scholarly journals EUS-guided fiducial placement for pancreatobiliary malignancies: safety, infection risk, and use of peri-procedural antibiotics

2020 ◽  
Vol 08 (02) ◽  
pp. E179-E185
Author(s):  
Madhuri Chandnani ◽  
Mir Fahad Faisal ◽  
Jeremy Glissen-Brown ◽  
Mandeep Sawhney ◽  
Douglas Pleskow ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Locally Advanced ◽  
Prophylactic Antibiotic ◽  
Infection Risk ◽  
Prophylactic Antibiotics ◽  
Patient Demographics ◽  
Single Center Study ◽  
Significant Difference ◽  
Ease Of Access

Abstract Background and study aims Chemoradiation with stereotactic body radiation therapy (SBRT) is increasingly being used for optimal treatment of locally advanced pancreatobiliary cancers. Fiducial markers are used to track these tumors during SBRT. Endoscopic ultrasound (EUS) is the preferred route for fiducial marker placement for ease of access to pancreatobiliary structures and accurate placement. Here we evaluate the safety and infection risk associated with EUS-guided fiducial placement for pancreatobiliary malignancies and use of peri-procedural prophylactic antibiotics. Patients and methods This was a retrospective, single-center study including consecutive patients presenting for EUS-guided fiducial placement in pancreatobiliary region by three expert interventional endoscopists for SBRT from July 2010 to February 2018 at a tertiary care center. Patient demographics, tumor characteristics, EUS technique, fiducials, use of prophylactic antibiotics, adverse events (AEs) and SBRT/Cyberknife administration were reported. Results A total of 355 patients with pancreatobiliary malignancy underwent EUS-guided fiducial placement, of whom 308 patients (86.76 %) successfully underwent SBRT. Of the patients, 304 (85.63 %) received peri-procedural prophylactic antibiotic. Of 355 total patients, 5.9 % (n = 21) were noted to develop AEs (mild to severe) with no significant difference in incidence of infection with or without use of peri-procedural prophylactic antibiotic. Only three patients developed infectious AEs, none of which were definitively related to fiducial placement. Conclusion EUS-guided fiducial placement for pancreatobiliary malignancy is safe and efficacious, and risk of infection is rare, regardless of whether or not peri-procedural antibiotics are used. We favor limiting routine use of peri-procedural antibiotics for patients undergoing EUS-guided fiducial placement in pancreaticobiliary malignancy.

Infection risk in endovascular neurointerventions: a comparative analysis of 549 cases with and without prophylactic antibiotic use

2020 ◽  
Vol 132 (3) ◽  
pp. 797-801 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Omar Tanweer ◽  
Miguel Litao ◽  
Pankaj Sharma ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Medical Center ◽  
Prophylactic Antibiotic ◽  
Systemic Infection ◽  
Antibiotic Use ◽  
Infection Risk ◽  
Prophylactic Antibiotics ◽  
Oral Antibiotic ◽  
Systematic Analysis ◽  
Significant Difference

OBJECTIVEA systematic analysis on the utility of prophylactic antibiotics for neuroendovascular procedures has not been performed. At the authors’ institution there is a unique setup to address this question, with some attending physicians using prophylactic antibiotics (cefazolin or vancomycin) for all of their neurointerventions while others generally do not.METHODSThe authors performed a retrospective review of the last 549 neurointerventional procedures in 484 patients at Tisch Hospital, NYU Langone Medical Center. Clinical and radiological data were collected for analysis, including presence of prophylactic antibiotic use, local or systemic infection, infection laboratory values, and treatment. Overall, 306 aneurysms, 117 arteriovenous malformations/arteriovenous fistulas, 86 tumors, and 40 vessel stenosis/dissections were treated with coiling (n = 109), Pipeline embolization device (n = 197), embolization (n = 203), or stenting (n = 40).RESULTSAntibiotic prophylaxis was used in 265 of 549 cases (48%). There was no significant difference between patients with or without antibiotic prophylaxis in sex (p = 0.48), presence of multiple interventions (p = 0.67), diseases treated (p = 0.11), or intervention device placed (p = 0.55). The mean age of patients in the antibiotic prophylaxis group (53.4 years) was significantly lower than that of the patients without prophylaxis (57.1 years; p = 0.014). Two mild local groin infections (0.36%) and no systemic infections (0%) were identified in this cohort, with one case in each group (1/265 [0.38%] vs 1/284 [0.35%]). Both patients recovered completely with local drainage (n = 1) and oral antibiotic treatment (n = 1).CONCLUSIONSThe risk of infection associated with endovascular neurointerventions with or without prophylactic antibiotic use was very low in this cohort. The data suggest that the routine use of antibiotic prophylaxis seems unnecessary and that to prevent antibiotic resistance and reduce costs antibiotic prophylaxis should be reserved for selected patients deemed to be at increased infection risk.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

2021 ◽  
pp. 1-4
Author(s):  
Ruo S. Chen ◽  
Laurel O’Connor ◽  
Matthew R. Rebesco ◽  
Kara L. LaBarge ◽  
Edgar J. Remotti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Cuff Pressure ◽  
Care Center ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Endotracheal Tube Cuff ◽  
Cross Sectional ◽  
Tube Cuff ◽  
Respiratory Therapists ◽  
Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

scholarly journals Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

2021 ◽  
pp. 1-8
Author(s):  
Halil Celik ◽  
Sadettin Burak Acikel ◽  
Fatih Mehmet Akif Ozdemir ◽  
Erhan Aksoy ◽  
Ulkuhan Oztoprak ◽  
...  
Keyword(s):  
Neurological Disease ◽  
Chronic Conditions ◽  
Care Center ◽  
Tertiary Care ◽  
Anxiety Level ◽  
Childhood And Adolescence ◽  
Routine Examination ◽  
Significant Difference ◽  
Anxiety Levels

<b><i>Background and Aim:</i></b> Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. <b><i>Methods:</i></b> The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. <b><i>Results:</i></b> There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. <b><i>Conclusion:</i></b> Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

scholarly journals Usefulness of the Non-Contact Tonometry in Out-Patient Screening

2016 ◽  
Vol 15 (2) ◽  
Author(s):  
Satheesh Solomon T Selvin ◽  
Chris Elsa Samson Jacob ◽  
Thomas Kuriakose
Keyword(s):  
Central Corneal Thickness ◽  
Care Center ◽  
Corneal Thickness ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Applanation Tonometry ◽  
Cross Sectional ◽  
Significant Difference ◽  
Iop Measurement ◽  
The Mean

Purpose: Goldmann applanation tonometry (GAT) is considered the gold standard for Intraocular Pressure (IOP) measurement. It has the disadvantages of being a contact device, need for a slit-lamp, non-portability and need of a skilled examiner. Many hospitals are using a Non Contact Tonometry (NCT) as a screening device to save clinician time, however the usefulness is not proved in terms of reliability. This study was aimed to determine the usefulness of the Air-puff tonometer (TONOREF NIDEK II, NIDEK CO., LTD., JAPAN) over a GAT in a tertiary care center. Design: Cross-sectional Study Methods: This was a cross-sectional, non interventional observational study conducted on 224 eyes (right eye) from 224 patients. All patients underwent the IOP measurement with both methods and a central corneal thickness (CCT) measured. The data was analyzed using SPSS 20.0 software. Results: The mean age of the patients was 40.3±11.29 years. There was a statistically significant difference (p<0.001) between the mean NCT and GAT readings which persisted even after correction for central corneal thickness. The correlation between NCT and GAT using Pearson’s correlation coefficient was strong irrespective of the corrections for their corneal thickness (r = 0.751 and 0.718 for uncorrected and corrected values respectively). The correlation of the individual clinicians for the readings varied from moderate to strong. The ROC curve showed the best sensitivity and specificity to occur at around 13 to 14 mmHg. Conclusion: NCT seems to overestimate the IOP at low ranges as compared to the GAT and underestimate at higher ranges. The crossover of the values is seen between 12 to 13 mmHg.  The clinician should do an individualized analysis of his/her GAT measurements to the readings of the NCT machine at the clinic to obtain clinician specific nomogram. 

Complementary therapies in controlling side-effects during cancer treatment

2021 ◽  
Vol 9 (7) ◽  
pp. 238-265
Author(s):  
Vinicius Teixeira Botelho ◽  
MELINE ROSSETTO RODRIGUES ◽  
Guilherme Augusto Rago Ferraz ◽  
Cassiana Mendes Bertoncello Fontes ◽  
Maria Helena Borgato ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Side Effects ◽  
Randomized Clinical Trials ◽  
Care Center ◽  
Tertiary Care ◽  
Risk Of Bias ◽  
Anxiety Control ◽  
Significant Difference

This systematic review evaluated whether reiki had an impact on patients undergoing chemo-therapy, with possible improvement of the following outcomes: fatigue, pain, anxiety and quality of life. Method: Systematic review study with meta-analysis conducted at a tertiary care center. The following databases were searched until July 2020: MEDLINE, LILACS and CENTRAL. Two re-viewers independently examined eligible articles, extracted data and assessed the risk of bias using the Cochrane tool. Results: The analyzes included eight studies and showed that there was a sta-tistically significant for anxiety control (MD = -2-09; 95% CI: -3.00 to -1.19; I2 = 51%) and Quality of life (MD = -5.97; 95% CI: -10.70 to -1.25; I2 = 97%) but no statistically significant difference was found for the other outcomes analyzed. An analysis of the risk of bias has uncertain methodological limitations in the studies. Conclusions: Although there is anxiety control and improved quality of life, there is a need for the elaboration of randomized clinical trials with larger populations to verify their real performance in controlling some side effects during chemotherapy.

Abnormal pathology seen on appendectomy in patients with predominant right-sided pelvic pain

2020 ◽  
Vol 12 (3-4) ◽  
pp. 142-150
Author(s):  
Catherine W Cai ◽  
Katelin E Sisler ◽  
Jeffrey A Gavard ◽  
Jose D Eugenio-Colon ◽  
Patrick P Yeung
Keyword(s):  
Pelvic Pain ◽  
Care Center ◽  
Tertiary Care ◽  
High Rate ◽  
Retrospective Case ◽  
Saint Louis ◽  
Pain Location ◽  
Significant Difference ◽  
Incidental Appendectomy ◽  
Abnormal Pathology

Introduction: Previous studies have linked chronic pelvic pain (CPP) to appendix pathologies. However, few studies have investigated appendix pathology specifically in the context of CPP that is right-side predominant (R-CPP). We hypothesized that women with R-CPP have higher rates of appendix pathology compared with women with CPP that is not right-side predominant (N-CPP). Methods: We conducted a retrospective case–control study of 220 women who underwent diagnostic laparoscopy and planned or incidental appendectomy for CPP and suspected endometriosis between January 2015 and December 2018 at a tertiary care center in Saint Louis, MO. Results: No significant difference in abnormal appendix pathology was found between women with R-CPP and women with N-CPP (30.9% vs 34.5%, p = 0.74, odds ratio = 0.85, 95% CI: (0.44, 1.62)). Gross abnormalities of the appendix were documented in 40 of 220 patients (18.2%), with the most common abnormal gross findings being adhesions (8.2%), followed by abnormal lesions (7.3%). Conclusion: In this study, the presence of abnormal pathology within the appendix did not correlate with R-CPP, indicating triage based on predominant pain location cannot help identify patients with underlying appendix pathology. However, consistent with previous studies, we identified a high rate of abnormal appendix pathology overall, supporting the practice of many surgeons to perform routine appendectomy in women with CPP.

scholarly journals Central line replacement following infection does not improve reinfection rates in pediatric pulmonary hypertension patients receiving intravenous prostanoid therapy

2018 ◽  
Vol 8 (1) ◽  
pp. 204589321875488 ◽  
Author(s):  
Elisa K. McCarthy ◽  
Michelle T. Ogawa ◽  
Rachel K. Hopper ◽  
Jeffrey A. Feinstein ◽  
Hayley A. Gans
Keyword(s):  
Pulmonary Hypertension ◽  
Care Center ◽  
Tertiary Care ◽  
Management Strategies ◽  
Blood Stream ◽  
Central Line ◽  
Infectious Complications ◽  
Infection Rates ◽  
Significant Difference ◽  
Line Management

Treatment of pediatric pulmonary hypertension (PH) with IV prostanoids has greatly improved outcomes but requires a central line, posing inherent infection risk. This study examines the types of infections, infection rates, and importantly the effect of line management strategies on reinfection in children receiving IV prostanoids for PH. This study is a retrospective review of all pediatric PH patients receiving intravenous epoprostenol (EPO) or treprostinil (TRE) at one academic tertiary care center between 2000 and 2014. No patients declined participation in the study or were otherwise excluded. Infectious complications were characterized by organism(s), infection rates, time to next infection, and line management decisions (salvage vs. replace). Of the 40 patients followed, 13 sustained 38 infections involving 49 pathogens, with a predominance of gram-positive (GP) organisms (n = 35). The pooled infection rate was 1.06 per 1000 prostanoid days with no difference between EPO and TRE. No significant difference in reinfection rate was observed when comparing line salvage to replacement, regardless of organism type. Both overall and organism-type comparisons suggest longer time between line infections following line salvage compared with line replacement (732 vs. 410 days overall; 793 vs. 363 days for GP; 611 vs. 581 days for gram-negative [GN]; P > 0.05 for all comparisons). Central line replacement following blood stream infections in pediatric PH patients does not improve subsequent infection rates or time to next infection, and may lead to unnecessary risks associated with line replacement, including potential loss of vascular access. A revised approach to central line infections in pediatric PH is proposed.

scholarly journals 1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S540-S540
Author(s):  
Bhavana Surapareddy ◽  
Muralidhar Varma ◽  
Shashidhar V
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Early Recognition ◽  
Care Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Significant Difference ◽  
Serum Bicarbonate Level

Abstract Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures.

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