Browsing by Author "Povitz, Marcus"

Now showing 1 - 3 of 3
  • Thumbnail Image
    ItemOpen Access
    Prevalence of Sleep Disordered Breathing in Obese Hypoxemic Individuals, and Association of Adherence to Positive Airway Pressure Treatment with Long Term Oxygen Use and Rates of Health Care Utilization in a Single Centre in Alberta Canada
    (2015-06-18) Povitz, Marcus; James, Matthew; Tsai, Willis
    Obesity affects 25-30% of Canadians. Obese individuals are at increased risk of obstructive sleep apnea (OSA) and the obesity hypoventilation syndrome (OHS), which may cause or complicate chronic hypoxemia. This thesis reports the prevalence of OSA and OHS in a cohort with obesity and chronic hypoxemia referred for sleep testing. Obstructive sleep apnea and OHS were highly prevalent, affecting 80% and 51% respectively. The obesity hypoventilation syndrome was more common than chronic obstructive pulmonary disease in this cohort. Adherence to treatment of OSA and OHS with positive airway pressure therapy was associated with an increase in mean arterial oxygen levels as well as a reduction in the number of individuals requiring oxygen. Adherence with PAP therapy was also associated with a reduction in the rate of hospitalizations though the frequency of outpatient visits rose. These findings support current provincial policies for testing for OSA and OHS in obese hypoxemic individuals.
  • Thumbnail Image
    ItemOpen Access
    Prolonged SARS-CoV-2 infection following rituximab treatment: clinical course and response to therapeutic interventions correlated with quantitative viral cultures and cycle threshold values
    (2022-02-05) Thornton, Christina S.; Huntley, Kevin; Berenger, Byron M.; Bristow, Michael; Evans, David H.; Fonseca, Kevin; Franko, Angela; Gillrie, Mark R.; Lin, Yi-Chan; Povitz, Marcus; Shafey, Mona; Conly, John M.; Tremblay, Alain
    Abstract Background Detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is completed through reverse transcriptase-PCR (RT-PCR) from either oropharyngeal or nasopharyngeal swabs, critically important for diagnostics but also from an infection control lens. Recent studies have suggested that COVID-19 patients can demonstrate prolonged viral shedding with immunosuppression as a key risk factor. Case presentation We present a case of an immunocompromised patient with SARS-CoV-2 infection demonstrating prolonged infectious viral shedding for 189 days with virus cultivability and clinical relapse with an identical strain based on whole genome sequencing, requiring a multi-modal therapeutic approach. We correlated clinical parameters, PCR cycle thresholds and viral culture until eventual resolution. Conclusions We successfully demonstrate resolution of viral shedding, administration of COVID-19 vaccination and maintenance of viral clearance. This case highlights implications in the immunosuppressed patient towards infection prevention and control that should consider those with prolonged viral shedding and may require ancillary testing to fully elucidate viral activity. Furthermore, this case raises several stimulating questions around complex COVID-19 patients around the role of steroids, effect of antiviral therapies in absence of B-cells, role for vaccination and the requirement of a multi-modal approach to eventually have successful clearance of the virus.
  • Thumbnail Image
    ItemOpen Access
    Quality of antibiotic prescribing for pediatric community-acquired Pneumonia in outpatient care
    (2023-10-28) Saatchi, Ariana; Haverkate, Manon R.; Reid, Jennifer N.; Shariff, Salimah Z.; Povitz, Marcus; Patrick, David M.; Silverman, Michael; Morris, Andrew M.; McCormack, James; Marra, Fawziah
    Abstract Background Antibiotics remain the primary treatment for community acquired pneumonia (CAP), however rising rates of antimicrobial resistance may jeopardize their future efficacy. With higher rates of disease reported in the youngest populations, effective treatment courses for pediatric pneumonia are of paramount importance. This study is the first to examine the quality of pediatric antibiotic use by agent, dose and duration. Methods A retrospective cohort study included all outpatient/primary care physician visits for pediatric CAP (aged < 19 years) between January 1 2014 to December 31 2018. Relevant practice guidelines were identified, and treatment recommendations extracted. Amoxicillin was the primary first-line agent for pediatric CAP. Categories of prescribing included: guideline adherent, effective but unnecessary (excess dose and/or duration), under treatment (insufficient dose and/or duration), and not recommended. Proportions of attributable-antibiotic use were examined by prescribing category, and then stratified by age and sex. Result(s) A total of 42,452 episodes of pediatric CAP were identified. Of those, 31,347 (76%) resulted in an antibiotic prescription. Amoxicillin accounted for 51% of all prescriptions. Overall, 27% of prescribing was fully guideline adherent, 19% effective but unnecessary, 10% under treatment, and 44% not recommended by agent. Excessive duration was the hallmark of effective but unnecessary prescribing (97%) Macrolides accounted for the majority on non-first line agent use, with only 32% of not recommended prescribing preceded by a previous course of antibiotics. Conclusion(s) This study is the first in Canada to examine prescribing quality for pediatric CAP by agent, dose and duration. Utilizing first-line agents, and shorter-course treatments are targets for stewardship.