor for vitamin K2 deficiency in newborns: A Chinese single-center, retrospective study. Saudi Med J 2023; 44:788-794. [PMID: 37582573 PMCID: PMC10425624 DOI: 10.15537/smj.2023.44.8.20230084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVES To identified vitamin K2 deficiency rate and risk factors among newborns in China and assess the importance of high-risk maternal intakes of vitamin K2. METHODS This retrospective study was performed at the Neonatology Department, the Affiliated Hospital of Guangdong Medical University, China. Routinely collected mother-neonate hospitalization data from July 2020 to January 2021 were analyzed. In total, data from 200 neonates who had completed vitamin K2 tests were utilized to assess the prevalence of vitamin K2 deficiency and identify the potential risk factors. According to the vitamin K2 level, the neonates were divided into 2 groups: cases (vitamin K2 deficiency) and controls (no vitamin K2 deficiency). The potential risk factors for vitamin K2 deficiency were evaluated by univariate and multivariate logistic regression. RESULTS The vitamin K2 level in 24 of the 200 neonates was undetectable (<0.05 ng/mL). The prevalence of low serum vitamin K2 (<0.1 ng/ml) was 33%. Study subjects with antenatal corticosteroids use had an approximately 5-fold greater risk of developing vitamin K2 deficiency. In the univariate analyses, small-for-gestational-age (SGA), caesarean section, maternal gestational diabetes and premature rupture of the membranes were risk factors for vitamin K2 deficiency. In the multivariate logistic regression analysis, high antenatal corticosteroids use, cesarean section, and SGA were independently associated with vitamin K2 deficiency. CONCLUSION The present study demonstrated that antenatal corticosteroids use is independently associated with vitamin K2 deficiency. This finding highlights the importance of routine vitamin K2 supplementation in late-stage pregnant women and neonates in China.
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Affiliation(s)
- Ling Liu
- From the Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Chao-Hong Chen
- From the Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Shi-Wen Rong
- From the Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Shao-Zhu Lin
- From the Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Na-Li Cai
- From the Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Dang Ao
- From the Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
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Wu Q, Wang L, Zhao R. Neglected vitamin K deficiency causing coagulation dysfunction in an older patient with pneumonia: a case report. BMC Geriatr 2022; 22:628. [PMID: 35907829 PMCID: PMC9338575 DOI: 10.1186/s12877-022-03327-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The development of coagulation disorders can be dangerous and fatal in the older people, especially those with multiple medical conditions. Vitamin K-dependent coagulation disorders are easily overlooked when anticoagulant drugs are not used and the patient shows no signs of bleeding. CASE PRESENTATION We report a case of a 71-year-old male suffering from pulmonary infection with severe coagulation disorder without bleeding symptoms. He also had a history of Parkinson's disease, Alzheimer's disease and cardiac insufficiency. Coagulation tests were normal at the time of admission, prothrombin time (PT) is 13.9 (normal, 9.5-13.1) seconds and the activated partial thromboplastin time (APTT) is 30.2 (normal, 25.1-36.5) seconds. But it turned severely abnormal after 20 days (PT: 136.1 s, APTT: 54.8 s). However, no anticoagulants such as warfarin was used and no bleeding symptoms were observed. Subsequent mixing studies with normal plasma showed a decrease in prothrombin times. Vitamin K deficiency was thought to be the cause of coagulation disorders considering long-term antibiotic therapy, especially cephalosporins, inadequate diet and abnormal liver function. After supplementation with 20 mg of vitamin K, coagulation dysfunction was rescued the next day and serious consequences were effectively prevented. CONCLUSIONS Overall, timely vitamin K supplementation with antimicrobials that affect vitamin K metabolism requires clinician attention, especially in older patients who are multimorbid, frail or nutritionally compromised, and are admitted to hospital because of an infection that needs antimicrobial therapy are at risk of clotting disorders due to abnormal vitamin K metabolism secondary to altered gut flora, which can exacerbate existing nutritional deficiencies.
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Affiliation(s)
- Qiaoping Wu
- Clinical Laboratory of Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Street, Ningbo, Zhejiang Province, China
| | - Lufeng Wang
- Clinical Laboratory of Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Street, Ningbo, Zhejiang Province, China
| | - Rongqing Zhao
- Clinical Laboratory of Ningbo Medical Centre Lihuili Hospital, Ningbo University, 1111 Jiangnan Street, Ningbo, Zhejiang Province, China.
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Zhang Y, Lu X, Tang LV. Prophylaxis use of vitamin K1 improves coagulation function in hematopoietic stem cell transplantation patients: a retrospective cohort study. Am J Transl Res 2022; 14:1729-1736. [PMID: 35422932 PMCID: PMC8991140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to investigate the efficacy of vitamin K1 in patients undergoing HSCT and find a feasible and safe option for HSCT patients to prevent bleeding. METHODS A retrospective analysis was performed on 96 HSCT patients admitted to the Department of Hematology of Wuhan Union Hospital from January 2018 to July 2019. Patients were divided into two groups (the vitamin K1 group and the control group) based on the administration of vitamin K1. All patients were reexamined for coagulation function during their hospitalization. The prothrombin time (PT), activated partial thromboplastin time (APTT), and plasma fibrinogen (FIB) were measured. The relationship between plasma infusion volumes were also analyzed. RESULTS In the independent sample T-test analysis, PT and APTT of the vitamin K1 group were significantly shorter than that of the control group after transplantation. There was no obvious difference in plasma FIB levels between the two groups. Total plasma infused volume in the vitamin K1 group was significantly lower than that in the control group. CONCLUSIONS Prophylactic intravenous drip of vitamin K1 has a good therapeutic effect on improving the coagulation function in HSCT patients without significant side effects and decreases the plasma transfusion.
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Savarino G, Corsello A, Corsello G. Macronutrient balance and micronutrient amounts through growth and development. Ital J Pediatr 2021; 47:109. [PMID: 33964956 PMCID: PMC8106138 DOI: 10.1186/s13052-021-01061-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
Nutrition is essential for human growth, particularly in newborns and children. An optimal growth needs a correct diet, in order to ensure an adequate intake of macronutrients and micronutrients. Macronutrients are the compounds that humans consume in largest quantities, mainly classified in carbohydrates, proteins and fats. Micronutrients are instead introduced in small quantities, but they are required for an adequate growth in the pediatric age, especially zinc, iron, vitamin D and folic acid. In this manuscript we describe the most important macro and micronutrients for children's growth.
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Affiliation(s)
- Giovanni Savarino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P.Giaccone", Palermo, Italy.
| | - Antonio Corsello
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Milan, Italy
| | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P.Giaccone", Palermo, Italy
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7
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Vitamin K Analogs Influence the Growth and Virulence Potential of Enterohemorrhagic Escherichia coli. Appl Environ Microbiol 2020; 86:AEM.00583-20. [PMID: 32769190 DOI: 10.1128/aem.00583-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Enterohemorrhagic Escherichia coli (EHEC) causes serious foodborne disease worldwide. It produces the very potent Shiga toxin 2 (Stx2). The Stx2-encoding genes are located on a prophage, and production of the toxin is linked to the synthesis of Stx phages. There is, currently, no good treatment for EHEC infections, as antibiotics may trigger lytic cycle activation of the phages and increased Stx production. This study addresses how four analogs of vitamin K, phylloquinone (K1), menaquinone (K2), menadione (K3), and menadione sodium bisulfite (MSB), influence growth, Stx2-converting phage synthesis, and Stx2 production by the EHEC O157:H7 strain EDL933. Menadione and MSB conferred a concentration-dependent negative effect on bacterial growth, while phylloquinone or menaquinone had little and no effect on bacterial growth, respectively. All four vitamin K analogs affected Stx2 phage production negatively in uninduced cultures and in cultures induced with either hydrogen peroxide (H2O2), ciprofloxacin, or mitomycin C. Menadione and MSB reduced Stx2 production in cultures induced with either H2O2 or ciprofloxacin. MSB also had a negative effect on Stx2 production in two other EHEC isolates tested. Phylloquinone and menaquinone had, on the other hand, variable and concentration-dependent effects on Stx2 production. MSB, which conferred the strongest inhibitory effect on both Stx2 phage and Stx2 production, improved the growth of EHEC in the presence of H2O2 and ciprofloxacin, which could be explained by the reduced uptake of ciprofloxacin into the bacterial cell. Together, the data suggest that vitamin K analogs have a growth- and potential virulence-reducing effect on EHEC, which could be of therapeutic interest.IMPORTANCE Enterohemorrhagic E. coli (EHEC) can cause serious illness and deaths in humans by producing toxins that can severely damage our intestines and kidneys. There is currently no optimal treatment for EHEC infections, as antibiotics can worsen disease development. Consequently, the need for new treatment options is urgent. Environmental factors in our intestines can affect the virulence of EHEC and help our bodies fight EHEC infections. The ruminant intestine, the main reservoir for EHEC, contains high levels of vitamin K, but the levels are variable in humans. This study shows that vitamin K analogs can inhibit the growth of EHEC and/or production of its main virulence factor, the Shiga toxin. They may also inhibit the spreading of the Shiga toxin encoding bacteriophage. Our findings indicate that vitamin K analogs have the potential to suppress the development of serious disease caused by EHEC.
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Nwaedozie ST, Najjar Mojarrab J, Svoboda DC, Medani A. Hemorrhagic Pleural Effusion: A Rare Presentation of Vitamin K Deficiency in an Adult Patient. Cureus 2020; 12:e11374. [PMID: 33312776 PMCID: PMC7723393 DOI: 10.7759/cureus.11374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/30/2022] Open
Abstract
Nutritionally acquired vitamin K deficiency is a rare condition in adults and can uncommonly present as hemorrhagic pleural effusion. We discuss the case of A 44-year-old apparently healthy man who presented with left-sided pleuritic chest pain two months after experiencing upper respiratory tract symptoms. Imaging revealed a loculated left-sided effusion, and a corresponding thoracentesis yielded exudative hemorrhagic fluid with no microbial growth. Laboratory work-up showed prolonged clotting time with low factors II, VII, and X activity, absence of clotting factor inhibitors, and very low serum vitamin K levels. A five-day course of oral vitamin K and nutritional optimization normalized the clotting profile. Acquired vitamin K deficiency from poor micronutrient intake is rare in adults and can result in hemorrhagic pleural effusion. Vitamin K supplementation can normalize the clotting profile while nutritional counseling helps prevent a recurrence. Malnutrition-induced vitamin K deficiency can occur in the setting of a major depressive disorder in adults. Thorough patient history and physical examination are necessary to promptly identify and reverse the coagulopathy.
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Affiliation(s)
| | | | - Dillon C Svoboda
- Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Abuzaid Medani
- Hospital Medicine, Marshfield Medical Center, Marshfield, USA
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Pradhan R, Sharma Gautam J, Tinkari BS, Adhikari N, Bose AS. Vaccine safety surveillance informs public health policy beyond immunization: A case-series on bleeding following vaccination, Nepal, 2016-2018. Vaccine 2020; 38:6320-6326. [PMID: 32788134 PMCID: PMC7482439 DOI: 10.1016/j.vaccine.2020.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance for adverse events following immunization (AEFI) is important to monitor vaccine safety and should lead to appropriate responses to improve health and immunization program. Bleeding following vaccination is not recognized as an important AEFI. Without policy of vitamin K (VK) prophylaxis at birth, vitamin K deficiency bleeding (VKDB) could be an important cause of bleeding in young infants and may manifest as AEFI. METHODS We retrospectively analysed all serious AEFI cases that presented with external or internal bleeding reported to Nepal's AEFI surveillance system during 2016-2018. The cases were classified as VKDB, suspected VKDB or non-VKDB. RESULTS During the period, 16 serious AEFI with symptom or sign of bleeding were reported representing 21.3% of all serious AEFI reported. Cases were between 40 and 94 days of age. The National AEFI Investigation Committee classified all cases as coincidental. Fourteen cases (87.5%) had bleeding from injection site. Median time from vaccination to injection site bleeding was 4.3 h (interquartile range: 2.1-11.6 h). Six cases (37.5%) had intra-cranial haemorrhage. Only one case had confirmed history of receiving VK at birth. Ten cases (62.5%) received appropriate treatment (VK injection; blood transfusion if needed). Based on limited laboratory investigations available, three cases (18.75%) could be classified as late onset VKDB and 11 cases (68.75%) as suspected late onset VKDB. CONCLUSION VKDB should be suspected in young infants presenting with bleeding including following vaccination, and prompt treatment should be initiated. Bleeding following vaccination should be recognized as an important AEFI as even a small amount of blood loss in young infants can be catastrophic. We posit that this series is a small subset of VKDB cases in Nepal detected through AEFI surveillance system. In countries without policy of VK prophylaxis at birth including Nepal, the policy should be introduced.
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Affiliation(s)
| | - Jhalak Sharma Gautam
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
| | - Bhim Singh Tinkari
- Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
| | - Neelam Adhikari
- National AEFI Investigation Committee, C/O Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal
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Abstract
Vitamin K is essential for the synthesis of few coagulation factors. Infants can easily develop vitamin K deficiency owing to poor placental transfer, low vitamin K content in breast milk, and poor intestinal absorption due to immature gut flora and malabsorption. Vitamin K deficiency bleeding (VKDB) in infancy is classified according to the time of presentation: early (within 24 h), classic (within 1 week after birth), and late (between 2 week and 6 months of age). VKDB in infancy, particularly late-onset VKDB, can be life-threatening. Therefore, all infants, including newborn infants, should receive vitamin K prophylaxis. Exclusive breastfeeding and cholestasis are closely associated with this deficiency and result in late-onset VKDB. Intramuscular prophylactic injections reduce the incidence of early-onset, classic, and late-onset VKDB. However, the prophylaxis strategy has recently been inclined toward oral administration because it is easier, safer, and cheaper to administer than intramuscular injection. Several epidemiological studies have shown that vitamin K oral administration is effective in the prevention of VKDB in infancy; however, the success of oral prophylaxis depends on the protocol regimen and parent compliance. Further national surveillance and studies are warranted to reveal the optimal prophylaxis regimen in term and preterm infants.
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Dominguez-Bello MG, Godoy-Vitorino F, Knight R, Blaser MJ. Role of the microbiome in human development. Gut 2019; 68:1108-1114. [PMID: 30670574 PMCID: PMC6580755 DOI: 10.1136/gutjnl-2018-317503] [Citation(s) in RCA: 401] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/15/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022]
Abstract
The host-microbiome supraorganism appears to have coevolved and the unperturbed microbial component of the dyad renders host health sustainable. This coevolution has likely shaped evolving phenotypes in all life forms on this predominantly microbial planet. The microbiota seems to exert effects on the next generation from gestation, via maternal microbiota and immune responses. The microbiota ecosystems develop, restricted to their epithelial niches by the host immune system, concomitantly with the host chronological development, providing early modulation of physiological host development and functions for nutrition, immunity and resistance to pathogens at all ages. Here, we review the role of the microbiome in human development, including evolutionary considerations, and the maternal/fetal relationships, contributions to nutrition and growth. We also discuss what constitutes a healthy microbiota, how antimicrobial modern practices are impacting the human microbiota, the associations between microbiota perturbations, host responses and diseases rocketing in urban societies and potential for future restoration.
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Affiliation(s)
- Maria Gloria Dominguez-Bello
- Department of Biochemistry and Microbiology, Rutgers, the State University of New Jersey, New Brunswick, New Jersey, USA
| | - Filipa Godoy-Vitorino
- Department of Microbiology and Medical Zoology, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico, USA
| | - Rob Knight
- Department of Computer Science and Engineering, University of California, San Diego, California, USA
| | - Martin J Blaser
- Department of Medicine, New York University Langone Medical Center, New York City, New York, USA
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Gao L, Lin XZ, Wu QQ, Lin YC, Hong KY. [Coagulation function and hemorrhagic diseases in preterm infants with different gestational ages]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:120-124. [PMID: 30782272 PMCID: PMC7389837 DOI: 10.7499/j.issn.1008-8830.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the correlation between coagulation function and gestational age in preterm infants and the possible value of coagulation function measurement in predicting hemorrhagic diseases. METHODS The clinical data of preterm infants who were hospitalized between September 2016 and August 2017 were collected. The coagulation indicators were measured within 2 hours after birth. According to the gestational age, the preterm infants were divided into late preterm infant group (n=322), early preterm infant group (n=241) and extremely/very early preterm infant group (n=128). Coagulation function was compared among the three groups, as well as between the preterm infants with and without hemorrhagic diseases within 3 days after birth. RESULTS There were significant differences in thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP) and D-dimer (DD) among the three groups (P<0.05). APTT, PT, FDP and DD were negatively correlated with gestational age, while TT was positively correlated with gestational age (P<0.05). The preterm infants with hemorrhagic diseases had a longer APTT and a higher level of DD (P<0.05). CONCLUSIONS Coagulation function gradually becomes mature in preterm infants with the increase in gestational age. Abnormal APTT and DD indicate that preterm infants may have a higher risk of hemorrhagic diseases.
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Affiliation(s)
- Liang Gao
- Department of Neonatology, Xiamen Maternal and Child Health Care Hospital, Xiamen, Fujian 361000, China.
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Sun F, Adrian M, Beztsinna N, van den Dikkenberg JB, Maas-Bakker RF, van Hasselt PM, van Steenbergen MJ, Su X, Kapitein LC, Hennink WE, van Nostrum CF. Influence of PEGylation of Vitamin-K-Loaded Mixed Micelles on the Uptake by and Transport through Caco-2 Cells. Mol Pharm 2018; 15:3786-3795. [PMID: 30063364 PMCID: PMC6150738 DOI: 10.1021/acs.molpharmaceut.8b00258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the study is to investigate the uptake by and transport through Caco-2 cells of two mixed micelle formulations (based on egg phosphatidylcholine and glycocholic acid) of vitamin K, i.e., with and without DSPE-PEG2000. The uptake of vitamin K and fluorescently labeled mixed micelles with and without PEG coating showed similar kinetics and their uptake ratio remained constant over time. Together with the fact that an inhibitor of scavenger receptor B1 (BLT-1) decreased cellular uptake of vitamin K by ∼80% compared to the uptake in the absence of this inhibitor, we conclude that both types of micelles loaded with vitamin K can be taken up intactly by Caco-2 cells via this scavenger receptor. The amount of vitamin K in chylomicrons fraction from Caco-2 cell monolayers further indicates that mixed micelles (with or without PEGylation) are likely packed into chylomicrons after internalization by Caco-2 cells. Uptake of vitamin K from PEGylated mixed micelles increased four- to five-fold at simulated gastrointestinal conditions. In conclusion, PEGylated mixed micelles are stable upon exposure to simulated gastric conditions, and as a result, they do show overall a higher cellular uptake efficiency of vitamin K as compared to mixed micelles without PEG coating.
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Affiliation(s)
- Feilong Sun
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
| | - Max Adrian
- Cell Biology, Department of Biology, Faculty of Science , Utrecht University , 3584 CH Utrecht , The Netherlands
| | - Nataliia Beztsinna
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
| | - Joep B van den Dikkenberg
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
| | - Roel F Maas-Bakker
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
| | - Peter M van Hasselt
- Department of Pediatrics, Wilhelmina Children's Hospital , University Medical Center Utrecht , Lundlaan 6 , 3584 EA Utrecht , The Netherlands
| | - Mies J van Steenbergen
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
| | - Xiangjie Su
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
| | - Lukas C Kapitein
- Cell Biology, Department of Biology, Faculty of Science , Utrecht University , 3584 CH Utrecht , The Netherlands
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
| | - Cornelus F van Nostrum
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences , Utrecht University , 3584 CG Utrecht , The Netherlands
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14
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Panchaud A, Cohen JM, Patorno E, Huybrechts KF, Desai RJ, Gray KJ, Mogun H, Hernandez-Diaz S, Bateman BT. Anticonvulsants and the risk of perinatal bleeding complications: A pregnancy cohort study. Neurology 2018; 91:e533-e542. [PMID: 29980637 DOI: 10.1212/wnl.0000000000005944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/08/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the risk of postpartum hemorrhage (PPH) and neonatal bleeding complications associated with late-pregnancy exposure to anticonvulsant drugs (ACDs) that induce cytochrome P450 enzymes (ACDi) and alter the metabolism of vitamin K compared to other ACDs. METHODS We used a population-based cohort study stemming from a nationwide sample of publicly insured pregnant women with a liveborn infant from the 2000 to 2010 Medicaid Analytic eXtract. ACDi (carbamazepine, phenobarbital, phenytoin, oxcarbazepine, topiramate) were compared to other ACDs dispensed during the last month of pregnancy. Relative risks (RRs) and 95% confidence intervals (CIs) of PPH and neonatal bleeding complications were estimated using generalized linear models with fine stratification on the propensity score to control for indication and other potential confounders. RESULTS Among 11,572 women with an ACD prescription overlapping delivery, 2.6% (135/5,109) in the ACDi group and 3.6% (231/6,463) in the other ACDs group had a diagnosis of PPH: unadjusted RR 0.74 (95% CI 0.60-0.91), adjusted RR 0.77 (95% CI 0.58-1.00). The prevalence of neonatal bleeding complications was 3.1% (157/5,109) in the ACDi group and 3.5% (229/6,463) in the other ACDs group: unadjusted RR 0.87 (95% CI 0.71-1.06), adjusted RR 0.83 (95% CI 0.64-1.08). CONCLUSIONS Evidence from this large observational study suggests that use of ACDi near delivery does not increase the risk of bleeding complications compared to other ACDs in clinical settings where neonatal intramuscular or oral vitamin K administration is considered standard of care. These findings provide reassurance for clinicians and pregnant women successfully treated with ACDi.
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Affiliation(s)
- Alice Panchaud
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
| | - Jacqueline M Cohen
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Elisabetta Patorno
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Krista F Huybrechts
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Rishi J Desai
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Kathryn J Gray
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Helen Mogun
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Sonia Hernandez-Diaz
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
| | - Brian T Bateman
- From the Department of Epidemiology (A.P., J.M.C., S.H.-D.), Harvard T.H. Chan School of Public Health, Boston; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine (E.P., K.F.H., R.J.D., H.M., B.T.B.), and Department of Anesthesiology, Perioperative and Pain Medicine (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston; and Division of Maternal-Fetal Medicine (K.J.G.), Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA
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15
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Coffey PS, Gerth-Guyette E. Current perspectives and practices of newborn vitamin K administration in low and middle income countries. RESEARCH AND REPORTS IN NEONATOLOGY 2018; 8:45-51. [PMID: 33488138 PMCID: PMC7745116 DOI: 10.2147/rrn.s154652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background Vitamin K prophylaxis can prevent vitamin K deficiency bleeding (VKDB), and current global recommendations support universal prophylactic use in newborns. Data about access to and use of vitamin K in low and middle income countries (LMIC) are scarce. To address this gap, we explored current perspectives and practices of newborn vitamin K administration in LMIC in order to better understand the barriers to more widespread coverage of this lifesaving preventative treatment. Methods We conducted an online survey of stakeholders involved in newborn health. We sent the survey via e-mail to 109 individuals who were based primarily in LMIC and 23 responses were received, resulting in a response rate of 21%. Respondents were generally health or development professionals from sub-Saharan Africa and Asia. Results Incidence rates at the country level were mostly unknown or not supported by adequate data. Many respondents (17/23) indicated that vitamin K prophylaxis is included in their national newborn care guidelines and policies, while 12 respondents indicated that administration at birth was widely practiced. Around half of respondents reported that health workers were trained in the diagnosis and treatment of VKDB. The most frequently cited barriers to more widespread vitamin K prophylaxis were (in rank order) high rates of home birth (which preclude injections that must be given by skilled health workers), lack of access to and availability of vitamin K, perception that vitamin K prophylactic treatment is not a priority among health workers, lack of vitamin K formulations appropriate for infants, cultural practices suggesting that injection at birth is not acceptable to parents, and vitamin K not being included in national guidelines and policies. There was no consensus as to the ideal formulation, respondents preferring both the current intramuscular (IM) injection and oral formulation. Reported product attributes of IM and oral formulations are summarized. Conclusion Prophylactic administration of vitamin K to newborns is relatively well integrated into policy at the global and country levels, but its practice is underutilized. Barriers to use are access, supply chain logistics, provider attitudes, and restrictions on the use of injections by providers at the community level. Technology innovation may offer some promise to mitigate these barriers, although advocacy and health system strengthening might be more likely to yield improved coverage. Further investigation using in-depth bottleneck analysis at the country level could help identify specific health system improvements.
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16
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Marchili MR, Santoro E, Marchesi A, Bianchi S, Rotondi Aufiero L, Villani A. Vitamin K deficiency: a case report and review of current guidelines. Ital J Pediatr 2018. [PMID: 29540231 PMCID: PMC5853086 DOI: 10.1186/s13052-018-0474-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Vitamin K, a fat soluble vitamin, is a necessary cofactor for the activation of coagulation factors II, VII, IX, X, and protein C and S. In neonatal period, vitamin K deficiency may lead to Vitamin K Deficiency Bleeding (VKDB). Case presentation We present the case of a 2 months and 20 days Caucasian male, presented for bleeding from the injections sites of vaccines. At birth oral vitamin K prophylaxis was administered. Neonatal period was normal. He was exclusively breastfed and received a daily oral supplementation with 25 μg of vitamin K. A late onset vitamin K deficiency bleeding was suspected. Intravenous Vitamin K was administered with complete recovery. Conclusions Nevertheless the oral prophylaxis, our case developed a VKDB: it is necessary to revise the current guidelines in order to standardize timing and dosage in different clinical conditions.
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Affiliation(s)
- Maria Rosaria Marchili
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy.
| | - Elisa Santoro
- Pediatric Department, University of Tor Vergata, Rome, Italy
| | - Alessandra Marchesi
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Simona Bianchi
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Lelia Rotondi Aufiero
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
| | - Alberto Villani
- Pediatric and Infectious Disease Unit, Bambino Gesu' Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome, Italy
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17
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Yarrington CD, Radoff K, Zera CA. Online Birth Plans and Anticipatory Guidance: A Critical Review Using Web Analytics and Crowdsourcing. J Perinat Educ 2018; 27:32-37. [PMID: 30858679 DOI: 10.1891/1058-1243.27.1.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We assessed the content of online birth plans using Web analytics and crowdsourcing to identify the most commonly accessed online birth plans. We analyzed the first 14 websites of 6 different searches across time. We repeated this search using 200 individuals recruited by a commercial crowdsourcing service. We identified the 12 URLs that appeared most frequently from all searches then categorized the content by relevance to stages of labor or newborn care. Twenty-five different URLs with customizable birth plans were identified by clinical and crowdsourced searches, with considerable overlap. Among the most commonly identified birth plans, we found prompts for outdated practices in a minority (18%-37%). The majority of online birth plans can be positive tools for shared decision making.
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18
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Fujioka K, Fukushima S, Nishida K, Iijima K, Morioka I. Intraventricular Hemorrhage Due to Coagulopathy After Vitamin K Administration in a Preterm Infant With Maternal Crohn Disease. JAPANESE CLINICAL MEDICINE 2017; 8:1179670717746333. [PMID: 29344001 PMCID: PMC5764135 DOI: 10.1177/1179670717746333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022]
Abstract
Intraventricular hemorrhage (IVH) is a devastating morbidity in preterm infants and can result in poor neurodevelopmental outcomes. Intraventricular hemorrhage usually occurs within 72 hours after birth; post-acute-phase IVH (>1 week after birth) is uncommon. Development of the hemostatic system in fetuses and neonates is an age-dependent evolving process, and the neonatal hemostatic system is characterized by low levels of vitamin K-dependent factors, with further reduction caused by prematurity. Importantly, a severe coagulation deficiency can be a major contributing factor of IVH. Active maternal Crohn disease (CD) during pregnancy causes malnutrition via enteral malabsorption; this may include vitamin K deficiency, resulting in fetal vitamin K deficiency. We herein describe a preterm infant who was born to a mother with CD and developed post-acute-phase IVH due to coagulopathy despite vitamin K administration.
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Affiliation(s)
- Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sachiyo Fukushima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kosuke Nishida
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiro Morioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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19
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Engevik MA, Versalovic J. Biochemical Features of Beneficial Microbes: Foundations for Therapeutic Microbiology. Microbiol Spectr 2017; 5:10.1128/microbiolspec.BAD-0012-2016. [PMID: 28984235 PMCID: PMC5873327 DOI: 10.1128/microbiolspec.bad-0012-2016] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Indexed: 12/15/2022] Open
Abstract
Commensal and beneficial microbes secrete myriad products which target the mammalian host and other microbes. These secreted substances aid in bacterial niche development, and select compounds beneficially modulate the host and promote health. Microbes produce unique compounds which can serve as signaling factors to the host, such as biogenic amine neuromodulators, or quorum-sensing molecules to facilitate inter-bacterial communication. Bacterial metabolites can also participate in functional enhancement of host metabolic capabilities, immunoregulation, and improvement of intestinal barrier function. Secreted products such as lactic acid, hydrogen peroxide, bacteriocins, and bacteriocin-like substances can also target the microbiome. Microbes differ greatly in their metabolic potential and subsequent host effects. As a result, knowledge about microbial metabolites will facilitate selection of next-generation probiotics and therapeutic compounds derived from the mammalian microbiome. In this article we describe prominent examples of microbial metabolites and their effects on microbial communities and the mammalian host.
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Affiliation(s)
- Melinda A Engevik
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030 and Department of Pathology, Texas Children's Hospital, Houston, TX 77030
| | - James Versalovic
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030 and Department of Pathology, Texas Children's Hospital, Houston, TX 77030
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20
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Chambers JD, Anderson JE, Salem MN, Bügel SG, Fenech M, Mason JB, Weber P, West KP, Wilde P, Eggersdorfer M, Booth SL. The Decline in Vitamin Research Funding: A Missed Opportunity? Curr Dev Nutr 2017; 1:e000430. [PMID: 29955714 PMCID: PMC5998363 DOI: 10.3945/cdn.117.000430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/13/2017] [Accepted: 03/03/2017] [Indexed: 01/08/2023] Open
Abstract
Background: The National Nutrition Research Roadmap has called for support of greater collaborative, interdisciplinary research for multiple areas of nutrition research. However, a substantial reduction in federal funding makes responding to these calls challenging. Objectives: The objectives of this study were to examine temporal trends in research funding and to discuss the potential consequences of these trends. Methods: We searched the NIH RePORTER database to identify NIH research grants and USASpending to identify National Science Foundation and USDA research grants awarded from 1992 to 2015. We focused on those that pertained to vitamin research. For the years 2000 to 2015, we examined funding trends for different vitamins, including vitamins A, B (one-carbon B-vitamins were considered separately from other B-vitamins), C, D, E, and K. Results: From 1992 to 2015, total federal research spending increased from ∼$14 to $45 billion (2016 US dollars). Although vitamin research spending increased from ∼$89 to $95 million, the proportion of grants awarded for vitamin research declined by more than two-thirds, from 0.65% in 1992 to 0.2% in 2015. Federal agencies awarded 6035 vitamin research grants over the time period, with vitamin A associated with the most research projects per year on average (n = 115) and vitamin K the fewest (n = 8). Vitamin D research projects were associated with the greatest average yearly project value ($34.8 million). Conclusions: Vitamin research has faced a disproportionate decline in research funding from 1992 to 2015. Insufficient federal research funding streams risk stalling progress in vitamin research and leaving important advancements unrealized.
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Affiliation(s)
- James D Chambers
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | - Jordan E Anderson
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | - Mark N Salem
- Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, Boston, MA
| | - Susanne G Bügel
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Michael Fenech
- Genome Health and Personalized Nutrition, Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity, Sydney, South Australia, Australia
| | - Joel B Mason
- Department of Medicine, Tufts University, Boston, MA
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
| | - Peter Weber
- Department of Nutrition, University Stuttgart-Hohenheim, Stuttgart, Germany
| | - Keith P West
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Parke Wilde
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Sarah L Booth
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA
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21
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Sun F, Jaspers TCC, van Hasselt PM, Hennink WE, van Nostrum CF. A Mixed Micelle Formulation for Oral Delivery of Vitamin K. Pharm Res 2016; 33:2168-79. [PMID: 27245464 PMCID: PMC4967097 DOI: 10.1007/s11095-016-1954-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/23/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE To develop a stable micellar formulation of vitamin K for oral delivery, because the commercial and clinically used formulation of vitamin K (Konakion® MM) destabilizes at gastric pH resulting in low bioavailability of this vitamin in neonates with cholestasis. METHODS Mixed micelles composed of EPC, DSPE-PEG 2000 and glycocholic acid, with and without vitamin K, were prepared by a film hydration method. The influence of pH on the stability of the micelles was analyzed by dynamic light scattering (DLS). The critical micelle concentration (CMC) was determined by fluorescence spectroscopy using pyrene and the morphology was evaluated by transmission electron microscopy . Caco-2 cells were used to study the cytocompatibilty. RESULTS Mixed micelles with mean diameters from 7.1 to 11.0 nm and a narrow size distribution (PDI < 0.2) were obtained after 3 membrane extrusion cycles. Konakion® MM formed aggregated particles at gastric pH, which was avoided through steric stabilization by introducing PEG. TEM showed that mixed micelles had a spherical size (diameter of around 10 nm) with a narrow size distribution in agreement with the DLS results. The loading capacities for vitamin K of mixed micelles with varying molar fractions of DSPE-PEG and EPC (from 0/100 to 50/50 (mol/mol)) were 10.8-5.0 w%, respectively. The mixed micelles showed good cytocompatibility at concentrations of glycocholic acid between 0.12 and 1.20 mM. CONCLUSIONS Mixed micelles with superior stability to Konakion® MM at low pH were obtained by introducing DSPE-PEG 2000. These are therefore attractive oral formulations for vitamin K.
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Affiliation(s)
- Feilong Sun
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, The Netherlands
| | - Tessa C C Jaspers
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, The Netherlands
| | - Peter M van Hasselt
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Wim E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, The Netherlands
| | - Cornelus F van Nostrum
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CG, Utrecht, The Netherlands.
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22
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Jug Došler A, Petročnik P, Mivšek AP, Zakšek T, Skubic M. Neonatal Prophylaxis: Prevention of Vitamin K Deficiency Haemorrhage and Neonatal Ophthalmia. Zdr Varst 2015; 54:184-93. [PMID: 27646726 PMCID: PMC4820155 DOI: 10.1515/sjph-2015-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/03/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction The aim of the study was to explore two aspects of neonatal prophylaxis: the application of the vitamin K injection to the newborns and the prophylaxis against chlamydial and gonococcal eye infections, comparing Slovenian and Croatian practices. Methods A causal non-experimental method of quantitative empirical approach was used. The data was collected by means of predesigned questionnaires. The questionnaires were sent to 14 Slovenian and 32 Croatian birth hospitals. The data was analysed with descriptive statistics and the Kullback test. Results Vitamin K is applied to all newborns in 9 (out of 14) Slovene and 22 (out of 32) Croatian birth hospitals that returned the questionnaire. The prophylaxis against chlamydial gonococcal eye infections is applied to all newborns in 9 Slovene and 16 Croatian birth hospitals that offered answers to the questionnaire. The majority of Slovene and Croatian birth hospitals perform these procedures in the first hour after birth. The majority of Slovene birth hospitals still apply vitamin K in the gluteal muscle, whereas the majority of Croatian birth hospitals usually use the thigh as an injection site. In Slovenia, 1 % Targesin is used for the prophylaxis against chlamydial and gonococcal eye infections, whereas in Croatia the prevailing medicine is Erythromycin. Conclusions The possibility of oral vitamin K application should be offered to parents, and pain management in practice should be discussed. The form of written informed consent could be offered to parents. Health professionals should provide intimacy and exclude routine procedures in the first couple of hours after birth. However, more research is needed as delayed administration might be related to lower efficacy and, as a consequence of that, the safety of newborns is questionable.
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Affiliation(s)
- Anita Jug Došler
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Petra Petročnik
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Ana Polona Mivšek
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Teja Zakšek
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
| | - Metka Skubic
- University of Ljubljana, Faculty of Health Sciences, Zdravstvena pot 1, 1000 Ljubljana, Slovenia
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Aggarwal V, Mishra K, Rath B, Chaudhary S, Kumar P. Hemothorax and hematocele: unusual presentations of vitamin K deficiency bleeding disorder. Indian J Pediatr 2013; 80:80-1. [PMID: 22544692 DOI: 10.1007/s12098-012-0750-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/30/2012] [Indexed: 10/28/2022]
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