Search

Background Staphylococcus aureus bacteremia (SAB) is a clinically heterogeneous disease. The ability to identify subgroups of patients with shared traits (subphenotypes) is an unmet need to allow patient stratification for clinical management and research. We aimed to test the hypothesis that clinically relevant subphenotypes can be reproducibly identified among patients with SAB. Methods We studied 3 cohorts of adults with monomicrobial SAB: a UK retrospective observational study (Edinburgh cohort, n = 458), the UK ARREST trial (n = 758), and the Spanish SAFO trial (n = 214). Latent class analysis was used to identify subphenotypes using routinely collected clinical data without considering outcomes. Mortality and microbiologic outcomes were then compared between subphenotypes. Results Included patients had predominantly methicillin-susceptible SAB (1366 of 1430, 95.5%). We identified 5 distinct, reproducible clinical subphenotypes: (A) SAB associated with older age and comorbidity, (B) nosocomial intravenous catheter-associated SAB in younger people without comorbidity, (C) community-acquired metastatic SAB, (D) SAB associated with chronic kidney disease, and (E) SAB associated with injection drug use. Survival and microbiologic outcomes differed between the subphenotypes. Mortality was highest in subphenotype A and lowest in subphenotypes B and E. Microbiologic outcomes were worse in subphenotype C. In a secondary analysis of the ARREST trial, adjunctive rifampicin was associated with increased mortality in subphenotype B and improved microbiologic outcomes in subphenotype C. Conclusions We have identified reproducible and clinically relevant subphenotypes within SAB and provide proof of principle of differential treatment effects. Through clinical trial enrichment and patient stratification, these subphenotypes could contribute to a personalized medicine approach to SAB. [ABSTRACT FROM AUTHOR]

Background We aimed to test the hypothesis that development of metastatic infection represents a distinct clinical endpoint from death due to Staphylococcus aureus bacteremia (SAB). Methods We conducted a retrospective observational study of adults with SAB between 20 December 2019 and 23 August st2022 (n = 464). Simple logistic regression, odds ratios, and z -scores were used to compare host, clinical, and microbiologic features. Results Co-occurrence of attributable mortality and metastatic infection was infrequent. Charlson Comorbidity Index and age were strongly associated with attributable mortality, but not metastatic infection. We compared patients with fatal SAB (without clinically-apparent metastatic complications, 14.4% of cohort), metastatic SAB (without attributable mortality, 22.2%), neither complication (56.7%), and overlapping fatal/metastatic SAB (6.7%). Compared to SAB without complications, fatal SAB was specifically associated with older age and multi-morbidity. Metastatic SAB was specifically associated with community acquisition, persistent fever, persistent bacteremia, and recurrence. Endocarditis was over-represented in the fatal/metastatic SAB overlap group, which shared patient characteristics with fatal SAB. In contrast to other (predominantly musculoskeletal) metastatic complications, endocarditis was associated with increased mortality, with death occurring in older multi-morbid patients later after SAB onset. Conclusions Patients with SAB experience distinct clinical endpoints: (i) early death, associated with multi-morbidity and age; (ii) metastatic (predominantly musculoskeletal) SAB; (iii) endocarditis, associated with late death occurring in older people with multi-morbidity, and (iv) bacteraemia without complications. These distinctions could be important for selecting appropriate outcomes in clinical trials: different interventions might be required to reduce mortality versus improve clinical response in patients with metastatic SAB. [ABSTRACT FROM AUTHOR]

A multidisciplinary team was formed to diagnose and treat patients with head and neck pain. This team consisted of specialists from oral surgery, psychiatry, psychology, psychometrics, kinesiology, prosthodontics, physical therapy, orthodontics and radiology. Neurology and otolaryngology (ear,nose and throat) specialists were also available for patient evaluation. A case report is presented to illustrate how the team functioned. A 23-year-old woman complained that the sides of her face hurt all the time. She also reported organic, psychiatric and psychosocial problems. A thorough medical history and physical examination were conducted. The surgical recommendations were to correct the patient's skeletal malocclusion after treating her pain. Behavioral medicine specialists diagnosed hyperactivity of the head muscles and suggested stress management therapy. Physical therapists noted a forward head posture, restriction of neck motion and neck pain, and recommended physical therapy to improve joint movements and posture. Depression, neurotic anxiety and somatoform conversion disorder (organic symptoms caused by psychogenic factors such as depression) were diagnosed by psychiatrists who advised psychotherapy and anti-depressant medication. Psychology/psychometric specialists administered tests which also indicated acute depression/anxiety syndrome. Orthotic specialists concurred with the surgical diagnosis of jaw deformity and malocclusion and questioned the possible need for long-term stabilization of the temporomandibular joint (where the upper jaw joins the skull). Successful treatment of this patient, who had both organic and psychiatric pathology, was due to recognition of the multifactorial nature of her facial pain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Copyright of Journal of Craniomandibular Disorders is the property of Quintessence Publishing Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A collagen mineral gel has recently been shown to stimulate revitalization of pulpless open apex teeth when syringed into debrided root canals. Experiments were conducted to examine possible stimulation of the immune system by the experimental procedure. Ring tests (interface precipitation analysis), Ouchterlony plates and hemagglutination tests on plasma samples taken from experimental rhesus monkeys throughout the healing process indicate a complete lack of humoral immune responsiveness to the injected collagen. [ABSTRACT FROM AUTHOR]