Publications by authors named "Arezou Saedi"
Background: The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults.
Methods: We conducted a matched cohort study comparing older adults (≥66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for ≥30 days starting within 30 days of a positive culture, with patients with positive urine cultures who received antibiotic treatment but did not receive prophylaxis.
Objective: Selective reporting of antibiotic susceptibility test results may help guide appropriate antibiotic prescribing, particularly for urinary tract infections. Our objective was to describe laboratory urine culture susceptibility reporting practices and to estimate their impact on antibiotic prescribing in outpatients.
Methods: We examined all positive urine cultures with Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis associated with an antibiotic prescription among outpatients over 65 years of age in Ontario, Canada from 2014 through 2017.
In Ontario, Canada, since 2012, some hospitals discontinued contact precautions for vancomycin-resistant Enterococcus (VRE). Between 2009 and 2018, there was an associated rise in VRE bloodstream infections in hospitals where contact precautions were discontinued but not in hospitals that maintained contact precautions. These data suggest contact precautions are important for hospital VRE control programs.
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- The study analyzed 500 patients who underwent the Fontan procedure between 1985 and 2012 to assess the frequency of Fontan failures and complications and their impact on mortality.
- There were improvements in survival rates over time, with no early deaths recorded after 2000, but 48% of survivors experienced late complications, primarily linked to modes of Fontan failure.
- Key predictors for death included ventricular dysfunction and elevated pulmonary artery pressures, underscoring the necessity for timely recognition and intervention in Fontan complications.
Background: We hypothesized that chylothorax could be a sign of intolerance to the Fontan physiology, and thus patients who develop chylothorax or pleural effusion have worse medium-term to long-term survival.
Methods: A total of 324 patients who underwent the Fontan operation between 2000 and 2013 were included. Chylothorax was defined as ≥5 mL/kg/day of chylomicron-positive chest drainage fluid no earlier than postoperative day 5 or drainage with >80% lymphocytes.
Article Synopsis
- The interdigitating technique used in aortic arch reconstruction for patients with hypoplastic left heart syndrome significantly lowers the chance of recoarctation (narrowing) after surgery.
- A study of 139 patients revealed aortic dimensions increased during staged procedures, indicating positive growth despite some sections exhibiting different growth patterns.
- The results suggest low rates of recoarctation after surgery and highlight the need for further enhancements in the materials and methods used for repair.
Article Synopsis
- The study investigates the relationship between mean pulmonary artery pressure (PAP) and medium-term survival in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries who underwent a surgical procedure called unifocalization.
- Results show that a mean PAP of 25 mm Hg or higher is linked to lower survival rates and is a predictor of death, while patients with open VSDs face higher risks of reoperation.
- The findings suggest that careful decision-making is essential for patients with elevated PAP levels, especially regarding VSD closure, as this group may require more conservative approaches like VSD fenestration.
Article Synopsis
- Aortic arch reconstruction is a complex part of heart surgeries like the Norwood operation, and this study compares the aortic arch shapes in patients undergoing Norwood or hybrid procedures.
- Data from 139 patients at the Hospital for Sick Children from 2007 to 2014 were analyzed, focusing on measurements of different aorta sections prior to subsequent heart surgery stages.
- Results showed similar aortic measurements between groups, with a slight increase in descending aorta size in Norwood patients, minimal need for further surgeries, and that issues leading to reintervention were varied, not just limited to aortic recoarctation.
Article Synopsis
- The study investigated whether primary sutureless (SL) repair of total anomalous pulmonary venous drainage (TAPVD) leads to fewer cases of pulmonary vein obstruction (PVO) compared to standard repair (SR) methods.
- Results from 195 patients showed that while survival rates were similar between SL and SR groups, the SL method significantly reduced the incidence of moderate or severe PVO, with all PVO cases in the SL group being peripheral.
- The findings suggest that primary SL repair is linked to less PVO overall and eliminates the risk of central PVO, although it may still allow for some peripheral PVO to occur.
Article Synopsis
- Extended end-to-end anastomosis (EEEA) for aortic coarctation and arch hypoplasia can lead to a smaller, but growing, proximal aortic arch segment in patients, indicating potential for improvement post-surgery.
- A study reviewing 140 patients showed a 57% prevalence of tubular hypoplasia of the aortic arch (THAA) and a low rate of surgical and catheter reinterventions during a median follow-up of 18 months.
- While the hypoplastic segment in THAA patients showed significant growth, it remained smaller compared to those without THAA, suggesting that repair is feasible with a low reintervention risk, particularly for z-scores above -6.
Persistent fenestration may be a marker for physiologic intolerance after Fontan completion.
J Thorac Cardiovasc Surg
December 2014
Article Synopsis
- The study examined the medium-term effects of maintaining or closing fenestration in patients who underwent an extracardiac Fontan procedure between 1994 and 2012, focusing on outcomes like death and Fontan failure.
- Out of 306 patients who had fenestration created, the majority had it closed by catheter intervention (62%) or spontaneously (25%), but those with open fenestration experienced significantly higher rates of late deaths, Fontan failure, and complications.
- The findings indicate that persistent fenestration predicts poorer long-term health outcomes, suggesting that pre-Fontan physiological assessments may not reliably inform long-term care decisions regarding fenestration status.