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“Background
Identifying hospitalized patients at risk for QT interval prolongation could lead to interventions to reduce the risk of torsades de pointes. Our objective was to develop and validate a risk score for QT prolongation in hospitalized patients.
Methods and Results
In this study, in a single tertiary care institution, consecutive patients (n=900) admitted to cardiac care units
comprised the risk score development group. The score was then applied to 300 CCI-779 additional patients in a validation group. Corrected QT (QT(c)) interval prolongation (defined as QT(c)>500 ms or an increase of >60 ms from baseline) occurred in 274 (30.4%) and 90 PF-03084014 inhibitor (30.0%) patients in the development group and validation group, respectively. Independent predictors of QT(c) prolongation included the following: female (odds ratio, 1.5; 95% confidence interval, 1.1-2.0), diagnosis of myocardial infarction (2.4 [1.6-3.9]), septic shock (2.7 [1.5-4.8]), left ventricular dysfunction (2.7 [1.6-5.0]), administration of a QT-prolonging
drug (2.8 [2.0-4.0]), 2 QT-prolonging drugs (2.6 [1.9-5.6]), or loop diuretic (1.4 [1.0-2.0]), age >68 years (1.3 [1.0-1.9]), serum K+ <3.5 mEq/L (2.1 [1.5-2.9]), and admitting QT(c) >450 ms (2.3; confidence interval [1.6-3.2]). Risk scores were developed by assigning points based on log odds ratios. Low-, moderate-, and high-risk ranges of 0 to 6, 7 to 10, and 11 to 21 points, respectively, best predicted QT(c)
prolongation (C statistic=0.823). A high-risk score 11 was associated with sensitivity=0.74, specificity=0.77, positive predictive value=0.79, and negative predictive value=0.76. In the validation group, the incidences of QT(c) prolongation were 15% (low risk); 37% (moderate risk); and 73% (high risk).
Conclusions
A selleck chemicals risk score using easily obtainable clinical variables predicts patients at highest risk for QT(c) interval prolongation and may be useful in guiding monitoring and treatment decisions.”
“Purpose of review
Despite focused efforts aimed at preventing infectious diseases among infants, recent years have seen a surge of infections among this population, particularly in pertussis, reminiscent of the 1940s prevaccine era. Given these trends, this review serves to discuss cocooning for infants against pertussis and its more recent application in influenza, and the barriers to and facilitators of this important strategy.
Recent findings
Infection with pertussis and influenza remains a significant cause of hospitalization among infants aged less than 1 year. Simultaneously, uptake of both tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines is very low among adults reporting close contact with an infant.