No abstract

The

BackgroundPatients with 2009 pandemic influenza A(H1N1pdm09)-related critical illness were frequently treated with systemic corticosteroids. While observational studies have reported significant corticosteroid-associated mortality after adjusting for baseline differences in patients treated with corticosteroids or not, corticosteroids have remained a common treatment in subsequent influenza outbreaks, including avian influenza A(H7N9). Our objective was to describe the use of corticosteroids in these patients and investigate predictors of steroid prescription and clinical outcomes, adjusting for both baseline and time-dependent factors.MethodsIn an observational cohort study of adults with H1N1pdm09-related critical illness from 51 Canadian ICUs, we investigated predictors of steroid administration and outcomes of patients who received and those who did not receive corticosteroids. We adjusted for potential baseline confounding using multivariate logistic regression and propensity score analysis and adjusted for potential time-dependent confounding using marginal structural models.ResultsAmong 607 patients, corticosteroids were administered to 280 patients (46.1 %) at a median daily dose of 227 (interquartile range, 154–443) mg of hydrocortisone equivalents for a median of 7.0 (4.0–13.0) days. Compared with patients who did not receive corticosteroids, patients who received corticosteroids had higher hospital crude mortality (25.5 % vs 16.4 %, p = 0.007) and fewer ventilator-free days at 28 days (12.5 ± 10.7 vs 15.7 ± 10.1, p < 0.001). The odds ratio association between corticosteroid use and hospital mortality decreased from 1.85 (95 % confidence interval 1.12–3.04, p = 0.02) with multivariate logistic regression, to 1.71 (1.05–2.78, p = 0.03) after adjustment for propensity score to receive corticosteroids, to 1.52 (0.90–2.58, p = 0.12) after case-matching on propensity score, and to 0.96 (0.28–3.28, p = 0.95) using marginal structural modeling to adjust for time-dependent between-group differences.ConclusionsCorticosteroids were commonly prescribed for H1N1pdm09-related critical illness. Adjusting for only baseline between-group differences suggested a significant increased risk of death associated with corticosteroids. However, after adjusting for time-dependent differences, we found no significant association between corticosteroids and mortality. These findings highlight the challenges and importance in adjusting for baseline and time-dependent confounders when estimating clinical effects of treatments using observational studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1230-8) contains supplementary material, which is available to authorized users.

growth and development, and neuropsychologic wellbeing (Sandstead, 1994). Iron and zinc deficiencies in humans are prevalent in areas whereAs staple crops contribute substantially to daily calomaize (Zea mays L.) constitutes a significant portion of the human diet, such as sub Saharan Africa. This study determined the breeding ric intake among people in developing countries, there potential for increasing grain Fe and Zn density to increase Fe and has been a resurgence of interest in addressing human mal-Zn intakes among maize-consuming populations. Fourteen southern nutrition through breeding of staple crops, specifically African-adapted white-grained maize inbred lines were crossed in a to address micronutrient malnutrition (Gregorio et al., diallel. The F 1 hybrids made among seven high and seven low Fe and 2000; Monasterio and Graham, 2000; Beebe et al., 2000). Zn concentration lines were evaluated in six locations, two replications Maize comprises an average of 30 to 50% of the daily per location, throughout Zimbabwe in 1999-2000. There were five caloric intake of people in most southern African counhigh productivity sites and one low-N site, typical of the low-input tries (FAO, 2001). In Zambia, and potentially in other production conditions of small-scale farmers in Zimbabwe. Grain Fe areas of southern Africa, poorer people tend to derive and Zn concentrations were analyzed with an inductively coupled an even greater proportion of their daily calories from argon plasma emission spectrometer. Variation among genotypes was highly significant for flour Fe and Zn concentration and per kernel cereal sources (Kumar, 1994). Iron-and zinc-enriched, Fe and Zn content. General combining ability (GCA) effects for flour Fe or biofortified, maize would serve as a logical vehicle and Zn concentration were significantly more important than specific for providing iron and zinc in the diets of people in combining ability (SCA) effects in high yielding environments, indicatsouthern Africa. ing that per se line evaluation could identify promising lines. Under Research on the nutritional quality of maize for hulow N conditions, one low Fe-Zn parent line had a significant positive man consumption is not a new approach to addressing GCA effect for flour Fe concentration, with no effect on flour Zn human malnutrition. Nutrition-related research in maize concentration. In inbred trials, this line was among the low Fe-Zn was seriously initiated with work on quality protein lines, though in hybrid combination it emerged as a highly promising maize in the 1960s and 1970s to address protein-energy line. Therefore, test-cross performance and per se line evaluation malnutrition (Pradilla et al., 1972). Early research on should be used to identify iron-and zinc-rich materials for low-N environments.

No abstract

No abstract

No abstract

Daptomycin is a lipopeptide antimicrobial used for the treatment of aerobic gram-positive skin and soft tissue infections. We describe a patient with acute myeloid leukemia whose febrile neutropenia was treated with daptomycin and who later developed daptomycin-resistant Enterococcus faecium infection. Defervescence and negative blood cultures ensued after treatment with linezolid. Guidelines for testing daptomycin susceptibillities of enterococci include breakpoints only for vancomycin-susceptible Enterococcus faecalis, making interpretation of minimum inhibitory concentrations for common clinical infections difficult. No enterococcal cross-resistance has been reported among daptomycin, linezolid, or quinupristin-dalfopristin, and these agents may be viable alternatives.