Association of Outpatient Oral Macrolide Use With Sensorineural Hearing Loss in Pediatric Patients

alexandrossfakianakis shared this article with you from Inoreader Association of Outpatient Oral Macrolide Use With Sensorineural Hearing Loss in Pediatric Patients via JAMA Otolaryngology–Head & Neck Surgery Current Issue This case-control study investigates whether increased ris k of sensorineural hearing loss is associated with macrolide use in a national study population of children, adolescents, and young adults. View on Web

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DNA2 mutation causing multisystemic disorder with impaired mitochondrial DNA maintenance

alexandrossfakianakis shared this article with you from Inoreader DNA2 mutation causing multisystemic disorder with impaired mitochondrial DNA maintenance via Journal of Human Genetics - Issue - nature.com science feeds View on Web

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Post-Ebola Symptoms 7 Years after Infection: The natural history of Long Ebola

alexandrossfakianakis shared this article with you from Inoreader Post-Ebola Symptoms 7 Years after Infection: The natural history of Long Ebola via Clinical Infectious Diseases Advance Access Abstract Background Lingering symptoms have been reported by survivors of Ebola Virus Disease (EVD). There are few data describing the persistence and severity of these symptoms over time. Methods Symptoms of headache, fatigue, joint pain, muscle pain, hearing loss, visual loss, numbness of hands or feet were longitudinally assessed among participants in the Liberian Ebola Survivors Cohort study. Generalized linear mixed effects models, adjusted for sex and age, were used to calculate the odds of reporting a symptom and it being rated as highly interfering with life. Results From June 2015 to June 2016, 326 survivors were enrolled a median of 389 days (range 51-614) from acute EVD. At baseline 75.2% reported at least one symptom; 85.8% were highly interfering with life. Over a median follow-up of 5.9 years, reporting of any symptom declined (odds ratio for each 90 days of follow-up = 0.96, 95% CI: 0.95,0.97; p < 0.00 01) with all symptoms declining except for numbness of hands or feet. Rating of any symptom as highly interfering decreased over time. Among 311 with 5 years of follow-up, 52% (n = 161) reported a symptom and 29% (n = 47) of these as highly interfering with their lives. Conclusion Major post-EVD symptoms are common early during convalescence and decline over time along with severity. However, even 5 years after acute infection, a majority continue to have symptoms and, for many, these continue to greatly impact their lives. These findings call for investigations to identify the mechanisms of post-EVD sequelae and therapeutic interventions to benefit the thousands of effected EVD survivors. View on Web

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Association between time to appropriate antimicrobial treatment and 30-day mortality in patients with bloodstream infections: a retrospective cohort study

alexandrossfakianakis shared this article with you from Inoreader Association between time to appropriate antimicrobial treatment and 30-day mortality in patients with bloodstream infections: a retrospective cohort study via Clinical Infectious Diseases Advance Access Abstract Background Effective antimicrobial treatment is key for survival in bloodstream infection (BSI), but the impact of timing of treatment remains unclear. Our aim was to assess the association between time to appropriate antimicrobial treatment and 30-day mortality in BSI patients. Methods This was a retrospective cohort study using electronic health record data from a large academic center in Sweden. Adult patients admitted between the years 2012-2019, with onset of BSI at the emergency department or general wards, were included. Pathogen-antimicrobial drug combinations were classified as appropriate or inappropriate based on reported in vitro susceptibilities. To avoid immortal time bias, the association between appropriate therapy and mortality was assessed with multivariable logistic regression analysis at pre-specified landmark times. Results We included 10628 BSI-episodes, occ urring in 9192 unique patients. The overall 30-day mortality was 11.8%. No association in favour of a protective effect between appropriate therapy and mortality was found at the 1, 3 and 6 hours landmark after blood culture collection. At 12 hours, the risk of death increased with inappropriate treatment (adjusted odds ratio 1.17 [95% confidence interval, 1.01-1.37]) and continued to increase gradually at 24, 48 and 72 hours. Stratifying by high or low SOFA-score generated similar odds ratios, with wider confidence intervals. Conclusion Delays in appropriate antimicrobial treatment were associated with increased 30-day mortality after 12 hours from blood culture collection, but not at 1, 3, and 6 hours, in BSI. These results indicate a benchmark for providing rapid microbiological diagnostics of blood cultures. View on Web

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Quinolone Ear Drops and Achilles Tendon Rupture

alexandrossfakianakis shared this article with you from Inoreader Quinolone Ear Drops and Achilles Tendon Rupture via Clinical Infectious Diseases Advance Access Abstract Background Delayed eardrum healing has been observed in the ear opposite to the ear treated with otic quinolones (OQ) in rats. Case reports describe tendinopathies after OQ treatment, suggesting adverse systemic effects. Methods We studied patients 19-64 years with diagnosis of otitis externa or media in private insurance between 2005-2015. We compared OQ treatment against otic neomycin, oral amoxicillin or azithromycin. Outcomes included Achilles tendon rupture (ATR), Achilles tendinitis (AT) and all-type tendon rupture (ATTR). We applied an active comparator, new user design with 1-year look-back and ceased follow-up at initiation of systemic steroids or oral quinolones, external injury, hospitalization and after 35 days. We used trimmed stabilized inverse probability of treatment weights to balance comparison groups in a survival framework. Negative outcomes (clavicle fractures or sports injuries) were examined to rule out d ifferences due to varied physical activity (unmeasured confounding). Results We examined 1,501,009 treated otitis episodes. Hazard ratios (HR) for OQ exposure associated with ATR were 4.49 (95%CI 1.83-11.02), AT 1.04 (95%CI 0.73-1.50), ATTR 1.71 (95%CI 1.21-2.41). Weighted risk differences (RD) per 100,000 episodes for OQ exposure were ATR 7.80 (95%CI 0.72-14.89), AT 1.01 (95%CI –12.80-14.81), ATTR 18.57 (95%CI 3.60-33.53). Corresponding HRs and RDs for clavicle fractures and sports injuries were HR = 1.71 (95%CI 0.55-5.27) and HR = 1.45 (95%CI 0.64-3.30), suggesting limited residual confounding. Conclusions OQ exposure may lead to systemic consequences. Clinicians should consider this potential risk and counsel patients accordingly. Risk factors and mechanisms for this rare, adverse effect deserve further evaluation. Mechanistic and other clinical studies are warranted to corroborate this finding.Presented at the American Otological Soci ety 154th Annual Virtual Meeting; April 11, 2021 View on Web

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