<b><i>Background:</i></b> Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding. <b><i>Objectives:</i></b> The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population. <b><i>Methods:</i></b> A cross-sectional study that utilized National Inpatient Sample for the years 2000–2017 was conducted. All preterm infants delivered nationally with birth weight (BW) <1,500 g or gestational age <32 weeks were included. Analyses were repeated after stratifying the population into 2 BW subcategories <1,000 g and 1,000–1,499 g. Logistic regression analysis was performed to adjust for confounding variables. <b><i>Results:</i></b> The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in <1,000-g infants (aOR = 1.96, CI: 1.76–2.18, <i>p</i> < 0.001) and 1,000–1,499-g infants (aOR = 2.02, CI: 1.62–2.53, <i>p</i> < 0.001). Platelet transfusion increased over the years in infants with BW <1,000 g (<i>p</i> = 0.001) and in infants with BW 1,000–1,499 g (<i>p</i> < 0.001). <b><i>Conclusions:</i></b> Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.
Recently, the first comprehensive guidelines were published for pre-exposure prophylaxis (PrEP) for the prevention of HIV infection in populations with substantial risk of infection. Guidelines include a daily regimen of emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as well as condom usage during sexual activity. The relationship between the TDF/FTC intake regimen and condom usage is not yet fully understood. If men who have sex with men (MSM,) engage in high-risk sexual activities without using condoms when prescribed TDF/FTC they might be at an increased risk for other sexually transmitted diseases (STD). Our study focuses on the possible occurrence of behavioral changes among MSM in the United States over time with regard to condom usage. In particular, we were interested in creating a model of how increased uptake of TDF/FTC might cause a decline in condom usage, causing significant increases in non-HIV STD incidence, using gonococcal infection incidence as a biological endpoint. We used the agent-based modeling software NetLogo, building upon an existing model of HIV infection. We found no significant evidence for increased gonorrhea prevalence due to increased PrEP usage at any level of sample-wide usage, with a range of 0-90% PrEP usage. However, we did find significant evidence for decreased prevalence of HIV, with a maximal effect being reached when 5% to 10% of the MSM population used PrEP. Our findings appear to indicate that attitudes of aversion, within the medical community, toward the promotion of PrEP due to the potential risk of increased STD transmission are unfounded.
This study set out to determine risk factors most predictive of early GDMA review was conducted of patients with positive early 1HR glucola screenings (≥135 mg/dL and reflex 3hr GTT before 20 weeks). Characteristics (comorbidities, family history, demographics) of patients who were diagnosed with early GDM were compared to those who were not. A multiple logistic regression model was constructed to compute adjusted odds ratios (aORs) for each covariate. Among 189 early GDM positive (BMI 36.1 ± 8.27; Age 32.7 ± 5.50) and 153 GDM negative (BMI 33.8 ± 7.24; Age 30.8 ± 5.45) patients were identified, the adjusted odds of developing GDM increases by: 6.7% (CI 1. 01-1.12; p 0. 01) or 4.5% (CI 1. 01-1. 08; p 0. 02) with a one unit increase in age or BMI, respectively. The aORs of developing GDM are 2. 0 (CI 1.24-3.26, p 0. 005), 3. 0 (CI 1.64-5.66; p 0. 0005), and 3.7 (CI 1.96-8.78, p 0. 0003) with family history of diabetes, prior history of GDM, or history of hypertension, respectively. This study was unique in that hypertension had the highest association with early GDM. Thus, individuals with HTN regardless of age, BMI, prior GDM, family history should receive an early glucola screen. Presentation: No date and time listed
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