Two populations of North Carolina have been analyzed for hemoglobin patterns by paper electrophoresis. Of 534 Cherokee Indians, both mixed and full bloods, all showed normal hemoglobin. Lumbee Indians of less certain ethnic status had 1.7 percent of hemoglobin S, an equal amount of hemoglobin C, and one possible hemoglobin D trait among 1332 bloods studied.
Approaching the best way to treat and manage a patient's surgical pain following total joint arthroplasty is a challenging task. To reduce the use of opioids, we utilize many different methods working together in a synergistic way. This is the true core of multimodal pain control. This task can be accomplished with a driven effort from the interdisciplinary team mostly comprising of but not limited to the surgeon, regional anesthesiologist, nurse, and physical therapist. The team addresses education of the patient, anesthesia type, medications, and nonpharmacological interventions within the development of the pain management plan. Achieving the goal of safe, effective pain management, in this population, will lead to improved outcomes, patient satisfaction, and enhanced functional life of patients.
Background Anti-SARS-CoV-2 monoclonal antibodies (mABs) target the viral spike protein and have been shown to have clinical benefit in treating COVID-19. The FDA had given emergency use authorization to mAB products: bamlanivimab+etesevinab (BAM), casirivimab+imdevimab (CAS), sotrovimab (SOT). However, due to reduced activity against the omicron variant the FDA recommended against use of BAM and CAS. SOT has retained efficacy against omicron. We reviewed the utilization of mABS in our institution during the pandemic as delta variant was replaced by omicron. Methods Retrospective chart review of US Veterans (USV) with confirmed SARS-CoV-2 infection who received mABs from 9/1/2021 to 2/28/22 at Northport Veterans Affairs Medical Center. Demographic data, comorbidities, choice of mAB, history of COVID-19 vaccination, SARS-CoV-2 sequencing, and IgG levels to the receptor-biding domain (RBD) of the spike protein in vaccinated USV were reviewed. Results 66 USV received mAB therapy, tolerated well. 30 got CAS, 29 BAM, 7 SOT. 52 doses were given from Dec 2021 to Jan 2022, none were given in Feb. The median age of the cohort was 72.5 (range 32 to 97 years). 97% were men. 85% White, 12% Black, 3% Hispanic. 22 USV were not vaccinated. The vaccine recipients were: 3 Janssen, Moderna-2 shots (MOD-2): 6; MOD-3: 3; Pfizer 2 (PFZ-2) shots: 22; PFZ-3:10 The median days of COVID diagnosis from last dose of vaccine: Janssen 211 days (104 to 257); MOD-2 291 (205-322); MOD-3 56 (16-61), PFZ-2 222 (96-302) PFZ-3 78 (8-112). 62% had cough, dyspnea 24%, malaise 50%, diarrhea 11%, anosmia 11%, sore throat 17%, nasal congestion 41%, fever 32% Median BMI 30.8 (16.6 - 47.3). 36% had Diabetes, HTN 67%. COPD 23%, Asthma 11%, CAD 32%, HLD 67%; one woman was 28 weeks pregnant. Two coinfections with rhinovirus, 1 with RSV. 20 vaccine recipients had anti-SARS-CoV-2 RBD titers at presentation, median 2.60 (0.06-48.08). 11 USV were hospitalized but only 4 got steroids/remdesivir. 3 USV died but not directly due to COVID. 15 USV with omicron who received CAS (8) and BAM (7) survived. See tables for further data. Demographic Data of US Veterans after receiving monoclonal antibody therapy Data on hospitalized US Veterans after receiving monoclonal antibody therapy Conclusion As the pandemic transitioned from Delta to Omicron variants, mAB treatments in USV remained successful even in those USV who received therapies not active for omicron. Delta and omicron infections were seen in vaccinated and boosted USV. Disclosures All Authors: No reported disclosures.
BackgroundMethicillin-resistant Staphylococcus aureus (MRSA)is the most common nosocomial infection worldwide. Infection control measures using molecular tests [polymerase chain reaction (PCR) on nares swabs] aid to prevent hospital transmission of MRSA. Nares screening for MRSA has proven to be a valuable tool for antimicrobial stewardship programs (ASP) to de-escalate empiric anti-MRSA therapy in patients with pneumonia (community/nosocomial acquired) not nasally colonized with MRSA. In January 2016, an ASP was initiated at our institution with emphasis on rational use of antibiotics, decrease antibiotic duration and timely de-escalation of all empiric antibiotics, including IV vancomycin using nares PCR for MRSA.MethodsWe compared the vancomycin use at the Northport Veterans Affairs Medical center by days of therapy/1,000 patient-days from 2011–2015 to 2016–2019. Screening for MRSA is by DNA PCR (Cepheid GeneXpert Infinity). ASP reviewed all restricted antibiotic requests via electronic consults and rendered approval or disapproval. In addition, ASP requested empiric vancomycin to be discontinued for patients hospitalized for pneumonia, if PCR was negative for MRSA; PCR results were available within 24hours of admission.ResultsThere were 21,330 admissions (including ICU) from March 1, 2011 to February 28, 2019. Since initiation of ASP in 2016, 4,021 total antibiotic approvals were requested and 483 were denied. 484 IV Vancomycin were requested and 43 were denied. There has been a statistically significant decrease in vancomycin use from 2011–2015 vs. 2016–2019, median by quarter (year divided in 4 quarters) 250 vs. 233, P = 0.012; Comparing the same time periods there has been a decrease in positive MRSA nares screening upon admission median annual rate 354 vs. 220, P = 0.011. There was no difference in vancomycin-resistant enterococci in clinical isolates, median 16 vs. 14.5, P = 0.465. Inpatient infectious diseases consultations increased by 30% since ASP was initiated.ConclusionOur ASP was successful in decreasing use of vancomycin through both disapproval of medication when a request was deemed inappropriate, and by promoting de-escalation of therapy by the use of MRSA nares screening in patients who were started empirically on MRSA antibiotic therapy for pneumonia. Disclosures All authors: No reported disclosures.
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